MEDGATE TODAY MAGAZINE by Medgate Today Magazine

RNI No. DELENG/2010/33833

www.medgatetoday.com

Volume II || Issue III || Sept-Oct, 2011

The Gateway to Health & Medical World

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Advances in Cardiac...P28

CATH LAB Equipment News Update | Doctor Speak | Healthcare Innovation Awards | Expert Views

Editor speak

Vol.: II Volume-2 Issue 2

Issue: III July-Aug 2011

Editor Dr. M.a Kamal

Advances in Medical Technology Continue to Offer Improved Diagnostics and Treatments

ew of the newest medical advancements in the medical field today; computed tomography (CT) methods such as nano-tomography, 3-D imaging of bone structure, and Â MicroNeedle technologies. Robotic surgical technologies like the daVinci System and CyberKnife technology offer the best in both diagnostic imaging and more effective medical treatment plans for global travelers seeking the best in affordable and quality medical care. New, state-of-the-art medical equipment and tools offer medical patients today the chance to catch diseases like cancer earlier. Take the portable breast scanner developed by the University of Manchester based on radio frequency that can spot both malignant (cancerous) and benign (non-cancerous) breast tumors on home computers. Technologies from NASA enabled a company in Connecticut to develop what is called the MED-SEG system, which aids doctors in the analysis and diagnosis of imaging such as mammograms, ultrasound and other types of medical imaging, reducing human error in diagnostics. And 3-D imaging offers high resolution for cardiac care and can view heart blood vessels, or cardiac vasculature, myocardial scar tissue and other injury or disease to the heart muscle. Known as 3-D Tesla MRI (magnetic resonance imaging), this technology can not only see the muscle tissue that makes up walls of the heart (myocardium) but the blood vessels of the heart, creating three-dimensional images. Patients recommended for bypass surgeries or pacemakers may benefit from the imaging technique when it comes to heart blood vessel interventions and procedures. Dr. M. A. Kamal (Editor-in-chief) Have an insightful reading. Your suggestions are most welcome! e-Mail: editor@medgatetoday.com

Chief Editorial Adviser Dr. Pradeep Bhardwaj National Head Afzal Kamal Sr. Manager I.A Khurshid Cheif Correspondent SA Rizvi l Dr HN Sharma Design and Layout Vikas Sales and Marketing Amjad Kamal Rahul Ranjan Neetu Sinha S.Y Ahmed Khan Subscribtion & Cirrculation Pallavi Gupta All right Reserved by all everts are made to insure that the information published is correct, Medgate today holds no responsibility any unlikely errors that might occur.

Published by Advance Media Group Circulation Office : 92/17 Zakir Nagar, Opp. New Friends Colony, Okhla New Delhi - 110 025 Tel: +91 11 26981342 Fax: +91 11 26982464 M: +91 9289336800, 9212366351 Email: info@medgatetoday.com medgatetoday@gmail.com Visit us: www.medgatetoday.com Mumbai Office: 7 Ground Floor, Aradhna CHS Ltd. Bal Samant Marg, Bandra (W), Mumbai - 400 050 Chennai Office: 11, Krishnan, Koil Street 3rd Floor Rotary Lane Chennai-600001 Mob: +91 9840054355 Printed by Dr MA Kamal Artxel: 76, DSIDC Shed, Okhla Editor-in-Cheif Industrial Area , Phase-II, New Delhi-110020

Contents

News Update

Advances in Cardiac rehabilitation

16 Meniscus TEAR

Current Trends in the Cath Lab:Product FFR Emerging Line as Stenting Gatekeeper

Part-II

52 Suicide today is a serious global problem especially among young people 6

6. INSULIN PUMPS LINKED TO BETTER CHILD BEHAVIOR 6. Smoking Raises Testosterone Levels in Women 10. INFANT FORMULAS WITH POLYUNSATURATED FATTY ACIDS BENEFIT BRAIN AND HEART 10. Vaccination with liposomes may protect against AIDS before sex 11. MEDICAL IMAGING, AN OPEN AND DYNAMIC SECTOR IN FRANCE

BREAST FEEDING Sep - Oct 2011

NEWS UPDATE

Insulin pumps linked to better child behavior

arents of children with type 1 diabetes report sustained improvements in their child’s behaviour after they start insulin pump therapy, including fewer “conduct problems” and less anxiety. The findings come from a study of 27 children with type 1 diabetes, conducted by endocrinologists and psychologists from the University of Melbourne and the University of Sydney. Previous research by the group showed short-term improvements in behaviour and metabolic control at 6-8 weeks after insulin pump therapy began among the children aged 6-16 at recruitment. At two years follow-up, these initial behavioural improvements were sustained, according to the study in this month’s issue of Diabetic Medicine. This was true for both ‘externalising’ behaviours such as hyperactivity, aggression and conduct problems, and internalising behaviours such as anxiety, depression and somatisation.

Smoking Raises Testosterone Levels in Women

ostmenopausal women who smoke have higher circulating levels of testosterone and other sex hormones than nonsmokers, potentially increasing their risk of hormone-related diseases, a study suggests. As hormone levels fell immediately when a person quit smoking, the authors suggested the risks of conditions such as diabetes and low bone mineral. 8

Early diabetes does not affect cognition

hildren with early onset diabetes do not show any long-term deficits in IQ or memory, nor do they have more behavioural problems, an Australian study shows. In a 16-year prospective follow up of 33 children who developed type 1 diabetes before the age of six, WA researchers found no difference in their intellectual ability, memory or emotional difficulties compared to a healthy control group. Sep - Oct 2011

NEWS UPDATE

World HAI Forum: Global Call to Action to Fight Antibiotic Resistance

ver 70 international experts in medicine, infectious diseases, microbiology and epidemiology, from every continent, gathered at the Fondation Mérieux’s Conference Center for the third edition of the World HAI Forum on healthcare-associated infections, a bioMérieux initiative. Forum participants call upon national and international health authorities and policy makers, the medical and veterinary communities, Industry, and the general public to take action to avoid an impending public health catastrophe caused by the emergence and spread of bacteria that are resistant to all antibiotics. While research to discover novel antibiotics has slowed to a virtual standstill, bacterial resistance has increased due to the massive use and misuse of antibiotics, not only for human health, but also for animals. The treatment of certain common infections is becoming difficult and the success of immunosuppressive therapies and surgical interventions (organ transplants, cardiac surgery), which are associated with a high risk of bacterial infection, could be compromised. To the Forum experts, the emergence of pan-resistant NDM-1 bacteria and epidemic of multidrugresistant E. coli infections currently in Europe should be taken as a major public health warning, indicating that a new era of antimicrobial resistance has begun. This must lead to a global awakening: the protection of antibiotics has now entered the sphere of sustainable development. In a continuation of calls to 10

action and proposals made by major national and international organizations (WHO, ECDC, IDSA, CDC, etc.), the Forum’s participants identified priority action areas to fight bacterial resistance and recommended 12 very concrete actions to be implemented, in the short to mid-term, to effectively address this serious problem. Priority actions for policy makers and health authorities

For animals, stop the administration of antibiotics used in human medicine and limit antibiotics to therapeutic use only. It is imperative to reserve the most important classes of antibiotics for humans.Banish, in all countries, the use of antibiotics as growth promoters in animal feed.Regulate the sale of antibiotics for use in human medicine and prohibit over-the-counter sales worldwide. l Have international organizations (WHO, European Union) develop a charter on good antibiotic stewardship and have all the ministries of health worldwide sign it and commit to respecting it. Priority actions for the human and veterinary healthcare communities l

l Establish standardized, universal surveillance of antibiotic use and resistance and monitor the emergence and spread of new forms of bacterial resistance. l Include, in the medical and veterinary school curricula, a solid training in bacterial resistance and the prudent use of antibiotics and establish on-the-job training programs for healthcare workers, taking into account the cultural specificities of each country. Priority actions for the general public l Develop culturally sensitive awareness campaigns, targeted to the general public, explaining the importance of protecting antibiotics and using them only when absolutely necessary. l Provide education about fundamental hygiene, such as handwashing to prevent the spread of infection. It is imperative to improve sanitation systems to eliminate resistant bacteria in wastewater. l Include consumers in the development and implementation of action plans. Priority actions for lndustry l Develop Point-of-Care and rapid diagnostic tests, which can be used at the patient’s bedside or the doctor’s office, to guide the prescription of antibiotics and avoid their prescription for viral infections. l Stimulate research and development of novel antibiotics. l Find new economic models, which reconcile public health interests with Industry needs for n profitability. Sep - Oct 2011

NEWS UPDATE

Infant formulas with polyunsaturated fatty acids benefit brain and heart

cientists have found new evidence that infant formulas fortified with long c h a i n

polyunsaturated fatty acids (LCPUFA) are good for developing brains and hearts. In the University of Kansas study, researchers fed 122 term infants one of four formulas from birth to 12 months, three were given varying levels of two LCPUFAs (DHA and ARA) and one formula with no LCPUFA, and tested at four, six and nine months of age.

Vaccination with liposomes may protect against AIDS before sex

esearchers have envisioned a new way for women to protect themselves from AIDS before sex: an applicator filled with specially formulated fatty particles called liposomes. In tests led by Daniel Kohane,

Country Biggest Green Field Project “SIX SIGMA HEALTH CITY

ix Sigma Star Healthcare Plans Country Biggest Green Field Project “SIX SIGMA HEALTH CITY” on Delhi Jaipur Highway, Rajasthan worth Rs. 1200 Crore. New Delhi: On biggest expansion mode in the Country, Six Sigma Star Healthcare Limited, New Delhi, One of the worlds leading healthcare management company engaged in Hospital Planning, Operations, Management, Medical Education, and Quality has recently unveiled plan to open “SIX SIGMA HEALTH CITY” Near Neemrana, Delhi Jaipur Highway in association with Govt. of Rajasthan. The Health City will Spread over sprawling 75 acres of land, having “Maharishi Bhardwaj Institute of Medical Sciences” (1800 Bedded Hospital), Medical College, Institute of Dental Sciences, 12

College of Nursing, College of Health Sciences, Institute of Pharmaceuticals & Paramedical Sciences, AYUSH College, Health Mall etc. According to Group CEO & Executive Director “Dr. Pradeep Bhardwaj” this venture would generate immense opportunities for employment. The “Six Sigma Health City” will provide cost cutting medical facility and medical education at par with International Standard in India. The best medical talents and technologies are being inducted to meet new healthcare challenges and provide cost- effective and compassionate treatment. Six Sigma will soon turn into a full-fledged Health city with all healthcare & medical education facilities available inside one campus,” said Maj. Gen. S.B Akali, Director.

MD, PhD, director of the Laboratory for Biomaterials and Drug Delivery at Children’’s Hospital Boston, liposomes inhibited HIV infection in cell culture and appeared safe in female mice when injected intravaginally. Liposomes are spherical particles with a double outer layer of lipids (fats) and hollow centres. They are relatively easy and cheap to engineer, and thus present a viable option for developing countries. Liposomes can be filled with drugs or other compounds, but in this case, Kohane and colleagues found, to their surprise, that the liposomes alone were effective in blockn ing infection. Sep - Oct 2011

NEWS UPDATE

MedicalImaging,anopenand dynamic sector in France

he French in vivo medical imaging market is estimated to be worth around €800 million, in a global market valued at €20 billion in 2010. The market comprises three different segments: traditional imaging techniques (radiography, ultrasound), which account for 59% of the market, endoscopy (19%) and the ‘large instrument segment’ (CT, MRI, PET), which makes up the remaining 22%. The field of biological imaging is developing rapidly, focusing in particular on: l functional imaging of the brain to improve the mapping of brain functions and to better understand development abnormalities and dysfunction; l radiobiology, used in the fight against cancer, where research is being developed in partnership with the CEA (French Atomic Energy and Alternative Energies Commission), which has unparalleled expertise in ionizing radiation and equipment; l telemedicine (remote monitoring, remote consultation, and telecommunications to promote preservation of social contact) to monitor the health of patients remotely, thus supporting improved life expectancy and preventing loss of independence. Many foreign companies in the sector have invested in the French market, including: Philips, General Electric Healthcare, Siemens Medical Solutions, Toshiba and Hitachi, Agfa Healthcare, Bioptics, Sep - Oct 2011

Digirad and MITA. Their production facilities and research centers in France account for two-thirds of all revenues in the sector and almost 80% of all exports. Medical imaging benefits from the research capabilities of medical and hospital environments, an area in which France has well-established advantages and prestigious players, such as the neuroimaging center NeuroSpin at the CEA, the imaging platform Mircen, hospitals such as Broussais and Pitié-Salpêtrière, and the centers of excellence at INRIA (National Institute for Research in Computer Science & Control), INRA (National Institute for Agricultural Research), INSERM (National Institute for Health and Medical Research) and the CNRS (National Center for Scientific Research). Groundbreaking partnerships are being set up in France’s innovation clusters, often involving foreign groups. As important sources of investment attractiveness in their host regions, the following clusters are working examples of open ‘ecosystems’ for businesses: Alsace BioValley (Alsace), Atlanpole Biothérapies (Pays-de-la-Loire), Cancer-Bio-Santé (Midi-Pyrénées), Elopsys (Limousin), Eurobiomed (Provence-Alpes-Côte-d’Azur), Minalogic, Optitec and Lyonbiopôle (Rhône-Alpes), Medicen Paris Region, Cap Digital Paris Region and Systematic (Ile-de-France), Images et Réseaux (Bretagne/ Paysde-la-Loire) and Alpha-Route des lasers (Aquitaine). Over 650 foreign companies belong to one of France’s

71 innovation clusters. This trend is backed by the existence of generous tax incentives to support innovation, in the form of France’s “Research Tax Credit” along with the “National Investment Program” launched by the French President. Under this policy, programs dedicated to health and biotechnologies, managed by the National Research Agency (NRA), have been awarded a budget of €1.55 billion. This will boost research in France by encouraging partnerships between companies and public-sector research bodies, and will accelerate the economic knock-on effects of recent advances in post-genomic technologies and the acceleration of biological data acquisition. Major players in the sector can also count on the expertise and innovation capacity of a large number of French SMEs, which have successfully developed specialist or niche strategies. For example, the company SuperSonic Imagine is the only company in the world to offer a multiwave imaging device for use in cancer treatment. Another example is Guerbet, one of the major players in the contrast agents market, which boasts a 25% market share in Europe. The Invest in France Agency (IFA) is the national agency responsible for promoting and facilitating international investment in France. It also coordinates initiatives to promote France’s economic attractiveness. The IFA n network operates worldwide. 13

NEWS UPDATE

recent report by Confederation of Indian Industry (CII) suggests that the Indian healthcare industry is estimated at USD 50 billion and is expected to double to a massive USD 100 billion by 2015. It also predicts that by 2020 the industry will be worth USD 275 billion, thereby, contributing a GDP of 8 percent by 2012. Private hospitals and continued investment in public health programmes are driving the boom. There are other factors which contribute to the figure, some of which are increasing population, higher spending capacity, increasing market of health insurance and focus on Public-private partnership models for hospitals. With demand expected to outstrip the supply, the role of private healthcare providers is set to increase. The demand for hospital beds in India is expected to around 2.8 million by 2014 to match the global average of 3 beds per 1000 population from the present 0.7 beds. This means that India will need 1 lac beds every year for the next 20 years at over USD 10 billion per year. Besides this domestic potential, medical tourism is all set to further drive the market by an additional USD 3 billion by 2013 with an annual growth rate of 26%. It is also estimated that 3.2 million medical tourists would arrive in Indian by 2015. Tamil Nadu, among others states, has been identified as the major destination for medical tourists in the country. The major reason for this is the fact that the cost of medical treatment in India is a fraction of that in developed countries. Apart from the regular medical services, India also offers a variety of holistic medicare such as yoga, meditation and ayurveda. Several Indian healthcare providers

Indian Healthcare Industry is estimated at

USD 50 Billion

are already tapping this ‘gold-mine’ by serving to the Middle East and South-east Asia. Serving more than 8.5 lacs international patients every year, India has been able to uphold a strategic advantage over other competing nations. The industry expects a significant contribution from the tier-II and tier-III Indian cities as well, which is overflowed with several

clinics, nursing homes and other non-governmental organizations. Confederation of Indian Industry (CII) believes in this untapped potential of the healthcare industry and is working towards organizing this unorganized section of the industry. South Tamil Nadu has always been considered as a haven to such smaller clinics and nursing homes, who dream to provide quality healthcare at a larger scale. MEDex 2011, is one-of-its-kind event, which is organized by the Confederation of Indian Industry (CII), Madurai zone in association with Meenakshi Mission Hospital & Research Centre (MMHRC), Madurai, where large corporate hospitals are willingly inviting smaller clinics to join the league and contribute towards the growth of the industry. MEDex 2011 offers a comprehensive platform for all hospitals – big and small – to meet

relevant suppliers, manufacturers and distributors of equipments, instruments and drugs. MEDex 2011 comprises of a 2-day medical equipment trade show and a 1-day conference on hospital management. The trade show will be housed in a state-of-the-art air-conditioned hall with more than 100 exhibitors, both Indian and international, with displays ranging from equipments to instruments and hospital consultants to manpower consultants. We have a structured approach, in which all exhibitors are classified base on their products, which enables visitors to identify suppliers that match their needs. MEDex 2011 is also supplemented by a one-day discussion on topics which deals with all dimensions of hospital management ranging from Finance to Construction and Marketing to Human Resource. As an icing on the cake, the Conference will end up with a Special Panel Discussion that will have stalwarts discussing on the future of the healthcare industry in the state and the country. In other words, MEDex 2011 is equipped with everything that will make it the most-sought after healthcare event in the country and will be a one-stop shop for doctors that will encompass everything what your hospital needs. For further details on MEDex 2011, you may contact D. Naganathan (@ 9944118584) or visit us at www. ciimedex.org. Sep- June - Oct 2011 May

NEWS UPDATE

Medicall 2011 a Huge Success

eing Organised by Medexpert in its Seventh edition now the main focus of MEDICALL 2011 concluded from 12th to 14th August 2011 at Chennai Trade Center, Chennai, INDIA was “Innovation”. With crowds thronging the venue the exhibition was abuzz with delegates from across the globe. Amid an audience of more than 7500 business visitors, MEDICAL intends to keep the pace going by planning a seminar on Lean Six sigma, with 250 registrations. Interesting seminars on Lean Six Sigma in Healthcare and Hospital Construction attracted hospital owners as well as Administrators. The Healthcare Innovation Awards instituted for first time in this edition of MEDICALL attracted more than 100 70 applications from across the country. A team of renowned Jury Members selected the winners and the Awards were given during the show. MEDICALL with its new avatar hosted the inauguration of the exhibition with the award distribution ceremony on the 12th August 2-11. The exhibition was inaugurated by Dr. N. Sethuraman, Founder Chairman, Meenakshi Mission Hospital and Research Center. Speaking on the occassion, he remarked “Today, the healthcare sector in India is not lagging behind the way it was a decade ago, there has been tremendous development and a lot of innovation has added to the glory of the nation. MEDICALL 16

deserves to be called the one-stop shop as it not only brings different companies from various parts of the country but also conducts outstanding seminars under one roof.” Today, learning is very important to keep oneself updated with what is happening around the world. MEDICALL for all such reasons has become a huge label and will keep flying high as it gets better with each passing year. Around 7500 visitors from India and Other countries like Srilanka, Nigeria, Nepal, Taiwan visited the three day show. A special delegation from Srilanka including Health Minister of Province, Heads of various leading Hospitals visited the show. The 65%of visitors were doctors and hospital owners.The distributors and procurement agents were happy to interact with International Exhibitors.The international exhibitors felt that they were able to get dealers for their products in

Indian market. More than 430 exhibitors from India , Germany, China, Taiwan, Korea, Japan and Iran participated in the show. Exhibitors displayed A-Z requirement of hospitals. Archimedis-the Hospital Infrastructure pavilion consisting of Modular Operation Theaters, Vinyl flooring, Dry wall partitions, Hospital Consultancy, HVAC companies was well received by the Hospital owners. South India has grown rapidly over the past years which is why MEDICALL has retained its centre at Chennai, “Chennai is the leading Healthcare service Centres in India today, they have skilled human resource as well as the infrastructure. That is why Chennai is the best place to conduct the exhibition. Though Medexpert is planning to expand our scale in 2012, we would definitely be sticking to Chennai said Dr. Manivannan, CEO, MEDICALL. Sep - Oct 2011

EXPERT VIEWS

Normal

Lateral Meniscus

Medial Meniscus

Flap Tear

Torn Horn Tear

Menisc

TEAR

Symptoms and Tr

Dr. Ashwani Maichand

M.S. (Ortho) M.Ch (Ortho) Fellowship Joint Replacement Senior Consultant & Head Joint Replacement Unit Dr. B L Kapur Memorial Hospital New Delhi 18

ne of the most commonly injured parts of the knee, the meniscus, is a wedge-like rubbery cushion where the major bones of your leg connect. Meniscal cartilage curves like the letter â&#x20AC;&#x153;Câ&#x20AC;? at the inside and outside of each knee. Injury can take place to one of the two crescent-shaped cartilage pads between the two joints formed by the femur (the thigh bone) and the tibia (the shin bone). Each meniscus acts as a smooth surface for Sep - Oct 2011

EXPERT VIEWS

Bucket Handle Tear

Transverse Tear

reatment Part-II

Sep - Oct 2011

the joint to move on. A strong stabilizing tissue, the meniscus helps the knee joint carry weight, glide and turn in many directions. It also keeps your femur (thighbone) and tibia (shinbone) from grinding against each other. A partial or total tear of a meniscus may occur when a person quickly twists or rotates the upper leg while the foot stays still (for example, when dribbling a basketball around an opponent or turning to hit a tennis ball). If the tear is small, the meniscus stays connected to the front and back of the knee; if the tear is large, the meniscus may be left hanging by a thread of cartilage. The seriousness of a tear depends on its location and extent. Football players and others in contact sports may tear the meniscus by twisting the

knee, pivoting, cutting, or decelerating too quickly. In athletes, meniscal tears often happen in combination with other injuries; such as, a torn ACL (anterior cruciate ligament). Severe pain may occur if a fragment of the meniscus catches between the femur and tibia. Swelling may occur soon after injury if blood vessels are disrupted, or swelling may occur several hours later if the joint fills with fluid produced by the joint lining (synovium) as a result of inflammation. If the synovium is injured, it may become inflamed and produce fluid to protect itself. This causes swelling of the knee. Sometimes, an injury that occurred in the past, but was not treated, becomes painful months or years later, particularly if the knee is injured a second time. Older people can injure the meniscus without any trauma as the cartilage weakens and wears thin over time, setting the stage for degenerative damage to the knee. Indications and symptoms Someone may experience a “popping” sensation when the meniscus is torn. Most people can still walk on the injured knee and many athletes keep playing; however, when symptoms of inflammation set in, the knee feels painful and tight. For several days there will be: 1. Stiffness and swelling. 2. Tenderness in the joint line. 3. The collection of fluid (“water on the knee”). 19

EXPERT VIEWS

Without treatment, a fragment of the meniscus may loosen and drift into the joint, causing it to slip, pop, or lock causing the knee to “stick”, often at a forty-five degree angle, until the knee can manually move or otherwise be manipulated. A doctor should be consulted as soon as possible whenever anyone suspects such knee damage. Diagnosis may include physical testing to evaluate the extent of the meniscal tear. It may be necessary to use X-rays to rule out osteoarthritis or other

possible causes of knee pain. Sometimes doctor may use a magnetic resonance imaging scan to get a better look at the soft tissues of tje knee joint. The doctor may also use a miniature telescope (arthroscope) to see into the knee joint; especially, if the knee locks. Menisci may be torn in different ways: 1. Young athletes often get longitudinal or “bucket handle” tears if the femur and tibia trap the meniscus when the knee turns. 2. Less commonly, young athletes get a combination

Minimal Access Orthopedic Surgery is the super specially branch of modern orthopedics. In this branch surgical procedures are done by an endoscope or by very small incision. MinOmax is credited with launching the facility of Minimal Access Orthopedic Surgery for the first time in North India. It deals with: l Joint Replacement (MIS) l Minimally Invasive Spine Surgery (MISS) l Arthroscopy & Sports Injuries Areas of Expertise: Orthopaedic Surgery & Joint Replacement Speciality : Minimal Access Orthopaedic Surgery including MIS Joint Replacement, Arthroscopic Surgery, and Endoscopic Spine Surgery. Cemented, non-cemented and hybrid Thr, Surface replacement Arthroplasty, metal on metal THR, Total Knee Replacement, and Unicondylar Knee Replacement 20

of tears called radial or “parrot beak” in which the meniscus splits in two directions as a result of repetitive stress activities; such as, running. 3. In older people, cartilage degeneration that starts at the inner edge causes a horizontal tear as it works its way back. Non-surgical treatment Initial treatment of a meniscal tear follows the basic RICE formula: rest, ice, compression, and elevation, combined with nonsteroidal anti-inflammatory medications for pain. If the knee is stable and does not lock, this conservative treatment may be all that is needed. Blood vessels feed the outer edges of the meniscus, giving that part the potential to heal on its own. Small tears on the outer edges often heal themselves with rest. Surgical repair procedures If meniscal tear does not heal on its own and the knee becomes painful, stiff or locked; it may need surgical repair. Depending on the type of tear, one’s age and other factors; the doctor may use an arthroscope to trim off damaged pieces of cartilage. The patient must complete a course of rehabilitation exercises before gradually n resuming any activity.

7A/75, W.E.A., Pusa Road Karol Bagh, New Delhi-05 Mob.: +91 9811129607 www.minomaxortho.com Sep - Oct 2011

EXPERT VIEWS

Ask a Question from Healthcare Industry Expert “Medgate Today, introduce a Special Section : Ask a Question from industry expert in Hospital & Healthcare Planning, Operations, Management, Quality, Medical Education, Medico Legal & Materials Management”.

UR EXPERT : DR. PRADEEP BHARDWAJ, CEO & Executive Director, Six Sigma Healthcare Limited, Delhi will answer your questions through his expertise knowledge & experience in Hospital & Healthcare Management. He is an expertise Healthcare Planning, Management, Medico Legal Consultant, Author’s and Visiting Professor & Faculty in leading Healthcare Management Colleges / Universities like Harvard, IIM – Lucknow, IIM-A, ISB – Hyderabad, Amity University, Symbiosis International University, AIIMS, National Board of Examinations etc. He is also Board of Advisory in many healthcare organizations / management institutes / universities. . Dr. Bhardwaj is renowned hospital and healthcare management expert, recipient of many prestigious awards 22

like Rajiv Gandhi Award -2010, Best Medico Legal Expert – IBN 7 Q . Our hospital is a 300 bedded hospital. The staff movement (Nurses, Doctors) is very high in our hospital. Can you suggest any solution for development of our own manpower ? - Harish Pandey, HD-HR, Mumbai

Expert View : The frequent movement of Nurses and Doctors from one hospital to another hospital is global Issue. The shortage of Nurses and Doctors will never end. You can develop and nurture your staff with some special benefits. We believe that, human capital is more important than financial capital. You are also advised to start your own medical education department, by starting medical education (Nurses Courses, Para medical and DNB Courses) you can produce your own staff and they will be your ambassador. Now a days medical education is the only

Dr. Pradeep Bhardwaj CEO, Six Sigma Health Care

option, where you can solve this problem. Lots of Indian hospital is benchmarking the best practices in patient care because they have their own staff in different courses. It will also add value to the prestige of your hospital and a matter of proud for the owner. Before starting medical education, You are advised to take consultation from the industry expert. Q. Our hospital is 100 bedded and blood requirement is very frequent. We can’t open Blood Bank due to space constraints and heavy investments. Is there is any other alternative for that? - Dr. Partaph, Rajasthan

Yes, Blood Bank is costly assignment. The other alternative is go for Blood Storage Centre. The concept of Blood Storage Centre is very new in Healthcare. The area required is only 10 sq. Mtr. The Blood Storage Centre can get affiliated to any Govt. Sep - Oct 2011

EXPERT VIEWS

Or regional blood bank, which is approved by SBTC and licensed for the propose. The cost involved in this project will be apprx. Rs. 8-10 Lacs. Q. I’ m the owner of 200 Bedded Hospital & Nursing College in Punjab. I’m very keen to do a course on Healthcare Architect and Medico Law. Due to my busy schedule, I’m not able to attend regular classes. Please advice? - Dr. S.K Sharma, Kanpur, UP

You can do these courses through Distance Education. Recently

“Global Institute of Healthcare Management, New Delhi” has started these courses in distance mode. For further details, you can write to them at E.Mail : gihmdelhi@gmail. com. The course fee is Rs. 28000/and Duration is One Year. Q. Our cardiologist is facing Medico Legal case and the patient is also blaming Hospital Management. Is there is any court decision, where hospital management can’t be blamed for the negligence of Doctor?

If a patient dies or suffers due to medical negligence in a hospital then its management can not be prosecuted. The High Court has given this decision and it published in Hindustan Times dated 9th August, 2010. The court said that, under such cases only doctor should be penalised. The court however said that, the management of the hospital would be liable in case of administrative negligence and failure to provide basic infran structure to the patient.

- Dr. Aswini Rawat, Director, Mohali

You can mail your query at

pradeepkb28@gmail.com editor@medgatetoday.com

Sep - Oct 2011

PRODUCT LINE

Caddo 15 B Syringe Pump

cientech Medicare, a Scientech Group Division offers Caddo 15B, Syringe Pump which is used to deliver precise a m o u n t s of fluids, nutrients or medications at specific time intervals into a patientâ&#x20AC;&#x2122;s body for various departments of hospitals, such as medicine, pediatrics, gynecology, obstetrics, neurology, ICU and CCU and for use in chemical and biomedical research. Caddo 15B is compatible with syringes of any brand with automatic calibration facility for syringes and automatic detection of syringes types and settings. It has three working modes i.e. Rate Control Mode, Time Control Mode and Dose Weight Control Mode. It has alarm functions for monitoring Occlusion, Empty, Near empty, Low battery, End of infusion, Syringe loose etc. It also has KVO function which prevents patient from thrombus. Other features of Caddo 15B include high resolution multi-color LCD screen, five hours internal battery backup and built-in rechargeable lithium battery.

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Sep - Oct 2011

DOCTOR SPEAK

BREAST

Nature has provided the best nutrients for the new born human being is “Breast Milk” and BREAST” is the feeding of infant or young child with Breast Milk Directly from female human breast. Breast Milk is economical, easy available all the times.

Dr. Rajiva Kumar Child Specialist 26

(1st week of August is celeb

reast milk made from nutrient in the mothers blood steam and bodily stores, Breast Milk has just the right amount of fat, sugar, water and protein that is needed for a babies growth and development. Breast feeding is not only beneficial for the infants but also for mothers. BENEFITS FOR THE INFANTS Greater immune system and fewer infections: colostrums i.e milk created for new born in earlier stage contains antibodies immunoglobulin A” several anti infective factors such as bile salt, stimulated lipase, lacto-ferrin and others which develop immune system and protect from infection and that’s why breast feed baby having less respiratory tract, urinary tract infection and other infection in comprision to non breast feed baby PROTECTION FROM SIDS The risk of sudden infant death syndrome (SIDS) has been halved in the children up to age of 1year which is on breast feeding. Sep - Oct 2011

DOCTOR SPEAK

FEEDING

rate as breast feeding week)

Sep - Oct 2011

HIGHER INTELLIGENCEHorwood, darhaw, mogridge (2009) study, shows that breast feed baby has Higher I.Q. LESS DIABETIES- Infant exclusively breast feed has less chances of developing diabities mellitus type 1 and protect against diabities mellitus type 2. LESS TENDENCE TO DEVELOPM ALLERGY DESEASE(Atopy) Atopicsyndrome can be prevent or delay through exclusive breast feeding for 4 months. BENEFITS FOR MOTHER It makes emotionally and psychological strong to mother. Frequent and exclusive breast feeding can delay the return of fertilicy the lactational amenorrhoea so birth control. Frequent and exclusive breast feeding beneficial harmone are released into the mothers body. Less risk of breast cancer, ovarian cancer, endomaterial cancer. Lower risk of coronary heart disease. Reduce risk of metabolic syndrome, the does of insulin decreases in case of diabetic mother who is giving breast feeding. Post purtum bleeding reduce and less chance of osteoporosis, lower chance of contracting Rhuemtarid arthritis. Give breast feeding exclusively up to six month us recommended by WHO 2API and can be n done Up to 2-3 YRS. 27

DOCTOR SPEAK

High Blood Pressure

lood pressure is the force put on the] walls of the blood vessels with each heartbeat. Blood pressure helps move blood through your body. Taking Your Blood Pressure Blood pressure is often checked by putting a wide band called a cuff around your upper arm. Air is pumped into the cuff. Your blood pressure is measured as the air is let out of the cuff. Blood pressure is one number over a second number. l The top number is higher and is called the systolic reading. It is the pressure in the blood vessels when the heart pumps. l The bottom number is lower and is called the diastolic reading. It is the pressure in the blood vessels when the heart rests between beats.

Dr. Ramjee Prasad Cardiodiabetologist

28 28

Normal Blood Pressure Normal blood pressure is 120 over 80 or less. Blood pressure varies from person to person. Each personâ&#x20AC;&#x2122;s blood pressure changes from

hour to hour and from day to day. High Blood Pressure High blood pressure is also called hypertension. High blood pressure is 140 over 90 or higher. A diagnosis of high blood pressure is not made until your blood pressure is checked several times and it stays high. The harder it is for blood to flow through your blood vessels, the higher your blood pressure numbers. With high blood pressure, your heart is working harder than normal. High blood pressure can lead to heart attack, stroke, kidney failure, and hardening of the blood vessels. Signs of High Blood Pressure The only way to know if you have high blood pressure is to have it checked. Most people do not have any signs. Some

people may have a headache or blurred vision. Your Care Blood pressure control is very important. If you have high blood pressure you should: l Check your blood pressure often. Call your doctor if your blood pressure stays high. l See your doctor as scheduled. l Take your blood pressure medicine as ordered by your doctor. l Take your medicine even if you feel well or your blood pressure is normal. l Lose weight if you are overweight. l Limit salt in your food and drinks. l Avoid alcohol. l Stop smoking or tobacco use. l Exercise most every day. l Reduce stress. l Practice relaxation daily. Call Doctor right away if you have: l A severe headache l Vision changes l Chest pain, pressure or tightness l Have a hard time breathing or get short of breath l Sudden numbness, tingling or weakness in the face, arm or leg l Sudden confusion, trouble understanding or trouble speaking l Trouble swallowing Sep - Oct 2011

COVER STORY

Advances rehabilit

Cardiovascular disorders are the leading cause of mortality and morbidity in the industrialized world, accounting for almost 50% of all deaths annually. The survivors constitute an additional reservoir of cardiovascular disease morbidity 30

ardiac rehabilitation aims to reverse l i m i t a t i o n s experienced by patients who have suffered the adverse pathophysiologic and psychological consequences of cardiac events. Cardiovascular disorders are the leading cause of mortality and morbidity in the industrialized world, accounting for almost 50% of all deaths annually. The survivors constitute an additional reservoir of cardiovascular disease morbidity. In the United States alone, over 14 million Sept - Oct 2011

COVER STORY

in Cardiac ation

therapist following bypass surgery. Traditionally, cardiac rehabilitation has been provided to somewhat lowerrisk patients who could exercise without getting into trouble. However, astonishingly rapid evolution in the management of CAD has now changed the demographics of the patients who can be candidates for rehabilitation training. Currently, about 400,000 patients who undergo coronary angioplasty each year make up a subgroup

that could benefit from cardiac rehabilitation. Furthermore, approximately 4.7 million patients with CHF are also eligible for a slightly modified program of rehabilitation, as are the everincreasing number of patients who have undergone heart transplantation. This review addresses the objectives, indications, program components, exercise training, monitoring, benefits, risks, safety issues, outcome measures, and cost-effectiveness of cardiac rehabilitation. Objectives The identification of the patients at risk for a cardiac eventâ&#x20AC;&#x2122;s recurrence (ie, risk stratification) is central to formulating an appropriate medical, rehabilitative, and

persons suffer from some form of coronary artery disease (CAD) or its complications, including congestive heart failure (CHF), angina, and arrhythmias. Of this number, approximately 1 million survivors of acute myocardial infarction (MI), as well as the more than 300,000 patients who undergo coronary bypass surgery annually, are candidates for cardiac rehabilitation. The image below depicts cardiac rehabilitation after bypass surgery. Phase 1: A patient walking in the hallway with a physical Sept - Oct 2011

COVER STORY

surgical strategy to prevent such a recurrence. Patients who are at low or moderate risk typically undergo early rehabilitation. The major goals of a cardiac rehabilitation program are: Curtail the pathophysiologic and psychosocial effects of heart disease Limit the risk for reinfarction or sudden death Relieve cardiac symptoms Retard or reverse atherosclerosis by instituting programs for exercise training, education, counseling, and risk factor alteration Reintegrate heart disease patients into successful functional status in their families and in society Cardiac rehabilitation programs have been consistently shown to improve objective measures of exercise tolerance and psychosocial well being without increasing the risk of significant complications. Current Trends Current cardiac care has already reduced early acute coronary mortality so much so that further exercise training, as an “isolated” intervention, may not be able to cause significant reduction in the morbidity and mortality.Nonetheless,

exercise training has the potential to act as a catalyst for promoting other aspects of rehabilitation, including risk factor modification through therapeutic lifestyle changes (TLC) and optimization of psychosocial support. Therefore, the outcome measures of cardiac rehabilitation now include improvement in quality of life (QOL), such as the patient’s perception of physical improvement, satisfaction with risk factor alteration, psychosocial adjustments in interpersonal roles, and potential for advancement at work commensurate with the patient’s skills (rather than simply return to work).

400,000 patients who undergo coronary angioplasty each year make up a subgroup that could benefit from cardiac rehabilitation 32

Similarly, among patients who are elderly, such outcome measures may include the achievement of functional independence, the prevention of premature disability, and a reduction in the need for custodial care. Despite limited data, older male and female patients in observational studies have shown improvement in their exercise tolerance comparable to that of younger patients participating in equivalent exercise programs. In addition, the safety of exercise within cardiac rehabilitation programs, as studied in over 4,500 patients, is well accepted and established. Cardiac rehabilitation services are, therefore, an effective and safe intervention. These services are undoubtedly an essential component of the contemporary treatment of patients with multiple presentations of coronary heart disease and heart n failure. Sept - Oct 2011

COVER STORY

Current Trends in the Cath Lab: FFR Emerging as Stenting Gatekeeper

linical advancements in the cardiac catheterization lab most often occur in fits and starts, rarely in smooth progressions. Momentous developments like the percutaneous transluminal coronary angioplasty (PTCA) catheter, the bare metal stent, and then the drug-eluting stent truly shook both the profession and the industry. Refinements usually

follow. More recently, following positive results from a landmark clinical study, measurement of fractional flow reserve (FFR), a guidewire-based tactical advance, is being utilized in greater numbers by interventional cardiologists as a combined refinement and development that shows great promise for both improving patient outcomes and lowering cost, all with few known negative consequences.

FFR is a unique tool that assesses the severity of a coronary artery blockage by comparing blood flow at the distal and proximal ends of the lesion. The test provides a blood flow index that helps cardiologists differentiate with relative ease between high-risk arterial lesions that can lead to ischemia and more stable lesions that are far less likely to cause a serious blockage. This critical evaluation is one that cannot always be made through traditional angiography, for years the key determinant of the need for percutaneous coronary intervention (PCI) procedures such as stenting. Perhaps most important, FFR may enable cardiologists to determine with a much higher degree of certainty whether stenting is really necessary or whether certain lower risk patients would be better managed with far less invasive and less expensive options, such as medical therapy. Such an advance would help address recent, widely publicized concerns about physicians accused of implanting stents in n patients unnecessarily. Sept - Oct 2011

Lub Dub Medical Technologies Pvt. Ltd. 68, Ellai Amman Koil Street, Shastri Nagar, Adyar, Chennai - 600 020. India Tel: +91 44 24463030 Fax: Extn 111 Mobile: 098410 98009, Email: lubdub@vsnl.com

www.lubdub.in

HEALTHCARE I

AWARDS 2

INNOVATION

2011

POST SHOW

Digital Radiography Existing Constraints

ince the time Sir William Roentgen invented X-Rays in 1895, the technology has not changed much. The possibility to digitize the X-Rays was the first major change that happened in late 1990s and early 2000.

However except for the imaging chain which has gone digital the rest of the equipment continue to use the old technology & concept. Under these circumstances we thought that there is a huge potential for innovation. Though the Digitization of the images were achieved

Sundar Eswar Babu. B Head - Operation Cura Healthcare Pvt. Ltd.

Sept - Oct 2011

POST SHOW

System - Dream ERA through digital technology, the X-ray machines continued to pose challenges to hospitals and diagnostic centres. Even the new Computed Radiography (CR) systems could not overcome the existing limitations of an X-ray machine such as Large Space requirement, High

Sept - Oct 2011

Power supply requirement and the need to shift the Cassettes (Analog X-ray) / Image Plate (CR) between X-ray room and the dark room / the CR reader. Also the requirement of high wattage power supply in rural India and the space constraint in the cities posed a challenge. The additional challenge which the industry failed to achieve was to come out with a robust cost effective solution that could trigger a mass adoption of the new technology mainly for the developing countries and Hospitals going in for multiple unit digitization. One of the primary constraints in the way of innovation were requirement of large space and high ceiling height for installation of X-Ray systems, Most of the Digital Radiography systems which are developed abroad are either a dual detector type or of portable detector type (for various positions) fitting directly into the conventional X-Ray systems instead of innovating any thing new, Long installation time, cost and the need for high power connectivity were the accompanying challenges. Indian scenario is totally different from the world market. Our needs & existing limitations are completely different from the world. Hence Industry leader like

CURA has a responsibility to solve these issues in an innovative way to bring in quick adoption of the new technology. Innovation Being aware that there cannot be a considerable value addition in the core imaging chain by the way of technology, we decided to redesign the whole system to overcome the above constraints effectively, using various proven methods adopted in different industries. We thereby have come up with a design innovation in the form of “DReam Era”. The highlights of our design are , • Reduced ceiling height requirement of 2.40 m for installation of the equipment which is usually 3.50 m to 4.00 m. • Room size reduced to 11.00 m2 from the usual 18.00 m2 . The reduction and optimization happened on all the parts of the equipment except the Image quality chain (The parts that are responsible for the image quality, this remains similar to any other digital radiography machine), while still maintaining the versatility of the system for patient positioning. • The input power is reduced to 3 KVA, which is usually above 60 KVA. Again 39

POST SHOW

without compromising on the image quality. We achieved this by adopting a technique which is similar to the commercially available camera photo flash save energy over a long period to discharge the energy in a flash. • Installation time of the system has been drastically brought down to few hours from usual installation time of three to four weeks, by adopting a simple technique of bringing the centre of gravity within the system’s base. Also the mechanics were made simple & appropriate materials used to reduce the weight. Still maintaining the complete versatility. By achieving the above innovations the way the X-ray equipment is going to be looked at in the future will be different. (i.e) 1. X-Ray machine can be installed in a mobile van without any compromise. Which will make mobile comprehensive master health check up & mobile ambulance with diagnostic X-Ray facility to save the golden hour of accident victim. 2. X-Ray machine can be installed in a remote location or in any part of the world. Say it in middle of the desert or even in a forest or in war zone or middle of the disaster site or at the site were natural calamity has just then happened. Because it can be installed quickly & can work on very less 40

resources, like low power, few square meters of solar panel / a portable power generator can power the complete system in any remote locations. 3. Highly improved image quality helps in reducing the diagnosis cost to the patient. Also helps surgeons as well to improve his output quality. Benefits to the Participating entity 1. Satisfied customers 2. Increased Market share 3. Increased business 4. Better brand image Benefits to the employees 1. Pride of association with the company that innovated a product 2. Identity 3. Motivation 4. Job stability 5. Professionalism at workplace Benefits to the Government 1. Radiology facility made available in rural areas 2. Making the expertise of Radiologist available to the rural areas through tele-radiology (digitization allows images to be sent for remote reporting) 3. Huge foreign exchange saving as this is the first step towards elimination of use of films (which is imported in huge quantity). DReam can eventually be a complete indigenous product which gets exported as well to earn foreign exchange. Benefits to the Customers/ Patients 1. Now the diagnostic centre can be brought to the

doorstep of the patient not only in developed countries but also in the developing countries. The way master health check up can be undertaken for many without the loss of productive man-days As the system can be installed in any plane surface within few hours & due to its mobility in a mobile van, the critically injured patients can be Radiographed at the accident site. As also the system is tele-radiology enabled, the image of patient is read by the radiologist, diagnosed and the operation theater can be made ready, while the patient is still travelling to the hospital by ambulance. This saves the ‘Golden Hour’ for the patient and his/her precious life. As the increase in population of the radiology equipments and the awareness / affordability of patients is growing rapidly and does not match with the availability of specialized Radiologists, we are simplifying the technology and connecting the scarcely located Radiologists to the need of the patient diaspora Avoids need for multiple x-ray rooms to meet the load of patients during peak hours (an image can be taken every 6 seconds) We have taken multiple steps to simplify the system to make it ease with the patient as well Sept - Oct 2011

POST SHOW

as the operator. Like touch screen, inbuilt AV tutorial for the operator to properly position the patient, multi lingual option & to adopt to any language easily. 6. Only fraction of radiation dose compared to the conventional system & CR systems. Hence much safer for pediatric patients / women, more importantly the operators as well. 7. Only with design the existing Indian kind of XRay machine can be upgraded to a complete DR system as a retrofit without needing to use the compromised potable Digital detector. In India the portable detector may

not work as it is fragile & made of glass, also the salary of the technician (end user) is in total disproportion to the cost of the completely portable panel. Hence the chances of adoption to such technique may slow down or become impractical. Benefits to the Healthcare Industry 1. Innovation in this area that can be improved upon further Benefits to the Environment 1. This machine is ecofriendly as the input power is low instead of a generated high power input connection. 2. Eliminates use any chemical and x-ray plastic

films (Since it is a digital radiology). 3. Radiation Dosage to the patient is multiple times low compared to the analog x-ray. 4. The amount of raw material used in building the machine is very less. Recognitions 1. We got the Frost & Sullivan award as the best DR company in India. 2. We are the market leader with 65% market share in the country. 3. We have the design patented in CURA name. 4. We are in the final stages of getting the CE mark done on the product. 5. We are in the final rounds n of RED-DOT award.

Society,

Sept - Oct 2011

POST SHOW

Jeevan Stem Cell Bank (Unit of Jeevan Blood Bank and Research Centre) (Regd. Public Charitable Trust (1995)

Quick and affordable access to matching stem cells for life-足saving treatment for Indian patients living globally with Blood Cancers and Thalassemia

Dr. P. Srinivasan, MD Chairman

Jeevan Blood Bank 42

ver 120,000 Indians are diagnosed with blood cancers, majority of them are children, and another 10,000 children are born with Thalassemia (a disease needing one or two blood transfusions every month for the children to live). Over 60% of these paBents can hope for a cure if they have access to matching stem cells from donated umbilical cord

blood. Since stem cell DNA match is highly dependent on ethnicity, the chances of an Indian finding a match in any other country is less than 10% while the possibility is over 60% in an Indian inventory. At this juncture, even if a match is found, it will cost over USD 45,000 (22 lakhs of rupees) to import one unit of stem cell, which is beyond the reach of most of these paBents. Ironically, 20 million births Sept - Oct 2011

POST SHOW

happen every year in India and the resources are being wasted. Jeevan Stem Cell bank is one of India’s first efforts to set up a public stem cell bank. It is professionally managed by a commited and competent

Jeevan Stem Cell Bank is a not for profit organisation built on a model of sustainability beyond the first five years. Jeevan works with the community, social organisations, obstetricians, net work of blood banks across the country to ensure adequate representation of cord blood donations from across India. Donated cord blood is transported to the central facility in Chennai for harvesting stem cells, typing and storage and is made available for treatment for Indians globally. Region of Impact: Indians Globally Budget: Rs. 10 Crores a year for 5 years Staff Strength: 24 full time employees Impact to Date: • 2008 Established the first public cord blood bank in India at a cost of 3 crores of Rupees • Have processed and stored for treatment 569 cord blood donations spending Rs. 1.8 crores. • Released the first unit for transplant on 1 August, 2011 Milestones: • 100,000 blood donations and 220,000 blood components since 1995 • 2000 Introduced the concept of satellite blood storage centres-2001 • 2006 Make Blood Free programme to support safe blood needs of children with Cancer and Thalassemia • 2010 Reduced the cost of ensuring blood safety by over 50% • 2010

Accredited and certified to the highest standards (NABH 15189) in India

team lead by the co-founders Drs. Srinivasan and Saranya Narayan who have a combined experience of over 50 years in starting and managing medical institutions. Jeevan will create an inventory of 30,000 stem cell units within the next five years. There are two challenges to this project, which will touch Indians globally. One is cord blood donation. With over 20 million births happening Sept - Oct 2011

every year targets are easily achievable. However, the other-meeting the cost of Rs. 30,000 ($ 650) of processing each cord blood donation, testing, typing and storing each unit of stem cells can only be surmounted

with the participation of the beneficiaries - Indian community across the world. Jeevan is looking for 30,000 Indians who could make a tax exempted donation of Rs. 30,000 or $ 650 each over one or two years.

Donations can be made online at www.jeevan.org . For tax exempted donations in USA and UK please write to

srinivasan@jeevan.org Donations can also be made online at www.jeevan.org

INTERVIEW

Hospital Infrastructure India – Growing stronger and bigger with participation from leading companies

he only dedicated event of its kind in India that will feature products & technology from leading healthcare infrastructure companies from India and abroad. There is a significant gap between the demand and supply in the hospital infrastructure sector. Through HII event we would be offering our exhibitors, visitors and the industry at large, a professional platform to develop and consolidate their business contacts within the healthcare industry says Guru Prasath, Group Exhibition Director, Informa Exhibitions India and organizers of HII. Following on the success of last edition, Hospital Infrastructure India (HII) – India’s premier international exhibition and conference on hospital infrastructure, planning, supplies and healthcare development - will be held this year at Bombay Exhibition Centre, Mumbai from 14 – 16 December 2011. Q. What is your outlook on the hospital infrastructure sector in India?

Guru Prasath

Group Exhibition Director 44

According to industry reports, the Indian healthcare sector is expected to grow at 23% annually to become a USD 77 billion industry by 2012. The Healthcare infrastructure expenditure is expected to touch USD 14.2 billion by 2013. The demand for hospital beds in India is expected to be around 2.8 million by 2014 to match the global average of 3 beds per 1000 population from the present 0.7 beds.

Hence, there is a clear gap between the demand and supply, as far as the healthcare infrastructure sector is concerned. At HII it is our endeavor to help minimize that gap. Q. What are the challenges and opportunities for hospitals in India and what role does HII event play in this? The challenges are huge. There is a need to improve physical hospital infrastructure, developing new infrastructure of global standards. Also issues like infection control in hospitals, educating doctors on hospital architecture planning, managing medical equipments demands, delivering telemedicine solutions in rural areas, conducting cost-effective clinical trials in India. In order to meet these challenges, we are already seeing many expansion plans from existing hospitals, besides major investment plans

announced by the government & private players. At HII, our aim is to bring together the senior healthcare decision makers from public & private hospitals, hospital administrators and other key professionals within this sector along with the hospital suppliers, hospital planners/consultants/ architects, medical equipment manufacturers, infrastructure providers and others, all under one roof. We had an overwhelming response in 2010 from visitors and arguably HII today is well positioned as a must attend event for everyone in healthcare industry. Q. The last HII 2010 edition attracted some very prominent participants like Sony, L & T, Armstrong World, Everest, HKS, BurtHill and so on - what is new for this edition and what are your expectations? With more than 80% of our past exhibitors having already re-booked for 2011 we are very strongly positioned to offer a strong ROI to our participants this year too. The event is slated to grow by 20% both in terms of exhibitors & space occupancy. Out of the space sold so far, we already have over 25% new exhibitors this time. There will be special features like product demonstrations, workshops, seminar forums as well as technical conferences touching upon infrastructure component of healthcare business. For more information visit the website www.hospitalinfra-india. com or call +91 22 4020 3341. n Sept - Oct 2011

POST SHOW

Any

Where Time Device PACS

Radiology Workflow

l l l l l

Next Generation Radiology Workflow Intelligence Higher Radiologist Productivity Work Flow Optimized for Multi Site, Multi Radiologist Setup Integrates and Works with Any Existing PACS Mobile RADSpa: Radiology Reporting from iPAD/iPhone

T A.B. Sivasankar

VP-Sales and Marketing Telerad Tech Pvt. Ltd. 46

elerad Tech (located in Whitefield , Bangalore) founded by a group of technology innovators and eminent radiologists with the focus to develop products and solutions to address the gaps and needs of Healthcare IT in general, and radiology automation systems in particular. RADSpa, web based, fully integrated RISPACS (RIS= Radiology Intelligent System), is a flexible intuitive work flow developed by radiologists with Anytime Anywhere Sept - Oct 2011

POST SHOW

Access ,most suitable for multi site, multi modality , Tele Radiology reads. Has an In built automated order re conciliation of Images and Data to ensure data integrity, with collaborative sharing of images ,report thru audio, chat etc., with the peer Radiologist, Physicians or the MT in real time .Intelligent auto assignment of Radiologists for studies ensures productivity and less Turn Around Time (TAT). FDA cleared, with comprehensive support for standard interfaces like DICOM,HL7 and HIPPA compliance ensures security .The system further includes History and Data Logs for user accountability ,integrated Dictation software for auto reporting and user configurable work flow for different customer needs.

Sept - Oct 2011

The Features include Fully integrated platform for RIS + PACS + Billing on a unified database, Integration to third party LIS/HIS for automated order entry through HL7 interface, Smart scheduling of the study work-list with Optional interface with radiologist calendar, alerts, mobile/PDA etc., Automatic routing of images to designated locations based on customizable routing criterion to save the valuable image access time. Radiologist friendly interface User level customizable report generation for administrators, radiologists, referring physicians/ institutes. Web hosted solution – can be accessed anywhere in the world by the radiologists,

referring physicians’/ hospitals, administrator, Billing point (Flexibility & Quality of care). Integrated billing system with interface to the referring hospital HIS system. Enables consolidated billing at the institution of referring physician. Supports customizable billing structure for the referring institutes to support fixed cost model, pay per study model etc. The system greatly contributes to Improved Radiologist Productivity, improved Quality of care. & Reduction in resources and overhead for managing the workflow. The system is presently used by the country’s leading Tele radiology service provider Ms Teleradiology Solutions which reports about 60,000 studies monthly to hospitals and diagnostic centres in USA &Singapore. The other users include Vikram Hospital Bangalore, Vijaya Medical Centre Vizag, Infocus Ahmedabad ,Atulaya Healthcare Chandigarh ,Chettinad Health city Chennai ,Deepam Hospital Chennai ,Super Scan Jalundhar etc., Telerad Tech awarded “Best Picture Archival and Communications System” as a part of prestigious NASSCOM-KPMG Healthcare IT Awards Best Product Innovation Award from Medicall 2011.

POST SHOW

Dr. Mahesh Reddy Executive Director

First time in India, Nova Medical Centers has introduced the concept of standalone ambulatory surgical centers

edical science in India has come a long way, from just a life saving system to a plethora of path breaking and innovative findings, leading to the betterment of society. Gone are the days when simple common water borne diseases like diarrhoea, dysentery and cholera created a sense of panic among people. Over the last two decades, India has witnessed 50

enormous development in the field of medical science, with Indian medical fraternity making their presence felt across the globe. Even as the country makes progress in the field of medical science, there is a long way to go to accomplish what developed countries have done till date, especially when it comes to surgeries. We lag behind not because of lack of expertise or dearth of good surgeons

but because of a skewed surgeon patient ratio, which generates huge pressure on the entire health system. In India, even for a minor surgical procedure, the patient is subjected to long strenuous processes, creating unwanted pressure on surgeons and the health system at large. This low percentage has resulted in increased administrative pressure on hospitals and in the long run patient wait time is increased and they are not Sept - Oct 2011

POST SHOW

provided with personalized care and attention. It also increases the cost of treatment leaving the patient in a bigger turmoil than before. As a solution to these problems, Nova Medical Centers for the first time in India, has introduced the concept of standalone ambulatory (day & short stay) surgical centers. Nova Medical Centers is Indiaâ&#x20AC;&#x2122;s first dedicated standalone ambulatory (day & short stay) surgical center which excels in Minimally Invasive Surgeries (MIS). Nova covers 70% of all surgical procedures across specialties under this model. With the use of advanced anesthesia, equipment and surgical techniques, numerous

Sept - Oct 2011

advanced procedures such as total knee replacements, hernias, rhinoplasties & laparoscopic vaginal hysterectomies are performed at Nova. At Nova, a patient is promised greater satisfaction â&#x20AC;&#x201C; satisfaction that comes from the fact that he/she can be discharged on the same day as the surgical procedure as well as the assurance of a speedy recovery. Expenses incurred by the patient are also approximately 20 percent lesser, since hospital stay and travel expenses are minimal. Nova Medical Centers is the epitome of an affordable world class medical service provider. Each Nova Center is a compact 10,000 â&#x20AC;&#x201C; 12,000 sq. ft.

facility with all the state of the art equipment and facilities. The center consists of 4-5 operating rooms, 1520 beds (Pre & Post Op) including 2-3 rooms, consultation offices, imaging, laboratory & a pharmacy. Apart from being an excellent medical center, Nova also presents a good business model for doctors, offering them a stake in the enterprise with a small investment. Apart from giving higher professional fees, Nova also shares performance linked incentives from center profits & equity appreciation with investing doctors. Each Nova centre is a 70:30 partnership between the Company & 30-40 doctors. n

POST SHOW

Suicide today is a seriou especially among young p

million people worldwide commit suicide each year, with anywhere from 10 million to 20 million suicide attempts annually. Seventy-three percent of suicides in the world occur in developing countries, though data is unavailable for 73% of countries.

Dr. Rohit Garg MD (Neuropsychiatry Central Executive Member

Mental Health Foundation 54

uicide is the act of deliberately taking oneâ&#x20AC;&#x2122;s own life. Suicidal behavior is any deliberate action with potentially life-threatening consequences, such as taking a drug overdose or deliberately crashing a car. Nearly 1 million people worldwide commit suicide each year, with anywhere from 10 million to 20 million suicide attempts annually. Seventy-three percent of suicides in the world occur in developing countries, though data is unavailable for 73% of countries. More than half the suicides (54%) in the world occur in China and India. In developing countries the highest rate is found in the young (below 30 years) It is closely associated with various

psychiatric illnesses like depression, bipolar disorder, psychosis and alcohol dependence. The social stressors associated with suicide are loneliness, rejection, and marital conflicts in developed countries, whereas inter-generational conflicts, love failure, and exam failure are found in developing countries. A highly significant relationship between domestic violence and suicidal ideation in women has been found in many developing nations. Many who make a suicide attempt are seeking relief from thoughts of feeling ashamed, guilty, or like a burden to others, feeling like a victim, feelings of rejection, loss, or loneliness. Suicide and suicidal behavior are Sept - Oct 2011

POST SHOW

s global problem eople

never normal responses to stress. Over 90% of people who die by suicide have clinical depression or another diagnosable mental disorder. Suicide is a potentially preventable public health problem. Adolescents may fail to seek help for suicidal thoughts as they believe nothing will help or are reluctant to talk about problems. They think it is a sign of weakness to seek help. The best way to prevent suicide is to know the risk factors for suicide and to recognize the warning signs of suicide. Risk Factors for Suicide Risk factors for thoughts of suicide can vary with age, gender, and ethnic group. Traumatic or stressful life events in combination with other Sept - Oct 2011

risk factors, such as depression, may lead to suicide. Other risk factors for suicide include: l Prior suicide attempts l Family history of mental disorder or substance abuse l Family history of suicide l Family violence l Physical or sexual abuse l Keeping firearms in the home l Chronic physical illness, including chronic pain Warning Signs Suicide can be prevented to a large extent if we recognize the warning signs. Be concerned if a person is exhibiting any of these warning signs which include l Difficulty concentrating or thinking clearly l Giving away belongings, taking about going away or the need to “get one’s affairs in order” l Sudden change in behavior, especially calmness after a period of anxiety l Loss of interest in activities that were previously enjoyable l Performing self-destructive behaviors, such as drinking alcohol, using illegal drugs, or cutting l Sudden difficulty in school or work performance l Talking about death or suicide, or even stating the desire to harm themselves l Talking about feeling hopeless, helpless, worthless or guilty l Unusual changes in sleep or eating habits l Withdrawal from friends or an unwillingness to go out anywhere l Having a “death wish,” Always talking or thinking about death

l Saying things like “it would be better if I wasn’t here” l Sudden, unexpected switch from being very sad to being very calm or appearing to be happy What to do if someone show warning signs of Suicide Suicide attempts and threats should always be taken seriously. About one-third of people who attempt suicide will repeat the attempt within 1 year, and about 10% of those who threaten or attempt suicide eventually do kill themselves. Only 7–10% of those who committed suicide had ever seen a mental health professional. Mental health care should be sought immediately. Dismissing the person’s behavior as attentionseeking can have devastating consequences. 1. take that person seriously and listen to what he or she is saying 2. Take the initiative to ask that person what he or she is planning 3. let the person know that you care and understand and are listeningAvoid statements like: “You have so much to live for.” 4. Seek immediate help from a health care professional (psychiatrist). 5. Do not leave him or her alone 6. Provide safe environment by removing weapons or drugs he or she could use There is a need to develop integrated suicide prevention strategies in developing countries, which function at the individual, family, community and societal level. There is a strong need to bring in changes in the law to decriminalize suicide so as to provide help to people who commit suicide and for better reporting. Suicide prevention in developing countries is more a social and public health objective than a traditional exercise in the mental health sector. n 55

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