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Volume III || Issue I || May-June 2012

The Gateway to Health & Medical World

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Hybrid ORs News Update | Expert Views | Dental Hygiene | Health & Fitness | Product Line

Editor speak Healthcare INDUSTRY SNAPSHOT on Hybrid OR

he global medical industry is one of the world’s fastest growing industries, absorbing over 10% of gross domestic product of most developed nations. It constitutes of broad services offered by various hospitals, physicians, nursing homes, diagnostic laboratories, pharmacies and ably supported by drugs, pharmaceuticals, chemicals, medical equipment, manufacturers and suppliers. The medical and health care industry provides enormous employment opportunities to choose from. Apart from using the services of medical professionals, this industry also utilizes the expert services of public policy workers, medical writers, clinical research lab workers, IT professionals, sales/ marketing professionals and health insurance providers. The Hybrid OR has been all the rage of late, but is it simply the latest trend, or is the idea here to stay? How widespread has the hybrid OR become? Do you see this becoming a new industry standard, or will it only be for the facilities with the space/dollars to make it happen? How do you see the Hybrid OR trend shaking out? I would love to hear any thoughts out there. Thanks. It’s fair to say that everyone agrees that the Hybrid OR concept is here to stay, and that they in general lead to better outcomes for patients. The opinions from there seem to differ slightly, however, especially as it comes to three main topics that work hand-in-hand to a degree: cost, space, and utilization. As far as cost goes, there is definitely a premimum upfront expense to adding all of this extra imaging equipment to the standard OR (as well as the support for it), but if the facility is buying the imaging equipment anyway, why not put it in the OR where it can be utilized to make for better clinical outcomes? The answer to that question lies in the space consideration, as the average Hybrid OR is several hundred square feet larger than the average standard OR, and hence some facilities simply wouldn’t be able to accomodate a Hybrid room--at least not without significant renovations (which, of course, takes you back to the cost issue...) And if it takes the space of (roughly) two standard ORs to create one Hybrid OR, is a facility going to utilize the Hybrid room often enough to jusitfy all that extra space? And will the doctors from the different disciplines who might use a Hybrid OR be able to work together to make sure it is being used to maximum efficiency? While my questions have definitely clarified some issues, they have also raised some other interesting ones. Where do you see the Hybrid OR trend going?

Have an insightful reading. Your suggestions are most welcome! e-Mail: editor@medgatetoday.com

Volume-III

Issue-I

May-June 2012

Editor Dr. M.a Kamal 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 Zyaul Haque Ansari 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: 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 Printed by Artxel, 76, DSIDC Shed, Okhla Industrial Area , Phase-II, New Delhi-110020

Contents Cover Story

Volume-III

Issue-I

May-June 2012

News Update Omega-3 fatty acids...

The First Hospital in ... 10 Women don’t receive...... 10

Hybrid ORs are the future

How to handle your child?

Parkinsons Disease Overview

38 Activating chronic disease patients using social media

Post Budget Quote... 12 Social stigma’ still........ 14 Medical fair india........ 16 Exercise helps........

Ask a Question ........

Advance surgical procedures come....

40 48 NASOPORE “Next generation packing”

44 Healthy Eating

How Toothpaste and Mouthwash 6

Laparoscopic Gastric Bypass May - June 2012

NEWS UPDATE

May - June 2012

NEWS UPDATE

CONFERENCE SECRETARIAT & EVENT MANAGER:

Dr.Sushrut babhaular

Dr. Sunil Kulkarni

Dr. Amit Ajgaonkar

OFFICIAL MEDIA PARTNER

C/o VAMA EVENTS OďŹ&#x192;ce No 4, Gr. Floor,Anmol Cooperative Housing Society, Saka Ram Keer Marg, Parallel to L. J. Road, Mahim, Mumbai 400 016 Tel.: + 91 22 2438 3498 Telefax: + 91 22 2438 3499 Email: vamahospitality@hotmail.com May - June 2012

NEWS UPDATE

Reasons for India’s growing cardiovascular disease epidemic pinpointed in largestever risk factor study

Alcohol use in Bollywood movies impacting alcohol use among Indian adolescents New study presented at the World Congress of Cardiology organized by the World Heart Federation

lcohol use in Bollywood movies is directly influencing the drinking habits of India’s adolescents, according to a new study presented today at the World Congress of Cardiology in Dubai. Data presented for the first Overall 10 per cent of the students (aged between 12–16 years) time at the World Congress surveyed in the study had already tried alcohol. But students that had been most exposed to alcohol use in Bollywood movies were found of Cardiology organized by to be 2.78 times more likely to have tried alcohol as compared with the World Heart Federation those who were least exposed. Even when adjustments were made for demographic variables, social influences and characteristics of he Indian Heart Watch (IHW) child and parenting, students were found to be 1.49 times more likely study has revealed the truth to have tried alcohol if they had been highly exposed to alcohol use behind the prevalence, awareness, in Bollywood films as compared to those who were least exposed. g treatment and control of key risk factors that are driving the country’s growing cardiovascular disease (CVD) epidemic, in a firstof-a-kind presentation of data at the World Congress of Cardiology report released today at the World Heart Federation World today. Congress of Cardiology in Dubai reveals significant gaps in The study assessed the public awareness regarding the cardiovascular risks of tobacco use prevalence of different “lifestyle” and secondhand smoke. The report, entitled “Cardiovascular harms and biological CVD risk factors from tobacco use and secondhand smoke”, was commissioned by across the country – and results the World Heart Federation and written by the International Tobacco show that these risk factors are Control Project (ITC Project), in collaboration with the Tobacco now at higher levels in India than Free Initiative at the World Health Organization. in developed countries and regions According to the report, half of all Chinese smokers and onesuch as the USA and Western third of Indian and Vietnamese smokers are unaware that smoking Europe. causes heart disease. Across a wide range of countries, including Seventy-nine per cent of men India, Uruguay, South Korea and Poland, around half of all smokers and 83 per cent of women were – and over 70 per cent of all Chinese smokers – do not know that found to be physically inactive, smoking causes stroke. Awareness of the risk of secondhand smoke while 51 per cent of men and 48 is even lower. In Vietnam, nearly 90 per cent of smokers and nonper cent of women were found smokers are unaware that secondhand smoke causes heart disease. to have high fat diets. Some 60 In China, 57 per cent of smokers and non-smokers are unaware of per cent of men and 57 per cent the link. Even in countries with well-developed health systems of women were found to have a and tobacco control regulation – such as Canada, the United low intake of fruit and vegetables, Kingdom, the United States, and Australia – between a third and a while 12 per cent of men and 0.5 half of smokers do not know that secondhand smoke can damage per cent of women smoke. g cardiovascular health. g

Global ignorance of tobacco’s harm to cardiovascular health costing lives

May - June 2012

NEWS UPDATE

Omega-3 fatty acids may help to reduce the physical harm caused by smoking

mega-3 fatty acids may help to reduce the physical harm caused by smoking, according to a new study presented today at the World Congress of Cardiology. The study, carried out in Greece, assessed the effect of four-week oral treatment with 2 g/day of omega-3 fatty acids on the arterial wall properties of cigarette smokers. The results showed that short-term treatment with omega-3 fatty acids

improves arterial stiffness and moderates the acute smokinginduced impairment of vascular elastic properties in smokers. “These findings suggest that omega-3 fatty acids inhibit the detrimental effects of smoking on arterial function, which is an independent prognostic marker of cardiovascular risk,” said Dr. Gerasimos Siasos, University of Athens Medical School, 1st Department of Cardiology, “Hippokration” Hospital. “The cardioprotective effects of omega-3 fatty acids appear to be due to a synergism between multiple, intricate mechanisms involving anti-inflammatory and anti-atherosclerotic effects.

Furthermore, AHA recommends that people without documented history of coronary heart disease should consume a variety of fish (preferably oily – rich in omega-3 fatty acids) at least twice per week.” “The World Heart Federation strongly encourages all smokers to quit,” said Dr Kathryn Taubert, Chief Science Officer at the World Heart Federation. “The only way to protect your body from the harmful effects of tobacco is to stop smoking. We encourage all people, both smokers and nonsmokers, to eat healthy diets, which includes foods rich in omega-3 fatty acids.

ENT doctors shifting from removable to non-removable nasal packs in INDIA

he most common purpose of nasal packing is to control the bleeding that is followed by surgeries of the septum or sinuses. It is also used to prevent synechiae or adhesions, and to treat epistaxis. The introduction of Nasopore® in India by NexusNovus at the very onset of 2012 has brought about a great sense of relief to ENT surgeons, as it helps them in solving the complications associated with the usage of removable Nasal packs. Renowned ENT surgeons in cities like Mumbai, Chennai, Delhi, Hyderabad, and from other places have not only gained confidence in Nasopore®, but also prefer it to the removable nasal packs that were used in India till date. It is aimed at providing peace of mind and comforts to the patients post 12

their nasal surgery. Nasopore® - A unique Bioresorbable postoperative Nasal dressing that has been a preferred choice for nasal packs among ENT surgeons globally, and it is now widely accepted in India. Nasopore® being the latest innovation in hemostatic dressings, does not only eliminates the drawbacks associated with conventional packs, but also offers additional benefits. Some of them are:

• NO Trauma due to subsequent bleeding upon removal • Provides significantly enhanced comfort • NO Mucosal damage or possible pressure necrosis • Helps in reducing possible obstructive sleep apnea syndrome NexusNovus Tech Consultancy Services Pvt. Ltd., an Indo-Dutch conglomerate based in Bangalore has introduced Nasopore® to address the complications associated with conventional nasal packs. May - June 2012

NEWS UPDATE

The First Hospital in India Achieves Global Recognition for Its Healthcare IT Systems Max Healthcare is ranked in top 5% worldwide for safety, quality of care and efficiency in new global rating by HIMSS Analytics Asia

IMSS Analytics Asia announced Max Healthcare in India, has achieved Stage 6 on the Electronic Medical Record Adoption Model (EMRAM). Max Healthcare has been recognized for meeting all criteria for a Stage 6 hospital in the deployment and use of clinical information technology to improve patient safety, quality and efficiency. The two facilities, which have reached this important milestone, include the Max Super Speciality Hospital East Wing Saket and Max Super Speciality Hospital West Wing Saket. HIMSS Analytics developed the EMR Adoption Model in 2005 as a methodology for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics® Database. Tracking their progress in completing eight stages (0-7), hospitals can review the implementation and utilization of information technology applications with the intent of reaching Stage 7, which represents an advanced electronic patient record environment. Putting the achievement into

perspective, as of Q4 2011, just 5.2% of more than 5,300 hospitals in the United States tracked by HIMSS Analytics had reached Stage 6 on its EMRAM. Max Healthcare has deployed several very strategic clinical

applications which have been shown to improve quality and safety, such as: • Computerized Practitioner Order Entry (CPOE) where physicians enter patient orders directly into the clinical information system which interacts with an intelligent clinical decision support system • Physician Documentation supported by clinical decision support • Closed Loop Medication Administration with the use of bar codes to verify the right medication for the right patient at the right time in the right strength and form

• Nursing Documentation online with some direct medical device connectivity There is increasing evidence that points to significant safety and quality improvements with clinical information systems. “We believe Max Healthcare’s commitment to medical and service excellence and patient care is further strengthened by the Electronic Medical Records (EMR) system at our hospitals. Our integrated information systems empower the care providers in delivering world class healthcare in a safe and effective manner. Being the first hospital in India to have reached an advanced level of electronic patient record environment, we take pride in our achievement of HIMSS Stage 6 Certification and at the same time resolve to continuously work towards our endeavor to improve patient care,” said Dr. Ajay Bakshi, CEO & MD, Max Healthcare. The Max Heal3thcare will be honored with their Stage 6 Award at the HIMSS Asia Pac12 Conference which takes place at the Marina Bay Sands in Singapore from 17-19 September 2012. May - June 2012

NEWS UPDATE

Post Budget Quote 2012-2013

Attributed to Ms. Ameera Shah, Managing Director & CEO, Metropolis Healthcare Ltd

ealthcare is one of the most eminent and dynamic sectors in terms of driving a country’s economic growth through increased revenue generation and promoting largescale employment opportunities. Fortunately, the Indian healthcare industry is expanding rapidly to US$ 70 billion by 2012, US$ 100 billion by 2015 and US$ 280 billion by 2020 successively. Although the Union budget 2012 – 13 has given some importance to strengthen preventive healthcare, to upgrade 7 more government colleges, and to modernize existing vaccine units, however, the industry expected much more than this.

Some of the key elements crucial for the sector’s growth were not highlighted by the government in this year’s budget such as n Reduction in customs duty on life-saving

medical devices and diagnostic reagents

n Granting subsidies for setting up new

healthcare services in small towns in India

n Tax benefits for investment in healthcare n A clear PPP model and plan in healthcare

In short, although the sector holds enormous potential, it is still waiting to be unleashed. The current scenario clearly indicates that health of the common man is of little interest and will be ignored for one more year. g

Two new drugs safe and effective in treating depression in PD

American researchers have presented Class 1 evidence that the drugs paroxetine and venlafaxine are safe and effective in treating depression in Parkinson’s disease (dPD). They claim their study, which enrolled 115 people with Parkinson’s but without dementia, “is the largest randomised, placebo-controlled clinical trial of commonly used antidepressant medications” in dPD.

Women don’t receive the same treatment as men for heart disease the world-over

Women with acute coronary syndrome (ACS) receive inferior or less aggressive treatment compared to men, according to three large studies presented today at the World Congress of Cardiology. The CREATE registry study of 20,468 patients in India revealed that relatively fewer women are admitted with ACS. Moreover, these women are older, reach hospital later, have more risk factors, receive inferior treatments and have 16

worse outcomes. While the BRIG project study of 3,168 patients in China concluded that a substantial portion of women with ACS did not receive proper treatment during hospitalization compared with men. Similarly, a study of 4,229 ACS patients in the Middle East found that women tended to be admitted to hospital later than men and had more comorbid disease. These women received commonly used treatments less

frequently than men, although in the case of the Middle East study this did not appear to impact inpatient mortality. “These three studies paint a consistent picture around the world and all serve to demonstrate that women with ACS are unfortunately not receiving the same treatment as men,” said Prof. Sidney C Smith Jr, MD, President, World Heart Federation. “This is something that has to be addressed as a matter of urgency. May - June 2012

NEWS UPDATE

‘Social stigma’ still attached to

mental health issues for Arab women

Experts at the upcoming Obs-Gyne Exhibition & Congress to discuss appropriate screening and treatment for methods depression among women in the Middle East

hile the UAE does not have any formal method of collecting information on mental health disorders, according to the World Health Organisation (WHO), depression is the second leading contributor to poor health and shorter lifespan among people between the ages of 15 and 44. Experts at the upcoming Obs-Gyne Exhibition & Congress, taking place from the 1-3 April at the Dubai International Convention & Exhibition Centre, will discuss this issue of depression among women in the Middle East, as well as appropriate screening and treatment for methods for this health concern. For the second year, Informa Exhibitions is partnering with the Arab Association of Obstetrics & Gynaecology Societies (AAOGS) drawing more than 100 regional and international speakers from around the world. According to Dr. Saliha Afridi, Clinical Psychologist and MD at The LightHouse Arabia, and speaker at the ObsGyne Exhibition & Congress, the ‘social stigma’ associated with going to see a mental health professional still acts as a strong deterrent for women seeking treatment for their emotional issues.

“The Arab and Asian world is very private with religion playing a strong mediating role in coping with mental health issues. For some, it is not considered to be acceptable to discuss family problems with an ‘outsider’. Women will often go to primary care physicians to report psychosomatic symptoms who will then refer them to psychiatrists or psychologist as it is much easier and more socially acceptable to admit that there is something wrong with the body then it is to admit that they need help coping,” says Dr Afridi. Lack of awareness is the main reason why women in the Arab world do not seek appropriate treatment for symptoms of depression. “Many women are unaware of the different ways that depression can present itself, and, being away from their support systems can often leave them alone to cope with life’s challenges. Stress is also a major issue trigger as women try to adhere to traditional gender definitions and while juggling the high demands of family, work, and social responsibilities,” Dr. Afridi explains. According to Dr. Afridi, prescribing antidepressants is only an effective form of treatment when the individual is treated holistically. “Antidepressants may alleviate the symptoms of depression; however, they will not treat the life choices and patterns that the person is involved in that resulted in the depression. Emotional health is very important as the patient must learn how to heal their wounds, learn their relational style, achieve work-life balance, know what their impact is on those around them, take accountability for their role in their depression, and feel empowered to make life changes,” she explains. g May - June 2012

NEWS UPDATE

MEDICAL FAIR INDIA Continueson Successful Course

Numerous Co-op Exhibitors Confirmed from Asia, Europe and the USA

he 18th MEDICAL FAIR INDIA 2012, International Exhibition and Conference on Diagnostics, Medical Technology, Rehabilitation, Medical Equipment and Components, continues on its successful course and will again exceed last yearâ&#x20AC;&#x2122;s number of exhibitors, as it has each year since 2009. This year, from 2-4 March 2012, 321 exhibitors from 16 countries will present a broad spectrum of healthcare products and services to more than 6,000 visitors on 3,600-plus square metres at the Bombay Exhibition Centre in

Mumbai. The level of internationality is growing in line with the increase in exhibitors and visitors. For the very first time there will be a US pavilion with the Illinois State Office, the Minnesota State Office and the US Commercial Service participating, as well as group exhibitions from the Czech Republic and Japan. Coop stands from Germany, France, Korea, Taiwan and Malaysia, along with the participation of Chinese companies under the sponsorship of the SAMD (Shenzhen Association of Medical

Devices, SPECTARIS) and the CCCMHPIE (Chinese Chamber of Commerce for the Import & Export of Medicine and Health Products) round off the strong international presence. Exhibitors from the UK, Russia, the Netherlands, Hong Kong and Italy will of course also be present again at the exhibition centre in Mumbai. The MEDICAL FAIR INDIA offers trade visitors the opportunity to acquire a comprehensive overview of international innovations in the medical technology and healthcare services sectors. Medical device technology, rehabilitation, components and service providers are the focal points of the trade fair. Once again, this yearâ&#x20AC;&#x2122;s MEDICAL FAIR INDIA begins under the best possible May - June 2012

NEWS UPDATE

conditions: India is enjoying both an excellent economical climate and a healthcare services sector that is one of the country’s most rapidly growing sectors and already accounts for six percent of the gross national product. Combined, these factors form an ideal basis for establishing new contacts and business opportunities at MEDICAL FAIR INDIA. According to the Indo-German Chamber of Commerce, the medical device technology sector alone will grow from three to five billion US dollars in 2013. With a current volume of more than 300 billion euros, the global medical technology market is also on a stable growth course. The event is supported by Indian associations such as AIMED (Association of Indian Medicals Device Industry) and IAPMR (Indian Association of Physical Medicine and Rehabilitation), as well as international institutions such as MREPC (Malaysian Rubber Export Promotion Council), CCCMHPIE, KMDICA (Korea Medical Devices

Industrial Cooperation Association), UBIFRANCE, SAMD, GHE (German Health Care Export Group) und ZVEI (German Electrical and Electronic Manufacturers’ Association). Cooperation agreements with Indian hospitals such as Fortis Hospital and Apollo Hospitals have also been confirmed. Road shows were planned in major cities i.e. Mumbai, Ahmedabad and Delhi. The invitees were from the medical industry where they got to meet and discuss about the event. The MEDICAL FAIR INDIA takes place annually, rotating between Mumbai and Delhi.

For further information, visit http://www. medicalfair-india.com or contact Mr. Suraj Ullal with Messe Düsseldorf India at UllalS@mdindia.com or +91-22-6678-9933.

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May - June 2012

NEWS UPDATE

Exercise helps smokers to quit smoking, to remain smoke-free and to reduce the risk of death

xercise may help smokers to quit and remain smokefree, according to new data presented today at the World Congress of Cardiology. Moreover, exercise increases life expectancy in smokers and non-smokers alike. The study of 434,190 people who went through medical examination program at a private fee-paying company between 1996 and 2008 in Taiwan revealed that active smokers (those engaged in at least moderate activity) were 55 per cent more likely to quit smoking that those that were inactive. Furthermore, these active smokers were 43 per cent less likely to relapse than smokers that were inactive. Physical activity among these subjects was also shown to increase life expectancy, even among smokers. Smokers that participated in physical activity had an increased life expectancy of 3.7 years and a reduction in all-cause mortality of 23 per cent – equivalent to levels achieved by ex-smokers with low activity levels. The results also demonstrated that active ex-smokers increased their life expectancy by 5.6 years and reduced their all-cause mortality by 43 per cent – equivalent to the levels seen in inactive non-smokers. “Exercise can help smokers to quit and quitting smoking has been shown to significantly reduce the risk of developing CVD and that must be the goal of all smokers,” said Dr. C.P. Wen, National Health Research Institute, Taiwan. “If smokers can continue to exercise, not only they can increase the quit rate, but also they can reduce their mortality for all cause and for CVD in the long run. 22

Women with heart disease more likely to have baby girls

Women with heart disease are more likely to give birth to female rather than male babies according to a new study presented today at the World Congress of Cardiology. The study found that three-quarters of the 216 children born to 200 pregnant women with diagnosed heart disease were female. The study reviewed the sex of children born to 200 pregnant women with diagnosed cardiac disease. Sixty-four per cent of these women had diagnosed valvular disease, 19 per cent were living with dilated cardiomyopathy, while 14 per cent had uncorrected or significant residual congenital heart disease. These 200 women delivered 216 babies of which 75 per cent were female. “We believe that this is the first study looking at the relationship between gender and the mother’s cardiac disease,” said Dr. A. Alizadehasl, Tabriz University, Tabriz, Iran. “We hope that this will lead to further investigation into this area.” “This is a very interesting observation,” said Dr Kathryn Taubert, Chief Science Officer, World Heart Federation. “The chromosomes in a man’s sperm are responsible for the sex of a baby but this study does suggest that there may be a relationship between the health status of the mother and the sex of the babies that she is able to carry to fullterm. As the number of women with heart disease is increasing around the world, this could prove to be a very interesting area for further research. May - June 2012

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 like Rajiv Gandhi Award -2010, Best Medico Legal Expert – IBN 7

Dr. Pradeep Bhardwaj CEO, Six Sigma Health Care

Q. We are doing Master of Hospital Admin (MHA), Can you suggest the Attributes & Qualities of a Good Hospital Administrator ? Dr. Ajay Raj, Dr. Vinay, Dr.Anjali, MHA- Final Year, Hyderabad

Expert View: Hospital administration is a challenging profession. The Qualities of head & heart that hospital administrator seeks : 1. KEEN OBSERVER : 360 Degree of vision, should be able to step back and look at the bigger picture and then devise solution. 2.FFECTIVE COMMUNICATOR : Good administrator should be able to convey the things with clarity and as simply as possible without patronizing or scaring other with the command of his vast knowledge or intellect. 3. GOOD LISTNER : Hospital requires a lot of patience and sympathy. At times people only need a good listener. 4. RESPECT FOR FACT & INTELLECTUAL HONEST : Administrator should not speak without facts and should have patience to find the whole truth. 5. SHOULD BEHAVE GRACEFULLY : Administrator should never loose temper even under stress. 6. TRANSPARENTLY HONEST : He should not be bluff. Truth is always more convenient in today’s busy world. He should know how to say no if that is what situation demands, without hurting people as far as possible. 7. GOOD LEADER : A hospital administrator must have leadership skill. Nowadays almost all corporate are realizing the importance of leadership in the management. 8. SHOULD NOT PANIC : In the face of problems or difficulties, he should be able to keep cool even in scary situations. When chips May - June 2012

EXPERT VIEWS

are down he should be able to stand i.e. hold his ground and be counted. Should be able to cope with change effortlessly in today’s ever changing environment and should not feel rattled by change. 9. GOOD JUDGE :This is the most essential quality for any administrator, you would need it all the time. 10. SHOULD BE SENSITIVE : He should be sensitive to other’s suffering and problems even if they are self inflicted or you are not able to help much.

11. SHOULD BE HABITUALLY OBJECTIVE : He should be

habitually

objective with a deep sense of fair play and justice. You should not be hesitant to give credit where it is due and share honour if the situation rightfully demands so. 12. TIME MANAGEMENT : Time and tide waits for none. Once the time is lost it is lost forever. So a particular task should be completed in the allotted time frame. IN FINAL ANALYSIS : He is a nice guy who does not mind even if he finishes second and lets somebody else win if that could bring cheer to someone’s life. At times a gesture is all that you can do. But remember sometimes even a gesture goes a long way.

Q. When A Criminal Case Occurs Against Doctor? Dr. Anuj Kumar, Delhi Expert View : Under the following circumstances,criminal case occurs against a doctor :l Sudden death after injection. l Death in Intensive Care Unit ICCU l Death in Operation Theatre. l Abortion cases, septic, death. l PNDT Cases-female child. l MTP Cases-places & doctor not registered. l Disabilities like Gangrene and Amputation after IV/IM Inj. l Death after delivery/LSCS.

You can mail your query at editor@medgatetoday.com

COVER STORY

Hybrid ORs are

May - June 2012

COVER STORY

the future

May - June 2012

Just as technological advances have driven the trend of collaborating surgeons, the new hybrid operating room will enable additional procedures and provide patients with access to new technologies, such as percutaneous valve interventions without open heart surgery or cardiovascular bypass. For example, the hybrid operating room is serving as one arm of a new clinical study designed to compare a new catheter-placed aortic valve, called the Sapien valve, to traditional surgery and medical therapy for advanced aortic stenosis in patients at high risk for traditional surgery.

COVER STORY

asically, a hybrid operating theatre (OT) is a combined operating room containing large imaging equipment, such as MRT and CT, which enables intra-operative diagnostics. If provided for in the hygiene and theatre concept, the hybrid OT can also be used purely as a diagnostics room, or as a classic operating room. Likewise, operating theatres with integrated inpatient or mobile angiography devices are also called hybrid OTs. Simply imagine an operating room with a completely equipped cardiac catheter laboratory.

This definition of a hybrid OT has gained increasing acceptance because more and more cardiologists and vascular surgeons employ hybrid procedures. Specifically, this means that interventional treatment by means of a vascular catheter, for example, is combined with open surgery. A hybrid OT enables a multitude of new surgical procedures â&#x20AC;&#x201C; for virtually all disciplines. New potential areas of application are emerging especially in trauma and orthopaedic surgery, neurosurgery, cardiac and vascular surgery. For example, the trend in vascular surgery

is shifting increasingly from open surgery to endovascular procedures, and also open and interventional therapies are combined. This is feasible in a hybrid OT. Even if open surgery is indicated for endovascular or minimally invasive surgery (MIS) in an emergency, this is possible in one time-saving session involving less risk and strain for the patient. Another example, from the field of neurosurgery: in this case intraoperative imaging serves to update preoperative image and navigation data. This results in key advantages with respect to perioperative delimitation of tumour tissue and determination of resection borders

May - June 2012

COVER NEWS STORY UPDATE

Commercial Purchasing large devices, such as MRTs, CTs or angiography equipment, is always a big investment. So it’s all the more important to use such equipment as economically as possible. If this is done in a hybrid OT, both human and technical resources can be utilised optimally. Integration of a hybrid OT into the central surgical department generates the most advantages. In particular because a hybrid OT permits interdisciplinary applications and is thus available to the theatre management as an operating room resource. In short, once the hybrid is set up, the clinic can save enormous costs through its use and additionally optimise the selection and 32

quality of treatment methods. This also increases patient and staff satisfaction. Current trends & Planning in hybrid OR’s Key factors include the right room design and an appropriate selection of technical equipment. At the same time the imaging device and operating table must form an integral unit. Planning therefore plays a crucial role, since both the room concept and the technical equipment have to be adapted to the respective in-house procedures and concepts. As for choosing the right operating table system, an interchangeable table top system with a fixed column offers the greatest scope. It ensures that a defined

reference point is provided in the room for the imaging devices. Moreover, you can take advantage of the entire spectrum of operating and diagnostic table tops. That’s the basis for interdisciplinary use. An example of an X-ray system suitable for interdisciplinary use in a hybrid theatre is the Siemens Artis Zeego. The C-arm and an exclusively developed version of the Trumpf operating table system TruSystem 7500 work together ‘as a team’, meaning both devices know where the other is positioned. That’s the basis for integrated collision protection. Furthermore, the C-arm and the operating table can be controlled via a joint control platform if necessary. May - June 2012

NEWS COVER UPDATE STORY

Installation is not exactly easy. When you equip an interdisciplinary hybrid OT with a CT or MRT, you must first keep the room concept in mind. Nowadays multiroom concepts are also implemented. In this case the large equipment is mobile and can be used alternately in two or even three rooms. No matter whether it involves a CT, MRT or devices like Artis Zeego, in every case there are additional requirements regarding room size as well as control and technical rooms. This is easier to accomplish during the early planning phase for new buildings. If you subsequently install equipment in hybrid OTs, things become

May May- -June June2012 2012

more difficult. Frequently, however, adjoining rooms are available for the respective use in central OT units. If they are ‘rededicated’, and operating theatre logistics, procedures and the OT concept are optimised simultaneously, you kill two birds with one stone. The factors that guarantee smooth incorporation of an interdisciplinary hybrid OT into a central OT unit include precise planning and prompt integration of the users in order to boost acceptance of interdisciplinary use. I mean, not only does the equipment work as a team in the hybrid OT, but also different and, from a historical viewpoint, ‘non-OR-related’ disciplines

must function as a team in the hybrid OT. The same applies to the companies whose medical technology products are to work together in the hybrid OT. Hybrid OTs are the future. Classic open OT procedures are reducing, so it’s necessary to integrate imaging into the operating theatre. Disciplines of internal medicine, with their interventional and endoscopic procedures, increasingly work hand in hand with surgical disciplines, with their open and minimally invasive methods. Even radiology cannot avoid this trend towards integration. Specialised departments are increasingly joining forces. Industry must also accept this development. The hybrid OT is one of the main drivers of this development. No supplier can cope with the complexity of the hybrid OT alone; teamwork is called for. Trends always involve hurdles. Mostly they naturally relate to available budgets. Another factor in the case of hybrid OTs is that an understanding regarding optimum exploitation of resources must grow and even greater focus must be placed on the importance of cooperation between clinics, planners and industry. In near future overcoming these hurdles, the realisation of hybrid OTs will become more than just a trend!

DOCTOR SPEAK

How to handle your child? 3 Steps to Improve Your Child’s Behavior When a child’s action elicits positive reinforcement, it will be repeated over time. When an action elicits punishment, it will eventually be extinguished.

ll children have episodes of bad behavior, some more frequently and severely and others less. Using these three steps will improve your child’s behavior and reduce the frequency and severity of any child behavior problem.

1) Relationship

Dr. Rajiva Kumar

Child Specialist, Muzaffarpur

A loving, stable relationship between parents and children is the basis for the child’s healthy social development. Tell your child you love him and show your love by taking time to listen, to play, and to teach. The parentchild relationship is built on the words you say and the tone of your voice. It is strengthened by

the laughter you share and the games you play together. It is forever bonded by the values and skills you pass on to your child every day.

2) Planning

Planning is the secret of good parenting. Watch your expectations so that you plan for good behavior rather than dread the bad. Most children’s behavior problems occur during times of transition and adjustment. Since childhood is by its nature a continual process of transition, and adjustment to rapid development, it’s easy to see that bad behavior is a natural reaction to challenges that the the May - June 2012

DOCTOR SPEAK

child doesn’t yet have the skills to accomplish. Planning involves knowing your child, her temperament and skills, and knowing the challenges of her environment. Use direct instruction, guidance, and practice opportunities to teach the skills she will need to cope with new challenges in the journey of childhood.

3) Response Attentiveness and response are the tools for improving your child’s behavior. An understanding of behavior modification principles will help you plan your responses to improve behavior. It all comes down to actions and consequences. When a child’s action elicits positive reinforcement, it will be repeated over time. When an action elicits punishment, it will eventually be extinguished. Children learn to make the connection between an action and its consequence when the reinforcement or punishment is immediate and logically related to the action. Parents don’t always have to provide the consequence; most consequences occur naturally. Parents can help make the connection by talking to the child about what they did and why it lead to a certain consequence. But, as parents, our responses to our child’s actions are powerful consequences, either rewarding or punishing and therefore, shaping his behavior. In the context of a May - June 2012

positive parent-child relationship, your approval or disapproval is usually enough of a response to reinforce or punish a behavior. When more intensive rewards or punishments are needed, parents should choose those that work for their family. The key is to attend to your child’s attitude, moods, and behavior; and then, respond to both good and bad behavior quickly. Learn to recognize when bad behavior is being reinforced or good behavior is being extinguished, and adjust the consequences to turn it around. This requires that we be attentive to our child and make the right response. g 35

DOCTOR SPEAK

Parkinsons Disease Overview

arkinson’s disease [PD], the neurological movement disorder, is known to affect one in 1000 people worldwide. A disease considered to be affecting only the elderly is found to be increasingly affecting people well below 40 years. World

the patient becomes a burden to the caregivers. Deep Brain Stimulation [DBS] therapy is a good option in carefully selected patients with advanced Parkinson’s disease, having side effects of medical therapy. DBS improves the quality of life of this group of patients.

Parkinson’s Day (11th DBS uses a surgically of April) is observed to battery-operated spread awareness about implanted, medical device called a the disease.

Dr Aditya Gupta

Associate Director, Neurosurgery Institute of Neurosciences Medanta Medicity Hospital Gurgaon, India

Parkinson’s Disease can be controlled though there is no cure. It can only be relieved to an extent by medication. Over a period of time the body does not respond to medicines and extensive medication does have side effects. When symptoms become more pronounced,

neurostimulator — similar to a heart pacemaker and approximately the size of a stopwatch — to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms. May - June 2012

DOCTOR SPEAK

Parkinson disease is characterized by tremor, muscle rigidity, and slowed movement (bradykinesia). Psychiatric manifestations, which include depression and visual hallucinations, are common but not uniformly present. Dementia eventually occurs in at least 20% of cases. Generally, individuals with onset before age 20 years are considered to have juvenile-onset Parkinson disease, those with onset before age 50 years are classified as having early-onset Parkinson disease, and those with onset after age 50 years are considered to have late-onset Parkinson disease.

Disease characteristics.

onset Parkinson disease.

Diagnosis The diagnosis of Parkinson disease is based solely on the clinical findings of tremor, rigidity, and bradykinesia. A good response to levodopa and asymmetric onset of limb involvement are generally regarded as supporting diagnostic features. The cardinal pathologic feature of Parkinson disease is the loss of dopaminergic neurons in the substantia nigra with intracytoplasmic inclusions (Lewy bodies) in the remaining, intact nigral neurons. The genetic cause of some forms of Parkinson disease has been identified. Seven disease genes have been implicated. Mutations in three known genes, SNCA (PARK1), UCHL1 (PARK5), and LRRK2 (PARK8) and one mapped gene (PARK3) result in autosomal dominant Parkinson disease. Mutations in three known genes, PARK2 (PARK2), PARK7 (PARK7), and PINK1 (PARK6), result in autosomal recessive Parkinson disease. Three susceptibility genes have been identified. Molecular genetic testing is clinically available for PARK2 (the gene encoding parkin), PINK1, PARK7, SNCA, and LRRK2.

Parkinsonism refers to all clinical states characterized by tremor, muscle rigidity, and slowed movement (bradykinesia). Parkinson disease is the primary and most common form of parkinsonism. Psychiatric manifestations, which include depression and visual hallucinations, are common but not uniformly present. Dementia eventually occurs in at least 20% of cases. Generally, individuals with onset before age 20 years are considered to have juvenileonset Parkinson disease, those with onset before age 50 years are classified as having earlyParkinson disease can be onset Parkinson disease, and inherited in an autosomal those with onset after age 50 dominant or autosomal recessive years are considered to have latemanner; however, most cases of

Genetic counseling.

May - June 2012

Parkinson disease are thought to result from the effects of multiple genes as well as environmental risk factors. Genetic counseling of affected individuals and their family members must be done on a family-by-family basis. The risk to first-degree relatives of a person with Parkinson disease varies from study to study and from country to country. In families with a non-mendelian form of Parkinson disease, firstdegree relatives of an affected individual are between 2.7 and 3.5 times more likely to develop Parkinson disease than individuals without a family history of Parkinson disease. Their cumulative lifetime risk of developing Parkinson disease is therefore between 3% and 7%.

Management.

Treatment of manifestations: The mainstay of the treatment of Parkinson disease is pharmacologic replacement of dopamine. Dopamine agonists may also be used as well as inhibitors of catechol-Omethyltransferase (COMT) or monoamine oxidase-B (MAO-B). Other medications include anticholinergics, selegiline, and amantadine. Treatment may also include neurosurgical procedures (e.g., pallidotomy, deep brain stimulation of the subthalamic nucleus, fetal brain transplant to the caudate nucleus) and occupational, physical, and speech therapy. g

SURGEONS CORNER

Advance surgical procedures come to the rescue of rising shoulder problems and injuries in India Mrs.Malani, a 70 year old lady sustained fracture shoulder, in which her ball broke into multiple pieces. The main portion of the ball was detached from all around, and had no blood supply. Hence it had to be removed, and replaced by a artificial ball. The operation was performed by Dr. J. Maheshwari, a shoulder surgeon at SitaramBhartia Hospital. She is doing well

ndia’s rapidly mobile youth and fast changing lifestyle has added yet another health woe to its already long list of health problems. Shoulder dislocations and ailments are now fast becoming very common thus rendering the citizens less productive and also unnecessarily increasing one’s health costs. Lower limb problems have always been more troubling as they affect the mobility of the patient. Lately, diagnosis and treatment of shoulder problems has undergone a sea change, and hence more and more patients are visiting doctors for shoulder problems. “I used to see 2 new patients with shoulder problem in a week about 10 years back. However, I see nearly 30 a week now. It seems shoulder problems have increased, or the patients have become aware, as it significantly affects the quality of life,” says Dr. J. Maheshwari of Sitaram Bhartia Institute of Science & Research, who also just recently conducted the country’s first reverse shoulder replacement. The reason for the increase is multifold: increased sporting activity, aging population and hence age-related degeneration. Early diagnosis by investigations such as MRI, and more predictable and less invasive arthroscopic surgery has been a boon in optimal care of a shoulder patient. May - June 2012

SURGEONS CORNER

Some of the most common shoulder problems in young people include the problem of repeated dislocation of the shoulder. Shoulder, by design, is an unstable joint – the ball is big and the socket is small. Once the shoulder dislocates, it is likely to do so again in 7 out of 10 cases! Earlier, people used to live with these problems with compromised life-styles as the only option was open surgery. The main disadvantage of open surgery was that it would lead to limitation of shoulder movement, which was an unacceptable trade for the dislocation not occurring again. But now, with the advent of key-hole surgery, this problem can be treated elegantly by just a few small cuts. Not only are the complications few, the results are as good, and of course the recovery is much faster. The other common problem is a painful shoulder following injury. This happens due to minor injuries often sustained in day to day life. Such problems went undiagnosed in the past as there are usually no clinical signs May - June 2012

on examination. One would refer these cases for physiotherapy for long periods, and eventually the patients learn to live with the limitation. Today with MRI and arthroscopy, it is possible to make a diagnosis in vast majority of the cases, and treatment is possible by arthroscopic surgery. In middle aged people, particularly in diabetics, often the shoulder gets stiff, what is commonly called ‘Frozen shoulder’. This is a self- limiting disease, and patients often recover completely in about a year. The period of recovery can be shortened by injecting cortisone in between the shoulder. In resistance cases, arthroscopic surgery may become necessary. Middle aged and elderly also suffer from Cuff Disease. Cuff is a group of muscles, controlling the movement of the shoulder. These run between the head and the roof of the shoulder. These often get pinched between bones, and sometimes get ruptured. Arthroscopic surgery is a successful treatment for this problem. Elderly people also

suffer from age related arthritis, in which the joint is damaged, and needs replacement. Explaining the procedure and benefits of Arthroscopic surgery Dr Maheshwari adds “We have heard our cricketers heading to UK and Australia for care of their shoulder in the past. All this is now being done in India. Arthroscopic surgery is a key-hole surgery of the shoulder where the inside of the joint is seen via a thin telescope, the size of a pencil. On the telescope is attached a small video-camera, and thus, the inside of the joint can be seen on the TV screen. This is done under anaesthesia through two or three small punctures. No cutting or stitching is required. There is minimal discomfort in the post-op period, and recovery is quicker.” Once the diagnosis is made, the repair is possible using special micro instruments & techniques of suturing the torn structures without opening the joint. The patient has to be hospitalised only for one day, and leaves the hospital with a light bandage. After a week, all dressings are removed and the 39

SURGEONS CORNER

patient is encouraged to move the shoulder. Physiotherapy helps in gaining back the movements and power. The other significant advancement in shoulder surgery is Shoulder Replacement. Over last few years, shoulder replacement has become common, though it is yet to take off in India. It is due to lack of awareness and misconceptions that shoulder replacement is yet not successful. Also, due to strong family support and low demand life-style, our elderly ‘manage’ to live with shoulder problems. The scenario is fast changing though, and more and more elderly people are opting for surgery for better quality of life. Shoulder is a ball-and-socket joint. The ball-shaped top end of the arm bone (humerus) articulates with the cupshaped part of the shoulder bone (Glenoid). Muscles and ligaments around the shoulder hold this ball and socket together. The shoulder needs to be replaced when the ball and socket structure of the shoulder gets damaged. This may happen as a result of arthritis, infection and injury. The damage results in the shoulder becoming painful and stiff. It becomes difficult to raise the hand beyond a point. Often the pain disturbs sleep. The damage can be prevented by adequate treatment early in the disease process. Early diagnosis by investigations such as MRI, and treatment by minimally 40

The first such operation in north India, a reverse shoulder replacement, has been recently conducted by Dr. J. Maheshwari a shoulder surgeon in Delhi, at Sitaram Bhartia Institute of Science & Research about a month ago. The patient is doing very well.

invasive procedures such as arthroscopic surgery may help prevent arthritis. Once arthritis sets in, and the joint surfaces are damaged, replacement remains the only option. Conventionally, the ball alone is replaced (partial replacement). Sometimes, both, the ball and the socket (shoulder replacement) are done. The

artificial components are made of metal and plastic. These are fixed to the native bone with ‘bone cement’ which acts like glue. Partial or total shoulder replacements are being done in India for some time now, and are fairly successful. A pre-requisite for success of the replaced shoulder is that the muscles around it are in good shape. Often, the patients reach so late for treatment that it is not possible to do the routine shoulder replacement. For such situations, newer shoulder replacement called ‘reverse shoulder replacement’ was invented in Europe in 80’s. This is meant for people who have painful arthritis in their shoulder and also have significant damage to the muscles around the shoulder. In this operation, after the surgeon removes the damaged bone and smoothens the ends, he attaches the ball shaped joint piece to the shoulder bone (scapula) and attaches the cupshaped piece to the top of the arm bone (fig-2). In a way, the parts are attached in ‘reverse’ fashion, hence the name. This surgery is not right for everyone, and not all surgeons have experience of doing it well. The implant for this operation has only recently been introduced in India, and only a few such operations have been done in India. g May - June 2012

EXPERT VIEWS

Activating chronic disease patients using social media Manish Nachnani

Health IT Innovation & Design Consultant

nengaged, Uninformed and Uneducated patients are the key reason behind increasing cost of chronic disease management in India. So the key lies in how we activate these patients? If social media can create a national revolt can’t it activate chronic disease patients? It can let’s see how. Key to chronic disease management is being active and involved in ones diseases. This is a behavioral issue rather than a medical one. Let’s see how this can be addressed using social media, concepts of behavioral finance and gamification. Chronic diseases today can also be called “epidemic”India today suffers from it and hence every nation needs a similar approach towards it , what needs to be tweaked is the content and cultural sensitivities of the region . Social media thrives on human 42

behavior which is universal .

from friend or a stars in ones Social media is the greatest profile, but games like FarmVille influencer of our times, it creates have proved that virtual rewards an enormous amount of peer are much craved for , more than pressure and the desire for being real rewards that people pay for liked and respected drives makes it . participants active . So the first Financial rewards :Health step is to make chronic disease insurance companies and states patients a part of social media can provide incentives to citizens community targeted for them. who are fit . Such rewards will go Once they are in social media , aa long way in creating healthy the aim is to create addiction to nations. keep them healthy. Patient engagement Chronic diseases are behavioral in nature , and behaviors can be changes using social media. Social media if used correctly can create aemotional connect with the patients and leverages it to modify behavior using the laws of carrot and stick. A stick for every bad behavior and carrot for bad behavior.

Key to patient engagement is gamification of regular tasks for patients with chronic disease say diabetes –

Gamification :-How

about a game that triggers them to upload blood sugar levels and give them rewards if they do on time and if its under control a bonus. If you don’t submit alerts , messages Social rewards: Rewards and from care givers and negative sticks are physiological in terms points . Such games will help of likes or dislikes, a comment collect regular data which is the May - June 2012

EXPERT VIEWS

key to managing chronic diseases. Once this data is uploaded it is shared with doctors and timely intervention can be done if required. Games can change behavior so integrating it with social media communities for chronic disease patients. Social media community by caregivers can be a trigger to adopt health lifestyle for such patients small challenges via tweets can help them be active Walk up to the 5th floor n Lets say no to escalator n Lets not have that Pizza today n Lets have a salad / fruit n Lets replace our coke by a fruit drink n Lets have skimmed milk n Lets walk a mile every morning

May - June 2012

Healthcare professionals also become part of such social media communities to monitor their patients activities, answering their questions and posting on social media to educate their patients . Thus they empower their patients and establish a relationship with them . In order to make patients engaged, you need to activate them , make them participate in such networks on regular basis , integrating above concepts same can be achieved . This will ensure employees are engaged in their health, they take care of themselves. The multifaceted social media is not just limited to online communities , it integrates , group video counseling calls , chats , sms and other reminder services making it a 360 degree solution for managing chronic diseases in a nation like India with unique demographics and challenges. g

PRODUCT LINE

NASOPORE

“Next generation packing”

A unique bioresorbable synthetic foam for the nasal cavity

esearch has shown that the removal of conventional nasal dressings is related to re-bleeding and thereby mucosal tissue damage. NexusNovus introduces Nasopore® to India, a post-operative nasal dressing.

Biodegradable Nasopore® is biodegradable synthetic polyurethane foam. It is available in different lengths and can be easily cut to the appropriate size depending on the application. This biologically inert foam has a highly interconnected porous structure with a rapid and high absorbent capacity (up to 25 times its weight).

Prevents formation of post-surgical adhesions Nasopore® separates mucosal surfaces during the critical, early days of post sinus surgery when mucosal swelling is intensified. By keeping mucosal tissue separated, Nasopore® prevents formation of post-surgical adhesions in the nasal cavity. 44

Natural drainage Nasopore® slowly starts to fragment whilst it continues to give sufficient wound support during the critical healing period. Throughout this time it doesn’t swell andthereforeit doesn’t hinder natural drainage. After fragmentation Nasopore® will be drained from the nasal cavity via natural pathways without any pain. Daily spraying with saline solution is recommended in the first week after surgery to fasten the fragmentation and to reduce the risk of infection.

Key Benefits Fully synthetic foam - clinically proven to be biologically inert n Gentle compression during a period of 36 - 48 hours after insertion n Biodegradable property results in rapid and uniform fragmentation n Easily manipulated to allow optimum placement within the nasal cavity n Retains its position after insertion and does not swell n

May - June 2012

PRODUCT LINE

Valuable wound support during the critical healing period n The unique structure has a proven high absorption capacity, being able to absorb up to 25 times its original weight n Prevention of adhesions after nasal and sinus surgery - can be used to medialize the middle turbinate and septum – and prevent lateralization n No need for post-operative removal n Atraumatic and comfortable for patients n

Improved Wound healing Nasopore® bioresorbable nasal dressing is intended for use in patients undergoing nasal/sinus surgery as a temporary wound dressing. Nasopore is intended to support tissue healing, minimize edema and prevent adhesion formation. Nasopore® can also be used as a topical applicator for the antibiotics Gentamiacin and Ciprofloxcinand the steroid Triamcinolone. Cote et al. recently reported a significant improvement in early postoperative healing in sinonasal cavities receiving triamcinolone-impregnated Nasopore® following ESS and is also associated with significantly improved healing up to 6 months postoperatively.

About NexusNovus

NexusNovus Tech Consultancy Services Pvt. Ltd. is an Indo-Dutch company that offers quality Import–Distribution Solutions and Consultancy Services for firms with the ambition to tap into the rapidly growing Indian market through unparalleled services ranging from exploration to implementation. It has a strong focus on bringing high quality, innovative healthcare products from Europe to India. NexusNovus proudly introduces Nasopore® into the Indian market and is the exclusive importer for the same.

For further information, contact: Mr.TanmaiSaxena (Product Manager)

NexusNovus Tech Consultancy Services Pvt. Ltd. 7/1, 5th ‘C’ Cross, Hutchins Road, Cooke Town, Bangalore – 560084. (T): +91 80 65464803 (M): +91 07259897978 (E): t.saxena@nexusnovus.com

May - June 2012

DENTAL HYGIENE

How Toothpaste and Mouthwash Can Kill Your Teeth

Toothpaste is vital in keeping your teeth and gums healthy, but toothpaste can have many harsh chemicals that harm instead of help your health. 46

oothpaste is vital in keeping your teeth and gums healthy, but toothpaste can have many harsh chemicals that harm instead of help your health. Brushing with natural, organic toothpaste is the better choice for your body and your pearly whites.

Crazy Chemicals in Toothpaste

Most toothpaste you will find on your grocery or drug store shelves contains sodium lauryl sulfate, which dries out your mouth and can cause canker sores. It can also damage the oral tissue that lines the inside of your mouth. May - June 2012

DENTAL HYGIENE

The harsh abrasives found in some toothpaste can also affect your tooth enamel and weaken it so it stains and decays more easily. There are so many harmful ingredients in these toothpastes that many have on their packaging not to swallow them. Mouthwash can be detrimental to your health too. If you swallow mouthwash it can damage your body or even be fatal since it contains ingredients also found in bathroom disinfectants: ammonia, formaldehyde and hydrogen peroxide. It is vital to buy organic toothpaste and mouthwash since 60% of whatever you put on your skin can be absorbed, inhaled and remain in your body your whole life.

Benefits of Natural Toothpaste

Natural toothpaste has no artificial chemicals, preservatives or sweeteners. Instead, it incorporates plant and fruit May - June 2012

extracts. Some brands use green tea to destroy bacteria, papaya to whiten teeth and licorice root to freshen breath. The clay found in organic toothpaste will also help your teeth stay spotless through slowing down tooth decay while even whitening teeth. Many organic types of toothpaste don’t use fluoride. Fluoride-free natural toothpaste might instead use mint oils or herbal extracts. These natural oils have antibacterial properties that

keep your mouth fresh, clean and cavity-free. Organic toothpaste also has antiseptic properties that help with healing diseased teeth or gums and stopping bacteria from growing. There are many popular brands of natural toothpaste and mouthwash. Yet, laws regulating the term “natural” are not very strict, so you should read the ingredients, and make sure that it has the USDA Organic stamp of approval on the tube. 47

HEALTH & FITNESS

Healthy Eating

ealthy eating is not about strict nutrition philosophies, staying unrealistically thin, or depriving yourself of the foods you love. Rather, it’s about feeling great, having more energy, stabilizing your mood, and keeping yourself as healthy as possible– all of which can be achieved by learning some nutrition basics and using them in a way that works for you. You can expand your range of healthy food choices and learn how to plan ahead to create and maintain a tasty, healthy diet.

Set yourself up for success To set yourself up for success, think about planning a healthy diet as a number of small, manageable steps rather than one big drastic change. If you approach the changes gradually and with commitment, you will have a healthy diet sooner than you think. l Simplify. Instead of being overly concerned with counting calories or measuring portion sizes, think of your diet in terms of color, variety, and freshness. This way it should be easier to make healthy choices. Focus on finding foods you love and easy recipes that incorporate a few fresh ingredients. Gradually, your diet will become healthier and more delicious. l Start slow and make changes to your eating habits over time. Trying to make your diet healthy overnight isn’t realistic or smart. Changing everything at once usually leads to cheating or giving up on your new eating plan. Make small steps, like adding a salad (full of different color vegetables) to your diet once a day or switching from butter to olive oil when cooking. As your small changes become habit, you can continue to add more healthy choices to your diet. l Every change you make to improve your diet matters. You don’t have to be perfect and you don’t have to completely eliminate foods you enjoy to have a healthy diet. The long term goal is to feel good, have more energy, and reduce 48

the risk of cancer and disease. Don’t let your missteps derail you—every healthy food choice you make counts.

Think of water and exercise as food groups in your diet. Water. Water helps flush our systems of waste products and toxins, yet many people go through life dehydrated—causing tiredness, low energy, and headaches. It’s common to mistake thirst for hunger, so staying well hydrated will also help you make healthier food choices. Exercise. Find something active that you like to do and add it to your day, just like you would add healthy greens, blueberries, or salmon. The benefits of lifelong exercise are abundant and regular exercise may even motivate you to make healthy food choices a habit. May - June 2012

HEALTH & FITNESS

Moderation is key

People often think of healthy eating as an all or nothing proposition, but a key foundation for any healthy diet is moderation. Despite what certain fad diets would have you believe, we all need a balance of carbohydrates, protein, fat, fiber, vitamins, and minerals to sustain a healthy body. l Try not to think of certain foods as “off-limits.” When you ban certain foods or food groups, it is natural to want those foods more, and then feel like a failure if you give in to temptation. If you are drawn towards sweet, salty, or unhealthy foods, start by reducing portion sizes and not eating them as often. Later you may find yourself craving them less or thinking of them as only occasional indulgences. l Think smaller portions. Serving sizes have ballooned recently, particularly in restaurants. When dining out, choose a starter instead of an entrée, split a dish with a friend, and don’t order supersized anything. At home, use smaller plates, think about serving sizes in realistic terms, and start small. Visual cues can help with portion sizes—your serving of meat, fish, or chicken should be the size of a deck of cards. A teaspoon of oil or salad dressing is about the size of a matchbook and your slice of bread should be the size of a CD case.

It’s not just what you eat, it’s how you eat Healthy eating is about more than the food on your plate—it is also about how you think about food. Healthy eating habits can be learned and it is important to slow down and think about food as nourishment rather than just something to gulp down in between meetings or on the way to pick up the kids. l Eat with others whenever possible. Eating with other people has numerous social and emotional benefits—particularly for children— and allows you to model healthy eating habits. Eating in front of the TV or computer often leads to mindless overeating. l Take time to chew your food and enjoy mealtimes. Chew your food slowly, savoring every bite. We tend to rush though our meals, forgetting to actually taste the flavors and feel the textures of our food. Reconnect with the joy of eating. l Listen to your body. Ask yourself if you are really hungry, or have a glass of water to see if you are thirsty instead of hungry. During a meal, stop eating before you feel full. It actually takes a few minutes for your brain to tell your body that it has had enough food, so eat slowly. l Eat breakfast, and eat smaller meals throughout the day. A healthy breakfast can jumpstart your metabolism, and eating small, healthy meals throughout the day (rather than the standard three large meals) keeps your energy up and your metabolism going.

Fill up on colorful fruits and vegetables Fruits and vegetables are the foundation of a healthy diet. They are low in calories and nutrient dense, which means they are packed with vitamins, minerals, antioxidants, and fiber. Try to eat a rainbow of fruits and vegetables every day and with every meal—the brighter the better. Colorful, deeply colored fruits and vegetables contain higher concentrations of vitamins, minerals, and antioxidants—and different colors provide different benefits, so eat a variety. Aim for a minimum of five portions each day. May - June 2012

HEALTH & FITNESS

Some great choices include: l Greens. Branch out beyond bright and dark green lettuce. Kale, mustard greens, broccoli, and Chinese cabbage are just a few of the options—all packed with calcium, magnesium, iron, potassium, zinc, and vitamins A, C, E, and K. vegetables. Naturally sweet l Sweet vegetables—such as corn, carrots, beets, sweet potatoes, yams, onions, and squash—add healthy sweetness to your meals and reduce your cravings for other sweets. l Fruit. Fruit is a tasty, satisfying way to fill up on fiber, vitamins, and antioxidants. Berries are cancer-fighting, apples provide fiber, oranges and mangos offer vitamin C, and so on.

A quick definition of healthy carbs and unhealthy carbs

Healthy carbs (sometimes known as good carbs) include whole grains, beans, fruits, and vegetables. Healthy carbs are digested slowly, helping you feel full longer and keeping blood sugar and insulin levels stable. The importance of getting vitamins from Unhealthy carbs (or bad carbs) are foods such food—not pills as white flour, refined sugar, and white rice that The antioxidants and other nutrients in fruits have been stripped of all bran, fiber, and nutrients. and vegetables help protect against certain types of Unhealthy carbs digest quickly and cause spikes in cancer and other diseases. And while advertisements blood sugar levels and energy. abound for supplements promising to deliver the Tips for eating more healthy carbs nutritional benefits of fruits and vegetables in pill or powder form, research suggests that it’s just not • Include a variety of whole grains in your healthy diet, including whole wheat, brown the same. rice, millet, quinoa, and barley. Experiment with A daily regimen of nutritional supplements is different grains to find your favorites. not going to have the same impact of eating right. That’s because the benefits of fruits and vegetables • Make sure you’re really getting whole grains. Be aware that the words stone-ground, multidon’t come from a single vitamin or an isolated grain, 100% wheat, or bran can be deceptive. antioxidant. Look for the words “whole grain” or “100% The health benefits of fruits and vegetables whole wheat” at the beginning of the ingredient come from numerous vitamins, minerals, and list. In the U.S., Canada, and some other phytochemicals working together synergistically. countries, check for the Whole Grain Stamps They can’t be broken down into the sum of their that distinguish between partial whole grain and parts or replicated in pill form. 100% whole grain. Eat more healthy carbs and whole grains • Try mixing grains as a first step to switching Choose healthy carbohydrates and fiber sources, to whole grains. If whole grains like brown rice especially whole grains, for long lasting energy. In and whole wheat pasta don’t sound good at first, addition to being delicious and satisfying, whole start by mixing what you normally use with the grains are rich in phytochemicals and antioxidants, whole grains. You can gradually increase the which help to protect against coronary heart disease, whole grain to 100%. certain cancers, and diabetes. Studies have shown Avoid: Refined foods such as breads, pastas, and people who eat more whole grains tend to have a breakfast cereals that are not whole grain. healthier heart.

May - June 2012

SURGEONS CORNER

Laparoscopic Gastric Bypass Is Superior to Laparoscopic Gastric Banding for Treatment of Morbid Obesity

design of a large prospectively collected database appears to be the best method. Therefore, we used our prospective database including 678 bariatric procedures performed at our institution since 1995. A total of 103 consecutive patients with laparoscopic gastric Two techniques, laparoscopic Since randomized trials bypass were randomly matched gastric bypass or gastric banding, are most likely not feasible to 103 patients with laparoscopic are currently widely used to because of the highly different gastric banding according to age, treat morbid obesity. Since invasiveness and irreversibility of body mass index, and gender. both procedures offer certain these procedures, a matched-pair

o define whether laparoscopic gastric banding or laparoscopic Roux-en-Y gastric bypass represents the better approach to treat patients with morbid obesity.

Background Data:

advantages, a strong controversy exists as to which operation should be proposed to these patients. Therefore, data are urgently needed to identify the best therapy.

Methods:

May - June 2012

SURGEONS CORNER

Results:

Both groups were comparable regarding age, gender, body mass index, excessive weight, fat mass, and comorbidites such as diabetes, heart disease, and hypertension. Feasibility and safety: All gastric banding procedures were performed laparoscopically, and

one gastric bypass operation had to be converted to an open procedure. Mean operating time was 145 minutes for gastric banding and 190 minutes for gastric bypass (P < 0.001). Hospital stay was 3.3 days for gastric banding and 8.4 days for gastric bypass. The incidence of early postoperative complications was not significantly different, but late complications were significantly more frequent in the gastric banding group (pouch dilatation). There was no mortality in both groups. Efficiency: Body mass index decreased from 48.0 to 36.8 kg/m2 in the gastric banding group and from 47.8 to 31.9 kg/ m2 in the gastric bypass group

within 2 years of surgery. These differences became significant from the first postoperative month until the end of the followup (24 months). The gastric bypass procedure achieved a significantly better reduction of comorbidities.

Conclusions:

Laparoscopic gastric banding and laparoscopic gastric bypass are feasible and safe. Pouch dilatations after gastric banding are responsible for more late complications compared with the gastric bypass. Laparoscopic gastric bypass offers a significant advantage regarding weight loss and reduction of comorbidities after surgery. Therefore, in our hands, laparoscopic Roux-en-Y gastric bypass appears to be the therapy of choice.

Laparoscopic gastric bypass offers a significant advantage regarding weight loss and reduction of comorbidities after surgery. May - June 2012

PRE EVENT

MEDICALL 2012 – Chennai, INDIA: Beyond Hospital & Medical Equipment

he hospital industry is an important component of the value chain in Indian Healthcare industry rendering services and recognized as healthcare delivery segment of the healthcare industry, which is growing at an annual rate of 15%. The size of the Indian healthcare industry is estimated to be a whopping US$ 280 billion by 2022 and slated to grow at 15 % CAGR. According to a WHO report, India needs to add in excess of 80,000 hospital beds each year for the next 5 years to meet the demands of its growing population. When it comes to naming successful events which bear a tremendous influence on the industry they represent, MEDICALL gets top of the mind recall. It is India’s premier Medical Equipment Expo and the first real “supermarket” for hospital equipment and supplies. Its awesome and comprehensive range of exhibits includes Hospital Information System and solutions, surgical and examination furniture, rescue and emergency equipment, diagnostic/laboratory, O.T. .equipment Refurbished equipments, Hospital linen and Laundry, Nurse

Alarm systems, Ambulance, Hospital floorings, Housekeeing Equipments, Liquid oxygen and central pipeline, Physiotherapy equipmnets, Autoclave and Sterilizer, dental / ophthalmology equipment, medical disposables and cleaning equipment. MEDICALL is a result of the acute vision and acumen of its organizers. As a brand it continues to draw the highest percentage of hospital owners, doctors, medical directors and purchase heads in addition to being a proven and highly successful platform for attracting affluent producers, dealers and suppliers. The fact that its previous hosting attracted over 430 exhibitors and over 8250 quality visitors mostly from the its core target group, speaks volumes about the potential of the event. After having established its presence convincingly for the second time in Ahmedabad from 3rd to 5th February 2012 the 8th Edition, MEDICALL 2012 will be held in Chennai from 3rd to 6th August 2012. It is slated to bring together the best in the business of ICU and Operation Theatre equipments, Refurbished equipments, Trolley, wheel chairs, Cots and other furniture, Hospital linen and laundry, Hospital charts and stationary, Office automation equipments, Printers dealing with pamphlet and file designing,

Communication equipments, Medical disposables etc. The surprise package would be the innovative Fashion Show on Hospital Garments. It was unveiled for the first time in India at the previous hosting of MEDICALL in Ahmedabad and was a runaway success. This show is based on the premise that patients like children and youngsters normally get bored of the seeing the conventional white uniform of doctors and nurses in hospitals. Hence the organisers hit upon a novel concept of introducing a fashion show on Hospital Garments in cooperation with NID (National Institute of Design, Ahmedabad ) at MEDICALL. Another value addition at Medicall Expo Chennai would be the Hospital Property Mela to guide doctors who want to purchase or set up a hospital or nursing home. The concurrent Conferences on Hospital Constructions throw light on important factors to be considered by doctors before setting up a hospital. info@medicall.in, panchal@medicall.in visit our website www.medicall.in n May - June 2012

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