Medgate sep oct 2017 by Medgate Today

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Volume VIII || Issue III || Sep-Oct 2017

The Gateway to Health & Medical World

Healthcare IT & Infrastructure Medical Tourism

World Heart Day

An Advance Media Publication

Advance Media Group A Health Journalism

EDITOR SPEAK

India’s medical tourism sector was estimated to be worth US$3 billion. It is projected to grow to $7–8 billion by 2020 India ranks among the top 3 medical tourism destinations in Asia. Medical tourism refers to people traveling to a country other than their own to obtain medical treatment. India offers some of the best medical treatment in the world. Its private hospitals have an excellent reputation and India’s health care sector has sustained an enormous boom in recent years. The country is now a global health destination, with medical tourism growing by 30 per cent each year. In the past this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable at homes. However, in recent years it may equally refer to those from developed countries who travel to developing countries for lower priced medical treatments. India offers world-class healthcare that costs substantially less than those in developed countries, using the same technology delivered by competent Specialists attaining similar success rates. The Global Medical Tourism Market was worth USD 19.7 billion in 2016 and estimated to be growing at a CAGR of 18.8%, to reach USD 46.6 billion by 2021. Medical tourism is a growing sector in India. In October 2015, India’s medical tourism sector was estimated to be worth US$3 billion. It is projected to grow to $7–8 billion by 2020. As healthcare turns costlier in developed countries, India’s medical tourism market is expected to more than double in size from USD 3 billion at present to around USD 8 billion by 2020, a report says.

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Volume - VIII Issue - III Sep-Oct 2017

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Contents

Volume - VIII Issue - III Sep-Oct 2017

06 Sequentially Programmed Magnetic Field Therapy Offers Ray of Hope for Brain Tumor (GBM) Patients �� 08 Growth Hormone Disorder: Diagnosis and Treatment �� 10 Trivitron’s Labsystems Diagnostics and Baebies, join hands to place innovative newborn screening globally �� 12 AiMeD leads the first time participation of Indian Medical Device Companies at MEDICAL FAIR THAILAND 2017 �� 14 Aurigene, a wholly owned subsidiary of Dr Reddy’s, and Curis announce CA-170 program �� 16 Narayana Health City becomes the first healthcare provider in the country to successfully treat �� 18 P.D. Hinduja Hospital A PIONEER IN Allied Health Sciences Courses �� 20 Modular Signage: Healthy for Hospitals �� 42 Surgical assessment tool could rapidly analyze cancerous tissue samples, improve patient outcomes ��

World Heart Day

IVF

Dr. Ajay Kaul

Dr. Naresh Tarehan

Dr. Sanjeev Chaudhary

Dr. Hemant Madan

Heart attack risks in women Are they different ?

Silent Heart Attack

Menopause and Coronary Artery Disease

Dr. Jamal Yusuf

Dr. T. S. Kler

By Dr. Nihar Mehta

Noted Cardiac Surgeon Konwn for Honest...

Cardiac Care for the Economically Challenged...

Dr. T.S Kler An effusive visionary Leader in...

Awareness for Healthy Heart This World Heart Day

Healthcare IT & Infrastructure (HPI 2017)

We Need to Put the ‘Care’ Back into Healthcare

Dr. Rita Bakshi

Suffering from Male Factor Infertility? Consider IVF with ICSI

Dr. Ramakant Panda

38-39

Dr. Sarthak Bakshi Expansion of 26 Fertility Centers Till 2020 by IFC

52-67

Latesh Sen

Dr. Salil Choudhary

Dr. Maradul Kaushik

Dr. Dharmindar Nagar

Zakir Hussain

Activity Based Costing in Healthcare: New Mantra...

How To Stop Hospitals From Insolvency

India needs to strengthen Health IT backbone...

India Can Achieve Better Healthcare Goals Just by...

Innovative technoligical Solution for Disinfected...

Medical Tourism

44-51

Guide to Choose a Right Hospital for Better Treatment �� Growth of Medical Tourism Industry and Wellness in India: Opportunities & Challenges ��

46 Why Space Medical Tourism is Worth The Risk �� 48 India Emerging as major destination for Quality Healthcare �� 50

68 70 E-Commerce And The Changing Trends In Healthcare Industry �� 72 New Concepts In Medical Storage And Dispensing Modular Storage A Boon to Hospital Planners �� 74 Navigation In Total Knee Replacement �� 76 Choosing the Right Combination of Generic (Indigenous) & Branded (Imported) Medical �� 78 “Paperless” HMS Application �� Call Systems, Bed-Head Panels, Pendants ��

NEWS Update

Surgical assessment tool could rapidly analyze cancerous tissue samples, improve patient outcomes A Purdue University precision innovation developed for brain tumor surgery is being expanded to provide medical professionals with a rapid, robust supplemental assessment tool to more efficiently preserve, analyze and remove identified cancerous tissue and increase patient survival rates. The technology was developed out of the Aston Lab in Purdue’s College of Science, headed by Graham Cooks, the Henry B. Hass distinguished professor of analytical chemistry. Valentina Pirro, a research scientist in Purdue’s Department of Chemistry, was also instrumental in the technology's development. The team’s morphologically friendly mass spectrometry imaging technique could determine if microscopic cancerous tissue is still present in a sample and thus provide more information to influence a surgeon’s decisions regarding further tissue removal. Pirro said other mass spectrometry techniques have limitations. “Mass spectrometry can identify and measure molecules within a tissue by measuring a signal that relates to the mass and structure of the molecule. It can be used in cancer diagnostics because it’s able to monitor the differential distribution of lipids or malformed metabolites that distinguish normal and cancerous tissue,” she said. “With some form of mass spectrometry imaging, the chemicals or solvents used in the process can often destroy the tissue sample. Essentially, you have one shot at getting the data and then the sample is gone.” Cooks and his research team have developed a morphologically friendly method for tissue imaging that can be used to perform Desorption Electrospray Ionization Mass Spectrometry (DESI-MS). “Our method allows researchers to choose solvent combinations that don’t affect the morphology, or form, of the tissue. This means the tissue’s native structure is preserved and after the experiment you’re able to take your tissue and stain it or use it for other experiments to retrieve complementary chemical information,” Pirro said. “The analysis is extremely simple and straightforward, because we can analyze tissue sections or smears with no sample preparation and then validate our results with standard histopathology. Essentially this solvent is used as a spray that is directed onto a small area of a sample and extracts molecules contained within. We can run an image by simply moving the spray right on top of a tissue section or smear.” This assessment can be completed quickly while in the operating room, without interfering with the surgery, Pirro added. “We were able to modify a commercial DESI-MS instrument so that it sits on top of a cart as a standalone system and can be easily wheeled in the operating room when needed. Once a surgeon resects a small biopsy, we can smear it on a glass slide and analyze it as is. After a few minutes we can tell the surgeon if the tumor is still present in the tissue sample and estimate the percentage of infiltration,” she said. “By adding these objective measures, we are hoping that the surgeon will be 6

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guided in the resection and make fast decisions on whether or not to remove more tissue.” Pirro said that preoperative MRI images are typically used to help guide surgeons; however, they are limited. “Preoperative MRI images don’t always precisely translate to the area of surgery,” she said. “Additionally, there may be high infiltration of the tumor beyond what the MRI image is able to see. These limitations can cause difficulty in safely removing as much of the tumor as possible.”The technical challenges for brain tumor surgery and treatment applications helped led the research team to this expanded use of the technology. “Brain tumors are specifically complicated because they infiltrate into the brain and don’t make clear borders,” Pirro said. “In order to make sure the patient has the highest chance of survival, it’s imperative that as much cancer tissue as possible is removed while trying to minimize neurological damages.” The technology is currently being used in preclinical settings. “We have completed studies on a lot of tissue samples to confirm that we are able to get valuable diagnostic information. We are currently using the technique in the operating room in preclinical assessments where we perform our experiment without influencing the surgical practice itself,” Pirro said. “We have completed 18 different surgeries to show that the assessment is feasible, rapid and robust. Additionally, we have been able to identify tissue highly-infiltrated with tumor even when the MRI images may say otherwise.” Pirro said the next step for the technology is a clinical trial. “Through a clinical trial the technology could influence the decision strategy. Ideally you would compare surgeries done with and without this technology and see if there is an improvement in the survival rate,” she said. “We imagine a company licensing this technology to take these next steps before eventually bringing it to market and provide this supplemental tool to surgeons everywhere.”

On December 19, 2016, the US FDA published a final rule to completely ban all powdered surgical and examination gloves. They judged that these products present an unreasonable and substantial risk to healthcare providers and patients. This rule is effective in the US as of January 18, 2017. Also hospitals in Europe and other regions are increasingly transitioning to powder-free gloves. An evolution that is set to accelerate on a global scale. So if you are still using powdered gloves: now is the time to change. As a world leader in providing superior health and safety protection solutions, we contiuously look to better protect patients and healthcare workers. That’s why we are initiating a new communication program to continue informing hospitals and healthcare workers on the benefits of powder-free surgical gloves. For both, there is significant clinical evidence that powder-free gloves offer numerous benefits: ! For patients, powder-free gloves can improve wound healing, prevent allergic reactions and decrease false test results. ! For healthcare workers, it can reduce allergic and other skin reactions and improve hygiene. If you share our concern for your own and the patient’s well-being and safety: consider the use of powder-free gloves, if it is not yet the case.

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NEWS Update

Sequentially Programmed Magnetic Field Therapy Offers Ray of Hope for Brain Tumor (GBM) Patients SBF Healthcare Receives US, Singapore & Russian Patents, European CE Certification and ISO 9001:2008 & ISO 13485 Certification Bangalore-based SBF Healthcare & Research Centre (SHRC) today announced that after treating 300 cases suffering from cancer, especially Brain Tumors like Glioblastoma Multiforme (GBM) – SPMF® therapy, is surely set to offer a ray of hope and much needed medical intervention in the treatment of brain tumors. GBM being a very common form of brain tumor occurring worldwide with very little or no chance of survival, has been successfully treated and patients have gone back to their normal routine. The only available mode of treatment today anywhere in the world, was surgery followed by radiation and chemotherapy. But recurrence is definite and loss of life is almost inevitable. For the very first time, new technology of SPMF therapy, which is essentially based on MRI technology, has shown definitive results and has offered hope for thousands of patients across the world. SPMF Therapy is performed for one hour every day for 28 consecutive days. The patient is evaluated using MRI and the Karnofsky Performance Score (KPS) which are gold standards for evaluating the efficacy of a therapy. Patients can go about their normal activity during the treatment. It halts the progression of the disease and improves quality of life and survival period. It also improves the patient’s emotional and psychological wellbeing. SBF Healthcare has also received the prestigious US Patent and CE Certification. It has also received Singapore and Russian Patents. Is currently awaiting Australian and European Patents. SBF Healthcare also received ISO 9001:2008 and ISO 13485 certificates. These credentials are just an added proof of how an Indian invention/innovation pioneered by Wg Cdr (Dr). V G Vasishta (Retd) is all set to offer relief to the highly prevalent cancer cases around the world. SPMF Therapy is India’s contribution to the world of medicine and is set to revolutionize the treatment of some forms of cancer. The number of overseas patients who have been successfully treated here at Bangalore is a firm testament to the efficacy of this therapy and how eager the medical world was for such a breakthrough. SBF Healthcare and Research Centre (SHRC) was founded in 2006. Pioneered by Wg Cdr.(Retd.) Dr Vasishta, SHRC was first in the world to use of SPMF Therapy in the treatment of cancer. SPMF is delivered by the device AKTIS SOMA® invented by Dr. Vasishta. SBF Centers are currently located at Bangalore, Mumbai, Pune and Chennai. Speaking at the occasion Wg Cdr (Dr.) V. G. Vasishta, Founder & CEO, SBF Healthcare said, “I am delighted to announce that 8

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we are formally launching our cancer treatment after treating more than 300 cases. SPMF therapy that we have pioneered has not only offered a ray of hope and gift of life to brain tumor patients, but has also been recognized worldwide as proven by the numerous patents and certificates we have received. The results of the therapy have been published in many international peer reviewed scientific journals. It is a historical movement for India as this therapy is our export to the western world in the treatment of certain forms of cancer. SPMF therapy will be a game changer for brain cancer treatment across the world”. THE THERAPY: SPMF is also being used to treat Osteoarthritis (OA). This therapy is a non-surgical treatment that helps both regenerate cells in OA and degenerate cells in cancer. It has proved to be effective in the treatment of OA and certain types of cancer. SPMF Therapy is a technology that produces highly complex sequentially programmed magnetic fields, which are computer-controlled and can be precisely focused on to the target tissues with the help of laser guides.

NEWS Update

Growth Hormone Disorder: Diagnosis and Treatment Identifying GHD symptoms and treating it an early age are crucial

Growth Hormone (GH), a type of protein, normally produced by the pituitary gland is situated in the brain. GH is needed for normal growth and development in children. GH also helps in maintaining appropriate balance of glucose, fat and cholesterol levels in blood and helps in building and maintaining muscles, bones and decreases fat mass that are required for normal healthy lifestyle. Talking about the symptoms of GHD, Dr. I.P.S. Kochar, Senior Pediatric and Adolescent Endocrinologist & Diabetologist, stated that, “Any decrease or a complete lack of production of GH is termed as growth hormone deficiency (GHD). GHD in children usually manifests as short stature and decreased growth rate in comparison to other children of same age and gender. Further children may appear overweight to obese, with deranged blood glucose, and cholesterol levels. Decreased school performance, behaviour problems, and reduced social competency were observed in children who were short.” Globally, the number of new children affected with GHD every year is estimated to range between 1 in 3500 to 10,000 live births. A child’s growth pattern is an important part of determining normal growth. The child may grow normally until he or she is about 2 or 3 years old; then, signs of growth delay begins to show. Other symptoms may include an immature face, he/she may look younger than his/her peers; and absent or delayed sexual development,no change in size of shoe over last 2 years,shortest in class .GHD children may have a prominent skull, and are often overweight for their age. In severe GH deficiency in children who are affected since birth there might be a delay in achieving milestones such as standing, walking, and jumping etc.

As short height or delay in height gain is the main manifestation of GHD, it is very critical and important to observe child’s growth pattern using a growth chart for early detection of delay in growth. Growth chart is a graph that can be used to plot vital measurements such as child’s height and weight from birth. On periodic assessments (once in 6 months or a year), it is possible to detect the child’s growth pattern and compare it to the growth pattern of the normal children of same age and gender. GHD or similar other growth disorders should be suspected in any child (≥4 years of age) who grows less than 4-5 cms every year. Dr. Kochar shared “GHD is treatable. Once GHD is diagnosed and confirmed, treatment with Growth Hormone can be initiated. Growth hormone therapy is recommended as a subcutaneous injection, either daily or several times per week, but one should always consult the doctor. Success to GH therapy is monitored by the ability to gain the height velocity and the ability to reach a normal adult height or achieve nearly their full growth potential. It is critical to abide by the doctor’s instructions to regularly adhere to GH injections without missing any dose to achieve the desired results.” Treatment initiation with growth hormone therapy at early age (between 4 – 6 years of age) has maximal benefit than starting later or after 10 -12 years of age. GH injections are recommended till the growing ends of the bone fuse that results in cessation of further growth. Any child diagnosed with GHD after the age of 12-14 years may not derive benefit of GH treatment because the growing ends of bone fuse even before the start of GH treatment. Hence early diagnosis is extremely important for timely initiation of treatment to achieve good results.

Time to end stereotype around mental illness The tragic reality of India is that 70 million people are suffering from major to minor mentalhealthrelated illnesses and it is prevalent across different sections of the society. There exists a stigma associated to this across India, especially in the rural and semi-urban partsour country; it requires exceptional effort sin spreading awareness among people. Another incident related to mental health and awareness involving a 24-year-old college student has recently been highlighted where the student has committed suicide by jumping from the 19th floor, stating the reason behind this as depression and anxiety. Every year many people commit suicide across the country stating that depression 10

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and/or anxiety have been the reason for their extreme actions. The number of urban-dwellers to face mental health issues has been increasing at a fast pace. Considering the young demography, it is a threatening sign for us. Despite a large number of people who need mental health attention we just have 3,500 trained psychiatrists and even fewer psychologists. Keeping the situation in mind, Impact Guru wants to raise funds by reaching out to general masses and raise awareness in association with LION’S and ROTARACT Clubs, in various locations. We hope to support and carry out various on-ground activities, initiate helplines with mental health-care professionals,

partnering with other organizations and NGOs to provide assistance to people who are suffering from any kind of mental issues. With additional support, the aim is to collaborate with other NGOs in the mental health space for onground programmes and projects, while also funding and supporting research on the same.

NEWS UPDATE

Trivitron’s Labsystems Diagnostics and Baebies, join hands to place innovative newborn screening globally Trivitron’s Labsystems Diagnostics Oy, a company that manufactures and develops high quality diagnostic tests for clinical laboratories and doctors, announced their collaboration with Baebies, a company focused on advancing newborn screening (NBS) and pediatric testing. September being the Newborn Screening awareness month, both the companies which are expert in innovative newborn screening products and services, have declared a joint bilateral distribution agreement to deliver a wider range of NBS solutions across several global markets. Making a mark in their ﬁeld and expanding their horizon, Baebies, a US based organization, will distribute Labsystems’ newborn screening products in the U.S. after obtaining regulatory clearance, while Labsystems will distribute Baebies’ SEEKER® platform internationally.

India has made signiﬁcant improvements in detecting newborn diseases. Various initiatives for newborn screening programs have helped in developing the market, which has led to increase in awareness around newborn health. Government of India largely recommends for active New Born Screening across the country and individual states have to implement the New Born Screening Program in the respective states. Trivitron’s Labsystems Diagnostics Oy, manufactures and develops high quality diagnostic tests for clinical laboratories and doctors. Labsystems Diagnostics is a global leader in the ﬁeld of newborn screening solutions with a complete range of neonatal screening test. NeoMass AAAC kit from Labsystems is used with Tandem Mass Spectrometry to detect concentrations of amino acids, free carnitine, acylcarnitines, succinylacetone and argininosuccinic acid.

“We are thrilled to add the SEEKER platform to our suite of newborn screening products. Overall this partnership will greatly beneﬁt newborn screening labs across the world by providing a more comprehensive menu of newborn screening solutions for multiple types of assays,” said Nikhil Bedekar, President of Labsystems Diagnostics Oy. “At this time, our newborn screening customers have only a single solution for many of their newborn screening tests. This exciting partnership allows us to offer the latest solutions and to provide a comprehensive offering to our growing customer base.” said Richard West, cofounder and CEO of Baebies Labsystems and Baebies will be exhibiting together at the upcoming APHL Newborn Screening and Genetic Testing Symposium during September 10-13 in New Orleans, USA.

Are you a vegetarian? You may be Vitamin B12 deficient 20% of the Indian Population is Deficient in Vitamin B12: Metropolis Healthcare Study

Data analysis conducted across 9 cities records vitamin B12 deficiency in 20 per cent of those tested

Vitamin B12 is commonly referred to as the energy vitamin. It is the powerhouse of the human body that helps generate DNA, nerve and blood cells. It also plays a pivotal role in ensuring healthy functioning of the brain, immune system and metabolism. The data study by Metropolis Healthcare recorded that over 15 per cent of the Indian population lack the optimum quantity of vitamin B12 and majority of them are vegetarians. People above the age of 50, suffering from celiac disease or other digestive problems are also more likely to develop this deficiency. While the human body is not equipped to produce Vitamin B12, it is usually obtained from animal-based foods like eggs, meat, shellfish, dairy or other supplements. The body needs to retain this vitamin through periodic consumption of vitamin B12 rich foods as it is not designed to replenish or store the vitamin for a long time. Certain other reasons for the development of vitamin B12 deficiency are as follows:  Thinning of the stomach lining due to atrophic gastritis 12

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 Inefficiency in absorption of vitamin B12 due to pernicious anemia, immune system disorders such as Graves’ disease or lupus  Ailments that affect smooth functioning of the small intestine such as Crohn’s disease, celiac disease or bacterial growth Shedding light on other causes of this condition, Dr Kirti Chadha, Head, Global Reference Laboratory, Metropolis Healthcare said, “Growing age makes it difficult to absorb Vitamin B12. It also becomes harder if one has had a weight loss surgery or any other surgery of the stomach. Drinking heavily or taking acid-reducing medications for a long time also affects the absorption of Vitamin B12. We have also observed that Vitamin B12 deficiency is predominantly higher in Vegetarians.” Surprisingly, gender-based data analysis suggests that number of males with vitamin B12 deficiency is higher than their female counterparts. This could partly because women take up supplements which help them maintain healthy levels of Vitamin B12.

TAG

NEWS UPDATE

AiMeD leads the first time participation of Indian Medical Device Companies at MEDICAL FAIR THAILAND 2017 First-time India National Pavilion at the 8th edition of Southeast Asia’s premier medical exhibition with more than 5,000 medical and healthcare products on show 700 exhibiting companies from 45 countries “I offer my gratitude to Medical Fair Thailand, Messe Dusseldorf Asia Pvt. Ltd., for their genuine efforts for the establishment and growth of Indian Medical and Healthcare Industry Overseas” Mr Rajiv Nath, Forum Coordinator, AiMeD In a historic first, under the aegis of Association of Indian Medical Device Industry (AiMeD), Mr Rajiv Nath, Forum Coordinator, AiMeD leads the first time India participation at MEDICAL FAIR THAILAND 2017 which was held from 06 – 08 September 2017 with an official Indian National pavilion . Debuting at MEDICAL FAIR THAILAND 2017 Mr Rajiv Nath, commented: “MEDICAL FAIR THAILAND 2017 provides Indian companies with an unparalleled chance to leverage on the potential of Southeast Asia’s booming medical and healthcare industry. We are excited to be leading our members to this biggest regional platform, to connect and create strong bonds with businesses from around the region and all over the world.” The major exhibitors from India were Allengers of Chandigarh with their range of X Ray Machines & Cathlabs , Hindustan Syringes & Medical Devices of DispoVan fame with their range of Syringe technologies, IV Cannulas and disposables , Auxein with their range of Orthopaedic Implants and Medion, Mumbai with their range of Hospital Equipment. “India is one of the fastest growing manufacturing base in South Asia in Medical & Healthcare Sector. Medical Fair Thailand provides plenty of opportunity for interacting with people of different trade and business at a single place to set up profitable business relationships and keep abreast with accessible technologies.” Added Mr Nath. “I heartily congratulate all participants and want to offer my gratitude to Medical Fair Thailand, Messe Dusseldorf Asia Pvt. Ltd., for their genuine efforts for the establishment and growth of Indian Medical and Healthcare Industry Overseas and help lead ‘Make in India’ mission of PM Modi to transform India into a global medical devices manufacturing hub.” Said Mr Nath The 3-day exhibition at Queen Sirikit National Convention Center is the largest of its kind in the Southeast Asian region with a record-breaking exhibitor participation and international 14

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Rajiv Nath, Forum Coordinator, AiMeD with other officials at the Indian National pavilion, Medical Fair Thailand 2017

representation led by 18 national pavilions and country groups. The exhibition presented more than 5,000 products and a full suite of equipment and supplies as well as new innovations for hospital, diagnostic, pharmaceutical, medical and rehabilitation use. Other highlights of the exhibition include focus on applying ‘Robotics for Mobility (to improve) the Quality of Life for the Ageing World’, augmenting prevention, monitoring and treatment services with the latest digital- and technologyenabled products to enhance connectivity between healthcare providers and patients. Exhibits ranging from machines for robotic surgery, 3D printing, implantable devices, automation for artiﬁcial intelligence-led clinical setting. Medical Fair Thailand is a one of its kind Medical & Healthcare Event offering an ideal International Platform to Medical & Healthcare Industry. It is on its way to become the most successful and exceptional Exhibition to showcase Medical Technologies in South East Asia. “We hope that Medical Fair Thailand can become the preferred Healthcare Exhibition for Indian Medical Devices Industry to tap the Indochine market and rise to the levels of Arab Health, Dubai and Medica, Germany, one day!” said Mr Nath.

NEWS UPDATE

Aurigene, a wholly owned subsidiary of Dr Reddy’s, and Curis announce CA-170 program update following data presented at ESMO 2017 Results from 34 patients demonstrate positive safety profile and support decision to expand Development -- Aurigene and Curis Plan Clinical Trial of CA-170 in India -Aurigene Discovery Technologies Limited, a wholly owned subsidiary of Dr. Reddy’s Laboratories Ltd. (BSE: 500124, NSE: DRREDDY, NYSE: RDY) and a specialized biotechnology company engaged in discovery and early clinical development of novel and best-in-class therapies to treat cancer and inflammatory diseases, today announced plans to initiate a Phase 2 trial of CA-170, a PDL1-VISTA inhibitor to be conducted at sites in India. This was announced following the presentation of preliminary data from the initial 34 patients with cancer treated in the dose escalation stage of the Phase 1 trial of CA-170 at the European Society for Medical Oncology (ESMO) 2017 Congress by Aurigene’s collaborator and licensee of CA-170, Curis, Inc. (NASDAQ: CRIS), a biotechnology company focused on the development and commercialization of innovative and effective therapeutics for the treatment of cancer. The trial has been conducted in the U.S., South Korea and Spain. The Phase 2 trial is the result of the initial safety data and preliminary evidence of clinical benefit observed in the trial. CA-170 is an oral small molecule targeting the immune checkpoints PDL1 and VISTA. Data presented at the ESMO 2017 conference represent the initial 34 patients treated to date in the dose escalation Phase 1 trial. 30 patients were naïve to prior immunotherapy treatment, while four patients had experienced prior treatment with approved anti-checkpoint antibodies. No dose limiting toxicities were observed at doses ranging from 50 mg to 800 mg once daily dosing examined thus far. CA-170 demonstrated good oral bioavailability and plasma drug levels were shown to increase in a nearlinear manner with increasing doses. Evidence of immune modulation, including an increase in activated CD8+ T cells, was observed in patient blood and tumor biopsy samples examined following treatment. Of the 21 patients evaluable for disease assessment, 13 patients experienced disease stabilization. Four immunotherapy treatment-naïve patients treated with CA-170 experienced shrinkage of their tumors. Six patients remained on drug treatment beyond three months, including all four patients with tumor shrinkages. In addition, seven of the 34 patients remain on study and are continuing with treatment. “These results are consistent with the observations made in the preclinical setting and further affirm CA-170’s mechanism of action as an oral small molecule checkpoint inhibitor. Based on these initial clinical results, we are excited for the opportunity to expand testing of CA-170, possibly in earlier 16

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lines of treatment and in a greater number of immunotherapy treatment-naïve cancer patients,” commented Mr. CSN Murthy, Chief Executive Officer of Aurigene. “Together with Curis, we have designed a Phase 2 trial, treating selected populations of patients of interest in the CA-170 program to be treated at major cancer centers in India. Aurigene’s decision to sponsor and fund this trial is further affirmation of our commitment to CA-170 and a reflection of the successful collaboration we have with Curis in multiple development programs. Aurigene has the commercial rights to the program in India and Russia in addition to milestones, royalties other commercial supply rights globally.” “We are pleased with these early results. Evidence of tumor shrinkage and multiple patients remaining on drug treatment for extended periods, along with signals for biomarkers of immune modulation in patient blood and tumor samples, tells us the program continues to move in the right direction. We plan to continue with the dose escalation and continued analysis of patient biopsy samples in the Phase 1 trial,” said Ali Fattaey, Ph.D., President and Chief Executive Officer of Curis. “We expect to provide additional updates at upcoming conferences including the Society for Immunotherapy of Cancer (SITC) annual meeting in November.” “The ability for cancer patients to administer a potential checkpoint inhibitor on their own as a once daily oral drug is a significant and unique opportunity in our field,” added Adil Daud, M.D., investigator in the CA-170 Phase 1 trial and director of Melanoma Clinical Research at the UCSF Helen Diller Family Comprehensive Cancer Center. “These initial clinical results are encouraging and merit continued development.”

NEWS UPDATE

Narayana Health City becomes the first healthcare provider in the country to successfully treat Patient suffering from Acute Myeloid Leukemia, with BMT & Triple Vessel Coronary Artery disease, with CABG Narayana Health City becomes the ﬁrst healthcare provider in the country to successfully treat a patient suffering from two life threatening disorders. The patient, Mr. Naresh Bala was suffering from Acute Myeloid Leukemia (AML) and Triple Vessel Coronary Artery disease (TVCAD) and has been cured of both his conditions through Bone Marrow Transplant (BMT) and a subsequent Coronary Artery Bypass Surgery (CABG). 48-year-old Naresh Bala was diagnosed with AML, a life-threatening disorder in July 2012 and was admitted at another center for chemotherapy. He was also diagnosed with TVCAD, which also needed intervention. As his condition did not improve he sought the help of Dr. Sharat Damodar. After detailed examination the doctor and team recommended following up the Chemotherapy with a Bone Marrow Transplant. However, unlike other patients, Naresh was suffering from a heart ailment making the case a highrisk procedure. As BMT was the only option for Naresh to be cured of cancer, Dr. Sharat Damodar and team took up the challenge. They did a detailed evaluation of his cardiac condition. Once the cardiac team gave a high-risk clearance, they set out to ﬁnd a matching HLA donor. Fortunately for Naresh, his brother’s HLA matched with him and the bone marrow transplant was conducted in August 2012. Naresh recovered fully and was discharged by August 2012. Though he recovered from AML, over the next 2-3 years he gradually began developing symptoms of heart failure. As he was on immunosuppressive medications, his surgery was deferred. However, his condition continued to deteriorate over a period making it imperative to perform a by-pass surgery, a life saving procedure for his heart. Speaking on the complexity of the case, Dr. Sharat Damodar, Clinical Director 18

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& Sr. Consultant Hematologist & Head – Bone Marrow Transplant Unit, Mazumdar Shaw Medical Centre, Narayana Health City, said, “Blood cancer and TVCAD at the same time is an extremely rare condition. While the Bone Marrow Transplant required taking utmost care and ensuring that the functioning of the heart was not adversely affected, the CABG presented high risk of infections as the patient was on immunosuppressant medicines. The numerous risks that both the conditions presented, required extraordinary efforts, the slightest deviation could have led to irreversible conditions, even death.” “We are extremely pleased that we could save Naresh’s life, and with this case, we become the ﬁrst hospital in India to have successfully treated a patient with two such critical life-threatening diseases”, added Dr. Damodar. After successful surgeries without any complications, Naresh is cured not only of cancer and TVCAD, he has been leading a near normal life for the last 5 years. Dr Ramesh Seshadri, Senior Consultant – Cardio Thoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health City said, “Mr. Naresh Bala, post BMT patient, presented with severe coronary artery disease with severe LV Dysfunction (Low EF). He was in CCF and had chronic kidney disease with high creatinine. He was on immunosuppressant medicines. All the above said factors added to present a complicated picture of high risk CABG. He underwent CABG without any complications and has steadily shown improvement in the last one year”. “I also believe that a lot of credit should go to Mr Naresh Bala & his wife, who remained very positive throughout the course of the treatment”, added Dr. Seshadri. AML is a type of blood cancer that affects the blood and bone marrow of the individual. In this condition, the

cancer begins in myeloid cells, which are immature forms of white blood cells. TVCAD on the other hand is a life threatening cardiac disease where in the arteries that supply blood to the heart muscle is blocked. The blockage and narrowing of the vessel is caused due to plaques which are a result of cholesterol deposits on the walls. This gradually leads to thickening of the lining of heart arteries and if ignored can cause heart attacks as well as sudden death. Expressing his joy of being saved, Mr. Naresh Bala said, “I never imagined that I would recover. As I had multiple ailments my condition needed an extraordinary co-ordination between different departments. My issues involved hematology, heart, kidney, lung and gastro teams to be a part of the treatment. Doctors at Narayana Health knew this very well and they worked together on one course of action. I could not have dreamt of a better team and platform than NH and am extremely grateful to each member in the team to giving me back my life not once, but twice.”

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P.D. Hinduja Hospital

A PIONEER IN Allied Health Sciences Courses

he Indian healthcare sector is expected to register a compound annual growth rate (CAGR) of 22.9 per cent during 201520 to US$ 280 billion. Rising income levels, higher health awareness, growing precedence of lifestyle diseases and increasing penetration and coverage of health insurance are the key contributors to growth. Thus, while the overall growth outlook is very positive for Indian healthcare, it will have to invest in skilled manpower and infrastructure to cater to the existing healthcare needs of the country and prepare for the demands which would grow in the future. Around 6 million additional jobs for allied health professionals are expected to emerge by 2025, according to a Bain report. Allied health professionals play a crucial role in the healthcare system, therefore, it is imperative that we build a capacity of these health professionals and ensure that they are appropriately skilled. As much as a doctor plays an important role in diagnosing a disease and a nurse in assessing the patient’s health charts; an allied health professional has the potential to improve quality of care and safety of the patient. One of the three pillars that P. D. Hinduja Hospital & Medical Research Centre stand for is Academics; other two being Research and Clinical Work. The hospital understood the necessity of these professionals in running a healthy healthcare institution, and that there is a lack of planned courses in the country. Hence it started the Allied Health Sciences courses in 2012 in association with Life Supporters Institute of Health Sciences (LIHS) with an aim to provide skilled manpower to healthcare industry. The courses have been carefully formulated by senior faculty members and technicians taking into consideration holistic approach and requirements of the industry. Duration of each course is of one year.

The key highlights of these courses are:

mechanism and assessment methodology, hence students passing out under this affiliation will have better industry acceptance during recruitments. The eligibility of some of some of the courses is HSC (Std.12) while for others one has to be a graduate. Details are given on the website.

• Hands on training at P.D. Hinduja Hospital • Limited students per batch for focused training and learning • Sessions by renowned and experienced faculty • Guest lectures by various industry experts • 100% placement assistance Currently there are 10 courses being offered by P. D. Hinduja Hospital; namely - Advanced Medical Laboratory Technician Course, Critical Care Technician Course, CSSD Technician Course, Dialysis Technician Course, Endoscopy Technician Course, Medical Records Technician Course, Neurology Technician Course, Operation Theatre & Anesthesia Technician Course, Phlebotomy Technician Course, Radiology Technician Course.

The Hospital also offers part time courses for the paramedics with relevant years of experience. Course Design: Course structure is semester based, duration of each semester being 3 months. During 1st semester, students of all faculties attend common lectures with a duration of 70hrs.

Of the above mentioned, 5 courses are also affiliated to Health Sector Skills Council (HSSC) are; Advanced Medical Laboratory Technician Course, Dialysis Technician Course, Operation Technician Course, Phlebotomy Technician Course and Radiology Technician Course. HSSC affiliated courses have been designed with industry involvement at all levels including course content, delivery

After completion of the common curriculum, students appear for the examination on above topics and later join in their respective field of specialization wherein course specific training covering theory and practical is initiated.

Topics include •

Human Anatomy and Physiology, covering all systems.

•

Hospital orientation topics covering Hospital functions, Information systems, Organogram, Infection control practices, Biomedical waste management, Hospital safety, Medical legal aspects and Inventory control practices. Soft Skills training include sessions on communication skills, grooming etc.

•

Students are also given access to library facilities and reference books for each course have been made available.

For details about the course: Visit: http://www.hindujahospital.com/for-professionals/academics.html Call: 9969644599 / 09702809390 / 26570411 / 21 / 29, Email: alliedhealthsciences@hindujahospital.com Admission forms can be collected and submitted at: OPD Building, 3rd floor, Wing No. 3, P. D. Hinduja Hospital, Mahim, Mumbai - 4000 016, India OR at LIHS Institute, CSSC, M.N. Roy Human Development Campus, C Wing, 2nd Floor, Behind Teacher’s Colony, Near Uttar Bhartiya Sangh College, Bandra East, Mumbai 400 051, India.

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SS TECHNOMED (P) LIMITED

DOCTOR SPEAK

29 September

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DOCTOR SPEAK

World Heart Day 29th September 2017 Dr. Shirish Hiremath, President of Cardiologist Society of India, Pune Dr. M.S. Hiremath, President, Cardiology Society of India said, “If the symptoms are not recognized on time, it might lead to complications like kidney failure and damage to the heart valves. Usually, patients relate this condition with obesity or age. It is important to identify the symptoms so that timely preventive measures can be taken. Lifestyle changes, medication and certain therapies can go a long way in improving a patient’s quality of life.”

Dr. Sundeep Mishra, Professor of Cardiology, AIIMS “The need of the hour is that there should be a community level approach to identify patients with heart failure to ensure timely diagnosis and special treatment for improving their quality of life. For heart failure patients, it is not only their weak heart that needs to be taken care of but other organs like kidneys and lungs need equally special care,” said Dr. Sundeep Mishra, Professor of Cardiology at AIIMS.

Dr. Prabhakara Shetty Heggunje, Head - Department of Cardiology, Columbia Asia Hospitals “With increasing life expectancy of the population (more elderly population) and availability of effective treatments to prevent death acutely (so that patients survive with damaged heart muscles), incidence of heart failure is increasing in an epidemic proportion. The mortality in low-income countries like India can be attributed to low awareness, economic burden, healthcare infrastructure, quality and access to primary healthcare facilities, environmental and genetic factors,” said Dr. Prabhakara Shetty Heggunje, Head - Department of Cardiology, Columbia Asia Hospitals.

Dr Sunil Kapoor

Senior Interventional Cardiologist attached to Apollo Hospitals

Dr Sunil Kapoor, Senior Interventional Cardiologist attached to Apollo Hospitals, said. The major reason for low awareness of heart failure among people is the fact that patients mistake it for signs of getting older. Although there is currently no cure for heart failure, patients who are diagnosed early need to follow their treatment and make lifestyle changes to live longer, feel better and be more active. It is therefore vital that patients and caregivers are aware of the symptoms of heart failure, leading to better recognition and earlier diagnosis.

Dr. Keyur Parikh

Senior Cardiologist & Chairman of CIMS Hospital

Dr. Keyur Parikh, Senior Cardiologist, CIMS said. “The incidence of heart failure is on the rise. In our Hospital, we collectively see around 100 heart failure patients in a month. We see a surprisingly high prevalence of symptomatic HF among the youth population. A significant proportion of this burden may be preventable with better screening and early and adequate treatment of the risk factors.” w w w.medegatetoday.com Sep-Oct 2017

COVER STORY

Woman’s Heart at Work, Care is the key

Dr. Ajay Kaul

Chairman & HOD, Cardio Thoracic and Vascular Surgery, BLK Heart Centre, BLK Super Speciality Hospital

Globally heart disease is a major cause of death among women. They are the most vulnerable when it comes to cardiovascular diseases (CVD) and there are several reasons for this. In India, situation is also alarming. Unfortunately, the diagnosis of heart disease is often missed out in women, which is why they get less care than men. Women usually don’t get the typical symptoms of angina. Shortness of breath is often the only symptom they get. Among women, the middle aged groups are suffering the most, both in rural as well urban areas. In our country, women are so devoted to take care of family members that their own health is ignored completely. But it is much needed to give importance of her own health, especially heart, for her beloved ones. Although, heart disease can strike at any age, as a woman, some stages of life make them more prone to heart disease than men and reasons are menopause, use of oral contraceptive pills and hormone replacement therapy along with sedentary and stressful life. . Each year more women die of heart disease than men. Symptom of coronary artery disease (CAD) and heart attack are often different in women. So, knowing about the risk factors and risk of heart diseases helps to change life style & habits, present risks, early diagnosis and management. 24

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Coronary Artery Disease (CAD) is most common type of heart disease which strikes in the form of heart attack. Coronary arteries supply blood and oxygen to heart. When they are damaged or diseased, results in plaque formation or atherosclerosis in the walls of coronary arteries, they become narrowed or blocked, as a result blood supply to heart decreases. CAD leads to chest pain (angina), heart attack, heart failure, heart rhythm problems. Experts say that these symptoms can occur more often in women than men without any evidence of CAD on tests, inspite of less blood flow. This makes diagnosis and management difficult in women. Women tend to build up plaque/blockage in small arteries while men are more prone to develop in larger arteries of heart. Apart from this, women are at more risk when they use oral contraceptive pill. Post menopausal women seems to have increase risk factors include weight gain, diabetes, high blood pressure, change in cholesterol levels (fall in HDL & rise in LDL& triglyceride levels). Various studies suggested that diabetes is stronger risk factor, as it triples the risk in women and doubles in men. The best thing one can do is to know and be aware of personal risk of developing heart disease. It is important to understand factors increasing the risk for heart disease and what to do to lower them. The usual suspected risk factors for heart disease include older age, obesity, family history of heart disease, diabetes, high blood pressure, smoking, not exercising. Diabetes, obesity, smoking and mental stress plays major role in development and progress of CAD in women than men. Certain risk factors are unique to women like menopause, poly cystic ovarian syndrome, having menstruation before 10 years or after 17 years of age, gestational hypertension/ diabetes/pre-eclampsia, pre-term delivery ( Before 37 weeks of pregnancy).

Signs and symptoms of heart attack:Common symptoms: Chest pain/ discomfort (more common in men), shortness of breath, arm/neck/jaw/back pain, cold, sweat

Women often can feels: Unusual tiredness, upper body discomfort or indigestion, palpitation, dizzy/nausea/vomiting, sudden anxiety, trouble sleeping. Prevention of CAD: - Positive life style changes help to prevent CAD & it’s progression. These are very important in determining risk of CAD & how quickly it might progress. Life style changes are main stay of prevention therapy. These are:  Eat plant-based food more and less processed foods  Regular exercise and lose weight if needed A dequate sound sleep  Lower mental stress  Quit smoking or don’t start  Care about blood pressure & cholesterol levels, if needed regular check up  Stop/ limit alcohol intake  Go for cardiac health tests - Lipid Profile– This tests checks your serum and blood lipid levels. It has a good predictability in diagnosing cardio-vascular disease. Creatine PhosphoKinase (CPK) test measures the damage to heart and skeletal muscle and High CPK levels in the blood indicate a muscle or heart injury.  Stress echo and ECG test— Measures the electrical signals and heart function during exercise. Has predictive value for adverse cardiac events. In addition to lifestyle changes, one may need: Medicine, Coronary angioplasty (stenting), Heart surgery or coronary artery bypass grafting (CABG) , the best possible management If women are suffering from CAD or are at high risk for developing it, they need to urgently consult with doctor for appropriate action and management. It is high time to understand how vulnerable women are, to develop heart disease and things they need do to prevent it. Women are natural caretakers and taking care of everyone else that their health slips to last. It is right time to pay attention, take care and adopt heart healthy habits and life style.

COVER Launches State of the Art Pediatric Cardiac Center STORY

adia Hospitals Mumbai is always in forefront to provide excellent service to the society at affordable cost with its state of the art infrastructure and clinical excellence continuing the philanthropic tradition to serve poor and needy. Bai Jerbai Hospital for children a unit of Wadia Hospitals has extended its horizon and come up with Pediatric Cardiac Surgical Service since March 2017. Again one of its kind, well equipped, state of the art infrastructure with Modular Cardiac OT, Cardiac Intensive Care Unit and Cath LAB with competent nursing and doctors team. We have the full spectrum of contributing teams like Pediatric cardiac surgery, Pediatric Cardiology, Pediatric Cardiac anesthesia and Intensive care, Pediatric Perfusion and Specialist nursing team. With dedicated cardiac operation theatre, pediatric cardiac intensive care unit, cardiac catheterization laboratory and noninvasive cardiology facility, the cardiac services provide a complete diagnostic as well as therapeutic coverage. We have full time specialists in all the cardiac divisions to provide us round the clock service.

provides treatment facilities to all types of cardiac problems including the most complicated ones. Being a tertiary referral center, we receive patients from all over Maharashtra as well as other parts of India.

Since inception, over 150 babies have undergone surgical treatment with excellent results. Our successes rates are 100 percent till now and are comparable to the best hospitals in the country as well as the developed countries. The service

Our state of art cardiac operation theatre is supported with all the modern devices and high end equipment. The dedicated Pediatric Cardiac Intensive Care Unit is designed to take all varieties of complex postoperative cases. w w w.medegatetoday.com Sep-Oct 2017

COVER STORY

Recent advances in Management of Heart Diseases

Dr.Naresh Trehan CMD Medanta The Medicity,Gurgaon Over the past couple of years significant advances have been made in the diagnosis and management of various heart diseases. While many of the previously available diagnostic techniques have been refined, new technologies have emerged which result in better characterisation of abnormalities in the structure and function of heart. Simultaneously exciting new treatment modalities have emerged and have been incorporated in routine clinical practice. Together these advances translate into faster and more accurate diagnoses and better and less invasive treatment options.

Diagnostic Modalities: Echocardiography has been with us several years now and has proved to be an invaluable tool. Here too newer softwares have been added which give far more accurate information about the structural and functional abnormalities of the heart and also help us in assessing the prognosis of patients. It is now possible to more accurately define various diseases of heart muscles and also various valvular and intracardiac structural defects. This information is of great help to surgeons as they can plan the operative procedure beforehand. Coronary CT angio machines have become much more accurate and give much less radiation to patients now. Early detection of coronary artery disease is now possible in several vulnerable individuals who may have no symptoms and there treadmill test may be normal. Patients with long standing diabetes and patients who have a family history of premature 26

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heart disease are some of the examples of those who can vastly benefit from this technology. Cardiac MRI has established its value in various heart muscle diseases where previously the diagnosis was not easy. New techniques have also become available to help interventional cardiologist place coronary stents more accurately, reducing the chances of reblockage. Two of these techniques are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). With these techniques it is possible to look inside the coronary arteries to see whether the desired results have been received during angioplasty and if there are any potential complications. Their use helps in better long term results.

Treatment modalities: Exciting new developments have occurred from the last 2-3 years in management of advanced heart diseases which in medical terms are called heart failure. These include ARNI and IVABRADINE which have significantly improved outcomes in this group of very sick patients. Intravenous iron preparations are being increasingly used in patients of heart failure to improve their functional capacities. Several other new drugs are under development and should be available in the near future.

TAVI This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges

COVER STORY

a replacement valve into the aortic valveâ&#x20AC;&#x2122;s place. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). This procedure is fairly new and is FDA approved for people with symptomatic shrinking of aortic valve for those patients who are considered an intermediate or high risk patient for standard valve replacement surgery. The differences in the two procedures are significant.Usually valve replacement requires an open heart procedure with a â&#x20AC;&#x153;sternotomyâ&#x20AC;?, in which the chest is surgically opened. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place. It also cuts down the hospital stay and results in faster recovery. The TAVR procedure is performed using one of two different approaches, either through a catheter or a small surgical procedure, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve.

PTCA with Exmicer laser Excimer laser angioplasty is one of the newest procedures being used in interventional cardiology. Excimer laser angioplasty (ELA) has been developed as a modality that offers an alternative to percutaneous transluminal coronary angioplasty. The laser energy is delivered via fiberoptics to the target lesion and the plaque material is rendered into a gaseous state (vaporized) by breaking the molecular bonds.

Pacemakers and Rhythm disorders: Newer generation of pacemakers have become much smaller and can be implanted inside the heart through a catheter, avoiding surgery. Further refinements in this technique are on the way. There are certain conditions where the heart beat becomes abnormally fast and can result in episodes of unconsciousness and even death. Newer techniques called Radiofrequency ablation have also benefited from new technologies and it is now possible to accurately define the origin of these abnormal beats and treat them by delivering radiofrequency energy through a catheter, resulting in a cure .

Cardiac Surgery: In the field to cardiac surgery two major developments have been the availability of an artificial heart called LVAD and heart transplantation. There are several patients where despite the best medical management the disease is too far advanced resulting in repeated hospitalisation and a poor quality of life. These two techniques can help patients live longer with a much better quality of life. While there are several challenges still present in these two techniques, over the year they have been steadily refined and now the results are quite acceptable. There are several centres in our country now offering both these techniques with results which are at par with the best centres abroad. Their cost is gradually coming down and hopefully they should become affordable for more and more patients.

w w w.medegatetoday.com Sep-Oct 2017

COVER STORY

SILENT HEART ATTACK GENDER DIFFERENCES

Dr Sanjeev Chaudhary

Director and unit head, Cardiology, Fortis Memorial Research Institute

The term “silent heart attack” describes the situation in which evidence of a prior heart attack is picked up during medical testing in a patient who did not realize that they have had a heart attack. Many people do not experience the typical chest discomfort that most people think of when they imagine what is like to have a heart attack, and this is how these heart attacks can be missed. For example, we know that patients with diabetes are at higher risk for heart disease, but they are also more likely to experience atypical chest pain or no chest pain at all when having a heart attack. We also know that there are different mechanisms by which patients can have heart attacks. While the end result is inadequate blood flow to a portion of the heart resulting in damage, there are many different ways that this can happen. Silent heart attacks have real consequences, and we are learning to take them just as seriously as heart attacks that manifest with traditional symptoms. Patients don’t experience symptoms during a silent heart attack. However, patients might feel the after-effects of the damage from a heart attack, particularly symptoms of heart failure that can include:  New difficulty breathing  Fluid accumulation (i.e. swelling), particularly in the legs  Fatigue 28

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We are still learning about the differences between men and women with respect to heart attacks, but while all patients can experience atypical symptoms, women— particularly young women—may be less likely to experience traditional symptoms and therefore may not recognize that they are having a heart attack. It is important for both patients and doctors to consider the possibility of a heart attack in patients, especially those who have risk factors for heart disease.

CAUSE OF SILENT HEART ATTACK. The causes of silent heart attacks are the same as those that cause heart attacks with symptoms. The most common cause of a heart attack is a blockage in a blood vessel that compromises blood supply to the portion of the heart that depends on that blood vessel. However, there are many different ways that blood flow to the heart can be compromised and women may be at higher risk for some of the less common mechanisms, which include:  Spontaneous coronary artery dissection, or SCAD (when a spontaneous tear forms in the wall of a blood vessel compromising blood flow)  Coronary vasospasm (a temporary, sudden spasm of a coronary artery that can impair blood flow)  Microvascular disease (disease of small blood vessels supplying the heart) By definition, silent heart attacks are those that patients do not know they are experiencing. However, because we know

that many patients do not experience the traditional symptoms of a heart attack, people should keep an open mind and seek medical care if they are experiencing new symptoms. Regardless of whether or not symptoms are from a heart attack, it is always important to bring them to medical attention so that doctors can determine the cause and provide appropriate treatment. Anyone who thinks that they may be experiencing a heart attack should seek immediate care.

PREVENTION Yes, ways to reduce your risk of having any type of heart attack include:  Eating a healthy diet  Maintaining an active lifestyle  Maintaining a healthy weight  Not smoking  Following up with doctors regularly Doctors can help people identify whether someone may be at higher risk for developing heart disease and can help treat some of these risk factors—like high blood pressure, high cholesterol and diabetes. Women with a history of preeclampsia may also be at increased risk for heart disease. It is very important that patients who already have heart disease or have had a heart attack see a cardiologist (a doctor who specializes in diseases of the heart) regularly to care for their hearts. Patients who have had a heart attack are at particularly high risk for another heart attack, and a cardiologist can help patients reduce this risk.

COVER STORY

Menopause and Coronary Artery Disease What are the hormonal changes during menopause?  There is decreased levels of :  Estrogen  Progesterone  Testosterone

How is child bearing age (fertile period) protective from atherosclerosis in women?

this, women have a higher prevalence of hypertension thanmen. High cholesterol: Lack of estrogenresults in a reduction in HDL and a concomitant elevation in LDL levels thereby producing a double whammy in lipid values and predisposing to acyte cardiac events such as heart attacks.

When does the risk of coronary artery disease in women and  During the fertile period, increased men equalize?

Dr. Hemant Madan

Additional Director, Cardiology, Fortis Shalimar Bagh, New Delhi

What is Menopause?

A woman’s reproductive life is deﬁned by several hormonal patterns – prime among them being changes in the levels of estrogen and progesterone. A woman is said to have attained menopause when she does not menstruate for a period of 12 months in a row. Associated with this the ovaries lose their reproductive function. Usually, this occurs between the ages of 45 and 55 years. Hormonally there is a decline in a woman’s estrogen and progesterone levels.

What are the physical changes during Menopause?  The various physical and psychological changes occurring during menopause include:  Erratic menstrual cycles.  Hot ﬂashes (“hot ﬂushes”)—getting warm in the face, neck and chest with and without sweating.  Night sweats that may lead to problems sleeping and feeling tired, stressed or tense.  Anxiety, depression  Hypertension, Tachycardia  Weight Gain

levels of estrogen and progesterone aid in prevention of atherosclerosis in mulitple ways. Salient among them are:  Increases HDL cholesterol (the good cholesterol)  Decreases LDL cholesterol (the bad cholesterol)  Relaxes, smooths and dilates blood vessels so blood ﬂow increases  Soaks up free radicals, naturally occurring particles in the blood that can damage the arteries and other tissues

How does the post menopausal period increase vulnerability for coronary artery disease? During the post menopausal period, due to the waning levels of estrogen and progesterone, the cardioprotective effcts of these hormones is gradually lost thereby placinga post menopausal woman at progressivly increasing risk of heart disease – specially blockages in the blood supply to the heart. This manifests as: High blood presure: With a drop in estrogen levels, the blood vessels become stiff and inelastic. As a result, the blood pressure tends to rise, causing hypertension.This can contribute to added strain on the heart. Before the age of 45, hypertension is more prevalent in men. The incidence tends to get even between the age of 45 to 64 years. Beyind

While conventionally women are protected against heart attacks in their fertile period, the onset of menopause erodes this protective value and the incidence of this life threatening disease in women tends to equalize the incidence in men at around 65 years of age.

What can be done to decrease the risk in postmenopausal women? Women should take care of their heart through regular exercise and good nutrition and by eliminating unhealthy habits like smoking, which may contribute to early menopause. American Heart Association recommends eating a dietary pattern that emphasizes on adequate intake offruits, vegetables, whole grains, low-fat dairy products and poultry, fish and nuts while limiting the intake of red meat and sugary foods and beverages. To conclude, menopause is not only an indicator for men to pause (men – o – pause), but is also associated with a gradual detrioration in the cardioprotective benefits of estorgens and progesterone. Hence, serious and aggressive life style modifications must be made in this phase to delay development of heart disease in a post menopausal woman as far as possible. w w w.medegatetoday.com SEP-OCT 2017

COVER STORY

Noted Cardiac Surgeon - Known for Honest medical opinion and ethical practice.

Dr Ramakanta Panda Vice Chairman & MD AsianHeart Institute, Mumbai

Dr Ramakanta Panda, world’s leading cardiac surgeon, is the Vice Chairman and MD of Asian Heart Institute, Mumbai. Known as the surgeon with the Midas touch, he has operated many high risk cardiac cases that were otherwise considered inoperable. Dr Panda was awarded the third highest civilian award –Padma Bhushan – by the Government of India, for his contribution in the ﬁeld of medicine. He has operated on several Parliamentarians, including exPM Dr. Manmohan Singh, Lalu Prasad Yadav, Tarun Gogoi, Rajiv Shukla and Rajya Sabha veteran D Raja. Dr Panda is also an ambassador for healthcare reform in India. His ethicsbased campaign “Honest Opinion, No Commission to Doctors”, started in May 2017, has found resonance with the State and Central Government, and also with the country’s senior most doctors and healthcare institutions. Your ascent to the league of the world’s top heart surgeons is awe-inspiring. Why did you choose cardiology to specialize in and what was your motivation behind starting Asian Heart Institute? In those days cardiology was one of the most exciting branches in medicine and most bright doctors wanted to pursue it. One incident that had an impact very 30

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early on me was seeing an issue of Life magazine with a cover picture of Dr Denton Cooley- one of all time great heart surgeons of the world, who had done the first heart transplant in the US. My uncle had bought a copy of the magazine, which had a cover picture of Dr Cooley, doing first heart transplant in the USA. When after my training, I came back to India in 1993, there were very few worldclass hospitals in the country. Having worked at Cleveland Clinic which is one of the best cardiac hospitals in the world, I had seen the gap and wanted to set up a cardiac hospital which can be a benchmark not only for design but also patient care in the country. I practiced in Mumbai at the time and it was natural to set up the hospital here. How do you ensure that under your leadership Asian Heart Institute delivers the best cardiac care, for every patient, every time? Asian Heart Institute (AHI) was set up with a dream to provide the highest quality cardiac care in India. Best medical care is a by-product of standardization and adherence to strict protocols. In line with this philosophy, AHI has strived to achieve the patient-centric design, best clinical results, and lowest infection rates. When it comes to patient’s well-being, the hospital has a strict zero-tolerance policy towards compromises. Hospital-acquired infections (HAIs) which afflict millions of people worldwide is a major global threat to patient safety. AHI has the lowest documented infection rates in India, which is on par with the best in the world. AHI is also one of the few centers in the world conducting nearly all bypass surgeries on a beating heart, with almost 90% patients getting arterial grafts. Surgery on a beating-heart helps reduce the risk of complications associated with the conventional way of doing this surgery where the heart is stopped temporarily during the operation. The hospital recently conducted one of the largest studies on beating heart redo bypass surgeries performed on cardiac patients, between

January 2003 and February 2016. AHI has several accreditations given by top notch global organisations. The hospital offers round-the-clock emergency services to the patients. It has 12 ultramodern operations theatres, 100 intensive care units, fully equipped modernised pathology services, radiology, imaging services, blood bank, 24 hours pharmacy services and cardiac ambulance service. I am proud to say that AHI has set a benchmark in quality care, ethical practice and imparting world-class training for those who are in the profession. The hospital is known for its ethical practices in offering honest opinions and not conducting any unnecessary treatments. What are the thumb rules for a layman to take care of his heart? Anyone at any age can beneﬁt from few simple steps to keep their heart healthy during each decade of life. Know your numbers. High blood pressure is called “the silent killer” because it sometimes has no symptoms. Many people don’t even know they have it, it’s important to get checked regularly. Control your diabetes. If you have diabetes, it’s essential to make healthy food choices, get to or maintain a healthy weight, be active every day, and stay on track with taking your medications. If you’re having a hard time with any aspect of your diabetes management, work with your doctor to make sure your condition is under control. Know your cholesterol level, too, especially if you have a family history of high cholesterol. Eat a heart-healthy diet. You can lower your cholesterol by consuming less saturated fat (such as whole dairy and butter), fewer processed meats, and fewer high-sodium foods. Have more of ﬁsh, fruit, vegetables, and whole grains.  Get regular exercise. Aim for at least 30 minutes of exercise on most days of the week. Quit smoking or Tobacco. Smoking dramatically increases your chances of developing cardiovascular disease

COVER STORY

One in every five adults develops heart failure, and the disease affects the children of one of every four heart failure patients. From your perspective as a cardio thoracic surgeon what are the most impressive innovations in cardiology that are entering in the market and how do you see the development in the future? Treatment of heart disease has evolved a great deal. Options that will become popular in the coming year will involve least trauma, greatest safety and best results. Bioabsorbable Stents: Having a piece of metal in your coronary arteries to keep them open has huge disadvantages. Bioabsorbable stents are made of specialised material that does its job and then dissolves in six months to a year. These cut the risk of stent-thrombosis, eliminating the long-term use of blood thinners. In addition, these wouldn’t interfere with future diagnostic evaluations like MRI and CT scan, as well as coronary surgery even with multiple stenting. Plus, these open up the possibility of doing stenting again and again in cases of reblockage. Transcatheter Aortic Replacement (TAVR): Until recently, the only way to replace a heart valve (in case of severe aortic stenosis, or narrowing of the aortic valve opening) was through a major surgery. This involved putting the patient on a bypass pump, stopping the heart, and cutting the heart open to put in a new valve. Now it can be done non-surgically through a puncture in the groin. In an angioplasty-like procedure, a compressed tissue heart valve is placed on the balloon catheter and is positioned directly inside the damaged valve. Once in position, the balloon is inflated to secure the valve in place. It’s much safer and recovery is quick too. The whole procedure takes just 1 to 2 hour. At present, it is recommended only to those patients who have a high risk for surgical AVR. 3-D bioprinting: With applications in congenital heart disease, coronary artery disease, and surgical and catheter-based structural disease, 3D printing is a new tool that is challenging how we image, plan, and carry out cardiovascular interventions. It can help with planning interventional

procedure, placing percutaneous valves, print implantable devices such as cardiac valves that could then be custom sized to the patient. Please tell us something about the campaign started by your hospital against the menace of ‘cut practice’ in healthcare. AHI has always stood for an honest medical opinion and ethical practice. Staying true to its core values, AHI in May 2017, started a billboard campaign “Honest Opinion, No commission to doctors. The hoarding got noticed all over the city and the country; with the Maharashtra Govt taking cognizance of the matter, and putting together a committee to work towards formulating a law to curb the cutpractice menace. This effort of AHI has been supported by some of the most respected doctors in the country such as Dr Vijay DSilva, Dr Pradyot Kumar Rath and Dr Sunil Vanzara from Asian Heart Institute and Dr V Mohan, Dr Sanjay Nagral, Dr Samiran Nundy, Dr Soma Raju, Dr GN Rao, Dr Srinath Reddy, Dr Shiv Sarin, Dr Gautam Sen, Dr Devi Shetty, Dr K K Talwar and Dr Himmatrao Bawaskar. Taking this movement, a step further, we have now launched the site ethicaldoctors. com. The website aims to provide an online platform for doctors wanting to curb ‘cut practice’ or commission practice in healthcare. I urge all the medical professionals who firmly believe in ethical medical practice to come forward and pledge their support on ethicaldoctors. com. Your reaction to the price capping of stents in India? Do u feel that it will decrease the quality of services? While capping the price of stents is necessary, we need to find a solution to provide cheaper stents without killing investment and innovation. Can we force all cell phone companies or television companies to sell their all models at the same price? We need to have a practical pricing structure which must have different pricing for different models and take into consideration the cost of innovation and newer technologies. Otherwise, we will end up using only older models and

it will be like driving the ambassadors and Premier cars while the automobile technology progressed in rest of the world. Also, I see a great opportunity for indigenous stent industry to come out with innovation for better quality affordable stents. Look at what Aravinda eye care did. They have revolutionised eye care with volume and compassion. What are your suggestions to smokers and alcoholics? Smoking and tobacco are the biggest risk factors for heart disease as they harm nearly every organ in the body, including the heart, blood vessels, lungs, eyes, mouth, reproductive organs, bones, bladder, and digestive organs. The chemicals in tobacco smoke harm your blood cells. They also can damage the function of your heart, and the structure and function of your blood vessels. This damage increases your risk of atherosclerosis, a disease in which a waxy substance called plaque, builds up in the arteries. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. American Heart Association mentions that drinking too much alcohol can raise the levels of some fats in the blood (triglycerides). It can also lead to high blood pressure, heart failure and an increased calorie intake. (Consuming too many calories can lead to obesity and a higher risk of developing diabetes.) Also, excessive drinking and binge drinking can lead to stroke. 8. Lastly, your message to young cardiologists across the globe? There is no substitute for honesty and hard work in this profession. When a patient comes to us with a medical problem, it is our duty to guide the patient to the doctor best positioned to cure or treat the patient. Likewise, we are to prescribe treatment that’s best positioned to cure or treat the patient. In both cases, there is no question of commercial gain. Our patients are our best ambassadors and an emphasis on ethical practices and a values orientation in medicine may benefit not only patients but physicians and other healthcare professionals as well.

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INTERVIEW Cardiac Care for the Economically Challenged Heart Patients.

THE HEART SAVER AND RISK TAKER DR. JAMAL YUSUF G.B.Pant Hospital and have seen it to evolve into the best in the country. What are the cardiac diseases in old age, middle age, younger age in child?

Dr. Jamal Yusuf

Professor Cardiologist G.B. Pant Hospital

Tell us about your journey in G.B Pant hospital as a cardiologist. G.B Pant hospital is one of the pioneer hospitals in the field of cardiology. I have had the privilege of being a part of the strong teaching programme of DM cardiology at G.B.Pant Hospital since my younger days. My journey here started as a student of cardiology and still continues as a professor in Cardiology, still learning and growing every step of the way.Most of the intervention procedures have been performed for the first time in our country in this institute like ballooning of mitral valve, permanent pacemaker implantation, electrophysiology studies, coronary interventions, device closure etc. Today this institute is performing maximum number of interventions in the whole country (coronary and noncoronary). Beside this our department has maximum number of publications in various national and international journals. This is the highest ranked centre for the DM course in the field of cardiology. I have had the privilege of being a part of the strong teaching programme of DM cardiology at 32

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Patient in older age and middle age generally suffer from acquired heart diseases like- coronary artery disease, hyper tension, cardio myopathy etc. Symptoms may be in the form of chest pain radiating to left arm, breathlessness and sweating, palpitations etc. Their differential diagnosis can be established with the help of various investigations like- ECG, Echocardiograph, coronary angiography, various stress test etc. Congenital heart diseases are common in the younger age group in various forms like- ASD, VSD, PDA, TOF etc. Valvular heart diseases are common in younger age group particularly in the lower socio economic population. This forms a huge burden on our society and for which appropriate measures should be taken to decrease its prevalence. What precaution normal people should be taken to avoid heart attack and what food habit should be adopted in daily life? DASH â&#x20AC;&#x201C; Diet, Alcohol and smoking cessation, Salt restriction and Healthy lifestyle is the basic need of every individual. In todayâ&#x20AC;&#x2122;s life,moderate intensity regular exercise for at least 30 minutes in a day; avoidanceof smoking and alcohol, salt restricted diet rich in green leafy vegetables and fruitsshould be a priority. Red meat should be consumed in moderation. Every one above the age of 40 years should regularly check the lipid profile annually at least once. Stressful situations should be avoided and mental peace should be given preference in such a hectic day to day life.

What are the latest advancement in cardiology? And what is your advice for young people in India to tackle the heart problems. The field of cardiology is anever changing one.We now we have effective treatment options available for many heart disease. Coronary angioplasty have undergone huge advances and the techniques continue to be modified and upgraded with the time. Combo devices providing cardiac resynchronization are being regularly used in patients with heart failure refractory to medical therapyand have been found to be improving the survival of such patients. Cardiac assist devices and cardiac transplantation are also now performed in patients with end stage heart failure not amenable to other forms of therapy. There also have been significant advances in peripheral procedures , percutaneous valve implantations, non-invasive and invasive imaging facilitating effective therapy for a gamut of cardiac conditions. Since heart treatment is so expensive these days in private sectors so, what is the government plan available for poor people in your hospital? At GB Pant Hospital, Delhi government provides free treatment to the catering population for most of the cardiac conditions. In our hospital there are no fees for Angioplasty, patient have to pay only for coronary stent which costs Rs. 23,625 since 2011. So this is the most approachable and economical hospital in our country for the patient with heart diseases. Nowadays many people died cause of sudden heart attack in young age. So, as per your perspective what are the reason behind that. Sedentary life style, excess of smoking, daily consumption of oily food, stressful activities etc. commonly pre-dispose for heart attack in younger age and sudden cardiac death. Hence, life style modification with regular exercise in any form including yoga should be encouraged to curb this curse.

INTERVIEW

Dr. T.S Kler An effusive visionary Leader in the field of Cardiac Sciences:

PSRI a good example of non corporate culture where some poor & less privileged people of India is also being treated.

Dr. T. S. Kler

Chairman PSRI Heart Institute

Why you moved from fortis Escort to PSRI?

Well, I was pretty happy at Fortis Escorts Heart institute & spent practically my whole life there (28 years), but lately ,I was little bit uncomfortable with corporate culture & then Pushpawati Singhania Hospital gave me a new chance & challenge to set up a centre of excellence in cardiac care in India according to my own wish & desire , the later was the main reason to change gears

How PSRI is doing services in cardiology in your leadership? We have state of the heart Cath lab, non invasive cardiovascular lab & great facilities to do high end cardiac surgery & the PSRI Heart Institute is taking good shape as per my expectations Good thing is we will be also able to treat some poor & less privileged people of India.

How we can prevent some cardiac diseases?

There are many recent advances in cardiology but most important are in the treatment of refractory heart failure in the form of CRT (heart failure device) LVAD (left ventricular assist device, also called artificial heart & heart transplantation.

Share something interesting about you. Well there is nothing much interesting about me. I am a small village boy from a poor farming family & had to fight my way from class 1 onwards. Even I had to fight a pitched battle with my father to marry Neelam, my wife because he was dead against it. Wherever I studied or worked I had to fight with my boss. I had no Godfather to help me or guide me, but luck was always on my side.

What are the recent advancement in cardiology There are lot of recent advances in cardiology but most important are in the treatment of refractory heart failure in the form of CRT (heart failure device) LVAD (left ventricular assist device , also called artificial heart & heart transplantation. Good thing is that these all are available in our country atleast in some hospitals in all major metro cities. Another area of recent development is structural heart disease Now we can replace valves without surgery via percutanous route in the cath lab like doing an angiography. Aortic Valve & even Mitral Valve can be repaired or replaced by this method.

Prevention of heart disease is of major concern today & needs immediate govt. & people’s participation. Good news is heart disease is preventable to large extent. K eeping clean environment will drastically decrease rheumatic heart disease  Change of life style will prevent diabetes, hypertension & coronary heart disease, the 3 major killers in India today W e should keep our weight & pet in control according to recommendations Z ero smoking G ood control of diabetes, means keeping your HbA1c between 6-7 G ood control of Blood pressure, below 140/90  4 5 minutes of some form of regular exercise Y early check up of blood sugars & lipid profile. Once a year or once in 2 years an exercise test can detect disease at an early stage L ast but perhaps the most important is to learn how to handle stress & how to distress oneself Some kind of prayer to God, yoga & meditation are of great help

Your message to young cardiologist across globe? My message to young cardiologists is to treat patients with empathy & ethics & doing evidence based medicine. They need to give sufficient time to address the prevention of cardiac disease in the society, rather than only focusing on treatment.

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COVER STORY

AWARENESS FOR

HEALTHY HEART

THIS WORLD HEART DAY By Dr. Nihar Mehta

MD, DNB (Medicine), DNB (Cardiology) Consultant Cardiologist, Jaslok Hospital & Research Centre Heart Diseases are on the rise in our country. One fourth of Indians die because of cardiovascular diseases. What’s more is that Indians are prone to ‘Premature Heart Disease’ meaning that heart diseases occur one decade earlier in our country as compared to the West. The impact this has the years of life lost, the loss of productivity and the burden on the family is immeasurable. To add fuel to the fire, Indians with heart attacks have less access to appropriate treatment and even if treated, have a higher mortality. The first step in the fight against these problems is Prevention. You must prevent heart problems from cropping up by strictly controlling all the factors which increase the risk for heart disease. It is estimated that one third of Indians use tobacco in some form – the smokeless tobacco and bidis being the most common. It is akin to slowly poisoning yourself! The content of fruits and vegetables in our diet contributes to preventing heart diseases. WHO recommends that more than five fruits and vegetables should be consumed daily. In India, this number is between zero and one! The possible explanation is increasing cost of fruits and vegetables. Additionally, the vegetables when consumed are often overcooked leading to loss of essential nutrients. In a large study in India, one of every two adults over the age of 20 was considered physically inactive. Lack of exercise was more prevalent among populations in the higher socio-economic strata, in urban areas and among women. It is 34

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recommended that 30-45 minutes of moderate intensity aerobic exercise must be undertaken 4-5 days per week to stay healthy. Stress is a silent killer which is often neglected and strongly contributes to ill health. Depression in our country is common and swept under the carpet due to social taboos of getting psychological help. We must grow beyond these stigmas to improve our mental health which in turn will improve the cardiac health. Yoga and meditation also go a long way in addressing this issue in India. The triple epidemic of high blood sugar (diabetes mellitus), high blood pressure (hypertension) and high blood cholesterol (dyslipidemia) must be checked. Even patients with these ailments should take all necessary steps to ensure that they stay in control of their disease rather than the other way around. The symptoms of heart attacks are usually chest heaviness or tightness with sweating or pain in the arm or jaw. In several patients, diabetics and elderly especially, these alarming complaints are absent altogether. Heart troubles may show themselves as breathlessness, fatigue, awareness of heart beats, giddiness and fainting. Sometimes it may be as subtle as feeling a bout of acidity or pain in the upper stomach or excessive belching! These should not be neglected. Time should not be wasted and reaching out to your doctor early is essential. Once a patient gets himself to a hospital, some basic cardiac tests can be performed to determine the problem like an ECG, Echocardiography (heart ultrasonography) and blood tests for determining cardiac damage and cardiac stress. These tests can guide further cardiac evaluation like Stress testing,

CT scans or Cardiac MRI, Coronary Angiography or 24 hour ECG monitoring (Holter monitoring). Dr. Nihar Mehta and Dr. A.B. Mehta at Jaslok hospital have pioneered a campaign for heart attacks called ‘Code PAMI’, which is a special system available 24 hours of the day, 7 days of the week. Once a patient walk in to the hospital with a chest pain with an ECG showing a heart attack, a team of 10 – 12 people including two cardiologists, an anesthetist, a specially trained nurse, a cath lab technician and other staff at the hospital is mobilized within minutes to ensure that the blockage causing the heart attack is removed and a stent is placed to restore blood flow to the culprit artery…. all within 60 to 90 minutes! This effort leads to better cardiac outcomes for this life threatening problem. Your heart is under attack everyday. The attacks are most of the time silent and usually come from inadequate knowledge of our own risks. Prevention is a ongoing endeavor and should be considered as an investment in your body. It is not a one time effort like a crash diet or a burst of exercise but a continuous process of conscious lifestyle choices. Small changes made in your daily schedules like factoring exercise or increasing fruits and vegetable or avoiding trans-fats in your diet will go a long way to keep your heart healthy. This world heart day, you should open your eyes towards risks factors for heart diseases, turn over a new leaf to exercise daily and eat healthy so that you can keep these silent killers at bay and change the numbers in your favor.

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EXPERT VIEWS

Suffering from Male Factor Infertility ? Consider IVF with ICSI egg to create the embryo. Talking about Male factor Infertility Before we move forward it is fair to have an insight of Male factor infertility. This is a situation when a male has impaired sperm or no sperm in the ejaculate at all because of any reasons. When a male is said to be infertile, he may have: • •

A very low sperm count Poor sperm motility

• •

Poor sperm morphology No sperm showing in the fresh sample but can be collected from the testicles or from the epididymis Erection and ejaculation related problems, for example due to spinal cord injuries or diabetes.

•

ICSI: The Process Now coming on to ICSI, it is a process where a single best quality sperm is picked and directly injected into the egg, where the Chair Person egg is already retrieved from the intended International Infertility Centre mother or may be from the donor. Then the fertilization process takes place and the embryo thus formed is implanted into the VF is a revolutionary treatment uterus. This process requires a very well allowing couples to feel the joy of equipped and advanced lab with all the parenthood. When we talk about latest micromanipulation tools. These tools of IVF or infertility treatments, it doesn’t always associate with female partners. A number of couples are facing problems while conceiving because of sperm related issues. To overcome these sperm related issues, an advanced technique known as ICSI made its way in the field of assisted reproduction.

Dr. Rita Bakshi

ICSI stands for Intracytoplasmic Sperm Injection. This technique is used where the conception doesn’t occur because of the male factor infertility. In this process, a single best quality sperm is retrieved and directly injected into the 38

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are used to pick up the sperm and then to inject it into the egg. Now you may think when the man is not able to produce the sperm then how does it all happen? Well, medical science has allowed us to do this all through specific sperm retrieval techniques. The sperm is retrieved directly from the testis or from the epididymis using some specially designed equipment. These sperm retrieval techniques may vary from person to person depending upon their individual needs. Consider only an expert while going for ICSI: As we already know that this procedure requires an advanced lab and latest equipment, the need of an experienced IVF specialist remains of utmost importance. Before you take a call on it, make sure that your IVF specialist is skilled enough to carry out the process. Closing Thoughts ICSI is an effective procedure to fertilize the eggs in a lab with the insemination of best quality sperm. It helps a lot of couples to fulfill their dream of parenting. ICSI may also increase the chances of a successful IVF cycle. However, the results may vary from couple to couple depending on their prior medical history.

EXPERT VIEWS

Expansion of 26 Fertility centers till 2020 by IFC mountain” and “flow like water” to achieve goal. Saarthak has also been rewarded with an appreciation letter from the prime minister of Nepal, Dr. Debua for opening of fertility centers at affordable rates with maximum success rates in Nepal. According to Saarthak “he provides the best services and in exchange for it, he grab lots of love with the blessings and their credibility of course which is priceless”.

Dr. Sarthak Bakshi CEO International Fertility Centre

aarthak Bakshi, CEO and cofounder of the International Fertility Centre, in an interview with Medgate magazine, said that “opening of fertility center was a dream of her mother who is a renowned gynecologist has expertise in IVF, IUI, ICSI and their treatments. He further adds that before the opening of the International Fertility Center he had seen despair in her mother’s eyes for inability to help infertile couples with low income groups. To achieve mother’s dream Saarthak left his cozy job of the world’s best companies. The International Fertility Center was first opened in New Delhi with a motto of “One Child per Couple” according to Saarthak. IFC was further extended to other states of India and worldwide with a maximum success rate at affordable prices.

The International Fertility Centre has helped various childless couples by providing infertility treatments services with highest success rates. This offer fertility treatments such as IVF, Natural IVF, IVF with Egg Donor, ICSI, IUI, Surrogacy, Surrogacy with Egg donor, Embryo Donation, Assisted Hatching, PESA/TESA, Hysteroscopy, Laparoscopy, Blastocyst and much more. Egg donation has become a latest trend among young women; Saarthak Bakshi has collaborated with the Seed ART Bank with an extensive egg donor index to benefit childless couples with vigorous and healthful egg donors. Its assistance and its quality egg donors, helped many couples in attaining successful pregnancies. To open more than 12 centers without any external funding in a very short span of time is a huge achievement indeed. Saarthak believes and also suggests other entrepreneurs that whatever the adverse condition arises always “stand like

Saarthak Bakshi has been enlisted in Forbes 30 under 30 Asia 2017 for improving health care systems and latest and advanced fertility treatments. He is also one of the Founding Member of an NGO named Upkaar Surrogacy Welfare Trust works for women empowerment and girl child education. To meet the requirement of quality trained professionals, Saarthak inaugurated the International Institute of Reproduction and Fertility Training (IIRFT). Saarthak Bakshi says “IIRFT has successfully trained over 500 candidates till now”. With a mission of creating awareness for fertility complications and its treatments Saarthak organized camps in Ethiopia, Uganda, Afghanistan and India educate people about fertility treatments. Saarthak says that organization of these camps were a huge success in spreading awareness in above mentioned countries. About future plans Saarthak revealed about his goal of opening 26 new centers in the near future across India and abroad by the end of 2020. To benefit more people he has a strategy of open more centers in other countries like Srilanka, Bangladesh, UAE, including states of India like Indore, Bhopal, Jammu, Ranchi, Raipur etc.

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Medical Tourism

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Guide to Choose a Right Hospital for Better Treatment There’s an exceedingly simple way to get better health care: Choose a better hospital. A recent study shows that many patients have already done so, driving up the market shares of higher-quality hospital.

Most people check restaurant ratings or read consumer reviews before they make a choice. Shouldn’t you also check the quality of the hospitals you rely on when you need medical care? In an emergency, your life may depend on getting to the nearest hospital. When you can plan ahead, you and your doctor should discuss which hospital will best meet your health care needs. Information is available to help you make an informed choice. Whether you have Medicare or another type of insurance, this booklet can help you find and use information about hospital quality. In an emergency, your life may depend on getting to the nearest hospital. When you can plan ahead, you and your doctor should discuss which hospital will best meet your health care needs. Information is available to help you make an informed choice. A great deal of the decrease in the deaths from heart attacks over the past two decades can be contributed to specific medical technologies like stents and drugs that break open arterial blood clots.

purposes. The ratings for CT scanning comes from billing data submitted to CMS that calculates the percent of scans of the abdomen and chest that are performed twice, once with and once without a dye. Such scans usually aren’t necessary and can expose you to unnecessary radiation.

Rate hospital on three measure bases:

Safety score: This is a summary of several key categories

Patient experience: Based on a government survey of millions of patients, these ratings tell you whether patients would recommend the hospital, their overall assessment of it, and their experience with topics such as communication with doctors and nurses, pain control, and whether their rooms were kept clean and hygienic also.

Patient outcome: These ratings, based on data submitted

by hospitals to the federal government, or states, provide information on how well hospitals prevent bloodstream and surgical-site infections, and the chance that patients have to be readmitted to a hospital within 30 days of their initial discharge. The need for such readmission can indicate problems in care while the patient was first hospitalized, including a hospitalacquired infection.

Hospital practices: Two measures are included under this heading, the use of electronic health records, and the appropriate use of CT scanning. The ratings for electronic health records are based on a survey of hospitals conducted by the American Hospital Association on the extent to which a hospital uses a computerized system for documenting physicians’ and nurses’ notes, viewing lab reports, and other

related to hospital safety: avoiding infections, avoiding readmissions, communicating about new medications and discharge, appropriate use of chest and abdominal CT scanning, avoiding serious complications, and avoiding mortality. The score is expressed on 100-point scale. A hospital would score 100 if it earned the highest possible score in all measures and would score 1 if it earned the lowest scores in all measures.

Avoiding adverse events in surgical patients: This rating is based on the percentage of patients undergoing scheduled surgery that died in the hospital or stayed longer than expected for their procedure. Research shows those measures are correlated with complications, and some hospitals themselves use this approach to monitor quality. To develop the ratings, we worked with MPA, a healthcare consulting firm with expertise in analyzing billing claims and clinical records data and in helping hospitals use the information to improve patient safety. In addition to an overall surgery rating summarizing results for 27 different kinds of surgeries, we also provide surgery ratings for five specific types of surgeries: back surgery, hip and knee replacement, angioplasty, and carotid artery surgery. The ratings are based on billing data submitted by hospitals to the Centers for Medicare and Medicaid Services. w w w.medegatetoday.com Sep-Oct 2017

COVER STORY

Growth of Medical Tourism Industry and Wellness in India:

Opportunities & Challenges THE most recent trend in privatization of health services is medical tourism, which is gaining prominence in developing countries. As healthcare turns costlier in developed countries, India’s medical tourism market is expected to more than double in size from USD 3 billion at present to around USD 8 billion by 2020, a report says. The costconsciousness factor and availability of accredited facilities have led to emergence of several global medical tourism corridors - Singapore, Thailand, India, Malaysia, Taiwan, Mexico and Costa Rica. “Amongst these corridors of health, India has the second largest number of accredited facilities (after Thailand). The Indian Medical Tourism market is expected to grow from its current size of USD 3 billion to USD 7-8 billion by 2020,” Grant Thornton India’s National Managing Partner Vishesh C Chandiok said. Globalization has promoted a consumerist culture, thereby promoting goods and services that can feed the aspirations arising from this culture. This has had its effect in the health sector too, with the emergence of a private sector that thrives by servicing a small percentage of the population that has the ability to “buy” medical care at the rates at which the “high end” of the private medical sector provides such care. This has changed the character of the medical care sector, with the entry of the corporate sector. Corporate run institutions are seized with the necessity to maximize profits and expand their coverage. These objectives face a constraint in the form of the relatively small size of the population in developing countries that can afford services offered by such institutions. In 44

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this background, corporate interests in the Medical Care sector are looking for opportunities that go beyond the limited domestic “market” for high cost medical care. This is the genesis of the “medical tourism” industry.

Medical Tourism as an Industry Medical tourism can be broadly defined as provision of ‘cost effective’ private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. In many developing countries it is being actively promoted by the government’s official policy. India’s National Health policy 2002, for example, says: “To

capitalize on the comparative cost advantage enjoyed by domestic health facilities in the secondary and tertiary sector, the policy will encourage the supply of services to patients of foreign origin on payment. The rendering of such services on payment in foreign exchange will be treated as ‘deemed exports’ and will be made eligible for all fiscal incentives extended to export earnings”. The formulation draws from recommendations that the corporate sector has been making in India and specifically from the “Policy Framework for Reforms in Health Care”, drafted by the prime minister’s Advisory Council on Trade and Industry, headed by Mukesh Ambani and Kumar mangalam Birla.

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Opportunities The Existing Markets: The top global medical tourism destinations include Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey and the United States. Close to 600,000 medical tourists travelled to India in 2015. Indian healthcare industry today caters to about 1.25 billion Indians and people coming from Africa, Middle-East and SAARC countries. We cater to the healthcare needs of a population of almost 2 billion people globally. We get high value patients for surgeries in key specialties such as organ transplants (liver, heart & lung and kidney), neurosurgeries, cardiothoracic surgeries, oncology, orthopaedics and many others. High Value Investments: Lately there has been a scramble of sorts to acquire Indian healthcare entities by some of the foreign healthcare groups. Last year alone there were two mega multi-million dollar investments by Parkway Pantai Group and Abraaj Group in Global Hospitals Group and CARE Hospital Group respectively. These acquisitions are further going to bring the very best in technology, clinical and managerial expertise in line with the best global practices, thus further enhancing the attractiveness of Indian medical tourism industry. Depreciation of Rupee: Depreciation of Rupee against dollar and other major Western currencies has been a boon to medical tourism and has made the costs of treatment far cheaper. This trend is likely to continue as India heads towards full convertibility in future.

are sundry other documentation and formalities to be carried out on a regular basis when the patients are already in India for treatment.

Growing

Competition: Medical Tourism Market Report: 2015 found that India was “one of the lowest cost and highest quality of all medical tourism destinations”. It offers a wide variety of procedures at about one-tenth the cost of similar procedures in the United States. Indian cost advantage accompanied by compatible quality speaks for itself. Various estimates put the treatment costs in India at around one-fifth to one-tenth of the price of comparable treatment costs in the US or the UK.

Quality & Patient Safety: Despite all

its inherent advantages, Indian healthcare industry suffers from serious issues of hygiene and patient safety. Indian hospitals are notorious for their Infection Control norms with one of the highest proportion of post-operative infections. Indiscriminate use of antibiotics has made many pathogens resistant to drugs in India. So, in many post operative infection cases, it is difficult to revive an infected patient. This problem is more acute in the organ & bone marrow transplant cases.

Legal Issues and Poor Follow up Care: Many of the countries that

offer healthcare tourism have weak

medical negligence laws, so the patient offers little recourse to nearby courts or medical entities if something goes wrong. Problems in organ donation abound as to complications in donating an organ, legality, safety and pricing. Surrogacy is permitted in India since 2012 and India is one of the most favored markets for the same. The market has not been free from controversies and litigation though. Organ transplantation too has plethora of legal complications in who can donate organs and various permissions required by the needy recipient.

Accreditations: Accreditations spell

standardization and international quality, something that inspires confidence in inbound patients. We have a limited number of JCI accredited hospitals – 24 in all today, a far cry from the global figure of 600; we have a long way to go if we want to be in the same league as the US, European, Singaporean, UAE, South African and the Australian markets. Creation of ‘Brand India’: Many countries including Singapore, Malaysia, Korea and others countries have established boards formed by tourism authorities, chambers of commerce, ministries of health and private organizations with single shared objective. India too needs to create a brand on the lines of ‘Singapore Medicine.’

Challenges Deteriorating Global Security Situation & Visa Restrictions: India is high on the target list of ISIS. This scare has forced India to tighten its security and visa norms, something that has put immense pressure on the fledgling medical tourism industry even as hospitals find it difficult to obtain visa and travel documents for their international patients. There w w w.medegatetoday.com Sep-Oct 2017

COVER STORY

WHY SPACE MEDICAL TOURISM IS WORTH THE RISK Medical tourism refers to people traveling to a country other than their own to obtain medical treatment. In the past this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable at homes. However, in recent years it may equally refer to those from developed countries who travel to developing countries for lower priced medical treatments. Medical tourism is the practice of travelling outside one’s home country for medical or surgical treatment. It includes dental tourism, but not wellness tourism, which usually refers to visiting spas, homeopathy treatments or traditional healing. It is a rapidly growing industry, especially in Southeast Asia, which is seeing a growth in international tourist arrivals from Australia. An XYZ suggested more than 15,000 Australians travel abroad each year for cosmetic surgery alone. Australians are spending more than a$300 million on medical treatment overseas every year. These are probably significant underestimates, since data is not collected on outgoing travelers for the purpose of medical tourism. The Southeast Asian medical tourism industry markets cosmetic surgery, dental procedures (including implants, dentures, crowns and whitening) and other surgery such as eye, cardiac, orthopedic and gastric bypass/banding surgery. There is also some promotion of fertility treatments, wellness checks and other medical and surgical procedures. Even many local health insurance companies are turning to the promotion of medical tourism packages for treatments such as cosmetic surgery and dental care. A list of international destinations where patients travel to obtain a wide array of procedures is growing, and they range from low to high 46

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risk according to possible complications or other negative outcomes. Hence it is vital to speak openly with the international physician about potential complications and how to minimize them prior to any medical procedure. Diverse standards with regards to hospitals and physicians can be a problem, as each country usually has its own licensing and certification protocols. Increased familiarity with destination country protocols is necessary, and all potential risks should be taken into account before making a final decision to travel abroad. A list of international destinations where patients travel to obtain a wide array of procedures is growing, and they range from low to high risk according to possible complications or other negative outcomes. Hence it is vital to speak openly with the international physician about potential complications and how to minimize them prior to any medical procedure. Diverse standards with regards to hospitals and physicians can be a problem, as each country usually has its own licensing and certification protocols. Increased familiarity with destination country protocols is

necessary, and all potential risks should be taken into account before making a final decision to travel abroad.

Medical risks

Medical tourism increases the risk of nosocomial infections, also referred to as healthcare or hospital acquired infections. For example, if needles are reused between patients or other unsafe injection practices are occurring, serious infections such as hepatitis and HIV can be transmitted. Infections with multiresistant organisms, the spread of nor viruses (common cause of acute gastroenteritis) and mycobacterium infections after cosmetic surgery are well documented cases of medical risks. Patients who cross borders in seek of a medical care are also potentially exposed to infections that they would not normally encounter, thus posing a public health risk when they return home. An apparent increase in so called “transplant tourism” in the last twenty years is also followed with a higher incidence of tissue rejection after the operation and critical infectious complications among transplant medical tourists, when

COVER STORY

compared to other transplant patients. Furthermore, blood supply in some countries comes predominately from paid donors and may not be adequately screened, which can additionally endanger patients. Traveling long distances after surgical procedures can also pose certain risks such as deep vein thrombosis and pulmonary embolism. The risk of these adverse events can be reduced by drinking plenty of water, exercising legs while seated and taking a walk every 2 to 3 hours on a long plane trip. Medical compression stockings and anti-clotting medications can also be prescribed for high-risk patients.

Ethical and legal risks

Patient autonomy and informed consent both represent a cornerstone of bioethics, which can sometimes mean a concerning issue for medical tourists. In the context of medical tourism, informed consent can be influenced by ambiguous or incomplete information on websites, problems in obtaining veracious information about success rates and the quality of care in destination facilities. Even under optimal circumstances it is often difficult to obtain informed consent

for medical procedures; the international dimension raises those concerns even more. Limited health literacy (coupled with aforementioned inadequate access to accurate information) can result in patients’ inability to make a thoroughly informed decision about medical tourism and to eventually accept the risks of seeking healthcare in another country. Countries may also have different standards of medical ethics. For example, a therapy that is considered experimental in one country (like stem cell therapy) can be commonly used in the private care institutions for medical tourists in other countries. Similarly, the medical ethics related to organ transplantation often differ from country to country. If problems arise, patients might be left without the opportunity to seek damages in malpractice lawsuits, due to the multiple jurisdictions involved and the lack of clarity in terms of which law should apply. Valid legal solutions to these issues are difficult to establish, thereby transferring pressure on patients’ healthcare systems at home – including health and safety professionals – to address them in a makeshift fashion.

Conclusion

Given its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a highly significant and contested phenomenon. This is especially true given its potential to serve as a powerful force for the inequitable delivery of health care services globally. It is recommended that empirical evidence and other data associated with medical tourism be subjected to clear and coherent definitions, including reports focused on the flows of medical tourists and surgery success rates. Additional primary research on the effects of medical tourism is needed if the industry is to develop in a manner that is beneficial to citizens of both departure and destination countries.

YEAR

FOREIGN TOURIST ARRIVAL

Year on year percent increases in FTA

Medical tourist arrivals (percent of FTA)

Year on year percent increase in MTA

2009

5167699

112689 (2.2)

2010

5775692

155944 (2.7)

38.3

2011

6309222

9.2

138803 (2.2)

-10.9

2012

6577745

4.2

171021 (2.6)

23.2

2013

6967601

5.9

236896 (3.4)

38.5

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COVER STORY

India Emerging as major destination for Quality Healthcare Medical sector is growing day by day in India. Foreign patients travelling to India to seek medical treatment in 2012, 2013 and 2014 numbered 171,021, 236,898, and 184,298 respectively. India offers medical facilities, including critical care at onetenth of the cost of U.S wellness is now a top priority and quality healthcare is more accessible compared to a decade ago. Government is also focusing on several areas including quality standards and easy visa processes to make India a global destination for healthcare services. India is a great location for foreign patients “because this is a place where entire range of healthcare sector finds place.” The market size of India’s healthcare sector is expected to increase USD 160 billion by 2017 from around 79 billion currently. As Indian healthcare sector develops, a new term has been coined called ‘Medical Tourism’, which is the process of people from all comes of the world visiting India to seek medical and relaxation treatments. The most common treatments sought are heart surgery, knee transplant, cosmetic surgery and dental care. Medical tourism chooses India as their favorable destination because of the key opportunities in Indian healthcare sector in the form of efficient infrastructure 48

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and technology. The health insurance market and national medical system here are well developed, which is convenient for visitors from the West and Middle East. They also find the hospital expenses very affordable. But one of the many challenges it faces is to provide good quality, affordable healthcare to all. For this, there is a need to reduce inequalities, imbalances that exist between regions, cities, villages and different socioeconomic groups. The Minister said that India has done exceptionally well in the past three years in tourism sector, with overseas footballs expanding at near 20% average every year. By January this year, 3.3 million travelers had already visited India, spending close to $5 billion. The domestic travel is also witnessing rapid growth. Some 368 million Indians are venturing out of their homes, based on rising incomes, lower aviation costs, and more peaceful time. The world travel and tourism council has forecast that tourism will grow at a rapid rate of 8.8% per year for the next ten years, the highest in the world. The Industry is projected to attract a capital investment of $21 billion by 2014, up from about $10.2 billion estimated in 2004, according to WTTC survey. Equally significant is

COVER STORY

the impact this growth will have on employment. The travel and tourism industry already accounts for one of every nine job opportunities created in India, currently aggregating over 20million employees. It is estimated that this industry generates more jobs per unit investment than any other sector.

people from Gulf countries which is likely to boost medical tourism. A visa-on-arrival scheme for tourists from select countries has been instituted which allows foreign nationals to stay in India for 30 days for medical reasons.

Why India is best for Health needs?

Despite India’s diversity of languages, English is an official language and is widely spoken. In Noida, which is fast emerging as a hotspot for medical tourism, a number of hospitals have hired language translators to make patients from Balkan and African countries feel more comfortable while at the same time helping in the facilitation of their treatment. Medisensehealth.com has been a front runner in providing Online Medical Opinion, Treatment Options & logistical support for international patients. This platform is a one-stopshop for all the health needs of the patients. This platform has a tie-up with all the major Hospitals in India viz. Fortis, Apollo, Manipal and many more depending on the treatment sought by the patients. Following are the benefits for patients availing the healthcare facilities in India.  Patients can choose the specialists / hospitals or ask Medicines for recommendations.  Patients receive treatment options both in allopathic and Ayurvedic health streams.  Depending on the treatment options, cost details, treating doctor’s details will be sent to the patient.  Patients get a choice to speak to the consultant and his team through Skype or phone.  If the patient decides to visit India, then medical Visa will be processed. Travel/accommodation can be arranged by the patients or else ask our coordinators to arrange for the same.  Post treatment in India, if a patient wants to recuperate at a holiday destination like Goa, Agra or any area interest, just let our travel team know, they shall arrange for the same.  Post treatment support back in the home country of the patient will also be arranged by medicines.

Cost

Most estimates found that treatment costs in India start at around one-tenth of the price of comparable treatment in the United States or the United Kingdom. The most popular treatments sought in India by medical tourists are alternative medicine, bone-marrow transplant, cardiac bypass, eye surgery and hip replacement. India is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine.

Quality of care India has 28 JCI accredited hospitals. However, for a patient traveling to India, it is important to find the optimal DoctorHospital combination. After the patient has been treated, the patient has the option of either recuperating in the hospital or at a paid accommodation nearby. Many hospitals also give the option of continuing the treatment through telemedicine. The city of Chennai has been termed “India’s health capital”. Multi- and super-specialty hospitals across the city bring in an estimated 150 international patients every day. Chennai attracts about 45 percent of health tourists from abroad arriving in the country and 30 to 40 percent of domestic health tourists. Factors behind the tourist’s inflow in the city include low costs, little to no waiting period, and facilities offered at the specialty hospitals in the city. The city has an estimated 12,500 hospital beds, of which only half is used by the city’s population with the rest being shared by patients from other states of the country and foreigners. Dental clinics have attracted dental care tourism to Chennai.

Ease of travel

The government has removed visa restrictions on tourist visas that required a two-month gap between consecutive visits for

Language

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Healthcare IT & Infrastructure

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Explore latest innovations, technology and ideas in the healthcare design and build space at 4thHospital Planning and Infrastructure (H.P.I.) Expo and Summit

Hospital Planning & Infrastructure (H.P.I.), South Asia’s leading exhibition on hospital infrastructure, design and planning will be back with its fourth edition on 6-8 October 2017 at Bombay Exhibition Centre, Mumbai. The expo is a focused trade show and summit that brings together senior industry buyers including key budget holders, policy makers and investors who represent the real power behind the development of world-class hospital infrastructure in South Asia. The healthcare industry in India is the fastest growing sector, both in terms of employment and revenue. This industry continues to grow at a tremendous pace owing to increasing expenditure by public as well as private players. This growth needs proper healthcare and design planning to help achieve India’s future healthcare vision. H.P.I. is providing this industry an exclusive platform for key stakeholders, potential investors and developers to further accelerate growth in this sector and meet India’s healthcare requirements.H.P.I. through its summits brings together veteran hospital design and planning professionals who share their knowledge and experiences on how to efficiently run a hospital and overcome the challenges of building sustainable and profitable hospital infrastructure across the region. This year, adding to the Mumbai conference, H.P.I. conducted a series of standaloneseminars for the first time in New Delhi, Nagpur and Kochi which was a tremendous success bringing together hundreds of buyers representing over 35,000 worth of bedded projects. The Gold Partners for the H.P.I. Summits, were Stryker India and DuPont Protection Solutions – Surfaces. Cognota Healthcare and KEF Infra were Silver Partners. Armstrong Flooring, Eureka Forbes, Helix Healthcare, SIO Vasunddhara and Paramount Bed India were Bronze Partners.Berkeley HealthEDU was Education Partner. It brought together top executives from more than 50 hospitals across India,leading healthcare consultants and architecture firms together under one roof to interact and witness latest innovations and trends in hospital design and planning space whilst improving the scope of healthcare construction in India. The final H.P.I Summit in Kochi saw leading industry professionals who shed light on their experiences of operating in the hospital infra sector, the challenges they encountered and solutions that helped them overcome those challenges. Harish Pillai, CEO, Aster Medcity gave a keynote speech on getting Kerala hospitals future ready. The second session was on integrated operation theatre which was addressed by Edmond Paul, Head of Biomedical & Materials Management,Aster DM Healthcare. This was followed by a topic on patient centricity in hospital designby Sujayanti Dasgupta, Managing Director, W-ARD FOUR. A case study on Meitra Hospital –India’s first healthcare facility designed and built using offsite technology was presented by Paul Blackmore, CEO, KEF Infra. w w w.medegatetoday.com Sep-Oct 2017

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The summit also hosted two panel discussions that covered critical topics pertaining to the healthcare design and finance. First panel session was on analysing how to drive profit in the competitive healthcare market, the panellists included Lloyd Nazareth, Group CEO, American Oncology Institute; Merzi Marker, Group Medical Director, Bhagwan Mahaveer Jain Hospital, Amit Sharma, Lead Consultant – Trauma Care, Medtronic and Fakhruddin Mohammed, Chairman, Health India Hospitals Consultancy Corp. The session was moderated by Vivek Desai, Managing Director, Hosmac India. The second panel session was on designing and executing a sustainable healthcare system which was moderated by Vivek Desai, Managing Director, Hosmac India. The panel members included Juzer Kothari, Managing Director, Conserve Consultants (P); Alex Cyriac, HVAC Consultant, Alex Cyriac Associates; George Jacob, Owner, Carambiah & George; Siddhart Puri, Director of Architecture, W-ARD FOUR and Binesh Sukumar, Chief Architect, Binesh Sukumar Architects & Planners. In 2016, the Hospital Planning & Infrastructure (H.P.I.)exhibition was an overwhelming success with more than 3300validated buyersattending the expo and over 160 crores worth of business generated. Now in its fourth edition, H.P.I. with DuPont Protection Solutions – Surfaces as Gold Partner and Draeger India as Silver Partneris set to further raise the benchmark for the industry with a greater contingent of industry experts attending the expo. Spread across more than 5000sqmfloor space, H.P.I. this year has participation from almost 105 national and international companies from the healthcare industry with an expected footfall of 5500+ visitors at the exhibition. Leading exhibitors showcasing their solutions include,Agora Climate Systems, Anest Iwata Motherson Pvt Ltd, C R Medisystems Pvt Limited, Esbee Dynamed Pvt Ltd, Isometrics India Pvt Ltd, Medicare Gas Pipeline, Medirail Systems, Modular Concepts India Pvt Ltd, Natroyal Industries Pvt Ltd, Philips India Ltd, Polfrost Aircon Pvt Ltd,RMG Polyvinyl India Ltd,Srishty Medical Pvt Ltd (SNG India) and many more. Hosted alongside the expo, the H.P.I. Mumbai Summit is a 3 day-longseminar that provides a knowledge-sharing platform for the industry and brings together leading hospital design and planning professionals from the domestic and global healthcare industry to share their insights and ideas on how to efficiently run a hospital and meet the growing demands of the healthcare consumers. In its fourth edition, the summit focuses on key topics around the broad theme “Greener and Leaner Hospitals”:  6th Oct, 2017 – To what extent are “Green hospitals” financially sustainable?  7th Oct, 2017 – Using “Lean” concepts to design and build healthier hospitals  8th Oct, 2017 – Technology as the driver for greener and leaner hospitals The summit this year will witness 30+ eminent speakers which include Anupam Verma, President, Wockhardt Hospitals 52

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Ltd;Ajey Joshi, Me Project Coordinator, AECOM; Ashok Ambhore, Sales Manager, Draeger India; Herdev Singh, Healthcare Segment Leader, DuPont Protection Solutions – Surfaces, Prashant Naidu, Head-Healthcare Transformation Services & Infrastructure (South Asia), Philips India Ltd, Sandeep Shikre, Owner, SSA Architects; Santosh Shetty, COO, Kokilaben Dirubhai Ambani Hospital; Sashi Balaian, Managing Director, ClearMedi Healthcare, U K Ananthapadmanabhan, Group President, Rainbow Hospitals; Vivek Desai, MD, Hosmacand many otherswho will address theconcernsof the Indian healthcare infrastructure and discuss the latest developments and technology in this field. Why you should attend the summit: Get updated information on key issues that your organisation is concerned with Learn about new emerging trends and product developments in your industry Network with industry leaders and key decision makers Have your issues addressed on a specific topic by recognised expert speakers who are up-to-date with the latest developments in the field The learning environment encourages you to exchange your experiences, ideas and practices from your company with others, helping you optimise your learning A new addition for this year, H.P.I. will also host awards for energy efficient hospitals in association with Hosmac, the “H.P.I. & Hosmac Energy Efficient Hospital Awards 2017”to recognise and reward hospitals that are applying sustainable measures and using green technologies to run their facilities to reduce their overall carbon footprint. Alongside with the awards, , H.P.I. will also host an architecture competition in association with Hosmac India, the “H.P.I. &Hosmac Architecture Competition (HHAC)” that aims to help architecture students get an insight into healthcare design and functioning of healthcare centres. The first successful round of HHAC in 2016 revolved around the design of a ‘Rural Community Healthcare Centre’. This year the competition will focus on designing ‘Centre for Assisted Living. “I had come to attend the H.P.I. Summit in Delhi because I wanted to learn whether whatever I’ve done in the last 27 years, I did right or wrong.” – Suversha Khanna, Founder, Dharamshala Cancer Hospital and Research Centre In anticipation for the exhibition, Mr. Vikas Vij, Managing Director at H.P.I said,“Hospital Planning & Infrastructure (H.P.I.) being the only dedicated trade fair and summit in hospital infrastructure, planning and design sector, serves as the perfect platform for companies showcasing high end capital goods and trying to win tenders, drive sales and increase their market share in the healthcare build space. With more visitors attending from across India and globally this is a great platform to support the development of India’s healthcare manufacturers and hospital planners”. For more information please visit www.hospitalinfra.in

COVER STORY

We Need to Put the ‘Care’ Back into Healthcare How India Healthcare System Can Tighten Its Belt and Become More Efficient !

India can certainly do a lot to improve public health in the country. Spending a lot more money may seem to be the obvious answer. Money is not the only constraint, even though we have been crying ourselves hoarse that the government needs to double or triple its spending on health. There are many other things that need to be streamlined for India to ensure quality healthcare to its citizens. Improving healthcare delivery systems ought to be the subject of intense policy deliberation and debate because the development of the country hinges, on the health of its citizens.

How is our children’s health?

But where does good health begin? It begins with our children. Unfortunately statistics in this regard are not too flattering. India is far behind than rest of the world in terms of number of malnourished children and surprisingly it is double than that of Sub-Saharan Africa.  Almost half of all deaths of children under 5 is undernourished children.  44% of children under the age of 5 are underweight  72% of our infants have anaemia  Inadequate sanitation safe water triggers infection-malnutrition cycle. If our children don’t get the right start to life, they will remain undernourished and under developed compared with the children in rest of the world. Where does this leave our future workforce? We will remain an unhealthy nation with human resources that function below par. Our physical strength, mental health and overall wellbeing are and will continue to be compromised. This has far-reaching consequences on the country’s economic and social development. It’s clear that investing in the health is investing in the future. At the moment, the Indian government spends about 1.15% of its gross domestic product on health care. This needs to increase to at least 2.5 per cent over the next few years to make any appreciable difference. Bad health hampers performance, productivity and negatively 54

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affects human capital development. Given our federal structure, we need to ensure that health remains a priority for the central as well as state governments. The State and the Centre Governments need to work collectively to ensure the four main prerequisites of a good healthcare system: quality, accessibility, availability and affordability. Quality is driven by market forces, but when supply is limited as compared to demand, quality takes a back seat. The government and health regulatory bodies need to ensure that quality standards and minimum patient safety protocols are enforced. The increase in public health spending should be accompanied by changes in where that money is spent. A substantial part of public spending should be channelized into primary health as committed in the health policy 2017. Offering better primary care will help reduce the number of cases where diseases or complications progress to a point where they require expensive and aggressive treatment at tertiary healthcare centres and cannot be cured. For a national health system that works, we need more medical and nursing schools and thousands of health workers, particularly in rural areas. What is urgently required is a multi-layered, qualified, trained and committed workforce. We need a large number of health management professionals to run facilities and programs efficiently. The healthcare sector in India is one of the largest sectors both in terms of employment and revenue generation. It has grown at a compounded annual growth rate of 16.5% and is likely to be worth $280 billion by 2020. But NSS figures over the last two decades show a decline in the share of public hospitals in treating patients. This could give monopoly to the private players to hike prices of diagnostics and medical treatment. High healthcare costs and lack of insurance coverage penetration often results in greater out-of-pocket expenditure for diagnosis, consultation and treatment. Still, people today prefer private healthcare despite its

whopping cost because of the dismal quality and lack of accessibility and accountability of public healthcare system in both rural and urban India. Clearly a lot needs to change. The doctorto-patient, patient-to-bed, and equipment availability-to-utilization ratio need to improve. The unbridled rise in the cost of secondary and tertiary care treatment in urban areas need to be checked. Communication and coordination skills among hospital staff and doctors, soft skills and time management, emergency health management, crisis management, and supply chain management need to improve drastically. A multi-prolonged approach is necessary, and its implementation needs to start immediately on fast-track basis. Public intervention in healthcare delivery needs to include:  Monitoring of both public and private delivery systems  Ensuring authentic diagnostic facilities at affordable cost  Supplementing healthcare with better municipal services --clean air and water, pest control, good sanitation and sewage systems, proper treatment of waste – and including healthcare awareness and physical fitness in school curriculum to ensure preventive healthcare. A robust public healthcare system is essential for transforming the socioeconomic trajectory of India. Institutions like IIHMR play a significant role in this regard. They can do this by providing trained manpower and through information technology by making doctors available for consultation long distance, maintaining digital individual and family health record and through providing good healthcare managers. Many problems arise because healthcare systems in hospitals and clinics are not managed well. We need people who are qualified and trained as hospital managers and who can take care of management related issues so that doctors can focus on providing clinical care which they are trained for.

By Dr. Sumesh Kumar Assistant Professor, International Health Management Research, Delhi

Institute

Dr Sanjiv Kumar Director, International Institute Management Research, Delhi

Health

PRODUCT LINE

Nurse-Call Systems, Bed-Head Panels & OPD Patient-Call Systems Nurse-Call Systems

Medisystems Electronic Nurse-Call Systems are modern microcontroller based digital systems. System features have been designed to cater for hospital practices prevailing in India. Hence, the basic audio visual arrangement has been deliberately simplified through an easy to understand red-yellow-green lamp mode with easily recognisable audio chimes. All calls are acknowledgeable, to relieve patient stress, and no call can be cancelled or reset except by visiting the patient bedside. Even trainee nurses placed on ward duty at short notice can adapt to the system in minutes. The system is modular, comprising a Central Display Console at the nursestation counter (Optionally, also with Ward Graphic Displays), a Bed Unit module behind each patient's bed and a Handset which reaches out to the patient through a length of flexible cable. A Door Display Unit can also be mounted at the room entrance â&#x20AC;&#x201C; with Nurse-Presence Registration. An Emergency Alert Unit can be mounted within the toilet and / or also within the shower stall. Optional features include Nurse Help Request, Patient-Nurse Intercom, CodeBlue Alert, IV-Drip Alert, Instrument Alarm Relay, Additional Call Signals, Call Transfer Facility, Multifunction Handsets, Corridor Display Modules, Nurse Call Response Monitoring and an SMS Alert facility for selected emergency calls to be forwarded directly to cell phones.

also available in custom configurations which include horizontal, vertical or wall angular orientation, in colours and finish of choice.

OPD Patient-Call Systems

Bed-Head Panels

Medisystems Bed-Head Panels are specially fabricated for hospital use and designed to converge all the essential utilities around a patientâ&#x20AC;&#x2122;s bed. Standard panels are available for ICU, Wards, Private Rooms / Suites. The circuit protected panels carry provision for electrical power, illumination, communications, Bio-signals, data, time and medical gas. A stainless steel universal medical rail is also provided for holding a range of accessories like Utility baskets, Case sheet holders, Blood Pressure instrument holders, I-V Poles, etc. Patient-Bed Lamps may also accompany the panels. Constructed from light weight extruded aluminium sheets and sections and stainless steel, and surface treated with an epoxy-polyester powder coat ensures a lifetime protection to the metal surface. It facilitates ease of cleaning and ability to withstand damage from common hospital fluids like saline, drugs, blood etc. These light weight panels can also be mounted on non brick walls made of siporex or gypsum board. All panels have safety metal partitions between high voltage, low voltage and medical gas outlets. Medisystems manufactures a very wide range of such panels to meet practically every kind of need. Such panels are

Medisystems OPD Patient-Call Systems are the ideal solution for queue management in busy crowded OPDs. Their configuration is based upon the number of consulting rooms and waiting areas of the OPD. The system consists of a Main Display Unit for the waiting area; door display units and desk units for the consulting rooms. The receptionist or cashier can also be connected to this system with additional desk units. The system scrolls all un-answered calls and can also remind for any un-attended calls. A lower programmable display line can carry social or promotional messages for the hospital. Bilingual displays can also be given. The system once installed is user-friendly, cost- effective and needs minimal support.

CR Medisystems Pvt. Ltd. Mumbai, India. Tel: 91-022-23094416, 23004930 E-Mail: medisystems@gmail.com Web: www.medisystems.in

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PRODUCT LINE

Modular Signage: Healthy for Hospitals Signage industry in India is undergoing a revolution in terms of getting upgraded to the global trends. The one thing growing healthcare infrastructure and facilities are demanding is ‘Quality’. The perfect combination of quality, functionality and architecturally tasteful looks are Modular Signage Systems. Cosign has been consistently working to design distinguished aluminum profile systems for signages with specific benefits. Flexibility: Environments like Hospitalsrequire frequent updation of information like consulting doctors, currently admitted patients, OPD timings etc. Cosign’s handy Strato system allows easy graphic change by hospital staff. Paper sizes like A4 and A3 are easily printable and offer good solution for changes if signages are designed for them. The hospital premises can look more elegant as there is no re-writing on existing signages nor paper print-outs are stuck on walls. Uniformity: For multi-speciality hospitals requiring large quantum of signages it becomes challenging to keep up the uniformity in production of signages. Modular Signages help in building deep precision work making each signage look perfect! Scalability: Modular Signages are built like Legosystems! They are scalable from a small door plate to a huge directory covering an entire wall. This helps in designing signages specific to every hospitals’ requirement. Speed: Total time for manufacturing and installation of signages is drastically reduced due to use of Modular systems. This allows easy in-time completion of projects. Life time guarantee: Cosign systems consist of aluminum extrusions and plastic accessories. Aluminum does not rust and hence has a long life. Aluminum 58

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profiles are anodized,finishing and bringing out a stylish look. Ease of cleaning and maintenance: The signages are very easy to maintain and require negligible maintenance. Housekeeping staff can be easily trained to take good care of them! Affordability: Modular Aluminum signages are budget friendly inspite of all the advantages they boast. These signages help in creating a strong brand identity and yet are sensitive about client spendings.

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COVER STORY

How Technology is Transforming Healthcare? Overview

Healthcare has improved so much in the last thirty years that World Health Organisation estimates that over 6.7 million lives have been saved. The world now spends a third more on health than it did five years ago, and on average people are living longer and healthier lives. That said, the burden of disease and disability is still tremendously high, and varies significantly in the developed and developing world. There is big potential on the transformation of the healthcare industry in the era of digital business. In this article we discuss what the impact of technology holds for the industry in the upcoming years. As healthcare has traditionally been serviced from a Macro and microperspective, we shall look at the potential impact of transformative digital initiatives in both.

Macro Healthcare perspective: In the Macro perspective, successive governments have started placing much emphasis on the quality of healthcare provisioned to its citizens through a combination of direct intervention as well as policy initiatives to drive the private healthcare ecosystem. A key area is Census taking and Vaccination initiatives. This is being revolutionized by the advent of ubiquitousavailability of the smartphones. Census takers and Vaccine delivery initiatives, know who to target, how to target, and record outcomes in matter of days rather than months. The second key area is controlling infectious disease out breaks. The global success in the halt of the spread of Ebola is a case in point where data was collected in near real time, outbreaks were easier to analyze with the use of GPS assisted maps, and interventions can be planned and executed with point of care diagnostics. Examples are a mobile diagnostics solution that can enable health workers in the field to quickly test patients, then send 60

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those results through a smartphone to public health experts for real-time tracking. A third key area is governments ensuring affordable healthcare for all. Removing the rural/urban healthcare facility divide is an area which is being done with the help of Mobile Telemedicine. Todayâ&#x20AC;&#x2122;s telemedicine programs are powered by affordable, offthe-shelf PC components, standard cameras and sensors&cloud software platforms. Integration with EMR systems is a baseline expectation, along with quality analytics of clinical, usage and financial data, covering things like individual consultations and physicians to setting-specific metrics and program-wide trends. Precision medicine, AI in Clinical research and 3D printing of casts are in advanced stages of Research & development aided by several medical institutions around the world. They have every chance of graduating to everyday use by 2020.

Micro Healthcare perspective: On the treatment side, Digital initiatives allow for a new approach to disease and health management by putting the patient/customer at the center. Digital ecosystems are being created where patients can report problems remotely, talk to care providers/hospital representatives, have Insurance companies track their situations and give seamless disbursement of monies to take the nerve wracking pain and unsureness away from those suffering, using their smartphones and tablets. They also give access to patient online communities where patients can discuss their issues with fellow sufferers, educating them and providing them much needed emotional support. On the prevention side, there has been quantum jump inconsumers interested in self-help ranging from exercise, diet management, alternative therapy, mood management etc. There are new entrants among consumer healthcare from technology providers â&#x20AC;&#x201D; both huge (Apple, Samsung and Google) and small (venture funding of digital health was a record-breaking $5 billion in 2016 and is on pace to match that in 2017). Additionally, there

COVER STORY

is great movement of Consumer Healthcare ‘products’ – ranging from vast & small websites handing out health/medical lifestyle advice to boutique equipment manufacturing like activity trackers, home medical monitoring devices& thousands of applications on the smartphone ecosystem. On the financial management of healthcare too, a lot of changes due to digitization are taking place. A key area is in the health insurance industry, which is riddled with problems. With Third Party Administrators (TPAs) there is the problem of long turnaround times(TAT). Most TPAs fail to meet the set deadline even if the insurance company has made the payment to them. In Hospitals, if you have a health cover, there is a 90 per cent chance that they will charge you more. Many people are hospitalized for an illness that does not require it. Another issue is that they take a policy after a disease has been diagnosed. Health insurance does not cover pre-existing diseases. Insurance companies have opted for direct settlement of claims, leveraging strong mobile & web-based applications and eliminating TPAs. These applications are location aware, GPS assisted, and instantly transfer information, and evidences such as photographs to save time, money and give quality service. IoT in healthcare — expected to be a $163 billion market in 2020 could be big as well.Data can come from fetal monitors, electrocardiograms, temperature monitors or blood glucose levels, be seen by healthcare professionals and therapies be advised, lessening the need for direct patient-physician interaction. “Smart beds” in hospitals can detect when they are occupied and when a patient is attempting to get up. Home medication dispensers can automatically upload data to the cloud when medication isn’t taken or on any other indicators for which the care team should be alerted Lastly, this great explosion of Software/Move to digital is also accompanied by an unfortunate opportunity for evildoers & criminals like the Wannacry Ransomware attack recently on NHS hospitals. Going forward there could be implications of medical device-level vulnerabilities. Hacked medical devices may now be the single biggest threat to healthcare IT security.

Example of the use of IT in healthcare,

Sample Case Study by Q3 technologies for Medocity:

Digital Ecosystem for Healthcare Management for Medocity Task at Hand: Maximize patient engagement using interactive communication, virtual patient support and tailored guidance. The App by Q3 focussed on B uilding an eco-system of patients, healthcare providers, dieticians etc. H elp patients track symptoms, medications, nutrition and exercise routines P rovide a very rich interactive and intuitive interface P rovide the ability to network with other patients M odules to chat/speak with other patients, health specialists or doctors  Allowing nurses and doctors to video conference with patients

by Mr. NavinParti, Vice President Q3 Technologies

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EXPERT VIEWS

Activity Based Costing in Healthcare: New Mantra for Financial Sustainability

Ms. Latesh Sen

Head- Costing & Business Analysis, BLK Super Speciality Hospital

Indian healthcare industry is undergoing a reforming era. Innovative solutions and tools are needed to achieve the goal of quality and affordable healthcare to all. By introduction of new tools with efficient management, we can look at transforming the healthcare sector and providing quality medical service at affordable cost. Activity based Costing (ABC) is one of new management tool which gives 360-degree control to the management to measure, analyze, plan, implement, and control financial as well as operational efficiency in quantifiable terms. Quality and affordable healthcare can only be possible if Indiaâ&#x20AC;&#x2122;s healthcare sector can maintain a balance between cost of services, itâ&#x20AC;&#x2122;s delivery and price at which these services are provided to the patients. The future of sustainability lies in efficient cost control strategies. For better results every department in a hospital set up needs 100% implementation of Activity Based Costing. With the help of Activity Based Costing and its application

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in a hospital, the targets of operational efficiency and cost reduction can be achieved in a short span of time. Accurate costing procedures and services leads to affordable pricing, which provides quality healthcare services to the patients. With a fifth of the worldâ&#x20AC;&#x2122;s disease burden, a growing incidence of non-communicable diseases such as diabetes, hypertension and poor financial arrangements to pay for care, India lags behind among the BRICS countries in health sector performance. Moreover, to address these challenges, the health management system needs to be strengthened. The pricing of services needs to be done on the basis of costing. Only then hospitals, be it public or private domain can provide the most competitive price or affordable quality services to patients as well as maintain financial sustainability. Various sectors like PSUs and insurance sector today are struggling to establish uniform pricing on the basis of actual cost incurred, whereas in healthcare sector (BLK Super Specialty Hospital) we have already achieved the pricing structure based on cost inputs. Mostly in organizations, cost reduction is done on a prorata basis, which however is not an accurate cost control strategy. Actual cost strategy can by attained by rationalization of over and underutilized resources, which at present we follow at BLK Super Speciality Hospital. It is widely admitted that affordability can only be achieved with efficient cost management. For private sector, where cost of healthcare service delivery is much higher, it becomes critical to adopt new and innovative tools to optimize resources for cost effective services. Balancing cost and price in private hospitals or Super Speciality hospitals is a big task and costing plays a very critical role for financial sustainability. In the National Capital BLK Super Speciality Hospital has successfully implemented ABC Cloud. The Hospital is certainly a case in point here to emphasize, how cost management can influence the outcome of services both in terms of quality and affordability. Recently the hospital received a National Award for excellence in cost management by Institute of Cost Accountants of India.

ABC Cloud comes as great support to provide affordable health services to the masses without compromising on quality as it results in efficient cost control. Though there are many challenges in front of the hospital management, first of all, we need to set targets. For example targets can include maintaining financial health of the hospital; stable pricing of services or it can be providing affordable services to patients. All the targets can be intertwined to get the best results. The new tool guides us to keep control on wastage and underutilized resources. As the adage goes â&#x20AC;&#x2DC;What cannot be measured cannot be controlledâ&#x20AC;&#x2122;; so It becomes essential to calculate the cost of each and every services, resource and then make a mechanism to control it. It is easier to adopt this in manufacturing industries but due to the complexities of services in healthcare, it is very difficult to get accurate data in real time in a hospital set up. To plug holes and leakages, it is also necessary that a hospital should implement ABC Costing in all departments full fledgedly. By doing this Hospitals can achieve operational efficiency and cost reduction. Hence, it becomes easy to achieve all the set targets. The uniqueness of this innovative tool is that the financial tool â&#x20AC;&#x201C; ABC Cloud can be integrated with the Quality tool - Six Sigma which seeks to improve the quality of the output of a process by identifying and removing the causes of defects and minimizing variability in business processes. Six Sigma uses a set of quality management methods, mainly empirical, statistical methods, and creates a special infrastructure of people within the organization who are experts in these methods. Traditionally, hospitals focused more on managing revenue rather than the cost to ensure profitability. Now due to competition,

focus on continuum of care and changing scenario of Healthcare ecosystem, financial health of organization is largely dependent on efficient cost management. The resources are limited so the optimum utilization of resources is the only way to sustain in long term. Accurate costing of procedures and services leads to affordable pricing, which provides quality healthcare services to the patients. Instead of market comparative pricing, standard costing for major surgeries and packages should be developed with calculation of cost and margin. Instead of allocating the burden of additional cost on all service centers, the price revision can be done strategically. The cost centers where revenue and cost ratio are balanced, there would certainly be no need to hike prices. If implemented meticulously, hospital can witness a radical change in cost management within a year. It would not be surprising to note that due to the effective cost control measures and accurate budgeting, the Price revision are being done rationally or it is at its lower end. ABC Cloud can also absorb the inflationary pressure which forces the management to go for 7-8% increase in the prices of services annually. Hence, it is recommended that the pricing of services must be done on the basis of ABC Cloud. Only then hospitals whether it is public or private domain can provide the most competitive price to patients as well as maintain financial sustainability. For patients, accurate costing of procedures and services leads to competitive pricing which will make high-end and quality healthcare services affordable to the masses. w w w.medegatetoday.com Sep-Oct 2017

EXPERT VIEWS

HOW TO STOP HOSPITALS FROM INSOLVENCY hospitals are closing at a rapid-fire pace. Now more than ever before hospitals are facing increasing debt and are unable to gain more capital or refinancing their existing loans because it is more difficult to obtain credit. As a result, hospitals all over the country are filing bankruptcy and many even closing down.

Dr. Salil Choudhary

Director, Hosconn Consulting Services Pvt Ltd

The hospital services’ market represents one of the most lucrative segments of the Indian healthcare industry. Various factors, such as increasing prevalence of diseases, improving affordability, and rising penetration of health insurance are fuelling the growth in the Indian hospital industry. Several private players are also entering the sector with new plans of establishing hospitals and health centers around the country. All leading articles and surveys by many big consultancies show the healthcare sector is booming like never before. But there is a dark side of this rosy picture also “The hospitals are closing “ A recent survey show that across India there are around 400 hospitals which are up for sale or closed due to insufficiency of fund flow. In such scenario the term booming healthcare looks meaningless. In the current financial crisis borrowers are finding it increasingly more difficult to access capital for their investments. This is affecting one of the most important industries in our society, heath care. Hospitals are a vital part of the health care industry and they are facing especially hard times in today’s economy. It is not a surprise to many people that hospitals are facing financial difficulties. Hospitals have consistently faced financial difficulties even in a good economy. Every given day Small & Mid segment 64

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“Why are hospitals more vulnerable in the current economic crisis than other organizations? Why are some hospitals successful in the current economy and others unable to stay open? What can be done about this?” In order to measure a hospitals financial viability there are several factors to consider. First, it is necessary to identify how a hospital generates its revenue. There are several sources of revenue for hospitals which include but are not limited to revenue for providing medical services, revenue for providing nonmedical services, investments, and donations and grants from individuals, foundations, and the government. Operating revenue, or income earned by delivering patient services, is the primary way that hospitals generate revenue. Hospitals rely directly on the patient or third party payers for reimbursement for their services. Second, it is necessary to identify hospital expenses. The majority of hospital expenses result from wages and salaries paid to employees. Other expenses include supplies, depreciation, interest payments, and bad debt. Bad debt is the charges the hospital expects to collect for the services but for which it does not receive payment. Hospital revenue and expenses are used to calculate the operating margin. The operating margin measures the “hospitals profitability, before taxes, and reflects a hospitals ability to sustain and

grow its business in the future.” This is measured generally by comparing the hospitals total operating revenue against its total operating expense. The first target of any hospital today is to get operational positive in order to pay the basic wages and salaries to sustain the hospital operations. But the PAT in most of the cases goes negative as the loans and interest on the loans added with the taxes eats up most of the profit. There are many reasons why hospitals are facing financial difficulties and considering closing down. The large organizational structure in hospitals often makes it difficult to isolate just a few factors responsible for hospitals poor financial health: R eimbursement rates from third party insurer have fallen/delayed which has put a significant financial burden on hospitals. H igh cost of hospital resources: updated equipment, training and labor.  Increased percentage for doctors / consultants on the treatment bill.  Over staffing in order to maintain the organization structure even when the need of multiple layers is not present.

Recommendations for hospitals in financial distress While 2017 may appear to be a grim time for hospitals to keep their finances positive, there are several things hospitals can do to go beyond just maintaining solvency. Hospitals and health systems essentially have two options: They can either cut costs or create new revenue streams. Several creative cost-cutting techniques have been detailed over the years — curbing food waste by weight, properly sorting hazardous from non-hazardous waste and more. However, as hospitals continue to evolve; new opportunities to save money are poking their heads to the surface.

EXPERT VIEWS

 Focus on the continuum of care. The continuum of care hospitals need to focus on includes the initial admission, how services are provided within that admission to create the most efficient process for a quick yet appropriate discharge, a discharge to the appropriate post-acute setting and follow-ups with that discharge.  Remove and reduce lighting. Reduce the number of bulbs in multiplelight fixtures where possible, eliminated unneeded lighting in areas like chart racks that are now digitized and installed switches in rooms and areas where lights do not need to be on at all hours of the day.  Install solar panels in sunny areas Installing solar brings down on the electricity bill and also government is providing subsidy on electricity bills for the hospitals having solar panels.  Manage new service lines to increase market share. If hospitals want to become or remain profitable next year, they will have to monitor their service lines to see if any are leaking money. Increasing market share through new services is the most effective way to deal with any reduction in net payments.  Control labor costs with meticulous data collecting At most hospitals, more than 50 percent of expenses are related to labor costs or labor-related costs, so it becomes essential that the management keep a tab on the labor cost and review the cost data against the budgeted data frequently.  Reduce supply costs by working with vendors and physicians. Hospital owners can reduce supply costs through two main ways: working with vendors to improve contracts and encouraging physicians to make fiscally responsible purchase decisions.  Replace inefficient sinks, toilets and urinals. Water wastage is a major problem which most of the hospitals ignore. As toilets are ignored by the management, they forget a major point that water saving can boost up there profitability.

B etter financial oversight and management Requiring hospitals to have better financial oversight and management can also help hospitals regulate their finances and prevent bankruptcy.  Design models to reduce readmissions Readmissions negatively impact a hospital’s bottom line in several ways, such as the high costs associated with them and scrutiny from private health insurers and patients. There are several ways hospitals and their physicians can effectively reduce their readmissions, such as ensuring patients attend post-acute OPD visits routinely after discharge and overall providing resources to people to ensure they are taking the proper post-discharge steps.  Consider outsourcing some services Laundry services, housekeeping, food services, facility maintenance and some biomedical and clinical departments are commonly outsourced services. A hospital must be prudent when it decides

to outsource a service, though, and it must have a contingency plan if the proposal does not work out. “Whenever you outsource a service, you need to be prepared to bring it back in case the relationship disintegrates or if the third party is not able to provide the level of service we expected or anticipated,”  Consolidations and acquisitions of services Mergers provide a good solution for weaker hospitals who are considering closing down. Mergers can provide hospitals with cost savings, greater access to capital, improved utilization of resources, and more efficiency in the delivery of health care. By saving costs the hospital decreases its operating expenses and as a result consumers can enjoy lower health care costs The list can be never ending as there are many small scopes which are primary ignored by hospitals. If proper planning is done and if management starts taking care of these small things then this will help hospital the state of insolvency.

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EXPERT VIEWS

India needs to strengthen Health IT

backbone and Management Standards

Dr. Mradul Kaushik

Director- Operation and Planning for Radiant Life Care Pvt Ltd, BLK Super Speciality hospital In view of rising dual disease burden and to provide cost effective quality healthcare to all under Universal Health Care campaign, India urgently needs to strengthen and scale up its Health IT backbone and Management standards. The government is making all efforts to encourage wider usage information technology in healthcare ecosystem and it is high time for all stakeholders to come together. Health information technology (HIT) is information technology applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors. Multiple health system archetypes exist, each with varying degrees of effectiveness. India must take lessons from these systems into account but adopt an India-centric health system that is capable of powering economic development in India.

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No doubt, scaling up Health IT or digital health can lower cost and improve health outcomes and recently announced National Health Policy 2017 has also proposed establishment of National Digital Health Authority (NDHA). This would lead the future growth of use of Information Technology (IT) in healthcare ecosystem as it aims to regulate, develop and deploy digital health across the continuum of care. Health IT can be of great help in India which has to battle the dual burden of communicable and non-communicable or lifestyle diseases. In view of wider adoption of digital health in the country the NDHA would play a very critical role in strengthening the entire healthcare ecosystem. According to industry estimates, non-communicable diseases will cost India $6.2 trillion by 2030. Hence, Indiaâ&#x20AC;&#x2122;s unique needs drive priorities for healthcare technologies. The priorities are: increasing affordability through low-cost products and services, overcoming access barriers and engaging patients through digital health and effective management of care across the continuum.

EXPERT VIEWS

All stakeholders including Private players need to collaborate to build IT-enabled Electronic health records (EHRs) and patient databases would improve integrated care and population health. Concentrating on regional initiatives using mobile and Internet strategies—such as telemedicine, doctors on call and remote patient monitoring—can help improve healthcare systems. Digital health is the integration of technology and healthcare to enable effective and uniform healthcare delivery which has full potential to radically transform the healthcare ecosystem. Digital health enables solutions across the healthcare value chain: Awareness, Diagnosis and Treatment & Follow-up. Through the use of technology, rural-urban gap can be bridged. Telemedicine that includes tele-consultations, Doctor on call, Tele-radiology centres and e-ICUs. E-Health centres are being successfully run in the country by a few healthcare service providers. Lifestyle management can be digitalized with education tools, reminders for diet and medication, mobile systems to track compliance and various mobile applications. Further the patient monitoring can be digitalized by Selftesting, basic treatment at home, tracking and monitoring of health related data. Internet of things (IOT) is also transforming healthcare management. We need to push it further in the sector. The IOT is the inter-networking of physical devices, vehicles, buildings, and other items—embedded with electronics, software, sensors, actuators, and network connectivity that enable these objects to collect and exchange data. IOT has provided the seamless connection between devices. Now it is possible for the medical staff to access patient information from the cloud. The goal is to provide quality medical care to patients, and by spending a small amount on IT infrastructure, hospitals can provide good care to patients at affordable rates. Remote health monitoring is an important application of IOT. A number of healthcare apps providing cutting-edge personalized solutions have been launched. Some applications show several different ways IOT can help healthcare service providers care better for their patients. There is certainly much scope for advancement for IOT in the healthcare sector. Digital technologies can help both private and public sector’s program leaders to improve service delivery for all and the digital health programmes would have much deeper impact for rural masses as it has all required performance attributes of awareness, accessibility and affordability so vital for universal healthcare and overall a healthy India. For effective health care management medical devices and technology play a critical role not only in screening, diagnosing and treating patients but also in restoring patients to normal lives and in regularly monitoring health indicators to prevent diseases. With technological advancements, the role of medical devices is now expanding to improve quality of care across each stage of the healthcare continuum. Such

as, screening and diagnosis both accuracy and complexity of screening and diagnosis are increasing. Point-of-care / portable diagnostic devices provide care at home resulting in improved outcomes, patient satisfaction and increased access to care in under-penetrated. Treatment/Care advanced surgical equipment is not only enabling doctors treat highly critical and complex cases but also reducing length of hospital stays. It is increasingly allowing elective but complex surgeries like knee replacement, bariatric, pain management, etc. to be shifted to outpatient / short stay surgery centres. Restoration Hospitals and physiotherapy-rehabilitative centres are now enabling patients to restore their health faster and return to normal productive lives through the use of advanced assistive and rehabilitative devices. Monitoring health screening devices are enabling patients to take charge of their health at home and regularly monitor health indicators. Further, devices are being used to monitor patients remotely for early diagnosis thus minimizing hospital visits and reducing pressure on the country’s overburdened medical resources Medical technology contributes significantly to healthcare delivery costs. An estimated 3040% of capital costs of setting up a tertiary care hospitals attributable to medical technology. Additionally, depending on the hospital type, cost of medical devices and diagnostics contribute approximately 20%-25% to the cost of medical services. India should adopt universal access to essential healthcare for all, with provision being led by the private sector and the government shifting towards a payer and regulator role, with provision support focussed on under-served areas/segments. As access expands, India should proactively manage the risk of healthcare cost inflation and ensure affordability for a defined basket of essential services. To accomplish this, the health system should focus on “encouraging healthy living practices; shifting payment models away from the fee for-service model; instituting reasonable pricing norms on essential goods and services; applying HTA tools to determine access to innovation; and limiting costly imports through focus on frugal innovation and Make in India.” Hospital management is another important part of health care as public focus on clean water and sanitation; large scale immunisation programmes for prevention and increased awareness on the part of individuals are needed to reduce risk factors. Making trained talent available at the grassroots level will enable multidisciplinary primary care. Creating a technology and health IT backbone that enables data integration and continuous customer engagement will also lead to coordinated care across different points of delivery. A payer shift towards prevention is needed, with outpatient services covered by insurance and with rewards for behaviours that prioritise prevention and wellness. w w w.medegatetoday.com Sep-Oct 2017

EXPERT VIEWS

India Can Achieve Better Healthcare Goals Just by Promoting Breastfeeding Practices When the Australian Member of Parliament, ‘Larissa Waters’, breastfed her daughter inside the Parliament earlier this year while moving a Senate motion, she not only made history but also made a strong statement in favour of the practice – Breastfeeding. While the world applauded her, we Indians clapped too but it was just noise. If you we around our surroundings, they look devoid of any compassion or consideration for the breastfeeding mother or baby. Despite definitive medical advances and India being recognized as one of the best countries in Asia for specialized tertiary care treatment, more than 1.2 million babies under five die every year. Half of these deaths occur in the first 28 days of life, neonatal period. The important component that can reduce the burden and save numerous bundles of joy is simple – Breastfeeding. Surprisingly out of the 26 million babies born every year in India, only 8 million are breastfed in the first hour of their birth – the golden hour for babies that secure their future life and health. In fact the recent reports also highlight that only 46% of the babies were breastfed even in the first day of their birth. Our neighboring countries fared better and are

Dr. Dharminder Nagar

Managing Director, Paras Healthcare.

far ahead with Sri Lanka at 75.8% and Bangladesh at 64%. These statistics do make some things clear. We do have a problem, a problem becoming an abyss and the fact that we immediately need to act. The question is HOW? Who will bring the change? Is it awareness, reach, perception or infrastructure? Or perhaps all? Given below are few recommendations to ensure that breastfeeding evolves into a right of every baby:

Knowledge & Education of Mothers is imperative: Pregnant women should be given proper guidance during their pregnancy about lactation and its immense importance, practical knowledge, proper feeding practices, pumps and dietary care. It is found that women who are given prior guidance are able to adopt better feeding practices and have better feeding experiences than those who have not been given such guidance. This can be done by both government as well as private players but a proper course to impart guidance should be charted out and public-private partnerships in this direction can go a long way in achieving better results. Private clinics can be roped in by the government and given incentives to provide guiding sessions to women including those from economically deprived background who may otherwise not come forward themselves to avail advice in this regard.

Be clear about the myths & superstitions associated with Breastfeeding There are a lot of myths associated with breastfeeding in India and those need to be quelled. First time mothers even in urban India experience issues emanating from lack of knowledge. Since families are only getting nuclear, most women have nowhere to go to seek advice on best feeding practices. The fact has to be emphasized to would-be mothers that while breastfeeding might require greater effort from them given their busy schedules, it is the best choice for babies and is absolutely worth the effort. Babies who have been breastfed have better chances of surviving, lower chances of acquiring diseases, malnutrition and stunting. Apart from better bonding between mother and baby, breastfeeding also leads to improvement in cognitive performance and better educational achievements in the child.

Make mothers understand that breastfeeding is good for them too It also needs to be emphasized that breastfeeding also holds health benefits for women. Women who breastfeed their babies for sufficiently long period of time have lower risk of breast cancer, ovarian cancer and type 2 diabetes. 68

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EXPERT VIEWS

Building enabling infrastructure

What can we do?

The India Newborn Action Plan (INAP) developed by Ministry of Health & Family Welfare in 2014 has been targeting a 90 percent rate of initiation of breastfeeding within an hour of birth by 2025. To achieve these rates, there is a need for investing in creating an enabling environment for mothers, especially the working mothers. Making workplaces friendly for breastfeeding: In Delhi, where the ratio of working women is higher, it was found by a survey that about 41% of mothers felt that their offices did not have any nursing facilities. Clearly, there is a need for making laws and regulations for building infrastructure that is conducive for mother to breastfeed their babies and maintain a proper feeding schedule. Developing crèches should also be considered and there should be laws for workplaces to have breastfeeding rooms. Public places should mandatorily have breastfeeding rooms: Women in public places feel awkward in breastfeeding their new-born because of the public gaze. To overcome this problem, government has to come out with proper feeding rooms at public places. Inclusion in metros, railway stations, airports, shopping malls and restaurants is a must. Point : A case in point here can be how the Australian Parliament has been made a more friendly place to young mothers over the past few years and how Larisa Waters was able to breastfeed her baby inside the Parliament. The Australian Parliament, as it stands today in this regard, can be a good example and can be the way forward for India in many of its endeavours to promote breastfeeding practices. We look forward to the day our parliament shall also be recognized for the same.

The private sector can play a very important role in changing the mindset and leading a change in making breastfeeding a part of our lives.  Private companies can come up for setting up milk banks, under proper policy framework by the government. The private sector will only augment government’s efforts in providing the ‘Liquid Gold’ to those babies who cannot have it from their own mothers.  Ensure that just like fire exist norms and disability ramps in buildings, rooms for breastfeeding mothers are also built.  We can be active participants in creating awareness about exclusive breastfeeding.  We need to create importance about the importance and need of a specialized lactation counselor.  We can set up breastfeeding rooms where mothers can comfortably feed their babies.  We can also urge others to follow, remember every change just needs two players -an initiator and a motivator. We as healthcare providers also understand that it is a key responsibility of doctors to ensure they administer the right knowledge and guidance to new mothers to groom them towards this practice. The increasing of the maternity leave period to six months is a very welcome initiative that will most certainly boost the practice among working women. We must remember that investing in breastfeeding is the single biggest healthcare investment we can make towards improving child health in India. Let’s begin a revolution that our future generations can appreciate and live.

Setting up and promoting human milk bank Setting up Human Milk bank is another way India can, without argument, make her babies stronger. The sad news was that despite its obvious advantages, such banks were non-existent in India until a few years ago. The good news in this regard is that there is some action now and some banks have come up. Even better news is that government is considering a network of banks across 661 newborn care units across the country. The banks collect, pasteurize and store milk and is used to feed babies who cannot be nursed by their mothers because the mothers are not producing their own milk for whatever reason. It is also given to those babies who sadly lose their mothers right after birth. India can learn from Brazil, another developing country like India, in this regard. In 2011, Brazil’s milk collection in its Milk Banks was 1,65,000 litres and was given to 1,70,000 babies. As many as 1,66,000 mothers were donating their milk to these banks. There is no reason why Indian cannot replicate that success. There has been only a start in India in this field, that too in metros. All we need is a strong will and push towards achieving this goal.

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EXPERT VIEWS

Innovative technological solution for disinfected operation theatres Preamble It is estimated that throughout the world, around two hundred and thirty four million operations are performed every year . During these procedures surgical healthcare becomes the most important integral part but such healthcare faces a considerable challenge in the form of surgical site infections (SSI). SSI is considered as one of the most common causes of surgical complications as it accounts for almost 35% of hospital acquired infections . Every SSI give rise to about two weeks of additional hospital stay and develop into ten times of higher complications like deaths as compared to patients undergone operations devoid of SSIs. Infection control in Operation theatres is now easier and it is possible to monitor the system in such a way which is nowhere available in the world. The innovation in air conditioning with ductless air handling have created a path breaking solution in the field of ideal conditions in operation theatres by our company Al-med Equipments from Mumbai, India. We have come up with the innovative indigenous technology by which the electrical cost for running the OTs is reduced and round a clock maintenance is possible with better monitoring of the system so as to reduce the SSI infection from the operation theatres. Al-med Equipments also helps in erecting operation theatres as per the norms accepted by the hospital fraternity. Let’s understand the issues with operation theatres about SSI and solutions provided by Al-med about the same. Enemy of operation theatre: Biological infections (SSI) Biological infections have been the most significant reason for reduction in the success rate of operative cases in hospitals with operation theatres, apart from human errors. To increase the success rate with the help of qualified surgeons, every operation theatre should avoid biological infections in the form of – ● Air-borne infections ● Particle count Class I – (1 to 10 particles per sq.ft.) ● Class II – (11 to 100 particles per sq. ft.) ● Biological infestation ● Surface infections ● Biological infestation ● Infections due to surgical instruments In case of air-borne infections air conditioning units (ACs) are considered as one of the most important source of the operation theatre. It is so because being pre-circulating units, the window and split ACs have convenient pockets that assist the microbial growth and these pockets are almost impossible to be sealed. It should be noted that these guidelines have been prepared keeping a focus on that of biological infections. Probable Solution 72

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Mr. Zakir Hussain

What if you get ● SMS notification and alert for all types of maintenance services and every fault in system which includes: ● Actual temperature display with control ● Actual humidity display and control ● Air flow with HEPA filters ● Air cycle per hour (ACH) ● Air particle quality ● HEPA filter working status ● Positive pressure (Pascal) inside the OT ● Multiple gas sensors for detecting harmful gasses such as carbon monoxide (CO), i-butane, propane, Methane, Hydrogen, Alcohol and smoke? ● USB to PC connection for camera capable of recording which is very useful from medico-legal point of view? ● Indication for OT to be ready for operation on mobile with display of all the parameters with every hour via SMS alert? Innovative Solution from Al-med Equipments To eradicate the problems and issues mentioned above, Al-med Equipments has come up with the innovative cooling system with ductless air handling unit (AHU) with air conditioner. It is an indigenous technology for which Al-med equipments has obtained a patent from Indian Patent Office. What is the innovation? Al-med Equipments innovative disinfectant system works for the major two types of infections occurring in the operation theatre, air-borne and surface infections.

Figures - Ductless AHU and Laminar flow. In case of controlling an airborne infection central air conditioning can be the solution but it is not practically possible to have such option for following reasons – ● It is practically not possible for a hospital to keep AHU (Air Handling Unit) operational even when operation theatre is not functioning.

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● Most of the AHUs do not have any temperature controlling device. ● Every operation theatre cannot have dedicated AHU. ● Keeping independent cooling system detached from other hospital wards considered as highly impractical. ● Ducts build for AHU are practically impossible to keep clean and 100% infestation free. ● HEPA filters used in centrally cooling system can chock up due to infestation thus shortening the lifespan and causing frequent changing. ● Any pricking in HEPA filters due to increase in internal pressure may practically increase the possibility of biological infestation like viral, bacterial and fungal infestations. ● Continuous activation of AHU based centrally air conditioning system would increase electrical consumption by almost 200%. ● AHU requires minimum 11 ton compressor unit with 5 HP blower which are quite expensive. ● It would be difficult to maintain such centrally cooling system to keep it as per the guidelines provided by NBAH. ● It is practically very difficult to monitor the systemic damages in centrally cooling system. Apart from the practical difficulties, there are some operational difficulties as well. In this system – ● The cold air generated from this centrally cooling system directly flows to the operation table through duct. ● The duct becomes the reason for increasing the amount of infections. ● This makes patient complaint of shivering. ● Patient requires heating blankets while operation. Air-borne infections The Al-med Equipments’ system for eradicating the air-borne infections works in three parts. They are explained hereafter one by one. The 1st part Al-med has created the AHU in such a way, that it is compact and circulates the air from the operation theatre in cooler and cleaner way so as to produces healthier environment inside the theatre. It has utilised the new and contemporary technology and crafted a system suitably essential for the purpose of clean and infestation free atmosphere in the most important area of the hospitals. Basically, this s ystem consists of a wall mounted AHU with attached cooling system, along with measures for cleaning the air and also keeping the biological infestations under control. It works as described in the diagrammatic representation ahead

Figure - AHU without duct

The process described in the figure can be given as follows – ● The air from the operation theatre is sucked in the first compartment of the ductless AHU by the air blower placed here. ● It is passed through the ultra violet (UV) light so as to be cleaned from any germs. ● It is then passed through flange type pre-filter to hamper the amount of dust particles in it. ● Such clean air is further passes through the cooling coil so as to reduce in the temperature. ● From here the air is then enters in the second compartment where it comes in contact with expansion valve with attached humidity controller for reduction of the moisture which may provide suitable environment for the infestation. ● This area is connected with aluminium air diverter sheet that diverts the cleaned air coming from the first compartment towards the third compartment situated at the upper side. ● At this point the air comes in contact with L shaped damper that dampens the air with desired amount of moisture as per norms. ● This dampened air then sucked through the acoustic puff panel in the third compartment. ● This third compartment is provided with quality HEPA filter that cleans the air coming from the second compartment from dust particles as well as biological infections. ● With the help of panels this air is given an upward direction towards the laminar flow placed above the operation table. This ductless AHU has many more features that help in keeping the air quality within the operation theatre as per the norms of the NABH. These features provided in this ductless AHU system in the form of various sensors and indicators, are listed as follows – ● Actual Temperature Display with control. ● Actual Humidity (Rh) Display with control. ● Air Cycle per Hour (ACH). ● Multiple gas sensor for the detection of Carbon monoxide, i-butane, Propane, Methane Alcohol, Hydrogen, Smoke. ● Air particle quantity indicator. ● HEPA filter working status. ● Positive pressure (Pascal) inside the OT. ● Indication for operation ready operation theatre which will get on concern person’s mobile with display of all parameters with sms alert. ● USB to PC (485) connection for recording with quality camera fitting for anytime inspection of the operation theatre. Specialty The specialty of Al-med’s ductless AHU lies in the second part of this system. Since the cleaned air is pushed back in the operation theatre with upward direction, with specifically crafted way, is sucked in the Laminar flow. This is done so as to comply with the norms prescribed by NABH for the quality operation theatres by exerting positive pressure through its w w w.medegatetoday.com Sep-Oct 2017

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system, through independent function. It is in no way interferes in air velocity on the operation table. Its main functions are as per NABH norms are as follows – ● It creates thirty air circulating cycles ● 16% of damped fresh air component via speculated pressure in the operation room to minimise the biological load of infections ● It generated positive pressure of specified CFM which prevents outside air from entering ● Conditioned air coming in the operation theatre is double filtered through pre-filter as well as HEPA ● 84% of air from inside the operation theatre is re-circulated maintaining the temperature thus reducing the need of air cooling. 2nd part The second part of this innovative air handling system starts with the participation of the laminar flow placed near the ceiling of the operation theatre. Laminar flow is a ductless devise utilised for the controlling and directing the required air flow within the premises it is used in. As ductless AHU blows out clean air towards the laminar flow, this air is again sucked inside with the help of a sucking blower. The activities taking place in this 2nd part are as follows – ● The air from AHU is sucked inside laminar flow through another pre-filter, reducing the amount of particles even more. ● It is then put back on the operation table in controlled manner in specified FPM flow. ● Before reaching on the operation table this air is once again passed through another HEPA filter so as to be devoid of any impurities. This laminar flow unit possesses its own special features. It is ● Outdoor unit sufficient to provide necessary cooling for the operation theatre ● It is attached with 0.35 HP blower to give air velocity of 90 to 120 FPM flow near the grills or diffuser level ● This unit is easy to clean with no need take it out of the operating area ● It is attached with HEPA filter having life of around 2 years.

Figure – Air flow circulation pattern 3rd part The 3rd part of AL-med Equipments’ pioneering ductless AHU system consists of chemical free air disinfecting device O3 74

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Gen, the medical air disinfectant. It is a device that produces the Ozone gas which is utilised for disinfection. Ozone is considered as one of the best disinfectant and it is devoid of harmful chemicals. The usual process for eradicating the airborne infections is fumigation. The process of fumigation requires unhealthy and carcinogenic chemicals like sulphur dioxide, formaldehyde and hydrocyanic acid. Such process may have – ● Toxic residues ●S ide effects in the form of respiratory infections and or skin infections ●U nsuitable for human usage Al-med Equipments’ disinfection process involves no such deadly chemicals. It uses Ozone gas which is highly effective as compared to other fumigation chemicals. The disinfection process when ozone is used from the device O3 Gen, works as follows – ●O zone generated from O3-GEN kills all types of bacteria, fungus, moulds and virus by destroying their DNA through nascent Oxygen and destroys them in short period of time. ● All micro organism are susceptible to Ozone even it kills pseudomonas which are considered to be a very critical problem. ● The process needs just 45-60 min to get sterile operation theatre ●H alf life of the Ozone gas is mere 10 minutes within which it is converted to Oxygen, when administered for the process of disinfection ● I nterval of an hour is enough to schedule next operation after the administration of disinfection process with O3 Gen.

Figure – O3 Gen

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Surface infections Mopping is the primary way to keep surface infection in control. Many different surface disinfectants are available for this purpose. Any one of them can be used but the real issue is to find out the amount of infection present at a particular time inside the operation theatre. This is important for resuming the operations after the process of cleaning. Normally the swabs are used for surface area sampling and then those are checked for the amount of various infections. This is quite time consuming function. For this purpose and to avoid the time consuming process, Al-med Equipments presents a device called Hygiena for diagnosis and monitoring hygiene levels across the hospitals. It checks the parameters provided by NABH for surface infections instantly and provide you its results. It is US FDA certified product Al-med has brought to assist solely the issue of surface infestation in India for the first time.

● Get specified results with respect to many surface infections and better monitoring ● Material of desired nature as prescribed by NABH for the construction of the operation theatre is procured by Al-med Equipments and it can build the theatre as per your design. ● Since operation theatre becomes ready in short period of time, surgeries can be schedules quickly and also in more number ● Reduction of SSI helps in gaining the good name and better operational advantage Operation theatre structure Any hospital where surgeries are performed, operating theatre is considered to be the heart. The operating theatres have completely independent ecosystem of their own which needs to be managed for the smooth running of the same. Surgical sights in the form of operation theatre have got definitive structure. Apart from main operation theatre, it consists of a preparation room and a recovery room, along with washrooms and changing rooms. While building operation theatres, The National Accreditation Board for Hospitals (NABH) has stated very clear guideline. According to these guidelines, every operation theatre must have – Walls and ceiling should be ● Made up with non-porous material ● They should be smooth ● They need to be seamless without corners ● They should be easily cleanable repeatedly. Anti-static Flooring should also be ● Made seamless ● Should include skirting, ● It should not be of porous stone as it absorbs moisture and could be a source of bio-burden. Conclusion

Figure – Hygiena device Application Al-med’s ductless airflow systems have been used in various hospitals in India, with minimum air and surface infections and have reduced the cases of SSIs. Al-med claims to provide maximum clean air for the operation theatres with minimum amount of biological infestation. When Al-med’s ductless airflow system is used by any hospital, it gains significantly in its operating activities. These gains are as follows – ● Operation theatre can be operational round the clock ● Reduces the cost of operation theatre maintenance ● Reduces the electricity charges ● Adhere with the criterions of NABH for clean environment in the operation theatre ● Get purest possible air without threat of infestations

Al-med Equipments’ operation theatre building with prescribed material and ductless airflow system are quite unique as compared to other available services and systems. At the same time it is one stop solution for the prevention of all sorts of operation theatre infections. It amalgamates the latest technological advancements and provides technical assistance for maintenance alerts and real time operation theatre view on the concern person’s mobile phone, which is a facility provided by any of such service provider for the first time In India. Therefore it is the call of the time to give the controls of your operation theatre maintenance to Al-med Equipment, for all your requirements to avoid all biological infestations and maximum quality clean air.

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“Paperless” HMS Application Desktops. The Lab Machine integration with HMS application eliminates the errors that can occur in the manual feeding of test reports.

 Operation theatres’ scheduling can be done directly in HMS that helps to plan the surgeries effectively. No manual registers to be maintained.  Allow hospital staff, Medicos and patients to access the info in real-time via Apps also.

Mr Raji Reddy (Product Director) Shivam Medisoft

Hospital Management Software users are inclined towards going ‘Paperless’ wherever possible in their routine hospital management operations. The development in the mobile apps technology makes its possible to address the ‘Go Paperless’ ( Go Green) drive. It’s not a myth anymore. In a paperless hospital system every process is monitored in Real Time. Paperless function creates an environment where:  Doctor Appointments can be easily scheduled and managed daily/weekly/ monthly This can be accessed by both call center staff of hospital, and patients in mobile App for booking appointment with desired doctors, results into a reception less hospital.  Patients’ visit, prescription data and tests performed are displayed in a few clicks ( e prescription, EMR). No need to carry paper records or retrieve files.  Drug distribution and stock management in pharmacy & Stores. Auto generated alerts via sms or e mail to concerned depts’s dealers, suppliers for stock replenishment based on ROQ ( re order quantity), ROL ( re order level) defined for each Store.  Lab and Radiology Reports can be viewed on the Mobiles/Tablets/ 76

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 Completely digital EMR available on mobile app., therefore patient do not have to carry paper files, can upload or update new records via App which can be accessed by doctor during Consultation.  Substantially reduce medication related errors since the prescription is entered directly into HMS.  Data security. Unauthorized users cannot have access to hospital or patients’ data.  Physicians can advice treatment through the App.

in their seating area and complete the Registration process. Even the patient’s image can be captured and attached to the Registration data. Registration process can also be done directly by the patient, Before visiting the hospital the patient can use the Hospital App Register self, and book an appointment with the desired doctor. Using the phone camera the patient can upload his old medical records for the doctor to view during consultation. Thus patient can avoid physical records or files. After completing the Registration process, Initial Assessment by Nurses, Assessment by Duty Doctors or DMO, Assessment by Dietians and Physiotherapist is done using Tabs by simply clicking on the buttons. Updating the medication details of each patient, investigation monitoring and viewing the reports, capturing of notes by nurses/doctors during daily rounds, can be done on the Tablets.

patient’s

 Auto alerts that supports in managing hospital operations effortlessly and effectively. Enhances hospital staffs’ productivity due to automation of routine daily works. Neosoft HMS is designed with the primary objective of keeping “Technology Simplified”. It’s an application that helps all the healthcare professionals and hospital directors/governing bodies to access the real time data either through system or via apps on their Mobile Phones or Tablets. All its Mobile Apps work on Android as well as iOS which is seamlessly integrated with the main HMS application. Some of the key ‘paperless’ related features are elaborated below. Patient Registration (IP as well as OP) is done on the Tab. Patients do not need to stand in queue at the registration counters, the hospital staff will approach the Patients

Doctor information system

Medication schedule can be viewed on the Tablets and Desktop screens. This information comes directly upon the Doctor prescribing the medication. No separate entry is needed. When and what medication has been given can be monitored. Reminders, alerts help the staff to follow the medication and other procedures as per given schedule. Thus avoiding medication errors, missing medication dose. Allows Doctor to view the patient’s clinical history during the IP rounds from the Tablets that would be carried by the nurses. Allows Doctors to order investigations, prescriptions, on the Tablet itself during the patient visits. The re-entry of such details in a manual process is thus avoided. This gives additional time to the nurses to serve and attend the patients. Doctor App. This application allows doctor to view his OP appointments, view his IP clinical data, prescribe medicines and investigations, make notes, refer a patient to another doctor, set reminders, upload clinical related videos/images, etc. Also, a doctor can approve the Clinical Laboratory and Radiology Reports from his mobile apps which will be reflected in the main HMS as well as in Patient’s app.

Patient App Patient’s App allows a patient to view the doctors by speciality in a hospital, availability of appointment slots, book the appointment, payment gateway for paying the consultation charges online (if required), view his clinical records, upload old EMR (done from other hospital/clinics), etc Patient Apps also has feature to give feedback on their experience which helps a hospital to continually enhance its service quality. In short, every operation/activity in a Hospital right from Patient Registration to Patient Discharge including other processes can be done on Mobiles/ Tablets/Desktops by avoiding the paperwork. There are many more features in the NeoSoft HMS application supporting the patient safety, prevention of medication errors, NABH compliance indicators, Objection Management dashboards, and so on.

Auto Prescription for Doctors

Established in 2002, Shivam Medisoft Services Pvt Ltd, is a prominent player in the HMS (Hospital Management Software) segment. The 600+ satisfied clients, the strong technical team, the framework on which the application is developed, the dedicated Customer Support team, complete functional knowledge of hospital operation acquired over these years, etc has evolved NeoSoft HMS application into a comprehensive ERP covering all hospital operations (viz. from Registration to Financial Accounts to NABH features, etc) including EMR (Electronic Medical Records) and the Mobile Apps in Android and iOS. Please visit www.shivammedisoft.com for more details.

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E-Commerce And The Changing Trends In Healthcare Industry Vivek Tiwari

Founder & CEO, Medikabazaar

The past few decades has seen a remarkable transformation in the buying behavior of Indian Consumers. Ecommerce has taken the retail world for a storm and given birth to a new generation of entrepreneurs who are resilient to experiment with new ideas. (eg) The ecommerce boom has led toinnovation of new business models that can be applicable across various industries.The major game players with the successful model in place of E-com Industry are Amazon India, Ecart, Paytm, Flipkart and Snapdeal in the India market with 450 million users and adding 6 million every month. Online retail is one of the fastest growing segments in today’s world.Online business enables the customers to save cost and that too at their own time and convenience without having to travel long distances. In India, the consumers have now started demanding services that can cater to them personallyButit is an equally challenging market, to ensure delivery of its fundamental proposition to eliminate geographical barriers and to offer entire range of products and services to the customers’ door step. Extensive reach, appropriate logistics and infrastructure planning is the key to this business.With the increasing use of internet, desktops, tabs and mobile phones; the dependence of Ecommerce on these facilities to reach their customers is strongly evident. Healthcare is not the exception in the league and is one of the biggest upcoming ecommerce markets with it’s presence and reach globally. The Healthcare industry holds immense potential for 78

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e-commerce due to its current chaotic and fragmented nature. After hitting the retail opportunity through the start ups like Your Dost, E-skincare, Rxpress, it is the correct time for B2B section to hit the iron. Medikabazaar is one of such positively growing co in B2B type of Customer segment for all the Medical supplies including critical care, Dental and Physiotherapy providing a huge basket of offerings. The growing population and increasing life expectancy is leading to a high demand of healthcare products and services which cannot be demographically fulfilled by offline players alone in the industry. Ecom plays a vital role in not only finding the customer based emergency solution but also is the cost effective and have proved much reliable. Also the presence of only few organized players in the online healthcare market offers a great opportunity for new entrants and startups to grow especially when the demand for quality products and services is high.The one biggest advantage is it’s power of extensive reach. Medikabazaar presently caters to more than 16000+ pincodes across India along with its’ global presence. With its’ various features like comparibility of Products online in terms of Specifications and costing to hitting the Refurbish market for the no longer used Equipment, through a concept called “MEDIKABAZAAR RECYCLE”, the Hospitals and various end users remain delighted more than the offline purchase. Hence there is no limit to the growth in online healthcare retail space.

The government is taking many initiatives to develop healthcare facilities in tier II & III cities and the rural areas Since majority of India’s population resides there; the demand from these cities has increased tremendously. With our public healthcare system still lacking basic facilities, these technological solutions will become a means through which rural India will get an easy and increased access to healthcare facilities. Therefore, online retailing in healthcare has become the fastest growing segment as it caters to demand not only in tier I but tier II, III cities and rural areas, which provides the rural India with the exact same options as that available to urban India along with the flexibility of choosing the attributes that suits based on their needs such as price, features, quality, durability and warranty assisted by user feedbacks and ratings. One more important attribute of going digital with technology in healthcare apart from online shopping is E-Health Record. The healthcare record keeping procedure in India is very scattered. Conventional Paper-based records are still used, which is disorganized, often illegiblewith no resilience.However, with increase in adaptability of digital technology, the records are now being maintained online and can be accessed anytime, from anywhere. The future of e-commerce in healthcare is certainly very bright and auroral. As the industry trends suggest,E-commerce healthcare is all set for an exciting period of exploding growth in the upcoming decade. This is expected to further lead to substantial investments in supporting infrastructure, innovative and game changing business models. But I would still like to remind “ Solution for the consumer and not only the Technology is the key to success

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B2B MEDICAL PROCUREMENT PLATFORM FOR HOSPITALS CLINICS, MEDICAL PROFESSIONALS & INDIVIDUALS

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50 K+ PRODUCTS CATALOGUE & CONTINUING...

MEDIKA RECYCLE AN UNIQUE CONCEPT TO RECYCLE USED OR DORMANT MEDICAL PRODUCTS.

ASSOCIATED WITH WORLD CLASS LOGISTICS COMPANIES

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New Concepts In Medical Storage And Dispensing Modular Storage A Boon to Hospital Planners

Joy Varkey

CEO, LBS Graphic (Sales) Healthcare Division Kochi

Features - Demand

ealthcare industry is one among top growing sectors in India. Medical tourism is expected to grow manifold in coming years. Healthcare planners and infrastructure providers are all geared up for the task. However many hospitals and clinics in India need improvements in medical storage and dispensing areas. If you observe the pharmacies across India, even of some leading institutions, you can find that the medicines are stored in a haphazard manner using card board boxes, plastic boxes and even on floor bins without any cover. There is the usual dust and dirt everywhere. The medicines are left open exposed to all sorts of atmospheric adversities. Under such

conditions the potency of the medicines are reduced or lost. The controlling agencies or accreditation agencies has given certain rules and regulations for improvement. Modular pharmacy storage solutions comes handy for both planners and management for safe storage and dispensing of medicines. Different type of solutions are available in the market now. Since most products are adapted for medical storage, the skill and experience of the service provider is important. The best system is a combination of Indian and Imported material handling and storage modules with international quality. Some of the leading hospitals in South India has successfully implemented modular pharmacies.

Conventional Racking - Shelves

Modular Storage

Space Utilization

Occupies more space -Vertical space under utilized.

Requires 40% less space due to density storage, crucial where less floor space is available.

Systematic storage

Not possible in busy environment

Precise storage and labeling

Medicine Wastage

Up to 20% due to cutting strip loss and spillage.

Near zero wastage as cut strips are deposited in spill free drawers.

Medication error

Possible due to small medicine cut strips are often misplaced without identity and served in rush hours

Totally avoidable

Patient waiting time

Long due to slow retrieval time

Short due to fast retrieval of medicines.

Nature of Storage

Open - subject to direct light / dust and other contamination

Closed and completely dust free

Time required for Installation

Un predicatable

Within 24 hours

Appearance

Clumsy

Neat & classy, improves hospital ambience

Durability and maintenance

Lasts very few years if plywood or board. Steel racks get rusted.

Lasts for a generation, rust free metal &plastic â&#x20AC;&#x201C; ABS.

Staff convenience

More Fatigue

Fatigue free

Relocation

Not possible in wood, racks not usable due to wear & tear, rust.

Completely reusable, relocates and installed in 12-24 hours.

Economy

Expensive in long run

Not very expensive at the time of installation, pays by usage.

So next time you are planning for a new hospital or renovating one, think of modular pharmacy to your advantage-on all fronts. Let the pharmacy in the lobby make you proud. 80

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DOCTOR SPEAK

NAVIGATION IN TOTAL KNEE REPLACEMENT

Knee arthroplasty has been indicated with growing frequency, especially over the last decade. Its success depends on various factors, such as component design, the quality of the material used to make the component, the manufacturing process, adequate patient selection and the surgical technique. Most of these are developed by the surgical material and implant industry, and the evolution of the industry has enabled great advances in the quality of the prostheses available. On the other hand, with regard to surgical technique, surgeons are the primary factor and evolution of concepts and surgical strategy are the main factors for advances. Within this field, the most significant advance over the past decade has been the emergence of navigation systems for knee arthroplasty. Computer Assisted Orthopedic Surgery (CAOS) is a field of technological evolution that has been developing particularly over the last 10 years. These include workstations for preoperative planning and simulation and robotics for use in carrying out surgical procedures, and among these, navigation systems. The basic precepts of knee arthroplasty include reestablishment of the alignment of the lower limb and maintenance or recovery of joint stability. Navigation systems provide guidance and they measure various intraoperative parameters that help surgeons to reach these objectives.

thereby giving surgeons a greater degree of control and precision in carrying out the procedure. One example in arthroplasty is in relation to the positioning of a cutting guide, in which the navigation system provides the surgeon with information on the special orientation of the resultant cut (varus/valgus, antecurvatum/recurvatum), with great precision (Figure 1), thus allowing the necessary adjustments to be made, in order to obtain a position that the surgeon considers ideal. Hence, these are systems that are capable of helping surgeons to carry out various stages of the operation with greater precision and safety, and also for enabling decision-making and adjustments to the surgical plan according to the data obtained during the operation through the navigation system.

NAVIGATION SYSTEMS

Navigation systems take the special positions of patientsâ&#x20AC;&#x2122; anatomical reference points and surgical instruments are transferred to a computer and processed using software that is capable of providing surgeons with information relating to various steps of the operation in a visual or graphical and numerical form,

Navigation Systems provides Coordinates and aids in precision during a total knee Replacement

These systems may be based on images acquired preoperatively or intraoperatively, or may be independent of images. In imagebased systems, the software works with images acquired previously using CT or MRI, or intraoperatively using fluoroscopy (mostly used for fractures). The images need to be coupled with the patientâ&#x20AC;&#x2122;s real spatial position on the surgical table. For this, it is necessary to furnish the system with one or more real anatomical reference points. From this, the system can then discern the surgical field and the parameters programmed 82

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DOCTOR SPEAK

by the system. In image-free navigation, the system is fed only with anatomical reference points acquired during the surgical procedure, in which some regions and reference points are digitized. The method most used for transmitting information to the system uses infrared signals. These systems may be active or passive, according to the infrared generation method. Recent Studies also show that the navigation system aids in precision and better alignment and patient have a better functional outcome.

The first navigation systems for total knee arthroplasty aimed to control the alignment and thickness of the proximal tibial and distal femoral bone cuts, so as to obtain correct limb alignment. Today, several other parameters have been incorporated by different systems, such as the size and rotational alignment of the components, the ligament balance, equalization of the flexion and extension spaces, and alignment of the extensor apparatus. The navigation system used for total knee arthroplasty is therefore a precision instrument for carrying out the operation, and it also has the potential for aiding the surgeon making intraoperative decisions, through the resource of simulating actions before implementing them. It has also been shown to be a good teaching tool, given that the effect of each action performed during the operation can be seen immediately. This does not mean that the navigator does away with the need for the surgeonâ&#x20AC;&#x2122;s skills or diminishes the value of his experience, since the navigator does not point out the path to follow or make the surgeonâ&#x20AC;&#x2122;s decisions for him, but only helps him to obtain and measure the result planned for each action. Thus, on the contrary, the navigator adds power to the surgeonâ&#x20AC;&#x2122;s knowledge and experience through providing him with precise and objective parameters in real time during the operation. Conditions that impose difficulty in using conventional anatomical reference points for positioning cutting guides, such as the presence of synthesis material obstructing the access to the medullary canal, and/or conditions that imply that the ligament balance is more complex, such as in cases of major deformity inside or outside the joint or in patients with previous surgery such as osteotomy, make the use of the navigator more significant. Under such conditions, the discernment capacity of the navigator remains unaffected, and the system continues to supply precise parameters to the surgeon. Likewise, another situation in which navigation has great potential for application is in minimally invasive arthroplasty, in which the reduced direct viewing of the surgical field can be compensated by the virtual reference provided by the navigator. Navigation is a way of performing a surgery with the help of computers which may help us in achieving more precision and this would enable a better outcome. Without the help of these systems it makes me stop and then ask why? Intraoperatively and not when I see the post operative X ray coz it shows cumulative mistakes which may go un notices with non navigation. It also improves motor skills as it gives a feedback and gives trainees added security.

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EXPERT VIEWS

Choosing the Right Combination of Generic (Indigenous) & Branded (Imported) Medical Equipments For Hospitals. Medical Equipment Procurement Planning & Sourcing is the most important phase for newly built Hospital. Today there are good numbers of manufacturers of Medical Equipment, internationally and also locally in India. Imported equipment having brands of repute may be natural & first preference of buyer provided the budget/finance for such purchases permits to do so. Medical equipments contribute a significant figure towards any project cost. This article throws lights on Comparative Performances for Branded Rajendra Kadu Director, Hosconn Consulting Services Pvt Ltd. and Generic Medical Equipment / Devices /items which are essential to run the hospital as per intended objectives. Important factors for hospital equipment planning, depending upon the speciality, are the perfect balances between performance expectation and budget (Finance) availability. It is fruitful to focus on following key factors while choosing Generic and Imported medical equipment for the hospital.

Medical equipment Acuity: Medical equipment can be categorised as Low, Medium and High Acuity considering the criticality of the medical equipment for usage inside the Hospital. All Critical Care area Medical Equipments have to be of High Acuity. High Acuity Medical Equipment like Cath Lab, CT Scan, MRI, Cancer Equipment, Robotic surgery critical Pathology Equipment are predominantly imported since most of these do not have any qualified Indian manufacturer. High Acuity equipments demand for Branded Products, hence asking for higher budget provision. However in Low Acuity items (like Hospital General Furniture, BP Apparatus, Weighing Machine etc.) and Mid Acuity segment (e.g. Monitors, OT Tables, ICU Beds, Diathermy, Semi/Full Auto Analyzer etc.) good number of manufactures are available in India.. Mid Acuity equipment need to be carefully chosen depending on the criticality of application, which may fall under category of either Branded or Generic .The Equipment which fulfil General Requirements of various departments, contributing high quantities, can be of low acuity.

Personal experience, using the medical equipment, is

something on which the practitioners have relied on throughout their practicing profession. Therefore, the equipment purchase decisions are taken more on personal preference of the clinicians. The personal factor of using particular brand/model equipment by

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user/doctor is the most prioritised in equipment selection. Finance any way is equally important. Lot of buyers who believe more on specific MNC brands /models prefer to go for refurbished solutions to address their personal choice & price factor. Currently there are lot of restrictions on import of refurbished/used equipment.

BEP ( Break Even Point). Branded Medical Equipment may be a much costly affair, whereas a generic can be available at lower affordable price. So there will be a significant difference in project cost which surely affects the BEP and turnaround time of a facility. The buyer must think about viability and breakeven of the project while making medical equipment purchase decision. After sales service and the availability of the spare parts for the useful life period of Medical equipment must be considered. After sales not to be “after thought” rather must be considered as important product feature as other technical features. Equipment obsolescence is important factor for Medical

equipment purchases particularly for already running hospital. Medical equipment obsolescence needs to be considered with respect to its replacement requirement and has the economic impact on Hospital facility. Medical equipment has to be considered obsolete based on the number of years of use , breakdown rate and by technology change. Technology & usage/good usable status of old equipment has to be considered. Usage life expected of medical equipment is longer at least 5 yrs & even more.

EMR: One more technology aspect for medical equipment is automation on Electronic Medical Record( EMR). It is now necessity that all medical equipment used for diagnostic, monitoring & therapeutic purpose must generate EMR in standard digital format. This EMR report should directly get uploaded to Hospital Information Management System (HIMS). LAB equipment, Diagnostic Imaging equipment have already achieved the standardization on EMR whereas general Medical Electronics Equipment like ECG Devices, Monitors are yet to achieve this.

Patient catchment area: Medical equipment purchase can be

impacted by another aspect the catchment population the hospital caters to. If it’s in area with low or middle income strata, a high investment would not yield good return on capital investment. Whereas in the context of facilities like Hospitals focusing on Medical Tourism which has patient flow from overseas countries need to focus on Branded Medical equipment purchase. In the era of continuous upgradation of technology other options like partnering, outsourcing or hire/ lease may be considered. This analysis is a way forward to medical equipment budgeting in sync with project funding.

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