Medgate Today July Aug 2018 by Medgate Today

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Volume IX | Issue II | July-Aug 2018

Your Gateway to Health & Medical World

NHA Launches Process to Empanel Public and Private Hospitals Across India for Ayushman Bharat

FDA Strengthens Warning for use of Antibiotics 50 Crore People to be Covered under the Ayushman Bharat Most Admired Products used by Doctors, Hospitals & Clinics

Healthcare IT

An Advance Media Publication

Advance Media Group A Healthy Journalism

EDITOR SPEAK

The outlook of Healthcare: Digital Health Importance of Technology In Today’s Medical field Future Advancement for the Betterment Of People lives The health care industry see a 21% increase in IT by 2020, according to research . Across all health care industries, there is a demand for creative, thoughtful uses of health related information, mobile technology, and digital diagnostics . Here some of the technology that are changing and update to the course of health care in future-:

Magazine

Volume - IX Issue - II July-Aug 2018 Editor Feature Editor Editorial Advisor

Digital Diagnostics

Making health care more affordable and accessible it includes digital diagnostics options for people who need it, especially those who can't get to doctor's clinic. This is one of the main themes of digital health. One example of digital diagnostics is a softwarebased Alzheimer's diagnostic test that can detect impairments on the hippocampus (the first area of the brain to be affected by the disease) by focusing eye movement.

Ultra-fast scans

Ultra-fast CT scanner in this year, which can capture a still image of a heart in one beat. According to research, about 60% of patients have heart rate of higher than 60 beats per minute and are turned away from scans because their heart beats too fast to scan. With this new technology CT, doctors can see specific areas of the heart that they could not see before.

National Head Honorary Editor Dy. Manager Sales & Marketing Subscription & Circulation Sales and Marketing Graphic Designing & Layout

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So the conclusion is that technology is the main part of the medical field to save, advancing and make life of people so easy . Have an insightful reading. Your suggestions are most welcome! E-mail: editor@medgatetoday.com Website: w w w . m e d g a t e t o d a y . c o m

Razi Ahsan, Neeraj Vats GP Capt. (Dr.) Sanjeev Sood Dr. Sharad Lakhotia Afzal Kamal Dr. Sarika Gupta Deepti Tripathi Asha Kumari Faiyaz Ali, Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath, Zyaul Haque Ansari

Circulation Office: Advance Media Group Bldg.No-256/6 Office No-02, Near Pocket 10B, Jasola, (Behind Apollo Hospital) New Delhi - 110025 Tel: +91 - 11 - 2694 6348 +91 - 11 - 64626351

Digital therapy

Digital therapy is very important for patients who need home care, and can't afford to travel to a clinic, or have no way to get to a clinic for therapy. So there are many medical companies that combines mobile technology with artificial intelligence to provide patients care after they returned home from the hospital or doctor's clinic. It's been described as a "GPS navigation system for patients." There is a daily to-do list for the patient and a tracker for diet and exercise. The company has performed trials with different-different fields like cardiovascular, pulmonary, and mental health patients.

Dr. ma Kamal

Wearables

Wearable technology is going to play a very important role in health care in upcoming years . The Consumer Electronics Association reports that sales of fitness trackers and smart watches will reach 1 billion this year. But monitoring fitness is only the beginning. For instance, Intel teamed up with the Michael J. Fox Foundation to use wearables to find certain characteristics of Parkinson's disease (second most significant neurogenerative disease in the world after Alzheimer) .

2018

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C o n t e n t s

Home Health care services, Changing demographic of patients

Tackling the price war in Pharma Sector

PSRI Hospital organized walkathon ��06 Delhi Orthopaedic Association (DAO) will bring out a consensus guideline to improve the trauma care ��08 Dr. Reddy’s and UCB India enter into an agreement to co-promote and distribute Briviact® for ��08 Fortis Hospitals joins hands with RNTCP & ICMR for a TB free India ��09 Fortis Hospitals joins hands with RNTCP & ICMR for a TB free India ��11 (NHA) launches process to empanel public and private hospitals across India for Ayushman Bharat ��10 UNSW student’s pioneering artificial intelligence boosts IVF success ��10 Dr. Reddy’s Laboratories defends its right to launch Buprenorphine and Naloxone Sublingual Film in the U.S. Market ��12 Bombay HC Cuts Short Sentence for Acid Attacker After He Marries Victim and Decides to ��12 Team Based Management - A Necessary Strength For Cancer Care ��14 High intensity exercise in teenagers could ward off heart disease ��16 India sees high level of stress due to work and finance related issues, reveals 2018 Cigna 360º Well-being Survey ��18 Potential for Reuse of Syringes based on recent government order for sale only through prescription ��20 Hospital plays matchmaker, guides 3 couples to cross-donate kidneys ��21 FDA strengthens warning for use of antibiotics ��22 E-learning in Medical Education ��24 How Relevant is it for Doctors to have Equivalent Knowledge of Computer Science with Medical Science. ��28 Spaces that bring cheer to reduce fear ��30 10 Ways to brand and market your hospital and practise ��32 Technology assisting doctors ��34 Transition Care to Improve Productivity of Hospitals & Patients’ Recovery ��36 Indian Doctor at Top U.S. Hospital Reveals Brain Cancer Treatment Breakthrough ��38 The unorganized state of the distribution system of the pharmaceutical market in India ��42 Infection Prevention and control ��46 10th VOH International Conference ��58

The Silent Killer “Hepatitis kills millions of people every year

Importance of timely diagnosis of cancer and its treatment

Healthcare is Predominantly Driven by Digital Technology

10th VOH Indore Conference:

Don’t ignore your child’s tummy troubles

We are what we eat!

Designing and rolling out a scheme that will benefit more than 50 crore......

‘50 crore people to be covered under the Ayushman Bharat

How Government spending is benefiting future of EMS in India

Most Admired Products used by Doctors, Hospitals & Clinics

NEWS Update

PSRI Hospital organized walkathon

✓ PSRI Hospitalorganized Walkathon to spread the message “How important a walk can be for Health” ✓ More than3500 responsible citizens and walked together this morning with an aim to create awareness about health in the society Spreading awareness about the intrinsic correlation between Good health and walking, over 3500 enthusiasts got together for ‘Walkathon’ organised by PSRI Hospital. Doctors, patients, celebrities from different walks of life, and students assembled to shake their legs to celebrate ‘22nd Foundation Day’ of the tertiary health care institution. Zumba dance and yoga session was also organised in the beginning to create an aura of a mesmerizing and magical morning. The event was organised in alignment with the ‘Fit India Campaign’ promoted by Prime Minister Sri Narendra Modi to promote overall health. The participants were cheered by Mrs. Sunanda Singhania – Director J K tyre, along with actor, TV presenter & fitness freak Ms. Mandira Bedi. Mrs Singhania flagged off the walkathon. The fitness enthusiasts displayed lot of excitement and were joined by Dr. Dipak Shukla, CEO, PSRI Hospital. Besides celebrities, over 1000 students from 12 colleges and executives from corporate houses like MMTC, KRIBHCO, ONGC, NTPC, IOC, EIL, BHEL, HERO HONDA, and Mother Dairy etc participated in the event. Other participants were from areas including GK 1, GK 2, Saket, CR Park, Malviya Nagar, Hauzkhas, Panchsheel RWA & association & DPS School, Green Field, Manav Rachna, Birla Vidhya Niketan, Jamia Milia Islamia. Embassy officials from Afghanistan, Uganda, Australia, Oman, Iraq, New Zealand, Canada, UAE, Fizi, Sudan, Rwanda too 6

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came forward for the participation. Their willpower, dedication and inner strength has brought them this far to lead a better and healthy life now. Walkathon covered around 5Km starting and ending at the hospital passing through select city walk, sports complex, Saket road etc. The hospital also organized energy drinks, First-Aid counters and 8 ambulances at various spots in order to take care of the participants. According to Mrs. Sunanda Singhania – Director J K tyre,’’I am happy that we took this initiative to bring together the society in order to spread awareness so that each one of us adds a day extra in our lives. On 22nd foundation day as a leading healthcare provider we feel it’s our responsibility to bring the society for a cause, which benefits health of all. According to World Health Organization (WHO),’’ Cardiovascular Diseases (CVD’S) are the number 1 causes of death globally: more people die annually from CVDs than from any other cause and walking can reduce the chances of Heart stroke. An estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to coronary heart disease and 6.7 million were due to stroke. Dr Dipak Shukla, CEO, PSRI Hospital also added,’’ This is a big initiative, and we at PSRI Hospitalhave come forward to walk together for good health. I am happy to see that our hospital is equally contributing to spread awareness among the people and their loved ones to stay healthy and keep fighting against many lifestyle diseases”. Taking steps and increasing physical activities can be an important step towards healthier life. People who are physically active live longer and have lower ricks of chronic diseases which include stroke, Type 2 diabetes, cancers, etc. Brisk walking for just 20 minutes a day can help you fight many chronic diseases.

NEWS Update

Delhi Orthopaedic Association (DAO) will bring out a consensus guideline to improve the trauma care ✓ Trauma is the most neglected disease of modern developing nations. ✓ Trauma claimed one live in India every 2 minutes. ✓ Conference on “Prevention of complications in trauma care.” will be organised by DOA on Sunday Trauma, the most neglected disease of modern developing nations, claimed one live in India every 2 minutes. Considering trauma as one of the leading healthcare problems, Delhi Orthopaedic Association (DOA), a group of over 1000 Orthopaedic surgeons of Delhi NCR is organizing its mid-year Conference (MIDCON, 2018) on Sunday in national capital New Delhi. According to a report by the Ministry of Road Transport & Highways, Government of India, more than 1.5 lakhs per year which means that 17 people are dying every hour. Another 5 lakhs are injured severely, in road crashes. The number of people killed in road accidents in India issecond highest globally, which is road crashes account for more than 44% of all un-natural accidental deaths in India and 51% of all those killed between the ages of 18 and 30. All Trauma is not Road Traffic Injuries. According to Indian Society For Trauma And Acute Care (ISTAC), 22.8% of all trauma is transport related injuries. Majority 77.2% is another trauma like - falls (pediatric age group), agriculturally related trauma, fire arms, intentional self-harm, assault, fall of objects, burns, drowning, natural disasters, and terrorist attacks. “An attempt to measure catastrophic levels of health expenditure on accidental injuries, road traffic accidents, and falls, finds that the burden of out-of-pocket expenditure is the highest for

such injuries. The financial burden is unusually high for poorer households in rural areas, and those seeking treatment at private health facilities with no health insurance. Public health facilities for trauma care and health coverage for low-income groups could help these vulnerable households,” said Dr. Raju Vaishya, scientific chairman of the MIDCON, 2018. According to Professor Ramesh Kumar (President, DOA), the theme of the conference is “Prevention of complications in trauma care.” The conference will cover the management of fractures of all parts of the body, with nine sessions of one hour each per segment. The faculty includes experts from the UK, from all parts of the country and local experts from Delhi. Over 250 surgeons are expected to attend the conference from Delhi and other parts of India. There is a poster competition for the members of Delhi Orthopaedic Association. Also, there is a PG quiz for postgraduate students attending the conference. The philosophy of the conference is based on the theme of IOA President: ‘Train the young, to enrich the future.’ Dr. Lalit Maini, secretary of DOA, said that for the first time, Delhi Orthopedic Association has also brought in the social direction in the conference, by promoting the idea of ‘No to Plastic”. Hence, during this conference, the writing pen and delegate bags used are eco-friendly and carry forward the message of ‘say no to plastic”. During the conference a questionnaire based Survey on Hip Fractures which would be filled up by each surgeon attending. The data coming out of this survey would be analyzed and brought out as a consensus guideline white paper in the coming months. It would help improve the trauma care in our population.

Dr. Reddy’s and UCB India enter into an agreement to co-promote and distribute Briviact® for the treatment of Epilepsy in India Dr. Reddy’s Laboratories Limited (BSE:500124, NSE:DRREDDY, NYSE:RDY) and UCB, a biopharmaceutical company, announced today that they have entered into a distribution and co-promotion agreement for Briviact®, a brand of brivaracetam. The agreement grants Dr. Reddy’s the exclusive right to distribute Briviact® in India. Briviact® (brivaracetam) is approved as an adjunctive therapy for the treatment of partial-onset seizures in epilepsy patients who are 16 years of age and older. 8

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V. Ramana, CEO – Branded Markets (India and Emerging Markets), Dr. Reddy’s said, “In our endeavor to make innovative medicines accessible to patients in India, we are excited to partner with UCB India for Briviact®, a novel treatment for epilepsy that will make a difference to the lives of patients living with epilepsy.” “We know that as many as one third of people with epilepsy are currently uncontrolled on their existing medicines.” Explained Max Bricchi, Head of International Markets, UCB Neurology Patient Value Unit. “This partnership

is another important step towards us providing value together to patients by making Briviact® available as an additional treatment choice for epilepsy.” Epilepsy is the second most common neurological condition and as per a recent study*, an estimate of 70 million people suffer from it worldwide. There are over 12 million people suffering from epilepsy in India, which contributes to nearly onesixth of the global burden.

Fortis Hospitals joins hands with RNTCP & ICMR for a TB free India

WORLD FORUM FOR MEDICINE Leading International Trade Fair

DÜSSELDORF, GERMANY 12–15 NOVEMBER 2018

Dr Veena Aurangabadwala

Midlife crisis is not a myth but a reality. For women, in addition to kids growing up and becoming independent, it is finally a time when the woman can focus on her ambitions and her career, while balancing her family responsibilities. This is also the time that 30-40 % women develop benign conditions such as fibroids in the uterus / breasts, cysts in the breasts causing some or no symptoms. They also have menstrual irregularities sometimes stress or sometimes hormonal change induced. This is the time to take additional contraceptive precautions. Menstrual abnormalities such as heavy menstrual bleeding leading to anaemia may indicate the extremes of hormonal changes that happen before and after menopause, known as the Climacteric. This phase of climacteric can last as long as 5 years prior and up to 2 years following menopause. Women do experience extremes of mood swings, hot flashes, phases of depression, loosening of abdominal skin, bloating, vaginal and at times urinary symptoms too. But they may also be a sign of the most dreaded precancerous or cancerous changes in the reproductive organs. It is important to seek medical attention of a specialist, to rule out possible cancerous changes and treat these conditions by medications, or surgically (if required). In the light of increasing sporadic (not inherited) incidence of breast cancers, and the less aggressive cervical cancer, all women above the age of 40 years, must get their Pap smears and Mammography done at regular intervals of 1-3 yrs (based on familial risk factors). All women must know the technique of Self Breast Examination (SBE). A health check up once in a year or two (including these screening tests) will help us women stay fit and help identify any new medical conditions requiring attention. A healthy Midlife can make a richer and healthier second innings

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NEWS Update

National Health Agency (NHA) launches process to empanel public and private hospitals across India for Ayushman Bharat CEO, National Health Agencyurges hospitals and healthcare service providers to maintain the motto of service to mankind The National Health Agency (NHA), apex body to implement AYUSHMAN BHARAT today launched a formal process to empanel public and private hospitals to implement Ayushman Bharat-National Health Protection Scheme (AB-NHPM) to achieve universal health coverage. The objective is to improve access for the most vulnerable, unreached sections of the population and holistically address healthcare by covering prevention, promotion and ambulatory care at primary, secondary and tertiary levels. Speaking on this development, Dr. Indu Bhushan, CEO, National Health Agency and Ayushman Bharat,urgedall the hospitals and healthcare service providers to maintain the motto of service to mankind and come forward to join Ayushman Bharat, India’s healthcare revolution, in spirit and deed. “I call upon each one of you to partner with the mission through the empanelment process initiated today to enhance the accessibility for the people who need it most. I also request all the States/ UTs Governments to help us in garnering the support of hospitals and healthcare providers for this path-breaking mission,” Dr. Bhushan said. Dr. Dinesh Arora, Dy. CEO, Ayushman Bharat said that the aim is to provide financial protection to 10.74 crore deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data. “We invite all private and super-speciality hospitals across India for empanelment as they play critical and indispensable role in this mission. “We are also making every effort to ensure

that the empanelment process is conducted in a transparent, time-bound and non-partisan manner based on specific criteria, eligibility and guidelines,” Dr Dinesh Arora added. He further said that under Ayushman Bharat, both public and private healthcare systems will get strengthened and work in partnership to provide accessible and equitable healthcare services to all entitled beneficiaries. Following the announcement today, the State Health Agencies (SHA) through State Empanelment Committees (SEC) will start empaneling private and public health care service providers and facilities in States and UTs as per the given guidelines. At the ground level, district, sub-district and block level workshops will be held to brief details of empanelment criteria, packages, processes and address any queries. Following the workshops, hospitals interested to get empaneled can do so by visiting the web portal, www.abnhpm.gov.inwhere complete details of the process can be accessed. The State Health Agencies shall ensure empanelment within stipulated timelines for quick implementation if the applicants meet the essential criteria as defined for general or specialty care facilities. Over and above the essential criteria, facilities undertaking defined speciality packages are required to certain additional eligibility requirements. Specific criteria are outlined for cardiology and cardio-thoracic vascular services, cancer care, Neurosurgery, Burns, Plastic & Reconstructive surgery, Neonatal/Paediatric Surgery, Polytrauma, Nephrology and Urology Surgery.

UNSW student's pioneering artificial intelligence boosts IVF success A problem first posed in a UNSW lecture has driven a current Medicine student to design a pioneering artificial intelligence system that is now helping women become pregnant via IVF. Aengus Tran, 24, is in the final year of his undergraduate studies but has already joined forces with his brother Dimitry – an AGSM @ UNSW Business School Executive MBA alumnus – to set up a company called Harrison-AI which is improving embryo selection in IVF clinics. The spark came from a visiting lecture by Dr Simon Cooke, the Scientific Director at IVF Australia, who explained how embryologists have traditionally manually assessed groups of embryos based on physical appearance at a limited 10 July-Aug 2018 w w w. m ed e g a te to d a y.co m

number of critical development check points, before selecting which one they felt would be most likely to result in a pregnancy. Aengus Tran identified that artificial intelligence could be used to make those decisions faster and also better – based on machine learning from thousands of previous successful and unsuccessful embryos – and ultimately designed a system that is now known as Ivy. Ivy is a self-improving artificial intelligence that continuously learns from the embryos it analyses via a comprehensive three-dimensional assessment of the growth of the embryos through all stages of development in an incubator. It then relates this data to whether a fetal heart has developed or not.

“Ivy has taught itself how to select out the embryo with the highest potential to create a fetal heart,” explains Tran, who is Chief Data Scientist at Harrison-AI. “It starts off with a completely blank canvas and it's not influenced by any previous human knowledge or bias. It has learned directly from thousands of embryos that have had a known fetal heart outcome and has slowly and steady improved itself to become better and better at selecting embryos.” Harrison-AI is now in partnership with Virtus Health, one of Australia’s leading providers of assisted reproductive services, which is poised to introduce Ivy technology in IVFAustralia clinics nationwide and also across Europe later this year.

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NEWS Update

Dr. Reddy's Laboratories defends its right to launch Buprenorphine and Naloxone Sublingual Film in the U.S. Market Dr. Reddy’s Laboratories Ltd. (BSE: 500124, NSE: DRREDDY, NYSE: RDY) announced today that following the launch of its generic Buprenorphine and Naloxone Sublingual Film in the U.S. Market, the U.S. District Court for the District of New Jersey has received and reviewed an emergency application from the plaintiffs in the current patent litigation for a temporary restraining order and preliminary injunction against Dr. Reddy’s. Pending a hearing and decision on the injunction application, the court has issued a temporary restraining order against Dr. Reddy’s with respect to further sales and commercialization of Buprenorphine and Naloxone Sublingual Film within

the U.S. The court order does not include a prohibition on commercial manufacturing of the product. The plaintiffs will be required to post a bond or other security totaling $18 million (USD) to satisfy any losses or damages incurred by Dr. Reddy’s during the period of the temporary restraining order. The court has scheduled an expedited hearing of the preliminary injunction for Thursday, June 28, and a ruling is expected soon thereafter. The proceeding only involves one patent, U.S. Patent No. 9,931,305. Dr. Reddy’s remains confident in its legal positions on this patent and believes it will prevail on the issues raised with respect to the application for injunction.

Bombay HC Cuts Short Sentence for Acid Attacker After He Marries Victim and Decides to Ger Treatment of Victim Done by Donating His Skin In the matter titled as “Anil Shivaji Patil versus The of Maharashtra”, bearing Criminal Appeal No. 312 of 2014, the Hon’ble Division Bench of High Court of Bombay vide judgment dated 27.06.2018 has reduced the sentence of the acid attacker accused as the said accused and the victim have decided to marry each other and lead a peaceful life and have also decided to get treatment of the victim done from a plastic surgeon for which the accused has undertaken to donate his skin.

Facts of the case The incident appears to be an outcome of a love affair between the accused and the victim of the crime. It appears that both the Appellant and the victim were having love affair with each other for a long time. However, when the accused asked her to marry, she refused. On such refusal the accused became angry and used to threaten the victim. On the date of incident i.e. on 16/04/2010 when the victim was proceeding towards her college along with her friends Bhagyashri and Pranali, the accused came there and threw Acid on the face and shoulder of the victim. Thereafter vide the Judgment and Order passed by the learned Additional Sessions Judge, Khed, dated 18/12/2013 convicted the accused for the offence punishable under Section 326 and 341 of IPC and sentenced to suffer rigorous imprisonment for life and to pay a fine of Rs.25,000/ in default to suffer simple imprisonment for three months. Insofar as the offence punishable under Section 341 is concerned, the learned trial Judge has sentenced Appellant to suffer rigorous imprisonment for one month. 12 July-Aug 2018 w w w. m ed e g a te to d a y.co m

Against the said judgment and order passed by the Ld. Trial Court, the accused filed the present appeal before the Hon’ble High Court of Bombay thereby submitting that the sentence of life which is imposed by the Learned Trial Court for the offence punishable u/s 326 is disproportionate to the facts of the case.

Judgment of Hon’ble High Court of Bombay After hearing all the submissions of the accused the Hon’ble High Court of Bombay reduced the sentence of the accused to 8 years which he had already undergone and has held that: 5. It is further to be noted that after the conviction and during the pendency of the Appeal, the matter has been amicably settled between the Appellant and the victim. Both of them have been married to each other on 22/06/2017. Not only that, after the marriage the victim is required to take a treatment from a plastic surgeon and for which the Appellant has undertaken to donate his skin. The learned APP on the last date was requested to enquire from the concerned Police Station. On enquiry he has confirmed the fact with regard to the marriage of the Appellant and the victim. 6. The Appellant has already undergone the sentence of more than 8 years. We find that the said sentence is more than sufficient taking into consideration the nature of the factual background. We find that the Appellant and the victim have decided to lead a peaceful life and have also decided to get treatment of the victim done from a plastic surgeon for which the Appellant has undertaken to donate his skin. It is just and necessary that the Appellant and the victim be permitted to lead a peaceful life.

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NEWS Update

Team Based Management A Necessary Strength For Cancer Care

etting diagnosed with cancer is the most difficult a person goes through – emotionally, psychologically and financially. The loved ones also go through the same roller coaster: feelings of doubt, uncertainties, challenges and so much more. It becomes all the more important to know and identify who will be working with you in your journey from diagnosis to cure in order to maintain a happy and positive sense of hope and belief! Generally, one is acquainted with only the word ‘Oncologist’ and rarely knows the difference between Medical, Surgical and Radiation Oncologist. It is important to know that an oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer. The field of oncology has three major areas: medical, surgical, and radiation. A medical oncologist treats cancer using chemotherapy or other medications, such as targeted therapy or immunotherapy. It is also important to realize that your team of health care professionals who will join hands to cure the disease you suffer from is knowledgeable about the many different aspects of cancer: the medical, physical, emotional, and spiritual. They will play a very important role in your life and therefore, you can cast your fears aside and be bold to ask any questions, clarify any doubts and seek answers for all your apprehensions. You deserve all the information that can make you strong to go through your journey of treatment for cure. Some of the health care professionals who work with people with cancer include: Surgical oncologist - A doctor specializing in treating cancer with surgery. Radiation oncologist - A doctor specializing in treating cancer using radiation therapy in the form of IMRT, IGRT, STEREOTACTIC RADIATION THERAPY along with conventional There Dimensional and Two Dimensional Radiotherapy. Medical Oncology: The doctor who specializes in cancer treatment with chemotherapy and targeted therapies. The good thing is that each person who is a part of the team to take care of you is there to help you to recover. You are the most important member of this team and all others are converging to focus on you to treat you and take you to the horizon of recovery. One needs to be aware that cancer care is a world of professionals who learn first about the cancer followed by learning about its treatment with various tools of surgery, radiation therapy and chemotherapy. Each one of them presents their perspective and value in its treatment.

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Dr Gagan Saini, Principal Consultant, Department of Oncology, Max Healthcare says, “It has been learnt that the best outcomes are achieved when all the different professionals sit together to plan the best course of treatment. We don’t get second chances and we have to ensure that cure is the only viable outcome we are focused on.” A “tumour board” approach where specialists of each type of cancer (called as disease management groups) sit together with radiologists, pathologists and nuclear medicine physicians for an extensive and thorough discussion about the patient in terms of disease and individual issues of age, medical condition and other socio-economic aspects to better personalise and better the outcomes and survival for each patient has guaranteed world class cancer treatment. Research reveals that care for cancer is getting better and over the last two decades an overall survival rate of an upwards of 80 percent is being reported internationally. The difference has come by strides in Cancer management from an individual based approach to a “disease management group” based approach along with an improvement in screening and detection. Improved survivorship has brought forward issues of quality of life that are a result of radical surgery or extensive radiotherapy or toxic chemotherapy. Now, these patients have the need for better rehabilitation in terms of physical rehabilitation of strength and skills so that they can live their life as normally as possible. There is a need of not just physiotherapy but also exercise therapy which not only improves quality of life but also cancer survival. There is a felt need of “target nutrition” for rehabilitation of cancer patients. Recovery is not just physical but also mental recovery with better psychological counselling goes a long way in bringing life back into the years. The intent of a world class quaternary cancer centre is to bring all this under one team under one roof to be able to provide a truly holistic treatment and healing to its patients. "When I was young and first heard the idiom, ‘Having your cake and eating it too’, I found it to be an impossible yet lovely thought. After all, who wouldn’t want the best of both worlds and yet here I am in my middle age looking at our patients who are recovering from this deadly disease and thereafter, finding their place back into this world after a holistic healing. It is therefore suitable to say that team based approach is a necessary strength for cancer care for better patient outcomes.”

NEWS Update

High intensity exercise in teenagers could ward off heart disease New research published in Experimental Physiology has indicated potential differences in heart health benefits of exercise intensity in teenagers. Teenage years are an important stage of life, with research suggesting it is a time during which heart diseases start to develop. These findings indicate that teenagers who participate in high intensity exercise have lower blood pressure. This may lead to a lower risk of developing heart disease later in life, but this requires confirmation with further research. This study, conducted by researchers at the Children’s Health & Exercise Research Centre, University of Exeter, recruited healthy teenage males (12-15 years old), who underwent testing on four separate occasions across three weeks. In the first visit, participants performed an exercise test to calculate the exercise intensities reflective of vigorous and moderate intensity exercise. After this first visit, all participants completed three experimental conditions in a randomised order and on separate days: 1) vigorous intensity exercise; 2) moderate intensity exercise; and 3) no exercise, which served as a control. Blood pressure was monitored every heart beat before and up to one-hour after the exercise. The measurements also involved ultrasound images of the carotid artery, the main blood vessels that supply the head and neck, to determine the ‘stretch’ of the artery and how this impacts the control of blood pressure following exercise. In the hours following exercise, blood pressure decreases below resting values. This is known as post-exercise hypotension. These results suggest that in teenagers, eight bouts of one-minute’s worth of running at a vigorous intensity (i.e. running close to the maximum heart rate) caused post-exercise hypotension lasting up to one-hour. The same effect was not observed following running at moderate intensity (i.e. jogging), where blood pressure was restored just twenty minutes after exercise. The stretch of the carotid artery (which supplies the brain with oxygenated blood) and the brain control of the heartbeat, which are known to monitor and adjust blood pressure, were similar between the two exercise intensities at one-hour after the exercise. These findings indicate that exercise intensity alters other mechanisms of adjustments in blood pressure differently, one-hour following the completion of the exercise in healthy teenagers. This study is thus the first to show that post-exercise hypotension is dependent on exercise intensity in healthy 12-15 year olds. The fall in blood pressure of healthy teenagers may have a long-term clinical importance if translated to those with high blood pressure, as previously reported in adults. Similarly, the blood pressure reducing effects of the exercise could lead to better blood pressure control, particularly when young people face stressful situations. 16 July-Aug 2018 w w w. m ed e g a te to d a y.co m

Although these data are novel, the ethical implications of working with teenagers meant that all measurements were taken non-invasively, which may have reduced accuracy in comparison to more invasive drug-infusion methods. Also, the research involved only boys, which does not allow extrapolation of the findings to girls. Furthermore, the observed reduction in blood pressure was only measured up to one-hour after a single bout of exercise. However, the authors aim to expand these initial findings to children, teenagers with hypertension and other conditions that increase the risk of heart disease, such as obesity and low levels of fitness. Similarly, the research team also wish to investigate whether the decrease in blood pressure results in lowered vessel reactivity to stressful situations. Finally, the effects of exercise training on the control of blood pressure following exercise in teenagers remain to be seen. Ricardo Oliveira, a Brazilian PhD student funded through the Science without Borders PhD scheme who led the research, enjoyed testing (and educating) the participants: “The best part of the research was the involvement and dedication of the participants, who we always find are better research participants than adults! All were disappointed that the project came to an end and they reported to have enjoyed visiting the university facilities, participating in a scientific study and learning new information about their heart, blood vessels and how the cardiovascular system responds to exercise.

NEWS Update

India sees high level of stress due to work and finance related issues, reveals 2018 Cigna 360º Well-being Survey Cigna’s (NYSE:CI) India business, Cigna TTK Health Insurance, a joint venture between U.S.-based global health services company, Cigna Corporation and Indian conglomerate TTK Group, today released the results of its 2018 Cigna 360º Well-Being Survey – Future Assured. The findings reveal that stress levels are high in India compared with other developed and emerging countries including the United States, UK, Germany, France, China, Brazil and Indonesia. About 89 percent of the population in India say they are suffering from stress compared to the global average of 86 percent. In addition, one in eight people have serious trouble in dealing with stress, with Millennials suffering more than other groups. Nearly, 75 percent of respondents in India do not feel comfortable talking to a medical professional about their stress - cost is one of the biggest barriers to seeking professional help. Now in its fourth year, the 2018 Survey adopted a more forward-looking approach #Future Assured, exploring people’s perceptions and concerns on health and their sense of well-being across five key areas - physical, family, social, finances and work. This year’s survey is Cigna’s most global yet, talking to nearly 14,500 people in 23 markets around the world. India takes the top spot in the overall global well-being Index for the fourth year running. The country only showed slight declines in Physical, Social and Family wellness this year, while respondents remain optimistic about Work and Financial well-being. The largest percentage falls are in the Physical area were seen in weight and nutrition management, followed by sleep-related challenges. In the Social pillar, over 50 percent of people from India said they are not spending sufficient time with

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friends or have enough time for hobbies. The dip in Family well-being is mostly due to growing concerns about the ability to financially support parents and children. WORKPLACE WELLNESS SCORES HIGH Work and finances are the key reasons people gave for their high level of stress. However, workplace wellness overall scored high, with about half the respondents saying they have received support and are participating in a workplace wellness program. The majority, 87 percent, said that workplace wellness programs are important in choosing between two potential employers. While current workplace wellness programs are making stress marginally more manageable, it seems there is still plenty of room for improvement. “The workplace plays an important role in the health and well-being of an employee. Managing workplace stress is important for corporations, as they can include health and wellness programs in every employee’s beneﬁts package. Employers can offer practical solutions such as flexi-hours or stress management programs that include mental wellness. These benefits can boost employee confidence and make them feel that their role in the workplace is really #Future Assured. At the end of the day, good health equals good business,” said Prasun Sikdar, Managing Director & Chief Executive Officer, Cigna TTK Health Insurance. FINANCIAL PREPAREDNESS IS A MAJOR CONCERN The findings show that one in two respondents in India plan to finance their medical expenses from their savings in old age, followed by insurance. Four in ten people in India have purchased health insurance for themselves. The

people who claim to be ready for older age are better at planning; they do regular health checks and own insurance. They are also more likely to be married with children, and a high proportion have full time employment and are more affluent. HIGH WILLINGNESS TO SHARE HEALTHCARE DATA In India, private healthcare is perceived to be superior to public care on every aspect, except cost, by a resounding majority. As a result, there is a huge preference for private healthcare in India, with the majority utilizing this system across all medical conditions. There is also a high willingness to share data in India. Almost 90 percent of those surveyed said that they would be open to sharing their healthcare data, as they see the benefits for better treatment and lower costs. Being clear about how data will be used is crucial, with about half of the respondents saying they would want to know how their data is being utilized. “Serving the under penetrated market with needs based solutions will continue to play a pivotal role in this sector. We believe that innovation in health insurance is especially important in India, with an increased focus on condition management, blockchain technology, adoption of wearable and portable devices. There are clear advantages from the use of digital health data. As digital health devices evolve, more data will be available about lifestyle and disease management for insurance companies to use proactively”, said Sapna Desai, Head of Marketing and Communications, Cigna TTK Health Insurance

NEWS Update

Potential for Reuse of Syringes based on recent government order for sale only through prescription The CM’s latest order comes in the wake of criticism & alarming concern raised by the Indian Medical Device Industry on the urgent need to amplify this order because restrictive practices can actually compel a user to reuse the old easily available syringes and thereby expose himself and all other members of community to various infections and health hazard of undetermined proportions adding to already huge burden of HIV/ Hep B /Hep C infections and a host of other diseases Hailing Punjab CM Amarinder Singh’s prompt decision to revoke the ban on the sale of syringes without a prescription, Safe Point India and HMD Foundation appreciated and thanked CM Amarinder Singh for the much needed timely action. After the order Safe Point India and HMD Foundation raised an alarming concern on the urgent need to amplify this order because restrictive practices can actually compel a user to reuse the old easily available syringes and thereby expose himself and all other members of community to various infections and health hazard of undetermined proportions adding to already huge burden of HIV/ Hep B /Hep C infections and a host of other diseases. Punjab Chief Minister Amarinder Singh on Monday revoked the ban on the sale of syringes without a prescription. The Chief Minister’s Office has directed deputy commissioners across the state to issue orders to chemists to prepare an inventory of syringes and keep a record of their sale and the customers sold to. “We do not know why the respective Deputy Commissioners issued such ban orders. There was no direction from the state government. We will amend it,” said a functionary. At least three district administrations, Faridkot, Bathinda and Fazilka have issued directives to medical stores to not sell syringes without a doctor’s written prescription. The order issued by the deputy commissioner using the power 20 July-Aug 2018 w w w. m ed e g a te to d a y.co m

under section 144 of CrPC will come into effect immediately and last till September 30, 2018. “Instead of restriction to syringes access it would be more prudent to accelerate a switch to Auto Disable Syringes in Punjab and have a State policy similar to the one by Government of Andhra Pradesh to prevent reuse with the help of State Drug Controller to address this magnifying problem” said Pardeep Sareen, Chief General ManagerMarketing, Hindustan Syringe and Medical Devices Ltd.

Mr. Sareen said Punjab has the highest incidence of hepatitis B and C spreading from drug addicts to other patients in the already-challenged healthcare infrastructure. “The order was distraught with trouble. We are thankful to CM Amarinder Singh for timely intervention. While the law exists in the US of syringe sale limited to prescription, this is not the case in India and the intent of solving a problem may be noble but the management tool being used is questionable and the wrong prescription as it will lead to bigger problem of infections being spread from Syringes reused. In other countries they promote free Needle exchange programs to addicts to motivate them not to share Syringes or reuse them ” Said Mr Rajiv Nath , Jt. Mg. Director of Hindustan Syringes & Medical Devices. The disposable syringes available in market are subject to re-use. Numerous and periodic media reports and case studies have identified reuse of syringes and needles as a major cause of spread of diseases.

“In order to prevent reuse and contain spread of infection, it is advisable and recommended to use AD syringes specifically designed to prevent reuse. This reuse prevention has been strongly advocated by WHO, MoH&FW has been seeking manufacturers to add capacity of AD Syringes and the recently concluded HTA study from PGI chandigarh on safety engineered devices under aegis of Punjab government and DHR, MoH, GoI had again proven the cost effectiveness of this intervention ” emphasised Dr Ratti , Healthcare Advisor, Safe Point India “Andhra Pradesh government has already taken a lead in this regard and issued instructions for 100% use of AD syringes in its public health facilities from 28th Jul 2018which is observed as World Hepatitis Day. Currently AD syringes are used in immunization programs only in most states though many Central Govt hospitals in Delhi are using these for years.” Dr. Ratti added. Safe point India and HMD Foundation which work in areas of promoting safe injection practices through policy advocacy and safe and proper use of injection practices including its safe disposal has been urging Central and State governments to adopt use of AD syringes in therapeutic practices also. The Indian Medical Device Industry therefore urged that Punjab government order be suitably amended to include: All prescriptions must specify use of AD syringes It would be more prudent to accelerate a switch to Auto Disable Syringes in private sector in Punjab and have a State policy as done by Government of Andhra Pradesh (issued instructions for 100% use of AD syringes in its public health facilities from 28th Jul 2018 which is observed as World Hepatitis Day) to prevent reuse with help of State Drug Controller to address this magnifying problem in Punjab.

DOCTOR SPEAK

Hospital plays matchmaker,

guides 3 couples to cross-donate kidneys 3 Women Donate For Each Other's Husbands; Happy Ending after Complex OT Doctors at Pushpawati Singhania Hospital and Research Institute (PSRI Hospital) south Delhi were confronted with a tricky situation recently when three couples landed at the hospital for kidney transplants. Their problem was that the wives were willing to donate their organs, but tests proved them Incompatible to their surprise, doctors discovered that the three women could separately donate their kidneys to the three men. The doctors explained the situation to the couples and once the six concurred the transplants were carried out, probably sparing the men Much discomfort, perhaps even their lives, waiting a long while for matching donors because an Incompatible donor transplant costs more than double and the families could not afford this, but conducting three concurrent transplant operations wasn't an easy proposition. Dr Sajiv Saxena, Chairman - PSRI Institute of Renal Sciences, said the transplants were successful and all six donors and recipients have been discharged. A major limiting factor in conducting kidney transplants in India is the lack of adequate donor pool, the kidney swap programme not only makes more kidneys available, but also makes them available earlier than otherwise" Dr P P Singh Director and Head of kidney transplant surgery at PSRI, told that five operation theaters were reserved for the marathon surgeries, which Involved retrieving the kidneys from the donors and transplanting them into the three recipients.

A challenging task

◆ All three transplants had to be carried out on the same day ◆ 5 operation theatres were simultaneously for the purpose

run

◆ 7 surgeons, 6 anesthetists, 18 staff nurses and 20 OT technicians worked for 15 hours, from 7am to 10 pm to complete the task ◆ Extra care was taken to ensure error free surgery and outcome. All three surgeries were successful The hospital carried out the three transplants on July 8th, A team of Nephrologists Headed by Dr Sanjiv Saxena Including Dr Ravi Bansal & Dr Rajesh Goel & a team of surgeons Headed By Dr P P Singh Including Dr Jagdeep Balyan, Dr Amit Malhotra & Dr Bhaskar Borah, six anesthetists, 18 staff nurses and 20 OT technicians started the procedure around 7am and wrapped up around 10 pm. Speaking to one of the donor said, the three women are now friends "and talk regularly". Her husband was diagnosed with kidney failure in March. "We approached everyone from the chief minister to PMO for financial assistance because my kidney was not compatible with my husband, eventually the doctor's suggested we swap organs with another couple"

The second recipient said "He learnt about his falling kidney when he sought a Medical certification to avail a work visa for Dubai. He couldn't go through an Incompatible transplant became his blood showed a high level of antibodies. "I would have died if this transplant hadn't taken place in time," he said. The third recipient. "He is a government employee In Bihar. Had tried In vain his luck to get a cadaver donor or a live donor. " The hospital then told me to find my own match?'' PSRI doctors claimed to keep a record of all potential donors (Swap transplant Registry) turned down for incompatibility if they come across a case where swapping is possible, they advise the two groups accordingly. Dr P P Singh told that in a country like India, the expense involved in the antibody removal protocol in the in incompatible kidney transplants is very high, as Is the risk of infections. "Transplant centers should work towards a national kidney paired donation programme and frame a uniformly acceptableallocation policy to expand donor pools"

w w w.medegatetoday.com July-Aug 2018

NEWS Update

FDA strengthens warning for use of antibiotics Need of the hour is to also restrict antibiotic use at a personal level and consume them only when required

he US Food and Drug Administration (FDA) has strengthened warnings for the fluoroquinolone class of antibiotics. This comes in the wake of findings indicating that this class of antibiotics can cause mental health problems and serious blood sugar disturbances, including hypoglycemic coma in people with diabetes. The fluoroquinolone class is among the most widely used in India, where hundreds of generic versions of the drugs are available. The new safety warnings are for all fluoroquinolones, including those taken by mouth or injected. India is the world’s largest consumer of antibiotics, with use more than doubling between 2000 and 2015. Against a global antibiotic increase of 65%, India reported a 103% increase, according to a study at Princeton University published in March this year. Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Antibiotics are only effective against bacterial infections. Several studies have corroborated the adverse impact of antibiotic overuse on health. Misuse and overuse of antibiotics have made once easily treatable bacterial infections harder and often impossible to cure because bacteria evolve rapidly to evade antibiotics, leading to drug resistance. This phenomenon is on the rise not only because of their inappropriate use in human medicine but also due to practices in the agricultural industry.” Twenty-four potent antibiotics are included in India’s Schedule H1 of the Drugs & Cosmetic Rules that make it mandatory for the medicines to have red-line labelling and for the pharmacist to keep a separate register with the name and address of the prescriber, patient’s name, the name of the drug and the quantity supplied. Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Doctors, as well as patients, should be aware of and advocate judicious use of antibiotics. Over-prescription and self-prescription, both, need to be checked. One of the biggest reasons for the misuse of antibiotics is buying them over the counter without consultation with a doctor. Before prescribing antibiotic, always ask yourself: Is it necessary? What is the most effective antibiotic? What is the most affordable antibiotic? What is the most effective dose? What is the most effective duration for which the antibiotic should be administered?” Across the fluoroquinolone antibiotic class, a range of mental health side effects are already described in the Warnings and Precautions section of the drug labeling, but differed by individual drug. The new class-wide labeling changes will

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require that the mental health side effects be listed separately from other central nervous system side effects and be consistent across the labeling of the fluoroquinolone class. The mental health side effects to be included in the labeling across all the fluoroquinolones are disturbances in attention, disorientation, agitation, nervousness, memory impairment and delirium. Additionally, the recent FDA review found instances of hypoglycemic coma where users of fluoroquinolones experienced hypoglycemia. As a result, the Blood Glucose Disturbances subsection of the labeling for all systemic fluoroquinolones will now be required to explicitly reflect the potential risk of coma with hypoglycemia. The FDA first added a Boxed Warning to fluoroquinolones in July 2008 for the increased risk of tendinitis and tendon rupture. In February 2011, the risk of worsening symptoms for those with myasthenia gravis was added to the Boxed Warning. In August 2013, the agency required updates to the labeling to describe the potential for irreversible peripheral neuropathy (serious nerve damage).

Some tips from HCFI • Practice rational use of drugs antibiotics • Use when needed and according to guidelines • Avoid broad spectrum antibiotics without appropriate diagnosis • Prevent infections with the use of vaccination and by improving basic hygiene including hand hygiene and infection control techniques and sanitation in health care settings as well as in the community • Farmers and food industry must stop using antibiotics routinely to promote growth and prevent disease in healthy animals to prevent the spread of antibiotic resistance.

EXPERT VIEWS

E-learning in Medical Education In major medical institutions around the world, the learning arc has transitioned from the traditional instructor-led teaching model to a more learner-centric model. Research has demonstrated that e-learning is as effective as other educational strategies for enhancement of knowledge and skills. E-learning represents one of the most seismic shifts in medical education and is being integrated into mainstream medical education curriculums around the globe. The assimilation of e-learning into Continuous Medical Education (CME) is now catching up. The widespread adoption of e-learning for continuous medical education can have significant impact on the clinician population of developing economies.

There are multiple demands on a clinicians’ time in such countries– handling an overwhelming patient load, research, remaining updated with the latest developments in one’s specialty amongst other academic pursuits. In such a scenario, an e-learning based CME program designed around the clinician’s workflow can really make a difference. E-learning tools provide enhanced accessibility to content, democratizing availability standardization and accountability. Online CME has shown to have positive outcomes across a wide variety of learners, learning contexts, clinical topics and learning outcomes. Learners benefit from by having control over the frequency, pace and style of learning, choice of media, providing them the opportunity to meet their personal learning objectives.

Why e-learning?

Mr. Prashant Mishra Managing Director, Asia and South Asia BMJ

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According to a study published in BMJ Open the average time that India's primary care consultants spend with patients is around two minutes whereas medical consultation time in developed countries is around 20 minutes. This is probably a reflection of the sheer volume of patients and shortage of healthcare staff. In this situation to offer quality care to patients may pose a challenge. Amongst all this a clinician needs to keep him/herself updated with the latest therapeutic advances. This is exactly what e-learning provides: a flexible convenient learning experience─mapped to the clinicians workflow. Availing other CME tools such as conferences, expert-led live sessions do have their advantages, but the clinician has to spend time to attend such sessions - leaving his clinical environment. Access to ondemand, online CME content offers convenience and flexibility to learners– providing them an opportunity to

synchronize their learning into their daily schedule. Some of the benefits of e-learning within the context of Continuous Medical Education (CME) are outlined below:

Richer learning experience E-learning based continuous medical education programs offer a much more richer learning experience. The same content can be designed for different consumption formats – written content podcasts videos– across a multitude of form factors – PC / mobile. The instructional design for the same content can be varied from digestible condensed formats to extensive long form materials. The availability of a collaborative learning environment comprising of online chats polls, message boards, and social media enhances the learning experience for the participants.

Flexibility & convenience For autonomous and self-directed learning participants like clinicians, e-learning may be the correct intervention for CME. Doctors can choose the time and place to complete their CME goals. E-learning offers the opportunity to doctors for self-paced and self-directed learning, an attribute not found often enough in expert-led sessions conferences or other CME interventions.

Personalized learning Many forms of traditional learning are linear in nature and do not provide a mechanism to progress down a different path based on an individual learning needs. Also in traditional CMEs, such as expert led sessions, individualized / personalized attention may not be feasible. However, in modern e-learning interventions, doing a learning inventory for the participants helps assess what is the suitable learning pathway for each participant.

EXPERT VIEWS

Few of the e-learning programs for clinicians offered by BMJ include BMJ Learning, Research to Publication and Courses in Diabetes & Chronic Kidney Disease. BMJ Learning offers high-quality continuing medical education for doctors and other healthcare professionals. It features hundreds of accredited, peer-reviewed learning modules in text, video, and audio

formats. The learning modules provided by BMJ Learning deal with everyday issues in primary care and hospital medicine. In India, BMJ Learning had received accreditation from Maharashtra Medical Council (MMC), Delhi Medical Council (DMC) and Goa Medical Council (GMC). Other accrediting organizations include European Board for Accreditation in Cardiology, University of Lancaster, Singapore Medical Council, Dubai Health Authority and many more. Research to Publication is a tool developed by BMJ jointly in collaboration with The University of California, San Francisco (UCSF), which focuses on developing skills in clinical and public health research skills. It comprises of stand-alone,

self-study modules that lets learners choose what to study, and do so at their own pace. Along with this, we also have a Six Months Certification Course in Diabetes & Three Months Certification Course in Chronic Kidney Disease. Both courses are online and designed for busy clinicians on the go. The content is modular and offers flexible, bite sized learning materials for clinicians. E learning helps to address the persistent challenges in CME: access, availability, and equity and has shown to positively impact satisfaction, knowledge and outcomes. We hope clinicians make use of accredited, peer-reviewed, and evidence based content for their CME needs â??

EXPERT VIEWS

Home Health care services, Changing demographic of patients • Increase in traction for children and adolescents; About 10,000 of Portea’s total consumer base is in this category • Convenience and affordability cited as the two key reasons

Ms Meena Ganesh

MD & CEO, Portea Medical

ortea Medical, India’s leading consumer healthcare provider, has observed a major shift in the demand dynamics of home healthcare services. Apart from the huge existing demand among the elderly and those needing post-operative care, there has been a marked surge in the infants and adolescent segment for these services. About 7% of Portea’s patients are below 14 years of age, and this segment is growing 1.3 times faster (CAGR of 70%) than the company’s total patient base. Home care offerings today are positioned on 'convenience' and 'affordability' and have clearly found connect with the younger segment (early adopters of the tech-driven new age offerings). With enhanced customer experience, this segment is going to be a huge asset to influence others to adopt home healthcare and return to home healthcare providers as and when healthcare needs arise in their lives. Consumer healthcare is gaining credibility among customers with long-term needs – something once only hospitals catered to.

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Speaking about this, Ms Meena Ganesh, MD and CEO, Portea Medical, said, “There is a visible increase in the demand for home healthcare services in categories other than the elderly and those with chronic illnesses. There has also been an increase in requests for care in case of acute treatment conditions (which need immediate attention). The infant and adolescent group, unlike the young adults, includes those with more critical medical conditions such as palsy, delayed milestones, Down’s syndrome etc. and thus, home care services like long term physiotherapy, attendants, nursing etc. are availed. The organized home healthcare services segment has the potential to become one of the key pillars in medical tourism as it meets most of these criteria but lacks a regulatory framework. The private sector would benefit with support from the government in terms of proactive policies and standards to regularize the industry.” In 2015 Portea served monthly about 700 patients below the age of 12 years, this number is now almost 400%. The youngest active member availing physio services is about 2 years old. The basket of services in the infant and adolescent categories includes neonatal care, hypertonia, torticollis (abnormal head position), physiotherapy for

pre-term babies, cerebral palsy care, autism, Infantile epilepsy, Anaphylactic shock, Down’s Syndrome, and juvenile arthritis. Portea's lab/basic physiotherapy offerings, and now nutrition, have created a consumer category, as opposed to the prescribed category by doctors/hospitals. Apart from all these services, Portea also offers a carefully designed Kanga and Roo programme. Under this, Portea assigns a medically trained caregiver to help the mother with newborn baby care and also offers after-delivery care for the mother. India’s home healthcare market stood at around $3.20 billion in 2016 and is expected to grow to around $4.46 billion by 2018 and $6.21 billion in 2020. Some social factors contributing to this growing demand for home care include the taboo surrounding institutional care for ageing parents, higher levels of perceived stress, social isolation, lack of work-life balance and negative impact on the emotional well-being of the family caregivers, and the fact that informal structures of support are unable to cope with the commitment required to take care of chronic patients and the elderly ❏

EXPERT VIEWS

How Relevant is it for Doctors to have Equivalent Knowledge of Computer Science with Medical Science.

For instance, a diabetic patient undergoing a surgery is usually categorized as high-risk and consequently, the cost of the surgery would be higher. At LetsMD, we always offer indicative pricing for surgery, not actual.

In a digital age, How relevant is it for doctors to have equivalent knowledge of computer science with medical science. How will it benefit the medical fraternity to build a strong healthcare ecosystem and be ready to leverage future technological advancements?

Mr. Nivesh Khandelwal Founder and CEO, Lets MD

How is Indian healthcare evolving with the help of the latest advanced equipment and technological innovations? For India, technology innovations in healthcare is a necessity, not a luxury. Because offering healthcare to 1.25 billion people in the country is a humungous task and the only way to achieve the target is to integrate technology into the process of delivering healthcare. The Indian healthcare sector of late is witnessing a definite momentum towards innovation â&#x20AC;&#x201C; which is quite encouraging to see. However, technology development or innovation for that matter has to be cost-effective. Because, the large chunk of the population still lacks access to basic healthcare, not advanced healthcare. To give you an example, telemedicine can ensure healthcare access to people living in the remote regions in the country. And telemedicine is a truly economical option.

Can I get an idea from LetsMD what medical inflation is like in India? Also, can I have a listing of ailments and how much they could cost in corporate chain high-end hospital? Medical inflation presently in India is around 15%-17%. I think the wage increase is a significant contributor to growth in medical inflation. For the last 10 years or so, medical inflation has been on double digits. And, there is no possibility of the trend reversing given the higher healthcare costs. To answer your second question, pricing of any surgery varies as per the medical condition and history of the patient concerned. 28 July-Aug 2018 w w w. m ed e g a te to d a y.co m

Well, I think a doctor with working knowledge of computers will add a lot of value to the process of building a strong and effective healthcare eco-system in the country. It actually facilitates better cooperation and synergy between a doctor and a tech company that requires precise knowledge of the healthcare condition to develop the most effective solutions. So, a doctor with working knowledge of IT will not only help in developing the right solution leveraging his/her knowledge, he/she will significantly help in reducing the time-to-market of a technology.

How can this help in boosting career opportunities for medical professionals in the leadership chain? Can you give some examples to support your point? Given the population of the country and the current supplydemand scenario, there is a huge headroom for growth for the healthcare eco-system of the country. With the faster digital adoption, the healthcare market will only scale up from here. According to various estimates, the healthcare market is pegged at $100 billion at the moment and the market size will touch $280 billion-mark by 2020. So, the market buoyancy will surely have a positive rub-off on the career opportunities of the medical professionals.

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Looking for National & International strategic partnership! M/s. nice Neotech Medical Systems Pvt. Ltd., was established in the year 1997. 'nice' stands for 'Neonatal Intensive Care Equipment' which aptly ampliﬁes the objectives of the organization. nice Neotech design the product as per world standard which symbolizes excellence in form, function, quality, safety, sustainability and innovation, and communicate that the product is usable, durable, aesthetically, appealing and socially responsible & most user-friendly. Our product range include Infant Incubator, Infant Transport Incubator, Infant Radiant Warmer with T – Piece Resuscitator & Infant Phototherapy, Infant Radiant Warmer, Infant CFL Phototherapy, Infant LED Phototherapy, Bubble CPAP System, Heated(Respiratory) Humidiﬁer, Infant T – Piece Resuscitator, Infant/Neonatal Fiber Optic Transilluminator, Oxygen Analyser, Infant/Neonatal Respiration Monitor, Infant Observation Trolley, Infant Weighing Scale, Oxygen Hood, Air Oxygen Blender, Medical Air Compressor, Reusable/ Disposable Breathing Chamber, Reusable/Disposable Breathing Circuit, Nasal Mask, Nasal Prongs, Head Bonnet, and Eye Mask etc. Applications: 7. Respiratory care

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EXPERT VIEWS

Spaces that bring cheer to reduce fear

hen confronted with physical ailments, it is an acceptable feeling for the general public to be overcome with fear and panic. People often feel intense pressure and anxiety associated with treating problems and look to various specialists and facilities to help find solutions. Patients visit medical establishments, spas, physiotherapy centres, boutique clinics, yoga facilities and other organisations, to recuperate and recover, based on their cutting edge facilities. While these are a very important aspects in the recovery and well-being of a patient, other factors could contribute to a patient’s healing which may help the family members and staff deal more effectively with the stress of providing care. The design of most such facilities may be driven by functional, practical and financial requirements. Although this is extremely essential to support the working, movement and circulation of the organisation, what may further enhance the services and care rendered by the establishment is to strengthen the focus on the patients’ and their families’ emotional and mental well-being. The potential benefits of modifying the ambience and atmosphere of these establishments through simple yet effective design changes could be considered while setting up a new undertaking or enhancing an existing unit. This might help facilitate a difference in care by shifting the focus from illness to wellness.

First Impressions Make A Difference

Visitors might feel the quality of assistance rendered may be a reflection of the type of infrastructure provided while approaching the unit. Patient concern and attention could begin with a well finished sidewalk, a well paved road abutting the building and steps and ramps with appropriate traction surfaces to the building to help support those with physical challenges. The entrance and interior may be designed to suit the patients’ profile. Care could be taken to ensure outpatients and their families are not disturbed by in-patient and emergency care. Patient recovery may not be linked only to the treatment and cure of physical ailments, but could also be connected to the emotional environment of the facility. Easy methods that could distract people may include playing soft calming music, placing non-medical reading material in waiting areas and the use of TV screens and paintings to show visual material that aid in joyful and humorous distractions.

Planning and The Focus on Landscape

On entering, designing ways and paths for people to navigate with ease would allow for access to the required spaces without encountering or disturbing other patients and departments. Providing healthy plants wherever possible, or pictures and murals of pleasing outdoors, would possibly prove beneficial owing to the therapeutic effects of greenery. Articulating outward openings to allow views and natural sunlight by incorporating large floor-to-ceiling glazing wherever possible, might calm and pacify patients, personnel and visitors. 30 July-Aug 2018 w w w. m ed e g a te to d a y.co m

By PSR Architecture The use of light, aromas and colour most often contributes to a pleasant ambience. In a medical facility, the use of these to create a recovery backdrop, can be done by placing paintings and pictures to make blank, sterile walls attractive. Redirecting light by altering the angle of mirrors, prisms and artificial sources that can softly illuminate the spaces can create reposeful environs. This, along with curative colours in the interiors to the fabrics and textures in the room, coupled with fragrances to induce sleep and relaxation, would perhaps contribute to a more tranquil space. To further heighten staff morale and perhaps lower the attrition rates of employees, restful lounges, green terraces and break out spaces could be provided for them to release their pressure and anxiety. This could augment their output and performance, and bring additional credit to the professional standards of the unit.

In Conclusion

As indicated above, the comforting environment of a patient extends to the home, wellness centres, spas and several other spaces where people visit and stay to de-stress, unwind and convalesce. Practical design could promote skill, assist in a quicker recovery, reduce costs and create a convenient and comfortable environment. Good design integrates the functional requirements with the human needs of its varied users and in turn might likely contribute to better staff morale and retention as well as patient care. Modest design changes such as incorporating factors of greenery, aroma, ventilation and light may possibly benefit by tackling concerns that surpass the treatment of certain immediate physical ailments. The implementation of these ideas could make a significant change to the comfort and prosperity of not only those who seek medical care and their family members, but also those who serve their patients. Principal Architect, Parvathi S. Rao established PSR Architecture in 2011. The firm specialises in the research and design of a wide spectrum of projects ranging from residences, retail, corporate, hospitality, renovations and institutions. The firm may be contacted at info@psrarchitecture.com. W: www.psrarchitecture.com

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10 Ways to brand and market your hospital and practise Building a brand can bring in a world of difference to your healthcare business, just as much difference that your healthcare business is capable of bringing into this world.

Mohammed Ilias

Director, BCC Healthcare

www.healthcarebranding.co.in

elax… branding or marketing is not a bad word for your noble profession. Branding is the scientific process of defining yourself and this process aims to shape your business’s identity as a unique and distinct one. Branding and marketing can help businesses that are striving hard to arrive, businesses that have arrived but are stagnant and businesses that are gigantic yet in need of growth. A well thought branding process will make your people remember you and relate to you in the exact way you want them to. So when they have needs that you can fulfill you will pop up as a mere messiah of respective solutions. So, here are few trends that are catching up and have successfully taken over the healthcare field. Look at yourself and your business through these lenses to have a clear idea on how it can comprehensively compliment your business:

① Cause Based Marketing Cause based marketing is the process of gracefully blending a cause to your business goals. Marketing a cause along with your organizational capabilities and increasing your brand awareness among people by reaching them is the most ethical way to market. Choose a cause that is dear to you and plan an event supported by marketing communication that revolves around the same cause, this will help them remember you and your institution for that specialty. Let the cause be genuine and the efforts taken be genuine so that people remember you forever and relate to you for the same. “Don’t battle with their minds; win their hearts with a cause”

② Specialty Specific Marketing There is a visible growth in the need for and availability of specialized healthcare services. Healthcare providers have exponentially multiplied in the recent past with the demand in 32 July-Aug 2018 w w w. m ed e g a te to d a y.co m

the market. Defining yourself in the way people need you the most is a better strategy than being generic about marketing your services. Specialty marketing helps you practise your niche much more and help people in need of the same. Marketing programs are most effective and efficient when the target is precise and services marketed belong to one specific discipline with an exclusive set of marketing components. “ Your niche is the better way to serve people"

③ Case Study Marketing A case study’s main purpose is to send a clear cut message to your potential patients that you have cured or treated one particular rare health issue in one particular patient with the resources, knowledge and skills that you possess. Case studies are an important part of your portfolio and your presentations at medical conferences will become strong with the addition of case studies. Market your case studies through online PR, newswire sites, print and digital medium. Publish a book of case studies to mark your professional excellence in the field. “ It helps people relate to you better"

④ Referral Marketing Without putting much intentional efforts if you are getting patients it means referral marketing is doing its work through word of mouth. With optimum usage of your professional contacts you can create a perfect referral marketing system that helps you and those who align with you in the referral program. Referrals come from three categories - doctors (individual practitioners / primary care / secondary care centers) refer patients to you, patients refer patients and employees refer patients. Stay keen to nurture your relationship in your circle tell them about your capabilities, case studies, specialties and cutting-edge technology that you have

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introduced in your healthcare organisation. When your referral partners are tuned to your progress they do not just hear you but amplify your reach. “ 70% of your patients are the result of your referrals"

⑤ Location Based Marketing As a healthcare institution that strives hard to reach each one in need, are you sure about your visibility’s scope to reach each one looking for a solution that you are specialised to provide?. You are aware about the fact that people are choosing someone else over you even though you have everything that it takes to give a high quality and trustworthy healthcare service simply because you aren’t in their visibility radar. Location-based strategies can be easily made functional with the help of technology, knowing your people or target audience in and out will help you create highly functional and rewarding location-based marketing campaigns. "Location-based strategies can cover up every possible void you can leave in a delimited market."

⑥ Digital Marketing In an era where demands have to be fulfilled in a jiffy and solutions should be in gifs, expecting people to walk pillar to post to get information about you and then take days to decide whether to choose your service is just as unproductive and as impractical as it sounds. Please realise that a patient’s time is just as important as the doctor’s. It is a question of delivering the content that people want to hear in the easiest, fastest and most accessible way. If content is the king then the medium it is delivered through is the throne. When right brand stories are narrated through the right mediums the retention of the story in people’s mind is higher. A strong website with effective SEO process, right social media mix and ORM strategies will make your web presence more rewarding. "Are you easy to find?"

⑦ Testimonial Marketing Testimonials are reviews that carry an informal note about how your service and care has changed or touched a life. Testimonials are unbiased and verifiable anecdotes of a past patient. “The more real it is, the more reliable it gets.” Since testimonials are directly from normal people to normal people it can become the strongest

reason for your potential patients to trust you. Please make sure this form of marketing is used only after getting approvals for the testimonials from patients, any deviation to this would be considered as a violation of the standards. "Your patients narrate the best stories about your brand"

⑧ International Patient Marketing It is well known that India is one of the lowest cost and highest quality provider of all medical tourism destinations. In this digital age with right branding approach getting a patient from Middle East to a tier 3 location in India is no big challenge. Make patient convenience your first priority. Okay, if everything is pitch perfect then how do you make people utilize them? Make your hospital website international patient friendly; let your online presence give the best insight into your hospital. Build a team that has exposure to global culture more particular to the places from where your patients come from; make your employees adapt a work culture that is inclusive. Provide transparency in cost to ensure a hassle-free healthcare experience. Make sure you leave no stone unturned to match world-class standards by all parameters. "The world needs you…are you available?"

⑨ Interior Branding Communication Hospital interior communication is the process of making your hospital infrastructure synonymous with your brand identity and personality. Interior branding can create a visual identity for your brand and it helps you establish yourself as a strong source of healthcare provider. Awards, accolades, case studies, testimonies, information pertaining to doctors, hospital etiquettes, your quality standards and more about the heroes of your hospital can be covered. People visiting you or coming to you for your service expect every part of your hospital to be giving an aura that everything is working in coordination to making their healthcare experience a satisfactory one. "Make your walls narrate your brand story"

⑩ Employer Branding Communication Employer branding is very essential in today’s market to retain and motivate the talent that will push the brand forward. Motivating the right team that shares your vision and mission will take your healthcare institution to next level. Showcasing your values through your employees helps you articulate your brand culture with more conviction. Your vision and mission have to be strongly etched even in smallest entities of your organization. If their individual vision aligns with your brand’s long-term vision and goals it contributes to the organisation to reach greater heights and continue the legacy even further. "Let your team take the legacy forward " Ponder over the above ways to market, there is a lot that can be learnt from the above proven ways to market your brand. The good can continue and reach greater heights only if the good gets the right marketing mix. w w w.medegatetoday.com July-Aug 2018

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Technology assisting doctors Dr Murali Chakravarthy Director, Department of Anaesthesia, Critical Care and Pain relief, Fortis Hospitals, Bangalore

n today’s world, technology plays an important role in every industry as well as in our personal lives. However, of all the industries that technology has empowered, healthcare is definitely one of the most important. Today, technology is not only making your smartphones better, but it is also changing how doctors diagnose and treat patients. Technology is responsible for improving and saving countless lives in addition to being a great backing for the doctors. India suffers a crisis of disease burden and huge gap between the ratio of doctors and patients; in such a scenario, the technological assistance to doctors becomes crucial. A study by Indian Journal of Public Health states that India will need 2.07 million more doctors by 2030 in order to achieve a modest doctor-to-population ratio of 1: 1,000. Witnessing the current ratio, there is a need for technologies to step in and assist doctors to fill the gap. Younger generation is being afflicted with increasing number of illnesses related to change in lifestyle; these neo patients become additional patient burden for physicians. With the available doctor: patient ratio, it might pose as an additional challenge to the pre-existing difficult schedule of doctors. The increasing elderly patient subsect (that is noted in India as well as globally) with multiple co morbidities is only making matters worse. Without doubt, doctors need technology assistance to expedite diagnosis and treatment. The available infrastructure, equipment and hospital beds will have to be utilized resourcefully by improving patient outcomes such as decreased complications, length of stay in the intensive care unit and hospital. According to the World Health Organization (WHO) and the ministry of health, India has seven doctors per 10,000 people. The research paper found that there were only 4.8 practising doctors per 10,000 people available in India in 2014. Witnessing the current scenario, the adoption of technology in the healthcare system will provide a boost to the doctors and improve the outcomes. The adoption of Electronic Health Records will cut down the time of patient diagnosis as

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Doctors have always attempted improve the quality of healthcare delivery. With right technology support the doctors’ time is effectively used to treat more number of patients efficiently. the patient’s past and present medical records can be easily accessed by the doctor and hospital staffs. Other technologies like Robotic assisted surgery, 24*7 patient monitoring through cloud based technology and new medical devices can help in improving the patient care and healthcare delivery in India. This further boosts patient’s trust and confidence in doctors and healthcare providers. Technologies currently supporting doctors: Robot-Assisted Surgery – This method of surgery enhances the ability of a doctor to carry out medical procedures with great precision. It has certain medical devices that are attached to it such as cutters and endoscopes. Certain delicate procedures that cannot be carried out by human hands may be carried out with the help of this technology. The benefits of robotic surgery can be evident in difficult areas such as pelvic cavity, prostate gland, and colonic cancer surgery; they are, early recovery of function, minimal incision, therefore lesser pain, less blood loss, enhanced safety. Wireless brain Sensors- These areused to enable doctors to monitor brain activity. There devices are placed inside the brain and eventually get absorbed into the body without any surgical procedures. This device is made of polylactic-co-glycolic acid and silicone which transmits the necessary information that the

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Electronic Health Record- This is a device which contains all the medical details and records of an individual, which are relevant to their health and wellbeing. This encloses record of all the clinical appointments, test reports, X rays, CT scans etc. The entire medical history of the individual proves to be very helpful in understanding an individual’s health. One’s medical history can reveal a lot of information such as the health risks that the individual might be vulnerable to or health problems which could be passed on genetically. This gives a better understanding to the doctor which can help them during diagnosis. A trended result of the laboratory test could identify high risk patients early.

doctor requires such as temperature and pressure within the brain. These devices reduce the risk and chances of infection and does not require additional surgery to remove the device.

Tele intensive care unit: The shortage of specialist doctors such as the intensive care doctors could impact patients’ outcome immediately. It is nearly impossible to churn out large number of critical care doctors in a short period of time. In order to provide world class cover to critically ill patients, tele ICUs come into picture. These ICUs permit a doctor to ‘examine’ the patient at a remote location with the help of a doctor or a nurse located by the patient bedside. Many times, timely institution of therapy based on data, is all that is required. This not only reduces morbidity, but also length of stay in the ICU and cost.

Vocal biomarkers – These devices enable doctors to understand certain aspects of an individual’s health through the characteristic of their voice. They detect diseases prior to the doctors. This technology is being used currently to see if it can be used to predict if certain individuals are going to suffer from mental health issues in the future or not. If required, it can also be further used to give preventive measures to people in the initial stages. This makes the process of diagnosis a lot quicker and easier for doctors so that they can give the required treatment as fast as possible. Centralized Monitoring of Hospital Patients- Cloud powered monitoring solution helps doctors and nurses to take care of patients even outside ICU. The patients in ICU requires nonstop treatment and supervision, however, it is not possible for a nurse to be available 24*7 dedicatedly for one person. But, with the help of cloud based technology it would help in centralized monitoring which provide care and assistance when they are not in the vicinity. The care giving doctor may observe patient parameters on the smart phone. In case of emergency, the doctor/nurse will receive notification when they are not around the patient. It allows the doctor/ nurse to monitor more patients while being connected to the device. A single doctor observing the central station of this monitor may observe and report the conditions of several patients without having to go there personally. Several studies have shown improved early warning of patient instability preventing occurrence of critical event. w w w.medegatetoday.com July-Aug 2018

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Transition Care to Improve Productivity of Hospitals & Patients’ Recovery

Dr Vijay Janagama Director, New Initiatives, SuVitas Holistic Healthcare

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ndia has around 10 Hospital beds per 10000 population vs around 30 per 10000 as a global average. There is 1 ICU bed expected for every 10 hospital beds, and India has number of ICU beds that are nowhere close to required norms. The shortage of ICU beds, insufficient number of trained professionals and financial challenges to setup more critical care centers etc, all points to the tremendous need for effective utilization of critical care services and ICU setups. Critical care has been exponentially growing for past few years in India. Advancement in global critical care research, specialized trainings in critical care, latest equipment and state of the art infrastructure have been contributive factors for driving efficient outcomes. While the depth of knowledge, man power, technology and infrastructure are growing drastically, the reach of critical services to the needful is way behind optimal level. Expertise to handle complexities and mandatory lab & diagnostics, state of the art infrastructure makes critical care synonymous with costly care and therefore not enough quality critical care centers are established. Therefore, the keyword is optimum utilization of our existing critical care facilities. Most of the ICU admissions are governed by admission criterion like dependency on ventilator or continuous medical monitoring. Sometimes, the absence of a trusted ward to continuously monitor a patient or manage conditions like tracheostomy or oxygen dependency, tube feeding are considered reasons for

admission, or prolonged stay in ICUs. As a result of this, hospitals find it difficult to provide the ICU beds for patients who require more intense critical aid. Effective utilization comprises of: ♦ Disciplined admission criterionPatients who are undergoing or recovering from surgical and medical conditions which need mandatory medical monitoring should alone be provided admissions in ICU. After they are medically stable, they could be moved to step down care or inpatient transition care facilities which provide rigorous monitoring by a multidisciplinary team of doctors. ♦ Prioritizing the ICU bed to the most desired in terms of severity with possible scope of recovery ♦ Optimal duration of ICU stay to ensure balance between medical stability and avoiding the risk of hospital acquired infections ♦ Early rehabilitation for patients to shift from ICU to next level of care-step down care, transition care or home care as per the individual condition and requirement. Step down care still needs a lot of medical attention and fits well when patient can might go back to ICU, or can be transferred to rehabilitation center. Home health care might work well when there is a slice of requirements from nursing or physio care, however this may not be desirable for patients recovering from critical illnesses since it will be too early for them to move into a nonmonitored environment. Transition care will be the perfect fit for such patients

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to ensure a holistic approach to recovery from post ICU status.

Inpatient Transition Care as a solution

Most major medical/surgical illness that require ICU admission are sudden, unanticipated and need a critical care team and infrastructure to manage the life-threatening conditions. After critical care is taken care, patient ideally needs to be shifted to the next level of care settings, like an inpatient rehabilitation facility to minimize hospital acquired infection and enhance recovery by early rehabilitation. To recover completely, one might need additional/continued medical services like skilled nursing care to manage tracheostomy, feeding tube care, catheter care etc. Other services like physiotherapy to enhance strength, mobility and balance, personalized diet program and emotional counselling, in additional to medical supervision will also be needed for complete recovery. In a medical rehab facility, patients are provided nursing care and follow a carefully crafted physiotherapy schedule. Extra attention is paid to designing a personalized diet program and specific nutritional requirements of the patient are taken into account.

not be outwardly evident, the patient is impacted psychologically too. Emotional counselling is a rehabilitation support service that helps in stabilizing the patient from a psychological perspective. A multi disciplinary rehabilitation care team ensures the following steps in care: ♦ Medical Supervision: A doctor who has specialized training, interest & experience in transitional care facility, can monitor the medical condition of the patient, work in collaboration with rehab team 24/7 for recovery and attend to medical emergencies, as required. ♦ Skilled Rehabilitation Nursing: Transitional care centers will be able to provide 24-hour skilled nursing care that will include vitals monitoring, tracheostomy care, feeding care, wound care, catheter care and more. ♦ Physiotherapy Care: Transition care center will provide specialized physio therapy and occupational therapy at different levels based on the requirement of the patient. ♦ Diet & Nutrition Care: In a recovering patient, diet plays a very critical role in accelerated recuperation. Transition care centers will provide a personalized diet plan based on the medical condition of the patient.

♦ Emotional Wellness: Most of the major illnesses demand more than physical recovery. Emotional wellbeing has a critical contribution in complete recovery, therefore trained counsellors are involved in the care plan provided by transition care centers. Support from family or friends will also play a major role in improving the emotional wellbeing of the recovering patient. ♦ Institutional discipline and multidisciplinary approach- Key differentiator of transition care facility is the institutional discipline and multidisciplinary approach of the specialized transition care team that includes the Doctors, nurses, physiotherapists, dieticians, counsellors, speech therapists, occupational therapists, respiratory therapists and other medical supporting staff. Overall, transition care facilities not just complete the care cycle for effective recovery but also ensure efficient utilization of critical care facilities in hospitals.

Another important aspect of transition care is that the patient is also provided with emotional counselling. Suffering from an illness or injury can be a traumatic experience and though it may

w w w.medegatetoday.com July-Aug 2018

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Indian Doctor at Top U.S. Hospital Reveals Brain Cancer Treatment Breakthrough

Immunotherapy vaccine shows promise in treating tumors, says neuro-oncologist Dr. Manmeet Ahluwalia- Cleveland Clinic’s Neurological Institute

novel vaccine that stimulates the immune system is improving outcomes for patients with the most aggressive form of brain cancer, a Delhi-trained doctor has revealed. Dr. Manmeet Ahluwalia is the director of the Brain Metastasis Research Program at Cleveland Clinic’s Neurological Institute, which is involved in a groundbreaking study of a new treatment for glioblastoma (GBM). “The use of the vaccine SurVaxM shows great promise for improving survival in newly diagnosed GBM patients,” he said. “While we are still in the relatively early phases of testing this vaccine, we are seeing some very promising results which give us a lot of hope for this patient population.” Dr. Ahluwalia, a graduate of Maulana Azad Medical College, University of Delhi, is a principal investigator in the multicenter study. He presented its interim findings at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago on June 3rd. Dr. Ahluwalia cited the case of Jeff Tabor, 53, one of the 55 patients who followed the traditional GBM treatments of surgery, chemotherapy and radiation with ongoing doses of SurVaxM, a first-of-its-kind immunotherapy that has been engineered to stimulate patients’ immune response to control tumor growth and recurrence. “In Jeff’s case, he has gone almost 18 months from his diagnosis, and – on his recent MRI scans – we do not see any evidence of cancer growing going back in his brain,” Dr. Ahluwalia Tabor, from Pittsburgh, Pennsylvania, makes lengthy round trips to Cleveland Clinic’s Ohio headquarters with his wife,

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Cynthia, to receive the treatment and periodic MRIs to gauge the results. The father of three said: “This vaccine is unique to this particular trial, and all the stars aligned for me to (be eligible) to get accepted into it. “Dr. Ahluwalia is really encouraged by my progress. Life is good!” Tabor began having difficulty speaking, reading, and comprehending certain words in early 2017, and was diagnosed with GBM. Doctors performed surgery at a hospital in Pittsburgh to remove the golf ball-sized tumor, which immediately alleviated his symptoms. Since most GBM patients only survive about 15 to 16 months with standard therapy, Tabor aggressively pursued additional treatment options, which led him to inquire about the vaccine trial, which is in its second phase. SurVaxM stimulates the immune system to kill tumor cells that contain survivin, a protein that helps cancer cells resist conventional treatments. Preliminary results of the first 55 patients in the SurVaxM trial reveal a 12-month overall survival rate of 90.9 percent from diagnosis and 70.8 percent from first immunization, a vast improvement over traditional treatment alone. Jeff and other patients experienced few, if any, side effects. Researchers now plan to conduct a randomized prospective trial of SurVaxM for GBM patients. With his oldest son about to go off to college at the University of Texas at Austin, Tabor is looking forward to spending a normal summer of trips to the local pool with his family, while continuing his career as a program manager for Microsoft. “If you would have told me a year ago that I would feel this great today, I wouldn’t have believed you,” he observed. “Every day has been better than the previous day.”

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Tackling the price war in Pharma Sector

harma Sector in India has been a booming and profitable business for the last few decades, where you could architect your supply chain, deliver products and expect the market to bear with whatever price manufacturers and distributors have decided upon. India has seen the major wave of movements in the price capping in many essential as well as non-essential drugs and medical consumable equipment including stents to name a few. Thus, many clinics and hospitals are struggling to tackle the price war yet, retain their profitability after managing their high operational expenses. As per the AIOCD AWACS report (All Indian Origin Chemists & Distributors Ltd.), the Indian pharma market witnessed a growth of 9.5% year-on-year (yoy) in March 2018 as compared to 7.1% yoy growth in February this year. On the other hand, the total sales reported were at Rs 10,029 crore in March 2018. The volume growth was in double digits, while prices continued to remain soft mainly due to the pricing caps on the NLEM (National List of Essential Medicines) list drug. However, with the rise in the branded medicine costs in the country, cost of treatment by doctors, cost of hospitalisation,

Dr. Sujit Paul

Managing Director StayHappi

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differential pricing, and similar, the common man is really under distress and is overburdened by the same. There is one more data point showcasing that MNC (MultiNational Company) pharma companies in the world have grown at a rate of 11.2% yoy in March 2018, corresponding to their Indian counterparts that grew at 9.1% rate. The MNC pharma companies have grown rapidly than domestic pharma companies in the non-NLEM category. However, itâ&#x20AC;&#x2122;s time that India needs to wake up and understand the True Value of Generic Medicines, and that is the journey that we have envisaged at StayHappi Pharmacy - to combat the Price war in the Drug market as well as to ensure that the overall monthly medicine expenses come down for all. Price wars can disturb economically and psychologically situations of an individual, a company, and industry profitability. It is becoming increasingly common as the price change is easy and quick action. The major challenge we faced while paving the way for StayHappi in the Indian Pharmaceutical market was the current mindset of the people â&#x20AC;&#x201C; they were convinced to buy branded medicines because these are prescribed by the doctor. The Government of India has taken several steps and initiatives in order to reduce costs and bring down the healthcare expenses. Speedy introduction of generic drugs into the market has remained in focus and is expected to benefit the Indian pharmaceutical companies. The government is providing support and in the coming years, India will shift from brand name to molecule name selling of medicines, and hospitals too will resort to this idea. In addition, the thrust on rural health programme, lifesaving drugs, and preventive vaccines also augurs well for the pharmaceutical companies. The implementation of the Goods and Services Tax (GST), on the other hand, is expected to be a game-changer for the Indian Pharmaceuticals industry. It will lead to tax-neutral inter-state transactions between two dealers, thereby, reducing the dependency on multiple states and increasing the focus on regional hubs. It is expected to result in an efficient supply chain management, which is expected to reduce its cost considerably. The cost of technology and investment is also expected to reduce on account of the tax credit which can be availed now on the duties levied on import of costly machinery and equipment to tackle the price war. However, keeping in view of all the great things launched, we have seen a major crunch of drug supplies in the government-driven generic stores. Unfortunately, since there is no other retail chain player in the country, we at StayHappi intended to launch our stores across Pan India that would offer High-Quality Generic Medicines at the most affordable price and would be insulated from the price war in Pharma Medicine sector. There are several ways to combat a price war before it even starts and for this, one has to make sure your competitors

understand the rationale behind your pricing policies. One need to compete on dimensions rather than price. Another way to fight a price war is to spread awareness to the masses about the risk of poor-quality products. We intend to offer best-quality medicines at a real value ranging from 40% to 90% (in some cases from branded drugs), which would enable the common man to get medicines at a much lower cost than branded drugs. Our concept is all about selling medicines by their molecule names. It will be offered in brick and mortar model as well as Online Mobile Platform for the ease of customers to get their medicines at the click of a button. Moreover, in tier II cities, where families are not financially strong and cannot afford high priced medicines, we provide them with the best quality of medicines at prices that they can afford. A large number of people suffer from diabetes, and considering the amount of medication required for this health issue, families would switch to more cost-effective medicines. It is also expected that this Mission of ours would truly address and tackle the price war in medicine segment, if not the whole of Pharma sector.

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The unorganized state of the distribution system of the pharmaceutical market in India

Dr. Piyush Gupta

Associate Director - GNH India

ealth care is one of the indicators of a country's development and a major hindrance in the path of that development is the highly fragmented and unorganized distribution market of the Indian pharma sector. India has become a prime destination for manufacture of branded, generic and branded generic medicines with a strong export element; however, the current pharma distribution market in India is in a completely erratic state. There is an absence of rules and regulations that should be levied on the distribution chain to trace back the exports or provide control to them. This takes away the element of authority from the distribution channel. Illegitimate storage protocols and the ambiguity in temperature controls are some other factors that stand in the idea of bringing about a systematic and standardized distribution process. The fungal meningitis outbreak that occurred from a steroid injection compounded under unhygienic conditions at New England Compounding Center in September 2012. This has proven to be a reminder of the risks associated with competing state standards. India enjoys an important position in the global pharmaceuticals sector. The Indian pharmaceutical sector is estimated to

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account for 3.1 – 3.6 per cent of the global pharmaceutical industry in value terms and 10 per cent in volume terms. With the Indian generics accounting for 20 per cent of global exports in terms of volume, India stands as the largest provider of generic drugs at the global level. According to Pharmexcil, India’s pharma exports grew 2.91% to $17.27 billion in 2017-18 which stands as a potential indicator of India reaching $20 bn by the year 2020. The various factors that contribute to this achievement are the holistic supply chain, the effective logistics involved in exporting to other countries, etc. However, the country still faces some challenges and hardships which, if worked on, shall let India cross the $20 bn mark and reach a higher estimate than predicted. The following diagram shows the penetration of illegitimate traders in the market leading to the decline in the standard of the distribution chain. The various forms of medicines need to be transported and stored at different environmental conditions, e.g. tablets need separate storage and temperature levels as compared to syrups. Hence, all medicines cannot be handled with one general rule. The study conducted by NIRT in Chennai on the drug to combat tuberculosis, it was found that the drug –

cycloserine was of substandard quality. The drugs are extremely sensitive to high temperature. Despite the fact, at a few centres, they found that there were no refrigerators. While the prescribed amount of the drug was 250mg, and the researchers found that the content of the key ingredient was as low as 108mg. We have heard of incidents wherein medicines have been exported in polythene bags. This risks the efficacy of the medicines which leads to the discarding of the entire lot of medicines along with the failure to fulfill the supply need. Such episodes not only show the level of disorientation but also the lack of proficiency present in the Indian pharmaceutical market. Loss of sales due to the unavailability of products at the retailer’s end is a reality in the current pharma distribution market. This can prove to be a bane at the times of emergencies and exporting during calamities. According to a study, the volume sales loss ranges to 5% in OTX brands primarily in tier 2 and rural areas which comprises 70% of the country’s population. The inability in uprooting this problem can lead to a revenue loss of 30% to 50% which will be a big blow to the pharma market. The distribution channels need to undergo crucial amendments in order to metamorphose into a structured and a regulated sector. If distribution is

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regularized, leakages can be prevented. Reduction and thereafter eradication of leakage will lead to enhancing the quality of distribution channel and provide security to the shipment and abolishment of the creation of spurious drugs. The pharma exports of India lack authority and responsibility. E.g. if a factory ships a consignment of 100 and the pharmacy receives one with 99, the damage is not recorded. There is no explanation or any investigation done for the shortage in the quantity of the shipment. The Freight Watch International sees it as a serious problem in countries like Brazil, Great Britain, India, Mexico, Russia, and South Africa. The cargo security is generally more of a problem in the countries with low- and middle-income, where problems like poor roads and slow transit times put shipments at risk for a long time, and in politically volatile places. Criminals take advantage of such places where the distribution chain breaks down and medicines depart from documented chain of custody. Drugs that leave the proper distribution system are called diverted drugs. Drug diversion is the means through which medicines approved for sale in one country are sold in the other countries, where they may not be registered. These schemes depend on false statements, forged customs declarations, or smuggling. In UW Health's University Hospital in Madison, Wisconsin; five patients were admitted to five different wards, were diagnosed with a bacterial infection in 2014. The epidemiologists figured that the outbreak occurred due to the syringes that were tampered while diverting the narcotics, a study published in Infection Control and Hospital Epidemiology said. The leakage in shipment also gives aid to producing counterfeit drugs. These drugs occur due to weak supply chains and pose a challenge in front of the pharmaceutical industry. Counterfeit pharmaceutical products are a real threat to public health and safety. They appear everywhere but the most seriously affected region is Africa, especially with anti-malarial medication. However, the legitimate supply chains in developing and industrialized countries are also compromised. The example of a

fake drug manufactured in Turkey in 2011 that found its way to several physiciansâ&#x20AC;&#x2122; office. The drug was often used alongside chemotherapy to treat several types of cancers. The drug contained salt and starch with some chemicals but no active ingredient. This affected practices in around 22 US states. Such incidents show the consequences of the counterfeit drugs in the system. In March 2010, $75 million worth of medicines were stolen from an Eli Lilly warehouse in Connecticut and later partially recovered in Florida. Annihilation of these drugs will allow the flow of genuine and effective medicines, retaining the caliber of exports. To enable a stringent system for the prevention of counterfeit drugs, registration and Intellectual Property Rights can play an important role. Managing the drug distribution system in developing countries includes various undertakings like containing the last minute costs, moving the medicines to the patients quickly, and keeping records of all transactions between the manufacturer and the consumer. This brings us to the other obstacle that lies in our path of reaching the goal is the administration system of India. We still live in the traditional age old order where many things in the country are paper based. We have come a long way in technology; however, our administration still proves to be a deterrent. It takes years for us companies to clear permissions. Unsafe storage i.e. poor warehousing is another factor that leads to the deterioration of the quality of the medicines and in turn, disrupts the cycle of distribution providing inconvenience to the manufacturer. If any chemical loses its efficacy, the entire shipment turns useless and the manufacturer is put to blame. For e.g. if a can of soda is damaged or not supervised and is left open for long, it loses its fizz. This leads to ruining the quality of the product and the consumers then blame the manufacturer for the delivery of deteriorated goods. This causes glitches in the distribution channel. Thus, significant amount of wastage can be prevented by undertaking quality warehousing. For all of the aforementioned problems, Good Distributing Practices (GDP)

proves to be an effective tool in providing structure to the Indian distribution market. Good distribution practices provide certain guidelines that ensure maintaining product safety and quality during distribution across the supply chain and this practice is of significant importance for the pharmaceutical industry. The objective of these GDP guidelines is to assist in ensuring the quality and identity of pharmaceutical products during all stages of the distribution process. These aspects include, but are not limited to, procurement, purchasing, storage, distribution, transportation, repackaging, relabeling, documentation and record-keeping practices. The GDP Compliance report for Pharmaceutical Industry demonstrates quality commitment & sound practices in the entire pharmaceutical distribution supply chain. India desperately needs to adapt to GDP. The certification should be made mandatory. The effective implementation of GDP will help in reducing the number of spurious medicines, owing to the end to end reporting guideline offered by it so as to track the supply chain back to the manufacturer in order to bring about orientation in the distribution. There is no initiative or emphasis from the governmentâ&#x20AC;&#x2122;s end for the encouragement of GDP pertaining to which there are about 10 companies in India that are certified with it. GDP stands as a potential growth factor of the future of the pharma industry. This is why, the international standard, WHO GDP stands as the most important and most practical protocol for the distributors. The implementation of GDP would allow the pharmacists to identify and eradicate the suspicious drugs before dispensing them to facilitate more efficient product recalls. The estimated mark predicted by the Pharmexcil council appears to be on the higher side. However, with the knowledge and experience that India holds, it is quite feasible. Undertaking the necessary measures and structuring the pharmaceutical distribution market will lead to devising an effective and lucrative supply chain â?? w w w.medegatetoday.com July-Aug 2018

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The Silent Killer

"Hepatitis kills millions of people every year, and most cases arise due to lack of knowledge"

he World Health Organization (WHO) estimates that in India 40 million people are chronically infected with hepatitis B and around 6-12 million people are chronically infected with hepatitis C. It is estimated that only 5 per cent of people with chronic hepatitis know of their infection and less than 1 per cent have access to treatment. The term hepatitis refers to inflammation of the liver happening secondary to either viruses or excessive accumulation of fat in liver. Hepatitis caused by infection is categorized into five main types depending on the viral agent causing the disease. These five types of hepatitis are currently of the greatest concern all over the world because they account for a huge burden of illness, outbreaks and epidemic spread, resulting in increased death cases and they are preventable.

Dr Roy Patankar leading Gastroenterologist & Director of Zen Hospital

Among 5 types, Hepatitis A and E spread through contaminated water or food through feco-oral route, where as Hep B and C are through body fluid, semen, blood and unsafe sex practices. Hepatitis D is always associated with Hepatitis B. HAV and HEV infections are usually mild and patients can fully recover, but in some cases HAV infections can be potentially severe as well as life threatening requiring emergency Liver transplant as treatment of choice. Mostly people living in poor hygienic conditions are more prone to acquire the virus. Hepatitis B and Hepatitis C is caused by exposure to infected blood transfusion, contaminated blood and blood products, usage of contaminated injection during medical procedures

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and through injected drugs. Hepatitis D occurs only in people who are already infected with HBV. Infection of HDV and HBV together can be extremely serious and may result in worse outcome. Hepatitis D vaccine is not available , but it can be prevented in people who are not already HBV-infected by hepatitis B vaccination In general, Symptoms associated with hepatitis of any cause are jaundice, yellowing of the skin and eyes, dark colored urine, extreme fatigue, nausea, stomach pain and bloating, itching, loss of appetite Based on your symptoms, you should undergo a few tests like the liver function test. When the liver cells get damaged, liver enzymes get released into the bloodstream which serves as a marker to diagnose hepatitis. Next comes the ultrasound of the abdomen. Ultrasound uses sound waves to produce an image of the abdomen. It enables the doctor to visualize the size and structure of liver. It also helps in evaluating jaundice or abnormal liver function test. It also show the presence of solid mass, cyst or tumour in the liver.

causing Liver swelling if taken in excess), medicines like acetaminophen/ Paracetamol (in excess quantities can cause inflammation of liver cells). Sometimes people mistake jaundice for hepatitis but jaundice is just a manifestation of the disease. Likewise malaria, dengue, swollen liver are pre-symptoms of the disease. Those having cirrhosis are at a greater risk of developing liver cancer; and should be careful to avoid any of above mentioned causes causing hepatitis and this carries high risk to life. Box

Preventive measures Here are a few things to keep in mind to avoid falling prey to hepatitis (A or B or in general?) ✓ Wash your hands after going to the bathroom and before cooking or eating. (Hep A and E) Drink either boiled or purified water (Hep A/E)

other major cause of hepatitis if excessive fat accumulation in Liver.

Avoid eating raw food during monsoon as it carries higher risk of transmission due to infected water (Hep A/E)

It is the sedentary lifestyle that leads to build up of fat in the liver, which is 5 to 10 per cent more than normal.

✓ Use latex condoms, which may lower the risk of transmission. (Hep B, C, D)

(How is this related to hepatitis? Does sedentary lifestyle cause hepatitis?) Yes, poor eating habits, lack of excercise

✓ Don't share drug needles. (Hep B, C, D)

But, if timely diagnosis and treatment occurs the condition can be reversed. Following a healthy lifestyle and physical activity can help prevent further damage to the liver. If ignored, fatty liver can interfere with the functioning of the liver and can cause permanent damage. Diabetes can increase risk of nonalcoholic fatty liver disease. (Is fatty liver or non-alcoholic fatty liver disease a part of hepatitis?)- Yes Anyone who are overweight are at a greater risk of developing liver cirrhosis secondary to Steatohepatitis ( inflammation of the liver with concurrent fat accumulation in liver ). (Liver cirrhosis is causes due to hepatitis?) - Yes, recurrent swelling i liver secondary to any reason either virus or fat i liver can cause liver cirrhosis which is irreversible condition and can be only cured with Liver transplant.

✓ Don't share personal items such as toothbrushes, razors and nail clippers with an infected person (All). ✓ Immunize children and high risk population like healthcare workers, with booster doze of hepatitis A and B Do not vaccinate infants and children when they are sick. It is advised to avoid live vaccination when the immune system is weak. Do not take analgesics or fever reducer before taking the vaccination as this may reduce the effectiveness of the vaccination. ✓ Be careful about equipment used while tattooing. ✓ Ensure body piercings are done with equipment that are clean ✓P ractice safe sex.

Every year approximately 200 new cases are reported on hepatitis and during the monsoon, the numbers are even higher. We need to focus on prevention of hepatitis a and E in general and during pregnancy as well as prevention of hepatitis b ,C and D. Hepatitis A and E are water borne diseases and are transmitted through contaminated food and water while hepatitis B and C get transmitted through blood, semen and saliva. Among various other reasons of hepatitis are Autoimmune hepatitis (here the immune cells of the body can recognize liver cell as harmful and raise a response against them leading to hepatitis), Alcohol (which directly metabolized by the liver w w w.medegatetoday.com July-Aug 2018

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Infection Prevention and control

Dr Anu Gupta

Lab Head and Microbiologist, SRL, Fortis Escorts Heart Institute

ospital infection prevention and control programme (IPC) is an important part of hospital epidemiology as it can save many lives in the hospital by curtailing the transmission of hospital acquired infections. A welldocumented and carefully implemented infection prevention and control programme helps hospitals in reducing the infections, identify risks and proactively establishing policies and protocols in hospitals. IPC programme addresses factors related to spread of infections within the hospitals (whether it is from patient to patient, from patients to staff, from staff to patients and from environment to patients and vice versa) and prevention practices (like Hand hygiene, standard precautions, cleaning & disinfection and sterilization practices, surveillance of healthcare associated infections (HAI), vaccination of staff, Occupational safety) and investigations of suspected infections eg outbreaks. For effective infection prevention practices in hospital, we can adopt few of following best strategies: Organization support: The most important part of a successful IPC programme is hospital management commitment and support towards the IPC

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policies in hospitals. In Fortis Escorts Heart institute, we have formulated a multidisciplinary infection control committee which meets quarterly and guides the IPC programme in the hospital. In addition to clinicians, administrators and non clinical departments, Infection control officer and Infection control nurses (ICN) are key members of this committee. We have a well documented infection control manual which has the infection control policies and protocols which needs to be followed in the hospital. All the policies are based on evidence based international and national guidelines. Educate the staff: Effective infection control requires continual staff education on correct practices and the organisations infection control policies. Hospitals should educate staff at the time of joining (orientation), throughout the year and as needed such as when new policies are instituted. Training can be either classroom training or practical simulated trainings. To monitor the effectiveness of trainings, pre and post training examination can be conducted. Training should cover all the departments of the hospital like nurses, doctors, paramedicals, technicians, housekepping, security, ambulance staff etc. Formulating a monthly/quarterly training calendar for all departments helps in better tracking of the education programme of the hospital. Hand hygiene : According to CDC, this is the simplest and cost effective approach to prevent the spread of infections in hospitals and needs to be incorporated in the culture of the organisations. Hand hygiene is an important component of the infection control “bundles” which have proven efficacy for prevention of catheter related infections, urinary catheter infections and ventilator associated pneumonias. The World Health Organization guidelines gives details about the local inexpensive method of manufacturing antiseptic hand rub. Soap and water, alcohol and chlorhexidine based products are commonly used for hand hygiene.

WHO also describes methodologies for measurement of hand hygiene practice compliance in hospitals. Across the world, studies document hand hygiene compliance to be between 40-60%. Removing the barriers to hand hygiene may be the most important intervention to improve the compliance. Health care workers should be properly educated and products should be easily accessible and available in hospital. At Fortis Escorts, hand hygiene compliance is monitored, analysed and communicated to staff regularly. Hand hygiene is monitored monthly by the ICN and link nurses. In addition third party audits are done quarterly for validation of data. World hand hygiene day and Global hand washing day are celebrated on 5th May and 15th October respectively to increase the awareness. Apart from this, orientation, in service education and on job training helps in spreading awareness and increasing the hand hygiene compliance. With this continuous effort, hand hygiene compliance rate has increased from 70% to 88% in last 2 years. Environmental hygiene (cleaning and disinfection practices): Environmental surfaces are the most common source of infections in the hospitals. Some microorganisms are known to survive on environmental surfaces (eg patient bed, call buttons, handles of the doors, equipments, monitors, tubings etc) for extended period of time. When health care workers or patients touch these surfaces, the bacteria can be transmitted causing infections. Thus, environment cleaning and disinfection is essential part of IPC programme. The CDC guidelines for “Disinfection and sterilization in healthcare facilities, 2008” has evidence based recommendations on the preferred methods for cleaning, disinfection and sterilization of patient care medical devices and for cleaning and disinfecting the healthcare environment. The hospital can develop protocols for cleaning and disinfection as per the hospital requirements. However, it should be emphasised that strict adherence to cleaning and disinfection protocols is

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mandatory for effective implementation of process. Further, monitoring of cleaning and disinfection practices is equally important. For, instruments chemical and biological indicators are available which confirm that the instruments have been properly sterilized. But there are not many tools available to monitor the room cleanliness. ATP test and florescent markers are some of the new methods to monitor the effectiveness of cleaning processes in the hospital. Another important aspect of environment hygiene is hospital cleaning staff. They are often low paid individuals, with high attrition rate and who may not realise the importance of their role. Hospitals should have a well defined intensive training programme for cleaning staff which in addition to the cleaning protocols should also focus on teaching them about the importance of cleaning in infection prevention. In our experience at fortis Escorts, these staff if trained well about the importance of their work, carry out their cleaning practices effectively. The housekeeping department head is also a member of infection control committee so that they can relate housekeeping tasks with other infection control activities in the hospital. Standard Precautions: Apart from hand hygiene and environmental cleaning, other standard precautions like use of Personal protective equipments(PPE), respiratory hygiene, isolation precautions, care of laundary, biomedical waste management etc should be properly implemented in hospital. PPE includes gloves, gowns, face shields, goggles, surgical masks, respirators etc and should be used by the healthcare workers to guard against blood borne pathogens ( like hepatitis B virus, HIV and Hepatitis C virus) if there is a reasonably anticipated exposure to blood or other potentially infectious materials. For patients who are suffering from transmissible infections, isolation precautions (contact/ Airborne/Droplet) are followed in hospital. Isolation precautions in medical field refers to various physical measures taken to interrupt nosocomial spread of transmissible infections.This may require infrastructural support from the hospital eg for Airborne precautions, negative pressure rooms should be

available in the hospital. Hospitals should also evaluate whether the staff is adhering to the specific protocols by audits. These findings should be shared with the concerned healthcare workers and infection control committee for better compliance. Biomedical waste should be disposed as per the Biomedical waste guidelines, 2016. Occupational safety of healthcare workers: Healthcare workers may be exposed to certain infections in course of their work. Vaccines are available to provide protection to healthcare workers in hospitals. Depending on recommendations, government regulations, specific work function they can take vaccines for Hepatitis B, Tetanus, Chickenpox etc. At Fortis Escorts, Tetanus and Hepatitis B vaccination is started at the time of employment and after 3 doses of vaccination of Hepatitis B, antibody titres are also checked to assess the immune status of healthcare worker. Hospitals should also have an occupational exposure policy (Sharps and blood and body fluid exposure). In some infections like HIV and Hepatitis C virus exposure where vaccines donot exist, post exposure prophylaxis is a means to protect the healthcare worker from these infections. The CDC guidelines for sharps exposure should be followed. Surveillance for infections: Surveillance is a continuous monitoring of hospital acquired infections (like Central line associated blood stream infections, Catheter associated urinary tract infections, ventilator associated pneumonias, surgical site infections etc) in the hospital. This should also include surveillance of recent infection prevention protocols (eg bundles). A good surveillance programme helps hospital measure outcomes and assess processes of care in hospitals. The trends of infections should always be analysed along with the compliance of the process of care for a meaningful analysis. This data should be shared and discussed with stakeholders to increase the compliance of infection prevention protocols. The surveillance guidelines are available on CDC- NHSN and is updated yearly in the month of January. At Fortis Escorts, trends of hospital acquired infections are analysed and compared with national

and international benchmarks available to compare and improve the infection prevention protocol of the hospital. Antimicrobial Stewardship: An effective antimicrobial stewardship programme (AMS) is important to prevent the misuse and overuse of antibiotics in the hospital. Antibiotic policy should be formulated based on the antibiogram of the hospital and the available national and international guidelines. This policy can guide the clinicians in appropriate selection and dosing of antibiotics. Restricting the use of some high end antibiotics can also be done to prevent the emergence of resistance of multidrug resistant bacteria. To monitor the effectiveness of the programme parameters like drug consumption data, antibiotic resistance data, Drug resistance index can be monitored. Audits should be conducted to monitor the selection of antibiotics. At Fortis Escorts, in addition to above methods, a mobile app for antibiotic policy is also being used since last 3 years. Data management: Infection control data should be collected, analysed and communicated to concerned personnel. These data should be discussed in infection control committee meeting. Infection control risk assessment should be done and focus areas should be decided based on the upward or downward trends of infections. Challenges: In current scenarios, infection prevention department of the hospitals face many challenges during the infection prevention and control implementation. Due to staff attrition in almost all the departments of the hospital, continuous education is needed. The attitude and willingness of healthcare workers to practice prevention practices like hand hygiene matters a lot. Also, there are no national benchmarks available for hospital acquired infections. In the current scenario, where many hospitals are now accredited and are following the uniform surveillance protocols, national benchmarks can be made available by the accrediting bodies. Another challenge is the emergence of new infections eg the recent scare of Nipah virus infections. As there is little data/experience available on these new infections, hospitals develop new policies based on whatever little data is available. w w w.medegatetoday.com July-Aug 2018

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Importance of timely diagnosis of cancer and its treatment

to carcinogens. Some of the naturally occurring carcinogen exposures can include ultraviolet light, radon gas, infectious agents, etc. Some types of cancer run in certain families and are inherited, especially breast, ovarian, colorectal, and prostate cancer.

Symptoms of cancer

Dr. Gowri Kulkarni

Heads of Operations, DocsApp

he latest news of Bollywood actress Sonali Bendre being diagnosed with high-grade cancer came as a complete shock to many. Her fans and near and dear ones are yet to come to terms with her illness. As per reports, her cancer has reached a critical stage for which she is undergoing treatment in New York. Why didn’t the actor see it coming? Several reports claim that the actress was experiencing infuriating body pain for a long time but she kept ignoring the symptoms. Due to her negligence or perhaps a human tendency to believe that nothing very serious can happen to oneself, the actress is now battling with life and death. Cancer occurs when abnormal cells grow in an uncontrolled way, often forming a tumor that can be either benign or malignant. If cancer is detected at an early stage, it can be nonlife-threatening and non-invasive. However, for the actress of Sarfarosh fame, cancer has metastasized and reached a dangerous stage. Therefore, the need of the hour is to spread awareness about cancer amongst the public and encourage them to conduct timely health check-ups and tests at every stage of life. As per reports, there are about 2.5 million people living with cancer in India and over 7 lakh new cases get registered every year. These figures make it amply clear that cancer awareness and an understanding of the available treatments is paramount amongst Indians today.

What are the causes of cancer? There are many possible causes of cancer; the most common being exposure to carcinogens, improper diet, no physical activity, over-consumption of alcohol and smoking and various types of radiation, including cumulative sun exposure. The substances labelled as carcinogens may have different levels of cancer-causing potential. Some may cause cancer only after prolonged and high levels of exposure, and the person's genetic makeup is also responsible for how their bodies react 48 July-Aug 2018 w w w. m ed e g a te to d a y.co m

A lot of people ignore the symptoms and conduct selfadministered therapies at home, which at a later stage prove costly. Many times, people neglect an additional growth or systemic symptoms witnessed in the body. Always remember, cancer does not cause pain at the initial stage. Pay heed to any suspicious growth or lump and get it examined by the doctor. Allow the doctor to decide whether the growth is benign or malignant. Here is a list of symptoms and signs that people should not ignore. If the symptoms last for a couple of weeks, it is important to consult a physician so that the problem is diagnosed and treated as early as possible. • Fatigue • Unexpected fever for a very long time • Unexplained weight loss • Changes in appetite and bowel movements • A new mole or a change in an existing mole • A sore that does not heal • Urinary tract problems • Change in size or shape of the breast or nipple • Change in the texture of breast skin • A thickening or lump on or under the skin • Unusual bleeding or discharge • Change in skin texture

Detecting cancer at an early stage so that the survival rates are much higher There are a lot of advanced treatments and modalities that have developed for the treatment of cancer. The four major types of clinical preventive care are: ✓ Immunization ✓ Screening ✓ Behavioural Counselling ✓ Chemoprevention Both men and women can develop cancer and should get timely check-ups done to significantly reduce their risks. For instance, getting a PET scan (an imaging test) done can show whether a tissue is active cancer or not. Women are at a high risk of breast cancer, ovarian cancer and cervical cancer. Women after the age of 21 should opt for a Pap smear test and a screening

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procedure for cervical cancer.The test must be taken once every 3 years. There is a vaccinationagainst human papillomavirus (HPV) that has been proved to be very effective in preventing the development of cervical cancer. To prevent the risk of breast cancer, women above the age of 40 should get a sono-mammogram done every year. Women below the age of 40 are at a higher risk of developing the disease if they have close relatives who've been diagnosed with breast cancer. They should get a clinical breast examination done or go to a doctor for a test at least once a year. Colon cancers are also common and they typically run in the family. About 5 to 10 per cent of colon cancer cases are caused by an inherited genetic mutation. Undergoing colonoscopy, starting from the age of 40 is a must if there is a family member who had colon cancer. The 2 common tests to be taken for ovarian cancer are trans-vaginal ultrasound (TVUS) and the CA-125 blood test. Prostate cancer is highly common in elderly men. It is advisable that all men post the age of 55 undergo regular scans or get a Prostate-Specific Antigen (PSA) test done above age 60.Apart from these, regular health check-ups are necessary for both men and women after they cross 40. Always remember, the incidence of cancer is much higher as you grow older.

Prevention is better than cure Hollywood star, Angelina Jolie had undergone a double mastectomy to reduce her risk of developing cancer. She took the step because she carried a faulty gene, which meant she was at a higher risk of breast or ovarian cancer. A lot of people opt for prophylactic surgery for cancer prevention. The goal of prophylactic surgery is to remove additional tissue or organs from the body which, although may currently show no signs of cancer, carry a high risk of developing cancer in the future.

Treatment Usually, the treatment for cancer depends on the type and stage of the disease along with the age and health status of the patient. Patients often undergo a combination of therapies depending on the intensity of the disease. Treatments usually are surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.

used to treat cancer that has spread or metastasized and the medicines are effective for the entire body. Doctors choose the drugs based on the kind and stage of cancer. The common side effects experienced are hair loss, nausea, fatigue, and vomiting.

Radiation If cancer has metastasized, then performing a surgery can be difficult. In this stage, a patient has to undergo radiotherapy first and then go for a surgery. Radiation treatment destroys the molecules that make up the cancer cells by utilizing highenergy gamma-rays on those damaged cells. Radiotherapy is used as a standalone treatment to shrink a tumour or destroy cancer cells and it is also used in combination with other cancer treatments. Other treatments include immunotherapy, gene therapy and hormone therapy. While these are relatively new and expensive treatments, they are effective and can be included in the combination of therapies for the cure. While hormone therapy helps to bring down the hormone production in the body so that cancer cells are killed completely, in immunotherapy, the body's immune system is used to fight the tumour. The goal of gene therapy is to replace damaged genes with ones that work to address theroot cause of cancer: damage to DNA. While potential side effects for all the treatments do exist, a patient and his family members need to monitor the risk to survival ratio carefully before considering a treatment.

Post-treatment care Post the cancer treatment, survivors need to take extreme care of their health to avoid the chances of relapse. From following a healthy diet, cutting down stress and reducing their exposure to chemicals, cancer survivors should stay away from everything that may put them at a risk for recurrence. A. cancer patient needs to be in constant touch with his/her doctor because the recurrence of the disease is very high. Cancer recurs because small areas of cancer cells may remain undetected in the body. Therefore, it is important for the patient to go for regular and timely check-ups. Also, maintaining a medical support system in place is essential for physical and emotional health.

Surgery One of the oldest and common treatments for cancer is surgery. If cancer has not metastasized, it is possible to completely cure a patient by surgically removing cancer from the body. If there is a lump detected, then it can be removed with the help of a surgery. However, a surgery is not just about removing the lump but also getting rid of the lymph nodes around it that are the portals through which cancer cells spread to other parts of the body.

Chemotherapy Chemotherapy is the use of drugs to slow or stop the growth of rapidly dividing cancer cells in the body. Chemotherapy is w w w.medegatetoday.com July-Aug 2018

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Don’t ignore your child’s tummy troubles Dr Anita Suryanarayan,

Vice President (South India & Sri Lanka), Metropolis Healthcare Young children are quick to refuse food, eat sweets through the day, pick junk food over healthy greens, and often ingest all sorts of rubbish like paper, tissue, and mud. More often than not, these habits make them sick. Along with fever and vomiting come frequent complains of abdominal pain. However, you must not easily dismiss the stomachaches as a sign of strange, childhood eating habits. Your child may be suffering from Inflammatory Bowel Disease (IBD). IBD represents a group of intestinal disorders that causes prolonged inflammation of the inner linings of the digestive tract, including the stomach, small intestine, large intestine, and often the rectum. The condition disrupts the functioning of the digestive system severely and prevents the good nutrients and calories from being absorbed into the child’s body, thus also hindering their normal development and growth. IBD can present itself as either of two chronic diseases – Ulcerative colitis and Crohn's disease. They are majorly caused due to consumption of junk food or unhealthy food on regular basis, a poor immune system, and often due to genetic disposition. Usually, abdominal pain occurs between the chest and pelvic regions. It can manifest in the form of cramps, aches, dull, intermittent or sharp pangs of pain. Few of the main reasons for abdominal pain in children are constipation, indigestion, and inflammation caused as a result of consumed bacteria. However, a child suffering from IBD has become a common occurrence and one needs to pay close attention to the symptoms or pain described by the child. Following are common types of abdominal pains based on their root cause: • Generalized pain over more than half of the belly could be due to a stomach virus, indigestion, gas, or when the child has become constipated • Cramp-like pain is most likely to occur due to gas and bloating. It is often followed by diarrhea and not very serious • Colicky pain is pain that comes in waves, usually starts and ends suddenly, and is often severe • Localized pain is pain in only one area of the belly. The child may be having problems with their appendix, gallbladder, a hernia (twisted bowel), ovary, testicles, or stomach (ulcers) 50 July-Aug 2018 w w w. m ed e g a te to d a y.co m

If you observe signs like slowed growth rate, rapid weight loss, tiredness, repeated bouts of diarrhea, blood in stools, rectal pain, bloating, fevers and anemia, along with complains of abdominal cramping, IBD may be the cause. It can also cause health problems that occur outside the digestive system, like inflammation of the joints, eyes, skin, and liver. It is essential that you call your doctor at first suspicion and ensure that your child gets proper evaluation and treatment. This may involve a Fecal Calprotectin test to determine the level of inflammation. Based on the results of this test, the doctor may recommend a further colonoscopy, endoscopy or an x-ray called Upper GI view organs, tissues, and other structures in the abdomen in detail and asses the condition’s level of progression. Not all kinds of abdominal pain are preventable however they can be minimized by healthy eating habits, consumption of water to prevent constipation, exercising regularly, avoiding lying down too soon after eating. If your child does indeed suffer from IBD, he or she may require special dietary monitoring and care. Diarrhea, loss of nutrients, and the side effects of drug treatment all can lead to malnutrition and hence it is important for the child to eat a proper balanced diet with adequate calories. You can encourage your child to eat small meals throughout the day to help manage symptoms. For slightly older children going to school, either ensure that the school provides healthy meals or pack nutritious snacks and lunches so he or she will not be tempted to indulge in salty, high-fat junk food that can intensify IBD symptoms.

DOCTOR SPEAK

We are what we eat! Dr Rajesh Bendre Associate Vice President, Metropolis Healthcare

Our health is a combination of a number of external and internal factors. Genetics and environment work in synergy to make us who we are. One of the most popular factors, and perhaps the most significant one, is food. In the age of instant over sharing and ensuring aesthetic over quality, we often see but don’t really understand what is on our plate. Most people are aware of common food allergies and how to deal with them, regardless of whether they suffer from it or not. Food intolerance on the other hand isn’t a widely popular or understood concept, as it should it. One may think that dish was undercooked, or a spice overpowered the whole dish, or the food contained ‘something that didn’t sit well with me’ and attribute to it as a cause of a physical reaction of discomfort after eating certain foods. Seldom do people realize that they may be intolerant. People often confuse and think that food allergy and food intolerance are same, but actually they are not. Food Allergy is

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caused due to an immune reaction towards a specific food protein (allergen). Food intolerance is actually a digestive system response to certain foods. Food Allergy is an acute immediate reaction, whereas food intolerance is a chronicle reaction. For example, lactose intolerance is a condition where one’s body cannot successfully digest milk. It does not make a person allergic to all milk byproducts. Metropolis Healthcare is one of the first labs to conduct a detailed research study using the Protein Microarray Biochip Test for Food intolerance. Using the microarray biochip, 220 food items are embedded on the chip and fluorescence Elisa is used for reporting. The data collected by Metropolis was analyzed age-wise and food item wise and the Percent positivity were calculated. Cut off levels were set, so that based on the values generated from the test researchers can then identify whether the food tolerance for the patient was normal, borderline or elevated. Only patients who had elevated results were retested after a specified amount time recommended by the doctors. The final results of the test found that most women, men, and children are intolerant to cow milk and wheat.

The reason it is most essential to know what food or ingredient one is intolerant to is that long-term consumption of non-tolerated food causes gut inflammation and accounts for development of various chronic diseases. This in turn may lead to several other health problem and serious chronic conditions. Elimination of diets based on food intolerance testing is recommended in irritable bowel syndrome, atopic dermatitis, and more such conditions. Most doctors believe that the protein miccroarray food intolerance test is a better tool for identifying Food Intolerance in the most non-invasive, adjuvant, objective and quantitative manner. The information provided by this test gives better insight for diet planning in terms of avoidance or usage of alternate sources for certain foods. Patients can further seek better guidance and interpretation of the reports from gastroenterologist and dieticians to correct their eating habits. Those who are taking the test need to keep some points in mind. The patients need to include everything they normally eat in their diet for at least two weeks before testing. This test is not recommended for children under 2 years and pregnant women.

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INTERVIEW Designing and rolling out a scheme that will benefit more than 50 crore people is a big challenge – Indu Bhushan, CEO, Ayushman Bharat--National Health Protection Mission (Government of India) Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization. Ayushman Bharat - National Health Protection Mission will subsume the on-going centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS) ☞ Ayushman Bharat - National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year. ☞ Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country. ☞ Ayushman Bharat - National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database. ☞ The beneficiaries can avail benefits in both public and empanelled private facilities. ☞ To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. ☞ One of the core principles of Ayushman Bharat - National Health Protection Mission is to co-operative federalism and flexibility to states. ☞ For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (ABNHPMC) at apex level Chaired by Union Health and Family Welfare Minister. 54 July-Aug 2018 w w w. m ed e g a te to d a y.co m

INTERVIEW ☞ States would need to have State Health Agency (SHA) to implement the scheme. ☞ To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat- National Health Protection Mission to State Health Agencies may be done through an escrow account directly. ☞ In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction. You have huge experience in financing and implementing projects at the Asian Development Bank and you have a PhD and Masters in health economics from Johns Hopkins University. So, how will you use your background for implementing the world’s largest healthcare insurance scheme? My international experience helps me in bringing lessons learnt from other countries to the scheme. We will seek to replicate the good practices from other countries and at the same time avoid the mistakes that were done by others. My international experience and education gave me an invaluable opportunity to work with world class experts, both Indian and international. I can also seek their help on how to better implement the scheme, especially when it is off the ground. As a C.E.O of Ayushman Bharat the biggest health care protection programme, Its bit challenging assignment for you? Yes, it is a challenging assignment. Designing and rolling out a scheme that will benefit more than 50 crore people is a big challenge. However, we have a highly motivated team and committed partners. We also have high level of political commitment, both at national as well as state levels. The challenge is to effectively channelize this commitment and energy for successfully implementing the scheme.

How you will involve private players/hospitals. What will be the criteria for empanelment? We have clearly specified detailed criteria for empanelment (which is available on our website ABNHPM.GOV.IN). We have indicated the required level of human resources, infrastructure, equipment and services that need to be available for empanelment. States can modify these criteria, especially for lagging areas. We are keen to attract all quality hospitals to the scheme. If we assume that 2% of our targeted population will seek hospital care, we will have more than 1 crores persons benefiting from the scheme every year. This cannot be achieved unless we have a strong network of health facility both public and private. For attracting private hospitals, we will offer them reasonable rates and prompt payment of their claims. Any delay in payment to hospitals will attract penalty on insurance company or Trust. What will be provider payment method? Is there will fix price for different diseases? We have identified 1350 packages and their rates. The States have been given the flexibility to change the rates based on their context. The rates will include prehospitalisation and post hospitalisation benefits including all tests, medicines, services, food and staying charges. As you have signed MOU with IMA for empanelment? What will be role of IMA? IMA is an important body that represents large number of health care providers. We expect IMA to actively support the implementation of this ambitious scheme. We expect them to disseminate information about this scheme to its members and other people. We also want them to encourage the hospitals to empanel for Ayushman Bharat in a big way. We want all eligible high quality private hospitals to empanel. We expect IMA to provide regular feedback on the implementation of the scheme including how to make it sustainable and prevent cost escalation.

Who all will be the beneficiaries’ of Ayushman Bharat and how they will avail these benefits? It will be cashless or on reimbursement basis? The scheme will be cashless. No upfront payment needs to be made by beneficiaries. The beneficiaries of the scheme are selected from SECC database. This is the census done in 2011. The idea is to cover bottom 40 percent most deprived population in the country. We had done a validation drive in several states in last few weeks and have been able to identify about 80% of these beneficiaries in rural areas and about 60% in urban areas. We will send them a letter informing that they are eligible to avail of services. They can bring this letter or any other identification card to the hospital when they have to seek health care. Our IT system will recognise the beneficiary and issue an e-card which can be used for any follow up visit. w w w.medegatetoday.com July-Aug 2018

HEALTHCARE Update

Healthcare IT

Healthcare is Predominantly Driven by Digital Technology with Most Medical Equipments Running on Digital Platform.

ealthcare industry is one of Indiaâ&#x20AC;&#x2122;s vastly expanding sectors in terms of economy, and anyone in pursuit of a fulfilling career has more than just a chance to establish themselves in it. The industry basically deals with hospitals, diagnostics, medical devices, and medical tourism. Though Indian healthcare is showing an exponential growth, the scope of development is yet to be explored. With the growing science and technology, use of medical apps have been on a rise and made IT considerably more understanding. Medical apps have become more customized providing a meaningful use of social media. The increased use of 3D printing technology has also evolved in the recent years, providing the surgeons with a game changing technology in diagnostics and study the human anatomy. Printing blood vessels and heart tissues, studying cancer cells and replacing organs to name a few has already seen practical application in diagnosis and disease management. The advents of smart watch, real time diagnosis in the operating room has helped the field with adherence control and inter disciplinary therapies. The technological advancement in the healthcare industry acts like an Artificial Intelligence in medical decision support, redesigning the hospital experience and poses like a virtual digital brain.

Dr. Ruchi Gupta Founder and CEO, 3hcare.in

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In the current situation, healthcare is predominantly driven by digital technology with most medical equipments running on digital platform. With more private players coming forward with better public â&#x20AC;&#x201C; private partnerships, this field is estimated to grow at a compound annual rate of 25% during this 5 year tenure to become much more vast and diverse. One of the most interesting and fascinating fields in this segment is genetic testing and research in molecular biology. With Unfolding opportunities in this field, genetic biomarkers are continuing to expand. A molecular biologist focuses on the genetic changes to assist in curing and slowing down of disease infestation. And screening in newborn is necessary

HEALTHCARE Update

as it helps in identifying genetic disorders and facilitating treatment early in life. As far as job opportunities are concerned, diagnostic management professionals are required not only in hospitals and clinics, but also in healthcare NGOs, hospital consultancy companies and IT industry involved in developing software and imaging equipments. IT firms like Dell, Accenture, Delloite etc hire such professionals. In case of a fresher, who has no work experience, the industry hires them as technicians and with the training and experience gained they will reach the zenith within few years. Many students are confused with what to opt for after completing their graduation- whether to go for low salary job or pursue further studies. Majority of them do their post graduation to get a decent job. Diagnostics is one such segment in the field of healthcare management that has brilliant prospects in job environment and a profitable career option. Besides getting lucrative remunerations, this also helps to achieve the goal of service to mankind. Healthcare operates in various segments of which the diagnostics segment is at a boom. Pathology, the type of diagnosis of human diseases by laboratory methods has open scope in areas either as a diagnostician, teacher or an investigator. Pathologists in clinical laboratories practice as consultant physicians, to analyse the laboratory reports for better diagnosis and treatment of a patient. One of the most interesting and fascinating fields in this segment is genetic testing and research in molecular biology. With Unfolding opportunities in this field, career in genetic biomarkers are continuing to expand. A molecular biologist focuses on the genetic changes to assist in curing and slowing down of disease infestation. And screening in newborn is necessary as it helps in identifying genetic disorders and treats early in life. Another field of diagnosis is radiology that deals with diagnosing and treating diseases with medical imaging techniques. With the increasing demand for radiologists in India, this field ensures a better career path and the occupation is expected to grow faster than any other. A radiology technician has an option to work as ultrasound technician, X-ray technician, MRI technician, CT technician and medical

professional. With an immediate and sustainable demand for technologists in hospitals, clinics, and physiciansâ&#x20AC;&#x2122; offices, the field of radiography continue to show higher than average job growth into the future. Job scenario for those planning to start their careers in radiology are expected to remain high, particularly for those interested in working for general medical and surgical hospitals. Radiation technicians can work in urgent care facilities, clinics, equipment sales, and private offices. Radiologic technology is a fascinating subject to study which in addition to providing certificate to work in the state of residence, also prepares a career in healthcare industry that s challenging, important and gratifying. Being one of the heart warming jobs, position of a radiologist holds 15th rank among the best jobs in this industry and considered one of the smartest choices to opt for. According to IBEF, the overall healthcare market is worth $ 100 billion and is expected to reach 280 billion by 2020. The Indian medical tourism will reach $ 10 billion with 2 times growth in health care IT market is expected by 2020. The data promises to provide a huge boost in generating employment opportunities in the upcoming years in the field of healthcare management. With several big investments being made in this sector, the functioning of the industry has become more professional, organised and efficient. Besides the urgent need for trained doctors and nursing staff, efficient management is required in various measures of the field. Looking for future experts, lack of talent is currently a drawback. The industry is growing at a swift rate, though the talent still is lagging. To nurture todayâ&#x20AC;&#x2122;s talent for a long term with focus on quality, opens up scope for many. Being a young industry open in the market, the learning curve will definitely be sharp and the talent will be nurtured to withhold greater responsibilities at a younger age. The industry is trying to seek out people who have a high moral purpose, eager to learn and lead. This will create an impact in advancing in the healthcare world by providing promising opportunities that will reshape and redefine it. With the growing science and technology, use of medical apps have been on a rise and made IT considerably more understanding. The role of a technician has undergone a major change over the past decade. Most modern hospitals and healthcare establishmentsâ&#x20AC;&#x2122; are in requirement of experienced technicians and radio-interventionist equipped with multidisciplinary skills. The healthcare industry desires a skilled workforce of professionals involved in research, market shaping and development and most importantly customer centric roles. India is the potential place to attract healthcare industry with its highly skilled specialised workforce. w w w.medegatetoday.com July-Aug 2018

POST 10th VOH Indore Conference: T EVENT

his conference was focused on “Challenges & Opportunities in Tier2 Healthcare Markets”. This conference marked the comeback of tier 2 markets as centre of excellence in healthcare The conference was held successfully on 25th -26th May 2018 at Indore at Medical Expo, India’s leading exhibition of medical products & equipments. The conference witnessed interactive & intensive deliberations on healthcare issues . This conference had many “FIRSTs” to its credit such as: ☞ First time any such conference was focused on tier 2 markets ☞ First time a detailed presentation on healthcare economics ☞ Media - Healthcare industry interface: First time a panel discussion on media management by the mainstream & healthcare journalists along with medical fraternity. ☞ Presentation on Integrated medicine: First time in non-clinical conferences ☞ Master class on fund raising …First such dedicated class in healthcare ☞ Presentation on Medical Equipment Library …First time a presentation on new medical planning concept in Indian healthcare context Last but not the least, for the first time many young thought leaders were introduced in any healthcare conference . The conference was inaugurated by Mr. HARi Narayan yadav Former VP indore development authority & Prof. (Dr.) Sharad Thora Dean MGM Medical College, Indore

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Dr. Santawana a leading healthcare quality guru anchored this conference and enthralled the audience by her energetic anchoring with witty remarks all along . The conference started off with the address of key note speaker & conference Chairman Dr. Sunil Khetrapal, COO, Rajiv Gandhi Cancer Research Institute, New Delhi. who shared his long experience of healthcare administration in tier 2 markets. He shared his valuable insights vis a vis developing tier 2 markets. The first presentation of the conference was “Is Healthcare IT an essential investment or inevitable expense in Tier 2 Markets ?” by Mr. Amit U Jain, founder of Hospital software shop.com. He emphasized over investment in healthcare IT to enable tier 2 healthcare service providers to better efficiency in hospital operations. This presentation was followed up by an excellent presentation on customized medical planning & designing for tier 2 healthcare facilities by Dr. Parvez Ahmed who is one of the leading healthcare experts . As momentum picked up, Mr. Vishal Gandhi who is founder & CEO of BIORX Venture Pvt. Ltd and specializes in healthcare & biotech industries, enlightened the audience in his master class on funding. As we know a meticulous Manpower planning is crucial for hospital operations, next speaker Dr. Sunil Khetrapal shared his thoughts on role of manpower in smart hospital management. Post Lunch session started with CEO Panel discussion on challenges & opportunities in tier 2 markets . The panel discussion was moderated by Mr. Vishal Gandhi and pearls of healthcare wisdom and excellence were shared by Dr. Sunil Khetrapal, Dr.

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Rajesh V Shah, well acclaimed Clinician and healthcare Thought Leader, Dr. Paramhans Mishra, CEO, BIMR Hospital, Gwalior, having rich International and Indian healthcare administrative experience, Dr. Suchin Bajaj, Director, Cygnus chain of hospitals, well known healthcare columnist, and thinker, Mr.Sanjay Jain, M.D. Akhil System an authority on Healthcare IT, and Dr. Sarthak Bakshi, a fast emerging healthcare thought leader. After Panel discussion, Dr. Shuchin Bajaj enlightened & enthralled the audience with his presentation on Design Thinking for healthcare delivery: cutting age or old wine in new bottle. He simplified the complicated topic for easy understanding of the audience. The simplification process was furthered by Dr. Joy Krishna Jeevan Bannejee, MD, Weisermanner Healthcare Consultancy. He creatively engaged audience & simplified his presentation on 10 key elements for hospital success. Next presentation was made by Mr. Aditya Tripathi, Manager, BMJ on Medical Education. Dr. Paramhans Mishra, CEO, BIMR Hospital, Gwalior made a thought provoking presentation on emergence of tier 2 markets: Is it driven by promoters cost considerations or patient cost considerations. It was well received by audience. The conference afterwards went into innovation mode with presentation on New medical planning concept-Medical Equipment Library by Mr. Rajinder Kadu & Mr. Shivam Anand, Directors, Concept Healthcare Solution Pvt Ltd. Finally Dr. Rajesh Shah, also a VOH Advisor gave Vote of Thanks on day one with his brief presentation on medico legal implications for healthcare. Day 2 of the conference started with comprehensive presentation on healthcare economics by Dr. Sharad Pandit, Retd. Regional Director, Deptt of Public health & family welfare, Govt of M.P. The next presentation on infection control in OT, was made by Mr. Zakir Hussain, CEO, Al Med Equipments. The next speaker was Mr.Srinivas Reddy, Senior Technical Officer & Manager, Business Development, AMTZ. AMTZ is India’s most prized and self reliance project of Medical Equipments & Device spearheaded by its visionary MD & CEO Dr.Jitender Sharma, Med Tech Man of India. Mr.Reddy in his presentation highlighted the role of indigenous medical equipment manufacturing capabilities in affordable healthcare. The next speaker was youngest speaker of the conference Dr.Sarthak Bakshi, CEO, International Facility Centre, one of the largest IVF Chain in India. In his presentation on Leveraging AI & IOT in healthcare in tier2 & 3 Markets,he dwelt upon role of AI & IOT as enabler in future healthcare . Well it was the time for Mr. Manish Rastogi to take over anchoring job for time being from Dr. Santawana Vernekar. Dr.Santawana is recently acknowledged by Medgate Today as woman healthcare leader among top most influential women leaders of healthcare. She made an impressive presentation on healthcare quality with specific reference to tier 2 markets. Dr. Millind Joshi, Director, SM Joshi healthcare moved the conference momentum from quality management to operational challenges in tier 2 cities and shared his consulting experience in tier 2 cities. Last presentation in pre lunch session on day two was

delivered by Mr. Sumit Marwah, CEO & Director, Dispoline India Pvt Ltd. He emphasized over necessity of infection prevention & single use protection. Post lunch session was kicked off with very interesting panel discussion on advantages of adopting & practicing quality in tier 2 hospital facilities. This panel discussion was moderated by Dr Santawana and enriched by insights of Dr.Sunil Khetrapal, Dr. Paramhans Mishra, Dr. Rajesh Koria, Director, and Quality head, Eureka Hospital & Research Centre, Indore, Dr. Mayank Gupta, SS Hospital& Research Centre, Ujjain. Dr.Digpal Dharkar, Honarary Secretary, Indore Cancer Foundation, Indore, was humbly invited to VOH Conference. Dr.Dharkar & his team offers charitable cancer care to poor patients. Dr.Dharkar has been fighting a war against dreaded cancer for last two decades. He shared his hands on experience in building & sustaining an oncology facility. It was now turn of another two young thought leaders Mr. Vinod Sawantwadkar, Centre Head, and Mr. Abhishek Sharma, Marketing Head, Wockhardt Hospital, Nasik to enlighten the audience through their presentation on healthcare dynamics in tier 2 cities. This was one of the most challenging topics of the conference and was presented very well by duo. After this powerful presentation conference moved to powerful Panel discussion on Media Management by Healthcare and Mainstream Journalists. Mr. Afzal Kamal, Chief Editor, Medgate Today & General Secretary, Voice of Healthcare moderated the Panel Discussion. The panelists were Mr. Praveen Kumar Khariwal, Founder-President of State Press Club,MP. Senior Office bearer of IFWJ,Indore Press Club etc in MP, Mrs. Sandhya Roychoudhary, Ex Sub Editor-Dainik Bhaskar. Content editor :www.pradeshvarta.com, Mr. Manish Joshi Senior Sub Editor Nai Dunia, Indore, Dr. Deepa Manish Vyas Educationist, Writer,Social Activist,Critic,& Anchor, Mr. Alok Vani, Editor, Ghamasan. com(National Hindi News Portal). The medical fraternity was represented by Dr. Sunil Khetrapal, The panelists advised medical fraternity to avoid communication gap with media during medical crisis, so that media should be able to present medical fraternity’s views as it is. Dr. Snehashish Chatterjee, a champion of integrated medicine and 24x7 healthcare activist pointed out merits and demits of current medicine systems and emphasized over synergy of merits of all medicine systems to deliver the best & most affordable healthcare to people. Another special invitee to the conference was Dr. Pankaj Parashar Serial Innovator. Founder: Cutting Edge Medical Devices Pvt Ltd.His presentation though the last one was well attended and received. Through his presentation on SCINTIGLO An Indigenous Innovation and Ingredients of Healthcare innovations he energized and motivated many in audience. The conference concluded with Vote of Thanks by Mr. Amit U Jain. Voice of Healthcare Conferences …Take away Inferences & References w w w.medegatetoday.com July-Aug 2018

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‘50 crore people to be covered under the Ayushman Bharat and Pradhan Mantri Rashtriya Suraksha Yojana’ Shri Ashwini Kumar Choubey

Minister of State for Health and Family Welfare, GOI

Affordable health care, doctor-patient relationship and policy affairs were among the key things discussed at The Economic Times Doctor’s Day Conclave 2018 On the eve of Dr. B.C. Roy’s birthday,The Economic Times Doctors Day Conclave, 2018 brought some of the finest healthcare professionals under one roof and delved into issues affecting healthcare in India, the challenges faced by doctors, recent key initiatives taken by the government and what the future holds in terms of technological innovations. Distinguished doctors from across India were felicitated at the event in the following categories: Gynecology, Diabetology, Gastroenterology, Cardiology, Neurology and Orthopedics and six coffee table books were unveiled for each of these specialisations. Chief Guest Smt. Anupriya Patel, Minister of State in the Ministry of Health and Family Welfare,alongwith renownedactor Tisca Chopraand Sunita Quadros, Business Head and Senior Vice President, Times Strategic Solutions, felicitated the doctors. Also present at the conclave was special addressee, Sonu Nigam who appreciated the efforts of doctors before entertaining the crowd with a rendition one of his popular songs. Chief Guest Smt. Anupriya Patel, Minister of State in the Ministry of Health and Family Welfare, said,“Providing primary healthcare to all and integrating the ecosystem in extending premium health care to those who can’t afford it should be at the heart our future initiatives. We aretaking steps such as ‘Ayushman Bharat Yojana’ and ‘Amrut Yojana’ to bring down cases of non-communicable diseases, making sure that affordable care reaches even the most impoverished quarters of the country”. Present as Chief Guest at the eventwas Shri Ashwini Kumar Choubey, Minister of State for Health and Family Welfare, who spoke about the challenges in the medical field and the solutions offered by the Indian Government. “Our country is very diverse and has a huge population of 100 crore plus people and this in itself is a challenge. Added to that the scale of non-communicable diseases in India ranging from diabetes to cancer makes it 62 July-Aug 2018 w w w. m ed e g a te to d a y.co m

Singer and Actor Sonu Nigam spoke of his personal experiences at the Economic Times Doctor's Day Conclave 2018

tougher, but the government is taking consolidated measures to ensure that these are gradually ironed out. In the last few years we have been able to check mothers’ mortality rates and upgrade our healthcare system to cater to a huge proportion of our country. I believe that we will in the times to come add to the existing 1.5 lakh illness centers and transform them into wellness centers.” He further added,” The PM has envisioned to bring the greater part of the population residing at the poverty line and below into a broad schemed master medical inclusion program. It is a oneof-a-kind program which plans to ensure that 10.5 crore families

(L-R)Ms. Sunita Quadros, Business Head and Senior Vice President, Times Strategic Solution with Smt. Anupriya Patel, Minister of State in the Ministry of Health and Family Welfare along with Actor Tisca Chopra

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making up more than 50 crore people are covered under the Ayushman Bharat, Pradhan Mantri Rashtriya Suraksha Yojana, by providing each family an insurance of Rs.5 lakhs. This holistic health care program will engage with all the stakeholders at every level and give the entire initiative the shape of a mass movement”. Among key speakers at the event was Padmashri Dr. K.K. Aggarwal, Vishwa Hindi Samman, National Science Communication Awardee and Dr. BC Roy National Awardee, Immediate Past IMA President who said,”India is the future and it is going to be a leader in healthcare. We need to focus on universal healthcare, in an environment of mass inclusion, where 100% of the population is medically insured, and the government is taking consolidated measures in ensuring that. We need to talk about pre-modal and primary prevention and stress on healthcare management vis-à-vis universal lifestyle management”. Touching upon the importance of communicating effectively with the patients

Commenting on future technologies Dr. Mamta Jain, Managing Director Medwiz Healthcare Communications was of the opinion that, “We are at the cusp of great technological innovations which are going spearhead the healthcare needs of the future. Be it diagnostics or organ replacements, technology will play a big role going ahead. Technological innovations are going to minimize the cost of medical services, making it more inclusive, accessible and impactful. The Economic Times Doctor’s Day Summit is the start of a dialogue between the industry and its various stakeholders and in the next few years it would grow into a very powerful voice in the sphere of healthcare, and expectedly a game changer”. Amit Indubhushan Bakshi,Chairman and Managing Director at Eris Lifesciences shared that, “We are glad to be associated with this great industry ice breaker, where we could bring under one roof all the concerned stakeholders of the industry together. The platform will immensely help consolidating the views and outlook of the industry as well as have the knowledge and expertise, prerequisite to influence and update national policies in favour of the many millions in our country”. The evening wrapped up with a lively panel discussion in which doctors discussed everything from growing mistrust among patients, doctor-patient relationship and the way forward to deal with the future challenges in the medical field.

Dr. Jaideep Malhotra, President FOGSI,said, “India needs an integrated approach to reach out to the many millions and train the various service segments attending to them. We need to take care of even the minute concerns of a patient especially in case of non-communicable diseases. The ecosystem has to combine its efforts and map the health facilities and sensitize them jointly at various levels at both rural and urban India.” She further added that cases have to be dealt with more sensitivity and doctors must recognize the uniqueness of every case not look for a one size fits all approach. w w w.medegatetoday.com July-Aug 2018

PRODUCT LINE

How Government spending is benefiting future of emergency medical services in India When Finance Minister Arun Jaitley announced the Union Budget for 201819 earlier this year, the Government reiterated its plan to achieve a high growth rate of 8%.He drew attention to how Indian polity, economy, and society had shown great resilience in the face of adjusting to structural reforms. In light of this, the Budget focused on rural development and strengthening the agricultural sector, infrastructural development, and providing quality education across the country. The Union Budget also committed towards ensuring quality healthcare for the economically less privileged, and saw the launch of the worldâ&#x20AC;&#x2122;s largest publicly funded healthcare programme. Under this, 10 crore low income families will each receive up to INR 5 lakhs per year, in government aid, for basic services. While this is certainly a welcome move, India still has a long way to go if we are to catch up with our Western counterparts. A large part of the reason for the lag is that in India, the total expense on healthcare is just approximately 4 percent of our GDP, whereas the United States allocated 17 percent towards the same. Similarly, close to 70 percent of the Indian population pays for medical bills out of their own pockets, compared to the US, where the out of pocket expenditure is as low as 1012 percent. In a survey conducted by the World Health Organisation (WHO), the US ranked 37 among the best performing countries in the healthcare sector, while India stood at 112. If India is to improve its ranking, as well as healthcare offerings, the Government should look at increasing its spends in healthcare, and investing more in emergency medical services, for which, life support ambulances are key to developing the sector. It is a proven fact, that a patient who receives basic emergency medical care, and is transported to a hospital within 15-20 minutes of a mishap, has the highest survival rates. To this extent, dialling a number from the list 64 July-Aug 2018 w w w. m ed e g a te to d a y.co m

of emergency numbers in India can be the biggest difference between a life saved and a life lost. Emergency medical services, including life support ambulances, have been in existence for a while now, but have comparatively new beginnings in India. If we are to use this to the fullest, the Government needs to increase its spending in the sector, in order to achieve improved outcomes and decreased morbidity and mortality rates. In India, the sector is still largely fragmented, and investing in it can bear several advantages, the foremost being that of improved public health. Investing in life support ambulances would give the public a greater chance of being able to access quality healthcare, thereby saving precious lives. Reduced cost of healthcare is also possible with government intervention and investment. If the government is to invest in the sector and help lower the costs of treatment, it would greatly help influence peopleâ&#x20AC;&#x2122;s decisions to get treatment for conditions that would otherwise go neglected owing to the cost factor. It is here also, that a predetermined list of emergency numbers in India can help citizens avail medical help at the earliest. By investing in emergency medical services, there is no doubt, then, that we will be able to enjoy a better source of employment, as it will create a huge demand for doctors, nurses, paramedics,

drivers, support staff, and more. Alternatively, it will also help improve the accuracy of data samples, and provide authorities with a clearer picture of healthcare in the country. Looking forward, we need to understand that public healthcare is not something we can ignore, and that, if we are to improve our rankings, investing in emergency medical services is the need of the hour.

Mr. Manish Sacheti

CFO, Zigitza Healthcare Limited

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Most Admired Products used by Doctors, Hospitals & Clinics

Product Industrial Gloves and Sleeves, Medical Grade Gloves, Protective Clothing, Medical Safety Devices Website: www.ansell.com

Waste Segregation System, Manual Needle Cum Syringe Hub Destroyer, Sharps Containers, Wringer Trolley, Round Trolley / Linen Trolley, Utility Trolley, Disposable Waste Containers, Bio-Degreadable Waste Collection Bags, Biomedical Liquid Waste Treatment, ARVS Sickness Bag, Laboratory / Hospital Disposable Products, Stainless Steel Waste Bins, Open Bin (Plastic), SteriplusTM Website: www.sharpsandwastecontainers.com Commode : Chairs, Wheelchairs, Raisers, Shower Commode Chairs & Urine Pots, Wheelchairs, Diabetic Products, Fetal Doppler, Hygiene Products, Massagers, Nebulizers, Pulse Oximeter, Stethoscope, Suction Machine, Thermometer, Walkers & Sticks, Weighing Scales, O2 Regulator, Humidifier Bottle Website: www.easycareglobal.com

Blood Collection Set, Blood Collection Tubes, Cathula, Surgical Blades, Infusion Set, AD Syringes, Safe Injection Website: www.hmdhealthcare.com

Rapid Test Kits, Elisa Test Kits, Confirmatory Test, Blood Grouping Sera, Fluorescence Immunoassay Test Kits Website: www.jmitra.co.in

LED Surgical Lights - OMEGA Series, LED Surgical Lights - NOVA Series, LED Surgical Lights - HEX Series, LED Surgical Lights - HEX CT Series, LED Surgical Lights - C Series, LED Examination Lights, Operating Surgical Tables Website: www.morbrosindia.com

Nulife is brought to you by MRK Healthcare, a medical technology company with a worldwide reputation for products that offer superior protection, with high levels of comfort and performance in over 70 countries around the world. MRK designs, develops, manufactures and markets a wide range of medical disposables and equipment for homes as well as hospitals. Website: www.nulife.co.in Handyneb Gold Nebulizer, Handyneb Nupro Nebulizer, Handyneb Smart Nebulizer, Handyneb Classic Nebulizer, Nebulizer Kit Nebukit, Air Pressure Mattress Air Bed Ab01, Automatic BP Monitor BP 10, Automatic BP Monitor BP 12, Needle Burner & Syringe Destroyer Dots, Oxygen Concentrator (Oxytec-Pro), Pulse Oxymeter Oxygard Og01 Website: www.medtechlife.com RIBBEL INTERNATIONAL LTD. is an established and reputed manufacturer of Foley Catheter, Surgical Blades, Safety Scalpels, Mini Thumb Scalpels, Stitch cutters,Skin Graft Blades, Gouge Blades, Mini Fine Blades, Speciality Blades, Post Mortem Knife, Ophthalmic knife, Circumcision Knife, for over 20 years, with all the International certifications. Ribbel International ltd. is awarded as a Disposable Product Manufacturer of the Year 2016 & 2015, 2times in a row. Website: www.ribbel.com Non Glare Finest Surgical Instruments In Medical Industry for all Specialties, General Surgery, Gynaecology & Obstetrics, Titanium - Micro Instruments, Micro- Hard Age Instruments, Ent Surgery, Ophthalmic Surgery, Fibre Optic Illuminated Instruments, Hard Age General Instruments, Cardio Thoracic & Vascular Surgery, Neuro & Spinal Surgery, Plastic Surgery, Orthopaedic Instruments, Anal Instruments, Anaesthesia & Consumables - Miscellaneous. Website: www.tufftinstruments.com

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A- 1201, Naman Midtown, Senapati Bapat marg, Elphinstone Road, Mumbai 400013. INDIA Customer Care No.: T: +91 22 62611111; +91 22 62611130/31 Fax: +91 22 62611199 â&#x20AC;¢ E-mail: info@mrkhealthcare.com Website: www.mrkhealthcare.com

RNI No. DELENG/2010/33833