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Hospital Projects Build it Faster Cheaper and Better!

Healthcare IT

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EDITOR’S NOTE magazine

HEALTHCARE IT MARKET is estimated to grow at a CAGR of 7.0% to reach $ 56.7 Billion by 2017 from $40.4 Billion in 2012 Healthcare IT has the potential to generate valuable information to improve workflow, safety, and efficiency within healthcare organizations. The ability to capture, store, exchange, and analyze medical information in electronic form will improve healthcare in many ways. Healthcare IT provides benefits such as improved patient care, increased engagement of patient in healthcare, improved population-based knowledge, development of new tools for medicine, and augmented administrative efficiency. The HCIT market is segmented on the basis of its application, delivery mode, and component. The HCIT market, by application is segmented into provider (clinical information technology and nonclinical information technology) and payer, while the market by delivery mode is further categorized as on-premises, web-premises, and cloud-premises. The healthcare information technology by component comprises of hardware, software, and services. North America (U.S. and Canada) commanded the highest share of the healthcare information technology market due to firm government support in terms of investment and incentives, growing demand for integrated healthcare IT systems to achieve high return on investment, growing patient consumerism for quality care and ensure safety, and rise in aging population.

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Nov - Dec 2013

Nov - Dec 2013 Contents

NEWS & POST EVENT

6 World’s First Antimicrobial Copper Train 8 FDA approves Gazyva for chronic 10 First of its kind Conference & Awards 12 CGH and TTSH Win Top Asia Pacific 14 Obese Patients may Benefir 16 GE Healthcare’s Silent

PRODUCT LINE

17 My Vision 20 Investigation of the Residual

INTERVIEW

22 Mitch Silong 44 Bimal B. Jhaveri 46 Chaitanya Dev Singh Sisodiya

Modern Trends in Healthcare

COVER STORY

Architecture

24 Modern Trends in Healthcare

DOCTOR SPEAK

24 Illness in Children & Infection Control 42 The silent suffering: Stigma is the biggest 54 SwastheXchange

EXPERT VIEWS

28 Healthcare Dreams 30 Hospital Projects Build 48 sdLDL The Small Dense Killer 52 Indian Vision on Healthcare

40 Nov - Dec 2013

HEALTHCARE IT

34 Impact of IT in Patient Care Cycle 36 A Web-based Information System 9

NEWS UPDATE

World’s First Antimicrobial Copper Train Antimicrobial Copper touch surfaces are becoming increasingly common in hospitals, but a train on the Valparaiso Metro in Chile is the first of its kind to be equipped with Antimicrobial Copper hand rails and poles. The move is intended to help reduce the risk of infections spreading between the Metro’s 18 million annual users and improve the public transport experience.

A train can carry up to 800 passengers and is the result of a partnership between Chilean stateowned company Codelco and the world’s leading transport company, Alstom. The initiative follows the outfitting of stations on the Santiago Metro with Antimicrobial Copper hand rails, and is planned for extension to other trains and metro networks in Chile.

ntimicrobial Copper is a portfolio of materials - comprising copper and copper alloys - that benefit from copper’s inherent ability to rapidly kill bacteria, viruses and fungi on contact. Given an estimated 80% of infections are spread by touch, manufacturing frequently-touched surfaces such as hand rails, light switches, taps and door handles from materials that will continuously kill germs - 24/7 and in between regular cleaning - can help reduce the spread of infection.

explains Thomas Keller, CEO of Codelco. ‘Improving the travel experience for passengers is in our DNA,’ adds July Friedmann, Vice President of Alstom South Cone. ‘We’re taking the first step, presenting the world’s first copper train, and hope that other networks will be interested in the health benefits it can offer.’ Chile’s Minister of Transport and Telecommunications, Pedro Pablo Errazuriz, was aboard the train for its maiden voyage and noted: ‘This is an imporant initiative that adds to the progress being made by the Valparaiso Metro in enhancing the travel experience. It reaffirms our commitment to strengthening the strategic role of public transport railways.’

The new, two-car train can carry up to 800 passengers and is the result of a partnership between Chilean state-owned company Codelco and the world’s leading transport company, Alstom. The initiative follows the outfitting of stations on the Santiago Metro with Antimicrobial Copper hand The Antimicrobial Copper hand rails, made rails, and is planned for extension to other by Chilean manufacturers, are a robust copper alloy, which will be hard-wearing trains and metro networks in Chile. and offers a beautiful, instantly-noticeable ‘Codelco is a world pioneer in developing reminder to passengers that their health is Antimicrobial Copper projects to improve being given top priority. people’s quality of life, especially in the fields of health and public transport,’ *** Nov - Dec 2013

NEWS UPDATE

FDA approves Gazyva for chronic lymphocytic leukemia Drug is first with breakthrough therapy designation to receive FDA approval

he U.S. Food and Drug Administration today approved Gazyva (obinutuzumab) for use in combination with chlorambucil to treat patients with previously untreated chronic lymphocytic leukemia (CLL). CLL is a blood and bone marrow disease that usually gets worse slowly. According to the National Cancer Institute, 15,680 Americans will be diagnosed and 4,580 will die from the disease this year. Gazyva works by helping certain cells

in the immune system attack cancer cells. Gazyva is intended to be used with chlorambucil, another drug used to treat patients with CLL. Gazyva is the first drug with breakthrough therapy designation to receive FDA approval. This designation was requested by the sponsor and granted soon after the biologic license application to support marketing approval was submitted to the FDA. The FDA can designate a drug a breakthrough therapy at the request

of the sponsor if preliminary clinical evidence indicates the drug may offer a substantial improvement over available therapies for patients with serious or life-threatening diseases. The FDA also granted Gazyva priority review because the drug demonstrated the potential to be a significant improvement in safety or effectiveness in the treatment of a serious condition. And the FDA granted Gazyva orphan product designation because it is intended to treat a rare disease.

Obese Patients may Benefir from XDclear Technology Enhancement to the Vivid Ultrasound Platform

Eâ&#x20AC;&#x2122;s Ultrasound business announced the clearance from the Food and Drug Administration (FDA) for the latest version of its Vivid E9 Cardiovascular Ultrasound system that features XDclear technology. The upgrade provides a boost to the systemâ&#x20AC;&#x2122;s capabilities further enhancing its image quality in 2D, 4D, color and Doppler. The clarity in image could be especially useful in individuals that have proved difficult to scan in the past, such as obese patients.

The Centers for Disease Control and Prevention (CDC) stated that the economic consequence of obesity in the United States to be $147 billion in 2008.** Built from the Vivid E9 platform, the new Vivid E9 with XDclear is designed to help shorten exam time and enhance diagnostic confidence in the adult and pediatric echo labs, during interventions or in the operating room.

The World Health Organization (WHO) has defined obesity as a BMI greater than or equal to 30 is obesity. They estimate that overweight and obesity are the fifth leading risk for global deaths.

The technologyâ&#x20AC;&#x2122;s efficiencies means that patients are minimally exposed to the high-stress setting of the echo lab, interventional suite or the OR. This means conducting an ultrasound examination on a patient who is difficult to scan can result in a quicker scan time, helping lead to reduced anxiety for the patient.

At least 2.8 million adults die each year as a result of being overweight or obese. In addition, 44% of the diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity.*

The technology also recently received CE Mark and is available in Europe and the video above features GE engineers discussing the need for the new XDclear technology and the positive impact it can have on healthcare providers.

Nov - Dec 2013

POST EVENT

First of its kind Conference & Awards Ceremonies Organized by

SIX SIGMA at MOUNT ABU Indiaâ&#x20AC;&#x2122;s TOP Hospitals & TOP Healthcare Professionals Honored with Six Sigma Healthcare Excellence Award- 2013

Nov - Dec 2013

POST EVENT

ix Sigma for the first time in India, to acknowledge the special achievements and contributions of individuals and institutions who have been torchbearers of “Excellence, Ethics, Professionalism and Leadership in diverse areas of Healthcare delivery”. Generally, one comes across only the clinicians being recognized for their efforts. Others like nurses, administrators, educational institutes, technicians, marketing personnel, pharmacy companies, energy efficient 'green' hospitals, Insurance companies etc - twenty categories in all - were also identified for these awards. We constituted, for this purpose, – Six Sigma Healthcare Excellence Awards – 2013. This was also a FIRST in our country. As regards the awards, we had over 234 entries from well established and reputed Hospitals, Academia, Pharmaceutical companies, diagnostic centres, individuals etc from across the country. It was a difficult task for the jury to shortlist the finalists. The choice was so difficult that it was decided to constitute more than one award in some of the chosen categories. Both these FIRSTs were primarily the efforts of our young and highly awarded CEO, Dr Pradeep Bhardwaj - himself a highly qualified and experienced in Hospital Administration. People like me (and all others) from nonmedical fields were there to help carry out the operations in a typical mission mode - a-laArmy-style. It was his JOSH which primed everyone to give his best.

Nov - Dec 2013

NEWS UPDATE

CGH and TTSH Win Top Asia Pacific Award For Automatic Patient Vital Signs Recording and Medication Management With QR Code Singapore, October 21, 2013 – Changi General Hospital, Tan Tock Seng Hospital and IHiS, the Health Ministry’s IT arm, today won two HIMSS Elsevier awards for outstanding achievement in health IT.

SmartSense automatically uploads the patient’s vital signs data into the hospital’s electronic medical records system, so healthcare staff can view them instantly to provide timely treatment.

an Tock Seng Hospital (TTSH) and IHiS clinched the Asia Pacific award for their SmartSense system which continuously monitors patients’ temperatures and wirelessly records their vital signs. Changi General Hospital (CGH) and IHiS won the award for their medication management system which uses Quick Response (QR) codes. Automatic Vital Signs Recording TTSH is one of the first hospitals in Southeast Asia to continuously monitor its patients’ temperatures and 16

wirelessly upload their vital signs data into its medical records system. IHiS has rolled out the SmartSense system at all TTSH general wards to benefit over 1,400 patients daily. The SmartSense RFID tag attached to the patient continually records his temperature, so nurses no longer need to wake him to check his temperature. A bedside tablet records his pulse, blood pressure, and oxygen readings, and wirelessly uploads them to the hospital’s electronic medical records. Nov - Dec 2013

NEWS UPDATE

SmartSense’ RFID tag attached to the patient provides continuous non-invasive temperature monitoring. CGH’s robot machines are filled with various drugs.

Doctors and nurses can instantly view online the patient’s latest vital signs to provide timely treatment. The RFID tag also tracks patients’ locations, enabling staff to better manage infection control during pandemics. It also protects nurses’ safety as there is minimal patient contact for temperature recording. TTSH, with its Communicable Diseases Centre, is a key hub in Singapore’s infectious disease control. TTSH’s Director of Nursing, Mr Yong Keng Kwang, said: “SmartSense has revolutionised the way our nurses work. They can now spend more time on direct patient care. With the system, we are today better equipped to manage pandemics”. IHiS CEO, Dr Chong Yoke Sin, said: “The system is a first in Southeast Asia in functionality and peripheral interfacing. There are plans to integrate SmartSense with other clinical charting applications”. SmartSense system increases patient safety by minimising human errors in vital signs recording. It also improves nurses’ productivity by reducing time spent measuring vital signs and locating patients to provide treatment. The location tracking feature also helps staff improve bed management to maximise the number of patients the hospital can admit. When a patient is discharged, housekeeping and bed-management units are alerted immediately, and the bed is cleaned within 30 minutes for the next patient.

The robot machines dispense patients’ medicines into sachets with QR code.

Before serving medication, the nurse scans the QR code on the medicine sachets to ensure the right drugs in the right dosages for the patient.

healthcare professionals such as nurses more time for direct patient care”

Dr. R. Chandrashekhar Appointed faculty at London

Medication Management With QR Code

CGH’s Closed Loop Medication Management (CLMM) system with QR code uses IT to improve patient safety. At key points in the medication process, QR codes are used instead of conventional barcodes to match and verify the doctors’ prescriptions, drugs and patient data. Eastern Health Alliance Group CEO, Mr TK Udairam, said: “The Closed Loop Medication Management system with QR code enables us to deliver safer care through the administration of the right drugs and right dosage to the right patient at the right time. “It has also substantially increased productivity and staff satisfaction by improving inventory management and enabling our Nov - Dec 2013

Dr. R. Chandrashekhar (Chief Architect Govt. of India) Prof. Rao Bhamidimarri (London South Bank University)

r. R. Chandrashekhar appointed visiting faculty of Engineeriing Science and the built environment. At London South Bank University, London.

NEWS UPDATE

Nov - Dec 2013

NEWS UPDATE

GE Healthcare’s Silent Scan Technology takes MRI Noise from a Rock Concert to a Whisper Inbox

Two New Cases of Human Infection with H7N9 are Reported to WHO

GE’s revolutionary software designed in India removes excessive noise from MR scanning for patient comfort& reduces the need for re-scans GE Healthcare introduced Silent Scan, a revolutionary technology designed to address one of the most significant impediments to patient comfort – excessive acoustic noise generated during an MR scan. Conventional MR scanners can generate noise in excess of 110 dBA (decibels) levels, roughly equivalent to rock concerts. GE’s exclusive Silent Scan technology is designed to reduce MR scanner noise to near ambient (background) sound levels and thus can improve a patient’s MR exam experience.

“Silent Scan is a huge breakthrough for the MR industry and for patients around the world,” says Dr. Richard Hausmann, President and CEO, GE Healthcare MR. “Excessive acoustic noise is a major cause of patient discomfort during MR scans and GE is addressing that with Silent Scan, a new MR advanced application and a major innovation in the healthcare industry. GE is very serious about Humanizing MR and making its MR systems patient-friendly, safe, and without compromise.”

The second patient is a 64-year-old woman from Zhejiang Province who is a farmer and had contact with live poultry. She became ill on Oct. 30, 2013, was admitted to a local hospital on Oct. 31, 2013, and was transferred to another hospital on Nov. 3, 2013. She is currently in a critical condition. To date, WHO has been informed of a total of 139 laboratory-confirmed human cases with avian influenza A(H7N9) virus infection including 45 deaths. Currently, six patients are hospitalized and 88 have been discharged. So far, there is no evidence of sustained human-to-human transmission. The Chinese government has taken the following surveillance and control measures:

Noise is one of the major complaints from patients who undergo a MRI exam. Historically, medical manufacturers have addressed the noise issue by muffling it using a combination of acoustic dampening material or performance degradation to reduce the noise level. Two years ago, GE engineers initiated their quest to reduce noise during an MRI scan. They developed a software – a radically new type of 3D MR acquisition, in combination with proprietary high-fidelity gradient and RF system electronics, and the noise is not merely dampened, it is virtually eliminated at the source.

he National Health and Family Planning Commission in China has notified the World Health Organization (WHO) of two new laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus. The first patient is a 3-year-old boy from Guangdong Province who had contact with live poultry. He became ill on Oct. 29, 2013, was admitted to a local hospital on Oct. 31, 2013, and transferred to another hospital on Nov. 4, 2013. He is currently in a stable condition.

●● strengthening of epidemic surveillance and analysis; ●● deployment of medical treatment; ●● conducting public risk communication and information

dissemination; ●● strengthening international cooperation and exchanges; and is continuing to carry out scientific research. WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. Nov - Dec 2013

PRODUCT LINE

O Vision my

ne could say this is a product that has been awaiting invention. The traditional power socket was designed close to 100years ago, and the basic design has not changed since that time.

Equipment and appliances that are plugged into these sockets have typically evolved several generations from electrical to electronic and then digital. They are however, still connected to the power source through antiquated wall sockets with all their limitations, inconveniences and hazards. Eubiq has taken advantage of the latest developments in material sciences and technologies and contemporary design philosophy to cultivate a product that is truly in step with the morden life style. The design has taken several years to develop, in the course of which a completely new, state-of-the-art system has emerged that addressees all the needs and demands of the modern hospitals. Moreover, it is extremely safe because of the GSS safety feature that is built into the system. The aim of the Eubiq design is to provide a unique hospital bed head panel systems, that supplies all-in-one power, data, lighting, gas outlets & other low voltage services that can be mounted in many ways. The bed head panel can be integrated to looks elegant and discreet. From an architectural point of view, Eubiq Bed Head Panels are sleek, handsome and beautifully detailed.

Saggar Saurabh Managing Director EUBIQ INDIA E-mail: saggar@eubiqindia.com Mob.: 91-9971155003

Nov - Dec 2013

We at eubiq are investing heavily specifically for the indian market, with our design drive philosophy of "taking something ordinary and making it extraordinary"' is an inspiring example what a creative economy looks like-combing the best practices of vision, innovation, design and scalable commercialisation.

PRODUCT LINE

INVESTIGATION OF THE RESIDUAL ACTIVITY OF CHLORHEXIDINE GLUCONATE USING A NOVEL METHOD TO SIMULATE REAL-WORLD CONDITIONS

hlorhexidine gluconate (CHG) is used routinely in a variety of product types to disinfect skin in healthcare settings. Following the use of these products, CHG adheres to skin and has been shown to slow the regrowth of resident skin flora. It has been suggested that this residual CHG can kill microorganisms which contaminate the skin long after product application (1-6). However, the methods used to measure “residual kill” are unrealistic. Specifically, the use of liquid bacterial suspensions to contaminate the skin will re-solubilize residual CHG and allow it to become active. In the real world, hands are typically contaminated by touching dry objects. Therefore, excessive moisture is not introduced to the skin. The purpose of this study was to investigate the residual kill of CHG using a dry contact contamination method, designed to more closely reflect skin contamination in typical healthcare situations.

DEFINITIONS ÂÂ Substantivity – the ability of antimicrobials to adhere to and remain on skin even after rinsing with water ÂÂ Cumulative effect – a progressive increase in product efficacy following repeated applications ÂÂ Persistence – slowing the regrowth of the resident flora for hours after the initial use ÂÂ Residual kill – killing transient organisms 24

contaminating the skin long after product application

METHODS Challenge suspensions were prepared by suspending overnight colonies of Staphylococcus aureus ATCC 6538 in tryptic soy broth to 8-8.5 log CFU/ml. Stainless steel discs 1 cm in diameter were spotted with 10 µl challenge suspension and allowed to dry overnight or approximately 24 hours. Ethical approval for this study was provided by the Gallatin Institutional Review Board and performed as follows.

RESULTS Consistent with previous studies, significant residual kill was observed when fingers were contaminated using liquid suspension, achieving a 3.02 ± 1.18 log reduction after 15 minutes. When hands were contaminated by dry contact, no residual kill was observed out to fifteen minutes (0.03 ± 0.05 log reduction). Average recovery per finger with standard deviation shown (8 subjects) ▼ Pretreat hands with CHG and contaminate by dry contact ● Pretreat hands with ethanol and contaminate with liquid suspension ■ Pretreat hands with CHG and contaminate with liquid suspension Nov - Dec 2013

PRODUCT LIINE

‘Load’ hands with CHG by rubbing 4 ml of 1% CHG in 70% w/w ethanol over all surfaces of both hands until completely dry

Contaminate one hand with liquid suspension by applying 5 μl of bacterial challenge suspension directly to the fingerpads

Contaminate other hand by dry contact by firmly pressing the fingerpads onto contaminated discs for 2 seconds

FIGURE: Effect of Contamination Method on Residual Kill Recover surviving bacteria by kneading individual fingers in 10 ml of neutralizer for 30 seconds at specific time points after contamination

When tested under realistic conditions, CHG does not continue to kill bacteria after product use

CONCLUSIONS ÂÂ The results demonstrate that CHG only exhibits residual kill when the bacteria is applied in a liquid suspension and suggest that the CHG must be resolubilized to exhibit activity. ÂÂ While residual CHG may be able to suppress growth of resident microorganisms, it does not kill transient microorganisms introduced to the skin after product use. ÂÂ Residual kill appears to be an artifact of methods which do not reflect reality. ÂÂ Healthcare workers are cautioned not to have a false sense of security when using CHG containing products and should disinfect hands according to established guidelines whenever hand contamination is suspected. Nov - Dec 2013

REFERENCES 1. Kaiser, Nancy, et al. “Inactivation of chlorhexidine gluconate on skin by incompatible alcohol hand sanitizing gels.” American journal of infection control 37.7 (2009): 569-573. 2. Benson, Lee, et al. “The effects of surfactant systems and moisturizing products on the residual activity of a chlorhexidine gluconate handwash using a pigskin substrate.” Infection control and Hospital Epidemiology (1990): 67-70. 3. Casewell, M. W., M. M. Law, and N. Desai. “A laboratory model for testing agents for hygienic hand disinfection: handwashing and chlorhexidine for the removal of klebsiella.” Journal of Hospital Infection 12.3 (1988): 163-175. 4. Wade, J. J., and M. W. Casewell. “The evaluation of residual antimicrobial activity on hands and its clinical relevance.” Journal of Hospital Infection 18 (1991): 23-28. 5. Sogawa, Yoshiro, et al. “Comparison of residual antimicrobial activity of chlorhexidine-containing antiseptics: An express report.” Journal of Healthcare-associated Infection 2 (2010): 32-36. 6. Lowbury, E. J. L., and H. A. Lilly. “Use of 4% chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection.” British Medical Journal 1.5852 (1973): 510.

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INTERVIEW

MEDGATE today

General Manager

GE Healthcare IT, Asia Pacific Mitch, can you tell us about GE’s future plans for the Healthcare IT business?

What are some of the challenges facing the healthcare market today?

In June of this year, GE Healthcare announced its plans to invest $2 billion over the next five years to accelerate the development of innovative software for healthcare systems and applications. The company has a long history in software with its Healthcare IT business; and this investment is designed to advance current and future offerings in order to address new and pressing operational and productivity challenges faced by healthcare organizations around the world.

The current models for healthcare provision are being challenged by several trends that will drive a convergence of healthcare and life sciences ecosystems. Inefficiencies in healthcare delivery systems have caused a shift towards healthcare providers competing on cost and quality.

As the largest software developer within GE, GE Healthcare provides a wide range of medical imaging technologies, IT services, patient monitoring and diagnostic solutions, biopharmaceutical manufacturing technologies and operational and technological service solutions. Specifically, this $2 billion investment will be focused on maximizing asset performance; improving hospital operations management; improving clinical effectiveness; and optimizing care across entire populations.

As a result, a framework for healthcare based on ‘value’ associated with outcomes for individual patients is emerging. Core to this outcomes-based focus is the adoption of healthcare information technology (IT), where sophisticated IT and information-management platforms are designed to integrate a vast and growing body of clinical, operational, research, and financial data. As this data accumulates, connecting these data sets together in a centralized model should remain a priority for the healthcare and life sciences industries. What’s GE’s solution? For us at GE, the solution is the company’s Industrial Internet a mission to create and enable technology and services which

Nov - Dec 2013

INTERVIEW can help improve the way healthcare is delivered to patients globally. Healthcare is a prime sector for Industrial Internet adoption due to the strong imperatives to reduce costs and improve performance; and the range of applications in global healthcare is as large as the potential to enable safe, efficient operations and improve productivity. GE estimates that a 1% reduction in system inefficiencies globally could lead to $63 billion in savings over fifteen years.* This vision would connect physicians, health facilities and machines to drive higher quality service and improve productivity. Tell us more about the Industrial Internet. What benefits will we see? With Industrial Internet technologies, we’re enabling caregivers to spend less time navigating the system and more time caring for patients. ●● For a clinician, this means quickly getting the diagnostic

information they need, when they need it. ●● For a patient visiting the ER, it means less waiting for results. ●● For a hospital trying to keep track of assets and provide quality care for thousands of patients, it means improved productivity and reduced costs. For healthcare systems, this means managing costs while helping to enhance care. The Industrial Internet is not just about creating newer, smarter systems in a tech-enabled world. It’s about connecting caregivers with the brilliant machines that provide more accurate information than ever before in an easily accessible way so they can care for patients in a healthcare system that’s facing new challenges every day. Who will benefit from the Industrial Internet and how? The Industrial Internet transforms care delivery across the healthcare system and impacts patients, caregivers and healthcare leaders: ●● It helps eliminate data fatigue for caregivers, allowing them

to spend less time with devices and inefficient processes and more time with patients ●● It can help strengthen the patient-caregiver connection and deliver a more informed healthcare experience ●● It helps eliminate unnecessary waste for providers, allowing them to reduce costs and deliver personalized care across entire populations ●● It helps minimize business disruption for healthcare CEOs,

Nov - Dec 2013

CIOs, government and other healthcare administrators and leaders as they address an aging population and changing healthcare needs By identifying, liberating and analyzing the data captured by software and technology, caregivers will have the information they need when they need it to help enable them to prevent, diagnose, treat and cure. It must be a core tenet of healthcare to deliver holistic care. In enabling the provider to follow the patient, we see information at earlier stages, to prevent or treat disease, and use information from populations to understand - for individual patients - how certain protocols work. This helps caregivers make better quality decisions. A key priority for us is to help prevent the ‘analysis paralysis’ that practitioners face today, by using technology to surface the most relevant data, contributing to accurate and faster care. Why now? How is this relevant to the healthcare market today? Healthcare has always relied on “big data” and the need to understand data is even greater now. What is important is how we use data, providing the right technology that allows physicians to pinpoint the right diagnosis; match it to the right treatment; and make more informed decisions. As the industry shifts towards accountable and integrated care, faster, more accurate real-time information has never been more important. The Industrial Internet will push the boundaries for intelligent machines, advanced analytics and people at work that will transform not only the way health policy decisions are made but the way we live and work.

Industrial Internet: Pushing the Boundaries of Minds and Machines. Peter C. Evans and Marco Annunziata About Mitchell Silong Mitchell Silong is the General Manager of the Asia Pacific region for GE Healthcare IT. He is responsible for leading and growing the Healthcare IT business in Asia Pacific, and leads a team responsible for commercial strategy, project execution and customer support in the region. Mitchell has a 13-year track record in the healthcare industry, including imaging and IT. He’s been based in Japan for more than 20 years and has held various Asia Pacific roles covering regions including India, Australia, China and Japan. He received his Bachelor of Science in Mechanical Engineering from the University of California, Santa Barbara. *** 27

COVER STORY

Modern Trends in Healthcare

Architecture

Ar. Saurabh Chandra Director DDF Consultants Pvt. Ltd.

John Hopkins Hospital Baltimore US

Nov - Dec 2013

COVER STORY

uilding design for Healthcare has always been a great challenge and specialization for designers. The complexity of design, circulation, functionality and workability of healthcare facilities requires constant innovation, knowledge up gradation and exposure to Medical developments. As the world progresses towards a more technological driven living, trends in healthcare design are changing as well. The healthcare facilities are more techno savvy, intelligent and primarily functional, focusing on Patient care, staff movements and ease of accessibility. Factors such low availability of large landmass, Population overflow, Healthcare tourism, Healthcare costs contribute to the way in which the healthcare facility is designed today. Following are a few trends that are catching up and governing the functionality of a healthcare facility. Vertical Hospitals The urban areas are developing around a center and as the land prices increase, the availability of large landmass in the center of the urban sprawl is scarce, leading to smaller landmasses with larger FSI. This leads to development of large healthcare facilities vertically. The functionality. the circulation, the interrelation of dependent activities and service integration are conceived and designed in a vertical format, with the help of patient lifts, service lifts, freight lifts, dumb waiters and mechanical transportation devices such as pneumatic tube systems etc. Modular Design In order to improve the adaptability, flexibility and usability of a healthcare facility, designers are expected to develop

Venice Hospital by Le Corbusier designed of geometrical grid in 1964

Nov - Dec 2013

COVER STORY

modular designs today, starting from the structural grids to building blocks. This not only gives the user flexibility of usage, but better adaptability for any other activity to be planned later. Intelligent Buildings Technology has changed the way Architects design buildings, with the advent of IBMS (Intelligent Building Management Systems) the design of a building like Hospital have become more technologically driven. All the services can be integrated to have one control center and have an excellent efficiency for the building. The operation costs are about 50-100 times he cost of design and construction, intelligent buildings render the healthcare environment with simplicity of operations. Centralization and Decentralization The healthcare facilities are being centralized in management and decentralized in operations. The use of HMIS (Hospital Management Information system) such as PACS are making the management of the hospital at a central command center or management center, while at the same time the ambulatory services such as OPDâ&#x20AC;&#x2122;s are being pushed out of the IPD and emergency areas to reduce the flow of traffic to specialized service areas. The physical connectivity is not an essential feature as perceived earlier.

A Friendly Neighborhood Hospital Gone are the days when a hospital used to be a dreadful place to enter, narrow corridors, badly lit space and smaller public places. The healthcare facilities are designed as magnificent public buildings with large atriums, spill over outdoor passive recreating gardens, coffee shops, flower shops, Gift galleries and more. A hospital is no more conceived as a potential hazard, it is considered as friendly place, a wellness center and in some cases a health resort and a spa. The design of hospital today require the design of the facilities and place making equally important. The Bumrungrad Hospital at Bangkok has a large food court and a shopping center attached to it. It caters not only to the general public but also to a large number of medical tourism cases. These are a few trends today, which influence the design for healthcare design. The way technology has been advancing the future is full of more promises. As healthcare remains a primary need we can be sure that itâ&#x20AC;&#x2122;s just the beginning especially in our country. We as designers have much to design, much to integrate and most importantly much to innovate. India is Unique, hence the solutions for Healthcare industry in India has to be unique, we are at an important juncture of development, our innovations and adaptations for designing great healthcare facilities can change the way we look at the Healthcare system in our country.

Nov - Dec 2013

PRODUCT LINE

Nov - Dec 2013

EXPERT VIEWS

Krishnedu Ghosh CEO - Hosconnn

HEALTHCARE DREAMS

Welcome intellectual differences but not amateur approach

et me start with a very simple example of driving a Car on Road. A four wheeler engages all the limbs and senses of a Human Being. The driving on the road involves an empathetic sense of social responsibility and social safety. So, if one is not capable of conforming to the above requirements, one should not drive. Also, any driver one hires should be capable enough to drive one all the destinations safely. The Hospital Projects whether New/Renovation/Retrofitting are complex ones, so de-learn your house building experience, Common Sense is the Sixth Sense ,so use judiciously. Hospital Projects are costly ventures Money wise, Time wise, Expectations wise, Clients are indeed wise but for any hospital project get some more wise (people). Otherwise nothing would work out break even wise. As far as Hospital Consultants are concerned, they have a

paid Job to do, Clients’ Dreams are very fragile, handle it with care and make it successful Hospital Consultancy is a vast field & Learning curve just keeps getting longer, so a structured approach is an absolute necessity, experiments are hazardous. Any Intellectual discussions / differences are must, and should be respected, and Client & Consultant must follow “Ready… Steady….Go… (Not ego). The ego jeopardizes Interactive learning and mutual empathy The Clients being medical consultants themselves know what it takes to succeed in Service Industry .Generally speaking their Core Competency is to deliver at patients care parameters. However getting in to other domains may accompany them with both Opportunity Lost & Cost. An Ethical & Professional Hospital Consultancy is like an assurance in a hospital project that all would always be well. Nov - Dec 2013

EXPERT VIEWS

Indian Healthcare: HOSCONNN’s Observations Hosconnn looks at different facets of healthcare through a Critical, Rational & Management consultant’s perspectives. We would like to present observations for your kind consideration & evaluation as under: 1. “Healthcare is like other Industries” .This “Myth” has to be

dispelled as early as possible. It is an exclusive & Unique industry as Norms, Parameters, Protocols, Factors etc of other industries do not fit in Healthcare 2. Over the years High commercialization of healthcare has taken its toll on its Credibility & Viability 3. Healthcare is a Commercial Activity indeed however with a Human Face 4. Healthcare Entrepreneurship and Infrastructure is not part of Medical Courses Syllabi 5. There has been Mechanical & Irrational growth of healthcare instead of Spontaneous & Objective growth 6. Many of the healthcare units (irrespective of sizes and locations) have been on ventilators for the hope of better tomorrow 7. Healthcare Dreams have always been inspired by “Me Too” rather than individual capability 8. Most of the healthcare projects are born with the Perpetual & Perceptual Defects “We Can Also Do” 9. “We Can Also Do” leads to cut throat competition affecting the entire local “Healthcare Eco-system” 10. Jeopardisation of local “Healthcare Eco-system” shifts the focus from planned & controlled operations to panic buttons with ever mounting overheads lurking in the backdrop. 11. In absence of any such knowledge/real time experience, heresy blurs the entire Systems, Process, Operations, and Objectives 12. A Sharp focus on Priority & Capability is an answer to Nov - Dec 2013

Objective, Structured & Planned functioning or “success” 13. As the unbridled & unplanned expansion (it is misnomer to call it growth) has taken centre stage, there is an urgent need to synchronize with Demand Gaps at local level 14. There are plenty of unfulfilled demand gaps in healthcare delivery everywhere, an objective &synchronized business model would have lesser chances of failures 15. There has been acute shortage of Quality talent pool, and Attrition rates being highest across all the industries, "a quality and reasonably (Charged) consultancy would be absolute “Necessity” 16. With Online cum Offline route we aim to not only tap the untapped market, but also expand the Market Size (new geographies/segments). 17. Ground realities like common sense at many times are not considered and may lead to operational failures. 18. Healthcare Consultants not only reduces the time of project life cycle but also minimizes loss, hence, triggering both the top line and bottom line. 19. During operational stage healthcare consultants become handy in examining the efficiency, profit and structure of the organization. 20. A Good Consultancy is like “A Stitch in Time Saves Nine”

Last but not Least…. ÂÂ More than 90%* Healthcare Units are done by Architects having residential & commercial specialization, hence a dedicated Healthcare consultancy is required ÂÂ More than 90%* Health Care Units (Hospitals, Nursing Home etc.) Owners come from Non-medical family background, and suffer commercially as most of the projects get delayed for the lack of proper Knowledge, Guidelines and even Objectives for existence

Hosconnn welcomes & solicits feedback from readers and industry peers in the larger interest of healthcare, E-mail: info@hosconnn.com

EXPERT VIEWS

Hospital Projects Build it Faster Cheaper and Better!

CJ Kosalraman Managing Director Infrabees

Nov - Dec 2013

EXPERT VIEWS

ospital projects are the most complicated and challenging building type in the construction industry. It takes many months of meticulous planning and comprehensive team work amongst stake holders for a successful completion of hospital on time/ budget. It is mission critical to engage experienced Consultants to pursue an Integrated Design Process and a LEAN approach to make key decisions to meet project cost/time for your signature hospital projects.

Why do you need â&#x20AC;&#x153;Hospital Planning Consultantsâ&#x20AC;? for planning your hospital? On an average,Time spent by a Doctor required in planning / coordination / procurement etc. for their hospital construction is nearly 25-50% of their daily productive time. Doctors lose almost ~Rs. 20-40 Lakhs worth of billable time during the project duration apart from losing patientsâ&#x20AC;&#x2122; confidence on their non-availability due to ending up entangled managing various construction vendors. Still the hospital may fall short of their vision as they are not fully oriented towards adequate planning. Consultants are constantly updated on these latest requirements and follow best industry practices to deliver projects. With un-skilled labor pool becoming non-existent and construction schedule getting reduced it is more apparent that Pre-Fabricated building components/mechanization is inevitable. Also the finished product is much superior, has less wastage and green credits are very much possible. Hospitals in particular can start operations many months in advance there by generating revenue and Return on Investment earlier than planned. A green hospital is a money saver for the Promoters in reducing overall Operational Expenses for many years to come. Successful Hospital projects are built with the following critical steps if implemented well (a)Pre-Design / Strategic Review, (b) Operations Planning, (c) Design & MEP Engineering, (d) Project Management, (e) Building Information Modeling, (f) Medical Equipment Planning (g) Precast Construction, (h) Hospital Management System and (i) Accreditations & Statutory Approvals.

Pre-Design and Strategic Review Pre-Design and Strategic Review stage of a project involves (1) Ideal Site Selection involves choosing a good location for the project, making sure desired built up area is possible on it and confirming the zoning of that site is suitable for hospital. (2) Concept Vetting involves choosing the type Nov - Dec 2013

EXPERT VIEWS

of hospital you want to build (i.e) Secondary or Tertiary care / Single or Multi Specialty / Light House Specialties and its Dependent Facilities, etc. (3) Market Study is a necessity to identify the requirement of the immediate and surrounding localities to test out the owners’ concepts. (4) Project Sign-off at this stage helps to decide on the hospital type & size, the acceptable specialty mix, tentative project budget and expected outcome projected. This becomes the basis for the financial closure to be undertaken by the Promoters.

Operational Planning Operational Planning stage of a project involves (1) an Operational Planner will consider different parameters to maintain synergy between departmental locations & operational/functional process flow. (2) Key Points include functional cohorting between OPD, IPD areas from Diagnostic & Supportive Services in addition to Infection Control Measurement/BMW Management Process. (3) Critical Parameters for consideration are bed count and matrix, progressive utilization of different departments and man power planning. (4) General Design Consideration recommendations such as appropriate functional segregation, separation of critical areas, concept 36

of zoning and ventilation standards, isolation wards and other spatial requirements.

Design Design stage of a project involves starting from Master Planning of site to Space Programming leading to Concept and Detailed Design/Tender. It is critical to make sure the FAR/FSI and Buildable Area is within the mandatory building regulations. Some of the guidelines followed are National Building Code, DCR’s, DTCP and Local Bye Law’s.

MEP Services MEP Services design stage of a project scope include (a) Mechanical - Heating, Ventilation and Air Conditioning popularly known as HVAC, (b) Electrical –Electrical systems, Fire Detection & Alarms and Data/Voice/Surveillance & Safety and (c) Plumbing – Public Health Engineering and Fire Protection System. Some of the guidelines followed are National Building Code, ASHRAE, & NABH Standards.

Project Management Project Management is the overall planning, coordination, and control of a project from concept to commissioning. Nov - Dec 2013

EXPERT VIEWS

Precast Construction

It has two main components namely Design Management (DM)and followed by Construction Management (CM). While DM coordinates project brief, design of project, material finishes, specification, tender etc, CM takes care of Quality, Cost and Time

Building Information Modeling Building Information Modeling (BIM) is virtual construction of a facility prior to its actual physical construction. It intelligently connects building components/assemblies,aids to revise the design instantly and accurate Bill of Quantities including real time accurate 3Dviews/early clash detection.

Medical Equipment Planning Medical Equipment Planning involves meticulously identifying and ordering appropriate equipment’s per Promoters budget, type of care of hospital, type of purchase, upgradeability, patient safety and uptime guarantee taking into account Mean Time between Failures.

Precast Construction Precast Construction is a construction product produced by casting concrete in a reusable mould or “form”. Using Precast slabs, beams and columns will save considerable cost and time as time-consuming shuttering and scaffolding are avoided. From the longevity of the building to the structural Nov - Dec 2013

soundness, it is the most revolutionary technology in the construction industry. Vendor/Procurement Management is most critical for effectively managing any construction project. It involves preparing and implementing strategies and guidelines for the procurement of all project services and materials, taking into consideration any specific conditions of the Project in terms of appropriate contractors, design, manpower resources, time, long lead items, local requirements and site conditions. Interestingly there is no one size fits all or no 100% cookie cutter model for hospital design. Doctors/Promoters should take First Mover’s advantage in embracing innovative ideas to build and stay Ahead of the Curve! INFRABEES Project Management Consultants Pvt Ltd is a professional firm offering project management consultancy focusing on healthcare projects. We provide complete end to end solution starting from Feasibility Study up to Commissioning of hospitals. Our core team members seasoned in healthcare industry, advice clients in bringing all phases of establishing any hospital project on track and within global standards. Contact: CJ Kosalraman - Managing Director M.Arch. (USA), AIA, LEED AP E-mail: kosalraman@infrabees.com 37

HEALTHCARE

Impact of IT in Patient Care Cycle

Amit U. Jain

Head New Projects & IT Infrastructure -Hosconnn www.hosconnn.com

ealthcare industry is unique in certain ways thus cannot be compared with any other industry. Firstly, it is the only industry in which the end users (read patients) canâ&#x20AC;&#x2122;t be created. Secondly, the focus of healthcare service providers has to be on patient care only, irrespective of the revenues that they are generating. Thirdly, hospitals need to differentiate between healthcare service providers and the ones who are managing the operations and administration. The Indian healthcare sector is witnessing a phase of revolutionary change (more of a paradigm shift) with the implementation of IT at various levels of functioning. This effective deployment of IT solutions presents the possibility of turning modern hospitals,not only into paperless entities, but help them improve the various aspects of Patient Care Cycle (PCC), which is becoming highly critical in these turbulent times, when options for patients are increasing and several new players, including Corporate hospitals are entering the market.Also India being considered the premier location for

Nov - Dec 2013

HEALTHCARE

availing healthcare services on the global map and increasing trends of Medical/Health Tourism, IT helps modernize the healthcare sector to a great extent, thus making the day-today functions in a hospital much faster. IT has a significant role in the management of not only hospitals but all processes related to healthcare services. IT helps streamline operations and improves process efficiency for various stakeholders, besides better management & maintenance of patient records. Moreover, new technologies &user-friendly applications are increasing usability and adoption, which will lead to easy integration of information at various levels in the healthcare sector.

Advantages of IT in Healthcare ÂÂ To assimilate and aggregate information related to the patient’s care cycle across various departments &decision makers ÂÂ Helps in cutting down waiting times &errors in reporting real-time information ÂÂ Patient / Surgeries Scheduling ÂÂ Cuts down Turn-around-times (TAT) at all levels ÂÂ Effective short & long term monitoring ÂÂ Umpteen possibilities of data-mining & data warehousing ÂÂ Dynamic Dashboards for quick response to day-today problems. ÂÂ Speedy generation and retrieval of electronic records at Point of Service (PoS)

Key Influencers in Implementing IT in Healthcare ●● Role in design of healthcare product & services ●● Impact on design of healthcare services ●● Information Power Effects & Impacts ●● Role in strengthening public-private partnerships ●● IT-induced vulnerablitiies & risks ●● Need of Global Governance

Latest Trends ●● Electronic Prescription Pad ●● RFID (Radio Frequency Identification) ●● Barcode in Medicine/Lab Samples ●● Speech to Data Conversion ●● PACS (Picture Archiving & Communication System)

Integration

●● DICOM-3 (Digital Imaging & Communication ) Integration Nov - Dec 2013

ÂÂ Electronics Prescription Pad: To write prescriptions on ordinary paper and a digital copy saved on software for future reference and retrieval. EPPs help the doctors write the prescription in their own handwriting on their own official stationery. These prescriptions are saved for later use and retrieval. They work even when electric power / computer network is not on, they have built-in memory, enabling them to be carried to operation theatres (OTs), Intensive Care Units (ICUs) and any other place outside the premises, as well. Some IT companies have smartly and seamlessly integrated these EPPs with HIS. ÂÂ Radio Frequency Identification (RFID): is a fast developing technology that uses radio waves for data collection and transfer; it can capture data efficiently and automatically without human intervention. RFID is believed to be the next generation innovation for automatic data collection and asset tracking. RFID not only offers tracking capability to locate equipment and people in real time, but also provides efficient and accurate access to medical data for doctors and other health professionals. Major barriers to adoption include prohibitive costs, technological limitations and privacy concerns. ÂÂ Barcode: use of barcode in health care is increasing at a fast pace. Bar codes are now applied to medicines, patient samples for diagnostics etc. ÂÂ Speech to data conversion: Speech recognition is the process of converting spoken words into data. This data can be stored in HIS for later retrieval, decisionmaking covering the legal aspects as well. ÂÂ PACS Integration: PACS stands for Picture Archiving and Communication System. PACS revolutionized the field of radiology, which now consists of all digital, computer-generated images as opposed to the analog film of the past. Analog films took up valuable disk space and time for filing and retrieval and storage and were prone to being lost or misfiled. PACS therefore saves precious time and money, and reduces the liability caused by filing errors and lost films.PACS is primarily responsible for the inception of virtual radiology, as images can now be viewed from across the globe. ÂÂ DICOM-3: stands for Digital Imaging and Communications in Medicine. It is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. The communication protocol is an application protocol that uses TCP/IP to communicate between systems. DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format. 39

HEALTHCARE

A Web-based Information System to Strengthen Infrastructure Planning and Management in

Nepal’s Health Sector Background Nepal’s difficult terrain, poor communication networks and limited resources pose enormous challenges for maintaining the necessary infrastructure and supplies to provide quality health services, especially in the country’s many remote hill and mountain areas. Much of the built health infrastructure has been planned in an ad hoc way resulting in many inappropriately located health facilities, a lack of building maintenanceand the inefficient use of scarce resources.The Ministry of Health and Population (MoHP) is addressing this problem with support from its partners by establishing

HIIS-3 alsoincludes information on district health offices, medical stores, health training centres and other types of government health sector related buildings.Among the wealth of information in the database are photographs,architectural plans and location data. The database is web-based and allows health staff with an internet connection to access and update the information from anywhere. It being web-based also allows policymakers and planners to use the system to plan new health buildings and to know the condition of existing buildings from the visual and written records contained in the database. Address of Corresponding author: Sunil Khadka Infrastructure Planning Adviser Nepal Health Sector Support Programme, Ministry of Health and Population, Kathmandu, Nepal Email: sunil@nhssp.org.np 40

systems to enable the rational planning and efficient management of the construction, operation and maintenance of its buildings. In 2007 the Support to Safe Motherhood Programme (SSMP, 2005– 2010), in partnership with the Ministry of Health and Population, developed a database inventory of health facility buildings to identify repair and maintenance needs. From 2011 the database was further developed with support from the Nepal Health Sector Support Programme (NHSSP, 2011–2015). These initiatives went ahead under the leadership and conceptualisation of the lead author of this paper. Version 3 of the resulting Health Infrastructure Information System (HIIS-3) is currently in use to support the systematic management of Nepal’s built health infrastructure. It is an electronic database of all the country’s different types of health institution buildings. The focus is on health facilities and the database includes information on all types of facilities ranging from village levelsub-health postsup to central level hospitals. HIIS-3 alsoincludes information on district health offices, medical stores, health training centres and other types of government health sector related buildings.Among the wealth of information in the database are photographs,architectural plans and location data. The database is web-based and allows health staff with an internet connection to access and update the information from anywhere. It being web-based also allows policymakers and planners to use the system to plan new health buildings and to know the condition of existing buildings from the visual and written records contained in the database.The HIIS is open access and can be located via the link on the home page of MoHP’s website: www.mohp.gov.np. Information Contained in HIIS The HIIS contains the following four types of data records and information components: 1. Infrastructure Planning Adviser, Nepal Health Sector Support Programme, Ministry of Health and Population 2. Senior Health Administrator, Department of Health Services, Ministry of Health Nepal 3. Senior Divisional Engineer, Department of Urban Development and Building Construction, Ministry of Urban Development 4. System Analyst and Developer, Delve Information System Solution, Kathmandu 5. SSMP was and NHSSP is managed by Options UK and funded by the UK’s Department for International Development (DFID). ●● Health institutions and health buildings inventory information The basic information on health institutions and health buildings comes from an initial nationwide survey carried out in 2007 andsubsequent periodic data collection exercises, and information on new health institutions as they are built and upgraded. This includes record of each health facilities and their buildings, number of buildings, type of constructions, age of each building, sizes, physical status, land size, ownership of land and Nov - Dec 2013

HEALTHCARE

details related to support services. Alongside this the system has photographs, images of architectural plans and geographic information system (GIS)location data. ●● Repair and maintenance information — The system computes the repair and maintenance needs of health buildings based on pre-defined criteria related to the age of buildings, floor area, physical conditions and other factors. The system also helps identify reconstruction needs based on the age and physical condition of buildings. ●● Procurement plan information — Procurement plan records are entered into the system for approved new buildings for construction and reconstruction. This includes information on contract and construction status in terms of percentage completion at the various stages, images of plans and photographs of construction progress. ●● Site selection and facility upgrading information — Location coordinates are being entered for all health institutions in the country. This task has so far been completed for 57 of Nepal’s 75 districts and for remaining district the location data has been created with the accuracy of VDC level. This information is being acquired by a GPS survey carried out by the Management Division of the Department of Health Services.This information allows for maps to be produced on screen of the relative location and distribution of health facilities. The system also has information on population, morbidity and accessibility of population within a defined radius to the health facility. The information is useful to plan the location of new health facilities by to developing prioritisation models with weightage and scoring criteria. In general the HIIS contains the following information: 1. The basic information on all health facilities, training centres, offices, stores and other built infrastructure of Nepal’s government health sector. 2. The Google Earth-based GIS locations of all public health institutions in Nepal. 3. Local settlement patterns, road networks and distances between health facilities. 4. Photographs and architectural plans of health institution buildings. 5. Standard designs of different levels of health facilities. 6. Information on maintenance and repair requirements of all health institution buildings. 7. The status of on-going building and renovation contracts. The system is at the moment in the process of District level web-based updating of HIIS information being implemented; The system in the future is planning to Link the system to other health related information systems with Ministry of Health and population like Health Management Information System (HMIS) and the Logistics Management Information System (LMIS); and Human Resource Information system (HuRIC); MoHP has decided to upgrade all the sub-health posts (SHPs) Nov - Dec 2013

in Nepal to Health Post. All the sub health posts in Nepal are managed by local government that is village development committees (VDCs) and are located in VDC buildings. During the development of HIIS, information regarding sub-health postswas not included in the system for the reason that they are not directly owned by MoHP. But with the announcement by MoHP to upgrade all the SHPs to HP, it has become very important that proper analysis be made before any investment is made in upgrading of physical infrastructure of the SHPs to Health Posts (HPs) which are more than 3000 in numbers. Therefore it is very important that SHP level information are incorporated into the system and analysed and prioritised for productive investment. Preparation to get these data incorporated into the system has been initiated.Location for all the SHP with regard to GIS points is already in the system. Results The HIIS is providing many benefits. It has improved access to information on the condition of health institution buildings across the country, enables the preliminary assessment of the suitability of sites for new health facilities, helps identifyareas under-served (and over-served) with health services, helps track the progress of construction projects, helps show transport connectivity between health facilities for patient referrals, and provides a rational basis for allocating budgets for new and existing health infrastructure. It also enables the more systematic planning of health building maintenance,the automatic calculation of repair and maintenance budgetsand the selection of health facilities for infrastructure upgrading. The availability of comprehensive and accurate data at the touch of a button has resulted in the improved annual and long term planning of the building and maintenance of Nepal’s built health infrastructure. A series of models have been developed for infrastructure planning based on different budget projections and priorities, linked to standard prototype designs for the different levels of facilities and geographical areas using the Google Earth interface. Using Google Earth location data in conjunction with population, accessibility, morbidity, referral capacity and other relevant data has made the site selection of new facilities more scientific. Planners can identify gaps in health service provision from their desks and make more efficient use of site visits. Conclusions Electronic information systems promote more equitable access to information about the state of health institution buildings in countries like Nepal where site visits can be time-consuming and costly. Such systems provide a sound information base for scientific trend studies and research to support evidence based planning and decision making. The transparency this promotesis encouraging other donors to invest in improving Nepal’s health infrastructure. 41

DOCTOR SPEAK

Illness in Children &

Infection Control

T Dr. Rajiva Kumar Child Specialist Muzaffarpur Bihar, INDIA

The most common illnesses in children are respiratory infections (colds, croup, strep throat) and ear infections. Because they haven’t yet developed immunity to most infections they’re exposed to, younger children are at greater risk of becoming ill. 42

he most common illnesses in children are respiratory infections (colds, croup, strep throat) and ear infections. Because they haven’t yet developed immunity to most infections they’re exposed to, younger children are at greater risk of becoming ill. To make things worse, infants and young children frequently put toys in their mouth, which only increases the spread of germs from one child to another. Therefore, child care providers must ensure that all toys, objects and surfaces children come into contact with, are cleaned and sanitized on a regular basis. Another common way children spread germs is by not washing their hands properly after using the toilet. This is why it’s extremely important for child care providers to teach proper hand washing procedures, and to be role models for the children. I recommend that young children be immunized and that immunizations be kept up to date. Nov - Dec 2013

DOCTOR SPEAK

Breaking the Chain (Spread) of Infection As we’ve seen, germs can spread easily from one person (or object) to another. However, there is a chain of transmission that must be present for the contamination to take place.

The chain of transmission has four links. ●● Germs-such as a virus or bacteria ●● Host-the person who is sick ●● Mode of transmission-anything germs can contaminate (ex:

toy, food, counter, our hands) and transmit to a new host

●● New host (the person at risk/susceptible to getting sick)

Germs are transmitted primarily through direct or indirect contact, airborne or droplet secretion. Once transmitted, germs can survive for hours, even days in the environment, increasing the risk for infection signiﬁcantly. In fact, the most contagious period is usually when the person doesn’t feel ill – so the key is prevention. The transmission can be prevented by breaking one of the links in the chain.

Routine Practices

tissues in a plastic-lined, covered garbage can and wash your hands. After wiping up a spill of blood or body fluids with a disposable paper towel, clean the soiled surface with a cleaning solution. Detergent, disinfectant detergent or chemical germicide, mixed in water, are acceptable cleaning solutions for this purpose. After cleaning a surface, sanitize it with a bleach solution. To prepare the bleach solution, mix 5 ml of bleach with 500 ml of water (1 part bleach to 100 parts water). Bleach solution must be prepared daily to be effective. If solutions are subjected to heat and/or light, the solution may have to be changed every four hours. If the spill is large and a mop needs to be used, be sure to rinse the mop with a sanitizing solution (ex: bleach solution) after using it. Allow the mop to air-dry before using it again. If mopping up blood, either use a disposable mop and discard it after use, or remove the mop head and wash in hot water with detergent immediately after. After cleaning up a spill, wash your hands promptly and thoroughly with soap and water. Do not care for another child until you have washed your hands. And remember, you need to wash your hands even if you have been wearing gloves. Immediately remove clothing or linens soiled with blood, vomit, urine or stool, and place them in a plastic bag. These items can be washed as regular laundry. However, if possible, you should send the clothing home with the parent for laundering.

To avoid spreading infectious (communicable) diseases, all parents of child and family child care homes should adopt Routine Practices for handling blood or body fluids, such as urine, saliva, vomit or stool.

The following good health practices are directed to child care providers. They will help you prevent the spread of infection and other communicable diseases in your child care centre/home.

Hand Washing Procedure

1. You must wear disposable gloves any time your hands may come in direct contact with blood (or body fluids containing blood). Hands must be washed immediately after discarding gloves. While the use of disposable gloves is highly recommended when changing diapers, Manitoba Health advises that gloves are not needed unless blood is visible in the urine or stool. If blood is visible, always wear gloves. If you have open cuts or sores on your hands (ex: hangnails,paper cuts), always use disposable gloves. After use, the gloves should be discarded into a plastic- lined, covered garbage can. Hands must be washed immediately after discarding the gloves. You can use household rubber gloves for things like washing dishes, or sanitizing toys and objects, as long as you don’t have any open sores on your hands. The gloves must be sanitized in a bleach solution before taking them off (see Step 4 for more on bleach solution), and hands must be washed immediately after removing gloves. 2. Use disposable paper towels or tissues when wiping up spills or cleaning soiled surfaces. Discard the towels or Nov - Dec 2013

Washing your hands is the most effective way to reduce the spread of germs and disease-causing bacteria and viruses. It is particularly important for child care

providers to follow this procedure.

How To Wash Your Hands wash for 10-15 seconds ●● Wet your hands under warm running water. ●● Put soap onto your hands and create a lather. ●● Rub your hands together thoroughly (creating

friction),scrubbing palm to palm, the backs of your hands, between your fi ngers, under your fi ngernails, and your wrists. ●● Rinse your hands under warm running water. ●● Dry your hands thoroughly using a clean disposable paper towel and throw it into the garbage. ●● Use a separate paper towel to turn off taps and throw into the garbage. ●● Use hand lotion to prevent chapping,if desired. 43

DOCTOR SPEAK

The silent suffering:

Stigma is the biggest barrier for

MENTAL HEALTH Dr Madhusudan Singh Solanki Consultant Psychiatrist

Saket City Hospit

n India, being a mentally ill patient carries a huge stigma and this is perhaps the biggest barrier for mental health. Because of the stigma people donâ&#x20AC;&#x2122;t prefer going to a mental health professional for an evaluation and they keep on suffering or seek solace in drugs and alcohol which actually makes it worse and furthermore many times they prefer going to faith healers considering it as a curse from the deities or the result of witchcraft or black magic delaying treatment which actually increases the suffering manifold and also increases the stigma attached. Various studies have reported an average gap spanning few years to more than 14 years in starting of symptoms of schizophrenia and treatment seeking in our country, the major damage has already taken place by that time says Dr. Madhusudan consultant psychiatrist at Saket city hospital New Delhi. The effects of stigma deeply affect an individual at all levels right from treatment seeking to social and financial opportunities and caregiver and family stress. Moreover, there is evidence that despite the significant scientific advances in our understanding of the cause and treatment of psychiatric disorders, stigma is growing says a report from a Global Programme of the World Psychiatric Association.

Nov - Dec 2013

DOCTOR SPEAK

What a patient can do ●● Understand that most of the mental illnesses are

treatable with proper and regular treatment. ●● Regular follow up and treatment compliance is essential as it is required for any other chronic physical illness. ●● Remember you are not alone, many people are living a life of dignity and self reliance with proper treatment despite having severe mental illnesses. ●● Take medicines as advised, take regular exercise, keep yourself busy, inculcate hobbies and keep a positive mindset. ●● Report to your psychiatrist about any change in symptoms or adverse effects. ●● Do not self medicate, do not stop the treatment on your own. In a country like ours where good and pure mental health has been the topic of various spiritual discourses and teachings since antiquity, it’s really disheartening that mental illness and mentally ill are frowned upon and are left to suffer in silence. People become scared of the social stigma and being consequently ostracized, they defer treatment and this affects the prognosis leading to poor quality of life and significant morbidity and mortality. Dr. Madhusudan who is a young Gold medalist Psychiatrist with value driven Saket city hospital has worked actively in the area of mental health awareness and stigma reduction using music and other arts. Using his music composing, song writing and poetic skills he has prepared a musical video presentation by the name of “Phool Kho Gaye” which beautifully displays the agony of mentally ill patients, spreads awareness regarding the stigma and generates hope that mental illnesses are treatable and it has been received very positively by patients, caregivers, NGOs and by the medical fraternity. He is working on a musical documentary these days for further enhancing and extending the message. Col Mehndiratta president of the NGO “Prayatan” which works for the welfare of mentally ill, also sites stigma as one of the most difficult barriers in the way of mental health improvement and says praising “phool kho gaye” that we need more such positive creative efforts to raise this issue and spread awareness regarding something Nov - Dec 2013

What the family members of a patient can do ●● Accept the fact that mental illnesses are like

physical illnesses and are treatable. ●● Keep an attitude of empathy and understanding towards the patient ●● Encourage the patient to take regular treatment. ●● Support and encourage when patient starts coming back to normal life. ●● Talk to your treating doctor regarding any issues that concern you. ●● There are group interventions available where such families can interact under the guidance of a therapist and find answers and support, ask your doctor about it.

which is often neglected and sidelined. The scenario is not much better amongst the medical fraternity too as evident by the lack of awareness and hence failure in recognition of mental illnesses comorbid with physical conditions consequently reflecting in poor consultation liaison between psychiatry and other specialities in our country as compared to western countries says a study published in Indian Journal of Social Psychiatry regarding consultation liaison patterns in a tertiary care centre in which Dr. Madhusudan was one of the chief investigators. We need a lot more efforts and the people need to be sensitized says Dr. Madhusudan who is pioneering free seminars in schools under the social outreach program of Saket city hospital for raising awareness regarding this issue. The need of the hour is to understand that mental illnesses are like any other physical illnesses which are required to be treated properly and they are treatable, we need to respect the dignity of a mentally ill patient as we respect a physically ill patient and there should be acceptance and compassion for them, the inclusion of psychiatric OPD and the stress on mental health in big hospitals like Saket city is a very positive and welcome step which generates positive acceptance, reduces stigma and paves way for the realization of holistic patient care says Dr. Madhusudan. 45

INTERVIEW

First and foremost Disposables provides the best possible protections for the Healthcare professional

SAFETEC

Mr. Bimal B. Jhaveri

Managing Director Safetec Healthcare and Hygiene Pvt. Ltd.

Rise in demand of hospital consumable & Disposables, What challenges you observed? ÂÂ Due to Increasing populations, improvements in medical technology and knowledge has caused the rise in demands of medical consumables supplies. ÂÂ Majorly of all top graded hospitals are concentrating on Premium & foreign patients for which they require world class facility including latest & fastest technologies, Foreign accreditations & certifications, disposable consumables to prevent HAI which leads to prolonged stay in Hospitals for patients. ÂÂ With support of Mediclaim facility booming,the awareness of using disposables had also increased, irrespective of total billing of hospital to be paid by an individual. ÂÂ As a mandatory norms of infection preventions, now the Indian government is also raising concern about using disposables in respective depts. A bulk purchase of disposables is floated in annual tenders. 46

Nov - Dec 2013

INTERVIEW

Challenges: ÂÂ Due to rapid awareness of using disposables in hospital industry,many organized & un-organised manufacturers have launched there products in the industry. ÂÂ Global fluctuation in prices had made uncertainty of purchase price of raw material resulting in price variations of the final products. ÂÂ Local or unorganized manufacturer have driven the market to compromise the quality of products to be actually used. ÂÂ Inspite of imparting knowledge & awareness to hospitals or an individual client, they are still using the good old traditional concepts of using reusables. ÂÂ Hospitals are offering a systemized complete package for a surgery of a patient,where they don’t need to increase their package by introducing any extra disposables.

What are role of disposable products in hospital acquired infections? ●● First and foremost Disposables provides the best possible

protections for the Healthcare professional, i.e the surgeon, the caregiver, i.e. the nurse and finally the patient himself/ herself. ●● The organized manufacturer of disposables maintains all the norms of infection control during manufacturing there goods.,As a result there is a mutual benefit provided between a patient and a user resulting in zero infection. ●● Using disposables during intra-operative procedures provides comfort & convenience to user and also earns the confidence by providing the consistent protections.

What are your future plans? ÂÂ To develop awareness of disposables in unreached parts of our country. ÂÂ Conduct educational & awareness program for using disposables,which in turn will reduce the infection related issues in many segments. ÂÂ To provide the best quality services to healthcare industry.

What is the market of disposable products in India? ÂÂ Indian disposable medical supplies demand is rising14.3 percent annually. Syringes and inhalers, IV and urinary catheters, hemodialysis bloodlines, peritoneal dialysis kits, tissue sealants, biological wound dressings, Class IV garments and textiles, and blood glucose test strips will be among the fastest growing products.

It will present historical demand data for the years 2001, 2006 and 2011, and forecasts for 2016 and 2021 by product (e.g., drug delivery devices, wound management supplies, nonwoven medical disposables, diagnostic and laboratory disposables, infection prevention supplies, surgical disposables), market (e.g., hospital, home health care, outpatient, physicians’ office, nursing home, dental office) and raw material (e.g., plastic resins, nonwoven fabrics, paper and paperboard, rubber).

SAFETEC HEALTHCARE AND HYGIENE PVT. LTD. Is one of the leading manufacturer & supplier of medical disposable apparels, viz. face masks, caps, Surgical gowns, Surgical drapes & Packs, shoe covers, garment accessories & Customized Procedure Trays & Standard Procedure Trays, Medical Packaging and Medical Disinfectant. These are made as per International codes / standards to serve the needs of Medical professionals working in medical institutions & pharmaceutical industry. The company was established in 1999 & is headed by Mr. Bimal B. Jhaveri. He is an M. S. in Pharmacy from University of Rhode Island, U. S. A. He is knowledgeable in Non-woven fabrics & their application in the medical field. A team of competent persons, committed to achieve quality through team work, assists him in day to day working.

SAFETEC

All the products are manufactured in the state of the art imported machinery under strict quality control. The Products are produced in Positive Static Pressure Room facility with completely hands free operation. Detailed company profile is maintained & submitted to various organizations when needed. The profile details our products, infrastructure & List of Reputed customers. All our products are manufactured to fulfill the customer requirements .Our customer’s list, including top ranking industry leaders, itself is the proof of quality performance of our products. We have in house ETO Sterilisation Facilities. We have ISO 9001:2008, ISO 13485:2003, CE Certified and US FDA approved Company.

ÂÂ Meet the demands of customers by providing consistent supplies. Nov - Dec 2013

INTERVIEW

Mr. Chaitanya Dev Singh Sisodiya Marketing Department, Scientech Technologies, Pvt. Ltd. 94, Electronic Complex, Pardesipura, Indore-452010, INDIA

Shed some light on the company’s journey since inception? How you are serving Healthcare Industry? From its humble beginning back in 1983, Scientech Technologies Pvt. Ltd. has been designing and manufacturing a wide range of Electronic Test and Measuring Instruments. After getting excellent response from its patron, it entered into Education sector especially in didactic products for Science and Engineering streams. Scientech established a strong reputation in this field in 90’s, and it was felt that we should extend our business in Healthcare and Environment. Today Scientech group has interest across sectors like Software, Education, Health care, Environment and Industry. The group has 12 branch offices across India and products are exported to over 70 countries. Scientech’s world class range provides a high degree of Quality, Reliability, and Value in its products.

Today Scientech group has interest across sectors like Software, Education, Health care, Environment and Industry

Elaborate on some unique products you have? Scientech Medicare offers a comprehensive range of Medical instruments, and Didactic products in the field of Cardiology, Imaging, Critical Care Instruments, Monitoring and Gynecology with excellent Customer Support. In addition to Hospital Equipments, Scientech Medicare offers some unique and exclusive products line known as TechBooks which are used in Medical Colleges, BioMedical Engineering Colleges, Paramedical Colleges, Training Institutes. Scientech TechBooks score heavily over the conventional text books. They help students in learning the theory of various subjects through animation and other innovative tools and more importantly enable them to perform real time experiment for holistic understandings of the topic. Scientech TechBooks are compact and user friendly learning platforms to provide a modern, portable,

Nov - Dec 2013

INTERVIEW comprehensive and practical way to learn technology. Each TechBook is provided with detailed multimedia learning material which covers basic theory, step by step procedure to conduct the experiment and other useful information.

How is the outlook in terms of the commercial front? Are you seeing any momentum? The focus will remain more on the Hospital equipments, but proportionate commercial space is also given to Solutions for the Medical Education sector. The growth is healthy.

What are your future plans? The company is planning to expand its business and our

Nov - Dec 2013

product portfolio with new projects. The new launches planned for the coming months include an ERP based Hospital Management System.

What marketing strategy do you manage to edge out competitors in your field? Customer-centric marketing strategies, flexibility, and speed of response are vital for success, and these are engrained in Scientechâ&#x20AC;&#x2122;s core marketing policy.

Brief about R&D of your company. We have very focused teams, working on various cutting edge technologies to provide modern and high end solutions to our customers.

EXPERT VIEWS

sdLDL

Dr Arnab Roy

Dr Faisal Khan

Sr. Research Scientist & Coordinator-Knowledge Management R & D, SRL Limited

Sr. Research Officer Knowledge Management R & D, SRL Limited

The Small Dense Killer When scientific discussions revolve around matters of the heart, “hypercholesterolemia” is often the heart of the matter!! Increasing HDL-C levels and controlling the LDL component have been traditional therapeutic goals. However, advancements in the molecular pathophysiology of LDL-C have opened up new vistas for the management of hypercholesterolemia. From this broadening horizon of understanding, what has held the medical fraternity in intrigue is the varied role played by different subclasses of LDL in the pathophysiology of atherosclerosis. The small dense fraction of LDL (sdLDL) brings to one’s imagination an army of innumerable tiny and small but aggressive and dense LDL-C particles. Particles, which by the sheer virtue of their small size can make their way through the smallest vascular injuries into the subendothelial space and by the virtue of their dense concentration can get oxidized really fast to wreak havoc!!. Read on to find more……………!!

Cardiovascular disease unconquered: Epidemiology speaks Recent evidence has reported the incidence of cardiovascular disease (CVD) to be 50% to 400% higher in Asian Indians than individuals of other ethnic origins. About 50% of reported infarctions are known to occur in Indian men under the age of 50 years, with 25% under the age of 40 years. In addition, some 30% to 40% of cardiovascular deaths occur between 35 and 64 years of age. An estimated 9.2 million productive years of life were lost to cardiovascular disease in India in 2000, a number that is expected to increase to nearly 18 million by 2030 (10 times the rate in the U.S.). An Indian Council of Medical Research project reported a prevalence of dyslipidemia of 37.5% among adults 15 to 64 years of age; with an even higher prevalence of dyslipidemia (62%) among young male industrial workers. Interestingly, the 4-fold increase in the prevalence of cardiovascular disease in the 30- to 69-year age Indian group over that in the U.S. was generally similar in Indians living in the U.S. and India. Atherosclerosis Management: A shift in focus from large LDL to sdLDL The role played by low density lipoproteins (LDL) in the etiopathogenesis of atherosclerosis is well established and extensively investigated. International

treatment guidelines promulgated in the last decade recommended reduction in the levels of LDL cholesterol for prevention of coronary heart disease (CHD). For patients of CHD, the guidelines recommended maintaining an LDL cholesterol level below 100 mg/dL. Statins, the mainstay of lipid lowering therapy, reduce CHD events and LDL-C has been employed as the monitoring marker during treatment. However, it has been observed over the years that many individuals in whom CHD develops, have LDL-C levels in the normal range. This observation challenges the traditional approach of using LDL-C concentrations as the main lipid target in the management of CHD risk. Infact, the sdLDL component of the total LDL-C is much more atherogenic in nature as compared to large buoyant LDL cholesterol and can provide a better projection of CHD risk. The increased atherogenicity of sdLDL is attributable to factors mentioned in the text box above.

The pronounced atherogenicity and risk predictive ability of sdLDL has been highlighted by several large clinical trials. A case in point is the evidence generated from large clinical studies like the Quebec cardiovascular study which confirmed that elevated sdLDL at baseline is an independent predictor of CHD. It has also been demonstrated that large LDL is a poor predictor of CHD and seems to be associated with a low CHD risk. This implies that the extent of atherogenicity differs among heterogenous LDL particles. The atherogenic nature of LDL cholesterol is mainly attributable to its sdLDL component. The table given below provides the age-wise biological reference ranges for sdLDL levels.

Nov - Dec 2013

EXPERT VIEWS sdLDL: An independent predictor of CHD risk It is noteworthy in this context that CHD risk assessment based upon sdLDL levels is completely independent of the patients’ total cholesterol levels as well as the large LDL subtype. This implies that although a patient’s LDL cholesterol might be under control, the sdLDL component could be elevated. With elevated sdLDL and normal LDL values; the patient still continues to be at an escalated risk for CHD or at risk of recurring events. In other words, lowering LDL alone cannot be a one-stop solution for risk aversion. Convincing clinical evidence has made it imperative, to measure the sdLDL component as well and to address it through clinical intervention.

Measuring sdLDL: A key factor in therapy decision making Patients with different sub-fractions of LDL respond differently to anti-hyperlipidemic treatment regimens. Patients with a high sdLDL component typically require therapy that would shift and change the LDL particle size from small, to the large and buoyant one. This implies that the selection of antihyperlipidemic medication cannot follow a “one size-fits-all” pattern. Therapy decisions need to be based upon the size and density of LDL particles, which may differ from patient to patient. Thus, based upon particle size and density, LDLlowering therapy would have to be customized for every case. Given this background, it is pertinent to present clinical evidence highlighting the effect of different anti hyperlipidemic agents on LDL particle size. To begin with statins; it has been confirmed through clinical studies that different “statins” have different effects upon the LDL particle size. For example, fluvastatin and atorvastatin have demonstrated a strong affinity towards shifting and changing the LDL profile towards larger and more buoyant particles. On the other hand, simvastatin and pravastatin are not known to have any such effect on particle size. Infact, fluvastatin is known to reduce the ultra-atherogenic sdLDL fraction in post-menopausal overweight women; one of the most vulnerable subgroup of patients. Fibrates like fenofibrate, gemfibrozil and bezafibrate have a more pronounced therapeutic effect in controlling hypertriglyceridemia and in patients with low HDL cholesterol. These drugs are less effective in managing high LDL cholesterol cases. Nevertheless, the efficacy of fibrates like fenofibrate, in shifting the LDL profile to a more buoyant one, is well established. Treatment with fenofibrate is known to reduce post-prandial increase in triglyceride levels and sdLDL in hypertriglyceridemic individuals. A large pool of dyslipidemic patients suffers from metabolic syndrome. In this scenario, management of type 2 diabetes concurrent with hyperlipidemia, presents a clinical challenge. Given this backdrop, the effect of anti-diabetic medications like pioglitazone and rosiglitazone on the LDL profile, assumes importance. In the light of clinical evidence, pioglitazone

Nov - Dec 2013

appears to be more effective than rosiglitazone in reducing triglycerides, LDL cholesterol and in increasing HDL cholesterol. In addition to this, pioglitazone has a much more pronounced effect on the reduction of LDL particle size as compared to rosiglitazone. In summary, patients presenting with a high sdLDL subfraction of LDL cholesterol, are at a greater risk of CVD or its recurrence. The therapeutic modulation of sdLDL thus warrants regular monitoring of sdLDL levels for risk estimation and for determining the efficacy of the ongoing anti-hyperlipidemic regimen. In this era of personalized therapeutics, clinicians need to consider the fact that patients with high sdLDL levels would benefit only from those lipid lowering medications which not only reduce the number of sdLDL particles but also convert them to large buoyant ones. (8) This in turn, reiterates the significance of the laboratory diagnosis of patients’ sdLDL status; for projection of risk and for therapy decision making. Several methods are available to determine the sdLDL sub fraction of LDL cholesterol. These include gel electrophoresis, ultracentrifugation, NMR and HPLC. However, these measurements are labour intensive, expensive and time consuming. Besides, these methods are dependent on specialized equipment and provide a qualitative assessment. A simple biochemical method for detection of sdLDL levels thus appears to be a more pragmatic option. It is simple rapid, less expensive, convenient and comparable to standard methods.

References: 1. Anthony De maria. Cardiology in India. Journal of the American College of Cardiology. Vol. 56, No. 8, Page numbers 678-79, 2010 2. http://www.textbookofcardiology.org/wiki/Atherosclerosis 3. Koba et al. Small LDL cholesterol is superior to LDLcholesterol in determining severe coronary atherosclerosis. J. Atheroscler. Thromb, 2008, 15: 250-260 4. John D Brunzell. Increased Apo-B in small dense LDL particles predicts premature coronary artery disease. Arterioscler Thromb Vasc Biol. 2005;25:474-475 5. Sharma and Garg. Small dense LDL: Risk factor for coronary artery diseaseand its therapeutic modulation. Indian journal of biochemistry and biophysics. Vol. 49, April 2012, pages 77-85 6. Ai M et al. Small dense LDL cholesterol and coronary heart disease: Results from the Framingham Offspring Study. Clin Chem. 2010 Jun;56(6):967-76 7. Annie C. St-Pierre et al. Low-Density Lipoprotein Subfractions and the Long-Term Risk of Ischemic Heart Disease in Men13-Year Follow-Up Data From the Québec Cardiovascular Study. Arteriosclerosis, Thrombosis, and Vascular Biology. 2005; 25: 553-559 8. Stamler Jet al. Serum cholesterol. Doing the right thing. Circulation. 1993; 88: 1954–1960 9. Lamarche B and Lewis GF. Atherosclerosis prevention for the next decade: risk assessment beyond low density lipoprotein cholesterol. Can J Cardiol. 1998; 14: 841–851

Nov - Dec 2013

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EXPERT VIEWS

Sachit Rajan

Director and Business Head Charter Mercantile

he World Economic Forum report on healthcare industry is all about its vision on the healthcare industry. The healthcare industry has tremendously grown since the last two decades especially in OECD countries it has grown beyond the GDP. This report encourages to look beyond the traditional healthcare trends and to adapt the changes which science and technology brings in. The truth is that healthcare industry is affected by the austerity measures established by various countries due to the economic crisis.

The success in the healthcare industry has given new challenges like ●● Chronic illnesses ●● Costly healthcare ●● Prolonged treatment

Over the last 50 years the average annual rate of healthcare has grown to 2% and by 2050 the annual average cost is expected to grow by 50-100%. Healthcare system not only includes treatment and care but it includes policies, products and services which are designed for the prevention of the disease and for the wellbeing. What we need are the plans for a long term period even though a short term plans gives and immediate results but only for the time being. The gap between the supply and demand, population health and individual healthcare should be filled. Nov - Dec 2013

EXPERT VIEWS cities and villages will be the target and this will be achieved through strong families, stronger communities and dedicated workers. They will target to eradicate chronic illness combining traditional and advanced medical knowledge.

Vision Germany What are the key factors that raise the healthcare costs? ●● Ageing population ●● Explosion of lifestyle diseases ●● Rise in public expectations ●● Lack of value consciousness among healthcare consumers ●● Poor allocation of resources ●● New therapies and technologies ●● New strategies for better results

Health care System and Health System what are they? Both terms are used interchangeably but they are two different terms. Institutions, facilities and people involved in delivering healthcare services come within healthcare systems. Whereas health system comprises of broad range of institutions and people who works beyond the traditional health sector who directly or indirectly influence the health of the society. Eg: Food and Beverages companies

Vision 2040 World Economic Forum conducted workshops in 5 countries in order to explore the possibilities of Sustainable Health Systems. The main question in this workshop conducted in China, Germany Spain, Netherlands and England was about the ideal health system in 2040?

The main concerns were ●● Aspirations for the future ●● Setting aside the current restraints ●● Departure from traditional healthcare ●● Relationship between individual and healthcare provider ●● Greater patient responsibilities

All these can only be achieved through the support of media, technology, tele communications, educational and financial sectors.

Vision China Chinese vision is healthy and harmonious society by 2040. Securing health system for nominal cost across the great Nov - Dec 2013

Germans envisage an efficient and good quality healthcare system that means a world class system. It should boost the economy as the German automotive industry. There will be full transparency in the quality and the cost of the care which they provide. Patients will play a greater role in improvement of the healthcare system

Vision Spain The Spanish will target the eradication of lifestyle diseases. More concentration will be on the quality and safety standard across the system. They will be carrying out health literacy programs even including the children.

Vision Netherlands The Dutch will bring up a greater healthcare system with the support of public. Through the public participation people will identify that healthcare is a responsibility and not a “right” and that will result in an effective healthcare system. Better healthcare initiatives will be rewarded. They will plan the healthcare system even to bring up export opportunities and thus boost economic activity.

Vision England England’s values of access and equity will be reflected in national health. The healthcare delivery models will be dynamic and adaptable according to the changes in society and technology. Primary centre will be home and hospitals will be centre of excellence with skilled people. Patience will be at their discretion.

What should be India’s Vision for 2040? India has improved a lot in healthcare but the infrastructure need to be improved a lot. There is a shortfall of around 600000 doctors in the service, lack of experts in technology, cost of the systems are the few challenges in Indian healthcare industry. Even though the child and mother mortality rate has come down we need to improve a lot here. The public is not fully satisfied with the service provided even in multi specialty hospitals. Government has to seriously see the healthcare industry and there should be strict guidelines for the operations in healthcare systems. 55

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TENDERS

Hospital Ref Number: 9304984 Tender Number: Tender Prod. No: 2013_DSCI_47239_1 Buyer/Seller: Delhi State Cancer Institute Requirement: Supply of Hospital Beds Location: New Delhi - Delhi - India EMD: INR300,000 Closing Date: 11/11/2013 at 13:30 Hrs. Document Sale To: 11-11-2013 at 13:30 Hrs _________________________________________________ Ref Number: 9204629 Tender Number: Buyer/Seller: Public Works Department Requirement: 1. 2. 3. 4. 5.

Additional/Alteration & Renovation work in hospital. Providing & Fixing of Shed in Hospital. Extension work of bed in Hospital. Civil & Sanitary work in office. Water proofing treatment work in office.

Location: Jaipur - Rajasthan - India EMD: Rs.1,353,000 Estimated Cost: Rs.6,765,000 Closing Date: 26/11/2013 at 15:00 Hrs. Contact Details: Public Works Department Jaipur, Rajasthan, India Document Sale To: 22-11-2013 at 15:00 Hrs _________________________________________________ Ref Number: 9204875 Tender Number: Tender Prod. No: 3807 Buyer/Seller: Public Works Department Requirement: Extension work of Bed in medical & surgical neonatal unit at Hospital Location: Jaipur - Rajasthan - India Document Fees: Rs.1,000 EMD: Rs.272,000 Estimated Cost: Rs.13,600,000 Closing Date: 3/12/2013 at 18:00 Hrs. Contact Details: Public Works Department Jaipur, Rajasthan, India Document Sale From: 6-11-2013 at 9:30 Hrs Document Sale To: 2-12-2013 at 18:00 Hrs _________________________________________________ _________________________________________________ DENTAL CHAIR Ref Number: 9339659 Tender Number: Buyer/Seller: Government Dental College Requirement: Supply of spare parts and for the repair of dental chairs & dental stools in the department of conservative dentistry of this college for the year 2013-2014. Location: Thiruvananthapuram-Kerala-India Document Fees: Rs.700 Closing Date: 2/12/2013 at 14:30 Hrs _______________________________________________

Ref Number: 9287116 Tender Number: Buyer/Seller: Government Medical College & Hospital Requirement: Procurement of 3D echo cardiography color doppler system, fully electronically operated dental chairs, yag laser, non contact biometry using optical cocherence, non contact tonometer, ophthalmic ultrasound imaging system + pachymetry, penta head microscope, modular HPLC system, brief pulse computerized ECT machine, pneumatic drill system, haemodialysis machine Location: Nainital - Uttaranchal - India Document Fees: Rs.2,270 EMD: Rs.200,000 Closing Date: 15/11/2013 at 13:00 Hrs _________________________________________________ Ref Number: 9335102 Tender Number: Tender Prod. No: 2013_DSCI_47415_1 Buyer/Seller: Delhi State Cancer Institute Requirement: Supply of dental chairs. Location: New Delhi - Delhi - India EMD: INR50,000 Closing Date: 15/11/2013 at 13:30 Hrs. Document Sale To: 15-11-2013 at 13:30 Hrs _________________________________________________ Ref Number: 9287659 Tender Number: Tender Prod. No: hq-pur-asn-e099-2013- 14 Buyer/Seller: Western Coalfields Limited Requirement: Supply, installation & commissioning of dental chair and dental unit Location: Nagpur - Maharashtra - India EMD: INR10,000 Estimated Cost: INR500,000 Closing Date: 22/11/2013 at 15:00 Hrs. Document Sale To: 22-11-2013 at 15:00 Hrs __________________________________________ Ref Number: 9371443 Tender Number: Buyer/Seller: Department Of Medical Education And Research Requirement: Supply of Nephroscope, Ureterorenoscope, ENT micro drilling system, Computerised biofeedback, Slit lamp, A scan biometer, Pulse oximeter with NIBP, Vein viewer, Impedance audiometer, Stand alone cardio pulmonary exercise testing system with bicycle ergometer, Piezu ultrasonic surgical unit, Dental loops with LED head light with power source, Electrically operated dental chair with unit Location: Mumbai - Maharashtra - India Document Fees: Rs.750 Closing Date: 29/11/2013 at 00:00 Hrs. Document Sale To: 28-11-2013 _________________________________________________

Ref Number: 9339659 Tender Number: Buyer/Seller: Government Dental College Requirement: Supply of spare parts and for the repair of dental chairs & dental stools in the department of conservative dentistry of this college for the year 2013-2014. Location: Thiruvananthapuram - Kerala - India Document Fees: Rs.700 Closing Date: 2/12/2013 at 14:30 Hrs _________________________________________________ Ref Number: 9339659 Tender Number: Buyer/Seller: Government Dental College Requirement: Supply of spare parts and for the repair of dental chairs & dental stools in the department of conservative dentistry of this college for the year 2013-2014. Location: Thiruvananthapuram - Kerala - India Document Fees: Rs.700 Closing Date: 2/12/2013 at 14:30 Hrs _________________________________________________ _________________________________________________ FOLDING STRETCHER Ref Number:9270378 Tender Number: Tender Prod. No: NIT 04 Buyer/Seller: Fire Service Department Requirement: Supply of fire fighting equipments PVC Suction Hose, Short Branch, Hand Control Branch (London type), Diffuser Branch, Revolving Branch, Long Branch with nozzle, Foam making branch, Collecting breaching, Dividing breaching, Rubber Washer, CO2 Fire Extinguisher, DCP Extinguisher, Folding Stretcher, Delivery Hose coupling, Delivery Hose Rubber line, Breathing Apparatus sets etc. Location: Agartala - Tripura - India Document Fees: INR3,000 EMD: INR500,000 Estimated Cost: INR10,000,000 Closing Date: 11/11/2013 at 16:00 Hrs. Contact Details: Er Tapan Kr Roy, 03812326451 03812324826, Government Of Tripura, Directorate Of Fire Services, Fire Brigade Choumohani, Agartala, Tripura, India, 799001 Document Sale To: 11-11-2013 at 15:00 Hrs _________________________________________________ Ref Number: 9310185 Tender Number: Tender Prod. No: 2013_ITBP_141160_1 Buyer/Seller: Indo Tibetan Border Police Requirement: Purchase of pet items (hospital equipment) - resucitation kit, pulse oxymeter, suction apparatus, bp apparatus, stetho scope, hot water bottle, thermometer, bowels s.s., i/v stand, feeding cup, urine pot, bed pan, light-

Nov - Dec 2013

TENDERS

Furniture Tender weight folding stretcher, disposal oxygen clyinder, water filter manual, emergency accidental kit, suturing material preparation- sterlizered & disposal, doctor/ paramedic bag, preparation-sterlized disposable surgical items, auroscope(heine), forgign body remover(ear, nose, throt), syringe insfusion pump, almirah(medium). Location: Dehradun - Uttaranchal-India Document Fees: Rs.100 EMD: Rs.13,600 Estimated Cost: Rs.340,000 Closing Date: 9/11/2013 at 16:00 Hrs. Document Sale To: 9-11-2013 at 15:00 Hrs _________________________________________________ _________________________________________________ LAB FURNITURE Ref Number: 9376536 Tender Number: Buyer/Seller: Dr. Harisinh Gaur University Requirement: Supply of Laboratory Modular Lab Table Both Side working Unit with Sink and mid reagent rack. Location: Multi Location - Multi State - India EMD: Rs.6,900 Estimated Cost: Rs.345,000 Closing Date: 11/11/2013 at 00:00 Hrs. _________________________________________________ Ref Number: 9314704 Tender Number: Buyer/Seller: Council Of Scientific And Industrial Research Requirement: Providing of Lab. Furniture work, Drying and storage Racks for Biodiv Division. Location: Palampur - Himachal Pradesh - India Document Fees: Rs.500 EMD: Rs.21,000 Estimated Cost: Rs.1,039,000 Closing Date: 6/11/2013 at 00:00 Hrs _________________________________________________ Ref Number: 9364087 Tender Number: Buyer/Seller: Government Higher Secondary School Requirement: Supply of Lab Furniture Location: Pauri - Uttaranchal - India Document Fees: Rs.340 Closing Date: 19/11/2013 at 00:00 Hrs. Remind Contact Details: Government Higher Secondary School, Pauri, Uttaranchal, India Document Sale To: 15-11-2013 _________________________________________________ ____ _____________________________________________ OT TABLE Ref Number: 9328177 Tender Number: Tender Prod. No: XX-190/SO(DO) /Surg./201314/FSC-I

Nov - Dec 2013

Buyer/Seller: All India Institute Of Medical Sciences Requirement: Supply of OT Table. Location: New Delhi - Delhi - India Document Fees: INR2,000 EMD: INR200,000 Closing Date: 18/11/2013 at 00:30 Hrs. Document Sale To: 16-11-2013 at 0:30 Hrs _________________________________________________ Ref Number: 9196527 Tender Number: Buyer/Seller: Dr Ram Manohar Lohia Hospital Requirement: Supply of OT Table. Location: New Delhi - Delhi - India Document Fees: Rs.200 EMD: Rs.50,000 Closing Date: 18/11/2013 at 14:00 Hrs _________________________________________________ Ref Number: 9286380 Tender Number: Buyer/Seller: Dr S N Medical College And Attached Teaching Hospital Requirement: Supply of Orthopedics Department - CCTV, Pharmacology Department - Combination Package Mouse Rota Rod & Rat Rota Road, Computer assisted Analgesiometer, Electro convulsiometer (E.C.T.), Skin VD Department, C02 laser super pulse with scanner wave length-10600 NM, Nd-yag laser, Surgery Department, Doppler with Accessories, Compartment Syndrome Monitor, Kits & Suppliers, Pneumatics Compression Device (DVT), Infusion Pumps, Mesher Cutters, Electro Dermatome, Respiratory Detection Instruments Oximeters Co- Oximeters, End Tidal C02 Detectors, Bronchoscope, Patient Care Beds (ICU Beds W/l soflex Mattress, Special Care Beds), A BG Analyzer, O.T Tables, Operating Ceiling Light, Electro Surgical Unit. Location: Jodhpur - Rajasthan - India Document Fees: Rs.200 EMD: Rs.6,000 Closing Date: 22/11/2013 at 00:00 Hrs _________________________________________________ Ref Number: 9207136 Tender Number: Buyer/Seller: Dr. S N Medical College And Attached Teaching Hospital Requirement: Supply of articles / items - CCTV, combination packet mouse rota rod & rat rota road, computer assistant analgesiometer, electro convulsiometer (ECT), CO2 laser super pulse with scanner wave, Nd-yag laser, dopper with accessories, compartment syndrome monitor kits & suppliers, pneumatics compression device (DVT), infuse pump, mesher cutter, electro dermatome, respiratory detection instrument oximeters Co-oximeter & tidal Co2 detector, bronchoscope, patient

care bed, mattress, ABG analyzer, Ot table, operating ceiling light, electro surgical unit etc Location: Jodhpur - Rajasthan - India Document Fees: Rs.400 EMD: Rs.48,000 Estimated Cost: Rs.4,200,000 Closing Date: 22/11/2013 at 12:00 Hrs. Contact Details: Dr. S N Medical college & attached Teaching Hospital, Jodhpur, Rajasthan, India _________________________________________________ Ref Number: 9254805 Tender Number: Buyer/Seller: Postgraduate Institute Of Medical Education And Research Requirement: Purchase of O.T. Table Location: Chandigarh - Punjab - India Document Fees: Rs.200 EMD: Rs.100,000 Closing Date: 25/11/2013 at 00:00 Hrs _________________________________________________ _________________________________________________ SCOOP STRETCHER Ref Number: 9242336 Tender Number: Buyer/Seller: Government Medical College & Hospital Requirement: Fabrication of ambulance & supply of various equipment with installation on above ambulance ventilator, multipara monitor defibrillator / AED, suction infusion, syringe pump ambu bag, spine board head immobilizer, scoop stretches, multifunctional stretches cum trolley, vacuum splint, Oxygen cylinder D2 type, Oxygen cylinder portable, Oxygen key, Nebulizer machine pulse oxymeter, Flow meter with bottle Location: Kannauj - Uttar Pradesh - India Document Fees: Rs.500 EMD: Rs.35,000 Closing Date: 14/11/2013 at 13:00 Hrs. Remind Contact Details: Government Medical College Kannauj, Uttar Pradesh, India Document Sale To: 13-11-2013 at 11:00 Hrs _________________________________________________

India’s First International Conference on Managing Health Communication Managing Health Communication People, Programmes and Products

ICMC 2014

February 12-14, 2014 MICA campus, Shela, Ahmedabad 380058

International Communication Management Conference

MICA is pioneering an Annual Conference series on themes and issues in Communication Management beginning in 2014. The conference series is intended to provide a platform for bringing together scholars, activists and practitioners to discuss frontier developments in communications theory and practice. While the annual conferences will announce particular thematic outlines inviting scholarly contributions around the focal theme, papers conceptualizing perennial and emerging issues in communications management would also be included. The idea takes into cognizance the significance of multiple linkages of interdisciplinary and critical scholarship in communication management. The focal theme of the first conference will be “Managing Health Communication: People, Programmes and Products.” The WHO defines health from a holistic perspective as “...a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” The dialogue around health, however, is fractured along domain knowledge versus specialization, profit versus humane goals, and products versus people. Further, the rapid pace of globalization in recent decades has led to greater concerns about health in the face of increasing population density, competition for resources, and rising social inequality. Can health communication and health management scholars, policy makers, practitioners, and activists create a space for holistic health?

Established in 1991, Mudra Institute of Communications, Ahmedabad (MICA) is India's premier institute in Communications Management dedicated to meeting the integrated marketing communication needs of the industry, government and community. www.mica.ac.in/icmc facebook.com/MICA.ICMC

T H E @MICAICMC

Conference coordinator: icmc@micamail.in

S C H O O L

O F

I D E A S

Mudra Institute of Communications, Ahmedabad (MICA) Shela, Ahmedabad 380 058, Gujarat, India Tel: +91 2717 308250 Fax: +91 2717 308349

www.mica.ac.in

For attending the conference, sponsorship opportunities, or more details, contact Mr. Sethu Iyer / Mr. Himanshu Patel: +91-2717-308250 extn 118/119, icmc@micamail.in

presents

a conference on

Strategic Management & Enhancement of Clinics & Clinical Practice Hotel Bangalore International Sunday, 01st Dec 2013 ; 9:00 am to 6:00 pm Topics and Discussion Registration of Clinics & the Medical Establishment Act. Legal issues related to Documentation, Waste Management and other issues related to enhanced Clinical Practise Marketing, Branding and Advertising Strategies for Clinics. Surviving Market Competition and Big Brands in the neighborhood Role of IT in improving Clinical practice and Healthcare delivery Virtual Medical Practice, Tomorrow's care Today. An Excellent Disease Management Tool. Virtual Practice : Benefits, Patient acceptance & Future in Chronic Care - A Case Study Social Media Marketing : Marketing your services on Facebook, Twitter and LinkedIN. Learn to Create your Clinic's Facebook Page Communcation skills for Doctors @ Clinics. Innovative Strategies for Patient Retention.. and Ensuring Customer Delight Scaling Up from a Stand alone Clinic to a chain of Clinics - Issues, Strategies and Challenges

n tratio s i g e R Open

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09035189824 / 25

PANEL DISCUSSION : CLINICS OF GLOBAL STANDARDS - ARE WE GEARED UP ?

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