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Volume V || Issue II || July-August 2014

News Update | Doctor Speak | Expert Views | Product Line | Interview | Healthcare Management

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When every detailmatters, we leaveno room to chance.

Indian healthcare sector is undergoing a period of major expansion. In line with his 2023 political vision, Prime

Minister Sh.Narendra Modi has set a goal for the country “Health to all “ and to become a global leader in the delivery of healthcare services over the coming decade.

Special focus on improving affordable healthcare for all. The government also hiked the allocation for AYUSH – Ayurveda, Yoga, Unani, Sidddha and Homoeopathy – by 36%. The department under the health ministry was allocated Rs.1,272.15 crore compared to Rs.935.75 crore in the last fiscal. With the focus on health research, the government also allocated more funds for it.

As the health ministry has a separate department for medical research, it was allocated Rs.1,017 crore compared to Rs.880 crore in the last fiscal – a jump of 15 percent. Finance Minister Arun Jaitley in his maiden budget speech said the NDA government wants to move towards ‘Health for All’ and to fulfill this aim on priority by providing free drug service and free diagnostic services. ‘In keeping with the government’s focus on improving affordable healthcare and to augment the transfer of technology for better health care facilities in rural India, 15 Model Rural Health Research Centres will be set up in the states, which will take up research on local health issues concerning rural population.

Have an insightful reading.Your suggestions are most welcome!E-mail: [email protected]: w w w . m e d g a t e t o d a y . c o m

Dr. ma Kamal

Dr. Pradeep BhardawajGP Capt. (Dr.) Sanjeev SoodDr. Sharad Lakhotia

afzal KamalSunder mewadi

Sonia Pandit

Sa Rizvi, Dr. HN Sharma

mohd. Javed ahmad

amjad Kamal, SY ahmed Khan, Ranjit Shirsath Deepti Tripathi

Jagruti Diddi, Saba Khan

all right Reserved by all everts are made to insure that the information published iscorrect ‘medgate today’ holds no responsibility any unlikely errors that might occur.

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Volume - V Issue - II July-August 2014

magazine

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Editor’s note

India hiked its health budget by 27% in 2014-15 to `35,163 crore

India Mange More; Roti, Kapda, Makan & HealthcareIndia Expects from New Govt. Healthcare in 5th Gear

time to Integrate Healthcare with National Infrastructure.

Good Health Contributes to National Economic Welfare.

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July - Aug 2014

July - August 2014 8

8 Compassion Beyond Borders...

10 Wadhwani Foundation & Narayana Health pilot...

11 Extensive Atherosclerosis involving...

12 A book on “Uttrakhand - Kedarnath Medical...

14 Encephalitis spreading in Muzaffarpur...

16 Symbiosis Centre of Health Care...

18 Vasudev Hospital Making Healthcare Affordable...

19 Kodak alaris achieves microsoft gold competency...

20 Largest ever analysis on the use of a polypill in...

33 IT in Improving Quality in Health Care...

34 Mobile-Enabled Remote Patient Monitoring...

38 Breast cancer is the most common cancer...

40 Homecare Services Open New...

46 Cygnus Medicare exploring New frontiers...

48 Men’s Health as an Integrated...

55 The Era of Smart Hospitals...

36 Unusual systemic venous Collateral channels...

42 Endoscopic Ultrasound a poorly understood...

52 Clinical manifestations and treatment of...

44 Buy Healthy, Eat Healthy!...

51 Quiet,EfficientScanners...

58 Managing Director, Omron Healthcare India.

Contents

Budget Planning ensures Healthcare for Every Citizen in the Country

22

News Update

Expert Views

Doctor Speak

Product Line

Interview

Cover Story

8 Compassion Beyond Borders...

10 Wadhwani Foundation & Narayana Health pilot...

11 Extensive Atherosclerosis involving...

12 A book on “Uttrakhand - Kedarnath Medical...

14 Encephalitis spreading in Muzaffarpur...

16 Symbiosis Centre of Health Care...

18 Vasudev Hospital Making Healthcare Affordable...

19 Kodak alaris achieves microsoft gold competency...

20 Largest ever analysis on the use of a polypill in...

33 IT in Improving Quality in Health Care...

34 Mobile-Enabled Remote Patient Monitoring...

38 Breast cancer is the most common cancer...

40 Homecare Services Open New...

46 Cygnus Medicare exploring New frontiers...

48 Men’s Health as an Integrated...

55 The Era of Smart Hospitals...

36 Unusual systemic venous Collateral channels...

42 Endoscopic Ultrasound a poorly understood...

52 Clinical manifestations and treatment of...

44 Buy Healthy, Eat Healthy!...

51 Quiet,EfficientScanners...

58 Managing Director, Omron Healthcare India.

UpdateNEWS

UpdateNEWS

w w w. m e d e g a t e t o d a y. c o m July-August 2014 11w w w. m e d e g a t e t o d a y. c o m July-August 201410

Granules India Ltd., a fast growing pharmaceutical manufacturing Company, announced its Paracetamol facility successfully passed a U.S. FDA inspection without any 483 observations.The facility has the world’s largest single API production line by volume. Granules’ four API facilities have successfully passed U.S. FDA inspections in the past 12months.AllofGranules’facilitiesincludingitsfinisheddosage and PFI facility are approved by leading regulatory agencies including the U.S. FDA, EDQM, Health Canada and Korean FDA.

Granules India’s Paracetamol API Facility completes U.S. FDA Inspection

Doctors at Fortis Noida give 9 year old Pakistani boy a fresh lease of life by performing a combined liver and kidney transplant

Noida, June 24, 2014: A well-co-ordinated effort between the High Commission of Pakistan, The Indian High Commission in Islamabad and Doctors at the Fortis Hospital, Noida, has given a fresh lease of life to a 9 year old boy Amaar Asif from Lahore, who was suffering from end-stage kidney and liver disease.

In a gratifying display of compassion, fortitude and medical skill, a battery of 10 surgeons, 6 anaesthetists and 30 nurses, persevered for nearly 10 hours to simultaneously transplant the kidney and liver, in the child, to save his precious life.

The child was suffering from primary hyperoxaluria (excessive urinary excretion of oxalate) and had to undergo a cleansing process (haemodialysis and peritoneal dialysis) prior to the operation to reduce the oxalate levels in the blood. The surgery was collaboratively performed under the guidance of Dr Vivek Vij, Director GI Surgery and Liver Transplant and Dr Dushayant Nadar, Senior Consultant-Urology, at Fortis Noida.

DrVijexplained,"Onlyoneinfivelakhpeopleareaffectedby primary hyperoxaluria. This is indeed one of the most challenging cases in transplants as it requires extensive dialysis pre-operatively and then post-operatively. In such an operation, the patient and the two donors are operated in tandem and this needs precision and absolute coordination with no scope for human error.”

“Thechildhasbeeninpainforthelastfiveyears.Overtime,he has become extremely weak, unable to even do routine activities including playing or going to school. As a result, his education has also been suffering. We are glad that the child will soon be able to go back to his daily activities.” said, Dr. Dushyant Nadar.

Primary hyperoxaluria is a rare condition characterized by the overproduction of a substance called oxalate (also called oxalic acid). In the kidneys, the excess oxalate combines with calcium to form calcium oxalate, a hard compound that is the main component of kidney stones. Deposits of calcium oxalate can lead to kidney damage, kidney failure, and injury to other organs.

Primaryhyperoxaluriaiscausedbytheshortage(deficiency)of a liver enzyme alanine-glyoxylate aminotransferase (AGXT) that prevents the buildup of oxalate in the human body. A simultaneous transplant of both organs is necessary for success, as a kidney transplant, by itself can fail because ofdeficientAGXT–producedintheliver.

compassion Beyond Borders

Amaar Asif; the patient along with this family and the team of treating doctors

“We are grateful to the doctors at Fortis who have given a new lease of life to my grandson. Finally, Amaar will be able to play, go to school and lead a normal life”, said Mr. Mubarak Haider, Amaar’s maternal grandfather.

The kidney was donated to him by his paternal uncle while the part liver donor was the patient’s maternal uncle. Amaar’s father is a shop owner and was unable to support his treatment. TheoperationwasparticularlydifficultbecauseofAmaar’sseverely compromised immunity status. The treatment of the child has been sponsored by the Government of Pakistan. The funding for this has been channelized through the Pakistan High Commission in India.

After the surgery, the patient was kept under the close observation of specialist paediatric hepatologists, urologists and nephrologists who attended on him for nearly 10 days, nursing him back to health. Amaar is now ready to be discharged and sent home.

UpdateNEWS

UpdateNEWS


Levetiracetam is the best of the newer anti-epileptic drugs at controlling seizures in pregnancy, new Australianresearchfinds.

The register-based study looks at seizure rates in pregnant women with epilepsy from 1998 to 2013, a period during which there was a transition from established seizure therapies such as carbamazepine and valproate to the new-generation anti-epileptic drugs (AEDs) levetiracetam, lamotrigine and topiramate.

The proportion of seizure-free pregnancies did not change

substantially over the period. In fact, women taking the newer drugs were more likely to suffer a convulsive seizure (29% versus 19%) as well as a seizure of any type (48% versus 35%).

But the study found a difference among the new-generation drugs,withlevetiracetamperformingsignificantlybetter.

Rates of seizure-affected pregnancies with levetiracetam were similar to those of older drugs while those for lamotrigine and topiramate were 50% and 30% higher, respectively.

Levetiracetam best for seizures in pregnancy

Wadhwani Foundation & Narayana Health pilot ‘game changing’ Healthcare training program using ground-breaking learning techniques

Wadhwani Foundation, in collaboration with Narayana Health (NH), has announced the success of its skills training pilot program for NH’s healthcare support staff. The program aims tofillthevoidofcriticalskillsneededinthehealthcareindustrythat are currently missing from formal and informal nursing education programs. Using videos and interactive, technology-based lessons, accessible on an online platform, Wadhwani Foundation’s courseware is designed for rapid rollout. To date, WF has reached more than 1,700 nurses and nursing assistants across 20 Narayana Health centers in just a few months. This program is part of Wadhwani Foundation’s larger vision of skilling India by leveraging technology and transformative learning techniques.

India continues to face a growing gap in maintaining a skilled labor force, or knowledge workers, to conduct some of the nation’smostcritical–thoughoftenoverlooked–jobs.Supportand paramedical staff represent this segment in the healthcare industry; individuals are required to perform a skilled job without access to a job competency driven curriculum or having undergone formal training. According to industry experts, India’s health care sector faces a shortage of 1 million nursing assistants. Wadhwani Foundation strives to meet this need by producing quality, open source training solutions. “Our strategic collaboration with Wadhwani Foundation is a step in the right direction. India’s healthcare industry is facing an acute shortage of support staff and I am glad that the skill

Pilot revolutionizes job readiness at scale via transformational, learner-centric, and scalable skills training program.

development initiative of Wadhwani Foundation has already skilled over 1,700 competent staff. This happened despite full shift schedules, because these learner-centric e- modules do not drain experienced teaching nurses’ time and allow the trainees flexibilityintakingcoursesinsideandoutsidetheclassroom.Since we seek to expand from 5,000 beds to 30,000 beds in three years, rather than running disparate and traditional teacher driven training courses, this approach of creating and deploying repeatable, modular self and peer- driven lessons can help us realize this goal without diluting the skills of our people or quality of our care,” said Dr. Devi Prasad Shetty, Chairman, Narayana Health.

UpdateNEWS

UpdateNEWS


Novartis convenes 13th annual malaria expert panel with a focus on access to

quality antimalarials across africaextensive atherosclerosis involving

coronary and carotid vertebral systems managed with hybrid approach : carotid

angioplasty followed by caBGMalaria experts from countries across Africa are meeting today at the 13th annual National Malaria Control Program (NMCP) Best Practice Sharing Workshop. The gathering provides a platform to discuss and share knowledge and experiences, and to drive dialogue around improved health outcomes and access to quality antimalarial treatments for patients in Africa. For these workshops, Novartis (http://www.novartis.com) works in collaboration with the Global Fund, World Health Organization, the WorldWide Antimalarial Resistance Network, the Kenya Medical Research Institute-Wellcome Trust, Swiss Tropical and Public Health Institute, US Pharmacopeia, Populations Services International, Ifakara Health Institute, and the Pharmacy and Poisons Board.

“These NMCP meetings have led to groundbreaking projects such as the development of SMS for Life to improve antimalarial stock management in rural health facilities,” said Dr. Linus Igwemezie, Head of the Novartis Malaria Initiative (http://www.malaria.novartis.com). “We believe that by bringing together the best minds and leaders in the field,wecanhelp fosternewapproaches thatwill helpusensure all patients have access to quality antimalarials and bring us closer to malaria elimination.”

The successful treatment of malaria depends on the public being informed about the risks of the disease, the importance of sleeping under insecticide treated bednets, and having access to health services including appropriate diagnostic tests and quality-assured antimalarial treatments.(3/page v) Unfortunately, in some countries bednet utilization remains a challenge;(3/page ix) while sub-standard antimalarials (3/page 9) and oral artemisinin monotherapies (3/page xii) remain available, primarily through the private sector. These treatments may contain too little or no active ingredient, thereby putting patients’ lives at risk. (4/pages 22&49)

Speaking on behalf of the WorldWide Antimalarial Resistance Network, Dr. Ambrose Talisuna says: “It’s crucial that governments take urgent action to ensure patients are not put at risk of sub-standard treatments. We must make sure that the public is made aware of the importance of taking preventative measures as well. The ongoing role of Novartis in facilitating these workshops provides a platform for discussing these important issues, for sharing best practice in public education and for mapping the sources of poor quality antimalarials.”

FEHI, New Delhi reinforced its leadership position by managing a complex case of a 60 years gentleman from Jamia Millia Islamia University, Okhla, New Delhi, who was a diabetic presenting with rest angina and transient ischemia attack (left hemiparesis). His coronary angiogram revealed extensive triple vessel disease requiring coronary artery bypass grafting (CABG). While awaiting his

CABG, his preoperative work-up revealed 4 vessel significantdiseasesofbilateralcarotidvertebralsystems.Management issues in this complex situation were to carry out CABG and carotid endarterectomy of both carotids or to do carotid stenting of the culprit lesion (Right internal carotid artery) before CABG. The main challenge was about the risk of periprocedural cerebro-vascular accident during surgical endarterectomy being higher than during carotid stenting in a case with 4 vessels atherosclerosis. Hence, the heart team decision favoured hybrid approach, whereby carotid stenting of Right carotid systemwasundertakenfirst usingdistalembolic protection device by Dr.Subhash Chandra, before sending him for CABG. He was taken-up for CABG by Dr.Z.S.Meharwal, two days after successful carotidplasty of right carotid system. Dr.Meharwal used arterial graft for LIMA to LAD and various grafts for other major vessels in an off-pump cardiac surgery. The patient recovered well and was discharged on 7th post-op day. He is awaiting carotid angioplasty of his left carotid system in coming days to ward off future risk of TIAs and major stroke. He is currently on dual antiplatelet drugs and high dose statins.

Dr. Subhash chandraFortis Escort Heart Institute

UpdateNEWS

UpdateNEWS


The suspected encephalitis death toll in Bihar's Muzaffarpur district is increasing by the day and according to the report, many children have died in the last two months.

Now, the outbreak is spreading to some of the adjoining districts. Three-year-old Salman, from Bihar's Sheohar district, has been at a government hospital in Muzaffarpur for over two days now, brought in with the familiar symptoms of fever, shivering and body ache, that affects hundreds of children in these parts each year, and has resulted in many deaths from what doctors suspect is acute encephalitis.

But over two decades after this disease started hit Muzaffarpur, no cause or cure has been found yet.

Encephalitis can be life-threatening, Says Dr.Rajiva Kumar

The Bihar government says it has provided an ambulance at eachblockofficewithinMuzaffarpursothatchildrenexhibitingany of the symptoms can be rushed to the designated hospitals. Currently, two hospitals in Muzaffarpur, one government and one private children's hospital have the required facilities and treatment available. However a dedicated encephalitis ward at the government hospital has not been set up but authorities says it will be created soon.

The Union Health Minister announced a series of measures to tackle encephalitis including a bigger effort to identify the causeofthediseaseandafive-yearactionplansimilartotheone implemented for polio.

Encephalitisisacuteinflammation(swellingup)ofthebrainresulting either from a viral infection or when the body's own immune system mistakenly attacks brain tissue. The most common cause is a viral infection. In medicine acute means it comes on abruptly; of abrupt onset, develops rapidly, and usually requires urgent care. Encephalitis occurs in 1 in every 1,000 cases of measles.

Encephalitis generally begins with fever and headache. The symptoms rapidly worsen, and there may be seizures (fits), confusion, drowsiness and loss of consciousness, andevencoma.

When there is direct viral infection of the brain or spinal cord it is called primary encephalitis. Secondary encephalitis refers to an infection which started off elsewhere in the body and then spread to the brain.

encephalitis spreading in muzaffarpur and adjoining districts

The majority of patients who have encephalitis go on to have at least one complication, especially elderly patients, those who had symptoms of coma

Medgate today spoke person talk about encephalitis to Dr.Rajiva Kumar

some of cases seen in Muzaffarpur as follows: Â SKMcH: Admitted -319 Â Died: 108 Â cured: 198 Â Kejriwal: Hospital- admitted -189 Â Died: 39 Â cured: 115 Â Referred: 25

Figure 1. Union Health Minister Dr Harsh vardhan with Dr Rajiva Kumar Figure 2. Chief Mimister of Bihar Jitan Ram Manjhi with Dr Rajiva Kumar

New data presented for the first timetoday at the World Heart Federation’s World Congress of Cardiology 2014 shows a significant improvement inboth patient adherence and risk factor control when patients at high risk of heart attack or stroke receive a polypill, compared to usual care. A polypill is a fixed dose combinationof commonly-used blood pressure and cholesterol lowering medications, along with aspirin, which helps prevent cardiovascular disease (CVD).

The Single Pill to Avert Cardiovascular Events (SPACE) project, led by researchers from The George Institute for Global Health, analysed data from 3140 patients with established CVD or at high risk of CVD in Europe, India and Australasia. The results showed a 43 per cent increase in patient adherence to medication at 12 months with the polypill, in addition to corresponding improvements in systolic blood pressure and LDL-cholesterol that were highly statistically significant.The largestbenefitswereseenamongpatients not receiving all recommended medications at baseline, which corresponds to most cardiovascular disease patients globally. “These results are an important step forward in the polypill journey and management of cardiovascular disease”,commented Ruth Webster of the George Institute for Global Health, Sydney. “Most patients globally either don’t start or don’t continue taking all the medications they

need, which can lead to untimely death or further CVD events. An important findingfrom our analyses is that the greatest benefitsfromapolypillwere for currently untreated individuals. Although the idea of a polypill has always been appealing, we now have the most c o m p r e h e n s i v e real-world analysis to date of this treatment strategy in high risk CVD patients. Given the potential affordability, even in low income countries, there is considerable potential to improve global health.”

CVD is the number one cause of death globally, killing 17.3 million people each year and it is expected to remain the world’s leading cause of death in the near future. Access to effective treatment like polypills can play a key part in achieving the bold World Health Organization (WHO) target of at least a 25 per cent reduction in premature mortality from NCDs by 2025, especially as a polypill can be cheaper than several individual drugs.

Professor Salim Yusuf, President-elect of the World Heart Federation said: “These results emphasize the importance of the polypill as a foundation for a global strategy on cardiovascular

disease prevention. It will improve patient access to essential medications at an affordable cost and wide use of the polypill can avoid several millions of premature CVD events. The polypill is however not a replacement for a healthy lifestyle and should be combined with tobacco avoidance, a healthy diet and enhanced physical activity. This broad strategy, if adopted widely, can reduce cardiovascular disease to a large extent.” SPACE combined results from three clinical studies which took place from 2009 – 2013: UMPIRE (Europe andIndia), Kanyini-GAP (Australia) and IMPACT (New Zealand). Importantly, in the Australasian trials, half the patients were indigenous. Further analysis of this unique data source is underway to investigate the effect of the polypill on major patient groups and the results of this are expected over the coming year.

largest ever Analysis on the use of a Polypill in cardiovascular disease shows Potential for improvements in Patient careAlmost1in4PatientsAdheredBettertoTreatment;Significant

Improvements in Blood Pressure and Cholesterol

UpdateNEWS

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w w w. m e d e g a t e t o d a y. c o m July-August 2014 23

“Budget Planning ensures Healthcare for Every Citizen in the Country”Dr Harsh Vardhan

Union Health Minister

StoryCOVER


StoryCOVER

StoryCOVER


In India, every opinion piece on health talks in terms of medical colleges, GDP, doctor population ratios etc.

India needs to talk health in terms of infant mortality rates (IMR), maternal mortality ratios (MMR) and life expectancies. In India health means medical care. The word ‘health’ very often misused for the

word ‘medical’.

Producing healthcare professionals in large numbers is not the same as making them available where their services are needed.

In 2013, the Union Cabinet approved the government’s plan for the creation of a specialised cadre of health care workers for rural areas by instituting a three-year-course in State universities. The Bachelor of Science (Community Health) course will create a cadre of Community HealthOfficerswhowillbepostedatsub-centres,functioningundertheMinistry of Health and Family Welfare, where they can provide basic health care.

This approval recognises that India’s MBBS doctors have not been stepping into villages. India seems to be thinking in terms of alternative professionals to its rural population. This is a good move, but they need to integrate seamlessly into the current rural healthcare structures.

India does live in its villages. According to census 2011, of the 121 crore population in India, 83.3 crore people live in the villages. According to

Dr. Ramakanta PandaVice Chairman Cardio Vascular Thoracic

surgeon Asian eart Institute

india still lives in villages Walking 5Km to get to a doctor is not a Sign of a healthy Nation

Â Major commitment from the government to reduce the IMR and MMR by half within 5 years. This again cannot be done without having adequate number of gynecologists, anesthetists, pediatricians and radiologists.

Once we have adequate number of these specialists they will ensure that the rest of the support system comes up on its own.

Â 3. We have to Cap malpractice compensation. Rs. 12 crore of malpractice compensation given by the supreme court for a patient’s death in Kolkata will reset the compensation from consumer court and this will result in major shutting down of small nursing homes where most of the children are born in tier II cities.

Â 4. Universal health care and health insurance should be offered through a mobile phone health insurance scheme by collecting Rs. 20/- from each mobile phone subscriber every month. This will cover health care of 850 million people.

Yashaswini health insurance of Karnataka started 10 years ago with a premium of five rupees per month and that has saved lakhs of life.

Â 5. Create a career progression for the nurses. Otherwise nursing profession will die in India. Admission to nursing colleges in Southern part of India has come down by 50% because nursing has become a dead end job and they are is no career progression like in the west where they can become nurse anesthetist, nurse intensivist, nurse practitioner or they can choose to became even doctors.

Â 6. Create a state wise paramedical university only for paramedical education. Behind every doctor there are 5 technicians who are helping the process of safe health care.

Unfortunately the paramedical and nursing bodies are controlled by the medical councils and doctors in the medical universities who do not want to empower the paramedical professionals and nursing professionals.

Unless they stand on their own, paramedical profession will not get its due recognition.

My most important point is the commitment by the government to halve the maternal mortality and infant mortality within 5 years.

expectation from new Government-Health for Allhealth care will drive the economy of the world since it is going to create the largest number of jobs.

Dr. Devi Shettyxxx

pRIoRItIeS FoR tHe goveRNmeNt

Â Without reforms in medical education health care reforms cannot happen. The biggest problem India is facing it not the lack of beds or the medical equipments, it is the lack of doctors at the right place with right qualification.

We have created first world regulatory structure with third world infrastructure. We prevent doctors with MBBS degree from anesthetizing the patient by law. And we only have less than 40,000 anesthetists across the country. Without anesthetists no surgery can happen.

We hardly have radiologists across the country and without a radiologist’s no diagnosis can be made and no patient can be treated.

MD radiology is worth Rs. 5 crore. There is something seriously wrong with medical education, I am not talking about the way medicine is taught, I am talking about how the students are chosen and the lack of adequate number of PG seats.

Like in the west, we must have more PG seats then UG seats to offer better health care to tier II cities without that maternal mortality and infant mortality will not go down.

StoryCOVER


Growing elderly population and the increase in diseases, along with the rising treatment costs,are driving the need for remote care delivery solutions. With the chronic diseases on the rise, the overall expenditure on the healthcare facilities is increasing; thereby, increasing the pressure for a constant

lookout for alternative methods to provide better healthcare and control the rising costs.

Solutions like mobile based remote patient care are intended to help in reducing the patient’s visits to hospitals and the overall cost on the healthcare facilities as the treatment can be provided at home. It also enables the care providers to effectively extend their services to the patients who may need care at home because of various medical conditions.

Some of The main factors that are driving the mobile Based health care Include

Â The increasing awareness about chronic diseases and their management with better medical practices and cost effectiveness

Â The evolving market of smartphones and tablets and the growing adoption

Â Availability of the advanced connectivity interfaces such as Bluetooth, Wi-Fi, 3G and 4G networks

however, there exists challenges, as Well Â The adherence to the stringent regulations of FDA and EU Â Security concerns particularly related tosensitive patient data

Mobile-Enabled remote Patient Monitoring

Somenath NagDirector-ISV & Enterprise Solutions, Alten Calsoft Labs

ViewsEXPERT


SpeakDOCTOR

SpeakDOCTOR


Endoscopic ultrasound (EUS) is a relatively new modality for most physicians, though it has been in existence for almost 3 decades. In gastroenterology and oncology it has become an essential tool just like ERCP, Endoscopy and

colonoscopy. EUS was born in 1980s with the marriage of upper endoscope andUltrasound. First 10 – 15 yearswere spent trying to identify the sensitivity, specificity,techniques of assessment and instrument modifications.Since mid 1990s it came into common clinical use. In India it has become widely available in most metros in the last 5–10years.

EUS has the unique ability to evaluate structures in the wall of esophagus, stomach, duodenum etc. as well as all structures within 4-5 cm outside the wall of GI tract. It also gives a very high resolution and can give detailed view of different layers of intestinal wall like mucosa, muscle layer, serosa, akin to performing an electronic dissection of the wall. It also give a great opportunity to perform real time ultrasound guided FNA of lesions in the wall and vicinity of GI tract. It is one of the best modalities to evaluate Pancreas, CBD, Gall bladder, Mediastinal nodes, peri-rectal nodes etc. It is a very safe procedure with minimal complication rate.

Main Indications for Endoscopic Ultrasound Â Diagnosis, including FNA, of Mediastinal Lymph

nodes (TB, Sarcoid, Metastatic etc)

endoscopic Ultrasounda poorly understood and poorly utilized investigative tool

Â Diagnosis, FNA, Staging of pancreaticobiliary tumors (Malignant and Benign)

Â Diagnosis of many benign pancreatic diseases like Chronic pancreatitis, Cystic lesions of pancreas, etc

Â Diagnosis of Choledocholithiasis, where its sensitivity and specificity is higher than MRCP, and risk far lower than ERCP.

Â Staging of Esophageal cancer, Rectal cancer Â Diagnosis of submucosal lesions of esophagus,

stomach, colon Â Staging of Lung Cancer. It is complementary to

Endobronchial ultrasound for this indication Â Therapeutic indications including Celiac Plexus block,

drainage of Pancreatic pseudocyst, , transgastric Biliary system access for drainage or assisted ERCP etc

Â A number of new therapeutic indications are emerging like placement of radioactive seeds into tumors, EUS guided RFA ablation

Since the equipment is expensive and training curve is long, EUShasyettofinditsdueplaceinthemindsetofmanyphysicians. However over the last 4-5 years, now it is easily available in most large hospitals in India, specially in metros, and the cost has also become reasonable. What is needed is a better understanding of its true value and a dialogue between gastroenterologists and non gastroenterology physician fraternity so that this valuable tool can be used to its full potential.

Dr. Vivek RajDirector & Sr. Consultant Dept. Gastroentrology & HepatologyMAX Super Speciality Hospital

SpeakDOCTOR

SpeakDOCTOR


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Work Cult

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Hitex HealthcareA-402, Laxmi Sadan, Thakur Village, Kandivali (E) Mumbai 400101

Ph.: +91 22 28860782 E-mail: [email protected]

SMMMS GownsProcedure Sets Surgical Drapes

CSSD SMMMS WrapsDrape Making Machine

Cygnus Medicare Asuperspecialtyhospitalchainwiththeirrecentflagshiphospitals, now have nine hospitals under their belt. A company formed in 2010, by a group of four highly-skilled doctors to create super specialty healthcare hubs to cater to all the sections of the society, has carved a niche for itself in a very short span.

Observing the paradigm shiftObserving the change in health care scenario during the 1990s, when there was emergence of multi-speciality corporate hospitals offering critical care, handling medical complications and emergency services all under one roof, the Directors of Cygnus observed that the district headquarters and towns remained untouched by this revolution in the healthcare services with all the major chains focussing on metropolises and category A cities. The passion to bring superspeciality healthcare to everyone’s doorsteps resulted in the creation of the Cygnus goup of Hospitals.

Dr Dinesh batra, Director, Cygnus Hospitals, while explaining the importance of the hospitals, says, “Cygnus boasts of the largest chain of multi specialty hospitals in HaryanaandDelhibringingtogetherthefinestdoctorsandmedical technologies. We intend to provide global standards in healthcare to masses at affordable prices.” For us it is more of passion rather than profession.’

He further adds, that “everyone has a right to receive best healthcare, therefore we endeavour to provide the highest quality of healthcare to our patients by creating, using and spreading knowledge through research and education.” We further aim to run centres for specialised surgeries in those areas where super specialty care may be missing.

‘The focus is to provide international standards in healthcare to masses at affordable price and bring super specialty healthcare to B and C category towns of North India.

Dr Shuchin bajaj, Director, Cygnus Hospitals, says that the Core value of Cygnus is to deliver excellence in all the fieldsoftreatment,teachingandresearchbyfocussingona

cygnus Medicareexploring New frontiers in healthcareWe endeavour to provide the highest quality of healthcare to our patients and aim to run centres for Specialised Surgeries in the areas where Super Specialty care may be missing

Dr Sudhir GuptaDirector

Cygnus Hospitals

Dr Dinesh batraDirector

Cygnus Hospitals

Dr Shuchin bajajDirector

Cygnus Hospitals

Dr Naveen NischalDirector

Cygnus Hospitals

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Men’s Health as an Integrated SpecializationIn the older era Men’s Health was considered only from the Sexual Perspective. Man was Considered and Portrayed as a stronger sex and there was a lack of awareness about other aspects of health. In the modern society there has been a paradigm shift in the way male health has been projected based on data and evidence.The older beliefs have been recognized as flawed and followed by transition to modern day practices. It is evident that average lifespan of men is 5 years less than women and is attributable in large part to a number of known and unknown factors apart from increased genetic susceptibility, stress of ‘being the provider’ for the family, Increased risk of hypertension, coronary artery disease, depression, associated risk factors and high risk behavior, professional hazards and certain gender specific diseases and cancers.

There is a need to integrate various specialties and provide an integrated and Comprehensive Package of Health Care (CPHC) to men under the label of integrated men’s health program (IMHP) pertaining to the low likelihood of men seeking consultation for health issues due to social beliefs, taboos and various other reasons. Incidentally erectile dysfunction has been found to proceed or correlate with a number of diseases affecting men at an early stage including major morbidities like coronary artery disease, depression and metabolic syndrome and its screening and prevention may be new avenues in preventive health. Men’s health should be projected as a new specialty with erectile dysfunction as a ‘Sentinel Marker’ of ‘Male Health’.

The hisTorical PersPecTive on Men’s healThMen’s Health has come a long way from the era when Hippocrates (5th-4th century BC) described the high incidence of impotence and infertility and attributed it to continuous trauma to the genitilia due to horse riding in “De aëre aquis et locis” or when Aristotle (384 till 322 BC) like many other Greek authors debated that air or ‘pneuma’ was the initiator of erection. It was not until the 15th century that

Prof (Dr) Rajeev SoodPresident MHSI

Today’s hospitals are plagued by communication problems. Frustrated, overworkednursingstaffandunsatisfiedpatientscreateacompellingneedforasolutionthatwillimprovecommunicationflowwhileenablingadvancesinmobile applications. A variety of new frameworks are available for healthcare organizations interested in streamlining communications and improving patient

care. By bringing smart phones to the point of care, healthcare organizations can simplify communications, increase nurse job satisfaction, improve patient care, and position hospitalstobenefitfromanewgenerationofgame-changingmobileapplications.

What are Smart Hospitals?Smart Hospitals are technologically driven hospitals designed to improve the quality of healthcare for the patients and the environment in which healthcare services are provided. The concept for Smart Hospital has been designed from the ground up to achieve the following goals: Safety and clinical quality, Productivity, Ease of use for patients, families, and caregivers, Service excellence, and Optimal use of technologies for medical, management information and consumer.

The goals of Smart Hospitals are achieved by taking integrated and current information and communication technologies and combining them with careful design of the facilitytobeaccessibleandefficient,initial engineering and continued redesign of clinical and business processes to operate reliably and safely, constant emphasis

The era of smart Hospitals

Prof. M. Habeeb GhatalaDean, Apollo Hospitals Group (Retd.)

Hyderabad

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Medgate today Correspondent taken Exclusive intervieW

Mr. sHinyA toModAmanaging director, Omron healthcare India

brief about the spokesperson.As Managing Director, OMRON healthcare India, Mr. Tomoda has been instrumental in conceptualizing and executing business strategies and steering the growth and expansion of OMRON’s healthcare business in India.

Mr. Tomoda joined OMRON Healthcare India as the Managing Director in 2012. A graduate from Meiji University (Tokyo) in Business Management, Mr. Tomoda started his career with OMRON and now has over 20 years of experience. He has gathered invaluable know-how and expertise by playing strategic roles in many important assignments on varied aspects of Healthcare monitoring and management domain, across the globe, such as Japan - from 1992 to 2007 in domestic sales, Taiwan - from 2007 to 2008 as President of the sales operations and China - from 2009 to 2011 in the sales strategy department.

By MtINTERVIEW


RNI No. DELENG/2010/33833

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Medgate Today Magazine - July-Aug 2014