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INNOVATE

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FROM IDEA TO

INNOVATION Effectiveness is driving Acceptance in Medical 3D Printing

INTERVIEW

AUGUST 2019

TIM SCHELLBERG, FOUNDER AND CEO, GORDON THOMAS HONEYWELL

IMPACT

BUSINESS STRESS IN SMALL & MID-SIZED HOSPITALS


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AUGUST 2019 EDITORIAL

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3D Printing and Medicine 3D PRINTING sits at an interesting intersection of technology and manufacturing. Add medicine to this mix and you would be on your way to a new era in healthcare delivery. With the advancement of technology and new insights into human anatomy 3D printing has found a niche in personalised and precision medicine. While the talks on personalised medicine are not new, 3D printing promises to overcome the challenges of implementing personalised medicine. Today, it is possible to model an organ or any other part of human anatomy with 3D printing to help plan surgery, understand the disease pathology and treat patients. Some have even advanced to print cells that can be taught to behave like normal cells to organize themselves into functional tissue and organs. The technology provides new insights to cardiac surgeons for correction of congenital heart defects. It helps oncology surgeons conserve and precisely cut bone to rebuild cancer affected jaw. 3D printed models and implants help neurosurgeons repair cranial defects, broken skull bone. In India, surgeons are using this technology to not only help patients, live better quality of life but also conserve organs and reduce morbidity.

Today, it is possible to model an organ or any other part of human anatomy with 3D printing to help plan surgery, understand the disease pathology and treat patients And yet there are very few who have published their experiences or talked about clinical usefulness of 3D printed implants. Hopefully, we will soon have more data on the 3D implants and know more about their safety and efficacy. But right now we have case studies and stories that tell us about improved patient outcomes and patient centered care.Through our cover story this month, we shed light on some of the surgeons and centers working with 3D implants.We look forward to highlight the current surgical applications of 3D printing, and the ease with which it can be adopted by health services. Do send feedbacks on editorial@indiamedtoday.com

not be used as a substitute for professional healthcare advice. Readers are advised to always seek specialist advice before acting on information contained in this publication. Never disregard professional medical advice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. Printed and published by M Neelam Kachhap, 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Supriya Print Art 143, Pragati Industrial Estate, N M Joshi Marg, Lower Parel West, Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

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CONTENTS

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UPFRONT 04 Editorial 06 Letters 07 News roundup

OPINION

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17

Renal Transplant and Ethics

PULSE

Decaying Oral Health in Children

CONSUMER CONNECT 30 Medical Education Innovation INNOVATE

Can Abnormal Embryos Result in Successful Fertilization Study in nonhuman primates gives new hope to people seeking infertility treatment

37 38

COVER STORY

From Idea to Innovation Effectiveness is driving Acceptance in Medical 3D Printing

APPROACH

Designing for the Millennial Mom

32 INTERVIEW

India Lacks DNA Database Law

Tim Schellberg, Founder and CEO, Gordon Thomas Honeywell talks to Divya Ramaswamy about India’s DNA database Policy

34

FEATURE

26

Early Intervention Crucial for Children with Hearing Loss

36

IMPACT

Business Stress in Small & Mid-Sized Hospitals

40

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LETTERS

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My compliments to the Finance Minister for outlining Modi 2.0’s vision to take the nation to new heights over the next five years. Reminding citizens of their duty to India, the budget presented a long term vision to achieve a $5 trillion economy by 2024. The Apollo Hospitals group resolves to do its duty and join the nation in waging a war against the tsunami of non-communicable diseases that threatens the health of society, leading the country into a global initiative to stop the growth of NCDs in its tracks.

oes it take a coffee baron suspected suicide to shake the nation into empathy for mental illness? Was VG Sidhartha in depression? His letter explains in so many words that “I give up”, even if his

financial dealings were delinquent, is money more powerful than life? I believe as a mental health advocate that nothing can supersede a human’smental well-being.

Dr Prathap C Reddy, Chairman, Apollo Hospitals Group

Can we as a society ignore such incidents? Does it take someone rich and powerful to bring us together in solidarity

In line with the Ayushman Bharat program, India has taken a number of initiatives towards equitable and affordable access of quality healthcare for 1.3 bn Indians. But it cannot be made affordable if India continues to import 70-80% of its total requirement of medical devices. While the overall approach and budget allocation to address healthcare by the current government has been positive, unfortunately there is nothing much to boost Make in India.

and express grief over suicide? Money may be essentialfor survival but is this, the example we want to set for future generations? As a society,as a country, we need to come together and address these issues. Can we finally shedthe cloak of shame and stigma surrounding mental illness? It can happen to anyone,anytime, anywhere! Shabri Prasad Singh, Renowned Author, Mental Health Activist

Suresh Vazirani, Chairman & Managing Director, Transasia-Erba Group

BUDGET REACTIONS

FOLLOW US ON...

We at AIMED are shell shocked to see that No action has been taken by the Govt. to stem the tsunami of imports of 24 per cent at Rs 38800Cr that’s crushing Indian manufacturers. It is appalling to notice that since last threeyears , it is the first budget with zero mention on healthcare not even higher allocation for Ayushman Bharat. Since the market is barely growing at 10-12 per cent, a 24 per cent increase in imports would mean further erosion of 10-30per cent in market share of domestic industry which may account for just 10 – 20per cent market share. Rajiv Nath, Forum Coordinator of AiMeD

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August 2019


NEWS ROUNDUP TRANSLUMINA ACQUIRES ITS GERMAN COUNTERPART, TRANSLUMINA GMBH Translumina Therapeutics LLP, recently announced that it has acquired Translumina GmbH, Germany to create a Global Company from India. “This acquisition shall open enormous growth opportunities to create a large multinational in healthcare delivery. It is a surreal feeling since we started as their distributor 12 years back for the territory of India and now shall lead the company to a leadership position in the world market. This acquisition shall enable us to create and manufacture global technologies at lower costs by creating a synergy of our Indian and German facilities,” said Gurmeet Singh Chugh, Managing director, Translumina Therapeutics. Translumina is a development and manufacturing specialist of medical devices for cardiology, radiology and minimal invasive surgery. Headquartered in the

town of Hechingen in Southwest Germany Translumina GMBH was started in 2000, and has now become the technology leader in innovative and biocompatible stent coatings with products now available in over 40 countries worldwide. The company said that the acquisition will also enable it to initiate strong R&D and clinical initiatives for creating newer technologies for global markets at affordable prices by creating synergies of German engineering with innovative manufacturing efficiencies of India.

DR DAVID WEINTRITT’S WORKSHOPS ON FLUORESCENCE IMAGING IN BREAST CANCER SURGERY Renowned breast cancer expert Dr David Weintritt from GW School of Medicine and Health Sciences, US, recently visited India

to hold clinical workshops on the role of Fluorescence Imaging in breast cancer surgery and reconstruction. Fluorescence Imaging uses near infrared technology and indocyanine green (ICG) dye that rapidly visualizes lymph nodes that can otherwise be challenging for surgeons to navigate. It has the potential to help save and improve lives of many patients suffering from breast cancer. The multicity workshops on Fluorescence Imaging involved eminent surgical oncologists of India.

METROPOLIS HEALTHCARE LAUNCHES TEST TO DIAGNOSE HYPERSENSITIVITY PNEUMONITIS Metropolis Healthcare, a leading diagnostic service provider with a pan India presence, has launched Hypersensitivity Pneumonitis (HP) Profile, a new series of test for timely diagnosis of Hypersensitivity Pneumonitis by

Gurmit Singh Chugh and Punita Sharma along with Bernd Beck, CEO and Lars Sunnanvaeder owner of Translumina GMBH

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NEWS ROUNDUP identifying the allergens (foreign substances) that causes the condition. Hypersensitivity Pneumonitis is a rare immune system disorder that affects the lungs of a segment of population which is caused by sensitization to inhaled organic antigens (like toxins or enzymes) or low molecular weight chemical compounds. These substances trigger the immune system, causing short or long term inflammation especially in part of the lungs called the interstitium. The inflammation makes it difficult for the lungs to function properly, even leading to permanent organ damage. Pigeon droppings and pigeon pertaining dust is the most common form of allergen that causes this ailment.

INDIA’S FIRST HOME GROWN ELECTRONIC WITNESSING SYSTEM LAUNCHED AT OASIS HYDERABAD Oasis Centre for Reproductive Medicine has announced that their fertility treatment will henceforth be equipped with a state-of-theart Electronic Witnessing System (EWS) in their laboratory which has been designed to further

Oasis Electronic Witnessing System Launch

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safeguard the transparency and to avoid any human errors. Their technology is India’s first home grown technology to witness a pioneer in web based fertility treatment software. Electronic Witnessing System is a ‘track and trace’ system which improves traceability and quality control, while reducing laboratorybased risk. It tracks samples at predefined procedural steps in IVF laboratories to prevent mix-ups and provide an automated solution for mandatory double witnessing. The system is safe and secure process which increases the confidence during every step of the cycle. EWS eliminates the potential risk of possible mismatching during sample handling and Vulnerability to human errors including check omission, check incomplete, involuntary automaticity, and non contemporaneous checking. It also Prevents Embryologists from accidentally working on more than one patient’s gametes at a time and Marks each course step, ensuring prevention of omitting key tasks in the process.

TELENGANA TO RUN INNOVATIVE DRONEDELIVERY PROJECT ‘MEDICINE FROM THE SKY’

The World Economic Forum Centre for the Fourth Industrial Revolution Network has announced that it will embark on an innovative drone-delivery project called ‘Medicine from the Sky’ in Telangana. The project, to run in partnership with the government of Telangana and Health Net Global, will include a comprehensive study of drone-based deliveries for blood, vaccines, medical samples and organs. The government of Telangana, World Economic Forum and Health Net Global signed an agreement for the project to be stewarded by leaders in medicine, technology and research. This partnership would embark on a historic effort to pilot the transport of medical supplies using drones.

NOW CIPLA TO SELL ALVOTECH’S ADALIMUMAB BIOSIMILAR IN EMERGING MARKETS Biopharmaceutical company Alvotech and Cipla Gulf, a wholly-owned subsidiary of the leading global pharmaceutical company Cipla Limited, today announced that Alvotech and Cipla Gulf have entered into an exclusive


Apollo’s HNG and AAPI to Provide Virtual Consultations

partnership for the commercialization of AVT02, an adalimumab biosimilar, in select emerging markets. Under this partnership, Alvotech will be responsible for development and supply of the product, while Cipla Gulf will be responsible for registration and commercialization. AVT02 is a leading drug indicated for the treatment of several autoimmune diseases, including (but not limited to) Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Plaque Psoriasis (PP), Psoriatic Arthritis, Ulcerative Colitis (UC), and Crohn’s Disease (CD). AbbVie’s HUMIRA® recorded sales of about US$20 billion in 2018, making it the largest-selling blockbuster medicine worldwide.

APOLLO’S HNG AND AAPI TO PROVIDE VIRTUAL CONSULTATIONS TO RURAL INDIA

HealthNet Global Limited (HNG) a company owned by the Apollo Hospitals Group, recently announced the signing of an MoU with the American Association of Physicians of Indian Origin (AAPI) to deliver virtual second opinion consultations. As part of the collaboration, AAPI members will deliver free virtual consultations to the underserved

rural population in states like Jharkhand, Uttar Pradesh, Andhra Pradesh, Rajasthan and other states where HNG has a presence. The collaboration would also enable patients to seek second opinions from distinguished doctors based in the United States for complicated clinical problems and procedures. People across the country will also be able to access the profiles of all the AAPI physicians through our App to seek consultations and second opinions and make informed decisions about their healthcare needs.

CHANGE IN NATHEALTH LEADERSHIP TEAM Apex healthcare industry body NATHEALTH announced changes in its leadership. Preetha Reddy has been elevated to the post of Senior Vice President and Dr Harsh Mahajan takes over as Vice President for the year 2019-20. Dr Ashutosh Raghuvanshi has been inducted to the leadership team as treasurer of NATHEALTH. Dr Sudarshan Ballal and Badri Iyengar continue their responsibilities as President and Secretary respectively. Rajit Mehta, Max Healthcare stepped down from the office of Senior Vice President and as a member of the Governing Council.

The decision was taken in the governing council meeting of the Federation. Welcoming leadership team in their new roles and responsibilities, Dr Sudarshan Ballal, President, NATHEALTH said, “NATHEALTH has emerged as a powerful voice of the healthcare sector and it has been playing a catalytic role in the transformation that is taking place to quality and affordable services and solutions. We will work closely with all stakeholders including the government on several issues and look forward to creating a new healthcare ecosystem.”

DATAR CANCER GENETICS (EUROPE) GMBH LAUNCHES ITS OPERATIONS IN GERMANY Datar Cancer Genetics (Europe) GmbH has set up its operations in Germany. It will advance access to Datar Cancer Genetics Ltd’s (DCGL) innovative solutions across the European Union and is a key milestone for the organisation. DCGL is one of the leading companies in molecular and genetic analysis and through the GmbH will offer molecular genetic services across the European region.

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NEWS ROUNDUP Dr Stefan Schuster, a specialist in oncology diagnostics, will provide strategic leadership to the European operations and expand the outreach of DCGL. Moving forward, their focus will be to change the current oncology paradigm of “one size fits all” model in most of the cancers, to one that is proactive and adapted to the individual patient needs with long-term benefits at all stages.

that can be used in plastics, microsurgical, reconstructive and gastrointestinal procedures. This technology with its accuracy and precision, not only helps improve patient outcomes, but also provides alternative options compared to current technologies like gamma probe. FI can also be used in breast oncoplasty and in breast reconstruction post mastectomy.

STRYKER LAUNCHES STATE-OF-THE ART FLUORESCENCE IMAGING (FI) TECHNOLOGY, SPY-PHI

HCG LAUNCHES MARKET ACCESS PROGRAME LUMOS FOCUSED ON SPEED SCALING

Global medical device company, Stryker announced the launch of its state-of-the art Fluorescence Imaging (FI) technology, Spy-Phi, for better outcomes and safety of patients suffering from breast cancer. The technology uses near-infrared fluorescence imaging during cancer surgery that allows real time, clinically significant and actionable information to improve quality of care and lower overall healthcare burden. Stryker’s SPY-PHI infrared fluorescence technology can be used in various procedures, but is especially helpful in mapping of lymphatics, identification of lymph nodes and confirming adequate tissue perfusion for safe breast reconstruction. Spy-Phi is a unique and highly advanced fluorescence imaging technology

Anthill Ventures, an investment and Speed Scaling platform for early growth stage startups, in partnership with HealthCare Global Enterprises Limited (HCG), the largest provider of cancer care in India, has announced that it has shortlisted six start-ups for Lumos Health: Alixir, AyuRythm, BiMedis, C-Test Medicals, Kronikare, and Raybaby. This program is designed to help startups focused on emerging technologies in Healthcare and Life Sciences, accelerate their business growth by providing them support and mentorship. Lumos Health will help the selected startups to raise investments, provide assistance with mentoring and regulatory approvals, increase their customer base and generate more revenues.

SAMSUNG AND APOLLO HOSPITALS LAUNCH MOBILE CLINIC TO FIGHT NCDS Samsung India Electronics and Apollo Hospitals Group launched the ‘SamsungApollo Mobile Clinic’ to provide access to quality, preventive healthcare against growing non-communicable diseases (NCDs) to the less privileged. With this program, the two organizations aim to leverage technology to ensure citizens in rural areas in need of healthcare have access to it. Through this collaboration, Samsung aspires to bridge the gap and provide access to quality healthcare facilities to the people of the state.

NSHM KNOWLEDGE CAMPUS, HEALTH SCIENCE DEPARTMENT GRANTED PATENT

NSHM Knowledge Campus, Kolkata added a few more feathers of success to a plethora of their talented bunch of academic strength from the School of health sciences. The professors and the research scholars have already published three patents for invention of: “Topical Liposomal Gel of Biochanin-A and Method of Preparation Thereof”, “Method of Synthesizing Chrysin Ruthenium Complex and Applications Thereof” and invention of “Novel Metallic – Oxicam Complexes and Method of Synthesizing the Same”.

TATTVAN E-CLINICS APPOINTS RANGA SUDHAKAR AS CHIEF STRATEGIC OFFICER

Stryker Spy-Phi

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August 2019

Tattvan, the first-of-its-kind telemedicine healthcare E-clinics has announced the appointment of Ranga Sudhakar as the Chief Strategic Officer. With the aim of transforming healthcare in remote areas, Tattvan E-Clinics works to provide healthcare services in Tier 2 and Tier 3 towns in India. As the company is working to achieve its objective, Sudhakar in his new role will guide


L - Mr. Ayush Mishra, CEO, Tattvan

R - Mr. Ranga Sudhakar, CSO, Tattvan

innovative programming and framework to enhance Tattvan’s value propositions and expansion plans. Over the next few months, Tattvan plans to set up 15 clinics in cities like Moradabad, Guwahati and few more. The brand is expanding its healthcare services across Uttar Pradesh, Bihar, Uttarakhand, and Jharkhand with 50 more E-Clinics in next 1820 months. On the International level, Tattvan E-Clinics is looking forward to expanding in Bangladesh, Tajikistan and Uganda.

TRANSASIA BIOMEDICALS UNVEILS BLOOD DONATION APP TO CONNECT PATIENTS AND DONORS Transasia Bio-Medicals Ltd., India’s leading Invitro Diagnostic Company, unveiled ‘SAVIOUR’, a location based blood donation app that is available free to everyone. It is the first in

India to be on both Google Play and App Store. The new app is likely to empower those who have the resources to acquire blood but lose out on timely help due to inadequate blood bank infrastructure. It connects patients to the nearest donors, and notifies the patient in real-time on the number of donors who accept the request. Additionally, it sends out notifications to the registered donors on the need for blood based on their type. Reminders sent by the app, ensure that the donors do not forget about their commitment. Once a donation has been made, a donor is advised to not donate blood in the recovery period. At this time, the app goes into a precautionary dormant state, in order to ensure complete safety of the donor. Moreover, the app makes it very convenient for donors; they just need to check-in at the nearest hospital through the app, a step that helps save time and ensure credibility. Donors are incentivized with personal goodwill points, based on the number of donations and lives saved.

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NEWS ROUNDUP MANIPAL HEALTH PARTNERS WITH NASSCOM TO ENABLE IOT AND AI BASED PATIENT CARE Manipal Hospitals, one of the nation’s leading healthcare providers, today announced its collaboration with NASSCOM Center of Excellence to capitalize on the multiple benefits of advanced technologies for improved healthcare delivery. The partnership will leverage the benefits that IoT and AI can bring to the healthcare sector. They aim to deploy emerging technologies, to ensure better delivery of healthcare.

ERIS LIFESCIENCES, PLEXUSMD TO OFFER AI-POWERED ONLINE LEARNING PLATFORM FOR DOCTORS Eris Lifesciences, a leading pharmaceutical

Fresenius Medical

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August 2019

company, and PlexusMD, India’s largest professional networking platform for doctors, today announced their partnership for a unique AI-powered learning platform named “Saarthi”. Through this endeavor, the companies aim to enable Indian physicians stay connected with global developments and practice evidence-based medicine to improve patient health outcomes. Artificial intelligence (AI) empowered technology and machine learning can help tailor the content and adapt the pace of delivery to each practicing physician’s unique learning needs for them to apply the insights more effectively in their practice. This app-based platform will be a one-stop destination to provide Continuing Medical Education (CME), medical content, medico-legal precedents, medical conference feeds, case discussions, etc. for physicians. “Saarthi” is an interactive, innovative and relevant platform to simplify learning for doctors, who continuously face time-constraints in their attempt to keep abreast with latest developments in the medical field.

FRESENIUS MEDICAL OPENS ASIA PACIFIC EDUCATION CENTER Fresenius Medical Care, the world’s largest provider of dialysis products and services, today celebrated the opening of its new dialysis learning hub: The Fresenius Medical Care Asia Pacific Education Center. Through the new Philippines-based center, clinicians and technicians who provide renal care throughout the Asia Pacific region will be able to access Fresenius Medical Care’s high standard of dialysis training, creating a new benchmark for training in the region. The center’s state-of-the-art environment will foster learning using advanced equipment in a fully functional clinical training area. Designed to simulate an innovative clinical environment, the center includes 18 dialysis machines that facilitate training across a range of different therapy areas used in different countries – from chronic hemodialysis, to home dialysis and nutrition management systems – through to a fully functional water treatment system.


ROSEWALK: DELHI’S ONE ITS KIND LUXURIOUS MATERNITY HOSPITAL Delhi’s most luxurious maternity hospital ROSEWALK located in Panchsheel Park was officially opened recently. The opening was accompanied by Abrar, Director of Rosewalk hospital. Rosewalk provides 15 patient rooms, state of art operation theatres, onsite blood storage unit and high end consultation suites. The medical services in Rosewalk include Maternity, Neonatology & Pediatrics and Gynecology. Rosewalk doesn’t spare any expense in providing a luxury experience to its clients, pampering them with facilities like inroom spa, café joya- An upscale cafe offering scrumptious treats and supreme service, Play space for kids, in house pharmacy, a boutique & shop and its signature 24 X 7 concierge service. Apart from all the world class facilities Rosewalk Hospital has in total forty two qualified doctors whose priority is to give utmost medical attention to its patients.

IMPORT OF MEDICAL DEVICES UP BY RECORD 24% MSME dominated medical domestic manufacturing takes a hit post GST as imports become 11% cheaper and shoot up 24%. Imports of medical devices are up by record 24 % at 7450 Cr from ₹31386 Cr in 2017-2018 to 38,837 Cr ₹ in 2018-2019. As the market is barely growing at 10-12%, overall the data of 24% increase in imports indicates further erosion of 10-30% Domestic market share to 10 to 20% market share stated a visibly upset Mr. Rajiv Nath, Forum Coordinator of AiMeD. GST on medical devices is in favour of imports and is detrimental to Make in India. MSME sector has been worst hit with huge job losses.

MEDIKABAZAAR APPOINTS MANOJ MANI AS HEAD OF TECHNOLOGY Continuing with its goal to provide robust tech-driven solutions in the healthcare sector,

Manoj Mani, appointed as Head of Technology, Medikabazaar

Medikabazaar, India’s largest online B2B platform for medical supplies, has announced the appointment of Manoj Mani as its Head of Technology. The hiring is in line with the company’s plans for rapid expansion, with a major focus on strengthening its technological infrastructure. With over 23 years of experience across Technology segments such as Information Systems, Information Security, Strategic Planning and Technology Management, Manoj will spearhead Medikabazaar’s technological strategy and business model from end-to-end.

HONOURABLE GOVERNOR OF KARNATAKA SHRI VAJUBHAI VALA INAUGURATES MULTISPECIALTY ASTER RV HOSPITAL Aster DM Healthcare, one of the largest integrated healthcare service network in the GCC and the third largest healthcare company in India, is expanding its footprint by commissioning its second multi-specialty quaternary care hospital in Bangalore called Aster RV Hospital. Located in the heart of the

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NEWS ROUNDUP CEO, KlinicApp, on the expansion. KlinicApp is providing online blood test operational services at home in Pan India. It has partnered with NABL, ISO and CAP certified labs to provide best possible diagnostic and path services to our customers. Along with path test and many broad health check-up with free home sample collection services are also available at the diagnostic centres. It conducts blood sample collection with their own fleet of expert technicians (phlebotomists) who are trained for home sample collection, hygiene sample handling and laboratory procedures. KlinicApp claims to have served more than 1 lakh customers with hassle free services through their phlebotomists.

city at JP Nagar 1st Phase, the hospital has been formally inaugurated by the Honourable Governor of Karnataka Shri Vajubhai Vala; in the presence of Ms. Sowmya Reddy, MLA, J.P. Nagar Constituency; Dr. Azad Moopen, Founder Chairman and Managing Director of Aster DM Healthcare and Dr. Panduranga Setty, President of RV Group of Institutions.

MEDTRONIC LAUNCHES VENASEAL CLOSURE SYSTEM India Medtronic, a wholly-owned subsidiary of Medtronic has launched the VenaSeal Closure System, which is a minimally invasive procedure that uses a proprietary medical adhesive to close the diseased vein in patients with chronic venous disease (CVD) – a condition affecting more than 190 million people globally. “Medtronic is committed to developing smart product and procedural solutions in the area of minimally invasive innovation to improve the quality of life for all patients,” said Madan Krishnan, VP and MD, India Medtronic. “VenaSeal is an innovative approach to vein closure and is designed to minimise patient discomfort and reduce recovery time. Thousands of patients around the world have benefited from this therapy and we are pleased to now offer this advanced technology in India.” VenaSeal uses a medical adhesive to close the diseased vein, with high closure rates across three clinical trials.1-5 Using ultrasound, the physician guides a catheter through a small access site in the leg and into the diseased area of the vein. Once in place, the physician administers the VenaSeal adhesive at various points in a segmental fashion, and with manual compression, closes the vein. Blood is re-routed through other healthy veins in the leg.

DR MAHESH BHALGAT IS THE NEW SYNGENE COO Syngene International Limited, a leading global Contract Research Organisation has

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August 2019

Dr. Mahesh Bhalgat, COO, Syngene

announced the appointment of Dr. Mahesh Bhalgat as Chief Operating Officer (COO). Dr. Bhalgat will take charge as COO with effect from 1st July, 2019. He comes to Syngene from Shantha Biotechnics, a Sanofi company, where he was responsible for all manufacturing operations, supply chain, engineering projects, HSE, manufacturing excellence and administrative services.

KLINICAPP TO HIRE 1000 PHLEBOTOMISTS BY YEAR END Gurugram based e-diagnostic startup KlinicApp announced that it is set to hire 1000 employees in 2019. The 1000 new employees would be trained to draw blood from a patient for clinical or medical testing-lab technicians with specialised BMLT and DMLT degrees. “Currently KlinicApp has more than 100 phlebotomists in the team and this number is growing exponentially every month. We are adding 200 phlebotomists per month especially in Delhi, Mumbai and Pune to our existing teams. With a strong and growing presence in north India, we now aim to expand across the country and hire over 1000 people this year,” announced Satkam Divya,

TWO-DAY LIVE ROBOTIC SURGERY TRAINING PROGRAMME HELD IN MANIPAL HOSPITALS, DWARKA Manipal Hospitals, Dwarka, New Delhi, recently concluded a two-day live Robotic Surgery Training Programme with hands on robotic training, live surgery workshop and video based teaching by national and international faculty with participation of around 160 surgeons doctors across the country. The workshop witnessed national faculty performing live robotic surgeries in GI, thoracic, head and neck, paediatric, bariatric and hernia. Speaking about the initiative, Dr Arun Prasad, Head of Department, Gastrointestinal and Bariatric Sciences, Manipal Hospitals, Dwarka, said “Robotic surgery has generated a lot of interest in the last decade and is being practised at over 70 centres in India. While urologists and gynaecologists are leading the usage, general surgery has the biggest future with this technology. So far, I have performed 500 plus robotic surgeries with complete minimal invasion and fast recovery of the patients through the facility and hope to perform more. There is an urgent need for training and education for this emerging


technology that has revolutionised surgical training across the globe and India should not be left behind.”

DR ASHOK SETH APPOINTED PRESIDENT OF APSIC Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute, New Delhi and Head, Cardiology Council, Fortis Group of Hospitals, has been appointed President of Asia Pacific Society of Interventional Cardiology (APSIC) for the next three years. The announcement was made at the AICT-ASIA PCR Conference in Singapore recently. Dr Seth said, “I feel truly honoured to have been appointed as APSIC. In the next three years, my aim would be to consolidate the researches and advancements in interventional cardiology of Asia Pacific and showcase it to the rest of the world. It has now got to be East teaching the West. We would also like to create a platform of teaching and exchange of knowledge and expertise to benefit our young gen interventional cardiologists across Asia Pacific, so that

Dr Ashok Seth

patient care and outcomes get even better.”

HEALTHASSURE RAISES $2.5 MILLION IN A SERIES A FUNDING LED BY BLUME

HealthAssure has announced a $2.5 million Series A round led by Blume Ventures. As a result, HealthAssure will use the funds to augment its healthtech platform, create sharper products that serve various primary care needs of the Indian market more effectively including insurance OPD products, build better data capabilities leveraging AI & ML and strengthen distribution. Speaking on the occasion, Varun Gera, Founder and CEO, HealthAssure said, “We are proud to be associated with Blume through this round of funding. Blume has established itself as one of the most vibrant start-up ecosystems in India and we look forward to leveraging their strengths in our journey of consumerising healthcare. We will be infusing the funds raised in our business to further deepen our technology, build new products, create a more robust distribution network and grow inorganically as well. HealthAssure aims to make quality healthcare easily accessible and affordable for the Indian population and would continue to touch the lives of millions of new customers over the next two years.” The company plans to accelerate its business through both organic and inorganic routes to unlock the opportunity for growth across India and Asia Pacific markets. Already establishing its footprint in the Middle East, the company now looks forward to mark its presence in other South-East Asian countries as well. HealthAssure currently operates a strong network of 4,000 primary care centres in 1,100 cities offering services including dental, paediatric, ophthalmology and diagnostics across India. The company has extended its services to more than 1.5 million customers and targets to serve millions more in the coming year.

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NEWS ROUNDUP

CARESTREAM INCREASES DIGITAL FOOTPRINT IN INDIAN GOVERNMENT HOSPITALS

Carestream Health is following an evolutionary path of making India a more healthcare friendly country. The Government of India has been adopting genuine efforts to enhance public healthcare services in India, through policy support and various other initiatives. The increasing installations of digital imaging equipment in various government hospitals are an affirmation of these efforts. Carestream Health, a pioneer in introducing the world’s first proven wireless digital radiographic detector, the first packaged X-ray film, the first medical dry laser imager and a unique new platform for mobile digital X-ray imaging, is proud to be part of this digital revolution. Their Full Room Digital Radiography Systems are designed to meet the needs of the growing healthcare sector of India. Their feature-rich solutions, scalable design and modular components can

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be configured as per ones requirements and budget. The image quality is exceptional and the positioning flexibility for all major exams is great, resulting in accelerated workflow and enhanced patient care.

ALNICHE LAUNCHED NOVEL PRODUCT IN COLLABORATION WITH DPSRU

Alniche Lifesciences has launched a Novel product Complipro / Ezepro in Vigyan Bhavan under the graceful presence of Shri Anil Baijal, Honourable Lieutenant Governor, Govt. of N.C.T. Speaking on this occasion, Girish Arora, Founder & Managing Director, Alniche Lifesciences said, that this launch will mark a beginning of Indian Pharma industry focusing on introducing products that are suited for Indian masses. He also expressed his gratitude to respected LG Sir for his presence & blessings. He also thanked Prof. Ramesh K Goyal, Vice Chancellor, DPSRU and

Prof Harvinder Popli, Dean, DPSRU for their encouragement and support. He further elaborated that Academia and industry are the two extremely important pillars of the economy. A robust collaboration between the two augurs well for the country, enabling innovation as well as growth in the education system for producing an employment-ready workforce. Under this initiative, Alniche and DPSRU have signed a Memorandum of Understanding for collaboration to develop innovative formulations in the field of Nephrology and Critical care. Under this collaboration, both the partners are working together for three broad areas: Formulation & Development, Concept to Creation and Analysis & Standardisation of differentiated novel Pharmaceuticals. Alniche also instituted two awards (Jwalant & Vijayin) to recognise the young researchers & new start-ups at DPSRU innovation and Incubation Foundation (DIIF) to bring new products, concepts & technologies to the Indian market.


OPINION

Renal Transplant and Ethics Dr Dilip Rangarajan, Senior nephrologist & Medical director, NU hospitals

CHRONIC KIDNEY disease incidence in India is on the rise. Though the exact figures are not available, various studies project the incidence of chronic kidney disease around 17.2 percent. The increase in incidence of chronic kidney disease is attributable to the increased prevalence of diabetes mellitus (7.1%) and hypertension (17%). In urban India nearly one fourths suffer from these two morbid illnesses. End stage renal disease incidence is estimated to be about 229/million population. The rate of renal transplantation is estimated to be around 3.25/million population (living related and deceased renal transplant inclusive). With such a demand and supply mismatch there is an opportunity created for middlemen to get involved and indulge in unethical practices. Indian government has enacted a law on organ transplantation in 1994 and subsequent modifications made as appropriate. Related donors include parents, siblings, children, spouses and grandparents. Law and Implementation Appropriate authority in each state has to give permission for organ transplants to centres. In-house authorisation committees and in-house competent authorities have been formed in individual transplant centres, which look into the requisitions for transplant and grants permission. Foreign patients and unrelated patients need to go through state authorisation committee for transplantation. Despite all these, forged documents and falsified laboratory reports are generated in most instances without the knowledge of the committees and transplants are done. These land the committee members and the institutions into trouble. There have also

been accusations that the committee grants permission to unrelated renal transplants even when the motive for organ donation is suspect. The Solution One of the ways to increase the supply of organs is to encourage deceased donor transplants. The deceased donor transplants constitute only about five percent of overall renal transplants in India. Southern states seem to be doing well compared to rest of the country in this. Deceased donor transplant was facilitated by the government after transplant act was enacted in 1994 where brain stem death was recognized and rules put down. There were many hurdles in this initially. The panel of neurology specialists appointed for recognition and certification of brain deaths were few. Some of them were reluctant in certifying brain deaths. There were also inordinate delays in certification owing to the fact that they were busy and unable to arrive on time for certification. Subsequently the panel of neurology specialists were increased to facilitate easier certification. The awareness of brain stem death was also poor and continues to be poor among medical fraternity itself. Lot of brain stem deaths are not recognized or not acted upon. Also the harvesting of organs need to be done at a certified centre and hence smaller hospitals with ICU facilities where brain stem dead patients are admitted cannot proceed with organ harvesting. This involves transferring a sick patient to a certified hospital. Also religious sentiments of relatives prevent some from offering donation of organs. Doctors and administrators need to put in effort to first educate medical fraternity about

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OPINION

the importance of this and then the general public awareness is to be intensified. Exchange Transplant Other way to increase the donor pool is to encourage and promote swap transplant which has been approved by the law. This involves maintaining of registry in all hospitals of the blood groups of all patients and their voluntary donors. Within this pool, matching donor-recipient are identified according to blood groups and then the pair can go ahead with investigations for transplant. Voluntary donor (relative of one patient) gives his/her kidney to the blood group matched recipient within the group and that recipient’s relative donates kidney to the relative of the donor. Intra-hospital programme and inter-hospital programme need to be facilitated. This involves a good rapport between institutions and

coordination. Prevention of chronic kidney disease needs to be taken on a war footing and this will be the ultimate solution for a problem that consumes life and money. Best practices in this area would be  For the hospital, state committees and transplant teams to be more vigilant while scrutinising the documents  Encourage deceased donor transplants and swap transplants  Encourage and motivate living related donors for donation.  Government organizations and NGO’s can felicitate donors and donor’s families in case of deceased donors and provide some incentives to them. It could be in the form of health insurance (as done in Iranian model) or some form of discounts in daily living expenses.

The rate of renal transplantation is estimated to be around 3.25/million population 18

August 2019

References  Evolution of renal transplantation in India

over the last four decades, Georgi Abraham, George T. John Shroff, Sunil Edwin M. Fernando, Yogesh N.V. Reddy, NDT Plus, Volume 3, Issue 2, April 2010, Pages 203–207 Prevalence of chronic kidney disease in India - Where are we heading ?,P.P.Varma, Indian Journal of Nephrology 25(3):133-5 • May-Jun 2015 Deceased donor renal transplantation: A single center experience, N Gopalakrishnan et al, Indian journal of Nephrology Year : 2017 | Volume : 27 | Issue : 1 | Page : 4-8 Current trends in kidney transplantation in India, Sunil Shroff, Indian J Urol. 2016 Jul-Sep; 32(3): 173–174. Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation, Ahad J. Ghods and Shekoufeh Savaj, CJASN November 2006, 1 (6) 1136-1145


COVER STORY

FROM IDEA TO

INNOVATION Effectiveness is driving Acceptance in Medical 3D Printing

M NEELAM KACHHAP

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August 2019

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COVER STORY

W

ith a twinkle in his eyes, the orthopedic surgeon pulled down his mask and declared, “It’s a perfect match!”A smile spread across Maltesh Somasekharappa’s face. I have accompanied Maltesh to an orthopaedic hospital, to witness how 3D printed devices are making doctor’s life easy and patient’s life painfree. A 70-year-old patient had come in for a revision hip-replacement for bone loss and the operation was successful. A 3D printed surgical implant has perfectly matched the patient’s deteriorating joint. Now Maltesh can make more such devices to help patients who have special needs for tailor-made implants. 3D printing is a medical buzz that has caught the imagination and the interest of the likes of Flipkart’s Binny Bansal, angel investors and venture capitalists across the nation. And why not, it is the future of medicine. “There is no doubt that 3D printing has captured the minds of medical professionals and this will transform healthcare delivery,” says Ramesh Kannan, Partner, Somerset Indus Healthcare Partners. Around 20 companies in India alone are working on 3D printing in medicine. Most are trying to use polymers to make anatomical models for surgical planning or educational purposes. Some are looking at tissue or organ fabrication, and yet there are others who are working to make 3D technology affordable and available for better medical outcomes. In the industrial town of Peenya, Bangalore, a dynamic duo is treading an unlikely path. Maltesh Somasekharappa and Srikrishna Prabhu have taken their mutual admiration for new technology and turned it into a thriving business. Their start-up Supercraft 3D is focused on engineering and scientific technology, with expertise in additive manufacturing in healthcare. While other companies are still working with polymers on smaller printers,Maltesh and SKP have moved on to metal 3D printing for medical implants using industrial 3D manufacturing equipment and supplies imported from Europe. “Supercraft3D is committed to bringing the best hospital experience to doctors, hospitals and to the patients around the world using innovative surgical

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solutions. Some of these solutions can also come through pioneering designs in surgical devices that help the end users, through software that augment skills via AI and through technology, such as additive manufacturing, and materials that were hitherto unavailable for conventional applications,” explains SKP. Success in tumultuous market According to a research report published by Market Data Forecast, the global 3D printing medical device market size is estimated to be around USD 1480 mil in 2018 and is expected to grow at a CAGR of 30 per cent to reach 5595 mil by 2023. In fact, healthcare providers globally will be the second largest industry to spend on 3D printing with a spending total of nearly $1.8 billion in 2019, says a Worldwide Semiannual 3D Printing Spending Guide from International Data Corporation. Indeed there is a great deal of enthusiasm for 3D printed medical devices. “Technology is improving and changing very rapidly in medicine. And its uptake by surgeons is also fast. 3D printing solutions for medicines have already been used and with good results,” says Dr Komal Prasad Chandrachari, Senior Consultant Neurosurgeon and Spinal Surgeon, Narayana Hrudayalaya Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City. However, with the Indian government cracking down on device manufacturers and capping the price of implants, it may look like a difficult time for companies to invest in 3D printing. Maltesh says that

There is no doubt that 3D printing has captured the minds of medical professionals and this will transform healthcare delivery,” says Ramesh Kannan, Partner, Somerset Indus Healthcare Partners Ramesh Kannan, Partner, Somerset Indus Healthcare Partners


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2

1. Frontal view of the cranial defec 2. Patient before being discharged (2 days after surgery)

the success lies in the ability to adapt to the tumultuous market landscape for long-term benefits. “There’s a perception that customized 3D printed implants would be prohibitively expensive. This is far from truth. On the contrary a personalised implant is likely to be at the same or even less costly than a conventionally manufactured implant,” says Maltesh. The advantage of 3D printed implants and components is that it can be made quickly and costeffectively. “There is a high demand for tailor made implants and components produced in small batches whose materials and manufacturing standards fulfill extremely stringent quality and safety requirements. This is our strength,” says Maltesh. The company uses FDA approved raw materials, manufacturing technology and software. In fact, Supercraft 3D has applied for patents for its products, which are at an advanced stage of approval. Making a Difference 3D printing is already disrupting healthcare delivery. “Today we are in the modern world of precision therapy and personalized medicine. This does not mean only genetic interventions; technological advancement should also be made for individualisation. If a patient is undergoing a surgery, we should be able to tell the patient, look this is how it is this is what we are going to do and this is how it will look after surgery; with technology for precision treatment. Biology is the king

in medicine, technology development is the prince and princes,” says Prof K S Gopinath, Promoter & Director, HCG Hospital and Bangalore Institute of Oncology; and Prof of Surgery & Oncology, Sri Devaraj Urs Medical College, Kolar. In the Indian population oral cancer is very rampant. “Gingivobuccal cancer is the most commonly seen oral cancer for which the treatment primarily is surgery. We call it the Indian oral cancer,” says Dr Gopinath. As part of this treatment usually the cancerous tissue is removed surgically. Most of the times the cancer is detected in advanced stages and by then the cancer has spread to the jaw and buccal cavity. In that case the jaw has to be removed. “Conventionally, we have always removed the bone and not much thought was given to reconstruction of the jaw because the aim of the treatment was cancer cure and survival years,” Dr Gopinath explains. “With the advancement of the understanding of the biology, development of technology and affordable cost now we can give not only cancer treatment but a better quality of life to the patient,” he adds. “With the help of 3D printed guides now we can precisely cut the bone, conserving the part that is not affected by cancer. We can also reconstruct the jaw using the patient’s own bone,” explains Dr Gopinath. “Mandibulectomy is complex,” shares Maltesh. “The surgeon must primarily deal with tumour but in the

Technology is improving and changing very rapidly in medicine. And its uptake by surgeons is also fast. 3D printing solutions for medicines have already been used and with good resultst Dr Komal Prasad Chandrachar, Senior Consultant Neurosurgeon and Spinal Surgeon, Narayana Hrudayalaya Institute of Neuro sciences, Mazumdar Shaw Medical Center, Narayana Health City.

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COVER STORY process they also ensure that post-surgical functionality of the jaw and the aesthetics are not compromised,” he further adds. “Today a typical oncological mandibulectomy surgery may last anywhere from 6-10hour. Using Supercraft3D’s innovative cutting guides for both mandible and fibula osteotomy we have been able to reduce the surgical time to less than 3hour. The need for surgical instruments and guides has also been significantly reduced,” Maltesh says. What’s more the company also makes jaw implants with tooth which is an alternative to dentures that doesn’t fit well. “In case of benign mandibulectomy, Supercraft3D offers 3D printed titanium jaw implant with pre-positioned tooth implants as well. In a sense the patient wakes up postsurgery with teeth in the mouth,” Maltesh explains. In another instance, Dr Chandrachari shares how 3D printed implants are helping patients with cranial deformity lead a normal life. A defect in the cranial (skull) bone is usually seen in patients with trauma, infection or tumor surgery and result in sever deformity both aesthetically and functionally. The available implants in the market are pre-

With the help of 3D imaging now we can precisely cut the bone, conserving the part that is not affected by cancer. We can also reconstruct the jaw using the patient’s own bone Prof K S Gopinath, Promoter & Director, HCG Hospital and Bangalore Institute of Oncology; and Prof of Surgery & Oncology, Sri Devaraj Urs Medical College, Kolar

designed and may not be suitable for the individual needs of the patient. “Earlier we used bone cement to try and fill the gap along with titanium mesh. But the end results were not perfect,” says Dr Chandrachari. “Now with the help of 3D modeling and implants it is easier to mirror patient specific

1

3

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1

3D Printed Patient Specific Implants 1. Acetabular Cup 2. Jaw Implant 3. Cranial Implant

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contour. The 3D model of the skull and the acrylic plate give us the understanding of the lost bone and the contour of the deformity. The final titanium implant is specific to the patient and can be manipulated to fit properly with screw attachment, giving the surgeon the flexibility to work,” shares Dr Chandrachari. “In the world of neurology, the complexities vary from patient to patient because of its uniqueness. Here 3D printing plays a valuable role. With the help of this technology surgeons can use patient specific pre-surgical models to assess and plan the surgery. They can also plan for surgery specific cutting guides and implants. For instance, thoracic braces can be customised and attuned for each patient without compromising on the comforts. Additionally, cranial implants can be made such that they don’t compromise the patients’ aesthetics. Similarly, spinal implants can be 3D printed to match the patients natural angle of the spine,” shares Maltesh. 3D printed implants can make a difference from a lifetime of discomfort and pain to hassle free and better quality of life. For instance in a revision hip surgery there is bone loss and compromised bone makes implant fixation and stability more difficult. The patient mobility is compromised and continuous pain hampers quality of life. Using 3D printing it is possible to create a porous implant that mimics the bone morphology and patient specific screws can be used to enhance implant stability and minimize micromotion after surgery. Orthopaedic applications of 3D printing have been widely known for many years now. From 3D printed fracture braces to customised implants there are a number of ways in which 3D printing is making a difference. “We offer patient specific solutions for revision and complex surgeries such as mono-block implants that reduce the need for any wedges with world class finish at the articulating surfaces. We also study in detail the patients’ case, including gait movements, before designing the implant. The location of screws is calculated to ensure maximum load bearing. Our acetabular cups are customised even at the trabecular texture levels to ensure better osseointegration,” says Maltesh. Heart is one of the most fascinating organs in the human body and has garnered immense interest from the 3D printing community. It is one of the most printed human organ models. Studies have shown that cardiovascular disease is the leading cause of mortality

in urban and rural India causing more than 11 percent of deaths. In addition, around 8 to 10 children per 1000 are born with congenital heart disease in India. The incidence comes to around 1 -2 per cent of children born with congenital heart disease in our country. Almost 70 per cent of these children can be treated with surgery. Now with the help of 3D printing surgeons can plan the surgeries better with more safely and better clinical outcomes. Medical imaging such as X-rays, MRI and CT are the means for surgical planning but they are not always sufficient to give the complete picture of the affected organ. A 3D surgical model fills the gaps in understanding and provides an accurate picture of the anatomical disparity required for surgical planning; making complex surgeries simpler with great outcomes.

There is a high demand for tailor made implants and components produced in small batches whose materials and manufacturing standards fulfill extremely stringent quality and safety requirements. This is our strength Maltesh Somasekharappa, Co-Founder, SuperCraft3D

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COVER STORY “We provide patient specific 3D heart model in glass transparent material, white material and soft material that mimics the heart texture. It has shown immense utility in planning and treating congenital heart diseases. The patient specific models allow for doctors to pre-plan the surgery, including harvesting of grafts and reconstruction of valves. We even offer cross section of the hearts to study the inside details,” shares Maltesh. The medical world is opening its eyes to the benefits of custom made implants. Managing large bone defects could be quite a challenge for Orthopaedic surgeons.“Custom made implants manufactured by 3D printing technology ensures a precise fit to the bone defect specific to that particular patient. The 3D printed implants offer a superior advantage on both mechanical and biological fronts compared to the current ‘off-the-shelf ’ implants. Custom made implants reduce the surgical time, minimize complications and are proving to be a cost –effective solution in difficult scenarios”, syas Dr Deepak G Shivarathre, Chief of Orthopaedic Oncology, Associate Chief, Hosmat Joint Replacement Center, Hosmat Hospital The technology also allows building models for a more effective surgical pre-planning and patient education. “The hindrances to 3D printed implants have been the cost, availability and the manufacturing time which have been

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The 3D printed implants offer a superior advantage on both mechanical and biological fronts compared to the current ‘off-the-shelf’ implants. Custom made implants reduce the surgical time, minimize complications and are proving to be a cost –effective solution in difficult scenarios Dr Deepak G Shivarathre, Chief of Orthopaedic Oncology, Associate Chief, Hosmat Joint Replacement Center, Hosmat Hospital

addressed by the Supercraft 3D team. With increasing awareness and availability, 3D printing is ready to take the next big leap in revolutionizing modern medicine”, he says Partnering with Med-tech companies Around 100 medical devices have US FDA clearance and


many more have applied for the same. Medical device manufacturers are using 3D printing for finished products as well as components. These companies are relying on 3D printing to improve manufacturing efficiency and product quality. In fact, 3D printing works around many of the limitations seen in more traditional manufacturing methods such as milling, casting or fabrication. 3D printing also opens up new possibilities for complex and numerous design revisions and customisation of parts, at a commercially viable cost, that were previously unfeasible. This has the capability of producing complex features and accurate parts, metal 3D printing is highly suited to the production of medical and dental devices in both cobalt chrome and titanium. Maltesh explains that medical device companies have two major challenges - short shelf life of the product and low volume sales. This makes for a complex and dynamic market. Conventional manufacturing of devices demands a certain ‘minimum order quantity’ for the product to be viable for production lines. This leads to unnecessary stock of components that may not really see the light of the day. It also means certain designs are locked in due to sunken investment in tooling. “Manufacturers are increasingly coming to terms with the benefits of additive manufactured components that give them the freedom from volumes, designs and MoQ’s,” he adds. “Medical Technology companies are partnering with us at various levels. Some are engaging with us at the design conception stage itself. While some are working with us to re-design an existing product to escape the MoQ for the next batch. In addition, we also give innovative solutions for new materials, lightweight designs and alternate approach to manufacturing and distribution,” he further adds. The Road Ahead Supercraft 3D products have medical utility and economic value but they are now working on publishing several case reports, feasibility studies and technical reports in the field. According to Maltesh it is not only important to bring a new technology to light, but it is also important to create an enabling ecosystem for the technology to grow. With this belief, Supercraft3D is open to sharing their learnings and support other med-

tech entrepreneurs. “Supercraft3D’s printing solution for healthcare is bringing about a paradigm change for medtech companies. Benefits in manufacturing like product weight , volume , function efficient parts, devices & sub-assemblies can be delivered by 3D printing,” says Kannan. “It would be a great opportunity for Medtech startups to leverage 3D printing solutions to prototype, iterate, change as many times as required before getting it perfect. Their problems of time cycle, mold, small quantity - high price production challenges can be easily resolved,” he adds. “Surgeons are able to provide better outcomes with well-planned surgeries. Hospitals are able to optimize OT time with better economics and ultimately patients are benefitting from customized perfect fit implants and better quality of life,” summarizes Kannan. For Maltesh and SKP this is just the beginning. They want to make Supercraft3D best in class design centre for medical applications and make meaningful impact for patients’ treatments where personalization is key. They dream of reaching out to patients and surgeons in Tier II, Tier III locations, so that the benefits of simplified and user-friendly designs that allow complex surgeries are available to all.

Supercraft3D is committed to bringing the best hospital experience to doctors, hospitals and to the patients around the world using innovative surgical solutions. Some of these solutions can also come through pioneering designs in surgical devices that help the end users, through software that augment skills via AI and through technology, such as additive manufacturing, and materials that were hitherto unavailable for conventional applications Srikrishna Prabhu, Co-Founder, SuperCraft3D

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APPROACH

Designing for the Millennial Mom Sujayanti Dasgupta, Director – Healthcare Architect, WARD FOUR, Bangalore

OPD waiting room

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INDIA IS witnessing a conspicuous transformation in birthing trends, particularly among the urban population. Couples are waiting longer to start a family; couples are also choosing to have fewer children. As the average age of new moms is on the rise bringing an erudite healthcare shopper to the market, this patient population is significantly younger than the medical/surgical patient, which in turn is also shaping their expectations. On the flip side, these choices are not free of complications and have led to a higher number of complicated pregnancies, higher rates of infertility interventions leading to difficulties of multiple births as well as gestational diabetes, rise in C-sections, among other risks.

Design for a New Healthcare Model To address the changing needs and expectations of the nuclear families of urban India, cities of India has seen an uptick in free standing Single Specialty Birthing Centres that cater to the entire gamut of requirements for the expectant family – from conception to postpartum care.While free standing centres address the hospitality and celebration factors rather well by putting this component of healthcare outside of larger hospitals usually associated with illness, this model also throws in challenges of managing care that may require higher acuity care for ante-partum, post-partum as well as neonatology and perinatology.


While some centres have chosen to cater primarily to low risk pregnancies which reduces the need for higher acuity spaces and allows plenty of room for traditional birthing methods like water births, home birthing options and midwives, other centres have chosen to take an approach of catering to older mothers with certain degrees of complications that comes with increased age of the mother and artificial reproductive techniques. In a nutshell then, the levels of care that birthing centres have chosen to address goes a long way in influencing the design of the facility. Having said that, some of the major touchpoints as one journey sthrough the building that pose challenges while shaping the experience for the family are as follows: Main Lobby The purpose of the Main Lobby of a birthing facility, like in all other facilities, is always the first interaction with the brand and the facility. Therefore, this area must inspire confidence with a clean, bright and uncluttered environment. Thing to note is that unlike a traditional hospital, the lobby gets significant utilization post the discharge and as the extended family prepares to leave the facility with the new-born. Care must be taken to design furniture that is comfortable to new mothers as well as to address the larger groups of people awaiting a departure from the facility with a new-born and usually a significant number of paraphernalia. OPD The OPD is the place where the expectant family spends the bulk of their time during the duration of their pregnancy and even for postpartum purposes.Operationally, healthcare groups span between catering to low risk to high risk including perinatal services and the number of OPD rooms as well as related diagnostics is accounted for. The principal challenge in these spaces is to instil a sense of calm and feel decongested. The traditional setup of placing OPD exam rooms around the periphery of the floorplatewhile locating the waiting in the middle does little to alleviate the pointlessness of the activity of “waiting�. It also

Lobby main

does little by way of distributing the waiting population effectively to create the sense of a serene environment. However, if the waiting area is distributed along exterior windows and along the corridors leading to the assigned OPD chamber, the waiting is distributed and seems less congested. The waiting area is also a prime space to introduce engaging activities like a dietician’s corner or a reading nook for related activities for families as well as a play area that allows for quiet play time replete with soft surfaces and noise absorption materials.

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APPROACH India is witnessing a conspicuous transformation in birthing trends, particularly among the urban population. Couples are waiting longer to start a family; couples are also choosing to have fewer children

Patient room

Clinical Areas Robust Intensive Care Units for mothers and neonates, surgical suites and the labour, delivery units remain central to birthing facilities and goes a long way in lending confidence in the ability for a standalone unit to provide a safe environment for the birthing process. Colocating the labour/delivery unit along with the surgical suites as well as the neonatology unit allows for emergency situations to be tackled effectively without compromising on safety. The challenge in these units, especially the ICUs is that access must be provided to the families and yet the level of sterility has to be maintained at all times. It is imperative that even in tight urban footplates, these clinical and public pathways remain segregated and controlled in order to maintain levels of clinical sterility as desired in these high acute care areas. The flow for these areas for patients, supplies, staff and public should be charted carefully is of prime importance. The NICU is an area which is a challenging area to design – while it is a clinically sensitive area; it has also the burden of allowing the opportunity for families to interact and bond with the new-born under trying circumstances. Family rooms close to neonatology may be

utilized for a day or two before the baby is discharged in order for the parents to gain comfort in dealing with a fragile life before they go home. Well Baby Unit The vicinity of the surgical suite/delivery unit is also the one where the extended families meet the new born for the first time – a viewing gallery into the well-baby nursery adjacent to the surgery waiting area allows for staff to determine the wellness of the new born as well as allows for the extended family to interact with the new-born for the first time – this is a space that is often overlooked. Inpatient units Birthing is no longer just about the mother and female members of the family. In order to accommodate the father, it is imperative that the boutique chains allow for areas within the inpatient room for a father to stay connected, work and rest. A mother in labour must have access to areas for walking and other mechanisms in order to speed up labour. Some facilities are also adding the possibility of waterbirths and several natural methodologies to induce labour, and in some cases even delivery within the same room - all of which has an impact on the size and zoning of the room. Additionally, with the increase in multiple births, inpatient rooms must allow for the flexibility of locating more than one bassinet in the room. Ancillary Services Relationship with abirthing facilities spans at least nine months and then some for postpartum and new-born care.And given that the families visiting here are shopping for the safest and the most comprehensive experience including the support areas of pre-natal and ante-natal options, a robust facility that allows for classes to be conducted for physical and emotional well-being of the mother, perinatal health as well as new-born wellbeing, financial counselling, family counselling, safety education, etc as well as retail options like newborn paraphernalia, health food, exercise gear all add up to a holistic birthing experience for

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Graphics

the millennial family. In summary, healthcare services for the urban mom are focussing broadly on the following:  Retail Options: Millennial mothers and families are shopping for the safest and the most comprehensive experience including the support areas of pre-natal and ante-natal options, a robust facility that allows for classes to be conducted for physical and emotional well-being of the mother, perinatal health as well as newborn well being, financial counselling, lactation support, family counselling, safety education, etc as well as retail options like new-born paraphernalia, health food, exercise gear, new-born photography all add up to a holistic birthing experience for the millennial family and the design needs to accommodate flexible and multipurpose spaces that can address these needs.  Control: Like all encounters with a healthcare environment, it’s important to feel you have control over your environment, because there will possibly be lowered control in other areas. Simple things like being able to adjust lighting or play your

own music during labour and delivery make all the difference. After delivery, on-demand room service and a family kitchenette allow you to eat on your own schedule. Also, an integral part of staying in control is designing facilities that provide the ability to stay connected to the world via technology.  Safe and Healthy: This is the area with perhaps the most unrealized marketing potential. Millennial moms expect that anything coming near their baby is BPA, PVC, VOC and lead-free. Baby products are one consumer area where the precautionary principle (avoidance of substances known or suspected of human or environmental harm) is practiced and transparency in ingredients is expected. Urban families who will choose to have babies in the next 15 years are for the most part Millennial. They’re more of a consumer or a client. Consumer-driven healthcare is a new concept for the most part, but it is here to stay when it comes to this specific segment. They’re looking for a process that affords those choices, safety, and information all within a calming environment.

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CONSUMER CONNECT

Medical Education Innovation Q

ISHIQA MULTANI,

President- Sagar Hospitals Group, Advisor- Dayananda Sagar University

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uality healthcare and a strong education

healthcare services in the developed world. Similar

system are the pillars upon which self-

advancements have occurred, to a large extent, in

sustaining nations stand.

Despite a

the level of healthcare services provided within

population that had topped 1.3 billion people as of

India. Sagar Hospitals has been at the forefront

2017, India graduates a mere 64,000 doctors each

of this change, adapting the latest state-of-the-

year. In addition, fewer students are choosing to

art technologies into many of its hospitals.

study to become paramedics, nurses, and lab and

example, Sagar Hospitals was the first corporate

diagnostic technicians. Such shortages means that

hospital to design LDRP rooms in a hospital setting

our population far exceeds the available healthcare

in the early 2000s, and was one of the first in India

personnel necessary to provide the urgent and

to introduce 80 watt Green Light Laser for the

preventative care necessary for a healthy populace.

treatment of enlarged prostate. Very recently, Sagar

This downward trend raises an alarm for the

Hospitals installed GE Innova IGS 520 Cathlab, thus

government, the private sector, and our educational

demonstrating its commitment to the advancement

institutions.

We must find a solution to these

of India’s healthcare system through technology.

shortages so that we can create a quality workforce

We are taking our understanding of healthcare

that will contribute to the success of healthcare in

technologies and applying them to medical education

India.

too.

For

Dayananda Sagar University recognizes the

Medical education brings with it not only the

changes and challenges that exist within the

opportunity to educate our best and brightest,

healthcare industry and has begun to reshape

but also provides us with tools through which we

itself from being just informational to an active

can offer safe and high-quality healthcare to our

education developmental institution. Our healthcare

patients. As educators, we play a vital role in shaping

industry requires employees with advanced critical

and training our young people so that they can take

thinking, communication, and problem-solving skills,

leadership roles within the healthcare field and thus

along with the core clinical and technical abilities

help to improve our nation. With rapid advancements

we would expect from new graduates. Eager to

in technologies such as Cloud Computing, Internet of

keep up with industry trends, Dayananda Sagar

Things (IoT), Artificial Intelligence, Big Data Analytics,

University has designed new courses in the area

and Blockchains, it becomes necessary for our

of medical electronics that take an interdisciplinary

students to understand the responsibility that comes

approach to learning like medical technology and

along with their education. It is not enough simply

entrepreneurship.

We understand that many

to use these new technologies; rather, we wish for

students are looking for new ways to learn which

our students to understand the social and economic

better fit their goals and lifestyles; as such, we have

impacts that technological shifts and advancements

begun to integrate a blend of campus classrooms and

in healthcare may bring for our patients and our

supplementary interactive digital content in medical

nation. The interdisciplinary approach to medical

education to accommodate the changing needs and

education provided by Dayananda Sagar University

demands of 21st century students.

will help our students to understand the ‘big picture’

The technological advancements of the last

that goes along with their education because, in the

several decades have brought dramatic change to

21st century, a degree in healthcare is so much more


century, a degree in healthcare is so much more

teachers assist students in repeat training in a safe

global aspirations. As part of the national mission

than a simple piece of paper; it carries with it the

environment to enhance their diagnostic, procedural,

under the Make in India, digital India initiative,

ability to bring about great and positive change for

and interpersonal skills. We understand that not

our team of researchers, funded by Department of

all of our citizens. understanding the applications

every student learns in the same way, and the use

Science and Technology, are collaborating to create

and societal impact is necessary for our students.

of virtual teachers will allow for students to adjust

a single open-source platform for comprehensive

We envision Augmented Reality (AR) and Virtual

their learning pace. Data is the fuel of the digital

MR algorithm development inclusive of simulations,

Reality (VR) technologies having substantial impact

age, driving all decisions in a modern enterprise, and

pulse

in medical education.

As humans, we process

medical education is not an exception. Dayananda

reconstruction, and image analysis. Other large-scale

visual information better than any other type

Sagar University is using the latest technologies

and innovative projects are currently underway with

of information, and AR will allow for students to

in big data and Internet of Things to capture and

our team of researchers.

learn theoretical concepts in real-time with live

store data. We are also collaborating with industry

surgery lessons. They can also study the details and

partners to create better healthcare applications

transforming education in India.

practice the same surgery virtually using simulated

and improve student understanding of medical

that potential students desire an educational

VR models in a lab environment. In addition, VR

processes.

environment which is challenging, supportive, and

sequence

design

and

deployment,

Dayananda Sagar University is committed to We understand

models can help us to make more informed medical

At Dayananda Sagar University we value

innovative. It is not enough to provide our future

decisions by leveraging other technologies such as

innovation above all else. It is our mission to create

healthcare leaders with opportunities to learn; we

Artificial Intelligence and Big Data.

a learning environment which supports the organic

must also offer them intellectually-rewarding and

Current Artificial Intelligence advancements

growth of ideas. Under the mantra of ‘quality with

technologically-driven programs that can compete

in speech recognition, computer vision, and deep

frugality’, we aim to create healthcare leaders

with the best medical educations worldwide. In this

learning methods can be used to create virtual

who will address the current deficits within India’s

way we will produce healthcare leaders who will

subject matter teaching assistants. These virtual

healthcare system while also lending strength to its

transform our nation for the better.

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31


PULSE

Decaying Oral Health in Children

Dr Salil Choudhary, Managing Partner, Dental connect

DENTAL CARE is a critical part of keeping a child healthy from their first birthday into adulthood. The earliest risks to a child’s oral health are crooked tooth growth from sucking on pacifiers and baby bottles and tooth decay both of which can cause serious problems. Pedodontics is the art and science that deals with comprehensive, interceptive oral health in children from childhood to adolescent age particularly and complete health in general. In other words, it is the branch of dentistry that includes training of child to accept dentistry, restoring and maintaining mixed permanent dentition and applying preventive methods for dental care. Earlier, it was thought that three years would be a good time for the child to visit the dentist. Recent knowledge in pediatric dentistry has enabled us to realize that, three years is too late to initiate any type of preventive strategy as the disease would have already taken its toll on the teeth and it no longer remains preventive but becomes Interceptive Pedodontics. Today, there is general consensus that a child’s first dentist visit should be initiated as soon as the first tooth erupts in oral cavity and the preventive educative aspect should start much earlier, by parent counseling. Early Screening Dental decay in infants and toddlers is now collectively known as early childhood caries or ECC. Although the etiology of ECC is similar to that of other types of coronal smooth surface caries, the biology may differ in some respects. The bacterial flora and host defense systems are in the process of being established; in addition the tooth surfaces are newly erupted and

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August 2019

immature and may show hypoplastic defects. Early screening for signs of caries development, starting from the first year of life, could identify the risk of developing ECC and could also assist in providing information to parents about how to promote oral health and prevent the development of tooth decay. High risk children should be targeted with a professional preventive program that includes fluporide, varnish application, fluoridated dentrifices, fluoride supplements, sealants, diet counseling, and chlorhexidine. Treatment Approach Prevention of ECC also requires addressing the social and economic factors that face many families where ECC is endemic. The education of mothers or caregivers to promote healthy dietary habits in infants has been the main strategy used for the prevention of ECC. There are three general approaches that have been used to prevent ECC; first is the community-based strategy that relies on educating mothers in the hope of influencing their dietary habits as well as those of their infants. Second approach is based on the provision of examination and preventive care in dental clinics and the third involves the development of appropriate dietary and self-care habits at home. Rampant Caries Caries in early stages of life is an unsolved enigma for most of us around the world. Rampant caries is appearance of more than five new lesions in an individual of any age group in a year whereas nursing caries is any caries which occurs in children or may be attributed to bottle feeding habit. The essence here is that nurs-


ing caries is a type of rampant caries. Nursing bottle caries is characterised by a rampant caries pattern initially involving maxillary deciduous anterior teeth; posterior teeth are then involved and mandibular anteriors are usually spared. This condition is attributable to frequent prolonged contact with bottle containing sweet beverages or milk.

oral hygiene to their child’s teeth and should encourage parents to bring their child to the dental office before they are 12 months of age for a screening examination and counseling, because pediatricians are often the first medical personnel to see the newborn baby. However, interest and co-operation from the parent and child are equally important.

Importance of Diet The type of treatment instituted for patients with rampant caries depends on the patients and parents motivation toward dental treatment, the extent of the decay, and the age and co-operation if the child. Initial treatment, including provisional restorations, diet assessment, oral hygiene instruction, and home and professional fluoride treatments, should be performed before any comprehensive restorative treatment commences. Because diet is on the major factors in the initiation and development of caries, a dietary assessment should form or fundamental part of the examination. If bottle feeding is still being practiced, particularly at night, it should be stopped by gradually diluting the bottle contents with water as well as decreasing the amount of added sugar over a 2 or 3 weeks period and finally substituting the bottle with a feeding cup. Once rampant caries is under control, comprehensive restorative treatment can be carried out. If the patient is seen at an early stage, when caries is still in the incipient or white spot stage, and there is minimal or no loss of enamel surface integrity, an improvement in oral hygiene technique, a change in dietary habits, and weekly home or professionally applied topical fluoride therapy will help arrest the lesions, and the need for restorations may be obviated. Unfortunately, dental treatment is only sought for most children with rampant caries when extensive cavitation has occurred and restorative treatment is required. Successful management of rampant caries depends on a co-ordinated team approach among the pediatrician,pediatric dentist,parents and child. The pediatrician should educate the parents about good nursing and dietary habits and the importance of good

Indian Scenario Unfortunately, large numbers of children in India have poor oral health, including untreated tooth decay, infection and pain. Oral health has been often overlooked, impediment to student learning and achievement. Poor oral health has resulted in failure to thrive, impaired speech development, absence from and inability to concentrate in school, and reduced self-esteem. Poor oral health has been related to decreased school performance, poor social relationships and less success later in life. Schools can be important partners in promoting good oral health practices and preventing oral disease among students. Schools have been and will continue to be an important environment for the dissemination of disease prevention information. Because the classroom maximizes the number of children reached simultaneously. Students will be better prepared to learn and succeed if the school environment, policies and personnel are aligned to help them maintain their oral health.

The earliest risks to a child’s oral health are crooked tooth growth from sucking on pacifiers and baby bottles and tooth decay both of which can cause serious problems

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33


INTERVIEW

India Lacks DNA Database Law Tim Schellberg, Founder and CEO, Gordon Thomas Honeywell talks to Divya Ramaswamy about India’s DNA database Policy GORDON THOMAS Honeywell Governmental Affairs is globally recognised public affairs consultancy firm that has expertise with forensic DNA database policy, legislative and law. For nearly twenty years, consultants at GTH-GA have consulted in over 50 countries and states on legislation and policies to establish or expand criminal offender DNA databases. GTH-GA collaborates closely with governmental officials, crime labs, police and the DNA industry. GTH-GA operates the DNAResource.com website that has been used as the world’s primary source for DNA database policy and legislative information since 2000.

What is the volume of forensic DNA testing work in India? Recent estimates by Gordon Thomas Honeywell 2018 highlighted that the number of DNA profiles developed from crime scene evidence has doubled over a year from 10,000 cases tested in 2017 to nearly 20,000 this year. Additionally, led by Delhi and Maharashtra, India’s forensic laboratories have managed to reduce pendency of DNA testing cases by a 50 per cent national average. While Delhi reduces pendency of 9,000 DNA tests to near zero, Maharashtra is upgrading facilities across regions to reduce backlogs that stood at 1,700 DNA cases in 2017.

This increase in DNA casework can be attributed to an upward trend in reporting of rape & sexual violence cases owing to public awareness and activism along with steps taken by the government to upgrade police and forensic infrastructure keeping women in mind. While this indicates progress in the right direction, we still have a long way to go to ensure zero backlogs across all states as well as keeping up with the. What are the biggest changes you have seen in India’s forensic infrastructure? The larger Cities/States have been buying more DNA sequencers and other DNA equipment due to the increased demand. However, with few exceptions, the middle and smaller states still do not have the necessary DNA infrastructure. How do you see forensic DNA testing evolving and where do you see the most investment in the next 3-5 years? The evolution in India will focus on basic capacity building to do DNA casework due to increased demand. States must invest in making sure they can quickly test DNA casework against known offenders. This will be the focus during the next 3-5 years. If the DNA database legislation passes, the national government must also quickly invest in offender sample. This would also be a focus in the next 3-5 years. What forensic testing methods you think will be discontinued in another ten years? And what

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August 2019


Tim Schellberg, Founder and CEO, Gordon Thomas Honeywell

newer forensic DNA testing techniques do you believe hold promise for the future? I do not see any DNA testing methods being discontinued. The CE method using the 20 or so STR’s is here to stay during this time frame. I do see supplemental technologies entering the picture during this. Next Generation Systems (NGS) will be used in complex casework, mixture cases, etc. Also, Rapid DNA machines will be used when quick responses are necessary, or in remote areas. What do you think are the main differences in forensic DNA testing practices you see when comparing India with that of other countries? The main difference between India and other developing countries is that India does not automatically collect, test and compare DNA against known suspect in all sexual assaults and homicides. India does use DNA in these cases, but it is still at small percentage. What do you think the Indian DNA law lacks, compared to other countries? What India lacks is a DNA database law. India and Indonesia are the only large countries in the world not to have a DNA database law. 59 countries have this legislation and as a result these countries match crime scene DNA to unknown suspect on daily basis. India does not have this. As a result, many crimes go unsolved. Hopefully, the legislation before the Indian Parliament now will pass soon.

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35


FEATURE

Early Intervention Crucial for Children with Hearing Loss EACH OF the sense organs in the human body enables a crucial function. Any defect in one or more of these sense organs can affect the entire body and overall growth more so in children. One of the rising concerns that have been observed in children ishearing loss.

Dr Rohit Udaya Prasad, Consultant- ENT & Cochlear Implant Surgery, Aster RV Hospital

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August 2019

Speech and Hearing For a growing child, speech and hearing are way more important than an adult as those are the instruments of learning, playing and building social skills during the developing years. If a child suffers from hearing loss and it goes undetected or untreated, there is a lot that the child misses out on in their surrounding especially related to speech and language. The delay in treatment or action can lead to delay in speech and/or language development, social behavioral issues and academic difficulties. According to WHO, 60 per cent of childhood hearing loss can be prevented. The temporary hear-ing loss in many children can be restored with medical treatment or minor surgery. If a child has sensorineural hearing loss, it is permanent.However, thanks to the advances in medical science, almost all of hearing loss can be treated if timely identified. Early intervention remains the keys-tone for better outcomes in terms of hearing and speech. The hearing loss in children are of two major categories that is congenital (present from birth) and acquired (occurring after birth). Hearing loss is also classified as pre-lingual (before the de-velopment of language), Peri-

lingual (during language development) and post-lingual (after lan-guage development). Causes Hearing loss in children can occur as a result of various possibilities, irrespective of being congenital or acquired. Children can suffer from conductive, sensorineural or the mixed form of hearing losses. Some of the possible causes of congenital hearing loss are infections at the time of pregnancy (German measles, toxoplasmosis, and cytomegalovirus) or medication like Ototoxic used during pregnancy. Congenital hearing loss can also occur due to birth complications or nervous system or brain disorder. Genetic syndromes, foreg., Ushers, Down’s and Waardenburg’s syndromes and family history of hearing loss are other causes of hearing loss. Acquired hearing loss is likely to happen due to some of the following reasons:  Middle-ear infections left untreated  Other infections like meningitis, mumps, measles or whooping cough  Eardrum perforation  Excess of exposure to extreme noise, such as fireworks or loud music  Diseases like otosclerosis or Ménière’s disease  A serious injury to the head  Ototoxic medication  Earwax


Signs of hearing loss in children For that, it is significant to observe the child for any signs of potential hearing loss. Some of the noticeable symptoms in the child include:  Turning up the volume of the TV excessively high  Not responding appropriately to questions  Not replying to call  Watching others imitate what they are doing  Have articulation problems or speech/ language delays  Academic struggle  Earaches, ear pain or head noises complaints  Difficulty in understanding what people are saying  Appear to be speaking differently from other children his or her age It is very important for parents, teachers, caretakers, guardians and physicians to carefully ob-serve the child for any of the above signs and make sure they are provided with early diagnosis, early hearing aids fitting/cochlear implant surgery if needed, early initiation of special education programs that can help enhance the child’s hearing and understanding and ensure better development early on. If not taken note of, hearing loss is a lifetime loss for a child who will face

de-velopmental challenges, emotional issues, self-esteem struggle, and societal challenges for their entire life. Early Diagnosis and Intervention The most effective treatment is achieved through early diagnosis and intervention. Universal newborn screening is done at birth to identify children with potential hearing loss. When identi-fied, these children can be further assessed with a series of audio logical tests and radiological assessment of the inner ear structures. Children with severe to profound hearing loss can be treated as early as 8 months of age with the help of cochlear implant surgery. Following cochlear implant surgery, the child can undergo aural habilitation and develop good hearing and speech. This will enable the child to enter mainstream schooling and lead a normal life. The neural emergency period in congenital hearing loss is up to the age of 2 years. If intervention is done within this period, the best possible outcomes in terms of speech and hearing can be achieved. Delay in surgical intervention by cochlear implant surgery, poorer the outcomes in hearing and expressive language.

According to WHO, 60 per cent of childhood hearing loss can be prevented. The temporary hearing loss in many children can be restored with medical treatment or minor surgery

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37


INNOVATE

Can Abnormal Embryos Result in Successful Fertilization Study in nonhuman primates gives new hope to people seeking infertility treatment Source: Oregon Health & Science University OHSU/Shawn Chavez, Ph.D.

The biological process of cell fragmentation (shown here) plays an important role in identifying genetic abnormalities within an embryo

NOT EVERY embryo contains 46 perfect chromosomes. Some have more, others have less. The result is a common abnormality known as aneuploidy, which occurs in as many as 80 percent of human embryos. Because aneuploidy has been linked to a risk of in-vitro fertilization (IVF) failure, miscarriage and certain genetic orders or birth defects; mosaic

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July 2019

embryos, those with both normal and abnormal cells, have not been considered ideal candidates for IVF transfer. For many individuals who only produce mosaic embryos, this can mean that the IVF journey may end before it begins. New research conducted by scientists at the Oregon National Primate Research Center at OHSU, in Portland, Oregon, gives new hope


Not every embryo contains 46 perfect chromosomes. Some have more, others have less to those seeking infertility treatments. Their findings published in the journal Genome Research. The study, led by Shawn L. Chavez, Ph.D., is the first to confirm in a nonhuman primate model that mosaic embryos can adapt to their abnormalities and persist in development, resulting in positive IVF outcomes. Using advanced time-lapse imaging and single-cell sequencing techniques to precisely track the development of mosaic embryos of a rhesus macaque, Chavez and team identified a unique relationship between mosaicism and two other biological processes: cell fragmentation and blastomere exclusion. In-utero and after IVF, large cells formed by the division of a fertilized egg, known as blastomeres, may break down into small pieces called cellular fragments. “We found that both the blastomeres and their fragments can act as trash bins within the embryo. As DNA-carrying cells divide and/ or fragment, the embryo appears to naturally identify which blastomeres have genetic abnormalities and stop them from further development,“says Chavez, an assistant professor of reproductive and developmental sciences at ONPRC at OHSU, and an assistant professor of obstetrics and gynecology, and physiology and pharmacology in the OHSU School of Medicine.

“By the stage that an embryo would implant into the uterus, these abnormal cells, or DNA have been visibly excluded from the rest of the embryo, suggesting that imperfect IVF embryos could be considered for use in transfer and might have the ability to endure in utero.” According to Paula Amato, M.D., an associate professor of obstetrics and gynecology in the OHSU School of Medicine, this discovery could positively impact IVF processes for humans in the future.” While selecting embryos with a normal chromosome complement is preferred and carries a high chance of pregnancy success, it is not a guarantee. For patients with only mosaic embryos available for transfer, these findings suggest that in some cases, these embryos will result in apparently normal pregnancies.” Ongoing research will use live-cell time-lapse imaging to better understand the relationship between aneuploidy, cell fragmentation and blastomere exclusion within the embryo. The scientists believe these results could open up new avenues for testing the efficacy of mosaic human embryos. “We expect that the overall results will be similar to the story of the ‘dark horse,’ said Chavez. “While not perceived as a contender at the start of the IVF race, a mosaic embryo may still be capable of winning and resulting in something wonderful,” she said.

Shawn Chavez, Ph.D. (OHSU)

OHSU/Shawn Chavez, Ph.D.

Researchers the Oregon National Primate Research Center at OHSU found that blastomeres (images 1-3) and their cellular fragments (image 4) can act as a trash bin within a mosaic embryo, and exclude genetic abnormalities

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39


IMPACT

Business Stress in Small & Mid-Sized Hospitals

Rama Venugopal, Executive Director, Value Added Corporate Services Pvt. Ltd, Chennai

Dr Aniruddha Chimote, Director, Hosconnn Consulting Services Pvt. Ltd, Nasik

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August 2019

CHANGING DYNAMICS in the Indian entrepreneurial ecosystem is altering ways of doing businesses. Hospitals are businesses too and a shifting external environment is causing many imbalances in the internal environment of a hospital. Running small and mid-sized hospitals is becoming increasingly stressful, the signs and symptoms are becoming too obvious to miss. Continuous stress in any business leads to sickness of the business. In an attempt to quantify this business stress faced by small and mid-sized hospitals, a survey was conducted recently by Smart Hospitals team. The survey had a good response and outcome was a validation of the challenges faced by this segment. Why this survey Smart Hospitals platform comprises of expert consultants who have been working in the Indian healthcare sector for many years. Over the last couple of years these consultants began picking up indications that small and mid-sized healthcare facilities are going through turbulences; causes and effects were multifoldbut uniquely different from those of large hospitals.

nursing homes. The average size of a nursing home is around 25-30 beds which is operated by a single specialty doctor or family of doctors or a groups of two or three doctors. And most of these small hospitals cater to mother and child care, general medicine or general surgery. Their advantages such as accessibility, cost, personalised service are still the USPs of these mid-sized hospitals. Recently, there have been a number of red flags popping up across this sector. Some of them are: Mounting financial stress  Shutdown of small hospitals  Medical entrepreneurs exiting businesses  Corporate brands taking over small hospitals for O & M  Clamping down of stressed assets by bankers  Medical practitioners quitting practice citing fatigue, burnout, lack of motivation, regulatory challenges Small and mid-sized hospitals are essential for the wellbeing of the society as communities cannot depend only on large hospitals. A survey was formulated to reach out to the market to validate the signals.

Red flags Small hospitals in India have their roots in family physicians system. In the post independent India 1960’s and 70’s, there were only large government hospitals to cater to the Indian population, which were very few and mostly in larger cities. People mostly had a family physician that took care of their healthcare requirements. These family physicians set up the first set of nursing homes in smaller cities. It was common across India for doctors to set up their own clinics or

Approach The survey titled “What is causing Business Stress in Small and Mid-Sized Hospitals?” was conceptualized and designed by Rama Venugopal, Executive Director, Value-Added Corporate Services Pvt Ltd, Chennai and Dr. Aniruddha Chimote, Director, Hosconnn Consulting Services Pvt Ltd, Nashik. The survey aimed to collect feedback on business stress and the causes for the stress, only from small and mid-sized hospitals (hospitals with bed size of 0-15 and above 200 were excluded from


the study, bed size under 15 was considered as micro hospitals). It was a pan-India online survey with questions related to causes of business stress that were picked up from market place - falling revenues, increasing expenses, managing finances, managing day-to-day hospital operations, stressful loan repayments, regulatory environment, changing market dynamicspatient expectations, their willingness to pay for services. The study was designed to be a dipstick survey and did have its limitations. The online survey was presented through Social Media platforms and mail campaign. The survey launched on 19 March was kept open till 8 April 2019. It received 236 responses from across India, majorly from Western Region especially Maharashtra, followed by Southern Region.

Hospitals are businesses too and a shifting external environment is causing many imbalances in the internal environment of a hospital Results The sample pool was divided into three categories – 16-50 bedded, 51-100 bedded and 101-200 bedded hospitals and a statistical analysis of the responses was done. The key takeaways from the survey revealed that falling revenues was a major cause of stress – this was more pronounced in 16-50 bedded category. Stress of increasing expenses was unanimous

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IMPACT - increased salary expenses due to implementation of minimum wage act in many states, increased establishment costs. High cost of equipment acquisition and maintenance and reduced insurance reimbursement were other stress factors. Stress due to loan repayments – responses were ambivalent but were related to decreased profitability. Stress due to changing regulatory environment was noteworthy – Govt. schemes like Ayushman Bharat has put hospital revenues under severe stress, regulations are constantly changing and conflicting leaving the hospital stressed. Increasing competition – clustered hospitals did have negative impact on revenue but large sections of population still have no proper access to quality care. Changes in patient expectations was a major cause of stress- While healing remains at the center of the hospital experience the hospitality expectations have increased causing severe stress to small hospitals.

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August 2019

Conclusion Hospitals across the country are facing intense heat and challenges in managing businesses in the recent years. Small and mid-sized hospitals are the worst hit as their ability to withstand strain on their revenues for a long time is limited. Prominent reasons for stress are falling revenues, rising costs, changing regulations and growing patient expectations. It is time for small hospitals to reinvent themselves to survive, these facilities have to adapt to changes in the healthcare scenario. Smart solutions are the need of the hour because healthcare domain is unique and unlike other businesses, the way of doing business in healthcare is different. Collaboration with other specialty hospitals homes, laboratories and pharmacies are also a good strategy. Hospital owners need to explore newer formats for healthcare delivery. Formats like home healthcare and telemedicine have been tried with varying degree of success but more needs to be done in this area. Faster bed turnover and adding value to patients’ experience could be one on the ways to fortify revenues.


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