National Health Portal: Time for a reality check Vol 9 I No 7 I June 2013 I www.modernmedicare.co.in I ` 100
Scan this code on your smart phone to visit www.modernmedicare.co.in
Neurology devices market
Driven by ageing population and developing world Microcatheters and advance imaging How neurological diagnosis is proceeding? Advancements in critical care
Reaching greater heights
Critical care nursing Paving way for a better future
Hospital architecture Reviewing the top 10 emerging trends
Medical waste management Need for effective strategies for a sustainable environment
Dr B S Singhal Director, Department of Neurology, Bombay Hospital
Opioids: Derisking the benefits pioid analgesics have historically been used as key pain medications across the world. While these benefit patients (for both non-cancer and cancer-related pain) significantly when properly used with approved indications, opioids also pose risk of abuse, misuse and in extreme cases, death. Of late, the growing concern about the inappropriate use of such drugs has become a major challenge before the public health systems of many countries. As far as the market for abuse-resistant opioid products is concerned, expert opinion suggests its current developmental pipeline to be rather small with hardly any novel compound and strong saturation across multiple pain indications. However, as the concentration and competition among such drugs increase, it is likely to provide a driving force in this largely stagnant market. As the recent trends in opioid abuse and dependency see a rise, there needs to be more concerted efforts towards developing abuse-resistant formulations of extended-release opioid analgesics, including both novel products and reformulations of existing ones. Also, it will be prudent to put in practice stricter regulations to get a better grip on this growing phenomenon. It will be topical to provide here an example of rigorous regulations that are in place to control the opioid drug market. In the US, almost every marketing approval for an (Extended Release) ER opioid launched recently has been accompanied by a Risk Evaluation and Mitigation Strategy (REMS). This requires the licence holders to provide physician training and raise patient awareness regarding the risks of opioid abuse. Besides, for many orally administered ER products, post-marketing studies examine the efficacy of abuse-resistant formulations. In this context, a recent research report titled â€˜Opioids market overview â€“ Increasing concentrations of abuseresistant branded generics alter competitive dynamics in this flat marketâ€™ offers useful insights. Released by leading business intelligence provider GBI Research, this report provides an overview of the current opioid product market, profiles of the most important opioid products, pipeline analysis of the opioid products currently in development, and an overview of mergers & acquisitions and licensing deals as well as co-development deals, across multiple indications. Further, it predicts the opioid pain management market to continue to evolve over the coming years with new products and post-marketing studies that aim to reduce the risk of abuse. As the decibel of debate in the medical and health policy communities gets louder about the best ways to ensure appropriate use of opioids, the need of the hour is to strike the right balance between their benefits in treating patients with moderate to severe pain and the risks associated with their misuse, abuse and addiction to the patients and possibly, others.
Editorial Advisory Board Dr Yash Paul Bhatia MD-Astron Hospital & Health Consultants Pvt (India) Ltd and Member, Editorial Advisory Board, Joint Commission Journal of Quality and Patient Safety, USA
Manas R Bastia firstname.lastname@example.org June 2013 I
REGULAR SECTIONS 05 Editorial
90 Event List
16 News, Views & Analysis
92 Book Review
24 Technology & Innovation 93 Products
In Conversation With
28 Technology Transfer
100 List of Products
103 List of Advertisers
Dr B S Singhal Director, Department of Neurology, Bombay Hospital
Neurology ................................... 39
Automation Trends Solutions for Indian healthcare Welcome to the tech future! ......................................72
Neurology devices market...................................................... 40 Managing radiation exposure in patients................................ 42
Microcatheters and advance imaging .................................... 46
Medical waste management Need for effective strategies for a sustainable environment ..............................................................76
Interface - Dr Arun Garg....................................................... 48 Interface - Dr N K Venkataramana ........................................ 50 Roundtable ........................................................................... 52
Policies & Regulations National Health Portal Time for a reality checkâ€Ś .............................................78 Rajendra Pratap Gupta, International Healthcare Expert and President - DMAI
Facility Visit Dr L H Hiranandani Hospital, Mumbai Where quality meets care
Strategy NABH-accredited Small Healthcare Organisations (SHCO) Revolutionising business with turnaround strategies ..82
Insight & Outlook
Critical Care .......................... 57
Indradip Das, Hospital Planning & Operations Management Expert - Fortis Medical Centre, Kolkata
Advancements in critical care ........................................... 58 Ethical issues faced in critical care ................................... 60 Critical care nursing ......................................................... 64 Interface - Ameera Shah .................................................. 66
Tips & Tricks Hospital architecture Reviewing the top 10 emerging trends ....................84 Gp Capt (Dr) Sanjeev Sood, Hospital Administrator and NABH Assessor
Interface - Dr Paresh Navalkar ......................................... 68 Roundtable ..................................................................... 70
Highlights of Next Edition: Special Focus: Dermatology Insight & Outlook: Hospital Audit Note: ` stands for Indian rupee, $ stands for US dollar and ÂŁ stands for UK pound, unless mentioned otherwise
June 2013 I
FOUNDER & EDITOR, NETWORK 18 Raghav Bahl PRESIDENT & EDITORIAL DIRECTOR, TV 18 Senthil Chengalvarayan EDITOR-IN-CHIEF, WEB & PUBLISHING R Jagannathan SENIOR EDITOR Manas R Bastia EDITORIAL TEAM Parita Dholakia, Savita V Jayaram, Pallavi Mukhopadhyay, Anubhav Sharma, Rishab Kothari, Nikunj Sharma (Delhi), Hardik Ashar (Bengaluru) ART DIRECTOR Varuna Naik DESIGN Varghees Tharakan CHIEF PHOTOGRAPHER Mexy Xavier PHOTOGRAPHY Joshua Navalkar, Nachiket Gujar BUSINESS CONTROLLERS Surekha Karmarkar, Lovey Fernandes, Akshata Rane, Deepak Bhatia, Ashish Kukreti, Shwetha ME, Jayashree N, Sugandha Kulkarni, Shefali Mahant, Varsha Nawathe
Surekha Karmarkar, Ravikumar Potdar, Ravi Salian, Sanjay Shelar
CHINA 1001 Tower 3, Donghai Plaza, 1486 Nanjing Road, West, Shanghai 200040, China Tel: +86-21 6289 – 5533 Ext. 368, Fax: +86-21 6247 – 4855 (Craig Shibinsky) Email: email@example.com Ringier Trade Media Ltd HONG KONG 9/F, Cheong Sun Tower, 118 Wing Lok Street, Sheung Wan, Hong Kong Tel: +852 2369 – 8788 Ext. 21, Fax: +852 2869 – 5919 (Octavia Au-Yeung) Email: firstname.lastname@example.org Ringier Trade Media Ltd TAIWAN Room 3, Fl. 12, No. 303, Chung Ming S. Rd., Taichung, Taiwan Tel: +886-4 2329 – 7318 Ext. 16, Fax: +886-4 2310 – 7167 (Sydney La) Email: email@example.com Ringier Trade Media Ltd GERMANY, AUSTRIA, SWITZERLAND Tel: +41-44 734 0472, Fax: +41 44 734 0680 Email: firstname.lastname@example.org Ringier Trade Media Ltd
USA Tel: (513) 527-8800 Fax: (513) 527-8801 Email: email@example.com USA Alfredo Domador, 6505 Blue Lagoon Drive, Suite 430 Miami, FL. 33126, USA Tel: (305) 448-6875, Fax: (305) 448-9942
GROUP CEO, NETWORK 18 B Sai Kumar CEO-NETWORK 18 PUBLISHING Sandeep Khosla EVP-HUMAN RESOURCES Sanjeev Kumar Singh ASSOCIATE VICE PRESIDENT Sudhanva Jategaonkar ADVERTISING SALES Shashin Bhagat (Ahmedabad) firstname.lastname@example.org Mahadev B (Bengaluru) email@example.com Hari Hara Subramaniam (Chennai) firstname.lastname@example.org Balakrishnan S (Coimbatore) email@example.com Surendra Agarwal (Delhi) Surendra.firstname.lastname@example.org Sunil Dakur (Hyderabad) email@example.com Ameya Gokhale (Indore) firstname.lastname@example.org Sandeep Arora (Jaipur) email@example.com Abhik Ghosal (Kolkata) firstname.lastname@example.org Inder Dhingra, Surajit Bhattacharjee (Ludhiana) email@example.com firstname.lastname@example.org Olwin Dsouza (Mumbai) email@example.com Rohit Dass (Pune) firstname.lastname@example.org Vipul Modha (Rajkot) email@example.com Chirag Pathak (Vadodara) firstname.lastname@example.org MARKETING TEAM Ganesh Mahale, Akshaya Jadhav
NEWSSTAND AND SUBSCRIPTIONS
DISTRIBUTION HEAD Sunil Nair DEPUTY GENERAL MANAGER Manoj Palsay SENIOR MANAGER - SUBSCRIPTIONS Sheetal Kotawdekar CO-ORDINATORS Rahul Mankar, Anant Shirke, Sarita Quadros, Chaitali Parkar, Kamlesh Mathkar, Vaibhav Ghavale
SUBSCRIPTION SERVICES For subscription queries, write to email@example.com or call +91 22 30034631-34 or toll free 1800 200 1021 PERMISSIONS For subscription to copy or reuse material from Modern Medicare, Write to firstname.lastname@example.org Monthly Issue Price: ` 100 $QQXDO6XEVFULSWLRQ` 899
Views and opinions expressed in this magazine are not necessarily those of Network18 Media & Investments Ltd (Network18)*, its publisher and/or editors. We at Network18 do our best to verify the information published but do not take any responsibility for the absolute accuracy of the information. Network18 does not accept the responsibility for any investment or other decision taken by readers on the basis of information provided herein. Network18 does not take responsibility for returning unsolicited material sent without due postal stamps for return postage. No part of this magazine can be reproduced without the prior written permission of the publisher. Network18 reserves the right to use the information published herein in any manner whatsoever. Printed by Mohan Gajria and published by Lakshmi Narasimhan on behalf of Network18. Senior Editor: Manas R Bastia Printed at Infomedia 18 Ltd, Plot no.3, Sector 7, off Sion-Panvel Road, Nerul, Navi Mumbai 400 706, and published at Network18, ‘A’ Wing, Ruby House, J K Sawant Marg, Dadar (W), Mumbai - 400 028. Modern Medicare is registered with the Registrar of Newspapers of India under No. MAHENG / 2007 / 21987. Network18 does not take any responsibility for loss or damage incurred or suffered by any subscriber of this magazine as a result of his/her accepting any invitation/offer published in this edition. *Ownership of this magazine stands transferred from Infomedia18 Ltd (Infomedia18) to Network18 Media & Investments Ltd (Network18) in pursuance of the scheme of arrangement between Network18 and Infomedia18 and their respective shareholders and creditors, as approved by the Hon’ble High Court of Delhi and the necessary approval of Ministry of Information and Broadcasting is being obtained.
June 2013 I
RedeďŹ ning our Identityâ€Ś with the new logo Janak Healthcare Pvt Ltd is a recognised and trusted player in the healthcare segment in India and pioneers in delivering quality healthcare solutions employing ethical business practices. Janakâ€™s continuous strive for Innovation makes Janak an expert in the segment it serves. A pulsating and vibrant work culture involving learning, training and development of teammates across the organization and recognizing and rewarding their achievements makes Janak Healthcare a progressive organisation.
News, Views & Analysis
In Brief Fortis to complete divestiture of Dental Corporation to BUPA for $ 270 million Fortis Healthcare announced that one of its stepdown subsidiaries will complete the divestiture of its entire holding in Dental Corporation Holdings Ltd by May 31, 2013 in favour of insurance major, Bupa. The Supreme Court of Victoria approved the scheme of arrangement for Bupa Australia health Pvt Ltd. to complete its full acquisition of Dental Corporation. Fortis had announced the sale of its entire stake in Dental Corporation, in December 2012. Fortis will receive A$ 2.347 per Dental Corporation share, aggregating to A$270.38 million. Fortis had acquired Dental Corporation in January 2011 and grew it from 140 dental practices to around 200 dental practices in Australia, New Zealand and Canada. The model however, remained confined to these countries. It found limited acceptance in other Fortis geographies, as originally envisaged, prompting the divestiture. Fortis Healthcare has demonstrated remarkable agility and has reacted swiftly to take advantage of changes in the competitive landscape as well as growth opportunities.
UK to focus on primary healthcare in India UK health delegation, who is currently visiting India, is planning to focus on the healthcare sector in India. A network of clinics in Chennai that will deliver home care, diagnostics and pharmacy services is in the pipeline, said Dr Rajnish Mohindroo, CEO, Brit Health Care. He was speaking at the Indo-UK healthcare meet organised by the Confederation of Indian Industry (CII) along with the UK Trade & Investment (UKTI) in the city. Representatives of many such UK-based companies led by British cabinet minister, Kenneth Clarke were in India, to explore ways of contributing to the healthcare system in the country. “A unique feature of the UK healthcare system is the General Practitioners (GPs) who provide preventive care and health education act as a gateway to a whole range of services from day-today domiciliary care to hospital care,” said Clarke. Though India has low-cost high-quality treatment, the scale on which it is needed has to be understood, “The UK delegation can help with the quality part by educating Indian professionals with concepts such as telehealth that will reach rural areas,” Shobana Kamineni, CII Public Health Committee Chairperson said.
I June 2013
GE Healthcare enters into PPP with Government of Maharashtra for diagnostic facilities GE Healthcare has entered into a Public Private Partnership (PPP) with the Government of Maharashtra. The association includes the Public Health Department of the Government of Maharashtra, Wipro GE Healthcare Pvt Ltd and Ensocare by Enso Group. Under this project, GE Healthcare will set up advanced diagnostic facilities at 22 Government district and women hospitals in Maharashtra at an investment of `150 crore. The diagnostic facilities will operate on round-the-clock basis and provide services at Government recommended rate cards for the benefit of the masses. Orange and Yellow ‘Below Poverty Line’ (BPL) card holders will be entitled to receive free diagnostic services under the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) scheme at all 22 facilities, which are expected to be operational within a year. Speaking on the occasion, Shri Prithviraj Chavan, Chief Minister, Government of Maharashtra said “We are on to a first of its kind, large scale modernisation of district hospitals with latest diagnostic technologies. We hope to give benefit of this PPP model to patients under Rajiv Gandhi Jeevandai Arogya Yojana Scheme in the State and also lower the costs for all categories of patients.” The PPP agreement with Government of Maharashtra includes the installation of 4 units of 64 slice CT scanners, 13 units of advance 16 slice CT scanners, 8 units of cutting edge 1.5T Magnetic Resonance Imaging Systems, 22 high-end digital radiography systems, 39 color Doppler’s and 39 analog x-ray units. These advanced imaging systems will allow District Hospitals provide early diagnosis on a 24/7 basis in various clinical specialty areas. Commenting on the partnership, John Rice, Vice Chairman, GE said, “Providing high quality, accessible and affordable healthcare is one of the biggest challenges faced by governments all over the world and such progressive public private partnerships will help patients get access to advanced and affordable healthcare that previously wasn’t available to them.” Besides, GE is also working on smaller projects with other states. They aim at training more individuals who can accurately operate diagnostic equipment at hospitals. Their rural mission is to reduce the costs of vaccines and make rural India self reliant. Pallavi Mukhopadhyay
Tamil Nadu to get VET’s integrated healthcare facility with the help of Accenture Velammal Educational Trust (VET), a Tamil Nadu-based group of 25 educational institutes has awarded a technology counsulting contract to Accenture to help in establishing an integrated healthcare facility in the city of Madurai. This facility will comprise a medical college, teaching hospital and corporate hospital. Accenture will assist VET’s overall strategy and the market positioning for the healthcare facility. By using Accenture Connected Health Services, the effort will also include the development of a technology strategy and implementation of Health Management Information System (HMIS) for the Velammal Medical College Hospital & Research Institute (VMCHRI). “We are in the process of operationalising a leading healthcare facility which is expected to be one of the largest private hospitals in India as well as Asia,” said MV Muthuramalingam, Chairman, VET. “We are pleased to have Accenture assistance in attracting high quality talent and developing an optimal positioning of the hospital in our bid to make the facility into a world-class institution.” As part of this effort, both organisations will help define the roles and responsibilities of the senior leadership for the healthcare facility. Accenture will also work with VET Leadership to develop and define their long term technology road map for their healthcare facility.
News, Views & Analysis
In Brief Zydus Cadila Q4 net profit up by 54 per cent
Zydus Cadila posted net profit of ` 263 crores, up by 54 per cent from ` 171 crores. During the quarter, the company registered gross sales of ` 1,599 crores, up by 16 per cent from ` 1,379 crores in the corresponding period last year, on a consolidated basis. The Board of Directors declared an interim dividend of ` 7.50 (150 per cent) per equity share of ` 5 each.
Carestream ships more than 6,000 wireless DR detectors Carestream Health has shipped more than 6,000 DRX detectors since launching the CARESTREAM DRX-1, a wireless X-ray detector used in surgical suites, ER/ICU and radiology departments—as well as clinics, imaging centers, nursing homes and field military hospitals. The DRX-1 detector delivers high-quality, affordable digital X-ray images in about four seconds. “Our wireless DRX detectors and DRX systems deliver exceptional image quality while simultaneously improving productivity and controlling costs,” said Diana L Nole, President, Digital Medical Solutions, Carestream Health. The family of DRX-based systems help streamline workflow, improve productivity and enhance patient care in both in-room and mobile environments. Carestream’s DRX detectors work with existing X-ray equipment and can easily be moved to any DRX room or mobile DRX system, a feature referred to as the ‘X-Factor.’ Healthcare providers can also move the detectors to new imaging systems when existing X-ray systems become outdated.
Beard hair can be used for hair transplant surgery Indian medical sector is embracing new techniques everyday for hair restoration. Delhi-based hair transplant surgeon Dr Arvind Poswal, reveals that beard hair acts as an additional advantage and saviour for people who lie under the belt of ‘extreme hair loss condition.’ “Recently I treated a 29 year-old male patient with moderate hair loss he wanted to go for hair restoration surgery. When he came to me he had already underwent a scalp expansion and flap procedure with some other doctor. But due to mistakes in the flap procedure and in patient selection, the results were not aesthetically acceptable,” said Dr Poswal.
I June 2013
Landmark study pinpoints rotavirus as major cause of diarrhoeal disease among Indian children A new international study published in The Lancet provides the clearest picture yet of the impact and most common causes of diarrhoeal diseases, the second leading killer of young children globally, after pneumonia. The Global Enteric Multicenter Study (GEMS) is the largest study ever conducted on diarrhoeal diseases in developing countries, enrolling more than 20,000 children from seven sites across Asia (including India) and Africa. With more than one lakh children dying every year from diarrhoea in India, and approximately 4,57,000 to 8,84,000 hospitalisations and two million outpatient clinic visits each year in Indian children, the Landmark study pinpoints the key causes of childhood diarrhea and suggests a roadmap to save hundreds of thousands of lives. GEMS, coordinated by the University of Maryland School of Medicine’s Center for Vaccine Development, confirmed rotavirus as the leading cause of diarrhoeal diseases among infants under 11 months across all sites and identified other top causes for which additional research is urgently needed. Combining data from all seven study countries, GEMS found that approximately one in five children under the age of two suffer from Moderate-to-Severe Diarrhoea (MSD) every year. In India, the study was conducted in Kolkata at the National Institute of Cholera and Enteric Diseases and overseen by Principal Investigator Dr Dipika Sur. Similar to other GEMS sites, just four pathogens – rotavirus, Cryptosporidium, Shigella, and ST-ETEC caused the majority of MSD cases in Kolkata. The overall incidence of MSD was higher in Kolkata than any other study site. “Without a full picture of which pathogens cause the most harm, it has been difficult to make evidence-based decisions around diarrhoeal disease control,” said Dipika Sur, Principal Investigator, National Institute of Cholera and Enteric Diseases, Kolkata. “GEMS will fill in those critical gaps in knowledge and will help governments to prioritise resources for research and action to reduce the burden of disease.” “The GEMS study clearly indicates that rotavirus is the leading cause for MSD in children under five years of age in India,” said Dr Gagandeep Kang, Professor, Department of Gastrointestinal Sciences, CMC Vellore. “It is important that the government expands access to existing interventions that protect against and treat all types of diarrhoeal diseases, including rotavirus vaccines, oral rehydration solutions, zinc supplements, clean water and sanitation. It is particularly timely that it coincides with the Government of India announcing the results of a pivotal clinical trial of an indigenous rotavirus vaccine.”
India and Switzerland to sign pact to improve India’s healthcare sector India and Switzerland will soon sign a pact to give further impetus to cooperation in the field of healthcare. Health & Family Welfare Minister, Ghulam Nabi Azad and his Swiss counterpart Alain Berset held a bilateral meeting on the sidelines of World Health Assembly at Geneva and discussed various issues of cooperation. Azad said in the continuum of strong Indo-Swiss bilateral cooperation, an MoU between the two countries will be inked soon to further broaden the scope of bilateral ties. “Considerable progress has been made in this regard, and a MoU in the field of health is being signed to promote bilateral cooperation between the two countries,” Azad said.
News, Views & Analysis
In Brief HP deploys virtual health platform to help deliver psychiatric care in rural India HP announced the availability of a virtual health technology platform that will enable healthcare professionals to virtually conduct specialist psychiatric consultations with patients. This initiative aims to improve access, quality and efficiency of global health, facilitates psychiatric care without requiring either the doctor or the patient travelling to meet each other. “In India, it is estimated that only 10 percent of mental health patients receive active psychiatric assistance or help. The virtual health technology solution aims to improve efficiencies in delivery of quality psychiatric care to underserved rural, semiurban and remote areas in India,” said Commander Girish Kumar, Practice Head, India – Healthcare & Life Sciences, HP Enterprise Services. HP is piloting the platform with MSC Trust, a leading NGO specialised in providing psychiatric solutions to patients in rural Tamil Nadu in south India. HP’s virtual health platform will support MSC Trust’s efforts to extend the reach of psychiatric care in rural India by providing the required Information Technology (IT) infrastructure and improving awareness through continued education of medical personnel onsite.
Prof K K Talwar to lead the Cardiology Department at Max Healthcare Max Healthcare announced the appointment of renowned Cardiologist and Padma Bhushan award winner Dr K K Talwar as Chairman, Cardiology at Max Healthcare. In his new role, Dr Talwar will be heading the Department of Cardiology at Max Healthcare. Dr Talwar has been honoured with Padma Bhushan, the country’s third highest civilian award by Government of India for his contributions in the field of Medicine. With over 39 years of clinical experience in cardiology, Dr Talwar has expertise and indepth knowledge of diagnosis, prevention, treatment and rehabilitation for varied cardiac ailments. Dr Talwar has made many pioneering contributions in the field of cardiology and cardiac electrophysiology. He was the first to implant and introduce the Implantable Cardioverter and Defibrillator (ICD) therapy in India and South Asia region that was recorded in the LIMCA Book of World Records (1997). He is also the first to introduce CRT (Cardiac Resynchronisation Therapy) in India in 2000.
I June 2013
Biogen Idec organises rally in 11 Indian cities to raise awareness about Multiple Sclerosis To commemorate World Multiple Sclerosis (MS) Day, Biogen Idec India observed World MS day in India through interactive and educative road shows across the country. As part of this initiative, employees rallied across 11 different cities viz; Gurgaon, Faridabad, Delhi, Ahmedabad, Kolkata, Mumbai, Biogen Idec India team observes Bangalore, Chennai, Hyderabad, World MS day Cochin and Pune to educate people about Multiple Sclerosis (MS) and express solidarity with people suffering from MS. The day of service was designed to increase the role of employee volunteerism with focus on patients, healthcare providers and local communities. Biogen Idec employees interacted with the local community and distributed information pamphlets at parks, local market and busy streets. With the theme message being, ‘Together let’s fight MS,’ healthcare providers were made aware about the significance of the day and importance of early diagnosis. The aim of the initiative was to raise awareness of MS, solicit public support for improving opportunities & outcomes for MS patients and create an environment where people can understand MS better.
FDA allows TPN injectables in US The USFDA allowed import of Total Parenteral Nutrition (TPN) injectable drugs in the country that were in short supply. TPN is an intravenous food solution containing several drugs that have been in short supply, including trace elements, potassium phosphate, and sodium phosphate. Hospitals nationwide rely on TPN, which is primarily used to treat premature infants who are unable to eat or drink or those experiencing other deficiencies. Informing about the ordeal, Margaret A. Hamburg, Commissioner, FDA said, “While we have made progress on the critical issue of drug shortages, we remain extremely concerned about all current and potential drug shortages, and we are vigilant in our efforts such that patients have access to the medicines they need, when they need them. The FDA is doing all it can, using every tool we have to resolve and prevent drug shortages.” The FDA is exercising regulatory discretion for Fresenius Kabi USA, LLC, based in Lake Zurich, Ill., to import trace elements and phosphate injection from its Norway plant such that the drugs can reach Americans in need. The shortages are largely the result of a decision by American Regent/ Luitpold, a large manufacturer of TPN products, to temporarily shut down at the end of 2012. The FDA worked with American Regent in an effort to avoid a shutdown. The company, however, ultimately decided that it had to cease operations temporarily in order to address quality issues that included particulate matter in its injectable products. The FDA continues to work with the company to prioritise the most critical drugs in shortage as it restarts production, and on the quality issues, to protect patient health. “TPN component shortages have been a high priority for the agency. Since the onset of these shortages, the FDA has been very concerned about the dwindling supply of injectable nutrition products and the effect this is having on children’s hospitals treating vulnerable patients. We believe the import of these injectable nutrition drugs is going to meet current supply needs over the coming weeks,”said Valerie Jensen, associate director of the drug shortages program in the FDA’s Center for Drug Evaluation and Research.
News, Views & Analysis
In Brief Fujifilm launches AMULET in India Fujifilm launched AMULET full field digital mammography system, one of the most advanced mammography system in India at a summit organised by Mahajan Imaging on ‘Advances in Medical Technology in the Fight against Breast Cancer’ on May 19, 2013 at the Oberoi Hotel, New Delhi. Sushma Swaraj, Leader of the Opposition in Loksabha, was the chief guest at the Summit. “We have seen a sea change in mammography technology over the last couple of decades, it started with screen-film mammography and gradually moved to CR based mammography, which is still the most popular form of mammography in India today,” said Dr Harsh Mahajan, Honorary Radiologist to the President of India, in his talk at the summit. Doctors shared facts based on studies related to breast cancer at the summit. According to the All India Institute of Medical Sciences (AIIMS) there will be 250,000 new cases of breast cancer in India by 2015. Speaking about the market dynamics of full field mammograms, Shekhar Sibal, Executive Vice President & Head of Medical Systems for Fujifilm India, said, “Such high-end equipment costs around five to ten times more than the commonly available mammography systems, and the incremental cost cannot be passed on to the patient, lest the very purpose of the machine be defeated. ”
Trivitron Healthcare receives licence for manufacturing hematology controls in India Trivitron Healthcare, involved into manufacturing hematology and infectious disease diagnostics equipment, has received license for manufacturing hematology controls in India. Currently, none of the Indian diagnostics companies have been able to get manufacturing license of hematology controls. Nearly 100 per cent of hematology controls are currently imported in India, making it a costly affair for any routine diagnostics laboratory to have its own decent QC programme and ensure reliability as well as accuracy of the most important routine test performed, CBC. While domestic demand for controls is still gaining momentum in India, the demand for hematology controls in western countries is at its peak. Hematology analyser controls market worldwide is estimated around US$ 100 million and is currently growing at 10-12 per cent annually.
I June 2013
Russian innovative valve technology import may resolve cardiovascular problems On May 29, 2013, a round table meeting was organised on ‘India Russia Health Tourism & Medical Technologies Co-operation’ chaired by Sergey Cheremin, Minister, Head of the Department for External Economic and International Relations, Government of Russia, with a motive to take the Indo-Russian friendship to the next level. Both the nations are hoping to improve their friendly relationship by extending collaboration for benefitting the healthcare sector. Russia’s Alexander Samkov, LLC ‘Roscardioinvest’ General Director, Director of Technical Science has as many as 29 Russian and international patents on heart valves. These valves have proven to be successful on several occasions. Alexander Samkov says, “The reason we have patents for these valves is they are the result of sheer technology which helps human to live a normal life. They might be a bit costly, but are certainly useful.” These valves can be prepared by using either carbon or polymer; the latter being the new innovation. These latest innovative measures attracted two Indian companies to approach them. “We were approached by two Indian companies with an offer to provide them the valves. So, we decided to meet the industry people and explain about our product before moving further,” said Samkov. According to the Indian market, these valves are quite costly. Polymer is the newer innovation and is much cheaper, but this technology cannot be used by the masses. With the government’s least attention towards the healthcare sector, more and more people are suffering from cardiovascular problems. The innovative technology by the Russians can be the possible solution for these problems. Anubhav Sharma
Mintel reports healthy growth for homeopathic and herbal remedies at $ 6.4 billion A new research from Mintel reveals that it may not just be over-the-counter (OTC) remedies, which consumers reach for when treating ailments. The company estimates US retail sales of homeopathic and herbal remedies to have reached $ 6.4 billion in 2012, up by almost 3 per cent from 2011, and growing at 16 per cent over the past five years. Today, around 30 per cent of respondents who suffered an ailment within the past year claim to have used a homeopathic or herbal remedy to treat it. Mintel further forecasts sales to increase to $ 7.5 billion by 2017. With people becoming increasingly proactive about health, the growth of homeopathic and herbal remedies will be fuelled by availability of these products with mass retailers. Emily Krol, health and wellness analyst at Mintel, said, “Recalls of traditional OTC remedies, a holistic approach to health, and more availability in traditional retailers, all helped to fuel growth in this market. The sector is primed for continued success as US consumers increasingly seek products that are natural and organic, particularly as it relates to healthcare. This is especially true for families with small children as many OTC medications are unsafe for children under the age of two.” However, less than 25 per cent of OTC users agree that they trust homeopathic and herbal remedies to relieve their symptoms, suggesting that many people do not use these products because they do not believe they will be effective. But, among users of homeopathic and herbal remedies, this increases to about half (48 per cent).
Technology & Innovation
Fully automated haematology analyser for precision diagnosis Automated hematology analyser is able to analyse 20 parameters in both whole blood (WB) mode and pre-diluted (PD) mode. This includes parameters such as WBC, RBC, HGB, HCT, MCV, MCH, MCHC, PLT, LYM%, MXD%, NEUT%, LYM#, MXD#, NEUT#, RDW-SD, RDW-CV, PDW, MPV, PCT, P-LCR.The throughput is approximately 60 samples per hour. It has a big colour touch screen with intuitive graphic icons. The XP-100 has online QC via SNCS (Sysmex Network Communication System). It consists of a barcode reader to enter reagent, patient and sample information. Data storage is 35,000 including histograms and has an automatic probe cleaning after each aspiration. The result output is displayed on the screen and hard copy printouts can be made. XP-100 provides real-time external quality assurance program with the help of Sysmex Network Communication System (SNCS), amongst other critical and cutting-edge features. This will positively impact the growing 3PDA segment in India. “Transasia is committed to add value to our customers and to improve the quality of healthcare. Our objective is to optimise and bring latest medical technologies to India. In order to provide better care for more people, we adopt and adapt technologies, thus making them suitable for Indian market,” stated Mr Suresh Vazirani, Chairman and Managing Director, Transasia Bio-Medicals Limited. He further stated that, “The new Sysmex XP-100 will further strengthen our mission to provide innovative solutions for the prevention, early detection, diagnosis and monitoring of diseases.” The new state-of-the-art hematology analyzer is made in Japan, and will prove to be useful in screening and clinical diagnosis of anaemia, thrombocytopenia, thalassemia, other hematological disorders, inflammation and malignancies. The instrument has been specially designed to meet the demands of healthcare professionals and deliver beyond.
Masimo introduces rainbow® Pulse CO-Oximetry™ Masimo rainbow® SET is a noninvasive monitoring platform enabling the assessment of multiple blood constituents and physiologic parameters that previously required invasive or complicated procedures, in addition to providing Masimo SET® measure through motion and low perfusion pulse oximetry. Masimo rainbow SET measures total haemoglobin (SpHb®), oxygen content (SpOC™), carboxyhaemoglobin (SpCO®), methemoglobin (SpMet®), Pleth Variability Index (PVI®), Plus: Masimo set measurements of oxygen saturation (SpO2), Pulse Rate (PR), Perfusion Index (PI) Based on its solid foundation of Masimo SET technology, the Pulse
I June 2013
CO-Oximetry has innovative noninvasive sensor technology uses more than 7 wavelengths of light to acquire blood constituent data based on light absorption. Further, it has an advanced signal processing algorithms and unique adaptive filters work together to isolate, identify and quantify various haemoglobin species and blood measurement results are then displayed numerically.
Discovery* MR750w 3.0T, new MRI machine from GE, designed with care GE has integrated the power of 3.0T with a 70 cm wide bore that patients deserve and it is just the beginning in the new MRI machine. Innovative technological developments including multidrive RF Transmit, optical RF, a 50 cm usable FOV and high-performance gradients have all been designed with the human element in mind, delivering a welcoming experience, high-performance and exceptional versatility in the MRI machine.
Smarter digital X-ray with clear high resolution images and intuitive GUI in India Samsung has launched three machines, the XGEO GC80, XGEO GU60 and the XGEO GR40 which cater to requirements across all digital radiography market segments. Targeted at large and mediumsized hospitals, the digital radiography machines are incorporated with the ultra-sensitive Flat Panel Detector (FPD) with the proprietary ALDAS (Advanced Low Dose Amorphous Silicon Sensor) technology. ALDAS improves patient safety and the reliability of the diagnosis by acquiring highresolution images with a very small amount of radiation. The compact, light-weighted, and portable detector provides a better medical environment by improving user convenience and the efficiency of work. Furthermore, these machines are equipped with an outstanding post-image processing technology ALCOS (Adaptive Local Contrast Stretching) that automatically determines suitable image conditions depending on the target body parts and tissues. This proprietary technology provides qualified images for diagnosis by applying high resolution image contrast and edge sharpness enhancement functions. Furthermore, intuitive Graphical User Interface (GUI) makes it easier to use and understand the equipment, while providing high levels of ease and convenience.
Technology & Innovation
Optimal cardiovascular system for advanced percutaneous coronary intervention The most important consideration for cardiovascular system used for percutaneous coronary intervention procedures is the image quality that accurately captures and visualises the target area. Shimadzu has developed the direct-conversion Flat Panel Detector (FPD) based on a concept, completely different from all other conventional designs. It creates exceptional image quality achieved by The Power of Safire. Direct-conversion detection, which converts X-rays directly to electrical signals, eliminates the blurring that results from the scattered light generated in conventional imaging processes, realising ‘pure digital imaging.’ It also features the smallest pixel size in its class - 150μm - to provide fluoroscopy / radiography images with exceptional visibility. The FPD has a 9 x 9 inch field view, which accommodates steep cardiac angles and also provides an optimal view of peripheral regions. It further boasts of outstanding image quality achieved only by a next-generation X-ray detector. The stateof-the-art digital technology ensures high-speed response, fast and easy C-arm operation, upgraded digital filter and improved visibility.
Detection of allergy-related symptoms made easy Thermo Scientific ImmunoCAP* Rapid allows generation of a patient’s IgE profile within minutes, resulting in a first-line evaluation of patients with allergy-related symptoms. This device is a first-line, point-of-care for evaluation of patients with allergy-related symptoms. The results are direct, clear and simple. ImmunoCAP* Rapid generates a reliable, easy-to-understand IgE profile of both children and adults with symptoms of wheezing and rhinitis. The test result provides direction on further action to take-such as appropriate medication and/ or referrals-right in the physician’s office. ImmunoCAP* Rapid is available in Italy, Spain, Sweden Switzerland, the UK, Japan and the USA. Now you can identify triggering allergens with readable results in 20 minutes.
Siemens introduces MAGNETOM Aera to detect seizures
Welcome the next movement in MRI. MAGNETOM Aera that will transform 1.5T economics with groundbreaking combination of Tim® 4G’s integrated coil technology and Dot. As a top-of-the-line 70 cm 1.5T system, MAGNETOM Aera offers a full range of applications and helps one provide the next level of patient care. It provides good patient comfort with 70 cm open bore and in combination with ultra-short system design, upto 50 per cent higher productivity with Tim 4G and Dot. It offers a full range of applications for the clinical routine and research.
ACUSON X300 PE for cardiovascular challenges The ACUSON X300™ ultrasound system, premium edition (PE) is a complete cardiology care platform that gives you superior imaging performance across a range of cardiovascular applications. The ACUSON X300™ PE is ideally suited to handle all of your cardiovascular challenges. Combining superior image quality with Siemens’ advanced imaging technologies, this fully featured system provides exceptional imaging performance for vascular and cardiac imaging. Applications including stress echo, adult TEE, left ventricular opacification and advanced imaging applications such as Intracardiac Echocardiography (ICE) make the ACUSON X300 PE a comprehensive cardiovascular solution.
I June 2013
The features and options include dynamic TCE™ tissue contrast
enhancement, SieClear™ multi-view spatial compounding, Clarify™ Vascular Enhancement (VE) technology SieScape™ panoramic imaging,
Comprehensive integrated stress echo package Doppler Tissue Imaging (DTI™), TEE and 3D TEE using syngo® fourSight™ TEE View. One-button Left Ventriclar Opacification (LVO) contrast*, anatomical M-mode colour M-mode and much more Intelligent design takes center stage with the ACUSON X300 PE that provides a range of powerful cardiologybased workflow tools that boost your efficiency, enhance diagnostic quality and simplify repetitive processes. Automated knowledge-based workflow tools including syngo arterial health package, syngo velocity vector imaging technology, syngo auto left heart, and syngo mitral valve assessment.
As part of our endeavour to spread the technology culture, this section provides a means to promote and facilitate exchange of select technologies. We strive to bring together suppliers of such technologies with suitable users for negotiations and industrial collaboration.
Technology Offered Diagnostic probe, kit and method for tonometric examination A Hungarian University in the field of modern healthcare and therapeutic diagnosis has developed a product, which is a novel tonometric probe that makes it possible to detect disorders of the respiratory system and of the regional perfusion of respiratory gases by measuring the partial gas pressure of CO2. This way, changes in the pCO2 can be detected that could forebode an organ failure. In the new model of tonometric probe, the test material inside of the probe (air or saline), takes up CO2 from the surrounding space through the wall of the probe at the whole length, therefore the filling time with carbon dioxide, that is, the time of measurement, is extremely short. In situations of emergency, a quick preliminary measurement is possible. Areas of application Medical technologies: medical institutions, including hospitals, clinics, ambulances, etc. Forms of transfer Subcontracting, Joint Venture (JV), technology licensing Healthcare products There is development of Thai balm roll-on for sniff and skin itch - Thai Tea for eyes, root hair, yellow liquid, liver, cancer. Areas of application Food, health and tea industries Forms of transfer Subcontracting, JV Deployable telemedicine kit AMD Telemedicine has created a deployable telemedicine kit that could be used to deploy and/or utilise in the event of a disaster. With the kit, healthcare providers in the field would have the ability to send photo images of inner ear/nose/throat, trauma to extremities, soft tissue injuries, captured ultrasound images, digital 12-lead electrocardiograms, digital lung capacity
I June 2013
reports, and heart or lung sounds. The specialist in the field would then send the information to a medical specialist via satellite, Internet, or Integrated Services Digital Networks (ISDN). The deployable telemedicine kit will speed the execution and management of trauma services and clinical emergency care. Areas of application Disaster management, tele-medicine/ tele health sectors, medical industry, etc Forms of transfer Consultancy, technology licensing, equipment supply, others Novel Polysaccharide as anti-cancer agent The invention in discussion, relates to a novel bioactive polysaccharide isolated from edible mushroom, Agaricus bisporus. The invention also relates to a pharma composition comprising the bioactive polysaccharide and provides steps of the process for isolation of the bioactive polysaccharide. There have been extensive studies demonstrating the anti-cancer activity of the extracted, purified glucan polysaccharides (Wasser & Weis 1999). From studies on various cancer cell lines, there is evidence for direct cytotoxic effects on the cancer cells for some of the polysaccharides. Highly encouraging results have been forthcoming together with the observations that the incorporation of bioactive polysaccharides into treatment regimes significantly reduced the side-effects so often encountered bypatients. Areas of application Anti-cancer, Polysaccharide Forms of transfer Technology licensing A novel therapeutic approach for preventing and treating atherosclerosis The proposed technology relates to prevention and treatment of atherosclerosis using inhibiting or reducing the level of
carbamylation of various circulating proteins. The technology suggests a method of determining whether an individual is at risk for atherosclerosis, by measuring the level of carbamylated LDL in the individual sample. It suggests a method of assessing the effectiveness of a treatment for atherosclerosis by monitoring carbamylated LDL and/or antibody to carbamylated LDL in said sample. It further provides a method of reducing carbamylation by treating said individual with enzymatic or non-enzymatic inhibitors of carbamylation. Areas of application Medical industry Forms of transfer Technology licensing Extracellular phytase with improved thermostability The proposed technology relates to a process for the production of extracellular phytase using a novel isolate of fungi. The phytases so produced using this process are thermostable and acid stable. The process comprises: (i) isolating phytase producing microorganisms from soil and water samples taken from live-stock units, poultry farms and rotten wood logs, identified and characterised the novel strain, (ii) keeping the strain in the Phytase Screening agar Medium (PSM) to obtain culture and incubating the above the culture at 30째C to 50째C for 24 to 48 hours. Inoculating the microorganism in PSM broth, starch medium, Luria broth and minimal medium to produce phytase, recovering phytase from the fermentation broth by conventional centrifugation and filtration method. Areas of application Food industry, pharma industry Forms of transfer Technology licensing
Technology Requested Small, portable, non-invasive and drug-free solutions for regular and chronic pain A leading provider of consumer lifestyle and healthcare products is actively searching for truly innovative technologies, products and devices to provide drug-free pain relief to those suffering from regular or chronic pain. Devices can be reusable or disposable with suitable price points. Solutions which combine more than one therapy could also be of interest. Platform technologies to enable device with multiple applications/attachments are of particular interest, as are opportunities to adapt technology from professional/ hospital use to consumer use – eg, scaling down large devices to hand-held. Alternatively, using the principles of invasive treatments such as acupuncture and providing a non-invasive device. Preventative devices, eg, to prevent a known pain, are also of interest. Areas of application Medical technologies: medical institutions like hospitals, clinics, ambulances, etc. Forms of transfer Others Solutions to enable consumers to maintain and improve their health A leading provider of consumer lifestyle and healthcare products is actively searching for truly innovative technologies, products and devices to enable the
consumers to maintain and improve their health through what they eat and drink. Areas of application Technologies for monitoring and advising the nutrient intake of consumers Forms of transfer Others Disposable syringe A company is interested in establishing a small plant for 3 part disposable plastic syringes (5 ml & 10 ml), auto disable syringes. Capacity approx 70 100 million units per annum, a mix of different sizes. Areas of application Manufacturing for healthcare application Forms of transfer Others Patented intraocular lens designs and IOL polishing A company is looking for technology or knowledge base that will help design and develop state-of-the-art intraocular lens or IOLs. It wants to develop IOLs that are more affordable for poor families but with superior design and quality. It is also looking for technology that will help it polish these new technologically developed lens - hydrophilic or hydrophobic lens. Areas of application Manufacturing process for hydrophilic or hydrophobic intra ocular lens Forms of transfer Others Glove automation equipment
A company is looking to develop glove process automation. Areas of application Latex glove process Forms of transfer Others Disposable plastic syringes This technology seeker needs consultancy on turn-key basis for manufacturing disposable syringes in standard sizes of 2 ml, 5 ml, etc. Areas of application Medical health Forms of transfer Consultancy Disposable syringe manufacturing unit A company is looking for information on the technologies used for the disposable syringe manufacturing unit and also the economic and technical feasibility of establishing a manufacturing unit for disposable syringes. Areas of application Manufacturing sector Forms of transfer Others Virgin oil (Fiji) A company is looking for medication for heart disease. Areas of application For community usage Forms of transfer Consultancy, technical services, equipment supply, research purpose, others
Information courtesy: Dr Krishnan S Raghavan, In-Charge, Technology Transfer Services Group, Asian and Pacific Centre for Transfer of Technology (APCTT) of United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP), APCTT Building, C-2, Qutab Institutional Area, New Delhi – 110 016, India.Tel: +91-11-3097 3758 (Direct), +91-11-3097 3710 (Board), Fax: +91-112685 6274 E-mail: email@example.com, Web: www.apctt.org. For more information on technology offers and requests, please log on to www.technology4sme.net and register with your contact details. This is a free of cost platform provided by APCTT for facilitating interaction between buyers and seekers of technologies across the globe. After submitting technology offer or request to this website, you are requested to wait for at least two weeks for receiving a response from a prospective buyer / seeker through this website, before contacting APCTT for further assistance.
Share and Solicit Technology The mission of Modern Medicare is to spread the technology culture. Here is an opportunity to be a part of this endeavour by sending your technology on offer or technology requirements. If you belong to any of these two categories, you are invited to furnish the techno-commercial details for publication. The write-up needs to be as per the format of this section with information about the particular technology offered or requested, its areas of application and forms of transfer. Contact us: Modern Medicare, Network18 Media & Investments Ltd, ‘A’ Wing, Ruby House, J K Sawant Marg, Dadar (W), Mumbai 400 028. Tel: 022-3024 5000, 3003 4695 Fax: 022-3003 4499 Email: firstname.lastname@example.org
I June 2013
In Conversation With: Dr B S Singhal
Currently, India is home to 1,300 neurologists who cater to a population of 1.2 billion …says Dr B S Singhal, Director - Department of Neurology, Bombay Hospital. A winner of numerous awards, Dr Singhal has been recognised for his work in India on multiple sclerosis, megalencephalic leukodystrophy, myelopathy associated with Eales’ disease and Myasthenia Gravis. Here, he talks about the issues at hand, advancements in the neurology sector in India and what the country is yet to learn from the West. Pallavi Mukhopadhyay
What are the commonly seen neurological disorders today? In the out patient sections, diseases such as epilepsy, headache and giddiness are commonly seen. In the in patient department, diseases such as strokes, infections, meningitis and tuberculosis of the central nervous system have been seen a lot more. However, on a positive note, elderly patients suffering from diseases such as Parkinson’s, memory failure and Alzheimer’s are living longer. When compared to the West, India is witnessing a higher number of infections. Neurological complications resulting from HIV is high here. Further, Multiple Sclerosis, commonly occurring in young patients is increasingly being recognised in India despite the prognosis being hard to predict. Increasing awareness among the population is a boon and diagnosis can be quicker. In India, environmental factors play a major role in the cause of infectious disorders. Inbreeding, often seen in many parts of India, gives rise to genetic neurological disorders.
I June 2013
Dr B S Singhal
What kinds of advancements in diagnostics are observed currently? India has seen major advancements in the field of imaging. The introduction and mass use of the CT scan and MRI machines have made a huge difference in diagnosis of neurological disorders. Nuclear imaging, laboratory diagnostics have also improved considerably.
Is there a need for better workforce? Currently, India is home to 1,300 neurologists who cater to a population of 1.2 billion. Mumbai has 90-100 neurologists and the number is increasing in smaller towns. However, we have a limited workforce in the field of neurology in India. We have an acute shortage of nurses and physiotherapists. There are no support systems in place. There is a dearth of social workers and clinical psychologists. The need of the hour is in house training of the staff. More emphasis should be laid on making nursing an acceptable and lucrative profession. The nurses must have better work hours and higher salaries. This will deter nurses from immigrating overseas. The government along with the private sectors must together set up more training colleges and include more seats for training in neurology. This will yield more neurologists. A significant number of students travel abroad for further studies and never return. This is another huge loss for the nation. The compensation for neurology doctors is not very high and has thus become less attractive for individuals wanting to make more money. It is a service-oriented profession and only commitment is of utmost importance. Improving facilities for neurology care would urge more individuals to take up this profession.
Are there enough number of colleges today? What more is needed to be done? With a collaborative effort between the government and the private sector, more colleges can be opened. Currently there is good staffing in colleges and diploma courses in neurology are being offered.
The infrastructure has to be improved and small steps are being taken in this direction. However, a complete makeover will take a long time.
How can neurological care be made affordable? Neurological care is currently expensive. For patients with advanced cases, surgery costs can cost between ` 5-10 lakh. For those in need of continuous treatment, rising medicine prices are a huge hindrance. The government must tackle this issue by providing subsidised treatment at major government centres. Private charities can also contribute to the cause. Insurance penetration is important and needs to be improved upon.
Genetic research has picked up in a big way and scientists are studying how genes can be modiďŹ ed to correct neurological diseases. Further, stem cells are also going to be used to regenerate nerve cells or nervous tissue in the coming years.
What are the main research areas in the ďŹ eld of neurology today? In India, research is not a priority. Research requires major investments in infrastructure and individual interest in research methodology. A platform and mindset for research should begin even before individuals enter medical school. Undergrad education should be imparted such that each doctor is able to individually undertake certain degree of research. There is a lack of will, funds and appropriate training. Thus the flaw lies at the educational level. Currently, India has no impactful publications and lacks research scientists. There needs to be more interaction between practicing clinicians and researchers. The neurologists based
in India are more service oriented. There needs to be foolproof statistics, good record system and a complete database of patient history etc. Currently, USA is undertaking a number of research studies on neurodegenerative disorders. A number of animal experiments and clinical trials are taking place and researchers are constantly looking for answers. Genetic research has picked up in a big way and scientists are studying how genes can be modified to correct neurological diseases. Further, stem cells are also going to be used to regenerate nerve cells or nervous tissue in the coming years.
What do awards mean to you? Whatever one does is a cumulative effort of many associates. An award is a recognition of the collective effort of many individuals. It urges you to contribute to the community much more than what you have in the past. It also means that the good work should continue.
What inspires you? When I put myself in the patientâ€™s shoes and see how they are bearing their suffering, they teach me the meaning of life with every new dawn. Looking at the patients, feeling their pain, understanding their problems and quietly listening to cries makes you humble and makes you want to reach out to them. My patients are my inspiration.
What is your vision for a healthy India? Where are we headed? Neurological treatment must be made more affordable. Doctors must reach out to the poor and they must be entitled to the same treatment as a rich patient. As a doctor, I would like to see more answers to the complexities of the growing number of neurological diseases. With the dawn of the Internet, people have quicker answers and patients can be followed up easily. The new government initiative of issuing every individual with a Unique Identification Number (UIN) will be of much help to the medical fraternity as the medical history of the patient can be traced. (email@example.com)
June 2013 I
Neurology Neurology devices market Driven by ageing population and developing world .................. 40 Managing radiation exposure in patients A challenge in neurointerventional radiology? .......................... 42 Microcatheters and advance imaging How neurological diagnosis is proceeding? ............................... 46 Interface - Dr Arun Garg Senior Neurologist, Institute of Neurosciences, Medanta Medicity.............48 Interface - Dr N K Venkataramana Vice Chairman & Chief Neurosurgeon, BGS Global Hospitals, Bengaluru ............................................ 50 Roundtable Rising cases of neurological disorders: Are Indian hospitals adequately equipped to combat the challenge? ......... 52 June 2013 I
Special Focus: Neurology devices market
Driven by ageing population and developing
Advanced neurological devices have changed the paradigm of neurointerventional diagnosis and treatment plans. In the coming years, the old population in developing world and growing symptoms of diseases in developing nations would be the key drivers of this niche market. Nikunj Sharma
he market for neurointerventional devices includes neurothrombectomy tools, aneurysm coiling devices, cerebral angiography and stenting devices and support systems. The segment comprise a range of products such as suction/aspiration system, snare device, clot retriever, embolic protection device, carotid stents, liquid embolic agents, platinum coil, flow diversion system, microguidewire and microcatheter. Neurologists require a number of instruments to understand and diagnose patients’ problems. Neurology diagnostic is the study and recording of electrical activity of the brain and nervous system. Physicians record electrical activity arising from the brain, spinal cord, peripheral nerves, somatosensory or motor nerve systems. For doing these studies, physicians use a variety of techniques and instruments, ie EEG, EMG/EP/NCS. A neurologist interprets the test results and reports these findings to referring physicians as necessary. Anil Srivastava, National Sales Manager, Head – Sales & Marketing (Medical Equipment), Nihon Kohden India Pvt Ltd, says, “Monitoring of neurological functions has assumed high significance, as changes in these functions are often an originator for
I June 2013
Neurovascular stents procedures, India, 2012 and 2019
2019 Source: iData Research inc
numerous degenerative diseases including sleep dysfunction, brain trauma, epilepsy and stroke. Consequently, the demand for monitoring systems such as EEG and EMG monitors is growing rapidly, as they are used in preventive diagnostic procedures. The development of specialised neurological facilities, such as sleep centres and EEG labs, has also contributed to enhance the demand for EEG equipment. These specialised facilities keep track of neurological activity for detecting and documenting any distortions.”
Market statistics According to a research report by Markets
and Markets, titled ‘Neurovascular/ Interventional Neurology Market – Global Trends & Competitive Analysis to 2017’, the global market for neurointerventional devices is projected to reach $ 1,733.7 million by 2017, exhibiting a CAGR of 6.8 per cent. According to iData Research, the neurological devices market in India comprise liquid embolics, detachable coils, neurovascular stents, neurovascular guidewires, neurovascular catheters, neuromodulation systems, neuroendoscopes, aneurysm clips and stereotactic systems. The growing penetration of endovascular techniques for neurological procedures to cure
Neurology devices market
The global market for EEG/EMG/brain function monitoring is projected to reach $ 1.26 billion by 2018. Maximum growth in the market is anticipated from developing FRXQWULHVRI$VLD3DFLÀFDQG/DWLQ$PHULFD Anil Srivastava National Sales Manager, Head – Sales & Marketing (Medical Equipment), Nihon Kohden India Pvt Ltd Arteriovenous Malformation (AVM) and apart from increased application of frameless stereotactic cure for cranial tumours is also forecast to fuel the market in future. Anticipating the demand scenario in future, Srivastava avers, “The global market for EEG/EMG/brain function monitoring is projected to reach $ 1.26 billion by 2018. Growth in the market is primarily driven by technology advancements and the increasing proportion of aged people, particularly in the developed world. Maximum growth in the market is anticipated from developing countries of AsiaPacific and Latin America. Globally, healthcare providers have relied on the quality and reliability of comprehensive and innovative neuro-diagnostic and monitoring instrumentation to aid in the diagnosis, information and treatment of their patients.”
Driving factors In future, the market for medical devices is projected to increase at a constant rate. Growing awareness about healthcare, increased healthcare funds and complex lifestyle-related diseases are expected to play a crucial role in driving the demand for medical equipment. In addition, other factors will also help boost the medical device market. Lack of high-end manufacturing Globally, India is among the major prospective markets that will generate the demand for medical equipment in future. At present, a major portion of these devices are imported, that offer considerable opportunities to be a global player in this field as the local manufacturers are producing low-end medicare aids such as needles, syringes, catheters, infection control gears, medical electronics, medical devices, blood collection tubes and implants.
Annual growth rate (%)
Neurological devices market, India, 2009-2019
Source: iData Research inc
Medical tourism Due to lower cost of treatment, in comparison to other developed nations, along with quality care services; the country has established itself as a preferred destination for medical tourism. The trend is expected to fuel the demand for more super speciality hospitals and world-class devices for better diagnosis and treatment. According to a report by Visiongain, ‘The Indian Medical Device Market Outlook 2013-2023’, the medical tourism market in India is exhibiting a growth rate of 30 per cent and projected to reach $ 2 billion through 2015. Growing health insurance sector Both government and private players are making efforts to increase the healthcare insurance penetration among various consumer groups in India. The growth of health insurance sector will also impact the medical devices sector in the country, as health insurance is registering significant growth rate at present. Ageing population and age-related disorders, for instance, Alzheimer’s disease and Cardiovascular Disease (CVD) are going to affect the market growth in a positive manner.
Challenges and future trends Despite the several favourable factors, the Indian market also offers some challenges that need to be addressed for realising these growth projections. In absence of clear and strict device regulatory for certain equipment, the transparent and speedy supply of medical devices will be a formidable task. Customers’ focus on quality for a price will continue to put pressure on device import segment. Many major players may opt to outsource their manufacturing operation in India to downsize the cost of equipment and extending consumer reach. The market is expected to witness more joint ventures and collaborations, increased participation in the medical device fairs and exhibitions for displaying the product ranges. To keep pace with market trends, tier II medical facilities and clinics are also generating considerable demand for advanced medical devices. The future belongs to innovative and cost-effective equipment, as manufacturers are trying to contain the cost by focussing on medical plastics. (firstname.lastname@example.org)
June 2013 I
Special Focus: Managing radiation exposure in patients
neurointerventional radiology? Radiation exposure to patient from neurointerventional procedures and diagnostic neuroimaging can be substantial, despite several recommendations being available to guide the operator for conscientious use of ionising radiation. Dr Tariq Martin, Consultant - Neuro Intervention, Fortis Memorial Research Institute (FMRI), Gurgaon and Dr Shrinivas Desai, Chief - Department of Radiology, Global Hospitals, Mumbai provide an insight and prospective measures to minimise the exposure. Nikunj Sharma
onising radiation is a critical component for the diagnosis and treatment of cerebrovascular disease. With the increasing use of endovascular techniques and the utility, speed and quality of CT technology, management of the patient with complex cereberovascular disease has evolved to routine use of these modalities. The repetitive imaging, however, carries the risk of radiation exposure to both the patient and physician. This recognised radiation risk has prompted multiple medical committees to regulate and monitor equipment and recommend techniques to reduce the exposure.
Dr Tariq Martin Consultant - Neuro Intervention, Fortis Memorial Research Institute (FMRI), Gurgaon The greatest contribution to the radiation exposure came during neurointerventional procedures composing 87 per cent of the total exposure, of which 54 per cent was during Digital Subtraction Angiography (DSA) runs and 33 per cent was during fluoroscopy during any endovascular procedure. Considering the index treatment only, dose from DSA runs contributed 46.2 per cent, while fluoroscopy contributed 28.3 per cent. This finding suggests that a significant contributor to the exposure is the index procedure. However, the contribution from secondary procedures cannot be dismissed as insignificant. There are two general types of radiation injuries: deterministic and stochastic. These need to be accounted for separately. In neuroradiology, the main organs susceptible to deterministic injury
I June 2013
Managing radiation exposure in patients
Not all body areas are equally sensitive. However, the scalp and beard are among the most sensitive to radiation epilation. Dr Tariq Martin Consultant - Neuro Intervention, Fortis Memorial Research Institute (FMRI), Gurgaon are the skin and the lens of the eyes. Skin erythema will generally be evident at 6–8 Gy. Doses exceeding 8 Gy will result in exudative and erosive changes to the skin, and doses exceeding 20 Gy will result in nonhealing ulceration. Temporary epilation will occur at 3–5 Gy, and permanent epilation, at single doses exceeding 7 Gy. Not all body areas are equally sensitive; however, the scalp and beard are among the most sensitive to radiation epilation. Irradiation of the eye will lead to cataract formation for single doses of 2 Gy and fractionated doses of 4 Gy. The stochastic effects refer to the formation of future cancers. The use and maintenance of personnel protection equipment should be a priority. Use of beam collimation: Both of the angiography systems we used have beam collimation systems that reduce the area of the zone irradiated and are usually used during the insertion of the catheter guide. Changes in the entry angle of the beam: In the procedures considered, it is possible to change the direction of the beam and, consequently, the area irradiated. Reduction of the use of electronic enlargement: As shown by the analysis of the characteristics of the equipment, the dose increases as the electronic enlargement is increased. Electronic enlargement, therefore, is used only during the therapeutic stage. Choice of the fluoroscopy mode: The procedures were carried out with unit 2, which employs pulsed fluoroscopy. In fact, during the analysis of the characteristics of the equipment, it was found that this reduced the dose by 20–30 per cent compared with that delivered using unit 1, which has continuous fluoroscopy.
I June 2013
Use of additional filtration: It is advisable, when possible (that is, when the image quality is diagnostically acceptable), to use the low mode, which reduces the dose by approximately 40 per cent compared to that delivered by the normal mode. It is not always possible to use additional filtration because of its detrimental effect on the image contrast. Optimisation for embolisation procedures can be reached by using additional filtration during both the catheter guide insertion and the diagnostic study and using non-additional filtration during the therapeutic stage. All said and done, when a neurointerventionist is doing a procedure , most of the time it is an emergency situation where the most important concern is the life of the patient. The radiation issues take a back seat to such an extent that it is rarely mentioned to the patient or the relatives. Having said that, one cannot trivialise the issue as we are experiencing many of these procedures and quite regularly are they performed with frequencies that really are detrimental to the personnel involved.
Dr Shrinivas Desai, Chief - Department of Radiology, Global Hospitals, Mumbai It is the operator who pilots the entire radar of radiation and hence it is very important for the operator to be aware of methods to minimise the radiation to patient and staff. Adequate operator training is essential, if deterministic injuries are to be avoided. In my opinion, operators who perform these procedures must have formal training in radiation safety,radiation biology and radiation dose management. These operators may require training in radiation dose management above and beyond that required for diagnostic radiology.
It is the operator who pilots the entire radar of radiation and hence it is very important for the operator to be aware of methods to minimise the radiation to patient and staff. Dr Shrinivas Desai Chief - Department of Radiology, Global Hospitals, Mumbai Few changes in the equipment factors can also lead in reduction in radiation dosage Spectral filtration: 0.1 mm Cu can reduce skin dose rate by 40 per cent (but has less impact on effective dose), increases tube loading and reduces contrast. A range of filters should be available for different programmes. Pulsed fluoroscopy: Is virtually essential for interventional work. In modern systems, the high tension is kept constant and a third grid controls the flow of electrons to the anode. Optimisation of fluoroscopy pulse widths and careful choice of entrance exposure/pulse during calibration of equipment is important. HernanzSchulman reported that, in paediatrics, grid-controlled pulsed fluoroscopy at 3.75 pulses s−1 can reduce dose by tenfold without significant reduction of contrast or spatial resolution. Organ curves: The X-ray set can respond to demand for increased output by increasing kV, mA or a combination of both. A range of options will be available so it is important to know the impact of each on contrast and dose. Image receptor: There is increasing emphasis on solid-state detectors and Flat Panel Detectors (FPDs), using either direct conversion with amorphous selenium or indirect conversion using caesium iodide, in preference to image intensifiers. The FPDs have a better dynamic range because there is no television camera. Thus, combining different factors to even marginally reduce radiation can go long way in reducing accumulated radiation in patients repeatedly undergoing procedures in multiple sessions, as well as in reducing life time radiation to the operator and staff. (email@example.com)
Special Focus: Microcatheters and advance imaging
How neurological diagnosis is proceeding? With every dimension of medical diagnosis taking route to advancement, neurology is also making its foray into modern age of imaging techniques and smart devices. Sophisticated tools of neuroimaging and micro catheters are playing a crucial role in solving the complex diseases. Presenting here some of the perspectives of new-age diagnosis tools. Nikunj Sharma
Photo courtesy: Indraprastha Apollo Hospitals
eurology has touched the unexplored dimension of this practice of medicine through novel advancements in neurointerventional devices, which were once on the imaginative radar of doctors. This acute field of medical science is gripping around the diseased brain nerves from every possible route that provide improved access and diagnosis option for neurological problems. Micro catheters refer to tiny hollow tubes, which are inserted into a patient’s groin through a minute incision. In neurological diagnosis, micro catheters are inserted via vessels in patient’s body to the location of treatment inside the brain.
Indian scenario According to a study titled, ‘Neurology: The Scenario in India’ - published in the Journal of Association of Physicians of India (API) in January 2012, India currently has only about 1,100 qualified clinical neurologists, and majority of them are concentrated in the four large metros, leaving behind a large chunk of rural population with almost no coverage by adequate neurology workforce and treatment facilities. This disparity results in limited exposure of rural patients to the trained professionals, and rest of the cases are treated by internal medicine specialists. The problem is multiplied by lack of adequate diagnosis tools, that are costlier and need trained staff to operate these highly sophisticated devices. Dr (Prof ) P N Renjen, Sr Consultant - Neurologist (Stroke), Department of Neurosciences, Indraprastha Apollo Hospitals, New Delhi, says, “A neurointerventionalist is a neuroradiologist with special training
I June 2013
in minimally invasive procedures. By inserting a micro catheter in the patient’s groin area and using advanced imaging for guidance, a neurointerventionalist is able to thread the micro catheter through the blood vessels leading into the brain. Neurointerventionalists use this minimally invasive technology to treat many complex disorders—including all types of strokes—with a lower risk of complications, shorter hospital stays and faster recovery.” When coupled with sophisticated imaging tools, neurosurgeons are well-equipped to visualise the site of infection more precisely and make better use of micro catheters to cure several complicated disease conditions. In general, these complications need recanalisation
or embolisation of the abnormal vessels. “Neurointerventional radiology or endovascular neurosurgery refers to special minimally invasive procedures to diagnose and treat vascular disorders of the brain and spine. With the help of advanced imaging for guidance, neurointerventionalists or neurosurgeons use microcatheters (tiny tubes) to treat many complex disorders. Normally, these disorders are treated either by closing or opening the abnormal vessels. The neurointerventional device market encompasses neurothrombectomy devices (suction/aspiration device, clot retriever and snare device), cerebral angiography and stenting system (carotid stent and embolic protection system), aneurysm coiling devices (platinum coil, liquid
Microcatheters and advance imaging
The PET-MR system will prove to be a boon in restricting the brain surgeries up to minimally invasive as well as handle complex neurological disorders. Dr (Prof ) P N Renjen Sr Consultant - Neurologist (Stroke), Department of Neurosciences, Indraprastha Apollo Hospitals embolic agents and flow diversion device) and support devices (microcatheter, and microguidewire),” informs Dr Renjen.
Advance imaging and prospects In neurology, PET SUITE is the most advanced imaging technology available in India at Indraprastha Apollo Hospitals after CT and MR technologies. This device integrates PET-MR and PET-CT, that allows technicians to acquire precise data on functions, morphology and metabolism. Unprecedented technological development around the world is allowing humans to cross the unlimited boundaries and enter into and era of advanced medical imaging. Most up-to-date advancements and breakthroughs in medical imaging technology have transformed the way patient care is delivered in the new age. Apart from its application in cancer, PET-MR also plays a greater role in understanding various disorders progression in cardiology and neurological diseases. Its ‘zero’ radiation exposure from the machine (unlike CT), makes it safe for paediatric case evaluation, reproductive age group women and can be used for disease follow up. PET-MR establishes a new understanding of the previously unknown interrelation between different measures of pathology and physiology in human body. With enhanced ability to explore correlations between structure and function, perfusion and metabolism, tissue diffusivity and cell proliferation, PET-MR potentiates doctor’s ability of gaining new insight into the progress of disease, unlocking new paths to treatment or even opening new areas of research. The PET-MR system will prove to be a boon in restricting the brain surgeries up to minimally invasive as well as handle complex neurological disorders, which are more evident with the changing lifestyle. “Growing ageing and obese population, rising patient pool for ischemic and haemorrhagic stroke and increasing demand for minimally invasive surgical procedures. Upcoming clinical trial data is favouring the interventional procedure over neurosurgery as it offers limited hospital stays, minimal damage to surrounding healthy tissues, lesser chances of infection in post-surgical phase, minimum surgical trauma and lesser surgical scar,” Dr Renjen avers. (firstname.lastname@example.org)
June 2013 I
Special Focus: Interface - Dr Arun Garg
“Advanced neuroimaging techniques have leveraged neurological diagnosis by offering enhanced precision and accuracy” Nikunj Sharma
How have the advances shaped neurosciences during the past decade or so? Significant advances have occurred in the field of neuroimaging in the past decade. Availability of 3-TESLA MRI machine along with 260-slice CT scanner and state-of-the-art flat panel angiography equipment along with dyna CT has improved the diagnostic accuracy and treatment outcome of patients suffering from various vascular disorders like stroke, AVM and aneurysm etc. Besides this, the availability of brain suite where intraoperative MRI can be performed and availability of colourful dyes, which can demarcate tumour from normal brain tissue, has helped in improving the longevity and quality of life of patients suffering from brain tumours. Use of navigation-guided endoscope for spinal and skull base surgery enables the surgeon to enter the diseased area through a very small incision or at times without incision, to visualise the lesion with clarity on the screen and excising the pathology without damaging normal tissue. The end result is that patient is mobile next day and post surgical morbidity is negligible. Incurable and intractable disorders such as refractory epilepsy or degenerative disorders such as Parkinson’s disease benefit from functional neurosurgery, in which either a pace maker is fitted to control brain’s activity or diseased part is excised after sparing eloquent part of the brain with the help of functional MRI.
What are the prevailing trends for neurological disorders? There was a time when infectious diseases were more prevalent in India. Over the past decade or two, trend has changed towards lifestyle-related disorders. Heart diseases, cancer and brain stroke are the three major killers now. Can you believe that the number
I June 2013
of deaths occurring in India, because of stroke, is 6 times higher than that of malaria? Second, we now see more cases suffering from tension headache, vertigo, depression, backache and dementia.
What are the basic causes of neurological problems? Busy working hours, not taking proper rest and sleep, blind race for earning wealth at the cost of health, not taking food at right time and eating fast food instead of healthy and nutritious food are the major culprits. Multitasking is another major issue.
How can we minimise the interventional procedures to cure neurology-related problems? Interventional procedures are required only in certain situations where disease treatment demands it. However, there are certain disorders which can be prevented by simply modifying the lifestyle. Such preventable disorders are stroke, dementia and backache. If one follows a regular exercise regime, healthy diet, practices meditation on regular basis, avoids multi-tasking, takes proper sleep and uses proper postures (sit straight, stand straight, sleep straight and walk straight) these lifestyle-related disorders can be prevented and interventional procedures will not be required.
With the advance imaging tools in place, do you feel more comfortable from diagnosis point of view? Advanced neuroimaging techniques have changed the approach towards neurological disorders. Nowadays, many of the disorders are accurately diagnosed and treated precisely with the help of these techniques.
Do you think that telemedicine can help patients in rural areas? With the population of 1.2 billion and 80 per cent of it living in rural areas with poor healthcare infrastructure, mortality and morbidity related
…says Dr Arun Garg, Senior Neurologist, Institute of Neurosciences, Medanta Medicity. In this conversation Dr Garg discusses the beneﬁts of advances in neurosciences. to stroke, and other neurological disorders is high in these areas. In some of the acute emergencies where golden period is important, telemedicine is the only light of hope. Because of long distances, traffic jams and lack of proper transport facilities patients cannot reach the proper hospital for treatment within the golden period. Telemedicine can significantly cut down the time required to start treatment in such patients.
What hurts more to this segment: lifestyle-induced stress or unavailability of qualiﬁed doctors and hospitals? Both are playing equal roles. While lifestyle-induced stress has resulted in increased number of neurological patients, shortage of properly qualified doctors is causing added disease burden to the society. When we compare United States, where the population is one fourth as compared to India, number of neurologists in US is 20,000, while it is hardly 1,500 in India. Sadly, there is a gross mismatch in India when we compare the doctor patient ratio. (email@example.com)
Special Focus: Interface - Dr N K Venkataramana
“If the infrastructure develops well, several young Indian scientists are looking forward to come back from developed countries” Hardik Ashar
Are we lagging behind in development as compared to the West?
What are the recent advances in the dynamic ﬁeld of neurosurgery in India? Extensive and pioneer research is happening in India in the field of neurosurgery. It is encouraging to see a lot of young scientists showing interest in research. With advanced technology and best available neurosurgeons, no Indian would require to go abroad for neurosurgical management. Some of the procedures which we carry out at our hospital includes stereotactic and functional surgeries (thalamotomy, pallidotomy and deep brain stimulation, cyst aspirations and biopsies), minimally invasive neurosurgery (endoscopic surgeries for pituitary and other skull base lesions), cerebro-vascular surgery (micro neurosurgery for aneurysms), carotid endartarectomy, (STA-MCA bypass), congenital skull and facial deformities, anomalies of the brain and skull, infectious diseases (brain abscess, tuberculoma, fungal , granulomas) and parasitic diseases to name a few. There has been awareness about the need to establish neuro critical care, and to address such needs our Bengaluru centre has established such a facility with dedicated ICUs for neurosurgical post-operative care, neurotrauma and stroke. Patients can now benefit from indigenous experts who are well equipped to perform complex multidisciplinary skull base surgery, conserve hearing in acoustic schwannomas and deploy neuroendoscopy and intraoperative magnetic resonance imaging. Ironically, such state-of-the-art facilities are few and chiefly available at major metro cities. With about one-third of Indian population residing in suburban and rural areas, India still has a limited direct access to even primary or general neurosurgery because most of the 1,700 neurosurgeons live in urban India.
I June 2013
We are way behind due to lack of grants, infrastructure and unequal distribution of human resources. The number of clinical problems are huge suggesting that majority of the research is confined to clinical research only. Basic research is taking a back seat. The clinicians hardly have any time given to their clinical load. Media repeatedly reports increasing requirements of neurospecialists. If the infrastructure develops well, several young Indian scientists are looking forward to come back from developed countries. We need to bring these talents back to home country.
What role is technology playing in improving neurological care? Technology is affecting every sphere of human life, and so is the case with the field of medicine and neurology. One of such latest technology is neuronavigation, an advanced surgical technology, which is based upon the principle of infrared and electromagnetic rays to generate 3D environment of brain anatomy. With this, a computer can guide the surgeon to critical areas of the brain and spinal cord making the surgery minimally invasive and enhancing safety. In addition, brain endoscopy also created a revolution in neurological treatment. This new generation endoscopes offer matchless resolution to create a panoromic view of hidden brain, thus making such areas visible to the surgeons. This has in turn enabled keyhole surgery for the brain and spinal cord. A variety of intra-ventricular brain surgeries and pituitary surgeries can be performed using new generation endoscopes for use in neurology. Cavitron Ultrasonic Surgical Aspirator (CUSA) helps neurosurgeons remove large brain and spinal cord tumours with minimal handling of neural structures. This enhances the safety and makes procedure
…believes Dr N K Venkataramana, Vice Chairman and Chief Neurosurgeon, BGS Global Hospitals, Bengaluru. In this succinct conversation, he talks about the recent advancements in the dynamic ﬁeld of neurosurgery. fast. The ultrasonic vibrations fragment the tumour into small parts and assist quick removal. Craniotome is a high speed pneumatic drilling system with 1 lakh rpm used to delicately remove the skull bones during neurosurgery. This facilitates faster removal of the bone with minimal blood loss ensuring safety to the underlying brain and spine.
What is your advice for someone considering this career? The foremost thing is to have a passion to learn. There is a common misconception that you have to be extra smart to be a brain surgeon but the fact is, hard work and perseverance are the key to success in this field. I know many talented neurosurgeons but I also know a lot of neurosurgeons who are not that smart. That is to say they are not geniuses. (firstname.lastname@example.org)
Special Focus: Roundtable
Rising cases of neurological disorders: Are Indian hospitals adequately equipped to combat the challenge? Several reports state that neurological disorders will increase in the coming years. This indicates that the country’s hospital should be well equipped to face the increasing numbers. Experts opine whether we are ready for the looming challenge. Anubhav Sharma
Dr Viswanathan Iyer Neurosurgeon, Kohinoor Hospital A recent study predicted that every year 35 lakh persons will get neurological disabilities. The three main diseases are dementia, stroke and accidents. This is about 11,000 per day. Due to increasing life expectancy especially among women, dementia in its various avatars, will increase. The annual incidence of stroke in India is about 145 per 1,00,000 people. Stroke leads to disability and dependence. Nearly 15 lakh people, with long-term brain disability due to accidents are added in India every year. The neurological healthcare facilities in India are very limited. The statistics is 1 bed for every 40,000. There is also a dearth of mental health professionals such as neurosurgeons, neurologists and psychiatrists. The healthcare system and the government should realise this epidemic and plan accordingly. Public education programmes for prevention and emergency care of stroke should be launched. Road safety measures and the golden hour concept for accident cases should get focus.
Roop Gursahani Consultant Neurologist and Epileptologist, P D Hinduja National Hospital The increasing awareness of neurologic illness and the hope for effective treatment are demand drivers for services of professionals trained in these fields. Let’s highlight deficiencies in two areas: stroke and epilepsy. Emergency treatment for stroke includes intravenous administration of thrombolytic medication. In selected cases direct intervention in the brain circulation can be highly effective. However, these are applicable in only a minority of stroke patients most of whom require protocoldriven good ICU care and appropriate rehabilitation strategies. Epilepsy is a disabling problem that affects about 0.5 per cent of the population, mainly the young. About 40 per cent of patients with refractory epilepsy can be candidates for epilepsy surgery. Unfortunately, insurance does not seem to cover epilepsy diagnosis and surgery. Hence, epilepsy surgery has never really taken off in India as compared to all other forms of neurosurgery where our expertise matches global standards.
Dr M Balamurugan Neurosurgeon, Apollo Hospitals, Chennai Neurological disorders are currently estimated to affect as many as a billion people worldwide. The most promising approach for reducing the burden of these disorders is to strengthen neurological care within the existing health systems. Management of patients with stroke by an organised unit signiﬁcantly reduces mortality and disability. The strategy of community-based rehabilitation has been implemented in many low-income countries around the world; where it is practised, it has successfully inﬂuenced the quality of life and participation of persons with disabilities in their societies. Governments should be urged to take account of the needs of people with dementia, as an integral part of a comprehensive programme of health and welfare services for older people. The priority should be to strengthen primary care services, through training and re-orientation from clinic-based acute treatment services to provision of outreach and long-term support.
The government’s apparent lack of focus towards the betterment in the sector and lack of innovative solutions might hamper the growth of the sector in equivalence to the number of patients in the near future. It is necessary for the hospitals to be prepared for this skewed ratio and have a plan of action.
I June 2013
Facility Visit: Dr L H Hiranandani Hospital, Mumbai
Where quality meets care Equipped with state-of-the-art facilities and modern healing systems, Dr L H Hiranandani Hospital houses specialised facilities such as vertigo clinic, diabetic foot clinic, voice clinic, centre for sports medicine, and many more, thus making it a remarkable healing centre for one and all. Here’s a review of Mumbai’s premier hospitals.
Labour delivery recovery and puerperium suite
ocated in the heart of Powai in Mumbai suburbs, Dr L H Hiranandani hospital’s magnificent structure stands out among its neighboring buildings. As one walks into this thirteen storey colossal splendour, it brings with it a sense of warmth and peace. The hospital is flanked by the famous Powai lake on one side and gorgeous hills on the other. Started with 7 doctors on February 22,2004, Hiranandani’s first operation was a tendon cut. Today, an accomplished multispeciality hospital, it was the first hospital in Mumbai to get the NABH accreditation in 2008. This helped Hiranandani render better services and aims at continually improving quality of care. The 250-bedded hospital renders 80 different services and performs 500,000 tests a year. Its OPD caters to more than 240,000 patients annually. With prestigious awards such as the IMC Ramkrishna Bajaj National Quality Award in 2008 and the International Asia Pacific Quality Award in 2009, Hiranandani hospital is en route to being an inspiration to its likes.
I June 2013
Hyperbaric oxygen therapy centre
Collaborative efforts Hiranandani believes in collaborative medicine. Dr Sujit Chatterjee, CEO, Dr L H Hiranandani Hospital, emphasises, “We perform strategic outsources so that we can bring in high-end technology to the hospital for the benefit of our patients.” Apex Kidney Care Centre has collaborated with the hospital to bring about high quality dialysis and support services for patients with kidney failure. The hospital also aims to carry out its own clinical research in India in the field of dialysis and transplantation. With good lab facilities, experienced in-house professionals in clinical research, the hospital aims at making a difference by contributing to further developments in the field of nephrology. Hiranandani undertakes training courses for dialysis technicians and nursing staffs who aspire to work in the field of nephrology. It has also tied up with Swasthya Liver Centre for liver transplant surgeries. The hospital has teamed up with SRL to offer a range of radiological services from conventional X-Rays to state-of-the-art cardiac CT and whole body
MRI. It provides its patients with 24/7 laboratory testing services. The Department of Laboratory Medicine is equipped with the latest state-of-art molecular diagnostic tools, which are fully integrated with the Laboratory Information System (LIS) providing for online patient results. The department undertakes stringent quality control measures and participation in external proficiency testing programmes to give quality results. International Oncology, primarily focussed on providing world-class global cancer care through its expertise and research, has entered into a strategic tie up with Dr L H Hiranandani Hospital and opened a state-of-the-art cancer care and bone marrow transplant centre within the hospital. The oncology centre is equipped to provide comprehensive cancer care with advanced radiation therapy equipment, state-of-theart Bone Marrow Transplant (BMT) unit and a comprehensive breast clinic. Recently, it has collaborated with Innovative Healing Systems, USA, to provide novel and comprehensive treatment services for wound care to its patients. Hyperbaric oxygen therapy used
Dr L H Hiranandani Hospital, Mumbai
We have collaborated with the American College of Cardiology for the Asian standards for treatment of heart-related ailments. Further, we have been the pioneers of the plasma rich platelet therapy and are now recognised for it throughout the country. Dr Sujit Chatterjee CEO, Dr L H Hiranandani Hospital for wound care is a new addition in the hospital. In this treatment, the patient breathes 100 per cent oxygen at pressures higher than normal atmospheric pressure. This increased delivery of oxygen to the tissues facilitates quick wound healing by regenerating epithelial cells, healing fractures, chronic injuries and ulcers. This is done under the supervision of a skilled physician and the process delivers natural and painless wound healing. Hiranandani also undertakes a variety of research projects. Dr Chatterjee elaborates, “We have collaborated with the American College of Cardiology for the Asian standards for treatment of heartrelated ailments. Our other projects are in the fields of anaesthesiology, dermatology, orthopaedics etc. Further, we have been the pioneers of the plasma rich platelet therapy and are now recognised for it throughout the country.”
Training programmes The
training seriously. Nurses at Hiranandani have many levels of hierarchy based on their experience and qualification. Dr Chatterjee states, “We train nurses in house to become managers. This initiative has been a success as the nurses look forward to getting a promotion. Moreover, the hospital is in the process of building star doctors. Furthermore, Hiranandani conducts Continuing Medical Education (CME) for doctors in the local and regional area and encourages doctors to present their work in international publications.”
Energy conservation measures The hospital has an east west orientation and has large glass windows thus maximising exposure to daylight until late afternoon. As the glass is energy efficient and insulated direct sunlight causes no radiation as the conduction and convection of the sun rays is minimal. The hospital uses no halogen lights, but makes use of energy efficient compact fluorescent light bulbs throughout every floor. All
the switches used are electronic and the hospital has sensors in public areas such as toilets for lighting control. They have an energy policy in place which is implemented at all times and individuals are requested to switch off the lights at all times when not in use. Use of air-conditioning is prohibited after 6 o’ clock. Adding another feather to its cap are the rain water harvesting activities undertaken by the hospital during the monsoon months. The hospital saves the BMC 50,000 litre of water in a day and gets a rebate of 3-4 lakh annually.
Awareness programmes Dr Chatterjee states, “We carry out plenty of public awareness programmes every Sunday where we invite the public for participation. We educate the elderly population about healthy living, proper nutrition, prevention of hearing loss, managing hypertension, lifestyle changes and rise of new and unknown diseases. For CSR, we have adopted a Foundation that looks after mentally and physically challenged patients. Their medical checkups and care is undertaken by Hiranandani. We have collaborated with the local Rotary Club Lakers for breast cancer awareness programs. We participate in walks and marathons. We are working with them on drug education and youth to sensitise the youngsters on the danger of drugs.”
Future goals Dr L H Hiranandani is in the process of launching a new hospital in Thane, which will be operational by 2014. Besides, Hiranandani aspires to be recognised as the best in fields of opthalmology, orthopaedics, reproductive research and dental surgery. A good number of processes are being constantly validated at Hiranandani to provide excellent healthcare services to its patients. Dr Chatterjee concludes, “While good health is provided by the doctors, care is provided by the nurse. Hiranandani should be known as the hospital where the doctor and the nurse are on the same platform and work in cohesion in order to provide quality healthcare to all.” (email@example.com)
Paediatric physiotherapy department
June 2013 I
Insight & Outlook
Critical Care Advancements in critical care Reaching greater heights .................................................58 Ethical issues faced in critical care Are we heading in the right direction? ............................60 Critical care nursing Paving way for a better future ..........................................64 Interface - Ameera Shah MD & CEO, Metropolis Healthcare Ltd .......................66 Interface - Dr Paresh Navalkar Head-Pre-hospital Care, Ziqitza Health Care Ltd .........68 Roundtable Does 24/7 intensivist staffing make ICU care better?......70
June 2013 I
Insight & Outlook: Advancements in critical care
Reaching greater heights Increasing awareness about the importance of emergency medical services has led to advanced technology-assisted intervention, use of sophisticated monitoring devices and improved quality of paramedics. Survival rates have been on the rise and management of life-threatening conditions has seen more success despite witnessing a shortage of staff.
n accord with the increase in demand, the medical demographics of critical care has evolved toward a patient population suffering from an increasing number of co-morbid medical conditions that require prolonged and more technologically sophisticated invasive support. Moreover, accumulating evidences have indicated that outcomes are better when critical care is provided by specially trained providers in a dedicated Intensive Care Unit (ICU).
Critical care advancements in neonatology In newborns, early diagnosis, treatment and continuous monitoring play key roles in ensuring successful outcomes. Management of sick premature babies needs precision care and margin of error should be close to nil in these patients. Dr Tushar Parikh, Consultant Neonatalogy, Columbia Asia Hospital,
I June 2013
Pune, elaborates, “Today, we are seeing an increased use of microprocessor-based ventilators for good respiratory care in sick babies. Volume of air inhaled during rest in a neonate is just 5 ml/kg. Therefore, in a premature baby the precision in delivery of breathing gases has become possible due to these new generation ventilators. Further, Bubble Continuous Positive Airway Pressure (CPAP) devices are used to treat newborns with breathing difficulty. CPAP is applied to the airways to help lungs work well for gas exchange. Initially introduced in 1960s, the re-invention of the CPAP in the last decade coupled with better understanding of lung pathologies in premature newborn has yielded good results in neonatals. The recently introduced LED-based phototherapy devices are being used to treat neonatal jaundice. These devices provide good irradiance and are more effective than conventional fluorescent tube light-based phototherapy devices. Moreover, LED-based phototherapy has
minimum maintenance cost and savings on electricity bills.” In babies born prematurely, surfactant deficiency is often observed. Today, surfactant derived from animal source (bovine or porcine) is widely available and helps premature babies, having severe breathing difficulty, by instilling the surfactant directly into the lung. This helps in lung expansion. Recently, the technique of functional echocardiography has been introduced in neonatal medicine. Currently, neonatologists’ are assessing the baby’s cardiac functioning and serially monitoring it bedside to look for the response to therapy. Neonates during their Neonatal Intensive Care Unit (NICU) stay may suffer from anaemia and need blood products transfusion. A major hurdle in management of tiny babies is limitation in amount of blood that can be taken for testing. A technology has been developed to perform blood tests on extremely small sample volumes, as low as 0.3 ml. Dr Parikh states, “At Columbia Asia Hospital, Pune, a newborn baby’s blood is collected in microtainers (tiny blood collection tubes), and processed in the latest machines, which accept small volume samples.” Babies that suffer birth asphyxia are at risk of death and long-term handicap if they survive. Thus, therapeutic hypothermia has been recently shown to protect asphyxiated brain from progression of cerebral injury. Dr Parikh elucidates, “Recent multi-center studies have shown that therapeutic hypothermia decreases risk of death and neuro-developmental disabilities by 25 per cent. Therapeutic hypothermia is administered either as whole body hypothermia or selective head cooling. Even though it has become a standard of practice to use therapeutic hypothermia in some western countries, it is still considered investigational in India due to high rates of infection in India. It is postulated that therapeutic hypothermia may not be as effective, instead it may increase mortality as shown in some studies from developing countries. This modality is yet to be accepted for use in India.”
Advancements in critical care
In the last decade, with the advent of thrombolytic treatment of stroke, there has been increased interest in the management of ischemic stroke, sequelae of reperfusion, and hemorrhage.
Invasive brain monitoring currently being carried out is Jugular venous oxygen saturation (SVo2) used to assess balance between oxygen delivery and its utilisation.
Dr Piyush Goel Consultant - Pulmonary and Critical Care Medicine, Rockland Hospital
Dr Praveen Sharma Neurologist, Seven Hills Hospital
Neurological intensive care advancements Neurological intensive care is a rapidly growing speciality. Brain injury is a dynamic process, which involves primary damaging insult followed by a cascade of physical, electrical and biochemical processes leading to secondary damage. Neurological intensive care aims at recognition of this secondary damage and its prevention and treatment. It encompasses management of wide range of acute neurological conditions like traumatic brain injury, stroke, status epilepticus and CNS infection. Bedside clinical neurological examination has long been a tool to assess neurological functions and degree of secondary damage, but today there are devices available to monitor secondary damage. Neurointensive care has shown significant developments in last decade and a number of monitoring tools have been developed. But there is also increase in volume and complexity of the data from these devices monitoring neurocritical care patients. Interpretation of data from single modality independently from other systemic, physiologic and metabolic parameters looks over simplistic and there is a need for development of systems or software for data collection and integration. Developments are also going on to minimise size of these devices to make them implantable and also portable and mobile SPECT and CT equipments for imaging. Dr Praveen Sharma, Neurologist, Seven Hills Hospital, elaborates the various invasive and non-invasive brain monitoring techniques currently being used. Invasive brain monitoring currently being carried out is Jugular venous
oxygen saturation (SVo2) used to assess balance between oxygen delivery and its utilisation. Continuous SVo2 monitoring is done by using fiber optic catheter or SVo2 estimation by repeated aspiration of blood samples and co-oxymeter. SVo2 less than 55 per cent shows inadequate oxygen. Intracranial Pressure (ICP) monitoring is important for measuring ICP and Cerebral Perfusion Pressure (CPP) directed treatment. It is performed by inserting a catheter in lateral ventricle connected to standard pressure transducer or placing such system inside brain parenchyma or subdural space. Continuous monitoring of ICP allows doctors to measure absolute ICP, CPP, and ICP waveform analysis and plan management. Another technique is the tissue oxygen tension (pBrO2) which involves insertion of a probe made up of semipermeable membrane with reversible electrochemical electrodes and allows direct measurement of oxygen tension. Because of its highly focal measurement, it can be used selectively monitoring critically perfused regions of brain. Further, cerebral microdialysis is widely being used and well established in research but its clinical use has recently taken place in neurocritical care. Non-invasive brain monitoring includes neuroimaging which includes structural neuroimaging such as MRI or functional neuroimaging such as f-MRI, SPECT or PET scan can provide detailed structural, haemodynamic and metabolic information. Continuous electro encephalography monitoring for the occurrence of seizures in a patient with acute brain injury may cause secondary damage and worsen outcome. Continuous EEG monitoring helps in identifying non-conclusive seizures and
timely management. It also helps in predicting prognosis in comatose patients due to traumatic and hypoxic brain injury. Trancscranial doppler is used to measure non-invasively cerebral blood flow velocity using principle of doppler shift caused by moving RBCs. Cerebro vascular reserve can also be assessed with TCD. Dr Piyush Goel, Consultant Pulmonary and Critical Care Medicine, Rockland Hospital, Dwarka, states, â€œIn the 1970s and 1980s, there was a growing recognition that specialised neurologic and neurosurgical intensive care was of life-saving importance. In the past ten years, with the advent of thrombolytic treatment of stroke, there has been increased interest in the management of ischemic stroke, sequelae of reperfusion, and hemorrhage. As more patients are being treated by endovascular methods, there is an increasing need for neurological intensivists to be the primary physicians for these patients and needs Critical care skills which include management of airway, hemodynamics, fluids, and coagulopathies.â€? Not all neurocritical care illnesses can be approached the same way. Therefore, combination or multimodal neuromonitoring of patients becomes more important to trend different physiologic parameters in each patient as indicators of the underlying and ongoing pathophysiologic mechanisms that will enhance and guide decision making, intervention and improve outcome. These advancements have changed the way hospitals approach their patients and improve working conditions in ICU and trauma wards. (firstname.lastname@example.org)
June 2013 I
Insight & Outlook: Ethical issues faced in critical care
Are we heading in the right
direction? Emergency medicine often brings the situation of ethical dilemmas for physician and other healthcare practitioners. In this feature, we explore such dilemmas and explore the possible answer, are we heading the right way? Read on... Hardik Ashar
onsider a situation, a 75-year old lady was struck down by a serious infection that resulted in the failure of several organs – the lungs, kidneys and circulation. In spite of 3 weeks of treatment with expensive antibiotics, artificial ventilation, dialysis support and pressor drugs to maintain her blood pressure the patient remained critically ill. All treating doctors agreed that the survival chances for the patient were very slim. The family desired that doctors stop intervention. Doctors faced a moral dilemma whether to continue aggressive treatment or to scale it down and they were also unsure as to the legal position of these decisions. Such observations are very common for physicians, intensivists and healthcare professionals treating
I June 2013
patients in ICUs on a daily basis.
“Ethical dilemmas are an everyday occurrence while treating critically ill patients. While consent of the patient for any medical intervention is mandatory, in the case of a critically ill patients, this can be secured only from a relative. Respecting patient’s autonomy therefore involves a more difficult process in the ICU. The physician must ensure that the patient’s surrogates truly represent their wishes and values. At the same time, the physician is obliged to act in the best interest of the patient from a medical perspective as well,” observes Dr R K Mani, Director - Pulmonology, Critical Care and Sleep Medicine, Saket City Hospital. Agrees Dr Rajesh Pande, Director - Department of Critical Care & Emergency Medicine, BLK Super Speciality Hospital, “The nature and
complexities of decision making in critical care puts physicians in dilemma. Some families would want to know the percentage chances of survival, which may be difficult to predict. Sometimes to choose between two therapeutic options poses a major dilemma for the physician. The family may not properly understand the pros & cons of a particular therapy. At times, families demand the treating team to follow directions given by an external physician or an expert located abroad who has not seen the clinical condition of the patient and may be unfamiliar with the medical resources available here.” The dilemmas are most evident when a critically ill patient is facing death and has no prospects of cure. In this context, medical interventions may be futile or burdensome or may impose avoidable financial or emotional burdens on the family. “In such setting the physician moral dilemma is between a narrow medical to a wider humanistic perspective. The current professional guidelines oblige the physician to accurately communicate the outlook for the patient and to weigh the benefits and burdens of his medical decision. It is a part of his responsibility to appropriately withhold or withdraw unnecessary, futile and burdensome interventions,” avers Dr Mani.
Ethical issues faced in critical care
All decisions with ethical complexities should be based on consensus between caregivers and patient’s families. Dr R K Mani Director - Pulmonology, Critical Care and Sleep Medicine, Saket City Hospital
Let us have a look at some more real day situations. Patient is sick and is not going to survive: Families bring their loved ones with lot of hope and expectations that they will become better and go home healthy as they were before. Many times the patients are terminally ill and it is obvious to the treating physician that they are not going to make it but to tell the family is a difficult task. The families generally request the team to be very aggressive and try everything available and are not willing to accept that nothing more can be done about the patient. Patient has fair chances of good outcome but families want to give up: Many a times they are influenced by friends and by what they hear in the society, that once patient is admitted to the ICU and is on a ventilator, they do not survive. Some would not agree for continuation of treatment and would request for withdrawal of treatment even when it is not clearly a situation of medical futility. On the other hand, some families would make the same request because they have exhausted all money and patient requires to be in the ICU for some more days. Circumspection: Sometimes, there are real day situations when hospitals do not want the physicians to share details of nosocomial infection with the patient families. “Educated families, who understand the situation and can read more from various resources available, are generally more understanding and helpful. The perception of different family members regarding the disease outcome varies from each other. There is no particular spokesperson in the family and, explaining the patient progress and sharing other information becomes a daunting task,” says Dr Pande.
Grounding in the principles of bioethics are becoming a part of curriculum in both undergraduate and postgraduate training. The consensus curriculum with respect to intensive care in Europe have identified several competencies relating to ethics, communication and end-of-life decision making that are mandatory for successful completion of training. “It is by experience and exposure to such patient care does one learns,” explains Dr Mani. While handling
I June 2013
The current professional guidelines oblige the physician to accurately communicate the outlook for the patient and to weigh the beneﬁts and burdens of his medical decision. such situations, people need to be trained, but less fortunately, no such formal programme is available in India for Critical Care Unit (CCU) staff including physicians to handle such dilemmas. “What we do for our postgraduates and trainee nurses is expose them to simulated situations that include the end of life care decisions, death, angry relatives and explaining about hospitalacquired infections,” stresses Dr Pande. “Another approach is to provide them with the legal perspectives and the guidelines given by the Indian Society of Critical care Medicine (ISCCM) in this regard,” he adds further.
The decision making Physicians and Health Care Professionals (HCPs) play a vital role in critical decision making. It is substantial if the patient is
Many a times in life-threatening situations where a quick decision is required, a good medical team can help by providing an appropriate and balanced explanation. Dr Rajesh Pande Director - Department of Critical Care & Emergency Medicine, BLK Super Speciality Hospital
unconscious or incompetent. His chances of survival at times depend on the understanding of his condition by the surrogate decision makers. Generally, the physician and nurses would try to present the actual clinical situation with the prognosis and further course of the disease. This information is very useful for taking the correct decision by the families. “Many a times in life-threatening situations where a quick decision is required, a good medical team can help by providing an appropriate and balanced explanation and the need of urgency. It is often a once in a lifetime situation for the family. The medical team can reduce their agony and provide comfort to them in difficult decision-making process because of their experience,” suggests Dr Pande. Commenting on role of physicians and HCPs, Dr Mani says, “All decisions with ethical complexities should be based on consensus between caregivers and patient’s families. There is increasing tendency to also involve senior nurses and social workers in decisions pertaining to terminal care.”
Curbing the unethical conduct The institutional system should make provision for complaints relating to misconduct to be addressed by a redressal committee with speedy adjudication. Clear ethical guidelines and codes of conduct should be available from professional bodies such as the Medical Council of India (MCI), the ISCCM, Association of Physicians of India (API). At the governmental level, there should be legislation and legal guidelines to facilitate the implementation of established professional ethical standards and penalties for violation of these codes of conduct. “Such measures can prevent chaos and ensure integrity,” concludes Dr Mani. (email@example.com)
Insight & Outlook: Critical care nursing
Paving way for a better future Dr Martindale and Vanessa Smith, two leading academics from Robert Gordon University (RGU), Aberdeen, Scotland, specialising in Critical Care Nursing (CCN) speak about the recent developments in the ďŹ eld. Pallavi Mukhopadhyay
he need of the hour in the healthcare setting is to develop an integrated approach to work. Critical care nurses are a crucial part of the system, which makes their role exceedingly demanding and interventional.
CCN in UK vs India In UK, CCN is a designated specialty. Critical care nurses seek to specialise in this area and the system underpins that with post graduate education. Nurses opt for masters, while some undertake research in critical care nursing. In India, a nurse can choose to go into the critical care environment. Education in the speciality and the career path are not properly charted. Robert Gordon University (RGU) wants to help promote the development of CCN in India. Obtaining a specialisation degree can help increase remuneration. Evidence-based healthcare and delivery improves quality and enhances the chances of positive patient outcomes. The Indian nurses are looking forward to move in this direction. Critical care nurse to patient ratio is higher in India than that in UK. While in UK the ratio is 1:1, India has a ratio
I June 2013
of 1:3. Every hospital must commit to a 1:1 nurse patient ratio. In UK, it is easy to standardise processes in healthcare. In India, the process is more cumbersome due to a large disparity between private and government hospitals. With Indian nurses coming together to form the Indian chapter of Critical Care Nurses Society, the nurses have an association and a collaborative framework to work within. This forum is an important step to aid in standardisation of processes.
researching on and validating them. It is crucial to know how and why these methods work and what makes them an integral part of nursing knowledge and its appropriate practice. Based on processes undertaken by nurses worldwide, these conventional approaches can be linked and validated for the benefit of all. Once this data is available, innovation can begin. Formation of the Critical Care Nurses Society in India will bring about groundbreaking changes in nursing in India.
Emergency critical care nursing Nurses are present round-the-clock all days of the year. Emergency cases are stressful situations for the patient and its family. The nurses must support both the patient and the grieving family. Having a specialist knowledge base and demonstration of competence gives the nurses skill to handle emergency situations and be a vital member of the multidisciplinary emergency care team. Having a patient centered focus is crucial. A nurse brings a lot to the team and enhancing their strength and drive is of utmost importance.
Conventional methods of nursing vs innovative methods Currently, conventional methods of nursing are being explored. It is important to understand these methods by further
Next step for India There should be multilayered workforce planning starting from the government level, organisational level right up to the unit level. At the unit level, discussion within the multidisciplinary team is the key to good working. While the Critical Care Nurses Society can make recommendations for nurses, the hospital must make appropriate appointments based on patient equity.
Improving quality of care Nurses must focus on person-centered care, for which proper education must be provided in line with evidence-based facts. They must be provided with necessary help to allow them flourish in their particular area of choice. Continuous upgradation of skill
Critical care nursing
Formation of the Critical Care Nurses Society in India will bring about groundbreaking changes in nursing in India. Dr Martindale Sheelagh Head of professional development, Robert Gordon University, Aberdeen, Scotland
sets is a key that determines and enhances competency. Proper communication between the nurses and patient and the grieving family should be overseen. This often sets the foundation of good nursing skills. Further, end-to-end communication between the multidisciplinary team within the hospital, between the nurses themselves and with individuals outside the hospital plays a crucial role in providing good quality of care. This must be included in the education curriculum of critical care nurses. Patient and family education strategies and bedside communication strategies
need to be visible and documented daily. A strategic plan of care based on education should be imparted. While communication strategies are a quality indicator, they must be regularly audited.
Type of leadership required India requires visionary and transformational leadership. Leaders in the nursing sector must be passionate, enthusiastic, committed and interminable. Good understanding of the subject is very important. In UK, modernising the nursing career framework was groundbreaking. This led to proper
Advanced nursing practice in UK includes clinical practice, education and research. Nurses are urged to think on a masterâ€™s level.
Vanessa Smith Lecturer, Robert Gordon University, Aberdeen, Scotland remuneration based on the nurseâ€™s individual expertise and experience. Advanced nursing practice in UK includes clinical practice, education and research. Nurses are urged to think on a masterâ€™s level. Further, nurses should be able to fix non medical prescriptions and be decision-makers. This change has been witnessed in UK over the last decade. The International Council of Nurses has a leadership framework to assist nurses worldwide and India should make use of all the available resources to further update their workforce. (firstname.lastname@example.org)
June 2013 I
Insight & Outlook: Interface - Ameera Shah
“The growth of healthcare IT has been bidirectional” ...says Ameera Shah, MD & CEO, Metropolis Healthcare Ltd. Here, she discusses the transformation brought about by the deployment of IT in healthcare and critical care, future scope and challenges that lie ahead.
How has IT transformed healthcare delivery? Healthcare IT today has grown to such size and complexity, that it would not be an overstatement to say that it will touch every life on our planet. Let us comprehend the magnanimity of healthcare IT through services that are utilised in ‘direct patient care’ and the ones that are primarily ‘enablers’ of healthcare service delivery. For example, patient management software is used to manage appointments would be an IT service that directly affects patient care. A healthcare IT solution that helps in financial management of a healthcare institution would be an enabler having indirect impact on patient care. If we view through this lens, one can comfortably say that IT has transformed the way healthcare services were perceived and delivered. Another important aspect that IT has brought to healthcare is that of accountability, transparency and efficiency for the entire healthcare
I June 2013
functionary (government, private and not-for-profit sectors). Thus, one can visualise the growth of healthcare IT to be bidirectional. From the macro perspective, it has allowed conceivable IT systems for better management of the healthcare functionary. From the micro perspective it has allowed healthcare personnel to manage and deliver services more effectively and efficiently.
What role does IT play in a critical care set up? The Intensive Care Unit (ICU) is a datafull environment where deployment of IT may improve patient care by ameliorating access to clinical data, reducing errors, tracking compliance with quality standards and providing decision support. Analysis suggests presence of high-end IT systems in the ICU linked with improved care. However, utilisation of IT in ICUs is variable. ICUs exhibit a high prevalence of the use of basic infrastructure. However, implementation of the more complex and potentially more beneficial applications is presently low.
How can deployment of IT help reduce the healthcare cost? There is a general conception that healthcare IT, or for that matter any IT solution reduces healthcare costs. It is not that immediately after deployment one would see a downward sloping curve of reducing costs. If seen holistically, one might actually see an increase in costs. If that is the case why do companies still deploy such systems? These systems are cost-effective from the resource optimisation point of view. A large ERP solution would have so many ramifications that a curious investigator could potentially jot down an endless list of systems and processes where IT has enabled resource optimisation. Efficacy in systems and delivery of care would have large and long-term benefits. Thus, to arrive at a decision for a healthcare IT solution, one needs to have the vision and acumen to identify these long-term goals. Thus, I caution healthcare leaders and managers against shortsightedness and lack of perspective while deploying a healthcare IT solution.
What are some of the challenges for adopting IT in the Indian healthcare system? A noteworthy development that has happened in IT is the acceptance of newer platforms and technologies. Users have become more flexible and adaptable. I would attribute this development to mobile technology which has shown significant and rapid advancements. But with these promising developments come the inherent challenges of healthcare industry. Iâ€™ve already mentioned the challenge of data confidentiality and security. Another challenge is the wide spectrum of healthcare providers in India and the lack of regulatory control. Due to lack of control, the regulatory environment in India is in a state of constant flux. This lack of regulatory control impairs the development and implementation of standards. In such an environment, and the fact that IT solutions demand standardisation and interoperability, implementation will be amongst the greatest challenge.
What are your views on deployment of cloud-based systems, telemedicine and telehealth for better healthcare delivery? Cloud has been a buzz word across sectors, including healthcare. The first most promising aspect of cloud is that it makes the entire IT environment less resource and maintenance intensive. Since cloud is a virtual IT resource controlled by the vendor, the primary delimiting factor particularly for healthcare is that of data confidentiality and security. Since cloud is still evolving in the country, we are treading slowly and cautiously on this new avenue. However, since healthcare applications and software are briskly developing on cloud-based technologies, it would prove to be a boon for all size healthcare companies, especially the growing ones, preferably who would want to keep resources low. Telemedicine and telehealth are set to benefit greatly from cloud technology. The most important benefit is that of standardisation of communication across systems and technologies. This could be particularly useful from a diagnostic industry point of view. Imagine a situation where a report is to be communicated to different doctors, at different locations and at the same time. In telemedicine, this would be the case in almost all situations, where we are attempting to arrange online consultations with multiple users. The challenge would lie in the standardisation of the diagnostic report, the lack of which would lead to the inability of users to access the report. In a cloud-based technology, such challenges would cease to exist. A cloud-driven solution by their very design and approach would have an inherent standardisation. (email@example.com)
June 2013 I
Insight & Outlook: Interface - Dr Paresh Navalkar
“Research should focus more on the outcomes to measure the condition of the patient during transportation and on arrival at the hospital and number of lives saved” Pallavi Mukhopadhyay
What kind of research is being carried out in Emergency Medical Services (EMS) today? EMS has been operational for the past three to five years in our country in majority of the States. This has led to an emerging opportunity for researchers to understand pre-hospital care systems in India. Current research is directed towards analysing the nature of illness or trauma, necessitating a need for emergency ambulance facilities to transport the patient to the hospital. Currently, the focus is on the time taken to reach the hospital. Ideally, research should focus more on the outcomes to measure the condition of the patient during transportation and on arrival at the hospital and number of lives saved.
What is the future demand for emergency ambulance services in India? Despite a major initiative by the Government of India to launch free ambulance services under the 108 ambulance project, the need for emergency ambulance services continues to remain high. The need for specialised intra-hospital transfers and the transfer of critical care and neonatal patients need sophisticated equipment on board as well as highly trained manpower. With emergency medicine developing in India and recognised by Medical Council of
I June 2013
India (MCI) as a specialty, we foresee development in this branch of medicine along with emergency departments. To support these departments, hospitalbased emergency ambulances that are fully equipped and manned by qualified paramedics will be required.
What kinds of paramedic preparation courses should be undertaken today? Emergency Medical Technicians (EMTs) are classified into Basic and Advance levels. There are separate courses available for each. The EMT-Basic Course involves 300 hours of skills and lecture training, while the EMT-Advance Course is of 1,000 hours. The Society for Emergency Medicine, India (SEMI) has designed and approved the curriculum for training EMTs. The criteria for evaluation and recognition of training institutes have also been recommended. This could be adopted as a model curriculum at the national level. EMTs undergo training that comprise lectures, skills training on manikins, simulated real-life scenario-based training and response to disasters.
Could you tell us about ﬂight nursing and its importance in the Indian context? There are specialised training courses for
...says Dr Paresh Navalkar, Head – Pre-hospital Care, Ziqitza Health Care Ltd. Here, he talks about the future demand and skills required to be the best in the ﬁeld. air transportation that can be undertaken by experienced paramedics, and it is a highly skilled job. Due to changes in the cabin pressures, restricted space and limited medical resources, this job requires highly skilled and trained personnel.
Does India have appropriate clinical and communication skills required for pre-hospital care? What more should be done in this regard? The courses mentioned take care of the clinical and communication skills required for pre-hospital care. Communication skills are mandatory and form an integral part of the EMT curriculum. The communication skills are targeted towards closed loop communication among the team members, etiquette of patient communication and use of wireless and telephony. EMTs are also trained in soft skills and grooming. (firstname.lastname@example.org)
Insight & Outlook: Roundtable
Does 24/7 intensivist stafﬁng Care for critically ill patients has come a long way. In 1960’s the concept of Intensive Care Units (ICUs) spread and it was only in the 1970’s that full time intensivist became popular. As the concept is evolving, so are the rising challenges. In this discussion, we asked intensivists if round-the-clock availability justiﬁes costs and outcomes? Hardik Ashar
Dr Khusrav Bajan Intensivist - Critical Care Medicine, P D Hinduja National Hospital and Medical Research Centre For the proper functioning of an ICU, the minimum requirements would be a proper infrastructure, dedicated trained and experienced staff, monitoring and therapeutic gadgets and above all protocol set guidelines to care for the critically ill. In our country, where there are dearth of resources and standardised ICUs, an enormous lacuna of trained nursing staff and medical personnel, it would be ironical to expect a consultant intensivist round the clock. Also, emphasising that an intensivist is also a human being and needs his sleep to make the right decisions when in charge. The caveat is that for the proper functioning of an organisation, it never expects the CEO to be present round the clock….then why only an intensivist? Hence, need of 24/7 intensivists must be decided upon as per the individual requirements of hospitals.
Dr Karthik Rao Consultant - Critical Care Medicine, Columbia Asia Referral Hospital
Dr Hemanth H R Consultant - Critical Care Medicine, BGS Global Hospitals
A modern ICU represents the hospital’s approach to provide continuous monitoring to critically ill patients. Majority of these patients require mechanical ventilation – artificial breathing support, sedation and continuous monitoring of vital parameters. A patient in the ICU, can in a matter of seconds deteriorate medically. In addition to clinical skills, intensivits are required to have excellent emergency management skills and the psychological strength to be able to handle such patients without panic and relatives, in a truthful and empathetic manner. An ICU which has well trained and qualified intensivists round the clock will definitely be able to provide the kind of continuous monitoring support, medical care and procedural interventions required. The presence of such intensivists supported by specially trained nurses, technicians and infrastructure will help in ensuring better outcomes at the ICU.
In present scenario, intensive care is mainly a day time affair. Units at night are usually covered by residents or interns who often lack managing critically ill patients. Similar approach applies to weekends as well. It is documented that mortality and length of stay rises for weekends and night admissions. Publications suggest no change in outcomes between night and weekend patients admitted to ICUs with 24/7 onsite intensivists. Besides, there is better staff satisfaction and decreased complication rates and reduced length of stay if there is 24/7 intensivist cover. On the downside, 24/7 cover increases the cost of care, increases burn out among intensivist and reduces the confidence level of trainee doctors. Ultimately, need for 24/7 intensivist care must be assessed based on local needs, the kind of patients managed and financial implications.
Despite decreasing fatal decisions and procedural complications,round-the-clock deployment of specialists do not show a statistically significant decline in overall mortality. Moreover, it becomes expensive. If a hospital puts necessary infrastructure in place, maintains guidelines along with a well trained staff such debates may be avoided. However, the final call needs to be taken based on the requirement of individual hospitals.
I June 2013
Automation Trends: Solutions for Indian healthcare
Welcome to the TECH FUTURE!
he healthcare sector in India is currently experiencing a steady growth because of increase in life expectancy, higher income levels, greater reach of health insurance, and growing lifestylerelated diseases. The industry is at an inflection point and is poised for rapid growth in the medium term. The Indian healthcare industry is expected to grow to $ 280 billion by 2020 from a base of $ 79 billion in 2012. The average Compound Annual Growth Rate (CAGR) for 2012-20 has been estimated at 21 per cent. Indiaâ€™s healthcare related expenditure is still amongst the lowest globally. Hence, there exists significant challenges that need to be addressed to fulfill the stated goal for healthcare for every citizen by 2020. The challenges include: Accessibility: Inadequate access to healthcare delivery has been a key issue with the Indian healthcare system. Though most Indians, especially rural population, depend on public health infrastructure, which is inefficient and inadequate too. With low investments in medical infrastructure, including
I June 2013
devices and automation, the access to healthcare is inadequate or absent in rural India. Affordability: Since most of the countryâ€™s population cannot afford to pay for healthcare, providers in turn pay careful attention to costs. Due to this we are yet to see any large scale initiatives in automating the diagnostic care, and follow-up processes. Fragmentation: The Indian healthcare industry is highly fragmented and dominated by many private players with low market share. Absence of any major player with a pan-India presence means low automation and integration of systems and online collaboration. Quality of care: Inequitable quality of care, along with non-availability doctors in rural India, is a major challenge faced by the Indian healthcare industry. This is partially fuelled by the demand-supply gap that exists with respect to doctors and trained medical professionals. Similarly, Indian healthcare providers today are facing two major challenges - one, in providing healthcare solution to all and other to grow the industry faster enough. These two challenges are
Photo courtesy: Alten Calsoft Labs
There has been ever increasing deployment of Information Technology (IT) in healthcare arena. However, the healthcare expenditure on such infrastructure continues to remain minimal. Here, we provide a review of some automation solutions to assist better healthcare delivery. interlinked with each other and cannot be solved independently. At a macro level, these challenges are caused by: A huge demand and supply gap in health infrastructure, skilled doctors, healthcare providers and basic medicines. Resource constraints both financial and workforce, to develop the reqired infrastructure to provide healthcare for all. Inefficiencies in healthcare operations due to low automation and isolated systems.
Solutions at hand Many of these challenges can be solved by increasing the automation of diagnostics, care, and collaboration processes. Though the usage of IT solutions for healthcare industry in India is not very high, the help of private sector investments in healthcare and increase in the use of modern diagnostic and treatment solutions, the healthcare providers and associated service providers like health insurers are adopting information technology at a much faster pace than earlier. Indian technology solution providers need to develop innovative solutions to seize this opportunity and create a strong healthcare technology industry. Few areas which have
Solutions for Indian healthcare
a higher potential of IT investment related to automation are: Hospital Management Systems, customised to meet the needs of Indian hospitals. Telemedicine systems for providing care to remote hospitals and primary health centers where trained or specialised doctors are not available. Patient health record portals for storing and sharing patient health record among different stakeholders such as patients, hospitals, clinics and physicians. Laboratory Information Management System (LIMS) for pharmaceutical and biotechnology companies for accelerating R&D activities. Indian healthcare providers both big and small, have an opportunity to use the disruptive technologies like cloud & mobility and change the way healthcare is provided in our country. This will create a sustainable competitive advantage in market place. Let us understand how usage of technology and higher level of automation can help healthcare providers in solving these challenges:
A cloud-based telemedicine system that can be accessed over a low cost tablet can go a long way in increasing the access to healthcare. This will enable people in remote areas to reach out to expert doctors at a much lower cost. Since, cloud based solutions are generally delivered on a â€˜pay-per-useâ€™ model, it creates less strain on the existing financial resources, and optimises the use of skilled human resources. A cloud based patient health record portal, accessible on a tablet, can increase operational efficiencies and reduce the diagnostic costs. A cloud based healthcare information system integrated with patient health record portal can increase operational efficiencies in any hospital by manifolds without creating a dent on financial resources of the hospital. Similarly, a cloud based LIMS can reduce the cost of drug discovery, which will result in low cost medicine availability. SMS based information system can take care of reminders, health information, report access, and mobile payments. Cloud based accounting framework can
help small and medium sized hospitals to manage entire billing, inventory, store management, customer management, and laboratory management related operations at a much lower fixed cost and total cost of ownership. Hence, disrupting technologies like cloud and mobility will be the major drivers in changing the face of Indian healthcare industry. Software as a Service (SaaS) or cloud based solutions eliminate the need of fixed costs in the form of IT infrastructure and converts the complete IT application cost to a variable cost. It is imperative that healthcare providers demonstrate agility, and out-of-the-box thinking capabilities to innovate IT strategies that are functional and cost effective to contribute to this growth journey. (email@example.com)
Somenath Nag Director â€“ Business Development and Marketing, ALTEN Calsoft Labs
June 2013 I
Energy Management: Medical waste management
Need for effective strategies for a sustainable environment In India, around 904 tonne of Biomedical Waste (BMW) is generated per day in hospitals, which contains approximately 15 per cent infectious materials, according to a report. In absence of adequate segregation and disposal procedures, this waste amounts to 33,000 tonne in a year. The healthcare sector is in dire need of adequate and stringent waste management procedures in place to combat this threat. Nikunj Sharma
iomedical Waste (BMW ) refers to the garbage generated in the immunisation, treatment or diagnosis of living creatures; manufacturing or research of biological materials that comprise all forms of toxic and infected waste, which may significantly impact ecology and people. BMW is mainly produced from hospitals, pathology laboratories, clinics, nursing
homes, microbiology laboratories, animal houses, blood banks and veterinary institutes among other organisations offering healthcare. Nowadays, the growth in medicare space has led to the adoption of advanced treatment protocols such as disposables or one-time use accessories, which have further added biowaste burden on our environment. Since large medical facilities handle bulk of patients and live human samples, these establishments are required to manage the BMW safely
and efficiently. Most common biomedical waste products include body fluid, surgical gloves, anatomical waste blood, used bandages, disposable syringes, and blood bags intravenous tubes. Globally, experts are making efforts to address this issue, as BMW may cause hazardous diseases such as TB, hepatitis, AIDS and several bacterial infections. Ranjeet Banerjee, Vice President & General Manager, Medical Surgical Systems, Becton Dickinson, says, “Across the healthcare industry, environmental
Categories of biomedical waste Option
Treatment & Disposal
Cat. No. 1
Incineration /deep burial
Human anatomical waste (human tissues, organs, body parts)
Cat. No. 2
Incineration /deep burial
Animal waste animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals / colleges,discharge from hospitals, animal houses)
Cat. No. 3
Local autoclaving/ micro waving/ incineration
Microbiology & biotechnology waste (wastes from laboratory cultures, stocks or specimens of micro-organisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biological, toxins, dishes and devices used for transfer of cultures)
Cat. No. 4
Disinfections (chemical Waste sharps (needles, syringes, scalpels blades, glass etc. that may cause puncture treatment /autoclaving micro and cuts. this includes both used & unused sharps) waving and mutilation shredding
Cat. No. 5
Incineration / destruction & Discarded medicines and cytotoxic drugs (wastes comprising drugs disposal in secured landfills contaminated and discarded medicines)
Cat. No. 6
Incineration , autoclaving/ micro waving
Solid waste (items contaminated with blood and body fluids including cotton, dressings, soiled plaster casts, line beddings, other material contaminated with blood)
Cat. No. 7
Disinfections by chemical treatment autoclaving/micro waving & mutilation shredding.
Solid waste (waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets etc.)
Cat. No. 8
Disinfections by chemical Liquid waste (waste generated from laboratory & washing, cleaning, house-keeping treatment and discharge into drain and disinfecting activities)
Cat. No. 9
Disposal in municipal landfill
Incineration ash (ash from incineration of any bio-medical waste)
Cat. No. 10 Chemical treatment & discharge into Chemical waste (chemicals used in production of biological, chemicals, used in drain for liquid & secured landfill for solids disinfection, as insecticides, etc) 74
I June 2013
Medical waste management
Colour coding and type of container disposal for disposing biomedical waste Colour coding
Type of containers
Treatment options as per schedule 1
Disinfected Container/ Plastic bag
Autoclaving/Micro waving/ Chemical Treatment
Blue/ White translucent
Plastic bag/ puncture proof container
Autoclaving/Micro waving/ chemical treatment and destruction/shredding
Disposal in secured landfill *Source: http://www.mppcb.nic.in
improvements are being achieved by meeting sustainability goals and addressing manufacturing practices around energy, waste and water. However, making changes that reduce the impact of medical waste after a product is used, without compromising patient care, is no small challenge. For medical equipment manufacturers, sustainable operations include management of the environmental impact of energy, greenhouse gases, waste and water throughout the supply chain.”
Regulatory framework The Environmental Protection Agency (EPA) regulates solid and hazardous waste under the Resource Conservation and Recovery Act (RCRA) in United States. Medical waste, which falls under non-hazardous industrial solid waste, are run by section D of the RCRA. In India, biomedical waste accounts to around 1-2 per cent of the total municipal solid waste stream. Further on, because of the serious threats imposed by hospital waste, the central government took initiatives by introducing an act in 1996 with bio-medical waste (handling and management) rules in 1998. The pollution control board has provided guidelines to handle BMW that involves four steps including categorisation of BMW, colour-coding and filling in different type of containers, and labelling for transportation to the disposal site. Pollution Control Board of India has divided BMW in different categories for managing and handling the waste as per standard procedures.
I June 2013
Chemicals treatment: Using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment treats disinfections.
India is projected to register robust growth in healthcare sector. Handling BMW must be a prime factor from hygiene assessment perspective for grading various healthcare facilities. Mutilation/Shredding: It must be such as to prevent unauthorised reuse. There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas. Segregation of BMW in hospital waste is an essential activity, which should be done at the premises of the hospital or nursing homes. The colour coding, container type to be used for different waste category and suggested treatment options are listed below.
Steps needed In practice of healthcare, one cannot rule out the use of disposables and other medical accessories in various facilities. One way is to handle BMW efficiently by
following safe disposal norms. The other potential way out is to develop more ecofriendly devices, that release less carbon footprints during manufacturing as well as after disposal. Incidences of re-packaging and reuse of disposed syringes and drugs were reported in past. The Ministry of Environment and Forests (MoEF) has issued various guidelines for healthcare facilities. However, few such facilities replicate with stringent follow up of the same. “An example of meeting the challenge to address medical waste can be found in the BD Emerald™ and BD Emerald™ PRO syringes. These products are produced in plants that are reducing consumption of energy and water, and sending less waste to landfill, year over year (YOY). The product design optimises the use of materials, resulting in up to 30 per cent less weight than other syringes. These contribute to the reduction of carbon footprint during manufacturing, transportation and disposal. In addition to being designed and produced to reduce environmental impact, the BD Emerald™ PRO syringe helps protect communities as well. The syringe has a feature that locks itself after an injection, thereby preventing it from being reused. This help in combating the spread of diseases such as Hepatitis B &C and prevents potential infections in case, biomedical waste is improperly handled,” Banerjee insists. India is projected to register robust growth in healthcare sector, which indicates increasing inflow of waste from the healthcare establishments. These trends will create huge demand for BMW handling units along with well- trained professionals to manage the bulk waste materials. Handling BMW must be a prime factor from hygiene assessment perspective for grading various healthcare facilities. “It is evident that sustainability will become increasingly important in coming decades, and that sustainable practices in design, production and disposal of medical devices are necessary for success. Communities and industry must partner together to ensure healthy people are supported by a healthy environment,” Banerjee concludes. (firstname.lastname@example.org)
Policies & Regulations: National Health Portal
Time for a reality check The National Health Portal (NHP) was ideated in 2010 and in June 2011, the Health Ministry announced that NHP, recommended by the National Knowledge Commission, would make optimum use of technology for establishing a database of medical records of all citizens and other health-related issues. Has this plan lived up to the expectations?
he National Health Portal (NHP) that was established a few years ago (2010-2011) was set up to put information on standardisation and protocols in the public domain. The effort was also to ensure that the medical records of the NHP project looked at a long-term view of creating a portal that, in the words of Sam Pitroda, ‘will be a game changer in healthcare.’ As of April 2013, the work continues to be moving at a snails pace and the expected date of launch (August 2013) seems unrealistic.
Reality: When it comes to information on health-related issues 1. Information overload confuses the patient or the information seeker.
2. Lack of credibility of information that is available for India/from India. 3. Inconsistency of information. 4. Literacy rate in India as per 2011 census is 74.04 per cent. 5. About 30 per cent (330 million) Indians belong to the poor category, where healthcare affordability and accessibility is a serious cause of concern. 6. Broadband connections at the end of January 2013, according to TRAI, were 15.01 million. Rural wireless subscribers are about 2 million. According to 2011 census, about 20 per cent of urban households and 5 per cent of rural households now own a computer or laptop. About 1 per cent rural India owns a laptop or computer with a net connection. In terms of information communication mediums, television is far ahead of others.
Then comes print. According to the Deloitte Media Democracy Survey, almost 64 per cent respondents identified television as the primary influencer and about 63 per cent mentioned newspapers as the next influencer. Mobile as a medium ranks third According to TRAI, the tele density has reached 74.24 per cent. However, according to GSMA, taking into account the multiple SIM cards and actual number of active users, there are about 380 million actual users -- about 26 per cent of the total population. Reports are indicating that Indian broadband users are switching to mobile internet. Clearly, mobile will be the game changer for the healthcare industry and the national health portal should be available as an app on all mobile phones Next is Radio. Indian Readership Survey (IRS) report says that, the share of radio listenership on mobile
Health Portal Home Page
Healthcare Provider Locator
National Health Programmes
Food & Nutrition
Yoga & Naturopathy
Women’s Health First Aid
Pregnancy Siddha Child Health
Public Health Alerts
International Standards Governance & Protocols
NEWS for Healthcare Professional Forums for Students and Professionals
Psychosocial Health Occupational Health
Year 1-4 & Beyond
I June 2013
Main Links M
Disaster Management Forums News
State Health Programmes
Should access to innovative diagnostics HIV point of care testing be accelerated? Vol 9 I No 3 I February 2013 I www.modernmedicare.co.in I ` 100
Post Budget Analysis: Did the Union Budget live up to the expectations? Vol 9 I No 4 I March 2013 I www.modernmedicare.co.in I ` 100
Scan this code on your smart phone to visit www.modernmedicare.co.in Scan this code on your smart phone to visit www.modernmedicare.co.in
ALSO INSIDE Organ transplant in India Slow and steady, will we win the race? Quality medical care during emergency Are the patients getting a fair deal? Healthcare policies in India Setting the right priorities
CRACKING THE CASE WIDE OPEN
Managing risk at healthcare organisations A 360Âş approach Five dilemmas faced by every hospital Tips to resolve the everyday problems
ALSO INSIDE Infertility remedies
Process automation for healthcare organisations
In Conversation With
Hope for a joyous future
Need for tailored automation
Rajen Padukone, CEO, Manipal Health Enterprises Pvt Ltd
Transforming Indiaâ€™s health sector
An insight into the emerging market
Innovation and shared value can lead the bandwagon
(E)ing CAR for over two decade fo decades dees The cardiologist, Padma Shri Dr B Soma Raju, who has his heart and mind focussed on QRWKLQJEXWWKHFDUGLDFEHVWUHĂ HFWVRQWKHSDWKWUDYHUVHGDQGWKHURDGDKHDG
National Health Portal phones has increased from 20 per cent in 2009 to about 30 per cent in 2011-12. Future growth in listenership is expected to come from increased penetration of FM radio in smaller cities. According to Prasar Bharati, over 99.19 per cent of the population have access to this cheap medium of communication. Against only six radio stations in 1947, today the number has increased to 326. The All India Radio (AIR) broadcasts program in 23 languages and 146 dialects. Now, let us relate the above-mentioned realities with the project site map as mentioned in the initial project document. It talks about health content, AYUSH content, regulatory information, disaster management and directory services. (Question: Do we actually need all this?)
Site map If we connect the intent behind the NHP, its objectives and outcomes, the site map and the reality on ground with the need of the hour, following must be taken into consideration: The NHP is not clear whom it wants to serve? Healthcare professionals, rural population, poor, urban elite etc, or all of them? What NHP can actually deliver with the above-mentioned complicated site map, which will be extremely difficult to navigate for 95 per cent of the population? Should NHP be just a web portal for electronic health records and protocols, which are meant for clinicians or educated urban elite, or it should provide clinically validated primary care information and OTC-based treatment and automated electronically guided referrals for the entire population, linking it to the nearest ASHA worker, PHC, Jan Aushadhi stores, hospitals, and diagnostic labs, mapped with geographic information system across the nation?
Primary suggestions 1. First and foremost, we need an introductory video of how to use the NHP, and this video must be not more than a minute. Let us not assume that all the people know how to use Internet (more so, a health website ) 2. The NHP needs to be mNHP (Mobile version is a must). A tie up with COAI
& TRAI could help in pre-loading this mNHP app in every mobile phone sold in India. 3. Instead of the complicated site map, which will put off majority of users & fail in its objective, it might be good to consider a simple, intuitive, user friendly and interactive interface. So if I log in from a remote class IV town, using the IP/ network location, the NHP should give me an option of opening a webpage indexed to my town in my local language (so that I could access the local resources that I might need and in the language that I can understand). 4. Next important thing I should be asked (pictorial or audio visual is better), is that whether I am looking for a disease-related information, doctor, diagnosis, medicine (substitute, price, drug interactions, side effects or availability) etc. If I click on disease-related information, I must be guided to something like this in the local language, If I click on the body part, I should be taken to the ailment and suggestions provided based on an interactive interface. Say, pain in stomach could further prompt, did you take (a) meal outside, (b) consume alcohol, (c) did pain happen before, (d) did you take medicine etc. If someone has taken a medicine, s/he could just feed his contact number which could be automatically forwarded to a national health helpline (local network of ASHA or primary health worker or healthcare service provider) for further consultation or suggest a locally available emergency care or healthcare provider (private or public). Alternatively, a user might like to check for medical information or availability of a particular medicine. Also, the user must be given an option to chose a line of treatment, be it AYUSH or allopathic system. NHP must be able to give the information needed that is actionable. Needless to say, that the clinical information on the website must be something that can be relied upon and not outsourced to organisations that have a conflict of interest.
Points to consider We must keep in mind that Indians, or for that matter anywhere in the world, we surf the
web either out of curiosity or need, and when it comes to health, it is a need-based search. Also, we must be clear which segment of the population the NHP wishes to serve? Will it be end users, or doctors, nurses, pharmacists, ASHA workers etc. and, would it be just the tablet wielding urban elite or people residing in the remotest parts of the country, or all of them? If we make it too wide (currently, the project document makes it look vague and intellectual) and the NHP comes up as mentioned in the document, it will be too cluttered and will end up being another government website available. Clearly, the NHP could provide links for healthcare professionals but, as a NHP, it must clearly demarcate its sections without being over crowded. It should also give an option of uploading the health records, which are secure, ensure privacy and ease of use anytime/anywhere. May be, a good idea would be to provide EHR-enabled patient portals, which are interoperable and can be connected to any healthcare providers Also, it might be a good idea to develop newsletters, health tips and alerts on various health topics and send it periodically to users who opt for them through email or SMS. Also, Facebook, Twitter, Doordarshan and AIR could be used for promoting NHP and keeping the users engaged. Since NHP is being managed by NIHFW, it would be good idea to link government medical colleges and its staff by giving a login ID to individual government doctors for answering the questions on the chat forums, which come from the public via live chats (this could happen at phase II). The chat section needs to be supervised at the NHP HQ. The difference that the NHP can make to the lives of Indians is phenomenal, but one needs to map the needs with the userâ€™s psyche, and fulfill it with advice that is credible, actionable and acceptable. (email@example.com)
Rajendra Pratap Gupta International Healthcare Expert, President, DMAI
June 2013 I
Strategy: NABH-accredited Small Healthcare Organisations (SHCO)
Revolutionising business with turnaround strategies Considering the changing medical landscape, it is time, Small Healthcare Organisations (SHCO) focus on their foremost priority of revenue upliftment and opt well-planned strategies to boost proﬁtability. Explore the strategies that will help reduce capital investment in healthcare and manage the increasing cost factors.
Want to turn around business for a small healthcare organisation? Here are some strategies that may help… Capital investment in healthcare will certainly decrease. Consumables are becoming cheaper with assured just in time delivery. Many qualified doctors and nurses are not getting jobs in India. Performer employees are not bothered to get salary hike and attractive perks. Patients are ready to pay whatever you may charge in hospitals. Expense habit towards healthcare delivery services has got a dramatic overnight change in India. All vendors are promising to pay you upfront leaving no scope for delay payment (or bad debt!) in credit business. No competition found amongst private players… no need to spend for promotional activity. The hospital investor is not bothered in Return on Investment (ROI). The author knows that none of you will believe these aforesaid statements. And we do not see a near or far future when these have a chance to be true. But interestingly we do find lot of privatefunded healthcare delivery institutions struggling with poor financial figures year-on-year (YOY ). People dealing with profitability of such institution will acknowledge the fact that hospitals are an expense house and to make a positive Earnings Before Interest, Taxes, Depreciation, and Amortization. (EBITDA) you not only have to keep on increasing your top line but have to manage the ever increasing cost factors.
I June 2013
Here we discuss some of the ground level and strategic moves, which may help a small healthcare delivery institution.
departments – emergency, critical wards, radiology & imaging, pathology, pharmacy and surgery are to be nurtured specially.
Revenue, Revenue and Revenue
As we can understand that there is hardly any opportunity to see expenses going down (in optimum utilisation level), so revenue upliftment becomes the first and foremost priority for any institution. For this, management must always prefer to identify and strengthen the strongest points of the revenue-profit matrix in the existing set up. The most catching point of the institution, be it some well-known doctors, technology, price, any particular specialty whatever, should be on prime focus initially for a year or more. The key profit earner
This will be mostly applicable to smaller set up where a needed department cannot be clubbed with present system for some unavoidable reason such as space shortage etc. Those services can be outsourced on revenue/profit sharing model. An SHCO should go for tie up with other reputed medical institutions for getting investigations and OP/IP procedures done (out of its own scope).
Welcome doctors If one’s hospital is running sick because of
NABH-accredited Small Healthcare Organisations (SHCO) not generating expected revenue, taking all factors as brand name, facility infrastructure, promotions, operational issues etc into consideration, one must confess the major problem that is ‘you have unhappy clinicians or your place is not a preferred place for clinicians to work.’ First and foremost, one needs to identify the reasons and work towards it. In case, the medical set up has limited number of established doctors, it is must to engage clinician from market who can come with personal patient base. The existing doctors are needed to be boosted up for cross referrals. It is important to identify if any investigation or surgery are referred to other hospitals by any doctor, if so management must understand the reason and communicate to the concerned person to stop the outsourcing.This has been a common scene in many places if the patient is doctor driven. In this scenario, management have to win the situation by making the concerned institution a first priority to the doctor.
Resource utilisation Promote day care procedure for a quicker bed turn over. Centre where investigation services remains off during nights or off days, look for utilisation of the same. Look for underutilised space and plan for new services, which may give you additional revenue. Facilities such as pharmacy, spectacles shop, gift shop, internet café, cafeteria etc can be planned with lower investment. A sick facility, in no way should have staff: bed ration as more than 3:1. If it is so then, one should look at the manpower utilisation in each category and think accordingly.
Tariff Tariff is a big card in your hand to play. First, do one should go for a OPD tariff comparison with 3-4 same line players. If there is a scope to hike then it should be enacted with a normal 10 per cent increase per annum. If the centre is a facility with beds, then it has got the double scope to increase your revenue. As all of us are aware about IPD / OPD difference for any investigation and OPD rates are seen by all but IPD rates are actually hidden, which differs with each bed category. So creating a higher jump in tariff there may not really affect the business but push the revenue substantially.
Organisation should design procedure package as per the clinical difference but with level flexibility to accompany any patient with a standard sharing pattern.
Prescription conversion A sick institution cannot afford to miss a single advice (medicine / tests / admission). If needed, one of the customer care staff with pleasant presentation should be dedicated for this purpose. S/he should tract all patients coming out from an OPD for post consultation guidance. Promoting home sample collection also generates additional revenue. In case the investigation is to be done few days/ week after, it can be offered with special rates for advance booking.
Branding through community presence It has often been seen that institutions which are not doing financially well have lost its visibility in community. This is mainly due to no or very limited promotional activities done by the centre. Management must go for low expense marketing tools in the form of health awareness camps at various public places and corporate / PSU offices. Continuity is the key factor to get results of these activities. This will immensely help to establish the brand presence which is vital to get footfalls and convert a footfall into footmark.
Marketing Focus on cost-effective marketing tools rather than going for paper advertisements, media promotions. This is just to keep expenses lower. Also, it is expected that a loss making centre will not be able to cater more than 3 per cent of its OPEX for marketing. Even with 2-3 per cent, the centre should manage group activities, direct marketing as patient contact programmes, GP’s gathering, sponsored CME, corporate meet, no parking boards, full page paper inserts, senior citizen / family privilege card etc.
Consumables Management must ensure that all consumables are supplied from institution; one should look at the MRP and fix selling
price based on market scenario, purchase price. One can expect an easy 20-25 per cent margin in this. Review the holding stock and re-order level is important to bring the cost down. Location: If well located within a city – go for out reach clinic and do a ‘door-to-door’ campaign in surroundings. If located in a remote place – go for a city-based information cum poly clinic model, even forming a tie up with any good existing place (not same line service providers but who may have link with healthcare delivery system). Arrange for transport for patients and staff. People: Engage with informal activities such as cultural programs, games, picnic and employee of the month. A listed company can offer its employee to purchase company share and be an investor. Otherwise, giving an incentive to all employees based on the financial performance also plays an interesting role for employees to be more concerned about the organisation. Process mapping: Study of workflow and functional process aiming at improved response to demands of patient care and collecting, collating and retrieving patient information. Credit business: Watch out for those companies who are not paying you for more than 2 years, the top management should directly connect with the same line people in those companies for recovery. And for new tie ups, thrust on cash business even for a lower profit. Power, fuel, repair and maintenance: Switching off lights is not enough! For a quick win, look at areas where utilisations are high such as AC, major equipments. Installing solar panel also helps in reducing electric bills though it needs capital investment. For fuel & repairing cost control, its vital to have a regular check on usage. (firstname.lastname@example.org)
Indradip Das Hospital Planning & Operations Management Expert, Fortis Medical Centre, Kolkata
June 2013 I
Tips & Tricks: Hospital architecture
Reviewing the top 10 emerging trends
ospitals are highly complex and resource-intensive organisations to build, operate and sustain. The planning and design of a hospital is an elaborate process that demands immense skills, multidisciplinary approach and consideration of several design factors
related to the safety of occupants, energy efficiency, preparedness to disasters, besides meeting the quality standards. Further, there is evidence that design of the hospital impacts the clinical outcomes, staff performance and organisational productivity. Here are top ten emerging trends in healthcare architecture that are
Evidence-based design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. This design process leads to demonstrated improvements in the organisation’s clinical outcomes, staff performance, productivity and clientele satisfaction.
Patient-centric design is a philosophy by which design teams create and develop spaces to be used by patients. This principle takes into account the needs of patients and their families and methods for delivering the best care to them.This thoughtful healthcare design requires continuous insight into the needs and concerns of patients.
3 Focus on safety and security of all occupants includes design features such as anti-seismic design, sufficient provisions for fire safety, anti-skid floorings, provision of hand washing stations to prevent infection, standardisation of procedure/ treatment areas to prevent medical error; provisions for unobstructed, clear, well‐lit circulation paths and hand rails and grab bars for patients to prevent falls.
Lean design is a philosophy to design hospitals to minimise wastage of materials, time, and effort in order to generate the maximum possible amount of value with inputs from first line staff and patients. These stakeholders are involved in planning who dive deep into the process flow to understand the current state.
‘Go green’ concept incorporates design features that blend natural elements, reduces carbon footprint, conserve water, use energy efficiently, promote usage of recycled, non-toxic, bio-based products and reuse of renewable energy sources.
I June 2013
being followed universally. (email@example.com)
Gp Capt (Dr) Sanjeev Sood Hospital Administrator and NABH Assessor
Universal design is the design of hospital buildings that allows everyone to make regular use of such structures to the greatest extent possible, regardless of their age, ability, or status in life. Accessible design features include sufficient space for maneuvering patients using medical or mobility assistive equipment, handrails along patient routes and wide doors for staff to assist patients.
Modular design plan for flexibility, convertibility and expandability as an approach aiming to subdivide a system into smaller parts (modules) that can be independently created and then used in different systems to drive multiple functionalities.
Hospital environment is full of noise reaching 70 dB level emanating out of staff conversations, alarms, communication systems and patients crying/coughing etc. This must be mitigated by installing sound attenuation building materials and more single patient rooms. Lower noise levels have been linked with a number of positive effects on staff, reduced perceived work demands, and increased workplace social support, improved quality of care for patients and better speech intelligibility.
Build better hospitals with Building Information Modeling (BIM) - an intelligent model–based process that helps service providers achieve business results by enabling more accurate, accessible and actionable insight throughout a project lifecycle.
Simulation tools using Computational Fluid Dynamics (CFD) can help building design teams model designs, such as OTs, to visualise and analyse room air flow and temperature distribution to minimise the risk from aerosol-transmitted infections.
Projects New projects and expansion activities are the barometers of industrial growth. These also present business opportunities to service providers like consultants, contractors, plant & equipment suppliers and others down the value chain. This feature will keep you updated with vital information regarding new projects and capacity expansions being planned by companies in the healthcare sector.
Constructing a 350-bed hospital in Guntur Project type New facility Project news Dr Ramesh cardiac and multispeciality hospital Pvt Ltd is planning to construct a 350-bed hospital in Guntur Project location Guntur, Andhra Pradesh Project cost ` 400 crore Implementation stage Planning Contact details: Dr. Ramesh Cardiac And Multispeciality Hospital Pvt. Ltd. Ring Road, Vijayawada - 520008 Andhra Pradesh Tel: +91 866 2484 800 / 811 / 822 Fax: +91 866 2473 554 Email: firstname.lastname@example.org ----------------------------------------
Construction of hospital building in DAE township at Anupuram Project type New facility Project news Construction includes all engineering works related to civil, public health, electrical, communication, HVAC, mechanical, elevators and fire fighting, safety, medical gas supply etc Project location Anupuram, Tamilnadu Project cost ` 24 crore (Approximate) Implementation stage Planning Contact details: Indira Gandhi Centre For Atomic Research Department of Atomic Energy, Kalpakkam, Tamil Nadu 603102 Tel: +91-44-27480267
I June 2013
Fax:+91-44-27480060 Email : email@example.com ----------------------------------------
Construction of Karunya Community Pharmacy outlet at GH, Palakkad Project type New facility Project news Construction of Karunya Community Pharmacy outlet at GH, Palakkad Project location Kottayam Project cost NA Implementation stage Planning
Construction of community health centre Singimari Hospital Project type New facility Name of Organisation National Rural Health Mission Project news National Rural Health Mission is planning to construct Community Health Centre Singimari Hospital in Kamrup. Project location Kamrup, Assam Project cost ` 4,87,82,215 Implementation stage Planning
Contact details: Kerala Medical Services Corporation Ltd Thycaud P.O, Thiruvananthapuram, Kerala- 695 014 Tel: 0471 - 2337354/ 3045600 Fax: 0471 - 3045647 Email : firstname.lastname@example.org ----------------------------------------
Contact details: National Rural Health Mission, Assam Saikia Commercial Complex, Srinagar Path, Christianbasti, G.S. Road, Guwahati-781005 Fax: 0361-2366236 Email : email@example.com, firstname.lastname@example.org ----------------------------------------
Cloudnine Hospital - greenfield hospital in Mysore
Construction of community health centre
Project type New facility Project news Construction of greenfield hospital in Mysore
Project type New facility Name of Organisation National Rural Health Mission Project news National Rural Health Mission is planning to construct a community health centre Nobera in Joitiat District.
Project location India Project cost N.A. Implementation stage Planning Contact details: Cloudnine Hospitals #1533, 9th main, 3rd block, Jayanagar, Jayanagar 3rd Block, Byrasandra, Bangalore, Karnataka 560011, Email : email@example.com Tel :+91 80 4020 2222
Project location Nagaon, Assam Project cost ` 5,63,15,205 Implementation stage Planning Contact details: National Rural Health Mission Saikia Commercial Complex, Srinagar Path, Christianbasti,
Projects G.S. Road, Guwahati-781005 Fax: 0361-2366236 Email: firstname.lastname@example.org, email@example.com ----------------------------------------
Construction of 100-bed ward & ICU at Angul Project type New facility Name of Organisation Government of Orissa Project news Government of Orissa is planning to construct 100 bedded ward & ICU at Angul Project location Angul, Orissa Project cost ` 3,30,10,639 Implementation stage Planning Contact details: Department of Information Technology Government of Odisha Bhubaneswar, Orissa Email: firstname.lastname@example.org Tel 91-674-2586584 Fax : 91-674-2582842 ----------------------------------------
Construction of referral hospital at Hosakerehalli Project type New facility Name of Organisation Madurai Municipal Corporation Project news Madurai Municipal Corporation is planning to construct referral hospital at Hosakerehalli in Ward No. 161 Project location Hosakerehalli, Karnataka Project cost ` 130.12 lakh Implementation stage Planning Contact details: Madurai Municipal Corporation
Office of the Executive Engineer, Project (South) Division, Jayanagar, 2nd Block, 9th Main, Bengaluru-560 011 Karnataka ----------------------------------------
Construction 100-bed Zila Mahila Chikitsalaya at Jaunpur Project type New facility Name of Organisation HSCC (India) Ltd Project news HSCC (India) Ltd is planning to construct 100 bedded MCH wing for Zila Mahila Chikitsalaya at Shahjahanpur, Uttar Pradesh. Project location Jaunpur, Uttar Pradesh Project cost ` 17.46 crore Implementation stage Planning
Contact details: HSCC (India) Ltd E-6(A), Sector 1, Noida - UP - 201301 Tel: 91-120-2542436-40 Fax: 91-120-2542447 Email: email@example.com ----------------------------------------
Construction 100-bed Zila Mahila Chikitsalaya at Pilibhit Project type New facility Name of Organisation National Rural Health Mission Project news Construction of 100 bedded MCH wing for Zila Mahila Chikitsalaya at Pilibhit, Uttar Pradesh, under National Rural Health Mission scheme. Project location Pilibhit, Uttar Pradesh Project cost NA Implementation stage Planning
Contact details: National Rural Health Mission 157-A Nirman Bhawan, Maulana Azad Marg, New Delhi Tel: +91-11-23061451 Email: firstname.lastname@example.org ----------------------------------------
Hospital development at Andheri, Mumbai Project type New facility Project news Hospital development West, Mumbai
Project location Mumbai, Maharashtra Project cost ` 2150 million Implementation stage Planning Contact details: Khubchandani Hospitals Pvt. Ltd 508 CeeJay House, Dr. Annie Besant Road, Worli, Mumbai 400 018 Email: email@example.com Tel :+91 22 2495 4720/21/22 Fax : +91 22 2495 4723 ----------------------------------------
Setting up specialised diagnostic centre at Pithoragarh Project type New facility Project news Setting up specialised diagnostic centre at Pithoragarh Project location INDIA Project cost ` 12 crore Implementation stage Planning Contact details: Directorate General Of Health Room No. 4, SBI Porta Building Secretariat, Government of Uttarakhand, Subhash Road, Dehradun, Uttarakhand -248001
Information courtesy: www.tendersinfo.com 1, Arch Gold, Next to MTNL Exchange, Poisar, S.V. Road, Kandivali (W), Mumbai - 400067, India Tel: s Fax: s Email: firstname.lastname@example.org
June 2013 I
Latest Popular Tenders Spirometer, ambulatory BP monitor and ambulatory holter Org : Armed Forces Medical Services (AFMS) TRN : 16270865 Desc : Supply, installation, consumables, transportation at Maldives for spirometer, ambulatory BP monitor and ambulatory holter BOD : 21 June 2013 Loc : Kollam, Kerala BT : Domestic (NCB) Medical equipment Org : Sri Lanka Army TRN : 16154332 Desc : Purchase of medical equipment BOD : 21 June 2013 Loc : Colombo BT : Global (ICB) Medical equipment Org : Dr. Ram Manohar Lohia Institute of Medical Sciences TRN : 16294821 Desc : Supply of equipment for various departments namely pathology, microbiology, neurosurgery, radiodiagnosis, cardiology, anaesthesiology and other departments for super specialities BOD : 24 June 2013 Loc : Lucknow, Uttar Pradesh BT : Domestic (NCB) Medical equipment Org : ESIC Model Hospital TRN : 16298122 Desc : Supply of medical equipment BOD : 25 June 2013
brought to you by www.tendersinfo.com
: Mumbai, Maharashtra : Domestic (NCB)
Electronic foetal monitor Org : South Central Railway (SCR) TRN : 16219851 Desc : Supply of electronic foetal monitor BOD : 27 June 2013 Loc : Andhra Pradesh BT : Domestic (NCB) Surgical consumables Org : State Pharmaceuticals Corporation of Sri Lanka TRN : 16171453 Desc : Supply of surgical consumables BOD : 04 June 2013 Loc : Colombo, Sri Lanka BT : Global (ICB) Surgical non-consumables Org : State Pharmaceuticals Corporation of Sri Lanka TRN : 16251816 Desc : Supply of surgical non-consumables BOD : 05 July 2013 Loc : Colombo BT : Global (ICB) Biochemistry analyser Org : Northern Railway TRN : 16201552 Desc : Supply of fully automated biochemistry analyser BOD : 05 July 2013 Loc : New Delhi BT : Domestic (NCB) Scientific equipment Org : National Dairy Research Institute (NDRI)
TRN : 16244008 Desc : Supply of scientific equipment: mass spectrometer facility, incubator shaker, multiple pathogen detection system, refrigerated centrifuge, HPLC system with various detectors and columns BOD : 06 July 2013 Loc : Karnal, Haryana BT : Domestic (NCB)
Surgical consumables : State Pharmaceuticals Corporation of Sri Lanka TRN : 16153332 Desc : Supply of surgical consumables microscope BOD : 09 July 2013 Loc : Colombo BT : Global (ICB) Org
Surgical Non Consumables Org : State Pharmaceuticals Corporation of Sri Lanka TRN : 16153331 Desc : Supply of Surgical Non Consumables. BOD : 10 July 2013 Loc : Colombo BT : Global (ICB) Scanning electron microscope Org : Department of Atomic Energy TRN : 16295025 Desc : Supply of tabletop/ benchtop/ desktop scanning electron microscope BOD : 12 July 2013 Loc : Hyderabad, Andhra Pradesh BT : Domestic (NCB)
Org: Organisationâ€™s name; TRN: Tendersinfo Ref No; Desc: Description; DSLD: Doc Sale Last Date; BOD: Bid Opening Date; Loc: Location; BT: Bidding Type
Information courtesy: www.tendersinfo.com 1, Arch Gold, Next to MTNL Exchange, Poisar, S.V. Road, Kandivali (W), Mumbai - 400067, India Tel: s Fax: s Email: email@example.com
I June 2013
NATIONAL 2nd Indo UK Pain Management Conference Indo UK Pain Management Conference is dedicated to beginners and freshers offering courses related to ultrasound guided procedures. Apart from the interactive session, this conference will have quizzes, demonstrations, workshops and group discussions. Globally recognised professionals will be present at the conference. The conference will emphasise on new ways of pain management treatment and anesthesiology, advance technologies and the applications used along with medications and preventions. Certain relevant issues will also be highlighted. Date: August 9-11, 2013 Venue: Max Super Specialty Hospital, New Delhi Organiser: Anaesthesia Co-ordinator Tel: +91-9811944856,Â 09818773083 Email: firstname.lastname@example.orgÂ Â Website: www.indoukpainconference.com
International Conference on Holistic Medicine 2013 International Conference on Holistic Medicine is organised with an aim to develop a holistic approach for the treatment of various diseases. It will deal with other bilateral research programmes between Department of Science and Technology (DST), India and rest of the world. It will provide a platform
Indiaâ€™s premier industrial trade fair on products and technologies related to Machine Tools, Hydraulics & Pneumatics, Process Machinery & Equipment, Automation Instrumentation, Packaging & Auxiliaries, IT Products, Electrical & Electronics, Material Handling and Safety Equipment.
for visitors to gain more knowledge about the theme and the topics that will be discussed. The conference will see attendance of various eminent personalities sharing important views with the interested candidates. Date: September 6-8, 2013 Venue: Kottayam, Kerala Organiser: Institute for Holistic Medical Sciences (IHMS) Tel: +91-9847460331, 9447223452 Email: email@example.comÂ Website: www.holistic.macromol.in
Conference of the Asian Federation on Intellectual Disabilities (ID) This conference will hold discussion panels, poster presentations and abstracts. A special session will be included in the conference that will emphasise on resource mobilisation, family mobilisation, non-discrimination or social acceptance, innovative habilitation practices. It will also emphasise on community mobilisation and family mobilisation. Women with ID, leisure and recreation will be other topics that will be covered in the conference. Social issues will also be raised. Date: October 7-11, 2013 Venue: India Habitat Centre, New Delhi Organiser: KW Conferences Pvt Ltd Tel: +91-124-4636700 Email: firstname.lastname@example.org Website: www.afid2013.in
Gujarat September 20-23, 2013
Maharashtra October 18-21, 2013
Punjab December 20-23, 2013
Maharashtra January 10-13, 2014
Madhya Pradesh Jan 31 â€“ Feb 03, 2014
West Bengal February 21-24, 2014
Tamil Nadu Rajasthan November 14-17, 2013 Nov 29 - Dec 02, 2013
For details Network18 Media & Investments Ltd
Ruby House, 1st Floor, J K Sawant Marg, Dadar (W), Mumbai 400 028. R5&95fhh5iffi5jlkg5R5295fhh5iffi5jjoo5R5'#&95(!2*)H(.1),%gn*/&#-"#(!8)'
Indian Orthodontic Conference Indian Orthodontic Conference is a platform wherein various innovative ways on most recent orthodontic issues will be discussed and attendees will get valuable insight on dentofacial orthopaedics. This is the summit which will be attended by reputed dentists, scientists and professionals to discuss and debate on the most recent challenges encountered as well as available solutions to face them. The conference will also ensure updated strategies to develop perfect collaboration through the proper execution of networking breaks thus optimising learning needs and fostering new research. Date: November 22-24, 2013 Venue: Gujarat University Exhibition Hall, Ahmedabad Organiser: Cimglobal Tel: +91-7926670720 Email: email@example.com Website: www.48ioc.com
I June 2013
International Congress of Dermatology will be a meeting ground for dermatologists from all over the world to explore the current advances in the field. It will organise â€˜Meet the Expertsâ€™ sessions with specialists from specific areas such as phototherapy, telederm and health informatics, urticaria and photosensitivity disorders. The conference will be a good forum for discussion and sharing of information and research results. Date: December 4-7, 2013 Venue: Ashok Hotel, New Delhi Organiser: Neumech Events Tel: +91-11-26593217, 26594224 Fax: +91-11-26588663 Email: firstname.lastname@example.org Website: www.icddelhi2013.com
The information published in this section is as per the details furnished by the respective organiser. In any case, it does not represent the views of Modern Medicare
INTERNATIONAL World Vaccine Asia 2013
World Vaccine Congress Asia 2013 is Asia’s largest vaccine event. It will bring together all the major vaccine stakeholders from pharma, biotech, NGOs, research institutes, regulators and CDCs to discuss latest industry trends, business strategies and scientific developments in the global and Asian vaccine markets. It will serve as a platform for exchange of ideas and viewpoints. Date: June 17-10, 2013 Venue: Great Copthorne Waterfront Hotel, Singapore Organiser: Terrapinn Holdings Ltd Tel: +65-6222 8550 Email: email@example.com Website: www.terrapinn.com/2013/ world-vaccines-congress-asia/index.stm
2nd Annual Global Healthcare Conference (GHC 2013) Healthcare privileges differ across societies and require the combined efforts of government, the private sector, the public and health workers themselves to ensure both the accessibility and affordability of healthcare services. Funding for health and medical facilities are vital for the health and public well-being. But most importantly, health and medical researchers and developers serve the task of advancing health care and medical science through study and proper dissemination of information, in order to improve the state of health care service of any country. Date: July 8-9, 2013 Venue: Hotel Fort Canning, Singapore Organiser: Global Science & Technology Forum Tel: +65 6327 0166 Email: firstname.lastname@example.org Website: www.globalhc-conf.org
5th Asian Congress of Health Psychology (ACHP) The theme of the 5th Asian Congress of
Health Psychology (ACHP) is ‘Health and Happiness’. Eminent scholars, promising researchers and students will present their recent findings and share their insights on health and happiness. Psychologists from around the world will exchange knowledge and the latest research findings on their subjects. This conference will play a pivotal role in helping people become healthier and happier. Date: August 22-24, 2013 Venue: DCC Daejeon, Korea Organiser: Korean Health Psychological Association Tel : +82-42-472-7462 Fax : +82-42-742-7459 Email: email@example.com Website: www.achp2013.org
2013 International Conference on Biological and Medical Sciences The main objective of the 2013 International Conference on Biological and Medical Sciences is to provide a platform for researchers, engineers, academicians as well as industrial professionals from all over the world to present their research results and development activities in biological and medical sciences. It will serve as a great place for inteaction. Date: September 23-24, 2013 Venue: Cape Panwa Hotel, Phuket, Thailand Organizer: Asia-Pacific Chemical, Biological & Environmental Engineering Society (APCBEES) Tel: +86-28-86528465 (China Branch) Email: firstname.lastname@example.org Website: www.icbms.org
1st International Conference on Orthofacial Surgery and Orthodontics Opinion leaders in orthodontics, maxillofacial and oral surgery from Europe, Latin America, South Africa,
and Russia will present lectures and master class during this world-scale event. Contemporary approaches to the treatment of patients with dysgnathia and other skeletal abnormalities of face will be demonstrated by means of presentations and live discussions. The master class with participation of reputable foreign and local specialists will be held before the conference for those who are interested in peculiarities of treatment plans for patients with different categories of deformities. Date: October 11-13, 2013 Venue: Cosmos Hotel, Moscow, Russia Organizer: LIVE CO, Scientific Events Organizers Tel: +370-689 07071 Email: email@example.com Website: www.orthofacial2013.info
29th Annual Echocardiography in Paediatric and Adult Congenital Heart Disease This four-day symposium focuses on the basics of recognising, understanding, and imaging patients with congenital heart disease. It will provide a comprehensive understanding of the anatomy, clinical aspects, imaging, and management of patients with congenital heart disease. The symposium features distinguished faculty of paediatric and adult congenital cardiologists, and surgeons with expertise in treatment, diagnosis, and management of patients with congenital heart disease. The format will include lectures, video examples, workshops and panel discussions. Date: October 13-16, 2013 Venue: Leighton Auditorium, Mayo Clinic, Rochester, MN, USA Organizer: Mayo Clinic Tel: +800-283-6296 (toll free) Email: firstname.lastname@example.org Website: www.mayo.edu/cme/ cardiovascular-diseases-2013R015
June 2013 I
Book Review Safety Management in Hospitals
shi Author: SK Jo 5/ Price : ` 49
Safety management is an important issue that has not been given due recognition, even as the incidents of patient safety violation continue to occur with grim regularity in Indian hospitals.The issue is of prime importance since the ensuing harm or injury caused to the patient or the provider are mostly preventable. This book is a comprehensive review on safety management in hospitals and deals with safety management theories and practices in the work culture of healthcare organisations. The scope of this book includes safety in all its dimensions in healthcare, the causes and effects of violation of safety rules, policies and practices. The book deals with all kinds of safety hazards such as unsafe infrastructure, unsafe services or unsafe procedures, medication and surgical errors, radiation safety, fire safety and medical device-related incidents. It provides insight into the causes of safety lapses and failures and provides effective solutions to this complex problem through implementation of the safety management programme with the involvement of entire team in the hospital. The book emphasises on achieving patient safety through a preventive, proactive and scientific approach. Other relevant issues to safety management like safety of staff, visitors and environment are discussed at length. The book is written in a lucid style with frequent references to relevant statutes, regulations and court judgments wherever applicable and newspaper clippings to make an interesting read. This book can be a useful guide for doctors, administrators, paramedical staff, policymakers and anyone concerned with patient safety.
Publisher: JAYPEE Brothers
Medical equipment and devices play a crucial role in patient care by achieving timely and accurate diagnosis, treatment and improving overall healthcare delivery. The issue of patient and user safety, quality assurance is very important for appropriate and optimum use of medical devices. National Accreditation Board for Hospitals and Healthcare Providers (NABH) has come out with this concise book covering entire lifecycle of medical devices, best practices for safety and quality, need analysis, equipment and vendor selection, procurement, installation, use and maintenance and finally decommissioning of medical devices. Though the guidelines on the subject are available in other countries under the aegis of Global Harmonization Task Force (GHTF),this book is a scientific endeavor in Indian context to provide generic guidelines for establishing the most desirable and impactful practices that could provide the framework for the various stages in the lifecycle of equipment management. The production phases have been outlined under ten broad themes, whereas the stages of procurement process, training, quality management, maintenance and use have been covered under the theme of Institutional management of medical devices. The author has related issues of device management to specific JCI and NABH objective elements and provided a format for the agreement for sale and purchase of medical devices in the appendices.And finally, the emerging science of health technology assessment is of critical importance in resource constrained countries like India. This has been elaborated for the benefit of readers. However, a reference to incident reporting and investigation and interfacing medical devices with Health Management Information System (HMIS) would have covered the subject in its entirety. Thus, this book outlines best practice guidelines for medical devices that would be of a Kumar Sharm ar nd te Ji : or immense use to manufacturers, clinical and biomedical engineers, regulators, hospital and Auth Price : ` 500/ healthcare administrators.
Medical Devices - Best Practices for Patient Safety
Publisher: NABH Secretariat Reviewer: Gp Capt (Dr) Sanjeev Sood, Hospital Administrator and NABH Assessor serving in Chandigarh. He is a prolific writer on healthcare matters. Email: email@example.com
I June 2013
Looking for a specific product? Searching and sourcing products was never so easy. Just type MMC (space) product name and send it to 51818
eg MMC OT Lights and send it to 51818
NATIONAL Nurse-call system Electronic Nurse-Call System is a modern microprocessor based digital system. Its features have been designed to cater hospital practices prevailing in India. Hence, the basic audio-visual arrangement has been deliberately simplified through an easy to understand red-yellow-green lamp mode with easily recognisable audio chimes. The system is modular, comprising a central display console at the nurse-station counter (optionally, also with ward graphic displays), a bed-unit module behind each patientâ€™s bed and a handset that can be
reached by the patient through a lengthy flexible cable. A door display unit can also be mounted at the room entrance with nurse presence registration. An emergency alert unit can be mounted within the toilet or also within the shower stall. Optional features include nurse help request, patient-nurse intercom, additional call signals, instrument alarm relay, IV-drip alert, code-blue alert, call transfer facility, multifunction handsets, corridor display modules, nurse call response monitoring and sms alert facility for selected calls to be forwarded directly to cell phones. CR Medisystems Pvt Ltd Mumbai, Maharashtra Tel: +91-022-23094416, 23004930 Fax: +91-022-23061903 Email: firstname.lastname@example.org Website: www.medisystems.in
June 2013 I
Urine ﬂuorescence ﬂow cytometer Fully-automated urine flow cytometers, UF-1000i and UF-500i employ high performance, laser-based Fluorescence Flow Cytometry (FCM) that gives reliable quantitative results. These systems improve laboratory turnaround time and offer worryfree urinalysis tool that you can totally rely on. FCM is a Sysmex core competence. It has been employed in X-class haematology analysers and its accuracy and reliability have been proven for many years. The analysers also offer value added clinical information of UTI, red cell morphology, and conductivity, and are able to accurately detect RBC, WBC, epithelial cells, casts, bacteria, crystals, yeasts and sperm in urine sample by using three different scatters. Forward scattered lightinformation on cell size, side scattered light-information on internal cell structure and side fluorescence light information on RNA / DNA contents. UF series offers excellent capabilities for the best differentiation and quantification of urine particles. It provides standardisation in urinalysis that complies with ISLH guidelines by analyzing uncentrifuged native urine sample. Sysmex India Pvt Ltd Mumbai, Maharashtra. Tel +91-22-2822-4040 Fax +91-22-2836-5068 Email: email@example.com Website: www.sysmex.co.in
Syringe infusion pump This machine is easy-to-use microprocessor controlled with a syringe status indicator. Wide range of syringe selections from 10 ml to 50 ml are available. Automatic identification of syringe size is loaded. Syringe calibration function allows any brand of syringe to be used to ensure high accuracy at effective cost. Convenient front-loading system allows easy access to clamp syringe plunger. It supports upto 3 levels of adjustable occlusion pressure along with a powerful battery that helps it run for more than 6 hours..
by LED technology. The machine also has an integrated audio output for archiving the audio signal. Variable phasing, slow-motion mode and frequency pre-selection are adjustable with foot switch. Readings of voice frequency and sound pressure level is easy to read on a LCD display. Atmos MedizinTechnik GmbH & Co KG Bangalore, Karnataka Phone: +91-80-41172227 Website: www.atmosmed.com
Digital mobile radiography system RollX DR is a new variant of the cost effective mobile DR system. This unique model was launched at IRIA 2013, Indore where it received a very encouraging response. The system has been specially designed to meet the demand of a cost effective mobile digital radiography system. With its unique fully integrated image acquisition system, IntegraX, the specialist can set the imaging factors and also review the image acquired then and there. This machine feature 15 KW generator (MARS-15) with 17” touch console, Integra X - Integrated image acquisition system and 14”x17” Flat Panel Detector (Wired / Wireless). The system operates on just 15 Amps/ 230-volt standard wall socket full DICOM 3.0 connectivity. Allengers Medical Systems Ltd Chandigarh Tel: +91-172-3012280/84 Fax: +91-172-2621913 Email: firstname.lastname@example.org Website: www.allengers.com
Ventilator system Medx Technologies Pvt ltd Surat, Gujarat Tel: 0261-2275949, 9920404079 Fax: 0261-776003 Email: email@example.com Website: www.medxtechnologies.ca
Stroboscopy Noiseless stroboscopy with strobo 21 LED technology without reduction. This machine can perform vocal-fold diagnostics with jitter-free white-light at freeze image. It features slow-motion mode and pilot light
I June 2013
This machine is compact-sized and has integrated medical grade air compressor. It is also equipped with microprocessor controlled with audio visual alarms ensuring safety. This machine features continuous flow of 40 l/ min3.5-7kg/ cm2, pressure with ion peak flow of 180l/min, low noise and vibration with power input: single phase 220v 50 Hz. It also comes with in-built battery module offering upto 2-hours of ventilator use and optional battery pack offering upto 4 hours of ventilator use.
Products Medion healthcare Pvt ltd Mumbai Maharashtra Tel: +91-22-61566565 Fax: +91-22-61566556 Email: firstname.lastname@example.org Website: www.medicon.co.in
Hydraullic ďŹ tness machine
This product is a new-generation CR that consumes 90 per cent less power. Regius desktop CR emits no sound, while in stand-by mode and poses no obstacle to medical examinations even when located in the same room. The product consumes power of only 100VA which is less than 10 per cent of the X-ray improcessors. This machine is an environmentally conscious product that saves electricity and prevents global warming.
This machine features hydraulic cylinders that can automatically and continuously adjust itself to the strength, power, speed, output and the need of the person using it. Opposing muscle groups therefore are alternately exercised during both flexion and extension without injury, damage or soreness as the user is not tied down to a preset speed of movement and never meets more resistance than he/she can handle. To make fitness easier, eye-level read out gauges in a panel allows the individual to see precisely how much force he/she is exerting exactly where in the body and at what point of the exercise. This machine can also be used by people having back problems without any fear of having any complications and itâ€™s one of the most comfortable sitting positions for workout. This machine is free standing and quiet, with no chains, pulleys, cams, cranks, water buckets, air hoses, cables or weights. It is also economical, durable and virtually maintenance-free. Resistance is variable by the twist of a control knob provided on the left side of the seat. Also a seat belt is provided for getting proper body hold on the machine.
Konica Minolta Healthcare India Pvt Ltd Mumbai, Maharashtra Tel: +91-22-61916912, +91-9969388214 Fax: +91-22-61916996 E-mail: email@example.com Website: www.konicaminolta.in
Fluid-Tech Fitness Mumbai, Maharashtra Tel: +91-22-28478855 Fax: +91-22-28478855 Email: firstname.lastname@example.org, email@example.com Website: www.fluidtechfitness.com
June 2013 I
Bariatric patient mobiliser/hoist system
Unisex portable urinal
This machine is an automatic remote-control operated, patient lifting system, ensuring maximum patient safety and comfort. The electric operated automatic hoist system is mobile on lockable wheels and capable of lifting a bariatric patient with ease and shifting onto the bed or chair. Caretakers appreciate the ease of operation ability to work in tight places. It has a built-in emergency lowering device and overload warning system. It has a 300 kg safe working load capacity. Operation Theatre (OT) equipment like fully automatic remote-controlled multi-procedure C-arm compatible operation theatre tables (Indian and imported), operation theater lights, latest technology multicolour LED OT lights and shadowless halogen lights, OT & ICU pendants and specialised bariatric OT packages.
The Uriwell portable mini urinal is a toilet for every contingency. Answering nature’s call cannot be postponed. The Uriwell urinal is a flexible, reusable, cylindrical corrugated polypropylene container, which can be extended and collapsed to suit the needs of the user. A unisex adapter makes it suitable for both male and female users. It can be used in any posture, sitting, lying or standing. It comes in attractive colours. The adult model is 150 mm long and can extend upto 350 mm to hold 750 ml of fluid. The children model is 120 mm long and can extend upto 200 mm to hold 350 ml. It is easy to store and use. It is spill-proof and odour proof when closed. Useful for long car and train journeys for children and adults, in hospitals, emergency rooms and ambulances after abdominal, spine or hip surgery, and in wheelchair and bed-bound individuals as of December 2009 Uriwell became available on the National Health Service in the UK. Doorstep delivery of product is available.
Magnatek Enterprises Hyderabad, Andhra Pradesh Tel: +91-40-66668036/ 65501094 Fax: +91-40-66668037 Email: firstname.lastname@example.org Website: www.magnatekenterprises.com
ADL Neurotech Chennai, Tamil Nadu Tel: +91-44-24939640, 09444049390 Email: email@example.com Website: www.adlneurotech.co.in
Silicone transparent braided hose
The Alter G anti-gravity treadmill offers a revolutionary approach to rehabilitation. The ability to defy gravity and work towards regaining function like never before. Alter G’s unique differential air pressure technology provides accurate, safe and comfortable partial weight-bearing therapy, while promoting normal gait patterns. The treadmill expands the concept of “weight bearing as tolerated” by offering precise unweighting in one per cent increments to as low as 20 per cent of patient’s body weight. Alter G’s unique precision gives patient’s ability to set the precise point where, exercise becomes pain-free and provides clinicians a way to accurately measure patient progress. This machine is used and recommended by leading physical therapy clinics, hospitals, colleges and pro sports teams.
Polyester-reinforced silicone transparent braided hoses are made for food, pharma, chemical, medical, heavy engineering, thermal power stations and PSUs. These braided hoses are made of 100 per cent pure silicone rubber by using fully automatic state-of-the-art machines and technologies. The product already caters to all the major pharmaceutical companies in India and is also exported to overseas customers. Medical grade braided hoses are manufactured under stringent quality control and have the following distinguished features: made of medical grade silicone rubber, temperature-resistant from -80°C to 250°C (-110°F to 480°F), non-reactive to body tissue and fluid, unaffected by most water-soluble materials, sterilisable by steam, dry heat, ethylene oxide and gamma radiation and indefinite shelf life. It is available in sizes from 6 to 60 mm ID.
Fit and Spa Solutions Pvt Ltd Bengaluru, Karnataka Tel: +91-80-25723894, 9916904256 Email: firstname.lastname@example.org Website: www.fitandspasolutions.com
I June 2013
Ami Polymer Pvt Ltd Mumbai, Maharashtra Tel: +91-22-28555107/631 Fax: +91-22-28555378 Email: email@example.com Website: www.amipolymer.com
INTERNATIONAL Reclining wheelchair LY-EB207-Bronco is using T-green on the appearance and has a streamlined design, that you can be so cool while riding the bronco and feel increased self-confidence. Users can sit to reclining of step less adjustment and increased foot depending to achieve the effect of the hip decompression to reduce bedsores generated probability. It is also equipped with a 12V x 62AH battery with high capacity to improve product life. Front wheels are 9â€? and rear wheel 16â€? large-size, and the design of rear suspension significantly enhances the climbing obstacle capability and comfort. Comfort Mobility Corp Chia-Yi, Taiwan Tel: +886-5-2892093 Fax: +886-5-2890070 Email: firstname.lastname@example.org Website: www.comfort-mobility.com
Electric hospital bed The bed ES-12DW ICU follows the new standard of IEC 60601-2-52 and it is specialised for ICU usage. The bed also has X-ray cassette for the backseat and a quick release for emergency CPR. There are two angle indicators for the back and trendelenburg with a central locking system. Drop-down side rail has an integrated weight scale system with a unique designed layout. This bed also holds certificates (ISO 13485, IEC 60601, IEC 60601-1-2, CE marck, FDA registration). Joson Care Enterprise Co Ltd Taoyuan, Taiwan Tel: +886-3-3290925 Fax: +886-3-3290921 Email: email@example.com Website: www.hospitalbed-josoncare.com The information published in this section is as per the details furnished by the respective manufacturer/distributor. In any case, it does not represent the views of
June 2013 I
An invite that rewards as well...
Dear Reader, ‘Modern Medicare’ solicits original, well-written, application-oriented, unpublished articles that reflect your valuable experience and expertise in the pharmaceutical industry. You can send us Technical Articles, Case Studies and Product Write-ups. The length of the article should not exceed 1,500 words, while that of a product write-up should not exceed 100 words. The articles should preferably reach us in soft copy (either E-mail or a CD). The text should be in MS Word format and images in 300 DPI resolution & JPG format. The final decision regarding the selection and publication of the articles shall rest solely with ‘Modern Medicare’. Authors whose articles are published will be sent a complimentary copy of that particular edition. Published by Network18 Media & Investments Ltd, ‘Modern Medicare’ is one of the leading monthly magazines on healthcare, and related equipment & technologies. This monthly magazine was launched in December 2004 and provides the latest and most apt updates exclusively for the medical fraternity. Moreover, ‘Modern Medicare’ acts as a sourcebook that facilitates buying decisions for this key sector hospitals, specialty clinics, pathology labs, nursing homes and doctors - and brings out highly useful business information on various healthcare facets such as surgeries, procedures, technologies, equipment et al. So get going and rush your articles, write-ups, etc… Thanking you, Yours sincerely,
0 t I ` 10 emen e.co.in manag edicar sease nic di odernm X: Chro I www.m R y ? : Polic 2013 ioons PLUS No 6 I May ctatti I xpe Vol 9 he e
Manas R. Bastia Senior Editor Modern Medicare Network18 Media & Investments Limited ‘A’ Wing, Ruby House, J K Sawant Marg, Dadar (W) Mumbai 400 028 India
D +91 22 3003 4669 T +91 22 3024 5000 F +91 22 3003 4499 E firstname.lastname@example.org W www.network18publishing.com
to e up I t liv in dge o.iin n Bu iiccarre.c d Unio the ernnme th d id is: D w.m mod alys w t An 3 I w 1 dge t Bu rch 20 Pos Ma : I S PLU I No 4 9 Vol
de this co Scan phone smart .in on your dicare.co me odern www.m
s in In
l aes Dent a
pirth changing ti
co.in de e are. is co t phon edic n th nm Sca ur smar.moder on yo t www si to vi
end Tech tr
ce g the fa Changin of option ing ad Grow
E SID India ? O IN nt in the raace ALS an transplawill we win Org nd steady, a care Slow ical y med
su gy con ng ener to sav marki Need Bench
stry n denti t
lthca in hea
patie Boon to
hosp ption in y
June 2013 I
List of Products
Looking For A Specific Product? Searching and sourcing products were never so easy. Just type MMC (space) Product Name and send it to 51818
eg, MMC OT Lights and send it to 51818 Product
Pg No Product
Adult pediatric transport ventilator ................... 19
Clinical consumables & accessories.....................BIC
Excellent bed ............................................................ 77
Advance instrument ................................................ 73
Clinical IT & software solution............................BIC
Fetal monitor ......................................................... 19
Advanced medical cart ............................................ 71
Consulting couch & table ....................................... 77
FICCI health insurance conference 2012 ............. 45
Aged centre and nursing home ............................. 29
CR image intensiﬁer................................................ 23
Fogging machine...................................................... 99
Air bed & BP monitor nutec.................................... 6
Critical care ventilator ............................................... 8
Fowler bed ................................................................ 85
Customised modular OT solution ........................ 61
Fumigation ............................................................... 99
Anesthesia ventilator ................................................. 8
Cylinder trolley ........................................................ 85
Gas detection equipment ...................................BIC
Anesthesia work station ........................................BIC
Deﬁbrillator/analyser ........................................... 27
Gynaec examination coach..................................... 65
Anti - Gravity Treadmill ......................................... 96
Delivery bed ........................................................14-15
Gynaecology treatment unit................................... 43
Bact- viral ﬁlter (adult) disposable bacterial/ viral
Desiccant compressed air dryer ............................. 35
Desktop pulse oximeter .......................................... 19
Health & hygiene ﬂooring system ......................... 69
Bact- viral ﬁlter with HME (adult) ......................BC
Digital Mobile Radiography System...................... 94
Health care furniture and equipments like electric
Barcode patient ID band ........................................ 47
Disinfectant product ............................................... 51
bed ............................................................................. 29
Bariatric OT table ...............................................14-15
Disposable bacterial/ viral ﬁlter with heat and
Hospital accessories ................................................. 85
Bariatric patient mobiliser/hoist system ............... 96
moisture exchanger ................................................BC
Hospital bed ............................................................. 85
Bed side accessories ................................................. 85
Diving equipment and system .............................BIC
Hospital equipment & furniture............................ 10
Bed side locker ....................................................77,85
Dressing trolley ........................................................ 85
Hospital equipments & steel furniture ................. 99
Billi ﬂux led phototherapy unit ............................. 31
DSA system............................................................... 23
Hospital furniture ..............................65,75,89,99,102
Biomedical waste solution ...................................... 49
Dual syringe infusion pump .................................. 19
Hospital stool ........................................................... 85
Biphasic deﬁbrillator ............................................... 19
Electric Hospital Bed ............................................ 97
Hospital trolley......................................................... 85
Blood pressure recorder .......................................... 19
Electric ventilator ....................................................... 8
Hospitals and healthcare organisations ................ 13
Blood transfusion chair .......................................... 85
Emergency medical services ................................... 21
HVAC system ........................................................... 10
Breathing circuit system(adult) disposable
Endoscopy & laparoscopy suites............................ 93
Hydraullic Fitness Machine.................................... 95
Breathing circuit .....................................................BC
ENT treatment unit................................................. 43
Cardiac OT table...............................................14-15
Epoxy ﬂooring.......................................................... 10
ICU pendant .......................................................14-15
C-arm OT table ..................................................14-15
Examination chair ..............................................14-15
Imported pendant ..............................................14-15
CFL double surface phototherapy ......................... 31
Examination couch.................................................. 99
Injection moulding machine................................FIC
Clinical chemical analyser ...................................... 17
Examination table.................................................... 85
Instrument trolley.................................................... 85
BC-Back cover, BIC- Back inside cover, FIC- Front inside cover
I June 2013
List of Products Sl No Product
Pg No Sl No Product
Pg No Sl No Product
Intensive care ventilator .......................................... 19
Nurse call system ..................................................... 10
Proton intensive care ventilator ............................... 8
Inverter ...................................................................... 25
Nurse call system ..................................................... 93
Radiology equipment .............................................. 93
IT & networking system ......................................... 10
Obstetric labour table telescopic......................... 85
Rapid endotoxin detection system ........................ 99
Label .......................................................................... 47
Operation light......................................................... 85
Reclining wheelchair ............................................... 97
Laparoscopy instrument ......................................... 93
Operation table ........................................................ 85
Recovery bed ............................................................ 65
Operation table (height adjustable) ...................... 65
Regius CR ................................................................. 95
LED medical lights & iv stand ............................... 71
Operation theater equipment .................... 14-15, 85
Respiratory tract suction device ............................ 43
LED phototherapy stand ........................................ 31
OR halogen light.................................................14-15
Services & training in hospital ..........................BIC
LED phototherapy stand with trolley ................... 31
OR LED light ......................................................14-15
Silicone transparent braided hose ....................96,99
Linen trolley ............................................................. 85
Silicone transparent tubing .................................... 99
LV critical electrical system .................................... 10
OR pendant .........................................................14-15
Mammography ...................................................... 23
OR table ...............................................................14-15
Stephen H Anatomical ............................................ 73
Manual beds & other medical supplies for hospital........29
Ortho neuro ENT plastic dental drill system ...... 93
Manufacturers of hospital furniture ..................... 97
OT equipment.......................................................... 77
Stretcher .................................................................... 85
Medial equipment ................................................... 93
OT light (imported) ...........................................14-15
Stretcher trolley & AC couch ................................. 71
Medical architectural systems light .....................BIC
OT solution .........................................................32-33
Stroboscopy .............................................................. 94
Medical breathing air dryer.................................... 35
OT table .................................................................... 99
Suction apparatus .................................................... 85
Medical chair ............................................................ 73
OT table ...............................................................75,89
Surgical instruments for all ďŹ elds of surgery ....... 93
Medical emergency equipment.............................. 85
OT table & medical equipment ........................... 102
Surgical light........................................................... 102
Medical gas management .....................................BIC
OT table (imported)...........................................14-15
Surgical suction device............................................ 43
Medical gas system .................................................. 10
Over bed table .......................................................... 85
Sustion machines ................................................... 102
Oxygen generator .................................................... 35
Syringe Infusion Pump ........................................... 94
Medicall 2013 ......................................................38,56
Patient lifter & ceiling hoist ................................. 71
Thoracic drainage system .................................... 43
Mobile DR Systems ................................................. 23
Patient monitor ........................................................ 30
Treatment chair ...................................................11,12
Mobile light .........................................................14-15
Patient trolley ........................................................... 85
ULVfogging machine ............................................ 99
Mobile OT light ..................................................14-15
Pedal suction ............................................................ 53
Unisex Portable Urinal ............................................ 96
Modular Operation Theater..............................10,93
Pediatric OT table...............................................14-15
UPS ............................................................................ 25
Monitor ..................................................................... 23
Urine Fluorescence Flow Cytometer ..................... 94
Multi parameter deďŹ brillator ................................. 19
Personal protection equipment............................BIC
Ventilator system ................................................... 94
Neo natal intensive care radiant warmer ........... 31
Plastic masterbatches............................................... 67
Ward care bed .......................................................... 77
Neonatal & pediatric equipment ............................. 4
Platinum cured silicone transparent tubing......... 99
Ward care bed -plain............................................... 77
Printer ....................................................................... 47
Ward care equipment.............................................. 77
Neonatal transport ventilator................................. 19
Products and services for clinical laboratories..... 13
Wound drainage system.......................................... 43
Neurology OT table............................................14-15
Professional pharmacy storage solution ............... 63
X-ray machine.......................................................... 23
BC-Back cover, BIC- Back inside cover, FIC- Front inside cover
June 2013 I
List of Advertisers To know more about the advertisers in this magazine, refer to our ‘List of advertisers’ or write to us at email@example.com or call us at +91-22-3003 4640 or fax us at +91-22-3003 4499 and we will send your enquiries to the advertisers directly to help you source better. Advertiser’s Name & Contact Details
A. B. Industries
Advertiser’s Name & Contact Details
Advertiser’s Name & Contact Details
Hospiment Care Equipments Pvt Ltd
Allengers Medical Systems Ltd.
Creative Healthtech Pvt Ltd
International Trading Co
Ami Polymer Pvt Ltd
Draeger Medical India (P) Ltd
Janak Healthcare Pvt Ltd
T: +91-022 - 40843838
W: www. draeger.com
Anand Medicaids Pvt Ltd
Jay Bhavani Enterprise
APC Schneider Electric India Pvt Ltd
Geeta Steel Furniture
ARVS Equipments Pvt Ltd
GMP Technical Solutions Pvt Ltd
Lakshmi Life Sciences Limited
T: +91-422 2360163
Atmos Medizintechnik Gmbh & Co. Kg
Great Eastern Impex Pvt Ltd
Lonza India Pvt Ltd
Hi-Tek Ots Pvt Ltd
Magna Tek Enterprises
T: +91-80 - 25588175
T: +91-40-6666 8036
BC-Back cover, BIC- Back inside cover, FIC- Front inside cover
June 2013 I
Our consistent advertisers
List of Advertisers To know more about the advertisers in this magazine, refer to our ‘List of advertisers’ or write to us at firstname.lastname@example.org or call us at +91-22-3003 4640 or fax us at +91-22-3003 4499 and we will send your enquiries to the advertisers directly to help you source better. Advertiser’s Name & Contact Details
Advertiser’s Name & Contact Details
Medexpert Business Consultants Pvt Ltd
Prayag Polytech Pvt Ltd
Pg No 67
Quali Surge Surgical Pvt Ltd
Sysmex India Pvt Ltd
T: +91-020 - 24270287
Meelan Hospital Steel Furniture
Sun Narula Group
T: +91 435 240 73
Monarch Surgical Industries
Transasia Bio-Medicals Pvt Ltd
MRK Healthcare Pvt Ltd
Samsung India Electronics Ltd
Trident Pneumatic Pvt Ltd
Neocraft Medical Pvt Ltd
Schiller Healthcare India Pvt Ltd
Woojin Plaimm Co Ltd
T: +91 80 4210 4183
Nihon Kohden India Pvt Ltd
Ziqitza Health Care Limited
W: www.nihonkohden.com Orange Medical
Shuter Enterprises India Pvt. Ltd.
T: +91 866 666 5667
I June 2013
BC-Back cover, BIC- Back inside cover, FIC- Front inside cover
Advertiser’s Name & Contact Details
Our consistent advertisers
RNI No: MAHENG 2007 / 21987 Postal Reg No: G2 / NMD / 73 / 2011-13 3RVWHGDW0XPEDL3DWULND&KDQQHO6RUWLQJ2IÂ¿FH Mailing Date: 11th & 12th of Every Month. 'DWHRI3XEOLFDWLRQWKRI(YHU\0RQWK
Published on Jun 1, 2013