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Volume IV || Issue II || July-August 2013

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News Update | Doctor Speak | Eye Care | Product Line | Expert Views | Healthcare Management


Editor’s Note

Updates and Recent advances in Medical Technologies

magazine Volume-IV Issue-I May-June 2013 Editor Editorial Adviser

Dr. m.a. Kamal Dr. Pradeep Bhardawaj Gp Capt. (Dr.) Sanjeev Sood Dr. Sharad Lakhotia

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recent advances in 4D medical imaging (4DMI) and 4D radiation therapy (4DRT), which study, characterize, and minimize patient motion during the processes of imaging and radiotherapy. Patient motion is inevitably present in these processes, producing artifacts and uncertainties in target (lesion) identification, delineation, and localization. 4DMI includes time-resolved volumetric CT, MRI, PET, PET/CT, SPECT, and US imaging. To enhance the performance of these volumetric imaging techniques, parallel multi-detector array has been employed for acquiring image projections and the volumetric image reconstruction has been advanced from the 2D to the 3D tomography paradigm. The time information required for motion characterization in 4D imaging can be obtained either prospectively or retrospectively using respiratory gating or motion tracking techniques. The former acquires snapshot projections for reconstructing a motion-free image. The latter acquires image projections continuously with an associated timestamp indicating respiratory phases using external surrogates and sorts these projections into bins that represent different respiratory phases prior to reconstructing the cyclical series of 3D images. These methodologies generally work for all imaging modalities with variations in detailed implementation. In 4D CT imaging, both multi-slice CT (MSCT) and cone-beam CT (CBCT) are applicable in 4D imaging. In 4D MR imaging, parallel imaging with multi-coil-detectors has made 4D volumetric MRI possible. In 4D PET and SPECT, rigid and non-rigid motions can be corrected with aid of rigid and deformable registration, respectively, without suffering from low statistics due to signal binning. In 4D PET/CT and SPECT/CT, a single set of 4D images can be utilized for motion-free image creation, intrinsic registration, and attenuation correction. In 4D US, volumetric ultrasonography can be employed to monitor fetal heart beating with relatively high temporal resolution.

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NTENTS

advances in Medical technology

Diarrhoea vomiting in children

24 Diabetes and sexual dysfunction in men

every Ophthalmologist

44 Hospital Furniture Tender

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20 Eat well to control

The Blood Pressure

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28 06

A fresh approach to developing...

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Novozymes Biopharma’s recombinant...

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Alzheimer’s leaves clues in blood...

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Rainforest remedy could spell end...

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Copper destroys norovirus...

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Association of Medical Consultants...

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Roundtable discussion...

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The People Of India Bestow Global...

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BJ Wadia Hospital For Children...

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National Institute of Healthcare...

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Six Sigma healthcare rescue team...

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Children’s eyes myths and facts...

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Hospital Aquired Infections...

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Swasthexchange...

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Scientech Technologies Introduces...

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Pharma coeconomics Current...

AMSBIO offers a range of kits and reagents

Designed by R-Tech Ueno, RU-101 ophthalmic solution

With approximately 75% of the estimated 36 million

An ancient Incan toothache remedy – for centuries handed

The virus can be contracted from contaminated food or water

Association of Medical Consultants, Mumbai (AMC) is one

HIMSS Asia Pacific India Chapter organized a roundtable discussion

One of the fast growing Multi-super specialty tertiary care

The Bai Jerbai Wadia Hospital for Children at Parel in Mumbai

The Post-Graduate Institute of Medical Education and Research

An eight-member team of doctors who returned after treating

There are certain myths regarding eyes being passed

Originally known as NOSOCOMIAL INFECTIONS, the term

It is a cloud based preventive and ailment health management system

A Syringe Pump is a medical apparatus that regulates

Economic evaluation is a process which involves weighing


NEWS UPDATE

High yield RNA isolation without the paraffin removal step

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MSBIO offers a range of kits and reagents for the extraction (isolation) of high quality RNA from FFPE tissues and LCM samples that can be used not only for PCR but also microarray applications. Using AMSBIO ExpressArt® RNA isolation technology it is now possible to achieve high RNA yield and maximum sequence length from FFPE or LCM samples without the paraffin removal step. ExpressArt®

RNA technology overcomes traditional limitations placed on research due to limited sample size, RNA degradation and interference from the crosslinking in FFPE samples. ExpressArt® FFPE RNAready isolation and mRNA amplification technology allows researcher to isolate higher quality and quantities of RNA from samples previously unsuitable for gene expression analysis. The kits includes patented de-cross linking technol-

ogy which is uniquely able to isolate high quality RNA from old, archival FFPE samples (10 years old or more). The FFPE RNAready Kit provides special lysis and incubation conditions for optimal RNA recovery and improved template activity. Deparaffinisation of the tissue samples is followed by homogenisation and lysis by incubation with proteinase K and detergents. The lysis buffer is supplemented with the nucleic acid analogue NucleoGuard,

which acts as universal inhibitor of RNases and displaces tightly bound RNA from high-molecular-weight aggregates, resulting in efficient release of RNA and preservation of the RNA quality. RNA solubilisation is followed by an innovative demodification step to reverse formalin induced cross-links and this enables the purified RNA to deliver maximal performance as template in reverse transcription reactions and subsequent downstream assays.

A fresh approach to developing chronic pain therapeutics Cellectricon will present a novel phenotypic assay at World Pharma Congress 2013, Tues 4th June, 5pm

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ellectricon, a leading provider of advanced cellbased screening technologies and services, will be attending the 12th annual World Pharma Congress, 4 – 6 June (Philadelphia, PA). At the event, Cellectricon’s Head of Discovery Services, Dr Paul Karila, will host a presentation describing a novel phenotypic assay for the identification of therapeutic compounds for chronic pain. The talk, entitled ‘Development of a Phenotypic Pain Assay for Identification of Modulators of Excitability in Native Sensory Neurons’, will take place on Tues 4th June, 5pm, as part of the ‘Targeting Pain with Novel Therapeutics’

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program. This exciting new assay is based on the Cellaxess® technology platform, and uses electric field stimulation of primary DRG neuronal cultures to allow compound identification during early stages of the project lifecycle. As such, Dr Karila will explain how the approach can add significant value to the overall decision-making process of drug development, saving valuable time and cost. Dr Paul Karila is Chairperson for the ‘Targeting Pain with Novel Therapeutics’ program, and will be on-hand throughout the day to answer any questions on Cellectricon’s services and technology.

July – August 2013


NEWS UPDATE

Alzheimer’s leaves clues in blood Alzheimer researchers in Spain have taken a step closer to finding a blood test to help in the diagnosis of Alzheimer’s disease

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ith approximately 75% of the estimated 36 million Alzheimer’ s sufferers worldwide yet to receive a reliable diagnosis, the potential impact on the lives of possible sufferers, present and future, could be huge. Alzheimer’ s disease is a neurodegenerative disease most frequently affecting the elderly. The most commonly associated symptom is a progressive loss of memory to the stage in which the patient is completely dependent on caregivers for their daily needs. There is a large amount of research supporting the theory that a group of peptides called beta amyloid (A), which are found naturally in the body, are major contributors to Alzheimer’ s disease. Through a process, so far unclear to science, there is a build up of these peptides in the brain that over a period of years cause memory complaints and other symptoms associated with the disease.

Stem cells enable personalised treatment for bleeding disorder

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cientists have shed light on a common bleeding disorder by growing and analysing stem cells from patients’ blood to discover the cause of the disease in individual patients. The technique may enable doctors to prescribe more effective treatments according to the defects identified in patients’ cells. In future, this approach could go much further: these same cells could be grown, manipulated, and applied as treatments for diseases of the heart, blood and circulation, including heart attacks and haemophilia. The study focused on von Willebrand disease (vWD), which is estimated to affect 1 in 100 people and can cause excessive, sometimes life-threatening bleeding. vWD is caused by a deficiency of von Willebrand factor (vWF), a blood component involved in making blood clot. vWF is produced by endothelial cells, which line the inside of every blood vessel in our body. Unfortunately, they are difficult to study because taking biopsies from patients is invasive and unpleasant.

Study reveals risk factors for blood clots in pregnant and postnatal women

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omen who have suffered a still birth or have medical conditions including varicose veins, inflammatory bowel disease (IBD) or heart disease are at greater risk of developing dangerous blood clots after giving birth, a study has revealed. The research, led by academics at The University of Nottingham, found that be-

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ing obese, suffering bleeding during pregnancy or labour and having a premature birth or delivery via caesarean section also increased the risk of a venous thromboembolism (VTE). Their findings, published in the American Society of Hematology journal Blood, could have important implications for the way in which at-risk women are identified

and preventative measures administered. Epidemiologist Dr Matthew Grainge, in the University’s School of Community Health Sciences, who led the study, said: “VTE is a rare but serious complication of pregnancy and childbirth. It affects around one or two pregnancies per 1,000 but, despite this, remains a leading cause of mortality in expectant and new mothers in developed countries.

July – August 2013


NEWS UPDATE

Rainforest remedy could Dental plaque bacteria may trigger blood clots spell end of dental pain

O the first westerner to be invited to live with the Keshwa Lamas in Amazonian Peru, is leading efforts to bring this wholly natural painkiller to the global marketplace as an organic alternative to synthetic painkillers.

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n ancient Incan toothache remedy – for centuries handed down among an indigenous people in the rainforests of Peru – could be on the cusp of revolutionising worldwide dental practice.

The remedy, made from an Amazonian plant species from varieties of Acmella Oleracea and turned into a gel for medical use, has proved hugely successful during the first two phases of clinical trials and may hasten the end of current reliance on local anaesthetics in dental use and Non-Steroid Anti-Inflammatory Drugs (NSAIDs) in specific applications. Cambridge University anthropologist Dr Françoise Barbira Freedman, the first westerner to be invited to live with the Keshwa Lamas in Amazonian Peru, is leading efforts to bring this wholly natural painkiller to the global marketplace as an organic alternative to synthetic painkillers.

ral bacteria that escape into the bloodstream are able to cause blood clots and trigger life-threatening endocarditis. Further research could lead to new drugs to tackle infective heart disease, say scientists presenting their work at the Society for General Microbiology’s Spring Conference in Dublin this week. Streptococcus gordonii is a normal inhabitant of the mouth and contributes to plaque that forms on the surface of teeth. If these bacteria enter into the blood stream through bleeding gums they can start to wreak havoc by masquerading as human proteins. The research led by Howard Jenkinson, Professor of Oral Microbiology and Head of Research at the University of Bristol’s School of Oral and Dental Sciences, in collaboration with Dr Steve Kerrigan from the Royal College of Surgeons in Ireland (RCSI) has discovered that S. gordonii is able to produce a molecule on its surface that lets it mimic the human protein fibrinogen – a blood-clotting factor. This activates the platelets, causing them to clump inside blood vessels. These unwanted blood clots encase the bacteria, protecting them from the immune system and from antibiotics that might be used to treat infection. Platelet clumping can lead to growths on the heart valves (endocarditis), or inflammation of blood vessels that can block the blood supply to the heart or brain.

In doing so, the company she founded, Ampika Ltd (a spin-out from Cambridge Enterprise, the University’s commercialisation arm) will be run according to strict ethical guidelines, and will be able to channel a percentage of any future profits back to the Keshwa Lamas community who agreed to share their expertise with her. With no known side-effects during the past five years of Phase I and II trials, Dr Freedman, who has continued to visit and live among the Keshwa Lamas over the past 30 years, is confident the stringent Phase III trials (multi-location trials across a diverse population mix) will be the final hurdle to clear. If successful, Ampika’s plan is to bring the product to market in 2014/15.

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July – August 2013


NEWS UPDATE

Copper destroys norovirus

New study to reduce falls for people with Parkinson’s disease

Scientists at the University of Southampton have begun a new study to evaluate the benefits of exercises and strategies for preventing falls among people with Parkinson’s disease. New research from the University of Southampton shows that copper and copper alloys will rapidly destroy norovirus - the highly-infectious sickness bug.

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he virus can be contracted from contaminated food or water, person-to-person contact, and contact with contaminated surfaces, meaning surfaces made from copper could effectively shut down one avenue of infection. Worldwide, norovirus is responsible for more than 267 million cases of acute gastroenteritis every year. There is no specific treatment or vaccine, and outbreaks regularly shut down hospital wards and care homes, requiring expensive deep-cleaning, incurring additional treatment costs and resulting in lost man days when staff are infected. Its impact is also felt beyond healthcare, with cruise ships and hotels suffering a significant loss of reputation when epidemics occur among guests. Professor Bill Keevil, Chair in Environmental Healthcare at the University of Southampton and lead researcher, presented his work at the American Society for Microbiology’s 2013 General Meeting last week. The presentation stated norovirus was rapidly destroyed on copper and its alloys, with those containing more than 60% copper proving particularly efficacious. The contamination model used was designed to simulate fingertip-touch contamination of surfaces. ‘Copper alloy surfaces can be employed in high-risk areas such as cruise ships and care homes, where norovirus outbreaks are hard to control because infected people can’t help but contaminate the environment with explosive vomiting and diarrhoea,’ Keevil explains. ‘The virus can remain infectious on solid surfaces and is also resistant to many cleaning solutions. That means it can spread to people who touch these surfaces, causing further infections and maintaining the cycle of infection. Copper surfaces, like door handles and taps, can disrupt the cycle and lower the risk of outbreaks.’

July – August 2013

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arkinson’s disease is a common, progressive condition that affects the body’s nervous system. Over time people with Parkinson’s disease are likely to become less steady, less able to move around within their homes and more prone to falls. Although drugs are available to treat the symptoms of the condition, balance control does not respond to drugs as well as some other symptoms. PDSAFE is a personalised treatment programme, which includes physiotherapy techniques that are tailored to the individual and have been shown to reduce symptoms and the number of falls. Now researchers, led by Professor Ann Ashburn, Professor of Rehabilitation at the University of Southampton, are to assess the benefits of PDSAFE and how cost effective it is. Professor Ashburn comments: “Parkinson’s disease mainly develops in people over 50 years of age. It becomes more common with increasing age. In the UK only a small percentage (28 per cent) of people with Parkinson’s disease have access to physiotherapy. Preventing a cycle of inactivity and falls is a priority for health care workers but research into the benefits of disease specific exercises and strategies is limited. We know that exercise can improve balance control but little work has been done on whether it actually reduces fall rates. We want to find out if patients who follow PDSAFE exercises fall less than those who don’t and in turn, how cost effective that reduction can be.” The study, funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme, aims to recruit 600 people with Parkinson’s disease from four areas in the South of England; Southampton, Bournemouth, Portsmouth and Exeter. Participants will be in one of two groups; one will receive PDSAFE and the other will not. Fall rates data will be taken, compared and analysed.

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NEWS UPDATE

Association of Medical Consultants

organizes health screening camps

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ssociation of Medical Consultants, Mumbai (AMC) is one of the frontline medical organization of over 7800 Specialist doctors practicing in and around the city of Mumbai and Thane District, and has Affiliate Units all over India.AMC celebrates Doctor’s day with a unique gift of a Blood Donation Drive, Organ Donation Awareness Drive and Anti Noise Pollution Drive to the society. This year the celebrations will be held from 30th June to 7th July. Glaxo Smithkline has collaborated with AMC to conduct the AMC Doctors’ Day Health Initiative. Maharashtra Health Minister Shri Suresh Shetty inaugurated and flagged off the week long Doctors Day Health Initiative on the 30th June 2013 AMC motivates the society to donate blood by setting a healthy example of donating blood themselves. AMC will be conducting this drive at around 20-25 centers across Mumbai in conjunction with State Blood Transfusion Council. The blood donated will be distributed to all the government and municipal hospitals to be used free of cost to needy patients. On this occasion we are also conducting the Eye, Skin and Organ Donation Awareness Campaign along with signing of the organ donation

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pledge card. This will be conducted by Eye Bank Association of India, National Liver Foundation, Zonal Transplant co-ordination committee, Mumbai Kidney Foundation and Narmada Kidney Foundation. Johnson & Johnson has collaborated with AMC to have Lifestyle Disease Detection Camps. Noise pollution has become a harsh reality today. Wherever one goes, however literate or illiterate one may be, we are either exposed to loud decibels or are addicted to communication devices which can harm our hearing. Phonak India Pvt Ltd, a leading provider of hearing systems and wireless communication systems for audiological applications, has continuously endeavored to improve the quality of life. In continuation with this philosophy, Phonak India along with AMC is organizing free hearing screening checks for persons with potential hearing problems. This will result in early detection and rehabilitation for individuals with hearing problems. The camps will be from 1st July to 6th July. Disaster is an unfortunate accidental calamity which can fall on an individual, community, state or a nation. We can never be forewarned about it but at least we can educate and empower ourselves to combat a disaster. This year AMC has decided to or-

ganize “Basic Life Support Training Workshops” in schools (IX, X Std), Colleges, citizen groups, police personnel, banks, etc. This workshop provides a person with basic know-how of responding to a calamity/ causality/accident/mishap occurring in our immediate surroundings. This is for the bystanders who want to help but do not know how to in such circumstances. Speaking on the occasion Mr. Andreas Gesigner Managing Director Phonak India Pvt Ltd said, “Phonak India Ltd is constantly endeavoring to reach out to people and make a difference. Phonak annually conducts screening camps at different locations with registered hearing aid dispensers; NGO’s and with Special Olympics along with hear the World Foundation. In June 2013 we have conducted 15 camps and reached to around 1500 people. We conduct these screening camps as a part of our CSR initiative.” Speaking on the occasion Dr. Sujata Rao, President, AMC said, “We believe that Doctors like Teachers and Parents play a vital role to motivate the lay public and AMC fulfills its obligations to the society by conducting these social service drives every year on the occasion of Doctors’ Day. Every year we are donating 2000 blood units to the free patients.

July – August 2013


NEWS UPDATE

Roundtable discussion

on the National Health Portal H

IMSS Asia Pacific India Chapter organized a roundtable discussion on the National Health Portal project of the Ministry of health & family welfare at JLN Auditorium, All India Institute of Medical Sciences, New Delhi on 8thJune. The idea behind the roundtable was to discuss, share the vision behind the project and discuss ideas that could make the national health portal successful. The participants included senior officials of the Ministry of Health & Family welfare and senior healthcare leaders from the healthcare sector. This was the first roundtable of its kind on this very important project. Mr. Rajendra Pratap Gupta, Chairman, HIMSS Asia Pacific India Chapter in his opening address said that the NHP should become a single point source of credible information for the common man. Also, he pointed that internet broad band is moving towards mobile broad band, and National Health portal should be mobile compatible. Also, about 330 million people live below the poverty line and about 300 million people are illiterate. Besides only 1 % rural Indians have access to computers with internet. The NHP portal should aim to service these segments of the population through innovate ways .NHP is a great move in disseminating health information and it will put forward greater health choices before the citizens which will help improve health status of the people. During the Roundtable Discussion organized by HIMSS India at AIIMS ,Dr. Suptendra NathSarbadhikari,Project Director, Centre for Health Informatics of the Na16

Main themes emerging from the roundtable discussion included;

posted by Contributors was stressed. • Ever changing and day to day advancement in healthcare landscape demands a nearly real time update of the portal. • With the current status in Healthcare Information Technology there is an urgent Need of e- Health Policy • One of the participant suggested the health information should be integrated with Aadhar. • Role of Social Media to increase the visibility was suggested. At present there are 22 official languages of India ,Use of vernacular language / Translation to increase usability was advised. Taking a cue from CDC, Atlanta ,Health Advisory services related to Travel should be included in the portal. Need of Directory services of Clinicians, Pharmacist, Nurses and Para Medical staff was discussed. Adverse reporting, Pharmacovigilance was also suggested to be included in the portal. • To increase the user friendliness, tutorial Video on navigation of website should be a part of the portal. • Participants suggested developing the portal adopting the Iterative model.

• With ever increase in tele–density, it was suggested that the portal needs to be integrated with Mobile and apps developed. • Health Information is crucial in making informed decision, the importance of Data Validation and authenticity of the Information

Representation from Doctors of Public and Private Hospitals, Senior Government Officials, Healthcare IT professional, Social Services Organizations, Students and academician brought out diverse thoughts and winning strategies for the development of the NHP.

tional Health Portal, and, Member-Secretary, Steering Committee for the National Health Portal announced the launch date of National Health Portal (NHP) as October 1, 2013.Dr. Sarbadhikari,presented the Road map of the national health Portal and enlightened the participants in his very informative presentation. He highlighted the objectives of National Health Portal; improve the health literacy of the masses in India, improve access to health services across the nation, decrease the burden of disease by educating the people on the preventive aspects of disease. At the end of the roundtable, an innovative implementation of digitization at AIIMS trauma centre was showcased by a presentation from Dr. S K Bhoi. Also, during this roundtable, the Report on medical devices and interoperability was released. Prof. Indrajit Bhattacharyya moderated the event.

July – August 2013


NEWS UPDATE

THE PEOPLE OF INDIA BESTOW GLOBAL HOSPITALS GROUP TWO PRESTIGIOUS HEALTHCARE AWARDS • I ndia’s Most Valuable Healthcare Chain’Award for 2013 • D r. K. Ravindranath, CMD, receives ‘Business Leader of the Year’ Award for 2013 • H onored at the 4th edition of the Annual India Leadership Conclave and Indian Affairs BusinessLead ership Awards 2013 Event at Mumbai

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ne of the fast growing Multi-super specialty tertiary care chains of India, Global Hospitals Group, has received yet again the most coveted and prestigious awards in Healthcare. At the 4th Annual India Leadership Conclave and Indian Affairs Business Leadership Awards 2013 Event at Mumbai that was attended by the healthcare industry luminaries, Global Hospitals Group was awarded the “India’s Most Valuable Health Care Chain Award’ for 2013 while the Group’s Chairman & Managing Director, Dr. K Ravindranath, received the prestigious “Business Leader of the Year” for his outstanding contribution to the field of medicine and for his visionary leadership. Both the Awards are extremely significant because the Awards Jury Committee adapted the Public Nomination Voting system. The Jury Members under the clause of Nominations looked at all the finer details before arriving at a conclusion. The decision came after a close scrutiny of all the

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nominees under voting, recognizing the tough task building a differentiated and niche multi-super speciality tertiary care hospital chain and evolving into a reckon to with, Brand & sustaining the momentum in a fiercely competitive Market. India Leadership Conclave & Indian Affairs Business Leadership Awards organized by Network7 Media Group’s Indian Affairs Magazine, Asia’s biggest analytical news Magazine, is one of India’s prestigious & coveted title & has established a credible platform of serious discussion where Brand India’s most illustrious Leaders & icons assemble to discuss the roadmap for India’s growth trajectory. Global Hospitals Group has made its mark & has been successful & is one of the fast growing super specialty care and multi-organ transplantation hospitals in India. It evolved into a Clinical Powerhouse pioneering many transplantation surgeries and cutting edge clinical programs establishing benchmarks that are difficult to surpass. Global Hospitals has to its credit

many trailblazing achievements made possible by combining research, teaching and patient care. On this occasion, Dr. K Ravindranath, Chairman & Managing Director, Global Hospitals Group said, “This is a great honor and we are thrilled to receive these prestigious awards. The journey for excellence in the healthcare space started a long time ago. We always try to set new standards of excellence in the field of Healthcare. We constantly introduced innovative and path-breaking services that are revolutionary and advanced to cater to the healthcare needs of the diverse and ever evolving Indian people. Business leader of the year award is a testimony to our beliefs and conviction, and we will continue in our endeavor to create innovative healthcare solutions for the people.” He also added, “We started the Group with a vision to provide the best tertiary care, multi-location, multi-organ transplant facilities and we are committed to set and surpass new benchmarks by continuously working towards it.” July – August 2013


NEWS UPDATE

BJ Wadia Hospital For Children opens new Clinic to treat Clubfoot Deformities

Over 50,000 kids born with clubfoot in India annually of which nearly 3700 hail from Maharashtra

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he Bai Jerbai Wadia Hospital for Children at Parel in Mumbai in association with two NGO’s; Miracle Feet Foundation and CURE International India have joined hands to create a special Clinic to treat Clubfoot deformities at their newly inaugurated Clubfoot Clinic. The Clubfoot Clinic was inaugurated by the former Deputy General of Police of Maharashtra, Mr. A N Roy. Mr. Kunal Premnarayen, Director, Miracle Feet said, “I have been associated with the Miracle Feet Foundation and something that I hold very close to my heart. Though the deformity is rare, the cure to it is something that not many are aware of and I have seen Miracle Feet contribute to this social cause helping cure children of the deformity and lead a normal lifestyle. I am extremely happy that the foundation has taken this initiative a notch above and has opened the first wing in India to treat children at a very early age and create awareness on the same.” With an overall incidence of 1 in 1000 births, it is estimated that over 2,00,000 children are born with Clubfoot worldwide. Over 50,000 children are born with Clubfoot in India and over 3700 children are born with Clubfoot in Maharashtra alone every year. Neglected Clubfoot can lead to a lifetime of disability. Surgical treatment of club foot although possible and still widely practiced, is fraught with complications and problems. The Ponseti method is a breakthrough in the treatment of clubfoot and when performed correctly, can yield successful results in over 95 per cent cases of clubfeet treated at birth. As explained by Dr. Rujuta Mehta, Head of Department at BJ Wadia Hospital For Children, “Clubfoot is a congenital deformity (present at birth) of multi-factorial origin. The exact causative mechanism is still unknown and hence it cannot be prevented. Lack of awareness regarding the need for early intervention is one of the principal reasons for late presentation and neglect in our country”. According to Dr. Alaric Aroojis, Medical Director, Maharashtra Clubfoot Program, “The Ponseti method involves gentle manipulation & serial casting of the deformed foot for a period of four to six weeks to achieve a complete correction. The results of this treatment are lasting and ensure that the child has a supple, pain-free and planti-grade foot for the rest of his lifetime. This simple low-cost method has revolutionized the treatment of July – August 2013

clubfoot since the past decade and is now the standard of care for treating clubfoot all over the world.” The inauguration of the Clubfoot Clinic was also graced by eminent and well known personalities including Dr. Rujuta Mehta – Head of Department, BJ Wadia Hospital for Children; Dr Alaric Aroojis, Medical Director, Maharashtra Clubfoot Programme, Mr. Sachin Pol, State Coordinator, Maharashtra Clubfoot Programme and Mr. Kunal Premnarayen, Director, Miracle Feet.

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NEWS UPDATE

National Institute of Healthcare Engineering & Architecture (NIHEA) to be setup by PGIMER ,Chandigarh

Facilities Planning and Designing and Healthcare Engineering and Management . This institute supported by the Indian Council of Medical Research(ICMR) Will be the First of its kind in Southeast Asia.

Dr. R. Chandrashekhar Chief Architect Ministry of Health & FW Govt. of India

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he Post-Graduate Institute of Medical Education and Research (PGIMER) isgoing to set up a National Institute of Healthcare Engineering and Architecture(NIHEA)-first of its kind master’s degree programme in Southeast Asia during the 12th five year plan. Announcing the plan during the 51st foundation day function of the PGIMER here today Union Minister of Health and Family welfare GhulamNabi Azad said” I am happy to announce the setting up of a National Institute of Healthcare Engineering and Architecture in PGI. It will be offering Masters Programmer in Health

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These are multi-disciplinary hi-tech training for Architects, Engineers, Doctors, Healthcare professionals, construction industry professionals to provide skills to develop high quality health estates based on design quality, management, technology, performance quality, specifications and environmental sustainability. The trained professionals can latter specialize in a number of matrix at national and international experts.The Institute of Healthcare Engineering and Estate Management (IHEEM) of UK & Texas A&M University of USA has offered their support to NIHEA, This Makes Ministry of Health & FW ‘Knowledge hub’ in South East Asia, Middle East, &supports Medical Tourism. Says Dr.R.Chandrashekhar (Chief Architect Ministry of Health & FW GOI) to our correspondence The function was presided over by Vice-president Hamid Ansari Addressing the gathering Ansari Shared the future plans of nation in the healthcare sector.These include substantial expansion and strengthening of a good quality andAffordable public sector healthcare system enhancing availability of skilled humanresources increase in the health sector expenditure to 2.5 per cent by the end ofthe 12th plan redesigning of financial and managerial systems to ensure more efficient utilization of available resources.

July – August 2013


NEWS UPDATE

six sigma healthcare rescue team in uttarakhand

Six Sigma Rescue team saved life for 300 people

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n eight-member team of doctors, who returned after treating people in the flood-ravaged state of Uttarakhand. Apart from the death and devastation that the team witnessed, what still sends shivers down their spine is the sight of having spotted two men roaming around the dead bodies, carrying a big pressure cooker each. “We spotted these men when we were camping near Gaurikund. They appeared to be Nepalese, holding pressure cookers and surveying the dead. We got suspicious and caught them, only to find the pressure cookers full of chopped fingers and arms with gold and diamond ornaments intact,” said Dr. Pradeep Bhardwaj, CEO, Six Sigma Healthcare, who led the team in providing medical

July – August 2013

care to the affected pilgrims. “They had cut the fingers and arms because due to excessively swollen dead bodies, it was difficult to take out the ornaments. We also found R86,000 cash on both the men. We handed them over to the Army personnel,” Bhardwaj added. During their 10-day stay, the doctors also found some pregnant women whose babies had died inside the womb. Apart from physical injuries, most of the affected people were suffering from depression and anxiety. “They feared what if no one rescued them. We met a 65-year-old woman who was the only survivor among a family of 10 that visited Kedarnath,” he said. “More than medicines, these people need psychological counseling,” Dr.Pradeep Bhardwaj added.

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DOCTOR SPEAK

Diabetes and sexual dysfunction in men

Sexual dysfunction is a common underreported and largely under appreciated complication of diabetes

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large number of cases go unrecognised owing naturally to the traditional reluctance both on the part of the patient as well as the physician in discussing such issues which are considered too personal to be discussed outside the bedroom. It is now well known that diabetes has a major impact on both male as well as female sexual functioning. Just as a good blood sugar control is necessary to lead a healthy life free from the well known complications of diabetes on kidney, eye, nerve, foot and heart, it is also very important for leading a normal sexual life.

Dr. M. Wali Physician to the President of India

Studies show that approximately 35% - 75 % of men with diabetes face this issue as compared to 26 percent of the general population. Also, diabetic men suffer from this problem 10-15 years early in their life as compared to their normal counterparts. It should be noted that this occurrence is gradual and never happens overnight.

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Prevention and treatment Once a diagnosis is made, preventive measures such as improving glycaemic and blood pressure control, de-stressing, quitting smoking and reducing alcohol intake have shown to be beneficial in patients with ED. Once ED has developed, oral agents can be prescribed by the doctor as a first line therapy. Testosterone injections or patches should be tried in patients with documented low testosterone levels. For patients who cannot be given oral therapy, intracavernosal injections of vasoactive drugs under the training of a trained urologist or andrologist are an acceptable alternative. Mechanical therapy involving vacuum-assisted erection devices as well as penile prosthesis are also a viable option. Psychotherapy should routinely be offered to all patients and their partners. Sexual dysfunction can be a huge psychological burden on patients with diabetes and can have a negative impact on marital relations that are already burdened by the existence of a chronic illness. Thus, the recognition and identification of this problem and proper treatment and counselling by the treating doctor go a long way in restoring normalcy in the lives of many couples who quietly suffer the agony of this disorder. It is very important to recognise that sexual dysfunction is a common complication of diabetes and it is alright to discuss it with your doctor who can help you get over it.

July – August 2013


DOCTOR SPEAK

every

t s i g o l o m l a h Opht rld o W e t a r o p r in Co

However if you have good financial back ground, you may start a set up and employ people to make it a complete ophthalmic unit. Otherwise one can join, Trust hospital in small cities, when one can get opportunities to learn and a reasonable life style.

Dr.Sharad Lakhotia M.S. (Ophth)

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July – August 2013


DOCTOR SPEAK

O

phthalmology today is not only a fine art of delivering skillful services in eye care but has acquired significant status of a corporate player with great financial involvement. Had it been simply a profession to perform specialized medical treatment than the prospects & future of different ophthalmologist should not have been so different. When great finances are involved, it becomes a commercial venture and eventually you become a market player. Your role is to study the trends in the market and make a successful profitable business. If you are not trained to handle money matters, you may even lend into great trouble both mentally & financially. Some three decades ago, supporting financially and getting an M.S in ophthalmology was not a big deal for majority of ophthalmologist. Today if we consider capitation fees & other part, it is already a 1 crore deal which has been spent along with a decade of hard working after schooling. When today lots of streams are available where you can complete your study for peanuts to moderate amount, with less than half of time spent and with better financial deals along with better quality of life & better prospects. Compare with 2 siblings, senior one with M.S (Ophth) and placement in hospital with junior one MBA & IIT qualification. Junior may become a great entrepreneur while the senior is still struggling. So the financial planning of an individual begins immediately after schooling. You may have to consider amount and its interest in education and number of years spent in relation to revenue generated. Once you become a full fledged ophthalmologist, the real game begins. If you are a general ophthalmologist, chances of getting a better job are difficult. It is better to do a fellowship, so that door is open for you in govt. hospital, corporate hospital and opportunities in group practice. However if you have good financial back ground, you may start a set up and employ people to make it a complete ophthalmic unit. Otherwise one can join, Trust hospital in small cities, when one can get opportunities to learn and a reasonable life style. With limited recourses a solo practice with moderate facilities may be an option for constant struggle in years to come. Profits & positions in future are determined now only. As setting up an ophthalmology clinic requires finance from 1 crore to 20 crores, depending on area of practice, in big cities. All the financial implication has to be studied carefully. You have to be like a corporate player, where every move has to be justified in competitive market. While opting for practice one can opt for solo practice or group practice. In either way, one has to consider 2 aspects of business (i) Internal business plan (ii) It’s periodical re-evaluation While building a plan, one is always at advantage if one is trained at a specialized institution with fellowship. Then you have to study the market and analyze where there is scarcity & demand for your services and design an internal business plan. You have to collect information from senior colleagues, medical representatives, sales executives and general practitioners of that area. Internal business plan can be a simple mission statement

July – August 2013

that defines your philosophy of practice and goals. It can be a detailed plan of few years, which you want to establish with your vision, mission, market analysis, defining priorities, objectives and a complete plan of action with periodic revaluation. There should be plan to change depending upon market focus. A mission statement can be a one stop shop for everything in ophthalmology where things are not clear. It can be a “specialized vitro retinal care”, if you have a fellowship & training programme with a distinct mission. You may add up other facilities later. Group Practice:- While joining group practice one has to study need & demand for the specialty in that set up & infrastructure available to work. Many practitioners today have family legacy where individual growth may be restrained & further positions are not apparently easily available. A practice of ophthalmologist of 55yrs plus and already established can give better prospects for future along with present position. If young ophthalmologist identifies practice of a senior ophthalmologist, who has no next generation to sustain practice, it can be a highly mutually beneficial, financially viable & futuristic relationship. Financial Feasibility:- Cost of land & property, cost of equipment, its maintenance, depreciation, cost of electricity, house tax, rent etc & cost of staff have to taken into account before profits are derived. If loans are taken then repayment schedule have to be taken into consideration before determining return of your skill. Thus also these factors are not very optimistic for solo practitioner. Need of the Hour:- The solo practitioner of neighborhood should group themselves and evolve a common set up for investigation, O.T, Lasik without OPD, where profits & facilities are shared by all group members. Others can be given courtesy attachment for further revenue generation. Eventually this specialized set up becomes a constant source of regular income even at old age, when you are not very active in profession but still would love to retain status of ophthalmologist. This is also the best way for optimal utilization of equipment. Also for Mediclaim insurance business, it is a good idea, as in small set up getting & maintaining TPA’s is a big problem. Alternately one can invest in property and get regular sources of income in old age but without ophthalmic indulgence. Lasik is true revenue earner, after cataract surgery. Lasik is the great revenue earner, as cataract is done every where with a reasonable investment. Lasik requires a large investment & planning. If 10 ophthalmologists of local area can form a group to have a neutral Lasik centre, it almost instantly guarantees success. Of late all great practices in ophthalmology worldwide have been essentiality due to a Lasik centre. Without your own Lasik unit, you can’t make a significant financial success .Thus owning a machine and sharing the utility & cost makes an excellent corporate decision. Now femto-laser technique is in pipeline, which is going to revolutionize cataract surgery and require group participation. Egos, which are integral part of most of ophthalmologist, have to be sacrificed for financial gains & prosperity. In nutshell, a total consideration of various factors makes a great success story.

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DOCTOR SPEAK

Diarrhoea vomiting in children Rotavirus is the most common virus causing gastroenteritis in children in the country. Almost every child in the countary has a rotavirus infection before they are 5 years old Dr. Rajiva Kumar Child Specialist Muzaffarpur Bihar, INDIA

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July – August 2013


DOCTOR SPEAK

G

astroenteritis is an infection of the gut. It causes diarrhoea, and may also cause vomiting, tummy pain and other symptoms. In most cases the infection clears within a few days, but sometimes takes longer. The main risk is dehydration. The main treatment is to give your child lots to drink. This may mean giving special rehydration drinks. Also, once any dehydration is treated with drinks, encourage your child to eat as normally as possible. See a doctor if you suspect that your child is dehydrating, or if they have any worrying symptoms such as those which are listed below.

What is gastroenteritis and what causes it? Gastroenteritis is an infection of the gut (intestines). It is common. Many children have more than one episode in a year. The severity can range from a mild tummy upset for a day or two with some mild diarrhoea, to severe diarrhoea and vomiting for several days or longer. Many viruses, bacteria and other microbes (germs) can cause gastroenteritis. A virus is the most common cause of gastroenteritis. Rotavirus is the most common virus causing gastroenteritis in children in the country. Almost every child in the countary has a rotavirus infection before they are 5 years old. Once you have had rotavirus, your body usually becomes immune to getting it again. Therefore, it is uncommon for adults to get rotavirus because most will have had it as a child. Adenoviruses are another common group of viruses that cause gastroenteritis in children. Adenovirus and rotavirus infection are more common in infants and younger children than in teenagers. Viruses are easily spread from an infected person to another by close contact. This is often because of the virus being present on the infected person’s hands after they have been to the toilet. Surfaces or objects touched by the infected person can also allow transmission of the virus. The virus can also be passed on if the infected person prepares food. Outbreaks of a virus causing gastroenteritis can often occur - for example, in schools or hospitals. Food poisoning (eating food infected with microbes) causes some cases of gastroenteritis. Food poisoning is usually caused by a bacterial infection. Common examples are species of bacteria called Campylobacter, Salmonella and Escherichia coli (usually shortened to E. coli). Toxins (poisons) produced by bacteria can also cause food poisoning. Another group of microbes called parasites can also be a cause of food poisoning. Water contaminated

July – August 2013

by bacteria or other microbes (germs) is another common cause, particularly in countries with poor sanitation. What are the symptoms of gastroenteritis? • The main symptom is diarrhoea, often with vomiting as well. Diarrhoea means loose or watery stools (faeces), usually at least three times in 24 hours. Blood or mucus can appear in the stools with some infections. • Crampy pains in the abdomen (tummy) are common. Pains may ease for a while each time some diarrhoea is passed. • A high temperature (fever), headache and aching limbs sometimes occur. In most children, the symptoms are mild and they tend to get better within a few days. If vomiting occurs, it often lasts only a day or so, but sometimes longer. Diarrhoea often continues after the vomiting stops and commonly lasts for between 5 to 7 days. Slightly loose stools may persist for a week or so further before a normal pattern returns. Sometimes the symptoms last longer. Symptoms of dehydration: Diarrhoea and vomiting may cause dehydration (a lack of fluid in the body). Consult a doctor quickly if you suspect that your child is becoming dehydrated. Mild dehydration is common and is usually easily and quickly rever‑‑sed by drinking lots. Severe dehydration can be fatal unless quickly treated because the organs of the body need a certain amount of fluid to function normally. • Symptoms of dehydration in children include: passing little urine, a dry mouth, a dry tongue and lips, fewer tears when crying, sunken eyes, weakness, being irritable or lethargic. • Symptoms of severe dehydration in children include: drowsiness, pale or mottled skin, cold hands or feet, very few wet nappies, fast (but often shallow) breathing. Severe dehydration is a medical emergency and immediate medical attention is needed.

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DOCTOR SPEAK

Dehydration in children with gastroenteritis is more likely to occur in: • Babies under the age of one year (and particularly those under six months old). This is because babies don’ t need to lose much fluid to lose a significant proportion of their total body fluid. • Babies under the age of one year who were a low birthweight and who have not ‘caught up’ with their weight. • A breast-fed baby that has stopped breast-feeding during their illness. • Any baby or child who does not drink much when they have gastroenteritis. • Any baby or child with severe diarrhoea and vomiting (particularly if they have passed six or more diarrhoeal stools and/or vomited three or more times in the previous 24 hours). How is gastroenteritis diagnosed and does my child need any tests? Most parents recognise gastroenteritis in their children because of their typical symptoms. The symptoms will often be quite mild and commonly get better within a few days without any treatment, other than drinking plenty of fluids. You will often not need to take your child to see a doctor or seek medical advice. However, in some circumstances, you may need to seek medical advice for your child (see below). If this is the case, the doctor may ask you questions about recent travel abroad, if your child has been in contact with someone with similar symptoms, or if they have recently taken antibiotics, or been admitted to hospital. This is to look for a possible cause of their gastroenteritis. They will usually examine your child for signs of dehydration. They may check their temperature and heart rate. They may also examine your child’s abdomen to look for any tenderness. Tests are not usually needed. However, in certain cases, the doctor may ask you to collect a stool sample from your child. For example, if your child is particularly unwell, has bloody stools, is admitted to hospital, if food poisoning is suspected, if your child has recently travelled abroad, or their symptoms are not getting better. The stool sample can then be examined in the laboratory to look for the cause of the infection. 28

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COVER STORY

advances in Medical technology INTEGRATION OF 4D MEDICAL IMAGING INTO 4D RADIATION THERAPY

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July – August 2013


COVER STORY

H

istorically, the evolution of radiation oncology, commonly known as radiation therapy, has been closely linked to the advances in medical imaging. Recent breakthroughs in imaging technology, particularly 4D medical imaging, have injected new momentum into radiation oncology, shedding new light on revitalizing this century old treatment modality. This eventually led to the creation of a primitive form of 4D radiation therapy (4DRT). 4DRT can be defined as a combination of using 4D imaging to guide radiation treatment planning, correcting for daily set-up errors through either patient repositioning or plan adaptation, and controlling radiation delivery based on internal or external fiducial markers that can be continu-

July – August 2013

ously tracked. 4DRT introduces the time dimension into the 3DRT in order to compensate for patient motion/changes occurring either during a single fraction (intra-fractional)or between successive fractions (inter-fractional). The major advantages of 4DRT arehigh-precision dose conformity,

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COVER STORY

minimized normal tissue complication probability, and possible further dose escalation to the target. To maximize the potential benefits of 4D medical imaging and promising improvements in patient survival and quality of life, an integrative and systemic approach to 4DRT is essential. Without such an integrated multi-disciplinary strategy, 4DRT would only remain as an ideal concept. Here, we propose a comprehensive approach that integrates 4D medical imaging into each of the key steps in 4DRT, including 4D simulation, 4D treatment planning, and 4D treatment delivery. Keywords: 4D, radiation therapy, medical image, tumor motion, internal target volume. 4D RADIATION THERAPY A major goal in radiation therapy is to deliver a high radiation dose to the perceived tumor volume while minimizing the dose to surrounding normal tissues. However, there are many sources of patient motion, such as respiratory, cardiac, digestive, and muscular motion, during the course of radiation therapy treatment planning and delivery process. Consequently, 3D imaging often produces images with motion artifacts. A fast imaging technique, such as single-slice CT, may only span a small portion of the respiratory cycle. Moreover, each slice may be acquired at different phases, resulting in image deformation artifact. For a slow imaging technique, such as PET, data acquisition is usually at a rate of 3-7 minutes per field of view (FOV). Therefore, signals from all phases of the breathing cycle are averaged, causing image blurring artifact. In order to remove such motion artifacts, various techniques have been developed and implemented clinically, including patient immobilization, breath holding, breath coaching, respiratory gating, and respiratory motion tracking. The A Systematic Approach to 4D Radiation Therapy 2 latter two approaches are frequently applied in 4D imaging techniques for both motion correction and motion control, which eventually led to the formation of the concept of 4D radiation therapy – the inclusion of temporal changes to patient anatomy. Without such a motion control, radiation beam may either irradiate more normal tissue than necessary or miss the tumor at certain phases of a motion cycle, leading to a situation called the geometric miss. This could potentially cause local failure or increased side effects. 4D SIMULATION The 4D imaging modalities, including 4DCT, 4DMRI, 4DPET, and 4DSPECT, should be used to provide needed clinical information. In addition, 4D multi-modality imaging techniques, such 4D CT/PET and 4D CT/SPECT, should also be used to minimize errors in image registration. Lung and liver tumors present a particularly unique challenge due to the

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July – August 2013


COVER STORY

effect of respiratory motion. More than 2.5 cm tumor movement has been observed during a free breathing cycle (Shirato, 2004). To provide a time-stamped indication of the motion stage (amplitude or phase), external or internal fiducial markers should be used for monitoring patient motion in 4DCT imaging. With this tracking information, image acquisition can be prospectively gated and the acquired images can be retrospectively sorted into image bins reflecting the different respiratory phases. One of the three respiratory tracking techniques should be considered: optical tracking methods using an infrared laser with reflectors placed on thorax or abdomen, use of a spirometer to measure tidalventilation volume, use of Bellows pressure sensor below diaphragm for monitoring anatomical volume change. 4D TREATMENT PLANNING An internal target volume (ITV) with more precise margin covering the moving clinical target volume (CTV) should be delineated on either 4DCT or 4DMRI. In addition, PET or SPECT 3D images should also be employed to accurately determine the true extent of the CTV. A full 4DCT image (multiple 3DCT images) acquired at each of the respiratory phases (at least eight) should be used to create an independent treatment plan for each phase. Or maximum intensity projection (MIP) images that A Systematic Approach to 4D Radiation Therapy 3 can accurately trace the trajectory of a moving lung tumor should be used to generate ITV. In the case of a pancreatic cancer or a lung cancer that has low attenuation component or invades the surrounding airways, minimum intensity projection (MinIP) may be the optimal techniques for defining the ITV. The physician contoured target and organs at risk (OAR) should be preserved through deformable image registration. Plans should be computed using adaptive dose calculation technique. 4D TREATMENT DELIVERY On-site Imaging for Patient Setup: The 2D/3D/4D imaging of the patient in the treatment position should be used to improve setup accuracy. These include multiple 2D x-ray imaging (Figures 3a-c), optical 3D superficial imaging, kV cone-beam CT (CBCT) imaging, helical MVCT imaging, and 4DCT imaging. Real-time Target Tracking: Superficial motion tracking and external surrogates are useful in determining the extent of respiratory motion, but are not sufficient for tracking tumor motion and change in volume and shape. Therefore, internal fiducial markers should be implanted into or around the target to precisely deliver radiation to the tumor.

July – August 2013

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DOCTOR SPEAK

EYES S ’ CHILDREN S T C A F ND A S H T Y M

There is a general belief that an eye check up is not necessary unless you are having some sort of eye problem. Many eye diseases do not exhibit early symptoms therefore regular yearly eye exams can help detect eye disease before it can damage the eyes. We will clarify some more conman myths in our next article. 34

July – August 2013


DOCTOR SPEAK

Dr. Mahipal Sachdev Chairman & Medical Director Centre for Sight

T

here are certain myths regarding eyes being passed on since ages. It’s time to crack the facts from fiction.

able to have an ophthalmologist examine the eye as soon as possible because the seriousness of an eye injury may not be immediately apparent.

Generally parents think that sitting close to the television will stress their children’s eyes. Normally, children can focus on nearer objects better than adults without eyestrain therefore, some of them develop this habit but they usually outgrow it. Children who are nearsighted see images better if they sit close to the T. V. However, there is no evidence that sitting close to the T.V. will damage their eyes.

Using computers damages a child’s eyes. When using a computer for long periods of time, the eyes blink less than normal (like they do when reading or performing other close work). This makes the eyes dry, which may lead to a feeling of eyestrain or fatigue. So, it’s a good idea to make sure your child takes frequent breaks from the computer or video games. However, working for long hours on the computer doesn’t harm your child’s eyes.

Wearing protective glasses is a bothersome and needless practice. This is a common myth, but the fact is that sports are the leading cause of eye injuries in children. To protect your child make sure he or she wears appropriate protective eyewear with polycarbonate lenses or wire shields, when playing field sports such as cricket, basketball, racquets sports, soccer, baseball and field hockey. Ophthalmologists strongly recommend that children with good vision in only one eye wear glasses at all times to protect the good eyeeven if they do not need glasses otherwise. To provide a safe environment for your children, select games and toys which are appropriate for their age and responsibility level. Avoid projectile toys like arrows, beyblade etc., keep all chemicals sprays out of reach and do not allow them to ignite fireworks. When an injury occurs, it is advis-

July – August 2013

Reading in poor light or prolonged reading of very fine print will ultimately harm your vision. Although reading in dim light is unwise because it may cause your eyes to feel tired or uncomfortable, it can’t hurt your eyes. Similarly, reading small print or reading extensively cannot cause damage to the eyes. This is true even for people who already have poor vision. Using a nightlight in your child’s room will contribute to nearsightedness There is not enough evidence to support this claim. Keeping a nightlight on in your child’s room may actually help them learn to focus and develop important eye coordination skills when they are awake.

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DOCTOR SPEAK

Eat well to control

The Blood Pressure

B Dr. Vipul Gupta Head Neuro Vascular Intervention Centre Medanta the Medcity

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lood Pressure is the first step towards manifestation of many diseases including stork, aneurysm, dementia, enlargement of left heart, heart failure, kidney dysfunction, arterial damage, eye blood vessel damage, sexual dysfunction etc. And the changing needs which has given rise to the ever changing lifestyle has increased the woe of blood pressure variations in the body. Long sitting hours in a monotonous cubical, continuous gazing at the laptop screen, constant peer pressure, frequent corporate tours, horde for promotion and increment and above all the hassles of maintaining a balance between family and professional life is giving rush to the blood flow. However, doctors suggest that maintaining a balance in the food intake can control the blood pressure to a greater extent and help keeping a normal life. It is estimated that about 1 in 3 U.S. adults—as estimated 68 million—have high blood pressure, which increases the risk for heart disease and stroke, leading causes of death in the United States. July – August 2013


DOCTOR SPEAK

Dr. Vipul Gupta, Head, Neurovascular Intervention Centre, Institute of neurosciences, Medanta the Medicity says, High blood pressure is called the “silent killer” because it often has no warning signs or symptoms, and many people don’t realize they have it. The body can adjust with slight low blood pressure however, if blood pressure rises above the normal level, there are increased chances of brain hemorrhage, stroke and aneurism. The condition can even be fatal if not treated on time. The cholesterol deposit due to excessive smoking and alcohol also leads to high blood pressure. That’s why it is important to maintain the balance in the salt intake, regular exercise and get your blood pressure checked regularly. Food for low blood pressure patients: Low blood pressure or Hypotension diet is nothing but a smart food choice that nourishes our body and helps to normalize blood pressure and relieve the symptoms of low BP. Get all the necessary nutrients needed for the good health. Your focus should be on various foods that include wholegrains, fruits, vegetables, lean-chicken and fish. Eat small, low-carb meal To help prevent blood pressure from dropping sharply after meals, eat small meal several times a day. Limit high-carbohydrate foods such as potatoes, rice, pasta, and bread. Caffeine containing drinks such as, coffee or tea with meals may temporarily raise blood pressure. However, because caffeine can cause other problems, so it is advised to seek consultaJuly – August 2013

tion before increasing the caffeine intake. Increase Sodium salt intake Increased intake of sodium salt is good for people with low BP. However, because excess sodium can lead to heart failure, especially in older adults, it is important to check with the doctor before increasing salt intake. Drink plenty of Water and less alcohol: Although nearly everyone can benefit from drinking enough water, this is especially true for people with low BP. Fluids increase, increases the volume of the blood in the body, in addition, and helps prevent dehydration. Food for high blood pressure patients: Although there has been no cause identified for hypertension in 90 percent of people, dietary factors have been shown to influence blood pressure. People with hypertension can use the following food guidelines: Avoid foods high in sodium Sodium causes vasoconstriction, the narrowing of blood vessels. Therefore, the amount of space blood has to travel through decreases. This decrease creates an increase in the resistance the blood has to overcome. This increased resistance makes it more difficult for the arteries to expand with each beat of the heart, causing the internal pressure to rise. High sodium foods include processed meats, salted snack foods, cheeses, and canned foods. 37


DOCTOR SPEAK

Eat foods high in potassium Good dietary sources of potassium include bananas, potatoes, avocados, tomato juice, grapefruit juice, and acorn squash. Potassium helps maintain intracellular osmotic pressure, which is the force required to stop the flow of water across a membrane. Limit adding salt to foods, particularly in restaurants Most foods, especially at restaurants, are already high in sodium. Use salt substitutes Eat calcium and magnesium rich foods to help reduce blood pressure. Food sources rich in calcium include low-fat milk, green beans, sardines with bones, broccoli, spinach, and tofu. Good sources of magnesium-rich foods include any legumes and seeds, such as navy beans and sunflower seeds.

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Low saturated fat intake Saturated fat increases the level of low density lipoproteins (LDL), which tend to stick to the sides of the arterial wall. This deposit of fat is known as atherosclerosis. Atherosclerosis begins with the accumulation of fatty streaks on the inner arterial walls. When this fatty buildup enlarges and becomes hardened with minerals, such as calcium, it forms plaque. Plaque stiffens the arteries and narrows the passages through them. Thus, blood pressure rises. This rise in blood pressure is due to the arteries’ lack of elasticity. To adapt the Dash Diet into your lifestyle, follow theseguidelines: • Make gradual changes in your eating patterns. • Center your meal around carbohydrates, such as pastas, rice, beans, or vegetables. • Increase consumption of fruits and vegetables. • Treat meat as one part of the whole meal. • Decrease use of fat. July – August 2013


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EXPERT VIEWS

Hospital Acquired Infections “An infection acquired in hospital by a patient who was admitted for a reason other than that infection .An infection occurring in apatient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility”

O Dr. Anukant Mital

Spokesperson, Antimicrobial Copper International Copper Promotion Council (India)

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riginally known as NOSOCOMIAL INFECTIONS, the term more widely accepted now is Hospital Acquired Infections(HAIs). As the term itself suggests these are infections that are acquired by the patient in any hospital or Healthcare setting. WHO defines the term, in the 2nd edition of its Practical Guide to Prevention of Hospital Acquired Infections, as “An infection acquired in hospital by a patient who was admitted for a reason other than that infection .An infection occurring in apatient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility”. Within hours after admission, a patient’s flora begins to acquire characteristics of the surrounding bacterial pool. Most infections that become clinically evident after 48 hours of hospiJuly – August 2013


EXPERT VIEWS

talization are considered hospital-acquired. Infections that occur after the patient is discharged from the hospital can be considered healthcare-associated if the organisms were acquired during the hospital stay. These infections affect Patients around the globe, whether in a resource poor developing country or the richer Developed one with Gold standards, in highly specialized and well equipped (with both equipment and trained staff) Hospitals or in basic mud walled Primary Health Care Facility in a rural outpost. As the advances in the fields of medicine and the diagnosis as well as management of diseases take place more and more cases of the HAIs are being identified. There are a number of superbugs that are appearing which are resistant to even the more potent Anti - bacterial drugs available. According to the infection statistics the exponential growth of some of these HAIs (as evinced in the graph below), due to these superbugs in the last few years itself, has become a major concern for healthcare administrators and doctors. Source: Infectious Diseases Society of America, derived from data collected by the Centers for Disease Control & Prevention.

MRSA – Methecillin Resistant Staphylococcus aureus VRE

– Vancomycin Resistant enterococcus

FQRP – Fluoroquinolone Resistant Pseudomonas aeruginosa

These infections do pose a significant burden both for the patient and for public health. under the auspices of WHO conducted a prevalence survey in 55 hospitals of 14 countries representing4 WHO Regions (Europe, Eastern Mediterranean, South-East Asia and Western Pacific) showed an average of 8.7% of hospital patients had HAIs. Hospitals in India have a high burden of infections in their intensive care units (ICU) and general wards, many of which are resistant to antibiotic treatment, according to a report by Global Antibiotic Resistance Partnership (GARP) – India Working Group and Centre for Disease Dynamics, Economics and Policy (CDDEP). The 2011 GARP report, Situation Analysis: Antibiotic Use and Resistance in India, also states that a large proportion of these hospital-acquired infections (HAI) are preventable with increased infection control measures. Research on hospital infections in India reveals several concerning trends. In Indian ICUs, the rate of Vancomycin-Resistant Enterococcus (VRE), a dangerous hospital infection, is five times the rate in the rest of the world. Rates of Methicillin-Resistant Staphylococcus aureus in Indian ICUs are also high, with one study finding over 80 per July – August 2013

cent of S. aureus isolates testing positive for resistance to methicillin and closely related antibiotics. Antibiotic resistant infections are difficult, and sometimes impossible, to treat. They lead to longer hospital stays, increased treatment costs, and in some cases, death. The GARP research estimates that of the approximately 190,000 neonatal deaths in India each year, due to sepsis – a bacterial infection that overwhelms the bloodstream – over 30 per cent are attributable to antibiotic resistance. Antibiotic resistant hospital infections can be especially deadly because antibiotics are used intensely in hospitals compared with the community, and frequent use drives the development of highly resistant bacteria. HAI causes urinary tract infections, ventilator associated pneumonia and central line related blood screen infections. Most common types of HAIs are surgical wounds and lower respiratory tract infections that are found among patients admitted to ICUs, labour rooms and among patients undergoing invasive procedures or those on immunosuppressive drugs. It has long been recognized that the transmission of infection can be associated with equipment. Inadequate decontamination of equipment and ward areas has led to several recorded outbreaks of infection in hospitals. Organisms have been shown to survive for long periods of time ( at times months) on the conventional surfaces in Health care settings. Even after disinfection measures like using bactericidals etc. organisms are known to survive and thrive in the microscopic scratches on these surfaces. Organisms causing hospital infections in India are similar to those around the world, with S. aureus and P. aeruginosa among the most common disease-causing pathogens. A prospective study of 71 burn patients at the Post Graduate Institute of Medical Education & Research, in Chandigarh found that up to 59 patients (83 per cent) had hospital-acquired infections: 35 per cent of pathogens isolated from wounds and blood were S. aureus, 24 per cent were P. aeruginosa, and 16 per cent were β-haemolytic streptococci. Another six-month study conducted in 2001 of the intensive care units (ICUs) at the All India Institute of Medical Sciences (AIIMS) in New Delhi, found that 140 of 1,253 patients (11 per cent) had 152 hospital-acquired infections, where P. aeruginosa made up 21 per cent of isolates, 23 per cent were S. aureus, 16 per cent Klebsiella spp., 15 per cent Acinetobacterbaumannii and 8 per cent Escherichia coli. Further, a study of 493 patients in a tertiary teaching hospital in Goa also found that 103 people (21 per cent) developed 169 infections. For a long time, India has been seeing Extended Spectrum Beta-Lactamase (ESBL), which are enzymes that have developed a resistance to antibiotics like penicillin &cephalosporins. ESBL enzymes are most commonly produced by two bacteria – E. coli and K. pneumoniae. There are many factors that determine the occurrence of HAIs. First amongst them is the risk of exposure to the organism of infection. The likelihood of exposure leading to infection depends partly on the characteristics of the microorganisms, their intrinsic virulence including resistance to antimicrobial agents, and the dose or inoculum of the infective material. HAIs may be caused by a microorganism acquired from another person in the hospital (cross-infection) or by the patient’s own flora (endogenous infection), that occurs naturally in all healthy individuals.. Important patient factors influencing acquisition of infection include age, underlying disease and it’s effects on the patient’s immune status,the amount and 41


EXPERT VIEWS

intrusive nature of the diagnostic and therapeutic interventions that the Patient has to undergo. The patients in the extremes of life are associated with a decreased resistance to infection, as are those with chronic disease such as malignant tumours,leukemia, diabetes mellitus, renal failure,or the acquired immunodeficiency syndrome (AIDS)have an increased susceptibility to HAIs. Some organisms may be acquired from objects contaminated from another human source (environmental infection). Health care settings are an environment where both infected persons and persons at increased risk of infection congregate. Patients with infections or carriersof pathogenic microorganisms( Called Vectors) when admitted to hospital are potential sources of infection for patients.Patients who become infected in thehospital are a further source of infection. Crowdedconditions, frequent transfers ofpatients and high dependency areas all contribute to the development of HAIs. Microbial flora may contaminateobjects, devices, and materials which subsequentlycontact susceptible body sites of patients. It is well established the between 70-80% of the HAIs happen through “Touch Surfaces�. These touch surfaces are those surfaces that are frequently touched by many in the hospital like bedrails, bedside tables, Intravenous fluid stands, over bed tables, door handles and taps as well as touch plates and handrails etc. apart from patients and visitors, ayahs, ward boys, nurses, doctors and other allied professionals end up touching these surfaces and becoming unwilling vectors. The major strategy in fighting this menace is to have a

42

multipronged approach. The first line of defense is the extra focus on Hand washing practices being implemented across all healthcare personnel in the hospital. The next line is that of adequate and proper disinfection of all surfaces and equipment that comes in contact with the patient. However it is a proven fact that all these touch surfaces have microscopic cracks in which these hardy organisms can survive for months. Thus the need for the third line of defense- a novel approach- i.e. to have all these commonly touched surfaces made of Copper Alloys which contain at least 60% copper. This has been proven to kill all bacteria including the superbugs and also the now common viruses like H1N1 etc. Studies in ICUs of super specialty Hospitals like the Memorial Sloane Kettering Hospital, as well as 2 other hospitals, in the USA, over a period of 42 months, found that in the wards that had these touch surfaces made of copper alloys with 60% copper, infection rates were reduced by 40-70% (depending on how many touch surfaces were of copper) as compared to identical ICU wards in the same hospital where no touch surface was made of copper. Thus we are seeing the dawn of a new standard of care where the healthcare setting would itself attempt to reduce the likelihood of HAIs by using this novel method of using Anti-Microbial copper in all the touch surfaces. In many countries newer ICUs are being made with this Anti-Microbial copper touch surfaces or are being retrofitted. The hospital equipment makers are starting new product lines with the Anti-Microbial copper touch surfaces incorporated.

July – August 2013


PRODUCT LINE

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swasthe change It is a cloud based preventive and ailment health management system focused on keeping the population healthy. It is one of the first platforms in India to truly integrate the two most advanced forms of sciences (Medical Science & Computer Science) into one platform.

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he platform aggregates health records for individuals at one place, allowing for analysis against recognized health standards, which could act as an early warning system for illness prevention on one hand and a road map for a healthy lifestyle on the other. For starters, it allows the ease of maintaining all health records at one place to ensure easy accessibility, as and when need arises. The platform has segregated the population in 3 product segments to support their unique requirements from the platform. IMMUNIZATION REGISTRY It captures all immunization records of children, something that is extremely critical for future references to ensure compliance with the immunization requirements and to rule out certain diseases at the time of deciding a line of treatment during disease control.

44

KID SURE This product captures health screening records of children on a regular basis and digitizes their records for analysis and healthcare. This is particularly relevant for schools across the country, as they are advised to capture bi-annual health records of children as per the sanitation guidelines of Government of India. The product also encourages parents to periodically capture health records and health incidents of children for enhancing the analysis and health care aspects of the product. SWASTH MANAGER Adults employed at various corporate entities or just doing their own thing need to ensure that they are adequately taking care of their health. ‘Swasth Manager’ with its various features, captures health records of adults and pegs them against the recognized standards to provide heads up on any early symptoms of health alarms. The product also advises on follow-up actions that are necessary to ensure the pre-

vention of disease in such a situation. Also, the health record capture feature and long term care elements in the product ensure that the preventive as well as curative aspects of healthcare are well taken care of through Swasth Manager. A very important aspect of Swasthexchange is the ‘Long Term Care’ (LTC) product, which is particularly relevant for patients of chronic diseases like diabetes, where micro-level care is pertinent. Built in features in the product like SMS alerts, e-mail alerts ensure that the patients are prompted to stick to the prescribed standard of health management and regime. Swasthexchange also aggregates different health providers on the platform through its product ‘Swasth Connect’, which would provide for easy and seamless tagging of all concurrent health check-up records, lab tests from these health providers at one place. To know more about us visit: www.swasthexchange.com

July – August 2013


PRODUCT LINE

SCIENTECH TECHNOLOGIES INTRODUCES NEW SYRINGE PUMP

SCIENTECH 15B A

Syringe Pump is a medical apparatus that regulates the rate of drug administration through a syringe. Scientech Technologies Pvt. Ltd introduces, Scientech 15B, a small, light and completely portable Syringe Pump. Doctors and patients can program the pump through the use of a small computer interface on the device. The pump has a variety of uses from critical care to saving the lives of infants. Scientech Medicare’s comprehensive range reflects the most recent and innovative technology in the market. Scientech Syringe Pump is compatible with Syringe of any brand

For further information please coantact

Mr. Chaitanya Dev Singh Sisodia Scientech Technologies Pvt. Ltd., 94, Electronic Complex, Pardesipura, Indore – 452010, INDIA Cell No. : +91-7389910103 Tel : 0731-4211100 Fax : 0731 2555643 Email : csingh@scientech.bz Website : www.ScientechWorld.com

46

providing high accuracy and automatic calibration. It has 3 different working modes such as; rate control mode, time control mode, & dose and weight control mode. The instrument is available with unique KVO function- After infusion is complete, the pump will automatically switches to the smallest flow to prevent thrombus. Scientech 15B Syringe Pump has a Bolus function which allows the user to add maximum of 25ml of preset fluid by bolus cable, without interruption of current infusion at a minimum of 30 minute intervals. There are functions like audible and visual alarms, near empty, Syringe empty, Volume complete (a volume limit has been set), Occlusion, Syringe loose, Operation error, Low battery and other device failures. The Scientech 15B uses internal Li Ion battery. The battery life is approximately 8 hours of continuous operation on a new and fully charged battery running at 5 ml / h. It can also operate on AC 240 V power supply. It comes complete with bolus cable, syringe cover protector, leather case and batteries. Scientech 15B includes function that increase patient comfort as there is less need for repeated injections. The equipment has bundle of advan-

tages over other forms of intravenous drug administration. Infants, especially those born premature, may need different range of medications to stay alive. Yet their little size has need of smaller quantity of medication. A well programmed syringe pump can accurately manage medication, lowering the possibilities of an accidental overdose. Not only it gives drug to patient according to time & patient weight but also drugs delivery rate and drug dose both can be controllable. Clinicians and patients rely on Scientech 15B for safe and accurate administration of fluids and medications. Scientech Technologies Pvt. Ltd. is a renowned provider of medical equipments. Our world class products provide user a high degree of quality & reliability. Scientech offers comprehensive range of medical instruments and technical support. Leveraging the heritage and domain expertise of Scientech, the products encompass a broad technology spectrum and high customer satisfaction across the globe. Our policy is not just offering customers with products but also providing them with prompt technical support. Scientech has 12 branch offices in India & its products are exported to over 52 countries.

July – August 2013


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TENDERS

Hospital Ref Number: 8341318 Tender Number: Buyer/Seller: Government Maharani Rameshwari Indian Medical Science Institute Requirement: Supply of Medicine, Stationery Items, Machine/Equipments, Furniture & Uniforms. Location: Darbhanga - Bihar - India EMD: Rs.20,000 Closing Date: 13/07/2013 at 00:00 Hrs. Contact Details: Government Maharani Rameshwari Indian Medical Science Institute, Darbhanga, Bihar, India __________________________________________ Ref Number: 8344617 Tender Number: Buyer/Seller: Controller Of Stores Requirement: Supply of Imported High End Beds for ICU & PACU Location: Chandigarh - Punjab - India Document Fees: Rs.20 EMD: Rs.500 Closing Date: 8/07/2013 at 11:00 Hrs __________________________________________ Ref Number: 8346192 Tender Number: Buyer/Seller: Controller Of Stores Requirement: Annual rate contract basis of Diagnostic Kit, Disinfectant Bath for Instruments Drills & Endoscopes. Hand & Skin disinfectant, Hard Surface Disinfectant A&B, Disposable Syringes with Needls. Chlorpyriphos 20% E.C. duly ISI Marked or approved/ Recommended brand from Punjab Agriculture University, Carbendazim 50% W.P. duly ISI Marked or approved/ Recommended brand from Punjab Agriculture University, Imported High End Beds for ICU & PACU, Imported Automated Sample Preparation and Integrated Molecular system for Cervical Cancer HPV & Molecular Study, Disposal of Unserviceable stores lying with Director General of Police. Disposal of 02 Brail Book Makers lying with Director Social Security Women & Child Development Location: Chandigarh - Punjab - India Closing Date: 8/07/2013 at 00:00 Hrs URL etender.punjabgovt.gov.in __________________________________________ 48

Ref Number: 8346883 Tender Number: Buyer/Seller: Prison Department Requirement: Supply of dental chair for central jail Location: Multi Location - Jammu-kashmir - India Document Fees: Rs.500 Closing Date: 5/07/2013 at 14:00 Hrs URL www.jkprisons.org __________________________________________ Ref Number: 8353084 Tender Number: Tender Prod. No: GMCH-PB-I-PA-V-PAIII-13/7647 Buyer/Seller: Medical Education And Research Requirement: Supply of Labour Tables Location: Chandigarh - Punjab - India EMD: INR6,000 Closing Date: 15/07/2013 at 14:00 Hrs. Document Sale To: 15-7-2013 at 14:00 Hrs __________________________________________ Ref Number: 8356520 Tender Number: Buyer/Seller: Shri Krishna Medical College Hospital Requirement: Supply of Machine Equipments, Furniture etc for Various Department of Shri Krishna Medical College Hospital Location: Muzaffarpur - Bihar - India Closing Date: 14/07/2013 at 17:00 Hrs. Contact Details: Shri Krishna Medical College Hospital, Muzaffarpur, Bihar, India __________________________________________ Ref Number: 8363092 Tender Number: Buyer/Seller: Indian Council Of Agricultural Research Requirement: Work of Modular Laboratory furniture & Room partitioning Location: Junagadh - Gujarat - India Document Fees: Rs.500 EMD: Rs.50,000 Closing Date: 10/07/2013 at 15:00 Hrs __________________________________________ Ref Number: 8363847 Tender Number: Buyer/Seller: Tamil Nadu Medical Services Corporation Limited July – August 2013


TENDERS

Furniture Tender Requirement: Supply of Hospital furniture’s, Patient cot with mattress, Examination table, Stretcher trolley, Mobile tray, Patient waiting chairs, Hospital bedside lockers, Crash cart , Revolving stool, Saline stand Location: Chennai - Tamil Nadu - India EMD: Rs.5,725 Closing Date: 3/07/2013 at 11:00 Hrs __________________________________________ Ref Number: 8331043 Tender Number: Buyer/Seller: Indo Tibetan Border Police Force Requirement: Supply of Bed Side Lockers SS, Book Shelves/Mag Shelves, Bowl SS, Bucket with LID SS, Case Sheet Holder, Catheter Self-Retaining (Foley’s), Cupboard, Digital Combined Height & Weight Machine, Digital Thermometer, Filling Cabinet, Forceps Artery (Spencer Wells), Forceps Dissecting Plain, Forceps Dissecting Toothed 5”, Forceps Mosquito, Forceps Sinus 7”, Forceps Sterilizer (Cheatles), Ishihara Book Original, Mattress Dunlop with Cover, Plaster Cutter, Proctoscope, Rack SS, Revolving Chair, Scissor, Stomach Wash Tube, Test Type Near Vision Chart, Auroscope, Dispo Oxygen Cylinder, Hot Water Bottle, Thermometer & Foreign Body Removal Forceps Location: Leh- Ladakh - Jammu-kashmir - India EMD: Rs.10,000 Closing Date: 8/07/2013 at 16:00 Hrs. Contact Details: Indo Tibetan Border Police Force, Leh- Ladakh, Jammu-kashmir, India __________________________________________ Ref Number: 8344617 Tender Number: Buyer/Seller: Controller Of Stores Requirement: Supply of Imported High End Beds for ICU & PACU Location: Chandigarh - Punjab - India Document Fees: Rs.20 EMD: Rs.500 Closing Date: 8/07/2013 at 11:00 Hrs __________________________________________ Ref Number: 8363847 Tender Number: Buyer/Seller: Tamil Nadu Medical Services Corporation Limited Requirement: Supply of Hospital furniJuly – August 2013

ture’s, Patient cot with mattress, Examination table, Stretcher trolley, Mobile tray, Patient waiting chairs, Hospital bedside lockers, Crash cart , Revolving stool, Saline stand Location: Chennai - Tamil Nadu - India EMD: Rs.5,725 Closing Date: 3/07/2013 at 11:00 Hrs. __________________________________________ Ref Number: 8270390 Tender Number: Buyer/Seller: Rajasthan Medicare Relief Society Requirement: Purchase of Computerized Radiographic System, Ultrasonic Cutting & Coagulation Device, Scan, Hospital & other Furniture. Location: Jaipur - Rajasthan - India Document Fees: Rs.400 Estimated Cost: Rs.3,000,000 Closing Date: 3/07/2013 at 13:00 Hrs. Contact Details: Rajasthan Medicare Relief Society, Jaipur, Rajasthan, India Document Sale From: 10-6-2013 at 10:00 Hrs Document Sale To: 1-7-2013 at 15:00 Hrs __________________________________________ Ref Number: 8363896 Tender Number: Buyer/Seller: Tamil Nadu Medical Services Corporation Limited Requirement: Supply of Hospital furniture’s, SS Bowls of various sizes, SS Basins, SS Gallipots, SS Water jugs, SS Dustbin Location: Chennai - Tamil Nadu - India EMD: Rs.5,725 Closing Date: 3/07/2013 at 15:00 Hrs. __________________________________________ Ref Number: 8196766 Tender Number: Tender Prod. No: DRDM13F013 Buyer/Seller: Indian Oil Corporation Limited Requirement: Supply of Bench top ductless fume hoods, fluidized bed/catalyst regeneration unit, worm gear efficiency test rig, pyrolysis pilot plant for biomass, dynamic shear rheometer, engine exhaust particle counter & particle size distribution measuring system, mini traction machine, temperature control systems.

Location: Faridabad - Haryana - India Closing Date: 3/07/2013 at 14:00 Hrs E-mail: maheshwarim@indianoil.in Phone: 129 2294573/2292012 Fax: 129 2227984 __________________________________________ Ref Number: 8434555 Tender Number: Buyer/Seller: Central Mine Planning And Design Institute Limited Requirement: Supply and installation of analytical balance, precision balance, microwave digester, water purification system, bod incubator, fume hood, laminar flow, incubator for bacteriological test Location: Ranchi - Jharkhand - India Document Fees: Rs.2,000 Estimated Cost: Rs.3,256,000 Closing Date: 1/08/2013 at 15:00 Hrs. Contact Details: Central Mine Planning And Design Institute Limited Central Mine Planning And Design Institute Limited, Ranchi , Jharkhand, India __________________________________________ Ref Number: 8310454 Tender Number: Tender Prod. No: 07-2013-04 Buyer/Seller: North Eastern Railway Requirement: Provision of Modular OT, Central (Medical ) gases and pipe line system and hand washing unit at CRI Location: Varanasi - Uttar Pradesh - India Document Fees: INR5,000 EMD: INR154,100 Estimated Cost: INR7,703,000 Closing Date: 16/07/2013 at 14:30 Hrs. Contact Details: Office of the DRM/Engineering, N.E. Railway, Near Lahartara Bridge Varanasi, Uttar Pradesh, India Document Sale To: 16-7-2013 at 13:00 Hrs

49


EXPERT VIEWS

l

Richa Goya

Pharmacoeconomics

Current Scenario and Way forward

E

conomic evaluation is a process which involves weighing benefits and costs in an incremental analysis. However, it is a framework that draws up a balance sheet between costs and benefits to assist decision-making. Health economics aims to make informed decisions which in turn influences health treatments, medications preference or technology assessments and subsequently contributes to state of art therapeutic strategies to maximize optimal health technology for the overall population of a country. Health economics is gaining importance worldwide as an important decision-making support science. It can be treated as a subset of the broader concept of health technology assessment (HTA), encompassing drugs, devices, medical and surgical procedures, diagnostics and the systems, processes and programmes that influence healthcare. Pharmacoeconomics evaluates the behaviour of individuals, firms and markets relevant to the use of pharmaceutical products, services and programmes. It focuses on the costs and consequences of such modalities. There has been a paradigm shift in the patient/consumer focus and attitude towards health and disease. Pharmacoeconomics can be defined as ‘a branch of health economics which particularly focuses upon the costs and

50

Consultant mes Health Outco Research

Mahendra

Rai

nt Sr. Consulta mes co ut O th al He h Reasearc

benefits of drug therapy’ . A few decades ago, patient groups had a ‘reactive’ approach towards disease wherein patients aimed for a cure by using pharmaceutical products and healthcare services . Challenges faced in Pharmacoeconomics: Pricing plays a major role in drug prescription and buying decisions. It is not necessary that high price assures high quality or more benefits and companies are finding it increasingly difficult to substantiate higher prices with commensurate benefits . Meanwhile government is tightening the regulatory framework in an attempt to curb manufacturing and marketing malpractices. In such a scenario, Pharmacoeconomics can be a viable tool for balancing the interests of all stakeholders in the industry. Various perspectives Patient’s perspective Patients are mostly concerned about the cost of therapy prescribed while doctors are concerned about affordable treatment so as to ensure compliance and complete recovery. If the pharmacoeconomic profile of a medicine is available, doctors can know and evaluate the additional benefits available from such a medicine over existing medicines and determine whether the incremental price is commensurate with the additional benefits claimed . Patient perspective is of paramount importance because patients are the ultimate consumers of healthcare services. Costs from the perspective of patients are essentially what patients pay for a product or service—that is, the portion not covered by insurance. Physician’s perspective New medicines are being launched now and then by pharma companies claiming incremental benefits over existing products available in the market. This incremental benefit comes at an extra cost which goes from the patient’s pocket. Performing an economic evaluation of a new medicine and comparing it with

July – August 2013


EXPERT VIEWS

existing ones provides significant advantage from the viewpoint of medical practitioners. It will empower physicians to compare medicines on different pharmacological parameters including safety and efficacy Health Insurer’s perspective The health insurance business is growing at a rapid pace and individuals today have a wide variety of health insurance options from both government bodies and private insurance companies. Currently, a standardized list or formulary of medicines and their cost is unavailable. This list is essential for determining the eligibility criteria for reimbursement at the insurer and patient levels irrespective of the insurance policy and the insurer. Pharmacoeconomics can serve as an essential tool in preparing this standardized list or formulary based on cost-effective analyses of drugs, which will benefit both patients and insurers in the process of reimbursement and impart further clarity and transparency to the health insurance system by helping insurers determine the clinical criteria for coverage . Manufacturer’s perspective For some of the diseases like cancer and diabetes, therapy is costly. It is always feasible to develop public–private partnership between health insurance companies and pharmaceutical companies manufacturing these medicines for developing a functional business model. Pharmacoeconomics can thus provide a methodology to design a mutually beneficial model in such scenarios. Researcher’s perspective Pharmacoeconomic concepts are mostly used for the retrospective evaluation of clinical trial data. Implications of efficacy or safety aspects are examined by pharmacoeconomic analyses, data bases are examined, literature is surveyed and expert opinions are solicited. This information was clubbed with retrospective analyses of trial data to develop a decision analysis model. Policy-maker’s perspective Measures of health-related quality of life (HRQOL) are increasingly viewed as important outcomes of medical and surgical interventions. The expenditure associated with adopting the new medical treatment, including new medicines, will have to be valued in terms of health outcomes. Such outcomes will include, among others, mortality, morbidity, cost, length of hospital stay, quality of care, and most importantly patient satisfaction . Pharmacoeconomics in India The Indian pharmaceutical industry (IPI) is the world’s fourth-largest by volume and is most likely to lead the manufacturing sector in India. The Indian Patent Act in 1970 played a major role in developing a base for the manufacturing units in India. In the post GATT (Global agreement on trade and tarrif) era, with the change in law in 2005, numerous opportunities for both international and Indian companies progressed at an exponential rate. However, the players need to pursue an innovation based approach rather than aggressive marketing. This has cascaded a sequence of job opportunities mainly in the field of clinical research, thus making way for health outcomes research. In addition to this, many governments worldwide are seeking to curb their soaring prescription drug costs by greater use of generics, thus giving importance to cost-effectiveness and cost-benefit analysis

July – August 2013

studies. In other words, ‘implementing the concept of Pharmacoeconomics’. Though there is availability of tremendous data on health sciences and clinical research, this data is not used for outcomes research and pharmacoeconomic analysis. The reason for this being the quality of primary data available and its suitability for secondary database research. Therefore, for the future of outcomes research and pharmacoeconomic analysis in India there is a need of development of a proper database to be used for comparative effectiveness research . In India, the concept of Pharmacoeconomics is still not used by the government in order to make reimbursement decisions. Furthermore, the concept of Pharmacoeconomics is not being used in academic research though cost-effectiveness studies have been performed in few research institutes. Challenges in Applicability of Pharmacoeconomics • Diversity in India such as socioeconomic development and population size make it difficult to adapt to the Pharmacoeconomics research being conducted in other countries. • Lack of complete appreciation of the potential importance and application of Pharmacoeconomics studies. • Poor technical skills of healthcare professionals, especially of pharmacists. • Lack of appropriate database of the healthcare system in order to bring about research adaptation from another country. Benefits of Pharmacoeconomics • Optimal use of finances for pharmaceutical expenditure. • Provision of job opportunities in the clinical, health economic and market research sectors . Implementing the Pharmacoeconomics concept–way forward The following measures can be undertaken to extend Pharmacoeconomics practice in India. • Introduction of the Pharmacoeconomics concept at the undergraduate level. • Workshops on how to implement the concept of Pharmacoeconomics in pharmacy practice. • Use of cost-effectiveness data in the pharmaceutical industry for reimbursement and other financial decisions, thus decreasing pharmaceutical expenditure. • Encouragement of pharma students to present posters participate in seminars and student chapters of International Society of Pharmacoeconomics and Outcomes Research (ISPOR) . • Value based pricing by government: Companies that offer unique or discernably valuable features or services are better positioned to take advantage of value-based pricing, than companies whose drug technology are relatively indistinguishable from those of their competitors. The concept will be implemented in UK in 2014 and rest of the nations may well align their health assessment and market access strategies on similar lines. The policy ensures the patient pays for the drugs which render better outcomes in comparison to existing ones. Conclusion: Pharmacoeconomics carries a wide scope in India with benefits ranging from drug prices to market access. However, further practical implications are necessary to understand its applicability.

51


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Feaures: • Medical Equipment • Cathlabs • Cardic • Opthomology • Gyne • Healthcare Management and IT Medical Equipment: India is one of the largest medical device markets in Asia, and growing at an impressive rate. Before manufacturers can legally sell medical devices within India, they must be in compliance with India medical device regulations. Governments need to put in place policies that will address all elements related to medical devices, ranging from access to high quality, affordable products, through to their safe and appropriate use and disposal. Surprisingly, regulatory controls for medical devices are scarce in the developing world, even though implementation of national medical device regulations will often address the very issues raised in countries as major concerns for patient safety. Participation of leading players in the Medical Device Industry:Healthcare Technology: As Information Technology increasingly penetrates the healthcare industry, physicians and patients are experiencing the benefits of on-demand access to medical information where, when and how it is needed. Recent advances in IT are enabling providers to improve the quality of patient care. Today’s healthcare IT is much more than traditional isolated computers and unfriendly applications. Increasingly, patient care is exploiting the new tools and information that systems can provide, while maintaining a patient-centric approach to their use. A sneak peak in the future of technology which allows machines in healthcare, much easier to operate. Product Reviews of latest technologies for Hospitals and healthcare providers and vendor community:Cardiology (World Heart Day): To raise of Indian Cardiology segment covers: • Developments that Have happened in Indian cardiology sector • Eminent cardiologists bytes • The forerunners who have contributed to the growth story Events coverage - will distribute free: • Healthex International 2013 International Medical Exhibition and Conference • Health & Hospital tech’13 is 3rd International Exhibition on Health, Medical Equipment & Hospital Infrastructure.

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Indian Hospital Association

Alpa Antani Head - Trade Fairs (WR) Prakash R. Boga Executive Officer alpa.antani@cii.in prakash.boga@cii.in Confederation of Indian Industry (WR) 105 Kakad Chambers, 132 Dr Annie Besant Road, Worli, Mumbai 400018. Tel: +91 22 24931790 Extn 438 | Fax: +91 22 24939463 / 24945831 | Mobile : +91 9821024284


Canon

3-4 October 2013, The Lalit, Mumbai, India

The best platform to meet your clients and be at the forefront of their attention Medtec India will attract

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700 + Visitors 150 + Conference Attendees 70 % Decision Makers 48 + Exhibition Spaces

Focussed onsite conference programme Separate modules on Consumables/ Surgicals/ Disposables/ In-vitro diagnostics and more.. Doctor’s Pavilion Students Pavilion Facilitated Business Networking Breakfast Briefings i-3 center Speed Networking Speed Geeking

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Flash Mob Networking Foot Print Themes Golf, Drum cafes Black jack tables Roulette tables Happy Hours Power Meetings Exhibition with area dedicated for Open Meetings with Doctors and Hospital Administrators List your Company in the Who’s Who of the Medical Devices Industry

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Poster Presentation Design Competition Lucky Draws

To register for free contact +91 (0) 6172 7001 / conferences-india@ubm.com or log on www.medtec-india.com/mg


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