www.pinkmedico.com
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M - Health
CV
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CONTENT
Contents
24
DOCTORS DRESS CODE Patients in the public healthcare sector prefer a formal, professional consulting environment that is determined largely by the doctor’s attire and conduct during the consultation.
14
MEDICAL TOURISM INCREASING PATIENTS CHOICE AND AFFORDABILITY The greatest concern of the majority of patients will be how to choose the hospital where they are least likely to suffer an adverse outcome.
30
IS HDL GOOD? Many people think of cholesterol as something that should be as low as possible. After all, high cholesterol is a well-documented risk factor for heart disease
20
M HEALTH With growing technology and healthcare awareness, mHealth applications have become necessity rathar than an option.
4
October 2017
Pink Medico
editor's note
India is proud of her status in medical tourism in global level as the number of foreign patients visiting India for treatment of various ailments is on the increase. According to official sources around 3.6 lakh patients visited India during 2016 compared to 2.3 lakh patients in 2015. It shows that India is an undisputable
EDITORIAL TEAM: Executive Editor: Prakash Subramanian Consulting Editor: S S N Sastry DESIGN & DEVELOPMENT TEAM
destination for medical tourism. The Centre is emphasising for Medical and
Creative Director: S Vidhyaa Prakash
Wellness tourism among various niche tourism services.
CORRESPONDENCES:
We at Pink Medico are coming out various schemes to promote Medical tourism
Email: contact @pinkmedico.com Tel: 080 4959 0544 Cell: +91 88610 55444
in India. The cost of Medical tourism in India is less compared to other countries
Owner :
which provide the same facility. Language does not pose any problem in India as western patients can interact with doctors in English. Treatment in India can be compared to any developed country. We act as service providers for the patients of various countries and take care of their amenities. Pink Medico is a dependable answer for the treatment under medical and Wellness tourism. We are at a distance of a phone call.
Prakash Subramanian
Anarghyaa ETech Solutions Pvt Ltd Published At: Anarghyaa ETech Solutions Pvt Ltd No.29, SVS Plaza, 4th Main, Vinayakanagar, Hebbal Bangalore 560 024 Email: info@pinkmedico.com Web: www.pinkmedico.com Tel: 0804959 0544 Mobile: +91 88610 55444
Disclaimer: All the details published in this magazine contain opinions, ideas and experiences of various writers, professionals and sources. It is intended to provide informative material on the subjects contained therein. It is sold or presented with the understanding that the members, managers, writers, publisher and Pink Medico are not engaged in providing medical or health or healthcare services, do not dispense, directly or indirectly, medical advice, or do not prescribe the use of any technique or products as a form of treatment for any medical or similar issues of any kind or nature whether physical, mental or otherwise, and do not recommend any of the product or services directly or indirectly. Pink Medico does not have any intention to provide specific medical advice, readers should not use any Content for diagnosing or treating a medical or health condition. If you have or suspect that you have a medical problem, you should contact your professional healthcare provider through appropriate means. You agree that you will not under any circumstances disregard any professional medical advice or delay in seeking such advice in reliance on any Content provided herein, reliance on any such Content is solely at your own risk. You should carefully read all information provided by the manufacturers of any products advertised or promoted before purchasing and/or using such products
Pink Medico
October 2017
5
NEWS & UPDATES
NEWs & UPdATEs
PHFI Awarded the Prestigious QCI-DL Shah Platinum Award
I
Sabha) and Shri Amitabh Kant, CEO, Niti Aayog,
n
recognition
outstanding
of
PHFI’s
Government of India during the Inaugural session
to
of the 12th National Quality Conclave at the Le
and
Meridian hotel. Professor K. Srinath Reddy, President,
advancement of knowledge in
PHFI, Professor. D Prabhakaran, Vice President –
the Indian healthcare sector,
Research and Policy, PHFI and Dr. Sandeep Bhalla
The Quality Council of India
– Programme Director, Trainings, Centre for Chronic
(QCI) awarded the Public Health
Conditions and Injuries, PHFI received the award on
Foundation
behalf of the PHFI team.
skill
contribution
building
initiatives
of
India
(PHFI)
the prestigious QCI - DL Shah Platinum award for skill building
Professor K. Srinath Reddy, President, PHFI said,
of primary care physicians in
“This is truly a moment of pride for the PHFI team.
chronic conditions in India.
Winning the prestigious QCI - DL Shah Platinum award in addition to other leading awards in skill
The
Platinum
was
development is a testimony to our endeavour and
Shri.
commitment of working towards a Healthier India.
Baijayant Jay Panda, Honourable
. Our health systems can be effective and equitable
Member
only when primary health care is widely accessible
presented
to of
award PHFI
by
Parliament
(Lok
and scientifically of sound quality. The award
6
October 2017
Pink Medico
NEWS & UPDATES exemplifies PHFI’s Mission which is to contribute to the better quality healthcare of all citizens, especially through
skill
knowledge
development
and
advancement
in
primary health care. We owe a
Fortis Hospitals teams up with Stasis, a cloud-powered health monitoring company, to monitor patients round the clock
debt of gratitude to Government of India, State Governments and all our partners for recognising PHFI
efforts
and
continuously
working with us to raise India’s health
to
global
standards.”
PHFI continues to be recognised for efforts in skills building in the area of Chronic Conditions in India. The capacity building initiatives in chronic conditions by the Public Health Foundation of India currently operates in over 500 centers in 23 States and 03 Union Territories
covering
more
than
100 cities all across the country. Under the guidance of eminent 65 national experts and 504 faculty (diabetologist,
endocrinologists,
obstetricians and gynaecologists, ophthalmologists,
cardiologists,
internists and pulmonologists) in the respective cities, these initiatives have trained over 20,000 primary care physicians till date. PHFI is running eleven capacity building programmes with various renowned National stakeholders.
and
International
F
ortis Hospitals has partnered
in the hospital that can improve
with Stasis, a global cloud-connected
clinical outcomes and hence a
patient monitoring company, with
cloud based technology for patient
an objective to provide the best care
monitoring is a big step towards
for high risk patients who require
digitalizing
round the clock monitoring outside
Stasis is the latest technology being
ICU.
used by Fortis Hospitals Bangalore,
healthcare
systems.
that helps round the clock care and Stasis vitals
builds
cloud-connected
monitoring
solutions
for
treatment to the patients with extra precision”, said Dr. Manish Mattoo,
vulnerable patients who require
Zonal
Director,
close observation without one-to-
Bengaluru.
Fortis
Hospitals,
one nursing care. Together, Fortis and Stasis are committed to ensure
It will help us in upgrading the
care extends well past the ICU.
patient monitoring, care and keep doctors clued into their patients’
“We are always looking to adopt
vital parameters at all times. It
new
will also help reduce costs as
technologies
and
facilities
Pink Medico
October 2017
7
NEWS & UPDATES several patients can now be closely monitored
outside
ICU
settings
without compromising on care and supervision. This partnership is a good example of good medicine meeting great technology to bring down healthcare costs, he added. The Stasis System keeps a watch on a patient’s core vitals such as heart rate, blood oxygen, respiratory rate, blood pressure, temperature, and even the electrocardiogram of vulnerable patients no matter where they are in the hospital. Unlike regular monitoring systems in ICU and wards that indicates the body functions of the patients in confusing numbers and waveforms, the Stasis System indicates different
WHO praises India’s role in promoting Generic Medicines
I
n a strong endorsement of India's move to make prescriptions of generic
medicines mandatory by doctors, the World Health Organisation (WHO) has
colors to communicate the patient
advised other countries to adopt similar policies which, it said, would ensure
status: green is good, yellow means
huge gains by significantly reducing out-of-pocket expenditure on medicines
patient requires care. The system
and making drugs available to all.
helps involve caregivers and family attendees at the bedside, ensuring
The UN agency also asked countries to develop a mechanism for bulk pro-
they are properly informed of their
curement of low-cost generic medicines and take advantage of TRIPS flex-
loved ones condition. These readings
ibilities and other opportunities in intellectual property and trade rules to
are displayed at a central tablet
support production and use of generic drugs in the region.
for medical experts to observe and
"India's move towards promoting generic medicines will make a huge differ-
take action. Most importantly, all the
ence by saving significant amount of money, most of which is spent out-of-
patients’ readings are easily accessible
pocket on healthcare. WHO applauds this move and we will also recommend
by their doctor from anywhere using
other countries in the region to adopt similar policies," WHO South-East Asia
the mobile app.
Regional Director Poonam Khetrapal Singh said while inaugurating the 70th session of the WHO Regional Committee meet in Maldives. The meeting was attended by public health experts, policy makers and other delegates from 11 countries, including India.
8
October 2017
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NEWS & UPDATES Calling on countries across the south-east Asia region to take bold action to ensure all people everywhere have access to safe, efficacious, quality and affordable medical products, the UN agency applauded India's role in supplying low-cost generic medicines across the world. Urging India to share information on procurement of generic medicines, Khetrapal Singh said countries in
Centre asks NEIGHRIMS to submit proposal for Air Ambulance
the region must work together to develop a procurement system for bulk buying as that helps in bringing down the cost. "Inter-country and regional collaboration on public procurement and pricing can be scaled up, including through sharing information on medicines prices. This will enhance countries'
negotiating
T
can be brought to the institute for
he Centre has asked the North
treatment besides medical samples
Eastern Indira Gandhi Regional In-
of patients can also be collected for
stitute of Health and Medical Sci-
investigation at the super speciality
ences (NEIGHRIMS) here to submit a
hospital.
proposal for air ambulance. Thappa further said that the insti-
positions
when they are purchasing on the international market," she said. Across the region, an estimated 65 million people are pushed into pov-
"The institute has been asked to
tute is proposing to involve the
prepare a proposal for having air
RIIMS Imphal to take care in respect
ambulance services in the region,"
of states like Nagaland and Mizoram
NEIGRIHMS director Dr DM Thappa
while NEIGRIHMS will look after
told.
Meghalaya, Arunachal Pradesh and Tripura.
erty due to out-of-pocket healthcare payments, with the cost of medicines being one of the main causes.
He said NEIGRIHMS would act as a nodal point for air ambulance dis-
The construction of the Regional
pensary system whose services can
Cancer Centre, the Medical College
reach out to the far flung areas of
Building, the Hostel and the Nursing
the region.
College is on at the institute premises at a cost of Rs 280 crore.
The NEIGRIHMS director said pa tients
in
medical
emergencies
Pink Medico
October 2017
9
NEWS & UPDATES
Govt to set up 49 Cancer Centres in 3 years With cancer cases on the rise in the country, the government plans to set up 49 cancer centres in the next three years. The centres will be in addition to 31 already functioning and upgraded since 2014-15, when the government floated the scheme.
struction or upgrade of existing fa-
cially cancer, are increasing at an
cilities like district hospitals, region-
alarming rate. However, there is a
al cancer centres and government
serious dearth of facilities, mainly
medical colleges — the government's
at the district level. The idea is to
programme will also provide sup-
make treatment options available
port for high-end equipment and ad-
across India so that patients do not
vanced technology for cancer treat-
necessarily have to travel to Delhi
ment, the official said.
and Mumbai, which often leads to
The health ministry has drawn up a detailed project plan which will be reviewed by the Prime Minister's Office (PMO) at a high-level meeting on Monday. According to the proposal, reviewed by TOI, the ministry has estimated a cost of around Rs 3,495 crore to implement the scheme over the next three years. The cancer centres will be set up in a phased manner under the existing National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.
10
Non-communicable diseases, espe-
October 2017
additional costs like accommoda-
There are only 600 radiotherapy
tion, travelling etc," an official said.
machines in the country against requirement of about 1,200 machines,
In India, over 10 lakh new cases of
as per estimates by the WHO. Under
cancer are diagnosed every year.
the scheme, there will be an in-
However, due to late diagnosis, over
crease of around 175 radiotherapy
7 lakh people die from the disease
machines in India by the end of
each year. Projections by Indian
2020. The proposal also entails the
Council of Medical Research (ICMR)
creation of more facilities for oncol-
show that India is likely to have over
ogy, onco-surgery, chemotherapy and
17.3 lakh new cases of cancer and
palliative care for diagnosis, treat-
over 8.8 lakh deaths due to the dis-
ment and rehabilitation of cancer.
ease by 2020. Apart from setting up cancer centres— which include con-
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MEDICAL TOURISM - COVER STORY
MEDICAL TOURISM M
edical tourism offers vari-
ous opportunities for patients. It increases choice and affordability of treatments. However, an in-
INCREASING PATIENTS CHOICE AND AFFORDABILITY
creasing range of options can be bewildering.
Impressive
hospital
websites offer a vast range of services, in 5 star settings. The patient’s challenge is to find the hospital or clinic offering high quality care in a low risk setting amongst these well-marketed
glossy
websites.
Patients need unbiased information to choose from the available choices. Most would access this information via the Internet. They will be looking for a safe provider in a convenient destination, at an affordable price. Some will be at a vulnerable stage in their lives, making decisions about complex surgery
or
treatments,
possibly
planning to travel far from home.
The greatest concern of the majority of patients will be how to choose the hospital where they are least likely to suffer an adverse outcome. They will require reassurance that the standard of clinical care, including management of postoperative complications, is of the highest quality. There are several key factors, which determine the level of safety in the healthcare setting. First, a hospital or clinic providing good clinical care depends upon its entire staff embracing a culture of delivering high quality healthcare and continual improvement in the standard of care offered.
12
October 2017
Pink Medico
MEDICAL TOURISM - COVER STORY
It will also ensure that care is provided by appropriately qualified staff that have regular training to ensure they have the required skills to perform procedures, in an environment where risk is minimized.
"Patients need unbiased information to make choices."
Pink Medico
October 2017
13
MEdiCAL TOUrisM - COVEr sTOrY One way is to look for hospitals
to assess the application of standards and procedures in practice. Surveyors
that have undergone an external
spend most of their time on the wards, talking to staff and patients and ob-
review of quality standards, by a
serving processes in action.
credible body, which has taken all of these factors into account.
Developmental accreditation programs support the organization in achieving
Healthcare providers are increas-
improvements by sharing best practice and offering ongoing mentoring sup-
ingly looking towards Interna-
port during the preparatory phase.
tional Accreditation to reassure patients about the care they can expect. A
The preparation for an accreditation survey involves all staff, clinical and non clinical, in a process of understanding how the organization works and how, by working as a team, patient and staff risk can be minimized.
hospital
successful
that
has
in
been
achieving
accreditation has been inspected by an independent accreditation body. The quality of care and the setting of that care have been carefully assessed to ensure that risk has been minimized. Accreditation looks at the whole organization,
from
manage-
ment to clinical care. The aim of accreditation in healthcare is to improve patient services. The standards that the facility is assessed against should be patient
This common goal improves communication, with cross-departmental work being necessary to achieve the required standards. A successful survey results in improved staff morale, and pride in the standard of care offered. Insurers can be assured of the risk minimization processes in place. The importance of accreditation is in the ability of the process to alter the culture of a healthcare setting into one of continual improvement in quality. A successful accreditation survey represents a commitment to quality, which is recognized externally. Of equal importance is the continued focus on the maintenance and improvement of patient care between surveys and the engagement of staff in the process. Accreditation at its best should make patients safer, and develop healthcare settings where staff can develop and thrive.
centred, and the
survey should test thoroughly how well the standards are adhered to in practice. Schemes
Accreditation Organizations:
such as Trent use a survey team of active NHS Professionals, all
• JCI - Joint Commission International Accreditation, USA
of whom have current knowl-
• NABH - National Accredititation Board for Hospitals and
edge of healthcare provision,
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October 2017
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Healthcare Providers, India
jci - joint commission international It is a continuous process. Every time a nurse double-checks a patient’s identification before administering a medication, every time a surgical team calls a" time out" to verify they agree they’re about to perform the correct procedure, at the correct site, on the correct patient, they live and breathe the accreditation process.
J
Every three months, hospitals sub-
oint Commission International
Joint Commission surveyors are
(JCI) seeks to continuously improve
highly trained experts who are
health care for the public, in col-
doctors, nurses, hospital adminis-
laboration with other stakeholders,
trators, laboratory medical tech-
by evaluating health care organiza-
nologists, and other health care
tions and inspiring them to excel in
professionals. The Joint Commis-
providing safe and effective care of
sion is the only health care accred-
the highest quality and value. Their
iting body that requires its survey-
main focus is to improve the qual-
ors be certified.
patients randomly and use their JCI is accrediting hospitals interna-
medical records as a roadmap to
tionally to ensure they are providing
evaluate standards compliance. As
safe, quality care.
surveyors trace a patient’s experience in a health care organization,
Joint Commission surveyors visit ac-
they talk to the doctors, nurses, and
credited health care organizations a
other staff who interacted with the
minimum of once every 39 months
patient. Surveyors also observe
(two years for laboratories) to evalu-
doctors and nurses providing care,
ate standards compliance. This visit
and often speak to the patients
is called a survey. All regular Joint
themselves.
Commission accreditation surveys Joint
Commission
accreditation
does not begin and end with the on-site survey.
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October 2017
Pink Medico
heart attack care and pneumonia. Throughout the accreditation cycle, organizations are provided with a self-assessment scoring tool to help monitor their ongoing standards creditation is woven into the fabric
During the survey, surveyors select
are unannounced.
how they treat conditions such as
compliance. Joint Commission ac-
ity and safety of patient care around the globe.
mit data to the Joint Commission on
of a health care organization’s operations. The Joint Commission standards are updated regularly to reflect the rapid advances in health care and medicine.
NABH ACCrEdiTATiON
N
ational
Accreditation
Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India (QCI), set up to establish and operate accreditation programme for healthcare organizations. Benefits of NABH Accreditation: all ownership of clinical processes.
with the global benchmarks set by
Patients are the biggest beneficiaries
It
ISQua and thus hospitals accredited
of
development
of
results in high quality of care and
Paramedical
staff
patient safety. The patients get
leadership for quality improvement
services by credential medical staff.
within medicine and nursing.
accreditation.
Accreditation
improves
overall
professional
Clinicians and
and
provides
in
protected. Patient satisfaction is
Accreditation
regularly evaluated.
objective system of empanelment
provides
an
by insurance and other Third Parties. Hospital
Accreditation provides access to
stimulates continuous improvement.
reliable and certified information
to
a
It enables hospital in demonstrating commitment to quality care. It raises community confidence in the services provided by the hospital. It also provides opportunity to healthcare unit to benchmark with the best.
on facilities, infrastructure and level of care.
Health
Care
(ISQua)
is
an
international body which grants approval to Accreditation Bodies in the area of healthcare as mark of
equivalence
of
accreditation
programme of member countries. NABH is also one of the founder members of newly emerging Asian
NABH is an institutional member of
recognition. International Society for Quality
Rights of patients are respected and
Accreditation
by NABH will have international
International
Society
for
Quality in Health Care (ISQua) as well as member of its Board
Society for Quality in Healthcare (ASQua).
This
initiative
to
strengthen the Asian representation at international level and improve
and Accreditation Council. NABH
the quality structure in healthcare.
standards
has
So how does a patient begin to
The Staff in an accredited hospital
been accredited by ISQua. The
assess whether the hospital takes
are satisfied lot as it provides for
accreditation of NABH standard
these factors seriously from the
continuous learning, good working
for
information
environment, leadership and above
NABH standards are in consonance
for
hospitals
hospitals
authenticates
that
Pink Medico
available
on
the
website?
October 2017
17
M-HEALTH
mHE
Revolutionizing Layo
Mobile Devices, rather Mobile Apps have
the dynamics of healthcare sect
Image courtesy:www.pixabay.com
The whole approach to medical care and diagnostics has change technology, and curing techniques. Research and development in t new dimensions through frequent discoveries and innovations. Th transformation to every industry and business vertical; in the sam
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October 2017
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M-HEALTH
A LTH
out of Indian Healthcare
e changed
tor
M
Health is generally viewed as
the
delivery
of
healthcare
services
or information with a mobile phone. The services available today in global markets vary greatly in their level of sophistication.
Some
provide
static
information about a disease or illness, while others move considerably up the value chain by providing comprehensive healthcare management beyond what could be delivered by only a face-to-face interaction with a healthcare provider. India’s healthcare system is ripe for innovation. The capacity of the healthcare system to deliver care is unlikely to meet both the demands of the growing urban middle and upper classes, or the needs of the urban and rural poor. Over 75% of healthcare costs paid out-ofpocket create a consumer-driven market capable of rapid change. Using technology to enable greater access to care at a lower price point is critical.
ed – adopting new medicines, care the medical sector has been gaining he IT revolution proffered an organic me way that it transformed our lives.
Pink Medico
October 2017
19
M-HEALTH
mHealth from
bridges
enabling
transformative
the
gap
services services
to
when
objective healthcare data can be collected. In other global markets services such as blood glucose and
pacemaker
monitoring
via mHealth have also been implemented. Physicians always struggle to collect accurate data to make informed decisions. If monitoring and data collection can be implemented in a cost-effective manner, mHealth could both increase quality to individuals with the ability and willingness to pay, as well as expand access to broader
20
October 2017
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m-Health
market segments in a low-cost
Mobile
provide
million people using some form
manner.
information offer an opportunity
of mobile health application or
to improve a health outcome.
telemedicine systems. A flaw in
and
On mHealth appls consumers
any of this software can open up
mHealth
get healthcare tips, which will
the data stored on the device or
applications have become necessity
eventually help them become
in the app to hackers or malware.
rathar than an option.
aware of diseases and their
This, inturn, can open up an
natural remedies, which will help
entire health network up to a
them to lead a healthier lifestyle.
data breach.
Despite the growing demand,
Hence it adds more repsonsibility
Smartphone adoption has increased
mHealth come with their set of
to the mHealth provider. They
dramatically in recent years. Leading
challenges as well.
need proper regulation, define
With
growing
healthcare
technology
awareness,
69% of Indian households have a
apps
that
mobile phone.
telecom operators are offering 3G and 4G services at affordable price
rules and policies to ensure the
Challenges of mHealth:
points. These factors are likely to both spur data usage and drive the adoption of mHealth services. Consumers are using mobile devices to replace desktops and laptops, and to get their need virtually faster and more conveniently. A new generation of products and services, based on wireless and
health informations are handled correctly.
“70% of the people worldwide are interested in having access to atleast one mHealth app, and they are willing to pay for it�
IT Support: Mobile devices and telemedicine require more than just the right devices. These devices need a strong and consistent wireless signal to be effective.
mobile technology, puts diagnosis
This means having a facility-
or treatment decisions directly into
wide network that can support
the hands of the patient.
multiple kinds of devices and can Confidentiality of data:
secure all the information that is
There are growing demands for
shared over it.
devices and services that help
Safeguarding
consumers to remain trim, fit and
is
mentally alert.
the mHealth app consumers.
the
personal
obvious
concern
data for
According to industry reports, there are an estimated 500
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October 2017
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Pink Medico
October 2017
23
Doctor's Dress Code: A Study
Do Dre
Patient preferences regarding during consu
T
he doctor–patient relation-
ship is important in determining the quality of healthcare provided. A study was conducted to identify patient preferences regarding dress code, conduct and resources used by doctors during consultations in the public healthcare sector. Information from this study can be
of
benefit
in
determining
policies and dress codes within hospitals
and
medical
schools.
Results: Of the 500 questionnaires distributed 410 were analysed.
24
October 2017
Pink Medico
Doctor's Dress Code: A Study
Introduction:
octors ess Code
It is doctors’ responsibility to fulfil the medical needs and expectations of their patients, but achieving this is becoming increasingly difficult. The way doctors dress and conduct themselves during a consultation, factors that can affect the doctor–patient relationship and the
g the dress code, conduct and resources used by doctors ultations in the public healthcare sector
patients’ confidence in their doctor (unpublished lecture notes; Myburg J. The Doctor and the Environ-
Patients preferred doctors to wear
ment, February 19, 2013). By abiding
formal attire.
Conclusion:
For female doctors this includ-
Patients in the public healthcare sec-
ed a neat blouse (77.9%), smart
tor prefer a formal, professional con-
pants (62.5%) or straight-cut jeans
sulting environment that is deter-
(51.4%) and flat pumps (56.3%).
mined largely by the doctor’s attire
these principles and remembering their responsibilities, doctors not only improve their interactions with patients, but also improve the healthcare system as a whole.
and conduct during the consultation. Patients
preferred male doctors
to wear collared shirts (52.4% and 57.6% for long- and short-sleeved shirts,
respectively)
with
smart
pants (66.8%) or straight-cut jeans (45.9%), and smart shoes (70.3%). Patients ing
and
during
did not condone eatdrinking
by
consultations;
doctors
“Healthcare professional consulting environment that is determined largely by the doctor’s attire and conduct during the consultation.”
work-re-
lated calls were deemed acceptable. The use of technological
resources
was
not
preferred
Pink Medico
October 2017
25
Universally, white coats are associated with the medical profession. A systematic review by Petrili et al. included 30 studies from 14 countries, involving 11 533 patients in a variety of medical settings. In 60% of these studies formal attire and white coats with other attire not specified were patients’ preference, more commonly in older patients and in studies conducted in Europe and Asia. A study in Japan found no difference between age groups, gender or region regarding the overall preference for white coats. With changing societal norms, tattoos and piercings have become more common, but patients do not find these acceptable for healthcare professionals. The manner in which doctors introduce themselves as well as the manner in which they address patients are equally important. Studies have shown that most patients prefer being addressed by their first name and for the doctor to be introduced by their full name and title, all the while wearing a smile on their face.
The majority (77.9%) of participants
Most (79.1%) participants preferred
chose a neat blouse as their pref-
dresses or skirts to extend below
erence for shirts for a female doc-
the knee. Flat pumps were accept-
tor. A see-through blouse, low-cut
able to 56.3% of participants, with
top and an exposed midriff were
heels being the second most select-
deemed acceptable by less than 5%
ed at 32.7%. Crocs were the least
of participants. Smart pants were
acceptable form of footwear (7.4%)
the most acceptable form (62.5%) of pants, followed by straight-cut
For
female
doctors,
jeans (51.4%). Faded jeans, torn
was acceptable to 9.6% of the
jeans, skinny jeans, shorts, leggings
participants
and exercise pants were acceptable
ferred long hair tied up. Almost all
to less than 10% of participants.
(94.7%) of participants favoured
while
dyed 66.7%
hair pre-
short nails for female doctors.
26
October 2017
Pink Medico
More than half of the participants selected long-sleeve
About half of the participants preferred to be addressed
collared (52.4%) and short-sleeve collared (57.6%) shirts
using their title (53.2%) and their surname (54.2%).
as acceptable attire for male doctors. Only 22.4% felt that a tie was also required. Smart pants (66.8%) and
Eating and drinking during the consultation were
straight-cut jeans (45.9%) were the most acceptable
deemed unacceptable by the majority of par-
attire. Faded, torn or skinny jeans, shorts and tracksuit
ticipants (91.5% and 83.8%, respectively), while
pants did not meet with approval in more than 5.5% of
67.1% found it acceptable for their doctor to
participants. Smart lace-up shoes were acceptable to
answer work-related calls during the consul-
70.3% of the participants, with slops or flip-flops and
tation. In comparison, only 9.5% felt that tak-
Crocs selected by only 6.8% and 12.1%, respectively
ing
Participants preferred short hair (85.1%) in male
Most
(92.4%)
doctors, whereas long hair that had been tied up
ferred
that
was selected by 24.2%. Dyed hair was found to
ing the examination phase of the consultation.
a
non-work-related
their
of
the doctor
call
was
in
order.
participants
pre-
wear
gloves
dur-
be acceptable for only 4.9% of the participants. Relating to this, 70.2% of participants indicated that Almost 60% of participants felt that the title ‘Doctor’
should doctors make use of these available resources
should be used when a doctor introduces him/herself.
it would not cause them to doubt their doctor’s ability.
28
October 2017
Pink Medico
Furthermore, if the technological resources were utilised during the consultation, 68.8% of participants would prefer to be able to view the screen of the device that the doctor was using. In our study, participants still placed great emphasis on keeping the doctor–patient consultation formal and professional as reflected in the attire that the participants preferred for their doctors. From the results obtained, the researchers were able to successfully establish an ideal dress code for male and female doctors, identify the patients’ expectations of doctors’ behaviour during
the
consultation,
and
highlight
poten-
tial pitfalls of doctors during the consultation. Patients in the public healthcare sector desire a formal, strictly professional consulting environment that is determined largely by both the attire of the doctor and the conduct of the doctor during the consultation. The motivation of the study was to compare the above findings with both the dress code and the code of conduct of the School of Medicine, Faculty of Health Sciences at the UFS. In comparing the two, it can be asserted that both the dress code and code of conduct of the School of Medicine are well aligned with the aforementioned desires of the patients. This places both medical students and doctors in good stead for establishing a successful and therapeutic doctor–patient interaction.
Pink Medico
October 2017
29
Cholesterol - LDL & HDL
Is HDL Good? "Many people think of cholesterol as something that should be as low as possible. After all, high cholesterol is a well-documented risk factor for heart disease"
30
October 2017
Pink Medico
Cholesterol - LDL & HDL
Most people will find that their
Another study in Circulation found
HDL cholesterol does not climb
that a defect in a specific protein
igh-density lipoprotein (HDL)
to levels that are considered "too
known as cholesteryl ester transfer
cholesterol, often known as "good"
high." Though no upper limit has
protein (CETP) may also cause
cholesterol, is actually beneficial for
been established, HDL cholesterol
abnormally high HDL levels and an
the heart.
does
to
increased risk of heart disease. The
H
not
naturally
elevate
unhealthy high levels in people with
study was large but only looked at
HDL cholesterol may remove the
normal cholesterol processing and
Caucasians. It found that the CETP
LDL cholesterol that can contribute
metabolism.
defect increased heart disease risk
to the clogging of arteries.
in the women but not men. In
There are two types of cholesterol
rare
cases,
however,
HDL
cholesterol can become too high.
in the body, and only one of them
A study mentioned in this review discusses a large group of men and
is usually considered to be a risk to
An article in the journal Science
women who had varying HDL levels.
heart health.
discusses a rare genetic variant that
They found that those with "extreme"
may cause exceptionally high HDL
high or low HDL levels had a higher
(LDL)
levels. The genetic variant alters
risk of death than those who had
cholesterol contributes to the fatty
the way that HDL works in the body,
more moderate levels.
buildup that can block the arteries.
and can increase the risk of heart
When these blocks
disease.
Low-density
lipoprotein
buildup or
The best levels, according to this
narrows the arteries, a heart attack
study:
or stroke is more likely to occur.
The variant is found in a specific
•
73 mg/dL in men
Hence the LDL cholesterol, lower is
molecule known as SR-BI. The
•
93 mg/dL in women.
better.
mutation in SR-BI causes increased
HDL cholesterol is useful for the
levels of HDL and an increased risk
Cholesterol tests will measure a
of heart disease.
persons HDL, LDL, and total (serum)
heart. HDL cholesterol may remove
cholesterol.
LDL cholesterol from the blood
The people studied had levels of
and transport it to the liver, where
HDL greater than 95 milligrams per
The American Heart Association
it can be processed and eliminated.
deciliter (mg/dL). These levels are
(AHA) recommend all people aged
A higher HDL number is desirable
abnormally high. The researchers
20 and older get a cholesterol test
because it usually signals a lower
found that some of the people in
at least every 4 to 6 years
risk of heart diseases.
their study did have this rare genetic defect.
Pink Medico
October 2017
31
Cholesterol - LDL & HDL
Cholesterol
tests
measure
the
amount of cholesterol in mg/dL. Most tests show HDL, LDL, and total (serum) cholesterol. The total cholesterol score is a person's HDL and LDL cholesterol levels and 20 percent of their triglyceride level added together. The
AHA
no
longer
publishes
specific cholesterol ranges and say that these numbers are not the final word on heart disease risk. Instead, cholesterol levels are just one of For an idea of where cholesterol numbers should be, the National Heart,
many factors to consider.
Lung, and Blood Institute and National Institutes of Health have pubA "desirable" cholesterol range, the AHA say, may vary from one person to the next. What is desirable will depend on other elements like triglyceride level, other existing health conditions, A "desirable" cholesterol range, the
lished the following cholesterol guidelines. These numbers should be discussed with a doctor to determine overall heart disease risk:
Total cholesterol level
Category
Less than 200 mg/dL
Desirable
200-239 mg/dL
Borderline high
240 mg/dL and above
High
LDL cholesterol level
Category
AHA say, may vary from one person
Less than 100 mg/dL
Optimal
to the next. What is desirable will
100-129 mg/dL
Near optimal - above optimal
depend on other elements like
130-159 mg/dL
Borderline high
triglyceride level, other existing
160-189 mg/dL
High
health
190 mg/dL and above
Very high
conditions,
lifestyle,
and
family history of heart disease.
HDL Cholesterol level
Category
lifestyle, and family history of heart
Less than 40 mg/dL
Heart disease risk
disease.
40-59 mg/dL
The higher, the better
Greater than 60 mg/dL
Protects against heart disease
32
October 2017
Pink Medico
CHOLEsTErOL - LdL & HdL
Knowing one's cholesterol lev-
• Exercising for 30 minutes, four
pressure, they have to take ad-
el and taking steps to reach or
to five times per week
ditional care.
ways to ensure HDL and LDL lev-
• Quit smoking
Cholesterol is an important in-
els are healthy.
If HDL levels are abnormally high
dicator of heart disease risk, and
(greater than 90 mg/dL), people
regular checks are important. Al-
A diet rich in vegetables, fruits,
should consider tests to look for
though extreme high HDL levels
lean proteins, and whole grains
genetic problems or other heart
are rare, they can be a cause for
may help people to achieve
disease risk factors.
concern in some cases.
High cholesterol can be caused
People with abnormally high HDL
• Going for cholesterol check at
by genetics. Even people who fol-
or LDL levels may need additional
least every 4 years, or as recom-
low a healthy lifestyle may need
testing and care to control it and
mended by a doctor.
additional help to reach healthy
to monitor heart health.
maintain ideal levels are the best
healthy cholesterol levels.
levels. • Eating a heart-healthy diet rich
Fortunately, high cholesterol is
in fruits, vegetables, whole grains,
When cholesterol medications
usually a manageable condition
and lean protein.
are prescribed by a doctor, the
that can be controlled with life-
same should be taken exactly
style changes and medications
as directed. In addition,
when needed.
•
Limiting saturated fats, fried
foods, salt, and sweets
if the
person has other health conditions, such as diabetes or blood
Pink Medico
October 2017
33
Image courtesy:www.pixabay.com
CARDIOVASCULAR DISEASE
C
CVD occurs when arteries become
and cause heart attack. When the
attack,
narrowed by a gradual build-up of
blood clot blocks the arteries of
heart
fatty materials (atheroma) within
the brain, then it causes stroke.
disease,
the walls. When atheroma breaks
Eighty per cent of the CVD pa-
atrial fibrillation,
away from the arteries, after clotting
tients died due to heart attack and
rheumatic
it can block coronary and obstruct
strokes. Narrow arteries can’t carry
heart disease, venous disease and
the oxygen-rich blood supply to
enough oxygen-rich blood to the
peripheral arterial disease.
the heart muscles. Then heart mus-
heart, that can cause pain and dis-
cles become permanently damaged
comfort in the chest called angina.
VD includes coronary heart
disease, heart disease
angina, failure,
congenital
(CHD),
cardiomyopathy, arrhythmia,
34
heart valvular
stroke,
October 2017
Pink Medico
CArdiO VAsCULAr disEAsE
"Cardio Vascular Diseases (CVD) are the number 1 cause of death globally: more people die annually from CVDs than from any other cause"
m
Cardiovascular diseases includes:
Fact: •
•
Most
cardiovascular
diseases can be prevented by addressing factors such
•
inactivity and harmful use of
•
•
Peripheral
arterial
disease
hyperlipidaemia
already
management
using
counselling and medicines, as appropriate.
disease
–
fever, caused by streptococcal bacteria; •
Congenital –
established
disease) need early detection
heart
heart valves from rheumatic
presence of one or more risk factors such as hypertension,
Rheumatic
damage to the heart muscle and
cardiovascular risk (due to the
and
–
– disease of blood vessels
disease or who are at high
or
disease
supplying the arms and legs;
People with cardiovascular
diabetes,
Cerebrovascular supplying the brain;
alcohol •
Coronary heart disease – disease of the blood vessels supplying the heart muscle; disease of the blood vessels
as tobacco use, unhealthy diet and obesity, physical
Heart
heart
malformations
disease of
heart
structure existing at birth; •
Deep Vein Thrombosis
and
Pulmonary Embolism – blood clots in the leg veins, which can
and
strokes
are
usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots.
Symptoms of heart attacks and strokes: Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first warning of underlying disease. Symptoms of a heart attack include: •
Pain or discomfort in the centre of the chest;
•
Pain or discomfort in the arms, the left shoulder, elbows, jaw, or
dislodge and move to the heart and lungs.
attacks
back. In
Pink Medico
addition
the
October 2017
person
may
35
CARDIO VASCULAR DISEASE experience difficulty in breathing
congenital heart disease. There is
Consultation
or shortness of breath; feeling sick
an overall threefold increased risk
counselor
or vomiting; feeling light-headed
for congenital heart disease when a
is encouraged for women with
or faint; breaking into a cold sweat;
first-degree relative has congenital
congenital heart disease before
and becoming pale. Women are
heart disease.
becoming pregnant. In families with
or
with
a
genetic
genetic specialist
CHD either in the parents or prior
more likely to have shortness of breath, nausea, vomiting, and back
Some heart defects are considered
children, fetal echocardiography can
or jaw pain.
to
autosomal-dominant
be done in the second trimester, at
inheritance. This means that a
about 18 to 22 weeks of pregnancy,
The most common symptom of a
parent with the defect has a 50%
to look for the presence of major
stroke is sudden weakness of the
chance, with each pregnancy, to
heart defects in the fetus.
face, arm, or leg, most often on one
have a child with the same heart
side of the body. Other symptoms
defect, and males and females are
Environmental
include sudden onset of:
equally affected. Similarly, there is
rubella infection, significant alcohol
also a 50% chance that a baby will
intake, insulin-dependent diabetes
not be affected.
and obesity of the mother are also
•
Numbness of the face, arm, or leg, especially on one side of the body;
•
Confusion, difficulty speaking or understanding speech;
•
difficulty seeing with one or both eyes;
•
Difficulty
walking,
dizziness,
loss of balance or coordination; •
severe headache with no known cause; and
•
Fainting or unconsciousness.
•
People
experiencing
these
symptoms should seek medical care immediately.
Congenital Heart Diseases (CHD) are associated with genetic syndromes. In the general population, about 1% of all children are born with
36
October 2017
Pink Medico
have
factors
including
contributing to develop CHD.
CARDIO VASCULAR DISEASE
Prevention is better than Cure: WHO/ISH
cardiovascular
prediction
charts
have
developed
specific
to
risk been
different
WHO sub regions. These charts are intended to allow the introduction of the total risk stratification approach for management of cardiovascular disease, particularly where cohort data and resources are not readily available
for
development
population-specific
charts.
of The
charts have been generated from the best available data, using a modeling approach, with age, sex, smoking, blood pressure, blood
cardiovascular
risk
management,
Risk prediction tools that easily and
cholesterol, and presence of diabetes
even in settings which do not have
accurately predict an individual's
as clinical entry points for overall
sophisticated technology.
absolute risk of CVD are key to targeting limited resources at high-
management of cardiovascular risk. WHO/ISH
charts
enable
the
prediction of future risk of heart
CVD is the leading cause of the
risk individuals who are likely to
growing global disease burden due
benefit the most.
to non-communicable diseases. As the degree of CVD and overall
attacks and strokes in people living in low and middle income countries,
For
and
morbidity and mortality changes, the
for the first time. Furthermore, since
control of CVD, strategies that focus
necessity of recalibrating existing
the charts use simple variables
on individual’s needs.should be
risk equations is needed. However,
they can be applied even in low
taken in to consideration as they are
further research is needed to be able
resource settings. Thus, the WHO/
cost effective also when targeted at
to apply these risk prediction tools,
ISH risk predication charts will
high-risk groups. Health systems in
intended for individualized patients,
improve
low-income countries do not have
to translate into larger population-
the basic infrastructure facilities
based health interventions.
the
effectiveness
of
successful
prevention
to support resource- intensive risk prediction tools,
particularly in
primary healthcare.
Pink Medico
October 2017
37
insulin pump therapy
DIABETIC CARE
Insulin pump therapy D
iabetes is a chronic disease
that can lead to devastating vascular complications. There is a huge explosion of diabetes in India with more than 60 million people with diabetes. This is expected to increase to more than 75 million by 2030 (World Health Organisation), earning the dubious distinction of India being the “Diabetes Capital of the world�.
38
October 2017
Pink Medico
insulin pump therapy Diabetes is not only a metabolic dis-
patient has to revolve around
especially for those with type 1
order, it is a vascular disease. Poor-
the type of insulin as any major
diabetes. A slow and painful death
ly controlled diabetes can lead to
changes can lead to either se-
was the norm. There have been
heart attacks, strokes, blindness, kid-
vere hypoglycaemia (low glu-
rapid advances since the discov-
ney failure and foot amputations.
cose) or persistent hyperglyce-
ery of insulin, especially in terms
mia (high glucose). Both these
of production of industrial quanti-
Effective control of diabetes can lead
conditions can increase the
ties of human insulin with recom-
to a great reduction in vascular com-
risk of vascular complications
binant DNA technology as well as
plications. There are many types of
like heart attacks or strokes.
insulin delivery devices with state
diabetes; the two important subtypes
of the art pens. However, the child
are referred to as Type 1 & Type 2
The closest to human pancreas
has to take anywhere between two
diabetes. The latter is more common
that we have now is an Insu-
to four injections per day. This is to
but there is an increasing prevalence
lin pump, which is a medical
replace the normal physiological in-
of type 1 diabetes in India as well.
device that delivers insulin 24
sulin production by the human body.
hours a day through a catheter Type 1 diabetes patients need to be
placed under the skin. There
The human pancreas secretes in-
on insulin for life long from the time
are inherent advantages in us-
sulin throughout the day, basal in-
of diagnosis. A significant majority
ing an insulin pump, especially
sulin that keeps the blood glucose
of Type 2 diabetes patients will need
in patients with type 1 diabe-
steady especially at times of fasting
long term insulin at some point in
tes and selected insulin requir-
and bolus insulin that is secreted
the course of their disease, as type
ing patients with type 2 diabe-
with each meal. To replicate this in
2 diabetes is a progressive disor-
tes and gestational diabetes
a child with absolute insulin defi-
der. Therefore, Insulin is a lifesaving medicine for people with diabetes.
ciency, ideally four injections per
Insulin therapy:
day is the best option (three boluses
The Basal Bolus concept Insulin is available predominantly as
with each meal and one basal insulin) but this can be extremely dif-
an injection that has to be given sub-
Before the discovery of insulin
ficult in a school going child. Many
cutaneously between two to four times
in 1922, diabetes was a feared
kids and their parents opt for twice
a day. Insulin delivery systems have im-
disease,
proved a lot over the last decade but this still does not take away the fact that insulin has to be given by an injection. Once an injection is given, insulin circulates in the blood anytime between 4 hours to 24 hours depending on the type of injection. The life of the
"India accounts for most of the children with Type 1 diabetes in South East Asia" Pink Medico
October 2017
39
2nd Annual
MENA PHYSICAL MEDICINE & REHABILITATION CONGRESS 2-4 November 2017 Dubai, UAE
Improving Lives through Interdisciplinary Rehabilitation Approach 19 CME
Pre-Congress Workshops: 2 November, 2017 International Conference: 3-4 November, 2017
Chairman Yousif Alnuaimi, MRCSEd, FRCP, Chair, Department of Physical Medicine & Rehabilitation, Zayed Military Hospital, UAE
Exclusive 10% Discount for Pink Medico subscribers. Please use the code PMR17PM to avail the discount.
Meet Some of Our Notable Speakers
Begad Abbas, MD, Specialist Physical Medicine and Rehabilitation, Head of the Department, Al Noor Hospitals Group, UAE, Lecturer at Physical Medicine & Rehabilitation Department, Faculty of Medicine, Ain Shams University, Egypt Sabahat Asim Wasti, MBBS; MRCPI; CST Rehabilitation Medicine (UK), Staff Physician (Neurorehabilitation), Neurology Institute, Rehabilitative Medicine, Cleveland Clinic Abu Dhabi, UAE
Ziad M. Hawamdeh, Md, EBPRM, Head of Rehabilitation Medicine Department, Professor Physical Medicine and Rehabilitation, Faculty of Medicine, The University of Jordan, Jordan
Key Benefits of Attending
Haitham El Bashir, MBBS, MRCP(UK), FRCPCH(UK), DCH,CCST, MD, Consultant Paediatric Rehabilitation, Al Jalila Children’s Speciality Hospital, UAE Suad Trebinjac, MD, MSc, PhD, Consultant in Physical Medicine & Rehabilitation (Physiatrist), Medical Director, Dubai Physiotherapy & Rehabilitation Center, Associated Professor, Dubai Medical College for Girls, UAE
Fahim Anwar, P.T, MBBS, MRCS, FRCP, FEBPRM, Consultant Rehabilitation Medicine, Neurologist, Cambridge University Hospital NHS Foundation Trust, UK
• Hear top regional and international experts discussing the most pressing rehabilitation conditions, and the current trend in physical medicine 'Robotics' • Join interactive hands-on workshops that will enhance your learning experience featuring the latest techniques from expert faculty in the industry such as hands on musculoskeletal ultrasounds, new technology on PRP for knee osteoarthritis, occupational therapists and disabled patients. • Gain continuing medical education (CME) credit hours that will enhance your professional development • Review and discuss up-to-date treatments for Musculoskeletal conditions, Stroke Rehabilitation and covering the common conditions in physical medicine across the Middle East • Enjoy interactive presentations, panel discussions covering the latest approaches and practical knowledge in the field of physical medicine and rehabilitation
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a day insulin (pre-mix insulin) that frequently leads to poor glucose control and increases the risk of complications.
Insulin Pump Therapy: To get around the problems associated with four times a day insulin injections or a sub-optimal twice a day insulin regime, insulin pump devices were developed in the early 1960’s The initial models were so big that they had to be worn like a back pack. However, continuous improvements in technology have made it possible to have insulin pumps the size of a mobile phone with plenty of advanced options including real time insulin pumps where the pump and glucose sensors are combined. There is no need for daily repeated injections, the pump infusion set has to be changed only every 4th day.
long term
In addition, the insulin pump gives great
• Cost effective in the long term
flexibility, the child or adult can be very flexible in their daily routines as the ba-
Who benefits from an insulin pump?
sal rates can be programmed at differ-
• All children and adults with type 1 diabetes
ent levels depending on various activi-
• Selected patients with brittle insulin requiring Type 2 diabetes
ties like exercise, swimming, eating etc.
• Type 1 diabetes complicating pregnancy • Selected cases of gestational and type 2 diabetes pregnant patients
There are various other advantages of insulin pump therapy • Better glucose control
on insulin • Patients with insulin requiring diabetes on dialysis or post renal transplant
• Better Quality of life • Reduced hypoglycaemia or low glucoses • Reduced risk of complications in the
Pink Medico
October 2017
41
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