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Volume VIII || Issue II || July-Aug 2017

The Gateway to Health & Medical World

GST Impact on the Health Care IndustryTwo Sides of a Coin

Stress as a contributing factor towards Infertility-IVF Digitalizing Indian Healthcare Industry An Advance Media Publication

Advance Media Group A Health Journalism

GST Impact on

Healthcare & Tax Slab

EDITOR SPEAK EVENT

GST

Boon or Bane

GST is a single progressive tax on the supply of goods and services, right from the producer to the consumer. The Goods and Services Tax (GST) has been one of the main things that have caught the attention of the market given it the indication on earning of businesses. There is a lower tax burden on medicaments, comprising Ayurvedic, Unani, Homeopathic medicines. While there may not be a heavy impact of GST on medicines, but a progressive tax rate of 5% on life-saving drugs, diseases like malaria, HIV-AIDS, Diabetes, TB is assumed to almost prices of these drugs. GST rates negotiated at the last GST assembly meeting in Srinagar, there is anxiety nervousness among the medical device process that the tax rates for the medical devices under the upcoming GST will result in price rise. In the present scenario, there is about 17 item in the negativity list in which there is no service tax is levied on the items. Including approximately 60 services similar to pilgrimage, health-care, education, skill development, journalistic activities which are exempted from the service tax duty and are not bounded by the abrupt taxation. In India, 5% of the GDP is spent on Health-care – 4% by the private division and now the Indian Health-care Industry has been exponentially developing in the current years, and the Ministry of Health focuses on the advancement of 50 new innovations before the current year’s over to treat ailments, for example, cancer and tuberculosis. To draw in more foreign direct investment (FDI), the Government raised the FDI top for brownfield Pharmaceutical investments to 74% in June. Inevitably, 100% FDI is allowed in green field Pharmaceutical investments and past 74% under government endorsement in brown-field Pharmaceutical investments. Pharmaceutical organisations will encounter enhanced operational effectiveness, diminished manufacturing & exchange costs and also enhanced compliance. Also, it will profit Pharmaceutical companies’ warehousing methodology. Starting at now, organisations kept distribution centres in various States to maintain a strategic distance from CST of various States. Presently, with CST subsumed under GST, they can merge stockrooms at vital areas as they will just need to pay Integrated GST (IGST) on inter-state supplies of Goods and Services. Generally speaking, the impacts of GST usage on the Healthcare and Pharmaceutical segment is somewhere very hard on the general public. The Healthcare Industry, on the off chance that the tax rate is set at an effective level, will profit as GST absolutely diminishes complexities and evacuates many obstacles to the business’ growth. The business is on a way of promising development and expanded profitability.

Have an insightful reading. Your suggestions are most welcome! E-mail: editor@medgatetoday.com Website: w w w . m e d g a t e t o d a y . c o m

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Magazine Volume - VIII Issue - II July-Aug 2017

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CONTENTS

Volume - VIII Issue - II July-Aug 2017

Global Hospitals Pioneers GST Impact on Healthcare & Tax Slab High Tech Shoulder Replacement Surgery

Eurasian Orthopedic Forum organized 2 days event held on 29-30 June 2017 at Moscow

Digitalizing Indian Healthcare Industry

IVF Giant Advanced Fertility Depression during & Gynaecology Centre Plans pregnancy is preventable Rapid Expansion in North India and can be treated as well

Welfare Medical after India Virtual Hospital its successful launch launches Patient Care App for Doctors few years ago

06 CurveBeam and Carestream Health Announce Collaboration to Promote Weight-Bearing CT Awareness and Research ��08 Development in treatment options and latest technologies to treat brain tumour ��08 iRevive – A Unique Ortho-care Therapy Center Opens in Bangalore ��10 Asia-Pacific drug delivery devices market set to leave North America behind by 2026, says GlobalData ��12 ‘Seaweed drug’ helps fight off infection ��13 LifeCell Partners with LifeCodexx AG to launch rapid and affordable Non-Invasive Prenatal DNA Testing (NIPT) in India ��14 Midmark India introduces path-breaking Nano technology to the Indian medical devices manufacturing industry ��16 RMS Regrow attains milestone in regenerative medicine with FDA India approval for CHONDRON ��18 Interaction on ambulance outsourcing business of Ziqitza Healthcare Ltd. ��20 GST impact on health sector ��22 Bike Ambulance - The New App which allows Consumers to find mobike clinic & Girst line treatment at your ��31 A Life Threatening Pregnancy ��32 Stress as a contributing factor towards Infertility ��36 IVF views of Dr. Nandita Palshetkar ��38 Percutaneous mitral balloon valvotomy for mitral stenosis ��40 Haploidentical Transplantation: New Option for People Seeking Donor Match ��42 Bringing medical imaging innovations to life ��50 Is Your Current Hospital Information System Driving Clinical and Business Transformations? ��52 Patient Safety: Medication Error ��54 Advent of IT into healthcare ��60 Possibilities of reducing healthcare costs using IT! ��62 NEED OF A CONSULTANT FOR YOUR HOSPITAL PROJECT ��64 Godrej HIT partners with Apollo Hospitals to launch India’s 1st online ‘PLATELET DONOR COMMUNITY’ to ��

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NEWS Update

Godrej HIT partners with Apollo Hospitals to launch India’s 1st online

‘PLATELET DONOR COMMUNITY’ to save lives of dengue patients

odrej HIT and the Apollo Hospitals Group announced its partnership to build India’s first online Platelet Donor Community for dengue patients. HIT is a well-known household insecticide brand trusted by millions of household in India when it comes to eliminating dangerous insects and pests from their homes. Brand HIT has been liberating people from the anxiety of pests and has been championing the cause and educating masses about prevention of mosquito borne diseases. In this crusade, both HIT & Apollo Hospitals - India’s largest healthcare and hospital group, have been leading multiple community outreach programs. Over the last many years both have been educating masses about mosquito borne diseases and its preventive measures. In India, dengue has emerged as one of the biggest threats to public health. Last year, more than 1 lakh dengue cases were reported in India with 245 unfortunate dengue deaths. Dengue is an acute viral disease, which is caused by a mosquito bite. It is growing rapidly and continues to take lives of innocent people unabatedly because dengue has no cure and has to be treated symptomatically. While people are aware of the cause of dengue, there is a lack of awareness on how dengue can be cured. Absence of a cure coupled with lack of awareness leads to a lot of anxiety, driving patients to get admitted the moment they are diagnosed positive. The dengue virus causes a sharp drop in the platelet count of the patient’s blood, triggering internal bleeding and other complications. In rare cases, when the platelet count drops below 20,000/ cu.mm, the patient may require an urgent transfusion of platelets. A recent survey carried out by Godrej HIT Nielsen states that 94% of citizens are unaware about the critical level of platelet count below which platelet transfusion is required.

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In such a situation, ready availability of a platelet donor becomes critical, as unlike blood, platelets cannot be stored for more than 5 days. However, the Godrej HIT Nielsen report also informed that 80% of the citizens are not aware of this important fact. Understanding the gravity of the situation, Godrej HIT and Apollo Hospitals has taken this bold initiative to educate citizens and build India’s first online nation-wide platelet donor community. As part of the initiative, Apollo Hospitals will be providing platelets to critical dengue patients and will manage the 24x7 helpline. Sunil Kataria, Business Head-India and SAARC, Godrej Consumer Products Limited (GCPL) said “Dengue has emerged as a serious threat to public health in India. While people are aware that mosquito bites causes dengue they are unaware of the curative measures, especially about platelets. Our Godrej HIT-Nielsen research reveals that 90% citizens are aware that platelets are blood components but a startling 66% believe that platelets are a cure for dengue and 80% believe that platelets can be stored like blood, both of which are factually incorrect! This lack of awareness leads to lot of anxiety among citizens. Hence Godrej HIT has partnered with Apollo Hospitals to build India’s first online nation-wide platelet donor community for dengue patients”. He further added “Through this initiative we urge citizens to register as a platelet donor on www.godrejhit.com/trackthebite

or on Hit Track the Bite app and help save lives of critical dengue patients. The registration response has been overwhelming and in less than 2 weeks, more than 20,000 citizens have registered as platelet donors. Dengue patients can call on a city-specific 24x7 platelet helpline number across 5 key metros to get platelets. For Delhi NCR, the platelet helpline number is 011-26825565.” On the occasion, Ms. Sangita Reddy, Joint Managing Director, Apollo Hospitals Group said, “Vector borne diseases like dengue are emerging as a threat to public health in India. To address this issue, we at Apollo Hospitals, have tied-up with Godrej HIT to build a platelet donor community. Through this initiative, we are trying to bridge the disparity in awareness and provide ready resources to manage diseases like dengue. Apollo Hospitals has set-up and will manage a 24x7 helpline for patients suffering from dengue. The helpline is available for donors willing to donate their platelets and for donees looking to receive platelets for their treatment. This initiative is aimed towards building a donor community that can help fellow citizens who fall victim to dengue. With Apollo’s wide reach, our clinical outcomes and the expertise our doctors we are confident that we will help significantly address the challenge posed by dengue and related fevers.” Godrej HIT’s association with Apollo Hospitals is a multi-channel awareness program. This initiative will drive citizen awareness in 5 key metros to start with.

On December 19, 2016, the US FDA published a final rule to completely ban all powdered surgical and examination gloves. They judged that these products present an unreasonable and substantial risk to healthcare providers and patients. This rule is effective in the US as of January 18, 2017. Also hospitals in Europe and other regions are increasingly transitioning to powder-free gloves. An evolution that is set to accelerate on a global scale. So if you are still using powdered gloves: now is the time to change. As a world leader in providing superior health and safety protection solutions, we contiuously look to better protect patients and healthcare workers. That’s why we are initiating a new communication program to continue informing hospitals and healthcare workers on the benefits of powder-free surgical gloves. For both, there is significant clinical evidence that powder-free gloves offer numerous benefits: ! For patients, powder-free gloves can improve wound healing, prevent allergic reactions and decrease false test results. ! For healthcare workers, it can reduce allergic and other skin reactions and improve hygiene. If you share our concern for your own and the patient’s well-being and safety: consider the use of powder-free gloves, if it is not yet the case.

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NEWS Update

CurveBeam and Carestream Health Announce Collaboration to Promote Weight-Bearing CT Awareness and Research

Medical device companies CurveBeam and Carestream Health announced a collaboration to support and facilitate education and research for weightbearing computed tomography imaging. “The ability to capture weight-bearing CT images allows foot and ankle specialists to study foot biomechanics in three dimensions. Significant clinical research has already demonstrated weight-bearing CT has the potential to be the new standard of care for an initial diagnosis. However, much work remains to be done to increase awareness among orthopaedic specialists,” said Vinti Singh, marketing manager for CurveBeam. “Through collaboration, CurveBeam and Carestream can best support these efforts.” Before the introduction of weightbearing CT imaging in 2012, patients could get either a weight-bearing radiographic 2D X-ray or a non-weight bearing medical CT scan. X-rays can at times obscure and distort anatomical

details, while non-weight bearing CT scans may inaccurately represent joint space and alignment. The American Orthopaedic Foot & Ankle Society recommends weight-bearing imaging when possible to get the most accurate assessment. “The image quality and detail captured with 3D weight-bearing CT exams allow the surgeon to view and measure anatomical abnormalities of lower extremities under natural load conditions,” said Helen Titus, Carestream’s Worldwide Marketing Director for Ultrasound & CT. “The goal of this collaboration is to spread the word about this new imaging modality among orthopaedic specialists.” The companies will work together to support the Weight-Bearing CT International Study Group, which is comprised of orthopaedic researchers from leading institutions in the U.S. and Europe. The group is working to create standardized protocols for weight-

Development in treatment options and latest technologies to treat brain tumour According to National Health Portal, India (NHP), the incidence and prevalence of brain tumour is growing in the country. The incidence (newly diagnosed cases of cancer in a year) of Brain Tumours in India is about 2 patients per 1,00,000 population, while the mortality rate (deaths due to brain cancer) is a little less than 2 patients per 1,00,000 population. The combination of technological and medical innovations has helped in the development of treatment options for brain tumour. Keeping this in mind, doctors from Columbia Asia Hospitals are raising awareness about the subject on World brain tumour day. “Technology has helped in brain tumour surgery by making it more accurate and yield better results. For instance, use 8

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of navigation in surgery helps doctor to remove tumour completely. Newer drugs, chemotherapy and latest radiation options like cyber knife and gamma knife has made it better for brain cancer. With the use of a good anaesthesia, doctors can even do surgery while the patient is awake,” said Dr. Arjun Srivatsa, Senior Consultant – Neurosurgery, Columbia Asia Hospitals, Bangalore. Brain tumour can occur at any age and can involve any part of the brain. “In older people, sudden slowdown of actions can be a warning sign for presence brain tumour. Sometimes a stroke can also be a possible symptom of a person suffering from brain tumour, “added the doctor. Some of the common symptoms of a brain tumour include:

bearing CT measurements and analysis. The companies’ first joint initiative is to co-sponsor an evening scientific session during the American Orthopaedic Foot & Ankle Society (AOFAS) annual meeting in Seattle, WA. Speakers at this session include Dr. Mark Easley of Duke Orthopaedics in Durham, NC, and Dr. Lew Schon of MedStar ● Change in the pattern of headaches ● Unexplained nausea or vomiting ● Vision problems such as blurred vision, double vision or peripheral vision ● Headache and seizures ● Speech problems or weakness in limbs depending upon the area the tumour involves A CT scan (computerized tomography) is done to diagnose a brain tumour, followed by an MRI (Magnetic resonance imaging). The latter is generally considered as the gold standard for the diagnosis of brain tumour as it provides accurate details on the tumour. Dr. Arjun Srivatsa who sees around 200 - 300 cases of brain tumour in a year, stresses the importance of timely treatment and correct medical expertise for treating brain tumour. “Any symptom should not be neglected and immediate consultation with an expert should

NEWS Update

iRevive – A Unique Ortho-care Therapy Center Opens in Bangalore Introduces medical breakthrough with machines that can regenerate cartilage, tendons, ligaments and enhance bone density internationally acclaimed technology to India and Bangalore and will be working closely with the medical fraternity to provide patients with a minimally invasive treatment form that will regenerate cartilage, increase bone density as well as ensure that there is no pain and no side effects. The machines from IEM MBST® are available for all those hospitals and diagnostic centers looking to provide Inaugurating the iRevive Ortho Care their patients with a non-invasive, yet Therapy Center and the machines, Mr. Axel revolutionary treatment”. Muntermann, Founder and CEO of MedTec Elaborating on the treatment through the Medizintechnik GmbH, Germany, the Medical Innovator behind the technology MBST machines, Dr. Gautam Kodikal, said, “In all my years I have seen patients Consultant Orthopedic Surgeon said, “This of bone and cartilage degeneration suffer form of treatment is ideal for patients who through immense pain. There was no non- are diagnosed early, especially in the first 3 invasive means of regenerating cartilage stages of cartilage and bone degeneration. and bone cells. When doctors began to It is only after stage 3 that surgery becomes notice how patients spoke of obvious pain the only option. The machines can be used relief post Magnetic Resonance Imaging to treat osteoarthritis, osteoporosis, sport (MRI), we researched more to develop injuries and other metabolic disorders therapeutic devices that are based on of the musculoskeletal system. It takes magnetic resonance. And that is how the about 10 sessions of an hour each for MBST® technology came about.” 10 consecutive days for the cartilage to “The Magnetic Resonance Therapy regenerate. A unique ortho-care Therapy center, iRevive has opened in Bangalore which brings to India for the first time machines that can regenerate your cartilage, tendons, ligaments as well as bone cells. These medical devices for the musculoskeletal system use Molecular Biophysical Stimulation (MBST®) and are manufactured by German company MedTec Medizintechnik GmbH.

technology used by the machines helps in regenerating cartilage and bone cells in a non-invasive procedure, treating both the symptoms and the cause. It also helps in effective pain management. The technology manipulates the hydrogen atoms in the human body which itself is made up of 67% of water. The technology works in a way to enable degenerated cells to absorb and release energy again. The cell in turn regenerates and cell metabolism is revived,” explained Mr. Axel. “We have over 300,000 successful treated patients worldwide & 1200 devices in 39 countries and now we are happy to bring this to India,” added Mr. Axel.

Speaking at the inauguration, Mr. Surendra Bhandari, Managing Director of iRevive and IEM International Pvt. Ltd., (IEM), importers of these machines said, “We are the first to bring this 10

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The treatment form provides patients with The MBST® OpenSystem700: This relief from both symptoms as well as the treatment cot covers application areas cause of an ailment”. of double-knee, lumbar-spine and hip, thoracic spine and the cervical spine/ The MBST® Machines: iRevive has two machines currently – shoulder areas. The Magnetic Resonance the MBST® - OpenSystem350, and the frequency is about 16 kilohertz. Treatment chips with optimized times are available MBST® - OpenSystem700. for osteoarthritis in 3, 5 and 7 hour ® The MBST OpenSystem350: This arm schedules. Bone metabolic diseases, and leg combination system includes a intervertebral discs and chronic ligament chair, trolley and table. The application conditions in 9 hour schedules. The entire areas of this machine are the elbows, device weighs around 145kg. hands, knees and foot. It can also be used for double-hand and double-foot The MBST® OsteoSystem will soon added applications. The Magnetic Resonance to the machines being made available. frequency is about 16 kilohertz. Optimized This is a flat bed aimed at a whole body treatment times are available in 3, 5 and treatment. The Magnetic Resonance 7 hour schedules. Bone and metabolic frequency is about 16 kilohertz. Treatment diseases as well as the post-treatment of chips for tissue specific treatments are fractures come in 9 hour schedules. The available in 10 hour schedules. Whole body entire system weighs around 75kg. treatment comes with three applicators.

NEWS Update

Asia-Pacific drug delivery devices market set to leave North America behind by 2026, says GlobalData

The drug delivery devices market in North America (United States, Canada and Mexico), which comprises approximate 50% of the global market, grew at a compound average growth rate (CAGR) of 2.6% from 2010 to 2016. However, the AsiaPacific (APAC) region showed a highest growth with a CAGR of 3.4% during the same period, according to research and consulting firm GlobalData. The company’s latest report states that the drug delivery devices market in APAC is expected to show a faster growth with a CAGR of 3.9% to 2026, followed by North America with a CAGR of 3.2% over the same period. Drug delivery devices encompass a diversified portfolio including central venous catheters, needle free injections, infusion systems and metered dose inhaler devices Once launched as drug carriers, these devices have now emerged as target specific, dose-optimized systems with a higher level of safety and efficiency. The global drug delivery devices market is preparing for the next phase of strategic innovation where device and pharma companies will join forces to develop

customized drug delivery devices at a very early stage of drug development. The FDA and other regulatory bodies have recognized the requirements of drug delivery devices and combination products. New drug entrants are being supported by drug delivery technology and as a result, the market is rapidly evolving. According to GlobalData, the need for customizable, cost-effective and user-friendly devices combined with regulatory success is driving the drug delivery devices market. Extended patent protection on existing drugs offered by drug delivery devices is attracting market giants to invest in this field. The decisions on in-house production, partneringlicensing agreements, and mergers and acquisitions will greatly impact device and pharma markets across geographies. North America dominates global drug delivery devices market with approximately 50% market share followed by Europe and APAC. According to Andrew S. Thompson, Ph.D., Director of Therapy and Analysis for Medical Devices at GlobalData, “This analysis indicates an increasing demand for drug delivery systems that meets the growing needs of imminent drug novelties and a rising patient pool. Opportunities for manufacturers and spiking commercial interest in drug delivery devices market will be the key factors for future growth. “Unclear regulatory and quality management guidelines on the new emerging technologies and diversified reimbursement policies across the globe can create some barriers to growth. Strategic decisions on R&D, production units, gathering investments, mergers and acquisitions, partnership deals could make or break the dynamics of market. Overall, the drug delivery devices market represents an attractive option for drug and device manufacturers looking to expand their business in different geographies.”

WORLD FORUM FOR MEDICINE ‘Seaweed drug’ helps fight off infection

13 – 16 NOVEMBER 2017 DÜSSELDORF GERMANY www.medica-tradefair.com

Alginates found in seaweed can combat multi-drug resistant infections Researchers at Cardiff University have worked with Norwegian biopharmaceutical company AlgiPharma to improve antibiotics. A team led by the School of Dentistry’s Professor David Thomas showed how alginates, found in seaweed, could disrupt the formation of microbial biofilms. They have also develop a new inhalation therapy being tested on cystic fibrosis patients. It helps clear mucus obstructions in the lungs and potentially slow the progression of the disease. If trials prove successful, it could be used in other more common respiratory diseases such as Chronic Obstructive Pulmonary Disease, which is reported to affect over one million people in the UK. The studies are also paving the way towards improved treatment of chronic non-healing skin wounds and fighting organisms that cause conditions such as gum disease. Professor Thomas said: “Our research allowed us to derive material from the natural world with powerful abilities to modify bacterial behaviour, making them more susceptible to antibiotic treatment, and to improve the properties of mucus in patients with lung disease. “These findings are being applied to the development of alternative treatment approaches for challenging and hard-totreat diseases.” The project began with a small grant from AlgiPharma in 2007 for exploratory microbiology studies, but developed into a nine-year collaboration between the University’s Advanced Therapies Group (ATG), AlgiPharma and Cardiff & Vale University Health Board.

The world of medicine at a glance: • Electromedical equipment/ Medical technology • Laboratory technology/Diagnostics • Physiotherapy/ orthopaedic technology • Commodities and consumer goods • Information and communications technology If you want to see it all, understand it all and experience it all, then come to Düsseldorf for the world’s largest forum for medicine!

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NEWS Update

LifeCell Partners with LifeCodexx AG to launch rapid and affordable Non-Invasive Prenatal DNA Testing (NIPT) in India With exclusive access to novel qNIPTTM technology, LifeCell aims at category leadership ~ LifeCodexx AG, a pioneer in non-invasive prenatal DNA testing in Europe has announced its partnership with LifeCell – India’s leading mother & baby preventive health care provider, to bring PrenaTesT® qNIPTTM testing for the first time to India. The qNIPT™ technology that detects the presence of fetal trisomy 21 (Down Syndrome) from maternal blood, received CE marking (European Conformity) in December 2016 last year. This certification was obtained after a successful blinded clinical validation of around 1000 samples, demonstrating a 100% credibility of test results obtained from PrenaTest®. The novel qNIPT™ technology clearly demonstrates a significant cost-efficiency and rapid turnaround time compared to other NIPT techniques as it doesn't rely on costly and lengthy sequencing methodology. Down Syndrome (DS), also called Trisomy 21, is a condition where extra genetic material causes delays in a child development both mentally & physically and is one of the most common genetic birth disorders. Down Syndrome (DS) is associated with mild to moderate learning disabilities, growth milestone delays, typical facial features and low muscle tone in early infancy. Though Down syndrome can't be prevented, it can be detected before a child is born. India has the highest incidence of Down syndrome and it occurs in approximately 1 of 830 live births, as per Down Syndrome Federation of India. Through a series of screenings and tests, Down syndrome can be detected before the baby is born. Routinely recommended prenatal screening tests are nonDNA based which unfortunately have lower detection rates (<95%) and higher false positives (5%). To confirm the

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diagnosis, further investigations are undertaken through invasive procedures causing a threat to the baby in the womb and added discomfort for the mother. Wider adoption of NIPT in global markets has substantially reduced the reporting of false positive diagnosis, which has reduced the need for any invasive tests by 60-70%. With this exclusive technology partnership with LifeCodexx AG, LifeCell will be able to perform the licensed qNIPTTM PrenaTest® at LifeCell’s laboratories in Chennai (India) and will be the first in the country to offer qNIPTTM technology that is more advanced than sequencing methodology being used by others. Mr. Mayur Abhaya, CEO and MD of Lifecell said “We are excited to bring Prenatest® using qNIPTTM technology the world’s most advanced NIPT technology to India that would lead to substantially lower parental anxiety, as they would be able to make better informed decisions with access to reliable and affordable test results, yet with no risk to the fetus” Dr. Michael Lutz, CEO of LifeCodexx AG said “We are very pleased to have partnered with LifeCell since they have a long standing expertise in the field of preventive healthcare services for mother and child in the Indian market,”. He further added “We are certain that our qNIPT™ technology will find a ready market in India due to its high cost-efficiency and rapid turnaround time and also, considering that India has a birth rate of over 25 million children per year.” “Our laboratory for Prenatest is being set-up and the service will be available for our customers post the month of November, this year” Mr Mayur Abhaya confirmed. Prenatest will be serviced under LifeCell flagship brand BabyShield - the division specialised in mother & baby diagnostic services.

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NEWS Update

Midmark India introduces path-breaking Nano technology to the Indian medical devices manufacturing industry ~ Shares commitment of manufacturing 100% “Made in India” products for the Indian healthcare industry ~ Launches new plant geared to enhance manufacturing capacity by 40% ~ Midmark India Pvt. Ltd., a global leader in providing medical, dental and veterinary equipment solutions, inaugurated its revamped manufacturing plant in Umbergaon, in the Valsad district, in the state of Gujarat, earlier today. The new state of the art manufacturing facility was inaugurated by Mr. John Baumann, President & Global CEO, Midmark Corporation. Working in tandem with the Indian governments’ “Make in India” initiative, the plant at Umbergaon not only showcases Midmark’s commitment to supply 100% indigenous medical devices and equipment for India’s growing healthcare needs, but also to significantly enhance its commitment in the Indian market. As such, the state-of-the-art will now see an increase of 40% in its production capacity. We are pleased to launch our new state-of-the art manufacturing unit and introduce new and advanced technology that will create a positive impact on the Indian healthcare industry, which stands at an inflection point today. Our vision is to bridge the gaps that exist in India’s healthcare ecosystem, the best we can, with the strength of our century old experience and success in enhancing patient comfort and care while remaining competitive for the healthcare service providers," said Mr. John Baumann, President & Global CEO, Midmark Corporation. “As a true global supplier, Midmark Corporation is well-positioned to support the Indian healthcare device industry, with apt localisations and innovations that meet global standards but are effective for the specific needs of an Indian healthcare provider. Our precision driven manufacturing process and the advanced technology added in this new facility will help deliver value-added capability to the Indian healthcare sector. 16

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The facility is spread across 13,665 square meters divided in unit I & II, with room for expansion based on business needs. Midmark India also leads the industry by introducing Nano technology for the first time in the patient positioning equipment manufacturing process in the country. The new production line is expected to further enhance the end product quality and longevity, reduce the process cost and also comply with sustainable manufacturing practices that have become a global norm. The plant is expected to automate at least 90% of the production cycle, thereby reducing human intervention and expanding manufacturing capacity significantly. Speaking on this occasion, Mr. Sumeet Agarwal, Managing Director said, “Midmark India has served patients & their families for more than 66 years and is committed to helping people experience all that life has to offer through good health. We believe that our ongoing commitment represents an investment in a healthier India by providing high-quality products and solutions that will meet the health needs of the country. We are manufacturing

in Umbergaon since 37 years and are encouraged by the trade friendly policies and infrastructure provided by the Government of Gujarat.” “Midmark’s strategy is to enrich the point of care experience by bringing clinical spaces, technology and workflows into harmony. With the healthcare market rapidly evolving, the company is making strategic moves to accelerate its product development cycle and strengthen its ability to stay ahead of customer needs. The decision to expand the unit supports this strategy by locating its engineering, marketing, product management, communications, among other functions connected to new product development, into close proximity of each other in a new, stateof-the-art facility that is conducive to innovation that today’s healthcare providers require”, added Mr. Vijay Paliwal - Vice President Customer Care, Midmark (India) Pvt. Ltd

NEWS Update

RMS Regrow attains milestone in regenerative medicine with FDA India approval for CHONDRON Is knee replacement now history for young arthritis?

F irst company in India to receive a market

authorization and sale license for cell therapy product in India for Chondron® ACI C hondron® ACI is India’s first ‘Make in India’ Stem cell success story R MS Regrow is the 1st company in India to offer cell therapy in orthopedic products. C hondron® ACI (Autologous Chondrocyte Implantation) is indicated for the use of articular cartilage defects of the knee, ankle and shoulder joints

he Ministry of Health, India and DCGI have granted Market Authorization for India’s First Cell Therapy Product of India that is Chondron® ACI by Regenerative Medical Services Regrow. Chondron® ACI is indicated for treatment of cartilage defects of the joints. It uses the body's own autologous cartilage cells which are cultured and multiplied for 3-4 weeks at Regrow’s Cell Processing Centre. The cultured cells are then implanted into the patient's damaged joint leading to new cartilage regeneration, avoiding the need of early joint replacement. Speaking on this, Chief Executive Officer & Managing Director, RMS Regrow, Mr. Yash Sanghavi said, “We are immensely happy with the FDA approval for Chondron® ACI. We are the first in the country and fourth in the world to achieve this FDA approval. We are creating new age cartilage regeneration procedure which optimizes the chances of healing due to the use of the body’s own cells. Patients can now expect a care free future with this treatment and RMS Regrow offers a perfect PEN solution (P -Permanent, E – Easy, N-Natural biological) to the patients”. Company Chief Scientific officer & Executive Director, RMS Regrow, Mr.Satyen Sanghavi said, “Today, knee pain is the most common ailment in every household. Osteoarthritis is the most prevalent form of arthritis, affecting over 15 million adults every year, with the number likely to escalate to over 60 million by 2025. Knee implants are expensive and the recovery of the cartilage is not fast. Chondron® ACI has 97% success rate with fast recovery, as observed in over 4-5 lakh cases performed worldwide. RMS Regrow is proud to announce the FDA approval for Chondron® ACI and it is proprietary and patented by RMS Regrow.”

www.m e d e g a t e t o d a y. c o m July-Aug 2017

Advantages of Chondron® ACI R egeneration of cartilage instead of replacing your

entire knee

M inimally invasive personalized treatment  I ncreased quality of life R esume complete physical activity, including of

professional sports

C ost Effective  J oint preservation providing Long term relief Chondron® ACI is recommended for patients of 15-65 years age group. It is imperative for a patient to go through rehabilitation process for a minimum of six weeks. The rehabilitation process is performed in the guidance of the doctor and the physiotherapist. There is also medical insurance reimbursement available with Chondron® ACI. In India, Osteoarthritis is the most prevalent form of arthritis, affecting over 15 million adults every year. There is no specific treatment proven as yet that can reverse the joint damage caused by osteoarthritis. Hence the objectives of Osteoarthritis management are to reduce the level of pain, reduce inflammation, slow cartilage degradation, improve function and reduce disability. There are about 4-5 lakhs of knee, ankle, shoulder and hip replacement revision surgeries being performed in India annually and the number is only going up every year. An artificial knee will only last about a decade before wearing out. So if you are under 60, you will have to undergo several more ‘revisions’ in your lifetime. Chondron® ACI helps for better solution with effective and fast term results. Similar nature products for Chondron® ACI have been available in use since 2001 in countries such as USA, Europe including UK & South Korea and being reimbursed by their respective Health agencies.

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INTERVIEW Interaction on ambulance outsourcing business of Ziqitza Healthcare Ltd. How has emergency medical ambulance services changed the face of patient transportation in India? Before a decade, there was no single ambulance service which could be called in case of medical emergencies. The sector was dominated by fragmented and small time private ambulances which could be called upon as they were more like hearse vans which were hardly equipped or hospital ambulances which offered services selectively in certain localities. From there to today, we have evolved a long way where states are integrating their ambulance services under one single number. Other states are moving towards replicating this model. However, India is taking steady steps to improve its ambulance services with the aim of saving more lives. The Government is introducing several schemes like `Integrated Ambulance Service' to help bring about this much required change in patient transfer. Apart from this, better road infrastructure, use of technology, training the right talent etc. has improved the face of this sector. India has a long way to go to achieve minimum deaths caused due to lack of emergency services but we are surely moving towards a positive future. With the aid of the government and the willingness of private organizations to service the sector, there has been reduction in the number of deaths and increase in the reach of ambulances. What are the services that you offer under ambulance outsourcing service? We have ambulance outsourcing operations in 15 states throughout India. Under this model, we provide fully-equipped ambulances staffed with trained paramedics and drivers to manage day-to-day fleet operations for hospitals and corporates so they, in turn, can focus on their core competencies. We help to transfer

www.m e d e g a t e t o d a y. c o m July-Aug 2017

patients across hospitals, corporates, and highway projects. We provide Advanced Life Support (ALS) and Basic Life Support (BLS) ambulances. BLS ambulances are equipped with emergency kits, medicines and patient transport equipment. ALS ambulances also carry life-saving equipment including defibrillator, oxygen cylinder and electrocardiography (ECG) machine to handle critical emergencies like heart attacks, accidents, paralysis attack, etc. Our trained doctors and emergency medical technicians (EMT) are on board in each ambulance and administers First Aid and Basic Life Support techniques and other prehospital care to stabilize patients. How long have you been in this business and which cities do you have your footprint in? We have been in the medical emergency business for 12 years now and have ventured in the ambulance outsourcing business in 2010. We are present in 15 states across the length and breadth of the country. However, a high intensity of our work comes from metro cities like Mumbai, Bengaluru and Kolkata as compared to Tier II and Tier III cities. Our clients range from multi-national companies to reputed Hospitals and look forward to expand our outsourcing business to pan India.

Manish Sacheti

CFO, Ziqitza Healthcare Ltd

Can you explain the general business model for the outsourcing business of ambulances? There has been tremendous economic development of the country over the years with a lot of MNCs coming to India. In order to concentrate on their competencies these MNCs and corporates reach out to experts like ZHL in order to take care of their emergency facilities need of their employees as part of their Human resource or corporate social responsibility. Also the other key segments like ss, private hospitals, factories and highway projects outsource the entire ambulance operations to us. ZHL provides advantage lies in the fact that we provide ambulance with trained paramedics/doctors and drivers who are available at all times in case of any medical emergencies. This helps them concentrate on their core competencies while experts like us take control of the ambulance support. Our expertise in the field and experience over 3000 ambulances enable ZHL to provide entire infrastructure, trained manpower and technology based service delivery to our clients. The revenue from this model depends on the service model which the client has opted for but we ensure commercially it is win win situation for both.

SS TECHNOMED (P) LIMITED

NEWS Update

GST impact on health sector

The roll-out of Goods and Services Tax (GST) the country's biggest tax reform promises to simplify and streamline the indirect tax structure and mitigate the cascading effect of the taxes, has exempted healthcare from GST. However, the industry healthcare leaders foresee a trickle-down effect with fears of rise in various rates which are applicable to drugs, equipments, Active Pharmaceutical Ingredients (APIs), disposables, reagents bracketed under 12 per cent. This will result in rise in the cost of healthcare delivery. Hospitals falling under 0 slab of GST may not get input tax credit; they are likely to pass on the additional tax burden to patients. Though the new tax regime is not directly impacting, high end medical equipments which attracted 12.63 percent tax will now be taxed 17.28 percent. Comprehensive maintenance contract is scaled up from 8 percent to 18 percent. This will add significant expenditure to hospitals. Labour contract will now attract 18 per cent from 15 per cent GST rate. Healthcare devices and accessories such as catheters which were charged 10.16 per cent will now be taxed 23.15 per cent. Hospital beds which were taxed 11 per cent, now they will be taxed 18 per

Dr. Dharminder Nagar

Managing Director, Paras Healthcare. cent. Life saving drugs and diagnostic kits will attract 18per cent from 5.5 per cent. Express Healthcare in the forthcoming August issue will have a special article on the aftermath of the GST implementation. The issue will contain interviews , expert opinions on the GST roll out. Compiled few questions on the same, if you have more inputs to share other than question asked you can do so.

Reaction by Ameera Shah, MD, Promoter, Metropolis Healthcare for GST Under GST, healthcare services are referred to as any service by way of diagnosis or treatment or care for illness, injury, deformity, abnormality or pregnancy as per recognised systems of medicine in India. They also include services by way of transportation of the patient to and from a clinical establishment. Given this, the healthcare sector had speculated, debated and discussed about implications of the impending GST Bill. The decision of the Indian Government to exempt healthcare services from GST has been good news for start-ups as well as established healthcare businesses. However, for the end-consumer the costs could rise, given the increase in input costs as proposed by GST. As per the GST regime, the tax rate for medical device sector was pegged at 12%, which

www.m e d e g a t e t o d a y. c o m July-Aug 2017

could affect the overall cost structure of the healthcare chain.Â Although hospital services are exempted from taxes under GST, the outsourced services, aesthetics and outpatient pharmacies are subject to GST imposition. In the pharmaceuticals landscape, the 5 per cent tax rate on life-saving drugs that treat diseases like malaria, HIV-AIDS, tuberculosis, and diabetes is expected to marginally increase the prices of medicinal drugs, leading to a domino effect in the cost structures for healthcare sector. While this shift is dramatic enough, I am glad that the GST council has decided to make the transition as smooth as possible for India, by not moving the tax needle too drastically on the healthcare related goods and services segments.

Ms Ameera Shah MD & Promoter, Metropolis Healthcare.

NEWS Update

GST Impact on the Health Care Industry- Two Sides of a Coin. Mr. Rajiv Nath

Mr. Siddharth Surana Associate Manager Tax and Regulatory K Vijayaraghavan and Associates llp.

Beginning July 1st, the Worldâ&#x20AC;&#x2122;s largest democracy has adopted a new tax regime- The Goods & Service Tax. This being a radical shift from the existing tax regime, the government of India has kept in mind a smooth and flawless transition by not raising or reducing the existing tax rate on goods and services too drastically. It was also agreed to keep the existing list of items that are exempt from taxes intact in the new regime. Healthcare, hence, found itself on the exemptions list again even under the new regime. But there exist two sides of a coin. Similarly, though the health care services are eAxempt on one side, the inputs used to provide such health care services are now taxed under the 12% tax bracket in total contrast to the old tax bracket of 2% -5.5%. Subsequently, the cost of surgeries and other medical procedures that involve use of such inputs, will now go up considerably. Secondly, Housekeeping services and Security services which are essential to the healthcare sector are also now taxed at a higher rate of 18%. An increase in the rate of these services lead to increase in the day to day operating costs of any health care establishment. Thirdly, ancillary medical procedures and diagnostics including reagents, which play a key role in treatment, have been put under the 12 percent and 18 percent slab. This means, cost of diagnostic services will go up considerably. Until now, life-saving drugs that treat diseases like malaria, HIV-AIDS, tuberculosis, and diabetes, had been exempted from excise and customs duties. But GST has now slotted them compulsorily under the five percent slab, while categorizing formulations into the 12 percent slab (up from nine percent). As a result of all the above, the increase in the input costs to the hospitals have only one way out. They have to be passed onto the end customers i.e. the patients. The only relief is that luxury tax on room charges has been subsumed into GST and hence, patients will no longer be charged a separate luxury tax. Hence, the overall cost of healthcare will increase as tax on inputs of hospitals including equipment, accessories and services such as maintenance of equipment and labour contracts, will rise. But the positive aspect of GST is that, there will exist a seamless input tax credit system, which shall pose like a boon in spite of all the enhanced costs.

Forum Coordinator | AiMeD

GST is expected to be a boon for the economy in long run but we have had more than a few teething problems - e.g. Manufacturer- Exporters in SEZ unable to registered in over 2 weeks and exports and manufacturing disrupted ,lack of clarification of HSN codes by those new to the system so invoicing and sales disrupted. Additionally while for most devices there should be no impact on MRP to consumers or pricing to dealers but for Clinical Thermometers , Pace Makers and IOL it's gone up surprisingly. There are some Devices like Analysers and Hospital Furniture kept at 18% GST whereas we had requested for a cap of 12% on Medical Devices.

w w w.medegatetoday.com July-Aug 2017

NEWS Update

GST

Impact on Healthcare & Tax Slab Tax Rate Healthcare Commodities 0% 5%

12%

18%

Contraceptives, Human Blood Medicines, Animal or Human Blood Vaccines Ayurvedic Medicines, Medicinal Grade Hydrogen Peroxide, Anaesthetics, Potassium Iodate, Iodine, Steam, Glands And Other Organs For OrganoTherapeutic Uses, Ayurvaedic, Unani, Homoeopathic Siddha Or Biochemic Systems Medicaments, Sterile Suture Tampons, Disinfectants

While many hospitals and specialists are going according to the old rates but it is done that once new stocks comes in, the revised rates will be applicable.The experts are very much shocked concerning the tax rates over the life saving medicines and machines and has predicted that if the government did not took any actions than a certain protest is awaiting . 24

www.m e d e g a t e t o d a y. c o m July-Aug 2017

NEWS Update

Let’s examine the fields where the impact will be severe along with the expert comment over it: PreGST

PostGST

Items Getting Expensive

Dialysis Under Heavy Tax

12%

Homo Dialysis Machine, Tubings, Dialysis needles, Catheter, Plasma filter, Dialysis fluid

Heart Treatment

Pacemaker under 18 percent GST

5.5%

12% to 18%

Eyes Treatment

Lens surged upto INR 500 while operations will be 15 percent costlier

12% to 18%

Orthopedics

Support devices getting costlier, Implants neutral

12% to 18%

Disposable items, Bone cement, Operation equipments like drill machines and its batteries.

7% to 12%

–

Department

Summary

Nephrology

Cancer Except treatments blood cancer treatments, every other treatment of cancer will cost 12% extra

Expert Comments

Impact

Currently, dialysis is charged at a Nephrologist Doc. Alok rate of INR 1800 to 2200 which jain from Fortis Hospital will be further burdened with mentioned that the must INR 300. According to this, those be tax free and the rates individuals who are getting dialysis must revised very soon. treatment 10 to 12 times per month will be getting additional INR 40,000 annual burden. Pacemaker worth 1.5 lakh will be Doctore Jitendra Makkad Lead valve of of EHCC hospital Pacemaker, Device costing 15-20 thousand extra after the august timeline. ICD also will mentions it as an error by (Heart failure be costing at an extra 40 thousand the government and seks machine which comes at currently 3 lakh for an correction as soon CRT – ICD) per machine. Currently there are as possible. 200 pacemakers installed across the state. Checkup machines, Lenses will be hiked up to Senior professor Kishor Indian lens INR 1200 12% from 9%, while many of Kumar of SMS hospital to 3000 will surge the machines will be attracting assured that government INR 1500 to 3500. 28%. Along with the lenses, hospitals will be away Foreign machines the operations cost will also from the impact however, which are coming at increase up to 15 to 20%. private hospitals will be INR 5000 to 9000 costlier upto currently will be hiked 15 to 20%. at NR 6000 to 10000. Implant taxes are 5% but the supported items in operation are now under 7% to 28% tax rate. Finger coat, Knee cap, Brep belt also attract 12% now.

Rajendra bhargav , a dealer in ortho implants mentioned that there will be an overall 15 to 20% higher tax rates while multiple meetings are being conducted to understand the future procedures. All the imported medicines Mahaveer cancer hospital director PS Lodha stated that will be getting expensive. Advanced stage cancer patient Anti cancer medicines will be getting costlier by 6.5% will be incurring INR 10,000 as there will be 12% GST extra on the treatment. applicable on them. However, it has to be seen how much exercise will be reduced.

These Health-care Products also in the List of Expensive Category: Items Surgical Item Wing Scale Hot Water Bag Wheel Chair

Pre-GST 5.5% 5% 5.5% 5%

Post-GST 12% 28% 28% 18%

w w w.medegatetoday.com July-Aug 2017

DOCTOR SPEAK

Global Hospitals Pioneers High Tech Shoulder Replacement Surgery

First of its kind stemless implant shoulder replacement surgery in India : Global Hospitals, a multi super specialty tertiary care hospital has successfully performed first of its kind stemless implant shoulder replacement surgery in India. The patient, 67 years old female was suffering from left shoulder pain for 2 years; who was on examination diagnosed with shoulder arthritis. After looking at the intricacies of the case, Dr. Chintan Desai planned a shoulder replacement surgery of the left shoulder using a special type of implant called as the Stem-less total shoulder replacement. The surgery was successfully performed without any complications. The patient was discharged only 2 days after the surgery with no pain. Commenting on the replacement surgery, Dr.Chintan Desai (Shoulder Replacement Surgeon), Global Hospitals said,“The patient suffered from acute shoulder pain which made it to day activities. Bringing in the learnings difficult for her to even perform her day from the west, we at Global Hospitals decided to go ahead with stemless implant; used for the first time in India for shoulder replacement surgery. The biggest advantage of stemless implant Regional CEO, Global Hospitals as compared to conventional surgery is that it reduces the risk of damaging the shoulder muscles with negligible pain.”

Manpreet Sohal

The patient commented, “I had a severe shoulder pain and was consulting a family doctor for the same. One day while exercising, I was unable to move my shoulder and immediately consulted Dr. Chintan Desai at Global Hospitals. After the surgery, I am now able to perform my daily chores independently without any support. Also, the doctor has not prescribed any medicines, instead, I have to undergo a few sessions of physiotherapy to ensure smooth shoulder movement without any pain.”

www.m e d e g a t e t o d a y. c o m July-Aug 2017

The surgery was successfully performed without any complications. The arthritic joint was removed and replaced with a metal ball and a plastic socket. The 4 inch skin incision was closed using selfdissolving sutures. ManpreetSohal, Regional CEO, Global Hospitals. “The shoulder replacement technology and innovations provide a simple and stable streamlined instrumentation to perform surgeries. Such investments enable us to introduce new technologies in the healthcare system. It is our ongoing endeavor to provide the best in class treatment and medical services to our patients; bringing in world class technologies, advancements and state of the art infrastructure.”

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R A L U G RE S E I R SE ON

IVF Myth, Q & A

DOCTOR SPEAK

IVF Giant Advanced Fertility & Gynaecology Centre Plans Rapid Expansion in North India

Dr. Kaberi Banerjee

dvanced Fertility & Gynaecological Centre, one of the best IVF centers in India, plans to increase its presence across the North India with centers in Ranchi, UP, Punjab, Lucknow, Delhi NCR etc. With an outstanding services in Assisted reproductive technology (IUI, IVF, ICSI, Surgical Sperm Retrieval, FERC), Donor Gametes, Treatments of infertility in men & women, and Gynaecological surgery, the centre is renowned for its high quality patient care, state-of-the-art infrastructure, cutting edge technology and highly experienced team of fertility experts that assures positive results.

According To WHO, 1 in every 4 couples in the developing countries is affected by infertility. Generally associated with women, the problem of infertility also affects men. Almost 30% males are infertile. However, due to the social stigma attached to the issue, lack of knowledge on infertility treatment and limited facilities of diagnosis and treatment especially in tier -2 cities in India, there are many couples who are still struggling with the issue of infertility. The main causes of infertility among men are low sperm count (More than 90% of male infertility cases are due to this issue), poor sperm motility, abnormal sperm shape, STDs, Varicocele and other lifestyle issues. In women, issues like Pelvic inflammatory diseases, ovulation disorders, uterine abnormalities, fallopian tube damage, endometriosis, early menopause etc. Dr. Kaberi Banerjee said that “Considering the fact that there are many childless couples who have lost hopes to experience parenthood, we plan to expand our reach in Tier-II cities in the Northern region to offer high-quality treatment at affordable

cost. Most couples are clueless about how to deal with the issue & don’t have adequate treatment facilities in their area. It was the need of the hour to set up a reliable diagnostic center that not just provides the most advanced technical support to the patients but provide moral, emotional, & ethical care. This is what sets us apart! Advance Fertility & Gynaecology Centre currently operates in South Delhi with its head office in Lajpat Nagar & Branch Office in CR Park. With an aim to help infertile couples to complete their family and continue research in this field to provide the best infertility treatments in India, Advanced Fertility Centre is planning to establish new centers in other states of the country. Recently Advance Fertility & Gynecological Centre has received the prestigious award for one of the leading IVF centers in South East Asia. Advanced Fertility Centre works under sterile working conditions with K-systems workstation using technology like Intracytoplasmic injection, assisted laser hatching, and spindle view technology.

“We are planning to expand and make our presence felt over the North Indian region. We are working on the detailed plan of the locations and the facilities offered at every location in order to maintain a high standard & quality in terms of patient care and treatments.” w w w.medegatetoday.com July-Aug 2017

DOCTOR SPEAK

Depression during pregnancy is preventable and can be treated as well In Pregnancy & in the first weeks following childbirth, a new mother goes through a roller coaster of emotions. She may feel many wonderful feelings including awe, joy and bliss. But what does one do when they are concurrently faced with confusion, fear, stress and even depression. Depression is a mood disorder that affects 1 in 4 women at some point during their lifetime, and about 1 in 10 women experience depression during pregnancy. The actual number could be higher because so many women affected by it are reluctant to admit or think it is just another type of hormonal imbalance. If depression runs in your family, you are at a higher risk of experiencing depression during your pregnancy. Pregnant women who are depressed often complain of fatigue or troubled sleeping patterns. Some of the most common symptoms experienced by women are: ●L osing interest in daily activities, or having a sense that nothing is enjoyable or fun anymore ●F eeling sad, or empty for most of the day ●C rying all the time ●F eeling extremely irritated or agitated ●F eeling anxious ●F inding it hard to concentrate ●H aving low energy or extreme fatigue that does not improve with rest ●E xperiencing changes in patterns of eating or sleeping, such as wanting to eat or sleep all the time or not being able to eat or sleep at all ●H aving overwhelming feelings of guilt, worthlessness, or hopelessness ●F eeling that life is not worth living There are a number of women who have been diagnosed with depression or anxiety even before conceiving. On learning about the coming of the new born, they very often stop medication in fear of exposing their baby to the effects of the medication. Stopping or changing of medication should be done only after consulting the doctor. Untreated depression in pregnancy also 30

www.m e d e g a t e t o d a y. c o m July-Aug 2017

bears risks, not only for the mother herself but for the newborn as well. The mother tries to cope up with her condition with unhealthy behaviors such as smoking, mild drinking; not following up with prenatal care or eating an unhealthy diet which in turn affects her unborn child. Depressed pregnant women show higher levels of prenatal stress hormone (cortisol) compared to healthy women which results in them having smaller babies in mid pregnancy and slower fetal growth compared to non-depressed women. They are more likely to have premature delivery and babies with low birth weight. The result on the newborns of depressed mothers ramifies in significantly higher urinary stress hormone themselves, compared to those of healthy mothers, which makes them more stress reactive, temperamentally difficult, and more challenging to care for and soothe. In the long run, children exposed to maternal depression in pregnancy face more social and emotional problems as young children, such as aggression and other behavioural problems. Depression is known to negatively impact a child’s IQ and their language is also delayed. Only women with extreme cases of depression are prescribed antidepressants, but most doctors suggest non-drug approaches including psychotherapy, light therapy, accupuncture, and meditation. There are some lifestyle changes you could also adopt to keep depression at bay. Such as: ● Rest as much as you can. Fatigue intensifies pregnancy mood swings, so make you are getting enough rest. Go to bed early, sleep late or take naps whenever possible. ● Being in nature has been proven to reduce stress and depression symptoms. So spend as much time outdoors as possible. ● Put your chores on hold. You do not have to set up the nursery, reorganize

Dr. Shilpa Ghosh Gynecologist, Venkateshwar Hospital, Dwarka, New Delhi your closets and stock up on baby supplies all at the same time. So resist the urge to get everything done all at once and include your family and friends in the tasks. ●E at a balanced pregnancy diet. Regular snacks and meals can keep your blood sugar up, keeping moods stable. Avoid caffeine, sugar and processed foods, and opt instead for a diet rich in omega-3 fatty acids which has been shown to lower the risk of depression during pregnancy. ●R egular, frequent physical activity boosts feel-good endorphins and has been shown to help stabilize your moods. Regular aerobic exercise is as effective at treating depression as taking an antidepressant. ●M ake time to visit friends and be alone with your partner, whether it is dinner out or just for a night of movies and popcorn. Intimacy of any kind from simple cuddling to handholding can help you feel closer and boost your mood. ● Avoid big life changes if possible which could induce stress like moving or starting a new job until you have got your symptoms of depression under control. If making a big change is unavoidable, try to arrange support ahead of time. ● I f you are worried, anxious or feeling unsettled about the future, do not hold it in. Discuss your feelings. Get support from your partner, family and friends.

PRODUCT LINE

Bike Ambulance - The New App which allows Consumers to find mobike clinic & first line treatment at your door step The past five years for every business, service, product and profession have been very volatile and the fundamentals of doing business have changed drastically, fortunately this disruption has been a positive one and has impacted millions of lives. While a lot of businesses have seen this shift towards super specialization, Internet enabled business and accessibility through mobile devices. Healthcare has been one industry which has had tremendous improvement, but has been a little slow on the customer interface front of things. While a few noticed this gap, one man noticed this gap and beyond and vowed to fill this void. The result is a start-up that set foot into the market in March 2016. Medapp has been the brain child of Niranjan Swamy N from Mysore. Shortly after starting Medapp, Niranjan met Dr Vinod Singh, Mr Abel Boaz, and Mr Krishna Raghavan at a coffee shop and one conversation led to another and soon his friends were a major part of the firm. After which there has been no looking back. Medapp is also supported and guided by Dr Sharaz Nisar., MBBS. MD (An eminent cardiologist from the US) Medapp is an application that fills the gap that exists between the healthcare system and the patient. It is an application that caters to all the healthcare needs of a patient at their door step. While Medapp primarily acts as an aggregator between healthcare services and the patient, it also offers bespoke services to each and every user with the help of a dedicated team of Registered Nurses with mobike clinic. The major thought that sets Medapp apart from its competitors is their patented service of a mobike clinic. The mobile clinic was setup not to treat patients upfront but to evaluate if the user really needs medical intervention or not. A lot of times a small symptom can be worrying, and this for a man or woman above the age of 50 years is a serious concern, this is where medapp's mobike clinic intervenes and determines whether immediate attention is required or not. What the mobile clinic does is eliminate the time and money a patient spends to get to a hospital and reach the doctor after beating the long lines outside every one of them.

WHAT IS MEDAPP

(medapp.in is a Healthcare Platform (mobike clinic), that allows Consumers to find mobike clinic (Registered Nurseâ&#x20AC;&#x2122;s) of their Requirement and Set Appointments, Get Basic Diagnostics (Blood pressure, Glucose check, ECG & Vital Signs) First line Treatment at site, Wound dressing, sample collection & Userâ&#x20AC;&#x2122;s Can Consult with the Doctors through our Nurseâ&#x20AC;&#x2122;s from the Privacy of their Homes/offices. The Network Doctors/Hospitals

in Turn gets Steady Surge of new foot fall of Patients to Their Practice. Consumers will have multiple ways to manage their health records and health care at their finger tips.) Medapp is currently operating in Mysore. After building a successful customer base, Medapp launched the Mobike clinic in Mysore and has got a tremendous response from the users. Each mobike clinic is harnessing healthcare services to more than 5-10 patients a day (An average of 150 patients a month ) w w w.medegatetoday.com July-Aug 2017

DOCTOR SPEAK

y c n a n g e r P g n i n e t a A Life Thre

The major cause of an ectopic pregnancy is a damaged fallopian tube. The defected tube doesn't let a fertilized egg enter into uterus, so it starts growing in the fallopian tube or somewhere else in your abdomen. There are several other reasons as well for ectopic pregnancy: Those who become pregnant while using an intrauterine device (IUD) might be more likely to have an ectopic pregnancy,  Smoking is another major cause of ectopic pregnancy,  Having multiple sexual partners also increase the risk of an ectopic pregnancy,  If someone has medical history of pelvic inflammatory disease (PID) results in ectopic pregnancy,  Sexually-transmitted diseases such as Chlamydia and gonorrhoea causes ectopic pregnancy,  Congenital abnormality of the fallopian tube,  Birth control method is also a reason of woman's risk of ectopic pregnancy,  Unsuccessful tubal ligation (surgical sterilization) or tubal ligation reversal,

Dr. Archana Dhawan Bajaj Gynaecologist & Obstetrician, Nurture IVF Centre

ctopic Pregnancy, a leading cause of Pregnancy Related Death is a rare condition of embryo development outside the normal uterine cavity. In a normal pregnancy, ovary releases an egg into fallopian tube. If the egg meets with a sperm, the fertilized egg moves into uterus to attach to its lining and continues to grow for the next 9 months. But in few cases, the fertilized egg stays in fallopian tube. In that case, it's called an ectopic pregnancy or a tubal pregnancy. In such a case, the pregnancy cannot continue and needs immediate attention and emergency treatment. Ectopic pregnancy happens mostly within the first few weeks of pregnancy. You might not even know you're pregnant, so it can be a big shock. Doctors usually discover it by the 8th week of pregnancy.

www.m e d e g a t e t o d a y. c o m July-Aug 2017

 Use of fertility drugs,  Some medical treatments also lead to ectopic pregnancy such as surgery on the fallopian tubes or in the pelvic area. Ectopic pregnancy is the leading cause of pregnancy-related death in the first trimester of pregnancy. These days abortion pills are very popular and are available easily, be sure that you are not ectopic pregnant before using these pills. Such a situation can be life threatening. This is even more crucial in unmarried pregnant girls who take these pills very secretly. It is advised to consult a doctor before taking abortion pills and rule out ectopic pregnancy. Early detection is the only solution for prevention of risk. The early symptoms of ectopic pregnancy are: Pelvic or belly pain  Light vaginal bleeding  Nausea and vomiting  Lower abdominal pain  Sharp abdominal cramps  Pain on one side of body  Dizziness or weakness  Pain in your shoulder, neck, or rectum

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If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause fainting. Sometimes you may not have any symptom; in that condition your routine early pregnancy ultrasound may show an ectopic pregnancy. Any pregnancy could be an ectopic pregnancy, so awareness of this problem is a must. This type of pregnancy usually presents with a lower abdominal pain. In any situation of doubt an ultrasound and blood test for serum Beta HCG helps in diagnosis. Many times when it is left undiagnosed and allowed to go beyond six weeks the pregnancy leads to rupture of the fallopian tube leading to bleeding inside the abdomen along with severe pain, leading to shock and the woman can collapse. This is an emergency situation as woman needs urgent surgery to stop the bleeding and would also require blood transfusion. If managed in time the patient recovers well although her ruptured fallopian tube might have to be removed. Treatment of this problem includes: B lood transfusion F luids given through a vein K eeping warm O xygen R aising the legs S urgery If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. After treatment for an ectopic pregnancy, patient usually have to have additional blood tests to make sure that the entire tubal pregnancy was removed. The blood tests detect the HCG level, the hormone that is produced during pregnancy. Timely treatment of ectopic pregnancy helps in securing fertility. After ectopic pregnancy, there is good chance of normal pregnancy in the future, but it could be challenging conceiving again. This difficulty is more common in women who also had fertility problems before the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of any damage incurred. The chances of having another ectopic pregnancy are approximately 15%. So if you are pregnant and have any concerns about the pregnancy consult your gynae as it is important to make sure that it's detected early. Pregnancy is a joyful journey however one has to cautious at every semester. Every symptom must be taken very seriously and immediate consultation to be sorted from a doctor. Similarly, early detection and awareness about Ectopic pregnancy is the only solution to prevent its risk.

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Stress as a contributing factor towards Infertility

Dr. Aanchal Agarwal

Sr. Consultant and IVF expert at BLK Superspeciality hoapital, New Delhi Meena , my long time friend was always the one with whom I could share almost everything and she would also talk about all her problems with me, since we were friends for many years now , even before we were married. For last few months, I could see a change in her behavior which left me wondering if I had hurt her in some way. After pondering over this for many days, I could think of only one reason and that was that I had a child and she did not. Although I got married two years later than her, I could conceive in the first year of marriage whereas she could not become pregnant even after 6 yrs of marriage. She has been taking treatment for 8-10 months now but nothing has materialized. Her behavior made me think how much infertility can affect one’s behavior. She looks stressed all the time now and her 36

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performance at office has also deteriorated. Is this stress due to infertility? Or is her infertility due to stress since her work profile is very stressful. As an infertility and IVF expert, I have come across so many patients who lead a highly stressful life with extremely demanding professions and are unable to conceive. In a study published online in the journal Fertility and Sterility, the scientists reported that women who stopped using contraceptives took longer to become pregnant if they had high saliva levels of the enzyme alpha-amylase — a biological indicator of stress. The authors say this is the first study to link a biomarker for stress with delayed conception in normal, healthy women, and they suggest that finding ways to reduce or manage stress may be a lowtech solution for some infertile couples. Stress is the one most consistent factor that shows an effect on how long it take to get pregnant, of all the lifestyle factors studied to date. Repeated failures to conceive month after month could potentially set off a vicious cycle in which it becomes ever more difficult to become pregnant, The study tracked 274 British women ages 18 to 40 who had just started trying to conceive, following them for six months or until they became pregnant. The volunteers were given at-home fertility test kits to track their monthly cycles, and on the sixth day collected saliva samples that were tested for the stress hormone cortisol and for alphaamylase, which is secreted when the nervous system produces catecholamines which initiate another stress response. Although there was no adverse effect apparent from high cortisol levels, women with the highest concentrations of alphaamylase were 12 percent less likely to become pregnant each month than those

with the lowest levels. alpha-amylase is part of the “fight or flight” response, usually activated by the sympathetic nervous system in response to acute stresses. Stress could theoretically interfere with pregnancy through direct hormonal effects, or indirectly by impairing a couple's capacity to have effective sexual intercourse or to follow the complex instructions and sexual prescriptions involved in medical treatment. So many times we have come across infertile couples who are unable to bear a child for many years despite all forms of treatment but as soon as they adopt a child, they are successful in conception also. Similarly, couples who give up all hopes of pregnancy and stop thinking about it miraculously get blessed with a child. All these are examples of negative effect of stress on reproduction. As soon as that stress is taken away, reproductive system starts functioning normally. In today’s modern world, demanding professions, hectic life style, Type A personality and family pressures all contribute towards increasing stress in our lives . Looking at the other aspect, infertility treatment also increases this stress further due to loss of self esteem on discovering an infertility problem, uncertainity about success of infertility treatment , marital stress because such treatment demands intercourse at proper times and financial stress for treatment. In the end, I would like to advice all couples facing difficulty in conceiving to adopt stress management methods like yoga, meditation etc. We, at our centre, try to address all psychological needs of these couples through long counseling sessions. Family support and patience during this trying time can go a long way in helping such couples conceive.

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IVF views of

Dr. Nandita Palshetkar

MD, FCPS, FICOG. Gynaecologist & Infertility Specialist

In the world of infertility, in vitro fertilization (IVF) is often viewed as “the last stop” on the infertility track. What most people don’t realize is that IVF can be the first and most successful option for many couples who battle infertility, or for whom traditional conception and pregnancy aren’t possible. In vitro fertilization, popularly referred to as IVF, has captured the attention of the public since its sensational introduction in 1978. Today assisted reproductive technology is available throughout most of the civilized world, and the practice is largely different from that used during the early days. Refinements in laboratory technology and clinical practice have allowed IVF to evolve into a medical procedure that is efficient, safe, readily accessible, and relatively affordable. In vitro fertilization overview In vitro fertilization (IVF) is a treatment for infertility in which a

woman's eggs (oocytes) are fertilized by sperm in a laboratory dish. One or more of the fertilized eggs (embryos) are then transferred into the woman's uterus, where it is hoped they will implant and produce a pregnancy Who should consider in vitro fertilization? IVF is usually considered by couples who have: ● Absent or blocked fallopian tubes. ● Severe male factor infertility (sperm counts or sperm motility is low, oligospermia, oligoasthenozoospermia, azoospermia, where sperm needs to be extracted surgically from the testicles). ● Advanced reproductive age ● All other causes of infertility, endometriosis, ovulation disorders, unexplained infertility). ● Ovarian failure, although donor eggs would be required in this case.

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DOCTOR SPEAK

Various technologies used these days Intra-cytoplasmic sperm injection (ICSI) differs from conventional in vitro fertilisation (IVF) in that the embryologist selects a single sperm to be injected directly into an egg, instead of fertilisation taking place in a dish where many sperm are placed near an egg ICSI enables fertilisation to happen when ● Very low sperm count ● Other problems with the sperm have been identified, such as poor morphology (abnormal shape) or poor motility (not moving normally) ● During previous attempts at IVF there was failure of fertilisation or an unexpectedly low fertilisation rate ● Sperm need to be collected surgically from the testicles or epididymis (a narrow tube inside the scrotum, where sperm are stored and matured); for example in case of vasectomy, ejaculatory dysfunction, ● frozen sperm in treatment which is not of optimum quality ● using embryo testing ICSI (Intra-cytoplasmic morphologically selected sperm injection) is a variation of ICSI that uses a high power light microscope. In ICSI (intracytoplasmic sperm injection) the sample is magnified up to 400 times. However in IMSI, the high power light microscope (enhanced by digital imaging) is able to magnify the sperm sample over 6000 times. This allows the embryologist to detect subtle structural alterations in sperm that a normal microscope could not detect. Sperm are then selected which have the most normally-shaped nuclei. Embryoscope an incubator with an integrated time-lapse system, where the embryos, cultured individually in microwells, are moved one by one into the field of view of the inbuilt microscope at each of the image acquisitions. In the Embryoscope system, embryos are cultured in special culture dishes (Embryoslide, Fertilitech). It takes pictures every 1220 minutes and can evaluate the embryos in 7 focal planes. Solutions to azoospermia (male infertility) Per epididymal sperm aspiration (PESA): It is done using a small needle under local anaesthesia to aspirate sperm from proximal to the obstruction. Testicular sperm is aspiration (TESA): Testicularsperm is aspirated from non obstructive azoospermic men by a syringe or butterfly needle. Testicular sperm extraction (TESE): If spermatoza isunavailable after PESA or TESA testicular tissue istaken under local or general anaesthesia. Gamete donation For women with extremely poor quality oocytes or premature ovarian failure, donation of oocytes offers the opportunity of a very real chance of success. Similarly, for men with

azoospermia and no possibility of sperm to be obtained by testicular biopsy, donor sperm is available. Vitrification in IVF can allow freezing of spare embryos with better post-thaw survival rates and higher pregnancy and live birth rates from frozen embryo transfer cycles. It provides cost effectiveness for future cycles to patients . Embryos / oocytes / sperms can be frozen for ages. Success rate The success rate depends on variable factors such as maternal age, cause of infertility, embryo status, reproductive history and lifestyle factors. Maternal age: Younger candidates of IVF are more likely to get pregnant. Women older than 41 are more likely to get pregnant with a donor eggs Reproductive history: Women who have been previously pregnant are in many cases more successful with IVF treatments than those who have never been pregnant Due to advances in reproductive technology, IVF success rates are substantially higher today than they were just a few years ago. Success rates have definitely gone up in our practise due to use of various technologies

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DOCTOR SPEAK

Percutaneous mitral balloon valvotomy for mitral stenosis

Dr. Rameshwar Bishnoi Interventional Cardiologist Cygnus Superspeciality Hospital Kaithal, Haryana

Mitral stenosis (MS) is a common valvular disease in developing countries. Most common etiology in these countries are rheumatic . Untreated progressive disease can lead to significant symptoms (eg, dyspnea and fatigue) and serious complications (eg, pulmonary edema, systemic embolism, and pulmonary hypertension). Symptoms usually appearing 10 to 20 years after the episode of acute rheumatic fever. Medical therapy can relieve symptoms but it does not affect the obstruction to flow. Earlier surgical commissurotomy and open valvuloplasty were the only methods by which MS corrected for many years . Percutaneous mitral balloon valvotomy (PMBV) by Inoue in 1984 and Lock in 1985 for the treatment of selected patients with MS has

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revolutionized the treatment of this disorder. Patients to be selected for percutaneous mitral balloon valvotomy (PMBV) on the basis of hemodynamic and echocardiographic criteria. When intervention is warranted, the 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines generally recommended that PMBV is preferred over surgery if the valve morphology is favorable and the patient does not have left atrial thrombus or moderate to severe (3+ to 4+) mitral regurgitation. Echocardiography– Echocardiography is an essential screening procedure in patients who appear to be candidates for PMBV. Valvular anatomy—The extent of valvular and subvalvular deformity should be evaluated and the likelihood of a successful

result after PMBV should be assessed by the Wilkins score, which is calculated from the sum of grades of 0 to 4 for each of the four factors. ● The degree of leaflet rigidity(mobility) ● The severity of leaflet thickening ● The amount of leaflet calcification ● The extent of subvalvular thickening The maximum score is 16; higher scores indicate more severe anatomic disease and a lower likelihood of a successful balloon valvotomy with durability.

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TECHNIQUE

Reference

During cardiac catheterization, a transseptal puncture is used to gain access to the mitral valve from the left atrium. A deflated balloon is advanced from the venous circulation to the right atrium, across the interatrial septum to the left atrium, and across the stenotic mitral valve. Inflation and rapid deflation of the balloon opens the stenotic valve via separation of the fused commissures . In addition to direct measurement of the transmitral pressure gradient, transthoracic echocardiography with measurement of mitral valve area and assessment of mitral regurgitant severity after each balloon dilation is the standard approach for monitoring percutaneous mitral balloon valvotomy (PMBV) The procedure is stopped when an adequate valve area has been achieved or if there is a significant increase in mitral regurgitant severity. Preference for PMBV — The salutary long-term results, lower costs, and the avoidance of thoracotomy make percutaneous mitral balloon valvotomy (PMBV) the treatment of choice in patients with mitral stenosis (MS) who have the following features ●Severe MS ●Pliable, noncalcified mitral valves ● Symptoms (or, if asymptomatic, very severe MS) ● The absence of left atrial thrombus ● The absence of moderate to severe mitral regurgitation Case history-27 yr old female patient admitted with complaint of shortness of breath despite of medical therapy.On examination she was having diastolic murmur at mitral area. Her echocardiography showed severe mitral valve stenosis(Image 1) and LA enlargement with no evidence of thrombus in LA/ LAA.Her ECG was having sinus rhythm. Patient’s echocardiographic Wilkins score for PTMC was favourable . Sizing of balloon according to patient height was 25mm (24-26mm). After septal puncture LA wire passed (image 1) and over the LA wire PTMC balloon crossed septum .This PTMC balloon with the help of Shaper passed in left ventricle. After inflation of distal part ,balloon put across mitral valve and complete inflation done (Image 3).Significant resolution of hemodynamic parameters occurred post procedure as well as mitral valve area increased by >50% of baseline. Patient is symptomatically better on follow up.

● Nishimura RA, Otto CM, Bonow RO, et al. 2014

AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57. ●C heitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline for the clinical application of echocardiography www. acc.org/qualityandscience/clinical/statements.htm (Accessed on August 24, 2006). ● Wilkins GT, Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 1988; 60:299. ●A bascal VM, Wilkins GT, O'Shea JP, et al. Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation 1990; 82:448.

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Haploidentical Transplantation:

New Option for People Seeking Donor Match

Dr. Dharma Choudhary

Director, Bone Marrow Transplant BLK Super Speciality Hospital

In recent years, there have been dramatic breakthroughs in the field of haematology and stem cell transplant, the latest being treatment through haploidentical transplantation technique that eliminates the wait time for the ones in immediate need of bone marrow transplants.

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Rahul age 30, working in an IT firm in Bangalore was suffering from blood cancer. He was under treatment for a long time and also underwent Bone Marrow transplant (BMT), which proved to be a failure after 6 months. He was back to the same severe condition. On exploring further options for treatment, fighting between life and death, came to know about Dr Dharma Chaudhary in 2015. He was diagnosed for ‘Plasma cell leukemia’. The previous autologous stem cell therapy did not work out for him for more than 6 months. And to again prescribe bone marrow transplant could be a herculean task due to mismatch. There were no proper registries in India as well. Then Dr Dharma Chaudhary advised for a new option known as ‘Haploidentical stem cell transplantation’. “This is better than the BMT as only half the matches are enough to take up the therapy.” – said the doctor. His father and sister were examined for match and both of their haploids matched. His sister was preferred as a donor due to the age factor. After one year of therapy he is perfectly fine and makes visit for regular check ups.

There are millions of people waiting desperately for lifesaving organs and bone marrow. Sadly, many die in wait to get perfectly matched donors, even for a bone marrow transplant (BMT). For a better understanding, bone marrow transplant is recommended in case of incurable or possible fatal blood disorders such as Acute Leukemia, Multiple Myeloma, Aplastic Anemia and Thalassaemia Major, which cannot be cured using conventional therapy, such as Chemotherapy and Radiotherapy. And for a lay reader to understand, bone marrow is the soft, fatty tissue inside our bones which produces blood cells. Stem cells are immature cells in the bone marrow that gives rise to all of our different blood cells. Now, in a typical bone marrow transplant, damaged or destroyed bone marrow is replaced with the healthy bone marrow stem cells but the major limiting factor was the availability of a suitably matched related donor. Although this limitation is partly overcome by voluntary unrelated donors available through various registries however, such representations are very less.

We spend much time of our lives But with advancement in medical waiting; be it in long queues, for a call sciences, there is a new procedure back, and sometimes even for a lifeline! called "haploidentical transplantation"

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Earlier people with leukemia and lymphoma used to wait endlessly for a bone marrow transplant until they could find a complete match among family members or from donors outside. With the result, as they waited, their cancer progressed, and most of them died. Until then half-matched, or haploidentical marrow transplants, were considered impossible because of high rate of immune system rejection, slow recovery and a substantial risk of treatment-related mortality. But better knowledge, significant improvement in immunosuppressive drugs and improved techniques of T cell depletion has lead to sea change in the success of haploidentical bone marrow or blood stem cells transplant. In this transplant program, patients are first put though few days of chemotherapy/immunotherapy or radiotherapy as per the condition of the patient before transplantation, just enough to suppress their immune system but not harm their organs. On the day of the procedure, Haploidentical donor had their stem cells collected through bone marrow. Next, the donor stem cell is injected into the patient and 3-4 days later a high dose of immunosuppressive drugs are administered which re-boots the immune system. The medication kills off the patient's immune cells but leaves the donated blood cells intact to create a new immune system that is more likely to be accepted by its host. Donor stem cells starts producing normal blood cells after 2-3 weeks. The conditioning regimes which are part of the treatment have different roles to play like to eradicate malignancy and graft versus marrow effect, to eradicate remnant progenitor cells of recipient, etc. Earlier reduced-intensity conditioning were often used in older patients or patients with comorbidities in whom the toxicity associated with ablative conditioning would be unacceptable but now their role have been extended for other indications, thereby, improving overall success of BMT with limited toxicity. Though there are certain complications like ulcer in mouth, infections, bleeding in the lungs, intestines, brain, and other areas of the body, cataract, clotting in small veins of liver, damage to the kidneys, liver, lungs, and heart, etc associated with BMT treatment, still the success rate of haploidentical transplant is essentially the same as for people who receive complete match transplants for high risk patients.

Advantages of Haploidentical Transplant: It increases the chance of finding a donor as almost everyone has at least one haploidentical relative. Relatives can usually be asked to donate stem cells much more quickly than unrelated volunteer donors. Transplant can be done more timely. Risks and failures of Haploidentical BMT BMT from a Haploidentical family donor is associated with a risk of graft failure, recurrent infections and graft versus host disease. Thus, the success of such BMT depends on the following:  Selection of the right Haploidentical Donor amongst the family members.  Deliver the most suitable ‘Conditioning’ therapy to prevent Graft Failure.  Prevent GVHD by processing the graft or using a combination of immunosuppressive drugs.  Better anti infective prophylaxis.

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POST EVENT

Eurasian Orthopedic Forum organized

2 days event held on 29-30 June 2017 at Moscow

Eurasian Orthopedic Forum In Moscow Brought Together 3750 Participants From 70 Countries EOF, consisting of various specialized conference on orthopedic, was first ever comprehensive orthopedic & trauma conference held in Moscow (Russia). Which covers all the latest topics & technologies for Orthopedic and spine apart from conference there was an excellent concurrent Exhibition from various countries related to orthopedic Implants, clinical testing, diagnostics and medicine. Gathering suppliers, importers/ distributors and end-users less than one roof. In the course of the Forum, the Association of Traumatologists and Orthopedists of Russia signed 13 memorandums on cooperation with medical institutions and professional associations of Azerbaijan, Bangladesh, Jordan, Iran, Kazakhstan, China, Moldova, Poland, Tajikistan, Uzbekistan, Japan. The increased interest in the program of the Forum is due to the significant role of traumatology and orthopedics in modern medicine and its high social relevance.

“The number of surgeries for the implantation of various types of medical products attributed to orthopedic traumatologists outruns all clinical specialties put together, and this indicator is growing. For example, 5 years ago there were 8 to 10 thousand surgeries performed in Russia with regard to large joints arthroplasty, and more than 110 thousand in 2016” comments Sergey Mironov, Director of the Federal State Budgetary Institution Priorov Central Scientific Research Institute of Traumatology and Orthopedics, Head supernumerary specialist of traumatology and orthopedics of the Ministry of Health of Russia, President of the Association of Traumatologists and Orthopedists of Russia, Member of the Russian Academy of Sciences, Co-Chairman of the Scientific Committee of the EOF..

This is a unique conference enabling academics to ‘kill all birds with one stone’ – network and make contacts, improve your own brand, learn from experts and share knowledge. All conferences and event held by EOF are examples of ideal teamwork combined with advances in technology and knowledge as well as fun and creativity Dr. (Prof) Ali Al Beloochi- Dubai

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POST EVENT

How successful was Event? EOF 2017 attracted high-level representatives from the Orthopedic sectors and other different healthcare in the region, namely hospitals, government, vendors, NGOs and other healthcare provider organizations. The delegates was largely senior, giving more value to the discussions on topics presented by the speakers.

Event Rating I received highly-satisfactory marks from our participants in various areas that we sought to measure through our feedback taken during interview and these areas are: Speakers (content and delivery) and Education Sessions (topics).

Some Feed back from attendees taken by me during Conference: An event like this provides an opportunity for people to exchange ideas, share their experiences, and maybe go back with one or two ideas that they can actually act on in their respective countries. (Shepilova-ottobock) I think it is very important for us to understand that healthcare across the world is becoming more expensive, but the outcomes don't commensurate with investments. So it calls for a drastic change, and the drastic change is disruptive innovation.( Leah He – Microport ) “It is a wonderful opportunity to be here in this conference that is about innovating in healthcare, because innovating healthcare has become a very important topic around the world where resources are becoming pressured in all countries and there is a need to get better value from the resources that we have for this purpose. “Thanks for giving me an opportunity to get very informative knowledge. This is very useful to provide better service for getting good business. The entire arrangements are very good. (Dr. Hisham Sammour-Oman)

Eurasian Orthopedic Forum in Moscow brought together 3750 participants from a variety of countries The number of delegates of the Eurasian Orthopedic Forum has significantly exceeded all expectations, which is due to doctors’ need to upgrade their skills, as well as to the relevance of cooperation between industry medical associations, authorities and manufacturers of medical products. The wide coverage of the countries participating in the EOF results from the desire of the global medical community to share experience improving the quality of medical care. The Forum was held on 29-30 June in Moscow with the support of the Ministry of Health and the Ministry of Industry and Trade of Russia. The Eurasian Orthopedic Forum held on 29-30 June 2017 in Moscow brought together 3750 participants. Delegations from over 70 foreign countries, including the CIS, the countries of the Asia-Pacific region, the Middle East and the European Union registered to participate in the Forum. The largest groups of specialists were sent by: China (63), Bangladesh (46), Belarus and Thailand (25), Germany and India (13), Singapore (12), Armenia, Uzbekistan, Ukraine, France (8), Kazakhstan (6), Jordan (5). In the course of the Forum, the Association of Traumatologists and Orthopedists of Russia signed 13 memorandums on cooperation with medical institutions and professional associations of Azerbaijan, Bangladesh, Jordan, Iran, Kazakhstan, China, Moldova, Poland, Tajikistan, Uzbekistan, Japan. The increased interest in the program of the Forum is due to the significant role of traumatology and orthopedics in modern medicine and its high social relevance. “The number of surgeries for the implantation of various types of medical products attributed to orthopedic traumatologists outruns all clinical specialties put together, and this indicator is growing. For example, 5 years ago there were 8 to 10 thousand surgeries performed in Russia with regard to large joints arthroplasty, and more than 110 thousand in 2016” comments Sergey Mironov, Director of the Federal State Budgetary Institution Priorov Central Scientific Research Institute of Traumatology and Orthopedics, Head supernumerary specialist of traumatology and orthopedics of the Ministry of Health of Russia, President of the Association of Traumatologists and Orthopedists of Russia, Member of the Russian Academy of Sciences, Co-Chairman of the Scientific Committee of the EOF.

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POST EVENT

Alongside, Chairman of the Forum’s organizing committee Sergey Mironov noted that the explosion of surgical activity is not always accompanied by an adequate increase in professional and technical training. Therefore, global conferences are extremely necessary to improve the skills of orthopedic traumatologists. The Forum allowed discussing together the existing difficulties in various areas of traumatology and orthopedics and the possibility to improve the quality of diagnosis and treatment, ensuring accessibility and validity of providing high-tech orthopedic and trauma care. The high activity of developers and manufacturers of medical products at the EOF was explained by Deputy Minister of Industry and Trade of the Russian Federation Sergey Tsyb: “Support of the enterprises manufacturing medical products is one of the priority areas for the development of industrial policy in the Russian Federation, therefore the market is attractive to manufacturers, and they seek to interact with the medical community, representatives of the healthcare system and federal executive authorities. The Ministry of Industry and Trade of Russia actively promotes this integration, including at medical forums, such as the EOF. This leads to an increase in the development dynamics of manufacturing high-tech export-oriented Russian products for traumatology and orthopedics.” Another important feature of the Eurasian Orthopedic Forum was the active participation of professional associations, such as the Association of Traumatologists and Orthopedists of Russia, the Association of Traumatologists and Orthopedists of Moscow, as well as partner associations from 25 Eurasian countries, which provided support to the Forum. Today active work is carried out on professional standards, the accreditation of specialists, clinical recommendations and protocols, as well as on the admission to the profession and particular place of work, causing the sharp growth of importance of professional medical organizations and their responsibility for the level of expert review related to documents issued by the Ministry of Health and the quality of medical care. To effectively solve all these tasks, medical specialists must act together. It is also impossible to overestimate the importance of the EuroAsian partnership, which has strengthened during the Forum, and will now develop – this is important for both civilian healthcare and the military medical service. “Military healthcare in Russia is extremely interested in this partnership, in the development of new technologies, receiving new materials for traumatology and orthopedics, and the introduction of modern digital technologies. In addition, the development of any specialty is especially efficient within the multidisciplinary approach that was used at the Forum. It is beneficial that orthopedic traumatologists have had the opportunity to visit the adjacent sections on anesthesiology, radiology, oncology, neurosurgery and military field surgery,” said Evgeniy Kryukov, Head of the Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian Federation. The first Eurasian Orthopedic Forum won active acceptance of the industry community, and its organizers received numerous requests to hold the event on a regular basis. 46

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Welfare Medical after its successful launch few years ago has proved to be a market leader. It is a Company which made a mark with its successful expansion strategies and insights. It has a strong presence PAN India. Today we got this opportunity to speak to the medical industry Genius Mr. Sushil Bagga, the founder of S.B Group, the Man behind Welfare Medical and his only daughter Ms. Swati Bagga, Executive Director SB Group and Marketing & Operations Director -Welfare Medical. reasonable cost and trying our best to reach B & C towns to cover Entire India. We are actively engaged in advanced research and development studies and continue introducing new products to become the most admired global medical company through innovation, manufacturing wideranging product solutions and world class customer service support.

Welfare Medical after its successful launch few years ago has proved to be a market leader. It is a company which made a mark with its successful expansion strategies and insights. It has strong presence PAN India. To be named as one of the most successful companies is a matter of pride for us. We at Welfare have grown as fastest medical equipment and devices manufacturer, supplier. We and our team have created fantastic recognition and growth potential over the past few years. Our sales have been increasing and heading upwards rapidly because of our product quality and unparalleled services and working 24x7 and open to supplies and emergency supplies all the 365 days so that products reach to save a precious life.

Mr. Sushil Bagga MD, Welfare Medical

Currently we have a strong marketing team of National Sales Managers, Product Managers and Business Managers with PAN-India Dealer We bought the primary range of network who are resolute on providing activity and portfolio with bringing the best medical solutions at a very surgical stapling line, products for the operation rooms, anesthesia, and minimum invasive surgery and have built its brand image to a level of high trust amongst the healthcare market and medical professionals. The products are in compliance with CE Marketing Regulations and Standards. Furthermore to achieve excellence in their functioning, Welfare Medical has created a system that formally checks ourÂ quality management systemÂ on a regular basisÂ which satisfies the requirement of ISO 13485:2003, an Internationally Recognized Standard. 48

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Ms. Swati Bagga

Director, Welfare Medical

With the core business of the company focusing on medical needs and necessities of the healthcare sector in India and Indian Sub-Continent, the Group (S.B Group) also ventured in Insurance, Garments exports, Real Estate and plans very seriously of manufacturing more advanced hi-tech equipments and Health Park in Madhya Pradesh. There is certainly a need for India to accelerate investment towards medical services and ensure that these services are world-class. On our part, we have made significant strides in boosting the quality of care available in the market by successively introducing newer, and more advanced product lines. I strongly believe that trend in this regard looks very promising, and that the India will advance steadfastly as far as the availability of quality medical care is concerned. Our future plans includes adding at least 2-3 new products every year after extensive R&D and shall be a sustained emphasis on quality, with each range proving its effectiveness in Europe before landing in India and Indian Sub Continent.

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We understand that what customer needs is Solution based approach therefore combined with our Video Conferencing products we provide a full proof solution allowing live production and high speed transmission from OR to high quality renditions in auditoriums, classrooms, offices and mobile devices.

www.m e d e g a t e t o d a y. c o m July-Aug 2017

At Sony we’re proud of our heritage in products and systems from Sony and providing video and printing solutions for other manufacturers. medical practitioners. As part of Sony’s commitment to deliver Sony draws on decades of expertise in enhanced visualization. Last year also cinema and broadcast industry to create at All India Ophthalmological Society a range of Professional Products and Conference, Jaipur we introduced two solutions suited to every application latest 4K medical monitors (LMDfrom everyday use to the most quality X310MD & LMD-X550MD) to Indian critical projects. Sony is the company market. As 4K and 3D imaging technology committed to video industry and has been is becoming increasingly popular in developing new technology and devices to today’s operating rooms, Sony’s LMDmaterialize the evolution of video images X550MT and 31-inch LMD-X310MT 4K from a long time such as analog to digital, 3D surgical monitors are able to display standard definition to high definition, 3D both 2D and 3D video images in 4K and now 4K. Sony Professional group or HD from endoscopic/laparoscopic has been deeply engaged with cinema cameras, surgical microscopes and other and broadcast industry wherein visual compatible medical imaging systems. expression and its development are of Their exceptional quality is an asset to both healthcare and educational utmost importance. settings, allowing students & Medical In this professional industry, not only Professionals to gain a more complete high quality image but also the precision view of the human internal organs. imaging and accurate color reproduction are the essential requirements. Sony We’re continually challenging the of medical imaging products give assurance to the customer boundaries that “What you see is what you get”. technology. Sony’s range of HD and Sometimes the image quality of consumer Standard Definition color video cameras products is not consistent or purposely helps clinicians capture medical 2D and manipulated in order to make the image 3D content with clarity and precision. looks attractive. It means what you see is We also understand clinician’s needs for surgical records hence, with Sony not always what you get. recording solutions, you can rely on Innovations in video technology explored clarity and integrity of medical images the opportunities to integrate video for years to come. devices into medical modalities, such as endoscopy, Ultra Sound and Radiology For more than thirty years we’ve led the equipment. Video Image use in these way with innovative, easy to use quality medical modalities is mission critical and medical printers to support the work of accurate image is essential for the reliable clinical staff. The entire range of Sony operation. We at Sony are strongly medical printers employs an advanced, printing confident of our product’s accuracy, environmentally-friendly system. No liquid chemicals are used in consistency and durability. I am sure the printing process, and no chemical that which makes doctors feel confident on various medical care occasions. waste is produced after printing. Our imaging, recording and networked In our portfolio, we have also recently sharing tools integrate seamlessly with introduced Content Management System, a wide range of modern modalities in the full proof application that streamlines today’s operating room and beyond. the storage, management and distribution Just as importantly, they’re designed for of medical videos, still images and other smooth interworking with legacy medical associated documents files.

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Is Your Current Hospital Information System Driving Clinical and Business Transformations? Need for Clinical Transformation Healthcare is experiencing a historic change as delivery becomes more patient-centered and cost constrained. The changing patient-disease mix, high volumes of transactions, active demands for personalised care, and the multiplicity of caregivers have changed the dynamics of healthcare industry irrevocably. Every healthcare provider now strives to deliver international standards of patient care at local affordable costs. Newer models of healthcare delivery and payment are bringing in some fundamental changes to the hospital structures and care systems.

Goals of Clinical Transformation The four fundamental goals of clinical transformation are:  Improvement of Patient Safety and clinical outcomes  Cost Control and Operational Efficiency  Enhancement of Patient Satisfaction and Patient Experience  Enablement of Research To achieve these top four goals, clinical transformation needs to be seen as an integrated program. Only a tightly integrated, clinician lead, patient centric platform drives process improvements that deliver the bottom line transformational performance. It leverages IT to achieve competitive and quality advantage, and supports true sharing, information exchange and immediate delivery of patient data to improve process performance, quality of care and patient safety. It is an imperative for hospitals pursuing targeted improvements for a safer, higher- quality environment for its patients.

What is Clinical Transformation? “Clinical transformation involves assessing and continually improving the way patient care is delivered at all levels in a care delivery organization. It occurs when an organization rejects existing practice patterns that deliver inefficient or less effective results, and embraces a common goal of patient safety, clinical outcomes and quality care through process redesign and IT implementation. By effectively blending people, processes and technology, clinical transformation occurs across facilities, departments and clinical fields of expertise.” • HIMSS 2011 Clinical Transformation Survey Report

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7 Steps in Achieving True Clinical Transformation: Despite the core focus being patient care and the fact that over 80% of all hospital operations are clinician driven, the emphasis of the current hospitals management software systems is solely on automating the administrative & operational processes. Clinical Transformation is THE only way to fully realize the benefits of information technology. An integrated solution that automates all 3 operations, namely, Administrative, Financial, and Clinical, will help control hospital costs and improve quality of care. It must also include a sophisticated clinical and business analytics tool that helps healthcare providers gain competitive advantage through actionable insights and improve delivery of services to world class standards. Step 1: Patient Centered Care Embark the new health care while putting the patient at the center of healthcare.

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* SCORETM Safety, Costs, Outcomes, Research, Experience

Key Benefits of Clinical Transformation:  Reduces readmission, paperwork, wait times, hospital acquired infections, revenue leakages, inventory carrying costs and staffing costs. H elps to achieve Zero Error in medication administration and ensure patient safety.  Improves discharge times, orderresult Turn-Around-Times, safety compliance, clinical outcomes, patient engagement, research, and reporting.

About ohum: Ohum offers an end-to-end integrated Enterprise Hospital Management System for Clinics, Nursing Homes, Enterprise hospital networks, and public healthcare facilities including State and Central government Hospitals worldwide. Our mission is to enable quality healthcare for all through appropriate adoption of world class clinical information systems in an affordable and sustainable manner. Ohum helps healthcare organizations streamline and optimize their core processes to drastically improve in critical performance measures such as quality, costs, and outcomes. Write to us at clinicaltransformation@ohumhealthcare.com or call us at +91 20 41357500 to discuss how we can help you complete your Clinical and Business Transformation journey. You may also visit our website www.ohumhealthcare.com for more details. w w w.medegatetoday.com July-Aug 2017

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Patient Safety: Medication Error harm while the medication is in the control of the health care professional, patient or consumer, … related to professional practice, health care products, procedures, and systems , including prescribing, order communication, product labelling, packaging, and nomenclature;”

Mr. R. Jaikishan CEO Shivam Medisoft

As per a survey, every year, around 5 million people die due to human errors in India and major contributor is the wrong medication. It is not always lack of medical skill of doctors or staff nurses, but that of team coordination and communication during an emergency that leads to medication errors. Countries like US also have more victims of medication error than of road accidents. Even WHO ranks it amongst the top 10 killers in the world. National Coordinating Council for Medication Error Reporting and Prevention defines medication error as “any preventable event that may cause or lead to inappropriate medication use or patient

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Common medication errors are Prescribing Error – illegible prescriptions or medications leading to errors; Omission Error- failure to administer an ordered dose to patient before the next scheduled dose; Wrong Time Error- administration of medication outside predefined time line; Wrong Dosage Error- administration of medication which is of higher or lower dose than prescribed; Expired Medicine Erroradministration of drug which is already deteriorated; Monitoring Error- failure to attain appropriate data to assess patient response to prescribed therapy/ drug; Fragmented Care Errors - where lack of communication exists between prescribing physician and attending nurses; and many more. Given the high frequency of medication error with resultant patient distress and cost, their prevention is a worldwide priority for healthcare players. Shivam’s Neosoft HMS application support the hospitals in addressing the medication errors issues through its various features like auto prescription, automated dispensing, barcode medication administration, computerized medication administration at nursing stations, electronic health records etc . Some of the key features in NeoSoft HMS application that support in the prevention of medication errors are:

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Medicine Dosages for baby, child and adult are defined in the medicine masters which prevents inadvertent dosage prescription by the doctors. Doctors will select from the menu and the standard dosage parameters as defined will figure in the prescription.

This screen at the Nursing station displays the list of In-Patients at real time in the form of bubbles. The number on top of each bubble indicates the pending medication/tests for the respective patients. This feature is not only appreciated by the nurses but also by the supervisors, doctors as well as persons attending the patients.

The various medication/tests to be done for each patient at different times as advised by the doctor gets listed in this screen directly from the prescription data. The schedule is not entered by the nurses (which not only saves their time but also eliminates the medication errors). Fifteen minutes prior to the schedule medication time, the icon will start blinking; and it will continue to do so till the medication is done. The nurse will carry a tablet and administer the medicine. Upon doing so, she will click the assigned button on the tablet. Application will ask her authentication. The time and the nurse who gave the medicine gets saved in the HMS application. There are many more features in the NeoSoft HMS application supporting the patient safety, prevention of medication errors, NABH compliance indicators,

Objection Management dashboards, feedback forms for patients, and so on. Established in 2002, Shivam Medisoft Services Pvt Ltd, is a prominent player in the HMS (Hospital Management Software) segment. The 600+ satisfied clients, the strong technical team, the framework on which the application is developed, the dedicated Customer Support team, complete functional knowledge of hospital operation acquired over these years, etc has evolved NeoSoft HMS application into a comprehensive ERP covering all hospital operations (viz. from Registration to Financial Accounts to NABH features, etc) including EMR (Electronic Medical Records) and the Mobile Apps in Android and iOS. Please visit www.shivammedisoft.com for more details. w w w.medegatetoday.com July-Aug 2017

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DIGITALIZING INDIAN HEALTHCARE INDUSTRY

Vivek Tiwari

Founder & CEO, Medikabazaar basis and now they have developed strong roots bringing doctors and medical practitioners close to each other and to their patients. Digital advancements are being embraced across industries. It began in the 1950s, when industries started using digital technology to automate standardized and repetitive tasks and to process highly important and confidential data. Healthcare and Pharma sectors too have actively accepted these positive changes, which has led to a technological transformation in the healthcare sector. The application of digital technologies has multiplied over the recent years. For example, the use and acceptance of websites and online apps have multiplied among users at a very fast pace. Full digitalization of enterprises is the current wave of development. The healthcare sector is growing actively with these digital transformations. Use of Healthcare websites and health apps for knowledge, treatment, and procurement has grown rapidly in the last few decades. Some of the major benefits of these digitally advanced apps and portals are; less time consumption, comparatively lower costs, and particularly, early and easy availability of data. 56

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The Indian government has taken considerable measures to digitalize service sector in the nation. A fast move towards the usage of online portals and applications is evidence enough that using technology to improve healthcare industry is not a myth anymore; but a developing reality for India. One of the primary factors mentioned in the National Health Policy Plan in 2014, was that more and more digital technology be used to improve the existing healthcare set up. Due to this, application of innovative technological options to the traditional healthcare system has seen a constant rise. The concept of e-healthcare has introduced a new pathway for India's healthcare industry. The gradual increase in acceptance and use of e-healthcare by medical professionals and patients is a proof enough, that technology is the base to provide efficient healthcare services to people. These online services have aided and addressed many significant challenges in the healthcare sector. As per government initiatives, digital technology was introduced on a trial

The Digital India Initiative is expected to overcome many challenges faced by the healthcare industry and change the existing face of Healthcare System in India. For the Digital India drive to successfully achieve its goals, digitalization of healthcare setup will go a long way. This truth is already realized by the government and hence a lot of efforts and resources are being allocated to give technology a strong base in the health industry. Determined to make the Digital India Initiative an effective attempt, the government has been directing many efforts to overcome any shortfalls in the healthcare sector. The introduction and use of a huge number of healthcare portals and applications show that there is enough scope to rebuild the healthcare industry on innovative technological grounds. The winds of progress are now in motion and digitalization will undoubtedly change the skylines of medicinal services conveyance altogether. Digitalization is undoubtedly taking a strong hold over healthcare business to eliminate the inconsistencies in a provision of quality healthcare services and to make healthcare accessible for all.

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India Virtual Hospital launches

Patient Care App for Doctors

 I ndia Virtual Hospital (IVH) launches Patient Care App on National Doctors’s Day, which will help them track their Referral Patients’ Treatment Journey as well as Recovery Process.  I VH Patient Care App aims to strengthen & streamline the Patient’s Treatment Journey from Primary & Secondary Care to Tertiary Care  I VH Patient Care App will also facilitate Doctors to interact and send Health Information to their Patients On the occasion of National Doctors Day, India Virtual Hospital, a tech enabled medical concierge service launched Patient Care App for doctors to strengthen & streamline the Patient’s Treatment Journey from Primary & Secondary Care to Tertiary Care. The IVH Patient Care App will help and enable doctors to track their Referral Patients’ Treatment Journey as well as Recovery Process. It is an integrated application which will keep doctors informed about their patients (once they are registered) they refer to specialists or super specialty hospitals. Says Dr. Tarun Sahani, Internal & Hyperbaric Medicine, Apollo Hospital, Indraprastha and Advisor, India Virtual Hospital, “There is little or no mechanism to keep track of your patients’ treatment journeys that are referred to specialists. Most of the time doctors (primary & secondary care) lose their patients in referral chains. The primary treating Doctor who examined the patient for the first time and knows most about the patient needs to be informed about the patient’s treatment cycle because their remarks really do matter in the entire treatment process. Also this is the doctor’s right to know about their patient whom they provided the primary treatment. An app like IVH Patient Care will certainly go a long way to help

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the doctor to be informed about their patient’s treatment status. This may become a platform where doctors and specialist can interact and discuss about the patient with each other.” IVH Patient Care App has detailed features like storing the patient reports, giving regular updates to doctors as well as the patients, providing general information about the disease and newer developments related to medical science. Launching the application, Swadeep Srivastava, Managing Partner, India Virtual Hospital says, “It is a struggle for doctors to trace their patients when they are referred by them to some other hospital in an

alien city. With IVH Patient Care App, we are trying to empower doctors with the right to be informed about their patients who are travelling for medical benefits. A Doctor just needs to register their patient with the App. When the patient visits their desired city for treatment, the Doctor who referred the patient can gets day to day update with the help of the application.”

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Advent of IT into healthcare

â&#x20AC;&#x2039;Dr. Ruchi Gupta

Founder and CEO, 3hcare.in Healthcare industry is one of Indiaâ&#x20AC;&#x2122;s vastly expanding sectors in terms of economy, and anyone in pursuit of a fulfilling career has more than just a chance to establish themselves in it. The industry basically deals with hospitals, diagnostics, medical devices, and medical tourism. Though Indian healthcare is showing an exponential growth, the scope of development is yet to be explored. With the growing science and technology, use of medical apps have been on a rise and made IT considerably more understanding. Medical apps have become more customized providing a meaningful use of social media. The increased use of 3D printing technology has also evolved in the recent years, providing the surgeons with a game changing technology in diagnostics and study the human anatomy. Printing blood vessels and heart tissues, studying cancer cells and replacing organs to name a few has already seen practical application in diagnosis and disease management. The advents of smart watch, real time diagnosis in the operating room has helped the field with adherence control and inter disciplinary therapies.

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The technological advancement in the healthcare industry acts like an Artificial Intelligence in medical decision support, redesigning the hospital experience and poses like a virtual digital brain. In the current situation, healthcare is predominantly driven by digital technology with most medical equipments running on digital platform. With more private players coming forward with better public â&#x20AC;&#x201C; private partnerships, this field is estimated to grow at a compound annual rate of 25% during this 5 year tenure to become much more vast and diverse. One of the most interesting and fascinating fields in this segment is genetic testing and research in molecular biology. With Unfolding opportunities in this field, genetic biomarkers are continuing to expand. A molecular biologist focuses on the genetic changes to assist in curing and slowing down of disease infestation. And screening in newborn is necessary as it helps in identifying genetic disorders and facilitating treatment early in life. As far as job opportunities are concerned, diagnostic management professionals are required not only in hospitals and clinics, but also in healthcare NGOs, hospital consultancy companies and IT industry involved in developing software and imaging equipments. IT firms like Dell, Accenture, Delloite etc hire such professionals. In case of a fresher, who has no work experience, the industry hires them as technicians and with the training and experience gained they will reach the zenith within few years. Many students are confused with what to opt for after completing their graduation- whether to go for low salary job or pursue further studies. Majority of them do their post graduation to get a decent job. Diagnostics is one

such segment in the field of healthcare management that has brilliant prospects in job environment and a profitable career option. Besides getting lucrative remunerations, this also helps to achieve the goal of service to mankind. Healthcare operates in various segments of which the diagnostics segment is at a boom. Pathology, the type of diagnosis of human diseases by laboratory methods has open scope in areas either as a diagnostician, teacher or an investigator. Pathologists in clinical laboratories practice as consultant physicians, to analyse the laboratory reports for better diagnosis and treatment of a patient. One of the most interesting and fascinating fields in this segment is genetic testing and research in molecular biology. With Unfolding opportunities in this field, career in genetic biomarkers are continuing to expand. A molecular biologist focuses on the genetic changes to assist in curing and slowing down of disease infestation. And screening in newborn is necessary as it helps in identifying genetic disorders and treats early in life. Another field of diagnosis is radiology that deals with diagnosing and treating diseases with medical imaging techniques. With the increasing demand for radiologists in India, this field ensures a better career path and the

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occupation is expected to grow faster than any other. A radiology technician has an option to work as ultrasound technician, X-ray technician, MRI technician, CT technician and medical professional. With an immediate and sustainable demand for technologists in hospitals, clinics, and physiciansâ&#x20AC;&#x2122; offices, the field of radiography continue to show higher than average job growth into the future. Job scenario for those planning to start their careers in radiology are expected to remain high, particularly for those interested in working for general medical and surgical hospitals. Radiation technicians can work in urgent care facilities, clinics, equipment sales, and private offices. Radiologic technology is a fascinating subject to study which in addition to providing certificate to work in the state of residence, also prepares a career in healthcare industry that s challenging, important and gratifying. Being one of the heart warming jobs, position of a radiologist holds 15th rank among the best jobs in this industry and considered one of the smartest choices to opt for.

According to IBEF, the overall healthcare market is worth $ 100 billion and is expected to reach 280 billion by 2020. The Indian medical tourism will reach $ 10 billion with 2 times growth in health care IT market is expected by 2020. The data promises to provide a huge boost in generating employment opportunities in the upcoming years in the field of healthcare management. With several big investments being made in this sector, the functioning of the industry has become more professional, organised and efficient. Besides the urgent need for trained doctors and nursing staff, efficient management is required in various measures of the field. Looking for future experts, lack of talent is currently a drawback. The industry is growing at a swift rate, though the talent still is lagging. To nurture todayâ&#x20AC;&#x2122;s talent for a long term with focus on quality, opens up scope for many. Being a young industry open in the market, the learning curve will definitely be sharp and the talent will be nurtured to withhold greater responsibilities at a younger age. The

industry is trying to seek out people who have a high moral purpose, eager to learn and lead. This will create an impact in advancing in the healthcare world by providing promising opportunities that will reshape and redefine it. With the growing science and technology, use of medical apps have been on a rise and made IT considerably more understanding. The role of a technician has undergone a major change over the past decade. Most modern hospitals and healthcare establishmentsâ&#x20AC;&#x2122; are in requirement of experienced technicians and radiointerventionist equipped with multidisciplinary skills. The healthcare industry desires a skilled workforce of professionals involved in research, market shaping and development and most importantly customer centric roles. India is the potential place to attract healthcare industry with its highly skilled specialised workforce.

w w w.medegatetoday.com July-Aug 2017

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Niranjan K Ramakrishnan CIO (IT), Sir Ganga Ram Hospital

Possibilities of reducing healthcare costs using IT!  As a hospital administrator, do we know the exact cost of delivering healthcare service or treating a patient?  Do the policy makers and Government understand what do they really mean by the healthcare costs?

The Centre announced the long-awaited National Health Policy 2017, which promises to increase public health spending to 2.5% of GDP in a time-bound manner and guarantees health care services to all Indian citizens, particularly the underprivileged during March 2017 (The Hindu dated 17 March 2017). But, when we carefully review the policy, it is shifting the commitment from “Healthcare is a fundamental right” to “progressively incremental assurance-based approach to health care”. Also it is important to note there is not progress in terms of budget for the key healthcare programs. Globally, healthcare costs continue to rise through the reasons may vary from country to country such as aging populations, development of new treatments and growing population etc. One of the fundamental reasons for increasing cost is compensation for healthcare services be it out of pocket from the patient, third party payers such as Insurance companies, TPAs, Corporates and Government programs all are focused on services and programs based not outcome based. Irrespective of the outcome, patient has a very little say on his / her health and healthcare costs. By changing the dynamics of reimbursement / compensating the healthcare costs toward outcome achieved both the healthcare is a fundamental right and reduced cost may be achieved.  As a patient, do I know the exact cost of my treatment for a particular procedure or healthcare services?

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of accuracy in resource management i.e. reduction of human resources, less stock in the store, efficient investment of the revenue, mapping the cost of the procedures in scientific way so that it doesn’t affect the patient outcomes without compromising the revenue.

Most of the hospitals arrive at the cost with poor assumptions without factual  Adoption of IT driven process saves the resources cost by combining multiple data, limited analysis, to define the cost common services instead of departmental of healthcare services and procedures. approach where the redundancy of Most of the time the cost is defined by the resources are very high. competition from the neighboring hospitals without any scientific approach. This  By allowing patient to be part of the results in devastating financial health of the treatment process, it brings in the organization and in turn increases the cost to transparency, good will about the the patient. provider organization and well informed cost management. Steps to control costs using IT

Adoption of the Information technology  Using Business Intelligence systems, hospitals can measure their cost, in the right sense aligned with the matured compliance to the processes based on processes, may enable the cost comparison the defined metrics and most importantly with outcomes achieved. The aggregated data benchmark themselves with the peer of the providers and analyzed costs involved groups. at the business unit level would give much control on the overall cost management of the  Integration of various services & healthcare delivery and in turn bring down departments using IT such as equipment the cost of treatment to the patients. Outcome usage with billing of the patients, usage achievement based costing also increases the of ancillary services such laboratories, provider’s responsibility and commitment pharmacies & diagnostic departments towards the treating patients. The hospitals with reference to the required referrals etc who do not manage their process, may not be would ensure the maximum utilization of able the measure their cost. the investment.  Hospitals should link the processes  A good cost management system warrants with the outcomes by implementing enhanced decision making process from measurable metrics using Information tracking individual patients, equipment, technology. processes and overheads.  Standard Operating Procedures should  Embracing of Clinical Pathway analysis, not be just in documentation but converted evidence based decision support system into work flow processes and deployed and protocol based clinical best practices as mandatory functional features of IT certify the best patient outcome and system and compliance of the SOPs reduced cost to the patient with improved should be measured as outcomes. This quality healthcare. needs to be done in clinical outcomes,  Executing time-driven activity-based human resource outcomes, finance costing system for measuring the exact outcomes and inventory outcomes. costs relating them to the processes  Automation driven processes removes at every steps will enable the key the dependency on the few persons but stakeholders to manage appropriate empowers the organization in terms decision.

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NEED OF A CONSULTANT FOR YOUR HOSPITAL PROJECT Dr. Vinod Singh

Founder & consultant Hospitech healthcare consultancy

Building a new hospital is an expensive task & careful financial planning needs to be done by the healthcare consultants before any visible activity is undertaken on site. By taking the help of a consultant, it may dramatically improve the efficiency and quality of your hospital business over time. A true successful project is one where goals are identified early on and where inter dependencies of all building systems are coordinated concurrently from the Planning and Programming phase. This applies more crucially to Hospitals than other type of buildings, because not only it pertains to occupant’s well-being, but also, HOSPITALS are the most complex and most regulated of all building types. Our hospital Consultancy firm offer a useful blend of strategic thinking, practicality and creativity for, Healthcare entities seeking to cut costs, maximize staff efficiency, and increase in Patient satisfaction. No one person can reasonably have complete knowledge & expertise, which is why specialized healthcare project consultants play an important role in Hospital Planning and Design. Few points are worth mentioning here: ● First and foremost one needs to address the Circulation, that is, in-flow and movement of patients, visitors, doctors, technicians, nursing staff, both inside and outside of the building. 64

www.m e d e g a t e t o d a y. c o m July-Aug 2017

● Consultants should be knowledgeable about operational processes and departmental activities and needs (Emergency, Diagnosis and Treatment, Nursing Units, Labs, Pharmacy, ICU, Surgery Services, etc.), familiar with Healing process, medical equipment, Building codes, Fire regulations etc. ● Location of spaces for different departments and inter-linking is very important; if it is properly designed it can reduce unnecessary movement and stress on everyone. ● The role of a Healthcare consultant should be recognized in health care design. In most cases it is usually left to a non-specialized Architect without adequate exposure to the functioning of a hospital building. The result is a design that does not address the apparent and latent needs of functionality. This impacts not only operational costs but also compromised patient outcomes. Today, hospitals and healthcare providers feel that their major competition is other providers. In reality, the major source of competition to their business is when one hospital hires a project consultant and another doesn’t. Competition begins there. In conclusion hospital administrators and owners planning to either establish and new hospital or extend or renovate an existing one must seek expertise from hospital consultants, clearly articulating their goals and objectives, defining the focus areas and expected function of the hospital building. These must be validated by a proper feasibility study, proper demand analysis, facility plan and design brief. This will result in a facility purpose built those facilities the healing process, reduces stress and is economical for operation and maintenance. Although the inputs from physicians, staff, and management leadership are vital to the survival of a hospital, a well experienced team of professional consultants add the cutting edge required in taking a broader look at the project

given the experience of multiple projects they have. If leadership chooses to build a new hospital based solely on past success, there is no guarantee that the new hospital will bring in the same amount of business as the old one. We have a specialized team of Project consultants, project managers, Biomedical engineers, Operations experts and engineers to meet any healthcare project need. ●H ospitech healthcare consultancy is a specialized healthcare consulting and management firm with a successful track record of more than 7 years. ● We offer our clients independent advisory services, covering the full range from developing and implementing healthcare strategy to improving ongoing operations. Thus we share the commitment and the interest for the optimisation of all our clients’ requirements. Our customers include small, medium and large hospital players. ● Hospitech healthcare’s experience includes the completion of numerous successful consulting projects for important players in many cities/towns. ● We develop long-term relationships with clients, which is reflected by approx. 75% follow-up service orders from our customers. ● These relationships prove our clients' high level of satisfaction with our services and ensure a substantial amount of repeat business. ● Our experience in Feasibility surveys, Business planning, Hospital designing, operations & management, health management services and processes create value to healthcare facilities development, redesign, and renovation and optimization projects. ● We have been involved as lead consultant in the planning and design of several healthcare facilities ranging from 15 beds to 1000 bed facility with project volumes ranging INR 3 Cr to 58 Cr. ● The projects include hospitals (primary, secondary, and tertiary care), rehabilitation centers, ambulatory healthcare centers and long-term care facilities.

Supported by

MINISTRY OF MEDICAL EDUCATION GOVERNMENT OF MAHARASHTRA

Organized by

MINISTRY OF PUBLIC HEALTH AND FAMILY WELFARE GOVERNMENT OF MAHARASHTRA

“National Health Policy – A New Era in Healthcare” Confederation of Indian Industry (WR) is organizing the Premier edition of Healthcare Conclave 2017 on Wednesday, 23 August 2017 at Hotel Taj Lands End, Bandra, Bandstand, Mumbai chaired by Mr Joy Chakraborty, Chief Operating Officer, P D Hinduja Hospital. The Healthcare Conclave will be looking at the outcomes and Impacts of the National Health Policy which seeks to reach everyone in a comprehensive integrated way to move towards wellness and look at various aspects of it and hence the theme ‘National Health Policy – A New Era in Healthcare’.

Chief Guest:

Who will benefit: Industry professionals in the following areas:

     

Shri Deepak Sawant Hon’ble Minister of Maharashtra for Public Health And Family Welfare

Key Note Speaker for Valedictory Session:



Shri Girish D. Mahajan Hon’ble Minister of Maharashtra for Medical Education, Water Resources and Command Area Development

Panel Discussions

   

● Public Private Partnership

   

● Digital Healthcare ● Insurance Last Mile ● Primary Healthcare

Insurance & Re-Insurance Organisations Public / Private Insurance & Health Insurance Companies Public & Private Hospitals TPA 's Medical Associations Banks: Public & Private Venture Capitalists & Private Equity firms NGO's in the Healthcare space, Insurance Space Academia and Research Scholars Pharmaceutical and Medical Device Companies Consultants/ Planners / Marketing & PR Public & Private Sector organizations / PPP’s IT / ITES / BPO’s / KPO’s MSME’s / SME’s and Entrepreneurs Not for Profit / Non Profit Pharma / Healthcare / Providers

● Imperatives for hospitals in changing operating context MEDIA PARTNER

Registration Details : Participation Fee Per Delegate

CII/IWM/Yi & Industry Support Members For Non – Members For Academia For Foreign Delegates

Rs 2500/Rs 3000/Rs 1500/US $150

PLATINUM PARTNER MAGAZINE PARTNER

● Participation fee per delegate is inclusive of taxes ● 10% off on 3 or more delegates

Speaker and Sponsorship opportunity Raghavendra Pandey , Raghavendra.pandey@cii.in Ronit Dutta, ronit.dutta@cii.in

Registration Reshma Hinde, conferencewr@cii.in

https://ciihealthcareconclave.com/ For Further Details Please contact: Confederation of Indian Industry(WR) 105, Kakad Chambers, 132, Dr. A.B. Road, Worli, Mumbai 400018, India Tel: +91 22 2493 1790, 66611 1691 • Fax: +91 22 2493 9463, 2494 5831

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September 2017 | Dubai

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For inquiry: M: +91 8268002160 | E: partnership@et-bestbrands.com www.et-bestbrands.com/asianhealthcare

KEY HIGHLIGHT The Best Asian Healthcare Brands Coffee Table Book will be unveiled at The Economic Times India UAE Strategic Conclave 2017, under the patronage of His Excellency SHEIKH NAHYAN BIN MUBARAK AL NAHYAN, Cabinet Member and Minister of Culture and Knowledge Development, UAE

Asian Countries included in the study this year:

India

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