Sep_Oct_2018 by Zyaul Designer

EDITOR SPEAK

Medical Negligence of Medical Devices & Equipments: In past few years India has witnessed a spate of medical negligence cases though most of them were not intentional and were accidental in nature as human physiology has many variable parameters to deal with. So professional immunity must be considered. However, off late medical negligence is further compounded by faulty medical devices and equipment, which is quite worrisome and alarming as well. Unfortunately, this addition of medical negligence was never paid attention to earlier, rather was conveniently ignored. Medical devices and equipment manufacturers have a serious responsibility as one of the key stake holders in quality and safe healthcare. There is no denying the fact that these highly priced devices and equipment do make treatment costlier. Their pricing betrays key fundamentals of economics like economy of scale and breakeven point; hence prices do not come down throughout the product life cycle. It's an ignominious feat achieved by only medical devices and equipment manufacturers. In fact other industries after going past break even points acknowledge and keep on bettering prices. The reference to unreasonable price is not only economic one but has reflection on accountability and responsibility of whole healthcare ecosystem, as it checks the unnecessary haste in commercial launch of products and serious consequences thereof due to malfunctioning of medical devices and equipment. It's quite surprising that champions of healthcare quality have never raised the questions on performance track records of these devices & equipments, knowing it very well that clinical outcome/ healthcare delivery is not an isolated but integrated phenomenon. Medgate Today raises following questions:

Magazine

Volume - IX Issue - III Sep-Oct 2018 Editor Feature Editor Editorial Advisor National Head Honorary Editor Dy. Manager Sales & Marketing Subscription & Circulation Sales and Marketing

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☞ Why should Indian patients be "discriminately compensated” against their global counterparts' huge compensation? Does cost of life vary from place to place? ☞ Should not Premium pricing of implants merit Premium compensation? ☞ Should not medical fraternity be compensated as being customers their reputation has also been damaged at a time when their clinical competence is being questioned in these tough times of medical negligence? 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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Deepti Tripathi Asha Kumari Faiyaz Ali, Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath, Zyaul Haque Ansari

All right reserved by all everts are made to ensure that the information published is correct 'Medgate today’ holds no responsibility any unlikely errors that might occur. Circulation Office: Published by

☞ As a R&D obsessed organization as well as well connected with global medical fraternity, what made company management to avoid timely feedback on new hip implant’s performance ?

☞ Do ethics matter to company management only when it is questioned or it is matter of their commercial convenience?

Dr. ma Kamal Razi Ahsan, Neeraj Vats GP Capt. (Dr.) Sanjeev Sood Dr. Sharad Lakhotia Afzal Kamal Dr. Sarika Gupta

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☞ Why should company management discriminate Indian customers and patients?

☞ Why have they not located all Indian patients using faulty implants even in almost one decade since they acknowledged their faulty hip implants in UK & USA?

2018

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Sep-Oct 2018 Cover Story

WORLD

Dr Ramakanta Panda

Dr. Ashok Seth

Vice Chairman and MD of Asian Heart Institute, Mumbai

Chairman of Fortis Escorts Heart Institute, New Delhi

News Update

Experts urge to establish a “National Joint Replacement Registry” to regulate Medical Implants �� 18 Dr� Reddy’s Laboratories announces the launch of Neostigmine Methylsulfate Injection, USPin the U�S� Market �� 18 Knee replacements now last longer with affordable ‘Golden Knee’ implants �� 24 25 year old boy saves three lives by donating his heart, kidney and liver�� 26 Max Healthcare honored at Sixth Confederation of Indian Industry (CII) National Excellence Practice �� 26 Strengthen emergency medical teams for better response to disasters: WHO �� 28 Madhavbaug and Ruby Hall registers with CTRI for treating �� 30

INTERVIEW

Mr. Rajeev Chhabra

Saurabh Kochhar

Resident of Orthopaedic Implants CEO- Meddo Manufacturers Association (OIMA)

Ashwini Kumar Choubey Minister of State for Health and Family Welfare (Govt. of India)

Dr Gaurav Thukral

COO, HealthCare atHome

Shireesh Sahai

Mr. Jatin Mahajan Managing Director, J Mitra & Co Pvt Ltd

Mr. Neeraj Lal

(Vice President, Bangalore and Karnataka Region)

Ishaq Quadri

CEO - India/South Asia & lead China Consultant CIO, Secretary HIMSS, APAC Health Learning, Wolters Kluwer India Chapter and Visiting faculty at TISS

Doctor Speak & Expert Views

Dr Mudit Khanna

Orthopedic Surgeon, Wockhardt Hospital Mumbai Central

Dr. Astha Dayal

Senior Consultan, C K Birla Hospital for women

Dr Arun Bal

Consultant, Diabetic Foot Surgeon, A Fortis Associate Hospital

Hitesh Asrani

Founder & Director, CRP Risk Management

Dr. Abhik Banerjee

M.D. Pathology S Suraksha Diagnostic Pvt. Ltd.

Dr. Naresh Trehan

Chairman And Managing Director, Medanta – The Medicity, Gurgaon

Dr. Zile Singh Meharwal

Director, Cardiovascular Surgery at Fortis Escorts Heart Institute.

Dr. H.K. Chopra

Dr Suman Bhandari

Chief Cardiologist, Moolchand Medcity, New Delhi

Director, Dept of Cardiology, Fortis Hospital, Noida

Dr. Bheem Rao Sangars Sr. Consultant - Vascular & Endo Vascular Surgeon

Rajiv nath

Founder Co Ordinator Aimed

Vivek Tiwari

Founder, and CEO of Medikabazaar.com

Dr. Suman Bhandari

Director, Dept of Cardiology, Fortis Hospital, Noida.

Dr. Nityanand Tripathi

AD – Cardiology, HOD- Cath Lab, Max Super S, Hospital, Shalimar Bagh

Cover Story

How has poor lifestyle led to an increase in risk of heart diseases among youth, �� 52 Heart diseases are now a lifestyle ailment! �� 55 Proper diet for heart�� 59 How has poor lifestyle led to an increase in risk of heart diseases among youth �� 60

Doctor Speak

Mapping the brain with data science �� 65

Post Event

BMJ and Smile Foundation enter into a partnership for conducting health camps in Delhi & NCR �� 70 Lt� Governor of Delhi felicitates 16 healthcare professionals & institutions �� 71 Indian Healthcare Industry unites to Commit to Ethical Professional Conduct �� 72 4th Annual Healthscape Summit India �� 74 The 3rd annual conference in medicine �� 75

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INTERVIEW An Ambassador for Healthcare Reforms in India

No.1 Cardiac Surgeon

Dr. Ramakanta Panda

Enlist facilities available at Asian Heart Institute.

Asian Heart Institute is equipped with 12 ultra-modern operations theatres, 100 intensive care units, fully equipped modernised pathology services, radiology, imaging services (CT scan, MRI), 24hrs pharmacy services and cardiac ambulance service. The hitech cath lab at the hospital for cardiac and vascular interventional procedures- comes with features like unique stent boost, ceiling suspended system gantry, superb image quality, MRC X-Ray tube technology with unique spectral filtration and continuous sensing safety mechanism. The entire design of the cath lab is made patient-centric. The hospital also houses some of the world’s most sophisticated imaging and diagnostic technologies. Asian Heart Institute offers round-the-clock emergency services to the patients. The hospital has a patient-centric design with stress on safety and comfort of patients and relatives. All patient areas have been designed to minimize the risk of infection which globally, is the no.1 cause for deaths in hospitals.

State salient features of Asian Heart Institute Asian Heart Institute has several accreditations given by top notch global organisations. We are the highest accredited hospital in the country. Our results are among the best in the world, not just in the country. The hospital is accredited by JCI (Joint Commission International), NIAHO (National Integrated Accreditation for Healthcare Organizations) and ISO (International Organization for Standardization) Asian Heart Institute also has the lowest documented infection rates in India, which is on par with the best in the world. The hospital is recognised as the 'go-to' for almost inoperable, highly complex heart surgeries. Ours’ is also one of the few centers in the world conducting nearly all bypass surgeries on a beating heart, with almost 90% patients getting arterial grafts. Surgery on a beating-heart helps reduce the risk of complications associated with the conventional way of doing this surgery where the heart is stopped temporarily during the operation. Since its inception, the hospital has stood for honest opinion and ethical practice. Almost a third of patients who have been advised procedures elsewhere, are advised medical treatment at our hospital. Recently Asian Heart Institute has launched a campaign against the menace of cut practice. While lauding this effort of the hospital, the Government of Maharashtra has formed a committee to suggest suitable law to curb this practice. This effort of Asian Heart Institute has been supported by some of the most respected doctors in the country such as Dr Vijay DSilva, Dr Pradyot Kumar Rath and Dr Sunil Vanzara from Asian Heart Institute and Dr V 6

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Dr Ramakanta Panda

Vice Chairman and MD of Asian Heart Institute, Mumbai Dr Ramakanta Panda, world’s leading cardiac surgeon, is the Vice Chairman and MD of Asian Heart Institute, Mumbai. Known as the surgeon with the Midas touch, he has operated many high risk cardiac cases that are otherwise considered inoperable. Dr Panda was awarded the third highest civilian award –Padmabhushan – by the Government of India, for his contribution in the field of medicine. He has operated on several Parliamentarians, including ex-PM Dr. Manmohan Singh, Lalu Prasad Yadav and Rajya Sabha veteran D Raja. Dr Panda is also an ambassador for healthcare reform in India. His ethics-based campaign "Honest Opinion, No Commission to Doctors”, has found resonance with the State and Central Government, and also with the country's senior most doctors and healthcare institutions.

INTERVIEW Mohan, Dr Sanjay Nagral, Dr Samiran Nundy, Dr Soma Raju, Dr GN Rao, Dr Srinath Reddy, Dr Shiv Sarin, Dr Gautam Sen, Dr Devi Shetty, Dr K K Talwar and Dr Himmatrao Bawaskar. Asian Heart Institute will soon be launching a website portal to give a platform to honest doctors.

unnecessary treatments. It is recognised the world over as a model healthcare institution. We have India’s most revered cardiac team including Dr.Pradyot Kumar Rath, Dr. Sunil Vanzara, Dr.Tilak Suvarna, Dr. Nilesh Gautam, Dr. Santosh Dora and Dr.Vijay D’Silva.

Why Asian Heart Institute should be considered as No. 1 cardiac Awards and Accolades institute in India? 2016: Voted by consumers as ‘Trusted Asian Heart Institute’s clinical excellence derives from the tenets of providing a holistic approach to heart care based on ethics, expertise, experience, excellence and quality care. From the corporate sector, to the entertainment industry to the political bigwigs of the world, the hospital has occupied a pride of place in the Indian medical diaspora, when it comes to handling high-risk cases that even the best of international doctors do not attempt. The former Prime Minister of India, Dr. Manmohan Singh had a successful coronary artery bypass surgery by our surgical team in 2009. Similarly, RJD leader Laloo Prasad Yadav, Tarun Gogoi-former CM of Assam, and several other parliamentarians and business owners have come to Asian Heart Institute to embark upon a new journey of health.

Hospital 2016” (Reader’s digest), Recognized as India’s no.1 brand in cardiac care ( Economic times ) , Dr. Panda recognized as India’s No.1 Cardiac surgeon and one of the 25 living legends in Healthcare in India ( Medgate). 2014:Identified as the Best Single Specialty Hospital, Cardiology (Times of India Health Care Achievers Awards) 2013: Ranked amongst the top five cardiac hospital (Indiatimes.com), Ranked among the world’s 10 best hospital for medical tourists (Medical Tourism Quality Alliance) 2012: Awarded the Best Single Specialty Cardiac Hospital (CNBC). 2011-2012: Ranked as the Best Private Cardiac Hospital in India for 2 years (The week and Hansa Survey). 2009-2011: In an international benchmarking study, AHI results were number one among all globally participating hospitals. The team specially chosen for the then hon’ble Prime Minister Dr. Manmohan Sigh’s complex Redo Bypass Surgery and Post – operative care.

In just 15 years since its inception in 2002, the hospital has treated more than 3,30,000 patients, and has completed over 40,000 angiographies, 22,000 high risk heart surgeries, and more than 3750 complex cases. AHI has a staggering success rate of 99.3% in treatment of cases considered What are the different cardiac almost inoperable elsewhere and overall programs conducted at Asian 99.83% success rate in bypass surgeries. Heart Institute? These success rates are among the highest In September 2016, Asian Heart Institute in the world. in Association with Maharashtra Asian Heart Institute is widely Government and Mumbai Police launched acknowledged as 'The Best Private a massive Mumbai Heart Healthy City Cardiac Care Hospital ' in India in Progamme for Mumbai Police, to provide multiple surveys. It has set a benchmark free heart health assessments to thousands in quality care, ethical practice and of Mumbai police personnel who work imparting world-class training for those round the clock to secure India’s financial who are in the profession. The hospital is capital. This initiative, which will cover as known for its ethical practices in offering many as 5000 policemen in its first phase, honest opinions and not conducting any will include a detailed assessment of risk

factors, a complete heart focused health check, pathological tests and medical mapping from the cardiac perspective for all these policemen. As an extension of our Mumbai Heart Healthy city initiative, of which heart risk mitigation and heart health awareness is the key focus, the hospital has also initiated a Cardio-pulmonary-resuscitation (CPR) training for the city population. As a part of this campaign, the hospital is planning to train 5000 Mumbaikars this year, including 1000 police personnel, and 25000 Mumbaikars over time in Cardiopulmonary-resuscitation (CPR). Asian Heart Institute, in association with Municipal Corporation of Grater Mumbai (MCGM) launched Jaanbachao.in- a campaign to promote healthy lifestyle featuring Akshay Kumar in Mumbai last year. The campaign is aimed at creating awareness on prevention of noncommunicable diseases (NCDs) such as diabetes, hypertension and heart diseases. As per the WHO report of 2015 Noncommunicable Diseases (NCD) Global Survey, 1 in 4 Indians face the risk of death from an NCD before they hit the age of 70. As a part of this campaign, a short film motivating citizens to adopt a healthy lifestyle was premiered at the launch. The film, directed by noted filmmaker Rajkumar Hirani, and featuring Akshay Kumar, highlights simple tips which can be easily followed by people as a part of their daily routine.

What are the upcoming projects and expansion plans? Asian Heart Institute, Mumbai has plans to double its present bed capacity. The hospital has purchased 2.5 lakh square feet of FSI for expansion. “At Bhubaneshwar, we are planning to build a 200-bed super specialty hospital. Our ultimate aim is to expand it to 400beds. The land has already been acquired,” shares Dr Ramakanta Panda, Vice Chairman, Asian Heart Institute. w w w.medegatetoday.com Sep-Oct 2018

INTERVIEW India is reeling under this menace of heart attacks and coronary artery diseases, near 50% of death in the world from heart attacks are happening in this country. World is celebrating World Heart Day on 29 September, what is your message to the masses?

Dr. Ashok Seth is the current Chairman of Fortis Escorts Heart Institute, New Delhi and Head, Cardiology Council of Fortis Group of Hospitals. His contributions in the field of Cardiology, especially Interventional Cardiology have been recognised extensively in India as well as across the world. During his career span of 30-years, he has pioneered numerous angioplasty techniques Directional Atherectomy, Angioscopy, Stents, Thrombectomy devices and Drug Eluting Stents, use of Impella heart support device failing heart, Bioabsorbable Stents and TAVI and implemented it successfully both in India and other regions in Asia Pacific. He has performed one of the highest number of angiographies and angioplasties which has been mentioned in the 'LIMCA Book of Records'. For his pioneering work in the field of Cardiology Dr Seth has been awarded with Padma Bhushan, Padam Shree and B C Roy Memorial award along with many national and international recognition. 8

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My message to the masses is that all need to realize that heart disease is the biggest killer. If you look around you, this is one disease process that either your close relative or a close friend has already suffered from heart disease or heart attacks. So, any day despite the fact that we feel that we are protected we ourselves can be stricken by heart attack. At the moment India is reeling under this menace of heart attacks and coronary artery diseases, near 50% of death in the world from heart attacks are happening in this country. So, the message is that we ourselves can be prone any day to heart attack and it is not a treatment of heart disease and the advancement of the treatment of heart diseases which is important at the moment, it is preventing heart diseases, which is important now. If we are able to prevent heart disease, we would be able to protect ourselves from this menace which could affects us at any stage and to prevent heart diseases it is in our hands. We always believe that government initiatives need to be performed for the prevention of most diseases process but I can assure you that protection of heart diseases is totally in our hands. It relates to regular exercise, staying active in our daily lives, eating the right food, takingnatural processed vegetables& fruits and avoiding fatty and fried food stuffs, avoiding trans-fats, saying no to the smoking and most importantly to smokers as well because it has been shown that even if you sit around the smoker you can actually like end up, its almost like smoking a cigarette yourself, taking care of your diabetes and hypertension. So my message to the masses is heart disease can strike us any time, we got to prevent it and the prevention of heart disease is in our hands. This year world heart day theme is “My heart is your heart’’– Please describe in your words? So this theme of “My heart is your heart”is about saying to ourselves that we care about our heart and the hearts of people around us. We want to do right things so as to keep our heart healthy and to keep your heart healthy. This is very important for those who are living in the community,at the work places, making sure that you encourage active life style not only for yourself but for others as well. We should discourage smoking to others and also smoking in public places. We need to inculcate an atmosphere where everyone wants to take care of their heartsthat is what is the importance of ‘’my heart is your heart’’. It also emphasizes to the healthcare professionals to save more lives and work harder to prevent heart diseases. It influences policy makers to keep understanding that non-communicable diseases

INTERVIEW control is important and that we should wake up every day with a simple promise to our own ourselves that I will take care of my heart and I will take care of other people’s heart. That is how we will make India heart healthy. Now a days not India whole world is facing cardiovascular diseases continues to be the leading cause of death and disability in the world today? Please elaborate and give your expert opinion on this? Yes, coronary artery disease is a biggest killer but in the western world over the past 30 years deaths from coronary artery diseases have actually decreased by 50% while in the Asia Pacific especially in Asia and in India deaths from heart disease have increased and presence and incidence of coronary artery disease had grown by 300%. And most of the reasons involvedaround are the changing lifestyle and the artificial food habits which have come in. Certainly smoking has increased in the public is one of the important parameters but lack of activity, lack of exercise, using more of transport like motorcycle & cars has led to obesity, eating out hasincreased and most of the foods that we have foundin various restaurants and eating places outside could be high in trans-fats which are harmful to the heart and influence coronary artery disease. Obesity has led to diabetes, hypertension which effectsone fourth of Indian population and has also contributed to increasing heart diseases. Stresses of lives have increased tremendously over last 30 years. Life has become more competitive and that has resulted in increasing coronary artery diseases and not to be forgetting the fact that pollution has also contributed and known to contribute to development of blockage and pollution has increased in most of our cities. So, really as we have grown more and more modern we have imbibed the vary ingredients which has actually increased the incidence of developing coronary heart diseases. And therefore we have to have this realization that it is our heart and our life depends on our heart. It is like an engine which keeps us alive and keeps us going and if heart damages, our life gets shortened and we can even die. That’s why we have to protect our heart and we have to protect everyone’s heart.

What are the latest advancements incardiology? Latest advancements in cardiology relate to more and more non – surgical treatment of many heart diseases. Certainly in the field of valve disease, catheter based technologies with minimally invasive approach in conscious patients are moving towards either changing the valve of the heart like TAVR or Transcatheter Aortic Valve Replacementand also proceeding to changing the mitral valve or treating leaking valves with a transformational procedure called Mitraclip. These procedures are now moving to even replacing other valve of heart with minimally invasive or even catheter based procedures done in the cath lab even in conscious patients with mobilization the very next day. In term of Coronary artery disease numerous tests to predict heart attacks are been worked on and genetic markers are been researched to identify those individuals well in advanced

who could develop coronary heart diseases in their life and therefore steps could be taken much earlier to prevent it. So, the future is exciting and in the next ten years we will see the further revolution in diagnostic, prediction and management of heart diseases as well as heart attacks. What is your take on Ayushman Bharat? Can this reduce heart disease burden of India and improve the healthcare scenario? I think Ayushman Bharat is a great initiative and very respectful for the thought which have been put inby the Government of India. To launch, this extremely important welfare scheme which is unprecedented perhaps in any Country of the world, half of a billion people would be ensured and get amazing options of having disease processes treated in a very comprehensive manner. The advantage of such a scheme is that individuals once registered can actually have treatment in any hospital anywhere in this country. States are able to modify the schemes to suitthe public on their own states and I think there is a lot of prevention in to the scheme. Also,it acts at the grass-root level of a primary center which are going to be made better to look after patients with diabetesand high blood pressure. If at primary level through Ayushman Bharat we can take care of diabetes and high blood pressure at a grass-root level, we would actually help in prevention of heart diseases because these are two most important risks factors for developing heart disease and strokes. So, I think this is animportant move in healthcare sector for not just enabling treatment of heart diseases for public but also for prevention of heart diseaseby taking care of diabetes and hypertension at multiple levels including primary care centers. What is going to be very important as we move forwards to ensure that patients not just get lowest and affordable treatment but also get the right quality of treatment. There is no reason that a person living in a smaller town or in a village if he has a heart disease or a heart attack should get any inferior treatment compare to what he is been given at the high centers like Fortis Escorts Heart Institute. We wish that our systems would strengthens up in the future through Ayushman Bharat Scheme to not just look at the cost but the quality to be given to the patients. In the most countries where government schemes have been initiated, a very important aspect to be looked at is not just a patient who had the treatment but also that patient remains well after treatment and that he continues to do well, whichis called the ‘quality outcome measures’. The results of treatment, looking at the success of that how many patients got treated and the fact that there should be no re-admissions of patient for further treatment, that’s when wecan actually saythat our masses will not just have best from Ayushman Bharat Scheme in future, affording the highest level of treatment but also highest quality of treatment. I am sure that as this AyushmanBharat proceeds these are the very factors which are going to be looked into.

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COVER STORY

Population of cardiovascular patients rising rapidly, the disease is afflicting younger people in their peak years of life

Latest Advancement & Management of Heart Diseases

and Diabetes. These are the key points to remember to keep a healthy heart and lead a happy life.

How affordable is cardiac surgery as govt. capping price on stent and various implants? People across the globe are facing cardiovascular disease (CVD) & mortality rate is increasing every year, what is your suggestion on this?

Dr. Naresh Trehan Chairman And Managing Director Medanta – The Medicity, Gurgaon

World Heart Day 2018. World Heart Day takes place on 29 September every year; this year theme is “My Heart-Your Heart”. Please give your insight on this? The theme for World Heart Day this year is ‘’My Heart, Your Heart’’. It seeks our commitment to care for our own heart and of our loved ones by adopting healthy lifestyle habits such as getting more active, saying no to smoking or eating a healthier diet. In India, half of all reported heart attacks occur in people under 50 years of age; of these 25% occur in those below 40 years. Not only is our population of cardiovascular patients rising rapidly, the disease is afflicting younger people in their peak years of life. This has a debilitating effect on our working population, our health as a country and our overall development. If the trend continues, we are staring at a grim future. There is thus an urgent need to drive action around the various aspects of heart care. These include early detection and prevention, affordability of treatment, heart health cover and more public awareness. We will be able to combat heart diseases as a nation only when there are concerted efforts towards addressing these factors. 10 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

According to a recent study published in the Journal of the American College of Cardiology, while the mortality rate due to cardiovascular diseases (CVDs) declined by 41% in the USA over the last 15 years, it rose by 34% in India. Apart from non-modifiable factors like age, gender and genetics, the risk factors for CVDs include high blood pressure, diabetes, deranged blood lipids, smoking, physical inactivity, obesity and stress among others. Even though people are aware of the risk factors, most of them get ignored till their condition worsens. Urban lifestyles need to be modified to reduce mortality rate due to CVDs. At Medanta, our focus is on disease prevention. We believe that if people can be diagnosed at an early stage when the progression of heart disease can be arrested or reversed, the healthcare expenditure will decrease and many more lives can be saved.

What are preventive measures or life style change that can be adopted for healthy heart? Cardiovascular diseasesto a great extent can be prevented with lifestyle changes. Making simple changes in what you eat, how often you exercise, how much you weigh and how you best manage stress can help put the brakes on the disease. One should learn not to give into the temptation to consume oily, sugary and junk food items, especially after the age of 40. Know your genes (family history), exercise at least 45 minutes a day, work towards de-stressing, keep your weight under in check, stop tobacco abuse in any form and control your Blood pressure

30 years back when we started doing coronary artery bypass surgery on a large scale in India, the cost of the procedure was about one lakh rupees. Over three decades, the cost has only grown. And this is the minimum price one has to pay if they want world-class quality, including expertise, equipment and consumables. However, we are cognizant that in the absence of organized insurance, this is still unaffordable for amajority in Indians. With insurance becoming more accessible and the government introducing schemes such as Ayushman Bharat, affordability will hopefully get addressed.

What is your take on Ayushman Bharat? How this scheme will help poor to prevent cardiac diseases? Ayushman Bharatcan exercise a transformative impact if implemented in an effective and coordinated manner. Under this initiative, the government will offer 500 million unprivileged people access to government and private healthcare facilities. It is important for the government and industry to develop partnerships with a focus on improving coverage and providing access to quality healthcare services to the people. A continuum of care systems also needs to be established by linking hospitals with health centres and with the community.

How Medanta will help in this to full fill the Ayushman Bharat scheme? As a responsible and committed partner in the country’s healthcare agenda, Medanta has always contributed extensively in addressing public health. We support the Ayushman Bharat initiative and are working with relevant stakeholders to address its operational aspects so that it can be activated in an efficient manner to realize its objective❏

INTERVIEW

In Conversation with Expert Heart Transplant Surgeon - DR.Z.S. Meharwal Dr. Zile Singh Meharwal Director, Cardiovascular Surgery at Fortis Escorts Heart Institute.

Heart transplant is used to treat severe, end-stage heart failure, which can be caused by damage to the heart from congenital heart defects, coronary artery disease, heart valve problems and infections. When a patient required a heart to transplant?

A heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. Heart transplant is a treatment that's usually reserved for people who have tried medications or other surgeries, but their conditions haven't sufficiently improved.

Patient needs heart transplant when he/she is in advanced heart failure with very poor heart function (poor ejection fraction) and continues to remain in heart failure in spite of best medical therapy. Certain tests need to be performed before transplant to know whether patient needs transplant or not and whether patient is suitable or not for transplant. The process to put a patient under heart transplant list is critical. There are guidelines and protocol that we follow to put a patient under the list. The evaluation of a cardiologist and cardiothoracic surgeon is must. We set up team to evaluate and keep the patient under radar of good health. Unfortunately we canâ&#x20AC;&#x2122;t help patient till a heart is available for transplant all we must do is to provide best care for them.

What is the success rate of heart transplant?

Success rate of transplant is about 95%.

What is heart transplant? Is it complete migration of heart?

A. Heart transplant is a surgical procedure where damaged heart of the patient is removed (explanted) and heart from brain dead donor is transplanted into the patient. The process is full migration of heart from donor to recipient within 5 hours of time. 12 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

What type of donor required for the heart transplant?

A. A patient who has suffered permanent brain damage (brain dead patient) donates heart and other organs. Certain tests are required to certify the patient as brain dead. The blood group of donor should match with the blood group of recipient. Also, there should not be too much of disparity between weight of donor and

recipient. There are set protocols that we follow before going for transplant. The harvesting team who has gone to fetch the heart is skilled and comprises of doctors and technicians who bring the heart back within time limit.

How many heart transplant done by Dr Meharwal & team?

Dr Meharwal and team has performed 10 successful heart transplants at Fortis Escorts Heart Institute, New Delhi. In the most recent transplant, donor was in Bangalore and the heart was retrieved and transported to Delhi by creating two green corridors.

Your message on World Heart day?

A. I wish everyone a happy world heart day. I would appeal to everyone to have a good life style to keep heart healthy and live a healthy long life. I will also appeal to everyone to pledge their organs so that the life of patients for whom transplant is the only option can be saved.

What are the tips to keep one heart healthy?

If somebody has risk factors for developing heart disease. He / she should control those risk factors which include diabetes, high blood pressure, high cholesterol and obesity. One should also have a healthy life style which will include healthy diet, no smoking and regular exercise. Regular routine checkup is also recommended.

COVER STORY

Reduce the Burden of Cardiovascular Disease in India: Ayurveda or Mind Body concept and Heart attack

Dr. H.K. Chopra Chief Cardiologist, Moolchand Medcity, New Delhi

The prevalence of Cardiovascular disease in the world is 1,75, 00,000, and is rising rather steeply in our country. 1 in 10 die from Cardiovascular Disease daily between the age group of 30-70. 31% of all the deaths are from cardiovascular disease. To a very large extent, heart attack is self-inflicted by our faulty lifestyle, which we adopt right from the childhood. The prevalence of Coronary Artery Disease in adults in India in the urban population is 14 percent, while in the rural population it is 8 percent. 14 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

According to Ayurveda we exist on many levels such as physical, mental, emotional and spiritual. Positively based lifestyle changes have a positive influence on the health of the heart. Ayurveda teaches us that the healthy heart is an expression of dynamic stream of intelligence and the consciousness give rise to this reality. By changing your perception in the presence you can change your life for tomorrow. You can experience in the beating of your heart, in your breathing, in your digestion, in your thinking and flow of energy in your muscles etc. The quantum mechanical body is comprised of our existence in three ways. Ayurveda refers to these as the physical body, the subtle body and the causal body. These are all software of our existence. Matter and energy are components of physical body. It is born, lives and then disappears at our death, when the atoms and molecules disperse. Infact the atoms of our bodies are constantly dispersing and are being replaced. The subtle body comprises of thoughts and feelings that exist beyond the limits of physical body. This is also a space and time event and its self life is little longer. Beyond the subtle body is the causal body, which is a unit of perfect order, and it encompasses all the space time events. In a way it is analogous to the genetic programming from which the nature of each individual derived. It is a greater field of energy and intelligence from where everything begins. It is both subjective and objective. It is the knower, the process of knowing and the known. Ayurveda calls this as a vast interconnecting network of energy and information, which is constantly flowing and changing. The heart is not just a pump whose welbeing depends on the fuel that is put into it. Every aspect of your perception, thoughts, interpretation

and experience and choices have their influence on the health of the heart. It is therefore necessary to have the self awareness to maintain a healthy heart and recognize heart disease in early stages so that they can be reversed. Diagnosing a coronary artery disease to an Ayurvedic Physician means knowing and understanding the patient and not the disease. When the true nature of the patient is know and only then and illness can be understood and treated at the most fundamental level. Thus understanding of patientâ&#x20AC;&#x2122;s mind body system can prevent imbalance from ever reaching the point where symptoms become manifest. Thus mind body intervention for a healthy heart is such an approach so that illness of coronary artery disease is prevented at a primary level first and then at secondary level. It also help us in analyzing the unique physical, emotional and spiritual makeup of an individual, so that an individualistic approach of a lifestyle such as work plan, exercise plan, diet plan, stress management protocol, sleeping profile, meditation, massage therapy and other modes of therapy can be instituted according to individuals mind body constitution. According to Ayurveda or Mind Body Medicine each of us is born with a unique proportion of three doshas, which creates us physical, intellectually and emotionally. If an individual has balance in these doshas then they remain healthy. Any fluctuation in the proportion of doshas because of the negative stress may increase the vulnerability to physical illness and emotional instability. These threes dosahs are know as vata, pitta and Khapha. Vata dominant persons mind body system if in balance then he or she may be creative, vibrant and enthusiastic and if the vata imbalance exceeds the normal then and individual is very anxious, sleepless, restless, irritable

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with lot of negative emotions which directly influence the health of the heart and increase the tendency for palpitation and arrhythmia and has less significant coronary artery disease than pitta and kapha imbalance. On the contrary if a person is pitta dominant then imbalance when exceeds the normal give rise to jealousy, negative competition, resentfulness, revengefulness, anger impatience and irritability which may influence the health of the heart by premature athersclerosis of coronary arteries and by inflammation of the arterial wall producing premature heart attack. Kapha imbalance when exceeds the normal give rise the lethargy and overweight and thereby affecting the heart by increasing the tendency for hypertension dyslipidemia and wide range of destructive emotion such depression procrastination and self pity. Our heart both literally and figuratively if congested with anger doubt, fear hostility, cynicism, irritability, repression due to dosha imbalance may produce premature coronary artery disease. It is therefore necessary that all the doshas should remain in balance to have a healthy heart. One should identify the emotion, be mindful of the physical sensation in your body, take the responsibility of what your experiencing, express what you have feeling in private and let go of the negative emotion through some personal ritual and then share your feeling with another persona and celebrate and rejuvenate.

Mind Heart Connections: The mind and the heart both are directly and indirectly connected. Direct connections exist through the autonomic nervous system, which can influence the heart rate and rhythm as well as blood pressure. Indirectly, negative emotions such as fear, jealousy, hostility, cynicism, negative competition, hard driving person, dead line oriented, highly demanding individuals, frequently angry individual so called type A personality release hormones such as adrenaline and nor-adrenaline and increase the vulnerability to heart attacks. This causes aggregation of platelets and activates clot formation. Every thought in the mind, either pain or pleasure, hope or fear,

love or hate, influence the heart. A four years study of middle aged men who expressed hopelessness about their future had 20% greater increase in narrowing of the coronary arteries as compared to those who were more optimistic. Negative psychological factors produce stress hormones, which precipitate pre mature angina and heart attack. Loss of social support such as divorce, death

of the spouse, loss of job or retirement, loneliness and frustration may all precipitate heart attack has been well documented in the research data. Central obesity (pot-belly) has been documented as one of the risk factors for premature Coronary Artery Disease. Normally, the waist and hip ratio is normally more than 0.95 in males, and 0.83 in females. The girth of waist in males should be less than 40 inches and in females, it should be less than 36 inches. “Longer the waist line, shorter the lifeline and vice-versa”. Morbid obesity is a higher risk for many illnesses such as heart attack, hypertension, diabetes, cancer etc. Perfect weight management may halt the menace of morbid obesity by regular exercise, yoga, dieting and meditation and mind body balance strategies. Physical inactivity – lack of exercise is also one of the risk factors for Coronary Artery Disease. It has been documented in one of the studies in U.K that the incidence of Coronary Artery Disease is higher in postmasters than in postal clerks, and it is higher in bus drivers than in bus conductors. Regular physical exercise, especially aerobic exercises such

as walking, wogging, jogging, cycling, swimming, dancing and skiing, increases the myocardial efficiency, reduces blood pressure, improves cardiac output, decreases peripheral vascular resistance and produces new collateral vessels (natural bypass), thus help in bypassing the bypass surgery. Exercise, especially walking for twenty minutes every day, keeps heart attack away. Exercise also reduces bad cholesterol, increases good cholesterol and reduces obesity. One should never do any unaccustomed exercise, as it may carry a risk of premature heart attack. The best exercise after the age of 40 is brisk walking, on a daily basis, in a beautiful, lush green garden, which will energize you. One should avoid anaerobic exercises such as weightlifting, pushups, etc. as they increase the tendency for hypertension. I firmly believe in “use your body or lose it”. Diet - A diet rich in saturated fats and cholesterol can raise blood cholesterol. These foods include oils rich in saturated fatty acids, such as palm and coconut oils, fatty foods of animal origin such as beef, pork and lamb, and high fat dairy products such as butter, whole milk, hard cheese, egg yolk, etc. It is recommended that one should consume a lot of vegetables, fruits, cereals and pulses, and for a non-vegetarian diet, one can have chicken without skin, and fish, which contains Omega-3 fatty acids, which are protective for the heart, low fat dairy products such as skim milk, and low fat yogurt, etc. Olive and Canola oils are monounsaturated oils and may be even more beneficial in reducing blood cholesterol than polyunsaturated oils. Avoid excess consumption of salt. Frequent outdoor brunching, lunching and munching should be avoided. Eating the right food at the right time, in the right place, in the right manner and in the right dose, makes the heart healthy. We are what we eat! Avoid saturated fats and take more of monounsaturated fats (MUFA) and polyunsaturated fats (PUFA). Refined oils are better cooking media than saturated fatty acids. Eating healthy food at a right time, at right place can influence our body metabolism, w w w.medegatetoday.com Sep-Oct 2018

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According to Ayurveda, eating is a holy experience in which energy and information from the environment are converted to life energy. We must eat when we are settled in our mind and we should experience not only the taste but also the sight, smell, texture of the meal. “ We are what we eat. What we eat is important, but what is eating us is much more important.” Uncontrolled diabetes increases the risk of Coronary Artery Disease by virtue of increasing the oxidation of low density LDL cholesterol, and hence it enhances hardening of the arteries. Adequate control of diabetes prevents Coronary Artery Disease. Hypertension is a medical term for high blood pressure, which threatens not only coronary arteries but also brain, eye and kidney arteries. Blood pressure increases the load on the heart muscle, which has deleterious effect on the circulation in the coronary arteries. Both systolic and diastolic hypertension is equally hazardous for premature coronary artery disease. Uncontrolled high blood pressure may increase the thickness of heart muscles and reduce coronary circulation. 80 percent of uncontrolled, moderately hypertensive patients have definite Coronary Artery Disease. Thus, blood pressure, both systolic and diastolic, should be adequately controlled. “Hypertension is a silent killer.” The common predisposing factor for accelerated hypertension are stress, excess of salt consumption, obesity, uncontrolled diabetes, indiscriminate use of nasal drops containing ephedrine, excessive smoking, excessive consumption of alcohol may precipitate hypertension. Mind body interventions such as yoga, meditation, exercise, massage therapy, sattvic diet, weight management, stress management, adequate sleep may help in managing the hypertension. Various non-modifiable risk factors for Coronary Artery Disease include advancing age, which causes hardening of coronary arteries. Male sex has higher vulnerability for premature coronary artery disease because of there faulty 16 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

lifestyle including sedentary habits, faulty eating habits such as consuming junk food, high levels of stress at work. Postmenopause states in women are equally at risk for a heart attack as men due to depletion of the oestrogen hormone. The higher risk group for women includes post menopausal, diabetic, smokers and obesity. Family history is also a very important factor for all people before the age of 50. However, modifiable risk factors are much more important then genetic predisposition. Fear of a coronary artery disease motivates many people to change their lifestyle but I must emphasized the fear motivated behaviour cannot be successful on long term basis. Fear of eating, exercising should not create any king of anxiety which has more deleterious effect on our system. We must always consider the physiological benefits of a lifestyle change by considering its emotional and spiritual origins.

8 Points Programme for your and my Heart. ☞ Promise to Exercise daily for 30 minutes. Avoid unaccustomed exercise. “Use it or loose it”. ☞ Promise to Eat the right food, at the right time, at the right place, in the right manner, in the right dose, in the right environment. Eat only when you are hungry, eat freshly cooked food in a quiet relaxed atmosphere and eat slowly and don’t eat when you are upset and avoid overeating. Have sattvic vegetarian food and not tamsic or rajsic food. All 6 tastes including sweat, sour, salty, bitter, pungent and astringent should be included in every meal. As most of the coronary artery disease are pitta or kapha imbalances. Eat more natural foods such as

vegetables, fruits, salads and nuts including walnuts & almonds, etc. Do not eat junk food such as fried food or sweets, etc. “You are, what you eat” ☞ Promise not to smoke or chew tobacco. “Tobacco or Health, You can’t have both” ☞ Meditate 20 minutes in the morning and evening and practice yoga. “Meditation is superior to medication” ☞ Maintain optimum body weight. Avoid a “pot-belly” abdomen. “” “Longer the waist line shorter the lifeline.” ☞ Remain cholesterol-fit. ☞ Promise to be emotionally stable. Don’t burn both the ends of the candle at the same time. Have adequate rest for 6-8 hrs everyday. Avoid lust, anger, greed, ego and attachment. Be honest, truthful and dedicated for work.Have good social support system. Work with self-referral and not with object referral. Don’t feel lonely. Have perfect choices to achieve any goal in a very peaceful manner. Develop intimate relationship.Become an embodiment of positive emotions such as love, compassion, humility, faith, confidence, peace, harmony, bless and happiness. Have planned daily routine and set weekly, monthly and yearly plans. Laughter is tranquillizer, energizer, stabilizer, equipoiser, happinessiser, equalizer. It is an experience of divinity for Healthy Heart.

“What you think & eat matters but what is eating you matters more ” ☞T ake antioxidants, folic acid, Co Q10, lycopene, Omega 3 FA, Vitamin D on daily basis especially after the age of 55. “Optimize your lifestyle to energizes your heart”

NEWS Update

Experts urge to establish a “National Joint Replacement Registry” to regulate Medical Implants Given the ‘faulty hip implants’ of Metal and Metal prosthesis made by Johnson & Johnson (J & J) that were put inside some 4,700 patients, four of who died, and 3,600 of whom could not be traced, medical experts urge the government to establish a national joint replacement registry to regulate medical implants and drugs for the patients safety. Dr. Raju Vaishya, Senior Joint Replacement Surgeon, Indraprastha Apollo Hospital, and President of Indian Cartilage Society (ICS) said that it is ironical that although about 4,700 patients received the ‘faulty hip implants’ in India, over 3,600 of them remain untraceable. The J & J Company has said that only the hospitals would have this data. However, it is not difficult to identify these patients from the hospital data, where these joints were supplied. “Incidentally, there is no government body like National Joint Replacement Registry in our country, though the formation of such a body was suggested, many years ago. But, the Central Drugs Standard Control Organization (CDSCO) did not take any timely action on this matter, despite knowing the problems related to these implants since at least 2010. It is, therefore, a gross regulatory failure, on the part of our Government Regulatory Authorities” said Dr. Raju Vaishya.

Dr. (Prof.) Raju Vaishya, said that he had voiced and highlighted the issue of ‘faulty hip implants’ in 2012 through a letter published in The Journal of Arthroplasty. This letter was written in response to a research paper “Hip Resurfacing Arthroplasty in Inflammatory Arthritis: A 3 to 5 Year Follow-up Study” by a team of Orthopaedic surgeons of AIIMS. r. Atul Srivastava, Secretary, Indian Orthopaedic Association (IOA) also agreed to the idea of setting such a national body, which may be called National Joint Replacement Registry or National Healthcare Data Storage and Management Committee so that the use of faulty implants or medical devices should be stopped. Dr. Rahul Gupta, Additional Director, Brain and Spine Surgery, Fortis Escorts Heart Institute & Research Centre, New Delhi said that more catastrophic failures of medical implants & devices are "almost guaranteed" to happen because there have been no significant reforms on the way in India, which regulates medical implants. Dr. R. N. Kalra, Medical Director of Kalra Hospital & SRCNC, New Delhi said that there are established systems in most developed countries where the doctors and patients can register their opinion and complain about any adverse effect of any

implant or drug. Hence, the government authority can immediately know, if there is any flaw in them but in India, there is no such apparent system. The Metal on Metal prostheses (ASR) was manufactured by a subsidiary of J & J and secured approval for sale and use in patients in India in 2006. In December 2009, the product was recalled in Australia, due to an unacceptable incidence of early complications related to these artificial hip joints. This recall became global in August 2010, yet India waited till 2017 to set up a committee to investigate it. It submitted the report in February 2018, recommending at least Rs. 20 lakh compensation for each patient, and the reimbursement by the company for all the costs related to their revision surgeries till August 2025.

Dr. Reddy's Laboratories announces the launch of Neostigmine Methylsulfate Injection, USPin the U.S. Market Dr. Reddy’s Laboratories Ltd. (BSE: 500124, NSE: DRREDDY, NYSE: RDY, along with its subsidiaries together referred to as “Dr. Reddy’s”) todayannounced the launch ofNeostigmine Methylsulfate Injection, USP, a therapeutic equivalent generic version of Bloxiverz(Neostigmine Methylsulfate) Injection approved by the U.S. Food and Drug Administration (USFDA). The Bloxiverz brand and generic had U.S. sales of approximately $111million MAT for the most recent twelve months ending in July 2018according to IMS Health*. 18 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

Dr. Reddy’s Neostigmine MethylsulfateInjection, USP is available in 5 mg/10 mL and 10 mg/10 mL multi-dose vials.

NEWS Update

Medical Negligence of Medical Devices & Equipments: J & J hip implants issue, a timely reminder. Recent raging controversy surrounding J&J ASR hip implants and company’s selective silence in global markets and delayed acknowledgment of its faulty product in Indian market has raised many questions. Medgate Today as vigilant fourth estate in healthcare tried to reach J& J officials but they refused to comment, hence we raise following questions in the interest of Indian patients & medical fraternity

n past few years India has witnessed a spate of medical negligence cases though most of them were not intentional and were accidental in nature as human physiology has many variable parameters to deal with. So professional immunity must be considered. However, off late medical negligence is further compounded by faulty medical devices and equipment, which is quite worrisome and alarming as well. Unfortunately, this addition of medical negligence was never paid attention to earlier, rather was conveniently ignored. Medical devices and equipment manufacturers have a serious responsibility as one of the key stake holders in quality and safe healthcare. There is no denying the fact that these highly priced devices and equipment do make treatment costlier. Their pricing betrays key fundamentals of economics like economy of scale and breakeven point; hence prices do not come down throughout the product life cycle. It's an ignominious feat achieved by only medical devices and equipment manufacturers. In fact other industries after going past break even points acknowledge and keep on bettering prices. The reference to unreasonable price is not only economic one but has reflection on accountability and responsibility of whole healthcare ecosystem, as it checks the unnecessary haste in commercial launch of products and serious consequences thereof due to malfunctioning of medical devices and equipment.

It's quite surprising that champions of healthcare quality have never raised the questions on performance track records of these devices & equipments, knowing it very well that clinical outcome/healthcare delivery is not an isolated but integrated phenomenon. Medgate Today raises following questions: ☞ Why should company management discriminate Indian customers and patients? ☞ As a R&D obsessed organization as well as well connected with global medical fraternity, what made company management to avoid timely feedback on new hip implant’s performance ? ☞ Why have they not located all Indian patients using faulty implants even in almost one decade since they acknowledged their faulty hip implants in UK & USA? ☞ Do ethics matter to company management only when it is questioned or it is matter of their commercial convenience? ☞ Why should Indian patients be "discriminately compensated” against their global counterparts' huge compensation? Does cost of life vary from place to place? ☞ Should not Premium pricing of implants merit Premium compensation? ☞ Should not medical fraternity be compensated as being customers their reputation has also been damaged at a time when their clinical competence is being questioned in these tough times of medical negligence? ☞ Should not regulations be made more stringent and comprehensive to prevent such reoccurrences in future? ☞ Should not all new products & technologies be assessed & allowed to commercialize based on their patient safety / clinical trial data for some specific period? ☞ Should not medical fraternity educate patients on all possible options of implants "in writing” with all comparative parameters in place? All stakeholders of healthcare need to remind themselves that they are all part of well integrated ecosystem and can't remain unaffected by cascading as well as ripple effects of any misadventures anywhere. Industry has enough internal & external challenges ranging from top-line to bottom-line to frequent disruptions of all kinds, and it just can not afford another formidable challenge –Medical Negligence. w w w.medegatetoday.com Sep-Oct 2018

INTERVIEW OIMA is a 65 members strong association of domestic manufacturers of Hip, Spine & Trauma Joints. In his interview to Medgate Todayâ&#x20AC;&#x2122;s correspondent, he shares his thoughts on issues concerning implants Mr. Rajeev Chhabra - President of Orthopaedic Implants Manufacturers Association ( OIMA )

How serious is threat of "medical negligence" caused by faulty medical device & equipment? It depends on case to case and for every case many details are required to respond. In recent case of hip implants of a reputed company, it was a design fault which was highlighted by Europe first than USA. "Hip joint deterioration can lead to pain, stiffness or difficulty in walking. When these symptoms do not respond to conservative treatment, such as physical therapy, patients may be advised to undergo total hip replacement. However it is a good lesson for all manufacturers to ensure product safety for patients and medical fraternity before launch of any new product technology

What would be the impact of this "new addition of medical negligence on medical fraternity" which has been battling medical negligence for many years? Itâ&#x20AC;&#x2122;s going to be very long time impact on medical fraternity, hope they would be more cautious before recommending any new products to their patients. Brands & benchmarks would be scrutinized regularly.

Despite J & J faulty hip implants designs reported in 2010 and subsequently mandatory product recalls, should not have company sounded alarm in India too ? Should not they have been proactive and preemptive? We as responsible manufacturers were surprised by J&J delayed approach in Indian market. In 2011 they started paying compensation and making replacements all over USA and Europe but not in India.

Don't you think healthcare MNCs with "Premium Pricing in Indian market, should pay "Premium Compensation" to faithful patients as well as loyal medical fraternity which has also suffered reputation damage? The concerned MNC which has long been selling it's products on premium pricing in India, should offer premium compensation to it's all Indian patients using faulty implants as well as to the surgeons who recommended these faulty 20 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

Implants to their patients believing the best quality and accuracy of these Implants. The concerned MNC should compensate patients with the same amount which they are paying in global markets outside India...they are paying 2.2Cr to each patient in USA but In India only 20 lac to each patient.

Is not it companies' responsibility to keep track of performance of new/ innovative products for at least 5 years after launch as part of ethical and moral responsibility towards patients & medical fraternity? It is good suggestion and all responsible companies should be sensitized to conduct product performance audit regularly to remain patient centric.

Don't we need stiffer Indian regulations for medical devices & equipment? Agree, we need stiff regulations in place. Any new materials or designs must be backed by audited clinical data before commercialization. In the name of innovation, experiments must not be allowed.

Could you please share some examples of medical negligence caused by indigenously manufactured medical devices & equipment? We are generic product manufacturers and so far no such incidence of negligence in my knowledge. We have good manufacturing facilities & practices. We attach utmost importance to product quality & patient safety.

Don't you think medical fraternity must learn from this incident and open up to domestic manufacturers with equally competent products? Hope after this incident, medical fraternity would realize and enhance their interaction with domestic manufacturers. At least being domestic manufacturers, we would be answerable & responsible to them any day.

We appreciate your letter to PMO emphasizing over level playing field for domestic manufacturers, is not the time to enforce "level paying by patients" i.e. uniform pricing for hip, trauma & spine implants and as well ? We want NPPA to follow same pricing approach as in case of Knee implants. It will boost the confidence of domestic players as well as ensure that needy patients get more good quality product options at more affordable price.

DOCTOR SPEAK

Senior people opting for knee replacement at older age Dr Mudit Khanna

Orthopedic surgeon, Wockhardt Hospital Mumbai Central

With advancing age, the incidence of health problems also increases. In our country, aside vision related conditions, diabetes and hypertension, degenerative joint conditions are commonly observed in the elderly population. Community based studies have reported approximately 44% prevalence of arthritis in the elderly population, with pain, stiffness and inability to walk comfortably being the chief symptoms. The reason behind this is that, with age, having accumulated several stress related factors throughout the life of the individual, repair mechanisms of the body slowly start declining. Moreover, old age is also associated with wear and tear of structures in our body, thereby resulting in degenerative arthritic conditions. The knee joint is commonly involved in Osteoarthritis (OA) and is caused due to cartilage degradation. The knee is a weight bearing joint and has an important role in horizontal (walking, running) and vertical (jumping) movements. As age advances, there are changes in muscle mass surrounding the joint structure as well as cell and matrix related changes inside the joint tissue which lead to degeneration. Also, loss of normal bone structure with age and other co-existing 22 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

factors such as obesity, traumatic injuries etc. all contribute to OA of the knee. In early stages of knee pain and stiffness, treatment can be done with medications and exercise. However, for those who have not obtained relief from nonsurgical treatments, joint replacement surgery must be considered. Most elders avoid discussing about joint replacement surgery due to fear of dependent living and doubtful treatment outcomes. Most doubts regarding surgery are due to misleading information. Explain to them that, with technological and material related advances, tremendous improvement has been observed in knee joint replacement techniques. Approximately 85% procedural success rates have been reported and results last for up to 20 years following replacement. Total knee replacements are considered amongst the safest, effective procedures in medicine. With the rise in awareness programs, our country has seen an

annual increase in the total number of knee replacement surgeries from 5000 to 65,000 (based on a 2013 report). Do’s and Don’ts after Knee Replacement Surgery ◆ Diabetes, hypertension, infectious diseases, immune-compromised status etc. may be prevalent in the elderly: Keep these under optimal control as they may interfere with healing. ◆ Maintain a hygienic environment and a wholesome diet to minimize chances of infections and help boost immunity. ◆ Give the body time to get used to the artificial prostheses: Do not immediately start with prolonged walking, sitting cross legged etc. Follow the rehabilitation protocol as advised by your physiotherapist. ◆ Ensure maintenance of optimum body weight: Do not over-stress the artificial joint! By ensuring maintenance of overall health status and a disciplined lifestyle, results of knee replacement (with respect to pain and ease of movements and daily activities) can be maintained for long periods of time.

EXPERT VIEWS

Knee replacements now last longer with affordable ‘Golden Knee’ implants

•T he “golden knee”, is a total knee replacement (TKR) implant which has a ‘Bionic Gold’ surface • The surface prevents direct contact with the base material of the implant and the surrounding tissues •A Golden Knee Replacement surgery takes around one hour only Golden Knee Implants, the advanced version of total knee replacement implants are proving to be a blessing to those patients with osteoarthritis (OA), who have metal allergy.

Addressing a press conference organized today at Indraprastha Apollo Hospital on the occasion of World Senior Citizen Day, Prof. (Dr.) Raju Vaishya, who has successfully performed around 25 golden knee implant replacements during last three months, said that these Golden Knee Implants have enhanced surface coating of Titanium Niobium Nitride (TiNiN). This coating gives the implant a golden colored look & improves the longevity and performance of knee replacement surgery. This coating also makes the implant allergy proof.

Advantages of the ‘golden knee’• Affordable • Outstanding biocompatibility • Metal allergy prevention •H ardness superior to conventional cobalt chromium-based alloys • Low Friction articulation and hence lesser polyethylene wear and longer implant life • Long-term chemical stability inflammation and end • Avoids oprosthetic loosening •S uitable for high risk patients such as young and obese individuals “Golden Knee implants do not induce allergic reaction with human tissue. Its wear and tear is very low.

24 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

Due to its improved longevity of up to 35 to 40 years, this implant is preferred for knee replacements in patients younger than 60 years” said Dr. Raju Vaishya, Senior Orthopaedics and Joint Replacement Surgeon, Indraprastha Apollo Hospitals. Dr Vaishya did the first ‘Golden Knee’ implant surgery at Indraprastha Apollo Hospitals on 26th May this year.

According to Dr. (Prof.) Raju Vaishya, today about 80% of the population above 65 years of age suffers from Osteoarthritis (OA). Golden Knee implants provide the best solution to people suffering from Osteoarthritis, a disease which causes cartilage degradation resulting into pain in major joints, especially in knee joint. Globally it ranks eighth in all diseases and covers around 15% proportions among all musculoskeletal problems. The incidence of the disease increases with age and generally affects women more frequently than men. Moreover, the problem is more commonly found in those who are obese and thus, lifestyle has inadvertently led to an increase in those suffering from this painful condition. Talking about the benefits of Golden Knee implants, Prof. Vaishya stated, “In this, the implant has a ‘Bionic Gold’ surface which prevents direct contact with the base material of the implant and the surrounding tissues. It

also reduces the release of particles and ions due to wear and therefore almost eliminates the chances of metal allergy. As the surface of this metal is smooth, it causes less friction thereby increasing the life of the joint to 30 – 35 years which in normal implants lasts up to 1520 years”. “The ‘Bionic Gold’ surface is made by a fully biocompatible titanium niobium nitride (TiNbN) surface coating on metallic implant components. This coating presents as metallic, light golden yellow (golden) appearance whereby the coating forms a firm bond with the implant,” added Dr Vaishya. Many patints were present on the occassion. One of the patient Premlata Jain after the surgery said, “I was in really bad condition when I consulted the doctors at Indraprastha Apollo hospitals. I could barely walk myself. Doctors told me that I will have to undergo a total knee transplant surgery for my treatment. They suggested me for a ‘golden knee’ implant which was a total new concept for me but doctors explained me the benefits of the implant. Having trust in the doctor’s expertise here, I underwent the Golden Knee Implant. I am really grateful to Dr Vaishya for treating me. It’s totally because of him that I am able to walk properly today.” Now the ‘golden knee’ implants are only marginally expensive than the routinely used implants, in India. These are therefore affordable by the most patients requiring total knee replacement. With these implants, the patients get ‘High Flexion’ ability i.e. they can even squat, kneel and climb stairs with ease and comfort,” concluded Dr Vaishya.

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NEWS Update

Dr. B. K. Rana elected as founding Member of IAQS Dr. B.K. Rana, Founding CEO of Quality & Accreditation Institute (QAI) on his election as the founding member of the International Academy of Quality & Safety (IAQS) founded by the International Society for Quality in Health Care (ISQua). IAQS is established to recognise distinguished individuals who have made a significant contribution in the field of Quality and Safety in Healthcare. The Academy recognises excellence of leadership within research, academia or service delivery in

quality and safety in healthcare. Membership of the Academy is one of the highest honours that an individual working in this area can receive. The 35 founding members of the IAQS were nominated and then elected by ISQua Experts and the Board in June 2018. Membership of the Academy is for life. Prof David Bates, Former President of ISQua, will lead the Academy. Dr. Rana has made 1.3 billion fellow countrymen proud.

25 year old boy saves three lives by donating his heart, kidney and liver

Narayana Health City conducted three successful transplants in a single day ~ Family of a 25 year old man from an was admitted at Narayana Health City agriculture background donated his heart, for heart condition. Upon review and kidney and liver to an 18 year old boy, consultations from the experts, it was 52 year old woman and 55 year old man diagnosed that the patient suffered a respectively. Three patients got a new heart failure and was advised to undergo lease of life as they underwent transplant a heart transplant. The patient was at Narayana Health City, Hosur Road. registered with Jeevasarthakathe for past The 25 year old donor who hails from 5 months. Malur was admitted at Narayana Health Another recipient, a 52 year old female City for severe traumatic head injury from Hoskote was on dialysis since 2014. following an accident in the month of On evaluation, it was diagnosed that the August. He was declared brain dead patient suffered chronic renal failure for post the formal protocols and the family which she was advised to undergo kidney consented to donate their son’s organs. transplant. However, the patient could The donor’s heart was given to an 18 not find a matched donor for transplant year old PU student from Hubli who until recently.

The third recipient is a 55 year old businessman from Delhi who was suffering from DLCD with Portal Hypertension. He was on medical management at Narayana Health, Delhi since April this year and was registered with Jeevasarthakate as advised by the doctors in July. Donor’s liver was allocated to him for transplantation on the same day. The retrieval and transplant procedures were carried out by the team of expert surgeons at Narayana Health City.

Max Healthcare honored at Sixth Confederation of Indian Industry (CII) National Excellence Practice Competition 2018 Max Healthcare was honored at the 6th CII National Excellence Practice Competition 2018.The Emergency Care

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Services was awarded for the Customer Engagement & Satisfaction Practice. The Competition organized by CII was aimed at showcasing the best practices implemented by the Organizations to drive Customer engagement models, Customer experience monitoring and Satisfaction measurement practices to deliver superior customer experience. The 2018 CII Awards witnessed participation of 16 leading companies who created breakthrough business through innovative strategies. This year, two Sectors namely “Manufacturing

and Services” were represented covering streams of Infrastructure/ Power and Engineering Industries (under Manufacturing) and IT&ITES, Hospitality, Non-Profit Organization & Financial (under Services). The Competition endeavors to bring the successful practices in the following areas Customer engagement models. Customer experience monitoring and Satisfaction measurement practices.

Worried about SSI, Air Quality and Airborn Infection in MOT ??? Al-Med Introduced Innovative Solution to give you 100% Infection Control for Airborn Infection

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Features of 03 GEN - The Magical Air Disinfectant Without Any Chemicals  03 GEN kills all types of bacteria, fungus, virus molds and reduces the biological burden upto 93% with 2.5 ppm concentration within 30 minutes.  Ozone having half life just 10 minutes and its biproduct is Oxygen so very safe to use in unoccupied operation theatres (Rooms).

Features of Infection Control Live Monitoring System (ICLMS)  Actual Temperature Display with control  Actual Humidity (Rh) Display with control  Air Flow From HEPA Filter  Air Cycle Per Hour (ACH)  Air Particle Quality  HEPA Filter working status ‘  Positive Pressure (Pascal) inside the OT  Multiple Gas Sensor detecting CO2, i-butane, Propane, Methane, Alcohol, Hydrogen, Smoke  OT ready for operation indication will get on mobile with display of all parameter with every hour sms alert.  USB to PC (485) connection for recording of Data for Air Quality Parameter for Infection Control medico-legal issue.  SMS Notification & Alert for any type of fault in system and sms will be sent to company and doctors.

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Features of AHU Without Duct Patented Innovative Solution for Air Condition of OT  Ductless Air Handling System needs to start just one hour before the operation starts to get Class ll Air Quality in entire Operation Theatre.  Ducted Air Conditioning System for OT has to keep on round the clock may be with temperature control (with VFD) but our Ductless AHU has to keep on just 1 hour before to get desired air quality (Class ll) in entire OT.  HEPA Filter needs to be replaced once in a 2 year as compared to ducted system required replacement of HEPA thrice in a year so saves maintenance cost.  Ducted laminar air flow system (LAF) required Robotic duct cleaning before changing HEPA Filter and duct insulation and maintenance required periodically and costly.  AHU without duct maintain all NABH requirement by giving 20air cycles / hour, positive pressure2.5 Pascal CLASS II Air Quality and With Laminar Air Flow Class I (0-10) Air Quality Get on of table & Routine Cleaning can be done from Inside OT by any non technical OT staff.

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NEWS Update

Strengthen emergency medical teams for better response to disasters: WHO The World Health Organization today called upon countries in its South-East Asia Region to strengthen emergency medical teams, to be better prepared to respond to public health emergencies. “Strengthening national and regional-level emergency medical teams is a high-impact investment in reducing deaths, diseases and disabilities due to disasters, outbreaks and other emergencies. Emergency medical teams contribute to life-saving critical interventions,” said Dr Poonam Khetrapal Singh, Regional Director WHO SouthEast Asia Region, at the ongoing Regional Committee meeting here in Delhi, being attended by Ministers of Health and senior officials of the 11-member countries. Experience from health emergencies in the Region have shown that following a sudden onset disaster, a large number of emergency medical teams (EMTs) or emergency response teams often arrive in the affected country to provide emergency care to affected people. The EMTs are national, international, government, non-governmental, civilian and military. These teams have varied capacities, and their deployment is often not based on assessed needs.

“To be more effective, EMTs need to be standardised, strengthened and wellcoordinated,” the Regional Director said. WHO is helping mentor EMTs to improve their capacities in line with international standards. The WHO EMT Initiative aims at supporting countries, nongovernmental organizations, international organizations,

by identifying minimum standards, best practices, logistics and standard operating procedures for operating field coordination, for saving lives, preserving health and protecting dignity. The initiative seeks to improve timeliness and quality of health services provided by national and international EMTs, enhance the capacity of national health system to lead and coordinate such teams. “In an emergency, the outcome of the response depends on how quickly the right expertise reaches the right place at the right time to meet the needs of the affected people,” Dr Khetrapal Singh said.

Co-worker donates kidney to save Patient suffering from Chronic Kidney Disease (CKD) at Fortis Hospital Doctors at Fortis Hospital & Kidney Institute (FHKI) successfully completes the surgery In a rare example of camaraderie, a 40-year-old lady from Kolkata donated her kidney to save the life of 32-year-old colleague who was suffering from Chronic Kidney Disease (CKD) at Fortis Hospital & Kidney Institute (FHKI) recently. The patient from Ranchi was advised by the doctors to undergo Kidney Transplantation urgently as her health situation deteriorated. Both the donor and recipient were working in an IT firm in Bengaluru where the latter was subordinate of the former. The patient – Ms Marshneil Sinha - has been undergoing treatment at the hospital under Dr Upal Sengupta, Consultant, Department of Nephrology for more than 4 years. She was undergoing dialysis regularly while 28 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

everyone waited for a suitable donor. None from her immediate family could donate due to medical issues. Having known her long ordeal, Ms Ditipriya Das, her senior at office, decided to donate one of her kidneys to save her from a painful agony. She travelled to Kolkata from Bengaluru for all tests. Adequate counselling was provided to the donor family and were made to understand complications that may arise post kidney donation before they agreed for the donation. Talking about this unique case, Dr Upal Sengupta said, “It is one of the rarest instance across the world when a coworker comes ahead to donate her kidney and save life of a fellow colleague. The

WHO urged Member countries to develop and implement a national plan for strengthening systems for emergency medical teams (EMTs) in collaboration with all key partners; and establish and strengthen national mechanisms which supports effective and high-performing national EMTs in line with the WHO Classification and Standards. The South-East Asia Region is vulnerable to various disasters and emergencies such as earthquakes, floods, tsunamis, landslides and volcanic eruptions. As per 2016 World Disaster Report, over the past decade the Region disproportionately accounted for 26.8% of the deaths in emergencies. Prone to natural disaster, the Region has been focusing on scaling up emergency risk management as a flagship priority. Better preparedness has helped saved lives during major disasters such as Nepal earthquake. surgery went well, and both the donor and recipient are doing fine. This donation has reposed faith back in humanity. Such altruistic example gives a fillip to the cause cadaver organ donation. We hope that this inspiring tale of solidarity will entice people to pledge for organ donation. So many lives can live a better life if we can donate our organs after we are gone.” Speaking on the challenges, Dr Sengupta said, “We provided adequate counselling to the donor and her family so that they understand repercussion as well as complication that may arise following kidney donation. They were very cooperative and supportive once their concerns were clarified amply. We also had to undertake lot legal formalities as the recipient and donor were from different domicile states. All necessary permissions were taken from respective state governments and concerned authorities.”

NEWS Update

PRIYANKA CHOPRA PARTNERS WITH CIPLA RESPIRATORY

to create awareness about asthma and break the stigma surrounding its treatment • Advocates timely intervention that can help one lead a better quality of life • Integrated Communication Campaign planned Cipla Limited (“Cipla”), announced a partnership with Priyanka Chopra – actor and global icon - to raise awareness about asthma, along with helping address its psychosocial aspects including stigma, one of the key contributing factors for patient anxiety, delayed diagnosis, denial & limited disclosure of being asthmatic and avoidance of inhaler use in public. As a part of a holistic multipronged campaign, Priyanka will help spread the word regarding the need for an attitudinal change towards inhalation therapy as the most effective for asthma management vis-à-vis oral medication. According to the World Health Organization in 2017, approximately 235 million people suffer from asthma. India is home to a whopping 37 mn asthmatics, the second largest in the world. Cipla Limited has continually led the charge in reinforcing awareness over the last 25 years about asthma with the objective to help increase acceptance of inhalation

therapy as the foremost and most effective medication among asthmatics, caregivers and the general public. Nikhil Chopra, Head India Business, Cipla Ltd said “Cipla has always placed patient well-being at the core of all its initiatives and believed in a holistic approach to disease management. We are continuously working towards providing people with asthma the right treatment while ensuring every citizen is made aware about its long-term implications. Asthma is always easier to control when diagnosed earlier and when one consistently stays on a treatment plan. We are happy to partner with Priyanka Chopra, a super achiever, and an inspiration for many to help increase both relevance and acceptance of inhalation therapy thereby ensuring better follow-up with optimal outcomes for asthmatics. This association and the upcoming #BerokZindagi campaign for inhalation therapy directly resonates with our endeavor of enabling people with

asthma to achieve more in their daily lives. Speaking on the partnership, Global Icon Priyanka Chopra, said, “As someone who is Asthmatic, I can say that there is social stigma associated with asthma and its therapy. It is evident that asthma is on the rise in India and there is little awareness about the most effective therapy on offer. I am glad that I have the opportunity to be a part of the initiative with Cipla, a company that has always stood for caring for people. Through this platform, I would like to tell people that it is very crucial to get treated for asthma as early as possible. Timely diagnosis and the right treatment combined with simple lifestyle modifications can help in managing asthma better.”

Madhavbaug and Ruby Hall registers with CTRI for treating Coronary Arteries diseases Madhavbaug, being one of the leading chains of cardiac care clinics and hospitals is in concordat to start a joint venture with Ruby hall to perform major nation research on the effects of the Panchakarma treatment on the patients suffering from a blockage in the coronary arteries. They have registered with Clinical Trial Registry of India (CTRI) to execute the research. Dr. Jagdish Hiremath will be the principal investigator of the research being conducted. He has the distinction of being the first doctor in Pune and among very first few doctors in India, to perform coronary Angioplasties. He has handled some of Maharashtra’s most complex cases and on numerous occasions has been brought on as an expert and savior to redo failed angioplasties. He specializes in handling any kind of coronary conditions including acute Myocardial Infractions, Chronic Total Occlusion, LIMA and many more. 30 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

The treatment will be conducted on 30patients suffering from the blockages for four weeks. 50 percent of patients will be treated with the healing provided by Madhavbaug, whereas the remaining patients will be continuing with their standard medicines. The IVUS – IntraVascular UltraSonography will be performed before and after the treatment. The IVUS allows seeing the coronary artery from the inside-out. This unique point-of-view picture, generated in real time, yields information that goes beyond what is possible with routine imagining methods. The IVUS has become increasingly important in both clinical and research applications. It has facilitated the refinement of diagnostic and therapeutic strategies for various vascular pathologies.

Dr.Rohit Sane founded Madhavbaug in 2006 and has successfully established itself as the dependable option for treating heart ailment with its unique approach of using non-invasive, multidisciplinary and pioneering therapies. It has over 150clinics, 2hospitals and 200+ doctors who are providing inexpensive, non-insidious treatment. The Ayurvedic methods and medications used in the treatment are safe for human beings. No adverse event or adverse drug reaction can occur during the treatment. Because of this research being conducted a new and promising approach can be statistically proved for the long-term management of the disease that the patients suffer through. Staying true to the vision of reducing mortality and morbidity, this research will be a step towards achieving larger goals, with a view of doing greater things in the near future.

DOCTOR SPEAK

Is Fasting Necessary for Thyroid Function Test?

Dr. Abhik Banerjee M.D. Pathology Senior Consultant - Pathology Suraksha Diagnostic Pvt. Ltd.

hyroid function tests (TFT) are used to evaluate thyroid function and they are one of the most commonly requested tests in a modern clinical laboratory. The usual and initial blood tests done for thyroid function are Thyroid stimulating hormone (TSH), Thyroxin (T4 ) and not always but definitely sometimes tri-iodothyronine (T3). Till now in day to day clinical practice, physicians have not raised any major concern regarding the importanceof time of sample collection or the fasting or nonfasting status of their patients in respect to thyroid function tests.Such practice might be well justified by the fact that, there is no definiteclinical or laboratory guidelines for thyroid function testing (unlike lipid profile)emphasizing the time of phlebotomy or the fasting or non-fasting status of the patient.

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However in last few years a few studies have indicated a statistically significant postprandial decline of TSH (not T3 or T4) in comparison to the fasting values. Unfortunately, whether this finding has any major and statistically significant clinical relevancein test interpretation that is till now a matter of debate. A few of these studies have raised their concerns that, such difference in values might be significant in diagnosis and rational management of subclinical hypothyroidism (SCH, mild thyroid failure with mild elevation of TSH but normal T3 and T4) and also in certain clinical scenarios (e.g. Pregnancy, subfertility) where even marginal variations in TSH is important to get detected and thereby managed judiciously. Interestingly, according to one school of thought and perhaps the majority, this post prandial decline of TSH value is more related to time of sampling or phlebotomy rather than food related alteration. Circulating Thyroid stimulating hormone (TSH) is known for its normal circadian rhythm with a peak around midnight whereas a nadir during late afternoon. Hence TSH level is subject to circadian variation and as per literatures, this variation is of the order of even upto 50% especially in between 8:00-9:30

am. Obviously a TSH measured in the early morning will be different than a TSH level measured later in the same day and with same subject. To conclude, currently in absence of larger studies considering and addressing all possible interfering factors (e.g. Interference by other drugs) including differences in testing platforms, let us observe this space for some time before labelling the fact that, fasting / non fasting state has definite impact on TSH results and thereby a fasting sample is mandatory. Till then, for patients with known thyroid dysfunctions, it will be prudent that, the sample for thyroid function test especially the TSH would preferentially be collected at the same time of the day (and preferably at morning to rule out the effect of decline in later half of the day) each and every time he or she comes back for follow up. For fresh cases also, where a patient is coming for initial evaluation, just to rule out the possibility of missing cases of SCH, morning sampling can be preferred and recommended. It is high time that, the physicians and clinical laboratories should reach a consensus regarding this as lack of uniformity in the time of sampling for TSH may lead to unnecessary repetition of tests resulting in anxiety and deferred treatment in patients â??

EXPERT VIEWS

Affordable Healthcare In India ‘Expectations of today’s population V/s. cost to deliver it’

Dr Arun Bal

Consultant, Diabetic Foot Surgeon, SL Raheja Hospital, Mahim – A Fortis Associate Hospital

ndian Healthcare sector is at crossroads. In recent past, there have been incidents of various types with wide publicity in print and visual media, as well as social media, creating doubts about efficacy, honesty and rationality of private as well as public health sector. There is a strong need for dispassionate analysis of the situation to arrive at an optimal solution. It must be noted that the attacks on doctors are not a recent phenomenon but increased frequency is a worrying factor. If one takes healthcare industry as 100%, doctors form only 25% component of this sector; rest is formed by various stakeholders over which neither doctors have control nor do they have any say in their functioning. There is also disparity of regulation. For example there is medical council, CPA, and many other laws for doctors but for other stakeholders there are no specific laws except central laws like Drugs and Cosmetics Act etc. This dichotomy of regulation creates an unhealthy situation for overall healthcare delivery. Basic purpose of any healthcare model is to offer patient optimal treatment, taking into account patients medical problems and his/her expectations about the treatment. There is at present wide gap in the achievement of these two goals, this is the root cause of the problem. Reasons for this widening gap needs to be understood. The disease profile of the country has changed over the past 20yrrs. Now lifestyle diseases form almost 50% of the disease profile as against 20% two decades ago. Management of diseases like Diabetes, Hypertension, Cancer etc. require strong preventive strategies which includes patient education, regular screening, very early detection, very active participation of community etc. Once these diseases become clinically apparent then the management and treatment of complication becomes costly. The prevention involves very robust patient and social participation. At present, almost 80% healthcare is provided by private sector. This sector has traditionally given more importance to aid higher input of technology and stress on clinical treatment. One hardly finds any private sector hospital having community data about lifestyle diseases in its area of operation. This coupled with very low insurance coverage (approximately 11%), the load of lifestyle disease

complication, is borne unequally by public and private sector. The cost of these complicated treatment is usually high, for which 90% patients have to pay out of their pockets; this is inherently untenable proposition. This creates discord between healthcare providers and patients/community leading to various unpleasant incidents. It is necessary for private healthcare sector to think about different models of costing for providing treatment. The current model of A LA CARTE treatment is inefficient, leaving doctors as well as patient dissatisfied. It must be emphasized that private sector, in market dominated economy, cannot provide free treatment and some method of payment will be always necessary.This will require out-of-box ideas, and formal management training models may not work. This will involve joint participation of community in their area of operation and medical profession. There is also an urgent need for impartial transparent grievance redress cell in each hospital. The gap between patient’s expectations about his treatment, including cost of treatment, and actual treatment model which includes various factors like drugs, technology, surgeries etc. is widening and needs to be bridged to avoid unpleasant incidents. It needs to be stressed that a patient who is ill and enters a hospital is not in frame of mind to be fully satisfied. Healthcare sector should strive to reduce patient’s dissatisfaction. This dissatisfaction goes on snowballing at every step during his treatment and stay in most of the hospitals, and efficient resolution of this dissatisfaction is very vital for health of the patient and that of the hospital ❏

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INTERVIEW

SUPERCHARGE YOUR CLINIC WITH MEDDO What made you move to healthcare?

SAURABH KOCHHAR CEO- Meddo

Saurabh Kochhar is a serial entrepreneur and currently Cofounder & CEO at Meddo, India’s firstend-to-end solution for private clinics. Most recently, Saurabh was Co-founder & CEO at Foodpanda India, India’s pioneer food ordering & delivery app. Saurabh embarked upon his entrepreneurial journey in the year 2012 with printvenue. com India’s largest printing and customization portal. Prior to cofounding Printvenue.com,Saurabh worked with top global organisations such as McKinsey & Co and Oracle India. A recipient of many prestigious accolades, Saurabh has Awarded “Young Leader of the Year -2018” at India-ASEAN Youth awards administered by governments of 11 countries. Won variousaccolades like India’s 50 Most Talented Retail professionals by Asia Retail Congress; Red HerringGlobal Top 100 Award & Entrepreneur of the Year in Manufacturing Business, 2014. Saurabh is an alumnus of IITRoorkee and IIM- Calcutta. 34 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

I had the opportunity to work in the healthcare sector during my stint at McKinsey &Company. I closely dealt with some of the largest Indian pharmaceutical companies and related healthcare organizations. The dynamics of this industry piqued my interest and the exponential rate of growth of the healthcare sector excited me like no other. But rather than getting in to established traditional business model, I wanted to use my experience in building multi-party businesses to create a unique offering that helps both doctors and patients in equal measure. That’s when we thought of amalgamating allied OPD services with our already existing network of single or multi-clinic operationsand coming up with a concept that truly cares for the patient and yet keeps the doctors at the forefront and center of the entire system.

So, what is Meddo?

It is a custom-built & comprehensive digital solution for Doctors practicing at their clinics. We provide in-house diagnostic services and facilitate doctors in medicine dispensing at the clinic as well as home collection & delivery for patient’s convenience. Our partner doctors get access to a bundle of digitized services such as electronic patient records & digitization of prescriptions through a dedicated EMR service. Meddo is a step towards transforming the healthcare industry by enhancing all aspects of patient care while using tech to enhance day-to-day operations at the clinics. In diagnostics, we have associations with the leading brands of India so that doctors don’t have to reach out to these brands individually. With one partnership, they can access all the diagnostic brands of their choice. To facilitate doctors in providing the best & most reliable test results for their patients, we tie up with the best Diagnostic brands in India. It not only enables them to provide convenience to their patients but also ensures timely & accurate reporting of results. Furthermore, the doctors don’t have to look for options, but have all the best brands on their panel to choose from. We are also aiming at working with doctors to enhance their digital presence. A lot of doctors struggle at getting their specialties & accomplishments to the masses because they lack the time & bandwidth to do digital marketing for themselves – because of busy schedules & multiple commitments. We help the doctors in doing just that! We work on brand building via marketing campaigns custom designed for the doctors & their clinics. Medication is an important aspect of treatment and a doctor knows which medicine and what brand is to be given to their patients. We act as facilitators for doctors in ensuring the right medicine, the right dosage and the right brand is given to their patients. With a simple yet efficient clinic management solution, the entire peri-clinical activities are managed by Meddo on behalf of our partner doctors. We take care of all the regulatory compliances required to run the multi-specialty

NEWS Update

clinic operation and extend that to the doctor’s prescription and diagnosis too. This helps our partner doctors to completely concentrate their medical practice and 100% patient care. By helping to upgrade individual clinics to full-service heath centers, the goal is to maintain the quality and excellence in the care provided to our patients through the Meddo experience. With this integrated platform available to our partner doctors, it will ensure that both doctors and patients are connected, and their needs are taken care of within a single healthcare facility. Thus, our partner doctors are able to fulfill the primary objective of serving the needs of the patients in one convenient location.

How do the doctor’s benefit on being associated with you?

Most medical practitioners operating their clinics have to divide their time between practicing medicine and be involved in the administration of the peri-clinical operations. That’s where Meddo comes into the picture. We partner with doctors/clinics and help them with activities beyond the core clinical consultation so that they have the free mind space to do what they do best – treat patients! In additionto that, we also look towards growing the clinical practice by virtue of being a part of the platform that encourages business growth and efficiency through associations like Corporate tie-ups and OPD Insurance etc.Compliance is a huge part of any healthcare operation. With our access to technology, we even take care of the majority of the required compliances as outlined by the Government of India. The overall objective in creating and nurturing these associations with our partner medical practitioners is to make healthcare facilities more budget friendly, accessible and convenient for the patients. We work towards making our Meddo experience for our patients

as smooth as possible.

What do you think about the doctors in India?

No doubt, practicing medicine anywhere in the world is one of the most respectable and challenging professions that anyone can take up. Having said that, I am personally associated with a number of medical practitioners who I have had the good fortune to know as my friends. I have seen the hard work and sweat that they put in day in and day out. I have a lot of admiration for their fraternity and hold them in high esteem. Whether being in duty in odd hours or; sacrificing the better part of their family life, I only have the highest of opinions for all our doctors who practice in India.

There’s a lot of hue & cry around data, how can a doctor trust you on data security? For any long-term association to last, the foundation of the relationship is based on mutual trust. As an organization, we have placed safety and security of data as one of our top priorities. We have access to the best possible technology that safeguards our confidential data through multilevel security checks and is additionally protected through several layers of encryption. This helps minimize any risk of unauthorized data access. As part of our multi-security structure, we have invested in data security through multiple versions across several server locations. We ensure that your data is not shared with any third party. Towards that we have the following certified 256 – Bit encryption, DSCI membership and secured SSL connections. In short, neither doctors nor patients need to worry about security and privacy of their data.

You say that you’ll bring more traffic to your clinics,

API came forward to help the Kerala Flood victim

Medical fraternity is deeply pained about the Kerala Disaster which happened due to heavy rain and flood. Lacs of people are homeless and staying in sheltered camps, which need rehabilitation. During this tuff time, Doctors are morally bound to help medically in current Disaster. This time, Doctor`s fraternity has helped financially besides medical aids. For this rehabilitation, Association of Physicians of India (An association of Physicians HQ at Mumbai) has donated a Draft of INR 25,00,000/(Twenty five lakh only) along with a cheque of INR 5,00,000/- (Five Lakh only) to Chief Minister Relief Fund for Kerala. Draft and Cheque were presented to Chief Minister of Kerala on 31st August 2018 at Trivandrum, Kerala by President, Dr Pritam Gupta, Prof. Dr Y. P. Munjal, and Prof. Dr Siddharth N Shah. Dr Pritam Gupta has also assured Kerala Govt. to render their further services in any form either Drugs or medical professionals API-HQ w w w.medegatetoday.com Sep-Oct 2018

INTERVIEW how do you plan on working to increase the business of doctors? With years of experience and going through tons of research in the healthcare sector, we now have a comprehensive understanding of what the customer expects from a multi-healthcare facility. While traditional marketing such as BTL and hyper local activities is a supplementary effort to create a brand presence, in today’s internet era, digital dictates primary marketing initiatives. Through continued digital promotions and by strategically marketing BTL and hyperlocal activities to our target audience, we know we can increase traffic to our partner clinics.

How do you think the patients will benefit? Meddo not only helps our partner doctors but benefits the patients too. Convenience, experience and better economics is what Meddo brings to its patients. With a wholesome healthcare ecosystem in place, the patient can now conveniently access doctors, basic and high-end diagnostic services and even get their medicines dispensed at clinic only. Meddomakes doctors and related healthcare amenities available under a single healthcare centre. Waiting times are reduced significantly. With a smooth transition from a doctor consultation to diagnostic testing and collection of medications.Patients do not have run to multiple locations to access various healthcare necessities. Lastly, we have focused on keeping our service pricing within an economical range so that the mass population are able to access these facilities without hesitation. The objective is to maximize repeat patients to our partner doctor’s clinics.

What is Meddo planning to change in the healthcare industry? World over, health is a subject mostly taken care by the state or insurance. India is one of the few countries where, at its scale, the dominant burden of health falls on its citizens. In fact, almost 52% of the healthcare costs are incurred on OPD and preventive health monitoring, which are not covered by any insurance and are borne as out of pocket expenses by the patients. At Meddo, our primary aim is to create a network where we can organize and unlock the OPD part of healthcare vertical and integrate them with our clinic management solutions. In the end, providing reliable, quality and continual care to all our patients at much more affordable cost is the driving force behind Meddo.

How do you see your tech integrations changing the healthcare industry further? The focal point of the entire integration still remains as bringing convenience to the patient. That fact that we are 36 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

providing a one stop shop for patient care at each partner clinic is what is going to bring about the change what we foresee in the healthcare industry in the near future. By minimizing waiting times at the clinic, providing ancillary amenities such as medication, diagnostic services, lifestyle and nutritional counseling, products, devices, etc. all under the same roofsignificantly reduces the time that a patient has to spend on getting their health in order. By choosing Meddo as their healthcare partner, the patient has the mental freedom to concentrate on healing their medical condition, whilst we take care of the rest.

What happens to those who don’t adopt the technology? When we started I thought only young doctors will be keen on adopting this platform, but I am happy that more and more senior doctors are open and willing to adopt the technology. We are living in the digital era and if we don’t adopt changes happening in the industry we are bound to lose out ❏

INTERVIEW

The Ayushman Bharat The biggest health security

Scheme of the world will be launched on 25th Sept - 2018 - Ashwini Chaubey

Ashwini Kumar Choubey Minister of State for Health and Family Welfare (Govt. of India)

What are the achievements of your Govt. during last 4 years? Our Government, committed to the ‘philosophy of harmonious development and inclusive growth’ has made spectacular achievements in last 4 years. The Health budget received significant increase in each financial year during the last 4 years. The budget allocation for the current financial year FY 2018-19 stands at 52,800 crores which shows a quantum jump of 11.5% vis-à-vis the budget allocation for the FY 201718. Likewise, the budget for National Health Mission in the financial year 2018-19 has been hiked by14% compared to the allocation for the preceding financial year. Our Government brought out a holistic, integrated and visionary National Health Policy-2017 with an objective to achieve highest possible level of good health and well-being through a preventive and promotive healthcare in programmatic interventions and to achieve universal access to good quality healthcare services to all. The Ayushman Bharat is a tangible manifestation of our holistic, integrated, and preventive and promotive healthcare philosophy enshrined in our National Health Policy-2017.

What are the major programmes on health launched by your Govt. in last 4 years? We have launched several interconnected programmes of far reaching consequence for strengthening and expanding the reach of our healthcare services. Our Govt. launched Mission Indradhanush in Dec, 2014 with a view to achieve full immunisation coverage of atleast 90% by the year 2020. The Mission has covered over 528 districts, vaccinating more than 3.15 crores children, fully immunising80.58 lakh children & immunising 80.63 lakh pregnant females. To give further fillip and stimulus to the Universal Immunisation Programme (UIP), the Ministry of Health launched country wide notified mission ‘Intensified Mission - Indradhanush’ in 125 identified districts, 17 urban areas and 52 districts of North Eastern States. Under Pradhan Mantri National Dialysis Programme, free dialysis service is being given to the poor and subsidized services to other patients. More than 2.38 lakh patients have benefited under the programme since its launch till May 2018. Under ‘AMRUT’, 134 AMRUT Pharmacies across 22 States have sold 5200 drugs implants, surgical disposables and 38 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

INTERVIEW other consumables, benefitting 72.44 lakh patients. At the initiative of Union Health Ministry, and as an example par excellence of cooperative federalism, all the States and UTs have notified the policy to provide drugs under Free Drugs for Dialysis Services. The total financial support of Rs. 13918.99 crores both in cash and kind has been given to the States in the last 4 years. In order that Tuberculosis patients do not re-lapse into TB, they are being given, for the first time, Rs. 500 per month as nutritional support under the Revised National Tuberculosis Control Programme (RNTCP). 8 New AIIMS have been sanctioned to be set up in different regions of the country under Pradhan MantriSwasthya Suraksha Yajna (PMSSY) viz. Mangalagiri (Andhra Pradesh), Nagpur (Maharashtra), Kalyani (West Bengal), Gorakhpur (Uttar Pradesh), Bathinda (Punjab), Guwahati (Assam) and Bilaspur (Himachal Pradesh). ✓ Other major programmes have been launched by our Govt. to eliminate TB by 2020, to control leprosy by 2025. Likewise, under the AMRUT, affordable medicines and Reliable Implants being given for the patients of cancer, cardiovascular diseases at a discount of 60-90% on the prevailing market rates. ✓ 5 new vaccines were added to India’s UIP, bringing the total from 7 to 12. These are Measles-Rubella (MR) vaccine, Pneumococcal Vaccine (PCV), Rotavirus Vaccine (RVV), Inactivated Polio Vaccine (IPV), Japanese Encephalitis Vaccine.

What are the blue prints of Ayushman Bharat? How it becomes Modi Care? The Ayushman Bharat, the biggest health security scheme of the world was announced in the budget of FY 201819. It has two components i) Pradhan MantriRashtriyaSwasthya Suraksha Mission (PMRSSM), and ii) Pradhan MantriRashtriya Health & Wellness Centre. PMRSSM, fully funded health

protection scheme, the largest of the world, will provide health insurance to over 10 crore poor and vulnerable families covering a population of more than 50 crores per annum, free of cost without any ceiling of the number of family members. The scheme is cashless and paperless and funded on entitlement based, i.e. a family figuring in the defined socio-economic caste database of 2011 will be entitled to claim benefit of this scheme. So far, 26 States have voluntarily signed the MOU with the Union Health Ministry and rest are also likely to join the scheme or will have to bring equally good or better health scheme at their own cost. Under Health and Wellness Centre (HWC) component of Ayushman Bharat, more than 1.5 lakh Sub Centres & Primary Health Centres are being transformed into Health & Wellness Centres (HWCs)

which will provide Comprehensive Primary Healthcare (CPHC) Services close to the community that will include essential diagnostic facilities as well. Interestingly, the Media has hailed this gigantic and all-encompassing health scheme as ‘Modi Care’.

Government Initiative on Vaccine, Mother-Child programme etc. I feel proud to say that due to various policy interventions and vigorously sustained immunization programmes, the Maternal and Neonatal Mortality Ratio (MMR) has gone down by 37% which is unprecedented. Our UIP continues with greater verve and vigour and is applauded world-wide particularly by the WHO.

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INTERVIEW

J Mitra at the Helm of Indian IVD Industry Tell us about your journey as MD of JMPL Even when I joined JMPL in 1998 (and became MD in 2000), it was one of the leading IVD company in India. Our growth was based on research and timely innovations, changing the course of diseases detection and treatment. But times were changing, and to support growth systems were required.

Mr. Jatin Mahajan Managing Director, J Mitra & Co Pvt Ltd

The government’s ‘Make in India’ initiative is a major step in making the country more selfreliant, independent and prosperous. There is nothing that we cannot match or achieve, and in fact, this is the exact belief which led to the formation of JMPL 50 years ago. Today, we are exporting to more than 45 countries across the globe and have been able to establish India as key player. 40 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

I was the only member in my family who pursued MBA. As I was growing up, I could see the need-gap within the company. It was 2-3 years of close observation of the various aspects of our business and juxtaposing it with various business learnings that was put into practice. I was entrusted the task of retaining its passion and core values, while making it more competitive, professional and profitable. I decided to focus on the basics and in ensuring a future-ready ecosystem. People-interest was still at the centre of all our activities, but we had to adapt to the changing times. While my father continues to retain and lead the research and innovation aspects, I took on the responsibilityof systems& processes, people management and marketing. We identified all the gap-areas and drew a road map with executions, timelines along with action-points. We revamped our systems and processes to bring in more automation and reliability and to mitigate all possible manual errorpoints. We went in for skill upgradation for all the employees, focusing on both hard (professional) and soft skills. The focus was on capacity building, both in the manufacturing processes as well as of the individuals. External consultants & trainers were involved to provide training and enhance team efficiencies. There was resistance initially towards these changes (which of course was expected in any such scenario), but as results came in, everyone realized the importance and necessity of these changes. Now we constantly get inputs

from the staff as well on how we can increase efficiencies because they see themselves as partners in growth, and we now profess a collaborative approach to problem-solving. We also focused on enhancing our sales network and marketing initiatives, ensuring that our brand salience was properly highlighted. We also identified new markets while further establishing our presence in the existing one.

What are the unique features of JMPL as a pioneer in invitro diagnostics sector? Our key differentiator is ‘innovations and research capabilities’. We are a R&D driven company and trend-setters in the IVD industry in India. And this is the reason why we have more than 55 patents – the highest in the industry. This has earned us both recognition and respect. The 2nd key differentiator is our affordability – we continuously strive to find solutions for driving down the prices of essential diagnostics. This has earned us tremendous trust amongst suppliers, clients and industry. Our people are yet another key differentiator – it’s a collaborative approach to work, where they see themselves as partners in progress Talking about our products – we have some of the industry-best offerings. In 2018, we launched iQuant with 8 parameters (diagnostics), a unique product based on FIA technology, that will transform diseases detection in the rural and semi-rural areas. Products like iQuant, HbA1c Quanti card, Dengue NS1 Ag Quanti card, Dengue IgM Quanti card are all innovative products that do not have a parallel in the industry. These help us stand out in the segment

INTERVIEW What are the new drugs and devices ruling? How do you view this? There have been several major developments recently. The Government has heeded to the industry’s nearly decadelong demand to distinguish medical device & IVD’s from pharmaceuticals. The Indian Government has published new medical device & IVD regulation which are in effect from 1st January 2018. The MDR 2017, has better clarity based on the following: ✓ Introduction of risk-based classification: The classification on basis of low (Class A), Low Moderate (Class B), Moderate High (Class C) & High (Class D). The Rules states that class A&B applications will be assessed by SLA & Class C&D by CLA. Class A devices does not require prior audit, Class B requires prior audit by third party & Class C&D will be assessed by CLA. ✓ A new system of “Third Party Conformity Assessment & Certification” through notified body is envisaged. The notified bodies will be accredited by the National Accreditation Board for Certification Bodies (NABCB). These bodies will undertake verification & assessment of the QMS of the Medical device manufacturer of class A & Class B categories, as – required or on basis. ✓ Single window clearance. All applications for import, manufacturing, sale or distribution and clinical investigations, whether to be assessed by CLA or SLA, will have to be through online portal. ✓ Product standards for Medical Devices & IVD’s. ✓ Timelines are defined. ✓ Perpetual License ✓ Consolidation of Registration certificate & import license into a single license. ✓ Certainty on consequences of changes made in license, particulars. ✓ Meaning of “Change in constitution” finally explained & change in constitution rationalized. ✓ License for sale of Medical devices. ✓ Mandatory recall on knowledge of Risk to safety.

The Government has tried to align itself with the international practices, hereby providing an environment which is transparent & predictable, which in turn will boost the confidence of all stakeholders and at the same time, the quality of product & services will improve.

What is the market size of the diagnostics industry, and what is your market share?

India’s Healthcare market is poised towards rapid growth, which is expected to reach to USD 372 Billion by 2022. (as per Assocham& Research firm KNOS) It is estimated that the diagnostics and pathology market is roughly around 1-2 percent of overall healthcare segment. India is the fourth largest market for IVD devices in Asia after China, Japan, South Korea and currently, India is counted amongst the top 20 global medical device market. It is projected that the market will grow tremendously in next couple of years. Growth Factors: The Market is expected to increase, to meet the demands of growing population. With socio-economic changes such as increase in income, changing lifestyle, rapid Urbanisation, self-awareness, promotion of insurance by insurance companies, increasing diagnostic centres, hospital, all these facilitating growth of this sector. IVD market consists of biochemistry, immunoassay, haematology reagents, molecular diagnostics, microbiology & tissue diagnostics. The market for diagnostics is highly competitive and increasing competition is driving the labs to improve their quality of service. There is huge potential and scope for growth for the indigenous manufacturers, enabling the market to be more accessible and affordable.

What is your expectation from the government for ‘Make in India’ scheme?

The government’s ‘Make in India’ initiative is a major step in making the country more self-reliant, independent and prosperous. There is nothing that we cannot match or achieve, and in fact, this is the exact belief which led to the formation of JMPL 50 years ago. Today, we are exporting to more than 45 countries across the globe and have been able to establish India as key player. Specific to the IVD industry, the government has been constantly reviewing various aspects to promote the Indian manufacturers and see how amore level-playing field can be created for us, especially since most of the raw materials have to be sourced from other countries, and the current inverted duty structure is weighing down heavily on the local manufacturers, making the business unproductive and non-viable. In terms of economy as a whole, ‘Make in India’ will lead to more jobs, less brain-drain and an even lesser load on the Rupee-Dollar ratio, making the Rupee stronger, which in turn will have a domino effect and help various industries that are dependent on import of raw material. w w w.medegatetoday.com Sep-Oct 2018

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Trade Margin Rationalization: Govt. To Walk The Fine Line Between Making Healthcare Affordable and Promoting Make In India or Make OUTSIDE India

omestic Medical Device Industry hails Govtâ&#x20AC;&#x2122;s move to rationalize and cap Trade Margins in Medical Devices to achieve the overall goal of affordable healthcare for all by making all critical and lifesaving medical devices available at affordable prices. However, we suggest that the government should tread the fine line carefully between affordability and boosting domestic manufacturing or suffocating domestic medical device industry and allowing importers to create artificial inflation. If the Government plans to bring down prices of commonly used medical devices by capping the trade margin at 30% on the first point of sale as reported in media then it is unrealistically low and won't allow delivery to last mile. It is pertinent that the government brings down trade margins from irrational to rational level in order toreduce overall healthcare cost. However, to lower it to irrationally low level may be disadvantageous to the Patients & Consumers. Medical Devices usually go through 4-7 change of hands along the supply chain from a Distributor to a Wholeseller to a

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Retailer and a Hospital before they reach a consumer in a distant village and each point in supply chain incurs various costs such as freight, inventory carrying, rental, salaries, marketing and sales overheads and service and statutory expenses of compliance and then there is also a need of net profit by a reseller. The main aim of Rationalization of Trade Margins in Medical Devices should be to help consumers, allow rationalized profits for Traders & Retailers, create level playing field for domestic industry vis-Ă -vis foreign manufacturers.There should be clear objectives for any policy intervention so as to avoid distress (to consumers), distrust (in industry) and disruption( to market). To begin with, there seems a confusion between Trade Margin which is based on sale price of product and Markup which is based on purchase price of products. These terms should be clearly defined to avoid any confusion among stakeholders. It is advisable to ensure consistency in use of terms and nomenclature or instead of realising its Make in Indiavision, the government will end up encouraging Make outside India.

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The trade margin is the difference between the price at which the manufacturers (indigenous /overseas) sell to trade and the price to patients (maximum retail price). The issue of unreasonably high trade margins in medical devices has been adversely affecting both the industry as well as consumer interest and creating distrust for the Medical profession .AIMED has been asking for trade margin rationalization and capping for last 2-3 years.

We are glad that finally the government is moving in this direction. For Trade Margin Rationalization, first point of sale by overseas and Indian Manufacturers should be defined as the price by Manufacturer, whether Overseas or Indian, on which GST is initially paid. In contrast, importers who are also Traders cunningly want first point of sale to be from their end to the distributors and not from overseas manufacturers to them to avoid coming into the trade margin regulation ambit. So if we talk about Rationalization of Trade Margins it has to include Imports, you can't have importers having over 200% irrational Margin as was indicated in NPPA report on Catheters & Guidewires and the rest of supply chain having only 35-50% Trade Margin.

not being unreasonably detrimental to traders and hospitals. Additionally, manufacturers will be encouraged to attract clients on Competitive features and hospitals will start buying on evaluating cost of purchase & quality, instead of margins to be made on higher MRP thus resulting in a level playing field between Imports and Domestic products. Thegovernment should provide level playing field, if not a strategic advantage to domestic manufacturing while safeguarding consumers or India will remain 70-90% import dependent. Indian manufacturers seek Preferential Market Access, Tariff Protection, Price Controls and strong deterrents like punishment to errant companies engaged in unethical marketing practices to boost domestic manufacturing. This can be done in a calibrated manner through ☞ 1% GST Cess on MRP as a Tax based disincentive; ☞ Capping Trade Margins to a Rational Level; & ☞ Price Caps on few Priority Devices, A pro-active policy formulation to regulate Medical Device differently than Drugs should permit free market dynamics to succeed and keep regulations simple,protecting Consumers and Incentivizing Make in India

Government todefine the following: ☞ First Point of sale for Mfr is Price on which GST is charged first time.

◆ On Overseas Mfr GST is charged on Import CIF landed price in BIE (Bill of Entry)

◆O n Indigenous Mfr GST is charged on Ex Factory Price post discounts

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☞ Indigenous Mfrs need to be equated with overseas Mfrs and not with Importers

Everyone in a supply chain has intermediate costs and value addition. It needs to be ascertained what value addition, if any, importers do and what's a rational margin for them? The reason the importers state intermediate costs like R&D and clinical evaluation are not part of the Import landed price is basically to avoid custom duties. They can't avoid Customs duty by lowering Transfer prices and then seek to induce hospitals with higher MRP and higher Trade Margins. This tactical marketing warfare has cost the consumers dearly and harmed ethical marketing. Thus importers should be brought under the purview of trade margins. The Government they consider toCap Trade Margins of Devices to 85%. This will help in reducing MRP of Medical Devices to less than half of current prices while

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This will help in creating a Level playing field between goods entering India via imports or domestic production thus encouraging domestic manufacturing. Also, there is transparent verifiable database linked to GST charged on Invoice or Bill of Entry available with the government and verifiable to implement and monitor this without making it complex.

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Combating Medical Fraud in India

he health sector is perhaps one of the most essential to exist within an economy, attracting some of the finest talent that a nation has to offer. The prospect of saving lives and making a difference is attractive to those with an inclination to serve society, and a desire to prevent human suffering, aside from the innumerable monetary incentives. It is for this reason that medicine is known as ‘the most noble of all professions’ and doctors and nurses are among the most respected and trusted members of the community. Unfortunately, like any other human endeavour, the medical profession has had more than its fair sure of serious issues in India. Medical fraud differs from other kinds of white-collar crime in that it can cause irreparable physicalharm to the victim, as opposed to mere financial losses. Due to tax regulations and a lack of stringent application of even those, many unqualified peoplelie about their credentials, in an attempt to dupe innocent patients. Because these quacks often lack basic medical training, their actions usually have disastrous, sometimes fatal, results. The recent instance in Uttar Pradesh where 21 people were infected with HIV from contaminated syringes by a quack doctor, is a story that only has only become too common due to the sheer scope for fraud in the Indian medical sector. According to a World Health Organization report on the state of healthcare in India among allopathic doctors, as many as 31.4% of the claimed doctors were discovered to have been educated only up to a secondary level. In fact, an astounding 57.3% did not possess any medical degree whatsoever. The statistics among dentists were even more damning, with 46.2% of all urban and just 27.4 of all rural dentists having the minimum legal qualifications to practice their profession. These numbers alone are indicative that a significant portion

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of medical practitioners in India are committing fraud in broad daylight, risking people’s personal safety and severely impacting the integrity of this noble profession. To weed out quacks, frauds, and unscrupulous doctors, it is necessary to take effective counter measures, especially given the fact that millions of lives at risk. The best solution to this problem is to deployvast on-field strength and technological capabilities to create a data repository of verified doctors. This can be achieved by • Visiting each doctor on the ground to register their biometric details along with copies of their medical degrees. • Authenticating these degrees and certificates at source, which means cross verified with the college/ university along with the doctors’ residency details. • Genuine doctors’ data be then uploaded to the repository creating a master list of medical professionals in a variety of fields and specialisations. • Data of fake doctors also be uploaded so patients can be fairly warned • Government store this repository on online & offline public domains, freely available to the public. This database will ensure that patients’ trust is backed up by thorough validation of the doctors' qualifications and secure credentials. This can only be achieved by – This system, which should be made accessible to the general public, would allow a patient or an organisation to easily choose from a database of verified doctors anywhere in the country, improving security and consumer confidence substantially. With effective risk management adoption at national level, instances of fraud will significantly reduce. Such a system would also serve as a strong deterrent for any person contemplating a career as a fake doctor. It will go a

long way in rebuilding people’s trust in regulatory institutions which have failed to protect usso far. Creating such a repository will take tremendous will and professional engagement, but as a nation we have all the necessary expertise and resources to achieve this ideal.

Hitesh Asrani Founder & Director, CRP Risk Management

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Technology shaping up healthcare in India

Mr. Vivek Tiwari Founder, and CEO of Medikabazaar.com

Augmented Reality (AR) has disrupted diagnosis. AR can potentially lessen the count of actual dissections which can result in a better understanding of the human body and other anatomical details. 3D printing, another disruptive technology, is being implemented profusely due to its broad scope of applications which include accurate casts and high precision in replacing bionic parts. AI is being used to screen breast cancer which has resulted in better survival rates among the patients. IoMT sensors have been implemented in ICU beds and ambulances which are helping hospitals monitor critical patients. These sensors track the vitals of the patients and trigger alarms to the clinicians on their cell phone who can advise a course of action. 46 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

he Indian healthcare industry has embraced the implementation of technology to a great extent. The Government is also enthusiastic about digitizing the medical sphere of the country. However, hindrances remain, and it is a long walk ahead for India to develop a digitized healthcare ecosystem. The Indian healthcare scenario shows an interesting dichotomy. Technology in healthcare has brought about significant developments in both clinical and non-clinical sectors. Diagnosis and treatment have become less invasive and more precise. On the non-clinical side, hospital operations management is more streamlined. The political environment is also very much supportive. The Indian government has taken appropriate measures to improve the healthcare system in the country and has also initiated programs which promote the application of technology in medical care. As per the report “Reimagining the possible in the Indian healthcare ecosystem with emerging technologies” by PricewaterhouseCoopers (PwC), the Union Budget of 2018 contains programs such as Ayushman Bharat which aims to provide insurance coverage to 10 crore families. More so, the budget, for the very first time, has allocated INR 3073 crores, under the supervision of The National Institution for Transforming India (NITI Aayog), to establish a digitized healthcare ecosystem. This would include the application of emerging technologies like Artificial Intelligence (AI), Internet of Medical Things (IoMT), the blockchain, and 3D printing in MedTech. Some other e-Health initiatives taken by the government’s Ministry of Health and Family Welfare (MoHFW) are as follows: ☞ National eHealth Authority (NeHA) ☞ Integrated Health Information ☞ mHealth ☞ Electronic Health Record Standards for India Healthcare providers have also welcomed the use of new and emerging technologies. 64% of Indian healthcare executives said that they are investing in Internet of MedicaI Things (IoMT: a network of enmeshed medical devices and applications). Artificial Intelligence (AI: the potential of machines to learn cognitively and execute), at 42% was revealed to be the second largest investment. (PwC’s Global Digital IQ Survey 2017) Despite the measures taken by the government and the positive statistics mentioned above, there are difficulties which still plague the Indian healthcare system. Firstly, there is a severe lack of healthcare data sharing among the various stakeholders in the medical sector although there are

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regulatory guidelines in place. Secondly, there is a shortage of India-centric clinical data which is imperative for the efficient working of AI and IoMT systems. Thirdly, and most importantly, the resistance to change. Many medical establishments have still not implemented basic systems like inventory management and Hospital Management System (HMS), and therefore, this results in a lack of clinical data and uncertain inventory. Problems are magnified due to a shortage of doctors and nurses and a large number of informal players. Above all, a reactive healthcare system where people visit hospitals only when their illnesses reach an advanced stage because of a lack of awareness and preventive care services. Along with these limitations, there is an uneven distribution of quality healthcare services.

Disruptive technological innovations will be able to eliminate the problems mentioned above. From a clinical perspective, Augmented Reality (AR) has disrupted diagnosis. AR can potentially lessen the count of actual dissections which can result in a better understanding of the human body and other anatomical details. 3D printing, another disruptive technology, is being implemented profusely due to its broad scope of applications which include accurate casts and high precision in replacing bionic parts. AI is being used to screen breast cancer which has resulted in better survival rates among the patients. IoMT sensors have been implemented in ICU beds and ambulances which are helping hospitals monitor critical patients. These sensors track the vitals of the patients and trigger alarms to the clinicians on their cell phones who can then advise a course of action. In the case of ambulances, sensors send the data to the doctors while the patient is in transit. This makes healthcare establishments better equipped to deal with the patient even before they arrive at the medical facility. Similarly on the non-clinical side, Medikabazaar.com, a B2B online medical supply platform has disrupted the fragmented medical supply space to a great extent. Conventional supply chains have various limitations. There is a shortage of exposure for hospitals in terms of product information and data for purchase planning. Both are imperative for making informed and analyzed procurement decisions. As offline processes offer no solutions to the problems mentioned above, medical establishments end up purchasing excessive quantities of supplies and mediocre quality equipment at high prices. It makes the task of supply management increasingly taxing which leads to excesses and deficiencies in the inventory. This results in revenue leakages, affects patient care and burdens medical establishments by increasing their total cost of operations (TCO). Medikabazaar.com has simplified medical product discovery, purchase and distribution especially in tier 2, 3 cities and remote locations. So, it can be seen that India has acknowledged the importance and necessity of technology to improve healthcare services. Organizations such as Medikabazaar.com are helping medical establishments adopt an online and transparent supply chain system. Whereas in the clinical sectors, mechanisms such as AI, IoMT, and Telemedicine are getting widespread adoption. However, the advancements are only happening in metro locations. But the actual success lies in making healthcare accessible in tier 2, 3 and remote areas in India. Medical centers must adopt digitization with a positive mindset, and only then, the goal of an affordable, accessible, uniform and efficient healthcare system can be realized â?? w w w.medegatetoday.com Sep-Oct 2018

INTERVIEW High-end healthcare services are possible not only at Hospitals but you can get good services at Home without admitting to hospital HCAH providing services like ICUs at HOME, Cancer treatment at home, elderly care, post-operative care, home dialysis, home nursing and physiotherapy along with providing plethora of other clinical procedures at home.

Dr Gaurav Thukral COO, HealthCare atHome

Dr Gaurav Thukral is the Executive Vice President and Chief Operating Officer (Acute and Pharma Services) of Health Care at Home India Pvt. Ltd. He has over 18-years of experience in the healthcare industry. Dr Thukral, with his enterprising vision, has been a driving force in heralding an innovation in this sector in the form of home healthcare. He was successfully practicing as an intensivist at Fortis hospital. A winner of several prestigious awards and recognitions, Dr. Thukral is a certified National Accreditation Board for Hospitals & Healthcare Providers (NABH) Assessor. He was awarded the first place in the Federation of Indian Chambers of Commerce and Industry (FICCI) Heal Poster Presentation on ‘Capacity Building in HealthCare’ in 2015, the Patient Safety Conference in 2011 and the presentation on Clinical Audits at FICCI Heal in 2010. 48 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

What is the service offered by your company? HealthCare atHOME has an extensive network of trained staff that can provide a complete spectrum of healthcare procedures at the patient’s home with the exception of surgeries and emergency medical procedures. Some of the key services offered by HCAH include setting up ICUs at HOME, providing Cancer treatment at home, elderly care, post-operative care, home dialysis, home nursing and physiotherapy along with providing plethora of other clinical procedures at home. 70% of all what can be done at the hospital can be done at home and we do it. We act as a one stop shop for the pharma companies to manage their patient journey right from awareness, screening, diagnostic, onboarding of patients, clinical services, patient training, and compliance management (PSP) and Patient Assistance Programs. We also deliver chronic medicines to patient’s right at their doorsteps all over India. What is the market size of the healthcare @ home business its growth future prospective? The growth factors are enormous. The current estimates market for home healthcare in India is projected to reach US $6.2 Billion by 2020 at a CAGR of 18% from US $3.2 Billion in 2016 million. In 2018, it is expected to touch USD 4.46 billion. This growth is largely fuelled by a surge in disease burden caused by an increase in geriatric population and diseases triggered by lifestyle changes. This increase is constantly stretching the existing conventional healthcare delivery system of hospitals. Also a shift towards nuclear family system is stretching both the logistic and economic resources of the consumer. Moreover, hospital facilities are currently inadequate to meet the national demand. In terms of healthcare facilities and medical manpower, disparity between metropolitan cities and tier II and III cities is startling leading to patients travelling to larger cities for treatment and even forgoing treatment mid-course due to cost challenges. More importantly, for chronic ailments, there is no need for long term hospitalization and frequent re-admissions. With appropriate use of technology, high-quality home healthcare services can be implemented and expanded to cover a wide base of population in India. There are many organised and credible players like HealthCare atHOME (HCAH) and others who have made a mark in the Indian home healthcare industry and the concept is yet to reach its potential, there are plenty of opportunities for all players. The key challenge comes from the unorganised sector, small time players who do not follow standards of care or maids or manservants hired as attendants for providing home care. Standardisation and accreditation practises have already begun to regulate home healthcare industry – which is the key to eliminating wrong practises.

INTERVIEW

How healthcare at home business in overseas apart from India? Global studies have shown that homecare is a proven model for both financial savings and patient satisfaction. According to a study conducted by Bupa Home Healthcare of the UK, 14.5 million bed-days and between £1.1 billion and £1.3 billion can be saved A report by Bupa Home Healthcare in the UK mentions that 14.5 million bed days and between £1.1 billion and £1.3 billion could be saved by moving patients into their homes when clinically safe to do so; while by avoiding hospital readmissions the National Health Service (NHS), UK’s public health services, could possibly save £300- £390 million nationally. A study by Deloitte Australia in 2011 titled ‘Economic analysis of Hospital in the Home’ states that homecare significantly decreased hospital length of stay and that there here was higher patient satisfaction as compared to hospital care. A paper published by the University of Western Sydney's Centre for Health Research also found that homecare improved patient satisfaction and quality of life while reducing hospital readmission rates. Through homecare, hospitals can reach out to a greater number of patients without having to spend additionally on real estate and infrastructure. What are the challenges in India for Healthcare atHome? Govt regulation or expectation from govt? The general perception about home healthcare services is having a nurse at home or an attendant at home. One of the major challenges in this segment is people find this hard to believe that high-end home healthcare services are possible. They feel that they can get good services only though admittance in hospitals. Also, healthcare industry is facing a crunch of not just doctors, but also qualified and trained paramedics. Another challenge that we face is the availability of trained clinical staff. There is a great need to ensure that clinical staff is effectively trained to be able to manage patient complication at home through an exhaustive induction programme, recurring on job trainings, refresher trainings & audits.

Additionally, several hospitals are reluctant to give a try to concept of home healthcare. They mistake home healthcare for a competitor, instead of viewing them as an extension of their services. Home healthcare, instead, as partners of hospitals can widen the reach of hospitals to prospective patients and also increase average revenue per bed by offering step down care to patients at their home and freeing up beds for more needy patients. Home healthcare plays a vital role in reducing the patient load in hospitals and healthcare professionals. For example, proper home healthcare is found to reduce rehospitalization, improve adherence to medication regimen, improve functional capacity, and bring cost of treatment down. Home healthcare is found to improve activities of daily living (ADLs) and instrumental ADLs of home healthcare recipients. Home healthcare industry in India needs standardisation to make it more regulated. Regulation will also lead to better coverage of home healthcare solutions in health insurance, thus, making home healthcare solutions even more affordable. Home healthcare is becoming a valuable part of the healthcare delivery chain in India. Just as hospitals are making home healthcare a part of their healthcare delivery system, it is high time that the government consider home healthcare as an integral part of the Indian healthcare industry too. It has the potential to relieve the ever increasing burden on hospitals and doctors. India needs over 6 lakh+ beds to cater to our population and home healthcare can help bridge this gap as it reduces the requirement of the hospital beds, which can be provided to more needy patients. Since the shortage of beds is more in tier-II & III cities, the hospitals can extend their reach without building expensive infrastructure with a home healthcare partnership. Ayushman Bharat Scheme – which offers health insurance cover of INR 5 lakhs for tertiary care to over 50 crore people – is an ambitious scheme. It is sure to increase burden on hospitals with more patients seeking treatment for tertiary healthcare needs. In such a scenario, home healthcare can become an immediate solution to reducing the expected increase in burden on hospitals. Government can support growth of home healthcare industry by introducing standardisation and regulation practices, mandating its inclusion in govt. led health insurance policies and formulating policies to reduce burden on hospital infrastructure through home healthcare partnerships. We are hopeful that moving forward, government will also understand the value those home healthcares solutions provide bring to the healthcare industry. Moreover, with a 200 million+ elderly population, India needs home healthcare solutions to cater to their healthcare needs. We can learn from countries like Dubai and Abu Dhabi who are setting norms for and giving incentives to the home healthcare industry.

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DOCTOR SPEAK

The Silent Disorder with a Lifetime Impact -

Polycystic Ovary Syndrome Getting to know PCOS

Experts are yet to find what actually causes PCOS. However, many consider that the condition develops due to the contribution of an amalgamation of maladies with a surplus of androgens, which is a male hormone along with ovulation occurring on an irregular basis. Experts are also of the belief that approximately 70% - 80% of women developing PCOS are due to hereditary factors. In fact, there are research and studies to support this theory that there is a 50% chance of a daughter being diagnosed with PCOS, if the mother has it too. PCOS impacts more than the woman’s ovaries. Therefore, the name - polycystic ovary syndrome, is slightlymisrepresentative. It is more than a fertility-related issue as it impacts the woman’s health across the board. One has to remember that is not a single condition and patients require individualised treatment depending on the severity of the disorder.

Understanding the Symptoms The majority of women fail to recognize the symptoms of PCOS. The symptoms are variable. While some women may experience mild symptoms, for other, the affect may be greater and more severe.

Nevertheless, the common physical signs are: ◆ If you observe that your menstruation cycle has become

irregular

Dr Astha Dayal

Senior Consultant, Obstetrician & Gynaecologist, MBBS, MD (OBG) MRCOG (London) C K Birla Hospital for women

urprisingly, Polycystic Ovary Syndromeor popularly referred to as PCOS is a fairly commoncondition that affects one in every ten women and is one of the prominent factors resulting in female infertility today. The disorder may have a prolonged impact on a woman’s life causing diabetes, cancer, heart disease and additional life-threatening conditions. However, more than 50%of women having PCOS do not get diagnosed. A key element that results in this alarming statistic is the fact that most women are not able to comprehend the signs of the condition and seek guidance from a medical practitioner at the right time. Therefore, to improve the chances of diagnosing and managing PCOS for women globally, evidence-based recommendations and regulations have been developed in 2018.

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◆ If you notice that you are not experiencing menstruation at all ◆ If you notice an increased growth in facial or body hair, a

condition known as hirsutism

◆If you observe a rise in loss of hair on your head ◆ If you feel that you are either suddenly gaining weight or

finding it hard to lose weight

◆ If your skin becomes oily with the appearance of acnes ◆ If you have difficulty conceiving a baby

There are other symptoms, namely depression and psychological issues that may also indicate towards PCOS in women. However, these symptoms may be harder for women to understand.

Causes of PCOS Experts have not been able to point towards the exact cause of PCOS. However, studies have shown that the condition may be passed on genetically within a family. One of the causes is a direct connection to abnormal hormone levels.

DOCTOR SPEAK

◆E xperienced gestational diabetes during pregnancy ◆O bese ◆H igh Blood Pressure is possibly related to the

increased insulin resistance in the body and obesity. It is not a direct affect of PCOS. In due course of time, high blood pressure can also be lead to heart problems. ◆C ancer, more precisely endometrial cancer has been seen to affect a small number of women suffering from PCOS. This may develop if the menstruation cycle is less than three times a year, causing the endometrium or the lining of womb to thicken. ◆D epression and mood swingsmay lead to the patient

experiencing feelings of low self-esteem.

◆A hormone known as testosterone has produced by a woman’s

ovaries in small amounts. However, in women with PCOS, there is an increased amount of testosteronepresent in the body.

◆ Insulin resistance results in the body retaining higher levels

of glucose or sugar in the blood. In order to counter the rising bloodsugar in the body, it begins an increased production of insulin. This may ultimately lead to women with PCOS gaining more weight, having irregular periods and other fertility issues.

Diagnosing PCOS It does not imply that you have PCOS if you are diagnosed with polycystic ovaries alone. There are additional symptoms such as a gain or loss in weight without any plausible reasons that is also a key element in diagnosing PCOS. Thus, diagnosis of the condition becomes more difficult. However, if you are experiencing any two of the following symptoms, it may lead to a more accurate diagnosis of the condition. ◆ I nfrequent menstrual cycles or no menstruation at all ◆ I ncrease in facial or body hair growth ◆T estosterone levels are higher than normal ◆A n ultrasound screening that detects polycystic ovaries

◆S noring and Daytime Drowsiness may also be an a significant

after effect of PCOS.

Minimizing Health Risks in the Future Leading a healthy lifestyle is the key to minimizing health risks in the long run. Eating a balanced diet that includes fruits, vegetables and whole foods, with a lot of lean meat, fish and chicken is a start. It is prudent to cut down on excessive consumption of sugar, salt and caffeine. Lifestyle changes should also include discipline in eating meals on time and exercising regularly. Keeping a check on your weight is essential. Monitoring your condition through periodic health check-ups also helps to reduce long-term health risks.

Curing PCOS Medical science has not defined a cure for this condition. However, there is effective and efficient ways to manage the disorder through regular consultations with your specialist healthcare provider. Given the fact that millions of women, worldwide are affected by PCOS, the way to go forward is by investing in quality research in order to identify targeted treatments and discover possible genetic elements of the condition. With increased research funding, the disorder should get the attention that it demands.

◆O n confirming the diagnosis, the case is then referred to a

gynecologist or an endocrinologist.

PCOS and the Impact on Long-term Health PCOS is that silent condition which has a long-term impact on a woman’s life. It can result in other health complication such as: ◆D iabetes and Insulin Resistancemay develop in PCOS

patients due to the imbalance of blood sugar levels in the body. Diabetes has long-term implications of its own, and possibly result in damaging other organs in the body. The risk of diabetes is greater if the patient is:

◆O ver 40 years of age ◆H as a family history of diabetes w w w.medegatetoday.com Sep-Oct 2018

COVER STORY

How has poor lifestyle led to an increase in risk of heart diseases among youth, especially population living in the cities? Dr Deepesh Venkatraman Consultant interventional Cardiologist, BGS Gleneagles Global Hospitals

LIFE AT THE COST OF LIFESTYLE Youth is the time when one is at the prime of their capabilities to deliver and make a difference. It’s a stage for which they and their families have prepared throughout the childhood and the memories of its exuberance would lighten up their retirement life. Unfortunately a healthy youth is no more a given, life threatening conditions are cutting short the quality and quantity of life. Cardiovascular events are masquerading lives like what plague and other infections did in the last centuries, transcending all ages and races. While major medical advancements have happened like never before, its benefits haven’t managed to mitigate the rapidity with which the heart conditions are consuming the lives, especially in young. The reason why heart disease particularly heart attack were confined to elderly was owing to the slow nature of its progression, the insult though always start young. The premature progression in the obstructive process has been a major observation in our recent cardiac practice and with genetic factors un-modifiable, it’s the lifestyle of current generations, which has to be blamed, and has a scope to be altered. The demarcating features between the previous generation and the current is the way one grows up, stress triggers and its handling tools with current youth, the environment they encounter, the diet and exercise patterns, the work life and work schedule, involvement in illicit substance abuse and the ill-effect of social media. Heart disease is not new to humans although a couple of generations back infections never let us live long enough to get a fatal cardiac event. With a longer lifespan, enhanced productivity even amongst hexagenerains and everincreasing aspirations, we can’t let this premature march of cardiac ailments 52 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

cripple us at young. It’s the need of the hour to identify and alter threatening lifestyle issues before youth is incapacitated by this fast progressing menace. Kids are increasingly born with preloaded comfort wherein they are pampered for no good. This early unreal start, underprepares them in terms of poorer dietary choices, point of seating delivery of comforts seeding sedentary lifestyle and a psychological milieu, which gets worked up in mildly hostile atmosphere. Providing the right perspective is the first responsibility of parent and teachers who shape the personality and in a sense the future of the kids. The dietary options are more to suit the taste buds and are devoid of the native virtues. Vegetables are fried, fruits are processed as jams and juices with sugar excess, cereals are powdered and refined compromising its fiber content, oil and ghee have been adulterating the taste expectations at the cost of unperceived hazards. Salt content in refrigerated products and ready to cook foods have been overwhelming our body’s water handling machinery leading to hypertension. In summary when we eat, 8 times out of 10, we will bombard ourselves with non-manageable tsunami of hard to handle food content, which bypasses our natural digestion&excretion and gets stored up at all abnormal places including arterial walls. The additive insult is when the taste bud lures us to consume more than required and our sedentary life fails to burn it. The busy competitive world, instant gratification from television, movies and social media, widespread availability and reliance of vehicular transport, etailers, home delivery of services, more occupations with bench and desk have systematically curbed our need to move around. It’s only a symptom, self-motivation to exercise or a doctor prescription, which can mobilize the people out of their comfort zones. Unknowingly the lack of exercise is leading to storage of food as fat, deposition of bad cholesterol, early onset

of diabetes and hypertension, obesity and various other psychosocialstresses. If there is one menace that can have the largest impact on heart disease, it would be substance abuse, especially smoking. Smokers owing to their thicker blood and clotting tendencies, more fragile cholesterol deposition, more rugged arterial walls forming scaffolds for obstructive cholesterol plaques and the in-built psychological background amongst smokers, subtend them for 3 -5 times higher risk of a cardiac event than their teetotaler peers. Having said that, prolonged cessation of smoking has significant reversal in the risk, with equivalence with others achieved by 5 years. Disease conditions like obesity; hypertension, hypothyroidism and diabetes are one of the commonest harbingers for a future heart attack in practice. Young patients often have an undetected comorbidity, found only retrospectively. These conditions are hybrid in etiology, with an environmental trigger expediting their genetic predisposition. Lack of daily exercise, high calorie, high glycemic and high salt food are avoidable catalysts. Regular screening above the age of 25 is the most definite way of anticipating and early control. Often the young who present with a heart attack aren’t found to have anobvious cause. The cause may be unraveled by further advanced blood tests, genetic assays and evaluation by someone who is an expert in the field. The tedious and unyielding nature of the pursuit discourages both patients and clinicians to proceed the entire distance. It takes a keen cardiologist, who has devoted himself to the purpose of exploring these mysteries, and is sufficiently updated of the latest advancements. In a good chunk of patients,it’s found that stress related to triggers at school, colleges, and work place and even at home and neighborhood have led to an unrealized magnitude of obstructive

COVER STORY

Heart Attack Vs. Heart Failure Both are very different clinical syndromes. Heart Attack results from a sudden blockage of one of the major arteries supplying the heart; resulting in damage to a part of the heart muscle. This could be preceded by prior history of chest pain on effort called angina which too result from a blockage in one of the three coronary arteries. A heart attack happens when the supply of blood to the heart is suddenly blocked, usually by a blood clot. Lack of blood to the heart can seriously damage the heart muscle. Heart attack is referred medically as a myocardial infarction or MI. Some heart attacks are sudden and intense but most heart attacks start slowly, with mild pain or discomfort. Often when the pain is mild, is mistaken for indigestion.

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The basic mechanism of this is a buildup of fat (cholesterol) into the heart arteries – a process called atherosclerosis and which is speedened by various risk factors like high blood pressure, diabetes, high cholesterol, smoking, overweight, stress, lack of exercise, advancing age and male sex or family history of premature heart attacks. Coronary heart disease (CHD) is the leading cause of heart attacks. In this condition coronary arteries get clogged with deposits of cholesterol called plaque. Before a heart attack, one of the plaques ruptures, causing a blood clot to develop. The clot may block the supply of blood running through the coronary artery, triggering a heart attack On the other hand, heart failure is a term which denotes poor heart pumping or poor relaxation of heart muscles from various diseases like prior heart attacks due to blockages, heart muscle weakness despite normal heart arteries, high blood pressure or diabetes etc. Normally echo is a good tool for assessment of both poor heart pumping or poor relaxation of heart muscles. Clinically the patient has swelling over feet/ face, congestion in the lungs, breathlessness on walking or if severe at rest too and signs of fluid overload in body and lungs / liver etc. Management of heart failure involves use of drugs to increase urine output (diuretics) or drugs to improve contractility of heart like digoxin and restricting of fluid intake.Further, evaluation with diagnostic procedures like angiography to identify treatable causes of heart failure like blockages in one or more major heart arteries is needed in all patient of heart failure. If symptoms do not improve – some patients will need special types of pacemakers called “biventricular pacemakers” which activate both left and right ventricular simultaneously and thus cause better emptying of heart and thus relief in symptoms.

General measures before patient is taken to the hospital✓ Make the patient sit down and loosen their clothing. ✓ Do no leave the person alone ✓ Immediately shift him to the nearest hospital or ambulance service ✓ A tablet of aspirin helps to limit the damage. 300 mgs of aspirin chewed at the time of a heart attack can reduce the mortality by 15-20% ✓ Keep monitoring the patient’s breathing and pulse until the patient is shifted to th emergency department or until the ambulance arrives.

Reducing your risk of a heart attack: There steps can reduce your risk of having a heart attack or having another heart attack✓ Smokers should quit smoking ✓ Lose weight if you are overweight or obese ✓ Do regular moderate-intensity aerobic activity unless advised otherwise by your doctor ✓ Eat a low-fat, high-fiber diet, whole grains, plenty of fresh fruit and vegetables ✓ Limit your consumption of alcohol Some patients with advanced heart failure are candidates for left ventricular assist devices (artificial heart) or even heart transplant. Thus, heart attack and heart failure are too distinct entities with their own causes and treatment strategies.

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Heart diseases are now a lifestyle ailment! Dr. Amar A Amale MBBS, MD Medicine and DNB Cardiology, DocsApp Medical App After diabetes, cardiovascular disease is now succeeding as the most prevalent lifestyle condition affecting a majority of Indians in the country. According to Indian Heart Association, 50% of heart attacks in India occur below the age of 50 and 25% affect those under 40 years of age. The incidence of heart disease is clearly increasing amongst the youngsters due to sedentary lifestyle, stress and increasing air pollution. Besides, deskbound jobs are also a major cause of heart disease turning into a lifestylemalady. The lack of physical activity results in blood clots, high blood pressure, heart attack, stroke and other heart-related problems. In a 2017 paper by the Sedentary Behavior Research Network (SBRN), sedentary behavior has been defined as any prolonged activity involving sitting, reclining or lying down, which has a very low energy expenditure. According to research, only 21% of adults meet the desired physical activity guidelines, with only less than 5% of people performing 30 minutes of physical activity everyday. Prevention is the key to living a healthier and improved life, and, it starts with

taking the necessary measures to decrease the chance of developing cardiovascular disease. It is one’s lifestyle that acts as the best defense against heart disease and stroke. Lack of exercise, a poor diet followed by unhealthy habits like smoking and consuming alcohol can take the toll over the years. Eating a healthy diet and maintaining an appropriate exercise regimen can work wonders on the body and keep the heart healthy but it is better to start early. Here’s how you can control risk factors associated with cardiovascular diseases: ☞ Choose a healthy eating plan: The food you eat plays a vital role in determining the overall health of your body. Avoid fatty-foods and choose foods low in saturated fat, trans fat, and sodium. Limit intake of sweetened beverages, junk food and red meat. If you choose to eat red meat, select the leanest cuts available. Select low-fat dairy products and skinless poultry. Consume more of fibre-rich whole grains, nuts, legumes and seeds regularly. ☞ Include more vegetables and fruits in your diet: Fresh fruits and vegetables are good sources of vitamins and minerals. Create a diet plan that includes plenty of them to keep you healthy and energized. Vegetables and fruits are also low in calories and rich in dietary fibre and consuming a variety of them

daily can actually help in reducing the risk of several diseases, including heart diseases. ☞ Be physically active: Practicing yoga, meditation or other exercises are crucial to stay fit. No matter what your age is, if you want to lead a long and healthy life then make sure you're physically active. If you are not able to stick to a particular exercise regimen or hit the gym regularly, pick an activity that can keep you on your toes and help in burning calories, like gardening, jogging, brisk walking bicycling, swimming, playing tennis, walking the dog, household activities like sweeping or dancing. Make sure that it does not feel like a chore. ☞ Control your portion size: While what you eat matters a lot, how much you eat is equally important. Do not overload your plate with different food items. Instead, keep a track of the number of servings you eat. Try cutting down on your favourite foods like chocolates and pizza completely and focus more on consuming larger portions of lowcalorie, nutrient-rich foods, such as fruits and vegetables. Break free of unhealthy eating and learn to fight against your food addictions. Remember, what you give to your body, it gives back to you.

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Hypertension & Heart Health: Ten Things to Keep in Mind Health awareness about high blood pressure among general population can prevent the development of hypertension or its complications. Below are the ten important things to keep in mind about high blood pressure.

Itâ&#x20AC;&#x2122;s a common medical condition: A recently conducted study in Delhi-NCR region showed that approximately 30% people in rural and 42% people in urban areas suffer from high blood pressure. Its prevalence is rising at an alarming proportion. The number of people suffering from high blood pressure has almost doubled over past two decades.

Itâ&#x20AC;&#x2122;s a silent killer:

Dr. Suman Bhandari Director, Dept of Cardiology, Fortis Hospital, Noida. Worldwide high blood pressure is a leading cause of morbidity and mortality. It is one of the major risk factor attributable to the development of cardiovascular disease. Hypertension is a cause of sudden death. Hypertensive, male smoker is a classic victim of sudden cardiac arrest. It is responsible for approximately 7.5 million deaths globally every year, or 13.5% of all the deaths. Almost one billion people or one fourth of the adult population suffers from hypertension and its prevalence is rising, especially in developing countries. By 2025 developing countries like India would account for about 80% of the total hypertensive patients. It poses a great public health challenge for economically weaker countries like India. Large population, poor health infrastructure, low public spending on health, low literacy rate and low health awareness etc. compound this problem. Almost one in three people suffer from high blood pressure in our country. A large proportion of people remain undiagnosed or poorly treated for hypertension. An untreated or poorly treated hypertension may lead to various complications including heart attack, heart failure, stroke, kidney failure etc. 56 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

In most cases hypertension causes no symptoms. In India less than half of the people with high blood pressure are aware about it, and even lesser number of those seeks treatment for it. The situation is worse in rural areas. Many people tend to deny their high blood pressure due to absence of symptoms. It may cause no symptoms but it can silently cause serious complications in your body. Denial or refusal to accept the diagnosis is very common even in the highly educated segment of our society.

Different people, different targets: All the people irrespective of age should get their blood pressure checked by their physician at least once in a year. If you are diagnosed with the high blood pressure, ask your physician about your target blood pressure. Your target blood pressure would be lower if you have comorbidities like diabetes or kidney disease. You may require one, two or more medicine to keep your blood pressure in the target range. Remember, only 20% people in urban and 10% in rural areas in our country have their blood pressure adequately controlled. The risk of cardiac disease or death doubles for every 20 mmHg (millimeters of mercury) increase in systolic blood pressure (the upper number in your blood pressure) and 10 mm Hg increase in diastolic blood pressure (the bottom number in your blood pressure measurement).

Reduce your risk: You may reduce your risk or delay the onset of high blood pressure by adopting healthy life style. It can also help to achieve the target blood pressure easily and reduce the doses of blood pressure medicine in those already diagnosed with hypertension. Point 5 to 10 mentions some of the healthy life style choices for reducing the risk of hypertension.

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Eat healthy: Dietary approaches to stop hypertension (DASH) trial showed that diet can reduced blood pressure. A diet high in fruits, vegetables, whole grains and legumes along with moderate quantities of nuts, lean meat (including poultry & fish), low fat dairy product and liquid vegetable oils is considered healthy. Also reduce saturated fat, trans fat, added sugar and salt in your diet. The total salt in your diet should not be more than 5 grams and even lesser if you are already diagnosed with hypertension. Donâ&#x20AC;&#x2122;t forget to include the salt already hidden in packaged/processed food items while calculating daily salt consumption. Make a habit of reading the food labels to find out the amount of calories, saturated fat, trans fat and salt present in the food items. Also avoid added sugar and sugar sweetened juices/ beverages.

Exercise regularly: 30-45 minutes of moderate intensity physical activity (brisk walking, cycling, swimming etc.), at least 5 days a week is recommended for a healthy life. It should include a warm up and cool down period before and after the exercise respectively. Muscle strengthening exercises at least 2 days a week are also needed to remain healthy. Exercise will not only reduce risk of high blood pressure, it also reduces the risk of diabetes, heart diseases, weight gain, cancers, depression, premature death etc.

Maintain a healthy weight: Body Mass Index (BMI) is a measure of healthy body weight. Ask your physician about your BMI. BMI of 18.5 to 25 kg/ m2 is considered to be healthy. But not only BMI,the fat distribution in your body is equally important. The central fat distribution (around abdomen) cause apple body configuration is not considered healthy, while peripheral fat distribution (around thighs) is healthy. The fat distribution is assessed by measuring waist circumference, hip circumference and waisthip ratio.

Stop Smoking: It should be completely stopped. Both active and passive smoking is considered a risk. Recent studies have shown that even one cigarette a day raises your risk for high blood pressure and heart diseases. Nicotine replacement therapy in the form of chewing gums, nicotine patches etc. may help you quit smoking. Talk to your doctor if you are not able to quit on your own, who may prescribe you medication to help you quit smoking.

Avoid alcohol: It is good if you avoid alcohol altogether; but if you want to continue drinking, avoid more than 2 standard drinks a day. For females the recommendation is to avoid more than one standard drink a day. On any single occasion no more than

4 standard drinks are permitted. Drinking does not protect Indians from stroke or heart attack.

Reduce stress: Stress increases the level of hormones and chemicals in the body which cause high blood pressure. Meditation, yoga, breathing exercises, regular physical activity, recreational activities, positive thinking etc. can help you reduce the stress of day to day life. At least 7 hours of sleep prevent vascular event. Indian classical music has been shown to be effective in reducing blood pressure. w w w.medegatetoday.com Sep-Oct 2018

COVER STORY

Progressive heart failure among Indian Youth set to become an epidemic otherwise it is set to become the leading killer by 2020.

Dr. Nityanand Tripathi Associate Director â&#x20AC;&#x201C; Cardiology, HOD- Cath Lab, Max Super Speciality Hospital, Shalimar Bagh

ardiac Ailments is the leading cause of death in India and worldwide killing about 1 in 5 men and 1 in 8 women, According to WHO reports. It is caused by blockage in heart's blood supply by a build-up of fatty substances in the arteries. It is primarily a disease caused by lifestyle habits and conditions such as smoking, overweight, high cholesterol, high blood pressure and diabetes. Heart attacks were once only associated with old age. Recently, more people in their 20s, 30s and 40s have been suffering from heart ailments. The increasing stress of modern life has exposed even younger people to the risk of heart diseases. While a person's genetic disposition and family history remain the most common and uncontrollable risk factors, majority of heart diseases in the younger generation is due to excessive stress and long working hours coupled with erratic sleep patterns, which cause inflammation and increase the risk of heart disease. Smoking and a sedentary lifestyle further accelerate the risk symptoms in people in the age group of 20 to 30 years.

Everyday about 9000 people die of heart ailments - which mean one in every 10 seconds. Out of them 900 are youths below the age of 40 years. The only way to prevent the Epidemic of Heart Disease in India is to educate the mass 58 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

Cardiac Hospitals in India perform more than 2 lakh open heart surgeries and are increasing annually by 25% but they are not able to control the numbers of heart attacks. The surgeries done are only palliative. Educating the essentials about Heart disease and its risk factors is important to eradicate the casualties from the root.

What are the symptoms? Not every CHD patient has the same symptoms and angina chest pain as its most common feature. Symptoms may vary from nil to severe, some may have an uncomfortable feeling like indigestion and some cases may be experiencing severe pain, heaviness or tightness. The pain is usually felt in centre of the chest, that spreads to the arms, neck, jaw and even to stomach, and is accompanied by palpitation and unusual breathlessness. If arteries become completely blocked, it can cause a heart attack that can cause permanent damage to the heart muscle. The discomfort or pain of a heart attack is usually similar to that of angina, but is often more severe and may be associated with sweating, lightheadedness, nausea and breathlessness. This is more common in people with diabetes. Heart attack if not treated straight away can be fatal.

How to do prognosis in advance? Assessment of a suspected CHD patient involves the medical and family history, assessing the lifestyle and taking blood tests. Further tests to confirm a diagnosis of CHD includes non-invasive tests like an electrocardiogram (ECG) to identify the structure, thickness and movement of each heart valve, X-ray to look at the heart, lungs and chest wall to rule out any other conditions that may be causing symptoms, Treadmill test (TMT) during exercise to know the effect of exercise on the heart, Cardiovascular cartography heart flow mapping, CT angiography

and the invasive coronary angiography to identify whether the coronary arteries are narrowed and how severe any blockages are.

How to manage the heart ailments? Although coronary heart disease cannot be cured, but treatment can help manage the symptoms, improve the functioning of the heart and reduce the chances of problems such as heart attacks. Effective management includes a combination of lifestyle changes, medicines and non-invasive treatments. Invasive and surgical treatments are required in more severe cases. In most cases it is possible to eventually resume normal life. Some simple lifestyle changes include eating a healthy balanced diet, being physically active, doing regular exercise, no smoking and controlling blood cholesterol and sugar levels. These can reduce the risk of CHD, stroke and dementia and also have other health benefits. Many different medicines are used to treat CHD. Cholesterol, high blood pressure and diabetes can usually be well controlled with medicines. Other medicines aim to slow down the heartbeat, thinning the blood and preventing it from clotting. Some of these medicines can cause side effects such as headaches, dizziness and flushed skin, weakness, body-aches, and affect the memory and sexual drive. When taking any medicine for a prolonged period, therefore it is advised to have periodic blood tests especially for kidney and liver function. While heart failure sounds dangerous, it can be treated with better care and diagnosis. The only and the easiest way to prevent heart failure is avoiding the lifestyle and food habits that encourage obesity, diabetes, high blood pressure. Heart Failure or Cardio Vascular disease refers to the fact that your heart is not as healthy as it should be. You have to take better care of it for better functioning. But the best part is that you can prevent it with a healthy lifestyle â??

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Proper diet for heart the health of our heart. In my view, we can categorize these into three different categories. Firstly the overall impact of quantity or calories of food consumed; secondly food items that is good for heart, and should be consumed; and lastly food items that are bad for heart and should be avoided.

Dr Vivek Chaturvedi Senior Consultant Cardiology, Narayana Superspeciality Hospital , Gurugram

proper healthy diet is one of the cornerstones for prevention of heart disease. Consumption of heart friendly food is also as important as drugs, angioplasty and coronary bypass surgery for treatment of established heart disease, and there is sufficient proof that it even saves lives besides preventing sudden death and recurrent heart attacks. While the field of nutrition is always evolving and sometimes surrounded with high profile controversies, we have sufficient evidence about certain dietary patterns that have unequivocal impact on

It is very important to limit the calorie intake as per our metabolic rate and physical activity. Too many calories consumed invariably lead to weight gain and abdominal obesity. These in turn not only aggravate the metabolic risk factors for heart disease (like diabetes, high blood pressure and high bad cholesterol), but have a direct harmful effect on heart as well. Green leafy vegetables, fruits (especially bright ones like berries), plant based diets ( like legumes) and seeds contain fiber, proteins, good fats, and antioxidants that are very good for the heart. Similarly nuts, like walnut, almonds are very healthy but should be consumed in moderation (about 30 gm/day) as they are dense in calories as well. Tea and coffee consumption is also good for heart but should be taken in the overall context of dairy and sugar added to it. Lean meats like chicken and fish are also probably okay for the heart but should be consumed in moderation. Vitamin B12, if found deficient, should also be supplemented

Synthetic sugars, sugary drinks (including colas, energy drinks, fruit juices with pulp removed) are not good for the heart. So also are the processed foods and namkeens including fried foods, especially those made using transfat and/or poor quality vegetable oils. Red meat is also high in fat and calories and not heart healthy. While too many circulating social media messages are claiming lack of bad effect of dietary cholesterol and fats on heart health, this is misinterpretation of facts. If consumed in large quantity, dietary fats definitely lead to increase in bad blood cholesterol levels. Eggs are good, but do increase cholesterol and should be taken in moderation. As far as cooking medium is concerned, olive oil as well monounsaturated or polyunsaturated oils like canola and sunflower oil are good for the heart. Mustard and peanut oil are also heart healthy. Coconut and palm oil, saturated oils, are not good for the heart. Alcohol in strict moderation is probably good for heart but this is not established. As it causes multiple other problems including increase in blood pressure, it cannot be recommended as a dietary advice. Dairy products contain fat and salt, but have vitamins and minerals also and hence are okay in moderation. High dose vitamins have no role as routine supplements for a healthy heart.

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COVER STORY

How has poor lifestyle led to an increase in risk of heart diseases among youth, especially population living in the cities? Dr Deepesh Venkatraman,

Consultant, Interventional Cardiologist, BGS Gleneagles Global Hospitals

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The demarcating features between the previous generation and the current is the way one grows up, stress triggers and its handling tools with current youth, the environment they encounter, the diet and exercise patterns, the work life and work schedule, involvement in illicit substance abuse and the ill-effect of social media. Heart disease is not new to humans although a couple of generations back infections never let us live long enough to get a fatal cardiac event. With a longer lifespan, enhanced productivity even amongst hexagenerains and ever-increasing aspirations, we can’t let this premature march of cardiac ailments cripple us at young. It’s the need of the hour to identify and alter threatening lifestyle issues before youth is incapacitated by this fast progressing menace. Kids are increasingly born with preloaded comfort wherein they are pampered for no good. This early unreal start, underprepares them in terms of poorer dietary choices, point of seating delivery of comforts seeding sedentary lifestyle and a psychological milieu, which gets worked up in mildly hostile atmosphere. Providing the right perspective is the first responsibility of parent and teachers who shape the personality and in a sense the future of the kids. The dietary options are more to suit the taste buds and are devoid of the native virtues. Vegetables are fried, fruits are processed as jams and juices with sugar excess, cereals are powdered and refined compromising its fiber content, oil and ghee have been adulterating the taste expectations at the cost of unperceived hazards. Salt content in refrigerated products and ready to cook foods have been overwhelming our body’s water handling machinery leading to hypertension. In summary when we eat, 8 times out of 10, we will bombard ourselves with non-manageable tsunami of hard to handle food content, which bypasses our natural digestion&excretion and gets stored up at all abnormal places including arterial walls. The additive insult is when the taste bud lures us to consume more than required and our sedentary life fails to burn it. The busy competitive world, instant gratification from television, movies and social media, widespread availability and reliance of vehicular transport, etailers, home delivery of services, more occupations with bench and desk have systematically curbed our need to move around. It’s only a symptom, self-motivation to exercise or a doctor prescription, which can mobilize the people out of their comfort zones. Unknowingly the lack of exercise is leading to storage of food as fat, deposition of bad cholesterol, early onset of diabetes and hypertension, obesity and various other psychosocialstresses.

COVER STORY

If there is one menace that can have the largest impact on heart disease, it would be substance abuse, especially smoking. Smokers owing to their thicker blood and clotting tendencies, more fragile cholesterol deposition, more rugged arterial walls forming scaffolds for obstructive cholesterol plaques and the inbuilt psychological background amongst smokers, subtend them for 3 -5 times higher risk of a cardiac event than their teetotaler peers. Having said that, prolonged cessation of smoking has significant reversal in the risk, with equivalence with others achieved by 5 years. Disease conditions like obesity; hypertension, hypothyroidism and diabetes are one of the commonest harbingers for a future heart attack in practice. Young patients often have an undetected comorbidity, found only retrospectively. These conditions are hybrid in etiology,

with an environmental trigger expediting their genetic predisposition. Lack of daily exercise, high calorie, high glycemic and high salt food are avoidable catalysts. Regular screening above the age of 25 is the most definite way of anticipating and early control. Often the young who present with a heart attack arenâ&#x20AC;&#x2122;t found to have anobvious cause. The cause may be unraveled by further advanced blood tests, genetic assays and evaluation by someone who is an expert in the field. The tedious and unyielding nature of the pursuit discourages both patients and clinicians to proceed the entire distance. It takes a keen cardiologist, who has devoted himself to the purpose of exploring these mysteries, and is sufficiently updated of the latest advancements. In a good chunk of patients,itâ&#x20AC;&#x2122;s found that stress related to triggers at school, colleges,

and work place and even at home and neighborhood have led to an unrealized magnitude of obstructive pathology of arterial tree. When we compare the phenomenon with last generation, it appears that the current generation is experiencing unprecedented levels of stress owing to peer pressure, longer working hours, late night shifts, double shifts, unfulfilled economical aspirations and on top of this our inability to manage these situations as well as our elders did. The lack of social support, stemming from disintegrating joint families, reliance on social media and growing up with a protected pampered childhood has disarmed us and rendered youth vulnerable. Meditation, social empathy and participation in community activities are our major hope for empowerment against stressful situations.

INTERVIEW

Rainbow Children’s Hospital is leading Tertiary Care Hospital in India

Rainbow Children's Hospital and BirthRight conceptualized the 1000-day program to spread awareness and assist mothers-to-be in bringing up a generation of healthy children. Medal" for the Best Outgoing Student of P.G.I.Chandigarh (1996). ☞ Healthcare expert with New York based On Frontiers in operations, quality, business and management of hospitals and medical institutions. ☞ Guest faculty with many Indian Universities and Business schools for teaching programs in Hospital Administration & healthcare quality. ☞ Likes mentoring start-ups and help them understand the detailing of healthcare

Tell us about your journey so far into healthcare since inception?

Mr. Neeraj Lal (Vice President and Cluster Head Rainbow Children’s Hospital, Bangalore and Karnataka Region)

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☞ I started my healthcare journey 18 years ago with graduation from PGI Chandigarh and post-graduation from prestigious Tata Institute of Social Sciences (TISS) Mumbai. ☞ Have worked as the Group Chief Operating Officer of the Sunshine Global Group of Hospitals based out of Gujaratand have held senior positions in various Indian Hospitals for a number of years including private , trust and corporate sets ups. ☞ I am one among the four Indian individual members of the International Society for Quality in Healthcare (ISQua) based out of Dublin and also an approved Surveyor for ISQua’s International Accreditation Programme. ☞ Won various awards and prestigious positions to my credit☞ Received the Award of Excellence for “Outstanding Contribution in Healthcare Sector” by North Gujarat University, Patan (2011). ☞ Winner of the Prestigious "Aikat Memorial Gold Memorial Gold

You have vast knowledge of running big hospitals successfully, where many hospitals are taking oxygen for survival. What is your strategy & key to success? Hospitals are very complex organizations to run as they are labor and capitalintensive.Generaly strategy should be to run operationally optimum depends on following actions◆ Good asset control ◆ Employee engagement ◆ Consultant liasoning ◆ Ensureoutsourced services are trusted to companies familiar with healthcare. ◆ Quality healthcare scenario and culture in hospital

As you are running single specialty for mother & child, how this is different from multi specialty. Share your experience? Yes running single super specialty mother and child is very different from running conventional multispecialty hospitals. During two decades of service in the field of childcare, hospital have gathered

INTERVIEW first-hand knowledge on the significance of the first 1000 days of life. That is why at Rainbow Children's Hospital and BirthRight conceptualized the 1000day program to spread awareness and assist mothers-to-be in bringing up a generation of healthy children. Rainbow recognize that childbirth is one of life's major events, sometimes complicated, but mostly a natural process involving intense emotions and physical experiences; an event which profoundly changes people's lives, and which can, and should be, very fulfilling for both the mother and father. Rainbow is the Pediatric Superspeciality Powerhouse; its Pediatric Intensive Care Unit treats more than 1000 critically ill children annually, in collaboration with various pediatric subspecialties such as Neurology, Nephrology, Hematology, Pediatric Surgery etc. and has the largest number of children managed on High Frequency Oscillatory Ventilation in the country. Rainbow launched its Perinatal Centre for Women with the sole aim of gifting soon-to-be mothers a safe, secure and happy motherhood especially in high risk pregnancy cases. With state-of-the-art labor rooms attached with Maternity ICU. Rainbow has initiated high end LDRP Suites (Labor, delivery, recovery, postpartum suites) the first of its kind in South India. Rainbow is also known for the least possible surgical interventions and pave way for natural birthing.Pediatric Tertiary Care Centres of Rainbow located across 11 locations, six in Hyderabad, two in Vijayawada, two in Bengaluru and one in Delhi and now one in Chennai that provides care right from birth through adolescence. Our goal is to provide comprehensive pediatric healthcare for your child all under one roof. Collectively, facilities make Rainbow leaders in critical care delivery for sick children with excellent clinical success rates at par with international standards, making us amongst the best pediatric critical care centers.

What challenges are there to run such hospital from competitor and patient prospective? These days because of accreditations, regulations and manpower shortage hospitals are running in very challenging situations. Some of them include◆ Employee turnover ◆ Consultant expectations ◆ Data collection & data privacy ◆ Convincing consumers for delivering best healthcare ◆ Technology update and people interaction ◆ Price conscious market including managing government schemes and TPS/Insurance business ◆ Aggressive competition

Please elaborate the modern ultra hi-tech facilities available at Rainbow hospital? Rainbow Children’s Hospital and Birthright by Rainbow is a Paediatric tertiary care Hospital that handles all the mother and paediatric specialties ranging from Paediatric Endocrinology to Paediatric neurology and Paediatric Oncology. With 18 glorious years of excellence in child and mother care, Rainbow Children Hospital is now the India’s largest network of child care hospitals and one of the leaders in Paediatric and Perinatal health care with 1000+ beds, 10 Hospitals across India, having 2 centres in Bangalore, Karnataka.

womb), Lulby Phototherapy ( for treating jaundice) , Billy Blanket ( for jaundice) ,High end warmers, transport incubators cum ventilators ( for safe transport) , SLE Ventilators. ☞ Largest PICU in private set up in the country with more than 40 beds treating most complex cases mixes and baby with burns. Centre Of excellence for Burns which have saved children with more than 60 % burns. ☞ Advanced Paediatrics Cancer Centre with Bone marrow transplantation unit. ☞ Advanced Child Development Centre in the country with Keto Clinic. ☞ Centre for Paediatrics Diabetes. ☞ Largest Centre in the country for Cerebral Palsy with Gait Lab and Paediatrics Orthopaedics facility. ☞ Only exclusive Paediatrics Kidney transplant centre in the country having completed more than 10 successful transplant till date and Advanced Nephrology with CRRT, SLED, IHD, Plasmapheresis and MARS which have dealt complex nephrology cases and renal failures with successful kidney transplants. ☞ Advanced Sleep Lab for Children’s ☞ All Paediatric Super Specialties including Paediatrics Surgery ,GI Surgery, Pulmonology, Rheumatology etc. under one roof

How is Rainbow Unique place for children’s ? ☞ Largest NICUin private setup in the country with more than 50 beds treating pre term babies from 24 weeks and doing retrievals from as far as 400 kms in specialised ambulance NICU on wheels. We are proud to deliver smallest baby in south East Asia with weight as low as 350 gms. ☞ NICU has state of heart High end equipment incl HFO( High Frequency Oscillator) , i NO ( Nitric Gas) delivery system , Giraffe Omni Bed High incubators ( Artificial Mother’s w w w.medegatetoday.com Sep-Oct 2018

DOCTOR SPEAK

Deep Venous ThrombosisA devil in the dark

Dr Bheem Rao Sangars MBBS, MS, MRCS, FRCS Sr. Consultant - Vascular & Endo Vascular Surgeon

64 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

uman body has two types of blood channels. Arteries are the blood channels which take oxygenated blood from heart to different body parts and Veins take the used, deoxygenated blood back from different parts of body to heart. The flow of blood in the arterial system is facilitated by Heart pump with pressure; the same is not there for venous blood flow. However there are ingenious mechanisms by which the Venous returns back to heart through venous channels. The Limb Muscle pumps and Valves in the Veins play a pivotal role in this process. Humans’ being bipedal animal’s gravity plays a negative role in venous blood flow. Clotting of blood in the Venous channels can lead to blockage of the flow. If this happens in deeper veins of the body parts it is called Deep Venous thrombosis (can happen in Upper limbs and Lower limbs). The effect of Deep Venous thrombosis (DVT) is venous return is blocked and the limb will swell with venous blood. The same clots can slowly travel to right side chambers of Heart and from there to Lungs and this condition is called Pulmonary Embolism (PE). If a very big clot goes and fills the main pulmonary artery it is called Massive PE and can be very fatal and one of the very common cause of sudden death. In Indian scenario the causes for DVT in majority cases are very simple like Fever, Accidents with fractures in Limbs and needing Immobilization, Paralysis, Episodes of Loose motions and vomiting, Excessive work in Hot environment, continuous long journeys and Pregnancy- the common factor in all the above cases are dehydration and immobility and to some extent pressure on Veins. In minority of cases People do have tendency to form more clots both by genetical composition and

environmental influences like smoking. Very rarely DVT can be a presentation of Cancers. The common symptoms of limb DVT is swelling with discomfort, redness and low grade fever. Sometimes the leg swelling can be very tight and intensely painful. Shortness of Breath, Palpitations and sweating could hint some of the clots might have travelled to Heart and lungs. Unfortunately some patients come with Massive Pulmonary Embolism which can be fatal. Once the clots form in venous channels this can slowly increase in size as the stasis in venous blood flow promotes further thrombosis and as mentioned above can travel towards heart. The longer the clot stays in venous channels it damages the valves inside veins leading to both structural and functional failure of venous blood return. This particular scenario can leave a patient with a permanent irreversible swollen limb with hardened discolored skin and Ulcers, in particular around ankle and lower legs. This condition is called post DVT syndrome (Post thrombosis Syndrome PTS). PTS can be crippling and functionally impair many people and unfortunately with discolored and ulcerated leg will be a social problem to many people. When a patient presents with DVT the immediate goal of the doctor is to reduce the risk of Massive Pulmonary embolism, attend to immediate lower limb symptoms and aim to prevent long term complications like PTS and evaluate patient to identify any factors which causes re occurrence of the problem. This particular problem can happen in many diverse varieties of patients and almost all specialties across medical field will have to recognize that there are preventive strategies for onset of DVT and immediate and long term implications and try as much as to reduce these dreadful problems ❏

DOCTOR SPEAK

Mapping the brain with data science Researchers at Purdue University are designing data-driven tools that will help clinicians better understand the progression of neurodegenerative diseases by identifying and tracking changes in the brain. Patients with dementia and other neural diseases show physical symptoms such as stumbling and confusion, but identifying the problem isn’t as simple as taking an X-ray. A group of researchers at Purdue University are designing data-driven tools that will help clinicians better understand the progression of neurodegenerative diseases by identifying and tracking changes in the brain. “We’re not to the point where we’re taking X-rays to see if you have a broken bone in your leg, but we’re at least at the stage where we’re saying, ‘Your gait is very funny,’” said Tom Talavage, professor of electrical and computer engineering and biomedical engineering, and a co-investigator for the project. “We can narrow it down to something wrong with your leg, and we can make inferences about what’s wrong with your leg. We can say, ‘You probably have a broken leg because of how you’re walking.’ That’s what we’re really getting at.” The project is led by Joaquín Goñi, an assistant professor of biomedical engineering who studies the network of neural connections composing the human brain. This network is called the connectome, the focus of an emerging field of study known as brain connectomics. Brain-imaging techniques, such as diffusion weighted imaging and functional magnetic resonance imaging (fMRI), allow neuroscientists to model and examine the connectome to understand communication between different regions of the brain. This helps them see which parts of the brain are functioning normally - and which regions are not - by observing changes over time. What we’re really doing is starting to create the means to see symptoms of neurodegenerative diseases; they become physical in the graphical approaches we apply. It’s very visual,” Talavage said. The team is using data from the Human Connectome Project, a collection of data sets from different projects focused on the connectome, to research and develop their method. Goñi and postdoctoral researcher Enrico Amico recently published a paper in Nature Scientific Reports using data from the Human Connectome Project to propose a data-driven method for assessing the connectome. Their work demonstrates that individual connectomes are unique enough to be identifiable – and could potentially be used to better understand the differences between people’s individual connectomes and how this relates to their health. Their project uses brain-imaging data that shows both “structural” and “functional” connectivity – physical connections between different regions of the brain, and the communication between those regions as a subject performs a given task. Making sense of an individual person’s network of connections and understanding their cognitive health depends on images of brain activity collected during these tasks.

“When my brain is performing activities, is it more consistently, uniquely me? Or does the task actually make me look like everybody else?” Talavage said. “The end results indicate that we are more uniquely ourselves even when we’re performing the same task.” Taking these detailed pictures of the connectome can be a challenge for neuroscientists. Often the neuro-images are affected by visual noise, which makes it more difficult to make sense of the data. “We want accurate representations of both structural and functional connectivity. Individual estimations of brain connectivity are quite noisy, meaning that they are not necessarily accurate in representing the subject’s characteristics,” said Goñi, who is the principal investigator for the research project. “We know that if we take the average of all those mapping connections, we get fairly good representations of the human connectomes.” One of the areas their research explores is to what extent the individual’s neural connections resemble each other because of genetics. Goñi and his colleagues are using the Humane Connectome Project’s data from pairs of identical (“monozygotic”) and fraternal (“dizygotic”) twins to see if genetic resemblance plays a role. If their method incorrectly identified one monozygotic twin as their identical counterpart, the team could then correct this mistake and improve the reliability of their results with each test. “Joaquin is working on a large study with twin data to document whether the twins, who were monozygotic versus dizygotic, looked like one another in terms of brain connectivity - and of course, they do.” Talavage said. “But they are still able to pull out the individual twin from the other twin. Even two identical twins do not look closer to one another in the end.” w w w.medegatetoday.com Sep-Oct 2018

INTERVIEW Wolters Kluwer helps the clinicians to give better point of care for the patients. Excited to launch the same in India with Akhil Systems, since it will improve the usage and benefit from the EHR. In conversation with - Ms.Neeraj Vats, Journalist Medgate Today Magazine

How does CDS allign with India's advanced digital capabilities and what is its potential in improving patient outcomes in rural India?

Shireesh Sahai

CEO - India/South Asia & lead China Health Learning, Research, Practice Business, Wolters Kluwer

“Every day around the world, healthcare professionals, students, and researchers are making important decisions on patient care and outcomes using our integrated solutions, premium content, and productivity tools.”Wolters Kluwer 66 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

Clinical decision support is a digital solution which helps the clinicians to impart better cure at the point of care for the patient. The reason it is relevant is because research has proven every day when a doctor is treating a patient n then he or she faces 11 clinical questions, unfortunately 60 percent of these clinical questions go unanswered and that’s because the doctor obviously does not have time to search for them in a journal, but in case if he or she are able to give those answers, 5 to 7 patient decision will change and that can impact the life’s of those patients. Now looking from the context it’s very important that for doctors to have a tool like that which can answer these questions, and up to date anywhere is one of the clinical decision support tool which can do just that by answering any clinical questions related to 25 specialty within 90 seconds . The answer given by the tool is validated by 6000 experts sitting around the world with a 3 tier pier reviewed and last but not the least and very relevant from the rules setting, the answer can be easily obtained by the doctor even without having an internet. So a person with Smartphone without internet answers can be obtained and this is why clinical evidence phase 2 is so important for our country especially in the rural areas

To further give examples of the various countries wherein use of clinical evidence 2 has become more relevant?” Mr. Sahai told that in US it’s pretty much 70 percent of all doctors are using it. In India over the least span of 3 years if you will look at the top 10 medical colleges, 8 of them have started using it, more than 50000 doctors in India have already started using it and more than 100 plus hospitals are also using it , so its starting but it’s the beginning , because once all of the rural areas will be covered then as per Mr. Sahai the scale can be much larger .

Brief about the ways through which CDA support prime ministers Ayushman Bharat program? Mr. Sahai said about Ayushman bharat programme,that it is one of the most ambitious programs not only for our country but for the entire world and he thinks so because it covers more than 100 million families , more than 500 million

INTERVIEW people with the insurance cover of Rs5 Lakhs. Further long as per Mr. Sahai, the key success factors for this program is going to lie in two aspects, number one being the cost of care giving which has to be kept at optimal level and number two, the errors in terms of diagnostic and medications has to be reduced drastically. And both of these are the hallmarks of having a good clinical evidence based system like up till today. Mr. Shay also elaborated 3 case studies through which he proved how both of these two aspects will be addressed. The first case study was that of Harvard University, where they looked at 3000 hospitals and a research spanning over 3 years they concluded that hospitals which were using a clinical evidence based tool like up to date which saved 11500 more life’s than the hospitals which were not using it.

Tell us about the value that the CDS driven practice at hospitals brings to our prime minister vision of digitally stronger healthcare that serves the nation better? Mr. Sahai answered the question by stating that as per him, if combined with the effect of using a clinical evidence based system with an EMR system in hospital, he also added benefits both for the hospital and for the patient. The biggest advantage for hospital is that, having a tool like this integrated with the EMR systems of the hospital reduces the length of stay of the patient, which is one of the critical parameter which the hospitals track. He also told that the study which he quoted for Harvard university, This will not only save life’s 11,500 but also reduced 300,000 days spent in the hospital in one years that is a big advantage for the hospital. Its also reduce the diagnostic quality or the errors in the diagnostic . Mr. Sahai also highlighted one more case study which was published in international journal of medical informatics this year, which said” that the clinicians who were using a clinical evidence based tool like up to date their diagnostic error was 2 percent compared to 24 percent diagnostic error by clinicians who did not use a tool like that. So for patient the biggest benefit is the diagnostic error in treatment boost up.

“So how does combining technically decision support system like with EHR, help improve patient outcomes?” Mr. Sahai said replied to the question by saying that , if the doctor is having a clinical decision support which is part of the work flow of the doctor , so when he is treating a patient then it comes automatically as the part of the work flow ( considering whether the doctor has considered that part)and that definitely will help an impact in improving the patient outcome and even in he studies which he quoted , most of the cases have been where the decision support is integrated with the EMR system.

Mr. Sahai whether the CDS system is pan India or not? Mr. Sahai immediately replied that he is in fact launching an integrated solution with up to date, which is the clinical evidence based system with an EHR system and so till now as, 100 hospitals and more than 50,000 doctors were still to be integrated but it would be very exciting day because they are launching it on the day of the conference.

Whether there has been any research that shows the efficiency of encrypting CDS with the work flow of hospitals?” Mr. Sahai told that his firm has studied around 1200 clinicians and this research found that 91 percent of them indicated that a clinical evidence based system integrated with EHR can improve patient outcomes. Therefore, this clearly indicates that a study conducted by their firm has found that the system to be efficient and what was even more satisfying was that 40 percent of these people that we surveyed said that by just having a clinical decision support helped them to use EHR more and so it encouraged them to go over EHR because they knew that it also had a clinical decision support.

This shows that there are cases to prove the same and Mr. Sahai was are very Last question asked by the media person from Mr. Sahai was “Does the hospital information system like integrated with CDS help in optimizing overall healthcare expenditure? He replied by stating that both at hospital level and at the patient level ,it will help in reducing the length of stay with the reduction of expenditure of the hospital and it will also reduce the patient outcomes and will also help in reducing the expenditure.

w w w.medegatetoday.com Sep-Oct 2018

INTERVIEW

Technology has changed the healthcareDigital Health Future of the Healthcare - Ishaq Quadri In conversation with - Ms.Neeraj Vats, Journalist Medgate Today Magazine

Mr. Ishaq Quadri

Consultant CIO, Secretary HIMSS, APAC India Chapter and Visiting faculty at TISS How can a hospital improve doctor’s engagement with the electronic health record? Mr. Quadri replied by saying, “yes there are a lot of advantages that a doctor gets in the way they practice medicine in the hospital and then if they are given good solutions specially in the electronic medical records front, which is got to do with looking at the patients and diagnosing and then entering those details into the system and then the system gives them the alerts with the possibility that when you implement an electronic medical records then there is a possibility that the system, can also for example the infants they have to be given immunization on regular basis and for example there are cases where two drugs cannot be given together , what they refer to as a contraindications and so there may be patients who have a lot of food related allergies and there may be situations where two drugs don’t go together , so when you look at all this then paper based system may not work because if not impossible then it is very difficult to make it happen”. 68 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

He further said that the doctor is using an electronic system like an electronic medical record or using any digital technology, these are the benefits where the access to information is there which is very easy and correlation of data is possible, for the same patients or across the patients when you look at the digital form and that is very much possible. The third aspect is if the doctor is doing a good job then the medication errors can drastically come down . Over and above all this , it brings in a culture where people are working as a team together , because the same information which we call as a single source of truth, is available for everyone and it kind of democratizes the whole process because the entire team is collaborating and so the same information is available across hospitals , it’s not that if the patient is admitted into a department which used to be the case earlier where file is stuck in one single department and here it cannot. So today what happens, is the patient if is admitted into orthopedic and he has got some bone related injury for which he is going to the treatment there and at the same time the radiology department can also see the report and so if the information is required there then they are able to see it . And so it improves their capability of care delivery and further it can improve the outcomes which they refer to as the results that can be much better if they improve the implement of digital system , so there are huge amount of benefits when it comes to the EMR usage by doctors. And so the industry is realizing that and it has it has come to realization now.

What is your experience in data analytics observed by Mr. Quadri in the whole process?” Mr. Quadri said that there are a lot of changes that has been witnessed by him when a they used a system where one is the reference, it is a quick ready reckoner, and since today most of us have lost touch with reading books and so is the case with lot of youngsters and lot of doctors who don’t have the time to go through this material and so imagining if the life of the patient is dependent on this critical information which is lying there it could be in a journal or an article published. And so one fundamental change that he has noticed is the availability of this information in a very presentable format and also it has been credentialed, providing what is the source through which the article is published and so this is the first benefit in terms of the access to this very important literary works and journal in the industry about the latest drugs and allergy exiting today. Second benefit as per Mr. Quadri, is correlating this data with the different kinds of patients that they are seeing now, and if

INTERVIEW the doctor uses a physical book or reference, then it’s quite difficult and so like on google search you put multiple details and then it brings up the required information , and that is the kind of correlation which happens. One more advantage that he stated was that juniors are benefiting from it a lot because seniors were having the advantage of being there in the industry for quite some time and for juniors there is absolutely no support to go to , especially during night shifts and so for in order to o take better decision as far as the care locations is concerned such technology is really helpful for them. And so the last but not the least the advantage which is applicable for both the experienced doctors as well as the youngsters is there, is that newer diseases and newer viruses are coming about with respect to which people have no clue at all and so it is always good to refer to something which has been curated or something which has been studied upon and all across the globe it has been acredited. Hence as per him there are three kinds of advantages that can be seen which is happening across all their organizations.

What are the insights on potential integrated through Clinical Decision Support System (CDSS) like up-to-date with work flow of the hospital that you pushed for it and made it happen? He answered, that an integrated solution is always very effective and its more user friendly if the context is there, for example if the doctor is looking at the symptoms of patient and he is still unclear about those symptoms as well as the case and so instead of looking out for the information it’s better to look into the information which is already present right there. And second example that he gave was that of the drug related information and so if some correlation can be done and if it is very much integrated with the system that the doctor is using then the chances of the doctor being involved is very high along with the result it brings about in terms of value and outcome is also very good and so it adds to overall effectiveness of the whole solution and the utilization and usability of the application because of which it is very easy because rather than using multiple systems that doctors can go ahead and use one system.

What happens in the case if the information hospital is integrated with solution of the work flow like (Wolters Kluwer’s up-to-date) have on overall service capability and patient outcomes in hospitals? To this Mr. Quadri replied, that it really enhances the overall efficiency of the clinical decisions as well as outcomes, Further looking at it as a benefit, from the difficult cases that they have

handled so far the whole system will benefit the hospitals in the long run because patients will always be satisfied and they will always refer to the hospital. And this is possible if the doctors are using the technology very well. It can also reduce the average length of stay like for example a very long duration of stay can be very expensive and may not be rewarding, and so it can really help in reducing the stay duration. Mr. Quadri also stated that efficiency benefits, financial benefits and overall patient satisfaction benefits will all be administered through the CDS. As per Mr. Quadri, the doctor will be much more confident in telling the patient that the drug will take more time but definitely work on the patient and he will be much more confident when he is backing his decision with the right kind of reference.

Does CDSS integrated with EHR make a difference to Hospitals capabilities for getting accredited? He said that an Integrated CDSS helps in overall usability of application and doctors will be overall be happy to use it if it is one single system ❏

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BMJ and Smile Foundation enter into a partnership for conducting health camps in Delhi & NCR In merely 4 years, the organization has trained 300+ doctors through its courses in Diabetes & CKD.

British Medical Journal (BMJ) India celebrated its 10 years of operations in South Asia on Wednesday, September 12 at the Claridges Hotel, New Delhi. Dr. S Venkatesh, Director General of Health Services GOvernment of India was the chief guest of the event. On the occasion Mr. Prashant Mishra Managing Director BMJ India & South Asia announced a charity initiative with Smile Foundation under which BMJ and Smile Foundation enter into partnership for conducting health camps in DelhiNCR through a programme named Smile Health Camp with the objective of providing primary health care services to the underserved women and adolescent girls in our society.

BMJ started out in South Asia with the commencement of its operations in India. Through its numerous educational initiatives, such as Journals from BMJ,

including The BMJ, BMJ Learning, BMJ Best Practice, Course in Diabetes, it has always endeavored to provide high quality, evidence-based resources to clinicians in South Asia. This event marks its way of thanking all their partners, customers, stakeholders and collaborators in India over the past decade. BMJ has gone all-out to provide the best platforms to delegates in South Asia through its numerous events, such as The BMJ Awards South Asia, Healthcare Improvement Summits and The BMJ Conclave. With its continuous support and dedication, BMJ has trained nearly 9000 doctors through BMJ Masterclass and received a cumulative of 5000 entries in the BMJ Awards since its launch in 2014.

70 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

Feeling extremely proud of his achievements, Mr. Prashant Mishra, Managing Director, BMJ India & South Asia, said “It gives me great pleasure to see BMJ India reach this milestone. We’ve covered a long journey ever since we established the first office for the South Asian region in New Delhi. I can assure all our stakeholders that we will continue to demonstrate our commitment towards creating a healthier world through our evidence-based educational resources: courses, journals, e-learning programs, and CME content. While sharing his vision and the help extended by BMJ, Mr. Santanu Mishra, Co-Founder and Executive Trustee, Smile Foundation said, “India is witnessing a rising demand for immediate medical facilities across urban and rural areas as a major part of the population continues to reside in urban slums or remote and hard-to-reach rural areas, and are also suffering and fighting the worst kind of ailments. In such a scenario a mobile healthcare service delivery system is the most practical mechanism that can deliver immediate relief to the needy. We are thankful to the British Medical Journal for their support in ‘Smile on Wheels’ programme. We are pleased to share with you that our partnership has facilitated the delivery of quality healthcare services to the very doorsteps of the needy, besides promoting healthcare awareness among the underprivileged.”

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Lt. Governor of Delhi felicitates 16 healthcare professionals & institutions at the 10th FICCI Healthcare Excellence Awards ceremony

he Lieutenant Governor of Delhi, Mr Anil Baijal, gave away the 10th FICCI Healthcare Excellence Awards to 16 healthcare professionals and institutions at an awards ceremony here late evening in the presence of Minister of State for Health and Family Welfare, Ms Anupriya Patel and Chairperson, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, Ms Tina Ambani.

The following are categories of the awards and the names of the recipients: CATEGORY

NAME

Patient Safety - Hospital

NU Hospital

Medical Technology /Devices

Vita Pathfinders Consultants LLP

Health Insurance Products

Religare Health Insurance Co. Ltd

Healthcare Start Up

Leowin Solutions Pvt. Ltd.

Environment Friendly Hospital

Aravind Eye Hospital, Pondicherry

Service Excellence - Diagnostic Centre Dr Lal PathLabs Service Excellence - Private Hospital

Artemis Hospitals

Service Excellence - Private Hospital

Max Healthcare Institute Limited

Service Excellence - Public

Government Spine Institute, Ahmedabad

Skill Development

Public Health Foundation of India

Social Initiative - Corporate

Fortis Healthcare Limited

Social Initiative - Corporate

HealthMaP Diagnostics Private Ltd

Social Initiative - Not for Profit

ICARE Eye Hospital & Postgraduate Institute (Unit of Ishwar Charitable Trust)

Healthcare Humanitarian Award

Dr Abhay Bang & Dr Rani Bang Founders – SEARCH

Healthcare Personality of the Year

Dr Girdhar J Gyani - Director General, AHPI

Lifetime Achievement

Dr Azad Moopen - Chairman, Aster DM Healthcare

Speaking on the occasion, Mr. Baijal urged to remove paradoxical situations present on the ground in providing quality healthcare to all. He said “development of a country is predicted on the basis of the healthcare situation in the country. We need right policy and regulatory framework to achieve remarkable growth.” Emphasising on the importance of startups, he said that they are redefining the healthcare sector and urged the private sector to come forward and work in collaboration with the government to take healthcare to the next level. Minister Ms Anupriya Patel reiterated the benefits of Ayushman Bharat scheme and said that government is working towards strengthening Public Private Partnership and creating workable and viable PPP model which can be implemented in next two-three years. Ms Tina Ambani mentioned five A’s important for the healthcare sector. She said “accessibility, affordability, awareness, aspiration and association are the five pillars that will help to bridge the gap in providing quality healthcare to the common man.” w w w.medegatetoday.com Sep-Oct 2018

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Indian Healthcare Industry unites to Commit to Ethical Professional Conduct

midst rising concerns of trust deficit between the patients and healthcare service providers, various healthcare providers united and pledged to be part of the FICCI Code of Ethics for Health Services Industry, released on Thursday.

Dr V K Paul, Member (Health), NITI Aayog, Government of India appreciated the industry’s endeavour towards selfregulation and said, “I am happy to see that the Code covers several aspects of ethical conduct including patient centricity, privacy and confidentiality, bribery and grievance redressal.”

The FICCI Code of Ethics was released by the Union Health and Family Welfare Minister Mr J P Nadda and Member (Health) NITI Aayog, Dr V K Paul, during the inaugural session of the 12th edition of FICCI’s annual healthcare conference- FICCI HEAL. The Declaration of the Code was handed to the endorsing associations by the Minister of State for Health and Family Welfare Ms Anupriya Patel, during the 10th FICCI Healthcare Excellence Awards ceremony, yesterday evening.

The Code, which encourages members to voluntarily and collectively commit to ethical professional conduct for patient care, is applicable to healthcare professionals, service providers, diagnostic centres and other healthcare institutions operating in India.

Recognising the need for transparency and accountability in the overall functioning of the healthcare establishments, the Code has been developed as a result of an extensive consultation with various stakeholders including Government and the private sector. Mr. J P Nadda in his address said, “the release of this Code is very appropriate and timely as the country moves towards the launch of Ayushman Bharat, which will require an effective collaboration between the government and private stakeholders. The Code addresses the fundamental challenge of accountability both at individual and industry level and should be adopted by all.” 72 Sep-Oct 2018 w w w. m e de g a te to d a y.co m

Dr Alok Roy, Co-chair, FICCI Health Services Committee and Chairman, Medica Group of Hospitals said, “already 7 other Associations, with more than 30,000 institutional and individual members; and more than 15 healthcare organizations from across India, have endorsed the FICCI Code of Ethics. However, this is just the beginning of our journey to propagate the Code to a large number of healthcare service providers across the country.” Being instrumental in developing the Code, Dr K K Agarwal, President, Heart Care Foundation of India and Immediate past President, IMA, said, “in case of healthcare, in addition to being scientifically correct, providers have an equally important responsibility to maintain moral and ethical conduct.” This voluntary Code can be used as a yardstick by the health service providers for their day to day conduct and interactions within the healthcare community as well as with patients.

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4th Annual Healthscape Summit India – North Edition With an event related to healthcare happening almost every day in some city or the other, the 4th edition of the Healthscape Summit, which recently concluded on August 28, was a truly stand-out initiative. Despite torrential rainfall on the day of the event, there was an impressive turnout in the Leela Ambience Hotel. Healthcare professionals were keen to listen to some of the most renowned leaders in the Indian healthcare fraternity. The morning conference session was a procession of high-quality and engaging presentations, including: ☞ Dr Jitendar Sharma - Advisor (Health), Government of Andhra Pradesh Managing Director & CEO, Andhra Pradesh Medtech Zone Executive Director, KIHT ☞ Dr Shubnum Singh - Director-Medical Education, Medical Research Advisor - Healthcare Framework, Max Healthcare Institute ☞ Dr Naveen Nishchal - Founder Director, Cygnus Hospitals Co – Founder, Meddo Network Of Clinics ☞ Dr Pankaj Gupta - Partner, Taurus Glocal Consulting ☞ Dr Sandeep Chatrath - Senior Healthcare Advisor & Hospital Management Consultant ☞ Dr Saarthak Bakshi - CEO & Founder, International Fertility Centre ☞ Mr Rajiv Nath - Forum Coordinator, AIMED | Jt. Managing Director, Hindustan Syringes & Medical Devices

Among several others.

The speakers highlighted the huge impact that the Ayushman Bharat scheme will have once it is implemented and in effect throughout the country. There were also key discussions of the implementation of technology that enable hospitals to run more efficiently. Post the lunch session, the hospital owners, developers, architects and procurement managers engaged in pre-scheduled face-to-face meetings with the suppliers. Every meeting between the buyer and supplier was pre-scheduled based on their choice which they expressed about a week prior to the event. It is the face-to-face meeting schedule that is the highlight of an IDE initiative. About 10 days prior to the initiative, all the buyers receive the complete list of the attending suppliers. The list includes information about the supplier’s product line, track record and innovative launches (if any). Simultaneously, the suppliers receive the complete list of all the attending hospital owners, developers, architects and purchase managers. This list includes vital information about the precise requirements of the hospital projects, including the product

requirements, procurement timeframes and budgets to procure the goods / services. Both the buyers and suppliers choose whom they want to meet based on their specific requirements. Once the organizers (IDE), receives this information, the meetings are set-up on the day of the event. “Events such as the Healthscape Summit bring together the key decision makers, as well as the movers and shakers of the healthcare fraternity under one roof. Not only is everyone on the same page, they also have advance information of who they are meeting and what exactly their requirements are. They are then able to immediately talk about business that will drive the industry forward.” Said Ganesh Babu, Director of IDE Consulting Services. The focus now shifts to the upcoming 5th Edition Healthscape Summit India - South Edition, taking place in Bengaluru on October-5-2018. This will be the 4th successive year the event is taking place in Bengaluru, which is a testament to how effective the event has been in the recent past. Some of the top global organizations have already confirmed their participation for this year’s event.If you would like to participate in the event or even know more about the unique format, feel free to reach out to the IDE team, or contact Shishir Prabhakar - the Event Producer on shishir@ide-global.com

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The 3rd annual conference in medicine was held on Sunday, July 22nd, 2018 at Hotel Crowne Plaza, Rohini

t was organized by North Dehli Physician Forum (An association of Physicians from North Delhi) under guidance from Dr. RM Chhabra and his team with generous financial support from various pharmaceuticals and special grant from Scientific Committee APICON-2018 by Dr Pritam Gupta, President, Association of Physicians of India. More than 400 delegates comprising of General Physicians, Specialists, and Super Specialists from Delhi and NCR were registered for the conference. The day long conference covered various topics of interest ranging from Orthopedics, Infectious Medicine, Chest, Hematology, Cardiology, Neurology, Neuro-Surgery, Oncology and Diabetes and Thyroid. Many eminent speakers like Dr. Askok Seth & his team, Dr. DS Gambhir, Dr. JC Mohan, Dr. Surinder kumar, Dr. Vinay Goel, Dr Navneet Kumar (From Kanpur), Dr. Ranga raju Rangarao, Dr.KK Pareek, Dr Rahul Bhargava, Dr Sonal Gupta, Dr BB Chanana,Dr Palash Gupta, Dr Nityanand Tripathi, Dr Hanish Gupta, Dr Deepak Khandelwal and others enthralled the packed audience with their presentations and replies.One session was devoted to recent concepts in Congestive Cardiac Failure, Cardiac transplant, Transcatheter valve therapy, it was well presented by Dr. Ashok seth and his team

There were panel discussions on long term OAD in ACS and another on need for treatment of 1st Seizure along with Latest combination therapy in management of T2DM. A symposium on safety of Gliptins in high risk Diabetics having CV Diseases,CKD and Elderly was well attended and drew applause from the audience. An expert Panel discussion on Medical ethics and Modern Health Care System was held and appreciated much by the audiences. The entire program was well attended and appreciated for its scientific content and the way it was conducted. We thank to our Bhishm Pitamah Dr YP Munjal for his blessings. We also thank to Dr RK Singal, Dr Rajesh Upadhyay, Dr NP Singh, Dr AP Misra, Dr. Anupam Prakash, Dr Atul Bhasin, Dr MD Gupta, Dr JK Sharma, Dr SK Bakshi, Dr Vinod Mittal and all API-DSC members The conference ended with vote of thanks followed by Fellowships and Dinner Thanks to all members of NDPF making this events wonderful, memorable and a grand success, special thanks to

Dr SK Arora, Dr Rajeev Gupta, Dr Anil Gomber, Dr Rakesh Gupta, Dr Ashok Pansari, Dr SK Mundra, Dr Atul Gupta, Dr Anil Jain, Dr Jagdeep Chugh, Dr Sundeep Miglani, Dr BK Aggarwal, Dr AK Sureka, Dr Rajeev Dewan, Dr Sanjay Dhall, Dr Rajeev Arora, Dr Praveen Bhatia, Dr Ram Babu, Dr. Naveen Nishchal and other active members for their untiring efforts Dr.RM Chhabra ( Founder & Past President), Rakesh Sood ( Organising Chairman),Dr.NN Jha(Organising Secretary) Dr.PK Goyal ( Chief Convener) â?? w w w.medegatetoday.com Sep-Oct 2018

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Conference Topics ➥ Healthcare IT Strategy ➥ Leverage IT for Operational Efficiency ➥ Digital Health in Sync with Digital India Create difference in delivery model to eliminate urban-rural difference Telemedicine & Tele radiology ➥ M-Health - Book My Health too!!! ➥ Healing Healthcare by Analytics ➥ Healthcare E-commerce: Work in Progress ➥ How to Build affordable and Viable Project ➥ Aging Hospitals /Heritage Hospitals How to rejuvenate them? ➥ Expansion vs. New Project Healthcare Promoters’ eternal dilemma ➥ Futuristic Hospital Is healthcare facilities turning in to technology hub REGISTRATION FEE EARLY BIRD - Closes on Dec 2018 Delegates : INR 1500/- per head Students : INR 1000/- per head

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