Caring for HealtH Sector in india · 2018-03-26 · Left to Right - Dr. Apurva Srivastava, Dr. Ajay...

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www.outlookindia.com January, 2018 CARING FOR HEALTH SECTOR IN INDIA THE BEST HEALTHCARE & WELLNESS IN DELHI NCR

Transcript of Caring for HealtH Sector in india · 2018-03-26 · Left to Right - Dr. Apurva Srivastava, Dr. Ajay...

Page 1: Caring for HealtH Sector in india · 2018-03-26 · Left to Right - Dr. Apurva Srivastava, Dr. Ajay Yadav, Dr. V.S. Bedi, Dr. Sandeep Agarwal, Dr. Dhruv Agarwal, Dr. Ambarish Satwik

www.outlookindia.com

January, 2018

Caring for HealtH Sector in india

The besT heALThCARe & weLLness in DeLhi nCR

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With globalization, healthcare facilities in India has registered significant growth in terms of expert medical professionals, particularly in the private sector, which consist of gigantic corporate players, who by providing a

dependable alternative and health support system to the masses are fast consolidating their positions. The overall quality of services and high-end facilities to the ailing health care system has improved with the advent of private players. According to reported projections, India’s healthcare industry is poised to become one of the largest sectors both in terms of revenue and employment. The healthcare market is reportedly expected to grow and touch USD280 billion by 2020. The health sector is growing at a rapid pace owing to its effective coverage, services and increasing expenditure by the stakeholders. Consolidating the position of prosperity are Indian companies who are entering into mergers and acquisitions with domestic and foreign companies propelling growth and exploring new markets. Consequently, the health sector has witnessed exponential development and growth in the country. As government health care centres are short of manpower and facilities, large corporate and private players have captured a sizeable segment of healthcare. Their focused, comprehensive and visionary approach led to the establishment of super multi-speciality medical conglomerates which are expanding rapidly as they are

easily accessible, patient-friendly and true value for money. The basic requirements of quality care, affordability, easy

accessibility and catering to a high patient turn out have been strong factors that led to the success of private players in the health sector. This dynamic approach has further strengthened the trust of the ailing people thereby directly impacting all aspects of medical care ranging from primary to tertiary levels of the health care industry. In metro cities and larger towns, the burgeoning industrial belts, economic zones and mushrooming cyber hubs have resulted in the need of larger number of medical care centres in the midst of the densely populated regions. Consequently, development is reciprocal to the demand for workforce aligned to market needs and so is the inevitable need for health care, which has kept abreast with the changing socio-economic dynamics of any region. This has attracted thriving private health care investments. People are flocking from far and near as well as abroad to the state-of-the art private hospitals with the hope of getting the best treatment by globally renowned doctors at affordable cost, giving tremendous boost to medical tourism. Unfortunately, penetration of private health services in smaller towns and rural areas is still a far cry.

Among emerging trends in health care is aggressive competition with incredible benchmark of medical care and efficiency that is maintained through various processes such as rapid innovation in technology, increasing role of nanotechnology,

Health is vital for leading a disease-free life. Measured as a quotient of one’s well-being in body, mind and soul, today health

is at the centre-stage of attention and concern because of lifestyle changes and pollution, a back lash of environmental

neglect and degradation. According to the Global Burden of Disease Study (GBD) report published in the medical journal The Lancet, India ranks a dismal 154th among 195 countries on the scale of

healthcare index, 2017. The consolation, however, lies in the fact that India’s

Healthcare Access and Quality (HAQ) index has reportedly increased by 14.1, up from 30.7 in 1990 to 44.8 in 2015. Though the magic figures of socio-economic growth

during the said period holds promise, the study has revealed that India is way off

the mark in tackling diseases such as tuberculosis, diabetes, chronic kidney

diseases and rheumatic heart diseases, as a result, the healthcare goals continue to be elusive. This is where a proactive and

comprehensive public-private partnership could establish the much-wanted universal

healthcare in India.

wider awareness and response in addressing issues, handshake of public-private entities, stringent safety norms, speedy and accurate services in medical emergency and many more. All of these explorations and their implementation are aimed at ensuring best of treatment that indicate an increased emphasis on adherence to high standards of practices in the medical field.

Both, government and private medical care centres have rolled out several facilities and attractive incentives such as augmenting accredited health care facilities, adoption of latest technologies in all spheres of functioning, constant up-gradation of infrastructure and a welcome awareness and adoption of eco-friendly or green projects among many other measures. These hospitals are also strengthening their work-force through several in-house initiatives such as taking a proactive interest in medical education, skills training, and health care delivery. However, there is a glaring dearth of doctors, nursing staff and other paramedics against the rising population. In India, where reportedly close to 30,000 doctors, 20,000 dentists and 45,000 nurses graduate annually from medical institutions, the doctor-patient ratio reportedly stands at a low 1:1,700 which is below the mark of a minimum ratio of 1:1,000 stipulated by the World Health Organisation (WHO). Today, about 85 percent doctors reportedly work in private hospitals which account for 93 per cent of all hospitals, leaving a large vacuum in government hospitals which are under staffed. Though health care facilities in metro cities are on par with some of the outstanding medical

centres in the world, the public health system in our country’s back yard is on a back foot and continues to remain a vexing issue.

A major drawback for equitable healthcare across the country is the lack of coordination between agencies and other players in the health sector such as insurance companies, government agencies, public and private investors, who together impact the overall health care delivery system. Reportedly, 76 per cent of the population have no health insurance cover resulting in heavy expense in face of any major illness or surgeries. The situation has led to drop of a sizeable segment of the population below the poverty line due to high expenses incurred for medical treatment.

In India, there are reportedly around 35,416 government hospitals with approximately 13,76,013 beds and sadly only a mere 2% of the doctors serve the rural population, which comprises of 68% of the country’s population. Also about 3,598 hospitals and 25,723 dispensaries offer AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) treatment offering alternative medicine and treatment to the people. Even the rural population prefers to get treated in private hospitals. The urban areas get the larger slice of cake when it comes to healthcare than their poor country cousins.

Over and above their professional duties, super multi-speciality hospitals under the Corporate Social Responsibility conduct free camps, consultancy and if necessary even operate patients free of cost. Outreach programmes have taken on a new dimension with franchise hospitals opening in two and three tier cities and other vantage towns that can act as a feeder to rest of the region. High technology and swift mode of communication have made monitoring and mentoring easier for hospitals with rest of the country and even the world. The capabilities of the Indian doctors and the will of both public and private sector have succeeded to bring in discipline and some semblance to the health care industry in an environment of trust and in the true spirit of public service.

Healthcare in India needs to work on a war footing to reach medical support to millions of people across the country. Some policies are already in place and efforts have started in the right direction. However, it requires more investments and facilities for this sector to cover all aspects of healthcare for creating a nation of healthy people.

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LEAKING / RUPTURED AORTIC ANEURYSMS The aorta is the main blood vessel of the body that emerges from the heart and supplies blood to the organs of the body. An aortic aneurysm is the term used for a portion of the blood vessel which gets enlarged or balloons out to ≥1.5 times its normal diameter. The larger the size of the aneurysm, the more likely it is to leak or rupture. A leaking aortic aneurysm is an absolute emergency, and intervention has to be done immediately. A ruptured aortic aneurysm carries a 100% mortality, if not intervened in time. Traditional open surgery carries a high mortality rate than the newer minimally invasive techniques (EVAR - Endo-vascular aortic aneurysm repair and TEVAR -Thoracic endo-vascular aortic aneurysm repair) which are routinely performed at our centre. Recently, a patient was airlifted from a different part of the country and shifted to our centre with a leaking thoracic aortic aneurysm leading to active bleeding in the thorax. A CT angiogram showed a defect in the aortic wall. He was immediately shifted to our hybrid vascular Cath lab and an emergency TEVAR was performed, after which the leaking site was sealed off completely and

the bleeding controlled. Patient had a good recovery following the procedure, and was discharged in a stable condition.

AV ACCESS PROCEDURESAn AV access is required in patients with long standing kidney disease, who are dialysis dependant. It involves a surgically created connection between an artery and a vein, usually on the arm or forearm. Known as an AV Fistula, this serves as a lifeline for these patients. There are numerous options for the combination of artery and vein to be used for AV fistula, and once these options get exhausted, a synthetic tube graft known as an AV graft may be surgically placed on the arm. Once a fistula starts to fail or gets blocked, we have many options for salvage of the access both surgically (thrombectomy) and endovascularly (venoplasty). A temporary venous access using different types of catheters may also be attained for dialysis, and we have expertise in placement of temporary as well as permanent catheters such as the Permacath for dialysis dependant patients

VARICOSE VEINSVaricose veins is the common term for the

medical condition better known as Chronic Venous Insufficiency. It occurs due to reversal of blood flow caused by defective valves in the leg and thigh veins. The condition leads to swelling and discomfort of the legs or enlarged, easily visible veins that may be painful. This condition can eventually lead to bleeding from the veins and non healing ulcers. It is common in people having jobs involving long periods of standing and conditions such as pregnancy. Diagnosis of varicose veins can be done with help of a simple Doppler examination. Traditional surgery (Ligation and Stripping of the vein) has been replaced by minimally invasive techniques (Endovenous Laser ablation and Radiofrequency ablation) at our center, which has maximum volume of patients undergoing treatment for varicose veins in the country. In addition to ablation, we do avulsions and sclerotherapy for the side varicosities. Benefits of this treatment are numerous, such as simple day care procedure, no incisions or scars, lesser treatment time, rapid recovery with reduced post operative pain and normal activities can be resumed immediately.

MASTERS OF THE BLOOD VESSELS

Department of Vascular &

Endovascular Surgery, Sir Ganga

Ram Hospital specialises in the management of

Vascular diseases

Left to Right - Dr. Apurva Srivastava, Dr. Ajay Yadav, Dr. V.S. Bedi, Dr. Sandeep Agarwal, Dr. Dhruv Agarwal, Dr. Ambarish Satwik

A surgically created A-V Fistula

Before treatment After treatment Before treatment After treatment

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Liver disease can be inherited (genetic) or caused by a variety of factors that damage the liver, such as viruses and alcohol use. Over

time, damage to the liver results in scarring (cirrhosis), which can lead to end stage liver failure, a life-threatening condition. It has been observed that patients who do not consume alcohol nor have any viral disease also suffer from end stage liver disease. The implicating factor identified is NASH (Non-Alcoholic Steatohepatitis), this is seen in patients who lead a sedentary life and have obesity or other metabolic disorders.

What is Fatty Liver Disease (Non- Alcoholic Steatohepatitis)Nonalcoholic steatohepatitis or NASH is a common but often “silent” liver disease. The inflammation and liver damage caused resembles alcoholic liver disease, but occurs in people who do not consume alcohol. The major feature in NASH is replacement of liver cells with fat causing permanent damage and scarring. What causes NASH?Exact cause of this disease is not clear. However environment may trigger the inflammation in certain cases, genetic predisposition is another theory for NASH. Predisposing factors:• Obesity.• Insulin resistance and type 2 diabetes.• High cholesterol and high triglycerides.• Metabolic syndrome.Most people who have NASH are 40 to 50 years old and have one or more factors listed above. However NASH has also been observed in people who have none of these risk factors.

What are the symptoms?As NASH progresses and liver damage gets worse, patient may start to have symptoms such as:

• Fatigue (feeling tired all the time).• Weight loss for no clear reason.• Generalized weakness.• An ache in the upper right part of the

belly.It may take many years for NASH to become severe enough to cause symptoms.

What is the Diagnostic Procedure to rule out NASH?NASH is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NASH is suspected. The only means of proving a diagnosis of NASH is a liver biopsy. NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. The development of severe fatty liver disease may also be asymptomatic and rarely shows the florid picture associated with alcoholic hepatitis.

What are the symptoms?NASH is usually a silent disease with few or no symptoms. Patients generally feel well in the early stages and only begin to have symptoms—such as fatigue, weight loss, and weakness—once the disease is

more advanced or cirrhosis develops. The progression of NASH can take years, even decades. The process can either stop and, in some cases, reverse on its own without specific therapy or worsen, causing scarring or “fibrosis”. As fibrosis worsens, cirrhosis develops; the liver becomes hardened, and unable to function normally. Once serious scarring or cirrhosis is present, it is difficult to halt its progression.A person with cirrhosis experiences fluid retention, muscle wasting, bleeding from the intestines, and liver failure. Liver transplantation is the only treatment for advanced cirrhosis. NASH ranks as one of the major causes of cirrhosis, after hepatitis C and alcoholic liver disease.

What is the treatment?Currently, no specific therapies for NASH exist. The most important recommendations given are:• Reduce their weight (if obese or

overweight)• Follow a balanced and healthy diet• Increase physical activity• Avoid alcohol• Avoid unnecessary medications• Treatment of Diabetes (if diagnosed)

A major attempt should be made to lower body weight into the healthy range. Weight loss can improve liver tests in patients with NASH and may reverse the disease to some extent. Research at present is focusing on how much weight loss improves the liver in patients with NASH and whether this improvement lasts over a period of time.

People with NASH often have other medical conditions, such as diabetes, high blood pressure, or elevated cholesterol. These conditions should be treated with medication and adequately controlled.In case of serious scarring and cirrhosis liver transplantation is the only long lasting treatment.

NASH - A Silent Liver KillerDr Naimish Mehta is the Lead HPB and Liver Transplant Surgeon, in the Deptt of Surgical Gastroenterology & Liver Transplant, Sir Ganga Ram Hospital, New Delhi. He has performed over 1000 liver transplantation surgeries and considered to be one of best liver transplant surgeons in India and has been honoured with several awards and recognition. He has over 18 years of experience in the field of Hepato- Pancreatico-Biliary (HPB) Surgery performing complex operations on the Liver, Bile Ducts and Pancreas.

DR. NaIMISH MeHTaChief Liver Transplant Surgeon &

Senior Consultant Gastro and HepatoPancreaticoBiliary (HPB) Surgery

surgical procedures. The number of knee replacements is growing at about 14 to 20% per year. For most patients it is a life changing surgery. They get their freedom back and their mobility back.

But many more people are still requiring this surgery for pain relief and an enjoyable retired life. But they have worries, apprehensions and concerns. One of the biggest concerns is pain soon after operation and in post op period, the other concern being about the longevity of the implant. The medical fraternity has risen to the challenge. Modern Orthopaedics intends to make this procedure as safe as able, pain free and once in a life time operation. It has involved a change in the way of thinking and utilising new knowledge and experience for doing the same.

Pain relief has become multimodal, multi-specialty and pre emptive. In our practice patients are counselled pre operatively in OPD and given realistic ideas about what to expect. Physiotherapy is started before the operation and so is stabilization of patients as regards Anaemia, Osteomalacia, Osteoporosis and Blood sugar. Patient willing we have encouraged Obesity or weight reduction surgery prior to operation. The battle of the mind cannot be underestimated. The patients have to have confidence and rapport with the surgical team which involves detailed consultations. They need to feel that this is a safe and reliable procedure and they are in good hands.

We have taken to more extensively doing procedures such as Computerised navigation surgery, customized knee

replacement surgery. This allows us ability to do smaller incisions and lesser injury to tissues. Which also translates to lesser blood loss and reduction of has blood transfusion rates from 54% in bilateral knees to 8% in bilateral knees. We have not transfused blood in any unilateral knee for ages. There is no doubt usage of modern implants with more precise instruments, has been of immense help. We have also started using more modern implants which are more like the natural knee and come in more sizes almost like customised knees.

Our pain relief between epidural anaesthesia and nerve blocks along with local injection of drugs has helped patients walk on the day of the surgery. Post operation pain relief with Paracetamol, synthetic Opioid derivatives, anti-inflammatory medication, and cold therapy has all been path changers. We now use lower doses of drugs but more of them with much lower side effects.

We do not impose restrictions in terms of stair climbing, use of walking aids, having a bath. Our patients are encouraged to return to normalcy on their own abilities.

It has been a learning curve for us from our interaction with patients and leading arthroplasty surgeons in the world. The journey has been long but our patient’s smiles and satisfaction have been reward enough. We feel that the combination of our patient connect, use of adequate new pain relieving techniques, modern implants and technology and early mobilization make our unit a leading joint replacement team.

Mr. GS, 74 yrs had bad knees for ages, he knew that the only solution was Knee replacement but he had his

wife at home who had a stroke and needed looking after. He could not be out of activity for more than 1 week. He had heard about post-operative issues after replacement hence was worried and avoiding an operation for 4 yrs. He got recommended to us, came to our hospital met a few patients saw our protocol for patients and 3 weeks after operation is back to normal life looking after his wife much more easily.

It’s established as an excellent surgical intervention, its efficacy is known, its acceptance and increase in usage is one of the highest amongst

CHANGING TIMES, Changing paradigms in Knee Replacement

One of the biggest concerns is pain soon

after operation and in post op period, the other concern being about the longevity of the implant.

The medical fraternity has risen to the challenge. Modern Orthopaedics

intends to make this procedure as safe as able,

pain free and once in a life time operation.

DR GuRINDeR BeDI, MBBS,MS(Ortho), DNB (Ortho), FRCS, FRCS(Ortho)Certificate of Surgical Training-Royal College,england. Director, Fortis Institute of advanced Orthopaedics (Joint Replacement/Spine Surgery/Sports Medicine)Vasant Kunj, New Delhi.

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excellent body of work in the field of healthcare communications and delivery.

His new venture, IndiaVirtualHopsital.com, an integrated tertiary care ecosystem is at the forefront in addressing the numerous challenges faced by patients and domestic medical travellers when they look out for treatments. India Virtual Hospital is a digital web and mobile based platform which acts as a medical concierge for all healthcare and medical needs of the masses. This portal is made highly credible with doctors, healthcare professionals, patient guides on board. The India Virtual Hospital team is trained to support and help patients manage their medical and surgical care. We help patients and their families take an informed decision with expert consultations, working out the best treatment plan, coordinating with hospital team for hospitalization and procedure providing much required counseling for patients and their family members along with post operation recovery needs and services.

IndiaVirtualHospital.com is also bringing in disruption through Trust Doc, India’s 1st technology-driven, Specialised Treatment Opinion platform by Industry Veterans like Government-Retired Super-Specialists (Ex-AIIMS, PGI etc.). TrustDoc.in aims to provide patients with an expert

opinion by very senior retired specialist doctors who have served in the best government hospitals across India. Today Trust Doc has India’s 100+ government-retired senior doctors and specialists covering over 20+ specialities. All one has to do is get in touch with us by either calling at 9999-668-222 or sms trustdoc to 56677 or register at easy-to-navigate online portal, trustdoc.in or mailing us at [email protected].

This year’s India Health & Wellness Summit and Awards witnessed the felicitation of different organizations excelling in the field of healthcare. Some of the other winners at the India Health & Wellness Awards were Mandira Bedi, Bhamashah Swasthya Beema Yojana by Govt. of Rajasthan, mMitra, Johnson & Johnson and United Nations Development Programme – India. The jury included renowned experts of the healthcare and beauty industry like All India Institute Of Medical Sciences (AIIMS) Director Dr Randeep Guleria, Mr Anshu Gupta, Founder Goonj (NGO), Mr Sukanti Ghosh, Managing Director APCO Worldwide, Dr Minnnie Bodhanwala, CEO, Wadia Hospital, Mr Sandeep Dikshit, MP and Founder Sanket etc. Eminent jury and speakers from diverse fields shared their opinions and statements regarding challenges faced in India’s health sector and measures undertaken to rectify them.

Health Leaders

Scoop To

Swadeep Srivastava, a healthcare evangelist wins

top honour, Healthcare Entrepreneur Award at India

Health & Wellness Summit and Awards 2017

SWAdEEp SrIvAStAvAManaging partner and Chief Belief Officer of

IndiavirtualHospital.com

Entrepreneurs Award

Swadeep Srivastava, Managing Partner and Chief Belief Officer of IndiaVirtualHospital.com won Healthcare Entrepreneur

Award at India Health & Wellness Summit and Awards 2017 for his

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Pushpawati Singhania Hospital & Research Institute (PSRI Hospital) is nationally and internationally reputed tertiary care institution,

promoted by JK Organization. Since the inception of the institute,

quality in healthcare has been central through the planning and operations of all the clinical disciplines and support services. To ensure quality and well defined patient care protocols, institute was accredited by ISO 9001:2008 in the year 2007. Subsequently institute got accredited by NABH for all the clinical disciplines in 2012 and NABL Accreditation for the Lab Medicine department in the year 2010. It is quality conscious approach, which enabled the Institute to attain levels to have these prestigious quality accreditations, in due course of time. There is a well-defined Quality Department supported by a well-trained and professional oriented quality team having representatives from all the clinical and non-clinical departments. There are periodical internal and external quality audits to ensure the improvement of the quality standards at all levels in all the services of the institute.

Sudden death is defined as any death occurring within one hour of start of symptoms. More than 95% of sudden deaths are cardiac in

nature. Non-cardiac sudden death can occur due to major bleeding into brain, massive bleeding in the tummy cavity or chest like rupture of aorta (major blood vessel carrying blood from heart to various organs of body) It can also occur due to severe allergic reaction called anaphylactic reaction. So, majority of sudden deaths are heart related.

Sudden death occurs due to severe slowing of heart beat (Bradycardia) or very fast heart beat (Tachycardia) In both situations of bradycardia & severe tachycardia heart is not able to pump enough blood into aorta & there is severe drop of Blood pressure & all the organs especially brain & heart don’t get enough blood for their functioning, causing death.

Sudden cardiac death usually occurs when there is already significant decrease

The indications of replacement arthroplasty in the upper extremity are ever expanding. With advances in implant

designs, materials and surgical techniques, clinical and functional outcomes have improved and are in some cases comparable with the commonly performed total hip and knee replacements. This has also led to increased acceptability of these procedures and such replacements are now performed very commonly it certainly improves the quality of life. At

Headache is one the common symptoms which every human being experience at sometime in their life. Headache generates lot

of anxiety because of associated fear of diseases like brain tumor. One must know the red flags for a sinister headache, which are as follows:-• Severe headache at onset , which

progresses rapidly• Accompanied fever, irrelevant talk,

drowsiness, double vision, recurrent projectile vomiting, slurring of speech, weakness in any limb or difficulty in walking

• Any new character of headache which

PSRI Hospital is situated in the pleasant ambience of South Delhi, which is helpful for early recuperation. To ensure high quality environment and services, institute has well-structured Water Harvesting System, Sewage Disposal and Effluent Treatment Plant with latest technology. Also, Solar Panels are in place to share institutes’ energy requirements.

On account of the world class services and very high patient satisfaction levels, PSRI hospital has been awarded many prestigious awards and recognitions. To mention a few –• Best muliti speciality Hospital by 7th

Healthcare leaders Award.• Best Multi Specialty hospital by 7th

Health achievers Award by Times of India.

• Best Super Specialty award Gastroenterology & Nephrology by Times of India Award 2017

• Best Super Speciality hospital by 6th MT India Health Care Award 2017

• Best Multi Speciality hospital for patient satisfaction by World Wide Achiever International Award in the year 2016

• Best Hospitality Award by DOC N Doc

in the pumping capacity of heart, technically called Left Ventricular ejection fraction. The chances of Sudden cardiac death are many fold when Left Ventricular Ejection Fraction (LVEF) drops below 35%. This drop of LVEF may be due to old heart attack or disease of heart muscle called cardiomyopathy.

Sudden death in these patients is usually due to Rhythm problems arising from the lower chambers of heart called Ventricular tachycardia or ventricular fibrillation. In ventricular tachycardia, usually there is some blood pressure, but in ventricular fibrillation blood pressure is practically Zero & is akin to cardiac arrest. In both Ventricular Tachycardia & Ventricular fibrillation, the most effective & reliable method to save a patient is to give electric shock on the chest & cardiopulmonary resuscitation.

Minority of sudden cardiac deaths occur due to major heart attack causing again Ventricular Tachycardia or Ventricular

in the year 2014• Energy Conservation Award by Govt. of

India, in the year 2014 only Corporate Hospital in Delhi NCR awarded on this account

PSRI Hospital is having unique and well - structured Research department to monitor wide range of research activities, contributed by all the Clinical Departments of the institute. To support academic and research activities PSRI has a grand Library, having rich inventory of national and international journals of all the specialities, referral books and reading room facility.

fibrillation though the patient may be totally healthy prior to this attack. very few sudden cardiac deaths occur in apparently healthy people who are prone to get Ventricular Tachycardia or ventricular fibrillation due to underlying electrical problems of heart like Hypertrophic cardiomyopathy, arrythmogenic Right Ventricular dysplasia and Brugada syndrome. Many of these 3 diseases run in families. So, a history of sudden death in the family should lead to screening of other family members for presence of these rare disorders.

QUALITY HEALTHCARE - PSRI PERSPECTIVE SUDDEN CARDIAC DEATH

REPLACEMENT ARTHROPLASTY IN THE UPPER EXTREMITY

UNDERSTAND YOUR HEADACHE

Dr. Dipak Shukla, Cheif Executive Officer,

pSri hospital

Dr. T.S. klEr Chairman, pSri heart institute,

pSri hospital

Dr. p.p kOTwal Chiarman, institute Orthopaedics &

Joint replacement, pSri hospital

Dr. ShamShEr DwivEDEE Chairman, institute of Neurosciences,

pSri hospital

our Institution, joint replacement is offered for shoulder, elbow, wrist and small joints of the hand.

For the shoulder joint, the most common condition where the joint needs to be replaced includes fractures which are in multiple pieces or neglected fractures which are not amenable to plate and screw fixation. Some of the other indications include arthritis of the shoulder joint which could be secondary to rheumatoid arthritis, post-traumatic, post-infection or degeneration of the rotator cuff (These constitute the muscles that aid in lifting and stabilizing your shoulder). The shoulder could be partially or totally replaced depending on the indication. One latest advancement is reverse shoulder replacement in which there is reversal of the ball and socket mechanism of the shoulder. This is particularly useful in elderly patients with advanced rotator cuff disease.

was always existing for years,onset of headache after age of 45Most of the chronic headaches are not

caused by life endangering diseases, but they affect the quality of life, can lead to depression and can have negative impact on personal and professional life. Migraine and Tension Type Headache constitute the bulk of headache patients in a neurology clinic. Tension type headache is associated with a gripping sensation or heaviness anywhere in head, nape of neck and shoulders. It is commonly associated with depression and anxiety. Tension type headache tends to persist for longer periods of time. Migrane on the other hand appears like a bolt from the blue with or without a warning symptoms like blurring of vision,tingling,giddiness etc. and is associated with the throbbing headache anywhere in head, nausea, vomiting, dislike for light and sound. They tend to happen as episodes.It is when such migrainous episodes happen more than once a week, do we introduce migraine preventive medication or else we treat the episodes with suitable pain killer

One has to rule out toothache, jaw joint

The elbow joint is commonly involved in rheumatoid arthritis and such patients present with complaints of elbow pain, stiffness and restricted function. Total elbow replacement in such patients provides them with a painless, mobile and stable joint thereby improving their quality of life. The operation gives movements to the stiff elbow joints. The elbow joint is also primarily replaced in patients having a shattered fracture of the lower end of humerus (the bone which forms the upper end of elbow joint). Revision of total elbow replacements done in the past which have loosened and are causing pain is also offered at this Institution.

diseases, ear infections, cervical spine diseases, bleed inside brain, brain infection, excessive use of substances and medications particularly pain killers and alcohol etc. These are known as secondary headaches . Certain lifestyle modifications are helpful in preventing and reducing headaches:• Exercise, relaxation, meditation and

quiet environment helps in Tension Type Headache as well as Migraine.

• Professionals who work for long hours on desk jobs should take intermittent breaks for 10-15 minutes and gently move their neck and shoulders to reduce spasm.

• Patients suffering from Migraine should avoid exposure to bright sunlight,erratic sleep timing, prolonged fasting or delayed meals, cheese, chocolate Chinese food too muchof tea, coffee and cola drinks, preserved food andd alcohol.

Press Enclave Marg, Sheikh Sarai-II, New Delhi -17. Ph.: 011-30611700, E-mail: [email protected] Press Enclave Marg, Sheikh Sarai-II, New Delhi -17. Ph.: 011-30611700, E-mail: [email protected]

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LifestyLe diseases: an emerging problem

Dr. rakesh TanDon Chairman,

Institute of Gastroenterology,PsrI hospital

Diseases attributed to unhealthy day-to-day living habits are referred to as Lifestyle Diseases. They include obesity, diabetes,

hypertension, heart diseases, chronic liver disease/cirrhosis, constipation, gassy abdomen and cancers. They have become a major health hazard in upcoming economies such as India and China. Of them, obesity, diabetes, hypertension and hyperlipidemia are of major concern and cause of death. They are attributed to increased insulin resistance and are grouped as metabolic syndrome. It is the outcome of increasing affluence and adoption of sedentary lifestyle and is being seen increasingly among Indians and other South Asians.

Peoples’ diet have changed substantially in the second half of the twentieth century with increase in consumption of dairy products, meat, vegetable oils, fruit juice, and alcoholic beverages, and decrease in consumption of starchy staple foods such as bread, potatoes, rice, and maize flour and vegetables, salad and fruits. Other aspects of lifestyle have also changed, notably, large reductions in physical activity and prevalence of obesity.

The western lifestyle, characterized by fast food, watching TV and playing video games is taking its toll on children as well as adults, and is producing increased numbers of overweight, passive youngsters with lifestyle diseases.

Obesity on the riseAccording to the National Family Health Survey (NFHS-3) (2005-06), 13 percent of women and nine percent of men in India are overweight or obese.

Presence of obesity increases greatly the chance of occurrence of other lifestyle diseases in the same person and they all work together to shorten the lifespan of the affected person. Additionally, obesity itself is associated with a huge number of complications and they could be the cause of early mortality (Figure).

Results of a recent study, published online in the American Journal of Public Health, indicated that previous research had underestimated the number of deaths caused by obesity in the US each year. This study included men and women between the ages of 40 to 85 over a 20-year period and discovered that obesity was likely responsible for about 18% of deaths during that time, one out of five Americans – an appalling figure.

Diabetes capital of the worldAccording to the World Health Statistics report 2012, 11.1 percent of the adult male population and 10.8 percent of the female population have raised fasting blood glucose.

India and other Asian countries predominate among them as shown in the table below.

It is estimated that in India 61.3 million people suffer from diabetes. Even its South Asian neighbours like Bangladesh, Nepal, Afghanistan and Sri Lanka have fewer diabetics. That is why India has achieved the dubious distinction of being called the world diabetes centre.

Globally, diabetes caused 4.6 million deaths in 2011. Diabetics and obese people are more prone to develop chronic liver disease which ultimately results in untimely and early death.

Heart disease – a major killerIt is estimated that about 166 per 100,000 people in India die due to ischemic heart disease (a condition which is characterized by reduced blood supply of the heart muscle) and around 116 per 100, 000 people in India die due to cerebrovascular diseases.

Around 74 percent of urban Indians

face the risk of heart attack, with their heart age greater than biological age. Fifty nine percent of those in the 30-49 age group have high risk levels of cholesterol and 61 percent of them have dangerously low levels of ‘good’ HDL cholesterol.

Uncontrolled hypertension, smoking, excessive drinking and sedentary life styles are other contributing factors for increased number of heart diseases. There is a misconception among young generation that smoking acts as a stress buster. It actually reduces a person’s stamina in the long run leading to the development of multiple diseases, particularly chronic lung disease, heart disease and cancer.

Nonalcoholic liver diseaseThe liver cells get clogged up with excess fat (triglycerides) as a by product of increased insulin resistance. Over time that causes inflammation of the liver cells which leads to cirrhosis of the liver and in a small percentage of cases even to liver cancer, analogous to what happens in alcohol induced fatty liver disease. This has indeed become the number one cause of chronic liver disease in the industrialised world. In India, the prevalence of NAFLD in the general population varies from 10% to 30%. In people with metabolic syndrome however, the prevalence is much higher; 15-80% among obese people, 25-60% in patients with dyslipidemia and 33-55% in pre diabetics and diabetics.

Press Enclave Marg, Sheikh Sarai-II, New Delhi -17. Ph.: 011-30611700, E-mail: [email protected]

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Your Right to a Safe Delivery

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www.rainbowhospitals.inwww.birthright.in

Rainbow Children’s Hospital in Delhi as Madhukar Rainbow Children’s Hospital.

Rainbow Children’s Hospital & BirthRight App:

Children First, AlwaysA Unit of Madhukar Multispecialty Hospital & Research Center

What inspired you to build aninstitution for children's healthcare?

How was your initial journey?

Dr. Ramesh Kancharla MD Peds., MRCP (UK)

Chairman & Managing Director, Rainbow Group of Hospitals

The willingness to take complete responsibility not just for survival, but improving the quality of life for the child is what distinguishes us. Our highly talented team of consultants with global exposure backed by local experience and state of the art infrastructure for children is a key differentiator. The expertise and dedication of our doctors who are available 24/7 while providing the highest quality of care from concep-tion to childbirth to treating all ailments of children has made Rainbow the first choice. We have benchmarked our practices and systems to world class centers. Our clinical care is unparalleled in the Healthcare system in India. Our doctors and paramedical staff are trained to take care of the little one as their needs are different. At Rainbow, we have created an ambience where the child feels at home. That's why we say, "Children First, Always"

We desire to add value to all the professionals practicing with us. This is supported by the infrastructure and the latest equipment under one roof, making a difference in the lives of those who come to us either as patients or partners in growth. At Rainbow, we believe in teamwork and provide unmatched medical care. We provide all pediatric care ranging from simple to complex and eventually would like to offer all specialty services under one roof.

I was working with world renowned experts and stalwarts at King's College Hospital, London and later at the Great Ormond Street Hospi-tal, UK. Here, all pediatric special-ties were available under one roof. The doctors were available 24/7 and all this coupled with the best technology. I returned to India after 9 years to find that we had no dedicated children's hospital. The idea was not to set up a venture for commercial success, but build a

"workplace" to practice skills we had acquired and improve the quality of life for children. The emphasis was on creating an ecosystem for the professionals to practice their skills, empower them with professional freedom while making a difference in caring for children. We began the practice of having the pediatrician stay overnight in the hospital to handle any emergency that may arise.

I returned to India and looked at the Healthcare scenario. The special needs of children were lost in the fast growing multi-specialty hospitals that were present. When I mooted the idea to have a dedicated children's hospital, many were wary of this approach.The interactions with young parents and other seniors gave me the confidence to start the venture. The first Rainbow Children's Hospital at Banjara Hills, Hyderabad started on Children's Day i.e. 14th November 1999. The work was difficult as we had to win the trust of the people. We had world class expertise coupled with best of equipment’s. We use to travel 200-300 km to bring the sick children in specially designed ambulances. We also used to visit different hospitals to treat critically ill children. During this period, we received requests to have all our specialized services under one roof and this propelled us to expand the scope of our services. Our commitment, specialized services, expertise in handling complex cases in children helped to prove ourselves and eventually win the trust and confi-dence of the people. Our work started getting the required appreci-ation and eventually, we became India's popular children's hospital.

What is the growth trajectory of Rainbow Hospitals?

Today, we are a medically respect-ed children's healthcare group in India. We have dispelled the myth that a children's hospital is not a sustainable model. Currently, we operate out of 10 locations - 6 in Hyderabad, 2 in Vijayawada and 2 in Bengaluru. Along with Delhi, we shall be shortly opening in Chennai and Visakhapatnam. We are now the largest children's hospital in the country with 1000+ beds, 400+ full time doctors and 3,000+ staff. In my opinion, we should have one dedicated children's hospital for every 15 lakh of population in India.It was a moment of pride for us on the World Prematurity Day, when we had the largest gathering of 445 preterm babies under one roof. It was one of its kind by any hospital and propelled us into the Guinness Book of World Records. What Rainbow has achieved is due to the trust and confidence of the people.

Tell us about the new Rain-bow venture in Delhi NCR?

We identified that Delhi NCR required many more beds for children. We also knew that a dedicated children's hospital will always be the preferred place to maintain high standards of care for children. In Delhi, Rainbow Hospitals is associated with Madhukar trust.The maternal needs would be addressed by the exclusive birthing division- BirthRight - "Your right to a safe delivery." The specialized perina-tal Center would offer high standards of maternal care and also focus on natural delivery, painless delivery & high risk pregnancies. BirthRight will have services ranging from pre-preg-nancy counselling, fertility treatment and fetal medicine to complete prenatal and postnatal care. Being a children's hospital our neonatal and specialty services would back our perinatal services comprehensively. At Rainbow we believe that the best place to have a child birth is in a children's hospital.

TAKING HEALTHCARE FOR CHILDREN TO ANOTHER LEVEL, RAINBOW CHILDREN’S HOSPITAL HAS CREATED ITS MARK IN THE MEDICAL FIELDAS A FIRST-OF-ITS-KIND

24/7 COMPLETE CARE FACILITY FOR CHILDREN.

What are the reasons behind Rainbow Hospital’s success?

n a heart-to-heart convesa- tion, Dr. Ramesh Kancharla shares the inspiring journey,his experiences and vision for the group.

I

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