Modern Medicare - January 2011

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Editorial

4 I January 2011

In hindsight, the last year can broadly be described as a period of recovery after the turbulent fi nancial phase of previous two years. The prospects for 2011, the fi rst year in the new decade, seem to be of growth, going

by the current macro-economic indicators, especially in the emerging economies. However, a dampener could be the rising crude oil prices and high infl ation in countries like China and India.

The bygone year was an infl ection point for the Indian healthcare sector and the economy, in general. Case in point is the global focus on India as a key destination for medical tourism and a marked shift in the approach – not as a mere provider but as a strategic partner. In other words, it signifi es the country’s leverage not only on better cost proposition, but also lean and effi cient business model as well as faster time-to-market capability.

Having said that there is an urgent need to address in a holistic manner the deep structural issues affecting the healthcare sector. Apart from an infrastructure status to help lower input costs, further reforms in areas such as health insurance, medical education, etc are the need of the hour.

Given the growing maturity of the Indian healthcare space, expanding ecosystem of start-ups, and rising demand for

better & affordable healthcare, there would be unparalleled opportunities to transform the lives of millions, and thereby attain the much sought-after inclusive growth.

This year can mark the beginning of a phase, wherein opportunities would be new and would call for greater focus on innovation & novel models of growth. Hopefully, the surging economy, coupled with timely policy implementation, will go a long way in transforming global as well as Indian healthcare scenario.

Believe, you will fi nd enough value while referring to this special edition with an eclectic mix of the past, present and future of the healthcare space, as much as we liked putting it together. Some of the content highlights include facilities & operations management, orthopaedic implants and usage of mercury in dental fi llings, among others. Of course, your opinions and feedback will add more value to our endeavour.

Here’s wishing you a Healthy New Year!

Manas R [email protected]

Healthcare: What’s next?

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Monthly Issue Price: ` 100

Contents

6 I January 2011

4 Editorial

18 National News

22 World News

36 Hospital Monitor Fortis Hospitals, Mulund: Keeping values intact

54 Facility Visit Poly Medicure Ltd: Making versatility a norm

56 Meditech Ossron™: A milestone in regenerative medicine

58 Events Calendar

Report62 Hospital Infrastructure India:

A catalyst to the sector’s growth

64 India Lab Expo 2010: Where science meets business

67 Product Update

74 Rx

78 Product Index

82 Advertiser’s List

87 Advertisement Inquiry

89 Product InquiryNote: ` stands for Indian rupee, $ stands for US dollar and £ stands for UK pound, unless mentioned otherwise

Highlights of Next IssueSector WatchDiagnostics

Specialty ScopeMedical Tourism

Sector WatchFacilities and operations management: Healthcare 24/7 Experts Speak

Prof Dr Victor Rosenthal President - International Nosocomial Infection Control Consortium (INICC) and Director - Infectious Diseases, Infection Control and Hospital Epidemiology Department, Bernal Medical Center, Buenos Aires, Argentina

REGULAR SECTIONS

26

Specialty ScopeOrthopaedic implants: Reducing pain, increasing fl exibility

44

39

RoundtableUse of mercury in dental fi llings:

Boons vs banes

33

Imaging DiagnosticsHybrid OR:

Merging diagnosis with therapeuticsSiemens Healthcare, Siemens Ltd

52

Policy MattersPatient safety:

Need for urgent action Dr Sanjay Gupte, President, Federation of Obstetric

and Gynaecological Societies of India ‘FRCOG’

48

Details on page no.65, 66

Cover Design: Joshua Navalkar Location Credit: Hinduja Hospital

8 Highlights of 2010 - National

14 Highlights of 2010 - International

Highlights of 2010 - National

8 I January 2011

(April) Trivitron Healthcare announced a JV – Trivitron Medical Technologies with ET Medical Devices, Italy, for manufacturing and marketing of advanced-technology cardiac diagnostic instruments. These include ECG systems, stress test ECG, Holter ECG, Ambulatory Blood Pressure Monitoring (ABPM) recording units, monitoring systems and telemedicine IT solutions. ET Medical Devices will manufacture and market cardiac diagnostic instruments by setting up its manufacturing facility at Trivitron’s Medical Technology Park at Chennai.

Trivitron & ET Medical Devices announce JV

(November) International Finance Corporation (IFC), member of the World Bank Group, supported Meghalaya to establish its fi rst Public Private Partnerships (PPP) for a new hospital & medical college for providing healthcare services to underserved groups, and addressing the critical shortage of trained medical & paramedical staff. As a lead transaction advisor, IFC will extend its global expertise in structuring and implementing PPP transactions to assist the State Government on this project. IFC will offer advice on providing quality healthcare and training.

IFC supports Meghalaya to establish its fi rst PPP

(June) Hosmac India Pvt Ltd, signed an exclusive agreement with the US design fi rm, Heery International. This alliance aims to deliver world-class healthcare facilities in India by enhancing Hosmac’s capabilities to design and construct state-of-the-art healthcare facilities at current costs. The new collaboration encompasses broad healthcare design services including peer review services, LEED consultation, value engineering, master planning & design-build opportunities in India, the Middle East, Africa, etc.

Heery International signs MoU with Hosmac

(November) Narayana Hrudalaya (NH) and SANA (a research group at Harvard/MIT) collaborated on a mobile healthcare project to enable screening and early detection of chronic diseases in India. Dr Devi Shetty, Chairman, NH, said, “The opportunities are unlimited and the use of technology will enable provision of high-quality medical care at minimal cost.” The double burden of disease with persistent infection and chronic diseases such as cancer & cardiovascular diseases are being experienced in India.

SANA and Narayana Hrudalaya launch M-health

Alliances

Announcements

(February) Carestream Health India announced that it will install its fi rst most advanced three-dimensional (3D) dental imaging machine – the Kodak 9500 3D at Diwanchand Imaging Center in New Delhi. This 3D dental imaging system enables dental professionals to obtain localised, high-resolution 3D images, as well as panoramic examinations, at an affordable price. Three-dimensional imaging in colour is now a diagnostic standard for most complex procedures performed by endodontists and implantologists.

New Delhi gets 3D dental imaging facility(March) Bombay Hospital performed 100 Total Knee Replacement (TKR) surgeries using the Stryker’s OrthoMap Articular Surface-Mounted (ASM) knee navigation. The ASM computer navigation perfectly complements, and is best recognised as an advanced surgical technique for Mini SubVastus Approach (MSVA) to TKR surgery without blood loss. TKR is a surgical procedure that involves knee replacement through a single small cut of size 8-10 cm. Latest computer navigation methods have simplifi ed it.

Bombay Hospital performs 100 TKRs using ASM

Expansions

(July) Apollo Hospitals plans to invest about ` 1,500 crore to add 3,000 beds in the next four years. “About 25 per cent of the amount would be through internal accruals, another 25 per cent through equity and the rest from the markets,” said Dr Prathap C Reddy, Chairman, Apollo Hospitals. Next, Apollo hopes to add 50 hospitals in the coming 10 years and 10 more super-specialty hospitals in tier-II & III towns. The hospital chain is also vying to roll out 1,000 telemedicine centres over the next three years.

Apollo Hospitals plans to add beds(September) Narayana Hrudalaya Hospitals launched the fi rst phase of its 600-bed multi-specialty facility in Hyderabad. The Narayana Hrudalaya–Malla Reddy Hospital hopes to increase its capacity to 5,000 beds, to address the healthcare needs of the city at a comparatively affordable cost. The hospital, will be spread over fi ve acres. It has also introduced a micro health insurance scheme for farmers – ‘Yeshasvini’, with the help of Karnataka government. The scheme provides coverage for all major operations with a premium of only ` 5.

Narayana Hrudalaya launches 600-bed facility

(February) Kohinoor Hospital was rated as the world’s second Leadership in Energy and Environmental Design (LEED) Platinum under the Green Building Rating System. The hospital was inaugurated by Ashok Chavan, Former Chief Minister, Maharashtra. The LEED India Platinum plaque was presented to Unmesh Joshi, CMD, Kohinoor Group, in presence of Manohar Joshi, Founder, Kohinoor Group, Dr Prem Jain, Chairman, Indian Green Building Council (IGBC), and other dignitaries.

Asia’s fi rst LEED Platinum hospital in Mumbai(April) The leading Australian audiology service provider, National Hearing Care (NHC) Group, launched its operations in India. The Indian operation – NHC Hearing Care (India) will be opening its fi rst three clinics in New Delhi, and National Capital Region (NCR) soon, further eight clinics in New Delhi by June 2010. This launch will be followed by a roll out of hearing clinics across India.

In India, NHC will offer free hearing screening checks for people with potential hearing problems.

Australian company initiates operations in India

Green Field Projects

Highlights of 2010 - National

10 I January 2011

(July) Seven Hills Group’s multi-specialty hospital with 1,500 beds was inaugurated on July 4, 2010, by Pratibha Devisingh Patil, President of India. While 300 beds will be operational in the fi rst phase, the remaining will be commissioned by the year end. Of the 1,500 beds, 300 will be dedicated towards critical care, eg, Intensive Care Units (ICUs) for cardiac, burns, neonates and paediatrics. Another 300 beds are reserved for BMC patients who will be able to avail services at the same cost as given by other BMC hospitals.

Seven Hills Group’s multi-specialty hospital(April) German medical devices manufacturer B Braun invested ` 35 crore in Andhra Pradesh, in a PPP project with the State Government, for setting up of a series of haemodialysis centres. The company, which operates a unit in Chennai for manufacture of sutures, is planning to replicate the project in other states. As part of the PPP project in AP, B Braun will be setting up 11 centres within government medical colleges and hospitals in the state, equipped with 111 haemodialysis machines to provide treatment.

B Braun set up kidney treatment units in AP

Miscellaneous

(September) The Government announced restoration of cashless medical facilities for people insured with public sector insurance companies in 449 hospitals across four metropolitan cities – Delhi, Mumbai, Chennai and Bengaluru, after hospitals agreed to charge policy holders at par with non-insured patients. However, major chains of hospitals such as Fortis, Apollo & Max and other multi-specialty facilities like Medanta, Hinduja and Leelavati are still out of this network.

Government restores cashless medical facility (December) The International Diabetes Federation (IDF) inaugurated its regional offi ce in South EastAsia at the S L Raheja Hospital (a Fortis Associate).According to the fourth edition of the IDF Diabetes Atlas, India has the second highest number of people with diabetes at 50.8 million adults. Also, 40 million Indians have Impaired Glucose Tolerance (IGT), and are at a high risk of developing type II diabetes. Ann Keeling, CEO, IDF, commented, “These fi gures are an eye-opener and a wake up call to governments & healthcare systems around the world.”

IDF inaugurates its South East Asia regional offi ce

Green Field Projects

(May) Milestone Religare Investment Advisors Pvt Ltd, a JV between Milestone Group and Religare Enterprises, announced an investment of ` 312 million in HealthCare Global Enterprises Ltd (HCG). HCG also operates CyberKnife, a radiation treatment centre for cancer at Bengaluru. This investment has been made from the India Build-Out Fund - I, which is a ̀ 6 billion private equity fund focussing on education and healthcare infrastructure. This makes Milestone Religare’s investment in the healthcare sector to about ` 1 billion.

Milestone Religare invests ` 312 million in HCG

(May) Vasan Eye Care Hospitals announced its plans to operate 100 eye care hospitals within India and abroad by the end of 2011. It is one of the largest networks of eye hospitals, investing nearly ` 300 crore for spreading to Northern cities and few Asian countries. The expansion would be funded mostly from internal accruals and partly by debt. Dr A M Arun, chairman, Vasan Eye Care, said, “We will be investing over $ 50 million into the Indian market and over $ 20 million in the overseas market in the next 18 months.

Vasan Eye Care plans ` 300 crore expansion

(December) Medfort Hospitals Pvt Ltd, a healthcare delivery business focussed on eye disorders and diabetes, has attracted an investment of ̀ 60 crore from TVS Shriram Growth Fund and ePlanet Ventures. Dr Velu, Chairman, Medfort Hospitals New Delhi, informed, “Medfort will primarily focus on creating a national eye and diabetic network across emerging markets of the world. The synergies between vision care and diabetes care are the reasons for Medfort focussing on both businesses together.”

Medfort receives an investment of ` 60 crore

Investments

(February) Wellness fi rm Vandana Luthra Curls and Curves (VLCC) planned to invest ` 400 crore to fund expansion activities and acquisition of three small-sized companies. “We are investing ` 400 crore for expanding our operations and for some major acquisitions. Nearly ` 100 crore will be used to fund two acquisitions,” said Sandeep Ahuja, Managing Director, VLCC. The company has identifi ed two medium-sized wellness chains in the Middle East and the US and one in South India as potential acquisition targets.

VLCC invests ` 400 crore to fund acquisitions

(January) A study jointly conducted by ASSOCHAM and Yes Bank reported that the private hospital sector is expected to reach $ 45 billion in the coming three years, riding on growth in Tier II & III cities. Currently, the private hospital sector is worth $ 22 billion. Dr Swati Piramal, President, ASSOCHAM, commented, “Investments by private players in Tier II & III cities are increasingly gaining momentum, with rising income levels and exposure to international standards of quality. Therefore, the sector is expected to rise exponentially.”

Revenues from private sector to reach $ 45 billion(May) Coimbatore is now emerging as a preferred healthcare destination among mid-sized cities in the country. In the last one year, nearly 800 beds have been added to hospitals, with the inherent entrepreneurial spirit of the city inspiring doctors to venture into specialty hospitals. The city is slowly catching up on medical tourism too. Hospitals in Coimbatore are performing 15-20 joint replacement surgeries and 10-12 kidney transplantations per week, with almost 10 open heart surgeries being done everyday.

Coimbatore to emerge as a healthcare destination

Projections

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Highlights of 2010 - International

14 I January 2011

(January) Telemis Group, a medical imaging company specialising in Picture Archiving and Communication System (PACS) solutions announced that it would make its innovative, platform-independent technologies available to OEMs and third parties for the fi rst time. This implementation will enable hospitals, clinics, radiology practices and other healthcare institutions to cost-effectively store and share images and other content including video, audio & diagnostic results.

Telemis to provide third party systems with PACS

(October) Sanofi -Aventis announced the baseline results of a worldwide prospective longitudinal epidemiological study – INternational Study of Prediction of Intra-abdominal adiposity and its RElationship with cardioMEtabolic risk/Intra-Abdominal Adiposity (INSPIRE-ME IAA) – designed to assess the predictive value of risk factors for developing cardiovascular diseases and type 2 diabetes. Four categories of glucose control were studied. Results showed that increasingly poor glucose control is associated with an increased cardiovascular risk profi le.

Pre-diabetes glucose abnormality a risk factor

(September) The World Health Organization (WHO) announced that the 2009 H1N1 pandemic has effectively ended, and the world has moved into a ‘post-pandemic’ phase characterised by traditional seasonal patterns of infl uenza. Dr Margaret Chan, Director-General, WHO, informed that the committee’s advice to declare an end to the pandemic was based on the global situation, but it also considered signifi cant infl uenza activity in several countries. Countries that were less affected during the pandemic could witness severe disease from H1N1 in a future season.

WHO declares the end of H1N1 pandemic

(November) Cytheris SA, a clinical stage biopharmaceutical company focussed on R&D of new therapies for immune modulation, announced initiation of Phase II clinical trial of the company’s investigative immunomodulatory agent, CYT107, in combination with two potent antiretroviral drugs. The study hypothesised that a combination of the most potent antiretroviral drugs, coupled with an immunomodulating agent capable of targeting or inducing activation of latently infected cells, can help decrease the HIV reservoirs.

Cytheris initiates ORVACS-sponsored Phase II study

Announcements

(December) The USFDA approved the high-resolution Computed Radiography (CR) system developed by Carestream Health for mammography. After the FDA approves the fi nal product labelling, Carestream Health can immediately begin commercial distribution of this innovative CR system for mammography in the US. The company’s DIRECTVIEW CR Mammography Feature enables digital capturing of mammography images while utilising a healthcare provider’s existing mammography X-ray unit and workfl ow processes.

FDA approves Carestream Health’s CR system

(May) ConvaTec, developer and marketer of innovative medical technologies for hospital care, had announced that the USFDA has granted 510 k clearances to market Vitala™, non-intrusive ostomy continence control device, for patients with an end colostomy.Indicated for use up to eight hours and recommended for 6-12 weeks after surgery, Vitala™ is a single-use, disposable disc, worn together with the ConvaTec Natura® skin barrier. Also, it is waterproof and can be worn when bathing, showering or swimming.

ConvaTec’s Vitala™ receives 510k clearance

(December) The US Food and Drug Administration (USFDA) had cleared the Investigational New Drug (IND) application developed by Advanced Cell Technology, Inc. This is to initiate a Phase I/II multi-centre clinical trial using retinal cells derived from human Embryonic Stem Cells (hESCs) to treat patients with Stargardt’s Macular Dystrophy (SMD), one of the most common forms of juvenile macular degeneration in the world.

FDA approval for macular degeneration treatment

Approvals

(February) Neomend, Inc, an innovator in sealant and adhesion-prevention products for the surgical marketplace has received pre-market approval from the USFDA for the company’s ProGEL™ pleural air- leak sealant. ProGEL is a hydrogel polymer sealant consisting of two components: human serum albumin and a cross-linking component of polyethylene glycol. FDA approval came following a multi-centre clinical study on the device that encompassed 161 patients in fi ve institutions in the US.

Neomend Inc’s lung surgery gets FDA approval

(April) Researchers at the University of Nebraska Medical Center (UNMC) have found an Infrared Thermal Detection Systems (ITDS) to be a fast and effective fever screening tool in clinical settings during the H1N1 infl uenza pandemic. Dr Angela Hewlett and colleagues evaluated the OptoTherm ThermoScreen in 566 patients in the emergency department of the Nebraska Medical Center, UNMC’s hospital partner during the peak of the H1N1 pandemic from November 18, 2009 to January 9, 2010, for testing the tool’s viability in a practical clinical setting.

ITDS for fever screening

Discoveries

(January) A new study funded by the National Heart, Lung, and Blood Institute (NHLBI) has discovered that a genetic variant may be associated with better preserved lung function among children with asthma and adults who smoke. It also found an association between the genetic variant and a lowered risk of developing Chronic Obstructive Pulmonary Disease (COPD) in adults who smoke. The team examined the genes and breathing capacity of more than 8,300 children and adult participants from seven different studies.

Genetic variants control lung function and COPD

Highlights of 2010 - International

16 I January 2011

(May) GE Healthcare and Nycomed formed a JV for local sales, marketing and distribution of GE Healthcare’s medical diagnostic contrast agents in Russia and the Commonwealth of Independent States (CIS). The new company will market and distribute Computed Tomography (CT), X-ray and Magnetic Resonance (MR) contrast media products from GE Healthcare Medical Diagnostics. This JV will bring GE Healthcare closer to its customers in Russia and further demonstrates the company’s commitment to the Russian medical & healthcare community.

GE Healthcare, Nycomed form JV

(November) Fortis Global Healthcare Holdings Pvt Ltd (Fortis Global Healthcare) had agreed to acquire the healthcare business of Hong Kong-listed Quality Healthcare Asia Ltd (QHA). It intends to build & aggregate healthcare businesses and assets internationally, covering various healthcare segments from hospitals, to diagnostics, primary care & other segments, to create an integrated healthcare business with high-quality medical professionals & infrastructure. The acquired businesses comprise a network of over 60 wholly owned medical centres.

Fortis Global Healthcare to buy QHA

(March) A recent report published by GBI Research has predicted that global diabetes care devices market will continue to experience increased growth over the next seven years. It is slated to reach $ 18 billion by 2016, with forecasted CAGR of 10 per cent during 2009-16. Key opinion leaders suggest that the market for diabetes care devices is huge in developing countries such as India, China and Brazil. However, they state that low-cost devices for diabetes care are still lacking in these markets.

Global diabetes care devices to reach $ 18 billion

(July) GE Healthcare, the healthcare business of GE and CardioDx, a pioneer in cardiovascular genomic diagnostics, entered into a strategic alliance to advance and co-develop diagnostic technologies to improve the care & management of patients with cardiovascular disease. Building on the alliance, the GE Healthymagination Fund, a new equity fund that invests in highly promising healthcare technology companies, had invested $ 5 million in CardioDx as part of a series D round that the fund is leading.

GE Healthcare in alliance with CardioDx

(December) Insurance behemoth, Humana, declared that it would buy Concentra, Inc, a private healthcare company, for $ 790 million. Through this acquisition, Humana will have access to over 300 medical centres in 42 states, where Concentra delivers occupational medicine, urgent care, physical therapy and wellness services to workers. Nearly three million Humana customers live near a Concentra centre. Also, Concentra’s annual revenue is about $ 800 million. The deal will help Humana to keep costs down for its customers.

Humana to buy Concentra for $ 790 million

(March) Globaldata recently reported that incremental technology innovation in the fi eld of implant material and design, which improves implant durability, will drive increased patient volumes, especially among the younger population. Further, implant materials such as advanced titanium alloys have led to a resurgence of metal-on-metal implants, while cross-linked polyethylene has enhanced the durability of metal-on-polymer implants. The report also highlights that the hip and knee replacement in the US market valued at $ 6.7 billion.

Incremental innovation to drive implants market

M&As

Projections

(October) Dr Linda Baker, Professor - Urology, UT Southwestern, and Surgeon - Children’s Medical Center Dallas, has pioneered a successful surgical procedure for absent or malformed vaginas. The surgery begins by removing a portion of the top layer of cheek tissue from inside a patient’s mouth. The tissue is then stretched and made into a graft with perforation, and is then wrapped around a plastic mould and fi tted inside the patient’s body. After approximately a week, the mould is removed, and the graft is vascularised. Healing occurs quickly and no scars are visible.

Surgical procedure for rare vaginal defects

Discoveries

(July) Nasendoscopy may help dentists predict Oral Appliance Therapy (OAT) success in patients with Obstructive Sleep Apnea (OSA) as per a Japan-based study which concluded that all severe OSA patients showed improved AHI following OAT. The patients who showed velopharyngeal widening during a nasendoscopy responded most effectively to OAT. Based on the Apnea-Hypopnea Index (AHI), this therapy is indicated in patients with mild to moderate OSA.

Nasendoscopy helps OSA patients

(February) Riester’s new portable spot-check monitor, ri-vital® provides reliable, accurate and fast measurement of Non-Invasive Blood Pressure (NIBP), pulse rate and blood oxygen level. Further, ri-vital® is portable, lightweight and protected by a shock-resistant casing and shock absorbing interior attachments. This German-engineered monitoring technology, designed for clinics, hospitals and outpatient treatment, provides simultaneous vital sign results within seconds for on-the-spot patient assessment, including a special mode for measuring newborns’ NIBP.

Riester’s spot-check measures vital signs in seconds(April) Keeler introduced single-use disposable probes for its cryomatic cryogenic surgery unit. These probes can be used with a disposable adaptor for single surgery or as a back-up for high-performance reusable probes. These do not require cleaning or sterilisation, and its single use eliminates the possibility of cross-infection or tip blockages caused by dust & debris, thus saving time and ensuring surgical reliability. It is a simple-to-use system with a reliable freeze and its console automatically confi gures itself according to the probe’s characteristics.

Keeler introduces single-use probes for surgery unit

Product Launches

National News

In Brief

18 I January 2011

Excellence in healthcare honoured by CNBC-TV18 and

ICICI Lombard ICICI Lombard General Insurance and CNBC-TV18 recently announced the winners of ‘India Healthcare Awards 2010’ in Mumbai. This award is the fi rst of its kind in the country, which recognises and honours the best medical service providers in the country. Dinesh Trivedi, Minister of State for Health & Family Welfare, felicitated the winners.

Trivedi commented, “The Indian healthcare ministry requires a dedicated bureaucracy, a system that cannot pause. India is capable of providing world-class hospitals and professional people and there is no reason why we cannot deliver. This is one area that genuinely requires a public-private partnership and we have to get off of all the shackles.”

Further, Chanda Kochhar, CEO & Managing Director, ICICI Bank Ltd, said, “The Indian healthcare industry needs to look at becoming six times its current size by 2020, and that is exactly the scale and size that the industry needs to gear itself for. The Indian healthcare system needs to deliver to the Indian population, the three A’s – increasing Accessibility, Affordability and Assurance of quality of healthcare facilities in India. By providing Indians with basic healthcare and education facilities, the healthcare sector as a whole will benefi t entire growth in India become truly inclusive.”

ISOT announces its new President Dr Ajit Huilgol, leading transplant surgeon with Columbia Asia, has recently been appointed as the President of the Indian Society of Organ Transplant (ISOT). This was announced at the Annual Conference in Hyderabad, a national association catering to the niche segment of transplant surgeons in the country.

Dr Huilgol has performed the maximum number of multiple renal artery transplants, double ureter transplants and double cadaver kidney transplant. He had also been

part of the fi rst transplant done in Karnataka in the 1980s. And with over 1,700 renal transplants performed, to his credit, his presidency term for the next two decades might be a promising one.

Speaking on his new appointment, Dr Huilgol, said, “My aim will be increasing organ donation, both cadaver and living, and also protecting the organ donors and their families with special schemes and incentives.”

Vascular Concepts sets up its fi rst R&D centre in India Vascular Concepts has recently outlined its plan to reinforce and build global leadership in cardiovascular technology. It has also announced an investment of over `15 crore to set up its fi rst facility for Research & Development (R&D), design and manufacture of endovascular medical devices such as vascular stents, drug-eluting vascular stents & vascular stent grafts that aid in less invasive therapy and address peripheral arterial diseases.

Swaminathan Jayaraman, CEO, Vascular Concepts, commented, “We have established a strong and innovative portfolio of products with our strong R&D focus over the last few years that provide us a fi rm foothold for future growth.”

L-R: Dinesh Trivedi, Bhargavdas Gupta, MD & CEO, ICICI Lombard, Dr Rashmin Gandhi, Director - Sankara Nethralaya (winner)

IMA to establish Central University The Indian Medical Association (IMA) is planning to establish a Central University and offer post-graduate courses like family and emergency medicine.

G Samaram, National President, IMA, said, “We have prepared a draft for national health policy. IMA is facing several challenges and is concentrating on healthcare of the country’s population and health education. We are also concerned about public health and rural healthcare.”

AIMS launches health scheme for rural populace Asian Institute of Medical Sciences (AIMS) has recently launched a major initiative and joined hands with ‘Grameen Swasthya Pariyojna’ to ensure that benefi ts of good health and modern medicine penetrate the remotest of villages & districts and is accessible to the marginalised and rural populace.

Dr N K Pandey, Chairman & Managing Director, AIMS, said, “The Grameen Swasthya Pariyojna was conceptualised to ensure that the best available healthcare services reach the rural and underprivileged sections of the population. Under this scheme, we have empowered the village sarpanch, who leads the panchayat in different villages and districts. They will be issued health cards for the people of their areas and districts, to help offer treatment in all specialities at AIMS at subsidised rates.”

Lifestyle diseases on the riseLifestyle diseases are on the rise in India. Although these diseases are not caused by bacteria or virus, they have crept into every corner of the country. Unlike normal diseases, which are temporary and can be cured by medicines that help remove toxins from the body or kill the germs, lifestyle diseases are caused by the way an individual leads his life.

Morbid obesity, sleep apnoea, stroke, mental disorders like schizophrenia, and hospital-acquired infections are some of the diseases that are on a rise.

According to doctors, these are defi nitely some of the diseases that a person needs to watch out for. Regular exercise, ample amount of sleep, healthy diet and maintaining proper hygiene are some of the ways in which these diseases can be controlled.

Dr Ajit Huilgol

National News

In Brief

20 I January 2011

Hinduja Hospital associates with MEMEX 2010Hinduja Hospital will be conducting a two-day drill in the city to provide training in advanced trauma life support for city doctors and paramedics at the hospital, and also provide faculties for the pre-hospital & hospital tracks. International faculties like New York Presbyterian Hospital and New York fi re brigade will monitor for areas of improvement & excellence.

At the MEMEX II inaugural ceremony, Vinoo Hinduja, Vice Chairman, Hinduja Hospital, and trustee of PD Hinduja Hospital, said, “We at Hinduja Hospital are proud to associate with MEMEX II. Our vision is to establish a state-of-the-art emergency services infrastructure, including trained manpower working with the government for the development of this infrastructure. Expanding the hospital’s vision, of providing healthcare accessible to the needy and the downtrodden, Hinduja will announce the launch of two Mobile Health Units (MHUs) in January 2011.”

Fortis Hiranandani gets advanced MAS centre and Fortis Healthcare launches special medical centres

Fortis Hiranandani Hospital, Navi Mumbai, has recently launched an Advanced Minimal Access Surgery (MAS) centre. Thus, Navi Mumbai and neighbouring areas will now have access to speedy and

world-class medical care facility. The MAS unit will include routine day care laparoscopic procedure like cholecystectomy, appendectomy and hernia and also advanced laparoscopic & thoracoscopic procedure like Natural Orifi ce Transluminal Endoscopic Surgery (NOTES), Video Assistant Thoracoscopic Surgery (VATS), etc.

Manpreet Sohal, Head of the Facility, Fortis Hiranandani Hospital, Navi Mumbai said, “With the recent consolidation of doctors to make a strong team for MAS, and with addition of a wide range of specialty surgical options, our hospital is the fi rst-of-its-kind in the city to provide total laparoscopic solutions to patients.”

Concurrent to this, Fortis Healthcare has announced its plans to set up specialty medical centres focussing on the management of diabetes, metabolic diseases and endocrinology. The specialty centre will offer holistic therapies and develop support programmes to improve the outcomes & quality of life of patients with diabetes and other metabolic diseases.

Dr N Karthik Nagesh conferred with Fellowship Dr N Karthik Nagesh, Consultant Neonatologist, Head of the Department, Neonatology and In-charge Neonatal Intensive Care Unit (NICU), Manipal Hospital, Bengaluru, has been conferred with the prestigious Fellowship of the Royal College of Paediatrics and Child Health, London. The fellowship has been given in recognition to his outstanding dedication and exemplary services for improving the health of children and attaining a high standard in medical education, training and commitment.

On being awarded, Dr Karthik, said, “I am happy to note that my contribution to improve neonatal care in India has been recognised by Royal College of Paediatrics and Child Health, London. It gives me a sense of achievement and motivates me to work better towards improving child health in India.”

New MRI scanner for personalised care Siemens Healthcare Ltd, has recently announced installation of its Magnetom Aera 1.5 Tesla (T) Magnetic Resonance Imaging (MRI) scanner at Scans World, Chennai. This new-generation scanner combines Total Imaging Matrix (TIM) 4G and Day optimising throughput (Dot) engine, which helps deliver personalised patient care and improves productivity by 30 per cent every day across the entire MRI workfl ow.

This technology has enabled radiologists to have a holistic understanding of the patient’s disease condition in a signifi cantly shorter time. This new coil system packs more coil elements into a smaller space, which provides the physician with enough channels to support imaging, offering high-resolution image quality while scanning the patient.

Lack of proper hygiene costs India $ 54 billion annuallyThe World Bank has recently reported that the lack of toilets and poor hygiene practices in India cost the economy almost $ 54 billion every year.

Further, the report stated that premature deaths, treatment for the sick, wasted time and productivity alongwith lost tourism revenues, are few of the reasons for high economis losses. According to World Bank experts, of the 575 million cases of diarrhoea every year in India, about 4,50,000 people die and the reason is attributed to the poor drainage system in the country.

New laser treatment to quit smoking New Look Cosmetic Skin and Laser Clinic, Mumbai, has recently come up with a programme, to help addicts get rid of smoking.

The programme includes four sessions. All treatments are confi dential and carried out by trained doctors & therapists. This includes a private consultation with doctors, and testing of the patient’s carbon monoxide and blood pressure levels.

An advanced technology, Nicolite, is used for smoking cessation. Nicolite is a state-of-the-art laser diode used to induce a biostimulative effect to assist in smoking cessation. The laser initiates the release of endorphins – naturally occurring chemicals in brain – which help reduce pain, stress levels and increase circulation of energy.

Dr Nagesh and Prof Terence Stephenson, President, Royal College of Paediatrics and Child Health, London

World News

In Brief

22 I January 2011

Lenzing AG unveils range of medical fi bres at Medica Lenzing AG, global leader among the manufacturers of man-made cellulose fi bres, presented a unique portfolio of fi bres especially designed to meet the demands of the healthcare sector, from special cellulose fi bres through to high-grade plastic polymer products. This was the fi rst time that Lenzing presented its TENCEL®, Lenzing Viscose® and Lenzing Profi len® fi bres to a specialist medical audience. Lenzing fi bres that offer relief to patients with sensitive skin and skin diseases generated signifi cant impact at Medica, one of world’s largest medical trade fair, in Dusseldorf. With about 137,200 visitors, Medica 2010 served as the platform for presenting Lenzing AG’s innovative portfolio of fi bres to the audience in medical fi eld.

With its smooth surface and unique moisture management abilities, TENCEL® offers a true alternative to traditional textiles. Further, the anti-adhesive characteristics of Lenzing Profi len® prevent medical textiles adhering to wounds. Thus, the key advantages of Lenzing Viscose® and TENCEL® are consistent product quality, outstanding purity along with highly effective fl uid management.

Another success for COMPAMEDCOMPAMED, one of the leading international trade fairs, in Düsseldorf, was a grand success. Joachim Schäfer, Managing Director, Messe Düsseldorf, said, “The number of exhibitors has grown steadily to 575. The international appeal is increasing equally among exhibitors & visitors, and the percentage of decision makers among

the visitors is also rising.” The packed halls at the event bear testimony to the steadily increasing interest in the manifold aspects of medical technology – from materials, to measuring and manufacturing processes, to fi nal products packaged under sterile conditions.

Dr Uwe Kleinkes, Managing Director of the professional association of microtechnology, IVAM, said, “More and more companies from completely different sectors are contributing their expertise to the medical technology market.” The trade fair enabled the purchasers a fi rst-hand experience with respect to technical maturity, quality & compactness of components and ascertain how the products provided by the suppliers were meeting their respective demands & expectations.

Shanghai aims to introduce new approaches to medical reformsShanghai aims to introduce novel approaches to its medical reform for balancing its resource allocation, so that more people can avail the benefi ts of basic healthcare. The new plan that was released by the Municipal Health Bureau stated that the city will lower the bar for access based on patients’ household registrations. Currently, Shanghai has nearly 3,000 hospitals and clinics, or about one in three square kilometers on average. Under this plan, every family will receive care from a family doctor, who will go beyond home visits.

US healthcare costs reported to rise 6.70 per centAccording to Standard & Poor’s for the S&P Healthcare Economic Composite Index, the average per capita cost of healthcare services covered by commercial insurance and Medicare programmes rose 6.70 per cent over the 12 months ending October 2010. This is a deceleration from the 7.08 per cent reported for the 12 months ending in September 2010.

Further, at S&P Healthcare Economic Medicare Index, Medicare claim costs for services, which are offered by physicians and doctors, rose at roughly half that growth rate, up 4.18 per cent. This is the lowest annual growth rate for Medicare claims costs since January 2008, when it was +4.02 per cent. These two indices witnessed growth deceleration versus their September reports of 8.53 and 4.68 per cent, respectively.

David M Blitzer, Chairman - Index Committee at Standard & Poor’s, said, “The annual growth rate of Medicare and commercial insurance costs has slowed signifi cantly in the last fi ve months and substantially dropped in October.”

Fortis to invest A$ 100 million in Dental Corporation, Australia Fortis Global Healthcare Holdings Pvt Ltd has agreed to a A$ 100 million strategic investment in Dental Corporation, Australia, and New Zealand’s largest operator of dental practices. Dental Corporation, one of Australia’s fastest-growing companies, was founded in October 2007 to acquire and partner with high-quality general & specialist dental practices. Consequently, Dental Corporation’s revenue has grown more than fourfold from A$ 40.3 million in FY08 to A$ 182.6 million in FY10. It now owns 135 practices located across Australia and New Zealand.

Discussing the venture, Malvinder Mohan Singh, Executive Chairman, Fortis Global Healthcare, said, “Dental Corporation is a premier dental care brand in Australia and in an industry that is highly fragmented & individualistic. Their model of business partnership with principal dentists is a signifi cant point of differentiation driving the success of the business and its rapid growth, while being the most effective way to manage high-performing professionals.”

World News

In Brief

24 I January 2011

Cool idea helps to save livesAn energy-effi cient fridge, which can store vaccines for more than 10 days without power, is helping to save lives in developing countries. The innovative machine – with capacity to hold 103 ltr of vaccines – has passed the World Health Organisation’s (WHO) stringent tests and is now listed on the Website.

The refrigerator was designed by Wales based sustainable energy fi rm True Energy by using its patented Sure Chill technology. Sure Chill enables effi cient storage of energy and provides controlled cooling even during power cuts. Janos Mate, Senior Consultant to Greenpeace International, Political Business Unit, said, “The innovations made by True Energy in solar-powered vaccine cooling are proving to be hugely benefi cial in parts of the world that have intermittent supplies of electricity.” The technology uses an intelligent monitoring system to keep temperatures stable.

Kaduna government provides free healthcare The State Government of Kaduna, Central Northern Nigeria, has spent about a billion to provide free healthcare services to children under fi ve years of age and pregnant women during 2007-10.

Commenting on this, Patrick Ibrahim Yakowa, Governor, said that over four million pregnant women including children have so far benefi ted from the free Maternal and Child Health (MCH) services in the state.

The governor believes malaria to be one of the primary reasons for causing under-fi ve mortality, and therefore responsible for 18 per cent of all cases of under-fi ve mortality in the country. Yakowa further added, “Since the launch of the War Against Malaria in 2008, the State Government has procured and distributed more than 3.6 million doses of Artemisinin-Based-Combination Therapy (ACT) for treatment of children aged under fi ve years with malaria, and over 200,000 doses of Sulphadoxine-Pyrimethamine (SP) for Intermittent Preventive Treatment (IPT) of malaria in pregnancy.”

Water Street Healthcare Partners invests in New Century HealthWater Street Healthcare Partners, a strategic PE fi rm focussing on healthcare, declared that it has made a majority investment in New Century Health, a specialty benefi t management company concentrating on oncology and cardiology.

Joseph Perez, Founder and President of New Century Health, said, “Water Street’s team approached us with ideas on a strategic partnership to help us grow and scale our company. Water Street’s industry expertise and relationships with national & regional payers will enable us to achieve our vision of offering payers, specialists and patients a comprehensive support on a national scale.”

Ned Villers, a partner with Water Street, said, “Over the past fi ve years, Water Street’s team has executed a disciplined approach for identifying the most attractive opportunities to accomplish these objectives.”

Autistic children lack visual searching skillsResearchers at University of Bristol have challenged the previous fi ndings that autistic children usually have enhanced visual searching skills.

They commented that the new research indicates that children with autism are unable to search effectively for objects in real-life situations. In a test, 40 children, half of whom were autistic, were requested to search for targets. Systematic behaviour was not observed in this test. Children with autism were less effi cient and more chaotic in their search.

The researchers added that such tests usually tend to answer why autistic children are often unable to complete simple tasks like fi nding their favourite animal at the zoo. Josie Briscoe, one of the authors of the report, said, “This research offers an exciting opportunity to explore the skills that could help people with autism achieve independence.”

ERT appoints Joel Morganroth, MD, as Interim CEODr Joel Morganroth, currently eResearch Technology, Inc (ERT)’s Chairman and Chief Scientifi c Offi cer (CEO), has been elected by the Board as President and CEO until a permanent CEO is hired. ERT is one of the global providers of technology & services to the pharmaceutical, biotechnology and medical device industries. Dr Morganroth is a globally recognised cardiologist & clinical researcher and has had more than 10 years of experience as a medical review offi cer/expert for the US Food & Drug Administration (FDA).

GE & Russian companies form JV General Electric Co (GE) has signed a framework agreement with two Russian companies to form JV in Russia in the arena of healthcare and power generation. The JV will help in manufacturing and sales of high-tech medical diagnostic equipment in Russia.

GE and Russian Technologies hope that the healthcare JV will help initiate production of CT scanners and further expand to other diagnostic equipment such as angiographs, Magnetic Resonance Imaging (MRI), ultrasound, digital X-ray, Positron Emission Tomography (PET), gamma cameras and medical devices.

Experts Speak

26 I January 2011

‘Death caused by nosocomial infections increases the mortality rate than any other form of

accidental death in the country’

Dr Asma Mohd Yousuf

...says Prof Dr VictoPresident, InternatiInfection Control C(INICC), and DirectDiseases, Infection CEpidemiology DepaMedical Center, BueHe has done active rnosocomial infectioconsultant to many World Health Organauthor of about 200in international sciemanuscripts publishjournals, Prof Dr Rosenthal talks about the reasons fonosocomial infectioin India and preventmeasures that can hsuch infections.

Experts Speak

26 I January 2011

Which are the common microorganisms responsible for nosocomial infections and what are their symptoms?Nosocomial infection usually occurs two days after admission in the hospital. The use of invasive devices like venous catheter, urinary catheters and ventilators during the treatment could lead to nosocomial infections.

There are no specifi c symptoms of nosocomial infections. Generally, such patients have fever, fall in blood

pressure and increased blood counts. These infections are Hospital Acquired Infections (HAIs), as the microorganisms are present in the hospital environment itself. Gram-positive bacteria, Gram-negative bacteria and fungi are the major microorganisms causing nosocomial infections. All patients admitted to the hospital, especially those in Intensive Care Unit (ICU) areas are susceptible to these infections. These infections increase the mortality and length of hospital stay of the patients.

What is the rate of nosocomial infections in Argentina? Where do you think India stands as far as nosocomial infections are concerned?The incidences of nosocomial infections in Argentina and India are similar because both are developing countries, and hence face similar challenges. Indian ICUs show high HAI rates. The possible reasons for this are absence of a legal framework for infection control programmes or their

Experts Speak

27January 2011 I

implementation, restricted funds, low nurse-to-patient staffi ng ratios, overcrowded wards and insuffi cient supplies. In India, thousands of patients die every year due to HAIs. According to a report by the International Nosocomial Infection Control Consortium (INICC) in 2006, overall 1.4 million people worldwide were suffering from nosocomial infections, and in India alone, the rate was over 25 per cent. Death caused by nosocomial infections increases the mortality rate than any other form of accidental death in the country. The irony of this condition is that about one-third of all nosocomial infections are preventable.

Fortunately, there are some quick and effective solutions to prevent HAI, eg introduction of air fi ltration systems in hospitals, mandatory usage of breakable syringes and replacement of plastic & glass Intravenous (IV) fl uid containers with closed infusion bags. However, so far, only the advanced

sector of the Indian healthcare industry is aware of these systems. The general public still has negligible information about the same.

How do nosocomial infections affect the overall healthcare expenditure?Nosocomial infections increase the cost of healthcare and add burden to

Table I: A study published by INICC in 2005 on nosocomial infections highlighted the following results:

ALOS – Average Length of Stay ELOS – Extra Length of StayThe data clearly shows that HAI increases the length of stay from 2 to 5 days, thereby increasing cost to patients. As per an estimate in Argentina, the rise in cost due to one HAI to a patient is about $ 5,000. In India, it could be about ` 25,000-100,000, depending on severity of infection and the hospital in which the patient is admitted. In fact in the US, from January 2011, the insurance companies will not bear the cost of HAI anymore. This cost has to be borne by the hospitals. Moreover, HAIs increase the burden on hospital resources, especially in public hospitals, where both resources and patient’s capacity to pay are limited.

NI N I (n)

Proportion in per cent Device-days NI rate per 1000

device days ALOS ELOS

IVD-BSI 43 48.3 5,308 8.1 7.3 2.0

VAP 34 38.2 1,374 24.7 10.7 5.4

CA-UTI 12 13.5 3,581 3.4 9.6 4.2

Experts Speak

28 I January 2011

the resources. As per some studies by INICC, these infections increase the length of hospital stay three times than normal. In Europe, nosocomial infections increase cost by EUROS 5,000-14,000. In Latin American countries like Argentina, Brazil and Mexico, the cost increases by $ 5,000-12,000. An Indian study has shown an increase of $ 14,000 in healthcare cost due to nosocomial infections.

Please elaborate on methods to combat HAIs.There are several measures to treat nosocomial infections depending on the type of infection, even though these are diffi cult to treat, as the microorganisms (eg, bacteria) are resistant to antibiotics. Management of these infections usually involves treatment with two or more expensive antibiotics. This not only increases the cost of treatment but is also responsible for higher mortality in these patients. As per INICC data, mortality rate in adults with nosocomial infection is 32 per cent due to Urinary Tract Infection (UTI), 35 per cent due to blood stream

infection and 42 per cent due to pneumonia, whereas about 38 per cent mortality in infants is caused by blood stream infections.

However, there is a set of precautions, which, if followed strictly, can help to a great extent in preventing Nosocomial Blood Stream Infections (NBSI). These are: Hand hygiene Using maximal sterile barrier during insertion of devices

Skin antisepsis with chlorhexidine Preferring subclavian or jugular vein over femoral vein for insertion of central lines

Using closed system IV fl uids (bags) over semi-rigid containers (plastic bottles)

Using sterile gauze at insertion site Removing unnecessary lines

Likewise, there are guidelines for prevention of other HAI’s like UTI, etc.

How do you think India can fight against this problem? All hospitals, the private as well as public healthcare setups, are susceptible to nosocomial infections. Therefore, it is important that the

government implement plans to reduce the incidence of these infections. Steps such as compulsory surveillance of nosocomial infections in both private & public hospitals, formulations of guidelines for prevention of these infections, promotion of bodies that would increase awareness of these infections and standardisation of nosocomial infection control programmes in the country would help in saving many lives.

Besides, hospitals need to have infection control committees to conduct outcome and process surveillance for nosocomial infections. This committee should meet regularly and publish the results of their surveillance. At the same time, healthcare institutions should adopt new and better technology, like closed system IV fl uids, in order to reduce the rates of infections. Further, training the paramedical staff on various aspects of HAIs and measures of infection prevention will help tremendously in reducing the morbidity & mortality resulting from nosocomial infections.

([email protected])

Researched results

Studies with published results have been conducted in India for both private and public hospitals. However, the data is not analysed Indian city wise by INICC as yet because the publications from INICC have been country specifi c. INICC has published data on HAIs for countries and the data for India suggests that the rate of Ventilator-Associated Pneumonia (VAP) is 10.5 per 1,000 ventilator days, hospital acquired blood infections is 8 per 1,000 catheter days and UTI by using Foley catheter is 1.5 per 1,000 Foley catheter days. However, with limited resources and manpower, the rate in public hospitals could be potentially higher than the ones from the study.

In the study, the data for HAIs was collected from hospitals throughout India; therefore, there is no specifi c patient’s data. But the rates from the study suggest that the number of patients with HAIs is high.

Table II: HCAIs per 1,000 device-days: VAP, CVC-BSI and CAUTI

Infection site Device type Device-days Device Utilisation

HCAI (N)

Distibution of HCAI (%)

Rate per 100 patients (%)

Rate per 1000 device-days

VAP MV 13 481 0.26 141 29.6 1.3 10.46

CVC-BSI CVC 36 857 0.70 292 61.3 2.7 7.92

CAUTI UC 30 464 0.58 43 9.0 0.4 1.41

Heathcare-Associated Infection (HCAI); Ventilator-Associated Pneumonia (VAP); Central Venous Catheter-Associated Bloodstream Infection (CVC-BSI); Catheter-Associated Urinary Tract Infection (CAUTI); Mechanical Ventilator (MV); Urinary Catherter (UC).

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that encompasses the entire value chain of manufacturing

and engineering with a special focus on Automation

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Brought electricity

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Roundtable

33January 2011 I

Dental amalgam is an alloy of mercury, silver, copper and tin, which may also contain palladium, zinc and other elements to improve handling characteristics and clinical performance. The wear resistance of amalgam is excellent, and bacteria do not adhere to its surface. Thus, in situations where aesthetics is not a prime consideration and

restorations have large contact bearing surfaces, dental amalgam is still considered as the most reliable direct fi lling material.

The controversy over the biocompatibility of amalgam has waxed and waned several times. Most of the debate stems from the presence of mercury in amalgam, which has potential toxic effects. Several studies have estimated the number of amalgam surfaces that would be needed to expose an individual to mercury concentrations with minimum observable effect. Studies estimate that 450-530 amalgam surfaces would be necessary to achieve these levels. Even if all 32 teeth were restored, the total number of surfaces would be only 192. Moreover, methyl mercury, the most toxic form of mercury that is easily absorbed in the gut, is not produced from amalgams.

Besides, humans are exposed to various sources of mercury in addition to dental amalgam. Air in the environment, water and diet contribute signifi cantly to the mercury levels in the body. Despite confi rmed exposure to these low levels of mercury from amalgam restorations, their biological effects are insignifi cant. Hence, amalgam restoration cannot be concluded as mercurial poisons.

Patients with silver amalgam restoration should not rush to have the restoration changed to other available alternatives. About 1-2 per cent of population can have allergic reaction to mercury, which is marked by itching, rashes, sneezing, diffi culty in breathing, swelling of gingival tissues, similar to certain number of people being allergic to other elements. When such a reaction is documented by a dermatologist or allergist, an alternative material must be used. For practitioners, the potential hazards of mercury are greatly reduced with well-ventilated operatories, use of disposable capsules, proper waste disposal and use of high copper silver alloys.

Over the years, concerns have been raised about the use of dental amalgam for fi llings because it contains mercury, and its use could cause mercury poisoning in the individual. Here are some expert opinions that will shed light on issues related to the utility of amalgam in dentistry.

Use of mercury in dental fi llings

Boons vs banes

Dental amalgam is a type of dental fi lling material that is used to repair the tooth structure and restore the biting surfaces of a decayed tooth. It is one of the oldest materials used in oral healthcare. Along with other metals, dental

amalgam contains mercury in amounts that would not be harmful to human body. There is a possibility of allergic reaction in some cases, and considering this, the amalgam is replaced by other options like composites that are also aesthetically appealing to patients. However, repeated exposure to mercury, if appropriate care is not taken, can cause harm to the treating dentist and other staff. Also, adequate care should be taken while disposing the waste containing dental amalgam in order to prevent damage to the environment.

Dr Asha Narde Endodontist, Breach Candy Hospital, Mumbai

Dr Asma Mohd Yousuf

Roundtable

34 I January 2011

Dr Pradyumna D JoshiConsultant Endodontist and Chief Treatment Coordinator Dental Dept, Lilavati Hospital and Research Centre, Mumbai

In dentistry, amalgam – an alloy primarily consisting of silver and mercury - is being used for more than 100 years. It is used for fi lling cavities in the teeth. Mercury is nearly 50 per cent of the mixture and the total amount depends on the quantity of amalgam required to fi ll the cavity. After complete setting of the alloy, there

is no free mercury that could leach out. Corrosion of amalgam was common in low copper alloy, as used in earlier days, which may release some mercury in the body. Nowadays, high-copper amalgam alloys are available that do not have the weaker gamma 2 phase to break down and release mercury.

Individually, the amount of mercury is not signifi cant to cause any adverse effects. The patient may show excess of mercury in his/her body in the long term only if he/she is exposed repeatedly to mercury vapours/fumes. This mercury may be from water, soil, food, etc. As far as amalgam is concerned, mercury vapours are generally present during the setting period of amalgam and more so when the amalgam is removed from the cavity using dental burs. Few studies claim to have demonstrated continuous presence of mercury vapours in amalgam restorations. For the dentist, repeated exposure to amalgam may pose health problem if proper protocol for mixing, dispensing, using, removing and disposing is not followed. It is the environmental damage that is more important than individual effects, as the disposal of amalgam waste is well guided and regulated.

For patients who have undergone amalgam treatment, if the restorations are sound and functioning well, there is no need to remove and replace it with new materials available, unless it is the personal choice of the patient to go for tooth coloured restorations. In some of the developed nations, amalgam restorations are not advised and done. Here, safer options, such as composite restoration and precious metal alloy/ceramic inlays or onlays are preferred. Some of the nations are revising the pros and cons of using amalgam in dentistry. But, for developing nations where cost of the treatment is more important than the questionable status of some material, amalgam is still used widely.

No epidemiological studies have shown adverse effects with any demonstrated correlation to amalgam alone. Clinical data available is not suffi cient to demonstrate clinical damage due to silver restorations. Some anecdotal accounts of the harmful effects in humans are compelling and raise important questions. However, no study gives concrete evidence that silver amalgam fi llings alone cause any systemic disease.

Perhaps, disposal of wastes containing mercury can be hazardous to the environment. Today, environmental pollution is increasing at a rapid rate, thus contaminating air, water, soil and food. Evidence suggests that toxic levels of mercury is present in the atmosphere compared to that in a dental fi lling. Thus, steps should be taken to prevent these hazards that pose a higher risk rather than exposure of an individual to minute amounts of mercury during amalgam restoration.

Dr Lavkesh Bansal Director and Chief Dental Surgeon, Durga Dental Care & Research Centre, Mumbai

Dental amalgam is a chemical compound of two metals (or an intermetallic compound). The most common metals used for this purpose are silver and mercury. Copper, tin and zinc are also used to improve the properties of the mix and set mass.

For more than 50 years, amalgam has been used as a dental material for filling teeth cavities. Since then, billions of dental fillings must have used amalgam. Moreover, dental amalgam is durable, economical and easy to use, though it is not aesthetic in appearance. Despite these drawbacks, it has served good purpose for over five decades.

The current controversy regarding this material is on the hazardous effect of mercury on the body, especially neurological and autoimmune disorders caused by it. There is a confusion

regarding mercurial poisoning and use of mercury in dental amalgam. When a person is exposed to environmental mercury, the exposure is to large amounts of mercury as compared to that from using dental amalgam. The mercury in dental filling is in the form of a compound and is not free to circulate in the body unlike environmental mercury. Thus, dental amalgam may not cause any side effects that people think about. However, it is harmful to the dental clinic or hospital staff handling it, as free mercury may evaporate from bottles, and can be absorbed through the skin while mixing the filling.

Many countries, including the advanced countries, still allow the use of amalgam for filling. It is slowly being replaced by composite fillings, as these are aesthetic in nature as compared to amalgam, which is blackish in colour. Therefore, many patients are now opting for this cosmetic composite filling.

Roundtable

35January 2011 I

Dental amalgams are composed of 43-54 per cent by weight of mercury and the remaining powder is made up of mainly silver (~20-35 per cent) and trace amounts of tin, copper (~10 per cent) & zinc (~2 per cent).

A study was conducted by measuring intraoral vapour levels over a 24-hour period in patients with

at least nine amalgam restorations. The fi ndings showed that the average daily dose of inhaled mercury vapour was 1.7 µg (range, 0.4-4.4 µg), which is approximately 1 per cent of the threshold limit value of 300-500 µg/day established by the World Health Organization (WHO), based on a maximum allowable environmental level of 50 µg/day in the workplace. Scientists agree that dental amalgam fi llings leach mercury into the mouth, but studies vary widely in regards to the amount of mercury leached.

Many people are unable to recognise their illness. By the time they feel ill, they are unable to attribute their illness to a particular cause. Moreover, specifi c symptoms of dental mercury poisoning may take years before becoming clearly visible.

However, the symptoms of mercury poisoning in humans include psychological disturbances like angry fi ts, short-term memory loss, low self-esteem, inability to sleep, loss of self-control and sleepiness. It could lead to digestive tract problems like cramps, infl amed colon, gastrointestinal problems, diarrhoea, etc. Cardiovascular and respiratory symptoms due to mercury poisoning include weak pulse, blood pressure changes, chest pain, or feeling of pressure in the chest area, weakness and problems with breathing, emphysema & persistent cough. Mercury poisoning may also show neurological signs like headaches, vertigo, tinnitus, etc. Exposure to mercury also affects the oral cavity and causes infl ammation of the mouth, loss of bone around teeth, ulcerated gums and

other areas in the mouth, loose teeth, darkening of gums, taste of metal and bleeding of gums. Mercury poisoning in children causes many symptoms of developmental disorders like autism, Asperger’s syndrome, Attention Defi cit Disorder (ADD), etc.

Dentists advocating the use of amalgam point out that it is durable, inexpensive, safe and easy to use. On average, resin composites last only half as long as dental amalgam, although more recent studies fi nd these comparable to amalgam in durability, and the use of dental porcelain is much more expensive.

In 2002, the Food and Drug Administration (FDA) issued a statement on dental amalgam, which asserted that no valid scientifi c evidence has shown that amalgams cause harm to patients with dental restorations, except in a rare case of allergy. However, the WHO notes that exposure can be greatly increased by personal habits such as bruxism or gum-chewing, and cites a report that found a 5.3-fold increase in mercury levels after chewing, eating or tooth brushing.

Further, the FDI World Dental Federation performed a meta-analysis of the literature on mercury toxicity and concluded that there is no documented scientifi c evidence to show adverse effects of mercury in amalgam restorations, except in extremely rare cases of mercury hypersensitivity.

Also, since its foundation in 1859, the American Dental Association (ADA) has asserted that dental amalgam is safe to use. In its advisory opinion to Rule 5.A. of the ADA Code of Ethics, it has also held that, ‘the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical’.

Dr Smriti BouriSenior Consultant, Dental Care, Max Healthcare, New Delhi

Silver amalgam has been used in dental restorations since the beginning of 19th

century. Dental amalgam contains mercury, but the amount of mercury used is small and in amalgamated form; therefore, most unlikely to enter the human system. However, dental

composite is a better choice for dental restorations, as it does not contain mercury. It also has more aesthetic appeal, as it is a tooth coloured restoration.

To the dentist, while performing the procedure using dental amalgam, the harm from mercury vapour may happen gradually, as the concentration is less. Thus, it is

better to opt for composite fi llings, as they are a better and safer option. Also, dental fi llings need to be replaced after some time, and at the time of replacement, it is better to consider composite material.

Mercury poisoning may lead to nephrotoxicity, neurobehavioural changes, autoimmunity, autism, skin & mucosa alterations or other non-specifi c symptoms and complaints. However, all these symptoms occur only when the person is exposed to large amounts of mercury, which is not the case with dental amalgam. Therefore, the use of dental amalgam does not cause mercury poisoning.

Dr Sunita KaulConsultant Dental Surgeon, Fortis Hiranandani, Vashi, Navi Mumbai

Hospital Monitor

36 I January 2011

A 61-year-old Nigerian woman, Dorothy Abba Paris, suffered a hip fracture in 1998 that had deformed her

hip. However, at that stage no surgery was performed to correct her deformity. She remained in pain until in 2002 when she underwent a hip surgery in Nigeria, where her hip joint was completely removed. Although her pain was reduced to a large extent, removal of the femoral head shortened her left leg by 4 inches, thus restricting her mobility. Later, a team of orthopaedic surgeons

led by Dr Sachin Bhonsle, Consultant Orthopaedic Surgeon, Fortis Hospitals, Mulund, performed a total hip replacement on Paris. She walked on the third day of her surgery. Her leg strength was corrected by 3 inches, and she feels stable after a long time. Paris now needs few weeks of physiotherapy to regain complete gait. Such goes the dedication of the Fortis Mulund team.

Fortis Hospitals Group is a part of the Fortis Healthcare Pvt Ltd network, which is widespread across the country focussing on the super specialty care.

The Fortis Hospitals currently has its presence in Mumbai, Kolkata and Bengaluru, providing quality healthcare in these regions.

Seamless shiftPursuing destination with fi rm determination, Fortis Group has come a long way. True, the path has not been smooth, but that had never hindered the pace in which the hospital plans to grow. Established in 2002, Fortis Hospital Mulund celebrated its ninth anniversary in 2010. The hospital was built on area of 1.6 lakh sq ft & now spans

With specialised academic courses and an effi cient R&D team in place, the hospital plans to expand from 200 beds to 500 beds. And, in doing so the mission of patient care at all times is the core focus. A glimpse of the strategies in place.

Fortis Hospitals, Mulund

Keeping values intact

Chandreyee Bhaumik

Hospital Monitor

37January 2011 I

3 lakh sq ft. It has manpower of about 850. The transition from Wockhardt to Fortis last year does not indicate the change of nomenclature only. To be precise, the shift was deeper, and more intrinsic. It was the question of change in the strategies, thus expecting a new game plan. Elaborating on this shift, V Vijayarathna, Regional General Manager, Fortis Hospitals Mulund, says, “As an organisation we were looking for a professional system and Fortis was a perfect choice considering both clinical and administrative attributes. This blend has enabled this hospital to assume a scientifi c approach and attitude.” At present, the hospital is gearing up at a Compounded Annual Growth Rate (CAGR) of 20 per cent.

Success tapestryThe hospital focusses on the tertiary care around the super specialty arena of - heart care, brain & spine care, bone & joint care, minimal access surgery and comprehensive cancer care. It concentrates on liver & kidney transplant. In this regard, Vijayarathna reiterates, “Our area of work primarily revolves around less invasive surgeries, especially in the gastroenterology arena that we call digestive care.” As a group, Fortis was the fi rst in the country to receive Joint Commission International (JCI) accreditation.

Initially, people residing in this part of the city were facing problems of commuting. Avers Vijayarathna, “This was indeed a welcome move. The hospital with its high-end facilities aims to fi ll this large gap. The patients now will not have to travel a long distance to avail quality healthcare. Thus, patients have established a special connect with the hospital.”

The different departments that are well integrated at the hospital ensure quality care at all times. The structural heads like human resource head, fi nance head, supply chain head and communication head form the blocks of achievement. Vijayarathna claims, “With these classifi cations in place, we are looking at growing aggressively, and thereby further expanding in Mumbai.”

The hospital also participates in several Corporate Social Responsibility (CSR) activities. Vijayarathna highlights, “Being in the healthcare industry, we offer a lot of lectures on disease prevention. On every Sunday, we visit community gatherings & corporate houses and conduct such lectures. This helps in creating awareness among the masses.”

Scanning the strategiesWith every additional milestone added to the plethora of achievements, the ambition to reach higher has now become all the more prominent. Comprehending the requirements

three to four months back, the hospital initiated an oncology department. Commenting on the need for a change and the expansion plans, Vijayarathna says, “At present, we have 56 critical beds and in 12-16 months, we are expecting to grow to 140 critical beds.” Further detailing the investment plan required to realise the expectation, Vijayarathna continues, “Each bed along with all the gadgets and equipment will cost approximately ` 70 lakh. ”

Currently, clinical trials form an integral part of most hospitals. Sharing his thoughts in this regard, Vijayarathna explains, “We are not conducting drug trials, but are concentrating more on device trials. Since we are concentrating more on the tertiary care, our patient enrolment is 10-15 over a period of one or one and a half year.”

Academic lens Nursing is a sensitive aspect. There are special nursing courses in the hospital, where aspiring nurses are trained and equipped with their daily chores. Further, there are special Diplomate National Board (DNB) courses in some streams like cardiology, cardiothoracic surgery, neurology, orthopaedics and family medicine. There are also paramedical courses recognised by University, such as fellowship in critical care medicine and fellowship in nephrology. Discussing the professional prospects,

We will be able to serve more people very soon. By the end of 2011, there would be two or three new modalities of treatment. Thus we are aiming to grow both in terms of human resources and size.

- V Vijayarathna Regional General Manager, Fortis Hospitals, Mulund

A glimpse of the patient care at the hospital

Hospital Monitor

38 I January 2011

Vijayarathna explains, “Depending on the potential of the students, they are employed in the hospital group. Some students after undergoing the training return to their native places and carry on their profession there.” Further, the hospital plans to strengthen the academic arena by collaborating with few universities overseas. Vijayarathna claims, “Although there is no formal declaration regarding the interaction with the foreign universities, yet we aim to come up with such programmes soon. Also, our senior surgeons & doctors go abroad for trainings, update themselves and then incorporate them at our facility.”

Unique servicesMaintaining the zeal in order to achieve the target is what separates the esteemed from the rest. The hospital is growing fast with a sound team of clinicians. It also claims to have the technology that tries to replicate the success that it has already achieved. Plans on the anvil include making the existing 200 beds to 500 beds in the hospital.

The hospital also upgrades itself regularly with technological innovations. They have recently inducted an oncology linear accelerator with Volumetric Modulated Arc Therapy (VMAT) technology that aims to reduce the duration of radiation treatment. Vijayarathna says, “While a conventional

radiation process takes 15-20 minutes, VMAT technology accomplishes the task in about 5 minutes. Thus, this helps serve 80 patients, whereas the conventional machine in the same time could offer radiation to 40-50 patients.” Commenting on the investment for this advancement, he adds, “We are looking at investing in cardiac intervention, neuronavigation system and imaging facilities.”

Going with this pace the R&D is on full swing, especially concentrating on better and promising clinical innovation. Vijayarathna elaborates, “We admit patients with complex

problems. Thus, providing continuous solutions to the challenges is an ongoing process. Usually, surgery of pituitary tumour is done through the skull, but we are trying to develop techniques to approach it through the nose.”

Further, the hospital participates in celebration of special days like World Epilepsy week and several other

occasions when the consultants interact with the patients’ families. Vijayarathna explains, “On these occasions, we try to convey our message to the society. We believe in prevention and that is what we practise.” Considering medical tourism as the topic of the hour, Fortis Mulund has big names like HTH Worldwide, World Access as its insurance partners. With this opportunity, patients from overseas can avail the advantage of undergoing treatment here, which will raise the fl ag of medical tourism even higher. The hospital earns almost 8-10 per cent of its overall revenue from international business.

Winning mantraEven the best of success stories have their share of impediments and so does this hospital. However, it is not a challenge specifi c to this hospital only but applicable to the entire sector as a whole. Vijayarathna agrees, “It is the entire healthcare sector in our country that faces the challenge. We lack quality manpower within the system. With practically no university recognised courses and very few medical colleges, the gap remains all the more glaring.” However, there lies a brighter vista in the near future. He continues, “Government has taken note of this situation, and some technical courses have also been introduced in colleges.”

Looking forwardVijayarathna believes that the hospital is at the threshold of an exciting future. He avers, “We will be able to serve more people very soon. By the end of 2011, there would be two or three new modalities of treatment. Thus, we are aiming to grow both in terms of human resources and size.” However, commenting on the situation where ‘competition’ is the norm of the hour, he remarks, “Considering the size of the city, Mumbai can easily hold 5-10 hospitals of this size and still remain busy.”

([email protected])

A nurse taking care of the diet of the patient

Quick BytesThe hospital is growing fast with a sound team of clinicians. It also claims to have the technology that tries to replicate the success that it has already achieved. Plans on the anvil include making the existing 200 beds to 500 beds in the hospital.

Quick Picks

Sector Watch

39January 2011 I

Over the years there has been change in the methods of management. Earlier, the facilities were autocratic

where, what the owner said was always correct. Even the hospitals then were doctor driven. However, with changing management ethos over the ages, hospitals have also started adopting modern management practices. Today, hospitals with corporate governance set-up, state-of-the-art infrastructure and facilities that are more patient-centric, are more than just huge architectural structures.

One such example is Apollo Hospitals. Anjali Kapoor Bissell, Vice President, Communications, Apollo Hospitals Group, says, “Apollo Hospitals is one of the foremost names in Indian healthcare, and indeed the entire region. For the past 27 years, Apollo Hospitals Group has played a pioneering role in shaping Indian healthcare. It is Asia’s largest healthcare group. Apollo Hospitals has completely transformed the way healthcare is perceived and practised in the sub-continent. The group provides healthcare delivery standards that set global benchmarks.”

Taking this topic further, Dr M K Maheshkant, Medical Superintendent, Fortis Hiranandani Hospital, Mumbai, informs, “Adopting modern operational management technique has helped our hospital streamline its functions at an early stage of becoming operational. It has increased patient satisfaction, and given us a tool to monitor our patient-centric activities. The quality of care has improved and resulted in greater confi dence among patients.”

Transforming healthcare Today, Indian hospitals are moving away from the traditional management

A healthcare facility is a multifaceted organisation, with multiple departments that have a cross-functional association. Here, facilities and operations management plays a crucial role, as it helps hospitals & health systems understand labour productivity, reduce waiting time and improve patient’s overall experience, thus enhancing organisation’s growth & revenue. A note on the effect this segment of management has on hospital administration.

Dr Asma Mohd Yousuf

Facilities and operations managementFacilities and operations management

Healthcare 24/7

Sector WatchSector Watch

Location Credit: Hinduja Hospital

Sector Watch

40 I January 2011

methods to more refi ned tech-savvy and consumer-friendly methods. However, to bring in a change, it is very important to make and implement appropriate plans. Dr Maheshkant informs, “At Fortis Vashi, we have adopted operations management, which entails the following steps – defi nea problem/requirement, develop a model to tackle it, collect data, validate this by comparing & taking expert opinion, simulate the model and analyse the effect. Once satisfi ed, this is implemented to effect the change. Principles from techniques like Six Sigma are used to tackle the problem. These processes help in providing adequate staffi ng, equipment utilisation and better patient satisfaction.”

Further, every hospital should set up models in order to achieve its targets. Highlighting the methods adopted by Apollo Hospitals, Kapoor Bissell informs, “Under the leadership of Dr Prathap C Reddy, our Chairman, Apollo Hospitals Group conceptualised an operational excellence programme called ‘Apolloway’, which is designed to enhance patient satisfaction at every level. Apollo Hospitals has been at the forefront in professionalising healthcare services, both by building scale and ensuring that best quality healthcare is available within India.”

“We have also defi ned our operating principles to govern the various

activities such as compliance, create trust, direct & open communication and caring – always,” remarks K S Ramsinghaney, Executive Director - Engineering, Commercial & Infrastructure, Max Healthcare, Delhi.

He continues, “We have a total of 38 improvement projects completed in the last two years. Some of the projects with substantial gains are reducing inventory days by 57 per cent, increasing Net Promoter Score (NPS) by 9 per cent, raising sigma level for reduction in customer complaint by 0.40 per cent and improving nursing time effi ciency improvement by 20 per cent in drugs management area.”

Planning in advanceIn setting up a department, it is necessary to understand the need of the client and whether that facility is encompassing all the essential aspects with respect to space, structural material, electrical & water connections, ventilation and waste disposal facility. Adequate provision should also be made for future expansion. Further, with growing awareness about environmental hazards leading to global warming, today, it is important to take measures to build an eco-friendly infrastructure. All these can be achieved with the help of professional services in engineering, architecture and project management.

“Disease and illness are concerns across the world. Considering the pace

at which India is growing to become an important emerging market, it is imperative that both multinationals and Indian companies look at services related to the healthcare segment,” says Allan Schouten, Managing Director - Asia, PM Group. Discussing PM Group’s focus areas, he mentions, “PM Group has both the international experience and local knowledge to design & deliver complex projects for pharmaceutical, nutritional and medical technology manufacturing facilities as well as R&D laboratories. Our services ensure that any pharmaceutical, nutritional or medical technology facility or R&D laboratory built in India meets both local and international standards.”

Schouten adds, “We focus on to bring our process expertise to these projects. We have good working relationships with clients such as Biocon & Dr Reddy’s, and our designs always employ sustainable & energy-effi cient designs.”

Facility checkBesides a well-designed architectural layout, it is important that a hospital has the necessary departments to take care of patients coming with various complaints. Further, each facility should be constantly upgraded with the latest technological developments to be at par with the global standards and provide best possible treatment to patients. Dr Vishal Goyal, Chief Operating Offi cer, BGS Global Hospitals, Bengaluru, says, “We strongly believe in the philosophy of patient satisfaction. We plan to introduce certain other specialties such as obstetrics & gynaecology and psychiatry. We are making forays into the area of heart transplantation as well. Coming up with new facilities at existing units and adding new units at different locations has helped us increase the patient base across the country, making the Global Hospitals group the third largest corporate hospital group in India with over 2,000 beds.”

Elaborating on the facilities available at Max Healthcare, Ramsinghaney says, “New facilities have been introduced both in terms of number of beds &

Apollo Hospitals has completely transformed the way healthcare is perceived and practised in the sub-continent. The group provides healthcare delivery standards that set global benchmarks.

- Anjali Kapoor Bissell Vice President, Communications, Apollo Hospitals Group

Adopting modern operational management technique has helped our hospital streamline its functions at an early stage of becoming operational.

- Dr M K Maheshkant Medical Superintendent, Fortis Hiranandani Hospital, Mumbai

Sector Watch

41January 2011 I

location and as healthcare services. Within National Capital Region (NCR), we started primary care in 2001, and at periodic intervals with more expertise, we added secondary & tertiary care later. Now, we have three super specialty & three multispecialty hospitals, in addition to two medcentres, within NCR that serve various medical faculties.”

Staff support and care Effi cient management of hospital helps clinicians deliver their best. But it is entirely based on the responsibility taken by the people at all levels and at all times. Supporting this fact, Dr Goyal says, “Staff motivation helps in improving the overall patient experience.” Further, describing the management techniques

at BGS Global Hospitals, he continues, “We believe in a bottom-up approach of management wherein people’s involvement in decision making is of essence. All administrators in our hospital are qualifi ed managers and well-trained for performing their duties. Earlier, in most hospitals, existing senior clinicians used to be administrators, but now with the changing management

trends, they have been replaced by professionals with management qualifi cations, preferably doctors with an MBA degree. Earlier, hospitals were treatment-centric, but now the focus is also towards the service aspect, thus making them patient-centric.”

Meanwhile, Dr Maheshkant points out, “Hospitals are manpower-intensive organisations; hence, understanding human behaviour is very important in ensuring smooth hospital operations. Doctors, nurses and technicians, who are at the forefront, work as well-organised and self-managing teams. They face increased pressure to optimise both effi ciency of their work process and quality of service they provide to their clients. This is also true for other departments, thereby increasing stress levels of the workforce. Directing these varied levels of taskforce together is a challenge for any top management. Therefore, we have adopted strong Human Resource (HR) policies to engage the employee in other non-core activities and concerns as well. This helps in keeping the team motivated and reduces possibility of errors. There is a robust process in place to streamline facility operations. “

Recognition through accreditationAccreditation has gained worldwide attention as an effective qualityevaluation and management tool. Dr Goyal agrees, “For the process of accreditation, the compliance of statutory requirements is inevitable. A well-planned facilities and operations management imparts quality infrastructure as well as effective maintenance of the existing facility, thus ensuring one of the most signifi cant aspects of accreditation, which

Testimony to our growth is our customer base backed by a team of clinicians refl ecting in our healthy & increased occupancy ratio. Occupancy has always been observed along with added beds & facilities, helping us improve our fi nances.

- K S Ramsinghaney Executive Director - Engineering, Commercial & Infrastructure, Max Healthcare, Delhi

Project: Maximising medicine availability

Complaints received from patients: Non-availability of medicines in

OPD pharmacy High billing and waiting time in

pharmacy Indent fi ll rate and late deliveries

Problem statement: Non-availability of medicine in local pharmacies resulting in patient dissatisfaction and revenue loss.

Project detail - Increase in central warehouse process effi ciency and thus increase in issuance capacity

Business need - Maximise the availability of medicines and optimise inventory level between CPS & units

Metric - Availability of medicines increase at customer end by 30 per cent thus increasing Outpatient Department (OPD) pharmacy revenue by 15 per cent

Project goal: Identify non-value added process and then improve it.

Steps taken:1. Divided on-hand inventory into

three classes: A, B and C 2. Basis is usually annual rupees volume

(` volume = annual demand × unit cost)

3. Policies based on ABC analysis Develop class A suppliers more

Give tighter physical control of A items

Forecast A items more carefully4. All medicines should be stacked in

racks based on their fi rst alphabet and stored according to dictionary principle.

5. Duplication of work should be done while entering batch number and expiry date, as all these entries are done at the time of receipt of material.Key results: Financial benefi ts in terms of

revenue increase as availability of medicines increases

Centrally controlled process helps in better management

Streamlined process in terms of better forecasting, thus saving time

Pharmacists can utilise their time more effectively as repetition of work is avoided

Increased productivity by six times both in receiving and issuance sections

Help in reducing patient waiting time at a local pharmacy

Financial benefi t: 20 per cent increase in OP sales was achieved, with additional contribution per month of 4 per cent.

Case study from Max Healthcare

Source: K S Ramsinghaney

Sector Watch

42 I January 2011

involves safety of patients, staff and community at large.”

Substantiating this statement, Dr Maheshkant says, “Accreditation would also help a patient to decide the type of healthcare facility where one would like to visit. It would help in getting tie ups with different agencies and gaining global recognition for international patients.”

Recipe for successIt is known that apt management helps in maximising hospital throughput, capacity and quality of care. Shedding some light on this, Dr Goyal says, “The investments made are secondary to the efforts put into both the clinical and non-clinical domain to achieve utmost patient satisfaction by optimal use of the resources. Implementation of quality standards and norms in the true sense has helped us in streamlining most operations.”

To this, adds Ramsinghaney, “Testimony to our growth is our customer base backed by a team of clinicians refl ecting in our healthy and increased occupancy ratio. Occupancy has always been observed along with added beds and facilities, helping us improve our fi nances.”

Besides, hospital logistics chain aids in smooth functioning of hospital operations. It ensures that materials are readily available and cost of

inventory remains low. Agreeing to this, Dr Maheshkant says, “A variety of medical supplies of drugs, consumables and specialised items should be ready at hand, as no one knows what type of case to expect in the hospital. Therefore, trends should be studied and stocking must be done accordingly. An excellent vendor management is the key to smooth supply chain management.”

Optimal utilisation of resources is a must for growth of any organisation. The same stands true even for the healthcare sector. Dr Goyal says, “As we are a growing organisation, most of the resources are being utilised for internal group expansions. We are collating the best practices from different units of the group to improve the overall effi ciency. There are patients who have become our brand ambassadors and helped us improve the quantum and quality of work. Besides our internal resources, we are open to and have been training students from various domains who carry out studies and help us in improving our processes.”

Innovative ideas also play a vital role in operations management. These help in expanding the existing facilities or coming up with new ideas to enhance the status of the organisation. Dr Maheshkant says, “As a multi-specialty tertiary care hospital, Fortis has established all core specialties. The next level would be in setting up specialised clinics within their

departments and feeder centres. The parent organisation of Fortis also undertakes operational management of suitable hospitals as and when opportunities present themselves. In the near future, many hospitals will be adopting modern operational management practices to keep costs down, without compromising on patient satisfaction. The faster one adapts, the better, as any new system takes some time to settle down.”

Next move in hospital management Operations management is an essential element of administration, as it is concerned with creating services and products on which everyone depends. When it comes to healthcare, operations research already has and will make considerable contributions in the effective & effi cient delivery of healthcare services.

With increasing globalisation of the markets, facility and operations management has been successful in providing solutions to technological & environmental challenges. Today, infl ation has affected every sphere of economy. Even the healthcare sector could not escape the stubborn attacks of soaring prices. However, administrators of healthcare facilities have to maintain a balance between the delivery of quality healthcare and appropriate allocation of resources. Therefore, the application of quantitative tools of operations management is crucial, as it helps in supporting the healthcare decision-making process. Besides, it assists in understanding the underlying environment within the healthcare sector to analyse the problems, fi nd solutions and deliver quality patient care while optimally utilising the available resources.

Today, like every industry in India, the healthcare sector is also in the process of transformation to make a mark in the competitive global market. And one of the factors that will help in bringing about this shift smoothly is effi cient facilities and operations management.

([email protected])

Considering the pace at which India is growing to become an important emerging market, it is imperative that both multinationals and Indian companies look at services related to the healthcare segment.

- Allan SchoutenManaging Director - Asia, PM Group

A well-planned facility & operations management imparts quality infrastructure as well as effective maintenance of the existing facility, thus ensuring one of the most signifi cant aspects of accreditation.

- Dr Vishal GoyalChief Operating Offi cer, BGS Global Hospitals, Bengaluru

Specialty Scope

44 I January 2011

Arthritis is one of the most common orthopaedicailments found in India and worldwide. Globally,

osteoarthritis is the most common articular disease in people of age 65 years and above. However, the age of onset of arthritis is going down and an increasing number of younger patients are affl icted with some form of this disease.

Most of the arthritis cases are

eventually treated with joint replacement surgeries, which use implants. These surgeries not only alleviate the chronic sufferers of the pain but also enable them to carry out daily living activities smoothly. Besides, implants are used in the management of fractures, which, if not treated, could lead to many complications.

Vital statistics“The high frequency of osteoarthritis in India is due to its high prevalence among women. Menopausal women are particularly prone to it. However, the disease is not limited to women. Both men and women can be affected with this disease,” informs Dr Kaushal Malhan, Knee and Hip Surgeon, Fortis Hospital (Mulund), Mumbai.

Taking this discussion further, Dr Shreedhar Archik, Consultant Orthopaedic Surgeon, Lilavati Hospital and Research Centre, Mumbai, says, “In India, the prevalence of fractures is high as incidences of trauma and arthritis are on the rise. Treating such conditions usually includes joint replacement surgeries.” He further informs that fractures are responsible for higher morbidity from 6-12 weeks based on the type of fracture and the bone affected. For

example, a lower limb fracture means the patient has to walk with an aid for three months. However, mortality due to fractures is very low due to the improved and safer treatment options available.

Spinal talksLow back pain is the most frequent cause of limitation of activity in the young and middle aged. It is also one of the most common reasons for medical consultation and the most frequent occupational injury. Back pain is the second leading cause of sick leave.

Expressing his views on spinal disorders, Dr Satyen Mehta, Consultant Spinal Surgeon, S L Raheja Hospital (a Fortis associate), Mumbai, says, “The common spinal pathologies found worldwide, including India, are mainly degenerative in nature. These are problems emanating from wear and tear of the spine. Some of the common pathologies are disc degeneration and herniation, spinal stenosis and spinal instability. In addition, tuberculosis of the spine, found in India and other developing countries is increasingly seen in developed countries as well. Other pathologies of spine are due to tumours and trauma.”

The right choiceImplants play a major role in all sections of orthopaedics. Dr Archik says, “Implants used in trauma, ie, fracture treatments vary from stainless steel alloys to titanium and now biodegradable implants. In joint replacement surgeries,

The use of implants in orthopaedics has relieved many patients from the chronic pain and disability accompanying various joint disorders. Here is an overview of the commonly used orthopaedic implants, along with the latest and possible future developments that will further simplify the treatment procedures in orthopaedics.

Orthopaedic implants

Reducing pain, increasing fl exibility

Dr Asma Mohd Yousuf

Specialty Scope

45January 2011 I

longevity depends on the material used, and now we use ceramics, special polyethylene and metals as joint replacement implants.”

There is a continuous attempt to make prosthesis more biocompatible and long lasting. The materials used for manufacturing joint replacement prosthesis have evolved signifi cantly over the years towards achieving these goals. Dr Malhan says, “The main body of the implant is metal, which can be special surgical steel, chromium-cobalt alloys or, in most cases, titanium. Further, hard-on-hard bearings like the metal-on-metal articulation & ceramic-on-ceramic show extremely low wear rates and promise greater longevity of the bearing surface, and freedom from bone destruction & loosening due to osteolysis by microscopic wear debris.”

Dr Malhan also explains that the surface texture and fi nish has also evolved signifi cantly. Highly smooth surface articulations can now be achieved even with hard metal and ceramic surfaces. Hybrid products like the oxynium combine the hardness of metal without the problem of metal ion release and smoothness of ceramic without the brittleness of ceramic. Hydroxyapatite coating is often used to induce bone ingrowth on the prosthetic surface. The extent of coating is varied to restrict stress shielding of bone and circumferential to prevent ingress of wear debris to reduce osteolysis.

Further, providing details on the implants used in spinal surgeries, Dr Mehta says, “Implants helps in stabilisation and fusion of the spine. However, we still do not have an effective joint replacement technology for the spine, as we do for the hip and knee joints. Implants have helped in relieving chronic pain to a certain degree but a lot of improvement in technology is still desired.” He further continues, “The commonly used implants for the spine are titanium implants. In addition, Polymethyl Methacrylate (PMMA) cement is used in certain conditions. Bone autografts and allografts are also commonly used. The current implants

effectively stabilise the spine. However, these are not yet effective in reproducing the complex spinal biomechanics when required.”

Pros and consEvery scientific discovery has advantages and disadvantages. Likewise, the use of implants is associated with infections, rejections and replacements. However, Dr Mehta clarifies, “The chances of infection increase by 2-3 per cent with the use of implants. In order to minimise this risk, such surgeries should be performed in good setups where the sterility chain is well maintained and laminar airflow systems are in place in the operation theatre. Also, patient morbidity factors, like diabetes, should be controlled.”

Dr Mehta informs that implants used nowadays are completely biocompatible and do not induce immune responses. However, allergies to implants are documented, although these are extremely rare. Implants in the spine can be placed via minimally invasive techniques. But, this technology is still in its infancy and current results are only similar to existing open techniques.

Further, Dr Archik adds, “Implants for joints wear out eventually, and therefore researches are going on to increase the longevity of these

materials. Steel implants cause problems in MRI, so we now use titanium implants. In certain cases, we use biodegradable implants, which dissolve in the body after their use is over. Implants in younger age groups need to be taken out after the fracture surgery. Only joint replacement implants require replacement if they loosen or wear out after some time.”

Demand for innovationsWhile discussing on the latest and the possible future developments that will further simplify the treatment procedures using implants, Dr Malhan says, “The future of joint replacements lies in making them more long lasting. Knee replacement surgery has also advanced signifi cantly with the use of high-bending implants, gender-specifi c implants, like special implants for women, and computer-assisted surgery. Just as implants have become durable and long lasting, so have patient expectations increased. Today’s patient looks for durable joint reconstructive surgery that gives quick return to full function.”

Meanwhile, Dr Mehta points out, “A lot of technological development is needed to develop effective implants to reproduce the spinal biomechanics. Researches in this fi eld have helped develop disc replacement and dynamic stabilisation systems. However, these

Implants used in trauma, ie, fracture treatments vary from stainless steel alloys to titanium and now biodegradable implants.

- Dr Shreedhar ArchikConsultant Orthopaedic Surgeon, Lilavati Hospital and Research Centre, Mumbai

Knee replacement surgery has also advanced signifi cantly with the use of high-bending implants, gender-specifi c implantsand computer-assisted surgery.

- Dr Kaushal MalhanKnee and Hip Surgeon, Fortis Hospital (Mulund), Mumbai

Specialty Scope

46 I January 2011

have not helped overcome age-related spinal degenerative pathologies. Stem cells may help reduce the effect of these problems in the future. The current stem cell technology is nowhere near to helping patients with spinal degenerative pathologies.”

Future with stem cellsRecent research demonstrates that articular cartilage may be repaired via percutaneous introduction of

Mesenchymal Stem Cells (MSCs). Discussing the role of stem cells and regenerative medicine in the repair of articular cartilage in injury & degenerative diseases, Prosanto Chowdhury, Medical Officer, Cordlife Sciences India Pvt Ltd, Kolkata, says, “MSCs derived from the bone matrix, bone marrow, umbilical cord blood and tissue had been utilised as the source in an attempt to regenerate cartilage and osseous tissue for

healing & repair of the damaged or degenerated tissue.”

Explaining further, he mentions, “MSCs are pluripotent cells found in multiple human adult tissues including bone marrow, synovial and adipose tissues. Since they are derived from the mesoderm, they have been shown to differentiate into bone, cartilage, muscle and adipose tissue. Because of their multi-potent capabilities, MSC lineages have been used successfully in animal models to regenerate articular cartilage and, in human models, to regenerate bone.”

Chowdhury further highlights, “Marrow nucleated cells are used regularly in regenerative orthopaedics. This cell population has also been shown to assist in the repair of non-united fractures.”

Although the use of stem cell therapies is still in the experimental phases, yet it has proved to have the potential to revolutionise the available treatment modalities. With such stem cell researches on the go, the future of orthopaedics treatment appears bright. It is now possible to imagine a day when implants and prosthesis will be words only to be found in old documented records.

([email protected])

Implants made of better and stronger materials, which are also more biocompatible and have a modulus of elasticity similar to that of bone, so that they do not shield the bone from stresses, should be developedImplants with smoother and harder bearing surfaces that do not wear out with time and do not generate any particulate harmful debris should be madeSmaller bone conserving implants that allow easy revision, if neededImplants that can be folded to make them smaller and allow them to be put through small surgical exposuresFoldable interpositional-type prosthesis with materials that allow safe function for many years. These can be simply folded and slipped in between the damaged surfaces to stop pain of friction between damaged surfacesProsthesis with size customised as per patient requirements

Prosthesis made of a surface of cartilage that is grown from the patient’s own cartilage and then embedded on a carrier that can be implanted Specialised instrumentation that allows access & exposure of joints through extremely small incisions, and also special implants that can be implanted through the sameRobotic surgery in which all critical steps of the procedure can be done more predictably and accurately using machines Computer navigation will recognise the shape, size and alignment base on imaging. There will be no need for a surgeon to give information to the computer. There will be no need for trackers. The computer will be linked to a machine to produce the necessary bone cutsExcellent techniques of biologic fi xation of implants, which would give predictable, quick & safe fi xation for years that can be reversed at any time to remove the implants easily and insert a new assembly, if needed

Implants and methods that can serve better

A lot of technological development is needed to develop effective implants to reproduce the spinal biomechanics.

- Dr Satyen MehtaConsultant Spinal Surgeon, S L Raheja Hospital (a Fortis associate), Mumbai

Marrow nucleated cells are used regularly in regenerative orthopaedics. This cell population has also been shown to assist in the repair of non-united fractures.

- Prosanto ChowdhuryMedical Offi cer, Cordlife Sciences India Pvt Ltd, Kolkata

Source: Dr Kaushal Malhan

Policy Matters

48 I January 2011

Hospitals today are extremely busy places and full of complex procedures, where every small action matters.

In such a situation, no matter how much care is taken, human errors are bound to occur; in fact, some of these can actually be fatal. Thus, time has now arrived in medical practice that healthcare providers address issues regarding the safety of their patients.

Patient safety is a serious global public health issue. Estimates show that in developed countries, as many as one in 10 patients is harmed while receiving hospital care. In an interesting study, engineers observed patient care in Intensive Care Units (ICUs) for 24 hour stretches. They found that the average patient required 178 individual actions per day, ranging from administering drug to suctioning the lungs, and every one of these actions posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions. But this fi gure still amounted to an average of two errors in a day with every patient. Intensive care succeeds only when the odds of doing

harm is held low enough to allow the odds of doing good to prevail.

Testing the clinician For testing the safety measures taken in hospitals, Dr Peter J Pronovost, Critical Care Specialist at Hopkins Hospital, gave doctors a checklist to follow. This checklist included certain steps to avoid infections:

Wash hands with soapClean patient’s skin with chlorhexidine antisepticCover patient completely with sterile drapesWear a mask, cap, sterile gown and glovesPut a sterile dressing over the insertion site once the line is in

Moreover, the nurses at the hospital were asked to observe the doctors for one month.

Surprisingly, in more than a third of patients, they had skipped at least one step. Nevertheless, at the end, it was found that the infection rate had declined from 11 per cent to 0 per cent.

Risks in healthcareIn developing countries, the probability of patients being harmed in hospitals is higher than that in industrialised nations. The risk of healthcare-associated infection in some developing countries is as much as 20 times higher than that in developed countries. At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals. Hand hygiene is the most essential measure for reducing healthcare-associated infection and the development of antimicrobial resistance.

According to estimates, one in every 10 patients is harmed while receiving patient care. And this rise is 20 times higher in developing countries, as over developed ones. A glimpse of the solutions that can help improve these numbers and help avoid human inadequacies.

Patient safety

Need for urgent action

Dr Sanjay GuptePresident, Federation of Obstetric & Gynaecological Societies of India (FOGSI) MD, DGO, FICOG, LLB, FRCOG

Policy Matters

49January 2011 I

In recent years, countries have increasingly recognised the importance of improving patient safety. In 2002, World Health Organization (WHO) Member States agreed on a World Health Assembly resolution on patient safety. At least 50 per cent of medical equipment in developing countries is unusable or only partly usable. Often, the equipment is not used due to lack of skills or commodities. As a result, diagnostic procedures or treatments cannot be performed. This leads to substandard or hazardous diagnosis or treatment that can pose a threat to the safety of patients and may result in serious injury or even death.

In some countries, the proportion of injections given with syringes or needles reused without sterilisation is as high as 70 per cent. This exposes millions of people to infections. Each year, unsafe injections cause 1.3 million deaths, primarily due to transmission of blood-borne pathogens such as Hepatitis B Virus, Hepatitis C Virus and Human Immunodefi ciency Virus (HIV).

Medical knowledge is expanding at such a pace that no individual, no matter how

expert or intelligent, can hope to master it all. To handle the complexities, the tasks are split up among specialties. Hence,

medicine is now divided into not only different specialties but super specialties and super-super-specialties. If one takes an excellent engine of BMW with state-of-the-art transmission of a Mercedes, a beautiful body of Ferrari and wonderful wheels of Audi, can one get the best car in the world? NO. Actually, it will be a very expensive junk. So, the idea is not just achieving excellence, but putting actions together in a cohesive manner.

Follow all healthcare steps The fi rst diffi culty that doctors face in complex situations is the distraction of human mind and memory when it comes to certain routine steps. These steps are sometimes overlooked under the pressure of more pressing events. For example, when a patient is in severe pain and relatives are agitated, it is easy to miss out on checking pulse or blood pressure or foetal heart. If a key element is missed, then all the efforts fall fl at. The second problem stems from presumption. People often tend to presume that nothing can go wrong if some small steps are omitted or skipped in a procedure. Once in a while, missing such a step itself can be disastrous. For example, auscultation of the chest after putting intratracheal tube is to be done routinely. If the anaesthetist assumes that he has easily intubated the patient and skips the auscultation step, the tube could end up being wrongly placed, with disastrous results.

The economic benefi ts of improving patient safety are compelling. Studies

There is a one in 10,00,000 chance of a traveller being harmed while in an aircraft. In comparison, there is a one in 300 probability of a patient being harmed during healthcare delivery.

Policy Matters

50 I January 2011

show that additional hospitalisation, litigation costs, infections acquired in hospitals, lost income, disability and medical expenses have cost some countries about $ 6-$ 29 billion a year. Industries with a perceived higher risk such as aviation and nuclear plants have a comparatively better safety record than healthcare. There is a one in 10,00,000 chance of a traveller being harmed while in an aircraft. In comparison, there is a one in 300 probability of a patient being harmed during healthcare delivery.

Thus, people involved in the medical profession need a different strategy to overcome failure. One that not only builds on experience and takes advantage of people’s knowledge, but somehow also makes up for the inevitable human inadequacies. Such a strategy does exist – though it will seem almost ridiculous in its simplicity – maybe even crazy to practitioners who have spent years carefully developing even more advanced skills and technologies.

The stage for actionConventionally, surgery has been regarded as an individual performance and the surgeons as virtuoso, like a concert pianist. The reason why the world over uses the phrase operating theatre is that the operating room is the surgeon’s stage. The surgeon strides under the lights and expects to start with everyone in their proper places, the patient laid out asleep and ready to go.

In one survey of 300 staff members as they exited the operating room following a case, one out of 8 reported that they were not even sure about where the incision would be until the operation started. In many large hospitals, the operating team members are reshuffl ed according to duty schedules, days and hours. Hence, a surgeon may not even know the anaesthetist personally or the nurse even by name. Such a situation obviously is not conducive to the management as a team.

Thus, as the fi rst step of check listing, it is good to introduce each other in the team so that everyone is aware of each other’s role precisely and expectations of the work processes are clarifi ed.

Surgery: Tackling complexitiesSurgery is one of the most complex health interventions to deliver. More than 100 million people require surgical treatment every year for different medical reasons. Problems associated with surgical safety in developed countries account for half of the avoidable adverse events that result in death or disability. The four killers of surgery include infection, bleeding, unsafe anaesthesia and, last but not the least, any unexpected occurrence.

For the fi rst three problems, science and experience have given some straightforward and valuable preventive measures that practitioners think they consistently follow but actually, they do not. That is why a checklist is so important.

Checklists are also used for risk assessment. It would be truly great to have a computer beeping a red light every time a doctor looks at the patient’s history sheet, to tell about the risks he/she has. A simple manual method would be RISK tagging. It is always important to anticipate and then actually act. It is rightfully said that the surgery is planned in the mind and executed on the table. This also includes risk assessment and anticipation of probable risks. Thus, it should also result in planning and preparing for the anticipated risk.

Consistency in practice and evolution of standard operating practices is another important strategy. The fi rst step is to formulate the Good Clinical Practice recommendations. These help in scientifi cally guiding the clinician, and thus minimising clinical mishaps pertaining to wrong diagnosis and treatment.

There are several situations when the clinician is caught unawares. A patient suddenly collapsing, anaphylactic reaction to a drug, post-partum haemorrhage in a labouring patient, etc, can test not only the capacity of the health facility but also the capability of the doctor and the healthcare personnel. Lack of amenities and lack of skills can result in serious morbidity & mortality, which could have been averted with checklisting, standardisation & anticipation. For this, it is also essential to brush one’s skills at a regular basis. One needs to always keep his axe sharpened and this can be done by regular practices of emergency drills. Every facility should have the practice of taking its staff through regular emergency drills so that these crisis situations are well handled.

Do not cause harmMedical practice today has reached a stage where the doctor truly needs to remember that – ‘above all do not cause any harm’. Patient safety has to be paramount and the doctor should strive to achieve this through practice recommendations, standardisation, checklisting and emergency drills.

([email protected])

Reminds the doctors of the minimum necessary steps and makes themvery clear

Reduces dependence on individual memory and possibility of the overlook phenomenon.

Empowers assistants and junior staff to participate and get involved in the actual work process. Often, a junior doctor or a peripheral nurse may notice that something is not the way it should be, but they hesitate to point out or feel that it is not their job or competence to correct the situation. Involving them in the checklisting process makes them feel more responsible and helps avoid many vital errors

Creates smooth communication, adding to the overall teamwork and effi ciency of the operating team

Advantages of using a checklist

Imaging Diagnostics

52 I January 2011

Advances in medical technology have contributed to increased life expectancy. These advances have also

helped in overcoming the challenges to cater to the needs of ageing population, thereby making minimally invasive procedures even more significant. Further, new advances have emerged in the field of minimally invasive procedures to treat very sick patients who are not fit to undergo surgery because of the high risk factors. With

these new therapeutic procedures, more number of patients can now be treated with greater care than before.

One such technology recently introduced in India and which is a highly future-oriented approach is Hybrid Operating Room (Hybrid OR). Siemens Healthcare is the first in India to introduce the world’s first hybrid OR system with a robotic arm, called Artis Zeego. There also exists other high-end angiography floor mounted systems that can be installed in the hybrid OR environments.

Possibilities with Hybrid ORA hybrid OR is an operating theatre with an integrated angiography device allowing for interventions. It offers several new possibilities for physicians,

as it primarily allows merging of diagnostic and therapeutic procedures on one operating table.

The applications of hybrid OR are prominent in the cardiovascular and vascular areas:

CardiovascularValve replacement and repair: eg, transapical and transcatheter aortic valve replacement/repair, pulmonary valve replacementMinimally invasive cardiac surgical procedures: eg, Concurrent Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) and percutaneous coronary intervention (stenting)Paediatric cardiac surgeries: eg, hypoplastic left heart syndrome correction, closure of Atrial Septal Defect (ASD), closure of muscular Ventricular Septal Defect (VSD)Routine intraoperative evaluation of bypass grafts

VascularThoracic and abdominal aneurysm stent grafts Diagnostic and therapeutic percutaneous vascular procedures

A noteworthy example in the Western world has been of heart transplant in a hybrid OR. A donated heart with a high-grade stenosis was transplanted. The stenosis was dilated with a heart catheter immediately after the transplant. Both procedures were performed as one and at the same operating table. Not very long ago, this type of heart (ie, with stenosis) would

Minimally invasive procedures have now advanced to the extent that patients who are unfi t for surgery due to high risk factors can also be treated. But these require high-end imaging for accurate diagnosis. Thus, a futuristic approach has been developed, which allows both diagnostic and therapeutic procedures on one operating table.

Hybrid OR

Merging diagnostics with therapeutics

Harish GulharHead-Marketing, Angiography Systems, Siemens Healthcare

Imaging Diagnostics

53January 2011 I

have been considered unsuitable for a transplant. However, the hybrid OR now makes it possible to transplant this type of heart because the narrowed vessels can be opened immediately after surgery. This method allows the physician to have complete access to different organs and, as a logical outcome, reduces casualties waiting to occur.

Hybrid suiteDue to its complexity, a hybrid suite requires meticulous planning and design. A cardiac surgeon needs a stable, stationary table that should not be too wide and can be tilted in all directions. In addition, the surgeon needs to be able to move freely around the operating table even while handling surgical instruments. Another essential feature is the ventilation field installed above the operating table to ensure a sterile environment. The cardiologist’s needs are varied. He requires a floating tabletop that can be moved back and forth with a joystick. He also needs a lead plate to protect himself against X-radiation. The anaesthetist’s team also has its requirements. During surgery, at least 8-10 people are present in the room and, at times, this number may swell to even more. All these requirements need to be considered before setting up a hybrid OR.

The hybrid OR allows surgical procedures like interventions and skin incisions, in addition to the surgical equipment. Hence, the setup requires high-end imaging equipment, such as an advanced angiography system used in interventional radiology and cardiology for excellent imaging guidance during complex hybrid procedures. The operating table is the most crucial part of this suite. Although experts recommend floor-mounted systems for hygiene reasons, some hospitals do not allow operating parts directly above the surgical field, because dust contamination may cause infection. As the operating table should meet the expectations of

both surgeons and interventionalists, tables with a floating table top and capable of vertical & lateral tilt are recommended.

Benefits of hybrid ORThe advantages of hybrid procedures are many: It is now possible to take care of patients with reduced cardiac functions who otherwise were unable to undergo two interventions. The number of such patients is increasing steadily, and there is a need to offer them an alternative treatment. Hybrid OR procedures thus allow improved patient outcomes, with the ability to combine the best therapeutic options from surgery and interventions.

Complex cases can be more easily managed due to multi-disciplinary approach.

The cardiology team does not lose time in patient repositioning or transporting the patient to an OR. The team can proceed immediately in accordance with its diagnostic findings. This is advantageous to everyone involved. The patient receives help quickly and the workflow improves. Hybrid OR thus enables pre-operative and post-operative imaging in the OR for more efficient patient management.

As the procedures are completed in less time and in a minimally invasive way, patients experience shorter hospital stay as a result of faster recovery.

Currently, in India, high-end angiography systems are available, the benefits of which are manifold.

The exceptional flexibility and unique imaging applications of these systems serve well as ideal systems for hybrid OR environments. Some of the key features and benefits of this system are as follows: Eight rotational axes for previously unknown degrees of freedom and flexibility

Compact C-arm, greater access for surgeons, anaesthetists and the OR team

Full body coverage from head to toe and left to right without repositioning the table or patient

Advanced three-dimensional (3D) imaging to image complete thoracic aorta

Variable isocenter and working height

Multiple park positions away from OR table

No ceiling-mounted components in the OR field, and no interference with surgical team or with monitors.

Future of hybrid OR The market for high-end imaging during surgery is growing fast and surgeons are actively interested in bringing minimally invasive procedures with interventional cardiology to their ORs. This rapid development in interventional cardiology has also led to a surge in innovations in heart surgery. Thus, increasing number of healthcare facilities across the globe are now installing hybrid ORs.

Equipped with highly advanced technologies for surgery, data management and imaging, these modern ORs create unprecedented opportunities for improved surgical treatment and workfl ow optimisation. In the future, classic operations with their known excellent long-term results may become less invasive and will possibly be performed in combination with interventional methods. All these factors clearly prove that hybrid OR has huge potential in the near future.

Courtesy: Siemens Healthcare, Siemens Ltd

([email protected])

In the future, classic operations with their known excellent long-term results may become less invasive and will possibly be performed in combination with interventional methods.

Facility Visit

54 I January 2011

Poly Medicure Ltd was founded by a group of engineers and technocrats dedicated to the idea of providing affordable

modern healthcare to mankind. This unique philosophy has been the driving force behind the company since its inception in 1995. Today, it has grown to become one of the most dynamically versatile manufacturers of disposable healthcare products in the region. The company had set up the plant in 1997 for manufacturing a variety of medical devices. It had also set up a greenfi eld plant in Haridwar in 2007 for expanding its manufacturing activities.

Internationally, the company had set up a 100 per cent subsidiary in China in 2008 to manufacture medical devices and a Joint Venture (JV) company in Egypt in 2003. This helped it gain entry into the Middle East & African markets.

Poly Medicure Ltd currently exports 75 per cent of its products to more than 70 countries in Europe, North & South America, Middle East, South East Asia and Africa. All products manufactured by the company are ISO & CE certifi ed. It is a public limited company listed at the Mumbai and Kolkata Stock Exchanges. One of the fastest growing companies in the ` 7,500 crore medical disposables

sector, Poly Medicure Ltd is growing at a healthy rate of 25 per cent against the industry growth of 10-15 per cent. Himanshu Baid, Managing Director, Poly Medicure Ltd, says, “The journey has been great, full of excitement, with each day bringing in a new experience and a new learning. The thrill of creating new and innovative products keeps us high on adrenaline. We strongly believe in creating new categories in the sector, not following product idea of others.”

Manufacturing facilityPoly Medicure Ltd manufactures its products by using state-of-the-art technology in ultra modern facilities spread over more than 300,000 sq ft of manufacturing fl oor space, with about 50,000 sq ft of clean rooms of class 100,000 to class 1,000. A tool room with modern facilities and Computer Numerical Control (CNC) machines supports the manufacturing processes. It also has a high degree of automation and an effective process control that helps in delivering consistent product quality. The core strength of Poly Medicure Ltd lies in its fully committed, well-trained and technically competent personnel. A highly qualifi ed, experienced and motivated management provides guidance and support to the team of over 2,000 employed for different activities. To keep pace with the ever-changing requirements of the market, the company has a fully staffed and highly equipped R&D section to design and develop new and innovative products. Using the latest CAD/CAM technology, new product development

Poly Medicure Ltd was established with a pursuit to excel in its commitment to matters closest to the heart – care, concern and love for humanity. Over the years, it has become one of the companies producing best-in-class medical equipment, with a thrust on providing affordable healthcare.

Poly Medicure Ltd

Making versatility a norm

Geetha Jayaraman

Facility Visit

55January 2011 I

becomes faster, and improvements, based on market response & customer feedback, are made with ease. Assuring world-class products at affordable prices is the hallmark of Poly Medicure Ltd.

The research mantraInnovation helps Poly Medicure Ltd to stay a step ahead of its competitors and demand a higher price for innovative products. It is now one of the most dynamically versatile manufacturers of disposable healthcare products in the region, with over 60 different products under different categories at its manufacturing facilities in India, Egypt, US and China. Its product portfolio includes IV cannula, blood collection systems, infusion therapy devices, central venous access catheters, anaesthesia, blood management devices and other surgical products, with exports to over 50 countries. Poly Medicure Ltd, today, has a workforce of over 1,500 spread across the world as well as fully equipped R&D section for design and development of new & innovative products.

The company established its own R&D division in 2004, which, in 2007, was recognised as an in-house R&D unit by Ministry of Science & Technology, Government of India. Outstanding in-house R&D facility enables the company to develop new products from design to production in a very short span of time. The company has fi led 30 patents in the last three years. Baid remarks, “With our R&D

facilities, manufacturing standards, our plants and quality international certifi cations, we at Poly Medicure Ltd strongly believe that we can deliver to the customer the best of products. We aim to become the research-based, most reputed and trusted company in the medical healthcare disposable products industry. In future, for manufacturing products, more knowledge & less materials will be required, and innovation is the key for this.”

Quality is paramountThe Quality System at Poly Medicure Ltd encompasses a comprehensive and exhaustive series of physical, chemical, biological & microbiological tests & inspection at different stages of the manufacturing cycle. The tests include constant surveillance of raw materials and its suppliers, intensive in-process control of all manufactured components & sub-assemblies as well as the fi nal inspection & testing of the fi nished products. The company has successfully implemented a well-documented Quality Management System (QMS), accredited by SGS

Yarsley International Certifi cation Services, United Kingdom, with ISO 9001:2000, ISO-13485: 2003 and CE mark from DNV, Norway, making the entire product range compliant with international quality standards.

The next move...Indian healthcare sector is growing at the rate of 15-20 per cent. Due to the rising income levels, awareness about healthcare is also increasing, which has led to an increased demand for medical devices. The Indian pharma market is expected to grow at a Compounded Annual Growth Rate (CAGR) of 12.3 per cent through to 2014. “Poly Medicure Ltd plans to invest ` 100 crore in manufacturing activities in the next three years. It also plans to increase manufacturing of medical devices across all plants. The second strategy would be to expand our product range. Currently, we have over 70 products in our portfolio. In the next 2-3 years, we plan to add 20-30 new products to the existing portfolio,” signs off Baid.

([email protected])

Currently, we have over 70 products in our portfolio. In the next 2-3 years, we plan to add 20-30 new products to the existing portfolio.

- Himanshu Baid Managing Director, Poly Medicure Ltd

A glimpse of high-end machines at Poly Medicure

Meditech

56 I January 2011

Bone grafting is used to repair bone fractures that are extremely complex in nature and pose signifi cant health risk

to the patient or fail to heal properly. But, this surgical procedure experienced major disadvantages like donor site morbidity and longer rehabilitation time, which impacted the lives of several people.

However, the 20th century witnessed the dawn of a regenerative procedure of autologous bone implantation, named Ossron™. This procedure involves harvesting patients’ own osteoblasts, culturing them in a laboratory and then re-implanting into the affected bones of the patient for new bone formation.

The procedure Ossron™ is the therapy for the treatment of bone defects, developed in India by RMS Regrow® in technical collaboration

with Sewon Cellontech of South Korea. RMS Regrow® has launched India’s fi rst cell therapy laboratory at Lonavala, Maharashtra. This laboratory will be used for culturing chondrocytes and osteoblasts for autologous use.

The procedure involves harvesting a patient’s bone marrow from the posterior iliac crest or iliac spine. Dr Dilip Tanna, MS Orthopaedics, Mumbai University; International Affi liate Member, American Academy of Orthopaedic Surgeons; and Consultant, Jaslok Hospital & Breach Candy Hospital, Mumbai, explains, “About 5 ml of the bone marrow sample is collected from the patient’s bone and transferred to the transport kit containing the media. The biopsy kit is then transported through a specialised logistics maintained at 2-8°C to the laboratory for culturing. Through the cell cultivation and expansion

technology, about 48 million osteoblasts are cultured over a period of 4-5 weeks. After culturing in the laboratory, the cells are sent back to the hospital under similar temperature conditions.”

He further elaborates, “The second step involves implantation of the autologous cultured osteoblasts onto the affected or fractured bone. The procedure is carried out by using a cell-gel mixture with fast gelling properties (5-7 minutes). This mixture can be directly injected at the affected site of the bone with the assistance of C-arm imaging. Ossron™ implantation can be combined with bone graft and other bone scaffold substituted for large defects of size more than 20 cm3.”

The upsideOssron™ is a highly evaluated safe & effi cient regenerative procedure, which not only helps the patient to recover soon but also ensures effective and permanent bone formation. It is a minimally invasive surgery, that causes minimal damage to the surrounding healthy tissue. Moreover, it bears no risk of treatment failure, ensures better quality of life and speeds up post-operative recovery.

More than 60 patients have been treated with Ossron™ in India so far and the therapy has witnessed positive outcomes. Currently, in India, about 11 hospitals conduct this therapy. Some of these hospitals are Bay View Clinic, Mumbai; Hinduja Hospital, Mumbai; Hiranandani Hospital, Mumbai; Fortis Hospital, Bengaluru; Base Hospital (Military Hospital), New Delhi; Lakeshore Hospital, Cochin; and Ortho One Hospital, Coimbatore.

World’s fi rst autologous bone implant therapy – Ossron™ – uses the patient’s cultured osteoblasts for new bone formation. This novel technique facilitates natural regeneration of cells in the affected part of the bone, and enables them to recover faster. An insight into the technique.

Ossron™

A milestone in regenerative medicine

Meghna Mukherjee

Stage 1:Bone marrow biopsy is aken from the patient

Stage 2:Bone marrow biopsy is sent to specialised laboratory and cultured for 4–5 weeks

tage 3:Implantation of culturedosteoblasts to the patient A regenerated bone

Court

esy:

RM

S R

egro

w®

Meditech

57January 2011 I

Dr Tanna asserts, “The procedure has a 97 per cent success rate, as it is an autologous transplantation of the patient’s own cells, and thus there is no probability of rejection of the implanted cells by the body. In contrast to the conventional bone graft technique, which takes longer time for re-absorption of the transplanted bone, with Ossron™, the osteoblasts are implanted to relieve the patient’s symptoms and provide considerable restoration of full range of joint motion.”

Cost-effectivenessOssron™ is an autologous cell therapy, available for bone regeneration. The time taken for complete bone formation is faster than the normal healing time, which is usually observed in case of a surgical procedure like bone grafting. The cost of the total regenerative procedure is approximately ` 2 lakh. This is comparatively inexpensive than other procedures like hip replacement surgery, which costs about ` 4-6 lakh. Also, replacement surgeries account for 20 per cent of revision surgeries, adding up to the patient cost, surgical and emotional trauma.

Future prospects Regenerative medicine has recently emerged as a new specialty in the scientifi c community. The development of regenerative medicine is closely linked to the new insights like stem cell and the therapeutic potential provided by cell-based therapy. Dr Tanna avers, “Regenerative medicine has tremendous scope. It has vast future prospects in reconstruction of bone and cases of bone non-union. We have made a woman walk and come back to her active normal life after four long years of her suffering from a non- union fracture. More and more applications of regenerative procedures are in the pipeline.”

Further, regenerative medicine has witnessed great potential in India. Similar to Ossron™, a new tissue engineering product, TheraformTM, has also been launched for the fi rst time in India. TheraformTM is a US Food & Drug Administration (USFDA) approved absorbable collagen biomatrix for soft tissue augmentation and advanced wound healing, especially for skin burns, such as second - & third-degree burns, partial- & full-thickness wounds, diabetic ulcer treatment and surgeries, all of which involve skin reconstruction.

(meghna.mukherjee @infomedia18.in)

We have made a woman walk and come back to her active normal life after four long years of her suffering from a non-union fracture. More and more applications of regenerative procedures are in the pipeline. - Dr Dilip TannaInternational Affi liate Member, American Academy of Orthopaedic Surgeons and Consultant, Jaslok Hospital & Breach Candy Hospital, Mumbai

Events Calendar

58 I January 2011

HIMT 2011Healthcare Infrastructure & Medical Technology (HIMT 2011) aims to deliberate upon recent advances & future trends in healthcare infrastructure and their impact on healthcare delivery. It will also dwell on the recent technological advances on patient care provisioning, and emphasise on the importance of stakeholders’ synergy and networking in providing optimal healthcare services.

Date: February 2-5, 2011Venue: Jawaharlal Nehru Auditorium, All India Institute of Medical Sciences (AIIMS), New DelhiOrganiser: Department of Hospital Administration, AIIMSTel: + 91 9313533875, + 91 9810233617Email: [email protected]: www.spirantcommunication.com

Medicall 2011 The 5th Medicall will be held in Kolkata. The event aims to attract the healthcare industry with more than 200 exhibitors will be displaying their different products & services in the fi eld of hospital information system and solutions, surgical and examination furniture, rescue & emergency equipment, medical disposables, cleaning equipment, rescue equipments, etc. The show will be a highly successful point in attracting affl uent producers, dealers and suppliers.

Date: February 11-13, 2011Venue: Netaji Indoor Stadium, KolkataOrganiser: MedexpertTel: + 91 9840326020

Email: [email protected] Website: www.medicall.in

Medical Fair India 2011An international exhibition and conference featuring diagnostic, medical equipment, devices and medical technology. Doctors, hospital administrators, hospital managers, directors, technicians and other healthcare professionals are expected to visit this exhibition.

Date: March 25-27, 2011Venue: Bombay Exhibition Centre, NSE Exhibition Complex, MumbaiOrganiser: Messe Düsseldorf GmbHTel: + 49 211 4560 900

Fax: + 49 211 4560 668Email: [email protected]: www.medicalfair-india.com

Meditec Clinika 2011Meditec Clinika is the 3rd

international trade fair for medical equipment and technology showcasing innovative medical products & systems in India. Meditec Clinika aims to take a fi rm step forward in revolutionising and effectively contributing to the effi cacy & quality of healthcare.

Date: July 2-4, 2011Venue: Palace Grounds, BengaluruOrganiser: Orbitz Exhibitions Pvt Ltd Tel: + 91 - 22 - 2410 2801/02/03/04Fax: + 91 - 22 - 2410 2805Email: [email protected]: www.meditec-clinika.com

Healthex 2011 Healthex 2011 is an international exhibition on hospital, medical and surgical equipment, materials, supplies and allied services, which aim to showcase the latest innovations in the fi eld of medical technology to the medical experts from all over the country and abroad.

Date: August 5-7, 2011Venue: Bangalore International Exhibition Centre, BengaluruOrganiser: Bangalore International Exhibition Services Pvt LtdTel: + 91 - 80 - 65833234Email: [email protected]: www.healthex.co.in

NATIONAL

India’s premier industrial trade fair on products and technologies related to Machine Tools, Hydraulics & Pneumactics, Process Machinery & Equipment, Automation Instrumentation, Packaging & Auxiliaries, IT

Products, Electrical & Electronics, Material Handling and Safety Equipment.

Concurrent Shows MUMBAIMaharashtra

February 17-19, 2011Bombay Exhibition Centre

One of the largest advanced design and manufacturing events in India featuring Machine Tools, Material Handling and Safety Equipment, Automation & Instrumentation, Hydraulics & Pneumactics,

Process Machinery & Equipment, Packaging & Auxiliaries, IT Products, Electrical & Electronics.

For details

Infomedia 18 Ltd,Ruby House, 1st Floor, J K Sawant Marg, Dadar (W), Mumbai 400 028.

• Tel: 022 3003 4651 • Fax: 022 3003 4499 • Email: [email protected]

For details

HiTech Manufacturing,Ruby House, 1st Floor, J K Sawant Marg, Dadar (W), Mumbai 400 028.

• Tel: 022 3003 4650 • Fax: 022 3003 4499 • Email: [email protected]

CHENNAITamil Nadu

Mar 11-13, 2011Chennai Trade

Centre

PUNEMaharastra

Oct 14-17, 2011Auto Cluster

Exhibition Centre

AHMEDABADGujaratNov 2011

Gujarat University Exhibition Hall

Events Calendar

60 I January 2011

INTERNATIONAL

Medical Device & Technology Test Expo 2011Medical Device & Technology Test Expo will showcase a full range of test and evaluation equipment, together with solutions and service providers. The innovation and products list includes an array of hospital equipment, medical consumer goods, diagnostics, medical technology and surgical & laboratory equipment.

Date: February 8-10, 2011Venue: Koelnmesse, Cologne, Germany Organiser: Total World Media Ltd Tel: +44 1306 803 030Fax: +44 1306 803 034 Email: [email protected]: www.medicaldevicetestexpo.com

Medtec 2011A trade fair on medical equipment design and technology. Designers, engineers and decision makers from this fi eld are expected to visit this exhibition. A concurrent conference would highlight and discuss various trends, quality and regulatory issues surrounding medical devices & equipment. A place to make new contacts and broaden one’s clientele base.

Date: March 22-24, 2011Venue: Stuttgart Trade Fair and Convention Center, Germany Organiser: Canon Communications LLC, Los Angeles, USATel: +1 310 445 4200Fax: +1 310 445 4299Email: [email protected]: www.canontradeshows.com

MED-E-TEL 2011An international educational and networking forum for ehealth, telemedicine and health ICT. The conference will feature over 150 presentations and workshops that will highlight the current applications and future trends in this fi eld and their impact on the

healthcare system. It will also provide a great platform for networking and establishing local as well as global contacts.

Date: April 06-08, 2011Venue: LUXEXPO Exhibition & Congress Center, Luxembourg, BelgiumOrganiser: International Society for Telemedicine & eHealth (ISfTeH)Tel: +32 2 269 84 56Fax: +32 2 269 79 53 Email: [email protected] [email protected]: www.medetel.lu

MEDTEC UK 2011A medical device & technology exhibition & conference showcasing technologies for design and manufacture of medical devices. Conferences will also be organised concurrent with the exhibition. It promises a good base for building new contacts and broadening one’s clientele.

Date: April 06-07, 2011Venue: National Exhibition Centre, Birmingham, UKOrganiser: Canon Communications LLC, USATel: +1 310 445 4200Fax: +1 310 445 4299Email: [email protected]: www.canontradeshows.com

World Vaccine Congress Washington 2011An international exhibition of the vaccine products industry to showcase modern vaccine technologies. The exhibitor profi le would include analytical instruments, labware, excipients, equipment, etc. Professionals from the pharma and biotech industry, sales and marketing personnel, technology delivery manufacturers and members of the higher management are expected to attend this event.

Date: April 11-14, 2011

Venue: Gaylord National Hotel and Convention Center, Washington DC, USAOrganiser: Terrapinn Pte LtdTel: +61 2 9005 0700Fax: +61 2 9281 3950Email: [email protected]: terrapinn.com

14th ASEAN Paediatric Congress The 14th ASEAN Paediatric Congress and the 3rd ASIAN Paediatric Otolaryngology meeting will concentrate on topics like trends, issues, priorities in paediatrics, and also translate & transmit new knowledge & information to doctors and allied health professionals. There will be sessions that will foster interactions between different organ-based disciples.

Date: April 14-17, 2011Venue: Suntec, SingaporeOrganiser: The Meeting Lab, Congress SecretariatTel: + 65 6346 4402Fax: + 65 6346 4403Email: [email protected]: www.apc2011.com.sg

REHAMEDEXPO 2011An international specialised exhibition showcasing modern rehabilitation technologies for remedial treatment. An array of diagnostic equipment, medical technology, IT equipment, etc, will be displayed at the exhibition. Professionals and consultants from the healthcare, health insurance, medical sciences, medical software systems, etc, are expected to attend this event.

Date: April 25-28, 2011Venue: EcoCenter Sokolniki, RussiaOrganiser: MVK - International Exhibition Company Tel: +7 495 995 05 95Email: [email protected]: www.mvk.ru/eng

The information published in this section is as per the details furnished by the respective organiser. In any case, it does not represent the views of

Report

62 I January 2011

According to a KPMG- Federation of Indian Chambers of Commerce and Industry (FICCI)

report, healthcare has emerged as one of the most progressive and largest service sectors in India, with an expected Gross Domestic Product (GDP) spend of 8 per cent by 2012 compared to 5.5 per cent in 2009. India spent 5.2 per cent of the GDP (valued at $ 22 billion) on healthcare, of which 4.3 per cent was spent by the private sector. Private sector expenditure in the healthcare segment is expected to reach $ 45 billion by 2012. It is estimated that

the hospital segment alone will reach $ 54.7 billion by 2012, representing more than 70 per cent of healthcare sector. Moreover, the Indian healthcare sector is expected to become a $ 280 billion industry by 2020, with spending on health estimated to grow at 14 per cent annually.

Looking at this, the maiden exhibition, Hospital Infrastructure India 2010 (HII 2010), catering to the global healthcare community, was held at Bombay Exhibition Centre, Mumbai, during December 7-9, 2010. The event was organised by Informa Exhibition India. The two-day event attracted almost 2,800

trade visitors comprising CEOs, medical directors, hospital administrators, medical superintendents, biomedical consultants, healthcare architects, project management consultants & developers, private equity fi rms, as well as many senior decision makers and healthcare professionals.

Also present at the exhibition was Magnatek Enterprises. Highlighting the takeaways from the event, Sanjay Agarwal, Director, Magnatek

Enterprises, said, “The participation in HII 2010 with our partner GMP Technical Solutions has enabled us to showcase our products to prospective customers in India. We are pleased with the response we received for our products at this premier event.”

Innovation on displayThe event offered visitors the opportunity to gain information about hospital infrastructural products, medical equipment, hospital consultancy & planning as well as their potential suppliers and future partners. The key objectives of exhibitors were to extend their business & solutions to hospitals, meet and network with hospital consultants & planners, as well as to deepen their collaboration & partnerships, while gaining information on emerging trends in hospital infrastructure & management segment. As exhibitors have now realised the signifi cance of cultivating their business relationship with direct infl uential contacts with hospital partners, there has been a continuous increase in number of participants at such events.

Hospital Infrastructure India 2010 marked the convergence of various constituents of the healthcare industry under one roof. It gave the entire healthcare community an opportunity to network and collaborate for hospital infrastructure & management. A glimpse of the happenings at the event.

Hospital Infrastructure India 2010

A catalyst to the sector’s growth

Meghna Mukherjee

Report

63January 2011 I

Judy Martin, Business Development Manager, Tahpi, said, “The exhibition gave us an excellent opportunity and exposure to the Indian healthcare market. The infrastructure focus has fi ne-tuned the delegates’ expectations and has extended to the exhibitors a far more targeted audience.”

A total of 107 exhibitors from 12 countries showcased an entire gamut of hospital infrastructure products, medical equipment/technology and hospital solutions all under one roof. Countries present at the event included the US, UK, Australia, Hungary, Taiwan, Switzerland, United Arab Emirates, Japan, Singapore, Italy, Germany, The Netherlands and the host India.

Some of the leading companies exhibiting their products included L&T, Sony India, Armstrong World, HKS, Burt Hill, GMP technical, Everest Industries, Tahpi, Draeger Medical, Smart Network International, Gerfl or, Tarkett, Responsive Industries, Medica Synergie, Hosmac, Hospaccx, Forbo, CCIL and Ediffi ce.

The conference Concurrent to the exhibition, there

were conferences that showcased the exhibitors’ products and focussed on vital issues concerning hospital planning & design, medical technology & equipment, healthcare IT and hospital accreditation. Further, panel discussions from domestic & internationally acclaimed companies as well as infl uential personalities from the healthcare industry in India gave an all round perspective to the companies on addressing challenges and highlighted avenues for growth.

Aditya Prakash, Modality Manager-IP, Draeger Medical India Pvt Ltd, said, “HII 2010 event received a genuine response. The conference was well organised and the topics selected helped in designing & planning of new set ups.”

Face valueThe event was appreciated by the healthcare industry in India. The exhibition and the conference together provided the visitors an opportunity to learn & understand the latest products and infrastructural developments in the healthcare system. Also, it served as an excellent platform for

exhibitors to network and establish new contacts to broaden their clientele base. The exhibition cum conference was also a gateway to gain knowledge & expertise from industry stalwarts and delegates.

The common sentiments of the exhibitors underlined the fact that the platform provided them an opportunity to exercise their skills and showcase their effi ciency.

Prashant Kavale, Director, GMP Technical India Pvt Ltd, said, “It was an excellent forum to showcase the innovative modular operation theatre and turnkey hospital solutions. We are pleased to have an excellent response and genuine enquiry from HII 2010.” Adding to this, Gaurav Seth, HKS India Design Consulting Pvt Ltd, commented, “HII 2010 is on its way to become a premier healthcare event in India.”

The next edition of Hospital Infrastructure India will be held at Bombay Exhibition Centre, Mumbai, during October 21-23, 2011. The event hopes to provide an opportunity to even more exhibitors for displaying their products and services.

([email protected])

Manas BastiaEditor

Infomedia 18 Limited‘A’ Wing, Ruby House,J K Sawant Marg, Dadar (W)Mumbai 400 028 India

T +91 22 3024 5000F +91 22 3003 4499E [email protected] www.modernmedicare.in

D +91 22 3003 4669

Dear Reader,

‘Modern Medicare’ solicits original, well-written, application-oriented, unpublished articles that refl ect your valuable experience and expertise in the pharmaceutical industry.

You can send us Technical Articles, Case Studies and Product Write-ups. The length of the article should not exceed 2000 words, while that of a product write-up should not exceed 200 words.

The articles should preferably reach us in soft copy (either E-mail or a CD). The text should be in MS Word format and images in 300 DPI resolution & JPG format.

The fi nal decision regarding the selection and publication of the articles shall rest solely with ‘Modern Medicare’. Authors whose articles are published will receive a complimentary copy of that particular issue and an honorarium cheque.

Published by Infomedia 18 Ltd, ‘Modern Medicare’ is India’s leading magazine on healthcare, and related equipment & technologies. This monthly magazine was launched in December 2004 and provides the latest and most apt updates exclusively for the medical fraternity. Moreover, ‘Modern Medicare’ acts as a sourcebook that facilitates buying decisions for this key sector - hospitals, specialty clinics, pathology labs, nursing homes and

So get going and rush your articles, write-ups, etc…

Thanking you,

Yours sincerely,

An invite that rewards as well...

Report

64 I January 2011

Creating a platform for the scientifi c & laboratory fraternity in India, the second International

Exhibition and Conference on Scientifi c & Laboratory Technology – India Lab Expo, 2010 was held during December 10-12, 2010, at Pragati Maidan, New Delhi. Lab managers, QC & QA heads, scientists, professors, industrialists, doctors, technicians and trade suppliers attended the show, with most of them lauding the standard of display of the latest products & services by Indian & international participants.

The Expo witnessed 160 exhibitors from 10 countries showcasing their products and innovations in the scientifi c, laboratory, analytical, biotechnology, educational and other related fi elds. Exhibitors from the US, Switzerland, Germany, South Korea, Malaysia, China, Singapore, France and Hungary along with a large

contingent from the Indian scientifi c industry made a strong presence at the event. The second edition of India Lab Expo celebrated diversity through globalisation. The aim of the exhibition was to provide a platform for business development, marketing and creating ways to open new avenues for transfer of technologies to motivated entrepreneurs and the scientifi c fraternity. Exhibitors expressed delight at their participation, with 80 per cent achieving the primary purpose of participation, ie, promoting new instruments & services, and 49 per cent fi nding local distributors or securing orders during the show. Moreover, a majority of visitors claimed complete or partial authority to make purchasing decisions. A total of 5,900 visitors and delegates converged at the show and conference (concurrent with the exhibition). The exhibitors were pleased with the quality and number of visitors. They claimed to have totally or

partially achieved the purpose of their visit of either seeking new instruments or placing orders. The exhibits covered an area of approximately 6,000 sq m.

The conferenceAnother highlight of the event was the co-located conferences at the India Lab Expo, where transfer of knowledge at the highest level was demonstrated. This featured 25 presentations held on the fi rst two days of the show. The conference was inaugurated by the Chief Guest, Dr Deepak Haldankar, Head - QC Department, Cipla Ltd, along with Guest of Honour Dr Y K Gupta, Chairman, GLP Monitoring Committee, and Dr Vipul Yamdagni, Head - Corporate Quality Assurance, Ranbaxy Ltd.

Guest speakers at the conference included Devina Bhardwaj (CEO, Intervein Laboratories Pvt Ltd), Dr Aparna Jha Ahuja (GM, Super Religare), Dr B R Das (Executive Director, Super Religare), Dr A K Dixit (Indian Agricultural Research Institute), Dr Ashish Agarwal (National Physical Laboratories), Dr Anil Kumar (National Physical Laboratories), Dr S K Singhal (National Physical Laboratories) and Dr H C Verma (Indian Institute of Technology, Kanpur). Speaking at the occasion, Dr Haldankar said, “I am pleased with the participation of the high quality of local and international exhibitors, which have made this exhibition an international trade fair. There were 400 delegates at the concurrent conferences.

The organisers plan to host the third edition – India lab Expo 2011 – during December 8-10, 2011.

([email protected])

The second edition of India Lab Expo recently held in New Delhi proved to be a networking platform for the scientifi c & laboratory fraternity in India. It helped them establish a connect and open new avenues for business & technological developments. The mega event in retrospect.

India Lab Expo 2010

Where science meets business

L-R: Vivek Vikram, Project Head, India Lab Expo; Deepak Haldankar (lighting the lamp);Vipul Yamdagni; Y K Gupta, Devraj Aiyar, General Manager, S G E Analytical Sciences, Mumbai

Product Update

67January 2011 I

This section offers an overview of the latest medical/surgical equipment available in the worldwide market. If you wish to have your products featured in this section, send us the details at [email protected]. Also gain added advantage through our ‘Product index’ and ‘Advertiser’s list’ to facilitate your business.

NATIONAL

Autoclave & sterlisersDevine Medihealth offers a new range of autoclave & sterlisers for laboratory, hospital and industrial purpose, designed and developed specially to be user-friendly and accurate. Microprocessor controlled, fully automatic horizontal steam sterilisers have strong and durable medical grade (ASME) stainless steel construction and design ensuring easy installation, ease of servicing, high steam quality and less water consumption. With comprehensive features, the

dual microprocessor and advanced software-controlled PLC, A/V signals, digital control panel, pressure and temperature provides accurate functioning and user satisfaction. The LCD screen and digital control panel allows easy programming and troubleshooting. The steam generator is equipped with water reservoir, pressure & temperature control switches and water level control switches. Various parameters are easily viewed on the LCD display. The pre & dry vacuum functions, accurately programmed sterilisation cycles and various validation tests adds to the outstanding functionality of the system.

Devine Medihealth Pvt Ltd - New Delhi Tel: 011-2681 0195Email: [email protected]

LED photo therapy unitnice Neotech Medical Systems offers the ‘Sapphire 4000’ LED-based photo therapy system. This is designed to meet both the NICU and Well Baby Nursery. This design eliminates a big & gauche box of the fl uorescent and halogen lamp type of photo therapy. This unit is designed specifi cally to overcome the drawbacks including low irradiance levels, temperature rising and scattered, and unfocussed coverage. This photo therapy system follows the international standard. A microprocessor system is provided to control the irradiance of the LED, treatment time and lamp usage hours. The system delivers up to 94 MW of penetrating light directly to the baby’s skin for effective jaundice management. This unit does not emit UV rays, but only blue rays to reduce the potential risk of skin damage. It also does not emit IR rays, but only cold light rays to reduce the potential risk of fl uid loss. The unit is light in weight, easy to handle and suitable for all types of incubators, radiant warmers and cradles. Alphanumeric display is provided to ensure simultaneous monitoring of lamp usage hours, treatment hours, lamp power output and real-time/date.

nice Neotech Medical Systems Pvt Ltd Chennai - Tamil NaduTel: 044-2476 4608, Fax: 044-24762594Email: [email protected]

Anaesthesia machineAshwani Diagnostics offers anaesthesia machine with square tubular electrostatic powder-coated steel sections. The ring top tray is for monitor. The table top is made of stainless steel. It comes with one large storage drawer and gas-specifi c yokes for gauges with claming bars. The machine is provided with large-diameter anti-static castors with brakes for mobility. It contains two pressure gauges for oxygen and nitrous oxide. The non-return cum pressure release valve minimises risk

of back fl ow of gases. It is provided with oxygen failure warning device and fl owmeter. Space for three vapourisers is provided as standard. Emergency oxygen fl ush outlet button is provided at table level and a changeover unit is provided for open or close circuit. The standard accessories include one/two built-in oxygen outlets (422 kPa) for driving ventilators, extended rear platform for two 10-ltr water capacity cylinders and facemask for adult & paediatric use.

Ashwani Diagnostics - New DelhiTel: 011-2209 0997, 2027 9390, Fax: 011-2209 4144Mob: 097170 98703Email: [email protected]

Product Update

68 I January 2011

Full body vacuum splintAndhra Surgical Emporium offers vacuum splint. This can be used during accidents or evacuations by ambulance or emergency crew for complete body immobilisation of patients with multiple fractures. The fl exible pad can be wrapped around the patient body using buckle straps. The pad becomes stiff and rigid once air is vacuumed out of the pad with the help of the pump provided along with it. The pad can then also be used as a stretcher to carry the patient. The entire system is foldable into a compact form which is placed in an attractive nylon bag for ease of transport.

Andhra Surgical Emporium - Hyderabad - Andhra PradeshTel: 040-2320 1024, 2320 2926, Fax: 040-2320 3771Email: [email protected]

ICU bedUnited Surgical Industries offers ICU electric bed, whose framework is made of rectangular MS tube. The ABS mattress platform is in four sections – back rest, knee rest, TB/RTB and high-low positions obtained by electric actuator operator by hand remote system. The ICU bed is equipped with ABS-moulded head and foot bows, ABS track away safety side railing and telescopic IV rod with two locations. The bed is mounted on a 125-mm diameter castor with central braking system. It has an overall size of 210 cm L x 90 cm W x 50-70 cm H, and is available in epoxy powder-coated fi nish. The company also offers mechanical ICU bed with ABS panels.

United Surgical Industries - New DelhiTel: 011-2214 9600/9694-95, Fax: 011-2215 2679Email: [email protected]

Pulse oximeterZigma Meditech India offers ‘Nellcor N-180’ pulse oximeter. It provides continuous, non-invasive measurement of oxygen saturation and pulse rate. These measurements are updated with each heartbeat. The saturation range is from 0-100 per cent and pulse rates from 20-250 bpm. The unit can run on AC power as well as on an internal battery. It is compact, light-weight, portable, has two 3-digit green and red displays for oxygen saturation and pulse rate and 16-segment display for pulse amplitude indicator. It measures functional oxygen saturation of arterial haemoglobin and pulse rate. This pulse oximeter is provided with RS-232 and analog communication ports for interfacing with central monitoring systems, recorders and computers.

Zigma Meditech India Pvt Ltd - Chennai - Tamil NaduTel: 044-2644 1285, Mob: 098408 78122Email: [email protected]

Hermetically sealed sliding doorsMetafl ex Doors India offers h e r m e t i c a l l y sealed sliding

doors (operation theatre doors). The door is surrounded by a four-sided rubber sealing gasket that ensures 99.9 per cent hermetic sealing, which reduces the contamination risk between the rooms and controls the pressure in the room. The door slides on an overhead track, which is made of high-quality aluminium extrusion with indentations, due to which there is no obstruction with the trolley movement on the fl oor. The 60-mm door blade with HPL cover and PU core has a 28-dB noise reducing value, which offers a safe working environment. Due to the insulation properties of PU the environment temperature and humidity can be maintained as required. It can withstand high abrasion as it is made of high-quality anodised aluminium and door blade made of compact laminate. The top rollers made of self-lubricating nylon ensure that there is no noise while moving the door. The door is user friendly and has large openings.

Metafl ex Doors India Pvt Ltd - Noida Tel: 0120-475 1000, Fax: 0120-475 1026Email: info@metafl ex.in

Product Update

70 I January 2011

INTERNATIONAL

Disposable probesKeeler offers single-use disposable probes for its cryomatic cryogenic surgery unit. These disposable probes are used with a disposable adaptor for single surgery use or as a backup for high-performance reusable probes. Important features of these probes include the following: it does not require cleaning or sterilisation , single use eliminates the possibility of cross infection or tip blockages due to dust and debris, saves time and ensures surgical reliability. The company’s cryomatic is engineered to create a simple to use system with a reliable freeze. The intuitive console automatically confi gures itself according to the probe’s characteristics, removing the need for manual set up. To simplify the set up pre-surgery procedures, the gas pressure is automatically set by the console for carbon dioxide (CO

2) or

nitrous oxide (N2O). The control console provides clear, digital

readouts of probe activity, temperature, time elapsed and gas pressure. Probe operation is controlled by a footswitch, leaving the user’s hands free at all times. The whole system is quick and easy to set up, a major advantage if experienced staff are not always available.

Keeler Ltd - Windsor - UKTel: +44-1753 857 177, Fax: +44-1753 827 145Email: [email protected]

Cardiotest lineSeca GmbH & Co offers ‘CT8000L Interpretive’ cardiotest line, which provides paperless ECG options when combined with Seca Achimed Passport Patient Record Software, allowing transmission of ECG traces into all leading clinical record systems, eg, EMIS, Vision, System One. It is equipped with 12-channel interpretive ECG with LCD screen for menu navigation and alpha-numeric keyboard and bundled with adult and paediatric interpretive software. It has easy selection of traces from 12 x 1, 6 x 2 or 4 x 3 plus Rhythm Strip one page report. All parameters including fi lters are easily programmed through the on-screen menu for a one-touch ECG. The features of the cardiotest line include on-screen lead test and lead-off indication, one-touch automatic or instant real-time operation, digital fi lters for clear traces, internal memory for up to 45 stored ECG records, etc.

Seca GmbH & Co KG - Hamburg - GermanyTel: +49-40-2000 0000, Fax: 49-40-2000 0050Email: [email protected]

Product Update

72 I January 2011

The information published in this section is as per the details furnished by the

respective manufacturer/distributor. In any case, it does not represent the views of

Re-circulating chillersThermo Fisher Scientifi c offers re-circulating chillers. These units are available with a deluxe controller and high-temperature range options for cooling capacities up to 10,000 watt. These chillers are able to operate from 5°C to 90°C with a high-temperature range option. These chillers are provided with a multi-line LCD deluxe controller that offers users ease-of-use through graphical display and text. The deluxe controller includes a full alphanumeric display, temperature alarms, pressure alarms, fl uid level readout and DI control & readout. It is ideal for users who want a more intuitive controller. Designed as a modular platform, these lines offer a wide variety of options and cooling capacities that can be confi gured for diverse applications in markets including optical, medical, laser, packaging, pharmaceutical and semiconductor processing.

Thermo Fisher Scientifi c Inc - Massachusetts - USATel: +1 781-622-1000, Fax: +1 781-622-1207Email: vaughn.harring@thermofi sher.com

Pulse oximeterSmiths Medical International offers rugged design ‘Digit®’fi nger oximeter, which delivers fast, reliable oximetry in an extremely handy, pocketsize solution by combining the monitor and sensor into one unit. It helps in SpO2, pulse rate and pulse strength measurements on patients from paediatric to adult. It is handy-to-use for clinicians in EMS, hospital, clinical environments and at home. Its features include easy-to-use one-button keypad, easy-to-read, large LED display, runs on standard AAA batteries, auto power shutdown after 8 seconds, low battery indicator and high-impact polycarbonate shell.

Smiths Medical International Ltd - Kent - UKTel: +44-0-1233 722 100, Fax: +44-0-1303 236 899Email: [email protected]

Rx

74 I January 2011

Rx

75January 2011 I

Rx

77January 2011 I

Product Index

78 I January 2011

To know more about the products in this magazine, refer to our ‘Product Index’ or write to us at [email protected] or call us at +91-22-3003 4684 or fax us at +91-22-3003 4499

and we will send your enquiries to the advertisers directly to help you source better.

Product Pg No Product Pg No Product Pg No

Acoustic lens/membrane replacement..........13

Adult/paediatric transport

ventilator ..............................Back Inside Cover

Anaesthesia machine ....................................... 67

Analyser .............................................................. 3

Anesthesia system ............................................ 11

Aspirators ......................................................... 92

Audio/video mounting system ......................... 7

Audio-visual auscultation device.................... 58

Autoclave & sterilisers ..................................... 67

Biomedical waste solution.............................23

Bipnasic defi brillator .............Back Inside Cover

Blood glucose monitoring system .................... 9

Blood pressure recorder ........Back Inside Cover

Cable replacement ..........................................13

Cardiac OT table.............................................. 12

Cardiotest line.................................................. 70

Cleanroom design............................................ 71

Clearroom equipment ..................................... 71

Coagulometer................................................... 17

Colour doppler ................................................ 74

Commercial inspection & testing services..... 47

Conformity assesment services....................... 47

Consulting & training ..................................... 47

Custom fabrication............................................ 7

Desktop pulse oximeter ......Back Inside Cover

Diagnostic equipment ..................................... 17

Disinfectant products ...................................... 21

Disposable probes............................................ 70

Dopplers ........................................................... 58

Dual syringe infusion

pump ....................................Back Inside Cover

ECG machine ......................................58, 74, 75

Electrolyte analyser .......................................... 17

Electronic patient

recorder ............................. Front Inside Cover

EMR...................................... Front Inside Cover

Endoscope .................................................. 57, 75

ERCP/endoscopy OT table.............................. 12

Exhibition - Engineering Expo....................... 65

Exhibition - HiTech Manufacturing

Show........................................................ 29, 32

Exhibition - India Healthcare Awards 2010 .....85

Exhibition - International Telemedicine

Congress 2011................................................ 91

Exhibition - Medicall 2011 ............................. 81

Exhibition - Meditec Clinika 2011 ................. 77

Fingertip pulse oxymeter...............................75

Foetal monitor .................75, Back Inside Cover

Fogging machine.............................................. 77

Full body vacuum splint ................................. 68

Fully automatic biochemistry analyser .......... 17

Fumigation ....................................................... 77

General surgery OT table & OT lights .........12

Gynaec examination coach ............................. 49

Hermetically sealed sliding doors.................68

Hospital bed ..................................................... 92

Hospital curtains................................................ 5

Hospital furniture ...................................... 27, 49

ICU bed .....................................................49, 68

Imported hospital furniture/equipment ........ 92

Infusion pump ................................................. 75

Intensive care ventilator ........Back Inside Cover

Kaematology analyser ....................................17

Laparoscopy OT table ....................................12

Laser blood cleaner.......................................... 75

LED lights......................................................... 12

LED photo therapy unit.................................. 67

Management system registration services .....47

Medical equipment.......................................... 59

Metal doors ...................................................... 71

Modular cleanroom......................................... 71

Monitor ............................................. Back Cover

Multi-parameter defi brillator....Back Inside Cover

Multipera monitor..................................... 74, 75

Nebulisers..................................................58, 68

Neonatal transport

ventilator ............................Back Inside Cover

Neurals.............................................................. 13

Neurosurgery OT table.................................... 12

Operation table height adjustable ................49

Orthopaedics OT table.................................... 12

OT tables .................................................... 12, 92

OT/examination lights .................................... 92

Oximeter........................................................... 75

Oxygen concentrator ....................................... 75

Oxygen fl owmeter............................................ 92

Oxygenators ..................................................... 58

Paediatric OT table ........................................12

Patient monitoring system........................ 58, 75

Patient privacy systems...................................... 7

Patient transfer systems................................... 12

Pedal suction .................................................... 19

Pendants ........................................................... 12

Pocket foetal monitoring system .................... 75

Portable colour doppler .................................. 74

Powder coated & stainless steel furniture ...... 77

Printer................................................ Back Cover

Probe head replacement.................................. 13

Pro-nebuliser.................................................... 69

Prosthetic and orthotic services ..................... 25

Pulse oximeter...................................... 68, 72, 75

Pulse oximeter & NIBP monitor .................... 74

PW ultra sound scanner ................................. 74

Rapid endotoxin detection system................75

Re-circulating chillers ...................................... 72

Recovery bed .................................................... 49

Refurbished goods ...................................... 57,75

Scandoc dicom workstation ..........................15

Scopy doc endoscopy IMS .............................. 15

Sensor controlled suction system ................... 61

Sphygmomanometer ....................................... 92

Sphygmomanometer (mercury-free) ............. 51

Surgical diathermy........................................... 61

Surgical instruments........................................ 92

Surgical lights................................................... 61

Surgical pumps ................................................ 61

Surgical/ICU pendants .................................... 92

Syringe infusion pump.................................... 75

Syringe pump................................................... 75

Tourniquet ......................................................43

Transducer replacement .................................. 13

Ultrasound probes .........................................13

Ultrasound scanner ............................. 58, 74, 75

ULV fogging machine...................................... 77

Urology OT table ............................................. 12

Ventilation technology...................................73

Ventilator .......................................................... 74

Vital signs monitor .......................................... 74

X imager C-arm memory ..............................15

X-ray machine............................................ 58, 74

X-ray viewers.................................................... 92

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82 I January 2011

A R V S Equipments Pvt Ltd 23

T: +91-11-41044444

E: [email protected]

W: www.sharpsandwastecontainers.com

Aavanor Systems Pvt Ltd FIC

T: +91-44-26208920

E: [email protected]

W: www.aavanor.com

Anand Medicaids Pvt Ltd 19

T: +91-11-25225225

E: [email protected]

W: www.anandind.com

Biometric Cables 13

T: +91-44-32533886

E: [email protected]

W: www.biometriccables.com

BPL Limited 58

T: +91-80-22270134

E: [email protected]

W: www..bpl.in/healthcare

Carewell Biotech Pvt Ltd 9

T: +91-11-41539602

E: [email protected]

W: www.carewellindia.com

Charles River 75

T: +91-80-25588175

E: [email protected]

W: www.charlsriverindia.com

CNBC TV 18 85

Endolite India Ltd 25

T: +91-11-45689955

E: [email protected]

W: www.endoliteindia.com

Engineering Expo 65

T: +91-09920401226

E: [email protected]

W: www.engg-expo.com

Genuine Medica Pvt Ltd 57

T: +91-11-40513401

E: [email protected]

W: www.genuinemedica.com

GMP Technical Solutions Pvt Ltd 71

T: +91-22-66083700

E: [email protected]

W: www.gmptech.net

GTB Surgical Industries 75

T: +91-11-22015913

E: [email protected]

W: www.gtbsurgicals.com

Hi Tech 29

T: +91-09820373804

E: [email protected]

Industrial Electronic & Allied Prod 43

T: +91-20-24222538

E: [email protected]

W: www.diamondbp.com

International Trading Co 75

T: +91-33-22379476

E: [email protected]

W: www.lifeplusmedical.com

Livewire 80

[email protected]

Lonza India Pvt Ltd 21

T: +91-22-43424000

E: [email protected]

W: www.lonza.com

M S Enterprises 92

T: +91-866-2442786

E: [email protected]

Magna Tek Enterprises 12

T: +91-40-66668036

E: [email protected]

W: www.magnatekenterprises.com

Medexpert Business Consultants Pvt Ltd 81

T: +91-9840326020

E: :[email protected]

W: www.medicall.in

Medi - Waves Inc 51

T: +91-11-47043178

E: sales.medi-waves.com

W: www.medi-waves.com

Meditech Engineers Pvt Ltd 59

T: +91-11-45545238

E: [email protected]

W: www.meditech-india.com

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86 I January 2011

Meditek Engineers 49

T: +91-09822092808

E: [email protected]

Medsynaptic Pvt Ltd 15

T: +91-20-25443349

E: [email protected]

W: www.medsynaptic.com

Meelan Hospital Steel Furniture 77

T: +91-20-24262562

E: [email protected]

W: www.meelanhospicare.com

Monash International Ltd 17

T: +91-11-24378779

E: [email protected]

MRK Healthcare 69

T: +91-22-23748371

E: [email protected]

W: www.mrkhealthcare.com

Orbitz Exhibitions Pvt Ltd 77

T: +91-22-24102801

E: [email protected]

W: www.orbitz-world.com

R D Plast Pvt Ltd 7

T: +91-11-25891219

E: [email protected]

W: www.rdplast.in

Radiant Enterprise 77

T: +91-79-26449120

E: [email protected]

W: www.fogstarindia.com

Rational Health Care Systems 74

T: +91-40-30727676

E: [email protected]

Schiller Healthcare India Pvt Ltd BIC

T: +91-22-66920520

E: [email protected]

W: www.schillerindia.com

Smart Logistics 79

T: +91-22-30034650

E: [email protected]

Soma Technology Pvt Ltd 73

T: +91-2667-264737

E: [email protected]

W: www.somatechnology.com

Sony India Pvt Ltd BC

T: +91-11-66006600

E: [email protected]

W: www.sony.co.in

Space Labs Health Care 11

T: +91-40-39803687

E: [email protected]

W: www.spacelabshealthcare.com

Spark Meditech Pvt Ltd 61

T: +91-484-2341335

E: [email protected]

Technocare Medisystems 75

T: +91-261-6569308

E: [email protected]

W: www.technocarem.com

Telemedicine Society Of India 91

T: +91-9811733058

W: www. telemedicon11.com

Transasia Bio-Medicalsp Ltd 3

T: +91-22-40309000

E: [email protected]

W: www.transasia.co.in

Ul India Private Limited 47

T: +91-80-41384500

E: [email protected]

W: www.ul.com

United Surgical Industries 27

T: +91-11-22149600

E: [email protected]

W: www.uniserg.com

Window Techs 5

T: +91-11-29992146

E: [email protected]

W: www.hospitalcurtains.in

Our consistent advertisers

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A R V S Equipments Pvt Ltd

Aavanor Systems Pvt Ltd

Anand Medicaids Pvt Ltd

Biometric Cables

BPL Limited

Carewell Biotech Pvt Ltd

Charles River

CNBC TV 18

Endolite India Ltd

Engineering Expo

Genuine Medica Pvt Ltd

GMP Technical Solutions Pvt Ltd

GTB Surgical Industries

Hi Tech

Industrial Electronic & Allied Prod

International Trading Co

Lonza India Pvt Ltd

M S Enterprises

Magna Tek Enterprises

Medexpert Business Consultants Pvt Ltd

Medi - Waves Inc

Meditech Engineers Pvt Ltd

Meditek Engineers

Medsynaptic Pvt Ltd

Meelan Hospital Steel Furniture

Monash International Ltd

MRK Healthcare

Orbitz Exhibitions Pvt Ltd

R D Plast Pvt Ltd

Radiant Enterprise

Rational Health Care Systems

Schiller Healthcare India Pvt Ltd

Smart Logistics

Soma Technology Pvt Ltd

Sony India Pvt Ltd

Space Labs Health Care

Spark Meditech Pvt Ltd

Technocare Medisystems

Telemedicine Society Of India

Transasia Bio-Medicalsp Ltd

Ul India Private Limited

United Surgical Industries

Window Techs

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Acoustic lens/membrane

replacement

Adult/paediatric transport

ventilator

Anaesthesia machine

Analyser

Anesthesia system

Aspirators

Audio/video mounting system

Audio-visual auscultation device

Autoclave & sterilisers

Biomedical waste solution

Bipnasic defi brillator

Blood glucose monitoring system

Blood pressure recorder

Cable replacement

Cardiac OT table

Cardiotest line

Cleanroom design

Clearroom equipment

Coagulometer

Colour doppler

Commercial inspection &

testing services

Conformity assesment services

Consulting & training

Custom fabrication

Desktop pulse oximeter

Diagnostic equipment

Disinfectant products

Disposable probes

Dopplers

Dual syringe infusion pump

ECG machine

Electrolyte analyser

Electronic patient recorder

EMR

Endoscope

ERCP/endoscopy ot table

Exhibition - Engineering Expo

Exhibition - HiTech

Manufacturing Show

Exhibition - India Healthcare

Awards 2010

Exhibition - International

Telemedicine Congress 2011

Exhibition - Medicall 2011

Exhibition - Meditec Clinika 2011

Fingertip pulse oxymeter

Foetal monitor

Fogging machine

Full body vacuum splint

Fully automatic biochemistry

analyser

Fumigation

General surgery OT table &

OT lights

Gynaec examination coach

Hermetically sealed sliding doors

Hospital bed

Hospital curtains

Hospital furniture

ICU bed

Imported hospital furniture/

equipment

Infusion pump

Intensive care ventilator

Kaematology analyser

Laparoscopy OT table

Laser blood cleaner

LED lights

LED photo therapy unit

Management system registration

services

Medical equipment

Metal doors

Modular cleanroom

Monitor

Multi-parameter defi brillator

Multipera monitor

Nebulisers

Neonatal transport ventilator

Neurals

Neurosurgery OT table

Operation table height adjustable

Orthopaedics OT table

OT tables

OT/examination lights

Oximeter

Oxygen concentrator

Oxygen fl owmeter

Oxygenators

Paediatric OT table

Patient monitoring system

Patient privacy systems

Patient transfer systems

Pedal suction

Pendants

Pocket foetal monitoring system

Portable colour doppler

Powder coated & stainless steel

furniture

Printer

Probe head replacement

Pro-nebuliser

Prosthetic and orthotic services

Pulse oximeter

Pulse oximeter & NIBP monitor

PW ultra sound scanner

Rapid endotoxin detection system

Re-circulating chillers

Recovery bed

Refurbished goods

Scandoc dicom workstation

Scopy doc endoscopy IMS

Sensor controlled suction system

Sphygmomanometer

Sphygmomanometer

(mercury-free)

Surgical diathermy

Surgical instruments

Surgical lights

Surgical pumps

Surgical/ICU pendants

Syringe infusion pump

Syringe pump

Tourniquet

Transducer replacement

Ultrasound probes

Ultrasound scanner

ULV fogging machine

Urology OT table

Ventilation technology

Ventilator

Vital signs monitor

X imager C-arm memory

X-ray machine

X-ray viewers

SOURCE LIGHT & MEDIUM ENGINEERING PRODUCTS @www.engg-expo.com

Please complete the following & get a quick effective response from suppliers: 1. Your company’s business function is (�one only)

� Wholesalers � Manufacturer � Distributor � Agent � Other, please specify ______________

2. Your role in your company’s buying process can best be described as:

� I buy � I identify potential suppliers � I approve purchases

� I negotiate contracts � I select suppliers.

3. Your line of business

4. Specifi c product requirement

Name:

Designation:

Company Name:

Address:

City: Pin:

Tel: Fax:

Email:

01 / 2

011

Business Reply InlandBR Permit No. 555

Bhavani Shankar Post Offi ce,Mumbai 400 028.

INFOMEDIA 18 LIMITED ‘A’ Wing, Ruby House, J.K. Sawant Marg, Dadar (W),Mumbai 400 028,INDIA.

POSTAGEWILL BEPAID BY

ADDRESSEE

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NECESSARYIF POSTEDIN INDIA

MODERN MEDICARE

94

Reg No: G2/NMD/73/2011–2013 RNI No: MAHENG/2007/21987

WPP Licence No: MR/Tech/WPP–352/Navi Mumbai/2011-2012

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