The 10 Most Trusted Hospitals in Pune 2018

1. www.insightscare.com August 2018 THE 10 MostTrusted HOSPITALS in PUNE2018 Dr. AditiKarad ExecutiveDirector Benefitting the‘Indigent’ Strata of Society with Affordable and Superior HealthcareServices

4. Fromthe Editor P ublic and private healthcare are the two most vital pillarsof our healthcare eco-system. While the private healthcarehas its deep root in the urban area, it's the publichealthcare setup that holds the responsibility for the well-being of oururban and semi-urban masses. The quality of private and public healthcare is not a secret anymore. And the tyranny is mostpoor reside in the rural parts of India for whom Government run hospitals are the only source ofhope. Various successive governments have successfully implemented many healthcare schemes that have benefitted the masses include eradication of polio and more. But there is huge disparity between public and private healthcare which needs to lessen. There are many areas where Government needs an urgent action. The topone includes the healthcarespending. The public sector spends approx. 1.4% of the GDP for healthcare while the contribution of private sector is about 3.3%. Marginal coverage for health insurance, huge scarcity of hospital beds and doctors, and lack of advanced medical infrastructure in rural areas are some vital aspects that Government must look into. Healthcare providers should also focus on capturing hospital data and ensure proper documentation for tracking of relevant performancemetrics in terms of process, outcome, andsafety. Private sector can assist in improving this gloomy picture. Over the last three decades, private sector has been making growing contribution and supporting already heavily burdened public health institutions at every level and today it provides 58 percent of the hospitals and 81 percent of the doctors in India and has the potential to turn this grim situation of public healthcare into amuch satisfying one. If the Government collaborates with private players then they can assist in expanding the bed density from 0.9 per thousand today to 2.0 per thousand by 2025 and can lead to augment the strength of hospital beds by 1.8million. The National Health Policy has also pledged to increase public spending to 2.5% of GDP by 2025 which is an appreciatedmove. Implementers of this policy must look at the problems and the solutions holistically with private sector as strategicpartners. To achieve the ultimate objective of qualitative healthcare at all levels, the government would need the support of private sector at primary to tertiary care levels. The support comes in the form of large investment, new technology, innovations and qualityservices. It is the responsibility of private players as well to work in tandem with the Government and do whatever they can in order to make ‘SwasthBharat’. Bridgingthe Gap is Need of theHour AshwiniDeshmukh

5. Editor-in-Chief Pooja M. Bansal Managing Editor Ashwini Deshmukh Executive Editor Shane Gomez Visualiser DavidKing Art & Design Director AmolKamble Associate Designer RahulKavanekar Co-designer Priyanka, ShwetaA Art & Picture Editor PaulBelin JayantKhanna Business Development Manager AkanshaGarewal Marketing Manager DhruvApte SalesExecutives Nikhil, Karishma,Yuga Technical Head SwapnilPatil Technical Specialist Amar, Vivek,Pratiksha Digital Marketing Manager MarryD’Souza SME-SMO Executives Prashant Chevale, Uma Dhenge Research Analyst ChidiebereMoses Circulation Manager Robert, Tanaji Database Management Stella Andrew Technology Consultant DavidStokes sales@insightscare.com August,2018 CorporateOfces: Insights Success MediaTechLLC 555 Metro Place North,Suite100, Dublin, OH 43017,UnitedStates Phone -(614)-602-1754 Email:info@insightscare.com For Subscription:www.insightscare.com Insights Success Media and Technology Pvt.Ltd. Ofce No. 510, 513, 5th Floor, Rainbow Plaza, Shivar Chowk, Pimple Saudagar, Pune, Maharashtra411017 Phone - India: 7410033802,74100058552 Email:info@insightscare.com For Subscription:www.insightscare.com Copyright © 2018 Insights Success, All rights reserved. The content and images used in this magazine should not be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from InsightsSuccess. Reprint rights remain solely with InsightsSuccess.

6. 08 CoverStory VishwaRajHospital: Benefitting the‘Indigent’ Strata of Society with Affordable and Superior HealthcareServices CONTENTS 30 16 16 Expert’sViewpoint Fertility Preservation: Science that is MakingParenthoodPossibleinLaterYears 30 40 IndustryInsights Healthcare Reforms inIndia 40 2 Insider’sOpinion WhatShouldNeedstobedonetoMake QualityHealthcareAccessibletoall? 2 46 Fine-Angle Functional and AestheticRhinoplasty 46 ExpertTalk Effectiveness of RoboticSurgery

7. 24 36 Editor’sTake CustomizedCare Mutant KRAS Gene: APotential Target to Suppress Associated Cancers Optimizing Healthcare with Precision Medicine andPersonalized PatientExperience 20 AIMSHospital & ResearchCenter: Serving the People with Utmost Devotion &Humility 28 Oyster&Pearl Hospitals: A PioneerinModern Multi-SpecialtyHealthcare Industry 34 PawanaHospital: Providing World ClassPatient CareforaHealthyLifeTime 4 PBMA's H V DesaiEye Hospital Delivering Excellencein QualitywithCareandConcern

8. LeadingEdge Healthcare 10 The Most Trusted HOSPITALS in Pune2018 Providers IAccording to reports, Indianhealthcaresector is projectedto bea $280 billion industry by 2020 with aCAGR of nvestment opportunities in the Indian healthcare sector have increased significantly and the sector is expectedto be one of the most lucrative investment targets for private equity (PE) and venture capital (VC)companies. 16%. This estimated growth will bring many benefits to all the stakeholders of the industry along with patientsand students who aspire to continue their career in medical vertical. This growth will augment the healthcare workforceto 7.4 million in near future. Medical tourism is also expected to rise in coming times due to the better patientoutcomes, greater patient engagement at much affordable cost than many developedcountries. The biggest carriers of this growth are the hospitals that provide cutting-edge healthcare services. To highlightsome of the best known hospitals, we have come up with an issue of “The 10 Most Trusted Hospitals in Pune2018”. These healthcare solution providers have built a strong repute in the market with their state-of-the-artinfrastructure, adept surgeons and affordable medical facilities. These providers have crafted a niche in patient's hearts by only taking care of them but also by reflecting the true colors of humanity and work ethics in the time ofneed. On the cover we have highlighted, VishwaRaj Hospital, which is a 300-bedded multispecialty and tertiarycare hospital that is known for its qualitative medical services at affordablerates. AIMS Hospital & Research Center is a committed hospital, which provides top class healthcare services usinglatest medical technology at an affordableprice. PBMA’s HV Desai Eye Hospital is the biggest tertiary eye care center in western India which offers allsubspecialty services in ophthalmology. Oyster & Pearl Hospitals is a leading group of hospitals in Pune that has pioneered in modern healthcare in numberof ways, specializing in IVF and mother & childcare. Pawana Hospital is a multispecialty hospital that provides round the clock facilities to serve its patients withthe highest quality care, in a cost-effectiveway. 7Orange Hospital, Ace Hospital Pune, Mahaveer Super Speciality Eye Hospital and Laser Centre, Poona Hospitaland Research Centre, and Surya Hospital are the other prominent healthcare providers in Puneregion. We have also included intriguing piece of articles written exclusively by various eminent persons of medicalindustry as well by our in-houseeditors. So, do flip the pages and enjoy reading!!

10. Benefitting the‘Indigent’ Strata of Society with Affordable and Superior HealthcareServices

11. CoverStory Dr. AditiKarad ExecutiveDirector

12. We believe qualitative healthcare is anecessity notluxury good hospital curesthe patient and builds anetwork hospital builds a longlasting relationship with the amalgamation of patients care with compassion. One such respected healthcare providerwho stands tall on the robust pillars of ethics, trust, quality, teamwork and innovation is VishwaRaj Hospital. It is a 300-bedded multispecialty and tertiary care hospital which is gaining prominence due to its commitment towards working for the indigent strata of society with the channel of affordable healthcare. This hospital is situated at the strategic location on Pune-Solapur highway that makes it easily accessible toall. With the noble mission of crafting a global ecosystem where physicians, patients and community come together with a single goal of proving excellent and affordable healthcare services to the masses under a single roof VishwaRaj hospital got established. It is a well-equipped hospital with advanced technology and devices that make it one of the sought-after medical tourism destinations among patients. It has a 65 Bedded ICU & 10 centralized operation theatres; with 1.5 Tesla GE MRI, 32 Slice Siemens CT Scan & FD 10 Philips Cath labs, Dialysis center, Cancer unit, Blood Storage, and free Cleft leap procedure. Recently, they have started operating open heart bypass surgery as well. Equipped with such leading medical technologies, comfortable stay options, a wide- spread network of ambulances and more makes its one of the best hospitals in the Pune region. Its excellence has been recentlycelebrated when the hospital was awarded as number one among the categoryofbest emerging Hospital in Maharashtra by Devendra Fadnavis, CM,Maharashtra. The Trailblazer behindVishwaRaj Hospital Dr. Aditi Karad is the truereflection of a soul that believes ingreater humanitarian values. With the intentof delivering qualitative yet affordable medical facilities to the masses, she dreamt to enter into the medical field. Her sheer dedication and commitment towards this noble goal led towardsthe inception of VishwaRajHospital. Today, Aditi is successfully running this super specialty hospital in the capacity of its Executive Director. She believes, in India, there is a huge gap between people’s demand for quality healthcare & accessible availability of such facilities. And if a healthcare solution is not affordableto all then it is not a solution at all. This belief inspires Aditi to work towards affordable healthcarefacilities. “I am a strong believer of values & ethics thus keeping them at the forefront my aim is to give best of technology, expertise, facilities to patients without losing personaltouch, dignity & compassion that they deserve,” asserts Aditi. “VishwaRaj is a vital step towards realizing this dream”. Aditi is an MBBS and completed her MA is Hospital management fromthe University of Leeds. Her meticulous attention to each process, proficiency in hospital management and adept leadership qualities are seen as the main reasons behind ‘VishwaRaj Hospitals’ soaring success. By successfully running this large multi- specialty hospital at a young age, she has become a true epitome of women empowerment. Aditi’s Source of Strength Even after coming from a verymodest background from the remote districtof Maharashtra, she never let her dream to die. It was her father’s dream tosee his daughter treating the patientswho otherwise find it difficult to cross the hospitals door due to economic conditions. Aditi’ also had a fascination with coat & stethoscope since childhood that eventually led her to earn a hardfought MBBS seat in one of the prominent medical colleges in Pune. She is a humble personality who neverhesitates to give a special credit to her family members who always stood behind her and did everything possible to transform her dreams into a reality.Her husband Rahul Karad, and father-in- law Dr. Vishwanath Karad are hermain pillars of strength that always encourage her to dream big and better for the benefit of people coming from all strata of thesociety. Aditi passion to serve the destitute persons of the society with themedium of affordable healthcare is truly an inspiration formany. Eminent Healthcare Servicesoffered byVishwaRaj The hospital is known for their patient centric approach that creates the best possible combination of medical, surgical, rehabilitative and supportive treatments for the betterment of its patients. Their services are qualitative yet economical which even offer free treatment to the needy in cases of emergency. It provides superiorclinical care, and cardiology services with least rates inPune. This hospital has a center of scientific and educational research,whichwould meet the challenges of the present and the future technical advancements of the fast changingworld. Aof satisfied clientsbutagreat

13. We believe and live each daynotonlyto cure sickness but to prevent it andpromote good health andhappiness

14. VishwaRaj hospital provides different types of surgery and procedures for various specialized treatments. It has many departments which offer numerous medical services. It caters services in the domain of: Anaesthesia, Ayurveda, Cardiologyand Catha Lab, Chest Medicine, Clinical Nutrition and Dietetics, Clinical Psychologist, Critical Care / ICU, Dental, Dermatology and Cosmetology, Diabetology, Dietics, Electrophysiology, Emergency Medicine, Endodontist, ENT, Gastroenterology, General Surgery, Haematology, Infectious Diseases, Interventional Pain, Interventional Radiology, IVF, Joint Replacement, Laparoscopic Surgery, Maxillo Facial Surgery, Medical Oncology, Medicine, Microbiology, Neonatology, Neuro Surgery, Neurology, Obstetrics and Gynaecology, Oculo Plastic Surgeon, Ophthalmology, Ortho Dentist, Orthopaedics, Paediatric Surgery, Pathology, Paediatric, Pedodontists, Periodontology and Implantology, Physicians, Physiotherapy and Rehabilitation, Plastic and Reconstructive Surgery, Prosthodontist, Psychiatry, Radiology, Rheumatology, Spine Surgery, Surgical Oncology, Urology, Urosurgery, Vascular surgery andmore. The hospital is well connected byroad and railways and is at a few minutes’ drive from Hadapsar, Pune. VRH makes sure that the needs of an advanced medical facility in the area are met, and also ensures that people do not have to compromise on healthcare standards or face the inconvenience and the risk of travelling too far. Some of their additional services like the outdoor yoga and physio center, nature walks, and music therapy services are truly unique. Every Department Offers aWorld- classTreatment VishwaRaj hospital has a robustteam of adept medical professionals that include some of the best names of the healthcare domain. Diverse talent of various specialized doctors are the real strength of VishwaRaj hospital which they feel proud of. Their on-roll speciality and super-speciality doctors are very well known in Pune and Maharashtra. This has led the hospital to achieve an exponential growthcurve in the number of both IPD and OPD patients since itsinauguration. Their Cardiology department has four top cardiologists who are associated with VishwaRaj Hospital on a fulltime basis, to provide the best cardiac treatment at all times. They feel proud for being considered among one of the two hospitals in Pune, where Electrophysiology study has beendone successfully. Their Haemodialysis unit has successfully collaborated with Nephroplus (India’s largest network of dialysis centers) and intend toestablish the largest 30 bedded dialysis center unit, to cater the ever increasing need for thesame. VishwawRaj’s Orthopedicsdepartment is considered among one of the best in Pune where hip and knee replacement surgeries are executed with utmost care. This department is now well prepared to nurture buddingorthopedic surgeons from all across the globewith its cutting-edge training module and renownedmentors. Extending the Arms for the‘Needy’ Aditi believes qualitative healthcareis a fundamental right not aprivilege. Therefore, she always encourages her staff to work more for the indigent section of the society. The hospital has conducted over 100 free medical check-up camps, where services like consultation across departments, routine tests (like blood sugar, X-ray, ECG, Hemoglobin level, and so on ) and dental checkups forchildren’s have been provided at absolutely free of cost. They have an on-going initiative such as free cleft lip surgeries for children’s and 50% off on maternity charges if a girl child isborn. Their camps not just provide consultation but educate people about the benefits of various treatments as well. To expand the accessibility of affordable healthcare, VishwaRaj hospital has partnered with many primary healthcare centers in the vicinity to provide concessional medical services. They offer best qualitative treatments at 40-50% ofthe actual rates. Initiative for Women Health Aditi is committed towards the noble initiative of ‘Beti Bachao’.Therefore; she has introduced various initiatives which directly benefit the mother and newlyborn. Sonography for pregnant ladies is provided at a concessional rate of50%. Nutritious food and transport is provided absolutely free of cost to make these women as comfortable as possible. Vaccination for new born is also provided at concessionalrates. If a woman delivers a baby girl, then hospital gives a concessional of 50% on the maternity bill. Such types of initiatives are a landmark in itself, which promotes a healthier sex ratioin thecountry. They also offer advanced integrated treatment for cancer care and offer a 10% concession on cancertreatment andchemotherapy. Till date, they have provided treatments and surgeries worth more than 43 lakhs for the weaker sectionof the society. The hospital has invested almost 81 lakhs in the indigent patient fund till date and has treated many patients under this scheme,with

15. discounts worth more than1.5crore. The hospital provides many more services that too at very concessional rates to promote quality healthcare to all, Radiology, Cardiology, Pharmacy, and Physiotherapy to name a few. Parent organization- A Prominent EducationalGroup The hospital is a part of MAEER’S MIT Group of Institutions which was established in 1983 under the visionary leadershipof a trailblazing leader Vishwanath Karad. MIT Group of Institutions provide the latest state-of-art infrastructural facilities by way of smart class-rooms, libraries, laboratories, equipment, machinery, computers, software, Internet centers and of course, the best faculty. With more than 10 campuses in the state of Maharashtra covering an area of almost 1000 acres, the MIT Group of institutions provides education in the fields of Engineering, Insurance, Distance Education, Telecom Management, Medicine, Pharmacy, Marine Engineering, Lighting, Design, Food & Technology, Masters in Business Administration,Retail Management, School of Government and also School Education. It has a student’s roll call of over 50,000 students who pursue various courses all over their 65+ institutes at any given point of time and that make it University itself in its own sense. Their Maharashtra Institute of Technology (MIT) is one of the first private engineering colleges in Maharashtra that still enjoys a repute of an excellent institute all across the nation. “I am confident that the students of MAEER family with wide exposure to academic and professional fields will leave a mark of their services, wherever they go, by exhibiting their sound professional knowledge, unimpeachable character, sense of discipline and commitment” asserts Dr. Vishwanath Karad, Founder, Executive President and Managing Trustee,MAEER’s MIT Pune. Dr. Vishwanath is an eminent educationist and philanthropist who always believe in altruism and always ready to give back to the society in terms of various social welfare services. Rahul V. Karad, Vice President, MAEER’s MIT Pune is a prominent educationist. He is a graduate in engineering anda post-graduate in Management from Cardiff U.K; he is an alumnus of the Harvard Business School,U.S.A. Rahul is advancing the inherited vision and mission of his visionary academician father Prof. Dr. Vishwanath Karad witha fearless passion and patriotism. His true nationalistic consciousness keeps finding expressions through numerous activities that he initiates and infuses a renewed sense of pride and patriotism amongst the young budding minds ofIndia. Our services are qualitative yeteconomical

16. SUBSCRIBE TODAY Never Miss anIssue Yes I would like to subscribe to Insights CareMagazine. GlobalSubscription 1 Year.......... (12 Issues) .... Rs.2500 3 Months ... (03 Issues) .... Rs.700 6 Months ..... (06 Issues) ..... Rs.1300 1 Month ...... (01 Issue) ..... Rs.250 Date: Name: Address: Telephone: Email: City: State:Zip: Country: INSIGHTS SUCCESS MEDIA TECHLLC Check should be drawn in favor of: CORPORATEOFFICE Insights Success Media Tech LLC 555 Metro Place North, Suite 100, Dublin, OH 43017, UnitedStates Phone -(614)-602-1754,(302)-319-9947 Email:info@insightscare.com For Subscription :www.insightscare.com

17. 10 The Most Trusted HOSPITALS in Pune2018

18. Preservation: Science that isMaking Parenthood Possible in LaterYears Fertility F ertility preservation or preserving ones’fertility potential for future use is a concept which isthough recent but gaining rapid popularity. Thisconcept was initially conceptualized for young cancer patientswho would after a lifesaving treatment have a long-life span. And the treatment offered to them had the potential of causing irrevocable damage to their gonads and gametes, there by compromising future prospects of having theirown biological child, this was termed as “Medical Fertility Preservation”. Medical fertility preservation allows such patients to safeguard their fertility and reproductiveabilities by storing reproductive cells(gametes) or tissues at subzero temperatures for future use as when desired. However, in recent times the application of this technique has also gained popularity with perfectly healthy women who are seeking to delay child birth. These women can preserve their oocytes(egg) of when they are young and use them in the future when they are ready to start their families this is known as “Social eggfreezing”. These two distinct entities of Medical Fertility preservation and Social Fertility preservation come under the purviewof distinctively different ethical and practical concepts. And since they both will have their own distinct risk and benefit consideration, we need to discuss the twoseparately. Medically Indicated FertilityPreservation Medically Indicated fertility preservation is offeredto 16 | August 2018|

19. Expert’sViewpoint About theAuthor Dr. Ritu Hinduja, MD, MRM (UK), DRM (Germany), Fellowship in Reproductive Medicine(India, Spain, Israel), and Certificate in Genetic Counselling, is renowned medical practitioner who has proficiency in reproductive medicine and infertilitytreatment. Dr. Ritu has more than eight years of vital experience in the infertility treatment field and has won many prestigious awards for her contribution towards healthcare vertical. Dr. Shantabai Gulabchand Travelling Fellowship Award, Dr. Pramila Bhatia-Young Scientist Awardaresomeofthenotablewardsthatshehaswonin recenttimes. Dr. RituHinduja MD,MRM (UK), DRM(Germany) patients who suffer from some medical condition, most commonly cancer or for some unavoidable circumstances have to face life saving medical treatments which have the potential of completely destroying their gonads (ovaries in women and testes in men). For example Chemotherapy and Radiotherapy while being lifesaving, are also toxic to the reproductive cells (eggs and sperms). So the ideaoffertility preservation is to cryopreserve reproductive cells (or tissues) away from the damage of the treatmentsorailment. With the dynamic advances in the treatment of cancer increasing number of young patients are able to battle this life threatening disease and are able to lead long lives with relative normalness. And hence a lot of cancer specialist now encourages these patients to preserve their fertility so that they can have a chance at having their own biological child whenever they are ready for it. Fertility preservation before Chemotherapy or radiotherapy allows these patients to realize an important human desire of procreation and more importantly with their owngenetics. As any new technique which is introduced in the medical branch initially medically indicated fertility preservation was considered experimental, however now after so many advances especially like vitrification (rapid freezing) and after successfully freezing thawing and eventually achieving pregnancies it is now a proven technique endorsed by many medical practitioners. Though the success rate of achieving pregnancy is not a 100 percentyet • the benefits of preserving fertility is far beyond when compared to lifelong sterility with no means of having a biological child which can be a devastatingconsequencefor almosteveryone. • There are different methods of fertility preservation thatcan be offered to a person depending on the medical condition or the type of treatment they are seeking along with the patient’s personal circumstance. Some of the things that need to be considered before drafting a line of management for cryopreserving gametes or tissuesare: • How soon is the treatment goingstart? • Does the patient have a committed relationship oris • What is the line of management drafted forher single? condition? Is it medical? or Is itsurgical? • What is the preference of the patient to preservehis/her fertility? • Therefore it is crucial that there is a close collaborationand communication between the patient, the treating physician, the reproductive medicine specialist assisting in fertility preservation and a clinicalpsychologist. • Following are the types of fertility preservation that canbe discussed • Egg or sperm cryopreservation – if not married or ina | August 2018 |17

20. Expert’sViewpoint undergone ovarian stimulation to increase the number of eggs available for collection. Once the eggs are collected, instead of fertilizing them with sperms and they are cryopreserved on the same day for egg freezing. The number and quality of eggs collected and the overall success rate for the procedure depends on the woman’sage, the reason for the treatment and other factors. A woman may need to undergo egg retrievals more than once to collect sufficient number of eggs. For Embryo freezing on the day of egg retrieval the eggs are fertilized with the partner’s sperms and then cultured in the laboratory for 3or 5 days the best created embryos which according to the embryologist can survive the stress of freezing and thawing are thencryopreserved. If just eggs are cryopreserved then whenever a pregnancyis desired, the frozen eggs are thawed and fertilized with sperms via a process called Intra-Cytoplasmic Sperm Injection (ICSI). Once the uterus has been appropriately prepared, one or two of the best quality embryos are transferred into the uterus forimplantation. Recent international researches have shown that, the use of frozen eggs has the potential to give similar results asusing freshly collected eggs provided the egg has survived thawing. Published data suggest that a single pregnancy may be achieved on an average from about 10 -15 frozen eggs. The introduction of a new freezing technique known as Vitrification has now made egg banking/ embryo banking a much more realistic option. Vitrification or flash-freezing is a technique which cools at a very fast rate, such that the tissue is preserved in a glass-like state (hence ‘vitrified’) without the formation of damaging ice crystals.Vitrification is associated with better survival rates for eggs/embryos than previously used slow-coolingtechnique. Ovarian TissueFreezing Currently considered as an experimental procedure it involves removal of the ovaries partially or in complete surgically before the treatment is started. Removed tissue that contains the immature eggs/ oocytes are divided into strips and then frozen for future use throughre-implantation or in vitro maturation of eggs (process of culturing the eggs in the lab and waiting for them to attainmaturity). Ovarian tissue freezing is not suitable for you there is a high risk for ovarian metastases. However, it may bethe only fertility preservation option for pre-pubertalgirls. • stable relationship/or patientspreference • Embryo Cryopreservation – if married or in astable relationship • Ovarian Tissuecryopreservation • Whatever technique is decided the pros and cons shouldbe discussed in depth with the person seeking fertility preservation. • Social Egg freezing • Fertility preservation via egg freezing was originally offered to women suffering from cancer or medicalreasons, but over recent years the popularity of putting eggs on ice for non-medical reasons, dubbed “social freezing”, has grownrapidly. • Owing to various reasons such as wish to pursue a career, achieving educational goals, attaining financial independence, wanting the freedom of exploring a relationship before starting a family or not finding the “Mr. Right”, a woman may wish to delay motherhood.However, time and aging can be cruel; the biological clock does not wait for the woman to fulfill all her desires before she can finally decide to take on the mammoth responsibility of being a mother. Her egg number and quality keeps declining as she ages and this decline is inevitable. Hence freezing of egg or egg freezing has become a lucrative option for these women, where they can buy time to achieve in life all that they aspire to and can plan motherhood exactly when they are ready for it without compromising on their fertilitypotential. • Freezing of eggs has become increasingly popularamongst professional women during key stages in theircareers. • Companies such as Apple and Facebook offer female employee’s egg freezing as one of the employee perks.This has ignited a debate; whether egg-freezing represents the ultimate type of family planning for today’s professional woman. • The advent of egg freezing can be compared with that of the birth control pill. It empowers women by giving them a form of insurance against later-life infertility. Women today can delay motherhood, until the time she is ready for it. It allows a woman to have the same probability of achieving pregnancy as she would have had when she cryopreserved her eggs – thereby freezing her fertility intime! • Egg Freezing/Embryo freezing • The approach is based on Assisted Reproductive Technology (ART) developed to assist couples battling infertility. Eggs /oocytes are retrieved after a womanhas 18 | August 2018|

22. AIMS Hospital & Research Center: ServingthePeoplewithUtmost Devotion &Humility Tforaying intothecityandmajor hospitals slated for he healthcare segment in Pune is undergoingan home like feel, and this fact makes AIMS different thanits competitorcolleagues. interesting metamorphosis with healthcareplayers expansion. The major strength of this city is itshugely AIMS recognizes and believes that, “Every patient is important, and hence deserves the very best carepossible. We will not be mechanical in our approach to work wedo, and will take personal care of ourpatients.” The Outstanding Doctors and Leaders ofAIMS Dr. M. S. Hiremath, is a qualified MD, DM, MNAMS, FISE, and is a leading Cardiologist of India. He strongly believes in providing the best quality treatmentandprompt services to patients. He is a world reputed interventional Cardiologist; Dr. Hiremath has performed over1, 00,000 angiographies, and more than 30,000 angioplasties including coronary, peripheral, and carotid interventions. He also specializes in Carotid Stenting, Aortoiliac interventions, and peripheral angioplasties for legattacks. expanding population base. With this, comes a challenge to provide the best healthcare to the ever increasingpopulation of the city. Aundh Institute of Medical Sciences or AIMS Pune is one of the newest additions to the healthcare segments in Pune. This hospital is already shaping to beone of the most committed hospitals that maintain clinical excellence by focusing on top class healthcare services, and uses the latest medical technology to doso. Having a team of qualified doctors for treatment, assisted with the well-trained Nursing & Para Medico staff working round the clock for patient care, assists AIMS to deliver state-of-the-art healthcare services to all its patients. It hasa prompt administrative staff to help patient to feel ease during their admission to the Hospital. It gives anoverall 20 | August 2018|

23. He has additionally proctoredmany interventions in Malaysia, China, Vietnam, and Bangladesh besides participating in global trials.Dr. Hiremath is also a prestigious faculty at various internationalinterventional programs. Another renowned Gynaec Laparoscopic Surgeon and IVF Specialist associated with AIMS is Dr. Kishore Pandit, who is a faculty & speaker at various national and international societies ofgynecological endoscopy. He has been bestowedwith memberships of many prestigious organizations such as Society of Laparoendoscopic Surgeons (SLS, USA), International Society of Gynecological Endoscopy (ISGE), International Society for Gynecologic Endoscopy (IAGE), Pune Association of Gynecologic Endoscopy Surgeon (PAGES) and Indian Medical Association (IMA). Dr. Kishore is the Founder President of PAGES, and General Secretary (2012– 2013) of Pune Obstetrics & Gynecological Society (POGS). At present, he is the Executive Vice President of POGS. One of the Directors of the hospitals Mr. Gokul Gaikwad is from the Social Service background andleading to AIMS, as continually improving its capability to identify, develop & provide services that are valued by its patients and result in good clinical outcome. Mr. Gokul Gaikwad vision is- The hospital always committed to quality, as an integral part of its total operations with the goal of achieving clinical excellence, patientsatisfaction, and safety, apart from its unique services. The distinguished ex-honorableMayor of Pune (1999-2002), Mr. Datta Gaikwad is also an integral part ofthe core team of AIMS. The recipient of ‘The Best Corporator, PMC’ (awarded by Rajiv Gandhi foundation), Mr.Gaikwad, is a Chairman of Chaturshrungi Devasthan Committee, and is a crusader pursuing multi- faceted development for the Aundh region. Mr. Rajeev Krishnani, is a real estate wizard. His Water Conservation theory & suggestions have been accepted by the PCMC. He is an elected President for the West Zone, of the Sports Development Board of India,including Therapies),AdvanceHAMILTON- C2andVentilator-ICU. AIMS is determined into supporting government schemes like BPL, PMC, PCMC & Own Social works to namea few. Growth & Testimonials thatSpeak Bounds Statistically, AIMS is growing significantly year after year with a remarkable progression. Thehospital’s recommendations and services themselves speak about trust it has built in the citizens. It has done the highest number of successful Cardiac treatments & Laparoscopic surgeriesin thearea. the states of Maharashtra,Madhya Pradesh, Gujrat, Goa andJharkhand. ‘ • A Senior Neuro Surgeon Dr.Sanjay Vhora (HOD of Sasoon Hospital) has operated a 52 years male patient with “h/o Cervical Cord Compression C4-C7 Stenosis.” Surgery- Decompressive Cervical Laminectomy C4-C5,C6-C7. • Dr. Wagholikar Gajanan &Dr. • Agashe Prasad operated, a 35years old female patient diagnosed with “Choledocal Cyst with lower CBD stricture, CBD stone and ERCP stenting done.”Surgery- Cholecystectomy with excision of Choledocal cyst, removal of CBD stone andHepatico-Jejunostomy. We believein providingpersonal care and quality services that are state-of-the-art to our patientsat ‘ an aflordableprice Exceptional ServicesBenefittingthe Patients & Industry AIMS, is working towards patient care with a motivated team ofMedicos,Para Medico’s & Administrative staff. Ithas been built by some of themosteminent Doctors & Social Entrepreneurs of Pune. In vicinity of seven km, no such equipped and qualified facility is available, accessible and affordable. It has one of the best world class ICU facilities in the area, a finest Cathlab facility & cardiac department, and IVF center. AIMS, is currently getting equipped with the latest CABG (Coronary artery bypass grafting), CRRT(Continuous RenalReplacement Future Goals & Vision ofAIMS The hospital is striving towards promote, restore, and maintain the health of all the people that come to AIMS. It works with a goal to achieve a bed capacity of twohundred,making Super Specialty Medical treatment available to all itspatients. | August 2018 |21

24. Fine-Angle -Functional andAesthetic Rhinoplasty About theAuthor Dr. Virendra Ghaisas is India’s leading ENT & Rhinoplasty Surgeon, based in Pune. A graduate from KIMS Karad in the year 1996, Dr. Virendra completed his MS (ENT) from JNMC, Belgaum in the year 2001. He then completed his special training on Rhinoplasty from Marien Hospital, Stuttgart and specialised in Facial PlasticSurgery. He has presented papers in National, Zonal and regional conferences and has won accolades for presentingpaper presentation. His contribution tomentor undergraduates and post graduates through an educational DVD helps students to learn from him. Virendra is an associate professor at MIMER Medical College. Being a renowned ENT Consultant and Rhinoplasty Surgeon, his professional experience includes: Guest Lecturer and Operating Faculty on Rhinoplasty and Live Surgical Otological workshops and camps at variousAOI&acrossthecountry. 22 | August 2018|

25. Fine-Angle n today’s world, we oftencome necessary techniques under direct vision. Although there is a small scarat the column of the nose which fades away in a few weeks, the outcomes of open Rhinoplasty gain advantage over the closed techniques. Most skilled surgeons do not use any artificial grafting materials. Tissues like cartilage and fascia from various sites like the nasal septum, ear cartilage,and rib cartilage are used to reshape the nose. There are a few non-surgical techniques like “fillers” an alternative for the surgery to camouflage minor defects although the outcome of such procedures is temporary. For a long lasting and permanent change “Rhinoplasty” is the only solution.The nasal anatomy and proportions of each individual are quite varied and thefinal look of any Rhinoplasty operation is the result of the patient’s anatomy, as well as of the surgeon’sskill. Rhinoplasty is generally an outpatient surgery which is done under general anaesthesia. With evolving technology and skilled surgeons in this field, the outcome is expected to be nothing but the best. Medical science cannotensure a 100% guarantee and keeping that in mind, surgeons take utmost care to deliver precise results. Few cases that sometimes need corrections after surgery can be revised after a waiting period of about 12 months. About 10% of patients require a second procedure; however, the revisions required are usuallyminor. Awareness on Rhinoplasty is wider in western countries compared to India. According to surveys, awareness level in countries like Europe, USA & Japan is huge. Most parents in Korea gift hospital coupons to their children atthe age of 17 to get a nose jobdone. Children in Europe mostly getsuch surgeries done at the age of 16 to improve the shape of thenose, aesthetically, not necessarily that they suffer from functional complexities. With the recent trends and vast exposure, India is witnessing growing awareness about Rhinoplasty in the younger generation. While our country is competing with the rest of the world in a variety of areas, Indian education plays a very important role in shaping a child’s career. Therefore, most of the aesthetic surgeries are planned afterthe age of 18 years until it is inevitable to adjourn. Although with changingtimes and with the influence of Bollywood industry, the younger generation opts for aesthetic Rhinoplasty. Having said this, our country is predominantly grounded to our traditions and culture. A surgery is more of a family’s decision than an individualchoice. Therefore even today 70% surgeries in India are done to improve the functionality of the nose rather thanfor aestheticpurpose. While Rhinoplasty is one of the most popular cosmetic surgeries in the world, a 2017 Report byInternational Society of Aesthetic Plastic Surgery (ISAPS) states India amongst the top 10 countries to perform Rhinoplasty surgeries, having male to femaleratio of 60:40. Countries with emerging economies like India, have more disposable income hence there is a growth in the spent for aesthetic surgeries seen mostly amongst the youngergeneration. In the future, Rhinoplasty is projected to grow in India with improved standards of healthcare technology driving the growth of medical tourism industry. Other factors such as rising aging population worldwide, availability of affordable world-class medical facilities in emerging economies, and high medicalinsurance costs in developed regions areboosting the demand for medical tourism globally. across people who havemade surgery either due to a malformed nose at birth, deformed by an injury or for a more pleasing appearance.Rhinoplasty more commonly known as “nose job” is a surgery performed to sculpt the shape of the nose which is referred as “Aesthetic Rhinoplasty” as well as to improve the breathing function of the nose, invariably termed as “Functional Rhinoplasty” which further helps to nullify the associated problems. If breathing is impaired due to the form of the nose or an injury, it can often be improved with Rhinoplasty. Although the expressed goal of such a surgery is to correct breathing issues, patients usually experience positive cosmetic benefits such as enhancing the shapeof the nose as a bonus. In this demanding world and growing trends,Rhinoplasty is not only done to improve the functional aspect of the nose but also for its aestheticoutcomes. Rhinoplasties have evolved over thousands of years. Many countries have put their imprints on the Nasal surgery procedures which are clearly stated in the medical history. Today, Rhinoplasty continues to advance at an even more rapid pace and has become safer and less invasive with the growing techniques and expertdoctors. Before a Rhinoplasty is performed, a patient’s nasal pyramid is thoroughly examined with an endo-nasal examination and its harmony with the otherfeaturesoftheface.Asimulation of the desired result is done using photos and computer techniques. A preoperative check-up is carried out. There are two types of techniques to perform the surgery, “open and closed”. In closed Rhinoplasty, all the incisions are inside the nostrils and thereby provide a very limited exposure. Open Rhinoplasty gives wide access to perform allthe Irevisions totheir nose through a | August 2018 |23

26. Wcomfort. Customer-centricity is setting newer trends inevery industry today. In thehealthcare ith every blink of an eye, someone somewhere is making new developments andinnovations. One of the key factors driving these advancements is the realized need to improve thepeople’s sector, patient-centric developments don’t just help in improving the patient’s comfort; it aims atbettering their lives. Personalizing care is the perfect formula for incorporating customer-centricity intohealthcare. The trend has changed from treating the immediate problem of the patients to helping them in leading healthier lives. Not all human bodies react similarly to a medicine or a treatment process. An optimizedcare has to be identified to deliver the perfect treatment for a particular patient. Although this is a far-fetched dream, the concept of personalized medicine has brought us a little closer toit. Additionally, the approach of people in selecting their healthcare provider has become more sophisticated.As consumers seek affordable healthcare resorts and worthwhile experiences with their doctors, the healthcare organizations have to work in the direction of satisfying these requirements. Providing health care is not a one-time transaction; people need this service repeatedly, throughout their lives. It also involves variedand 24 | August 2018|

27. CustomizedCare HEALTHCARE Optimizing with Precision Medicine and Personalized PatientExperience genomic medicine, is the answer toamelioratethe existing healthcaremethodologies. complex experiences, involving emotional andpersonal subjects. Meticulous attention to the patients’ preferences and behavior is of importance. With this, instant connection, instant solution, real-time feedback, and personalization in the care industry have drifted far from just being a luxury; they have become anecessity. Precision Medicine The medicines and treatment processes that have been known to the human kind are based on the defined “standards of care”. These standards are described based on the responses of the general population, i.e. howmost of the patients react to a particular treatment ormedicine when detected with certain specific symptoms. This method is based on “trial and error”; if the given treatment does not have any effect on the patient’s condition, a new treatment is tried. Every human body does not just react differently to different drugs; it reacts differently to various doses of the same drug aswell. Precision medicine, also known as personalizedor Personalization of medicine means tailoring a specific medicine for a particular person depending on thefactors like the person's gender, age, genetic structure, proteins, environmental conditions, and so on. It has emerged as a new frontier in the care industry based on population health, genomics, and big data. Overcoming the drawbacks of the currently used “trial and error”method, it comes with the promise to not only improve extant treatment methods but the lives of the patients aswell. Prevention and cure of chronic diseases will beenhanced to a great extent with the introduction of precision medicine. Personalizing Healthcare Enhancing PatientEngagement The old ways to communicate with patients have rendered unpopular in today’s digital world. Most ofthe | August 2018 |25

28. CustomizedCare healthcare providers are focusing on personalizing the communication between the doctors and their patients. It can be beneficial for both the parties. To create a relevant and targeted patient outreach, now the healthcare industry has various tools for upgrading patient engagement. With the help of technologyit has become possible to digitally maintain and manage patients’ records, their history, appointment management, and much more, making the process very smooth. And with big data in the picture, it is possible to collect and store immeasurable amount of information. It is also easy for the doctors or the healthcare providers to access and process this digital information in real-time, subsequently helping in better patientengagement. Since patients are increasingly taking charge of their own decisions and selecting what they find bestfor themselves, personalized communication will help to attract and retain more number of people. With patients going digital, it is necessary for the healthcare providers to align to their needs. Delivering relevant and accurate information on time to the patients has become significant the healthcare professionals. Elevating Patient Experience to TriggerSatisfaction According to a prominent source, now-a-days, numerous patients tend to change their healthcare operators if they are not satisfied with the service received. This focus on increasing the satisfaction is due to thefact that most of the medical costs are shouldered by the patients today. This satisfaction is directly related to the patient’s experience. Enriching this experience depends upon the healthcare provider’s expertise and facilities. Organizations can trigger this by simple methods of patient personalization, like clear communication, spending sufficient time with the patients during the appointments, patient engagement after appointment, incorporating timely reminders for medicines in the patient’s routine, and soon. There is a shift in healthcare philosophy from treating the detected illness to enhancing the health of the patients. To address this shift patient personalization provides a discourse to topics like preventive healthcare screenings, lifestyle changes, and so on. It has become easier for the patients to select theright healthcare provider as well as to place their trust in their doctors. Patient- Centered Care will enable the healthcare providers to fulfill the wishes and the needs of the patients as well as improve the health ofthe population, as awhole. The digital revolution has brought with it many changes across various industries. The newly emerging tech-savvy generation, today, demands better experiences and personalized content. Staying alignedwith this pattern; the healthcare industry is moving ahead to improve patient-centered care. Patient-centered care can be categorized broadly into two: Personalized Medicine and Patient Personalization. While patient personalization is focused on improving the whole experience of the patients in order to ensure satisfaction, precision medicine will trigger better treatments and prevention of diseases in patients, improving the quality of life. To stay in the race, patient personalization has become the need of the hour for healthcare professionals across all sub-domains of the careindustry. 26 | August 2018|

30. Oyster & Pearl Hospitals: A Pioneer in ModernMulti-Specialty HealthcareIndustry Dr. AmitaPhadnis CMD H ealthcare has been a subject ofimmense providing cutting-edge treatment to patients fromacross India and the world with the comfort of experienced doctors. Having a sixty year old legacy, the skilled professionals at ONP have seen it all: the most critical cases and the most challenging medical problems. Aided by years of experience, they provide the best treatment to theirpatients. About the Ingenuous, PassionateLeader The CMD of Oyster & Pearl Group of Hospitals, Dr. Amita Phadnis, is a multifaceted personality, whose driving principle in life is the pursuit of excellence. Shehas achieved professional excellence in the fields of Pediatrics & Neonatology and excelled as a healthcare entrepreneur. She continuously updates her skills and knowledge tostay importance to the humanity since itsinception. Good health is the key factor to humanhappiness and well-being. In today’s scenario, healthcare hasbecome even more crucial. By leveraging the technological innovations, the healthcare sector is developing gradually every day. In the recent times, India has led the path of offering the most advanced and remarkable medical care. Oyster & Pearl Hospitals, popularly known as ONP, isone such leading brand who have pioneered modern healthcare in number ofways. Oyster & Pearl Hospital is a team of passionateindividuals that came together due to their shared quest for a healthy community. With five hospitals across Pune, ONP is the leader of medical care in Western Maharashtra. It specializes in IVF and mother & childcare inPune, 28 | August 2018|

31. an advantage ofwidespread exposure. • Expertise: Having experts and pioneers in numeroushealthcare fields helps them to assist their patientsefficiently. • Safety: Patient’s safety is ofutmost importance. • Trust: Patients have placed theirtrust in ONP’s services from last sixty years. • Providing Benevolent Facilitiesfor theUnderprivileged • Oyster & Pearl provides free checkup to the underprivileged. They organize “Shibir” and health camps jointlywith NGOs and civil society. They conduct WOMB (Wellness of Mother and Baby) sessions cost-free for thepublic at large. There are provisions for child deliveries at nominal rates as well as specially designed MOM and WOMB packages for ‘below poverty line’ mothers and lower socio-economic strata of the society. • Future Plans • In the next few years, ONP plans to specialize in all the medical treatment facilities, including liver and kidney transplant. They are working on upgrading the existing neonatal care units to the leading-edge tertiary/quaternary neonatalcareunits, which will be supported and managed by highly qualifiedneonatologists. • Their aim is to develop state-of-the-art infrastructure and expertise, in order to serve the society in multiple specialties, including organtransplants. abreast with new developments and technology by reading journals and visiting conferences and renowned healthcare centers, keeping asidefew weeks of time for this purpose every year. Amita is also a charismatic speaker and has been successfully conducting workshops on various topics. She started her practice in Pune in the year 1992; she set up the first tertiary level Neonatal ICU, called Neo Clinic. In a few years, this clinic grew into a full-fledged Children’s Hospital offering comprehensive medical & surgical services for children,including a transport ambulance. After that, she worked at Sumati Health – Health Evaluation & Lifestyle Therapeutics as well as in the diagnosis sector, before joining Oyster & Pearl Hospital in 2008. Bringing with herself the vast experience of twenty-two years in clinical practice, she has established ‘The Pediatrics and Neonatology Department’ in ONP. Under her guidance, ONP has been expanding continuously and there’s no looking back. Multi-Specialty HealthcareServices From basic services like general medicine and surgery, pathology, ENT, and ophthalmology to complex treatments like plastic and cosmetic surgery, neurology, and oncology, Oyster & Pearl Hospital provides everything. It provides the facilities for endoscopy and cardio-thoracic surgery, neurosurgery, spine surgery, orthopedic and joint replacement, oncosurgeryand radiology for cancer treatment, as well as treatment for EMS trauma, childand adult psychiatry. It also has departments for urology, nephrology, and gastroenterology. ONPspecializes in child-birth and infant care and provides services in obstetrics, gynecology, pediatrics, and neonatology. Moving along with the technology, it has adopted modern medical techniques like, laparoscopic surgery, as well. Other than these services, ONP has various healthcare units like ICU, neonatal ICU,coronary care unit, modular operation theatres, and cathlabs. Patient-Centricity at Oyster &Pearl The journey of ONP started 60years ago and since then the hospital isbased ‘ Touching lives, Changing Futures ‘ on the most basic aspect ofhealthcare- the bond between a patient and a hospital, where the patient is centralto every thought and action. This is what the name of the hospital as well as its symbol reflects; a pearl inside an oyster. With a team of highly qualified doctors and skilled professionals, supported ably by cutting-edge technology, ONP has become atrusted name acrossgeneration. ONP’s CoreValues It is driven by four core values thatall the people at ONP believe in: Experience, Expertise, Safety, and Trust. ŸExperience: Sixty years of legacy in healthcare industry, givesthem | August 2018 |29

32. Reforms inIndia Healthcare WIndia is currentlyahometo ith a population ofmore provide the people their right to free quality health care. The fact that 57% of households have cited poor quality of care offered at governmenthospitals as the major reason for preferring private sector over public sector is a major testimonial to the negligent attitude of the government towards healthcare reforms. Currently the healthcare system of India cannot completely mitigate the needs of Indian population. Because the Indian government spends only 1.2% of its GDP on the health sector, out-of- pocket payments make up 75% of the total expenditure on health care. 40% of the people that are hospitalized are either pushed into lifelong debts or below the poverty line! About 23% of patients do not have sufficient money to afford medical treatment where as 63% of the patients lack regularaccess to necessary medications. In simpler terms, this means that, the government has not been able to provide for a major proportion of our population an access to health care services. These facts and figures make us contemplate about the healthcare policies and reforms introduced by the government and question whether their implementation was in synergy with the true spirit of theirformulation. than 1.3 billionpeople, a fifth of the world’spopulation. Although India’s population growth rate has been showing a decreasing trend since more than three decades, population is still increasing by 1.2% annually. The UN predicts that India will be world’s most populouscountry by 2024 and by 2030 India will become the first political entity to reach the 1.5 billion peoplemark! India is world’s sixth largesteconomy by GDP (nominal) and the thirdlargest by purchasing power parity, and yet it spends only about 1.2% of its GDP on health sector – among the lowest inthe world. The constitution of India guarantees free healthcare for all its citizens, and yet private healthcare sector has been the primary source of health care for 70% and 63% of households in urban and rural areas of India respectively. 58% of India’s hospitals are run by private sector and a whopping 81% of doctors serve in private healthcare sector. On the other hand public healthcare sector has catered to only 18% of total outpatient care and 44% of total inpatient care. Clearly the Indian government has failed by farto 30 | August 2018|

33. IndustryInsights AboutAuthor ThisarticleiswrittenbyProf.Dr.SudhirV.Medhekarand Mr. PankhilGandhi. Dr. Sudhir is currently serving as the Head of the Dermatology, Venereology and Leprology, at Government Medical College, Aurangabad. He is one oftheestablishednamesinthefieldofmedicineinIndia. Having completed his M.D. in dermatology and cosmetology from the University of Mumbai, he has distinguished skills in the fields of Clinical research, Medical education and Technology. Prof. Sudhir has investedhissoulstrengthtowardshelpingtheneedyand enlighteningthebrightmindsoftomorrow. Prof. Dr. Sudhir V.Medhekar Head of the Dermatology VenereologyandLeprology OntheotherhandPankhilwiththestrongbackingofhis PharmD education, from the esteemed Government College of Pharmacy, Aurangabad, is achieving great heights at his organization. He possesses exceptional expertise in Clinical Research, Biostatistics and Clinical PharmacyServices. Mr. PankhilGandhi In 2005, the government launched National Rural Health Mission (NRHM) with an aim to address the longstanding issue of lack of professionals in rural area. The goalsof NRHM were to provide effective healthcare to rural people. For this a compulsory rural service for young doctors was instituted in the hopes that they will remain in rural areas. In the Twelfth National Plan, Indian government decided to expand NRHM to the entire country and called it National Health Mission (NHM). In 2013, National Urban Health Mission (NUHM) was approved as a sub- mission of NHM. NUHM aims to have one Urban Public Health Centre for each population of 50,000 and aims to fix current facilities and create new ones. Improving sanitation and drinking water and reduction ofout-of- pocket expenditure for treatmentare among other aims ofNUHM. In 2011, a report that was compiled by High Level Expert Group (HLEG), which was constituted by the Planning Commission of India, gave an elaborate financial plan andframework for Universal Health Coverage (UHC). The HLEG defines UHC as “ensuring equitable access for all Indian citizens, resident in any part of the country, regardless of income, social status, gender, caste or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative, and rehabilitative), as well as public health services addressing the wider determinants of health deliveredto | August 2018 | 31

34. IndustryInsights • individuals and populations, with the government being guarantor and enabler, although notnecessarily the only provider, of health and related services.” Following were some of the key recommendations of theHLEG: • Development of a national health package which would offer essential services as a part ofcitizen entitlement • No fee of any kind to be charged for healthcare services under UHC • General taxation to be used as principal source of healthfinancing • District hospital networks to be strengthened as care delivery and trainingnetworks • Effective contracting guidelines with checks and balances for care provision to the formalprivate sector • However due to some slackening in India’s economic growth, UHC was shelved. It was only in 2018 that the course of UHC was reset when the government introduced ‘Aayushman Bharat’ project in the national budget. This initiative has two components, the first of which has been named NationalHealth Protection Scheme (NHPS). The government has allocated a fund of INR 20 billion. The central government will bear 60% of the costs of NHPS and the remaining 40% will be contributed by each state. Under NHPS, the government plans to provide coverage up to about INR 5 lakhs per family per year for secondary and tertiary care hospitalization. Second component consists of upgradation of 150000 subcentres into Health and Wellness Centres (HWCs) across the country. These HWCs will offer free basic clinical and preventive services including simple diagnostic tests and provide essential generic drugs toall. • Upon implementation of these aforementioned schemes it is obvious that the vacancies will be on the rise. The WHO prescribes ideal doctor population ratio of 1:1000. India has a doctor population ratioof 0.62:1000, far less than the recommended figure. To overcome this dearth of physicians, the government has an ambitious plan of one medical college in each district of India. Even though the government is a long way from achieving this herculean task, the progress of government for the same iscommendable. • The profession of pharmacy has been an integral part of the healthcare systems of many countriessince decades, and yet it was not until recently that a curriculum for Clinical Pharmacists was initiated in India. Till then India was essentially missing on an entire segment of clinical pharmacy services in its healthcare system, considered to be crucial for the provision of quality healthcare. In 2008, a six years integrated post-graduation course for the qualification PharmD (Doctor of Pharmacy) was instituted by the Pharmacy Council of India. With initiation of PharmD course, Indian healthcare sector will nowsee a rise in the number of clinical pharmacists. Being trained to provide services like comprehensive patient counselling, detection and management of drug related problems and adverse events, therapeutic drug monitoring and provision of cost effective therapy, these clinical pharmacists will add a previously non-existent segment of clinical pharmacy services into the Indian healthcaresegment. • In conclusion, it can be said that although the government has now initiated ambitious healthcare reforms, it still needs to ensure their success by meticulous planning and robust implementation. The government needs to do more to utilize other healthcare professionals like physicians from Ayurveda, Homeopathy, Siddha and Unani backgrounds, Pharmacists and Nurses, but at the same time ensurethat the quality of healthcare services is not compromised. Surely HWC-led comprehensive primary health care and NHPS will increase access to health services. For these schemes to succeed, the healthcare workforce needs to be scaled up in both, number and quality. On other hand, regulatory systems also need to be strengthened to improve quality and accountability by keeping stringent checks on the healthcare sector. Although India has committed to UHC, it may take years to achieve it in true sense. Nonetheless, provision of UHC is a revolutionary reform for Indian HealthcareSystem. 32 | August 2018|

35. Community Care Collaboration (C3)Model CareTeams Family, friends and Professional communitycare providers Mobilize CareActions Care instructions distributed via mobile devices sharedby CareTeams vi LifestyleSupport Access to lifestyle products/servicestokeep people in theirhomes Because together, we’re better. Our C3 model – Community Care Collaboration – supports care programs that require high levels of collaboration between interdisciplinary care providers, patients,andfamily caregivers. Our goal is your goal: to keep patients independent, living comfortably in theirhomes. Care3.co

36. PawanaHospital: ProvidingWorldClassPatientCare foraHealthyLifeTime Dr. SatyajitWadhokar ManagingDirector Ehospitals within theMaval Pune region.Sincethen, Forerunners in Providing Multispecialty Care Pawana was instigated with a humble beginning of 10 bedded hospitals, in February 1997, and today it hasgrown to over 120 bedded multispecialty hospital. Since then, Pawana is uninterruptedly serving needy patients with the widening domain of services. After this initialmomentum, PH introduced ICU services in December 2000 whichwere inaugurated by Late MP Sunil Dutt, to providelifesaving facilities to critical patients in remote areas, ataffordable costs. From its experience, the essential traits which has lead the organization to achieve outstanding heights, are leadership skills with the effective communication, accompanied by the positive energy, followed by the ability to energize others, and releasing their positive energy to take any hill. As a responsible corporate citizen, Pawana Hospitalstakes the spirit of leadership well beyond business, and has embraced the responsibility of keeping community healthier. stablished in 1997, Pawana Hospital is one ofthe largest time-honored privatemulti-specialty Pawana Hospital has risen to a position of leadership,and has emerged as the foremost integrated healthcareservices provider. The mission of Pawana Hospital is to continuously strive hard to serve the society, accomplishing highest quality health care services, providing this in a cost-effective way. Though in the rural area, the hospital NABH and ISO 9001:2015 accredited and these are the cornerstones of Pawana’s legacy. The healthcare provider focuses on patient safety, affordable healthcare, clinical excellence, customer welfare, ethical practices, occupational healthand safety, workforce training, and compassionate care of mankind. Pawana Hospitals is among the first fewhospitals in Maval Taluka to be influenced by the technology to facilitate seamless healthcare delivery through, hospital information systems, and outreachinitiatives. 34 | August 2018|

37. group etc. Currently, the hospital is providing free mobile clinic service to Interior Rural Area of Maval villages which are Urse, Chandkhed, Bebedohol, Baur, Parandwadi, and Ozarde, in collaboration with Finolex Cables ltd. After catering needs ofrural population, hospital also extends its services & hospitality to foreign patients from Middle East countries like Yemen, Qataretc. Though serving in the rural area, pioneer in critical health careservices and cardiac services in MavalTaluka. Accolades of PawanaHospitals Neuro, Spine, and JointReplacement Surgery with ultra-modularoperation theatre setup. They provide roundthe clock facilities like Emergency and Trauma unit, ICU, CCU, NICU, Modular Operation Theaters, LDR, Physiotherapy, Dialysis,etc. Apart from these core services,Pawana has super specialty services in various disciplines like Cardiology (Cath lab), cardiothoracic surgery, Neurosurgery, Neurology, Urology, Nephrology, Gastroenterology, Plastic & Vascular surgery, Oncosurgery, Oncology Pediatric surgery, Spine & Joint Replacement Surgery. Diagnostic laboratory & Imaging Services, they have 24hrs available MRI, CT scan, pathology lab, microbiology lab,USG, The Able and ExperiencedHands behind Pawana When one talks about ordinarypeople bringing about change, one cannot afford to miss out on the guiding light of Pawana Hospitals; its Managing Director, Dr. Satyajit Wadhokar. He is the one who single-handedly renewed Maval Taluka in the map of Pune along with the support of hiswife Dr. Varsha Wadhokar. Dr. Satyajit has always been inspired by his father Dr. Krishnakant Wadhokar, who works in providing healthcare to the rural and tribal communities of MavalTaluka. He decided to follow hisfather’s footsteps in very early days of his childhood. After completing hishigher secondary education from Wadia College Pune, he completed his graduation from University of Pune in 1986. After the academics, he turned toget the real hands-on experience in medicine under the guidance and motivation of elite surgeonDr. Shrinivas Gore (Nana). Dr. Satyajit,an honored captain of the ship offers a blend of the finest medical andsurgical skills delivered with compassion, anda patient centric approach. Working on the noble principle of “patient’s interest first”, and with the support of his better half Dr. Varsha Wadhokar, Executive Director who is very much focused on quality health careservices, she aimed to provide high-levelquality care. Chief Operating Officer of the hospital, Mrs. Revati Mani has akeen eye on the quality & safety concernsof theHospital. Following parents footsteps elderson Dr. Pratik is pursuing MD Medicine and younger Dr. Pranav is pursuing MS Surgery. Distinctive Plethora ofServices Pawana HospitalsOffers Pawana Hospital is also one of thefirst centers to have critical lifesaving modalities with modern medical equipment in Cath lab, Medical ICU, and cardiac ICU. It also performsupra major surgeries like Cardiacbypass, • Vikas Ratna Gold Award for International Integration &Growth Society • Pardarshi Award byYeshwantrao • ChavanPratishtan • Appreciation award for outstanding& dedicatedservices rendered by RotaryClub • Kartabgar MahilaLaxmibai • Gokhale Purskar by hand offormer President PratibhataiPatil 2D Echo with carotid Doppler,digital X-Ray,etc. ‘ We strive hardto serve thesociety, accomplishinghighest quality healthcare Abiding by Its Precious Values At Pawana Hospitals patients’ satisfaction always comes first. Respect, Innovation, Team Work, Excellence, and Integrity are someof the prominent values that thehospital strictly follows to providestate-of-the- art patient care and healthcareservices. Pawana Hospitals adheres to the highest standard of professionalism, ethics, personnel responsibility, open communication, honesty, and trustworthy of its patients andteam. Present and Future ofPawana Hospitals Pawana hospitals’five-year development plan includes expansion with the new floors for ICU andwards. Pawana’s plans don’t just stop at infrastructure; it goes beyond providing medical careservices. Considering the rising emergenciesand road traffic accidents, a team has been trained to handle emergencysituations. The hospital also focuses on organ donationawareness. services, and providing all this ina cost-eflective way ‘ Regarding health services Pawana hospital focuses on preventive health screening and initiative. Considering the need of the time, PH would like to become accessible by digital appliances and utilize modern technology, to control administrative and operational work. PawanaHospital actively promotes awareness and educational programs on preventive care and training people on several health-relatedproblems. It has employees volunteering CSR initiatives and community development. Pawana Hospital organizes camps and awareness programs like blood donation camps, AIDS awareness programs, cancer detection and gutkha awarenesscamp for men, awareness ofadolescence | August 2018 |35

38. Mutant KRASGene: A Potential Targetto Suppress AssociatedCancers R AS is a gene family that makes proteins which control cell growth andcell death in a human body. KRAS, HRAS and NRAS are the members ofRAS gene family. This family produces more than 150 proteins. The RASgene in its mutated (changed) form can be found in one-third of the cancers. This mutated form of RAS gene produces defective proteins, which causes uncontrolled growthof cells leading to cancer, as well as it makes cancer resistant to the existing therapies. The most researched gene among the RAS family is KRAS. The mutated form of KRAS gene is capable of transforming healthy cells into tumours. It is majorly associated with aggressive cancers; KRAS mutations occur approximately in 30%of all the cancers. The studies say that 95% of pancreatic cancers, 30% of lungcancers, and about 45% of colon cancers have mutations in KRAS genes and do not haveany successful treatments currently. While some cancers originate from mutant KRAS, few cancers even seek this gene continuously to survive. Cancer-causing mutated KRAS genes were identified over three decades ago, and yet no therapy has been veryeffectiveagainstthem.Alotofresearchworkisbeingcontinuouslydoneinthis direction and some effective solutions have come tolight. A thorough study of KRAS structure, signalling and processing has helped infinding several anti-cancer treatments. Various direct and indirect methods, targeting KRAS mutations, are being explored. Inhibition of mutated KRAS genes that will blockthe 36 | August 2018|

39. Editor’sTake | August 2018 |37

40. Editor’sTake growth of cancer cells can be categorized as a direct method. Alternately, synthetic lethality falls underindirect methods to eliminate cancers associated with KRAS mutation. Mechanism of CancerFormation In the healthy cells, the information travels from the cell boundary to cell nucleus due to the protein made by the genes. The mutated cells produce defective proteins. The signals sent by the proteins determine whether or not the cell growth should take place further or the cell shouldstop dividing and mature. KRAS acts as a switch that turns“on” and “off”; when on, the cell division continues and when off, the cell division stops. Consider a small molecule, x, which is responsible to turn the switch “on”. In a healthy cell, this x molecule is converted to another molecule, y, which is responsible to turn the switch off. The x molecule in KRAS functioning is GTP and the y molecule is GDP. If the switch does not go to the “off” state the cells will continue to divide uncontrollably, further leading to cancer. Due to KRAS mutation, the switch is stuck at “on”state. This is because the proteins cannot perform x to y conversion. The stated process initiates the cancer formation. Some of the cancers that seek this mutatedgene for survival further trigger the excessive uncontrolled growth of cells. Therefore, even if successfully treated, there are high chances of the tumour to be formedagain. Possible TreatmentMethodologies Direct Method Using Inhibitors: Researchers have looked for a drug that can turn the stuck at “on” state switch off. But the x molecule forms a very specific bond with the protein. Breaking this bond is very difficult and no proper solution for it has been reached. It was then found that a mutant form of protein, called KRASG12C, can create permanent bonds with the small molecules. These bonded molecules can capture the cell in its inactive state, before it is trapped at the “on” state. This will further stop thegrowth of cancer cells and cause the shrinking of thetumour. Certain inhibitors have been discovered for theKRASG12C mutant. These inhibitors have been tested on mice, induced with human cancer. One of them is ARS-853. Inhibitor, GCS-100, has shown the capability of killing the cancer cellsaddictedto KRASmutants.AcompoundnamedARS- 1620 has also been discovered which is very effective and has to be taken orally. It was tested on a mouse and after some period of regular doses, it resulted in significantly reduced tumour growth. The stated compounds can beused as potential drugs in treating aggressive cancers in the future . Indirect Method Using Synthetic Lethality: It is found that synthetic lethality can also be used for cancer treatment. Two genes are said to be synthetically lethal if a simultaneous mutation in both leads to the death of both while a mutation in either one does not. Therefore, if the cells associated with cancer are targeted for synthetic lethality, only the cancer cells will die, sparing the normal cells. Synthetic lethality is also possible between genesand molecules. To identify synthetically lethal interaction in particular cells, the screening process isused. Varieties of screening methods are now available to study these interactions. As the process of synthetic lethality causes cellular death, this can be used in anti-cancerdrugs. Synthetic lethality is extensively being used in gene- selective anti-canceragents. Different compounds leading to synthetic lethality of mutant KRAS have been identified using RNAi screening technology. It has been found that a compound named “TBK1” is very effective with mutant KRAS. This discovery is being considered for clinically treatingmutant KRAS associated and addicted cancers. Research and discovery of other synthetically lethal pairs of mutant KRAS can help to develop successful treatments for the pancreatic and lungcancers. Mutation in KRAS genes is majorly found in various aggressive cancers, like pancreatic cancer, colon cancer, and lung cancer. For a long time, no effective treatments have been found against these cancers. Direct andindirect methods are being studied and developed to fightthem. Inhibitors, used to block the abnormal cell growth due to mutated KRAS genes, and synthetic lethality, used to destroy the mutant KRAS, are the two technologies that have shown great potential to help in creating anti-cancer drugs. Study and implementation of these technologiesand discovering better inhibitors and compounds will further lead in finding the effective cancer treatments and help to save manylives. 38 | August 2018|

41. For more information about these products and where topurchase please visitcardinalhealth.com/products. Follow usonLinked and also on twitter at@CardinalHealth. And share your best practice for your loved ones by using#BringTheCaringHome.

42. Dr. GirijaWagh MD FICOG 40 | August 2018|

43. Insider’sOpinion donetoMakeQuality ? Healthcare Accessible toall WhatShould Needs to be About theAuthor Q Dr. Girija Wagh is a MD FICOG, Dip in endoscopy, FICS. She delivers her services as a professor at Bharati Vidyapeeth University Medical College, Pune. She isa renowned consultant as well at Girija Hospital and Fertility Center, Cloud nine Hospitals. uality health care encompasses care whichis accessible, efficient and rational. The care has tobe able to deliver what is essential in the given settingto help ameliorate disease and restore life and itsessentials. Most importantly it should not harm and nor try to achieve which is impossible. The foremost challenge in India is the excessive population. Access to quality medical education is increasingly becoming challenging. Rural and urban divideis phenomenal. Education, awareness and outreach is poor and above all the government budget allocation for health is meagre compared to the poor in the country. Poor have more health care needs and unfortunately have limited access to qualitative healthcare facilities. Insecurity and illiteracy are important reasons for population explosion. Population growth needs to be curbed. Freebie services should be curtailed for more than two issues in a family and awareness of preventive measures such as birth control should be effectivelyimplemented. | August 2018 |41

44. Insider’sOpinion Basic services such as birth control, medical terminationof pregnancy, delivery, neonatal care and paediatric health should be easily and universally available. Regular preventive measures such as immunisations, nutritional guidance, physical activity (can be through education of yoga), hygiene practices (personal, community and environmental) should be made mandatory and easily accessible and inculcated as essential practices. Regular health assessment activities such as screening for cancers, anaemia, mental disorders, metabolic diseases should be accessible through simple tools and reinforced with awareness about these to nurture a healthysociety. Healthcare facilities should have defined roles and limitations well identified. Primary health facilities should be run by paramedics and the care be limited to firstaidand attending to basic emergency needs. The medical officers can run half a day out patient department at the public health centres and sub-centres and run hospitals at the sub- district level. These hospitals can be run on public private partnership basis. Public health facilities should be empowered with video conferencing and access to immediate consultations available. Facilities for the community transfer to and from health care service units are made available. Emergency health care services should be standardised, universally accessible and provisions for investigations and immediate care be made. Mobile and accessible efficient emergency services are the need of time for the population dwelling in inaccessibleterrains. Personnel delivering traditional medicine therapies or paramedics offering services to the community shouldbe trained and offered skill enhancementprograms. Private medical college hospitals should partner with the government programs to provide services to the poor andin return be granted funds and recognition to do so. This will help in increasing clinical workload for better teaching learning practices in medicine. Skill enhancement in medicine can be achieved by increased clinical load and this needs to reinforce through such activities. This canalso help in better research activities for health care quality improvement. World class amenities and facilities for education and research of medical students should be insistedupon. The government can consider graded charging systems based on economical class of the beneficiary .Universal standardised protocols for quality care are a necessityand these should be regularly evolved , disseminated and implemented .Much of the government programs arewell studied and drafted but seriously fail in appropriate implementation . Accountability should be sought from everyone concerned about simple mandates such as fumigation of disinfectants, cleaning of trench, cleanpublic lavatories, garbage disposal, pollution control etc. The national programs should not only be limited to the government facilities but the information should be made easily accessible to private practitioners as 85 % of the medical care is provided in the private sector. Doctors should be well paid to compensate for the rigours they undergo to learn the subject. The skills of the doctor should be appreciated and well compensated. Much of the skilled doctors are moving to corporate sector due tobetter working conditions and revenue generation. Medicos also choose to leave the country for better research avenuesand facilities for children education and access to super speciality education and services .This needs to be made available on our country to avoid skilled communitydrain .Paramedical services should be improvised throughskills training and largeraccessibility. The school curricula should be revised and much stress upon basic health information and knowledge should be imparted. Serious lack of awareness about nutrition and physical activity has already put the country on the edge to blow up into a metabolic diseases volcano and these can have far reaching implications for the geneticprogramming of the generations to come .We as a country have our own special health needs and much of indigenous research be supported to evolve our own unique practices to achieve optimum and qualityhealth. The doctors and health care providers should be protected and respected and attacks on the doctors and medical personnel dealt with seriously. Such attacks are a result of ignorance and refusal of acceptance of the eventualities, a reflection of serious dearth of knowledge andunderstanding of lifelimitations. Budget spent on health needs to be quadrupled and provisions be made for essentials universally .Finally the onus also should be on the population at large. With the digital medium everyone should be made accountable for his or her health and take responsibility of nurturinghealth within the individual, family and thesociety. 42 | August 2018|

45. Helping allpeople live healthylives www.bd.com

46. PBMA’s H V Desai EyeHospital Delivering Excellence inQuality with Care andConcern Col. M.Deshpande Chief Medical Director &Trustee P BMA’s H V Desai Eye Hospital is thebiggest About the Percipient Leader Col. M. Deshpande is the Chief Medical Director ofthis organization. He is a highly respected professor nationally and an extremely popular teacher across generations of ophthalmologists. He served as a professor and Head of ophthalmology department of Armed Forces Medical College, Pune till 1997. Col. Deshpande has received Vishishtha Seva Medal (VSM) at the hands of Presidentof India for his exemplary service inArmy. He has also received many accolades in the form of ‘outstanding service’ award (2012) from Asia Pacific Association for Ophthalmology (APAO) and a prestigious post of ‘President, Vision 2020 India right to sight’between 2013 and 2015. He was actively involved with advocacy and policy making in close collaboration with Govt. of India during thisperiod. tertiary eye care center in western India. It offersall subspecialty services in ophthalmology suchas cataract, retina, glaucoma, cornea, pediatricophthalmology, oculoplasty and ocular oncology, LASIK, low vision,and rehabilitationservices. Apart from the excellent services that they provide,they believe it is their moral duty to train more and more ophthalmologists to make them better surgeons and specialists. Larger benefit to the society is possible only through this approach. They are a nationally and internationally recognized training center for not only cataract surgical skills but also all othersubspecialties. Moreover, for betterment of healthcare, the hospital believes in and performs research that can directly or indirectly improve eye health of lakhs of people inthe society. 44 | August 2018|

47. Dedicated Patient Service High Volume High Quality The hospital aims atproviding complete care and assistance tothe patients. They provide a variety of services benefitting thepatients. Patients can access services for all eye conditions under one roof rather than running from one specialist to other. The hospital has fully developed subspecialty departments with a team of specialists in each department.Also, patients have access to the best of doctors as well as all modern diagnosticequipment. The multi-tier fees structure and a dedicated charity wing allows patients from all socio-economic classes (the richest to the poorest) to avail their services. There is simply no discrimination as far as ability to payis concerned. The hospital’s sought after training programs churn out doctors whohave not only excellent skills but also a humane attitude. Society at large stands to benefit from these freshly skilleddoctors. Assisting the ones inNeed The hospital aims at assisting thepoor and deprived. They have a dedicated charity wing which provides free surgeries to persons from lower socioeconomic class. Nearly 65% of their surgical services are free or subsidized. They also provide free transport, accommodation and food facility to these poor patients who would have otherwise goneblind. The hospital is very sensitive to eye health needs of children andprovides free/subsidized eye care services to children from poor families. They believe in excellent quality as wellas timeliness of theservices. Providing the ‘Human Touch’-(Care &Concern) HV Desai strives to provide a personalized touch to theirclinical services. They take pride in this approach and vouch not to turnany patient for the lack ofmoney. Moreover, offering excellent quality services to the patients is their prime motto. One of the major qualities ofthe hospital is the provision of affordable services to one andall. Creating ophthalmologist forfuture H V Desai Eye Hospital offers Postgraduate Education in Ophthalmology, Nodal hospital for skill transfer to Government of India andResearch. FuturePlans HV Desai Eye Hospital aims toexpand outreach of their services across various regions in Maharashtra, so that patients with serious eye diseases do not have to travel to Pune for treatment. They are implementing this through the establishment of vision centers and eye hospitals across various places (Nandurbar, Jalgaon, Solapur, Wai, and soon). They also intend to become a sought after training center internationally,and provide consultancy services to other eye hospitals, nationally and internationally. The hospital is in the process of achieving this objective through close collaboration with globally recognized NGOs/institutes such as Seva Canada, Orbis USA, CBM Germany, International Centre for Eye Health London UK, and soon. They are on the way to becomean internationally acclaimedresearch institute by implementing many clinical as well as public health researchprojects. This NGO institute has bestmixtureof management & technical, social & professional leadership. Nitin Desai, Chairman has provided corporate intelligence in managing operations & policy. Col. M. Deshpande provided professional & technical guideline of High quality other supported with resource mobilization and young team has helped to develop & continue to serve for years tocome. Facing ChallengesHead-On HV Desai believes in being compassionate; they have a ‘neversay die’ attitude and a sense of a social responsibility. The hospital has strong faith in continuousquality improvement which makes themthrive ‘ We providehigh quality Eye Carewith care and concern to all to reduce the burden ofAvoidable Blindness ‘ on challenges. Excellent networking abilities enable them to raise fundsfor serving the unserved and move ahead with full vigor. They believe in learning from the challenges and look at them asopportunities. Noteworthy Accomplishments Throughout its glorious journey, the hospital has also achieved various awards and accolades. Founder and former president of PBMA’s H. V. Desai Eye Hospital, Niranjan Pranshankar Pandya was awarded with ‘Padmashree’ at the hands of President of India in 2013 for outstanding contribution of HVDesai Eye Hospital in prevention of blindness and rehabilitation of the blind. | August 2018 |45

48. ExpertTalk Robotic Effectivenessof Surgery Rwhere robotic systems are used toaidsurgical obotic surgery or computer-assisted surgery isthe Robotic surgery is an advanced form of laparoscopic surgery where computer-controlled robots are used to assist the surgeon in performing certain surgicalprocedures. Using the robotic technology, surgeons can perform complex surgical procedures through tiny incisions. Surgical robots are computer-controlled devices which can be programmed to aid in the positioning and manipulation of the surgical instruments thus, enabling the surgeon with increased accuracy, flexibility andcontrol. In computer-assisted surgery, the surgeon controls the instruments either by a direct telemanipulator orthrough computercontrol. terms used to address technologicaldevelopments procedures. Robotic surgery has been quite effectivein addressing the limitations of traditional laparoscopic surgery; thereby completing complex and advancedsurgical procedures with increased precision in a minimallyinvasive approach is creating euphoria among healthcare professionals. Large number of advantages & increased favorable outcomes linked with robotic surgery has proved its effectiveness. The field of robotic surgery is constantly growing and evolving. Surgeons believe that robotic surgery is, indeed, the future of surgical healthcare. It is predicted that the coming years shall observe an increased adoption of robotic-assisted techniques thereby, driving the growth of the robotic surgery market to greaterheights. Research analysts have estimated the global roboticsurgery market to grow at a CAGR of more than 11% by 2020, during the forecast period,2018-2020. Robotic surgery enables surgeons to perform operations which were traditionally not amenable to minimal access techniques. This technology is a boon for patients with conditions in an organ located in “cramped spaces”.Thus, robotic surgery can be applicable to a wider range of procedures & is presently used to perform a plethora of surgical procedures. It is noted that numerous cases have reported favorable results through roboticsurgery. o A telemanipulator is a manipulator whichpermits the surgeon to perform the normal movements linked with surgery while these movementsare carried out by the robotic arms by utilizing end-effectors andmanipulators. o In computer-controlled systems, a computeris used by the surgeon to control the robotic armsand itsend-effectors. Advantages Advantages for surgeons using robotic surgeryare: o Bettervisualization. o Increaseddexterity. o Improvedprecision. 46 | August 2018|

49. About theAuthor Dr. Varsha Sharma-Kapila, MD (Hom) is a ConsultantHomoeopath, practicing for more than two decades. She is an Associate Professor & Guide to post graduate students at Dr. G D Pol Foundation, YMT Homoeopathic Medical College, Mumbai. She has gotavast experience in treating several acute & chronic ailments through Homoeopathy. As compared to the traditional surgery, roboticsurgery offers several benefits to the patients, whichinclude: o Mazor Robotics’ Renaissance Guidance System Renaissance Guidance System by Mazor Robotics is indicated in spinal procedures. A small robot is placed just over the patient while the patient is under anesthesia. Using a computer system & computed tomography scans, the surgeon canview the patient’s spine & the robot is used to align a special type of drill, to exactly place pedicle screws used in spinalsurgery. o Smart Tissue Autonomous Robot(STAR) Smart Tissue Autonomous Robot illuminates its surroundings (inside the body) using lightssimilar to infrared. STAR is good in performingrepetitive procedures that require ample ofprecision. o Virtual Incision Corp’s Miniature Robot Virtual Incision’s robot features a small, self-contained surgical device which canbe inserted into the patient's abdomen through atiny incision. • Reduced operativetime. • Shortened hospitalstay. • Reduced complicationrates. • Enables surgeons to perform finer tasks, as compared to the traditional laparoscopic andopen procedures. • Decreased pain &discomfort. • Quicker recoverytime. • Decreased chances of infection as the incisionsare small. • Lesser bloodloss. • Minimalscarring. Limitations Robotic surgical technology is yet to achieve its full potential. This is due to a few limitations, which areas follows:- o Performance of robotic proceduresrequires specializedtraining. The aim of developing robotically-assisted surgery wasto overcome the limitations of thetraditional minimally-invasive surgical procedures and to boost the capabilities of surgeons performing open surgery. This advancement in surgical technology is likely to reshape the way surgery is practiced. Robotic surgery does indeedhave a great future in the medicalindustry. o Cost-effectiveness is a major issue, but thereduced operative time and hospital stay contribute tothe cost-effectiveness of roboticsurgery. o Weight of the robotic equipment currentlyused. Advancements in RoboticSurgery Some of the most impressive advancements inrobotic surgery are as follows:- | August 2018 |47