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Healthcare Delivery

Decoding Total Knee Replacement

Total knee replacement is a surgical process in which the joint of the knee is replaced using an artificial material. If any part of the body experiences intolerable pain, it is difficult for a person to use it and the same is true for knees as well. If a person’s knee is damaged due to an injury or due to arthritis, then he/she may find it difficult to person daily tasks and activities such as climbing stairs, walking and general moving around.

Diagnosis is a critical part of managing total knee replacements

The pain remains even while lying down or sitting. In such a situation, a doctor may first prescribe medications and physiotherapy but in extreme cases, one may have to undergo total knee replacement.

Total knee replacement is also termed as resurfacing of the knee mainly because in the process, only the surface of the bones is replaced. The process combines of 4 broad steps and they are given as follows:

  1. Preparing the bone- in this step, the cartilage surfaces present at the ends of femur and tibia are removed together with a small part of the underlying bone.
  2. Positioning of the metal implants-metal components are used in place of the removed cartilage and bone so that they can recreate the surface of the knee joint. These parts of metal are press-fit or cemented into the bone.
  3. Resurfacing the patella-patella is basically the kneecap and in this step, the under surface of the patella is cut and a plastic button is used for its resurfacing. This process or step may vary depending upon patient to patient.
  4. Inserting a spacer- in between the metal parts, a plastic spacer is placed so as to create a smooth gliding surface. This plastic spacer is of course of medical grade quality.

If you are wondering whether total knee replacement is a process for you, then it is best to consult a good doctor. Most patients who undergo this process are between the age 50-80 however the treatment does not depend upon the age but rather the severity of the problem. One is likely to stay in the hospital for 3 days and has to recover at home for pain management and movement for a few weeks.

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Healthcare Delivery

Management and care of Migraine

One of the common questions asked by people is the difference between headaches and migraine.

Headache, as the name suggests is a kind of pain which is experienced by a person in the head area. In medical terms, headaches is a pain located in head confined within certain boundaries which doctors describe from upper edges of eyes to backwards towards the ears to the nape of the neck. On the other hand, migraine is a neurological condition which can lead to several symptoms, one of which is a headache.

Headaches are of two types-primary headaches and secondary headaches. Primary headaches are common and take up to 90% of cases of headaches and migraine is one of them.  This kind of a headache starts from one side of the head and usually progresses to cause pain in the entire head. The patient may also complain of vomiting sensation and intolerance to light and sound in case of migraines.  One episode of migraine may last up to an interval of 4 hours but in severe cases, it may go on for 3 days.  Some other symptoms of migraine apart from pulsating headaches include nausea, fatigue, irritability, neck stiffness and numbness.

There are two types of migraines-one is the common type which is migraines without aura and the other is classic migraines or migraines with aura. An aura is basically a phase before onset of migraine wherein patient may experience improper vision, seeing flashes of light or bright spots and even difficulty in speaking. Some common triggers of migraine include fasting for long periods of time, sensitivity to sunlight or other lights, dehydration, loud sounds, changes in sleep pattern and stress.

Some red flags of migraines include sudden onset of headaches, high intensity headaches, headaches accompanied with other symptoms or signs such as double vision and headaches in elderly population. In such cases, the headaches must not be taken casually and neurological help must be taken. If headaches are increasing in intensity progressively, even in that case, consultation must be taken without any delay.

The treatment approach for migraines includes proper evaluation by a neurologist. The doctor may suggest a 3 point strategy.

First point is preventive. One must be able to analyse the triggers that may be causing them pulsating headaches or migraines and should avoid them to avoid chances of headaches altogether. Avoiding common triggers like high sunlight, certain foods and drinks and loud music etc is recommended.

The second point is to go for over the counter medicines prescribed by the doctor to control the episodes of migraines. The doctor may suggest medicines depending upon the intensity of the condition.

The third therapy is suggested for those who have frequent episodes of headaches or migraines and as many as 3 to 4 episodes per month. In this case, the doctor may give medicines especially suited for those who have high frequency and high intensity migraines.

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Healthcare Delivery

Causes and Management of Drug Resistant Epilepsy

Epilepsy is a disorder of the Central Nervous System which causes the brain to act differently or abnormally. In this disorder one may experience seizures, loss of awareness and certain sensations. It is one of the most common neurological disorders and can affect people of any age or race. In most cases, Epilepsy can be managed and controlled using anti-epileptic drugs but in some cases, patients fail to gain from these. This type of epilepsy is known as Drug Resistant Epilepsy.

Drug Resistant Epilepsy (DRE), as the name suggests is that form of epilepsy in which the patient doesn’t respond to drug therapy as expected. Some other names by which this treatment is known are medically refractory epilepsy, intractable or pharmacoresistent epilepsy. It is rather surprising to know that as many as 20-40% cases of Epilepsy are refractory Epilepsy. However, it is recommended that a patient takes a few drug trials before DRE is established just to be sure so that the further treatment can be hence recommended by the doctors.

Treatment options for Drug Resistant Epilepsy patients:

–   Once DRE is established, doctors may refer the patient for a presurgical evaluation that is generally done at an Epilepsy center or healthcare facility. This is done in order to find out whether or not the patient is suitable for epilepsy surgery.

–   If surgery is the way to go, then two options are available-resective procedure and disconnective procedure.

–   In case, the patient is not a suitable candidate for surgery or if the patient declines a brain surgery, the next step could be either a proper diet program or vagus nerve stimulation.

–   Vagus nerve stimulation is a procedure in which a pacemaker type of a device is implanted in the chest area to send electrical impulses to the vagus nerve. This inhibits the generation of seizures through the brain.

–   It has been a known fact that diet can help with Epilepsy and may reduce the occurrence of seizures. Those who do not benefit from medication or drugs thus rely on a high fat content low carbohydrate content diet. Some diets which epilepsy patients swear by include ketogenic diet, MCT-ketogenic diet, modified Atkins diet and others.

DRE is not totally incurable but one has to undergo trials and different forms of treatments to be able to identify which fits best in their case. Deep brain stimulation as well as responsive neuro-stimulation is approved in certain countries and may prove beneficial for Drug resistant epilepsy patients.

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Healthcare Delivery

Why patient experience would be the key in the post covid world?

In January 30 2020, India recorded its first case for Corona Virus popularly known as Covid19. Since then India has seen a series of lockdowns and as we inch towards somewhat of a partial recovery, the question around the state of our healthcare system has become centre stage again.

Since the 1940’s where the Bhore committee gave its recommendations for developing the healthcare structure in India, as a nation we have been playing catch up with demand far exceeding the supply in terms of doctors, diagnostic equipment, hospital beds and medicines.

In addition the wellness programs have been struggling and preventive measures have not been very successful. In this context the corner stone of the healthcare system in India has become the hospital.

What determines a successful healthcare intervention is patient experience. Today with the advent of telehealth and the guidelines given by Medical Council of India, it becomes even more important for hospitals to focus on patient experience and add to the growth of the industry.

What is Patient Experience?

Private hospitals have long tracked patient satisfaction ratings, but they didn’t always carry great significance. While all hospitals want happy patients, most hospitals have been historically plagued with the “doctor knows best” mentality — a mentality where clinical outcomes outweigh “touchy-feely” indicators such as patient satisfaction or overall patient experience.

However, in recent years, some leading institutions in India have begun to focus more heavily on providing an outstanding patient experience. Drivers for this include growing consumerism and transparency for healthcare services and increased interest from both consumers and providers in patient-centred care.

Why Patient Experience is important to Hospitals?

Healthcare consumers increasingly view their experience with a provider as a key consideration for determining if they’ll return to or recommend the provider, largely because it remains one of the few ways consumers can differentiate providers. Over the past few decades, clinical outcomes have improved dramatically, and patients no longer view favourable outcomes as a key differentiator as these are expected. What remains is the patient’s overall experience, which encompasses everything from customer service to patient-centeredness and care coordination among providers.  Also given the growth of Tele Health, it would become even more important for hospitals to focus on patient experience in order to create a favourable experience and create the hook that would bring patients and others in the community back to the hospital.

We are working on a report on understanding the current digital levers to manage patient experience. We will be releasing the report soon.

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Healthcare Delivery

Regular patients are severely affected as India battled Corona Virus

In the last week of April 2020, a septuagenarian in the state of J&K who was a renal dialysis patient for 2 years, was asked to get his next round of dialysis from a private nursing home as the hospital where he normally went for treatment refused the dialysis procedure since the entire hospital was converted into a COVID care center. The nursing home neither had the apt infrastructure nor the skilled personnel to handle any kind of complications that is common during a dialysis. Unfortunately, the patient died in less than a week. Another dialysis patient in Mumbai had to wait for 7 hours for treatment as he was not carrying his covid test result report. Around 1,30,000 patients are on dialysis in India and most of them depend on private dialysis centers.

In another caustic case, last week, a 25 yr old pregnant woman in Delhi, visited 2 of the leading government hospitals in Delhi for antenatal care. Both the hospitals denied her admission as she was not Covid-19 positive. As a result, she visited 6 hospitals and maternity clinics in next 48hrs before giving birth outside AIIMS. Many hospitals and nursing homes are completely shut even if one case comes up in them.

There are a plethora of such cases rising across the country as our healthcare system is under stress from managing the contagion outbreak. This is despite the fact that the Government of India has asked state chief secretaries to ensure that hospitals and clinics do not ask for a Covid test report from every patient who requires medical treatment. This raises red-flags and serious questions on the local authorities and regulatory bodies who have also threatened to cancel the operating license of hospitals and clinics if they turn away any non-Covid patient. Patients also fear the escalated economic cost if their treatment cost is not claimed or reimbursed as not all nursing homes and clinics fall under health insurance policies.

Similar danger mounts on Cancer and TB patients. India has the world’s largest TB load of 25%. In Mumbai, due to COVID, lack of adherence to TB drug regimen has risen to 40% from 15%. A significant decrease in TB notification has been witnessed which indicated that access to a TB center and subsequent diagnosis and reporting has been severely hit. These are dangerous signs which are being ignored. A TB patient can infect 10-15 more, and such patient can become a breeding-ground of new Coronavirus cases as Covid hits hard on low immunity patients. Many senior oncologists have claimed that due to difficulty in travelling during lockdown, many hospitals not providing regular treatment, hospitals shutting down and fear of contracting covid, have resulted in a delayed diagnosis of cancer patients which can push them to an advanced stage of cancer.

There has to be clear and stringent guidelines by MoH to each state health authorities highlighting the delirious effect of not providing critical care to non-Covid cases. State should ensure that no patient is denied treatment for any ailment by a hospital (government or private). Instead of shutting down the entire hospital even for one covid case, a wiser approach of creating zones within the hospital can be implemented. Online, phone consultation and Tele-medicine modules should be made widespread thorough proper communication channels.

Our healthcare infrastructure is one of the weakest in the world with a lack of adequately qualified health care professionals adding to the woes. We certainly can’t afford to inflict more burden on the already fragile healthcare services by denying treatment to those who are in need.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care