Friday August 17, 2018

Why patients are not put first in Indian hospitals

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By Dr Aniruddha Malpani
New Delhi: Despite most Indian hospitals claiming that serving the patient is their only priority, the reality is quite different.
Most patients in government-run hospitals are treated very shabbily – and their family members are treated much worse.
Why do hospitals continue putting patients last?
I think there are two reasons for this.
One, of course, is the fact that the hospital authorities can get away with it. They’ve done this for many years, and they feel that it’s not a problem which they need to address.  The number of hospital beds are far fewer than the number of patients, and since they have enough bed-occupancy (and, therefore, enough profitability), they see no need to change what they’re doing.
Their primary focus today is in incentivising doctors ( and other middle-men) to make sure that their beds are full, rather than trying to delight patients. This is a short-sighted approach which will come back to haunt them later.
Times are changing, especially in large cities, where lots of corporate hospitals have empty beds and are no longer profitable. At some point, when they find that their balance sheets are in the red, they will hopefully get their act together.
I think the second reason is that whatever initiatives they’ve tried in order to put patients first haven’t worked very well. Part of this is because they’ve been very half- hearted interventions – for  example, holding a conference;  or adding a few videos on their website.
However, the problem is that no one in senior management has taken ownership of trying to delight patients.  Each hospital should have a chief patient officer, whose job is to make sure that everyone in the hospital remembers that the only reason the hospital exists is to help patients to get better. He needs to champion the cause of the patient if we want things to improve. Ideally, this should be the Chairman of the Board, who can inspire change by taking rounds daily.
Dr Aniruddha Malpani is the Medical Director at Malpani Infertility Clinic
the article first published at docplexus.in
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To Treat Brain Cancer Scientists Taking Polio’s Help

The result is a longer life for patients whose brain cancer returned

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A radiologist examines the brain X-rays of a patient. In a small study, patients with brain tumors were given genetically modified poliovirus, which helped their bodies attack the cancer.
A radiologist examines the brain X-rays of a patient. In a small study, patients with brain tumors were given genetically modified poliovirus, which helped their bodies attack the cancer. VOA

There’s an exciting new breakthrough in treating some types of deadly brain tumors, that uses, of all things, a polio virus. Doctors at Duke Health in North Carolina genetically altered the virus because it produces such a strong immune response in our bodies. The result is a longer life for patients whose brain cancer returned. All had glioblastoma, an aggressive and lethal type of brain cancer. Of the 61 patients in the study, 21 percent who got this new treatment had were alive three years later.

While that number is low, the survival rate for glioblastoma is normally even lower, usually, a year and a half after diagnosis. The researchers compared the study group to a group of patients drawn from historical cases at Duke. Only four percent of these patients survived three years after treatment.

Dr. Annick Desjardins, one of the authors, said not all patients respond, but if they do, they often become long-term survivors. Desjardins said, “The big question is, how can we make sure that everybody responds?”

Stephanie Hopper was the first patient in the Duke study. She was diagnosed with glioblastoma eight years ago. She had the tumor removed, but two years later, it returned. The modified virus is directly injected into the brain during surgery. After treatment, Hopper’s tumor shrunk to the point where it’s barely noticeable in her brain scans, and the tumor is continuing to shrink.

Dr. Darell Bigner is the senior author of the study which was published in the New England Journal of Medicine. He explained that by modifying the virus, it destroyed its ability to infect nerve cells and cause polio, but the virus retained the ability to kill cancer cells. In fact, the modified virus targeted the tumor cells.

Prior to the study, the researchers decided they needed a different approach to treating glioblastomas which is why they looked at experimenting with the polio virus.

There's an exciting new breakthrough in treating some types of deadly brain tumors, that uses, of all things, a polio virus. Doctors at Duke Health in North Carolina genetically altered the virus because it produces such a strong immune response in our bodies
There’s an exciting new breakthrough in treating some types of deadly brain tumors, that uses, of all things, a polio virus. Doctors at Duke Health in North Carolina genetically altered the virus because it produces such a strong immune response in our bodies. Flickr

One of the goals of a phase one trial is to find a dose that is safe. In some patients, the therapy caused their brains to swell and they experienced seizures and other bad side effects so the dose was lowered. Study participants were selected according to the size of their recurring tumor, its location in the brain and other factors designed for patient protection.

For five of the 61 patients in the trial, the cancer returned. They were treated a second time and Bigner says, “Those that we’ve been able to follow long enough have responded to the treatment the second time. That’s extremely important.” Combining the polio virus with other approved therapies is one approach already being tested at Duke to improve survival.

Also read: A One-Shot Nanoparticle Vaccine for Polio is Developed by MIT scientists

The researchers are continuing their work on treating glioblastomas and planning other studies as well. They want to test the therapy on children’s brain tumors. The therapy may also expand beyond brain tumors to include breast cancer and melanoma patient as well. (VOA)