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New Delhi: Taking note of problems affecting the healthcare services at the Government-run hospitals in Delhi, a committee constituted by the Delhi High Court recently submitted its interim report listing the immediate, short term and long-term measures required to be implemented for the betterment of the system.

Medical Dialogues had previously reported that earlier this year, expressing displeasure over the “misleading” information provided to it on the functioning of medical equipment in GTB hospital, the Delhi High Court had advised the State to constitute a committee of doctors to examine the hospitals run by the city government to come up with a solution. These directions were issued by the Court while considering a PIL initiated by it on its own in 2017 concerning the issue of the non-availability of ICU beds and ventilator facilities in government hospitals in Delhi.

To fill up these vacant posts of Specialists, GDMOs, and resident doctors immediately, the panel has recommended giving autonomy to the respective hospitals to fill up the vacant posts on adhoc/contractual basis. 

It has been recommended by the committee that emoluments and other benefits for the contractual employees should be at par with the regular appointments to attract candidates for such contractual employment.

“Filling these posts will be easier if the salary is 25% more than that of a regular employee,” recommended the panel.

2. Hire Visiting Consultants on Hour-based Remuneration: 

Noting around 50% vacancies of specialists in the Delhi-based hospitals, the panel suggested paying remuneration based on working hours to the visiting consultants to deal with the shortage of specialists. In its interim report, the panel recommended that such visiting consultants should be paid Rs 1.5 lakh plus incentives for 4 hours, Rs 3 lakh plus incentives for 8 hours, Rs 4 lakh plus incentives for 12 hours and Rs 2 lakh plus incentives or on-call basis for night calls.

As a long-time measure to tackle the scarcity of specialists in Delhi government hospitals, the committee has suggested creating a panel of consultants comprising private practitioners who can cater to government hospitals on a part-time basis. However, the committee recommended ensuring that such specialists were receiving at least 1.5 times more salary or fees than that of a regular employee on weekdays and double on holidays and weekends.

3. Compulsory One-year Residentship at Parent Institutes: 

Taking note of the huge vacancies in the posts of Senior and Junior Residents, the committee, constituted by the Delhi High Court, has recommended making one-year residentship (JRs/SRs) compulsory at the parent institutes where the doctors pursued their MBBS or MD courses.

“Compulsory one year of SR ship in the institution from where MD is done (like being followed in some states/Institution),” the panel recommended in respect of the vacant posts of Senior Residents.

Similarly, for the vacant posts of Junior Residents as well, the panel suggested introducing “compulsory one year of JR ship in the institution from where MBBS is done like being followed in some states/Institution.”

Also Read: Shortage of Resident doctors! Panel suggests Compulsory 1-yr JRship at medical college from Where MBBS is Done

4. Implement PPP Model to Deal with Shortage of Equipment: 

In its report, the panel highlighted the huge numbers of non-functional medical equipment in the Delhi hospitals and suggested implementing a Public-Private Partnership (PPP) model for CT scan and MRI services by identifying successful bidder for this purpose. It also suggested that PPP model or leasing models could be implemented for procuring various equipment like ultrasound machines, dialysis machines, ventilators, lab diagnostic machines, ICU and cardiac monitors, ABG machines, etc.

Currently, at the Janakpuri Super-Specialty Hospital {JSSH) and PGI Rohtak a PPP model is running successfully. In all hospitals where CT/MRI scan or radiologist is not available, the aforesaid model can be adopted and implemented, especially in level 3 & 4 hospitals, highlighted the panel.

5. Requirement of Additional ICU Beds: 

Referring to the recommendations of the World Health Organization (WHO) of having 3 hospital beds for a population of 1000 people, the panel noted in its report that for around 3 crore population in Delhi, 90000 hospital beds are required. It also highlighted that as a general rule, it is suggested that there should be 5-10 percent of hospital beds as ICU beds. This number can be more in a tertiary care or a super-specialty hospital. Some of the Delhi hospitals have up to 25% of hospital beds as ICU beds.

As per the report, currently, Delhi government hospitals have 1058 ICU beds. However, according to the committee, these beds should be enhanced to 2028 beds by adding 1046 additional beds in the existing hospitals, but eventually Delhi will require 4500 beds out of which Delhi government hospitals should contribute at least 2400 ICU beds.

6. Centralised Command and Control Room, Referral Coordinator in Every Hospital: 

Considering the issue of providing real-time information concerning the availability of ICU/HDU beds in various hospitals and their timely availability for patients, the panel suggested setting up a centralized command and control room (CCR) by the IT department of GNTCD which should be manned by adequately trained executives and medical professionals round the clock.

“This control room should at least have a live screen showing the location of available emergency and ICU hospital beds and medical services (like CT I MRI, OT facility, etc.) in the near vicinity of the patient and the promptness and availability of an ambulance service. There should be a screen showing region-wise Gee-mapping of all the Delhi hospitals with dynamic details of available facilities,” recommended the panel.

Further, the panel recommended that every hospital shall designate a referral coordinator, who shall update the information on the dashboard linked to the Centralised Command and Control Room (CCR).

7. Reverse Referral Policy: 

To ensure that healthcare resources are utilized optimally, the panel constituted by the Delhi High Court suggested implementing a reverse referral policy to streamline patient transfers from higher-level to lower-level facilities when appropriate.

8. Convert large service hospitals into medical colleges: 

The committee recommended in its report that spending money on large service hospitals results in suboptimal outcomes as the staff of such hospitals is not updated to the recent developments of rapidly evolving medical science. Therefore, they are inclined to refer difficult patients to medical colleges or tertiary care institutions.

As per the panel, by increasing the budget of such hospitals by around 20-25%, these institutes can be converted into teaching institutions. This will ensure that the specialists of such institutes will become teachers and they will remain updated and in return will produce medical graduates.

9. Proposal to create the “Delhi State Health Authority”: 

The panel has recommended setting up a High-Power Delhi Health Authority directly under the control of the Principal Secretary of Health, Department of Health and Family Welfare, Government of NCT of Delhi. It suggested that there should be a Central Authority named “Delhi State Health Authority” (DESHA) and further “District Health Authority” in the districts.

As per the panel, DESHA should be chaired by the Principal Secretary of Health and also comprise the Director of OSHA. It should have a 24×7 working office and should be manned by the CMOs around the clock. DGHS (Govt of India), DGHS (Delhi), Director, Lok Nayak Hospital, Director, GTB Hospital, Director, Hindu Rao Hospital, and Director IBHAS should be other members of the committee. 

The committee recommended that the Authority will have the District Level Dm/DC as In-charge & responsible for implementation & execution. Their responsibility will be to ensure any healthcare emergency in their respective districts will be attended through Central Control room and appropriate action is taken. It will enable timely action as desired.

Subsequently, it will conduct arrangement and audit of hospitals in terms of service provided, outcome and other infrastructure-related issues. Such an authority will also have a grievance redressal mechanism, recommended the panel.

10. CGHS Rates at Private Hospitals: 

The report highlighted that the Delhi Government currently has the Delhi Arogya Kosh (DAK) scheme which allows the patient to avail the services of private hospitals at CGHS rates.

Such facility can be extended to emergency services (E-DAK) as well, recommended the panel, adding that this will ensure that any patient in an emergency can be transferred to the nearest private hospital and avail the services at CGHS rates and have online approval within 4 hours.

“Every citizen should with a Delhi Aadhar card should be entitled to receive emergency health care at any nearby private hospital by producing the Adhar card. Some mechanism for the migrant population should also be worked out in this regard,” the panel recommended.

“Aadhar card holders should be permitted to avail such facilities and the government should sign MOUs with select private players who can provide care at CGHS rates,” it further added.

A recent study found a significant discovery in the treatment of patients with from type 2 diabetes (T2D) with concurrent atrial fibrillation (AF) which is a combination that markedly increases the risk of adverse cardiovascular events. The major outcomes of this study were published in The Journal of Clinical Endocrinology and Metabolism.

This comprehensive nationwide retrospective cohort study utilized data from the Taiwan National Health Insurance Research Database and the findings highlight the comparative effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) on the patients with and without AF.

The study spanned from May 1, 2016 to December 31, 2019 and observed a total of 344,392 T2D patients without AF and a total of 31,351 with AF treated with SGLT2i, along with 11,462 and 816 T2D patients with and without AF, respectively with GLP-1RA administration. The participants were monitored up to December 31, 2020 for various cardiovascular outcomes after employing propensity score stabilized weighting to ensure the equitable comparison between the two medication groups.

The results unveiled a striking distinction in treatment outcomes, specially for the patients with concomitant AF. The individuals treated with SGLT2i experienced a significantly reduced risk of hospitalization for heart failure when compared to their counterparts on GLP-1RA with an incidence rate of 2.32 versus 4.74 events per 100 person-years. SGLT2i was associated with a lower risk of composite kidney outcomes in both groups that highlights its benefits beyond heart health.

This study observed no significant difference between the two drugs in terms of major adverse cardiovascular events and all-cause mortality, regardless of AF status. This neutrality illuminates the complexity of T2D management along with cardiovascular conditions and highlights the need for personalized treatment strategies.

The positive effects of these findings are significant in diabetic patients with the high prevalence and risk of heart failure. This evidence strongly suggests that SGLT2i may offer superior protection against heart failure and renal complications for the T2D patients with AF which elevated the risk for these debilitating conditions. However, this study warrants further investigation to conclusively determine whether SGLT2i should be the preferred treatment option over GLP-1RA for this high-risk demographic.

Source:

Chan, Y.-H., Chao, T.-F., Chen, S.-W., Lee, H.-F., Li, P.-R., Yeh, Y.-H., Kuo, C.-T., See, L.-C., & Lip, G. Y. H. (2024). SGLT2 inhibitors vs. GLP-1 receptor agonists and clinical outcomes in patients with diabetes with/without atrial fibrillation. In The Journal of Clinical Endocrinology & Metabolism. The Endocrine Society. https://doi.org/10.1210/clinem/dgae157

People who use e-cigarettes are significantly more likely to develop heart failure compared with those who have never used them, according to one of the largest prospective studies to date investigating possible links between vaping and heart failure. The findings are being presented at the American College of Cardiology’s Annual Scientific Session.

Heart failure is a condition affecting more than 6 million U.S. adults in which the heart becomes too stiff or too weak to pump blood as effectively as it should. It can often lead to debilitating symptoms and frequent hospitalizations as people age. Electronic nicotine products, which include e-cigarettes, vape pens, hookah pens, personal vaporizers and mods, e-cigars, e-pipes and e-hookahs, deliver nicotine in aerosol form without combustion. Since they were first introduced in the U.S. in the late 2000s, electronic nicotine products have often been portrayed as a safer alternative to smoking, but a growing body of research has led to increased concern about potential negative health effects.

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” said Yakubu Bene-Alhasan, MD, a resident physician at MedStar Health in Baltimore and the study’s lead author. “The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

For the study, researchers used data from surveys and electronic health records in All of Us, a large national study of U.S. adults run by the National Institutes of Health, to analyze associations between e-cigarette use and new diagnoses of heart failure in 175,667 study participants (an average age of 52 years and 60.5% female). Of this sample, 3,242 participants developed heart failure within a median follow-up time of 45 months.

The results showed that people who used e-cigarettes at any point were 19% more likely to develop heart failure compared with people who had never used e-cigarettes. In calculating this difference, researchers accounted for a variety of demographic and socioeconomic factors, other heart disease risk factors and participants’ past and current use of other substances, including alcohol and tobacco products. The researchers also found no evidence that participants’ age, sex or smoking status modified the relationship between e-cigarettes and heart failure.

Breaking the data down by type of heart failure, the increased risk associated with e-cigarette use was statistically significant for heart failure with preserved ejection fraction (HFpEF)-in which the heart muscle becomes stiff and does not properly fill with blood between contractions. However, this association was not significant for heart failure with reduced ejection fraction (HFrEF)-in which the heart muscle becomes weak and the left ventricle does not squeeze as hard as it should during contractions. Rates of HFpEF have risen in recent decades, which has led to an increased focus on determining risk factors and improving treatment options for this type of heart failure.

The findings align with previous studies conducted in animals, which signaled e-cigarette use can affect the heart in ways that are relevant to the heart changes involved in heart failure. Other studies in humans have also shown links between e-cigarette use and some risk factors associated with developing heart failure. However, previous studies attempting to assess the direct connection between e-cigarette use and heart failure have been inconclusive, which Bene-Alhasan said is due to the inherent limitations of the cross-sectional study designs, smaller sample sizes and the smaller number of heart failure events seen in previous research.

Researchers said the new study findings point to a need for additional investigations of the potential impacts of vaping on heart health, especially considering the prevalence of e-cigarette use among younger people. Surveys indicate that about 5% to 10% of U.S. teens and adults use e-cigarettes. In 2018, the U.S. Surgeon General called youth e-cigarette use an epidemic and warned about the health risks associated with nicotine addiction.

“I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information out to the public.”

Bene-Alhasan also said e-cigarettes are not recommended as a tool to quit smoking, since many people may continue vaping long after they quit smoking. The U.S. Centers for Disease Control and Prevention recommends a combination of counseling and medications as the best strategy for quitting smoking.

Researchers said that the study’s prospective observational design allows them to infer, but not conclusively determine, a causal relationship between e-cigarette use and heart failure. However, with its large sample size and detailed data on substance use and health information, Bene-Alhasan said the study is one of the most comprehensive studies to assess this relationship to date.

Reference:

Study links e-cigarette use with higher risk of heart failure, American College of Cardiology, Meeting: American College of Cardiology’s Annual Scientific Session.