National Institute of Business Management

Chennai - 020
EMBA/ MBA
Elective: Healthcare and Hospital Management (Part - 2)
Attend any 4 questions. Each question carries 25 marks
(Each answer should be of minimum 2 pages / of 300
words)

3.

Write

a detailed

account on

Magnetic

Resonance

Imaging.
Magnetic resonance imaging (MRI) is a diagnostic procedure that uses a
combination of a large magnet, radiofrequencies, and a computer to
produce detailed images of organs and structures within the body.
Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging
(NMRI), or magnetic resonance tomography (MRT) is a medical imaging
technique used in radiology to investigate the anatomy and physiology of
the body in both health and disease. MRI scanners use strong magnetic
fields and radio waves to form images of the body. The technique is widely
used in hospitals for medical diagnosis, staging of disease and for follow-up
without exposure to ionizing radiation.
An MRI is similar to a computerized tomography (CT) scanner in that it
produces cross-sectional images of the body. Looking at images of the body

in cross section can be compared to looking at the inside of a loaf of bread

by slicing it. Unlike a CT scan, MRI does not use X-rays. Instead, it uses a
strong magnetic field and radio waves to produce very clear and detailed
computerized images of the inside of the body. MRI is commonly used to
examine the brain, spine, joints, abdomen, and pelvis. A special kind of MRI
exam, called magnetic resonance angiography (MRA), examines the blood
vessels.
The MRI machine is a large, cylindrical machine that creates a strong
magnetic field around the patient. This magnetic field, along with a
radiofrequency, alters the hydrogen atoms' natural alignment in the body.
Computers are then used to form two-dimensional (2D) images of a body
structure or organ based on the activity of the hydrogen atoms. Crosssectional views can be obtained to reveal further details. MRI does not use
ionizing radiation, as do X-rays or computed tomography (CT scans).
A magnetic field is created and pulses of radio waves are sent from a
scanner. The magnetic field aligns the hydrogen protons in your body along
the same vector. The radio waves then knock the particles out of this
aligned position. As the nuclei realign back into proper position, the nuclei
send out radio signals. These signals are received by a computer that
analyzes and converts them into an image of the part of the body being
examined. This image appears on a viewing monitor. Some MRI machines
look like narrow tunnels, while others are more open.

Magnetic resonance (MRI) may be used instead of computed tomography

(CT) in situations where organs or soft tissue are being studied, because
with MRI scanning bones do not obscure the images of organs and soft
tissues, as does CT scanning.
New uses and indications for MRI have contributed to the development of
additional magnetic resonance technology. Magnetic resonance angiography
(MRA) is a new procedure used to evaluate blood flow through arteries in a
noninvasive (the skin is not pierced) manner. MRA can also be used to
detect intracranial (within the brain) aneurysms and vascular malformations
(abnormalities of blood vessels within the brain, spinal cord, or other parts
of the body).
Magnetic resonance spectroscopy (MRS) is another noninvasive procedure
used to assess chemical abnormalities in body tissues, such as the brain.
MRS may be used to assess disorders such as HIV infection of the brain,
stroke, head injury, coma, Alzheimer's disease, tumors, and multiple
sclerosis.
Functional magnetic resonance imaging of the brain is used to determine
the specific location of the brain where a certain function, such as speech or
memory, occurs. The general areas of the brain in which such functions
occur are known, but the exact location may vary from person to person.
During functional resonance imaging of the brain, you will be asked to
perform a specific task, such as recite the Pledge of Allegiance, while the

scan is being done. By pinpointing the exact location of the functional

center in the brain, doctors can plan surgery or other treatments for a
particular disorder of the brain.
An MRI of the brain produces very detailed pictures of the brain and is
commonly used to study people with such problems as headaches, seizures,
weakness, hearing loss, and blurry vision. It can also be used to further
evaluate an abnormality seen on a CT scan. During a brain MRI, a special
device called a head coil is placed around the person's head to help produce
very detailed pictures of the brain. The head coil does not touch the person,
and the person can see through large gaps in the coil.
Spine MRI is most commonly used to look for a herniated disk or narrowing
of the spinal canal (spinal stenosis) in people with neck, arm, back, and/or
leg pain. It is also the best test to use to look for a recurrent disk herniation
in a person with a history of prior back surgery.
Bone and joint MRI can be used to check virtually all of the bones, joints,
and soft tissues. MRI can be used to identify injured tendons, ligaments,
muscles, cartilage, and bones. It can also be used to look for infections and
masses.
MRI of the abdomen is most frequently used to look more specifically at an
abnormality seen on another test, such as an ultrasound or a CT scan. The
exam is usually tailored to look at just the liver, pancreas, or adrenal glands.

For women, pelvic MRI provides a detailed look at the ovaries and uterus
and is often used to follow up an abnormality seen on ultrasound. It is also
used to evaluate the spread of cancer of the uterus. For men, pelvic MRI is
sometimes used to check those diagnosed with prostate cancer. Pelvic MRI
is also used to look at the bones and muscles of the pelvis.
Magnetic resonance angiography (MRA) depicts the blood vessels. The blood
vessels in the neck (carotid and vertebral arteries) and brain are frequently
studied by MRA to look for areas of constriction (narrowing) or dilatation
(widening). In the abdomen, the arteries supplying blood to the kidneys are
also frequently examined using this technique.
Open MRI scanners are available for patients who are claustrophobic or
have severe anxiety. Many of these are not available on the NHS routinely.
Sensitivity and specificity of MRI scans are enhanced with contrast agents.
Various different types of MRI contrast agents are available depending on
the site of imaging and the nature of any lesion. Gadolinium is one contrast
agent for example.
Reasons for the procedure
MRI may be used to examine the brain and/or spinal cord for injuries or the
presence of structural abnormalities or certain other conditions, such as:

Tumors

Abscesses

Congenital abnormalities

Aneurysms

Venous malformations

Hemorrhage, or bleeding into the brain or spinal cord

Subdural hematoma (an area of bleeding just under the dura mater, or
covering of the brain)

Degenerative

diseases,

such

as

multiple

sclerosis,

hypoxic

encephalopathy (dysfunction of the brain due to a lack of oxygen), or

encephalomyelitis (inflammation or infection of the brain and/or spinal
cord)

Hydrocephalus, or fluid in the brain

Herniation or degeneration of discs of the spinal cord

Help plan surgeries on the spine, such as decompression of a pinched

nerve or spinal fusion

MRI can also help to identify the specific location of a functional center of
the brain (the specific part of the brain controlling a function, such as
speech or memory) to assist in treatment of a condition of the brain.
There may be other reasons for your doctor to recommend MRI of the spine
or brain.
Risks of the procedure

Because radiation is not used, there is no risk of exposure to ionizing

radiation during an MRI procedure.
Due to the use of the strong magnet, MRI cannot be performed on patients
with implanted pacemakers, some older intracranial aneurysm clips,
cochlear implants, certain prosthetic devices, implanted drug infusion
pumps, neurostimulators, bone-growth stimulators, certain intrauterine
contraceptive devices, or any other type of iron-based metal implants. MRI
is also contraindicated in the presence of some internal metallic objects
such as bullets or shrapnel, as well as surgical clips, pins, plates, screws,
metal sutures, or wire mesh.
If you are pregnant or suspect that you may be pregnant, you should notify
your doctor. In general, there is no known risk of MRI in pregnancy.
However, particularly in the first trimester, MRI should be reserved for use
only to address very important problems or suspected abnormalities.
If contrast dye is used, there is a risk for allergic reaction to the dye.
Patients who are allergic to or sensitive to medications, contrast dye, or
iodine should notify their physician.
MRI contrast may have an effect on other conditions such as allergies,
asthma, anemia, hypotension (low blood pressure), kidney disease, and
sickle cell disease.

Nephrogenic systemic fibrosis (NSF) is a very rare but serious complication

of MRI contrast use in patients with kidney disease or kidney failure. If you
have a history of kidney disease, kidney failure, kidney transplant, liver
disease or are on dialysis, you must inform the MRI technologist or
radiologist prior to receiving contrast.
There may be other risks depending on your specific medical condition. Be
sure to discuss any concerns with your physician prior to the procedure.
Before the procedure
Your doctor will explain the procedure to you and offer you the opportunity
to ask any questions that you might have about the procedure.
If your procedure involves the use of contrast dye, you will be asked to sign
a consent form that gives permission to do the procedure. Read the form
carefully and ask questions if something is not clear.
Generally, there is no special restriction on diet or activity prior to an MRI
procedure.
Before the examination, it is extremely important that you inform the
technologist if any of the following apply to you:

You are claustrophobic and think that you will be unable to lie still while
inside the scanning machine, in which case you may be given a
sedative

You have a pacemaker inserted, or have had heart valves replaced

You have any type of implanted pump, such as an insulin pump

You have metal plates, pins, metal implants, surgical staples, or

aneurysm clips

You have any metallic fragments anywhere in the body

You have permanent eyeliner or tattoos

You are pregnant or suspect you may be pregnant

You have ever had a bullet wound

You have ever worked with metal (for example, a metal grinder or
welder)

You have any body piercing

You have an intrauterine device (IUD)

You are wearing a medication patch

As there is a possibility that you may receive a sedative before the

procedure, you should plan to have someone drive you home afterward.
Based upon your medical condition, your doctor may request other specific
preparation.
During the procedure
MRI may be performed on an outpatient basis or as part of your stay in a
hospital. Procedures may vary depending on your condition and your
physician's practices.

Generally, MRI of the spine and brain follows this process:

You will be asked to remove any clothing, jewelry, eyeglasses, hearing aids,
hairpins, removable dental work, or other objects that may interfere with
the procedure.

If you are asked to remove clothing, you will be given a gown to wear.

If you are to have a procedure done with contrast, an intravenous (IV)

line will be started in the hand or arm for injection of the contrast dye.

You will lie on a scan table that slides into a large circular opening of
the scanning machine. Pillows and straps may be used to prevent
movement during the procedure.

The technologist will be in another room where the scanner controls

are located. However, you will be in constant sight of the technologist
through a window. Speakers inside the scanner will enable the
technologist to communicate with and hear you.

You will have a call button so that you can let the technologist know if
you have any problems during the procedure. The technologist will be
watching you at all times and will be in constant communication.

You will be given earplugs or a headset to wear to help block out the
noise from the scanner. Some headsets may provide music for you to
listen to.

During the scanning process, a clicking noise will sound as the magnetic
field is created and pulses of radio waves are sent from the scanner.
It will be important for you to remain very still during the examination, as
any movement could cause distortion and affect the quality of the scan.
At intervals, you may be instructed to hold your breath, or to not breathe,
for a few seconds, depending on the body part being examined. You will
then be told when you can breathe. You should not have to hold your breath
for longer than a few seconds.
If contrast dye is used for your procedure, you may feel some effects when
the dye is injected into the IV line. These effects include a flushing sensation
or a feeling of coldness, a salty or metallic taste in the mouth, a brief
headache, itching, or nausea and/or vomiting. These effects usually last for
a few moments.
You should notify the technologist if you feel any breathing difficulties,
sweating, numbness, or heart palpitations.
Once the scan has been completed, the table will slide out of the scanner
and you will be assisted off the table.
If an IV line was inserted for contrast administration, the line will be
removed.
While the MRI procedure itself causes no pain, having to lie still for the
length of the procedure might cause some discomfort or pain, particularly in

the case of a recent injury or invasive procedure such as surgery. The

technologist will use all possible comfort measures and complete the
procedure as quickly as possible to minimize any discomfort or pain.
On occasion, some patients with metal fillings in their teeth may experience
some slight tingling of the teeth during the procedure.
After the procedure
You should move slowly when getting up from the scanner table to avoid
any dizziness or lightheadedness from lying flat for the length of the
procedure.
If any sedatives were taken for the procedure, you may be required to rest
until the sedatives have worn off. You will also need to avoid driving. If
contrast dye is used during your procedure, you may be monitored for a
period of time for any side effects or reactions to the contrast dye, such as
itching, swelling, rash, or difficulty breathing.
If you notice any pain, redness, and/or swelling at the IV site after you
return home following your procedure, you should notify your physician as
this could indicate an infection or other type of reaction.
Otherwise, there is no special type of care required after a MRI scan of the
spine and brain. You may resume your usual diet and activities, unless your
physician advises you differently.

Your doctor may give you additional or alternate instructions after the
procedure, depending on your particular situation.
Advantages of magnetic resonance imaging scanning

Harmless to the patient - no radiation is involved (unlike computed

tomography (CT) scanning and conventional radiology).

Excellent detail makes it similar and even superior to, CT scanning in

some situations.

MRI contrast agent used is normally gadolinium which is less allergenic

than iodine-based contrast agents used in CT scanning.

Disadvantages of magnetic resonance imaging scanning

Limited availability - although this is rapidly improving.
It is a lengthy procedure - e.g., a pituitary gland MRI scan can take up
to 30 minutes.
In MRI scanning of the chest and abdomen the patient must lie still for
long periods, which can prove difficult. Therefore, CT scanning is
preferred in these situations.
MRI scanning cannot be performed in the presence of foreign bodies or
metallic implants - e.g., pacemakers, aneurysm clips and some cardiac
stents (even if distant from the site of the image). However, stainless
steel objects, such as those in hip prostheses, may be OK.

 It is relatively expensive compared with other forms of imaging.

It may not be available 'out of hours'.
Uses a powerful magnetic field.
Patients with some metal implants, cochlear implants, and cardiac
pacemakers are prevented from having an MRI scan due to effects of
the strong magnetic field and powerful radio frequency pulses.
During the scan it is important to lie completely still. For this reason it
might be necessary to give a child an anesthetic before they are
tested.

4.

Explain

the

changing

trends

in

the

diagnostic

facilities.
Several changes within the diagnostic industry has resulted in consolidation
of the industry. The market size of the diagnostic industry is pegged at
Rs10000 crore and exhibits a healthy CAGR of more than 15 per cent. The
industry is comprised of more than 100,000 labs across the country and
only 10 per cent of the market is consolidated by three major players. The
major segments which need services of diagnostic players are the doctors
who prescribe tests to patients, corporate clients for wellness programmes
and clinical trial lab support as well as routine laboratories and hospitals
who need a referral center for specialised tests.

With the rising awareness for healthcare, demand for good quality
diagnostics has grown as well, and customers prefer to partner with
laboratories demonstrating high levels of accuracy and service. The other
major change has come through advances in technology and automation of
equipment, resulting in reducing the turnaround time for reports and
providing quicker diagnosis. The focus is on convenience to customers, be it
through all varieties of tests processed in India, home health services, using
technology for result communication or providing a network of collection
centres for easier access. All these changes have contributed to the
consolidation of the lab industry.
New Trends
We are witnessing many trends that will create substantial changes in the
landscape of the industry in the coming years. With more information and
awareness, preventive healthcare and self-monitoring are becoming more
popular. There is a conflict between increasing lifestyle diseases in the
population and increase in levels of awareness about mortality ratio of these
diseases. We now see young adults between ages of 30-45 years suffering
from heart attacks and severe diabetes. Using tools like health checks and
regular testing, these deadly diseases can be curbed and a healthy life can
be enjoyed by taking necessary precautions. The business model has
expanded beyond diagnostic tests to offering wellness solutions including
services like dentistry and nutritional guidance under one roof. This trend

however, is yet to reach Tier-II, Tier-III cities, small towns and rural areas
where health awareness is minimal. Various government bodies and NGOs
are engaged in improving the awareness level of people living in smaller
townships. However, lack of sufficient manpower as well as infrastructure
limits the success of these programmes. Currently, leading chains like
Metropolis are reaching even small towns with the message of keeping good
health by providing customers access to regular blood monitoring.
The March Forward
In the future, government will realise that rather than being a health
provider, they must focus on being only a health funder and take the
support of private institutions to provide good quality healthcare. The focus
of the government should be to initiate publicprivate partnerships (PPP)
that reach large number of patients and provide easy access to diagnostic
facilities at their doorstep using the existing public facilities and expertise of
private labs. Improvement in test facilities at government hospitals must be
done by introducing automation in equipments, keeping costs low without
compromising quality, training of personnel or using information technology
to store health records.
The deeper penetration of the health insurance industry in India will lead to
closer integration of the health insurance industry with diagnostic centres.
As the number of people holding health insurance policies expands and
outpatient diagnostics gets covered, we will see health insurance companies

partnering with diagnostic centres for standardised services. The focus will
be to partner with good quality labs as health insurance companies would
want to ensure the pre-existing diseases are correctly identified so their
monetary outgoing for claims are kept low. Diagnostic partners will play a
very important role in identifying and monitoring disease trends in health
insurance policy holders. Some insurance schemes even motivate patients
to keep disease levels low by offering lower premiums, and labs will be the
key third party partner for monitoring the same.
(a) General rule.
(1) Effective for diagnostic procedures performed on or after March 15,
1999, carriers will pay for diagnostic procedures under the physician fee
schedule only when performed by a physician, a group practice of
physicians, an approved supplier of portable x-ray services, a nurse
practitioner, or a clinical nurse specialist when he or she performs a test he
or she is authorized by the State to perform, or an independent diagnostic
testing facility (IDTF). An IDTF may be a fixed location, a mobile entity, or an
individual nonphysician practitioner. It is independent of a physician's office
or hospital; however, these rules apply when an IDTF furnishes diagnostic
procedures in a physician's office.
(2) Exceptions. The following diagnostic tests that are payable under the
physician fee schedule and furnished by a nonhospital testing entity are not

required to be furnished (i) Diagnostic mammography procedures, which are

regulated by the Food and Drug Administration.
(ii) Diagnostic tests personally furnished by a qualified audiologist as
defined in section 1861(ll)(3) of the Act.
(iii) Diagnostic psychological testing services personally furnished by a
clinical psychologist or a qualified independent psychologist as defined in
program instructions.
(iv)

Diagnostic

tests

(as

established

through

program

instructions)

personally performed by a physical therapist who is certified by the

American

Board

of

Physical

Therapy

Specialties

as

qualified

electrophysiological clinical specialist and permitted to provide the service

under State law.
(b) Supervising physician.
(1) Each supervising physician must be limited to providing general
supervision to no more than three IDTF sites. This applies to both fixed sites
and mobile units where three concurrent operations are capable of
performing tests.
(2) The supervising physician must evidence proficiency in the performance
and interpretation of each type of diagnostic procedure performed by the
IDTF. The proficiency may be documented by certification in specific medical
specialties or subspecialties or by criteria established by the carrier for the

service area in which the IDTF is located. In the case of a procedure

requiring the direct or personal supervision of a physician the IDTF's
supervising physician must personally furnish this level of supervision
whether the procedure is performed in the IDTF or, in the case of mobile
services, at the remote location. The IDTF must maintain documentation of
sufficient physician resources during all hours of operations to assure that
the required physician supervision is furnished. In the case of procedures
requiring direct supervision, the supervising physician may oversee
concurrent procedures.
(c) Nonphysician personnel.
Any nonphysician personnel used by the IDTF to perform tests must
demonstrate the basic qualifications to perform the tests in question and
have training and proficiency as evidenced by licensure or certification by
the appropriate State health or education department. In the absence of a
State licensing board, the technician must be certified by an appropriate
national credentialing body. The IDTF must maintain documentation
available for review that these requirements are met.
(d) Ordering of tests.
All procedures performed by the IDTF must be specifically ordered in writing
by the physician who is treating the beneficiary, that is, the physician who is
furnishing a consultation or treating a beneficiary for a specific medical

problem and who uses the results in the management of the beneficiary's
specific medical problem. The order must specify the diagnosis or other
basis for the testing. The supervising physician for the IDTF may not order
tests to be performed by the IDTF, unless the IDTF's supervising physician is
in fact the beneficiary's treating physician. That is, the physician in question
had a relationship with the beneficiary prior to the performance of the
testing and is treating the beneficiary for a specific medical problem. The
IDTF may not add any procedures based on internal protocols without a
written order from the treating physician.
Diagnosis is always the first step to disease management as without
accurate identification, there is no chance for accurate treatment. Hence, on
this background we will see the diagnostics industry get more regulated in
the coming years which will result in improvement in standards for the
entire industry and accreditations, local and global, will play an important
role in differentiating an average laboratory from a good quality laboratory.
=============================================
==============

5.Write an essay on the Heart and the Pacemaker.

Answer:- The heart is a specialised muscle that contracts regularly and
continuously, pumping blood to the body and the lungs. The pumping action
is caused by a flow of electricity through the heart that repeats itself in a
cycle. If this electrical activity is disrupted - for example by a disturbance in

the heart's rhythm known as an 'arrhythmia' - it can affect the heart's ability
to pump properly.
Figure 1: How the heart functions electrically

The heart's natural pacemaker - the SA node sends out regular electrical impulses from the
top chamber (the atrium) causing it to
contract and pump blood into the bottom
chamber

(the

ventricle).

The

electrical

impulse is then conducted to the ventricles through a form of 'junction box'

called the AV node. The impulse spreads into the ventricles, causing the
muscle to contract and to pump out the blood. The blood from the right
ventricle goes to the lungs, and the blood from the left ventricle goes to the
body.
The heart has four chambers - two at the top (the atria) and two at the
bottom (the ventricles). The normal trigger for the heart to contract arises
from the heart's natural pacemaker, the SA node, which is in the top
chamber (see the diagram, right). The SA node sends out regular electrical
impulses causing the atrium to contract and to pump blood into the bottom
chamber (the ventricle). The electrical impulse then passes to the ventricles
through a form of 'junction box' called the AV node (atrio-ventricular node).
This electrical impulse spreads into the ventricles, causing the muscle to
contract and to pump blood to the lungs and the body. Chemicals which
circulate in the blood, and which are released by the nerves that regulate
the heart, alter the speed of the pacemaker and the force of the pumping
action of the ventricles. For example, adrenaline increases the heart rate
and the volume of blood pumped by the heart.

The electrical activity of the heart can be detected by

doing an 'electrocardiogram' (also called an ECG). An
ECG recording looks something like the one shown
below.
A death is described as sudden when it occurs unexpectedly, spontaneously
and/or even dramatically. Some will be unwitnessed; some may occur during
sleep or during or just after exercise. Most sudden deaths are due to a heart
condition and are then called sudden cardiac death (SCD). Up to 95 in every
100 sudden cardiac deaths are due to disease that causes abnormality of
the structure of the heart. The actual mechanism of death is most
commonly a serious disturbance of the heart's rhythm known as a
'ventricular arrhythmia' (a disturbance in the heart rhythm in the ventricles)
or 'ventricular tachycardia' (a rapid heart rate in the ventricles). This can
disrupt the ability of the ventricles to pump blood effectively to the body
and can cause a loss of all blood pressure. This is known as a cardiac arrest.
If this problem is not resolved in about two minutes, and if no-one is
available to begin resuscitation, the brain and heart become significantly
damaged and death follows quickly.
Pacemaker The human heart is an essential organ of the human body. Its
sole purpose is to supply the body with oxygen by pumping blood through a
complex system of veins and arteries. However, it is often common for the
human heart to suffer from various heart conditions, such as a heart block,
slow heart beat, heart attack or heart failure. Such heart conditions can lead
to weakness, fainting, shortness of breath, or even possibly death. These
can usually be treated with medication but in cases where medication is not
sufficient, doctors turn to the implantable pacemaker for the solution. The
pacemaker is a battery-powered, implantable device, which electronically
stimulates the heart to contract and thus pump blood throughout the body.

A pacemaker is a small device that's placed in the chest to help control

abnormal heart rhythms. Pacemaker uses electrical pulses. 1. 2. 3. 4. 5.
Pacemakers are used to treat arrhythmias. Fast heartbeat is called
tachycardia. Slow heartbeat is called bradycardia Arrhythmias are problems
with the rate or rhythm of the heartbeat. During an arrhythmia, the heart
can beat too fast, too slow, or with an irregular rhythm.
1.During an arrhythmia, the heart is not be able to pump enough blood to
the body. 2) This can cause fatigue, shortness of breath, or fainting. 3)
Severe arrhythmias can damage the vital organs and may cause
unconsciousness or death.
4) A pacemaker helps a person to resume a more active lifestyle by
1. Speeding up the heart rate when it is too slow
2. Slowing down the heart rate when it is too fast
3. Helping the rhythm of the heart beat regularly this is if you have a
pacemaker combined with a defibrillator, also called an ICD .
4. Speed up a slow heart rhythm. 5.
5. Help control an abnormal or fast heart rhythm.
6.Control atrial fibrillation.
7.Coordinate electrical signaling between the upper and lower chambers of
the heart.
A pacemaker is placed in the chest during surgery. Wires called leads are
put into the heart muscle. The device with the battery is placed under your
skin, below your shoulder

Heart's Electrical System

Heart has its own internal electrical system that controls the rate and
rhythm of heartbeat. With each heartbeat, an electrical signal spreads from
the top of heart to the bottom. it causes the heart to contract and pump
blood. 2. Electrical signals normally begin in a group of cells called the sinus
node or sinoatrial (SA) node. 3. First of all, the heart's upper two chambers,
the atria contract. This contraction pumps blood into the heart's two lower
chambers, the ventricles. The ventricles then contract and pump blood to
the rest of the body. 4. This alternate contraction of the atria and ventricles
is a heartbeat.
Pacemakers can be 1. Temporary or 2. Permanent. Temporary pacemakers
are used to treat short-term heart problems, such as a slow heartbeat that's
caused by a heart attack, heart surgery, or an overdose of medicine.
Permanent pacemakers are used to control long-term heart rhythm
problems and It is implanted just under the skin of the chest during minor
surgery. Arrhythmias are also treated by an implantable cardioverter
defibrillator (ICD). An ICD is similar to a pacemaker. An ICD besides using
low-energy electrical pulses. An ICD also can use high-energy pulses to treat
life-threatening arrhythmias.
It consists of three parts, the generator, leads and electrodes. The generator
supplies power to the pacemaker via lithium batteries, which typically last
5-10 years. The generator generates the electric impulses that correct the
slow heartbeat. Connected to the generator are a series of platinum leads,
insulated with a coating of silicone or polyurethane. The leads are
responsible for carrying the electric impulses from the generator. Lastly, at
the tip of each lead lies a tiny electrode that delivers the necessary
electrical impulse to the heart

There are several types of pacemakers, such as demand pacemakers, fixedrate pacemakers and rate-responsive pacemakers. Demand pacemakers
constantly monitor the patient's heart rate and only deliver an electric
impulse when needed, such as when the heart skips a beat or falls below a
programmed minimum. Fixed-rate pacemakers constantly discharge at a
regular rate, regardless of the patient's heart rate. Rate-responsive
pacemakers monitor other physical discharges or the body, such as
respiration, and change the discharge rate accordingly. The ranges of
pacemakers are available to patients to give them a choice of which they
would prefer or which would best suit their condition.The pacemaker is not
without its limitations.
Patients with pacemakers are advised to avoid devices with powerful
electromagnetic fields, as they can reprogram the pacemaker. Such devices
include

Magnetic

Resonance

Imaging

(MRI)

machines,

which

mean

pacemaker patients are unable to take advantage of this new technology.

Additionally, pacemaker batteries typically last only 5-10 years, which
means when the battery runs low, the patient will have to undergo an
operation to change the battery. In this operation the entire generator is
replaced

with

new

batteries.

Pacemaker

technology

is

constantly

developing.
Existing pacemakers have been found to be useful in treating other medical
conditions. For example, the pacemaker's role in correcting slow heartbeats
may be effective in the treatment of central sleep apnea. Central sleep
apnea is a medical condition in which a patient's breathing ceases during
sleep. The patient essentially "forgets" to breathe. Pacemakers can improve
this condition by setting the pacemaker at a higher resting rate.

Furthermore, devices that function as both a pacemaker and a defibrillator

are being developed. Such a device would be able to treat both abnormally
fast and abnormally slow heart rates.
==============================================
==============

6.Write an essay on Healthcare in India.

Health

care

facilities

and

personnel

increased

substantially

between the early 1950s and early 1980s, but because of fast
population growth, the number of licensed medical practitioners
per 10,000 individuals had fallen by die late 1980s to three per
10,000 from the 1981 level of four per 10,000. In 1991 there were
approximately ten hospital beds per 10,000 individuals.
Primary health centres are the cornerstones of the rural health
care system. By 1991, India had about 22,400 primary health
centres, 11,200 hospitals, and 27,400 dispensaries. These facilities
are part of a tiered health care system that funnels more difficult
cases into urban hospitals while attempting to provide routine
medical care to the vast majority in the countryside. Primary
health centres and sub-centres rely on trained paramedics to meet
most of their needs.
The main problems affecting the success primary health centres
are the predominance of clinical and curative concerns over the
intended emphasis on preventive work and the reluctance of staff

to work in rural areas. In addition, die integration of health

services with family planning programmes often causes the local
population to perceive the primary health centres as hostile to
their traditional preference for large families. Therefore, primary
health centres often play an adversarial role in local efforts to
implement national health policies.
According to data provided in 1989 by the Ministry of Health and
Family Welfare, the total number of civilian hospitals for all states
and union territories combined was 10,157. In 1991 there was a
total of 811,000 hospital and health care facilities beds. The
geographical distribution of hospitals varied according to local
socio-economic conditions. In Indias most populous state, Uttar
Pradesh, with a 1991 population of more than 139 million, there
were 735 hospitals as of 1990. In Kerala, with a 1991 population of
29 million occupying an area only one-seventh the size of Uttar
Pradesh, there were 2,053 hospitals. In light of the central
governments goal of health care for all by 2000, the uneven
distribution of hospitals needs to be re-examined. Private studies
of Indias total number of hospitals in the early 1990s were more
conservative than official Indian data, estimating that in 1992
there were ^300 hospitals. Of this total, nearly 4,000 were owned
a1(d managed by central, state, or local governments. Another
2,000, owned and managed by charitable trusts, received
Partial support from the government, and the remaining 1,300
hospitals, many of which were relatively small facilities were

owned and managed by the private sector. The use of state-of-theart medical equipment, often imported from Western countries,
was primarily limited to urban centres in the early 1990s. A
network of regional cancer diagnostic and treatment facilities was
being established in the early 1990s in major hospitals that were
part of government medical colleges. By 1992 twenty-two such
centres were in operation.
Most of the 1,300 private hospitals lacked sophisticated medical
facilities, although, in 1992, approximately 12 per cent possessed
state-of-the-art equipment for diagnosis and treatment of all major
diseases, including cancer. The fast pace of development of the
private medical sector and the burgeoning middle class in the
1990s have led to the emergence of the new concept in India of
establishing hospitals and health care facilities on a for-profit
basis.
By the late 1980s, there were approximately 128 medical colleges
roughly three times more than in 1950. These medical colleges
in 1987 accepted a combined annual class of 14,166 students.
Data for 1987 show that there were 320,000 registered medical
practitioners and 219,300 registered nurses. Various studies have
shown that in both urban and rural areas people preferred to pay
and seek the more sophisticated services provided by private
physicians rather than use free treatment at public health centres.
Indigenous or traditional medical practitioners continue to practice
throughout the country.

The two main forms of traditional medicine practiced are the

ayurvedic (meaning science of life) system, which deals with
causes, symptoms, diagnoses, and treatment based on all aspects
of well- being (mental, physical, and spiritual), and the unani (socalled Galenic medicine) herbal medical practice. A vaidya is a
practitioner of the ayurvedic tradition, and a hakim (Arabic for a
Muslim physician) is a practitioner of the unani tradition. These
professions are frequently hereditary. A variety of institutions offer
training in indigenous medical practice. Only in the late 1970s did
official health policy refer to any form of integration between
Western-oriented medical personnel and indigenous medical
practitioners. In the early 1990s, there were ninety-eight ayurvedic
colleges and seventeen unani colleges operating in both the
governmental and non-governmental sectors.
The Indian constitution charges the states with the raising of the
level of nutrition and the standard of living of its People and the
improvement of public health. However, many critics of Indias
National Health Policy, endorsed by Parliament in 1983, point out
that the policy lacks specific measures to achieve broad stated
goals. Particular Problems include the failure to integrate health
services With wider economic and social development, the lack of
Nutritional support and sanitation, and the poor participatory
involvement at the local level.
Central government efforts at influencing public health have
focused on the five-year plans, on coordinated planning with the

states, and on sponsoring major health programmes. Government

expenditures

are

jointly

shared

by

the

central

and

state

governments. Goals and strategies are set through central-state

government consultations of the Central Council of Health and
Family Welfare. Central government efforts are administered by
the Ministry of Health and Family Welfare, which provides both
administrative and technical services and manages medical
education. States provide public services and health education.
The 1983 National Health Policy is committed to providing health
services to all by 2000. In 1983, health care expenditures varied
greatly among the states and union territories, from Rs.13 per
capita in Bihar to Rs.60 per capita in Himachal Pradesh, and Indian
per capita expenditure was low when compared with other Asian
countries outside of South Asia. Although government health care
spending progressively grew throughout the 1980s, such spending
as a percentage of the gross national product remained fairly
constant. In the meantime, health care spending as a share of
total government spending decreased. During the same period,
private sector spending on health care was about 1.5 times as
much as government spending.
In the mid-1990s, spending on health amounts to 6 per cent of
GDP, one of the highest levels among developing nations. The
established per capita spending is around Rs.320 per year with the
major input from private households (75 per cent). State
governments contribute 15.2 per cent, the central government 5.2

per cent, third- party insurance and employers 3.3 per cent, and
municipal government and foreign donors about 1.3, according to
a 1995 World Bank study. Of these proportions, 58.7 per cent goes
toward primary health care (curative, preventive, and promotive)
and 38.8 per cent is spent on secondary and tertiary inpatient
care. The rest goes for non-service costs.