Hospital

A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals are usually funded by the public sector, by health organizations (for profit or nonprofit), health insurance companies, or charities, including direct charitable donations. Historically, hospitals were often founded and funded by religious orders or charitable individuals and leaders. Today, hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in the past, this work was usually performed by the founding religious orders or by volunteers. However, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters, which still focus on hospital ministry today. There are over 17,000 hospitals in the world. In accord with the original meaning of the word, hospitals were originally "places of hospitality", and this meaning is still preserved in the names of some institutions such as the Royal Hospital Chelsea, established in 1681 as a retirement and nursing home for veteran soldiers.

which developed a silent s, which letter was eventually removed from the word, the loss of which is signified by a circumflex in the modern French word htel. The German word 'Spital' shares similar roots. Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usually requires an article; in Britain and elsewhere, the word normally is used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both uses are found.

Types
Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ('outpatients') without staying overnight; while others are 'admitted' and stay overnight or for several days or weeks or months ('inpatients'). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others often are described as clinics.

General
The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States, have their own ambulance service.

District
A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth.

Specialized
McMaster University Medical Centre, a teaching hospital in Canada Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth. A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre-twentieth-century origins began as one building and evolved into campuses. Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. There are however a few exceptions, e.g. China, where government funding only constitutes 10% of income of hospitals.

Clinics
A medical facility smaller than a hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.

Departments

Resuscitation room bed after a trauma intervention, showing the highly technical equipment of modern hospitals Hospitals vary widely in the services they offer and therefore, in the departments (or "wards") they have. They may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as:

Emergency department Cardiology Intensive care unit o Pediatric intensive care unit o Neonatal intensive care unit o Cardiovascular intensive care unit Neurology Oncology Obstetrics and gynecology

Some hospitals will have outpatient departments and some will have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy. Common support units include a dispensary or pharmacy, pathology, and radiology, and on the non-medical side, there often are medical records departments, release of information departments, Information Management (IM)(aka IT or IS), Clinical Engineering (aka Biomed),

Facilities Management, Plant Ops (aka Maintenance), Dining Services, and Security departments. Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is htelDieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580AD at Mrida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mrida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests. The Ospedale Maggiore, traditionally named Ca' Granda (i.e. Big House), in Milan, northern Italy, was constructed to house one of the first community hospitals, the largest such undertaking of the fifteenth century. Commissioned by Francesco Sforza in 1456 and designed by Antonio Filarete it is among the first examples of Renaissance architecture in Lombardy. The Normans brought their hospital system along when they conquered England in 1066. By merging with traditional land-tenure and customs, the new charitable houses became popular and were distinct from both English monasteries and French hospitals. They dispensed alms and some medicine, and were generously endowed by the nobility and gentry who counted on them for spiritual rewards after death.

Modern era
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charit (founded in Berlin in 1710) is an early example. Guy's Hospital was founded in London in 1724 from a bequest by the wealthy merchant, Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751, after 2,000 from private subscription was matched by funds from the Assembly. When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important research center. During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef koda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialized medicine.

By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In continental Europe the new hospitals generally were built and run from public funds. The National Health Service, the principle provider of health care in the United Kingdom, was founded in 1948. In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. One of the earliest of these "almshouses" in what would become the United States was started by William Penn in Philadelphia in 1713. These hospitals are taxexempt due to their charitable purpose, but provide only a minimum of charitable medical care. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. The largest public hospital system in America is the New York City Health and Hospitals Corporation, which includes Bellevue Hospital, the oldest U.S. hospital, affiliated with New York University Medical School. In the late twentieth century, chains of for-profit hospitals arose in the United States. The decline in the membership of religious orders has changed the status of Catholic hospitals. In the 2000s, modern private hospitals began to appear in developing countries such as India. In the modern era, hospitals are, broadly, either funded by the government of the country in which they are situated, or survive financially by competing in the private sector (a number of hospitals also are still supported by the historical type of charitable or religious associations). In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health care system exists, funded by the state. Hospital care is thus relatively easily available to all legal residents, although free emergency care is available to anyone, regardless of nationality or status. As hospitals prioritize their limited resources, there is a tendency for 'waiting lists' for non-crucial treatment in countries with such systems, as opposed to letting higher-payers get treated first, so sometimes those who can afford it take out private health care to get treatment more quickly. On the other hand, some countries, including the USA, have in the twentieth century introduced a private-based, for-profit-approach to providing hospital care, with few state-money supported 'charity' hospitals remaining today. Where for-profit hospitals in such countries admit uninsured patients in emergency situations (such as during and after Hurricane Katrina in the USA), they incur direct financial losses, ensuring that there is a clear disincentive to admit such patients. As the quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this matter. Independent external assessment of quality is one of the most powerful ways to assess this aspect of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international healthcare accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the USA, the Trent Accreditation Scheme from Great Britain, and Haute Authorit de sant (HAS) from France.

Buildings
Modern hospital buildings are designed to minimize the effort of medical personnel and the possibility of contamination while maximizing the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimized. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design. However, the reality is that many hospitals, even those considered 'modern', are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals: "... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety." Some newer hospitals now try to re-establish design that takes the patient's psychological needs into account, such as providing more fresh air, better views and more pleasant colour schemes. These ideas harken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings. The research of British Medical Association is showing that good hospital design can reduce patient's recovery time. Exposure to daylight is effective in reducing depression. Single sex accommodation help ensure that patients are treated in privacy and with dignity. Exposure to nature and hospital gardens is also important - looking out windows improves patients' moods and reduces blood pressure and stress level. Eliminating long corridors can reduce nurses' fatigue and stress. Another ongoing major development is the change from a ward-based system (where patients are accommodated in communal rooms, separated by movable partitions) to one in which they are accommodated in individual rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital; this causes some hospitals to charge for private rooms.

A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals are usually funded by the public sector, by health organizations (for profit or nonprofit), health insurance companies, or charities, including direct charitable donations. Historically, hospitals were often founded and funded by religious orders or charitable individuals and leaders. Today, hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in the past, this work was usually performed by the founding religious orders or by volunteers. However, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters, which still focus on hospital ministry today. There are over 17,000 hospitals in the world. In accord with the original meaning of the word, hospitals were originally "places of hospitality", and this meaning is still preserved in the names of some institutions such as the Royal Hospital Chelsea, established in 1681 as a retirement and nursing home for veteran soldiers. Common support units include a dispensary or pharmacy, pathology, and radiology, and on the non-medical side, there often are medical records departments, release of information departments, Information Management (IM)(aka IT or IS), Clinical Engineering (aka Biomed), Facilities Management, Plant Ops (aka Maintenance), Dining Services, and Security departments. In ancient cultures, religion and medicine were linked. The earliest documented institutions aiming to provide cures were ancient Egyptian temples. In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (Ancient Greek: , sing. Asclepieion, ), functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as enkoimesis () not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BC preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium. The worship of Asclepius was adopted by the Romans. Under his Roman name sculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed. Institutions created specifically to care for the ill also appeared early in India. Fa Xian, a Chinese Buddhist monk who travelled across India ca. 400 CE, recorded in his travelogue that "The heads of the Vaisya [merchant] families in them [all the kingdoms of north India] establish in the cities houses for dispensing charity and medicine. All the poor and destitute in the country,

orphans, widowers, and childless men, maimed people and cripples, and all who are diseased, go to those houses, and are provided with every kind of help, and doctors examine their diseases. They get the food and medicines which their cases require, and are made to feel at ease; and when they are better, they go away of themselves." The earliest surviving encyclopedia of medicine in Sanskrit is the Carakasamhita (Compendium of Caraka). This text, which describes the building of a hospital is dated by Dominik Wujastyk of the University College London from the period between 100 BCE and CE150. According to Dr.Wujastyk, the description by Fa Xian is one of the earliest accounts of a civic hospital system anywhere in the world and, coupled with Carakas description of how a clinic should be equipped, suggests that India may have been the first part of the world to have evolved an organized cosmopolitan system of institutionally-based medical provision. King Ashoka is said to have founded at least eighteen hospitals ca. 230 B.C., with physicians and nursing staff, the expense being borne by the royal treasury. Stanley Finger (2001) in his book, Origins of Neuroscience: A History of Explorations Into Brain Function, cites an Ashokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds of hospitals, hospitals for people and hospitals for animals. Where there were no healing herbs for people and animals, he ordered that they be bought and planted." However Dominik Wujastyk disputes this, arguing that the edict indicates that Ashoka built rest houses (for travellers) instead of hospitals, and that this was misinterpreted due to the reference to medical herbs. According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century A.D., King Pandukabhaya of Sri Lanka (reigned 437 BC to 367 BC) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world. Mihintale Hospital is the oldest in the world. Ruins of ancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura, and Medirigiriya. The first teaching hospital where students were authorized to practice methodically on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia".

The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C., and many were identified by later archeology. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools. A hospital and medical training center also existed at Jundishapur. The city of Jundishapur was founded in 271 CE by the Sassanid king Shapur I. It was one of the major cities in Khuzestan province of the Persian empire in what is today Iran. A large percentage of the population were Syriacs, most of whom were Christians. Under the rule of Khusraw I, refuge was granted to

Greek Nestorian Christian philosophers including the scholars of the Persian School of Edessa (Urfa)(also called the Academy of Athens), a Christian theological and medical university. These scholars made their way to Jundishapur in 529 following the closing of the academy by Emperor Justinian. They were engaged in medical sciences and initiated the first translation projects of medical texts. The arrival of these medical practitioners from Edessa marks the beginning of the hospital and medical center at Jundishapur. It included a medical school and hospital (bimaristan), a pharmacology laboratory, a translation house, a library and an observatory. Indian doctors also contributed to the school at Jundishapur, most notably the medical researcher Mankah. Later after Islamic invasion, the writings of Mankah and of the Indian doctor Sustura were translated into Arabic at Baghdad. In the ninth and tenth centuries the hospital in Baghdad employed twenty-five staff physicians and had separate wards for different conditions. The Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 and was simple, but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The first hospital in Egypt was opened in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia. The first Islamic psychiatric hospital was built in Baghdad in 705. Many other Islamic hospitals also often had their own wards dedicated to mental health. Thus between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care. Some suggest that physicians and surgeons were appointed who gave lectures to medical students and issued diplomas (ijazah) to those who were considered qualified to practice. However others assert that, in contrast to medieval Europe, medical schools under Islam did not develop a system of academic evaluation and certification. Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is htelDieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580AD at Mrida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mrida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests. The Ospedale Maggiore, traditionally named Ca' Granda (i.e. Big House), in Milan, northern Italy, was constructed to house one of the first community hospitals, the largest such undertaking of the fifteenth century. Commissioned by Francesco Sforza in 1456 and designed by Antonio Filarete it is among the first examples of Renaissance architecture in Lombardy. The Normans brought their hospital system along when they conquered England in 1066. By merging with traditional land-tenure and customs, the new charitable houses became popular and were distinct from both English monasteries and French hospitals. They dispensed alms and some medicine, and were generously endowed by the nobility and gentry who counted on them for spiritual rewards after death.

Modern era
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charit

The Horton General Hospital in Banbury, during 2010. It was built in 1872 and slightly expanded in both 1964 and 1972 and was nearly closed early in 2005. Modern hospital buildings are designed to minimize the effort of medical personnel and the possibility of contamination while maximizing the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimized. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design. However, the reality is that many hospitals, even those considered 'modern', are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals: "... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety." Some newer hospitals now try to re-establish design that takes the patient's psychological needs into account, such as providing more fresh air, better views and more pleasant colour schemes. These ideas harken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings. The research of British Medical Association is showing that good hospital design can reduce patient's recovery time. Exposure to daylight is effective in reducing depression. Single sex accommodation help ensure that patients are treated in privacy and with dignity. Exposure to nature and hospital gardens is also important - looking out windows improves patients' moods and reduces blood pressure and stress level. Eliminating long corridors can reduce nurses' fatigue and stress. Another ongoing major development is the change from a ward-based system (where patients are accommodated in communal rooms, separated by movable partitions) to one in which they are accommodated in individual rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental

to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital; this causes some hospitals to charge for private rooms. There are various titles and acronyms which all declare similar approaches to managing the information flow and storage in hospital routine services, as

Hospital Information System (HIS), or Healthcare Information System, or Clinical Information System (CIS), or Patient Data Management System (PDMS)

are comprehensive, integrated information systems designed to manage the medical, administrative, financial and legal aspects of a hospital and its service processing. Traditional approaches encompass paper-based information processing as well as resident work position and mobile data acquisition and presentation.

Standardization
There is no standardization but for data formats and for data interchange, as with the HL7 initiative supported by ISO.

Aim
As an area of medical informatics the aim of an HIS is to achieve the best possible support of patient care and outcome and administration by presenting data where needed and acquiring data when generated with networked electronic data processing.

Organizational Structure
The head of the HIS department is a person who is qualified and experienced in computer systems. Graduate and postgraduate computer diploma/degree holders are available. Depending on the set-up and the extent of computerization and its sophistication, the department may have some or all of the following staff in addition to the head of the department. Systems Administrator/Database Administrator The systems administrator-cum-database administrator is responsible for systems administration to ensure high uptime of the system and for handling all database back-up and restoration activities. Application Specialist and Trainer

The hospitals application specialist together with the software vendor is involved in all the activities required for implementing the application software. Trainers train and retrain new employees in the hospital. Hardware/network Engineers Hardware/Network engineers are responsible for maintaining the hardware and network systems in the hospital. They undertake all troubleshooting activities that may be required to keep the system online and patient data available to doctors and nurses.

Benefits of HIS
Easy Access to Patient Data to generate varied records, including classification based on demographic, gender, age, and so on. It is especially beneficial at ambulatory (out-patient) point, hence enhancing continuity of care. As well as, Internet-based access improves the ability to remotely access such data. It helps as a decision support system for the hospital authorities for developing comprehensive health care policies. Efficient and accurate administration of finance, diet of patient, engineering, and distribution of medical aid. It helps to view a broad picture of hospital growth Improved monitoring of drug usage, and study of effectiveness. This leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization. Enhances information integrity, reduces transcription errors, and reduces duplication of information entrie

Trauma center

Typical trauma room at at Level I Trauma Center. A trauma center is a hospital equipped to provide comprehensive emergency medical services to patients suffering traumatic injuries. Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced multidisciplinary treatment and specialized resources. According to the CDC, injuries are the leading cause of death for children and adults ages 144. The leading causes of trauma are motor vehicle accidents, falls, and assaults. In the United States, a hospital can receive Trauma Center verification by meeting specific criteria established by the American College of Surgeons (ACS) and passing a site review by the Verification Review Committee. Official designation as a Trauma Center is determined by individual state law provisions. Trauma centers vary in their specific capabilities and are identified by "Level" designation: Level-I (Level-1) being the highest, to Level-III (Level-3) being the lowest (some states have five designated levels, in which case Level-V (Level-5) is the lowest). Higher levels of trauma centers will have trauma surgeons available, including those trained in such specialties as Neurosurgery and Orthopedic surgery as well as highly sophisticated medical diagnostic equipment. Lower levels of trauma centers may only be able to provide initial care and stabilization of a traumatic injury and arrange for transfer of the victim to a higher level of trauma care. The operation of a trauma center is extremely expensive. Some areas are under-served by trauma centers because of this expense (for example, Harborview Medical Center in Seattle is the only Level I trauma center to serve the entirety of Washington, Alaska, Montana, and Idaho. As there is no way to schedule the need for emergency services, patient traffic at trauma centers can vary widely. A variety of different methods have been developed for dealing with this. A trauma center will often have a helipad for receiving patients that have been airlifted to the hospital. In many cases, persons injured in remote areas and transported to a distant trauma center by helicopter can receive faster and better medical care than if they had been transported by ground ambulance to a closer hospital that does not have a designated trauma center. The

trauma level certification can directly affect the patient's outcome and determine if the patient needs to be transferred to a higher level trauma center.

Note: A trauma center is a hospital that is designated by a state or local authority or is verified by the American College of Surgeons.

Level I
A Level I Trauma Center provides the highest level of surgical care to trauma patients. Being treated at a Level I Trauma Center increases a seriously injured patients chances of survival by an estimated 20 to 25 percent. It has a full range of specialists and equipment available 24 hours a day and admits a minimum required annual volume of severely injured patients. A Level I trauma center is required to have a certain number of surgeons, emergency physicians and anesthesiologists on duty 24 hours a day at the hospital, an education program, and preventive and outreach programs. Key elements include 24-hour in-house coverage by general surgeons and prompt availability of care in varying specialtiessuch as orthopedic surgery, neurosurgery, plastic surgery (plastic surgeons often take calls for hand injuries), anesthesiology, emergency medicine, radiology, internal medicine, oral and maxillofacial surgery (trained to treat injuries of the facial skin, muscles, bones), and critical carewhich are needed to adequately respond and care for various forms of trauma that a patient may suffer. Additionally, a Level I center has a program of research, is a leader in trauma education and injury prevention, and is a referral resource for communities in nearby regions.

Level II
A Level II trauma center works in collaboration with a Level I center. It provides comprehensive trauma care and supplements the clinical expertise of a Level I institution. It provides 24-hour availability of all essential specialties, personnel, and equipment. Minimum volume requirements may depend on local conditions. These institutions are not required to have an ongoing program of research or a surgical residency program.

Level III
A Level III trauma center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A Level III center has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of exceptionally severe injuries, Example: Rural or Community hospitals.

Level IV
A Level IV trauma center exists in some states where the resources do not exist for a Level III trauma center. It provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. It may also provide surgery and critical-care services, as defined in the scope of services for trauma care. A trauma-trained nurse is immediately available, and physicians are available upon the patient's arrival to the Emergency Department. Transfer agreements exist with other trauma centers of higher levels, for use when conditions warrant a transfer.

Level V
Provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. May provide surgical and critical-care services, as defined in the service's scope of traumacare services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the Emergency Department. If not open 24 hours daily, the facility must have an after-hours trauma response protocol.

Pediatric Trauma Centers

A facility can be designated an adult Trauma Center, a pediatric Trauma Center, or an adult & pediatric Trauma Center. If a hospital provides trauma care to both adult and pediatric patients, the Level designation may not be the same for each group. For example, a Level 1 adult Trauma Center may also be a Level 2 pediatric Trauma Center. This is because pediatric trauma surgery is a specialty unto itself. Adult trauma surgeons are not generally specialized in providing surgical trauma care to children, and vice versa, and the difference in practice is significant

Operation Theatre
A well equipped modern OT with all necessary equipment as listed below functions round the clock.

C-Arm Laparoscope Boyles Apparatus Vital Monitors Pulse Oxi-meters ECG Monitors Cautery units Diathermy Unit Operating Microscopes for Eye & ENT Hydraulic Operation Tables Suction Apparatus Pipeline Gas System Liquid Oxygen High Pressure steam sterilizer Shadowless Lamp (Halogen) Phaco Emulsification for Eye Cryo Unit for skin

Laboratory
The Hospital is well Equipped with a Modern Laboratory functioning 24 hrs with State of Art Equipment like Fully Automated Analyser, Semi-Auto Analyzers, Electrolyte Analyzer, ELISA Strip Reader, One Touch Gluco-meter. Major Tests for the Diagnosis of Thyroid, ELISA Tests for AIDS, Cardiology, Diabetes, Hepatitis etc, are done here apart from other investigations related to Bio-chemistry, Microbiology, Clinical Pathology etc.

CT Scan
A modern CT Scan is added to the diagnostic armamentorium of the hospital and this will serve the poor people of the area at a very low cost.

X-ray

The Hospital has a well Equipped Pleophos D/Ployskop 300MA Siemens X-ray Machine, 500 MA Toshiba X-ray Machine and a Genius 60 Mobile 60MA X-ray unit for taking x-rays. The Xray department is converted into a modern Computerised Radiography Unit.

ECG
The Hospital has Multi-channel ECG Machines for the Diagnosis of Cardiac Conditions and functions in the Casuality, OP and the ICU. Echo Cardiogram An exclusive ECHO machine is available and ECHOs are taken on Wednesdays and Sundays. Scan An advanced 3D/4D scan machine is installed in the scan department for accurate reporting. Wards In-patients Bed Distribution Female Medical Gynaec ICU Male Medical Maternity New Surgical Block 20 37 11 12 24 31

NICU Paediatric Surgical Special Ward Step down ICU Grand Total Outpatient Departments

4 37 25 9 210

The following Out patients departments work from morning 8 AM to 4 PM. On an average 1800 patients are seen in the OPD everyday. ANC & Gynaecology Cardiology Casuality 24 hours functioning. CT Scan Computerised Radiography Dental Dermatology Diabetology Dialysis ENT Female Medical Gastroentrology Child Immunisation Male Medical Nephrology Neurology Opthalmology Orthopeadic Peadiatric Physiotheraphy Surgery

Urology Scan Educational Programmes Training Programs The Hospital imparts training for the following Medical Institution: 1. Omayal Achi College of Nursing for the Graduate & PG Nursing Student. 2. Other institutions viz. a. Loyola College of Management b. Apollo Hospital c. Meenakshi College of Nursing d. AMM Nellikuppam Hospital e. Institute of Health Management and Research f. Vel RS Medical College g. DRBCCC Hindu College Future Expansion Plan 1. Additional Building for expansion 2. Advanced Eye Care 3. Cardiology with CathLab 4. Cardio Throacic Surgery 5. MRI Scan 6. Neuro Surgery 7. Trauma Care 8. Hospital Information and Management System Continuous Educational Programs As part of the efforts to update the knowledge in the field of Medicine and Nursing, Continuous Educational Programs - Classes and Workshops are held in the Hospital, every month. Ambulance Service

The Hospital is equipped with 24 hrs Ambulance facility equipped with basic life saving equipments and for the transportation of patients.

The Hirco hospital concept

Create a multi-speciality hospital with over 250 beds Provide all essential speciality and super-speciality services Blood banks Imaging and diagnostic facilities Holistic wellness services Research and development specialized training for doctors Develop a highly skilled and experienced healthcare team made up of the best specialists in their field Deliver buildings that comply with LEED certification as well as healthcare operational accreditations such as NABH, NABL, JCI, ISO and NIAHO

International healthcare accreditation

Due to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process. Healthcare is a vital and emotive issueits importance pervades all aspects of societies, and it has medical, dental, social, political, ethical, business, and financial ramifications. In any part of the world healthcare services can be provided either by the public sector or by the private sector, or by a combination of both, and the site of delivery of healthcare can be located in hospitals or be accessed through practitioners working in the community, such as general medical practitioners and dentists. This is occurring in most parts of the developed world in a setting in which people are expressing ever-greater expectations of hospitals and healthcare services. This trend is especially strong where socialised medical systems exist. For example, in the European Union "... patients have ever-greater expectations of what health systems ought to deliver," although there has been a "... continuous rise in costs of services determined by scientific and technological innovation." And in one particular EU member state, the United Kingdom, "... People are going to increase demand and they have also got an increased expectation of what the NHS can deliver." Interestingly, the USA manifests some differences here, and is an unusual and distinct oddity among developed Western countries. In 2007, 45.7 million of the overall US population (i.e. 15.3%) had no health insurance whatsoever yet in 2007 the USA spent nearly $2.3 trillion on healthcare, or 16% of the country's gross domestic product, more than twice as much per capita as the OECD average. Because of this, some US citizens are having to look outside of their

country to find affordable healthcare, through the medium of medical tourism, also known as "Global Healthcare" (see below). Apart from using hospitals and healthcare services to regain their health if it has become impaired, or to prevent ill health occurring in the first place, people the world over may also use them for a wide variety of other services, for example improving upon nature (e.g. cosmetic surgery, gender re-assignment surgery or acquiring help to overcome difficulties with becoming a parent (e.g. infertility treatment).

Healthcare and hospital accreditation

Fundamentally healthcare and hospital accreditation is about improving how care is delivered to patients and the quality of the care they receive. Accreditation has been defined as "A selfassessment and external peer assessment process used by health care organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve" Interest in hospital accreditation ascends as far as the World Health Organisation (see external links). Accreditation is one important component in patient safety. However, there is limited and contested evidence supporting the effectiveness of accreditation programs. In the USA in the early 20th century, there was concern over how to best create an appropriate environment in which clinicians could work. Standards to improve the control of the hospital environment were thus generated, and these subsequently grew into accreditation schemes with the remit to facilitate and improve organisational development. Part of the process is not only about assessing quality, but also about promoting and improving quality. Similar accreditation schemes were soon developed elsewhere in the world. In countries such as the United Kingdom, the USA, Australia, New Zealand and Canada, sophisticated accreditation groups have grown up to survey hospitals (and, in some cases, healthcare in the community). Furthermore, other accreditation groups have been set up with openly declared remits to look after just one particular area of healthcare, such as laboratory medicine or psychiatric services or sexual health. Accreditation systems are structured so as to provide objective measures for the external evaluation of quality and quality management. Accreditation schemes should ideally focus primarily on the patient and their pathway through the healthcare system this includes how they access care, how they are cared for after discharge from hospital, and the quality of the services provided for them. At the heart of these schemes is a list of standards which, ideally, serve to assess evaluate in a systematic and comprehensive way the standards of professional performance in a hospital. This includes not only hand-on patient care but also training and education of staff, credentials, clinical governance and audit, research activity, ethical standards etc. The standards can also be used internally by hospitals to develop and improve their quality

standards and quality management. Some international accreditation schemes believe that the standards applied should be fixed and are non-negotiable, while others operate a system of negotiation over standards - however, whatever approach is taken the every aspect of the process should be evidence-based. International standardization groups also exist, but it must be pointed out that the mere achieving of set standards is not the only factor involved in quality accreditation - there is also the significant matter of the incorporating into participating hospitals systems of self-examination, problem solving and self-improvement, and hence there is more to accreditation than following some sort of overall "standardization" process. As governments and the general public have increasingly come to demand more and more openness about health care and its delivery, including and especially hospital quality and safety and the clinical performance of doctors, and these accreditation systems have generally adapted to fulfill this extended role. However, accreditation should ideally be independent of governmental control, and accreditation groups should assess hospitals holistically, and not just some isolated facet of the hospitals activities or services such as the laboratories, pharmacy services, infection control, financial health or information technology services (indeed, partial accreditation of this type should be publicly acknowledged as such by both the accreditation scheme and the hospital). The best accreditation schemes also assess academic and intellectual activity (such as teaching and research) within those hospitals that they survey (see later) and have a clear and declared interest in medical ethics. In some parts of the world, accessing healthcare can be very expensive, even prohibitively so. While some countries have elected to provide comprehensive healthcare services for all of their populations, others appear to be satisfied with leaving portions of their population without access to healthcare. When it comes to who pays the bills for healthcare, it may be the government or it may be the individual (sometimes either by direct payment, and sometimes through employerrun schemes, insurance companies etc.), or a combination of both. However, healthcare can never be truly free someone somewhere will always have to pay, and the payer will always want the best value for money possible. "Affordability" of healthcare can be the insurmountable hurdle for some human beings. Value for money is hence another factor in assessing the true quality of healthcare.

Delhi Hospitals
Delhi is the second largest metropolitan city in India after Mumbai. It is the seat of Indian Government because government houses and administrative offices located here only. Delhi has well connected transport via air, rail and bus. International airport used to reach anywhere in India and worldwide. New Delhi is designed by Edwin Lutyens - British architect for built administrative and political houses. Old Delhi is completely dominated by historical monuments and temples. We can explore lot of tourist attractions in Old Delhi. You cant finish your trip within one day required at least 2-3 days spent to enjoy our traditional architecture and culture. Lot of tombs are located in Old Delhi. Climate of Delhi is extremely hot in summer in March to May and monsoon in July to August. Accommodation in Delhi highly appreciated because lot of private concern built hotels and apartments for staying purpose. They provide luxury and budget oriented rooms and arrangements of transportation. Medical Industry of Delhi is well improved sector and made international standard facilities arrange to cure disease and problems. Lot of multispecialty hospitals and medical college are in and around the Delhi. Doctors and staff well trained and highly qualified to taking care of patients and needs. Delhi Hospitals are well maintained by government and private concern give best service to the people. We have made some list of hospitals in Delhi with contact information.

Delhi Hospitals Apollo Hospitals

Indraprastha Apollo is one of the largest corporate hospitals in the Delhi. It is the third super specialty tertiary care hospital set by the Apollo Hospitals Group, jointly with the Government of New Delhi. Contact Sarita Vihar, Delhi Mathura Road, New Delhi - 110076 (India) Tel.: +(91)-11-26925858 E-mail: helpdesk_delhi@apollohospitals.com

Sir Ganga Ram Hospital in India

We have more than 200 patients taking free medicines from us under our T.B. eradication programme. Medicines are distributed every Tuesday and Friday from 10 a.m. to 12 a.m. These expensive drugs are distributed from our hospital premises, free of charge till the patient recovers.
Contact Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, INDIA Tel.: +(91)-11-25750000 E-mail:gangaram@sgrh.com Max Super Speciality Hospital Max Super Speciality Hospital (A unit of Devki Devi Foundation), Saket provides world class cardiovascular care with a service focus and creates unparalleled standards of medical and service excellence. Contact 2 Press Enclave Road, Saket New Delhi 110 017 Tel.: +(91)-11-2651 5050 Batra Hospitals Batra Hospital is the capitals first multi-specialty private hospital of Delhi. Our aim has always been to bring world-class medical care within the reach of common man. Contact 1, Tughlakabad Institutional Area, Mehrauli Badarpur Road, New Delhi-110062 Tel.: +(91)-11-29958747 E-mail:info@batrahospitaldelhi.org

Hospitals in India
Hospitals in India provide outstanding healthcare that expense significantly less than those in developed countries. These hospitals use sophisticated medical instrument and modern updated technology, delivered by proficient professionals. The success rates of these hospitals are similar to that of the developed nations. There are many government and private hospitals in India that are designed to offer superlative medical care service. These hospitals operate with some of the best medical equipment meet accurate international standards. The hospitals in India give great emphasis on the safety and comfort of the patient. They are designed with modern technologies to minimize the risk of infection. These hospitals are felicitated with a team of qualified professional doctors, surgeons, and nurses and for that reason patient from all over the globe make an attempt to avail medical tourism in India. There are many private companies that assist the patients to find the best healthcare clinics in India. We are one of the recognized agency and we have a tie-up with a large network of excellent hospitals. We offer you an opportunity to get best medical services from some of our carefully evaluated and selected hospitals that meet very high international standards. Some of the renowned names of hospitals in India are given below:-

AIIMS Fortis

MAX Healthcare Tata Memorial Hospital

Apollo Hospitals B.M. Birla Heart Research Centr

Why India
Healthcare in India excels in treatments relating to cardiothoracic surgery, joint replacement, transplants, orthopedic surgery, ophthalmology, and urology to name a few. Indian medical institutes offer gamut of services ranging from general medicine & surgery for many diseases and complications. Some of the hi-tech treatments at Indian hospitals include pathology, comprehensive physical and gynecological examinations, dental checkup, eye checkup, cancer risk markers, spiral CT scan and MRI. All the above mentioned treatment processes are carried out with standard and latest medical technology and equipment at par with the international treatment standards. The standard of medical investigations that are conducted in the Indian healthcare centers are at par with the international standards. The advanced diagnostic equipment that is used in different Indian hospitals is very sophisticated and updated. Treatment quality at Indian hospitals ensures reliable and high class test results. The corporate hospitals in India offer a group of renowned hospitals like Escorts Hospitals in New Delhi, the Apollo Group, and Jaslok Hospitals in Mumbai to name a few of them. India is a preferred medical destination by the foreign tourists. The costs of any medical treatment in India healthcare centers are cheap as compared to the treatment cost in Thailand, Singapore, UK, USA, etc. The priority in treatment standard at an affordable price at the Indian healthcare centers makes it the most preferable medical tourism destination in the entire world.

Healthcare Infrastructure
Over the last few years, India had put up an enormous healthcare infrastructure to all government and private healthcare sectors. Every healthcare institute is equipped with professionals and paraprofessionals medical surgeons. The renowned healthcare centers in India boasts of providing significant healthcare services at all small hospitals, nursing homes, dispensaries and large corporate hospitals. The bulk of healthcare infrastructure that is spent for high quality of medical treatment and technology in India accounts for recent effective growth of health tourism in India. Medical tourism in India is cost effective as compared to treatment cost in other Asian and European countries. So, travelers from all round the globe come to India to avail preventive healthcare services and medical treatments. With the raising healthcare demand, the Government of India is taking all necessary steps to improve the healthcare infrastructure in the country. Tourist coming to India for medical services can ensure specialized treatment as per the international standards at a reasonable cost.

India vs USA
India offers treatment of various complicated diseases at a very reasonable cost. The highly proficient team of surgeons at high standard hospitals in India ensures best treatment to the patients. The standard of the medical services in India are at per to the international standards. Inspite of providing equivalent services in terms of quality of treatment, technology and efficient surgeons, the cost of the treatment is comparatively low in comparison to the cost treatment in India. Below is the table that shows the cost comparison of different treatment procedure in United States and India. Procedure Heart bypass Heart valve replacement Angioplasty Hip replacement Hysterectomy Knee replacement Spinal fusion Open Heart Surgery (CABG) Total Knee Replacement Hip Resurfacing LA Hysterectomy Lap Cholcystectomy Spinal Decompression Fusion Obesity Surgery (Gastric Bypass) United States ($) 130000 160000 57000 43000 20000 40000 62000 100000 48000 55000 22000 18000 60000 65000 India ($) 10000 9000 11000 9000 3000 8500 5500 7500 6300 7000 4000 3000 5500 9500

International Patient Care in India

The International Patient care program in Indian provides support to patients and family members who are far from home. It offers all assistance to the patients and their family members to cope up with the new environment and thus makes the medical procedures, a bit easier. This program provides translation services, healthy nutritive cuisine and checks of their vaccination at time. India offer most comprehensive medical care and treatment to take care of the international patients. They are examined by experienced medical professionals who use modern technologies and methodologies for the treatment. Other healthcare services and facilities for the international patients include:1. 2. 3. 4. 5. Translator facilities. Accommodation for patients and attendants. All major international credit cards are accepted. Locker facilities. hopping and recreational options.

Medical Service in India

With the elapsing time, the medical service in India is upgrading day by day. India is promoting establishment of many high-tech healing healthcare sector to provide best services to the patients. All these healthcare sectors are equipped with modern medical instruments and best doctors. Medical services in India also include zero waiting periods, which mean appointments are fixed even before the arrival of the patient. Get the best and high quality of medical and nursing care at a reasonable cost. Our mission is to encourage a promising trade in medical tourism by promoting the idea of traveling to India to avail world-class medical treatment. We recommend best healthcare service according to the needs and budget of the client. We take care of your accommodation, appointment and other services as per your requirement. So, get the best possible cure from specialized doctors without spending large amount of money while availing medical tourism in India. Some of the common medical services that are available in every healthcare sector are given below:- Weight Loss Services - Joint Replacement - Health Check Up - Dental Care - Eye Care - Heart Care - Preventive Health Care - Skin Care

Spinal cord stimulator

A spinal cord stimulator is a device used to exert pulsed electrical signals to the spinal cord to control chronic pain. Further applications is in motor disorders. The lumbar spinal cord is a preferred target for the control of spinal spasticity or augmentation of standing and stepping capabilities. Spinal cord stimulation (SCS), in the simplest form, consists of stimulating electrodes, implanted in the epidural space, an electrical pulse generator, implanted in the lower abdominal area or gluteal region, conducting wires connecting the electrodes to the generator, and the generator remote control. SCS has notable analgesic properties and, at the present, is used mostly in the treatment of failed back surgery syndrome, complex regional pain syndrome and refractory pain due to ischemia.

Mechanism of action
The neurophysiologic mechanisms of action of spinal cord stimulation are not completely understood yet. Linderoth and others have noted that the mechanism of analgesia when SCS is applied in neuropathic pain states may be very different from that involved in analgesia due to limb ischemia. In neuropathic pain states, experimental evidence show that SCS alters the local neurochemistry in dorsal horn, suppressing the hyperexcitability of the neurons. Specifically, there is some evidence for increased levels of GABA release, serotonin, and perhaps suppression of levels of some excitatory amino acids, including glutamate and aspartate. In the case of ischemic pain, analgesia seems to derive from restoration of the oxygen demand supply. This effect could be mediated by inhibition of the sympathetic system, although vasodilation is another possibility. It is also probable that a combination of the two abovementioned mechanisms is involved.

Technical consideration
Equipment
SCS, in simplest form, consists of a pulse generator with its remote controls, implanted stimulating electrodes and conducting wires connecting the electrodes to the generator. Generator The generator, implanted subcutaneously, could be a complete pulse generator module with its own battery or only a radio frequency (RF) receiver. The former case, usually called implantable pulse generator or IPG, has a battery of its own and could come with rechargeable battery which can be charged externally via a wireless power charger so that it does not need to be replaced surgically when it loses charge. The RF receiver on the other hand is externally driven by a transmitter from which it gets its power and pulses. This external transmitter has a battery which can be easily replaced. RF receivers have traditionally been used for patients who require high power settings that would quickly deplete a primary-cell IPG.

The patient is also provided with a remote control to turn on and off the stimulator, and depending on the device and the surgeons preference, can change the programming of the stimulation patterns. The surgeon has a programming device that could be used to modify a wide range of stimulation settings of the RF generator. Various current, voltage and waveforms configurations are possible. SC stimulators come in constant current, variable voltage or constant voltage, variable current. A distinction is also made with respect to the number of independent power sources incorporated within the device. There are single source devices and multiple-source devices. Up to now, a maximum of 16-source devices are manufactured.

Electrodes
The electrodes, which consist of an array of leads, could be percutaneous type or paddle type. Percutaneous electrodes are easier to insert in comparison with paddle type, which are inserted via incision over spinal cord and laminectomy.

Insertion procedures and techniques

SCS procedure involves careful placement of electrodes in the epidural space, a trial period (which takes between 57 days), and, if the results of pain relieving was satisfactory in the trial period, anchoring the electrodes to the interspinal ligaments, positioning and implantation of the pulse generator, tunneling and connection of the connecting wires, programming the system for the special pattern of stimulation and performing required postoperative cares. Selecting the level of stimulation The representation of the dermatomal level in the dorsal columns of the spinal cord is much higher than the corresponding vertebral level. For instance, the sweet spot for sciatic pain (dermatomal level L5/S1) is around T10 nerve. See dermatome and Spinal cord segments.
Electrodes selection

For the SCS to be effective, the area of paresthesia must overlap the area of pain. Selection of leads depends on which arrangement will give the best paresthesia coverage to the painful area. At present up to 16 electrodes can be stimulated by one system. A patient could have two octrodes (eight lead electrodes), which can be placed parallel to each other or at two different vertical sites. Four quatrodes (four lead electrodes) could be inserted to cover two different sites bilaterally or up to four sites vertically.
Generator implant

The IPG or the RF unit is usually implanted in the lower abdominal area or in the posterior superior gluteal region. It should be in a location that patients can access with their dominant hand for adjustment of their settings with the patient-held remote control. The decision to use a

fully implantable IPG or an RF unit depends on several considerations. If the patients pain pattern requires the use of many electrodes with high power settings, an RF unit should be used. The IPG battery life will largely depend on the power settings utilized, but the newer IPG units will generally last several years at average power settings.

Programming
Programming involves selecting the electrode stimulating configuration, adjusting the amplitude, width and frequency of electrical pulses. Amplitude indicates the intensity of stimulation. This is delivered in milliamperes or volts depending on the system used. Lower voltage or current is chosen for peripheral nerves and paddle leads. Pulse width usually varies from 100 to 400 us. Widening the pulse width will also broaden the area of paraesthesia. Frequency of pulse wave is usually between 20 and 120 hertz. It is an individual preference: some patients choose low frequency beating sensation whereas others prefer high frequency buzzing. Selection of lowest possible setting on all parameters is important in conserving battery life in non-rechargeable models of SCS. Cycling of stimulation is also employed to save battery life. Changing of stimulator program may have to be undertaken during the course of therapy and follow-up.

Patient selection
Appropriate patients for neurostimulation implants must meet the following criteria: the patient has a diagnosis amenable to this therapy, the patient has failed conservative therapy, significant psychological issues have been ruled out, and a trial has demonstrated pain relief. A trial period of stimulation over a period of 57 days should follow the psychiatric evaluation to demonstrate its effectiveness. This part of the protocol is important because of the cost of the equipment and the invasive nature of the procedure. The trial is considered successful if the patient achieves more than a 50% reduction in pain.

Low back pain

Non-specific low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment only headache is more common. It can be either acute, subacute or chronic in duration. With conservative measures, the symptoms of low back pain typically show significant improvement within a few weeks from onset.

Cause
The majority of lower back pain is referred to as non specific low back pain and does not have a definitive cause. It is believed to stem from benign musculoskeletal problems such as muscle or soft tissues sprain or strains. This is particularly true when the pain arose suddenly during physical loading of the back, with the pain lateral to the spine. Over 99% of back pain instances fall within this category. The full differential diagnosis includes many other less common conditions.

Mechanical: o Apophyseal osteoarthritis o Diffuse idiopathic skeletal hyperostosis o Degenerative discs o Scheuermann's kyphosis o Spinal disc herniation ("slipped disc") o Thoracic or lumbar spinal stenosis o Spondylolisthesis and other congenital abnormalities o Fractures o Sacroiliac joint dysfunction o Leg length difference o Restricted hip motion o Misaligned pelvis - pelvic obliquity, anteversion or retroversion o Abnormal foot pronation Inflammatory: o Seronegative spondylarthritides (e.g. ankylosing spondylitis) o Rheumatoid arthritis o Infection - epidural abscess or osteomyelitis o Sacroiliitis

Neoplastic: o Bone tumors (primary or metastatic) o Intradural spinal tumors Metabolic: o Osteoporotic fractures o Osteomalacia o Ochronosis o Chondrocalcinosis Psychosomatic o Tension myositis syndrome Paget's disease Referred pain: o Pelvic/abdominal disease o Prostate Cancer o Posture Oxygen deprivation

Pathophysiology

The lumbar region in regards to the rest of the spine.

The lumbar region (or lower back region) is made up of five vertebrae (L1-L5). In between these vertebrae lie fibrocartilage discs (intervertebral discs), which act as cushions, preventing the vertebrae from rubbing together while at the same time protecting the spinal cord. Nerves stem from the spinal cord through foramina within the vertebrae, providing muscles with sensations and motor associated messages. Stability of the spine is provided through ligaments and muscles of the back, lower back and abdomen. Small joints which prevent, as well as direct, motion of the spine are called facet joints (zygapophysial joints). Causes of lower back pain are varied. Most cases are believed to be due to a sprain or strain in the muscles and soft tissues of the back. Overactivity of the muscles of the back can lead to an injured or torn ligament in the back which in turn leads to pain. An injury can also occur to one of the intervertebral discs (disc tear, disc herniation). Due to aging, discs begin to diminish and shrink in size, resulting in vertebrae and facet joints rubbing against one another. Ligament and joint functionality also diminishes as one ages, leading to spondylolisthesis, which causes the vertebrae to move much more than they should. Pain is also generated through lumbar spinal stenosis, sciatica and scoliosis. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain or coccydynia). Others may have pain from their sacroiliac joint, where the spinal column attaches to the pelvis, called sacroiliac joint dysfunction which may be responsible for 22.6% of low back pain. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, a vertebral fracture (such as from osteoporosis), or rarely, an infection or tumor. In the vast majority of cases, no noteworthy or serious cause is ever identified. If the pain resolves after a few weeks, intensive testing is not indicated.

Departments/ Facilities: A. Following Super-specialties / facilities should be accommodated in the OPD 1. Ophthalmology (Managed by to Dr Ruma & Dr Manju) 2. Neurosciences & Robotics 3. Joint & trauma & Plastic 4. Cardiology (Outsourced) 5. Nephrology & Dialysis unit (Out sourced) 6. Infertility (Out sourced) B. General OPD 1. Medicine 2. Surgery & Lap 3. Obstetric & Gynecology 4. Dental 5. Pediatrics 6. ENT 7. Homeopathy

Note: - Some special clinics - such as Endocrinology, Rheumatology, Urology , Well baby, Vascular surgery, Ayurvedic, Aesthetics surgery, Dermatology, Bariatric Surgery clinics will be run in same rooms at designated time and day.

C. Casualty/ ER, Emergency OT/ Labor room & Dressing room D. Blood Collection/Pathology E. Pharmacy F. Radiology G. Administration & Marketing H. Ambulance and Travel I. Research Lab and Library

3.4 Support Services: Following Support Services shall be provided: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Operation Theatre Block with 3 Ors + Cath lab Emergency with 4 beds and one Minor OT Blood Bank (Out sourced) Radiology (X-Ray & Mobile X-ray, CT, MRI , USG Echo ) Cafeteria (Outsourced) Pathology Lab Physiotherapy (Outsourced) CSSD (Central Sterile & Supply Department) Central Medical Gases Pharmacy (Shop out sourced) General Stores Kitchen Security and Fire Maintenance & IT Electricity & Generators Accounts and Marketing Medical Records

Hospital kitchen: For preparation and distribution of general, special and therapeutic diets to the patients. Cafeteria : Catering for ambulatory patients, their relatives and staff. Central sterile supply services (C.S.S.D.) for recycling and replenishment of re-usable sterile supplies to various areas of patient care Medical records services for management of hospital informatics including filing and retrieval of outpatient records and statistical evaluation of hospital performance Medical and general store for inventory management of hospital supplies and their distribution to the areas of patient care.