Rajesh Chandwani

Discordance between lipid markers used for predicting cardiovascular risk in patients with type 2 diabetes

AIMS Non-high density lipoprotein cholesterol (non-HDL-C) is gaining importance over low density lipoprotein cholesterol (LDL-C) as cardiovascular risk marker in patients with type 2 diabetes. It represents the overall lipid burden and is a surrogate marker for the apolipoprotein B. We studied the discordance between the old (LDL-C) and the new (non-HDL-C) lipid markers in a large group of diabetes patients. METHODS The lipid profile data of all diabetes (T2DM, aged 18-75, using oral or injectable anti diabetic agents) patients was analyzed in this study. We excluded patients with type1 diabetes, secondary forms of diabetes and gestational diabetes. Elevated lipid parameters (LDL>100mg/dL and non HDL-C>130mg/dL) were defined as per the guidelines of Adult Treatment Panel III. RESULTS The study participants (409 M:360 F) had a mean age of 47.3±12.4 years, BMI of 28.4±5.6kg/m(2) and an A1c of 8.8±2.2%. Elevated LDL-C was observed in 383 patients (49.8%) and elevated non HDL-C in 418 (54.4%) patients. Of the 383 patients with elevated LDL-C, 346 (90.3%) had corresponding elevated levels of non-HDL-C and out of 418 patients with elevated non HDL-C, 346 (83%) had elevated LDL-C. Discordance between the elevated LDL-C and non-HDL-C values were greater among patients with low triglyceride levels when compared with those with high triglycerides (Pearsons χ(2) test=67.7; P<0.001). CONCLUSION Our data suggest a significant discordance between the LDL-C and non-HDL-C in patients with diabetes. This discordance leads to the residual cardiovascular risk in diabetes patients.

Telemedicine in India: current state, challenges and opportunities

Purpose – The purpose of this conceptual paper is to present the scope of telemedicine, current state of telemedicine in India, challenges in its diffusion and suggest the way forward for implementation of such initiatives. Design/methodology/approach – This is a viewpoint paper that is prepared based on authors’ exposure and knowledge about research topic and the context. A number of appropriate and current citations have been utilised to illustrate current state on the topic as well as to support authors arguments presented in this paper. Findings – The discussion presented in this paper suggests that optimal utilisation of technology in healthcare delivery system requires overcoming barriers at multiple levels including policy, resources and socio-cultural levels. Successful implementation of telemedicine entails involvement of all the stakeholders, namely, the specialists, general duty doctors, paramedical personnel, technical staff, coordination staff, policymakers and, most importantly, the target c...

The Institutional Dynamics Perspective of ICT for Health Initiatives in India

As there has been a considerable investment in ICT for development (ICT4D) initiatives, policymakers, practitioners and academics are calling for a more comprehensive and meaningful assessment of the impact of such initiatives. While the impact assessment of ICT4D can be carried out from multiple perspectives, the institutional lens is opportune in examining the softer aspects of the impact such as the behavioural, cultural, and social dimensions. ICT4D interventions juxtapose two institutional logics, that of designer and of the users, which may or may not align with each other. The impact of the initiative depends on how the interplay between the logics unfolds. We exemplify the importance of institutional context in impact assessment of ICT4D initiatives by examining the interplay of the institutional logics in the healthcare system. We conceptualise healthcare system in terms of the logic of choice, perpetuated by the ICT for health initiative, and the logic of care which is embedded in the core of the health system. The interaction between the two logics, in turn, determines how the intervention evolves. We arrive at a framework outlining the tensions arising from the interplay of the logic of choice and logic of care in the healthcare system when an ICT4D intervention is introduced.

Factors affecting Web 2.0 adoption: exploring the knowledge sharing and knowledge seeking aspects in health care professionals

Purpose This research aims to explore the factors that affect the adoption of Web 2.0 among knowledge workers. The research specifically investigated the role of factors related to both knowledge seeking and knowledge sharing, in the context of Web 2.0 use by health care professionals. Design/methodology/approach For this research, a cross-sectional survey design was adopted. The data were analyzed using the partial least square-structural equation modeling. Findings The results confirmed that the intention to adopt Web 2.0 depends upon both the knowledge-seeking and the knowledge-sharing attitudes. However, between the two, it is knowledge-sharing factors that are more important. Health care professionals tend to share knowledge driven by intrinsic motivators rather than by extrinsic motivators. On the other hand, knowledge-seeking attitude was determined by usefulness of knowledge and was not affected by the effort involved. Research limitations/implications All the respondents were health care professionals from India, and convenience sampling was used to reach them. This may limit the generalizability of the findings. Practical implications This research provides useful insights on implementing Web 2.0-based knowledge management systems, specifically for health care professionals. Particularly, it emphasizes the need to focus on reinforcing intrinsic motivators like self-efficacy and the joy of sharing. Originality/value It is perhaps the first study that integrates the factors related to knowledge sharing and seeking in a single theoretical model, thereby presents and tests a more realistic model of knowledge management.

Doctor-patient interaction in telemedicine: Logic of choice and logic of care perspectives

This paper focuses on telemedicine implementation, which can be used to extend modern medical knowledge to remote areas in developing countries. By examining doctor- patient interactions in the context of a telemedicine program in India, we posit how the behaviour of the actors interacting over virtual media is determined by interplay between two dominant institutional logics, namely logic of care and logic of choice. The paper draws on the tenets of institutional logics to extend the theoretical understanding about processes of engagement of actors with a new technology and explicates how the engagement evolves with the use of technology. The research emphasizes the essential role of considering the dynamics of logic of care and logic of choice in the design and implementation process.

Common Services Centres (CSCs) as an approach to bridge the digital divide: Reflecting on challenges and obstacles

Purpose Despite the increasing technological capabilities and its affordability, a significantly large proportion of developing nations’ population are still lacking resources to own basic information and communication technologies such as computer and internet. This suggests that majority of the citizens from developing countries (e.g. India) are also not able to access and use emerging electronic government applications and services. This is leading to a further and bigger digital divide gap that already exists between rural and urban as well as economically less and more able population. To reduce the widening digital divide, India has innovated Common Services Centres (CSCs) as means to deliver public services electronically to citizens at the village level. This viewpoint paper aims to discuss some of the challenges and obstacles of such CSCs and to offer some recommendations for their effective implementations and sustainable operations. Design/methodology/approach This is a viewpoint paper that is based on authors’ awareness of the context as well as knowledge and issues relevant to the research topic. A number of appropriate and current citations have been utilised to illustrate the current state on the topic as well as to support authors’ arguments presented in this paper. Findings The paper identified a number of key issues relevant for effective implementation and sustainable operation of CSCs. The authors present their views and recommendations related to the following key issues: connectivity problems, lack of or delayed rollout of government to citizen (G2C) services, demotivated village-level entrepreneurs due to lack of G2C services, low computer literacy, lack of awareness about services and facilities, lack of adequate training and support, poor provisioning of an effective infrastructure, lack of support from the concerned government officials, inaccessible locations, burden of high investment, corruption at the government level, lack of skilled manpower to run the CSCs, lack of power supply, language barrier, lack of space, problem with maintenance and management of connectivity network and problem caused by the Naxalite and anarchist activity. Originality/value The discussion and recommendations presented in this paper would be valuable to various agencies (both from public and private sectors) as well as policymakers for effective implementation and long-term sustainability of CSCs. The approach discussed in this paper offers an effective way to diffuse e-government applications and services in other developing countries (particularly resource-constrained nations from African, Asian and Latin American regions).

Role of Intermediaries in Providing Financial Access: Current and Future Research Trends

Access to financial products and services is considered to be an important determinant of development, as it has been linked to poverty alleviation. Policymakers in the emerging economies design and implement various solutions to overcome barriers to financial access. Mobile phones have been highlighted as the potential means to extend financial services, especially in countries like India, where mobile penetration is high. However, gaps in digital literacy and financial literacy need to be overcome to realize the potential of mobile phones in enabling financial access. Scholars and practitioners have highlighted the role of ‘intermediaries’ who can bridge these gaps and provide the last mile connectivity between ICT initiatives and the user community. Traditionally, ‘intermediaries’ refer to the human intermediaries. We do, however, have some initiatives that use technology itself to bridge gaps related to financial literacy as well as digital literacy. For instance, user-friendly interactive systems that provide information about the use of mobile phones for payment as well as about financial products and services. In this chapter, we describe such initiatives where intermediation through both human intervention and technology was used for enabling financial access. Further, we outline potential research directions that can further illuminate the role of intermediation in enabling financial access.

APML drives a culture of ownership and innovation: Open-door policy makes employees feel part of the family

Purpose – Discusses the key dimensions of organizational culture at Agarwal Packers and Movers Ltd (APML), India. Design/methodology/approach – Describes the role of human resource management (HRM) practices in building an organizational culture which enhances performance through innovation and a strong customer-service orientation. Findings – Discusses how field-level employees in APML are connected with the organization through the owners and top management. Through different HRM practices, APML has been successful in instilling a feeling of ownership among the employees and in harnessing their energy for fostering innovation, superior customer service and profitability. Practical implications – Highlights the positive aspects of employee involvement in the context of an Indian family business. Social implications – Illustrates that emphasizing family values in the organizational culture can enable the organization to develop a sense of gratitude and reciprocity. Originality/value – Stresses the importa...