In an endeavor to spread awareness about prevention of heart disease and to emphasize the importance of a healthy lifestyle, Indraprastha Apollo Hospitals in support with the Billion Hearts Beating Campaign organized “”Apollo Dil Ki Daud”” – a mini marathon today. 1000 people participated in the mini marathon supported by the Billion Hearts Beating Campaign. The marathon was supported by Manish Chaudhury, President, Delhi University Student Union along with CWG wrestlers Rajv Tomar, Anuj Chaudhary & Jaiprakash Nath; famous swimmer Khajan Singh; singers Ashok Masti and Shankar Sahini who feel that there is a huge need for such events to generate awareness among the masses. 200 doctors and nurses from Indraprastha Apollo Hospitals also ran for the cause. Heart disease is the biggest killer in urban India today. It is estimated that 60% of the world’s heart disease will belong to India (and Indians) in the near future. Indians are genetically prone to heart disease. Our sedentary and stressed modern lifestyle just multiplies the risk. In fact, an Indian is four times as likely to suffer from heart disease as compared to his Western counterpart. A heart attack also brings a lot of emotional turmoil for the family; it doesn’t only affect the one who gets a heart attack. Addressing this concern, Indraprastha Apollo Hospitals brought together 1000 people from Sarita Vihar, Jasola Vihar, Sukhdev Vihar, Ashram, Friends Colony, New Friends Colony, Defence Colony, GK-I, Jamia, etc, motivating them throughout the marathon would be a team of doctors present, also participating to spread awareness on the need of a healthy heart. “This marathon isn’t only about running – it intends to bring people together and motivate the community to take necessary possible steps towards a healthy heart. While we would encourage everyone to run, we also believe that its necessary to create awareness among people about the risk of heart disease if they do not adopt healthier lifestyles. The Apollo Dil Ki Daud could be the beginning for them to do that,” said Mr. Jaideep Gupta, Managing Director, Indraprastha Apollo Hospitals. Indraprastha Apollo Hospitals has always promoted steps towards being heart healthy. Billion Hearts Beating in one such campaign with the objective to spread awareness and spur positive action, as the risk of heart disease can be significantly reduced. Such health parades accelerate the awareness drive on sensitive health issues and encourage healthy living.

Those who have been going under the surgeon’s scalpel for weight-loss surgeries had one concern – the ugly scar the surgery would leave behind. No longer. Apollo Hospitals has introduced a Bariatric Surgery procedure done through a single incision in the belly button that leaves no visible scar. Bariatric surgery reduces the size of the stomach of morbidly obese people. Till recently, doctors had to either cut open the abdomen or make at least three holes to do these surgeries. The new technique does away with cuts and multiple incisions. Surgeons in the US are experimenting with a method to use a pipe as thick as a garden hose through the mouth to do bariatric surgery without external cuts. At the Apollo Hospitals, a team of surgeons headed by Dr Rajkumar Palaniappan began doing these surgeries a few months ago. “Many of patients undergoing the surgery are young who prefer a scarless surgery, ” Dr Palaniappan said. Obesity is most commonly caused by a combination of factors including poor diet, lack of physical activity, and genetic reasons. It leads to various health problems such as heart diseases, diabetes, breathing difficulties and even certain types of cancer. While many of them are advised better lifestyle, for some surgeries are inevitable. Usually, patients with a body mass index of above 32.5 are advised the surgery. During the surgery, doctors either remove a portion of the stomach to make the stomach look like the sleeve (Sleeve Gastrectomy) or reduce it using an implant (Gastric Banding). In people with morbid obesity along with complications such as diabetes, the stomach is not only made smaller, but it also restricts entry of food into the small intestine (Gastric Bypass). This reduces the intake of food and absorption of calories. Many of them who underwent the surgery including Mr.Venugopal from Chennai, who weighed 140 kg, said he had reduced nine kg in ten days. Diabetics, who underwent the surgery have reduced sugar levels. In some others, blood pressure and cholesterol were brought under control. Doctors are expecting lesser complaints of sleep apnea, asthma and joint pain, the usual side effects associated with bariatric surgery.

The Newsweek – March 14, 2011 : With a fiery new energy, women are starting businesses, building schools, fighting corruption, harnessing new technologies and breaking down old prejudices. Whenever a woman gains control of her destiny, the local standard of living goes up and the values of human rights spread. So, this year and every year, the Newsweek will honor local heroes and the growing network of powerful women who support their efforts ! Dr. Preetha Reddy has been honored this year, as one of the 150 Women who shake the World by the Newsweek, for her efforts towards transforming India’s medical landscape among other great women like Ms.Madeleine Albright, Ms. Melinda Gates, Ms. Michelle Obama, Ms. Aung San Suu Kyi, Ms. Angelina Jolie, Ms. Condoleezza Rice and others.

Apollo Hospitals Group has performed more than 775 solid organ transplants for the year, 2010, making it one of the World’s Busiest Liver Transplant Centre’s. Indraprastha Apollo Hospitals, Delhi has also completed over 500 liver transplants in February, 2011. The statistics portray an alarming need for organ transplants in India. According to the estimated statistics, every 3 minutes a patient is added to the list of patients needing a transplant. More than 200,000 Indians require organ transplantation annually, an estimated 20,000 liver transplants are required per year in India. The first successful adult and pediatric liver transplant in India were performed at Indraprastha Apollo Hospitals, Delhi in 1998. The first successful liver and kidney transplant happened in 1999 at our centre. While liver transplantation was established late in India, a tremendous progress has been made in the last decade. “We gave a commitment to the nation 27 years ago of bringing world class healthcare to the reach of common man. The success of our liver transplant program exhibits that we are second to none and India is well on its way to become a global healthcare destination. Our program has encouraged all sections of the society to come together to promote organ donation so that many more lives can be saved. Indraprastha Apollo Hospitals, Delhi, performed the first successful Liver Transplant in 1998 and in February, 2011 we have achieved a milestone of completing 500 liver transplants, while the Group has performed more than 775 solid organ transplants for the year 2010,” said Dr Prathap C Reddy, Chairman, Apollo Hospitals Group. “Apollo’s comprehensive liver transplant care programme aims to provide effective health care by providing quality treatment to people with liver disease. The team at Apollo Hospitals has provided consistent results and maintained the highest standard for donor safety. As a result not only patients from India, but from around the world have undergone successful liver transplantations here,” said Dr.Preetha Reddy, Managing director, Apollo Hospitals Group. Liver transplantation is the epitome of advanced medical care where a team interaction is necessary to optimize result. It is not possible to achieve good results unless the departments of anesthesia, radiology, intensive care, gastroenterology, transfusion medicine, microbiology, pathology and of course the transplant team are of an excellent standard. A difficult operation should be broken down in to simple steps and different team members can specialize in one aspect of this major surgical exercise resulting in overall good outcome. This has been the mantra of the Apollo Hospitals transplant team. “Apollo Hospitals has five centers for liver transplant in Delhi, Chennai, Ahmedabad, Bangalore and Kolkata. Apollo is planning to establish a total of 6 liver centers and 14 kidney transplant centers in the next 12 months. Having established the first successful liver transplant in India we believe we have enough experience to establish liver transplant centers in other locations. This year we have already completed 500 liver transplants” said Dr. Anupam Sibal, Group Medical Director Apollo Group and Senior Pediatric Gastroenterologist. Liver Transplant is often recommended as an option when other modes of treatment are not successful. The purpose is to replace your diseased liver with a healthy liver. Ideally, after a transplant you will be free from disease, and lead a fairly normal life as long as the transplant functions.

Eastern India’s first dedicated comprehensive Bone Marrow Transplant Unit was launched by Dr. Preetha Reddy, Managing Director, Apollo Hospitals Group at Apollo Gleneagles Cancer Hospital, the only super specialty Cancer hospital in the region. The stem cells in our bone marrow produce blood cells essential for survival. When it is sick and unable to produce the normal healthy blood cells, a patient is considered for a bone marrow transplant where the diseased marrow is replaced with healthy marrow. The Bone Marrow Transplant Unit at Apollo Gleneagles Cancer Hospital is the only dedicated comprehensive BMT in the region. The key features of the BMT unit are: Internationally renowned BMT Physicians with expertise in high risk allogeneic transplantation Dedicated team of Specialized Nurses, Technicians, Pharmacists, Dieticians , Social Workers, Co-coordinators and specialized support staff 6-bedded state-of-the-art BMT unit Pre and post-BMT counseling and support services HLA-Typing laboratory and flow cytometry stem cell counting Unrelated Cord Blood Transplantation for suitable candidates in collaboration with Public Cord Blood Bank of STEMCYTE, USA Real-Time PCR for diagnosing post-BMT infections Harvesting and storage of blood stem cells for BMT at a later date Multi-disciplinary support services of a 425-bedded JCI accredited multispeciality hospital Patient and family education and support Dr. Preetha Reddy, Managing Director, Apollo Hospitals Group said during the launch, “”Apollo Hospitals have been the frontrunners in providing the best cancer care in the country. Our hospitals are known for introducing new technologies and the team of cancer specialists are relentlessly offering their expertise and services to help our thousands of patients who need world class cancer care. We are committed to bring all treatment modalities to fight cancer in our hospitals””. She also added, “”Apollo Gleneagles Cancer Hospital started its journey in the month of March 2010 and within this short span it has already become the one step destination for cancer care in the eastern region. Bone Marrow Transplant is a very intensive therapy and requires a highly dedicated Transplant Team. We are very confident that our BMT program will help immensely to the cancer patients of the region””. The Bone Marrow Transplant team at Apollo Gleneagles Cancer Hospital is led by Dr Suparno Chakrabarti, one of the world renowned bone marrow transplant specialists and has been involved in evolving newer modalities of bone marrow transplantations for over a decade. Among present during the launch were Dr Rupali Basu, CEO – Apollo Gleneagles Hospitals, Dr V R Ramanan, Director Medical Services (Eastern Region) and Lt Gen (Retd) Dr Saibal Mukherjee, Director of Oncology Services at Apollo Gleneagles Cancer Hospital.

After the Marketing Campaign of The Year award at the World Brand Congress 2010, BHB is a proud winner in the Corporate Social Responsibility Practice category, at the 5th Indy’s Awards 2011. The Indy’s Awards Ceremony is a showcase event held annually to honour the best talents for outstanding performance in the field of marketing, PR, advertising & branding. Luminaries of the Indian advertising, marketing and communication world feature at this prestigious event. The Indy’s Awards are organized by CMO Council, USA to recognize excellence in categories such as Mass Communications, Marketing Communications, Public Relations, and Advertising & Branding. This time, in its 5th year, Indy’s announced a new awards category – Corporate Social Responsibility practice. This new category was a natural fit for the imperatives of the BHB Campaign, which has engaged individuals across the country and increased awareness about heart disease. The ‘do good’ intent of the BHB campaign has been amply demonstrated through the screening camps and topical interventions (such as those at the World Heart Day and World Diabetes Day), which have kept the campaign fresh and interesting. Out of the hundreds of entries that were received, a total of 103 awards were given out, across all the categories. Joint winners in our category include Hexaware Technologies, Mahindra Finance, UCB, Coal India, Max India Foundation & MCX Commodity Exchange. Being acknowledged along with stalwarts of the Indian CSR space by an independent, professional and eminent forum such as the CMO council is a vindication of our Chairman’s vision and also the fresh, warm and conversational approach that the campaign has employed over the past year. In the period ahead, the BHB team will work actively to take the campaign to every Indian family and visualize Chairman Dr. Prathap Reddy’s vision of reversing the burden of heart disease in India. Visit www.billionheartsbeating.com. Take the pledge to save your heart. Spread the message, you have the power to touch over a billion lives.

Apollo Hospital Chennai’s newest initiative for Cancer patients. Apollo Specialty Cancer Hospital, inaugurated a special “”Sunshine Store”” – a retailer shop catering to the needs of cancer patients. The store was inaugurated by renowned South Indian Actress, Gowthami. It has all the things that would make the journey to better health just that much easier. Speaking on the event, Gowthami commented, “This is really a very beautiful and thoughtful initiative by Apollo which will lead the way for cancer patients for a better tomorrow. Cancer is a disease which not only affects our health but also our hearts and families. I am extremely happy and proud to be a part of this lovely activity and would urge everyone to spread awareness on this.” Products Available: Wigs – The Sunshine Store has on display a variety of wigs in different styles, colours and lengths. The store also has the expert services of a professional to take measurements according to individual needs. A proper wig goes a long way in helping overcome their insecurity regarding the loss of hair. Breast prosthesis – Breast prosthesis are available on display, and there are experts on call when required to attend to and counsel patients who get embarrassed to discuss the loss of an important body part. It is always a huge help and relief to know that the product is available in the hospital premises itself. Pressure garments – Pressure garments and stockings help immensely in post operative conditions. They prevent swelling or can be utilized in case of grafting during mastectomy. The Sunshine Store is a great place to pick the best quality product. Gowns – There are patients who prefer to use their own gowns for radiation treatment and reviews. The Sunshine Store is sensitive to this need. It stocks two different sizes for the Patients Scarves – It is common knowledge that hair falls as a result of chemotherapy. Patients especially ladies prefer to wear scarves to ward off the cold and also for aesthetic reasons. A wide range of scarves are available to meet this frequent requirement Inner wear – Following mastectomy, patients often prefer to wear appropriate innerwear to boost their morale. The range available at the Sunshine store is both of superior quality and more importantly easily available. Its availability in a familiar environment is a huge advantage to cancer patients. CDs – The world over some of the smartest minds are working relentlessly to decode cancer, to demystify it and make it more curable. All this wealth of knowledge is now available in various books and CDs. The Sunshine Store has a comprehensive library of CDs to educate patient about the various aspects of chemotherapy etc.

The Apollo Hospitals, one of the six centres in India to be part of a global trial on using drug-eluting bio-resorbable stents, are the first in Chennai to use the product. The next generation in devices that relieve blood vessel blocks will dissolve within a couple of years. The device works like a regular stent by restoring blood flow to a clogged vessel. It also contains a drug that is slowly released to help the healing process. But what stands out is the fact that the stent dissolves harmlessly inside the blood vessel and restores flexibility of the affected vessel. Dr. Mathew Samuel Kalarickal, Director, Interventional Cardiology, Apollo Hospitals, Chennai, said that the bio-absorbable stent, which initially propped up the blood vessel, aided the healing process and, after a while, disappeared from the body. In this aspect, it scores tremendously over the previous generation of drug-eluting stents that leave the metal support inside the blood vessel, additionally requiring the patient to be on blood-thinner drugs for life. – “Leaving a metal stent in the coronaries always was an anxiety for us, even though the medicated stent has proved its safety and efficacy. It was our wish to have a device that could provide the necessary scaffolding, deliver the medications, and dissolve without leaving any metal trace in the body,- ” Dr. Kalarickal said. Abbott- ’s ABSORB stent is made of polylactide, a bio-compatible material being used in dissolving sutures. The product, which was currently available for coronary vessel use only, had received the CE mark of approval in Europe and this would allow it to be marketed, Dr. Kalarickal said. Dr. Sai Satish, consultant interventional cardiologist, Apollo Hospitals, explained that the hospital had implanted the stent successfully in two male patients with coronary artery disease, having been chosen to be part of the ABSORB EXTEND global trial to study the use of the product in about 1,000 patients at 100 centres. To date, up to 200 patients have received the device, including 30 patients who have had the device put in four years ago. The study showed that patients who had the stent experienced no blood clots due to the presence of the foreign body, and that the treated vessels were able to expand and contract without being restricted by a permanent implant — indicating that the device had dissolved. Apollo Hospitals Chairman Dr. Pratap C Reddy said the stent was part of the group’s endeavour to use cutting-edge technology to give the best possible outcomes for coronary artery disease.

A revolutionary textbook on Surgical Oncology, dealing with the fundamental principles, evidence based approaches and emergent technologies was released by Dr. Prathap C. Reddy, Chairman, Apollo Hospitals. The book has been edited and compiled by Dr. David L Bartlett, Dr. Pragatheeshwar Thirunavukarasu and Dr. Mathew D Neal, Division of Surgical Oncology, University of Pittsburgh, USA. The first copy of the book was received by Pariventhar Thiru. T.R.Pachamuthu, Chancellor, SRM University. The first chapter of the book has been authored by the iconic figure in cancer research, Dr. Bernard Fisher, after whom is named the commonly known “ Fisher Concept of Cancer”, a concept that explains how cancer spreads. Its the first book with a Level of Evidence table at the end of each chapter. The first copy of this book was seen by Former President of India, Dr. APJ Abdul Kalam. Dr. Kalam expressed exuberant encouragement and appreciation on the groundbreaking work being done by Dr. Pragatheeshwar and his team on the gene therapy for cancer. In his speech at a medical convention, Dr. Kalam said,“Today I received an email from Dr Pregatheeswar Thirunavukarasu, from University of Pittsburg, USA, who recently came to address the Science Congress at Chennai. He is an expert in gene therapy and has found a gene therapy for cancer. The results of his work are published in many reputed peer-reviewed scientific journals. The early results are very promising, but there is a long way for them to go. He and his team are working on many ideas to fine-tune the function of vaccinia virus and make it more effective and safe. ” He further added,“They are looking for opportunities to increase awareness and interest among the medical community in India and other countries about this method of cancer therapy, so that more research and clinical trials will happen. My greetings to him and his team for the success. If this successfully comes up, certainly there is a great revolution in cancer management.” The book comprises contributions of 40 authors from the USA, including experts in their respective fields. This is the first ever book in oncology which has a Level of Evidence table at the end of each chapter which lists down the strength of scientific evidence available for each procedure or treatment that is practiced. Such information is priceless in an era of evidence-based medicine. There is one exclusive chapter for Robotic surgery in the book, which would be the future of Surgical Oncology. Speaking at the launch, Dr. Prathap C. Reddy, Chairman Apollo Hospitals Group said,“This pathbreaking book enlightens one on several aspects of cancer research. It can lead and steer many more future researches in understanding cancer and developing innovative and futuristic therapies. Apollo Hospitals is committed to making every type of Cancer curable and my teams pursue this goal relentlessly. In India, almost 35% of the world’s cancer population resides and cognizant of this statistic, Apollo Hospitals has stepped up efforts for the prevention of cancer, early detetction of cancer and is forefront of developing innovative protocols to treat cancer. On this momentous occasion, I convey my heartiest congratulations to Dr. Pragatheeshwar and his team for having brought upon this commendable work to India. This is indeed an opportunity for the medical fraternity in India to raise the bar in cancer surgery and treatment.” Dr. Pragatheeshwar, who has pioneered this project, said,“This book has been specially crafted to educate and update oncologists in India on the latest evidence, technologies and the future of cancer surgery. It is a text book which has been supported by Level of Evidence tables so as to provide enough research-based approaches to cancer care. Dr. Bartlett’s team and I have been working on a particular therapy named Vaccinia Oncolytic Gene Therapy, which is still in the stages of testing and fool proofing. We hope that through the collaborations with the healthcare pioneer in India, Apollo Hospitals, we will be able facilitate more studies and trials on these futuristic technologies. ”

ICICI Lombard Health Insurance and CNBC-TV18 announced the winners of the first ever India Healthcare Awards 2010 – India’s unique initiative recognizing the best Indian Healthcare Providers. Apollo Hospitals bags the – “”India’s Most Preferred Hospital””- Viewer’s Choice Award and Apollo Hospitals Chennai wins the third best Hospital in India award. ICICI Lombard General Insurance, India’s largest private sector general insurer and CNBC-TV18, India’s biggest business medium today announced the winners of ‘India Healthcare Awards 2010’. These awards are a first-of-its-kind in the country that recognizes and honors the best medical service providers in India. The winners were felicitated at a gala awards ceremony in Mumbai by Mr. Dinesh Trivedi, Honorable Minister of State for Health & Family Welfare. The India Healthcare Awards 2010 aims at recognizing the achievements of the best Indian Health Care Providers who have undoubtedly extended best infrastructural facilities, excellent in-house services to the patients and have provided holistic care for the well-being on an individual. The awards witnessed the presence of the Indian Healthcare community, leaders and representatives from Indian private and government organizations, policy makers and important luminaries from sectors affiliated to the industry. The ICICI Lombard Health Insurance and CNBC-TV18 India Healthcare Awards 2010 received an overwhelming response with around 2000 applicants from India’s biggest hospitals from all parts of the country. The best hospitals were chosen based on a robust three phased research methodology commissioned by CNBC-TV18, sponsored by ICICI Lombard Health Insurance and conducted by IMRB International, pioneers of Indian market research who were also the knowledge partners for these awards. For more details, visit http://www.dishtracking.com/blog/2010/12/cnbc-tv18-announces-winners-of-india-healthcare-awards-2010

Apollo Health Street, a developer of world-class solutions that tackle healthcare’s toughest financial challenges, recently announced a new partnership to provide Apollo’s Full Business Office program to the Roxborough Memorial Hospital. Roxborough Memorial Hospital is a 141-bed community hospital. The hospital has been serving the medical and health care needs of the Roxborough, Manayunk, East Falls and northwest section of Philadelphia communities for more than a century, having first opened its doors in 1890. Roxborough Memorial Hospital’s School of Nursing has been educating nurses since 1898. The hospital is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nation’s oldest and largest hospital accreditation agency. Roxborough Memorial Hospital is part of Solis Healthcare. Over the next five years, Apollo’s healthcare experts will be responsible for office site management that will include the oversight of electronic and manual billing, patient account follow-up, correspondence processing, payment and remittance posting, reconciliation and follow-up, financial counseling, self pay patient and account follow-up, patient accounting customer service, and clinical denials. “”Our comprehensive Full Business Office solution meets Roxborough’s need to address aging accounts receivable and improve cash collections. We believe the hospital will quickly realize results that enhance their bottom line,”” said Karen Ferrell, President and CEO of Apollo Health Street. Using technology and healthcare experts, Apollo will streamline patient interactions including pre-registration data collection, eligibility, billing, insurance follow-up, and self pay collections using a comprehensive approach. As a result, Roxborough will increase compliance, maximize appropriate billings and improve cash flow. “”We are confident that teaming with Apollo and utilizing their expertise will allow us to increase cash flow and remain focused on providing excellent patient care,”” said Tony Esposito, Chief Financial Officer at Roxborough Memorial Hospital.

Indraprastha Apollo Hospitals launched Novalis Tx – a major advancement treating cancer. The technology was unveiled by the Delhi Chief Minister, Smt. Sheila Dikshit, in the presence of Dr Prathap C Reddy, Chairman, Apollo Hospitals Group. Novalis Tx is an advanced form of radiotherapy and radiosurgery that offers a versatile combination of advanced technologies for treatment of tumors and lesions. Novalis Tx is one of the most effective methods of radiotherapy and radio surgery. In sensitive and crucial areas like the brain, pinpoint accuracy is paramount; a conventional radiation treatment can potentially cause severe complications. To overcome this shortcoming, Indraprastha Apollo Hospitals has installed the Novalis Tx Radiosurgery and Radiotherapy platform. This advanced equipment shapes the radiation beam precisely to the tumor or lesion, ensuring that the best possible treatment dose is delivered while damage to the healthy tissue is minimized. Indraprastha Apollo Hospitals is one of the very few hospitals in India offering this advanced technology. Speaking on the occasion, Dr. Prathap C Reddy, Chairman, Apollo Hospitals Group said, “Today, Indian hospitals such as Apollo are at par with the best, anywhere in the world in terms of outcomes, doctors and technology. We are honoured that our Chief Minister, Smt. Sheila Dikhsit has inaugurated the first Novalis Tx unit in this part of the country. This latest technology, along with the Bone Marrow Transplant Unit, are in line with our mission to provide the highest level of care to our patients.” Standard radiation systems use fixed shape beams to treat tumors and lesions. Most tumors are irregular in shape, so the conventional dose cannot completely conform to the exact shape which can lead to radiation causing damage to the surrounding healthy tissue. Novalis Tx, with its cutting-edge technology, addresses this limitation in overcoming cancer. “I am delighted to launch the Novalis Tx and the Bone Marrow Transplant Unit at Indraprastha Apollo Hospitals today. Apollo Hospitals has done tremendous work in creating awareness about cancer, its burden can be decreased significantly if cases are detected and treated early.” said Smt. Sheila Dikshit, Chief Minister, Government of NCT of Delhi. Novalis Tx is an advanced technology which helps in improved and effective treatment of tumors and lesions as it is precise, fast, non-invasive, flexible and offers a good alternative for those patients who are unfit to undergo surgery.Novalis Tx is equipped with sophisticated image-guidance tools and motion management tools that can perform a CT scan of targeted tissues in real-time. It is therefore able to pinpoint the position of the tumor at every movement and move the radiation beam to deliver the required dose accurately, completely and safely. Smt. Sheila Dikshit appreciated the efforts undertaken by Indraprastha Apollo Hospitals to provide state-of-the-art health facilities to the patients.