HOSPITALS Magazine issue 62 by The Arab Hospital Magazine

Issue 62 / 184 JAN-FEB 2022

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

Award-winning care worth traveling for.

NEWS

JAN.FEB 2022

Publisher Arab Health Media Communication General Manager Simon Chammas schammas@tahmag.com

THE GULF’S RACE FOR LEADERSHIP The Kingdom of Saudi Arabia is leading the digital transformation The Kingdom of Saudi Arabia has completed its preparations to launch the health sector transformation program as one of the Saudi Vision 2030 updated programs. The program, which will be launched soon, aims to ensure the continued development of healthcare services in the Kingdom while focusing efforts on this important sector. It is known that the programs to achieve Saudi Vision 2030 had an important and pivotal role in facing the Kingdom’s health, economic and social effects caused by the pandemic, and overcoming the crisis with all its challenges. This initiative comes after the National Transformation Program accomplished strategic achievements and objectives that developed the health sector to face the challenges related to health services by raising their quality and efficiency, in addition to raising prevention level against health risks. As part of the global health systems’ development, the health transformation program will work to enable a comprehensive transformation in the sector and restructure it to be a comprehensive, effective and integrated health system. These achievements made by Saudi Arabia, such as improving the quality and efficiency of health services, facilitating access to them by focusing on the digitization of the health sector, launching a package of applications (Sehhaty, Mawid) and increasing service coverage for all Saudi regions, have started to pay off in terms of the development of the health sector and world-class services, which has won the citizens’ approval and was praised by the relevant international authorities. It is certain that digital transformation on the one hand, and hotel service in medical centers on the other hand, are being developed in the Arab Gulf region, bolstered by efficiency, investments and leadership achieved at all levels. Publisher

Creative Department Roula Haddad - Georges Habka Creative Director Jessy E. Hajj Photographer Hanna Nehme Copy Editor Jessica Achkar Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa, Elham Najem Advertising & Marketing advertising@tahmag.com Mirna Khayrallah mirna@tahmag.com Business Development Manager Elie Yammine Offices & Adresses AHMC, Lebanon Mansourieh High way, Jihad Wakim center, 3rd floor. T/F: +961 4 53 40 58 M: +961 3 60 61 00 tahmag@tahmag.com Simon Chammas schammas@tahmag.com Dubai Schammas@tahmag.com +967 50 2971007

Printing

Distribution KSA - UAE - OMAN - TURKEY LEBANON - JORDAN - KUWAIT BAHRAIN - QATAR - EGYPT All rights reserved by the HOSPITALS magazine. No part of this publication can be reproduced in any form without prior permission in writting from the publisher.

JAN . FEB 2022

38 Baylor St. Luke’s Medical Center

NEWS

8 UAE entering a significant new wave of healthcare for women 10 International Hospital Federation announces Geneva Centre of Healthcare Leadership for Sustainability 14 How do we deal with severe healthcare associated infections (HAI’s) and the danger of antimicrobial resistance in the future? 16 Medlab Middle East to return as a standalone event in 2023 24 Over 60 international countries represented at Arab Health 2022 28 Al-Ahli Hospital treats uterine fibers with the latest technologies 32 WCM-Q neuromusicology research reveals secrets of human creativity

INTERVIEWS

47 Bassem Bibi, Divisional Vice President for Abbott’s

JAN.FEB 2022

Rapid Diagnostic Business in the Middle East & Africa 76 Dr. Ziyad Mahfoud, Professor of Research in Population Health Sciences at Weill Cornell Medicine-Qatar (WCM-Q) 92 Göksel ARAS CEO "NITROCARE" and Gökhan ARAS Board Member “NITROCARE"

COVER STORY

38 CARE WORTH TRAVELING FOR Baylor St. Luke’s Medical Center

FEATURES

50 Patient Safety... The cornerstone of healthcare sponsored by LINET MEA 66 Green Hospitals... A revolutionary change that benefits hospitals patients and the environment 104 Hybrid Operating Rooms Innovation in Surgery 108 The Digital Health Sector Accelerated growth and increased investments

Discover new ICU solution designed by nurses for nurses

67%

Decrease in force needed to turn the patient with lateral tilt

Don´t miss the launch of Multicare X bed at Arab Health 2022

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JAN . FEB 2022

50 Patient Safety

MEDICAL INSTITUTIONS

60 Nationwide Children’s Hospital Best Children’s Hospital for all rated specialty areas 74 Get inspired by French innovation and expertise in healthcare and join the French Healthcare two-day conference at the France Pavilion at Expo 2020 Dubai on January 25-26, 2022 86 ACIBADEM: A HAPPY BREAK-UP! 3-dimensional dummy, 27-hour surgery, multidisciplinary medical team and an army of healthcare professionals!

ARTICLES

30 The Role of Clinical Documentation Integrity (CDI) in Patient Safety by Dr. Tammy Combs RN, MSN, CDIP, CCS, CNE 56 Digital Health and Patient Safety By Dr Yasir Khan, Lead

JAN.FEB 2022

108 The Digital Health Sector

Physician Executive at Cerner in Middle East & Africa 64 VOCERA: Dr. Annie Ideker on Streamlining EHR Work to Improve Clinician Well-Being 80 Al-Ahli Hospital adds high-flow oxygen technique to its services by Dr. Mohammad Abd Al-Karim Al-Hashemi, Anesthesia Consultant and Head of Anesthesia Department at Al-Ahli Hospital / Qatar 81 Al-Ahli Hospital treats pneumomediastinum cases Dr. Mohammad Al-Nazer, Pulmonologist at Al-Ahli Hospital / Qatar 82 Omnicell’s solutions-based approach addresses the Gulf region’s key healthcare challenges 84 stiegelmeyer: Evario one The economical hospital bed for global use 94 Becton Dickinson - TCI Anesthesia: New and More Universal Models

NEWS

UAE entering a significant new wave of healthcare for women

he UAE appears to be entering a significant new wave of healthcare for women, driven by greater awareness and openness about female health topics, changing perceptions about women’s health issues, market accessibility for female founders, increasing demand for reproductive health products and services, growing interest from VCs and angel investors in FemTech, facilitative government efforts and a number of FemTech projects set to launch in 2022 and beyond, according to the latest 2021 Global FemTech Industry report published by FemTech Analytics, a subsidiary of UK-based consortium Deep Knowledge Group. The US remains the leader of FemTech investments with over $10 billion invested in USbased companies, followed by Israel with $1.25 billion, the UK with $611 million and Switzerland with $398 million. Moreover, 65% of investors in FemTech are based in the US, 7% in the UK and 3% in Canada and Switzerland. The USA also hosts the highest number of FemTech networks and accelerator programs with 32% of the global share, followed by the UK and Switzerland with 23% and 14% respectively. “Over the past few years, we have witnessed a steep rise in FemTech solutions due to the adoption of new technologies and new business models, transforming the way women access healthcare”, said Kate Batz, Director of FemTech Analytics. “Several countries have been advancing their FemTech agendas in line with their women empowerment policies. The FemTech market is expected to grow significantly in the next few years and our study provides valuable insights into this market to all stakeholders”. The UAE is well positioned to achieve exponential growth within the FemTech industry, considering the array of existing startups providing feminine hygiene products and educational tools such as Pectiv, Orgabliss, MyLily and LiZZOM, and the several more expected to arise over the coming few years.

JAN.FEB 2022

ACCORDING TO THE REPORT, THE US CONTINUES TO DOMINATE THE FEMTECH MARKET WITH OVER 50% OF FEMTECH COMPANIES GLOBALLY, FOLLOWED BY EUROPE (25%) AND ASIA (9%). THE UK AND ISRAEL BOAST THE HIGHEST NUMBER OF FEMTECH COMPANIES IN THEIR RESPECTIVE REGIONS WITH 10% AND 6% OF THE TOTAL NUMBER OF BUSINESSES, WHILE ASIA'S UNDISPUTED MARKET LEADER IS INDIA WITH 4% OF FEMTECH COMPANIES.

E-commerce platforms focused on women’s healthcare represent a key driver of the UAE’s FemTech sector. Digital platforms in the Pregnancy & Nursing sub sector offering consumer products for mums-to-be, new mums and kids to enjoy motherhood journey include Mama's Box, Mumzworld and BabySouk.com. “One-third of MENA’s FemTech companies are based in the UAE, where innovation, women empowerment and gender equality are matters of national priority. Countries like the UAE are leading the way and gradually breaking down taboos surrounding female health thanks to a culture of openness, high-levels of health awareness and the tech savviness of the government, the private sector and civil society. As a result, society at large is becoming more and more receptive to engage in conversations about such topics and embrace positive change in support of the FemTech sector,” Kate added. Based on the analysis of over 1,300 FemTech companies, 1,290 investors, 14 R&D centres and 22 community organisations worldwide, the 2021 Global FemTech report showcases market trends, innovations, growth opportunities and investment prospects of a rapidly growing industry. It also includes interviews with FemTech leaders, a list of the top 150 FemTech influencers and case studies featuring prominent FemTech companies.

Improving healthcare for all

Join the French Healthcare 2-day conference Tuesday, january 25, 2022

Wednesday, January 26, 2022

10:00 - 11:30

Future perspectives in health and urban planning

10:00 - 11:30

Diabetes education and prevention: facing rising challenges in the Middle East

12:00 - 13:30

Getting medical treatment in France

12:00 - 12:45

French excellence in pediatric congenital heart disease surgery

14:30 - 16:00

French innovation for women at risk or affected with female cancer

13:00 - 13:45

Adressing the cardiometabolism diseases challenge: IHU ICAN Fundation model

14:30 - 16:00

Digital health for underserved areas: disruption from the French healthcare ecosystem

France Pavilion at Expo 2020 Dubai Organized by

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NEWS

International Hospital Federation announces Geneva Centre of Healthcare Leadership for Sustainability

he International Hospital Federation (IHF) is preparing to launch the Geneva Centre of Healthcare Leadership for Sustainability (the Centre) in 2022 in response to the need for hospitals and healthcare services to address climate change.

As the urgent messages of the UN Climate Change Conference (COP26) are reflected on across the globe, hospital leaders are increasingly aware of their responsibility to advance the sustainability agenda. Research shows that if the world’s healthcare sector were a country, it would be the fifth-largest emitter of carbon emissions on the planet (The Lancet, Commission on Climate Change, 2009). At the 44th World Hospital Congress in Barcelona (Spain) in November, sustainability was a key theme amongst delegates from around the world. Healthcare leaders and patients share the goal to make reducing climate impact a priority. However, this is a long-term challenge for the healthcare sector that will likely require multiyear commitments and the transformation of almost every aspect of how hospitals operate. There are currently few common standards within the industry, leading to different approaches and measurements which prevent comparisons and benchmarking. Ronald Lavater, CEO of the IHF explained the role that the Centre will play: “Hospital leaders are increasingly aware of this need for action on climate change. However, without adequate support for the development of new leadership competencies in sustainability, progress will come too slowly. With its global network of health authorities and hospital leaders, as well as strong links to institutions and NGOs within the international Geneva landscape, the International Hospital Federation is uniquely positioned to take a leadership role for this work.” The Centre’s global reach and impact will build awareness and promote action among healthcare leaders, and provide capacity-build-

JAN.FEB 2022

HEALTHCARE LEADERS AND PATIENTS SHARE THE GOAL TO MAKE REDUCING CLIMATE IMPACT A PRIORITY. HOWEVER, THIS IS A LONG-TERM CHALLENGE FOR THE HEALTHCARE SECTOR THAT WILL LIKELY REQUIRE MULTI-YEAR COMMITMENTS AND THE TRANSFORMATION OF ALMOST EVERY ASPECT OF HOW HOSPITALS OPERATE.

ing to anchor leadership for sustainability into the healthcare sector for the long-term: • Establishing the message and communicating the urgency for action, and the call to lead. • Building the platform for initiatives, communication, programmes, and collective action. • Constructing long-term support to keep the work ongoing for the decade ahead. Recruitment is underway for the Centre’s core team, to be headquartered in Geneva, Switzerland. As well as appointing an experienced Executive Director, initial hires will include skilled professionals for communication, education and training, and project management. The Centre will be established with the support of a private donor based in Geneva, channelled through the Geneva University Hospitals (HUG), who are a member of the IHF. Bertrand Levrat, Director-General of the HUG and IHF Governing Council Member, noted the timely and important role that the Centre will play in supporting healthcare leaders: “We are at a pivotal moment to act against a global crisis. The Geneva Centre of Healthcare Leadership for Sustainability provides a timely opportunity to guide hospitals leaders on the agenda of climate change. Responding to the sustainability agenda is a long-term challenge for the healthcare sector, and hospital leaders cannot fully address this issue without adequate support.”

NEWS

How do we deal with severe healthcare associated infections (HAI’s) and the danger of antimicrobial resistance in the future? “This innovation makes it possible to operate while people are present in a room or in the hallway. Something that has not been possible until now. The robot is also fitted with 6 outer UV-C bulbs that performs a 360-degree disinfection that allows it to reach a 99,99% surface disinfection rate.” According to Jacob Sohrabi the disinfection robot the possibility of disinfecting both the air and surfaces in a single, fully autonomous solution is a great step towards cleaner hospitals and less deaths caused by preventable HAI’S. For CTO Hans Peter B. Nielsen, formerly a part of the successful UVD robots, it has been a long journey that has provoked multiple technical considerations:

hrough the Covid-19 pandemic autonomous UV-C disinfection has proven to be an effective tool against dangerous pathogens including, but not restricted to, Covid-19. But what does the future hold within UV-C disinfection? At Arab Health 2022 in Dubai, Autonomous Disinfection Technologies (AUDITE) will be showcasing our brand new AUDITE UV-C Hybrid Robot, which is a FULLY AUTONOMOUS UV-robot that ALSO disinfects the air. With an independent air disinfection system, the robot can move around disinfecting the air freely around people without hurting anyone. The robot drags in 3000 liters of air pr. minute through two large filters, which then passes by two additional inner UV-C tubes that eventually destroys the remaining microorganisms in the air. According to CEO Jacob Sohrabi Niclassen, this is a major innovation towards safer use of UV-C light for infection prevention:

JAN.FEB 2022

THE ROBOT IS ALSO FITTED WITH 6 OUTER UV-C BULBS THAT PERFORMS A 360-DEGREE DISINFECTION THAT ALLOWS IT TO REACH A 99,99% SURFACE DISINFECTION RATE.

According to Hans, “this innovation performs better than any other robots I have worked with on three key parameters – safety, efficiency and autonomy. Being able to disinfect the air effectively through an independent system sets a new safety standard for UV-C robots. Also, we have insisted that the robot should be 100% autonomous to be of any value for hospitals around the world. Who wants an autonomous robot, that needs to be followed around wherever it goes?” To see this new innovation for yourselves we would be very pleased to welcome you at our stand at the Pavillion of Denmark, SA.C57. Here, we will be showcasing the AUDITE UV-C Hybrid Robot, which was released October 1st 2021, for the first time in the Middle East – and we also promise to ensure clean and disinfected air for everyone who stops by our stand. Autonomous Disinfection Technologies are based in the city of Odense, Denmark, which is home to one of the fastest accelerating and most influential robot clusters in the world right now. AUDITE was founded with the ambition to prevent Cross-contamination and healthcare associated infections with technologically superior, user safe and effective autonomous solutions.

NEWS

Medlab Middle East to return as a standalone event in 2023

Beckman Coulter, Abbott, Biomerieux and Mindray. In addition to the growth in exhibitors, which is expected to increase to over 500 in 2023, country pavilions have risen from nine in 2021 to ten in 2022, with that figure expected to increase to 14 in 2023.

nforma Markets, organisers of Medlab Middle East, have announced the MENA region’s leading exhibition for the laboratory industry will return to a standalone event in 2023, following unprecedented demand from exhibitors and visitors for the 2022 edition of the show, which takes place at the Dubai World Trade Centre from 24-27 January 2022. As a result of the pandemic, Medlab Middle East and Arab Health co-located in 2021 to provide a platform for both the laboratory and general healthcare industries to come together, reconnect and do business face-to-face in a safe and secure environment. However, following high-level demand from leading laboratory companies to showcase their offering in a dedicated space, and from attendees keen to capitalise on the latest laboratory releases, the event will now revert to a standalone format, with dates confirmed for 7 – 9 February 2023. Tom Coleman, Exhibition Director of Medlab Middle East, said: “Advances in the medical laboratory have been pivotal in the defence against the continued threat that COVID-19 poses to industries around the world. Due to the speed at which the laboratory industry has responded to these threats by developing solutions, products and technology to counter the impact of the pandemic, we have seen a surge in companies wanting to showcase their latest innovations and from buyers eager to capitalise on these advances. “As a result of this demand, following the 2022 edition of the show, which will be held from 24 -27 January, Medlab Middle East will return as a standalone event in 2023 with a total of six halls, showcasing the latest innovations and new technologies being utilised in the laboratory industry.”

The 2022 edition of Medlab Middle East is expected to welcome more than 400 exhibitors, a 100% increase from 2021. Key players participating in this edition include Roche, Siemens,

JAN.FEB 2022

Tom Coleman

AS PART OF INFORMA'S COMMITMENT TO PROVIDING THE HIGHEST HYGIENE AND SAFETY LEVELS, THE 2022 EDITION OF MEDLAB MIDDLE EAST WILL AGAIN TAKE PLACE UNDER THE PROTOCOLS INTRODUCED VIA THE COMPANY’S INFORMA ALL SECURE HEALTH AND SAFETY MANDATE. THE ENHANCED MEASURES INCLUDE 35 GUIDELINES COVERING ALL ASPECTS OF CLEANING AND HYGIENE, SOCIAL DISTANCING MEASURES, AND THE USE OF PPE, SCREENING, AND A TRACK AND TRACE IN CONJUNCTION WITH LOCAL AUTHORITIES.

Fueling the surge in exhibitors is the anticipated growth in the global laboratory industry. According to the Global Clinical Laboratory Market – Analysis by test, end-user, by region, by country (2021 edition), the global laboratory market is expected to grow by a Compound Annual Growth Rate (CAGR) of 6% between 2021 and 2026, which puts the predicted value of the global laboratory market at US$ 33.07 billion by 2026. The report attributed the growth rate to the increasing number of lifestyle-related ailments and chronic illnesses, and spurts of infectious diseases in different parts of the world. The introduction of accurate and technologically advanced products, such as companion diagnostics, biochips, and microarrays, has bolstered the demand for early disease detection. Moreover, rapid technological advancements to enhance productivity and reduce costs are anticipated to boost the market further. These solutions offer clinicians maximum efficiency and minimum risk of errors, which has driven the uptake of services in the market.

Product Fact Sheet

CyStain VitalCount TM

Fast, safe, sensitive: Control your production the easy way

Product picture

Sysmex Partec GmbH Arndtstraße 11 a-b 02826 Görlitz Germany www.sysmex-partec.com Sysmex Partec is an ISO 9001:2015 and EN ISO 13485:2016 certified company.

Product name CyStainTM VitalCount

Manufacturer information CyStain VitalCount is manufactured by Sysmex Partec GmbH.

Summary CyStain VitalCount is a microbial detection kit for the unspecific detection and quantification of vital microorganisms, yeast and bacteria, in fruit juice, including clear fruit juices, fruit juices with fruit pulp and highviscosity fruit juices. The kit involves manual or automated sample preparation by pipetting robots in a 96-well format. Juice samples are automatically analysed and results are automatically reported by the CyFlow™ Cube 6 V2m analyser and the CyFlow™ Robby 6 Autoloading Station.

Product Fact Sheet CyStain VitalCount

Productivity values The CyStain VitalCount Kit is an automated, cost-eﬀective and rapid alternative to conventional plate counts. The enumeration of total viable microorganisms allows to assess the microbial burden during in-process control and final product control of any type of fruit juice. The objective and automated read-out of the results allows clear release decision with confidence in routine quality control during juice production.

Specifications Features

Description

Technology

Vital cell stain / Flow cytometry

Sample type

Fruit juice

Species type

Living bacteria and yeast cells

Limit of detection (LoD)

At least < 1000 cells/mL

Limit of blank (LoB)

At least < 500 cells/mL

Sensitivity of the method

1 organism/bottle for bacteria and yeast (after pre-incubation)

Decrease inventory / warehouse costs

Number of tests

480

Reduce human errors due to the automate procedure

Shelf-life

12 months

In-use stability

2 months

Simplified automated operation dedicated to this application

Storage temperature

2 - 8 °C

Format

96-well plate

Objective clear-cut decision due to standardised data reporting

Sample preparation time ~ 80 min for 96 samples

Key features in industrial testing Speed up product release

Highest sensitivity: 1 organism / bottle (pre-incubation necessary)

Ordering information Reagent Article number

Item

05-5029

CyStain VitalCount

Consumables and Instruments Article number

Item

04-2026

96 Well Filter Plates

04-2025

96 Well Receiver Plates

CY-S-3061R-V2m

CyFlow Cube 6 V2m

CY-S-3083-V2m

CyFlow Robby V2m Autoloading Station

Throughput (analysis time)

< 180 min 96 samples

Carry-Over

< 0.1 %

JAN.FEB 2022

Live, in-person: 24-27 January 2022 Dubai World Trade Centre, UAE Online: 5 January - 28 February 2022

United by business, forging ahead Where the world of healthcare meets

JAN.FEB 2022

Together for a healthier world

Earn CME points with 12 Live and Online conferences to choose from Conferences include: Total Radiology*

Quality Management

Orthopaedics*

Family Medicine

Surgery*

ENT

Obs & Gyne*

Emergency Medicine and Critical Care

*Live conferences

What to expect at Arab Health 2022 3,590+

34,800+

60+

3,300+

exhibiting companies

healthcare & trade professional visits

exhibiting countries

delegates

conferences

Learn, network and trade Live in-person or Online at Arab Health Register your interest today arabhealthonline.com

NEWS

Over 60 international countries represented at Arab Health 2022

total of 62 countries will be represented on the exhibition floor of the 2022 edition of Arab Health, the MENA region’s leading exhibition for the healthcare industry, taking place at the Dubai World Trade Centre from 24 – 27 January. The 2022 edition of the show, which returns as a co-located event for the healthcare and laboratory industries, has attracted more than 3,590 exhibitors from countries around the world. They include the UAE, Lebanon, Turkey, and a host of European countries such as the UK, Switzerland, Germany, Italy, France, Spain, Portugal, Slovenia, Hungary, Czech Republic, Poland, and Belgium. Russia, China, Taiwan, Japan, Korea, India, the US and Canada will also have several exhibitors showcasing the latest technology and innovation through a range of healthcare products. Ross Williams, Exhibition Director for Informa Markets, said: “The global healthcare industry has shown its resilience throughout the pandemic and continues to be the driving force for global recovery. Despite the ongoing challenges of COVID-19, we have seen the commitment from healthcare exhibitors and experts from around the world to meet live and in-person at Arab Health to discuss the latest healthcare solutions.” Continuing with the international theme, Saudi Arabia, Egypt, and Pakistan have all confirmed hosting international pavilions. Each pavilion will host between 16 and 33 healthcare-related companies. In addition, the European Innovation Council Pavilion will host 20 selected companies from across the healthcare landscape. Appropriately, the theme for Arab Health 2022 is 'United by business, forging ahead’ with new technology and innovation taking the stage with a host of exhibitors showcasing their latest products and services. Canon, Draeger, NAFFCO, Philips and NEOM will again be exhibiting this year. At the same time, GE Healthcare, Karl Storz, Siemens Healthineers and a host of other leading names in the healthcare sector

JAN.FEB 2022

Ross Williams

62 COUNTRIES WILL BE REPRESENTED IN-PERSON AT ARAB HEALTH THIS YEAR, INCLUDING INDIA, THE UNITED KINGDOM, CANADA, CHINA, JAPAN, THE US, RUSSIA, SPAIN AND GERMANY.

Arab Health, colocated with Medlab Middle East 2022, is the largest healthcare exhibition and congress in the MENA region. The event will attract global healthcare professionals and feature a range of scientific lectures, industry briefings, product demonstrations and networking opportunities.

will return following a one-year hiatus due to COVID-19. In addition to having the opportunity to explore thousands of products on display, conveniently split into eight sectors across 16 halls of the Dubai World Trade Centre, other features at Arab Health this year include the return of the Innov8 Talks as part of the Healthcare Transformation Zone. The popular start-up competition will feature 24 companies in various stages of maturity, with each showcasing unique and innovative solutions in prevention, management, operations, diagnostics, amongst others. Four medical conferences and hands-on workshops will also return to the exhibition, bringing together 200 globally recognised medical expert speakers and over 1500 delegates from across the GCC. Popular returning tracks include Obs & Gyn, Total Radiology, Orthopaedics and Surgery. Following a hybrid model last year, Arab Health will also host a virtual event running in conjunction with the live event from 5 January – 28 February. With over 200 educational sessions and more than 250 international experts, the online event will provide a range of thought leadership and medical updates to over 3000 delegates. "This will be a vital addition to our offering and will be instrumental in reaching a wider audience. Not every industry professional from around the world can attend in-person every year; therefore, the online facility provides opportunities to maintain partnerships and do business,” added Williams. As part of Informa's commitment to providing the highest hygiene and safety levels, the event will again occur under the protocols introduced via the company's Informa AllSecure health and safety mandate. The enhanced measures include 35 guidelines covering all aspects of cleaning and hygiene, social distancing measures, and the use of PPE, screening, and a track and trace in conjunction with local authorities.

Award-winning care meets humankindness. Medical breakthroughs have continued to help people live healthier lives, and we’re honored to be recognized for them. With our new rankings by U.S. News & World Report, we celebrate these advancements and the power of humankindness to provide healing for our communities in the best way. Learn more at stlukeshealth.org./bslmcinternational

Bacterial count in routine quality control

CyStain™ BacCount

Quantify bacteria in minutes instead of days

JAN.FEB 2022

NATIONWIDE CHILDREN’S HOSPITAL WORLD-CLASS PROGRAMS. TRAILBLAZING RESEARCH. PERSONALIZED CARE. Columbus, Ohio, may feel like a world away, but our faculty, researchers and facility have earned international reputations for expertise in rare and complex conditions. Our Cardiovascular team is leading groundbreaking development of a biodegradable tissue-engineered vascular graft for children with congenital heart defects. Our multidisciplinary Center for Colorectal and Pelvic Reconstruction excels in advanced care for even the rarest congenital disorders, motility issues, fecal incontinence concerns and more, for patients in more than 60 countries. And the powerhouse team at the helm of our Neurosurgery and Neuro-Oncology programs excels in both leadership and collaboration in multinational cancer research. When you’re here, you are the center of our attention. Come to Nationwide Children’s —nothing but the best in care, in an accessible, cosmopolitan city. Reach out to our Global Patient Services team to find out why we should be your new global destination for complex care. Learn more, refer a patient or plan a trip: NationwideChildrens.org/Global-Patient-Services GlobalPatientServices@NationwideChildrens.org +1 614 362 9127 Nationwide Children’s Hospital, Columbus, Ohio – USA

W295713

AMERICA’S SECOND

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NEWS

Al-Ahli Hospital treats uterine fibers with the latest technologies

sing the latest technologies to treat uterine fibroids in Al-Ahli Hospital, Al-Ahli Hospital uses modern technology to remove fibroids, benign tumors and other tissues without the need to remove the uterus. Dr. Mazen Bishtawi, Obstetrician and Gynecologist Consultant, said that, “The MyoSure device is used to remove fibroids and polyps within the uterine cavity. It also removes benign tumors and unwanted tissues without the need to remove the uterus. He added, "This type of surgery is conducted under simple anesthesia and the patient does not need to be hospitalized. By using it, there is no need to make any incisions in the abdominal area that could cause scars, and women return to normal life soon after surgery. He indicated that this is a safe technology because it works with mechanical energy and not with electrical one compared to the traditional technologies that were used previously, which

JAN.FEB 2022

reduces complications. It works on cutting the fibers and not burning them. Not only that, it shortens time and effort as polyps and fibroids are removed in a very short time. Dr. Bishtawi praised that this technology decreases the heavy bleeding accompanied with fibroids or benign tumors, and removes only the targeted tissues in the uterus. This technology may also be a treatment option for infertility patients associated with unwanted tissue in the uterus, which preserves its functions. He mentioned that in general, women may not complain of symptoms of uterine fibroids, but in case they become symptomatic then surgical removal with myosure is appropriate. However, this technology is for the management of fibroids within the uterine cavity and not for the one in the muscles or outside the uterus. Regular check-up and annual ultrasound scan can identify uterine fibroids. Your doctor will be able to tell you whether it needs surgical removal or not.

AL-AHLI HOSPITAL USES MODERN TECHNOLOGY TO REMOVE FIBROIDS, BENIGN TUMORS AND OTHER TISSUES WITHOUT THE NEED TO REMOVE THE UTERUS.

ARTICLE

The Role of Clinical Documentation Integrity (CDI) in Patient Safety Dr. Tammy Combs RN, MSN, CDIP, CCS, CNE

linical documentation integrity (CDI) programs have historically been recognized for their ability to ensure organizations capture accurate quality scores and appropriate reimbursement. This is due to clinical documentation being a foundational element of every patient encounter. The information captured in the clinical documentation provides a picture of the patient’s severity of illness, risk of mortality, and the services that were provided. Having information captured to the highest level of detail, that is supported by the clinical evidence, also results in CDI having a direct impact on patient care and outcomes. This article will discuss some of the ways in which CDI can impact patient safety which includes medical decision-making, recognition of missing or incomplete information, identifying any potential patient safety concerns, and validating that documentation has been added to the health record. Providers rely on the information within the health record to make informed decisions regarding diagnosing conditions and developing treatment plans. One instance would be if the documentation in the inpatient health record is incomplete, this could result in an outpatient provider not having all of the necessary data to develop an informed diagnosis and treatment plan. For example, if the patient had chest x-ray in the inpatient setting which noted pneumonia but this finding was never addressed in the health record, the outpatient provider may not know to follow up on the finding. CDI professionals review the provider notes and findings to recognize any potential gaps in the documentation, they then can request to have those addressed by the provider. If there is incomplete information in the health record a diagnosis may be missed. For example, if a laboratory finding indicates a low sodium but this was never assessed by the provider a patient may have an undiagnosed condition. CDI professionals review all information and if an abnormal finding is seen but not addressed in the documentation then they will

JAN.FEB 2022

Tammy Combs

THE CLINICAL INFORMATION WITHIN THE HEALTH RECORD IS ESSENTIAL IN IDENTIFYING HIGHQUALITY PATIENT CARE.

clarify with the treating provider. CDI professionals are also in a unique position to recognize patient safety concerns. For example, if the health records indicated conflicting documentation on the laterality of an extremity that is scheduled to be operated on, the CDI professional could clarify that information with the surgeon. Another example is when documentation may be missing from the health record. If there are missing provider notes, the CDI professional can verify a provider has seen and is managing the patient. The clinical information within the health record is essential in identifying high-quality patient care. From the examples mentioned in this article, it is easy to see that the impact of CDI goes beyond reimbursement and the capture of quality measures, it has a direct impact on patient safety. The primary goal of all healthcare organizations is to provide high-quality patient care. Having CDI programs in place provides a valuable resource to providers to ensure there is a consistent theme seen within the clinical documentation and that high-quality of care is reflected through high-quality clinical documentation.

‫َر ْبط الصحة‬ ‫والتعليم‬ ‫والبحوث‬ Linking health, education and research

.‫ لكل مريض من مرضانا‬،‫وفعالة‬ ،‫ وحانية‬،‫تقديم أفضل رعاية صحية آمنة‬ َّ Providing the safest, most effective and most compassionate care to each and every one of our patients.

www.hamad.qa

NEWS

WCM-Q neuromusicology research reveals secrets of human creativity

esearchers at Weill Cornell Medicine-Qatar (WCM-Q) have explored the cognitive and neural basis of human creativity by monitoring the brain activity of a musician improvising on the ney, or Arabic flute. The research has been published in Frontiers in Psychology, a leading journal, and is the first scientific study of the neuromusicology of Middle Eastern music.

Led by Dr. Ghizlane Bendriss, PhD of Neuroscience and Assistant Professor of Biology, the team of researchers used a wireless electroencephalographic (EEG) headset to record the brainwaves of a musician as he played a total of 24 improvisations at low, medium and high tempos on the ney. Dr. Bendriss designed this project after a student, Mohamed Yaghmour, demonstrated strong interest in research. Dr. Bendriss gathered a complete team to mentor him for this original and first-of-its-kind study in neuromusicology. The team was composed of psychology specialist Sarah Roach, biostatistics expert Padmakumari Sarada, and music educators Ibrahim Kadar and Zhivka Pesheva from Qatar Music Academy. Dr. Bendriss said: “Middle Eastern Music is characterized by the use of additional microtones, resulting in a tonal-spatial system called maqam. These scales have played an important role in healing and medicine since the 10th century in the Middle East, and many theories associate the use of specific maqams with treatment of specific conditions. Unfortunately, these theories are only based on empirical observations and are not yet supported by a strong body of peer-reviewed studies. For the first time, this study explores the neural correlates of these maqams, giving us a detailed picture of their true effects on the activity of the brain and providing new insight into how they might be used for therapeutic means.” Using sophisticated computer software, the researchers compared the data from the EEG signals and observed that each maqam was characterized by a topographically unique combination of significant EEG changes, suggesting the existence of what they termed “maqam electro-

JAN.FEB 2022

Dr. Ghizlane Bendriss

THE RESEARCHERS FOUND PATTERNS IN THE EEG DATA THAT SHOWED SIMILARITIES IN THE PERCEPTION OF MAQAMS WITH SIMILAR INTERVALS. IN COMMON WITH STUDIES OF WESTERN MUSIC, A GREATER INCIDENCE OF HIGHFREQUENCY BRAINWAVES, WHICH ARE ASSOCIATED WITH NEGATIVE EMOTIONS, WAS OBSERVED IN RELATION TO IMPROVISATIONS BASED ON NAHAWAND, WHICH APPROXIMATES TO THE MINOR SCALE.

encephalographic signatures.” The study also provides further support to previous research that has associated musical improvisation with increased activity in the left-brain hemisphere, particularly of low-frequency brain waves in the frontal and temporal areas of the left-brain. The study also supports the observation that musical improvisation is also characterized by an increase in levels of integrated activity in both brain hemispheres at high-frequency signatures. Until now, almost all research in the field of neuromusicology has concentrated on Western music - it is believed this is the first project to use EEG data to study brain activity while improvising with Arabic maqams and while playing a Middle Eastern instrument, the ney. WCM-Q student Mohammad Yaghmour contributed to the research under the mentorship of Dr. Bendriss. Mohammad said: “This project was extremely exciting to work on because it has given us fascinating insight into human creativity as well as being the first study of its kind based on Middle Eastern musical styles and instruments. Being involved in research at this early point in my training has been very rewarding.” Dr. Bendriss added: “The results of the study are highly relevant because they highlight the importance of considering intervals, tones, and microtones in studies concerned with the processing of music and emotional correlates. This study on spontaneous music performance backs up evidence from pre-existing research which suggests that the prefrontal cortex is of critical importance for creativity, self- reflection, and sensory processing.

WCM-Q student Mohammad Yaghmour contributed to the research project under the mentorship of Dr. Ghizlane Bendriss

NEVER STOP LEARNING. NEVER STOP GROWING. High quality professional development opportunities for healthcare professionals based on the latest scientific and medical advances that increase competence, enhance performance and improve healthcare for patients. Visit: qatar-weill.cornell.edu/continuing-professional-development/

JAN.FEB 2022

Your partner in building a culture of safety At BD patient safety is at the heart of everything we do. At every step of the patient journey BD helps maximize clinician performance, with efficient workflows, and timely and accurate diagnoses. Imagine your expertise with our innovations. Find out how BD’s extensive portfolio of products, services and innovations can help harness a healthcare team’s full potential to drive your safety culture. Learn more on bd.com/en-mena/our-solutions/patient-safety and visit us during Arab Health and Medlab 2022 to engage with us in wholly new and innovative ways.

bd.com This content is intended for healthcare professionals only. Not all products, services or features may be available in your local area. Please check with your local BD representative.

NEWS

JAN.FEB 2022

NEWS

DICOM Medical Printers

A First in Digital Printer Technology OKI’s DICOM medical printers combine the cost effectiveness and high quality output of an LED printer with embedded DICOM software. This allows you to print directly from medical equipment without the use of conversion software or external print servers. Easy-to-use, devices.

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COVER STORY

hen it comes to treating serious illness, patients from the Middle East and beyond regularly choose Baylor St. Luke's Medical Center in Houston, Texas, the fourth largest city in the United States. We are a quaternary care facility that is part of the Texas Medical Center, the largest medical center in the world. We are home to the Texas Heart® Institute, a world-class cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. Baylor St. Luke’s is ranked as one of the United State’s best in Cardiovascular Services & Heart Surgery, Cancer, Neurology & Neurosurgery, Gastroenterology and GI surgery and Geriatrics by U.S. News & World Report. We were the first hospital in Texas and the Southwest designated a Magnet® hospital for nursing excellence five consecutive times by the American Nurses Credentialing Center. Baylor St. Luke’s is committed to excellence and compassion in caring for the whole person while creating healthier communities. The hospital has embarked on a new era in healthcare through a joint venture with Baylor College of Medicine, one of the top medical schools in the United States.

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We are transforming the way healthcare is delivered through our new McNair campus, 27.5 acres that will connect one of the country’s top medical schools, a world-renowned cardiovascular research institute, and a nationally recognized hospital all located within a carefully planned corridor designed to ease patient stress and travel.

COVER STORY

The Future of Baylor St. Luke’s We are transitioning to the new state-ofthe-science McNair Campus, one of the most innovative, unique medical communities in the world, where patients and visitors are rarely exposed to daily hospital operations to create a more comforting environment. The hustle and bustle associated with running a medical center will be out of view and instead directed to separate sets of elevators, hallways and entrances to avoid intermingling with patients. “It really elevates the look and the feel of the campus. The result is a space that is warm and soothing yet offers access to the high-quality cutting-edge care we are known for,” said Liz Youngblood, President, Baylor St. Luke’s Medical Center. “Patients will have convenient access to lush garden-like areas, restaurants, retail, a hotel and conference center that add to a comfortable, positive experience.” A layered arrival garden and a series of elevated micro-gardens will enhance and vitalize the human experience, with light and views of nature acting as a backdrop for the waiting areas on each level of the building. Daylight is emphasized throughout the campus. Technology plays a key role. An innovative “Control Center” application will allow hospital patients to adjust room temperature, lighting, food orders and facilitate communication with medical staff.

JAN.FEB 2022

“It was important to bring this technology to the bedside and fingertips of our patients so that they can control their environment while acting as a partner with us on the care we are providing,” Youngblood said. Its visionary design ensures the highest quality care for patients while leveraging academics and research. The campus is equipped with the latest technologies from radiology, interventional radiology to nuclear medicine studies and new linear accelerators at the Dan L Duncan Comprehensive Cancer Center, which will be housed in the 12-story O’Quinn Medical Tower. The expanded cancer center will offer radiation therapy and other diagnostic and treatment services and will feature multiple specialized oncology clinics and an infusion center as well as house multiple outpatient services including radiology, endoscopy and an ambulatory surgery center. Among the new services expected to be offered at the new tower are a pain center and a women’s center for diagnostic breast imaging.

Pioneering Cardiovascular Care Our tradition of innovative heart care dates back to 1969, with the world’s first successful human implantation of an artificial heart by renowned cardiac surgeon Denton Cooley. It is a legacy of innovation and research that we uphold to this day. At Baylor St. Luke’s, we bring together internationally recognized research, education, and innovation from Baylor College of Medicine, the Texas Heart Institute® and other leading independent specialists to provide the latest treatments and advances in cardiology, cardiovascular surgery, minimally invasive cardiac surgery, structural heart, valve, and vascular procedures, heart transplant, arrhythmia management, stem cell, and gene therapy, and regenerative medicine. We are able to achieve more life-changing breakthroughs, discover more methods of prevention, and save more lives than ever before.

COVER STORY

Complex Aortic Arch Repair Our cardiac physicians are healers and researchers at the forefront of breakthrough therapies. Dr. Joseph Coselli, Chief Adult Cardiac Surgery Section, Baylor St. Luke’s Medical Center, is a world-renowned pioneer in the development of innovations including the Thoraflex Hybrid Stented Device for Complex Aortic Arch Repair, which was recently awarded a breakthrough designation from the United States Food and Drug Administration (FDA). The device is expected to significantly lower mortality rates among aortic rupture patients. DR. COSELLI IS THE WORLD’S MOST EXPERIENCED AORTIC SURGEON. HE AND HIS TEAM HAVE PERFORMED MORE THAN 10,000 REPAIRS OF THE AORTA AND OVER 3,600 REPAIRS OF THORACOABDOMINAL AORTIC ANEURYSMS.

Robotic-Assisted Cardiac Surgery Dr. Kenneth K. Liao, Chief Section of Cardiothoracic Transplantation and Mechanical Circulatory Support, Baylor St. Luke’s Medical Center, is among a handful of highly experienced robotic cardiac surgeons in the U.S. and the only cardiac surgeon in Greater Houston using the da Vinci Robotic Surgical System to treat valve and coronary disease. The minimally invasive, highly advanced technology uses 3D high-definition scope and robot-controlled fine instruments inside the chest to perform mitral valve repair and coronary artery bypass grafting surgery, which allows the surgeon to perform gentle and complex surgical maneuvers inside the heart. The robotic cardiac surgery program at Baylor St. Luke’s is among the top 10 programs in the U.S. and the fastest-growing program in the United States.

Leaders in AFib Care Baylor St. Luke’s was the first in Houston to perform the convergent procedure for treating atrial fibrillation, a hybrid procedure involving a cardiac surgeon who advances an ablation catheter in conjunction with a cardiac electrophysiologist who maps and completes the isolation of the pulmonary veins and posterior wall. In a recent study, normal sinus rhythm was restored in 87% of patients, 43% were off their AFib medications three months after the procedure, and 76% were no longer having symptoms at the 6-month mark.

Convergent Procedure

COVER STORY

Cancer Care With A Personal Touch From precision medicine to immunology to genomics, some of the most effective advances in cancer care are taking place at Baylor St. Luke’s. We remain laser-focused on the care and wellbeing of our patients. Our clinical teams and researchers come together to provide oncology care that is individually tailored to the patient, allowing us to provide leading-edge cancer treatment to patients from around the world. Baylor St. Luke’s is home to the Dan L Duncan Comprehensive Center. It earned the prestigious Comprehensive Cancer Center designation from the National Cancer Institute for its cutting-edge clinical research and state-of-the-art cancer therapies. “Our researchers bring innovative treatments from lab to bedside faster than ever before to help stop cancer in its tracks,” said Dr. Motthafar Rimawi, Executive Medical Director & Associate Director of Clinical Affairs of the Dan L Duncan Comprehensive Cancer Center. “It is one of the many reasons that U.S. News & World Report recently recognized Baylor St. Luke’s as one of the best hospitals in the United States for cancer care.”

JAN.FEB 2022

COVER STORY

Genetic Advances Through our partnership with Baylor College of Medicine, our patients gain access to the largest clinical genetics programs in the United States. This means we have the opportunity to analyze the genetic makeup of the patient to identify the potential for cancer, take measures to prevent its onset, and develop custom treatments. This emergent research has led to impressive clinical applications. For example, specific gene changes can be used to predict patient outcomes. This provides the oncology team with greater insight when planning the intensity of each patient’s treatment plan. Additionally, doctors can test for gene mutations in cancer cells that can indicate efficacy of certain medications.

A Scarless Approach to Thyroid Surgery Baylor St. Luke’s is the only center in Texas that offers the transoral endoscopic thyroidectomy vestibular approach (TOETVA) which leaves no visible scars. Dr. Raymon Grogan, Section Chief of Endocrine Surgery at Baylor St. Luke’s Medical Center, is one of only a few experts performing the TOETVA procedure in the United States. He was the first surgeon to perform this operation in the Midwest United States and Texas. Dr. Grogan estimates that well over 50-percent of his thyroid patients are candidates for the scarless procedure.

Thyroidectomy Vestibular Approach (TOETVA)

Precise Breast Cancer Surgery Baylor St. Luke’s is the first hospital in the Southern U.S. to use the Sentimag Magnetic Localization System with both the Magseed technology and the newly FDA-approved Magtrace liquid tracer to locate and remove tumors in patients with invasive breast cancer. A seed is placed into the tumor and immediately evaluated during surgery by pathologists, significantly reducing the need for a second operation for re-excision. “This procedure is really transformational for the patient because it allows us to perform a finely-tuned delicate surgery rather than a big operation,” said Dr. Alastair Thompson, Chief, Section of Breast Surgery.

Genomics and Bladder Cancer Research Baylor St. Luke’s Urologist Dr. Seth Paul Lerner, Chair of Urologic Oncology at Baylor College of Medicine, and his colleagues at Baylor College of Medicine found a connection between cancer subtype and outcomes by studying the genomic underpinnings of muscle-invasive bladder cancer. Their research found that mutation signatures, molecular subtypes, the load of new cancer-associated molecules, and known clinical and pathological factors have a clear influence on overall patient survival. Taking these factors into account allows for more personalized and effective treatment for patients, translating into a very high survival probability, which is unprecedented in advanced bladder cancer.

COVER STORY

Revolutionizing Tumor Treatment and Removal

Advancing the Neurosciences As one of the leaders in stroke care in Houston and surrounding areas, Baylor St. Luke’s Medical Center leverages the most advanced innovations to improve access to the most optimal treatments for patients. Our neurosciences team offers comprehensive care for a broad range of neurological conditions and brain disorders. We use the latest advancements in neurological medicine to treat patients effectively and with a shorter recovery time. Using breakthrough research and a collaborative approach with Baylor College of Medicine, we help patients recover lost function due to a brain tumor, stroke, or ruptured brain aneurysm. In addition to offering the latest treatment options, our neurologists and neurosurgeons continue to develop new and advanced therapies such as building a brain computer to restore vision to the blind and revolutionizing benign pituitary tumor removal.

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As Chief of neuroscience service line, Baylor St. Luke’s Medical Center, Dr. Ganesh Rao, focuses on surgical management of primary and metastatic brain tumors, with a specialty in spinal column tumors. “We specialize in removing brain tumors that are difficult to access and close to areas affecting speech or motor function. We often perform these procedures while patients are awake so we can test those functions and minimize any injury to the brain while we are removing the tumor.” Dr. Rao also utilizes minimally invasive techniques such as stereotactic radiosurgery and laser interstitial thermal therapy to treat tumors that are difficult to access. Baylor St. Luke’s pituitary center is one of the most active in the United States, with published superior surgical outcomes. We utilize a multidisciplinary approach that combines patient management protocol with a less invasive endonasal surgical technique in which surgeons enter through the nasal passage to remove the pituitary tumor. The protocol emphasizes patient education, early mobilization, and scheduled inpatient and outpatient endocrine assessments that have been shown to decrease hospital stay, complications, and readmission.

Treating Complex Spine Cases Our specially trained team uses the latest advances to diagnose and conservatively treat spine conditions. When surgery is the best option, our surgeons use the most advanced minimally invasive techniques to alleviate and repair spine injuries and deformities.

Our team has extensive experience treating the most complex conditions, including: • •

Chin-on-Chest Deformity Kyphotic Deformity

WE SPECIALIZE IN REMOVING BRAIN TUMORS THAT ARE DIFFICULT TO ACCESS AND CLOSE TO AREAS AFFECTING SPEECH OR MOTOR FUNCTION. WE OFTEN PERFORM THESE PROCEDURES WHILE PATIENTS ARE AWAKE SO WE CAN TEST THOSE FUNCTIONS AND MINIMIZE ANY INJURY TO THE BRAIN WHILE WE ARE REMOVING THE TUMOR.

COVER STORY

• • • •

Swan-Neck Deformity Adult Degenerative Deformity Unstable Fractures Post-Infectious Deformity of the Spine

International Services For many decades, Baylor St. Luke’s Medical Center has been privileged to collaborate with healthcare leaders across the Middle East on patient care, training and education. Our physicians and researchers visit the Gulf region regularly to exchange knowledge and expertise and participate in medical conferences. As part of its mission to improve healthcare worldwide, Baylor St. Luke’s and its affiliates offer customized training and education services

to meet the individual needs of each organization through onsite visits, rotations and remote video conferences. In addition, Baylor St. Luke’s International team works closely with patients traveling from all over the world to make them feel at home during their stay at the hospital. We create a positive hospital experience by bridging cultural and language differences, providing personal support, and accommodating service requests. We work closely with patients and families to integrate transcultural patient care practices to provide efficient, holistic, caring, and culturally congruent care. We provide 360-degree services from prearrival scheduling to assist during their stay at our medical center, to follow up once the patient returns home.

WE PROVIDE 360-DEGREE SERVICES FROM PREARRIVAL SCHEDULING TO ASSIST DURING THEIR STAY AT OUR MEDICAL CENTER, TO FOLLOW UP ONCE THE PATIENT RETURNS HOME.

INTERVIEW

JAN.FEB 2022

INTERVIEW

Bassem Bibi Divisional Vice President for Abbott’s Rapid Diagnostic Business in the Middle East & Africa

“Abbott has developed and launched 12 tests to detect the SARS-CoV-2 virus and its antibodies"

bbott has developed and launched 12 tests to detect the SARS-CoV-2 virus and its antibodies and has so far delivered more than 1 billion tests globally. "Hospitals" magazine recently interviewed Mr. Bassem Bibi, Divisional Vice President for Abbott’s rapid diagnostic business in the Middle East & Africa who talked about Abbott’s rapid diagnostic tests and their role in detecting the virus.

What’s Abbott’s most important to contribution in curbing the spread of the coronavirus? Since the onset of the pandemic, diagnostics have been a focal point of the COVID-19 response and Abbott’s main goal has been to get as many tests as possible to as many people as possible. From the very beginning, we knew that no individual test would work in all settings, so we invested in R&D to quickly develop a suite of tests and manufacture them at a massive scale. Since early 2020, Abbott has developed and launched 12 tests to detect the SARS-CoV-2 virus and its antibodies and has so far delivered more than 1 billion tests globally. Besides, Abbott has continued to make its full portfolio of nutritional, pharmaceutical and medical device products and solutions available to the people we serve around the world.

In many countries, rapid testing has demonstrated its worth as a viable tool in fighting the pandemic; how did Abbott play a role in that perspective? Rapid testing isn’t new to the Middle East and Africa – Abbott has worked in the region for decades to bring affordable and accessible

rapid tests for malaria, hepatitis, HIV, and other infectious diseases. In 2018 and 2019, Abbott supported the 100 Million SEHA campaign launched by the Ministry of Health in Egypt to screen the entire population of Egypt for hepatitis C by providing our rapid tests. Today, with the COVID-19 pandemic, more countries around the world have turned to rapid tests, like our Panbio and ID NOW tests, as an effective tool in limiting the spread of the virus and bringing the economy back to its feet.

Panbio Ag COVID-19 rapid test is one of several tests developed by Abbott. Can you explain what makes it so useful? Abbott's Panbio™ COVID-19 Ag Rapid Test Device is an accurate and affordable tool for healthcare professionals to detect active coronavirus infections at a massive scale to help slow virus spread. Panbio is one of the most widely studied rapid antigen tests in the world for COVID-19, with dozens of published studies, reaffirming its ability to detect the SARSCoV-2 virus in people, especially those who are infectious and therefore most likely to spread the virus. Abbott also obtained the CE Mark for the Panbio COVID-19 Antigen Self-Test on June 26th. This easy-to-use test allows people to test in the privacy of their homes by using a simple nasal swab (not the deep nasopharyngeal swab) with simple instructions to follow. With results available in 15 minutes, the test delivers results quickly enough to prevent people who are infected from potentially spreading the virus to others—and gets them back to school, work or living with more confidence. Rapid diagnostics

PANBIO IS ONE OF THE MOST WIDELY STUDIED RAPID ANTIGEN TESTS IN THE WORLD FOR COVID-19, WITH DOZENS OF PUBLISHED STUDIES, REAFFIRMING ITS ABILITY TO DETECT THE SARS-COV-2 VIRUS IN PEOPLE, ESPECIALLY THOSE WHO ARE INFECTIOUS AND THEREFORE MOST LIKELY TO SPREAD THE VIRUS.

INTERVIEW like these are important to connect people with answers about their health – quickly – and puts them in greater control of their own care.

Can anyone use the Panbio Ag SelfTest on their own or do they require healthcare assistance? Adults can perform the test on their own, whereas children under 14 years need the help of an adult caretaker to help collect the nasal samples and conduct the test procedures. The real value of these self-tests is that they can be performed by anyone, anywhere testing may be needed – helping to give people more confidence and slow infection transmission.

What’s the sensitivity and specificity of the Panbio Ag Self-Test? In clinical evaluations with self-test users, the test correctly identified 95.2% of positive samples and 100% of negative samples. All samples were confirmed positive or negative by the Panbio COVID-19 Antigen Rapid Test Device (Nasopharyngeal).

How many Panbio Ag rapid tests has Abbott distributed so far? Since the beginning of the pandemic, Abbott has distributed over 1 billion Panbio COVID-19 antigen tests around the world.

What other COVID-19 rapid tests has Abbott launched in the Middle East? In addition to Panbio Ag (Nasal and Nasopharyngeal) Professional Use and Panbio Ag Self-Test, Abbott has launched in the Middle East the ID NOW™ platform, a rapid molecular test which is small, lightweight (3.0kg) and portable (the size of a small toaster), and uses nucleic acid amplification technology, which is valued by clinicians for its high degree of accuracy. The easy-to-use ID NOW test delivers results in 13 minutes or less, providing timely health information when it’s needed most.

How does rapid tests help the economy recover? Thanks to their ease of use, reliability, affordability and fast results, rapid tests can play an important role in bringing the economy

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back to its feet. Abbott’s ID NOW device has been deployed as a confirmatory test in several leading airports and trade events around the Middle East, making it a valuable and effective tool to slow the spread of COVID-19 and support local and national programs. On the other hand, Panbio Ag and Panbio Ag Self-Test have demonstrated their great worth in providing invaluable information for symptomatic people with regard to their COVID-19 status. While the tests are important to confirm COVID-19 cases, help slow the spread and promote economies to recover, the data and insights about positivity rate, hospitalizations and case numbers and also essential public health tools. To facilitate easier monitoring, tracking and reporting of rapid test data, Abbott has developed its Sympheos™ connectivity solution. This system combines the Panbio rapid antigen test with a mobile app, web portal, and visual dashboard reporting tool so that healthcare providers and local officials can access decentralized test data in real-time and deploy resources where they are needed most. Test data uploaded into the Sympheos system provides real-time data to decision-makers, which is critical to deploying resources to locations experiencing disease outbreaks. It supports officials to monitor cases, understand positivity rate and act quickly when identifying an outbreak. We have many tools at our disposal to combat the COVID-19 pandemic and help the economy recover – rapid tests, monitoring and surveillance, vaccines and mitigation measures. But it must be a combination of these public health tools, working in partnership, that will help us slow the spread of the virus and support the recovery of economies across the globe.

TO FACILITATE EASIER MONITORING, TRACKING AND REPORTING OF RAPID TEST DATA, ABBOTT HAS DEVELOPED ITS SYMPHEOS™ CONNECTIVITY SOLUTION.

ARTICLE FEATURES . Patient Safety

LINET´s Image 3 low bed combines hotel design with several safety parameters such as extraordinary high individually adjustable side rails, low positioning and many more. It comes in a washable version for enhanced infection control.

JAN.FEB 2022

ARTICLE FEATURES . Patient Safety

PATIENT SAFETY

The cornerstone of healthcare

atient safety and medical error prevention have been receiving significant attention in recent years as they have become the cornerstone in hospitals. Improving patient safety and quality of healthcare is key as every patient has the right to receive care in a safe and secure setting. Patient safety is the cornerstone of healthcare and the goal is to prevent any avoidable harm when the patient receives a health service, anytime anywhere. Patient safety is fundamental to delivering quality essential health services. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of healthcare. Since patient safety is built on certain foundations and behaviors, it contributes to accelerating patient recovery. The application of international accreditation standards has contributed to improving patient safety and reducing medical errors by raising the quality of medical services offered by healthcare providers. Physicians’ adherence to treatment protocols and clinical practices within the medical community, in addition to following evidence-based medical practices and applying the foundations of patient-centered healthcare, contributed to reducing medical error rates, and providing the patient with the safety needed. Patient safety is a top priority for hospitals as they attract patients thanks to their good reputation in the medical community. It will also facilitate the process of obtaining international accreditations, making the patient trust the medical service he will receive. A quality certification is a testament to the hospital’s commitment to international patient safety standards, because it includes the medical and administrative work of any health facility.

PATIENT SAFETY IS A TOP PRIORITY FOR HOSPITALS AS THEY ATTRACT PATIENTS THANKS TO THEIR GOOD REPUTATION IN THE MEDICAL COMMUNITY. IT WILL ALSO FACILITATE THE PROCESS OF OBTAINING INTERNATIONAL ACCREDITATIONS, MAKING THE PATIENT TRUST THE MEDICAL SERVICE HE WILL RECEIVE.

Patient-centered care Today, patient-centered care is a key aspect of patient safety. Hospital administrators focus on patient-centered care as it is tied to the

ARTICLE FEATURES . Patient Safety

patient experience and health outcomes. It is not only about caring for and treating the patient, but it goes beyond that to include dealing with him in a more comprehensive way by talking with him and listening to his complaints, as he should be considered a real partner in the treatment journey. This modern approach to patient care and safety aims to strengthen the human-centered comprehensive care model, which has shown a tangible improvement in the patient experience or the healthcare provider’s. This has increased patient satisfaction, decreased hospital readmission rates and reduced healthcare costs.

FOUNDATIONS OF PATIENT SAFETY IN HEALTH FACILITIES There are many elements that must be achieved and acted upon in order to ensure that the patient receives the necessary healthcare.

Safety management system Some hospitals and health facilities were keen to establish a health and safety management system where healthcare providers develop guidelines that determine the performance of this system in the institution based on their

hands-on work experience and their experience with patients. Business strategies were developed to enhance performance and patient safety by providing quality healthcare, in addition to preparing effective rapid response teams. The hospital administration shall make all its employees and personnel undergo training programs on workplace safety in hospitals, including patient and worker safety. Every individual should know the importance of the responsibility that falls upon him in terms of maintaining their safety and the safety of those around him. The medical facility management must follow up closely on the matter in order to ensure that safety and security standards are implemented.

THIS MODERN APPROACH TO PATIENT CARE AND SAFETY AIMS TO STRENGTHEN THE HUMAN-CENTERED COMPREHENSIVE CARE MODEL, WHICH HAS SHOWN A TANGIBLE IMPROVEMENT IN THE PATIENT EXPERIENCE OR THE HEALTHCARE PROVIDER’S.

Infection Control Hospitals have attached special importance to infection control programs by establishing a special department that seeks to implement international standards and monitor the hospital environment to reduce the risk of infection as much as possible in order to ensure patient safety. Infection control practices and hygiene procedures should be performed on a daily basis; they are the responsibility of each indi-

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ARTICLE FEATURES . Patient Safety

vidual working in the hospital. Ensuring patient safety during the hospital stay requires creating a clean healthy environment and applying the latest mechanisms and strategies to prevent the spread of infection or its presence in the hospital environment. The standard infection control precautions include hand hygiene, dealing with hospital-acquired infections and epidemic outbreaks, disinfection and sterilization of machines and surgical equipment, safe management and care of environment, personal protective equipment, safe management of blood and body fluids and safe disposal of waste.

Global infection control guidelines that should be implemented include: •

Regular handwashing before and after

•

touching a patient especially when taking samples from him. Personal Protective Equipment that should be worn by healthcare staff to protect themselves against exposure to harmful pathogens. Safe disposal of waste followed by cleaning and disinfection to eliminate enough pathogens to prevent transmission of infection. Isolation precautions should be used for patients who are either known or suspected to have an infectious disease or who are particularly susceptible to infection. Cleaning of high-risk touchpoints is essential. When cleaning it is essential the appropriate cleaning products and

TODAY, PATIENTCENTERED CARE IS A KEY ASPECT OF PATIENT SAFETY. HOSPITAL ADMINISTRATORS FOCUS ON PATIENTCENTERED CARE AS IT IS TIED TO THE PATIENT EXPERIENCE AND HEALTH OUTCOMES.

ARTICLE FEATURES . Patient Safety

disinfectants are used. The environment for patients and healthcare staff must be safe for practice. Even if an area may look clean, many dangerous micro-organisms can live on surfaces.

Hospital Design The hospital’s interior and exterior design contributes to improving recovery rates by creating patient rooms and private bathrooms that provide the necessary comfort to the patient. Nursing Units should be in close proximity to patient rooms. It is also necessary to ventilate the rooms to remove pathogens present in the air of the hospital room, as well as providing of sufficient and appropriate hand hygiene facilities in the entire hospital to increase safety. A pest control program must be developed and implemented in the health facility, with the selection of appropriate furniture that meets the necessary conditions to ensure patient safety,

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such as medical beds, transport stretcher trolleys, fire retardant and washable curtains, etc. The hospital design should include specifications in terms of location, area, interior space distribution, standards and specifications of the building materials used, as well as appropriate ventilation and lighting systems, around-theclock water and power supply. When developing the health facility design, people with special needs should be taken into account and safety requirements should be available to protect patients, workers and visitors from accidents and injuries during the project implementation.

Nursing Staff The presence of a professional and highly trained nursing staff who has the ability to accurately organize medication administration in a timely manner, and to develop a medication schedule and explain it to the patient in a simple way in order for him to understand.

ENSURING PATIENT SAFETY IN THE OPERATING ROOM IS FUNDAMENTAL AND IT BEGINS BEFORE THE PATIENT ENTERS THE OPERATIVE SUITE. IT INCLUDES ATTENTION TO ALL APPLICABLE TYPES OF PREVENTABLE MEDICAL ERRORS. THE SURGICAL TEAM SHOULD FOLLOW THE HOSPITAL’S PROCEDURES FOR SURGICAL HANDWASH AND HAND HYGIENE.

ARTICLE FEATURES . Patient Safety

After being discharged from hospital, nurses should educate the patient about how to take their medication doses, and the major consequences of medication errors. In addition, the nursing staff and other healthcare providers should reduce the risk of bloodstream infections.

Surgeries Ensuring patient safety in the operating room is fundamental and it begins before the patient enters the operative suite. It includes attention to all applicable types of preventable medical errors. The surgical team should follow the hospital’s procedures for surgical handwash and hand hygiene. Sterile operating gowns should be worn in addition to tight surgical masks which cover the nose and mouth. The appropriate surgical site skin preparation should be done prior to surgery within the operating room. The skin around the incision site should be carefully washed and cleaned. To maintain patient safety in the operating room, the surgical team should undergo training programs on the policies and procedures adopted in surgeries and related to infection control. Movement in the OR should be kept to a minimum to avoid contamination of sterile items or persons. When operating room doors are opened, it decreases the sterility of the surgical suite. Therefore, the doors should remain closed at all times. Disposal of unusable and unused tools and equipment from the operating rooms is necessary. The process of cleaning and preparing between surgeries takes about 15-20 minutes, which is enough time to have a proper air ventilation in the operating room in a way that ensures patient safety.

through a communication network between hospital departments and the pharmacy, which is in turn connected to the medical warehouses to provide medications while mentioning the expiry date of every medicine. Then, the pharmacist or nurse distributes these medications to patients by passing through the various hospital departments in order to ensure the expiry of medicines they have. There are also regulations for good storage practices such as the need to maintain storage temperature. Today, this mechanism of action is carried out through the “smart pharmacy” system, with the presence of an automated program that saves time for the pharmacist, who checks prescriptions and educates the patient about how to use the medication to ensure its optimal use.

THE HOSPITAL DESIGN SHOULD INCLUDE SPECIFICATIONS IN TERMS OF LOCATION, AREA, INTERIOR SPACE DISTRIBUTION, STANDARDS AND SPECIFICATIONS OF THE BUILDING MATERIALS USED, AS WELL AS APPROPRIATE VENTILATION AND LIGHTING SYSTEMS, AROUND-THE-CLOCK WATER AND POWER SUPPLY.

Lab and Blood Bank Safety The lab and blood bank safety rules must be followed by both employees and patients. Respecting the safety and security measures also aims to control the quality of lab tests to ensure the delivery of reliable and accurate results that help make the optimal decision to treat the patient in order to prevent errors that may negatively affect the patient’s health. The necessary technical procedures including the storage, transportation and disposal of blood and blood components, as well as the need to ensure that the donor is disease-free are all very important steps to ensure the safety of blood samples before sending them to patients while covering the needs of the health facility for normal and emergency cases.

Medication Administration Safety Being administered the right medication at the right time is one of the key elements of public safety, as this contributes to improving the drug treatment service, promoting health and wellness, and preventing disease. Hospitals follow specific policies and procedures based on scientific studies. The medicine reaches the patient after passing through an integrated cycle that ensures that he gets the right medicine that meets international standards. This is done

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Digital Health and Patient Safety By Dr Yasir Khan, Lead Physician Executive at Cerner in Middle East & Africa ‘Do no harm’ – an undertaking that every clinician takes when they enter the world of healthcare provision. It is one of the oldest guiding principles of medical service that has existed since the Hippocratic Oath was first uttered. This principle reflects on a huge responsibility that lies on the shoulders of healthcare providers and organizations across the entire spectrum of healthcare.

atient safety is a healthcare discipline that has emerged out of a similar concept of avoiding harm to the patient. The application of patient safety isn’t limited to therapeutic care, but it also applies to preventive care, as well as healthcare research, to ensure

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TECHNOLOGY HAS SWIFTLY TRANSITIONED FAR-FETCHED IDEAS TO EVERYDAY COMMODITIES FOR ALL.

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best ethics are practiced. Creating a culture of safety is a core pillar of the patient safety concept – it has been derived from practice outside the medical sphere, where it was found that reducing undesirable events on a sustained level contributes heavily towards an increased performance and quality of service in such organizations. Over the past century, we have made remarkable advances in the science and technology space. Technology has swiftly transitioned far-fetched ideas to everyday commodities for all. In the technology space for healthcare, digital health tools were conceived in the early 1960s as an idea of replacing manual documentation with electronic files for an improved care process that would be consistent and reliable. The initial efforts were perceived as an advanced yet unaffordable invention for the majority of healthcare organizations. Ever since then, continuous work has gone into this field to make health information technology (HIT) more accessible and more relevant to the service requirements. With the passage of time, the value of HIT has also increased manifold – from provision of vital documentation platform to becoming a core pillar for modernization of entire health systems. The infamous 1999 Institute of Medicine report To Err is Human presented compelling evidence that errors and adverse events occur widely in healthcare. It was widely expected that adoption of HIT would substantially ameliorate threats to patient safety. More recent evidence posits that to truly benefit from HIT, organizations need to maintain a sustained focus on the following three dimensions: • Clinically relevant system design • User-focused implementation • Effective utilization When done correctly, HIT can address key areas of patient safety concern, particularly those relating to medication safety, diagnostic errors, and communication issues. Computerized physician order entry (CPOE) has been shown to reduce medication-related errors. Health information exchanges (HIE) can enhance patient safety by establishing more effective

INFORMATION STORAGE AND ITS PRESENTATION SHOULD BE CONSIDERED A BASIC FUNCTION FOR ANY HIT SOLUTION. INFORMATION SHARING ACROSS CLINICAL SPECIALTIES AND ITS HIGH AVAILABILITY IS AN ELEMENTARY EXPECTATION. ANOTHER ASPECT IS CLINICALLY RELEVANT SUMMARIES OF THE EXTENSIVE CLINICAL INFORMATION THAT A SOLUTION MAY HOLD ON AN INDIVIDUAL.

communication methods. EHRs can also enhance patient safety by detecting missed diagnoses, producing diagnostic error alerts to prevent misdiagnosis, and assisting the practitioner in gathering and synthesizing patient information. Following are some of the important design considerations for development and implementation of clinical workflows for digital health. Research has shown that when done well, these significantly contribute to end-user ownership and meaningful utilization of digital solutions.

Right information at the right time Healthcare provision is an extremely information-dependent modality. For effective diagnostic and therapeutic decision-making, clinicians require access to not only a patient’s previous issues, but what treatments have been undertaken and extent to which they were effective. A clinician’s own medical notes are not the only ones requiring consideration, but also those contributed by other disciplines and investigations. With added complexity of an individual’s care being spread out across multiple geographically distant facilities, it is easy to see how a critical information can be missed leading to harm. Information storage and its presentation should be considered a basic function for any HIT solution. Information sharing across clinical specialties and its high availability is an elementary expectation. Another aspect is clinically relevant summaries of the extensive clinical information that a solution may hold on an individual. Highlighting abnormalities in lab results and captured vital signs upfront makes it difficult for these to be missed.

Care standardization Standardization of care has long been known to be an effective strategy for care quality, especially when it is evidence-based. Care practice guidelines and care pathways make entire care processes predictable and safe.

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HIT builds on the same concept by not only digitizing approved care pathways, but also digitally transforming workflows. Care pathways are baked into a well-designed solution, providing step-by-step guidance to ensure maximum compliance. Additionally, approved abbreviations and data elements, common formulary items across facilities within a single enterprise, approved practice guidelines for core measure reporting and defined structure during the ordering process reduce the chances for unintentional practice variation. The benefits of standardization far exceed the challenges, the design/build once and implement/use many times is the foundation of good standardization.

Automated flags and alerts HIT designed to improve clinical decisionmaking is particularly attractive for its ability to address the growing information overload clinicians face and to provide a platform for integrating evidence-based knowledge into care delivery. With the extensive clinical information captured for every patient visit, critical clinical information can become difficult to identify, especially in highly charged and busy clinical environments like the emergency department. HIT solutions contain smart algorithms that utilize complex logics and rules to understand the clinical context of information and bring it within the clinician’s workflow. One such example is detection of abnormal kidney functions from laboratory investigations and highlighting more ‘kidney-friendly’ alternatives to the clinician during prescription. For more clinically critical scenarios, more restrictive approaches are employed. In such cases, certain intervention is either not allowed by the system or will have a ‘break glass’ step implemented where the user has to acknowledge a system highlighted clinical risk and submit for approval.

Automation of workflows To make workflows efficient, standardized and effective, workflow automation has been

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MODERN HIT SOLUTIONS ARE EQUIPPED WITH A UNIVERSE OF SUCH CLINICAL DECISION SUPPORT TOOLS. FROM MEDICAL CALCULATORS THAT CAN INTERPRET PATIENT DOCUMENTATION INTO CLINICALLY RELEVANT INTERPRETATIONS THAT AID CLINICIANS IN DEFINING THE COURSE OF PATIENT MANAGEMENT.

applied to many protocols. It can utilize smart rules to identify cues and prompt automated tasks for patient management. Such automation reduces cognitive load on the clinician by programming certain crucial steps according to the agreed clinical protocol. These represents an extremely potent approach to utilize HIT for patient safety and quality. A good example is monitoring certain medications that are necessary for treatment but known to have adverse effect for some individuals. These medications are prescribed under a monitoring protocol that usually involves a laboratory test after a month of starting the medication. In this case, automated scripts schedule the right investigation within the most appropriate duration after starting the treatment, with no additional human intervention. Once results become available, they are only highlighted to the prescribing physician. If they are abnormal, the physician can then either alter the dose or stop the medication.

Clinical decision support Any digital system that helps a clinician to make prompt, timely and accurate decision is classified as clinical decision support. Some of the aspects described above certainly fall under it. However, some additional dimensions of clinical decision support are worth mentioning and only became possible with the advent of HIT. One such dimension is automatic risk stratification and escalation. Longitudinal medical records hold extensive clinical data on every patient. This is then utilized to create a risk profile of every individual and stratify the resulting cohort from low to high risk of an adverse outcome. The clinician can use this information to plan proactive care for patients at higher risk. A practical application of risk stratification is for maternity care. At the time of first antenatal visit, the system can look back at historic data (e.g. previous pregnancies, miscarriages, patients age, existing conditions, medications, and historic results of laboratory tests) and combine it with current presentation data to create a risk profile through an intelligent algorithm. Modern HIT solutions are equipped with a

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universe of such clinical decision support tools. From medical calculators that can interpret patient documentation into clinically relevant interpretations that aid clinicians in defining the course of patient management.

Artificial Intelligence Data captured in the EHR is widely utilized for not just monitoring and management, but now mature EHRs have the capability to convert available data into predictive models to forecast a patient’s risk of deterioration in future. This can be utilized to prevent any adverse events and improve health outcomes.

Conclusions While HIT solutions (EHRs, HIEs, data acquisition and analysis tools, and clinical decision support systems among others) are extremely effective instruments for patient safety, it is important to note that they aren’t configured to work out of the box. Organizations

THE BENEFITS OF STANDARDIZATION FAR EXCEED THE CHALLENGES, THE DESIGN/BUILD ONCE AND IMPLEMENT/ USE MANY TIMES IS THE FOUNDATION OF GOOD STANDARDIZATION.

need to invest into clinical decision support governance and capable implementation teams to take full advantage of their investment. Lastly and certainly not least, this is an iterative and continuous process. Organizations need to focus on entire ecosystem i.e. system design, intended uses, and how it is actually utilized. Implementation of newer intelligent patient safety solutions into an existing environment with individuals resistant to change is destined to failure. Research has clearly shown that if digital solutions are not properly embedded through end-user testing and ownership, they may become a patient safety concern themselves. Delivering safe and effective user experience requires co-design and co-production by developers, clinicians and patients.

MEDICAL INSTITUTIONS

Nationwide Children’s Hospital Best Children’s Hospital for all rated specialty areas TOP-10 PROGRAMS. LEADING RESEARCH. INCOMPARABLE EXPERIENCE/PEOPLE. TOP 10 IN CLINICAL CARE AND RESEARCH. UNSURPASSED IN BEDSIDE MANNER. TOP 10 IN CLINICAL CARE AND RESEARCH. NUMBER 1 IN PUTTING PATIENTS FIRST/DEDICATION/ DETERMINATION/DRIVE/AMBITION/COMMITMENT/RESOLVE/TENACITY. LEADING CLINICAL INNOVATIONS. GROWING PROGRAMS AND RESEARCH. TRANSFORMING QUALITY CARE. CREATING THE FUTURE OF PEDIATRIC CARE AND RESEARCH. TODAY. TOP-RATED CLINICAL PROGRAMS. A LEADER IN RESEARCH FUNDING. BEST OF THE BEST IN DEDICATION.

ationwide Children’s Hospital is the second-largest pediatric hospital in the United States. We are one of only 10 hospitals to be named to the U.S. News & World Report Best Children’s Hospital Honor Roll, and we rank 6th in research funding from the National Institutes of Health. Together, our clinical expertise and research prowess help us do great things for today’s children while we create the future of pediatric medicine.

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MEDICAL INSTITUTIONS

We believe that when children need better options, everything matters.

A leader among leaders Nationwide Children’s Hospital is consistently ranked as a Top 10 children’s hospital in the United States. We are also ranked as a Best Children’s Hospital for all rated specialty areas.

The proof is in our people — and our programs Our reputation for quality and innovation comes from seeking out the nation’s best surgeons, clinicians and physician-scientists to lead and staff our highly specialized programs. We support our faculty in their efforts to craft clinics that offer some of the world’s most advanced pediatric procedures, and we care for children with even the rarest conditions. We provide our clinical leaders with the top-quality staff and cutting-edge equipment they require to improve the standard of care for their entire field of medicine. And we open our doors to everyone. Nationwide Children’s provides more than 1.6 million patient visits per year and has 1,489 medical staff and more than 13,000 employees. We offer the largest neonatal network and are the largest provider of pediatric surgery in the United States, according to the Children’s Hospital Association. We have cared for children from all 50 states and more than 50 countries, and national and international referrals are growing for our prestigious programs. The following highlighted programs represent just a sample of the unique, highly specialized care available at Nationwide Children’s.

Comprehensive Neuro-Oncology Care and Research Opportunities Our neuro-oncology program is an international destination for pediatric, adolescent and young adult patients with malignant brain and spinal cord tumors, thanks to the leadership and expertise of Medical Director Maryam Fouladi, MD, MSc, FRCP, and Surgical Director Jeffrey Leonard, MD. They continue the program’s long tradition of professional leadership and internationally collaborative research through the Head Start program and the CONNECT consortium, which develop and test novel brain tumor therapies in early-phase clinical trials.

NATIONWIDE CHILDREN’S PROVIDES MORE THAN 1.6 MILLION PATIENT VISITS PER YEAR AND HAS 1,489 MEDICAL STAFF AND MORE THAN 13,000 EMPLOYEES.

Innovative Approaches for Rare Neuromuscular and Genetic Conditions Nationwide Children’s physician-researchers including Jerry Mendell, MD, led the Phase 1 clinical trial studying the first gene therapy for spinal muscular atrophy type 1 (SMA1), a severe and progressive neuromuscular disease that often results in death by the age of 2. Thanks to his groundbreaking research, the FDA-approved ZOLGENSMA®, an intravenous gene therapy injection that transforms the disease trajectory for these children and dramatically improves patient and caregiver quality of life. The Center for Gene Therapy at The Abigail Wexner Research Institute at Nationwide Children’s now has more than 20 gene therapy targets in its research pipeline.

MEDICAL INSTITUTIONS

Neurology Programs With Transformative Neurosurgery Techniques Ranked 7th in the nation in Neurology and Neurosurgery, we are one of only a few hospitals in the United States offering selective dorsal rhizotomy (SDR), a specialized procedure for children with spasticity to reduce pain and improve mobility. Nationwide Children’s is also home to the world’s top experts in epilepsy care, providing a wide range of advanced treatment options for medically intractable epilepsy that can lessen seizure severity and may cure the child’s epilepsy entirely. Our Level 4 Epilepsy Center has achieved 100 percent surgical survival and post-surgery (Engle class) outcomes significantly higher than national averages.

Plastic and Reconstructive Surgery for Every Need From our Cleft Lip and Palate Center to our 22q Center, our internationally recognized clinicians and surgeons work in multidisciplinary teams to provide the best of both surgical and clinical care to each and every patient. Experts in each subspecialty of this precise surgical field perform even the most complex palate, velopharyngeal, vascular, skin, post-trauma and craniofacial operations—including brachial plexus, microsurgery, muscle reinnervation and facial reanimation procedures offered at only a handful of institutions in the United States.

Cardiothoracic Surgery Expertise That Reinvented Multiple Cardiac Operations Our experts in minimally invasive heart surgery and open-heart surgery developed and now lead the world in novel hybrid procedures, allowing greater use of minimally invasive approaches for complicated heart operations. This reduces patient exposure to blood products, shortens recovery time, and can often improve outcome while reducing risk. Our innovative Hybrid Catheterization Suite is designed specifically to facilitate safer and faster cardiac procedures. The Heart Center at Nationwide Children’s also hosts the country’s first FDA-approved clinical study of the safety and effectiveness of tissue-engineered blood vessels in infants with congenital

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heart defects—a novel treatment approach that allows a child’s body to take over the graft with healthy tissue that will grow and function like a native vessel.

500,000+

SQUARE FEET OF DEDICATED RESEARCH SPACE

One-of-a-Kind Collaboration in Colorectal and Pelvic Reconstruction Our comprehensive team of pediatric surgeons and physicians have special expertise in colorectal surgery, reconstructive urology and gynecology, and gastroenterology with a specific interest and advanced training in motility disorders. The Center for Colorectal and Pelvic Reconstruction (CCPR) treats children with anorectal and cloacal malformations, cloacal exstrophy, bladder exstrophy, Hirschsprung disease, severe functional constipation and the most complex reconstructive problems—including re-operative surgery on children treated elsewhere. Our center serves children of all ages at various stages in their care continuum and throughout the life span, and more than 60% of patients come from outside of Ohio.

Gastroenterology Care Focused on Permanent Solutions Chief Carlo Di Lorenzo, MD, is widely regarded as one of the world’s top experts in diagnosing and treating functional neurogastrointestinal and motility disorders in children. Under his guidance, the Motility Center at Nationwide Children’s has developed unique and innovative expertise in diagnosing and treating pediatric intestinal pseudo-obstruction, gastroparesis, rumination syndrome and post-surgical defecation disorders. In many cases, our treatment programs for these conditions are among only a handful of such centers in the world. Our extensive expertise with the nerve, muscle and behavioral elements of these complex conditions allows us to skillfully and holistically treat our patients with a multidisciplinary and collaborative team.

Driving advanced pediatric research forward At Nationwide Children’s, we believe research enables us to offer better care for our patients, today and tomorrow. We believe it helps

IN RESEARCH FUNDING FROM THE NIH AMONG FREESTANDING PEDIATRIC RESEARCH FACILITIES

$54.6 Million IN DIRECT NIH AWARDS

1000+

CLINICAL STUDIES UNDERWAY

100s

OF DEDICATED RESEARCH FACULTY AND STAFF

100+

INNOVATIVE, RESEARCH-BASED PATENT APPLICATIONS FILED PER YEAR

MEDICAL INSTITUTIONS

our clinicians innovate to create new and better care solutions for patients. It helps us learn how we can do better. And it helps deliver the science behind future breakthroughs in pediatric medicine. That’s why we prioritize both clinical research and basic scientific study.

Support and resources for traveling (and remote) families Our Global Patient Services program exists to help international families decide about coming to Nationwide Children’s. Once they do, we help families get here conveniently, stay here comfortably and return home with the information they need to transition smoothly back into their local care plan. The program guides families through all aspects of care and provides seamless, personalized assistance with appointments, care and finance coordination, and more. We also coordinate with referring physicians to connect them with the right specialists and ensure that communication runs smoothly before and after their patients’ visits.

Go online to explore Nationwide Children’s — located in friendly, metropolitan Columbus, Ohio — as a destination for some of the best available pediatric care in the United States. Read more about our specialty programs, renowned clinical leaders, research trials and more at NationwideChildrens.org Get more information about international patient experiences and even remote international consultations at NationwideChildrens.org/Global-Patient-Services Fill out a medical inquiry form online to be contacted by one of our specialty referral clinics at NationwideChildrens.org/medical-inquiry-form LEARN MORE, REFER A PATIENT, OR PLAN A TRIP: NationwideChildrens.org/Global-Patient-Services GlobalPatientServices@NationwideChildrens.org +1 614 362 9127

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Dr. Annie Ideker on Streamlining EHR Work to Improve Clinician Well-Being THE CARING GREATLY™ PODCAST IS A DESTINATION WHERE HEALTHCARE LEADERS FIND STORIES AND RESOURCES DESIGNED TO HELP THEM TO GROW, LEAD, INNOVATE, AND REJUVENATE. IN AN INTERVIEW FORMAT, THOUGHT LEADERS FROM ACROSS HEALTHCARE DISCIPLINES SHARE INSIGHTS AND INSPIRATION ABOUT LEADING AND THRIVING AS THE INDUSTRY TRANSFORMS.

n this excerpt from the Caring Greatly™ podcast, Annie Ideker, MD, a family medicine physician and Senior Medical Advisor for both Clinician Experience and Clinician/Patient Relationships in ambulatory practice for HealthPartners in Minnesota, discusses her team’s efforts to streamline EHR work and its impact on clinician well-being with Liz Boehm, Executive Strategist for Vocera Communications.

You said that after COVID necessitated an incredibly rapid uptake of telehealth, your team recognized the technology was playing this increasingly large part of the clinician experience. You and your team took on the EHR to make sure that it was working for clinicians as opposed to clinicians working for it. Can you explain what you're focused on and how it impacts the clinician experience?

In 2020, Dr. Ideker and her team identified four key areas of focus for EHR improvement: orders redesign, documentation, best practice and medication alerts, and EMR proficiency. In each of these areas, Dr. Ideker and her team designed solutions using a data-driven approach, in partnership with clinicians, and always with the aim of making the technology effective, efficient, and even delightful.

Dr. Ideker: We looked at the landscape of what we were hearing from our clinicians, in terms of their interactions with the EHR and we looked at data. That really informed the four key priorities that we started working on under the umbrella of clinician experience. One of those key priorities is what we have grouped as medication dose alerts, best

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practice alerts (BPA), and health maintenance alerts. I think of it as anything that interrupts a clinician. The guiding principle for this body of work is that if I'm going to interrupt a clinician, there better be a really good reason. We can systematically, again using data, tell what are the alerts that are firing most commonly, and we start with the low-hanging fruit. We are able to evaluate and analyze what's actually happening as a result of presenting those alerts to clinicians. Then the bar is quite simple. If it's not resulting in a change in action or a meaningful change in what a clinician does, it doesn't meet the bar, and we take it out. By doing that, and this work has been underway now for a little over six months, but we've eliminated literally millions of clicks. The reason that we have continued to calculate those clicks and hours is it has become part of our communication with our clinicians. It's part of what we are doing as a team to help build and, to some degree restore, trust that our clinicians have with our organization around the fact that we're making it very visible, that this is what we're working on, why we're working on it. We're telling the story and we're using the data to tell the story. I can talk all I want to about some strategic initiative that we have, but that's a very different conversation than if I told a clinician that I removed a million clicks from their dayto-day work. That's the story that resonates and that's why we continue to measure and communicate about it in those terms.

of it and engaging our clinicians early and often and upstream in the design of what we're trying to build, because ultimately it needs to work for them. I really think about the fact that if we're doing our job well and accomplishing the goals that we've set out, that clinicians won't have to think about the technology anymore. It'll just be in the background. Clinicians won't see themselves as working for their EMR. The EMR will work for them, but it allows us to, as clinicians, focus on why we are in the practice of medicine to begin with, which is our patients. This excerpt has been edited for length and clarity. The full interview is available at Vocera.com/podcast/Streamlining-EHR-WorkFor-Well-Being or listen on Apple Podcasts, Spotify, or Google Play Music. The Caring Greatly™ podcast is a destination where healthcare leaders find stories and resources designed to help them to grow, lead, innovate, and rejuvenate. In an interview format, thought leaders from across healthcare disciplines share insights and inspiration about leading and thriving as the industry transforms. The Caring Greatly podcast is supported by Vocera.

ONE OF THE THINGS THAT OUR TEAM HAS BEEN TRYING TO CHANGE IS THIS IDEA THAT OUR TECHNICAL PEOPLE WHO UNDERSTAND HOW TO BUILD ARE IN THE BEST POSITION TO KNOW WHAT TO BUILD FOR CLINICIANS.

www.vocera.com/me

It's incredibly powerful that you're doing this in partnership with the frontline people who will be using these tools. They both are designing solutions that work for them, and then also potentially become champions for those who aren't directly involved in the process. Dr. Ideker: One of the things that our team has been trying to change is this idea that our technical people who understand how to build are in the best position to know what to build for clinicians. We've been intentional in all of this work about putting clinicians at the center

NEWS FEATURES . Green Hospitals ARTICLE

A revolutionary change that benefits hospitals patients and the environment

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ARTICLE FEATURES . Green Hospitals NEWS

ccording to many studies, one hospital can consume as much power as a small town and can also produce medical waste that corresponds and sometimes exceeds the same level of pollution of the same town. That’s where comes the importance of the pursuit to transform hospitals into green eco-friendly facilities. The priority of healthcare previously consisted in providing the best health services to its patients and environmental protection came second but with the new understanding of the environmental protection concept, the majority of hospitals shifted to a more ecological, economic, and socially sustainable environment. For example, the Sunshine Coast University hospital in Australia was ranked fourth amongst the top 6 green buildings in the world. It is the first healthcare facility to be awarded Six-Star Green Star ratings for design and construction. The studies show that the global healthcare industry is responsible for 4.4 percent of carbon dioxide emissions each year. That's higher than gas emissions from aviation and shipping. An average hospital uses 500 liters of water and produces several kilograms of partly hazardous waste per day. This consumption seems necessary to provide the best healthcare services for patients and ensure their safety. Plastic syringes, tubes needles and much more might be contaminated with chemicals or biological materials after use. The number of syringes used worldwide per year can reach 16 million pieces which is why recycling is out of the question because of the high probability of contamination. The only way for hospitals is to find solutions for the proper management of toxic substances by going green. Seeing the resources consumption and the amount of waste a hospital can produce shows the need for hospitals to shift to green buildings where they practice the reduction of the environmental impact of healthcare institutions and enhance the health and wellbeing of their patients. In general, only 15% of the hospital's waste is considered hazardous and can be dangerous to others so the method of disposal should be effective and safe.

ACCORDING TO A REPORT BY SBI ENERGY, GREEN BUILDING RENOVATIONS WILL EXPERIENCE A SIGNIFICANT INCREASE IN THE FEW YEARS TO COME AND AT A MORE RAPID PACE TILL THE YEAR 2050.

The green hospitals realize the importance of the connection between the environment and human health. We see more and more hospital managements demanding architects to incorporate green concepts into hospital design. Actually, according to a report by SBI Energy, green building renovations will experience a significant increase in the few years to come and at a more rapid pace till the year 2050.

Benefits of green buildings For the European Union, the shift to green buildings is a way of saving natural resources and protecting the environment. Buildings are responsible for about 40 percent of energy consumption in the EU and 36 percent of greenhouse gas emissions from energy consumption. But only 1 percent of buildings undergo an energy-efficient renovation each year. Hospitals come at the top of the list of buildings that must be converted into environmentally friendly, given the health, economic and social benefits that this change can have on the environment. In order to achieve their target of reducing greenhouse gas emissions by at least 55 percent by 2030, experts said that buildings must reduce emissions by 60 percent and reduce energy consumption by 14 percent. The energy used for heating and cooling must be reduced by 18 percent.

NEWS FEATURES . Green Hospitals ARTICLE

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ARTICLE FEATURES . Green Hospitals NEWS

Thanks to the European policy and the funds provided for that, buildings are now consuming half the energy compared to 20-yearold buildings. But 85 percent of the buildings in the European Union, about 220 million buildings, were built before 2001. It is expected that about 85 to 95 percent of them will remain in place until 2050. For this, the union is working to support what it describes as "The wave of building renovation" to become more in line with the new environmental standards and also to create new job opportunities, and to improve the quality of life. The European Commission expects that the implementation of this strategy will improve the quality of life for people who live in green buildings, especially in hospitals, to reduce greenhouse gas emissions in Europe, and promote digitization and the reuse of recyclable materials. The Commission estimates that by 2030, 35 million buildings will have been renovated and up to 160,000 additional green jobs created in the construction sector. This strategy will give priority to renovating public buildings such as hospitals, schools and administrative buildings. The World Green Building Council divides the benefits of green buildings into three environmental, economic and social benefits. According to a report by the Council, green buildings in Australia that received "Green Star Certification" by the Australian Green Building Council resulted in a 62 percent reduction in greenhouse gas emissions compared to the average Australian building. It was found that globally, green buildings will save up to 84 gigatonnes of carbon dioxide by 2050. Green buildings also provide a lot of economic benefits globally, at the country level and at the construction level. Some of the benefits include cost savings on utility bills, lower operating costs, higher property values for property developers, and new job opportunities. In this regard, building owners' observation as reported by Dodge Data & Analytics, is that green buildings, whether newly built or old and renovated resulted in a 7 percent increase in asset value compared to traditional non-green buildings.

GREEN BUILDING OFFERS A NUMBER OF BENEFITS TO ITS OCCUPANTS. STUDIES HAVE SHOWN THAT GREEN BUILDING WORKERS REPORT A 101 PERCENT IMPROVEMENT IN KNOWLEDGE LEVELS.

From a social perspective, the green building offers a number of benefits to its occupants. Studies have shown that green building workers report a 101 percent improvement in knowledge levels. In addition, employees in green buildings with well-ventilated offices reported sleeping an average of 46 minutes more each night. This was also reported by hospital patients, who reported a positive impact of the environmentally friendly features of green hospitals on their psychological and physical comfort. Also, about 55 percent of them said that they would be willing to pay a higher bill in an environmentally friendly hospital due to the benefits it provides.

NEWS FEATURES . Green Hospitals ARTICLE

Inspiring Green Stories What are the ways in which hospitals can become environmentally friendly? What are the obstacles to overcome in order to reach that goal? To begin with, experts believe that "a green hospital must be sustainable wherever there is the use of resources." And that the first step to being followed in the path of becoming a green hospital is to seek to improve energy efficiency and switch to renewable energy such as photo-

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GREEN HOSPITALS FOCUS ON CREATING SUSTAINABLE MECHANISMS AND METHODS THAT ARE SUCCESSFUL IN THE LONG RUN.

voltaic technology. Energy-saving insulation and more efficient heating systems are other ways to save energy. Dealing with water consumption is another important aspect of green hospitals. Successful water use reduction depends primarily on changing water consumption habits starting with employees to patients. Even simple changes to a building's structure can lead to a rapid and significant impact. On the other hand, hospital waste man-

ARTICLE FEATURES . Green Hospitals NEWS

agement is another challenging aspect. The idea is to reduce waste in general, and hazardous waste in particular. And dealing with recyclable waste so that it can be reused. For example, some types of generated waste can be converted into compost. For hospitals, this procedure means balancing between environmental protection and hygiene requirements and ensuring the best service for the patients and hospital staff. Green hospitals focus on creating sustainable mechanisms and methods that are successful in the long run. This also involves logistics. Optimal delivery service strategy according to fixed schedules and avoiding unnecessary transfers, help reach that goal. This allows hospitals to save materials, avoid waste and reduce carbon dioxide emissions. The Green Hospital's measures also include the use of environmentally friendly building materials and the reduction of meat consumption by for example; introducing a meatless day once a week. "It's not just about environmental, economic and social sustainability," says expert Shawnheit Muller of Klinikum Lichtenfels. She explains: “In my opinion, the employees' knowledge and motivation remain the most valuable assets because their commitment drives the quality of health care. As with all other valuable resources, the Green Hospital helps employees to be more productive and attract talents which raises the standard of health service for patients and the hospital environment in general. The importance of the Green Hospital lies in the fact that caring for environmental integrity is no less than caring for the safety and well-being of patients. In this regard, the Lichtenfels Hospital is an example of green hospitals' successful stories in Germany. It was inaugurated in the summer of 2018, after nine years of planning and construction. The designers improved the hospital building envelope with a triple-glazed window system, the use of heat recovery and geothermal energy. Thus, the Green Hospital Initiative in Bayern (Green Bavarian Hospital Initiative), provided a successful model and specific roadmap for the standards that hospitals should follow. After successfully fulfilling the required

THE IMPORTANCE OF THE GREEN HOSPITAL LIES IN THE FACT THAT CARING FOR ENVIRONMENTAL INTEGRITY IS NO LESS THAN CARING FOR THE SAFETY AND WELL-BEING OF PATIENTS.

conditions and adopting all environmental standards, the Bavaria Hospital was awarded the title "Green Hospital in Bavaria". The German Federation for the Environment and Nature Conservation BUND participates in climate protection projects in hospitals throughout Germany and supports them in managing green hospitals. The so-called "energy-saving hospital" label is awarded to a hospital that adheres to the required environmental conditions. The Hubertus Protestant Hospital in Berlin was the first hospital in Germany to receive this mark. It reduced its energy consumption by 37 percent and carbon dioxide emissions by 2,600 tons.

Green Hospitals: A Necessity or an Option Stakeholders used to think that transforming a hospital into a green building was very expensive and that was the main obstacle that delayed the process until they discovered the

NEWS FEATURES . Green Hospitals ARTICLE

contrary. The plans that promote sustainability are initially expensive and their effects on patient care may not be immediate. Preference was given to less expensive suppliers, even though a regional or local supplier was a more sustainable option. Hence, innovative solutions and assistance in planning, financing and implementing were necessary to overcome these barriers. In addition to the basic requirements for sustainable changes, the issue of mental transformation and changing habits. For example, there should always be ongoing efforts to educate and raise awareness of the fact that green hospitals also have a positive impact and significant benefits on both patient and staff health. Moreover, smart improvements in energy consumption can reduce carbon dioxide emissions and keep energy costs low, which come to about $1,700 per year per bed. This will enhance both economic growth and environmental sustainability. Aside from education and awareness, we also need formal legal commitments to achieve comprehensive implementation of sustainable strategies in the healthcare sector.

The main key points for transforming a hospital into a green one are as follows: Reliance on local supply: Hospital cafeterias serve plenty of food every day. The source of this food can have a significant impact on the hospital environment. Accordingly, hospitals can contract with group purchasing organizations and use more fresh, locally grown products thus reducing the cost of import and food conservation which leads to less energy consumption.

Water conservation and management: There is an interesting example of how much water can be saved when using it, as demonstrated by Virginia Mason Medical Center in Seattle, a non-profit hospital that saves more than six million gallons of water annually by making several changes. The hospital replaced radiotherapy machines with better models, replaced toilets, faucets, showers, and washing machines with better alternatives.

JAN.FEB 2022

Scientific ways to consume less energy: SMART IMPROVEMENTS IN ENERGY CONSUMPTION CAN REDUCE CARBON DIOXIDE EMISSIONS AND KEEP ENERGY COSTS LOW, WHICH COME TO ABOUT $1,700 PER YEAR PER BED. THIS WILL ENHANCE BOTH ECONOMIC GROWTH AND ENVIRONMENTAL SUSTAINABILITY.

For example, Greenwich Hospital in Connecticut saved more than 1.7 million kilowatt-hours, reducing electricity costs by $303,000 annually and reduced its total energy consumption by 35 percent. The hospital reprogrammed its heating and cooling plants, re-engineered ventilation systems, and upgraded electric lights. This can be achieved in any hospital if proper measures are taken.

Waste disposal methods: US hospitals produce more than 5.9 million tons of waste annually, according to Practice Greenhealth. A major challenge for hospitals is the variety of waste they produce, which makes environmentally friendly disposal tiring. Organizations must disinfect medical waste before it goes to a landfill to ensure that there is no environmental pollution. While disinfection methods, such as incineration, consume a lot of energy and are known to release harmful emissions, processes such as sterilization, chemical processing, and microwaves can vary widely in order to be environmentally friendly.

Purchasing health and safety: Many medical types of equipment may contain toxic particles like LCD screens, fluorescent lights, wheelchair cushions, and baby bottles that can be harmful to the environment. Also, many products can contain dangerous chemicals if purchased from the wrong manufacturer. Therefore, experts suggest that hospitals should have a proper purchasing system that can help them make the right decisions in order to avoid piling toxic materials. In conclusion, studies have proven that transforming buildings in general and hospitals in particular into environmentally friendly centers benefits them in many ways.

Organizations should be able to save energy They should really look at the green building as more of an investment than anything else. An investment that will be able to save money as well as an investment that will be able to help the environment! It is a win-win situation for everyone!

ARTICLE FEATURES . Green Hospitals NEWS

MEDICAL INSTITUTIONS

Get inspired by French innovation and expertise in healthcare and join the French Healthcare two-day conference at the France Pavilion at Expo 2020 Dubai on January 25-26, 2022 biomedical engineers, information systems division managers, endocrinologists and medical specialists in the diabetes field, diabetes patient associations, oncologists and medical specialists in the cancer field, cancer patient associations, local economic operators, insurance companies, Emirati and Saudi private operators, investors in the healthcare field, healthcare device dealers, health advisors of local embassies, journalists or media… Please do not hesitate to attend the conference.

Tuesday, January 25, 2022 January 25 – 10:00am – 11:30am – Future perspectives in health and urban planning

rench Healthcare, the innovative public-private initiative aimed at bringing together under a single banner all the players in the French healthcare ecosystem to jointly promote their expertise, technologies and innovations internationally, is organizing, in partnership with the French Healthcare Association and Business France, a high-profile phygital conference in English at the France Pavilion at Expo 2020 Dubai from January 25-26, 2022 during Arab Health.

Challenges of the health-themed fortnight The Covid-19 pandemic has raised a number of questions regarding the resources allocated to health services and research in health sciences. Not every country can address the health crisis in the same way. Such an acknowledgement should drive a massive investment in essential public health services. By 2030, the health sector will have to face numerous challenges, including access to health services in all areas, the promotion of health professions, the fight against health inequalities, the attractiveness of public hospitals, an ageing population, and the inclusion of disabled people. Hospital buyers and decision-makers,

JAN.FEB 2022

BY 2030, THE HEALTH SECTOR WILL HAVE TO FACE NUMEROUS CHALLENGES, INCLUDING ACCESS TO HEALTH SERVICES IN ALL AREAS, THE PROMOTION OF HEALTH PROFESSIONS, THE FIGHT AGAINST HEALTH INEQUALITIES, THE ATTRACTIVENESS OF PUBLIC HOSPITALS, AN AGEING POPULATION, AND THE INCLUSION OF DISABLED PEOPLE.

A conference led by Virginie Rault (Property and Legal Director, PariSanté Campus), with Emmanuel Masson (CEO Orpea), Simon Chassain (Deputy Director of International Sales, Enovacom, Orange Group), Emmanuelle Gaudemer (Development Manager, AIA), Elias Oussalah (International Business Director, Hoppen), Yannick Lucas (Director Public Affairs Division, Mutualité Française), Miquel Lozano (President of Tesalys).

January 25 – 12:00pm – 1:30pm – Getting medical treatment in France The French Healthcare Association introduces the French healthcare system and treatment opportunities for international patients. A conference led by Cécile David (Writer, analyst and editorial manager, Health & Tech Intelligence – Care Insight), with Guillaume Huart (CEO ORPEA Middle East), Jean Patrick Lajonchère (CEO Saint-Joseph Hospital, Paris), Lambert Montevecchi (CEO Boost Consulting, Expert for the Caen Cancer Center), Jérôme Soistier (CEO C3 Medical), Adrien Rebot (CEO Bealy) and Jean-François Gendron (President of the French Healthcare Association).

MEDICAL INSTITUTIONS

January 25 – 2:30pm – 4:00pm – French innovations for women at risk or affected with female cancer A conference led by Prof. Frédérique Penault-Llorca (nominated by Forbes France as one of the 40 most remarkable women of 2021), with Frédérique Penault-Llorca (Centre Jean Perrin), Eric Lambaudie (Institut Paoli-Calmettes), Alexandra Leary (Gustave Roussy), Jean-Louis Habrand (Centre François Baclesse), Christine Rousset-Jablonski (Centre Léon Bérard), Suzette Delaloge (Gustave Roussy), Dominique Stoppa-Lyonnet (Institut Curie) and Eric Leblanc (Oscar Lambret).

Wednesday, January 26, 2022 January 26 – 10:00am – 11:30am – Diabetes education and prevention: facing rising challenges in the Middle East A conference led by Cécile David (Writer, Analyst and Editorial Manager at Health & Tech Intelligence), with Dr. Fatheya Al Awadi (Head of Endocrine Department Dubai Hospital & President of EDEC), Niven Al-Khoury (General Manager of Sanofi’s General Medicine within Gulf Countries & the Kingdom of Saudi Arabia), Anthony Mallet (General Manager of GCC, Saudi Arabia and Gulf Countries at Servier) and a pitching session of three French companies, with Eric Dessertaine (CEO Biocorp), Arnaud Lambert (CEO AiScreenings), Frédéric Dayan (CEO ExactCure).

January 26 – 12:00pm – 12:45pm – French excellence in pediatric congenital heart disease surgery By Prof. Joy Zoghbi.

January 26 – 1:00pm – 1:45pm – Addressing the cardiometabolism diseases challenge: IHU ICAN Foundation model A conference with Stéphane Commans (Scientific Director, PhD, IHU-ICAN), Stéphane Hatem (CEO of IHU-ICAN) and Stéphane Barritault (MSc, MPH, General Secretary at IHU ICAN Foundation for Innovation in Cardiometabolism and Nutrition).

January 26 – 2:30pm – 4:00pm – Digital health for underserved areas: disruption from the French healthcare ecosystem A conference led by Franck Droin (President of Kaissa & Diagonales Consulting, Specialist in digital health and public care systems), with Simon Chassain (Deputy Director of International Sales, Enovacom, Orange Group), Franck Baudino (CEO of H4D), Robin Ohannessian (CEO of TLM360), Alain Habra (CEO of Quantiq) and Prof. Antoine Tesniere (Full Professor of Intensive Care Medicine, Head of PariSanté Campus).

PLEASE NOTE THAT THE CONFERENCES WILL BE HELD IN THE DUBAI TIME ZONE (GULF STANDARD TIME – GST), IN ENGLISH, AND CAN BE ATTENDED EITHER IN PERSON OR ONLINE.

TO REGISTER, PLEASE VISIT: frenchhealthcare-expo2020dubai.site.digitevent.com FOLLOW FRENCH HEALTHCARE: #FrenchHealthcare Website: www.frenchhealthcare.fr LinkedIn: French Healthcare Twitter: @FrHealthCare_EN YouTube: French Healthcare x Business France

INTERVIEWS

Dr. Ziyad Mahfoud Professor of Research in Population Health Sciences at Weill Cornell Medicine-Qatar (WCM-Q)

“Our courses are designed to equip healthcare professionals in Qatar and beyond with core biostatistical research tools"

r. Ziyad Mahfoud is a Professor of Research in Population Health Sciences at Weill Cornell Medicine-Qatar (WCM-Q). Dr. Mahfoud is an internationally recognized authority in the field of biostatistics and population health sciences, with special expertise in the design of complex studies including clinical trials, and in advanced data analyses.

An experienced researcher and educator, Dr. Mahfoud has a strong record of winning extramural funding and publishing studies in a variety of fields, including patterns of tobacco use, mental health, adolescent health and medical education. He has also created and taught undergraduate, graduate, and Continuing Professional Development courses, for which he has received high praise and numerous awards. Dr. Mahfoud holds a Ph.D. in Statistics (2001) from the University of Florida at Gainesville. He joined WCM-Q in 2010 from the American University in Beirut where he served as an Associate Professor in the Department of Epidemiology and Population Health. Dr. Mahfoud currently delivers several Continuing Professional Development courses on research methods designed to equip healthcare professionals in Qatar and beyond with core biostatistical research tools to enable them to design, execute and interpret the results of their own medical research studies. Dr. Mahfoud spoke with “Hospitals” mag-

JAN.FEB 2022

OUR ULTIMATE GOAL IS TO ENABLE HEALTHCARE PROFESSIONALS TO ORGANIZE, MANAGE AND ANALYZE THEIR DATA, WHICH WILL HELP INCREASE THE RESEARCH OUTPUT IN QATAR AND BEYOND, ULTIMATELY HELPING TO IMPROVE PATIENT CARE AND POPULATION HEALTH.

azine about the success of these courses and how his work is helping Qatar leverage the expertise of healthcare professionals within the country to conduct high-quality research that benefits patients and contributes new scientific knowledge to the world of medicine. The training provided by Dr. Mahfoud and the Division of Continuing Professional Development makes a strong contribution to the mission of WCM-Q to provide excellence in teaching and patient care, as well as supporting Qatar’s aim to establish a thriving biomedical research sector in the country as part of the drive towards a knowledge-based economy.

What was the motivation for the Division of Continuing Professional Development at WCM-Q to create these research methods courses? As a biostatistician, I was inundated with requests for help from healthcare professionals. There is a shortage of biostatisticians in academia, not just in Qatar and the region, but also

INTERVIEWS

in the US, Europe and indeed all over the world. I realized there was a tremendous bottleneck caused by a general lack of training in biostatistics among healthcare professionals of all types which was holding back a great deal of useful research and insight. So, with my colleagues in the Division of Continuing Professional Development (WCM-Q), I began designing a program to address this need. Our ultimate goal is to enable healthcare professionals to organize, manage and analyze their data, which will help increase the research output in Qatar and beyond, ultimately helping to improve patient care and population health.

Please describe the program you created. Our Research Methods Training series of activities is designed to suit all levels, beginning with the basics and building up to more advanced materials and methods, with a strong emphasis on the development of practical skills that will be useful in the real world. It spans from the knowledge and interpretation of statistical results presented in articles, to critical appraisal of such articles and ultimately the design and analysis of studies. The centerpiece of the series is our Certificate in the Analysis of Medical Data, which we launched in 2019. This comprises three workshops: introductory, intermediate and advanced, and featured a combination of didactic lectures and hands-on training with dedicated statistical analysis software using case studies.

What factors influenced the type of training you developed? The idea is that we want actually to enable healthcare professionals to be able to do research; this is not supposed to remain purely theoretical knowledge. Our participants are highly motivated because they already work in the healthcare field and they want to understand how they can serve the profession and their patients with maximum effectiveness. Our participants are

OUR PARTICIPANTS ARE HIGHLY MOTIVATED BECAUSE THEY ALREADY WORK IN THE HEALTHCARE FIELD AND THEY WANT TO UNDERSTAND HOW THEY CAN SERVE THE PROFESSION AND THEIR PATIENTS WITH MAXIMUM EFFECTIVENESS. OUR PARTICIPANTS ARE PHYSICIANS, PHARMACISTS, DENTISTS, NURSES AND OTHER ALLIED HEALTHCARE PROFESSIONALS, SO THEY ARE HIGHLY TRAINED AND KNOWLEDGEABLE IN THEIR FIELDS.

physicians, pharmacists, dentists, nurses and other allied healthcare professionals, so they are highly trained and knowledgeable in their fields. However, during their academic years they don’t get enough training on research methods or data analysis because training is traditionally patient-focused rather than research-focused, for obvious reasons. Our idea was to create a training series, starting from basic principles, where we want them to start understanding biostatistics and data analysis, the output in articles and the vocabulary of biostatistics. So when I tell them something like a P-value or a 95% confidence interval, or the word ‘accuracy’ versus ‘precision’ and what the difference is between them, they understand what I am talking about, and very quickly they become oriented to this new way of thinking about data. Then we can move to more advanced reading, for example, something like survival analysis. This leads us to a point where I can begin to encourage them to design their own study, such as clinical trials.

What is the benefit of healthcare professionals undertaking this training? Especially when the COVID-19 pandemic began, we started seeing a lot of clinical trials being conducted as the healthcare professionals were trying out the new vaccines and new and existing drugs as treatments for the disease. So we saw in an accelerated and intensified way why critical appraisal of clinical trials and an understanding of statistical analysis are so important – it allows healthcare workers to find out very quickly what helps their patients and what doesn’t and to finesse their actions accordingly. For this, we did a two-part webinar on critical appraisal of clinical trials, which is not just about understanding the results, but also interpreting existing research better, answering the question, “Is this a good study?” and, “can I trust these results?”. Regardless of what the results are, to answer the crucial questions of whether the study has utilized a good methodology and done a good job. I think that once you

INTERVIEWS

can criticize somebody’s work you are looking with a lot of detail at the study in totality and can determine how much weight to give to the conclusions, rather than just focusing on a few lines in the results section and attempting to understand the research from that in a fairly basic way. And by becoming able to critically appraise research like this, clinicians develop an understanding of what it takes to build a good research methodology. This allows healthcare professionals, their patients and the healthcare sector as a whole to benefit from the existing body of medical research, and for the professionals to begin to add to it. It’s very powerful to be able to plug into that sort of knowledge.

practitioners ask for – this helps us to keep the training very practical and highly focused.

How do you intend to develop the training you offer in the future?

How do you lead healthcare professionals from a theoretical understanding of the material to conducting their own research? This is quite straightforward. For example, in the workshops of our certificate in the analysis of medical data, I lecture and we do case studies. The participants are given some data, they analyze the data and I give them exercises that they work on with the help of facilitators. After each of the workshops, I send the participants an assessment and they have to pass all three assessments to get the certificate. The idea here is to make sure the participants know what they need to do and that they are able to do it. For that, I give them another dataset and I ask them to tell me what kind of analyses I should do for different research questions. We also use a specialized software platform that is very widely used in the region and all over the world. We are also guided by the feedback we receive from participants. A very common question asked by researchers and participants in our training is how many patients they need to recruit to a study. Study sample size depends on many things such as the study design and the type of outcome used. In response to this demand, we planned and delivered a half-day training on this guided by what the

NOV.DEC 2021

THIS YEAR, WE ARE LAUNCHING TWO MORE TRAINING WORKSHOPS - WE ARE GOING TO DO A HANDS-ON DATA ANALYSIS WORKSHOP USING ANOTHER SOFTWARE PLATFORM, WHICH WAS RECOMMENDED BY PAST PARTICIPANTS AND IS VERY POPULAR IN THE REGION. I’M ALSO PREPARING AN INTRODUCTION TO SCIENTIFIC WRITING. THIS WAS ALSO MOTIVATED BY THE PARTICIPANTS IN OUR OTHER TRAINING.

This year, we are launching two more training workshops - we are going to do a hands-on data analysis workshop using another software platform, which was recommended by past participants and is very popular in the region. I’m also preparing an introduction to scientific writing. This was also motivated by the participants in our other training. Some researchers have data that they have analyzed, but they don’t know how to write a manuscript, what each section should contain, how they can edit it, how they can submit it, how to choose a journal, or what’s the impact of a journal. We also have plans for other things coming up and hopefully what we are doing is ‘filling in the gaps’ for would-be researchers in terms of making them able to plan a project, analyze a project and write it up. One thing we did that was very pleasing was that we sent out a follow-up survey a full two years after running the first certificate program and the main goal was to see the impact on actual scientific output. We asked our former participants if our training had actually helped them draft a paper, submit a paper, and finally to publish a paper. The result was that 70 percent of the former participants said yes, the workshops helped them to draft an original article and 56 percent said yes, it had helped them actually publish an article, and around 86 percent said the workshop improved their ability in a variety of statistical analysis skills and their understanding of the discipline in general. So we are very encouraged moving forwards that our work is having the desired results and we are full of enthusiasm for the future of this project.

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ARTICLE

Al-Ahli Hospital adds high-flow oxygen technique to its services Dr. Mohammad Abd Al-Karim Al-Hashemi, Anesthesia Consultant and Head of Anesthesia Department at Al-Ahli Hospital / Qatar

r. Mohammad Abd Al-Karim Al-Hashemi: It significantly improves the level of oxygen in the blood and decreases the re-breathing of carbon dioxide, which positively benefits the patient comfort and safety.

Dr. Mohammad Abd Al-Karim Al-Hashemi: It can be used in hospital departments, and Al-Ahli Hospital is the only hospital in Qatar that uses this modern technique of anesthesia in the GI endoscopy unit. Al-Ahli Hospital announced the addition of the high-flow oxygen technique to the services it provides to patients. It is used to deliver oxygen in a higher flow and in the desired concentration to the patient during the anesthesia period, within which the amount of oxygen in the blood is usually reduced. This technique is considered one of the modern and promising techniques in anesthesiology. It is characterized by its ability to produce positive air pressure and significantly improve the level of oxygen in the blood. Dr. Mohammad Abd Al-Karim Al-Hashemi, Anesthesia Consultant and Head of Anesthesia Department at the hospital, said that the high flow generates a reservoir of oxygen, decreases the re-breathing of carbon dioxide and increases the rate of ventilation. It also maintains an excellent degree of mucosal hydration and decreases the dryness of the upper airways, which improves patient comfort. He added: "High-flow oxygen therapy also provides patients with non-invasive respiratory support in addition to warm, humid, oxygen-rich air with a high flow rate". Dr. Al- Hashemi emphasized that the use of high-flow oxygen is usually for spontaneously breathing patients who need oxygen at higher flow rates. Treatment with high-flow oxygen also provides respiratory support for patients

JAN.FEB 2022

with acute respiratory failure due to hypoxia. Al-Hashemi added that high-flow oxygen can also prevent post intubation and help to greatly increase the oxygen content in the blood, improve respiratory rate and relieve shortness of breath, which is reflected in patient comfort, in addition to helping patients to recover faster after removing the tube, which leads to improved results and shorter stay in the intensive care unit. He indicated that it is also economically beneficial in reducing the need to use a respirator and it can be used in various hospital departments, pointing out that Al-Ahli Hospital is currently the only hospital in Qatar that uses this device for anesthesia in the GI endoscopy unit, which contributed significantly to reducing the risks of anesthesia on patients, especially those who suffer from obesity and obstruction of the airways. This reflected positively on the safety and level of services provided to our dear guests.

HIGH-FLOW OXYGEN THERAPY ALSO PROVIDES PATIENTS WITH NON-INVASIVE RESPIRATORY SUPPORT IN ADDITION TO WARM, HUMID, OXYGENRICH AIR WITH A HIGH FLOW RATE.

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Al-Ahli Hospital treats pneumomediastinum cases Dr. Mohammad Al-Nazer, Pulmonologist at Al-Ahli Hospital / Qatar

l-Ahli Hospital treats pneumomediastinum cases. It is an abnormal leakage of air or gases into the chest area and it is a rare case in which air leaks from both lungs into the intestines or chest cavity. It may occur as a result of body trauma and affects persons often in the winter, where the patient feels severe pain in the center of the chest, difficulty in breathing, change in the voice and swelling in the lung under the skin, which affects specially the face, neck and chest. Dr. Mohammad Al-Nazer said: "This type of disease is rare and affects some people suddenly without having sufficient awareness of the features of this disease." He added: "It is important to raise awareness among people of the symptoms of this disease, because if it is not diagnosed quickly as needed, it may lead to complications due to the air pressure surrounding the heart, which causes weakness in the functions of the heart muscles in pumping blood to the arteries." He continued, "The best diagnosis to make sure that the patient has a pneumomediastinum case is to conduct chest X-ray or CT." Dr. Al-Nazer explained the case of a 16-yearold child who arrived at Al-Ahli Emergency Department, suffering from sudden severe pain

in the chest while moving his head to the right side during sitting, he has no trauma or injury, as the pain began to increase and move to the center of the chest, which led to difficulty in swallowing and heart rate disturbances. Al-Nazer said: "After conducting all the necessary tests, and a CT scan, it was found that the child had a pneumomediastinum case, and he was treated with high-flow oxygen, which is the effective treatment for this disease, because inhaling high-flow oxygen increases the absorption of air in the cavity until treatment is completed."

IT IS IMPORTANT TO RAISE AWARENESS AMONG PEOPLE OF THE SYMPTOMS OF THIS DISEASE, BECAUSE IF IT IS NOT DIAGNOSED QUICKLY AS NEEDED, IT MAY LEAD TO COMPLICATIONS DUE TO THE AIR PRESSURE SURROUNDING THE HEART.

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Omnicell’s solutions-based approach addresses the Gulf region’s key healthcare challenges

lose partnerships between the healthcare and technology sectors are essential for driving long-term improvements. Omnicell is using its presence at this year’s Arab Health to share its message about closer engagement, which is key to unlocking the specific challenges of each provider. Globally, the key areas which are causing the greatest issues for healthcare providers are patient safety, pressure on costs and lack of resources – the latter issue has particularly risen in prominence as a medical staff have become “burned out” during the pandemic. Through its solutions-based strategy, Omnicell is helping its clients to understand how best to apply technology in order to eliminate errors, minimize waste and drive efficiencies.

JAN.FEB 2022

THROUGH ITS SOLUTIONSBASED STRATEGY, OMNICELL IS HELPING ITS CLIENTS TO UNDERSTAND HOW BEST TO APPLY TECHNOLOGY IN ORDER TO ELIMINATE ERRORS, MINIMIZE WASTE AND DRIVE EFFICIENCIES.

Salim Hammoud, Director of Middle East Sales for Omnicell International, says: “Each healthcare provider is unique, so our partnering approach is based on carefully understanding their pain points, as well as their long-term strategies. This enables the formulation of appropriate solutions, which can be integrated seamlessly within the complex and constantly evolving health system infrastructure. “Connected technology and intelligence-rich solutions help our customers solve the most pressing challenges in medication and supplies management. Omnicell’s hardware, software and service solutions connect to give clients the data they need to make informed decisions and significantly improve quality, efficiency, safety and reduce costs across the entire healthcare setting.”

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In the Gulf region, one of the biggest issues is the fact that around 25% of the total cost of medication goes to waste. This represents a huge opportunity for improvement by swapping manual tasks, such as inventory keeping and re-ordering, for digital automation. Furthermore, digitalization frees up valuable staff time, which can be dedicated instead to patient care.

Solutions-based technologies offer benefits across all aspects of the healthcare environment, including: For the Hospital • • • • •

ptimizing hospital labor productivity O Freeing-up nursing time to spend more time with patients Supporting compliance with regulatory standards Creating streamlined operational efficiency Improving patient outcomes

For Central Pharmacy •

Lowering inventory costs – with

• •

documented inventory reductions of up to 38% Streamlining the medication repackaging process One system that supports distribution for both cart-less and cart-fill models, while giving unprecedented inventory visibility, accuracy and insight.

For Wards •

• •

Closed-loop inventory trail from dispense to restock when used with automated central pharmacy systems 54% reduction in nurse retrieval time 100% reduction in unaccounted floor stock

Salim adds: “By fully automating their pharmacy and supplies operations, healthcare providers can fulfill a vision of zero errors, zero paper and zero waste across their whole care continuum. Our approach is based on supporting clients on every step of their journey, when and where they need it most while offering a market-leading level of interoperability.”

OMNICELL’S PORTFOLIO OF SOLUTIONS INCLUDES: AUTOMATED DISPENSING CABINETS, MEDX AND SUPPLYX SOFTWARE, ROBOTIC DISPENSING SYSTEMS AND VBM MEDICATION ADHERENCE FILLING MACHINE AND WILL BE AVAILABLE AT STAND H4:C10 AT ARAB HEALTH 2022. FOR MORE INFORMATION, PLEASE VISIT OMNICELL.COM

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The head-side element of the split ¾-safety side offers support during mobilisation

Evario one The economical hospital bed for global use

odern hospital beds help to overcome many challenges. In times of staff shortage, they have to reduce workload and physical stress. In the fight against nosocomial infections, good hygiene properties are a strong asset. And in view of the many cost-cutting pressures, economical operation of the beds with little maintenance is a great relief. Stiegelmeyer, the leading German manufacturer of medical beds, has used its innovative strength and over 120 years of experience to design a new bed for all these requirements. Its name is Evario one.

JAN.FEB 2022

ALL DESIGN FEATURES HAVE BEEN TESTED FAR BEYOND STANDARDS FOR HIGH DURABILITY.

The Evario one is characterized by a large selection of individual features, making it suitable for use on different wards and the demands of international markets.

Choice of two safety sides An attractive feature of the bed is the choice between two new safety side systems. The split ¾-safety side supports early mobilization of patients. Lowering its foot-side element creates sufficient space to leave the bed. The short head-side element is ideal as a stand-up

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aid. The nurse can easily operate this safety side with one hand. The second system, the pivoting ¾-safety side, is a good choice for smaller rooms. It swings down quietly without taking up additional space along the bedside. Its slender bars offer an unobstructed view into the room and do not hide attached accessories when lowered. If a patient needs maximum protection, an optional infill piece closes the space at the foot end of both safety sides. It can be inserted without tools. Even without the use of safety sides, the Evario one supports fall prevention. With its large height adjustment range from 36 to 82 cm, it reduces the risk of fall injuries in the lowest position. At the same time, nurses can work in the maximum position in an upright posture that is easy on the back. Back pain is one of the main causes of sick leave in hospitals. The Evario one helps to solve this problem.

Operation with handset or panel The staff is also relieved by the bed’s customized operating concepts. An intuitive handset is available for all equipment variants. With the help of an unlocking magnet, the nurse can also activate the CPR and Trendelenburg functions directly at the handset. If things need to go even faster, the Evario one can be brought instantly into the CPR position with a mechanical lever under the head section. If the bed is equipped with the split ¾-safety side, integrated control panels can also be selected on both sides of the bed. The practical "control panel light" was developed especially for the Evario one. Facing inside, it offers comfortable adjustment options for the patient. The outside combines important functions for nurses and technicians. The control panels are always in an ideal position close to the head end, so that the nurse does not have to take their eyes off the patient even in hectic situations. If they have their hands full, they can also adjust the height of the mattress base with a footswitch. The Evario one was developed in Germany and fully lives up to the good reputation of German engineering. All design features have been

The optimum working height can be set smoothly with the available control elements, e.g. the handset tested far beyond standards for high durability. The low maintenance requirements increase the economic efficiency of the bed. Likewise, its planar design with little niches reduces the effort required for manual reprocessing and still ensures optimal hygiene. In the fight against hospital germs, the Evario one is a strong ally. Discover the Evario one – a bed for worldwide use that was also created for your very individual requirements.

Optional supply brackets and practical handle bars enable modern patient care from all sides

MEDICAL INSTITUTIONS

A HAPPY BREAK-UP! 3-dimensional dummy, 27-hour surgery, multidisciplinary medical team and an army of healthcare professionals!

resenting from Cameroon when they were 9 months old, the conjoined twins, Elizabeth and Mary, were discharged after they got healthy again following 7-month treatment in Turkey! Being born in July of last year in Cameroon, the Siamese twins Elizabeth and Mary were joined at the hip. They had shared numerous

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aspects of the body system along with physical body parts. Ranging from the spinal cord and a part of the spine to the urinary tract, digestive tract, urogenital systems and neurovascular structure… Following a tremendously comprehensive search, the conjoined twins were brought to Acıbadem Altunizade Hospital from Cameroon when they were 9 months old. Physicians of numerous departments, an army of

FEELING GRATEFUL THAT THEIR BABIES WERE ALIVE, THE YOUNG PARENTS WERE STILL STANDING STURDY.

MEDICAL INSTITUTIONS

healthcare professionals, numerous diagnoses made in 7 months and finally the surgery and postoperative treatment; now, these cute twins are living as two physically independent babies. The separation surgery that lasted for 27 hours was successful. Now, they are 16 months old and they are happy to have their own bodies before they are discharged. Caroline and Richard Akwe, a couple married for 3 years living in Cameroon, were unbelievably eager to hug their twins. Caroline Akwe, 26, had pregnancy supervision visits regularly and everything was seemingly alright. When the calendar hit July 6th, 2020, the twins were given birth with Caesarean section on term, but with a much unexpected surprise! Twins were joined at their hips!... When the mother completely recovered from anesthesia, nurses were not pretty willing to meet the twins with their mother. They were experiencing hard times to answer the mother’s questions where words fail, only their eyes could not be hiding how confused they were. Feeling grateful that their babies were alive, the young parents were still standing sturdy.

I had difficulty in breastfeeding as they were conjoined 28-year-old father Richard Akwe says “Believing that they were getting hurt, as they could not be moving comfortable, we were terribly up-

set. Besides, we were feeling very sorry for their cry while my wife was trying to nurse them one by one when they were hungry, but they were our gifts and we, therefore, devoted ourselves for their best care”, while the mom Caroline Akwe adds “I nursed my conjoined babies for one year despite all challenges. We had never given up our hope that they would be separated in a healthy manner. And our dream has come true through extraordinary efforts and success of Turkish doctors”.

Twins bite off more than they can chew! Cameroon was lacking the medical and technical means to separate the twins. While the Akwes were struggling with many challenges, the father, Richard Akwe, on top of it, was locked out in Covid-19 pandemic that had deeply influenced Cameroon, as is the case with the whole world. However, a hope had come out of the blue sky; Cameroon Presidency Office had undertaken treatment of the conjoined twins. Doctors of Acıbadem Hospital were contacted. All plans were made and cute Siamese twins were brought to Acıbadem Altunizade Hospital on March 30th, 2021 before the matchless surgery process has started.

DOCTORS OF ACIBADEM HOSPITAL WERE CONTACTED. ALL PLANS WERE MADE AND CUTE SIAMESE TWINS WERE BROUGHT TO ACIBADEM ALTUNIZADE HOSPITAL ON MARCH 30TH, 2021 BEFORE THE MATCHLESS SURGERY PROCESS HAS STARTED.

Mobilization was ordered! Physicians of numerous departments,

MEDICAL INSTITUTIONS

ranging from urology and intensive care unit to radiology, physical medicine and rehabilitation and cardiovascular surgery, and an army of healthcare professionals have campaigned under supervision of Professor of Pediatric Surgery Burak Tander, Professor of Pediatric Neurosurgery Memet Özek, Professor of Aesthetic, Plastic and Reconstructive Surgery Hakan Ağır, Associate Professor of Anesthesiology Serpil Ustalar and Professor of Pediatric Intensive Care Agop Çıtak – all from Acıbadem Altunizade Hospital – to separate the conjoined twins. The multidisciplinary treatment has lasted for 7 months.

Each detail is clarified on 3-dimensional dummies! The aim was to help both babies hold on to life. Three-dimensional dummies of the twins were created through preoperative radiological and angiographic examinations to help both of them gain their own bodies and to minimize the risk. Because the babies had both personal and joint complex problems. The three-dimensional dummy of the conjoined twins preoperatively created by Bio-design Center of Acıbadem University had made significant contribution to the success of the surgery, as physicians examined the dummy for numerous days.

Left the operating theater with their own bodies following 27-hour surgery! The twins had opened eyes to the morning of a very big and critical day, when the calendar

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hit August 12th, 2021. They were placed on the surgical table to separate their fused bodies. Starting at 08:00 a.m., the surgery has lasted for 27 hours. After such a critical surgery was successfully completed, Elizabeth and Mary were, for the first time in their life, lying on different beds at the intensive care unit on August 13th, 2021. They woke up into a totally new life! They had a conjoined 1st year birthday, but they were reborn when they were 13 months old! Since they were fused at their hips, they had never seen the face of each other. It was not a surprise to see them how confused with their separated bodies, but they gradually started enjoying the comfort of having an own body; their happiness

SINCE ELIZABETH AND MARY HAD BEEN CONJOINED FOR 13 MONTHS, THEY WERE CONSTANTLY CRYING WHILE LOOKING FOR EACH OTHER.

MEDICAL INSTITUTIONS

was reflected by their shiny eyes and kittlish body language, as they need some time to express verbally what they actually feel.

They looked for each other after being separated Falling short of words to express the happiness they felt when they say their babies separated following a long and critical surgery and stating that they felt like at home in Acıbadem Altunizade Hospital, where they found the remedy they were desperately seeking for, the Akwes say “Seeing them move freely in their beds in their own rooms, we were sitting on the top of the world. Since Elizabeth and Mary had been conjoined for 13 months, they were constantly crying while looking for each other. Following their stay at the intensive care unit, Elizabeth has constantly kept her tiny hands on Mary till the morning of the evening that she has re-united Mary for the first time. We owe this unbelievable happiness to the confidence instilled by physicians, nurses, management and all other personnel, who were extremely proficient, and their warm behaviors that had also boosted our mood. Words actually fail to express our happiness. Many citizens are waiting impatiently to hear from and see us in our home country and it is exceptionally pleasing to fly back with a happy ending into a new and a healthy beginning.”

surgical procedures that are related to our specialty. Even positioning the patient on the surgical table is a detail. Here, we have two fused children and the ideal position of one child is the one that complicates surgery of the other one very substantially! Due to the fusion, we had performed the surgery in a very extraordinary position, may be for the first time in our life, because you cannot position the conjoined twins on the surgical table as you wish and even this fact makes the surgery very distinctive and complex. We are so happy to perform this surgery successfully. But it is also important not to ignore efforts of pediatric physiotherapy team. The team visited them three times a day and thus, these children are recovered regarding movement and gait”, while Professor of Pediatric Surgery Burak Tander adds: “The spinal cord, urinary tracts, rectum and some blood vessels were shared. The rectum was opening to a joint anus. The muscle complex that was regulating the defecation was also conjoined and it was one of the most significant challenges. Colostomy was performed to divide it into two parts. One of the twins did not have a vagina, while other’s vagina was also problematic. A pouch was created during the surgery to construct a vagina in the future. None of them

THE THREEDIMENSIONAL DUMMY OF THE CONJOINED TWINS PREOPERATIVELY CREATED BY BIODESIGN CENTER OF ACIBADEM UNIVERSITY HAD MADE SIGNIFICANT CONTRIBUTION TO THE SUCCESS OF THE SURGERY, AS PHYSICIANS EXAMINED THE DUMMY FOR NUMEROUS DAYS.

What did they do? How did they feel? The road to this ‘most lovely separation’ was paved by rigorous and careful efforts of numerous physicians from many departments, ranging from pediatric neurosurgery to plastic surgery, pediatric surgery, radiology, urology, anesthesiology, cardiovascular surgery and intensive care team, and a gigantic army of healthcare professionals. Professor of Pediatric Neurosurgery Memet Özek says “We, the neurosurgery team, started the separation surgery. Since they shared the spinal cord, myelomeningocele, spinal membranes and sacrococcygeal bone, we separated such structures and thus, completed the

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had any uterus or it was extremely underdeveloped. Their digestive and urinary systems, genital system and neurovascular systems were joined. All members of the team reviewed the three-dimensional dummy, which was ordered to perform a flawless separation surgery. Mary was the first to leave the operating theater followed by Elizabeth. It was an incredibly emotional moment for the team, when they saw each other for the first time.” Professor of Aesthetic, Plastic and Reconstructive Surgery Hakan Ağır “We carried out procedures to liberate skin, subcutaneous tissues and muscles before the separation surgery of the conjoined twins. We placed tissue expanders in the first phase of the separation surgery at body parts, where the conjoined twins would be separated. It was a preparatory process and the first phase. In the second phase, we had undertaken the role of closing the areas operated on by pediatric surgery and pediatric neurosurgery teams. We also acted as a team to overcome postoperative wound healing problems with general intensive care and infectious diseases teams and with a maximized the nursing care”. Associate Professor of Anesthesiology Serpil Ustalar Özgen adds: “Our role, as the anesthesiology team, was to have these babies sleep safely throughout the surgery to help our surgeons work comfortable and to recover them again safely. We prepared all equipment in two colors to avoid confusion between two babies before we started the surgery; the team was divided into the ‘Elizabeth team’ and the ‘Mary team’. In fact, 27 hours have elapsed somewhat within an hour for us, because everybody has used all technological means, proceeded very professionally and strongly focused on its role. The babies are, now, very well and they are growing very quickly. I am so happy to be a member of the team that has successfully separated them; it is priceless to see the babies so healthy in their own bodies and singing songs and dancing on their own way.”

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Professor of Pediatric Intensive Care Agop Çıtak summarized the intensive care period as follows: “The surgical separation of the twins is a long, complicated and challenging work. This aspect of the surgery dictated adaptation of postoperative care, monitoring and treatment of the babies at the pediatric intensive care unit accordingly. Potential problems were predicted in advance and all preparations were based on such estimations, including rooms, beds, the nurses who would take care of them, medications, blood products and devices. When they were postoperatively admitted to the intensive care unit, all vital signs of twins were closely monitored. A long surgery may pose a risk of infection and we, therefore, focused our attention very strictly on infection. We had maintained proper communication with the surgical team. They were recovered from sedation and weaned from the respiratory device, as there was no problem in their vital signs. After the twins were monitored at pediatric intensive care unit for further couple of days, they were discharged to their room at the inpatient clinic."

THE SURGICAL SEPARATION OF THE TWINS IS A LONG, COMPLICATED AND CHALLENGING WORK. THIS ASPECT OF THE SURGERY DICTATED ADAPTATION OF POSTOPERATIVE CARE, MONITORING AND TREATMENT OF THE BABIES AT THE PEDIATRIC INTENSIVE CARE UNIT ACCORDINGLY.

INTERVIEW

NITROCARE

Innovation is our secret recipe

Göksel ARAS, CEO

ITROCARE is a member of Gökler Group specialized in hospital furniture and medical equipment. It has proved its unique designs to the world by developing its quality and flexible production. "Hospitals" magazine recently interviewed Göksel ARAS CEO "NITROCARE" and Gökhan ARAS Board Member "NITROCARE" to highlight the company and its future plans.

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Gökhan ARAS, Board Member

Would you please brief us about NITROCARE? When was it established? What is your mission? NITROCARE was established in 2009 as a member of Gökler Group specialized in hospital furniture and medical equipment, it has then spread to the world. NITROCARE supported by the power and history of Gökler Group

ALL DESIGN FEATURES HAVE BEEN TESTED FAR BEYOND STANDARDS FOR HIGH DURABILITY.

INTERVIEW

has quickly become a leader company in the domestic market. At the same time, it is considered today one of the most important players in the international market. NITROCARE, which serves with the principle of ‘The assurance of success and sustainability in production is honesty and quality in the service’, sustains its progress emphatically in being a world-brand as the ascending value of Anatolia.

What are the medical equipment and hospital furniture that you produce? Gökler Group produces both medical and non-medical furniture that all kinds of businesses such as the health sector, hospitals, clinics consider as turnkey solutions. NITROCARE is specialized in the medical sector with many award-winning products. Nitrocare managed to rank among the leading producers in the sector, by increasing its production capacity day by day with its high technology machine park at 80.000 SQM indoor areas.

What is the difference and specifications of your products? Innovation is our secret recipe. Our international team of designers works closely with caregivers from all around the world to design and enhance products for the safety and comfort of the patients. NITROCARE has proved its unique designs to the world by developing its quality and flexible production skills with its expert designers, and it won ‘RED DOT DESIGN AWARD, GOOD INDUSTRIAL DESIGN, GOOD DESIGN AWARD, GERMAN DESIGN AWARD, IF DESIGN AWARD INTERNATIONAL DESIGN AWARD and PRODUCT DESIGN AWARD’ international design awards. It will continue its nomination in worldwide awards with its new products. Fixed principles of the firm have been quality products, systematic working, qualified service, delivery in time and affordable prices. It has proved to its customers that it values the

quality product with its quality certificates and it received recompense with its exports to more than 104 countries, international design awards that it received and with its place among Turkey’s fastest-growing 100 companies.

Where do we find NITROCARE products? In which countries and which hospitals? Currently, we export NITROCARE products to more than 104 countries around the world. Our network of partners is in daily contact with Hospitals and Clinics to offer, install and maintain NITROCARE products. Recently, we started our regional office in Dubai to cover and support our partners and customers in the Middle East and Africa region by a team of sales & service managers.

WE EXPORT NITROCARE PRODUCTS TO MORE THAN 104 COUNTRIES AROUND THE WORLD.

What about your future plans? Our aim is to deliver NITROCARE quality products to every hospital and clinic around the world and ensure that we can use our innovation and technology to help patients and caregivers. NITROCARE proceeds to the future with firm steps with its dynamic working team, its product range increasing day by day and its developing machine park. NITROCARE will keep making innovations, working non-stop and will reach new objectives, succeed with new successes with its distinction and quality. So ‘Nitrocare Signature’ is a prestige and this signature brings excellence to life.

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TCI can be used in combination with other bolus drugs and also with inhalational anaesthesia

TCI Anesthesia: New and More Universal Models Natalie Samuda. RM, BSc. Becton Dickinson. Senior Clinical Resource Consultant. Medication Management Solutions. MENAT. James Waterson. RN, M.Med.Ed. MHE. Becton Dickinson. Medical Affairs Manager, Middle East & Africa. An Evolving Science Total intravenous anesthesia (TIVA) has been a viable technique since the synthesis of the first intravenous anesthetics. From the introduction of barbiturates in 1921 and Thiopental in 1934, TIVA has continued to develop. Research in the area really took off however after the launch of the fast-acting hypnotic Propofol by Astra Zeneca in 1977. It is important to define clearly between TIVA and Target-Controlled Infusion (TCI). TIVA means nothing more than anesthesia is being provided to the patient solely via the IV route

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and that no gas agents are being delivered. The technique known as IVA is a combination of IV drugs and inhalation anesthesia. TCI was part revolution and part evolution. The first pharmacokinetic (PK) model for the use of TCI was described by Schwilden in 19811 but research had been in undertaken from 1968 onwards. Essentially TCI refers to maintaining the desired plasma or effect site concentration of a drug using an infusion pump managed by a computer, and PK and pharmacodynamic (PD) models. The drug models and the clinical trials that develop them are vital components of the

TIVA MEANS NOTHING MORE THAN ANESTHESIA IS BEING PROVIDED TO THE PATIENT SOLELY VIA THE IV ROUTE AND THAT NO GAS AGENTS ARE BEING DELIVERED.

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TCI technique, and advances in pump technology have made the technique a common anesthesia technique for the practitioner and have taken it far beyond being just a research tool for specialists. In simple terms, instead of setting a rate (ml/h) rate or a dose rate (µg or mg/kg/h) on the pump, the pump is programmed to target a required plasma concentration or effect-site concentration. A TCI pump automatically calculates how much drug is needed as induction and maintenance to maintain the desired effect-site or plasma concentration.

The Theory of TCI In TCI, drugs are delivered to achieve specific predicted target blood or effect site drug concentrations. TCI gives us a standardised infusion system for the administration of hypnotic (Propofol) and analgesic drugs. But how were these blood/effect drug concentrations and pharmacokinetic/pharmacodynamics parameters derived, and how are the models for plasma and effect-site concentrations incorporated into the pump which will control induction and subsequent rate of delivery? In simple terms a TCI algorithm (the ‘target’ and plan on which the pump relies to deliver appropriate induction and maintenance rates to maintain anesthesia without overdosing the patient) is based on four processes that occur following injection of any intravenous drug into the body: • Absorption. • Distribution. • Metabolism. • Excretion. All of the above are commonly, but not always, affected by weight, and of course renal and hepatic health will affect metabolism and elimination. The differences between adults and children in terms of the three processes will be looked at later with a brief review of the specific pediatric TCI models that are currently available. PK models are derived from pharmacokinetic studies involving heterogeneous volunteers from across a wide spectrum of physiological variables- height, weight, age, and gender. Blood draws are correlated against the clinical

endpoint of ‘awareness’ or depth of anesthesia assessed through EEG monitoring or Bispectral Index (BIS) monitors (See Figure 1) and clinical inference using standard observation tools such as the Modified Observer’s Assessment of Alertness/ Sedation Scale (MOAA/S) (See Figure 2)

Figure 1: BIS Scores versus clinical state. BIS Score. 0 20 40 60 80 100

Clinical State. Flat Line EEG. Burst Suppression. Deep Hypnotic Sleep. General Anesthesia. Light Moderate Sedation. Awake

Figure 2: The Modified Observer’s Assessment of Alertness/ Sedation Scale (MOAA/S). Responsiveness Agitated 6 Responds readily to name spoken in normal tone. (‘Alert’) 5 Lethargic response to name spoken in normal tone. 4 Responds only after name is called loudly and/or repeatedly. 3 Responds only after mild prodding or shaking. 2 Does not respond to mild prodding or shaking. 1 Does not respond to deep stimulus. 0 Examples of common PK study results for Propofol and Remifentanil are: In an un-premedicated patient, the effect-site concentration of Propofol required to produce loss of consciousness is about 3 to 6 µg/ ml, depending on the patients’ demographics. Volunteers waking from anesthesia generally have a blood concentration of around 1- 2 µg/ ml, though this is dependent on other drugs given during anesthesia. Adequate analgesia with Remifentanil is achieved with 3-6ng/ml. A Remifentanil infusion of 0.25-0.5 µg/kg/min in an ‘average’ man- 70kg, 170cm, 40 years old- produces a blood concentration of around 6ng/ml after 25 minutes. Although various models for propofol were published before, Astra Zeneca decided to implement the pharmacokinetic-dynamic model published by Marsh et al. in their Diprifusor2. This

PK MODELS ARE DERIVED FROM PHARMACOKINETIC STUDIES INVOLVING HETEROGENEOUS VOLUNTEERS FROM ACROSS A WIDE SPECTRUM OF PHYSIOLOGICAL VARIABLES- HEIGHT, WEIGHT, AGE, AND GENDER. BLOOD DRAWS ARE CORRELATED AGAINST THE CLINICAL ENDPOINT OF ‘AWARENESS’ OR DEPTH OF ANESTHESIA ASSESSED THROUGH EEG MONITORING OR BISPECTRAL INDEX (BIS) MONITORS (SEE FIGURE 1) AND CLINICAL INFERENCE USING STANDARD OBSERVATION TOOLS SUCH AS THE MODIFIED OBSERVER’S ASSESSMENT OF ALERTNESS/ SEDATION SCALE (MOAA/S) (SEE FIGURE 2).

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Ideally a PK pump should have a large, clear display with minimal ‘shuffling’ between screens to show all infusion data

‘classic’ study is an ideal example to show how a mathematical-pharmacokinetic model is derived from volunteer trials. The Marsh study and model uses a three-compartment model. ‘Compartments’ relate to theoretical body ‘spaces’ in which a drug will be distributed following injection. Conventionally the body compartment that the drug is injected into is V1 or Vc (plasma/blood), the next compartment is the ‘vessel-rich’ or ‘fast re-distribution’ compartment and is characterized as V2 (heart, liver etc.). The final compartment, which is anatomically ‘vessel-poor’ and ‘slow’ in terms of re-distribution, is V3.(fatty tissue) Once a steady state of drug distribution has occurred V1+V2+V3=Vdss where Vdss is the steady-state volume of distribution of the drug. Of course drug distribution and the metabolism/elimination of each drug in each compartment also need to be modelled. By convention the rate of elimination of a drug is K10, whilst the movement/distribution between compartments is denoted by K12 (V1 to V2), K21 (V2 to V1), K13 (V1 to V3) and K31 (V3 to V1). If one wants to describe the hysteresis between the time course of plasma concentration and clinical effect, the pharmacokinetic model must be enlarged with a pharmacodynamic part. The link between the plasma and the effect-site is

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done by using the time constant ke0. The above provides only a brief overview but assists us when we are reviewing the literature pertaining to the original TCI models, developments built on the original ‘classics’ and papers that address the future potential and current limitations of the technique. Computer simulations and mathematical modelling of infusion schemes based on the above theories of compartments and clearances give us our models for both Target Plasma Concentration (Cpt) and Target Effect Concentration (Cet) and these can be incorporated into specialist computerised infusion pumps.

The TCI ‘Classics’ and current developments The pharmacokinetic model most anesthetists may be familiar with is the Marsh model for Propofol 1% and 2%. The model requires age and weight to be programmed in the pump, but does not, in fact, incorporate age into its calculation. The Schnider model is an alternative model for Propofol 1% and 2% and has advantages in elderly patients as it is based on a lean body mass (LBM) calculation for each patient derived from patient height, and total body weight. The pump calculates doses and infusion rates ac-

PHARMACOKINETIC MODEL MOST ANESTHETISTS MAY BE FAMILIAR WITH IS THE MARSH MODEL FOR PROPOFOL 1% AND 2%. THE MODEL REQUIRES AGE AND WEIGHT TO BE PROGRAMMED IN THE PUMP, BUT DOES NOT, IN FACT, INCORPORATE AGE INTO ITS CALCULATION.

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cording to the LBM. It also uses age, height, and gender as factors in addition to weight. Elderly patients, with their lower LBM, therefore receive a lower induction and maintenance dose to maintain a constant plasma concentration. It has been shown that when used in combination with the TCI Remifentanil Minto model a lower effect site concentration is required to induce loss of consciousness.3 One major difference between the Marsh model and the Schnider4,5 model is the assumed size of the V1 compartment. For a 70 kg patient the Marsh model calculates V1 as 15.9 L whereas the corresponding value for Schnider model is 4.27 L. Because of this the estimated concentrations following a bolus or rapid infusions vary greatly. When Propofol administration is stopped, large differences in the estimated concentrations are again found, with the Schnider model estimating a much more rapid fall in concentration than the Marsh model. Up to now the most commonly used pharmacokinetic model for Remifentanil is the Minto model6, a three-compartment model that uses age, height, gender and weight, and determines LBM for its calculations. Remifentanil is an ultra-short acting opioid (Half-life of 3 minutes) and this allows prolonged infusions without drug accumulation. The Alfentanil Maitre model is a weight, age and gender adjusted three-compartment model.7 Interaction studies between this model and Propofol8 have shown that a plasma level of 500µg/ml of Alfentanil corresponds with a much reduced Propofol plasma level being required to ensure loss of consciousness. Knowledge of interactions such as this is vital for optimising the day-today use of TCI. The Gepts-Sufentanil9 model is commonly used in cardiac surgery and has been found to be accurate even in obese patients.10 Bariatric patients, and their response to opioids and sedatives, is an area of ongoing work in TCI. Until now separate models have been required for pediatric patients as there are distinct physiological differences between children and adults and this affects the PK of both sedatives and analgesics. A pediatric patient’s V1 is proportionally far larger than that of an adult. This then requires a far higher induction dose per kg body weight. Furthermore, due to higher

heart rates, higher organ perfusion and higher metabolism children have a higher cardiac index, drugs therefore move far faster into V2 from V1. A higher maintenance dose per kg body weight is also therefore required, particularly in the age 1-2 years group. The decrement time in children can also be expected to be longer because drugs accumulate in other body compartments other than in the plasma to a greater degree than in adults. In this respect the ‘context sensitive half-life’ of a drug becomes very significant, this is the relationship between the half-life of a drug and the length of time of infusion. In simple terms the longer a drug runs for, the longer the half-life and the longer the decrement time. Children less than 1 year old differ significantly from older children in terms of their metabolic pathways, and their ability to eliminate drugs is markedly inferior. Although special models for neonates have been published, these have not been implemented into TCI.11,12 The Propofol-Paedfusor Model13,14 can be used for children over the age of 1, and with a body weight of greater than 5 kg. Initially, low plasma targets are recommended at the outset of anesthesia with increases then being made according to the patient MOOA/S response. The Propofol (1% and 2%) three-compartment Kataria model15 has been used for children from age 3-11 years and 15 kg upwards. It uses plasma targeting and no effect site data is available at present. As with all pediatric TCI models experience and expertise in the specifics of pediatric anesthesia is required of the practitioner.

THE ALFENTANIL MAITRE MODEL IS A WEIGHT, AGE AND GENDER ADJUSTED THREECOMPARTMENT MODEL.7 INTERACTION STUDIES BETWEEN THIS MODEL AND PROPOFOL8 HAVE SHOWN THAT A PLASMA LEVEL OF 500ΜG/ML OF ALFENTANIL CORRESPONDS WITH A MUCH REDUCED PROPOFOL PLASMA LEVEL BEING REQUIRED TO ENSURE LOSS OF CONSCIOUSNESS. KNOWLEDGE OF INTERACTIONS SUCH AS THIS IS VITAL FOR OPTIMISING THE DAY-TODAY USE OF TCI.

What is new? The Eleveld model for both Propofol and Remifentanil is essentially a mathematical ‘synthesis’ of the data from multiple previous studies and model builds. It also has the added feature of adjusting the expected patient response to Propofol in the presence of Remifentanil. The key advantage of this model is that it is near universal and simplifies and streamlines the number of different models in use by the anesthesia department- this makes for better risk management and makes training more focussed. In a recent study16 the model showed a better median prediction of actual measured propofol plasma concentration than could be achieved with the

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Marsh or Schnider models. The Eleveld model captures patients from age 5 days to 85 years old and with weights between 2.5 kg and 106 kg. The Kim-Obara-Egan Remifentanil model was developed in 2017 and has been used in patients with age and weight ranges of 20-85 years and 45-215 kg. Clinically, it acts in a similar manner to the Minto model.17 The Hannivort-Colin Dexmetomidine Model is a very interesting development for a medication that is growing in its use and application across critical care. The model has Cpt values and the MOAA/S scale is used rather than BIS, along with clinical assessment of the patient to guide therapy. Achieving steady state anesthesia takes a comparatively long time of 10 minutes, and a Cpt of about 1.5 ng/ml would be expected to result in light sedation. The model has not however been tested on pediatrics or bariatric patients but there is ongoing work to bring a Cet model and assessment by BIS into clinical usage.18

ly decreasing infusions to match drug removed from central compartment to other peripheral compartments of distribution. The pump will also predict a decrement time- this is the time that it takes for the pump’s plasma/effect site predictions to go from the current level to the decrement concentration level. This of course is also a dynamic value and is constantly recalculated by the pump as the length of anesthesia and any changes to target concentrations are changed.

Key features of an ideal TCI infusion system or pump are: •

•

Delivering TCI: Pump Attributes. A TCI pump consists of a user-interface to enter patient details and target plasma or effect-site concentration, a software package with pharmacokinetic/pharmacodynamic models to control the infusion rate and hardware to accurately deliver the infusion. The patient’s expected drug concentration is continuously calculated by the pump, and pump infusion rates are almost continuously adjusted, typically at 10-second intervals. The anesthetist selects the model and concentration of drug to be used. They then program the desired target Cpt or Cet concentrations, and input patient data: weight, age, gender and height (depending on the model). The anesthetist may lengthen the induction time for patients who have a fragile cardiovascular status, or start at lower concentrations and slowly induce. TCI pumps are of course delivering one infusion at a constantly altering rate (in fact they decrease the rate slightly every 8 seconds). But it can be useful to think of this one infusion as being a mean-average comprised of three continually calculated infusion rates: a constant rate to replace drug elimination and two exponential-

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A large, clear display that is easy to navigate during the many critical phases of anesthesia and easily viewed from a distance when multiple devices surround the patient during surgery. Critical information such as decrement time, current Cet or Cpt and respective targets, current dose rate and concentration and type of agent being infused can be displayed at the same time on one screen. Patient parameters used during the setting-up of infusions appear on one screen to avoid the need for shuttling through multiple screens to check vital information. An option for using pediatric TCI models. The ability to edit and customise the programs used. For example to allow for the most commonly used drugs to be at the head of every loaded formulary, to have dedicated profiles for individual anesthetists and to be able to load research agents or new medications into the pump’s drug library. The ability to set default values and safety limits for the parameters that TCI commonly require to be loaded in order to calculate induction and maintenance doses. For example if adult patients are being anesthetised it is ideal if the weight default is set at 75 kg, age to 50 years and height at 180 cm. This saves a great deal of time for the anesthetist in a busy Operating Theatre.

A TCI PUMP CONSISTS OF A USER-INTERFACE TO ENTER PATIENT DETAILS AND TARGET PLASMA OR EFFECTSITE CONCENTRATION, A SOFTWARE PACKAGE WITH PHARMACOKINETIC / PHARMACODYNAMIC MODELS TO CONTROL THE INFUSION RATE AND HARDWARE TO ACCURATELY DELIVER THE INFUSION. THE PATIENT’S EXPECTED DRUG CONCENTRATION IS CONTINUOUSLY CALCULATED BY THE PUMP, AND PUMP INFUSION RATES ARE ALMOST CONTINUOUSLY ADJUSTED, TYPICALLY AT 10-SECOND INTERVALS.

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An Induction Time adjustable from seconds to minutes to allow for a gentle induction for patients with cardiovascular conditions or established hypotension. An ability to automatically pause after induction to allow for assessment of the patient. A capacity for a wide range of Dose and Rate units including nanogram dosing, particularly when using the TIVA mode of the pump. A capacity for setting default dose rates, patient weight, height and age to match the common patient population that the individual anesthetist works with. The capacity to have multiple ‘profiles’ loaded on one pump to allow for tailoring of the drugs and models for individual anesthetists’ needs and for specialist patient / procedure requirements.

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The ability to use a Predictive TIVA mode. Predictive TIVA can be used with drugs that have an associated TCI model, but the mode allows the user to select infusion rates and to administer bolus doses as required. The PK model is used to estimate the plasma and effect site concentration and to calculate the decrement time. An ideal TCI Pump will show a graphical representation of the ‘background’ TCI model and current patient Cet or Cpt.

Practicalities and Practical Concerns. TIVA and TCI allow full anesthesia to take place with just two TCI pumps. The most common combination being a Propofol model and Remifentanil model. Specialist lines should be used with integrated anti-syphon valves (to prevent accidental infusion/injection during syringe

TIVA AND TCI ALLOW FULL ANESTHESIA TO TAKE PLACE WITH JUST TWO TCI PUMPS. THE MOST COMMON COMBINATION BEING A PROPOFOL MODEL AND REMIFENTANIL MODEL.

TIVA and TCI requires two pumps- one for the hypnotic infusion and one for analgesia

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changeover) and back-check valves to ensure infusions are delivered to the patient during high rate induction without back-flow occurring in other lines. These lines should also include a back-check valve protected access port for IV fluids or other replacement. (See Images II and III) Interaction does occur between TCI modelled drugs. For example Propofol and Remifentanil have been reported to show a 41% decrease in volume of distribution when used together (See the note above on the Schnider and Eleveld model). Users should consider reducing effect– site or plasma targets where interactions are known to exist or in patients with known health concerns. Of course, patient pharmacokinetics and pharmacodynamics vary with age, cardiac output, co-existing disease, concurrent drug administration, body temperature as well as the weight of the patient. These factors play an important role in choosing target concentrations and induction rates.19 Whilst all TCI models have default plasma or effect targets the anesthetist must assess the likely needs of his patient. To this end there has been a drive towards harnessing TCI to continuous Bispectral Index monitoring for all patients.20,21 Training systems that utilise simulation have been available since the late 1990s.22 They are useful in that they can allow trainees to simulate specific patient responses to differing doses and also to situations such as large-scale patient bleeding during anesthesia. Extensive patient bleeding requires swift interventions during TCI- specifically the reduction of targets for sedatives as their plasma concentrations will increase with dropping blood volume, thereby increasing the depth of anesthesia and potentially causing further hypotension to the detriment of the patient’s circulation and oxygenation. This can act as a ‘vicious cycle’ as this reduction in oxygenation causes further accumulation of the sedative agent in the patient’s compartments. TCI systems have not been extensively studied in terms of their impact on patient comfort, time to discharge home, and reduction in post-operative side-effects such as nausea but the advantages of ‘gas-free’ anesthesia appear obvious and TCI, with its emphasis on evi-

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dence-based care and management and its new models seems primed to change our approach to the management of patients receiving sedatives and analgesic agents. References. 1. Schwilden H. A general method for calculating the dosage scheme in linear pharmacokinetics. Eur J Clin Pharmacol 1981; 20:279-289. 2. Marsh et al.: Brit J Anesth 1991, 67, 41-48. 3. Struys et Al. Comparison of plasma compartment versus two methods for effect compartment-controlled target-controlled infusion for Propofol. Anesthesiology, 2000, 92, 399-406. 4. Schnider et Al. The influence of method of administration and covariates on the pharmacokinetics of Propofol in adult volunteers. Anesthesiology, 1998, 88, 1170-1182. 5. Schnider TW, Minto CF, Shafer SL et al. - The influence of age on Propofol pharmacodynamic. Anesthesiology, 1999, 90, 1502-1516. 6. Minto, Schnider and Shafer. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology 1997, 86, 24-33. 7. Maitre et Al. Population pharmacokinetics of alfentanil: The average dose–plasma concentration relationship and interindividual variability in patients. Anesthesiology, 1987, 66: 3–12. 8. Vuyk et Al. Alfentanil modifies the pharmacokinetics of Propofol in volunteers. Anesthesiology. 1997, 87:A300. 9. Gepts et Al. Linearity of pharmacokinetics and model estimation of sufentanil. Anesthesiology, 1995, 83:6, 1194–1204. 10. Barvais et Al. Pharmacokinetic model-driven infusion of sufentanil and midazolam during cardiac surgery: Assessment of the prospective predictive accuracy and the quality of anesthesia. J Cardiothorac Vasc Anesth 2000,14, 402-408. 11. Allegaert K, de Hoon J, Verbesselt R et Al. Maturational pharmacokinetics of single intravenous bolus of propofol. Pediatr Anesth 2007; 17: 1028-34 12. Allegaert K, Peeters MY, Verbesselt R, et Al. Inter-individual variability in propofol pharmacokinetics in preterm and term neonates. Br J Anesth 2007; 99: 864-70). 13. Absalom et Al. Accuracy of the 'Paedfusor' in children undergoing cardiac surgery or catheterization. Br J Anesth. 2003, 91:4, 507-13. 14. Absalom et Al. Paedfusor pharmacokinetic data set. British Journal of Anesthesia, 2005, 95:1, 110. 15. Kataria et Al. The Pharmacokinetics of Propofol in Children Using Three Different Data Analysis Approaches. Anesthesiology. 1994, 80, 104-122. 16. Hüppe T, Maurer F, Sessler DI, Volk T, Kreuer S. Retrospective comparison of Eleveld, Marsh, and Schnider propofol pharmacokinetic models in 50 patients. Br J Anesth. 2020 Feb;124(2):e22-e24. 17. Kim TK, Obara S, Egan TD. Disposition of remifentanil in obesity: a new pharmacokinetic model incorporating the influence of body mass. Anesthesiology 2017; 126: 1019e32 18. Colin PJ, Hannivoort LN, Eleveld DJ, Reyntjens KMEM, Absalom AR, Vereecke HEM, Struys MMRF. Dexmedetomidine pharmacokinetic-pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation. Br J Anesth. 2017 Aug 1;119(2):200-210. doi: 10.1093/bja/aex085. PMID: 28854538. 19. Coppens et Al. Influence of administration rate on Propofol plasma-effect site equilibration. Anesthesiology. 2007, 107, 386-396. 20. Gan et Al. BIS Utility Study Group, bispectral index monitoring allows faster emergence and improved recovery from Propofol, Alfentanil, and Nitrous Oxide anesthesia. Anesthesiology. 1997, 87, 808–815. 21. Struys et Al: Clinical usefulness of the bispectral index for titrating Propofol target effect–site concentration. Anesthesia. 1998, 53, 4–12. 22. Shafer et Al. Testing computer-controlled infusion pumps by simulation. Anesthesiology. 1998, 68, 261–266.

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ARTICLE FEATURES . Hybrid Operating Rooms

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ARTICLE FEATURES . Hybrid Operating Rooms

Hybrid Operating Rooms Innovation in Surgery

tate-of-the-art operating rooms reflect the various medical developments in modern medical equipment, imaging devices, or even sterilization and hygiene, while taking into account the surgeon’s primary role. This shows how hospitals are investing in digital devices and technologies as well as advanced medical imaging. Medical imaging companies have been able to combine high-quality surgical imaging technology with utmost flexibility in various surgical fields, from orthopedics and spine surgery to vascular, cardiac and surgical imaging solutions, offering the latest technologies that improve healthcare efficiency. A hybrid operating room is equipped with all the medical instruments, equipment and devices required for diagnostic imaging and scanning, allowing the surgeon to perform minimally invasive surgeries, with the possibility of rapidly converting to traditional surgeries. It is an integrated operating room with advanced imaging equipment designed for complex surgeries in the heart, blood vessels, brain and bones, allowing the surgeon and interventional radiologist to perform minimally invasive procedures from one location in a single session. Specialized companies have been able to help by achieving their goals in establishing hybrid operating rooms to provide medical and surgical services in addition to comprehensive solutions that exceed patients' expectations. This multidisciplinary hybrid system within the operating room offers a unique model in organizing workflow within a single environment. The hybrid operating room has become a safe haven for patients, as it combines the ordinary room and the advanced digital medical imaging system. It reflects medical advances and pioneering technology, as it is possible to perform surgery with the least complications unlike

HYBRID ORS OFFER THE CAPABILITY TO PERFORM COMBINED IMAGE-GUIDED PROCEDURES WITH MINIMALLY INVASIVE PROCEDURES. THESE STATE-OFTHE-ART SPACES ALSO ALLOW FOR THE COMBINATION OF IMAGE-GUIDED SURGERY WITH OPEN PROCEDURES.

surgeries performed in the traditional operating rooms. This would save time and costs and the patient can be discharged from hospital faster. Hybrid ORs allow for the ability to attempt a minimally invasive surgery procedure that was once considered unsafe due to the potential of the procedure rapidly converting to an open procedure that requires an equipped environment, specific equipment and personnel. In hybrid ORs, the surgeon remains the maestro who is able to professionally use modern technology while dealing with any emergency that may occur, so it can be treated immediately. Today, hybrid ORs have become the modern trend for minimally invasive surgeries due to the integration of modern imaging technology and traditional surgical technology to improve and develop treatment methods, which had a positive impact on the patient's general condition. Hybrid ORs offer the capability to perform combined image-guided procedures with minimally invasive procedures. These state-ofthe-art spaces also allow for the combination of image-guided surgery with open procedures. Finally, if the need arises to convert a minimally

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invasive surgery to an open procedure, these spaces allow for a smooth transition to an open procedure by providing all the necessary capability and personnel in one space. Hybrid ORs help improve patient outcomes, speed patient recovery time and reduce length of patient stays, decreasing cost for the healthcare organization. Diagnostic imaging systems such as MRI and catheters are integrated into the hybrid operating rooms to assist surgeons when performing specialized neurological and cardiac procedures. Today, the operating room is more efficient and less dangerous to patients’ lives, thanks to new digital devices and technologies that help avoid surgeries that result in large wounds and significant blood loss. Hybrid ORs have witnessed remarkable developments in recent years thanks to the hospitals’ tendency to promote the concept of day surgeries in addition to performing minimally invasive surgeries that result in less stress and are less costly; this will automatically lead to higher comfort and quicker recovery in patients. Therefore, investing in this type of operating room will have several advantages for both the patient and the hospital. Hybrid operating rooms are flexible and can

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HYBRID ORS GIVE SURGEONS THE OPPORTUNITY TO HAVE A CLEARER PICTURE OF THE INSIDE OF THE BODY TO ACCURATELY REFLECT THE MEDICAL CONDITION, WHICH CONTRIBUTES TO IMPROVING THE QUALITY OF CARE THAT THE PATIENT WILL RECEIVE WITH THE LEAST INVASIVENESS POSSIBLE.

adapt to the patient's needs during the surgical intervention while using the latest medical imaging technologies. Hybrid ORs offer benefits for patients, surgeons and hospitals alike. For patients, they have the potential to speed diagnosis and therapy, have access to minimally invasive techniques that support the goal of faster recovery, shorter procedures, eventual elimination of corrective surgeries and reduction of anesthetics in addition to real-time availability of high-quality imaging that helps surgeons preserve as much healthy tissue as possible. Hybrid ORs give surgeons the opportunity to have a clearer picture of the inside of the body to accurately reflect the medical condition, which contributes to improving the quality of care that the patient will receive with the least invasiveness possible. On the other hand, hospitals benefit from the expansion of reputation-enhancing medical services, the potential to reduce the length of procedures, application of cost-effective multidisciplinary use of strategic resources, flexibility to focus on increasing the number of patient-preferred minimally-invasive procedures, in addition to shorter patient stay resulting in patient satisfaction and revenue generation.

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ARTICLE FEATURES . The Digital Health Sector

The Digital Health Sector Accelerated growth and increased investments

fter the COVID-19 pandemic and most sectors going into pivotal digital transformations, digital transformation in the healthcare sector has become more important than ever. Hence, healthcare institutions started developing a digital strategy centered around patients and healthcare workers with an in-depth study of the IT options, financing issues and best practices that can be adopted in this field. This transformation urged specialists and decision-makers in the health sector to ask many questions, including: How can digital transformation help achieve the goals of health institutions and add value to patients and quality of healthcare services? This is based on the fact that digital transformation should make healthcare institutions more financially sustainable, more confident and future-ready. The World Health Organization stresses that digital health should be an integral part of health priorities and benefit people in a way that is ethical, safe, reliable, equitable and sustainable. Digital transformation in healthcare has been described as the art of using IT to transform its work methodology, including patient

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ACCORDING TO THE WORLD HEALTH ORGANIZATION, THE IMPLEMENTATION OF APPROPRIATE DIGITAL HEALTH TECHNOLOGIES IS A KEY COMPONENT OF A NATIONAL STRATEGY BUT MAY BE DIFFICULT TO ACCOMPLISH ESPECIALLY IN LOW- AND MIDDLEINCOME COUNTRIES.

care, business strategy, and organizational processes in these organizations using technologies such as telehealth, predictive analytics, and artificial intelligence (AI). Today, this digital transformation has become more important than ever before. The coronavirus pandemic was an opportunity to accelerate the pace of digital transformation when other sectors such as economy and education entered this field and succeeded in it. Studies indicate that telemedicine is one of the most cost-effective medical technologies in the global healthcare sector. Healthcare applications, video chats with doctors, and electronic database are examples of some of the innovations that patients can apply. It has also become clear that the COVID-19 outbreak has contributed to accelerating digital innovation at an unprecedented pace, with the aim of improving the healthcare level, as digital health, in addition to AI techniques, depend on the use of mobile computing and wearable devices to improve healthcare efficiency and quality. According to the World Health Organization, the implementation of appropriate digital health technologies is a key component of a

ARTICLE FEATURES . The Digital Health Sector

national strategy but may be difficult to accomplish especially in low- and middle-income countries. Exploring the potential of global solutions and shared services should be considered as part of the national health strategy of Member States, at the same time as generating evidence on the implications for access, cost, quality, safety and sustainability of applying these global solutions in health systems within vastly different country contexts.

Bringing digital health to the forefront Technological innovation, robotics and the Internet of Things (IoT) have led to the increased use of various digital devices by healthcare professionals, hospital workers and others. The conversion of electronic health records (EHR) has facilitated the treatment of many patients. In addition, there is an ever-growing set of digital data related to treatment methods. Given the increasing spread of devices, Information and Communications Technology (ICT) can be a major part of health prevention and treatment strategies. Digital health is not just about using certain technologies and tools, it also adopts data interoperability and AI, open and secure platforms, as they are fundamental to delivering more consumer-focused care. Advances in artificial intelligence, robotics, and machine learning continue to drive major changes in digital healthcare, as well as the development of devices such as Ingestible Sensors, used to diagnose diseases, as well as robotic caregivers, devices and applications for remote patient monitoring. With the increase in the number of people with chronic diseases and the high healthcare costs, digital health platforms enable patients to access health services faster and obtain better quality of care. These platforms also help alleviate the burdens on healthcare facilities by pioneering the idea of self-care for patients. By redefining the patient-doctor relationship, digital health systems engage patients with their caregivers promptly and directly, making them part of the treatment plan, and increasing the patient's sense of partnership, trust, and transparency. While access to medical technologies reduces the financial burdens associated

TECHNOLOGICAL INNOVATION, ROBOTICS AND THE INTERNET OF THINGS (IOT) HAVE LED TO THE INCREASED USE OF VARIOUS DIGITAL DEVICES BY HEALTHCARE PROFESSIONALS, HOSPITAL WORKERS AND OTHERS.

The use of digital technology in the health sector aims to achieve a set of goals, namely: ensuring the best health service for the patient, reducing hospitalization cost, providing health for all, especially those who don’t have access to healthcare in many regions around the world, securing greater protection from infectious viruses inside hospitals and medical centers, and optimizing patient information and health records. While digital health technologies help patients regularly check their own medical condition and monitor their symptoms, they are also a tool for early detection of significant changes in the progression of a patient’s medical condition.

with patient treatment, many digital health platforms are a gateway to like-minded communities where patients can find encouragement and engagement with others going through similar health issues. After the widespread damage caused by the coronavirus, large parts of the US healthcare market, which is worth 3.6 trillion dollars, are rapidly heading towards digital transformation, and the same applies to Europe, Asia and most countries of the world. According to the McKinsey Global Institute, global digital health revenues will rise from $350 billion last year to $600 billion by 2024. Telemedicine has been ranked as one of the most cost-effective medical technologies in the global healthcare sector, and is set to save $21 billion globally by 2025, representing a growth rate of over 80%.

Coronavirus and the drive towards digitization It has become known and accepted that the world has changed after the coronavirus pandemic, and this is clearly shown in many fields in all countries around the world, especially with the fast digital transformation that has affected various economic sectors, from remote learning, e-commerce to the transportation sector and the health sector, which is rapidly shifting towards digitization. The health sector appears most affected by the pandemic, and the one that shifted towards digitization the most, with the spread of digital medicine, electronic pharmacies, medical applications, telemedicine, and many other transformations that did not exist before the pandemic. Telemedicine was definitely the most prominent in the health technology sector during the coronavirus pandemic, allowing patients the ability to receive consultations and treatments from their doctors without the need for personal appointments, or going through the travel inconvenience, or going to the clinic or hospital, with all the risks involved, especially during the quarantine that occurred all over the world. This concept includes the use of digital information and communications technologies such as computers, smartphones and cloud computing to access and manage healthcare services.

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It is reported that remote medical consultations will be the main service that will enable significant savings, noting that 280 million medical consultations were carried out in the world in 2019 before the pandemic, but this number rose to 348 million consultations in 2020 after the pandemic. However, this development is a promising indicator of what digital medicine will look like in the future. It is also expected that the activities of healthcare service developers will be crucial in accelerating the use of emerging telemedicine services, and increasing the capacity among healthcare providers in the world. However, the biggest challenge facing the growth of this sector is the lack of sufficient laws and legislation capable of protecting service providers, including protecting patient data and information, especially in small healthcare service institutions such as private health centers and others. Therefore, the need to develop current legislation and establish new laws capable of providing the required protection for all entities working in this vital sector is highly recommended.

Increasing and channeling investments This digital transformation in the health sector required increasing investments in digital technology, especially in the last two years 2020-2021. Health sectors around the world, including the Arab world, began to raise the value of the amounts allocated to invest in digital healthcare. According to McKinsey, the United States of America has increased the health spending budget for virtual care by 20 percent, including telehealth services, so did Europe, Asia and the Gulf States. With the COVID-19 pandemic emphasizing the importance of digital healthcare, US academic agencies such as the National Institute on Aging have increased their spending on digital health to support research and development in this growing industry. Investment in the US digital health sector began to grow after the introduction of the Affordable Care Act, which increased funding nearly 6-fold. The digital health market value for 2020 was between $96.5 billion and $111.4 billion. Global venture capital funding for digital health companies hit a $15 billion high in the

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HEALTH SECTORS AROUND THE WORLD, INCLUDING THE ARAB WORLD, BEGAN TO RAISE THE VALUE OF THE AMOUNTS ALLOCATED TO INVEST IN DIGITAL HEALTHCARE. ACCORDING TO MCKINSEY, THE UNITED STATES OF AMERICA HAS INCREASED THE HEALTH SPENDING BUDGET FOR VIRTUAL CARE BY 20 PERCENT, INCLUDING TELEHEALTH SERVICES, SO DID EUROPE, ASIA AND THE GULF STATES.

first half of 2021, the highest level since 2010, driven in large part by telehealth investment. Funding activity was up by 138% during the first half of 2021, compared to $6.3 billion raised in the first half of 2020, according to a report from “Mercom Capital Group”, a global communications and research firm. Corporate funding into digital health companies, including venture capital, public market financing, and debt, totaled $19 billion so far in 2021. Government authorities indicated that there is great interest in funding state-ofthe-art projects and technologies, such as technologies that will allow the elderly to live alone safely, technology related to psychiatric rehabilitation and social reintegration, as well as preventive medicine through applications and technologies that allow close monitoring of the patient with minimal effort.

The top three trends in healthcare investing 1. Telehealth: Virtual ambulatory care expanded from 2% pre-COVID to 30% on an ongoing basis. 2. Remote Patient Monitoring: Total funding increased from $417 million to $941 million in 2020. 3. Behavioral Health Technologies: Funding for mental health solutions increased from $599 million to $1.4 billion in 2020, driven by investments from the financial community as well as governments, health and education systems.

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HOSPITALS Magazine issue 62

Articles inside

Hybrid Operating Rooms Innovation in Surgery

Dr. Ziyad Mahfoud, Professor of Research in Population

Göksel ARAS CEO "NITROCARE" and Gökhan ARAS Board Member “NITROCARE"

The Digital Health Sector Accelerated growth and increased investments

Green Hospitals... A revolutionary change that benefits

Bassem Bibi, Divisional Vice President for Abbott’s

CARE WORTH TRAVELING FOR

International Hospital Federation announces Geneva

Over 60 international countries represented at Arab Health 2022

UAE entering a significant new wave of healthcare

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Al-Ahli Hospital treats uterine fibers with the latest

How do we deal with severe healthcare associated infections (HAI’s) and the danger of antimicrobial resistance in the future?

WCM-Q neuromusicology research reveals secrets of human creativity