29 minute read
Dr. Ziyad Mahfoud, Professor of Research in Population
Dr. Ziyad Mahfoud
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Dr. 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” magOUR 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
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
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.
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 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. 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?
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.
Al-Ahli Hospital adds high-flow oxygen technique to its services
Dr. 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 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.
Al-Ahli Hospital treats pneumomediastinum cases
Dr. Mohammad Al-Nazer, Pulmonologist at Al-Ahli Hospital / Qatar
Al-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.
Omnicell’s solutions-based approach addresses the Gulf region’s key healthcare challenges
Close 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. 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.”
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
• Optimizing hospital labor productivity • 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
The head-side element of the split ¾-safety side offers support during mobilisation
Evario one
The economical hospital bed for global use
Modern 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. 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
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
Optional supply brackets and practical handle bars enable modern patient care from all sides
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.
A HAPPY BREAK-UP!
3-dimensional dummy, 27-hour surgery, multidisciplinary medical team and an army of healthcare professionals!
Presenting 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 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.
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 upset. 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.
Mobilization was ordered!
Physicians of numerous departments, 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.
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 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.
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.”
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 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.
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.”
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.
