HOSPITALS Magazine issue 47 by The Arab Hospital Magazine

Issue 47 / 154 JULY-AUGUST 2019

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

Leukemia Uncontrolled growth of abnormal blood cells Medical Education in the Arab World Why BREAST CT instead of Mammography?

Smart & Digital Hospitals Hospitals of the future

Diagnostic tests for

CARDIOVASCULAR DISEASES

Remote Healthcare

Applications and communications for better service

Publisher Arab Health Media Communication General Manager Simon Chammas schammas@tahmag.com Creative Department Roula Haddad - Georges Habka Creative Director: Jessy E. Hajj

The more developments we witness, the more access medicine will have to health services at the best and easiest level. Today, with the technological means and the use of mobile phones by more than 2 billion people around the world, there is an increasing need to use mobile applications that meet the needs of users in health sectors. The demand for developing and downloading applications that will help its users to be more involved in the management and follow-up of their health issues has become a necessity. The provision of health services is not limited to mobile phones only, but also includes patient monitoring devices, personal digital assistants (PDAs), and other mobile wireless devices, putting the health service on another level of ease and efficiency. Over the past years, applications have been informational only and more than 50% have limited capabilities. However, with the rapid development, this technology has managed to reach the digital devices market, and several companies worked on updating and developing more applications in order to expand their functions and have more personalized services suitable for each user and his medical condition. There are information healthcare applications, healthcare guidelines applications, communicative healthcare applications, etc. It is noteworthy that the patient’s use of these applications never replaces a doctor’s consultation to learn about their health condition and the right treatment, and it is complementary to the doctor’s work and helps him provide the patient with a better service. The Publisher

Photographer Hanna Nehme Copy Editor Jessica Achkar Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa Advertising & Marketing advertising@tahmag.com Mirna Khayrallah mirna@tahmag.com Business Development Manager Ralph Rahal tahmag@tahmag.com 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 KSA Elias Aramouni Business Dot Sulaimaniah Ofﬁces building • 2nd ﬂr M: +966 55 1595 000 T: +966 11 4568282 F: +966 11 2253666 P.O. Box: 085092 Riyadh 11691 Printing

Distribution KSA - UAE - OMAN LEBANON - JORDAN SYRIA - KUWAIT BAHRAIN - QATAR - EGYPT

Best practice SLNB for more patients, at any hospital, at any time Many treatments for early-stage cancer involve ‘sentinel lymph node biopsy’, or SLNB. This method, which identifies the lymph nodes with the highest potential for harbouring metastases, helps to determine the nodal stage of the cancer and make informed decisions for surgery and subsequent treatment. Standard SLNB uses radioisotopes for sentinel node localisation. We oﬀer an eﬀective clinical solution that uses safe magnetic fields instead. This eliminates concerns related to the safety, workflow and availability associated with ionising radiation. Best practice SLNB is now possible everywhere, with no time restrictions. Our system consists of the Sentimag® probe and the Sienna+® magnetic tracer. First, the tracer is injected into the interstitial tissue to provide a traceable signal. Next, using the Sentimag® probe, you locate the sentinel lymph nodes to determine how far the cancer has spread.

Sentimag® – An eﬀective clinical solution n Perform best practice SLNB in any clinical setting n Eliminate issues with radioactive materials; reach

equivalent clinical outcomes [1 – 2] n As a surgeon, organise and manage the SLNB

procedure to suit your needs n Inject the tracer at the best moment, up to seven

days in advance n No evidence of anaphylaxis with interstitial tracer

injection n Sentimag

and Sienna+® are CE-approved for SLN localisation ®

As eﬀective as the radiotracer, as easy as blue dye With the Sentimag® /Sienna+® system, you can quantify the amount of tracer located in a specific node relative to others. This higher tracer loading is a hallmark of the sentinel node identification process and is similar to the radioactive method. With Sienna+®, however, neither you nor your patients are exposed to radiation at any stage.

Magnetic SLNB procedure Sienna+® is injected into the interstitial tissue

follows drainage path to nearest lymph nodes As eﬀective as the radiotracer, as easy Tracer as blue dye Draining lymph nodes are detected with Sentimag®

® ® ® WithAthe Sentimag system, you can quantify tracer is that it can be Magnetic SLNB procedure unique benefit/Sienna+ of the Sienna+ the amount located a specific nodeThanks relative injected of uptracer to seven daysin before surgery. toto this OSNA orishistological analysis of sentinel lymph nodes Sienna+ injected into the interstitial tissue others. This workflow, higher tracer loading is a no hallmark of thebetween flexible which requires scheduling sentinel node identification and is similar to the departments and almostprocess no pre-operative preparation, ® Lymph nodes show path to nearest lymph Lymph nodes show Tracer follows drainage nodes , however,per neither you radioactive With Sienna+ you canmethod. arrange more SLNB procedures day, help no signs of malignancy signs of malignancy nor those your patients aretreatment exposed to radiation any stage. who need sooner, and at conduct more ®®

out-patient surgery. A unique benefit of the Sienna+® tracer is that it can be injected to aseven days beforeuser, surgery. Thanks If youupare gamma system you will havetonothis issues ® flexible workflow, which requires no scheduling procedure as the between probe adapting to the Sentimag departments and almost no pre-operative preparation, handling is remarkably similar. This also means you will you need can arrange SLNB procedures per day, almost more no additional training. There arehelp no special those who need treatment sooner, and conduct more procedural requirements either, such as darkening the out-patient surgery.for fluorescent localisation systems. room required If you are a gamma system user, you will have no issues adapting to the Sentimag® procedure as the probe handling is remarkably similar. This also means you will Technique/ Sentimag® Gamma Fluorescent need Benefit almost no additional training. There systemare no special system procedural requirements either, such as darkening the Quantifiable √ √ x roomSLNs required for fluorescent localisation systems. Avoids radiation

√

7-day injection ® √ Technique/ Sentimag window Benefit Surgeon√ Quantifiable controlled √ SLNs Established √ Avoids practice √ radiation

x x Gamma system √ x

x √

√ x Fluorescent system x √

7-day injection window

√

Surgeoncontrolled

√

Established practice

√

√ x

Draining lymph nodes are detected with Sentimag® Remaining regional nodes Clinicians follow their are not removed standard protocol OSNA® or histological analysis of sentinel lymph nodes

Lymph nodes show no signs of malignancy

Lymph nodes show signs of malignancy

Remaining regional nodes are not removed

Clinicians follow their standard protocol

MAY . JUNE 2019

NEWS

8 Department of Community Development introduces ‘Get Social Support’ journey 16 World Anti-Doping Agency Coordinates Global Implementation of Sysmex Analyzers at All Blood Laboratories 18 Baylor St. Luke’s Continues to Pave the Path for Breathing Lung Transplants 20 Cerner Middle East and Africa unveils its 2019 Achievement and Innovation Award Winners 26 Cornell Stars help trainee doctors learn new skills at Weill Cornell Medicine - Qatar 28 IME Medical Electrospinning Launches MediSpin XL™ 30 Aspire Zone Foundation and Carnegie Mellon University in Qatar ink a strategic partnership agreement 38 Saudi German Hospitals Group signs new partnership with Careem for the benefit of patients 94 IHF assembles leading healthcare thinkers for the 43rd World Hospital Congress

MEDICAL INSTITUTIONS

10 Hill-Rom Unveils New Corporate Logo And Global Brand Identity

32 Hôtel-Dieu de France (HDF) 74 Acıbadem International 88 College of Dental Medicine - Qatar University 90 Weill Cornell Medicine-Qatar (WCM-Q)

INTERVIEWS

46 Dr. Sama Adnan Zibdeh MAY.JUNE 2019

86 56 Pierre Appert 60 Dr. Colin Fincham 64 Dr. Claudia Mika

FEATURES

40 Diagnostic tests for cardiovascular diseases 82 Leukemia 86 Medical Education in the Arab World 96 Smart and Digital Hospitals

ARTICLES

34 Why BREAST CT instead of Mammography? 50 Twin-to-twin transfusion syndrome 52 ID Doct A FIRM COMMITMENT TO THE DIGITIZATION OF DOCTORS

68 What do you know about autism 70 Ectopic pregnancy or ectopic minded 72 Healthy teeth in children 78 Project Management for Medical & Healthcare Sector: 92 Cook Children’s Health Care System

MORE THAN JUST A MEDICAL SCHOOL At Weill Cornell Medicine-Qatar, we are so much more than just a medical school; we are a world-renowned institution and network of influential partners that combines groundbreaking research, world-class medical education, and best-in-class care to put patients at the center of everything we do.

Care. Discover. Teach.

NEWS

Department of Community Development introduces ‘Get Social Support’ journey

n line with the Abu Dhabi Government directions towards providing the next-generation of government services, the Department of Community Development (DCD) has launched the ‘Social Services’ journey in cooperation with the Abu Dhabi Digital Authority (ADDA) via the Abu Dhabi Government Services ‘TAMM’. The newly launched journey is designed to better serve its society and help citizens and residents benefit from a total of 47 services. The ‘Social Services’ journey is part of the ‘TAMM’ initiative and also under the ‘Ghadan 21’ program. This journey has been created to help in community development while also consolidating unity and cooperation of the community members to take part in future opportunities. The initiative looks towards providing a single access point to apply for 47 social support services, provided separately by 12 government entities. The new journey offers an integrated customer experience in one place via a unified eligibility engine available at TAMM’s digital channels and customer centres as well as The Abu Dhabi Government Contact Centre. Now, the customer can check

JULY.AUGUST 2019

his eligibility and apply for the social benefits in accordance with his desired category. The ‘Social Services’ journey connects citizens to the suitable social and community development entity, depending on their requirements. The journey offers services in six different aspects of life, namely community, health, education, housing, business and family services. Marking the launch of this journey, H.E Dr Mugheer Al Khaili, Chairman of the Department of Community Development said: “In line with the enduring directions of our wise leadership, the Abu Dhabi Government saves no effort towards providing assured and dignified life. The Government continues its efforts towards achieving sustainable community development that complies with Abu Dhabi’s prominent achievements in different sectors. H.E Dr. Al Khaili added “Serving the community and fulfilling the society’s expectations are the key fundamentals of our efforts in Department of Community Development and other associated entities. Hence, we keep inaugurating the initiatives and strategies aimed to achieve the prosperity of the citizens and residents via estab-

lishing family and social stability that promotes the individual’s contribution in the development march of the UAE.” “The Abu Dhabi emirate has an efficient government framework that complies with the dynamic changes in different arenas. Now, The Abu Dhabi Government has a leading capacity to foresee the future and address tomorrow’s needs to enrich people’s lives via different programs, initiatives and projects that further enhance services sector via applying the best international practices and standards in education, health, housing and other aspects of life.” H.E commends the launch of the “Social Services” journey to be a governmental gateway that takes the welfare of Abu Dhabi Community to a new level of creativity in providing services. Such journeys reflect the UAE’s progress and capacity to leverage technology to serve the society in more creative, proactive and seamless manner. H.E Dr. Al Khaili commented that “The Social Services Journey” is one of the Abu Dhabi government initiatives, designed for providing prosperity to the individuals with their different ages including senior citizens, people of determination and other components of the society. H.E Dr. Mugheer commends the extensive efforts of the Abu Dhabi Digital Authority to overcome all the challenges on the way to provide a seamless and proactive customer experience via unified digital platform. H.E affirms the fruitful collaboration among Abu Dhabi government entities that led to the launch of this journey as a significant bid to achieve the happiness of the community.

NEWS Commenting on the launch of this new initiative, H.E. Dr. Rauda Al Saadi, Director General of ADDA, said: “With the launch of this important “Social Services” journey, TAMM has achieved a new milestone, in line with ADDA’s efforts to reinforce joint initiatives and government collaborations that support the digital transformation agenda. Fulfilling the social needs of the people of Abu Dhabi through a seamless single digital platform is in line with the Emirate’s vision of achieving a model government that provides next-generation services for all vital sectors and segments of our society. We are proud to incubate an integrated journey that provides an array of social benefits via TAMM’s digital channels and customer centres. We also affirm the readiness of the Abu Dhabi Government Contact Centre to receive all inquiries in support to this newly launched journey.”

H.E Al Saadi added, “The Abu Dhabi Digital Authority commends the cooperation efforts to launch this journey, exemplified through this initiative by key government entities, particularly the Department of Community Development, with common goal of the betterment of Abu Dhabi’s community.” The Social Services Journey facilitates applications for house constructions, home purchase loans and online requests for land grants as well as maintenance and rebuilding service. The journey also will facilitate applications for welfare-related benefits and the registration of citizens and people of determination. Health services include requests for Health Insurance Policies, cards for people of determination and senior Emirati nationals, including but not limited, “Ounk” and “Absher” cards. Family services includes facilitating marriage funds, family

counselling and social consultations. The financial category addresses the needs of citizens seeking financial support to start up a business or entrepreneurial project. Education services facilitate requests for scholarships, country status updates, change of university course or major, and change in university. Sponsoring Abu Dhabi Government entities include the Department of Community Development, Department of Education and Knowledge, Department of Health, Family Development Foundation, Abu Dhabi Housing Authority, General Directorate of Abu Dhabi Police, Social Care and Minors Affairs Foundation, Abu Dhabi Health Services Company – SEHA, Zayed Higher Organization for People of Determination, Dar Zayed for Islamic Culture, and Khalifa Fund for Enterprise Development.

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NEWS

Cleveland Clinic in the United States Left-Over Painkillers are a Potential Source of Narcotics Abuse uting to dependency and abuse in America.” Lack of clear prescribing standards for adequate postoperative pain control is a big part of the problem. The project at Cleveland Clinic’s Department of Breast Services aimed to solve this, with a goal of providing optimum pain control without excess narcotic medications.

Dr. Stephanie Valente

study at Cleveland Clinic in the United States has found that patients recovering from breast surgery are often only using a fraction of the medication they are prescribed, raising concerns that left-over pills could lead to potential abuse. As America faces a growing problem with opioid addiction, in many cases beginning with a prescription to painkillers, hospitals are reconsidering the best way to use narcotics to relieve pain, including for short-term use after surgery. Cleveland Clinic reviewed prescriptions after three types of surgery to treat breast cancer – it found almost half the patients used none of the medication post-surgery, leaving narcotics open to misuse.

“For years, I don’t think many surgeons realized the magnitude of the amount of narcotic pain medications that they prescribed to patients for postoperative or other pain management,” says Stephanie Valente, DO, a surgeon with the Department of Breast Services at Cleveland Clinic. “We were surprised and disheartened to see that the prescriptions we were writing to help with postoperative pain were unknowingly contrib-

JULY.AUGUST 2019

“As a group of surgeons at a large academic institution, we wanted to see how we could standardize and improve our narcotic prescribing patterns while engaging patients in the quality improvement process,” says Dr. Valente. Researchers reviewed prescribing data on breast surgery patients treated in 2017 to establish baseline postoperative narcotic prescribing patterns. Based on data from 100 consecutive patients, inconsistencies were found in the type and number of narcotics prescribed: Tramadol, Tylenol-3, Norco/hydrocodone and Percocet®/ oxycodone prescriptions ranged from zero to 40 pills. The median number of pills varied with procedures: 15 for excisional biopsy/lumpectomy, 20 for mastectomy and 28 for mastectomy with reconstruction. As a first step, the department educated surgeons and standardized the number of pills prescribed at 10 for excisional biopsy/lumpectomy and to 25 for mastectomy with reconstruction – both slightly below the previous median – with no reduction in the 20 pills prescribed for mastectomy. But when doctors followed up with 100 patients to find out how many pills they used, the median

number of pills taken by patients was significantly less than what was prescribed for all procedures. The ‘average’ patient took just one pill for excisional biopsy/lumpectomy, leaving nine pills unused; three for mastectomy, leaving 17 pills unused; and 18 for mastectomy with reconstruction, leaving seven pills. Nearly half (40 percent) of the patients reported using zero narcotics following their procedure, having a significant impact on the overall average. “When we decided on the number of narcotics to prescribe, we were concerned that it might be too little. We were surprised how little narcotics patients took and how many patients took no narcotics at all. Many patients opt for ice and Tylenol,” says Dr. Valente. Guided by this data, Cleveland Clinic is focusing on surgeon and patient education. “Pain medications can have a necessary, temporary role in the management of surgical pain,” explains Dr. Valente. “Patients need to understand that there will be some degree of discomfort from surgery and know that the amount of narcotics given after surgery will not be renewed. “At the same time, we now have a better understanding of multi-modality non-narcotic alternatives for pain management. Many breast surgery patients will be able to safely avoid all postoperative narcotics.” The study results were presented at the 2019 annual meeting of the American Society of Breast Surgeons.

NEWS

‫َ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

World Anti-Doping Agency Coordinates Global Implementation of Sysmex Analyzers at All Blood Laboratories Contributing to Clean and Fair Sports Management by Enhancing the Quality of Doping Tests

he World Anti-Doping Agency (WADA) has coordinated the simultaneous introduction of Sysmex’s XN-Series automated hematology analyzers at all WADA-accredited and approved laboratories throughout the world. Doping tests require results that are comparable and traceable over time, regardless of the testing institution or location. WADA selected our analyzers for their high level of measurement precision supported by our global quality assurance system. Doping tests of blood samples taken from athletes as part of the Athlete Biological Passport (ABP) program are conducted at WADA-accredited or approved laboratories around the world and in all sports, using consistent procedures. Along with the conventional direct method of doping tests, which involves testing for banned substances, the ABP indirect approach was introduced in 2009 to conduct accurate monitoring of blood variables to reveal blood manipulations. The ABP is routinely used throughout the world for two types of testing: tests to determine blood doping and urine tests to detect the use of steroids. In adopting ABP, it is extremely important to ensure that the results of tests taken over time from athletes who move around the world can be compared and monitored

JULY.AUGUST 2019

with a high degree of accuracy and comparability, regardless of the testing location. Sysmex is in the global healthcare business, playing an important role in people’s lives and health. As such, we have defined the responsible provision of products and services as a priority issue (materiality). As part of our activities, we provide hematology analyzers, which detect information related to red blood cell production with a high degree of sensitivity and reproducibility, helping the implementation of strict but fair doping tests. In discussions with WADA, the organization decided to introduce Sysmex’s XN-1000 of the XN-Series, its flagship line of automated hematology analyzers that can measure blood variables to a higher degree of precision and comparison throughout the world, at all 30 WADA-accredited and approved laboratories that conduct ABP tests. Validation activities on these products are complete for almost all accredited and approved laboratories, and ABP blood tests for a host of international sporting federations and anti-doping agencies in various countries are set to commence in early June 2019 in preparation for upcoming major international sport events, including the Olympic Games and the Tour de France.

The decision to introduce the XN-Series at all accredited and approved laboratories stems from the instruments’ high measurement precision, our proprietary quality control service, and the high marks we have received for a robust support structure that delivers globally stable and highly reliable measurement results. For WADA, the full adoption of the XN-Series allows test results at individual laboratories to be accurately compared, resulting in higher-quality, more efficient and more streamlined ABP operations globally. As a healthcare company, going forward Sysmex will leverage the technologies and expertise cultivated through in vitro diagnostics to realize an affluent and healthy society, and foster a fair competitive environment and the promotion of sports.

An upstart on the global stage. A consistent leader in the U.S. We know children deserve the best possible care, in a safe and welcoming environment. Here in Columbus, Ohio, we have it all: world-class cultural attractions, cuisine and entertainment and — most importantly — pediatric specialty care that makes us a leading destination for patients from around the world. Our innovative research and dedicated health care team develop internationally recognized programs. From hosting a worldwide clinical trial consortium for childhood neuroblastoma to renowned gene therapy research aimed at making neuromuscular disorders a thing of the past, we aim to provide the highest level of expertise and care for our patients. Reach out to our Global Patient Services team to learn more about our unique combination of a welcoming city and remarkable 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

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NEWS

Baylor St. Luke’s Continues to Pave the Path for Breathing Lung Transplants

aylor St. Luke’s Medical Center is the first in Texas to use the Organ Care System (OCS) lung technology to perform a breathing lung transplant after the device recently received FDA approval for standard use. The technology is designed to keep donor lungs functioning and “breathing” in human-like conditions from the time of the donor procedure to the recipient’s transplant surgery, with warm blood perfusion, ventilation and a sophisticated monitoring system to continually assess the organ while in transport. Baylor St. Luke’s was a study site during the device’s clinical trials and Dr. Gabriel Loor, surgical director of the lung transplant program at Baylor St. Luke’s, was the International Principal Investigator for the largest study in the U.S. evaluating the ability to increase

the number of useable donor lungs using OCS technology. During the clinical trials last year, Baylor St. Luke’s became the first hospital in Texas to perform a breathing lung transplant using the OCS. Earlier this year, Jackie Cundiff came to Dr. Loor and Baylor St. Luke’s as her quality of life was worsening. She suffered from a relatively rare genetic condition called Alpha-1 antitrypsin deficiency, which is a genetic mutation that leads to breakdown of the protein support structure that provides integrity in the lungs. This condition eventually develops into COPD, which is the third leading cause of death in the world. As Jackie’s disease progressed, she was limited in the amount of activity she could do and was required to be on oxygen. This led to her inclusion on the transplant list and eventually

receiving the first breathing lung transplant in Texas since FDA approval. Her procedure only took four hours and she was discharged after six days. “Six days is among the shortest hospital stays I’ve seen after this procedure,” said Dr. Loor. “This gave us a glimpse into the future of what transplant options and outcomes may be. The use of the OCS lung device for standard donors results in better initial lung function. This may translate into better short and long-term outcomes, decreased resource utilization and faster recovery.” The lung transplant program at Baylor St. Luke’s in Houston’s renowned Texas Medical Center continually strives to meet the needs of patients through innovative breakthrough research and cutting-edge technology, and is committed to compassionate quality healthcare that improves and saves lives.

FOR MORE INFORMATION CONTACT INTERNATIONAL SERVICES AT BAYLOR ST LUKE’S MEDICAL CENTER Via email at international@stlukeshealth.org or call +1 832 355 3350 or visit StLukesInternational.org Texas Medical Center, Houston, Texas - USA

MAY.JUNE 2019

We offer personalized medicine where specialists use your genetic makeup to help select the best course of therapy, targeting the specific characteristics unique to the cancer. Our experts at the NCI-designated Dan L Duncan Comprehensive Cancer Center at Baylor St. Luke’s Medical Center offer the latest innovations in cancer treatment—many of which stem from our own internationally recognized research. That’s our answer to cancer.

Tel: 1.800.670.3924 Email: International@stlukeshealth.org StLukesInternational.org Texas Medical Center, Houston, Texas – U.S.A.

Baylor St. Luke’s Medical Center

NEWS

Cerner Middle East and Africa unveils its 2019 Achievement and Innovation Award Winners

erner Middle East & Africa celebrated the eighth edition of its annual Achievement and Innovation Awards by honoring clients across the region for their most rewarding healthcare technology adoptions in four categories: User Experience, Patient Experience, Financial Outcomes and Health Outcomes. To reflect the changing dynamics in the healthcare industry, Cerner created four new award categories this year to acknowledge their clients’ innovative use of technology over the past 12 months for achieving outstanding patient outcomes and further advancing the quality of healthcare information technology systems. “The quality of entries received for the 2019 Achievement and Innovation Awards was remarkable. It clearly shows the diversity of projects and expertise highlighting the progress our clients are accomplishing to transform healthcare and connecting everything that matters to the patient,” said Bachir Awad, Vice President and Managing Director, Cerner Middle East & Africa. “We look forward to continuing the journey of advancing healthcare together with our visionary client leadership.”

JULY.AUGUST 2019

During the annual Cerner Middle East Collaboration Forum at Le Meridien Hotel & Conference Centre in Dubai, United Arab Emirates, the top three shortlisted nominees for each award category presented on their successes. After the presentations, the audience voted to select a winner in each category and winners were announced during the forum’s awards ceremony. Healthpoint was recognized with the Achievement and Innovation in User Experience award for its work related to ‘Bariatric Pathways.’ The award-winning Bariatric Department digitized their entire patient journey using Cerner’s care plans. Implementing a standard pathway supported Healthpoint to achieve savings in clinical time and improved quality of patient treatment. Al Jalila Children’s Specialty Hospital was awarded the Achievement and Innovation in Patient Experience award for its project ‘Meds to Beds – Leveraging EMR Data for Improving Patient Care Delivery.’ This project highlights an important service wherein discharge outpatient prescriptions are delivered to the patient’s bedside before discharge. This personal service allows patients and their parents to receive counseling from pharmacists in the comfort

of their hospital room. UAE Ministry of Health & Prevention was granted the Achievement and Innovation in Health Outcomes award for their project ‘Leveraging EMR to Launch Critical Congenital Heart Disease (CCHD) Screening for Newborns.’ The project utilizes a broad spectrum of functionality with appropriate training and communication to detect CCHD cases in newborns before leaving the hospital and receive critical interventions in a timely manner. Abu Dhabi Health Services Company (SEHA) in UAE and King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Saudi Arabia were both announced as winners of the Achievement in Financial Outcomes award. The SEHA ‘Nursing Documentation and Revenue’ project was awarded for their innovation in enhancing nursing documentation, establishing the nursing informatics specialty training and competencies, as well as restructuring the informatics committee to improve the clinical documentation. The KFSH&RC ‘Influence of Integration on Enterprise Cost’ project was recognized for the best use of technology to drive down costs and turnaround time by integrating different medical departments such as ICU, anesthesia, lab, radiology and respiratory. “We would like to thank our clients for their nominations and for giving us the opportunity to share their success stories, which help foster more knowledge exchange among healthcare professionals,” added Awad. “We are honored to play our part in facilitating the exchange of ideas and showcasing the achievements being made in defining the next era of healthcare.”

NEWS

New patient network to support people with obesity across the Middle East

new Patient Network to support people living with obesity, backed by clinicians across the Gulf and Lebanon, is being launched by the World Obesity Federation. Designed to raise awareness of the multiple causes of obesity and provide access to information about healthier lifestyle choices, treatment options and ongoing management, the programme marks World Obesity’s first major initiative in the region. Dr Nasreen Alfaris, Endocrinologist and Obesity Medicine specialist in KSA and co-chair of the World Obesity Gulf & Lebanon Network Steering Committee, said: “In some countries in our region, a third of our people are living with obesity*. This initiative will help people make informed choices about healthier lifestyles and the different treatment options available. Obesity is a complex disease that is driven by a multitude of factors, including our living environment,

cultural traditions and genetics. It’s also one of the key health and lifestyle challenges facing our region. The Patient Network is an opportunity for people to share their own experiences and, in doing so, support other people living with obesity to manage weight loss and live a healthy, active lifestyle.” The Global Patient Network hosts evidence and features on several key factors associated with obesity in the Gulf including: changes in food habits and increasing consumption of fast food; rising levels of childhood obesity; supporting men and women living with obesity and explaining treatment options; and promoting higher physical activity levels. Speaking in the UAE, Lucy Keightley, Director of Communications and Partnerships at World Obesity, said: “If you are living with obesity and want a source of evidence-based information, please join the Patient Network at www.worldobesity.org/patient-por-

tal - a source of facts and information on obesity. The Patient Network is an online hub enabling people to connect with other people’s stories and experiences. We are looking for people living with obesity to share their story. By sharing your personal experience, more people living with obesity will have access to the information and support to enable them to live a healthier active lifestyle.” World Obesity has worked in collaboration with a steering group of leading clinicians from across the region, drawing on their experiences to develop and roll-out the initiative. The Gulf and Lebanon Steering Committee met in Muscat earlier this year and will continue to provide expert advice to the Network. The website will be promoted over the coming months via social media and traditional media channels. If you have a story or experience to share, simply log onto www.worldobesity.org/patient-portal

Ministry of Health announces July schedule for Visiting Consultants Program

he Ministry of Health and Prevention (MoHAP) unveiled the July schedule of its Visiting Consultants Program, which features an elite group of medical consultants, 16 Consultants, in addition to a team of 6 consultants specializing in cardiothoracic surgery. The Consultants’ expertise cover 15 Specialties and Sub-specialties, including pediatric neurology, pedi-

JULY.AUGUST 2019

atric endocrinology, robotic surgery, endocrinology (Metabolic syndrome), neurosurgery, anesthesia and pain management, pediatric hematology, cardiothoracic surgery. The doctors’ expertise includes other disciplines such as obesity surgery, psychiatry, mood disorders, anxiety disorders, eating disorders, psychiatric diseases associated with organic diseases, ophthalmology, reti-

nal surgery, interventional cardiology, and shoulder surgery. The July Visiting Consultants Program will benefit patients at 9 MoHAP hospitals, namely Al Qassimi Hospital for Women and Children, Kuwait Hospital in Sharjah, Al Qassimi Hospital, Ibrahim Bin Hamad Obaidullah Hospital (Ras Al-Khaimah) Khorfakkan Hospital, Al Amal Psychiatric Hospital, Saqr Hospital, Shaam Hospital and Dibba Hospital.

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NEWS

Cornell Stars help trainee doctors learn new skills at Weill Cornell Medicine - Qatar Center, who passed on their years of experience in pediatrics.

Dr. Stella Major, associate professor of family medicine in clinical medicine, demonstrates the best technique for examining a child’s ears

n the latest phase of their training, students at Weill Cornell Medicine – Qatar (WCM-Q) had to deal with the world’s most interesting and unpredictable patients – young children. The medical students, who are all in the third year of the medical curriculum, attended the clinical orientation week - which incorporates the annual Cornell Stars event - to prepare them to start their full-time clinical courses (clerkships). This involves faculty and staff members at WCM-Q bringing in their own children so that the medical students can learn the best techniques for examining children in a clinical setting. The event offers students experience of interacting and examining babies, toddlers and children up to the age of seven. The examinations are all held in WCM-Q’s Clinical Skills and Simulation Lab, which features a number of realistic mock clinics.

nity for the students, demonstrating that children and adults make for very different patients and encounters. For example, examining a child may involve encouragement from the physician, help from the parent, but also a willingness to be opportunistic and flexible on the part of the doctor. Dr. Khidir said: “We are trying to give our students the chance to experience what it is genuinely like to engage a child and perform a basic physical examination of a child, but also to pass on hints and tips that may help with that examination. For example, we show the students how to keep the children calm, maybe let the children listen to their own hearts through the stethoscope, and generally build up a rapport with them. We want them to learn how to negotiate, communicate and be creative in engaging the children and their care-giver in a relaxed environment.”

Dr. Amal Khidir, associate professor of pediatrics, and organizer of the Cornell Stars program, said the annual event is a valuable learning opportu-

The examinations were all overseen by experienced doctors from WCM-Q, Hamad Medical Corporation and Sidra Medical and Research

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Dr. Khidir said that without the invaluable support of Dr. Stella Major, Dr. Madeeha Kamal, Dr. Mehdi Adeli, Dr. Sharda Udassi, Dr. Manasik Hassan, Dr. Suzan Gamel, Dr. Ahmed Eltayeb, Dr. Mohamed Elkalaf, and Dr. Marva Yahya, the Cornell Stars event would not be as successful as it is. She also thanked the members of faculty and staff who brought their children in for the event, and, of course, she thanked the children themselves. For Class of 2021 student Rozaleen Aleyadeh it was a useful learning experience. “The kids were so cute,” she said. “They were really, really nice and obviously this won’t be exactly how it is in the hospital, but it was very good practice. The doctors were really helpful and showed us how to interact with the children depending on their age. We’ve also been talking to the parents and it was really useful to know how to deal with them as well as it’s not just about the children.” Fellow student Sherif Mostafa said it was nerve-wracking at first. He said: “I was definitely scared of the kids. They are like tiny creatures, but the examinations were easy to navigate as these children were healthy, although I don’t know how it will be with kids who are sick. The physical examination was easier than I thought but it’s mostly about observation and although it’s obvious, I didn’t realize it until now as the children can’t tell you anything.”

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Weill Cornell Medicine - Qatar shares expertise on continuing medical education

Deema Al-Sheikhly, CPD Director at WCM-Q

eill Cornell Medicine-Qatar (WCM-Q) was invited to share its expertise on providing high-quality continuing medical education (CME) at the annual conference of the Accreditation Council for Continuing Medical Education (ACCME) – recognized as the leading accreditation body in the US. WCM-Q is well-qualified to provide advice on CME matters, having been awarded the ACCME’s highest level of accreditation - Accreditation with Commendation – earlier this year. Thanks to that success, members of the WCM-Q Division of Continuing Development (CPD) were asked to join an expert panel at the ACCME’s annual meeting in Chicago to share their strategies, tools and advice on attaining the top level of accreditation with other international medical education institutions. As part of their involvement, WCM-Q CPD team members Deema Al-Sheikhly, CPD Director, and Laudy Mattar, CPD Manager, presented a

WCM-Q’s Demma Al-Sheikhly, right, and Laudy Mattar

workshop entitled ‘Digital Tools to Engage our Lifelong Learners’ at the three-day conference. Ms. Al-Sheikhly also joined a panel of senior executives and CME staff for a discussion session entitled ‘Actualizing Best Practice with ACCME’s Menu of Criteria of Accreditation with Commendation’. In addition, a submission outlining WCM-Q’s innovative programs developed to meet the needs of an evolving healthcare system was published on the ACCME conference app.

our peers at other leading medical education institutions.” WCM-Q achieved Accreditation with Commendation in January by following ‘Option B’, the second of the ACCME’s two sets of advanced accreditation criteria, which requires organizations to advance interprofessional collaborative practice, address public health priorities, create behavioral change, show leadership, leverage educational technology, and demonstrate the impact of education on healthcare professionals and patients.

Ms. Al-Sheikhly said: “We were delighted to be asked to share our experiences of achieving Accreditation with Commendation from the ACCME with other ambitious CME providers from across the US and beyond. Developing high-quality CME activities for physicians and other medical professionals is a crucial part of ensuring standards of medical care and patient outcomes are continuously improved, so we were extremely keen to both share our knowledge and learn from

Dr. Thurayya Arayssi, Senior Associate Dean for Medical Education and Continuing Professional Development said: “I am extremely proud and pleased that our WCM-Q CPD team has created a CME program of such quality that we are being invited to share our expertise with other leading medical education institutions around the world. This is testament to the hard work and ambition of Deema Al-Sheikhly and the rest of our extraordinarily dedicated CPD team.”

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IME Medical Electrospinning Launches MediSpin XL™, a Cutting-Edge High-Volume Electrospinning Production Platform

ME Medical Electrospinning is the worldwide leader and scientific partner in electrospinning equipment development and services for medical devices and regenerative medicine. The company announced the launch of its newly developed revolutionary MediSpin XL™ platform for large-scale industrial manufacturing of reproducible and scalable fiber-based scaffolds for Class I, II and III medical devices. The launch of the platform marks a global breakthrough in the controlled large-scale production of well-defined scaffolds for implants and membranes using fibers ranging from nanometer up to micrometer scale. Applying specific polymers, IME’s advanced equipment creates fiber-based medical device solutions that mimic the natural human extracellular matrix in nanometer and micrometer format for implants and membranes in the human body. Human cells recognize this artificial matrix (scaffold) as the body’s own facilitating the repair of the damaged tissue for heart valves, blood vessels, nerves, tendons, skin and bone etc. This is in contrast to implants and membranes of traditional structures, which are seen as foreign and therefore can lead to scar tissue or rejection phenomena. The MediSpin XL™ platform has been developed specifically for MedTech industrial manufacturing of medical devices and ensures the firm control of the crucial parameters of the electrospinning process, leading to identical and consistent end-products. Judith Heikoop, Managing Director of IME Medical Electrospin-

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ning, says: “The global launch of our state-of-the-art production platform is testimony to our strong belief in the strategic goal of becoming the leading developer and producer of the most advanced electrospinning equipment for both large-scale production and R&D purpose, and broadens our trusted partnership worldwide in co-developing electrospun medical devices, which are seen as true game changers in the MedTech industry.” Ramon Solberg, Founder and Managing Director of IME Medical Electrospinning, says: “This technology enables the large-scale manufacturing of reproducible and scalable fiber-based scaffolds, the wonderful pieces of art that will substantially transform the medical device market for a wide variety of medical applications and thus revolutionize regenerative medicine.”

MediSpin XL™, resolving distorting factors in electrospinning The electrospinning process is governed by a number of variables that are crucial for success in research and development, but certainly also for large-scale manufacturing of fiber-based medical device solutions. Crucial parameters in fiber diameter and structure, porosity, mesh thickness and tensile strength are vital for the in-vitro and in-vivo functionality of products, but were challenging to control in the past. In particular, changes in temperature and relative humidity between the seasons and during the day, could lead to inconsistencies within one batch as well as between batches. The groundbreaking MediSpin XL™ platform resolved all this and is the result of IME’s pioneering

research and more than a decade of medical electrospinning experience in manufacturing smaller scale R&D equipment. MediSpin XL™ is the first large-scale production platform that eliminates all the important factors that might distort the electrospinning process, enabling an optimal process set-up and stability, including climate control and on-line quality monitoring measurements, ensuring a consistent end-product. The MediSpin XL™ equipment is built using state-of-the-art materials & process controls in compliance with tight regulatory requirements for medical products to minimize the chance of product contamination during the process. Down-stream process steps such as cutting and blistering can be easily included in the system. And lastly, ultimate automation minimizes the need for operator intervention, which further adds to a reproducible process and minimization of product contamination during the process.

New world standard With the introduction of the MediSpin XL™ platform, IME has further strengthened its global standard for the joint development and production of scalable and reproducible nanometer and micrometer scaffolds. To this respect the company recently commissioned its brand new high-end GLP Laboratory and set of ISO 7 cleanrooms. With these, IME is now able to not only develop and manufacture its top-end proprietary electrospinning equipment, but to also produce the actual scaffolds for the intended medical implants for their customers. The cleanroom facilities enable the production of Class I, II and III medical devices.

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Aspire Zone Foundation and Carnegie Mellon University in Qatar ink a strategic partnership agreement backbone of our professional future. The doors of Aspetar and Aspire Zone Foundation will always remain open to educational organisations, which have a wonderful opportunity to benefit from Aspetar’s vast experience in sports medicine, Aspire Logistics’ experience sports event management, and Aspire Academy’s talent development experience.”

spire Zone Foundation (AZF), has signed an agreement with Carnegie Mellon University in Qatar (CMU-Q) at Aspetar, the orthopaedic and sports medicine hospital. The agreement paves the way for strategic collaboration in multidisciplinary areas including research and strategic studies, and organising joint conferences, seminars and workshops. Abdulla Nasser Al Naimi, Director General of Aspire Logistics, and Michael Trick, Dean of CMU-Q, signed the new memorandum of understanding at Aspetar in the presence of Khalid Al Mawlawi, Chief Administrative Officer at Aspetar, and Fadhel Annan, Assistant Dean, Government and Corporate Affairs at CMU-Q. The new partnership provides CMU-Q students with access to numerous educational benefits, including training by Aspetar’s experienced scientists in Pathology, Biomedical Informatics, Translational Medicine, Experimental Genetics and Genom-

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ics. Students will also have access to training, development, scholarship, internship and employment opportunities at Aspetar and other AZF member organisations.

Meanwhile, Michael Trick, Dean of CMU-Q, said: “We are very pleased to sign this agreement with the Aspire Zone Foundation. At Carnegie Mellon University, we emphasize real-world problem solving in all of our academic programs. By working closely with organizations like the foundation, our students gain the insight, experience and understanding of questions that are important on a local, national and global scale.”

Commenting on signing the agreement, Abdulla Nasser Al Naimi, Director General of Aspire Logistics, said: “By formalising our collaboration with one of the top-ranked global universities here in Qatar, we are continuing our commitment to developing the next generation, who will become the

The agreement will provide many avenues of collaboration between CMU-Q and Aspire Zone Foundation, particularly in the areas of CMU-Q’s undergraduate program offerings: biological sciences, business administration, computational biology, computer science and information systems.

MEDICAL INSTITUTIONS

Hôtel-Dieu de France (HDF) Vision 2020 succeeded in imprinting the hospital’s status as a reference medical center

ince its inauguration in 1923, Hôtel-Dieu de France (HDF), the Saint Joseph University (USJ) Medical Center, has always been considered as a reference medical center in Lebanon and the Middle East. Even after enduring years of war – especially given its position on the frontline – the hospital emerged intact and maintained its status as a renowned hospital with top quality care. In recent years, the hospital has experienced many changes and renovation projects and it adopted several policies to renew its infrastructure and to grow. The reason behind this is a 10-year strategy plan, Vision HDF 2020, set up by the Board of Directors in 2011. Vision HDF 2020 is based on six main strategic orientations: Human Resources, High-End Medicine, Fluidity, Quality and Risk Management,

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Optimization and Partnerships, and Positioning. For its strategic focus on Human Resources, the hospital’s main objective was to develop a recruitment policy of high-level professionals, as well as succession and retention policies. As such, Hôtel-Dieu recruited since 2011, 94 highly specialized and sub-specialized doctors (40 in 2018 alone) practicing cutting-edge medicine to join the team of the 200 already operational doctors. On the other hand, the retention of specialized and sub-specialized skills capable of transmitting knowledge and know-how is now regarded as a priority. While focusing on its High-End Medicine, Hôtel-Dieu de France acquired the latest medical equipment for several specializations including Radiation Therapy, 4D Ultrasound,

3D Mammography, Breast Macrobiopsy System, Osteodensitometry, HD Gastrointestinal Endoscopy, HD Endoscopic Surgery Systems, Immunohistochemistry Automata and Cardiac Catheterization (cath.lab). In fact, the department of Radiation Oncology at HDF has announced the upgrade of the radiation delivery systems to the latest version released to date by Varian Medical Systems. This included an upgrade of both TrueBeam radiation delivery systems to offer the latest Advanced Imaging Software designed and assure accurate targeting of the cancer, an upgrade of the Oncology Information Management System and an upgrade of the Eclipse Treatment Planning System. In addition, the hospital created several specialized centers, considered reference centers in Lebanon and even

MEDICAL INSTITUTIONS

the Middle East. As of today, the hospital has a unique Smoking Cessation Center, a Diabetes Education Center, a Sleep Center, a Rehabilitation Center (in partnership with RJC-Chicago), a Women’s Imaging Center, an Anesthesia, Resuscitation and Pain Treatment Center and a Family Medicine Center. To improve Fluidity, HDF established new circuits for its Operating Rooms and tech labs. However, the opening of the newly renovated ER was the biggest achievement in terms of fluidity. The new department is designed to meet the latest international accreditation requirements and equipped to handle any type of emergency. The centralized reception area will serve as a reception, sorting and orientation station that helps patients to swiftly complete their paperwork; while the centralized medical monitoring will allow the staff to promptly receive any updates regarding any patient. When it comes to Quality and Risk Management, the hospital enforces multidisciplinarity in its health care service and management. With team members from different backgrounds and professions, the hospital promoted good communication between all its agents, who were able together to develop patient satisfaction. In addi-

tion to its high-quality service, HDF obtained the highest accreditation scores in 2011 and is currently working on the upcoming accreditation requirements aiming to meet them and pass the benchmark with flying colors. Optimization wise, the hospital adopted new policies to increase its activity while maintaining adequate financing and budget management. In addition, and to keep up with the latest medical advancements, Hôtel-Dieu de France was the first Lebanese hospital to implement a fully integrated Hospital Information System (HIS), rendering itself Lebanon’s first “e-hospital.”

And finally, to enhance its Positioning and Partnerships in the MENA region, HDF improved its visibility and even created international packages for check-ups. In fact, Hôtel-Dieu de France participated in the 2017 Arab Health held in Dubai where the HDF team presented four medical packages set up for international patients offering general, cardiovascular, gynecological and smokers/former smokers medical evaluations. With numerous collaborations with the Lebanese Ministry of Public Health and several new partnerships with insurance companies and medical centers, Hôtel-Dieu’s positioning was greatly enhanced. Furthermore, the hospital took part in numerous international campaigns and conferences such as the Child-Mother Network of Francophonie conference and the World No Tobacco Day campaign. The past decade at HDF has certainly been buzzing with activities. However, reaching the end of the 10year mark, Hôtel-Dieu de France can proudly say that Vision 2020 has, and greatly so, succeeded in imprinting the hospital’s status as a reference medical center.

ARTICLE

Why BREAST CT instead of Mammography?

n general, women have been seeking change for decades and rightfully so! Dedicated cone beam breast computed tomography (CBBCT)is the latest in a long history of breast imaging techniques dating back to the 1960s. Breast imaging is performed both for cancer screening as well as for diagnostic evaluation of symptomatic patients. Dedicated breast CT received US Food and Drug Administration approval for diagnostic use in 2015 and again in October of 2017 for the redesigned commercial model. Breast CT is slowly gaining recognition for its value in diagnostic 3-dimensional imaging of the breast, and for injected contrast-enhanced imaging applications. Conventional mammography has known limitations in sensitivity and specificity, especially in dense breasts.

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Although breast tomosynthesis (limited sweep angle linear tomography) was US Food and Drug Administration approved in 2011 and is now widely used, dedicated Cone Beam Breast CT (CBBCT) is the next technological advance combining Isotropic, 3-dimensional imaging allowing for the ease of contrast administration as needed; much like whole body CT imaging with and without contrast. CBBCT removes painful compression and manipulation of the breast currently required to obtain digital mammography (FFDM) or tomosynthesis (DBT) images. Since the beginning of mammography women have complained about painful compression. Dedicated cone beam breast CT provides a long-awaited answer to these complaints.

TOP 10 Reasons Cone Beam Breast CT (CBBCT) is needed

1. It is the next technical improvement after mammography and tomosynthesis have reached their limits. 2. One “view” only per breast, then we can “manipulate the image not the patient.” 3. It is better for dense breasts (eliminates overlap). 4. Reduces false positives and false negatives. 5. Better resolution than MRI (CBBCT can achieve as high as 0.155mm3 resolution and can visualize fine calcifications). 6. Ease of contrast administration when needed. 7. Less costly to perform. 8. Shorter time to perform than diagnostic mammography and MRI (10 second acquisition time). 9. Improved patient comfort, no compression and no hands-on manipu-

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lation of the breast. 10. 3D-guided biopsy reduces dose by over 50%

Why we need Breast CT - Problems with Mammography •

Mammography has Low sensitivity - 85% at best < 50% in dense breasts >40% of women in the US have dense breasts >80% in Asia • Note: The risk of cancer in dense breasts is 4 – 6 X relative risk • Compression (“masking” effect- overlapping structures) • Uncomfortable • Undignified procedure to withstand • We need something better...

Why Breast CT – True Isotropic 3D Imaging •

• •

•

Breast is a 3D structure – 2D imaging is subjective leading to much more additional imaging Compression increases problematic tissue overlap Mammography has distortion –false positives and false negatives Women don’t like it!

Simply stated, there is a need to detect breast cancer at the earliest possible stage, ideally before it becomes invasive. Recent national benchmarks show that 76.9% of cancers detected by screening digital mammography are stage 0 or 1, indicating that one- fourth of the cancers are not detected early enough. Imaging of the breast needs a high-resolution, high-contrast technology capable of both detecting calcifications as small as a few hundred microns, as well as subtle density differences to be able to detect early

cancers. This requires moving beyond mammography and recognizing that it is also important to plan for contrast administration. When a contrast enhanced examination is indicated, it needs to be performed at an acceptable radiation dose. CBBCT utilizes a high-quality mammography X-ray tube and detector placed onto a slip ring very similar to whole body CT scanners although utilizing radiation doses in the same range as diagnostic mammography. Since all of imaging exists in a continuum, it can be understood as to how breast imaging exemplifies this concept. From the earliest experiences in breast imaging in the 1960s, imaging of the breast has evolved through xeromammography, screen-film mammography, digital mammography, and now breast tomosynthesis. Breast imaging has become more sensitive and specific with each technological advance. Each technology ultimately reaches a performance plateau, and subsequent technological advances are needed such as with digital mammography gradually giving way to breast tomosynthesis. At this time, breast tomosynthesis is the closest mammography can come to 3D imaging. It is a technique, allowing several low- dose slices of the breast to be reconstructed in planes parallel to the detector. However, it still has many of the limitations of 2-dimensional mammography such as compression and substantial tissue overlap between successive slices, particularly in dense breasts. Limited angle linear tomography or in the case of breast imaging, digital breast tomosynthesis, suffers from SSP (Slice Sensitivity Profile), a condition that is avoided by introducing Isotropic 3D imaging only found in CT imaging. CBBCT is the next technical development, allowing

Avice O’Connell MD. FACR, FRCPI. Director, Women’s Imaging Professor, Imaging Science University of Rochester, New York for true Isotropic 3D imaging of the uncompressed breast resulting in visualization of potential abnormalities equally from any angle.

Need 3D Imaging for a 3D Structure If we were to start designing an imaging system today for early detection of breast cancer, the current method of compression 2-Dimensional mammography would almost certainly not be the first choice. Requirements would include low radiation dose, some form of 3D imaging that would not require vigorous and often painful compression of each breast twice for the initial screening and to replicate how cancer is detected in the rest of the body via CT imaging with and without contrast. CBBCT provides all these modern benefits, eliminates many of the well documented limitations of FFDM and DBT and will stand as an effective and efficient alternative to breast MRI.

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OGT celebrates opening of new Cambridge site State-of-the-art premises increases operational footprint and will host Sysmex global R&D facility the opening of our state-of-the-art facility in the heart of the Cambridge life science hub. OGT continues to perform well with sustained growth and this investment by Sysmex will accelerate our next phase of product development and global expansion.”

xford Gene Technology (OGT), A Sysmex Group Company, has celebrated the opening of its new facility in Cambridge, UK. The opening ceremony, which took place on 3rd June at the company’s new premises on the prestigious Cambridge Science Park, was attended by the Department for International Trade (DIT) and local media as well as top-level representatives from OGT and its parent company, Sysmex Corporation. The new facility boasts impressive, state-of-the-art refitted laboratories and is approximately three times the floorspace of the previous site. OGT acquired fluorescence in situ hybridisation (FISH) probe manufacturer Cytocell® in February 2014 with 30 employees. Since then, the company has significantly increased

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its portfolio, including launching the largest FDA-cleared in vitro diagnostic (IVD) FISH probe range for AML (Acute myeloid Leukaemia) and MDS (Myelodysplastic syndromes) on the market. The number of employees based in Cambridge has increased to 53 and continues to grow, driven by strong double-digit sales growth. As a result, Sysmex has demonstrated its confidence in OGT and the Cytocell brand by expanding operations with the opening of this new facility to cope with increased volume of product manufacture and shipment. In addition, OGT plans to create a training and demonstration facility where customers can benefit from the company’s renowned FISH expertise. John Anson, CEO of OGT commented, “We are thrilled to celebrate

As well as demonstrating its support for OGT, Sysmex also affirmed its confidence in the UK’s life science industry, by confirming that it will set up a global R&D facility within the OGT laboratories - similar to other sites in Hamburg and Chicago. This facility will serve to evaluate new technologies in the life sciences field and pursue collaborations with key opinion leaders, delivering innovative new products to the market. The facility will also be a hub for networking within the life sciences community, Cambridge University and global healthcare companies International Trade Secretary Dr Liam Fox MP said: “With a combination of top universities, research institutions, global life sciences companies, increasing government support and world-leading talent, the UK is a fantastic place to invest in research and development. As an international economic department, DIT is determined to boost investment into our life sciences sector and we are pleased to support Sysmex’s significant investment in Cambridge. We are busy forging a vision of the UK as a world-leader in innovation and technology, and aim to make the UK the best place for life sciences businesses to grow.”

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Saudi German Hospitals Group signs new partnership with Careem for the benefit of patients

audi German Hospitals (SGH) Group has revealed the signing of a new strategic partnership agreement with Careem to provide its patients with convenient transportation services to and from the hospitals across the Kingdom of Saudi Arabia. The newly formed alliance demonstrates the hospital’s continuing commitment towards providing its patients with world-class healthcare services-improving the patients’ experience and making their hospital visit more pleasant and convenient. Makarem Sobhi Batterjee, Vice Chairman and Deputy President, Saudi German Hospitals Group, said: “We are

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proud to announce the signing of this strategic new alliance with Careem, which aims to provide key transportation solutions to patients who are coming and leaving the hospital. This agreement will help pave the way in addressing our patient’s transportation needs. This move is part of our continuing commitment towards improving lives as well as ensuring our patient’s happiness.” Iyad Anwar Al Dalooj, General Manager, Careem, shared that the company is pleased with the signing of this new partnership agreement, which reflects the company’s continued commitment towards establishing

new quality standards to provide safe and reliable services to its passengers. He also stressed on the importance of the new cooperation, especially in facilitating the transport of patients to world-class healthcare providers such as Saudi German Hospitals to take care of the health needs of the community. As part of this agreement, patients will benefit from 20 per cent discount to patients going to and from Saudi German Hospitals. In addition, complementary rides will also be provided to discharge patients upon their departure from the facility, allowing them to get back home safely and comfortably.

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ARTICLE FEATURES . Diagnostic Tests for Cardiovascular Diseases

DIAGNOSTIC TESTS FOR CARDIOVASCULAR DISEASES Wide Range of Options for a Highly Accurate Diagnostic

any diseases fall within the category of heart disease, such as those related to arteries, the valve, or the myocardium and the weakness it may experience due to ischemia. Nowadays, cardiovascular diseases are the most deadly ones and the leading cause of death around the world, which has raised awareness about the possibility of prevention by avoiding some bad habits in daily life. Statistics and huge numbers of patients with cardiovascular disease are the greatest motivation of many scientific studies and medical research

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that led to advanced treatments, which had a crucial role in making a radical change in medicine and heart disease. Some of the diseases that had been fatal in the past became treatable and with which the patient can live for several years. Modern treatments have been able to prolong the life of heart patients, provided they follow a healthy lifestyle. Modern treatments have been preceded by a remarkable development in the diagnostic field. Cardiovascular diseases have had an ample share in terms of accurate diagnosis. Today, there is a wide range of diagnostic options that allow the doctor to

ARTICLE FEATURES . Diagnostic Tests for Cardiovascular Diseases

check and look for heart palpitations, clogged arteries, cardiomyopathy, and other diseases that can affect the heart and its arteries. Cardiology diagnostic tests contributed to a great extent not only to the development of an accurate treatment plan and prolongation of patients’ lives, but also to the early detection based on the principle of prevention, especially if the disease runs in the family. The patient can detect the disease before it occurs and reduce the possibility of its development by following advanced medical and therapeutic guidelines.

Electrocardiography (ECG) This test detects the problems related to the electrical function of the heart by transforming the electrical activity in the heart from electrical signals to waves displayed on a paper. Cardiologists consider this test a diagnostic tool if the patient suffers from arrhythmia, coronary artery disease that causes chest pain or a heart attack, a previous heart attack, or structural problems in the heart chambers. The mechanism of this test relies on activating each heartbeat by an electrical charge usually generated from special cells in the atrioventricular node, and then the ECG records the timing and strength of these signals as they travel through the heart.

The symptoms that require an ECG are: • • • • •

Heart palpitations. Chest pain. Shortness of breath. Dizziness. Weakness and inability to exercise.

This test provides the doctors with adequate information about the electrical function of the heart, which

enables them to diagnose arrhythmia and determine the cause of chest pain, shortness of breath, heart palpitations, dizziness, and other symptoms. It also ensures that there are no risk factors that may affect the heart function such as high blood pressure, high cholesterol, triglycerides, smoking, diabetes, and family history of heart disease. ECG can diagnose many heart diseases such as acute myocardial infarction, arrhythmia, hypertrophic cardiomyopathy, pericarditis, myocarditis, and abnormal sodium levels. This test gathers information about electrical charges in the heart by connecting 12 leads to different areas of the body. These leads, or electrodes, are sensors for the body’s electricity that is related to the circulatory system, and are usually attached to the chest and upper and lower limbs. A standard ECG can record an abnormal heart rhythm only if it happens during the test. The patient lies on his/her back and small metal pieces (electrodes) are attached to his/her chest, wrists, and ankles after having sterilized the skin, and are connected to the ECG through electrical wires. After having attached the electrodes, the ECG is turned on to record the electrical signals in the heart and display them as waves on a special paper. The first thing to do is to inform the patient not to move or speak during this painless and risk-free test because this may distort the results. It should be noted that some abnormal heart rhythms may be temporary; in other terms, they tend to come and go within a short period of time. In this case, the doctor may recommend another type of heart rhythm monitor, such as Holter monitor, a small device that can be worn for a day or two in order to record the heartbeats and monitor the heart.

ARTICLE FEATURES . Diagnostic Tests for Cardiovascular Diseases

Holter monitor It is a battery-operated medical device that measures the heart’s activity, such as rate and rhythm. The doctor may recommend it to gather more detailed information about the heart functions because it is used for 24 hours during which it registers the heart rate. The Holter monitor also consists of electrodes, but fewer than the ECG. It is also known as the ambulatory electrocardiogram because the patient can wear it during the day and normally go about the daily life. It is a small device that contains

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many leads connected to electrodes that are attached to the chest skin with a glue-like gel. These electrodes pick up the heart’s activity as electrical signals and then transmit them to the monitor. This test is performed if the patient has signs of a heart problem, such as irregular heartbeat or fainting for unknown reasons. It is preceded by an ECG, but it’s a short test and sometimes it doesn’t detect the problem. Therefore, the doctor resorts to the Holter monitor which helps to detect irregular heartbeat. The Holter monitor is also used to

detect any pain in the chest and to look for other abnormalities that may affect the normal functioning of the heart. This test also helps to determine the long-term stability of the heart, whether the heart is getting enough oxygen, a delay of the electrical impulses in the heart, as well as the extent of the medication’s effect or whether any adjustments are needed. Once the monitoring period is over, the device will be returned to the doctor along with the registered data. Subsequently, he or she determines what is happening in the heart.

ARTICLE FEATURES . Diagnostic Tests for Cardiovascular Diseases

Echocardiogram Echocardiogram, or cardiac ultrasound, is a procedure through which the structure and the function of the heart are assessed. The waves transmitted by a special device bounce off the heart structure, producing an image of it. The audio signal is converted by a computer attached to the echocardiogram to an image displayed on the screen. The doctor performs an echocardiogram to assess the size and function of the heart, to determine the cause of cardiomegaly, chest pain, or shortness of breath, to evaluate the function of the heart valves, to check the causes of fatigue, heart palpitations, or high blood pressure, and to determine the causes of blood clotting that may lead to a brain attack. Echocardiogram helps the doctor diagnose certain diseases accurately and clearly in case the patient is suffering from a cardiac insufficiency, cardiomyopathy, irregular heartbeat, cardiomegaly, or heart clots. Sometimes, it can be done annually to monitor the heart function in heart patients, to check the heart be-

fore an operation, to monitor it after an operation, or to assess the risk of heart disease that runs in the family. Preparing for this test starts by injecting the patient with anesthesia. Then, he/she lies on the left side. The doctor or sonographer applies a gel to the chest near the heart, moves around a transducer, and starts recording images of the heart. This procedure takes between 30 and 60 minutes. This test doesnâ&#x20AC;&#x2122;t cause any pain but the patient may feel some discomfort in the chest or abdomen where the sonographer presses the device, which is necessary to obtain accurate images of the heart.

There are several types of echocardiograms:

blood flow in the arteries, veins, and various parts of the heart. The only addition in this procedure is the use of the computer. This test assesses the blood flow in the heart valves, its velocity, and its pressure. The flow increases if the valve is tightened.

Stress Echocardiogram: During this test, normal echocardiogram is performed before and after stressing the heart which can be done by physical exertion or by injecting the patient with medications that increase the speed of the heartbeat and the heartâ&#x20AC;&#x2122;s contraction. This test is used to diagnose coronary heart disease which leads to cardiac arrhythmia during effort due to a lack of blood flow to the heart.

Transthoracic Echocardiogram (TTE): This traditional test is performed by placing the ultrasound device on the chest on top of the heart and thus conveying the image of the heart.

Doppler Echocardiogram: It is a technical addition to the normal echocardiogram. It is possible to monitor the

Transesophageal Echocardiogram (TEE): The tube containing the transducer is guided down the throat and into the esophagus so that the transducer is directed towards the heart. This type of echocardiogram records a clear image due to the proximity of the heart to the esophagus.

ARTICLE FEATURES . Diagnostic Tests for Cardiovascular Diseases

Radionuclide Ventriculography (MUGA SCAN) It is an accurate method for assessing the general condition and situational status of the function of the left and right ventricles. Doctors resort to this technique in order to check the performance of the heart and the blood flow to it, and from it, in addition to examining the coronary arteries in charge of supplying the heart with blood. The narrowing of these arteries is called coronary artery disease. In short, it is possible to record images of the heart while pumping blood at each impulse. This test provides a cine type of image of the heart while pumping blood, which means during its contraction and relaxation. It shows if there is an increase or a decrease of the internal size of the ventricle. Therefore, the doctor can measure the amount of blood during the different stages of the heart cycle and then calculate the equivalent of the blood pumping of the ventricle. This test is characterized by its accuracy and credibility compared to other tests. Before the scanning, the patient is injected with a small amount of zinc pyrophosphate, which sticks to the red blood cells. After half an hour, the patient is also injected with radioactive technetium, which in turn follows

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the path of the pyrophosphate to stick to the red blood cells and make them radioactive. These substances allow the doctor to see and assess the inner wall of the ventricle. A healthy heart muscle absorbs the radioactive substance. However, it is impossible if the patient suffers from a myocardial infarction because the muscle is transformed into a connective tissue that does not contract nor absorbs the radioactive substance. During the scanning, the ECG starts recording because it is connected to the gamma device. The computer catches the heartbeat of the patient and generates a cine type of image of the contraction and relaxation of the ventricles, especially the left ventricle which is in charge of pumping blood to all parts of the body. The images obtained allow the doctor to assess the movements of the left ventricle and detect the cases of immobility, dyskinesia, or lack of movement. Any weakness of movement in any part of the ventricle wall indicates a narrowing of the coronary artery, whereas the lack of movement of the entire ventricle indicates a myocardial disease.

Few of the things that can be assessed while doing a MUGA scan are:

•

Assessing the volume of the ventricular pumping of blood and its percentage. Estimating the function of the myocardium after a heart attack. Evaluating the results of the medical or surgical treatment of coronary atherosclerosis. Checking the effect of some medications on myocardial function.

The MUGA scan is performed after having injected a radioactive substance into the body through a vein, where the patient is lying down beside a camera that captures gamma rays emitted by the radioactive substance. During an ECG, electrodes are attached to the patient’s chest. The radioactive substance is then injected and the patient should not move during the whole process. Before conducting the MUGA scan, the patient should inform the doctor if he/she is taking certain medications or is allergic to a particular one. Women who are pregnant should not have a MUGA scan. In case a woman is breastfeeding, she has to stop it for two days after the test. The patient should abstain from eating for about three hours.

NEWS

INTERVIEW

Sysmex Middle East is highlighting the breast cancer screening with Dr. Sama Adnan Zibdeh using Sentimag device

r. Sama Adnan Zibdeh is a Breast Surgeon at Mediclinic Parkview Hospital in Dubai, who has a wealth of experience, spanning over 14 years of practice. The Marketing Communications Specialist from Sysmex Middle East had the pleasure to meet with Dr. Sama Zibdeh to talk about breast cancer in general, her importance as a female Breast Surgeon and the role of the Sysmex Sentimag device in treating patients.

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INTERVIEW

SENTIMAG is a navigation system that uses magnetic particles to locate Sentinel lymph nodes. Application fields include Breast Cancer, Colon Cancer, Prostate and Gynecological Cancers. It is used with a magnetic tracer (MAGTRACE). It achieves the same results as standard radioactive tracers and allows the breast surgeon the possibility to work on his or her own and therefore simplifying the workflow. Below is the full interview:

Can you brief us about yourself? My name is Dr. Sama Al-Zibdeh, I am a breast surgeon from Jordan and I am considered the first female breast surgeon in my country. As you know, it is rare to find female surgeons in the Arab world in general, but in the last few years, we have seen more women working in the surgical field and those who choose to deal directly with women and perform breast surgeries like myself. I graduated from medical school in Iraq-Baghdad, and then I studied 7 years in General Surgery. During that time, I felt that I was interested in women who were suffering from cancer and I felt that I had a connection with them. Once I had completed my surgical training, I decided to do something to help our communities across the Arab world and I chose breast cancer surgery. I was lucky enough to have a three-year training in one of the foremost centre’s in Breast Cancer in Sydney, Australia’s Breast Cancer Institute. I had excellent training here because that center does not only focus on surgery itself but also incorporates breast imaging so I can read mammograms and I can perform ultrasounds, as well as MRI tests. I gained

a great deal of experience since we witnessed various cases that helped me a lot. When I finished my fellowship there, I decided to come back to my country so I stayed in Jordan and then I worked in the Kingdom of Saudi Arabia and Dubai. So, I was officially a breast surgeon as of 2005 and since then, I have been only doing breast surgeries.

What are the advantages of being a female working in breast surgeries in our countries? I think this is a blessing because for many years, women avoided visiting physicians to seek advice or for general checkups due to many barriers and cultural issues. Hence, being a female working in this field will make the patients feel less shy to expose themselves and talk about their breasts. Moreover, a female surgeon is able to understand exactly what a woman can feel.

At what age should a woman start checking her breasts? Women who feel a strange lump or experience pain or anything unfamiliar should try to seek advice from a professional physician. If there isn’t any dedicated breast surgeon in their country, then they can visit their gynecologist or family physician since he or she is able to examine the breast in a different and more specific way. The doctor can know if it is a serious condition or a simple one that is only due to hormonal changes. If women have no issues, when should they start doing their breast self-exam which is a simple exam performed by the women themselves? It can be done at home and doesn’t require any train-

ing. There are many resources on the internet and videos on how to do it. For young ladies, we ask them to do a breast self-exam until the age of 35. We advise it to be done a day after menstruation and once per month; you can alternatively do it anytime during the month. Once you get familiar with your breast tissues, then you will have a kind of memory about how your breast feels. If you start to feel something different or if you experience new symptoms, then this is excellent and you can help yourself by visiting a physician. From age 35 till 40, a woman should visit her family physician, breast surgeon or even her gynecologist to have an ultrasound because sometimes it can show things that the woman herself couldn’t feel while doing her breast self-exam. In addition, the physician will perform a clinical examination. When you reach the age of 40 and even if you don’t have any complaint, a visit to any dedicated clinic or center is a must in order to have your first mammogram. If a woman at any age has a problem or noticed something unfamiliar, she should immediately visit a dedicated center to examine her case. If a woman has a significant family history, first or second-degree relatives who had breast or ovarian cancer, she must not wait until the age of 40 because these ladies are at higher risk. If women have been exposed to certain hormone medications or radiation, they should be also visiting breast clinics sooner. We cannot tell those cases to stay at home and come only at age 40; we recommend them to visit earlier if they notice something different in their breast just like if they

INTERVIEW

are at a higher risk. Cancer can happen at any age, whether a woman has had children or not, and it might happen in the left or right breast. But if we want to be scientific, there are certain risk factors that increase the chance of having breast cancer. For instance, it’s more common among older women but that is not to say that young ladies are not also at risk. Also, breastfeeding is a protective factor but there is no guarantee. I always tell the patients you are always at risk because you are a woman.

How much does the environment play a role in risk factors? We can have genetic as well as environmental factors and we can keep talking for hours about environmental factors like toxins found in food and cosmetics and in everything around us. But again many people lead a healthy lifestyle and still have cancer. Studies show that women who have an unhealthy lifestyle and gain weight without doing any regular exercise have a higher risk of having cancers in general. Until we have studies from all over the world and all ethnic groups we cannot say that there is a specific reason but we can talk about risk factors. I wish we could have a specific reason.

What do you think about the importance of awareness campaigns? Women are very anxious and I think campaigns are a positive thing because nowadays we have awareness everywhere and people are talking about it. Women have become more conscious about checking their

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breasts and they want to see specialists and dedicated breast clinics, so yes we see more women coming in for the examination. But on the other side, and from my own experience, sadly there is a high level of anxiety around the subject still. I want women to come all year round not only during the campaign, and I don’t want them to panic since we should not exaggerate or create fear around it.

What are the different stages of breast cancer? In general, there is a universal rule for any cancer that we stage it according to three elements: the size of the tumor, and then we check the lymph nodes to see if they are affected, also we look into the tumor if it’s spreading beyond the local area which is the breast or the region which is the lymph node so it becomes systemic which means that its spread into different organs such as the brain or lungs or bones. Once we know this information by performing the special tests and physical examination sometimes including CT scan, ultrasound, a check of the whole body by doing the complete workup which we call a staging workup, then we have all the data to classify cancer into stages: 1. Stage 1 is when the cancer is small, less than 2 cm in the breast without lymph nodes, this is the best stage to detect since the cancer is so early and the treatment is not heavy. 2. Stage 2 means that there are some spreads into the lymph nodes but the tumor is still small less than 5 cm. 3. Stage 3 when the tumor becomes bigger more than 5 cm with some changes in the nipple and the

skin. It looks like an orange peel and the nipple is inverted and, we have more lymph nodes involved. 4. Stage 4 any size of the tumor or any number of the lymph nodes is involved but it is spread outside the local and the regional area. The tumor spreads into other organs in the body which we consider to be ‘Metastatic’. Stage 4 doesn’t mean the end and we should not treat it as such. Of course, it would be best to diagnose it early for optimal results; but if we look at stage 4, the treatment is heavier and the chemotherapy will be taken for a long time with high concentrated dosage. In some cases, the patient must undergo surgery. Frankly, we don’t expect any specific results as we don’t know how the body will react to treatment; in some cases, treatment works very well and they can stay free of the disease or at least controlled. The rule is that if we can catch the tumor earlier this would be ideal.

What are the different treatments one can undergo? To make it simple, surgery is

INTERVIEW

part of the treatment and it can be done to remove part of the breast or the whole breast. Surgery involves removing the lymph nodes depending on each case and removing one node called the sentinel lymph node biopsy which means we don’t remove the whole axillary nodes glands. We just take one and check if it is positive for cancer cells than we have to clean all the other nodes, and if it is negative we don’t perform a major surgery to remove the woman’s axillary nodes because once we do this surgery there is a high chance of having complications in the future such as shoulder pain and swelling, these symptoms obviously deteriorate the quality of day-to-day life. Nowadays, surgery has many advantages, even if we do a mastectomy we can still preserve the natural skin of the breast with the nipple, so this is called skin and nipple scale mastectomy. Also, we can do an immediate reconstruction of the breast using implants or the woman’s body tissues. It is a kind of plastic surgery along with the cancer surgery and I think this is something good for the woman not to think that they will end up with flat chests. The second element in treatment is chemotherapy, which is most of the time an intravenous medication but now we have a lot of oral medications and usually, we follow protocols since we give a mix of medications and we follow a certain dosage which could be given on a weekly basis or every three weeks. The response will be monitored by an oncologist. Sometimes women need to undergo the surgery first and then chemotherapy or vice versa. It depends on the stage

of the tumor or the case itself. The third element is the hormonal therapy which is about giving injections, or tablets because some tumors are very sensitive to estrogen and progesterone so we give certain medications to block these hormones then we can achieve some sort of control of the cancer cells. We have also immunotherapy and the famous one is called HERCEPTIN which is not chemotherapy, it was actually a breakthrough in medicine in treating breast cancer. This is an antibody that works in blocking the receptors of a growth hormone called human growth factor. However, it cannot be used in all cases. I think nowadays, many treatments are evolving and I have to mention that hand in hand we have conventional and non-conventional treatments like alternative medicine such as focusing on eating healthy and doing exercises. I’m not saying we treat cancer with these ways personally but it goes hand in hand because it helps detoxify the body and improve the immune system and it makes the women respond to treatment better. So I always tell patients don’t ignore your soul, your food, don’t stop exercising and try to make a balance. Don’t forget that we are using heavy toxic treatments and we need to counter the effect of toxicity on the tissues.

You have already collaborated with Sysmex before, by using one of our devices in the Sentimag. Can you tell us how much it helped you to make a better diagnosis? Actually, I use it after diagnosis when we are operating on the tumor so we want to do a procedure called

sentinel node biopsy. I’m a big fan of it for many reasons and I encourage all breast surgeons to try it. The reason is that there is no dye involved as methylene blue or vital blue so I don’t have issues with allergy and with permanent pigmentation of the skin. This can be done when the woman is under general anesthesia, so she doesn’t see needles going into her breast and won’t have any anxiety. Once you learn the technique and get used to it, it becomes very useful, easy and simple. The technique itself is easy like any sentinel node mapping technology but the difference is that you don’t have to do tests in other departments and get approvals. In addition, there are no other persons involved as when you do nuclear medicine mapping with the radioactive material. To clarify, I know that some techniques remain the gold standard and the preference for surgeons, but I think every breast surgeon should give this modality a try. For me, these are the main points, and when I summarize it, I find it very easy for women as they don’t need to go from one department to another and won’t need to worry about insurance, double payment or approval issues. With a procedure that is done in another facility, they don’t have this anxiety of going back to have their needles injected while they are awake. If you compare it to blue dye, it can be given when a woman is under general anesthesia, but again you don’t have the mapping device so you have to dissect and it depends on your experience and visualization of blue dye.

ARTICLE

Twin-to-twin transfusion syndrome: First successful fetoscopies in Lebanon Gihad CHALOUHI MD, PhD Fetal medicine and Fetal surgery

or too many years now, twin-to-twin transfusion syndrome (TTTS) affecting monochorionic twins* has been an untreated pathology in the Middle East. It is a serious pathology which, if left untreated, causes the death of both twins in 90% of cases. In recent years, the development of new treatments has changed this prognosis, reducing intrauterine mortality to around 20%. Few medical teams around the world have qualified doctors to do it and the resources to perform such complex procedures.

After the initiation of the first fetal surgery center in Lebanon a year ago, and the success of ten fetoscopies for laser coagulation of anastomoses for twin-twin transfusion syndrome (TTTS) in Beirut, we are proud to share this story and talk about this dangerous but curable disease. In all monozygotic pregnancies, these identical twins share the same placenta on which the 2 umbilical cords are inserted. In these specific cases, blood vessels connect the cords of the 2 babies. In 15 to 30% of cases, these connections (called anastomoses) will cause a circulatory imbalance, causing the transfusion of a twin, the recipient, by the other who becomes the twin donor. Because of this poor distribution of blood between the two fetuses, a big volume of fluid from the donor twin passes into the blood of the recipient twin: the mechanisms involved in this imbalance are responsible for the symptoms of TTTS: The recipient twin will have an

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overload of blood volume which will cause an increase in his urine output, which creates an excess of amniotic fluid (polyhydramnios). The donor twin may have a ‘decrease in blood pressure’ and a small/ empty bladder. The donor twin will hence not produce urine and therefore will have too little amniotic fluid volume (oligoamnios). TTTS is hence also called Twin Oligoamnios Polyhydramnios Sequence (TOPS). The diagnosis of TTTS is made in most cases in the second trimester of pregnancy, during the routine follow-up ultrasound.

The diagnostic criteria are as follows: •

Difference in amniotic fluid with too much amniotic fluid (polyhydramnios) in the recipient and very little amniotic fluid (oligoamnios) in the donor. When this oligoamnios is extreme (anamnios), the fetus

•

is pressed against the uterine wall and is called stuck-twin. Difference in the size of fetal bladders with the bladder of the recipient clearly visible and that of the donor most often little or not visible. The weight discrepancy between the fetuses is classic, although absent in half of the cases. For the pregnant woman, excessive weight gain (related to excess fluid), distended and sometimes painful uterus.

Once the diagnosis of TTTS is confirmed, the gold-standard treatment is fetoscopy for laser photocoagulation of the anastomoses. This treatment has been scientifically proven efficient and superior to amnioreduction (removal of excess fluid from the recipient’s amniotic sac). It is a technique of micro-surgery in utero, developed validated in 2004

ARTICLE

by Pr Yves Ville and his team. The coagulation of laser anastomoses treats the cause of the syndrome, thus interrupting the blood circulation between the two fetuses. After local or regional anesthesia and under ultrasound control, the doctor introduces into the amniotic sac of the recipient twin, a trocar (big needle) through which will pass the fetoscope which is a small camera to see the anastomoses on the placenta. With the help of the fetoscope and the laser, the anastomoses will be coagulated under direct vision. The average duration of intervention is approximately 20 minutes; it ends with an amnioreduction intended to immediately relieve the patient, and to follow up on the effectiveness of the intervention on the long term. With this treatment, the prognosis of TTTS has been transformed. Recent studies demonstrated an overall survival rate of at least one child in 80% of cases. In our center, Gihad CHALOUHI, MD, PhD has returned to Beirut after an extensive experience in Hôpital Necker-Enfants Malades in Paris, under the supervision and training of Professor Yves Ville, a pioneer in fetal surgery. We were able to manage during the first two years and while acquiring all

FETUS HANDS

the needed equipment, numerous vesicoamniotic shunting for lower urinary tract obstruction, and thoraco-amniotic shunting for compressive pleural effusions. Moreover, and as national and regional premières, we succeeded in performing two fetoscopies for plug tracheal occlusion to cure congenital diaphragmatic hernia in Beirut.

“Where there is life, THERE IS HOPE!” With today’s medical advances, we fight with all our Heart and competence against loss of pregnancies and fetal deaths due to treatable fetal pathologies. We make it our mission and advocacy to do our utmost to protect

FETUS FACE

and treat these babies-to-be. We hope to offer more fetal therapies and surgeries to more expectant women in our fetal surgery center. Let’s change the world, one baby at a time... *Monochorionic twins are identical twins who share the same placenta. If they share the same amniotic sac they are called monochrionic monoamniotic twins. When each twin has his own amniotic sac, they are called monochorionic diamniotic twins. Gihad CHALOUHI MD, PhD: gihad.chalouhi@gmail.com +961 3 803 214

HAND STUCK TWIN

MEDICAL INSTITUTIONS

ID Doct

A FIRM COMMITMENT TO THE DIGITIZATION OF DOCTORS

hysicians cannot live outside the digital revolution that floods practically all areas of society. Digitization has become the mantra of many of the organizations operating in the health sector, and medical associations and colleges cannot be left behind. In this context, ID Doct, the digital identification developed by MMG, was born. The Spanish technological start-up is making a firm commitment to the digitization of doctors with the launch of this mobile application. ID Doct offers a secure environment that provides a direct communication link between the professional and their representative bodies. ID Doct is a digital card that unites professionals and their organizations, whether ministries of health, professional associations or scientific societies. The digital card designed by MMG makes the doctor the protagonist of this digital revolution. With ID Doct, the professional can identify themselves digitally before any institution, store documents related to their professional life and access the services and benefits of their institution in an agile and simple way.

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Thanks to ID Doct, doctors can carry their curriculum vitae, certificates and continuing medical education diplomas on their mobile phones. Among the functionalities of this tool are the digital identification of the doctor, the storage of all types of documents related to their education, real-time notifications, emergency alerts and access to votes and surveys conducted by the professional organization to which they belong. In the future, it will also make it possible to manage electronical prescriptions. The institutions will be able to request, if they wish so, the digital numbers of the electronic prescriptions.

How does ID Doct work? ID Doct is the tool that MMG puts at the service of medical organizations to better know their members and thus be able to respond to all their needs. The professional organization (medical association, scientific society, etc.) will manage the application. They will have a management panel where they can organize and analyze all the information of their members. For their part, professionals only need to download the application in Google Play or App Store and have an

internet connection. The institution will provide the professional with the account with which to begin to enjoy the advantages of ID Doct. In the panel, the professional organization will be able to register new users in a massive or individualized way. It will also be able to create work groups by specialty, work centre or place of residence. The permanent updating of doctors will also be done through this panel, as it allows to issue all kinds of notifications in real time. Thus, the institution to which the doctor belongs will be able to send communiquĂŠs, news, organized events, etc. ID Doct will also allow the professional organization to get to know its members better through surveys and votes that can be programmed in the management panel. From this same space, the manager will be able to access the results and participation data of the survey or vote.

Digital certification of competences Among the advantages of having a digital ID such as ID Doct is the fact that it allows the doctor to certify their professional condition, as well as their skills and specialties. On the oth-

MEDICAL INSTITUTIONS

er hand, having a digital ID allows the professional to interact at a distance with administrations and other professional organizations. It also favors the exploitation of data related to the management of the organization and speeds up the formalities that previously required a personal appearance. In addition to the advantages for the organization, the implementation of ID Doct will also bring benefits to members. Medical professionals registered with ID Doct will have access to MedsBla: MMG’s encrypted communication system. MedsBla is a corporate environment that allows the user to be in contact with other professional colleagues. This mobile application also has a desktop version and guarantees the confidentiality and absolute security of the information. It has been developed under the protection of European and American data protection regulations (GDPR and HIPAA). Professionals will be able to enjoy tools such as a specialized semantic search engine, a complete pharmacological guide, more than 250 medical calculators classified by specialty, scientific and medical news and an attractive 3D anatomy software. Thanks to MedsBla, doctors will be able to have private communication spaces. These channels encourage free communication between profession-

als. Users can also have an unlimited number of private work groups, make individual and collective video calls, send and receive multimedia messages and share documents.

Why bet on ID Doct? Despite the rapid development of digitization, there are still barriers in certain organizations. One of the most outstanding of all is the lack of trust. As the “Balance on Fujitsu’s Digital Roadmap” report points out, it is essential to strike a balance between digital solutions and existing structures.

One of the advantages of ID Doct is that it is a two-way communication channel, which fosters cohesion and a sense of belonging among professionals. “ID Doct guarantees a more agile and efficient management of the organization,” explains Alberto Celada, Product Owner of ID Doct. “At the same time, it favors a more personalized attention to the members of the organization and encourages their commitment to the institution that represents them,” he adds.

Digitization:The Road to Growth

MEDICAL INSTITUTIONS

As the Fujitsu report emphasizes, “by harnessing the power of data offered by digitization, organizations will be able to follow the right path to growth and competitiveness. Among the advantages Fujistsu sees in the digitization of organizations is customer retention and loyalty. In addition, a successful digital transformation guarantees an increase in productivity in the organization and favors the optimization of processes and operational efficiency. For Juan José Rodríguez Sendín, President of the Central Commission of Deontology of the OMC (Organización Médica Colegial de España), “ID Doct is already defending the future of the digital era in the health sector”. Rodríguez Sendín believes that institutions are improving communication with doctors through direct and secure channels. This contributes to making the services of medical organizations visible, says Rodriguez Sendín. Mónica Terán, co-founder of the Vocalía de Médicos Jóvenes de Familia in Catalonia (Spain), stressed that “ID Doct is essential in the age of online content”. Terán assures that ID Doct helps the doctor to have his professional information accessible and stored in a secure way. “The doctors feel this way an agile service because we reduce the bureaucracy of the institutions. In this way we save time and invest in the future,” he says.

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ID Doct in Latin America Another possibility offered by ID Doct is to make a register of professionals available to medical organizations. The Medical Associations of Mexico, Cochabamba (Bolivia) and Lima (Peru) have taken advantage of this opportunity. These institutions have opted to integrate ID Doct among the services offered to their members. Thanks to this tool, professional associations will have an updated database and a wide knowledge of their members in order to respond to all their needs. The digitization of medical colleges offers a number of advantag-

es. One of them is that it increases interaction with the members, by involving them in the management of the school and making them the protagonists of change. It also gives them leadership and helps them to play a greater role and feel more secure and engaged. On the other hand, with ID Doct institutions reduce management time and the organization becomes an agile tool adapted to its time. In addition, the digitalization that guarantees avoids the fragmentation in the administrative procedures and minimizes the errors in the managements.

Shaping the industry, keeping the patient first.

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For enquiries please contact: +971 4 513 6977 | info@mecomed.com

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INTERVIEW

CEO and General Manager of Gruppo San Donato Healthcare

Pierre Appert “The digitization of the healthcare world will cut down healthcare spending and increase productivity and effectiveness”

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ruppo Ospedaliero San Donato (GSD), Italy’s leading private hospital group, is the premier provider of health services at all levels of care in all specialties. Its unique model is centered on the patient, and combines clinical, academic and research excellence to provide the very best tailor-made care to everyone. “Hospitals” magazine had the privilege to meet with Pierre Appert, CEO and General Manager of Gruppo San Donato Healthcare to discuss hospitals and smart patient rooms of the future and how developments in hospitals 2020 contribute to improving treatment and medical care. Below is the full interview:

INTERVIEW

What is your vision for hospitals of the future 2020 in terms of smart design and advanced technologies? When we think about hospitals 2020, two immediate things come to mind. Digitization & Prevention, which are at the forefront of Gruppo San Donato (GSD) digitization strategy. Year after year, we are witnessing the birth of disruptive technologies that fundamentally alter the healthcare landscape. Advanced Technologies and innovations such as TeleMedicine (TeleHealth), wearables, smart implants and AI to name a few are all catalysts towards a digitized future. A future that will undoubtedly transform the hospitals of today into the hospitals of the future, and we here at Gruppo San Donato are committed into making that future a reality. Moreover, the general approach to healthcare has always been reactionary. Now, and thanks to these technological marvels we will begin to see GSD hospitals taking a more proactive approach by utilizing Population Health tools and data collection to prevent illnesses rather than treat them. This in turn will cut down healthcare costs all the while improving patients’ quality of life.

We would like to shed light on the digital capabilities of the hospital of the future in terms of contacting the patient’s room via an iPad or in terms of electronic medical record? In order to achieve actual digital communication between clinicians and patients (iPad, EMR, etc..), GSD has put into motion three major steps which will completely overhaul our infrastructure towards full digital integration. We are currently in the process of creating full interconnect-

edness between our hospitals by using state-of-the-art technologies such as lightning-fast optical and dark fibers which will connect our structures to data centers. These data centers not only ensure continuity of all our businesses but also prevents loss of data and connection in case of a disaster. Moreover, at GSD, we are committed towards the privacy of our patients which is why we are currently in the process of constructing a data center geared solely towards data integrity, protection and recovery. Furthermore, teamed up with a third-party developers to create our own EMR system scheduled to be released by the first half of 2020. The EMR will be distributed to all GSD hospitals and will be enriched with devices such as iPads, tablets and wearables in order to create a truly digital environment.

How can we describe the “smart patient rooms of the future”? Smart patient rooms of the future will reach new levels of automation which will grant the patient more flexibility, freedom and independence. GSD will have AI placed in every room with the sole purpose of helping the patient. Each room will be fitted with a state-of-the-art beaconing system and WiFi come 2020. Furthermore, an AR-inspired patient assistance system fitted with door-to-door way-finding and indoor navigation capabilities will be installed as well. Moreover, to cater to patients with visual and hearing impairments, sounds and visual indicators will guide them through the hospital.

We should consider at length the four-dimensional medical imaging techniques and their high diagnostic ability, as well as

the ability of the doctor to check them on his mobile phone. What can you tell us about it? In order for clinicians to view and check on patients and imaging results remotely and privately, GSD is currently implementing the HealthMeeting. HealthMeeting is a digital and clinical platform that will allow clinical personnel to communicate on the fly and discuss patient cases and offer second opinions. These technical solutions will finally make the multidisciplinary team and patient centredness a reality in our premises and thus guaranteeing the best quality standards of care to everyone. The ability to perform operational activities, as booking services or scheduling timely surgery, will also be available physicians. Moreover, view imaging results such will be readily available to clinicians 24/7. The implementation of this system will undoubtedly cut down bureaucratic procedures, waiting times and improve patient satisfaction.

In your opinion, how will these amazing developments in hospitals 2020 contribute to improving treatment and medical care through the availability of elements of the healing environment? That these developments contribute to the betterment of care is a fact as they not only improve the quality of care, but the overall performance of hospitals as well. The implementation of these disruptive technologies is the only way to truly improve the healthcare sector. The digitization of the healthcare world will cut down healthcare spending and increase productivity and effectiveness by focusing on patient outcomes and care pathways centred on patients’ needs.

INTERVIEW

Interoperability and interconnectedness ensure that information is readily available with instantaneous data exchanges, between professionals and patients and carers. The ecosystem of information and the healing environments will be more agile and focus on the individual health and wellbeing.

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Some believe that the role of a doctor or nursing staff will diminish with the widespread digital revolution. In your opinion, is this true or does their role complement the doctorâ&#x20AC;&#x2122;s work and the resultsâ&#x20AC;&#x2122; accuracy? The end goal of this pervasive digitization is to create a more efficient

and attractive healthcare system. That the roles of doctors and nurses will diminish is erroneous. The reason why these disruptive technologies are being invented is to make their jobs easier. Disruptive innovations such as Precision Medicine, Machine Learning and the increasing interconnection of EHR undoubtedly aid doctors in performing more precise procedures and giving more accurate diagnosis and opportunities of personalized therapies. Nothing will ever replace or diminish their roles, only help them achieve better results which translates into better care. The AI is far behind from replacing the professional expertise of doctors and nurses in providing care. On the contrary, GSD is investing in the digitalization and technologies to sustain our professionalsâ&#x20AC;&#x2122; excellence in caring, by waving them off of operations and speeding up the search for personalized treatments.

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INTERVIEW

Senior Director & Chief Medical Officer, Cerner EMEA, LATAM and Canada

Dr. Colin Fincham “CERNER BELIEVES THAT ONE OF THE PILLARS FOR BUILDING A HEALTHIER POPULATION IS THROUGH TECHNOLOGY”

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INTERVIEW

erner, one of the leading companies in healthcare information technology, has been working for 40 years to make healthcare safer and more efficient. It uses the latest technology to create solutions that let communities and people engage in their own health. “Hospitals” magazine had the privilege to meet with Dr. Colin Fincham, Senior Director & Chief Medical Officer, Cerner EMEA, LATAM and Canada to discuss the company’s strategies, the steps to enhance the integration between healthcare and technology among others. Below is the full interview:

It is well known that Cerner creates solutions that make communities and people engage in their own health. Can you introduce our readers to the strategies that you follow to implement them? The best way to explain Cerner’s approach to helping communities and citizens get more engaged in their own health is by giving a couple of examples of where we have worked with our partners to deliver outcomes. The first example I would give is that of the Wirral peninsula, an area in the North West of England, which has a significant health discrepancy. On the east side is Birkenhead, the third-worst area for health inequalities in the UK, and on the west side is Heswell, which is one of the most affluent areas – the seven-mile, 20-minute drive between the two encompasses a 12-year difference in life expectancy. Cerner worked with the hospital, community, mental health and primary care providers to tackle this. The first fundamental question to

answer is “what matters to you?”, rather than the normal medical question “what is the matter with you?”. Some of the fundamental answers included integrated, joined up services, accessibility, use of community resources. We then worked with all the agencies to identify the best citizen-centered approach. This method was founded around Cerner’s proven methodology of ‘Know, Engage, Manage’. • Know: Identifying and predicting what will happen within the population • Engage: Encouraging people, their family and care providers to take action • Manage: Managing outcomes to improve health and care Cerner works with our clients as partners to understand the needs of the patient, citizen and users of the system in delivering the appropriate solutions depending on the situation and challenge the client is undertaking. Firstly, knowing the citizens, and their needs, by utilizing patient data from all sectors to build up a comprehensive record of the patients and understanding their needs using Cerner’s population health platform and our electronic health record (EHR). This step alone identified over 10,000 patients that would benefit from some form of intervention or advice. Patients were engaged using tools such as websites, social media, the Cerner patient portal (HealtheLifeTM) and the electronic patient record, whether that be Cerner’s hospital system, or the primary care system or community care system, neither of which were from Cerner. Finally, providing individualized management

plans for citizens with known conditions as well as suggesting preventative guidance or screening for those who would benefit. These included weight loss programs, treating patients with uncontrolled high blood pressure, etc. In another program at Children’s Hospital of Orange County in San Diego, the clinicians actively manage the child asthma patients, an issue that is recognized as being of significance in the Middle East. They are incorporating health and air quality data on days of predicted low air quality by sending SMS messages to remind parents to take precautions. In addition to the ‘breath bus’ services for schools, whereby nurses carrying medications are sent to schools to prevent children from needing to go to the emergency department for treatment should they have issues. This intervention has seen the admission to the hospital for asthma-related conditions fall by half in only its first year. In the region Cerner has been working with our clients to tackle problems such as the burden of diabetes, by ensuring that individuals with the condition are receiving the correct follow-up and are being appropriately treated.

Through your experience in the Middle East, how can you describe the healthcare systems and the development of the sector? The healthcare sector in the Middle East has traditionally been very hospital-centric, with patients attending emergency departments for self-limiting or minor illnesses, increasing waiting times and placing pressure on stretched hospital re-

INTERVIEW

sources. There has been less emphasis on primary and community care as well as preventative care. Gradually, in keeping with other parts of the world, the region is recognizing the need to manage conditions in the community, as well as improve screenings to prevent non-communicable diseases. Our clients in the region have recognized the need for patients to take responsibility for their own health and the Cerner Healthelife patient portal allows patients access to their records and communicate with their clinical team.

To what extent governments along with the private sector are striving for better innovative solutions? The region is looking for best practices around the world to improve the health of their citizens, including improving the care delivered in the primary healthcare sector, and available screenings – including for cancer. These are in addition to the innovative approach to the screening of babies for early heart disease using technology integrated with their EHRs in the Ministry of Health UAE. This program which automatically, via the Cerner system, reminds nurses to perform assessments of the babies’ hearts and should a possible abnormality be detected, it automatically alerts the appropriate doctors and suggests appropriate follow-up. There is a recognition that the use of machine learning and other AI techniques will allow for improved identification of conditions, as well as personalizing the care provided to citizens. Across the region the Cerner Sepsis algorithm is installed in over

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100 facilities continuously monitoring lives using its AI algorithm, which should abnormalities in the patient’s condition, blood tests, kidney function be detected, it automatically alerts the appropriate staff. In addition, Cerner has been working with clients in the region to use data and machine learning to identify who is at risk of being readmitted to hospital early after discharge to allow the hospital to provide interventions to prevent this.

What are your strategies for building healthier population through technology? What are the steps followed by Cerner in order to enhance the integration between healthcare and technology? Cerner believes that one of the pillars for building a healthier population is through technology – as our vision statement states, we want ‘a seamless and connected world where everyone thrives’. We have long recognized the shift from reactive sick care to proactive health management, and fragmented care to a cross-continuum system of care. Ultimately, we are looking at a shift from rewarding healthcare providers for treating volume to rewarding them for improved quality, safety and efficiency. We do this utilizing technology such as our population health tools. Cerner’s population health tools are currently supporting clients around the world to identify and care for 223 million patients on our solution by integrating 1,080 different data sources including over 65 different EHRs. The Cerner patient portal allows patients to not only view their patient record,

but also to communicate with their care providers, such as requesting medications, booking appointments and messaging the care team. Additionally, it allows fully integrated video consultations and enables patients to complete questionnaires and undertake self-directed education into their own health. We recognize that no one company has a monopoly on great ideas. Cerner provides an open and interoperable system as a platform for other companies to develop or integrate their great ideas into our tools, with the aim of helping our client organizations work closely with their patients to sync their personal health devices, such as the Fitbits, with their health record. In addition, we collaborate with some of the biggest names in the industry, like Amazon and Salesforce, to bring their experience in customer relationship management to the world of healthcare.

Can you brief us about the latest Cerner solutions? Cerner started as a lab solution back in 1979 and has now developed into a fully integrated health and wellness platform. Some of our most recent advancements have been in the area of health and wellbeing, not just for citizens but also for clinicians. I have already mentioned our population health platform but with the power of our data scientists in our division we call Cerner Intelligence, we have incorporated significant numbers of world leading AI algorithms. This includes Cerner’s sepsis algorithm, which monitors over a million lives every day to identify this

INTERVIEW

life-threatening condition as early as possible, as well as our readmission algorithm that has reduced the incidence of 30-day readmissions by nearly half at some of our client organizations. But one the most important areas we have been working on is the social determinants of health. These are things such as access to fresh food, finance, mobility and other social vulnerability indices we know have a significant effect on the health and wellbeing of citizens. Cerner’s comprehensive consumer platform, the HealtheLife patient portal, is providing support for third-party applications and client developed components within the patient portal, including integration with devices such as Apple HealthKit and other consumer devices. The other area of attention is looking into reducing the impact of the EHR on clinicians and cutting clinician burnout. Our focus is to utilize technology, such as mobility solutions and devices, to prevent clinicians being ‘tied’ to PCs, including using AI such as voice for speech to text, voice reminders and guidance, to reduce the need for physical interactions with the technology.

How can you improve the quality of life through these solutions? Cerner works with the National Health Service (NHS) in the UK and receives data from all the hospitals in the country to produce a single view dashboard for the organization. This helps to review and improve areas such patient experience, per capita cost and population health. In addition, we have seen great

outcomes such as Healthy Nevada, Missouri – county health ranking scores have enhanced by 24 percent for healthcare outcomes and 45 percent for health behaviors. In addition, 36 percent of patients improved their blood pressure and 26 percent improved their BMI. In Chicago, Advocate Health Care enabled an enterprise-wide change through data-driven workflows, which saw a 76 percent increase in the asthma control rate – 26 percent above the national average. In the Middle East, one of our clients using Cerner solutions improved the incidence of exclusive breast feeding by 50% to over 92% of babies, which we know has incredibly important positive effects on emotional brain development and the baby’s immune system.

What is the importance of awareness? What is your mission in spreading awareness and education through society? Ultimately, prevention is better than cure, and Cerner believes that communication is key. That is why we have ensured that patient education and communication is embedded in Cerner’s clinical workflows throughout the care process, whether that be self-directed information via HealtheLife, or education provided directly by the clinical team. Whatever the approach, it is critical that information is provided in a form that best suits the patient. These could be SMS reminders for appointments, education provided in the patient’s preferred language (printed out or sent to their portal), or even ensuring that medication in-

structions are automatically provided in their preferred language on their medication boxes. We have partnered with Salesforce to improve the customer/ citizen experience and target screening throughout the population. By working with our partner we have been able to identify the best ways to contact individuals, but also to ensure that when a citizen contacts the hospital to make an appointment, for instance, that information such as whether the patient would benefit from having their ‘Flu shot’ at the same time as they attend for the appointment, so preventing multiple trips and ensuring appropriate screening is completed.

What about your future innovations? Cerner has spent a cumulative nearly US$7 billion on innovation and we continue to innovate at faster rates, particularly in the areas of AI and population health throughout the care delivery process. One of the interesting areas we are working on is ‘Virtual Scribe’ and ‘Chart Assist’ – both AI-based tools that can identify the doctor and the patient in the consultation. The doctor can enter information such as symptoms, drugs, allergies and other factors that are discussed in the consultation automatically into the medical record without needing to type the entry. The tool will even suggest possible diagnosis and treatment options, allowing the doctor to spend more time talking with the patient and explaining what is happening whilst having a complete documentation in the record.

INTERVIEW

Founder & CEO- Temos

Dr. Claudia Mika “WE ARE PROUD OF OUR EIGHT ACCREDITED HOSPITALS AND CLINICS IN THE MENA”

emos is the first international healthcare accreditation organization to incorporate standards specifically designed for hospitals and clinics that serve international patients. “Hospitals” magazine had the privilege to meet with Dr. Claudia Mika, Founder & CEO - Temos.

How can we tell our readers about Temos? What are your services? Who benefits from your accreditation? Founded in 2010, Temos is the first international healthcare accreditation organization to incorporate standards specifically designed for hospitals and clinics that serve international patients. Since then, the company has evolved into an ISQua/ IEEA accredited organization offering the highest standards of accreditation for hospitals and clinics globally serving both domestic and international patients. The Temos accreditation process involves an independent assessment of the healthcare provider’s policies and procedures evaluated against a backdrop of international best practices and evidence-based standards to help hospitals and clinics provide the best possible clinical and non-clinical outcomes. Temos clients are healthcare leaders who believe in innovation to deliver better clinical and non-clinical services while differentiating themselves in the global marketplace. In the increasingly competitive world

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of health and medical travel, Temos accreditation leads the way in excellence, innovation, and an unwavering focus on the evolving needs of patients and providers. Our clients share our principles and goals for the improvement of healthcare services.

What are the accreditation programs that you offer whether for international patients or for hospitals and clinics? Temos offers the widest selection of choice of accreditation programs by any international organization. It is the first international accreditation organization to develop specialized accreditation programs for different types of healthcare providers. Rather than take a one-size-fitsall approach, Temos offers a tailored approach to its accreditation. From single, stand-alone clinics to multisite hospitals offering complex care, Temos accreditation programs meet the needs of: • Hospitals offering primary to quaternary care. • Clinics including primary care facilities, medical centers, and

outpatient centers. Dental hospitals, clinics and practices. • Physical rehabilitation centers IVF clinics. • Eye clinics. These distinct accreditation programs are based on a core set of standards and principles that apply to every healthcare Temos accredited provider. Each program is tailored to the particular discipline to address the unique services provided to the patients they serve. Temos also created and offered the first accreditation program for medical travel coordinators/facilitators. •

What is the process that you follow? What about requirements for Temos accreditation? There are pre-conditions that must be met to qualify for accreditation including but not limited to: Having governmental license(s) to practice; a quality management system implemented; engage in continuous quality improvement; defined outcomes and performance indicators; and excellent medical staff.

INTERVIEW

The accreditation process is begun by submitting online basic information about the organization to Temos Headquarters where it is reviewed, for free, by Temos staff to ensure that the pre-requisites are met. Then the interactive and collaborative process of submitting documentation for review to ensure that the hospital or clinic meets the various accreditation standards takes place. Once the off-site review is completed, an on-site two to five-day visit by Temos assessors is scheduled to ensure compliance with the standards. Once that verification process is completed, the accreditation certificate is issued for three years with annual follow-ups in between.

Can you brief us about your newly awarded ISQua/IEEA accreditation? What is the importance of this accreditation to offer the highest healthcare standards? ISQua, known as the “Accreditor of Accreditors” is universally recognized as the “gold standard” for global accrediting organizations such as Temos. Temos submitted its comprehensive set of accreditation standards to undergo a rigorous process of review of its unique patient-centered clinical and non-clinical standards. Those standards were accredited in record time. With ISQua accreditation, Temos joins an elite group of international accreditation organizations to offer the very

highest healthcare standards. The accreditation of Temos’ standards demonstrates to hospitals, clinics, patients, insurance and self-insured companies, Ministries of Health and others that Temos-accredited providers adhere to international best practices as verified by Temos.

It’s well known that there are eight accredited hospitals and clinics in the MENA in Egypt, Jordan and in UAE. What are their reasons for seeking accreditation and for selecting Temos? Temos is very proud of its eight accredited hospitals and clinics in the MENA and is working with others in the region that are in the process of accreditation with us. These organizations demonstrate a commitment to providing the highest quality of clinical and non-clinical services by working with Temos. We believe that the hospitals and clinics selected Temos for the comprehensive set of accredited standards as well as our excellent business reputation including our high ethical standards. The Temos assessment process is also culturally sensitive so that we can accommodate the specific religious, dietary, and cultural needs of the patients being served. Our clients are very loyal and satisfied with our services. We look to work with many more hospitals and clinics in the MENA.

What about the quality solutions

that you offer for innovative healthcare leaders? Temos has been and continues to be an innovator in accreditation. Temos is the first ISQua accredited organization to assess services including sustainability in healthcare; patient blood management; legal aspects in international patient management; and ethics and international patients. Among its many “firsts”, Temos is the: • First German accreditation organization with ISQua accredited standards. • First ISQua accreditation organization owned by a woman. • First healthcare accreditation organization having a dedicated chapter for “sustainability in healthcare”. • First healthcare accreditation organization having a dedicated chapter for “patient blood management”. • First healthcare accreditation organization having a dedicated chapter for “legal aspects in international patient management”. • First ISQua accreditation organization offering healthcare accreditation and combining it with international patient management and medical tourism. • First and only healthcare accreditation organization having an exclusive partner-

INTERVIEW

•

ship with Diplomatic Council and “DC preferred partner” certification. First accreditation organization offering specialized accreditation program for dental organizations, eye clinics, rehabilitation and reproductive care clinics. First accreditation organization that developed an accreditation program for medical travel coordinators/ facilitators. CEO, Dr. Claudia Mika is first and the only woman awarded the “Dr. Sanjiv Malik Lifetime Award” for her achievements for the medical travel industry.

The company leads by example and sets standards for the industry. It is not content to follow or imitate others.

What is the importance of continuous quality improvement for the hospitals? Continuous Quality Improvement is a prerequisite for accreditation because it demonstrates that the healthcare provider engages in the process of constantly reviewing its services to ensure that excellence is maintained and that efforts are made to improve services that fall short of excellence. That management approach is the foundation upon which accreditation is based.

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Temos is specified by offering healthcare accreditation combined with international patient management and medical tourism. What is the process that you follow in this field? What is the importance of this kind of accreditation? Temos accreditation is designed for hospitals and clinics that serve domestic as well as international patients and is based on the belief that all patients deserve the best clinical and non-clinical outcomes possible. Because of the nature of the international patient journey, they have additional needs compared to domestic patients. It is essential that healthcare providers have systems, processes and procedures in place to ensure that

the end-to-end patient experience is served. Since 2010, Temos has offered standards that take into account the entire patient experience, innovating this approach that has only been imitated by others.

What is your future vision for better services and continuous quality improvement? Accreditation is an important part of the process of improving healthcare services to patients around the world. It can raise the standard of care provided to patients in every corner of the world. The Temos team already serves accredited partners on five continents. We are ready to do our part to improve access to affordable quality healthcare services for all patients worldwide.

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ARTICLE

What do you know about autism and the right ways to deal with it?

utism or Autism spectrum disorder is a neurodevelopmental disorder, which affects the child from early childhood and accompanies him throughout his life, affecting his ability to communicate, learn and interact with others around him; a child with autism has difficulty in speaking directly with others, or visual contact with them.

Signs of Autism in children Signs of autism usually appear surprisingly, although the child grows very naturally, and the signs of the disease vary greatly from one child to another, including those who show signs early in the first months of life, and may appear late in their early years.

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Behavior-related signs •

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Language-related signs •

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Late pronunciation and speech, starting to speak after reaching the age of two years. Poor ability to pronounce all

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different words and phrases properly. Speaking in a strange way, it looks like he sings, or speaks as a robot. Inability to start a conversation and cannot continue to talk for a long time. Cannot determine the right time to use words, repeating some words.

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Doing some frequent movements like vibration, rotation, and fun with hands. Imprisoning in certain rituals, and becoming irritable as soon as these rituals change. Moving dramatically and continuously. Astonishment at some parts of the stuff around him (surprised by the wheels of the toy car).

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Sensitivity to light, unusual sound, as well as lack of awareness of any pain he feels.

Signs related to social skills • • • • • •

Not responding when calling him in his name. Not looking at the eyes of those who speak with him. Appearing like he doesn’t hear what’s going on around him. Rejecting anyone approaching, or trying to embrace him. Lack of awareness of others ‘ feelings and expressions . Wanting to be isolated and play alone.

What is the treatment? The initiation of child assistance and the use of therapeutic methods available since the beginning of diagnosis are important, to increase the chances of the child to meet his

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challenges and successfully adapt to autism, which increases the chances of improvement and the ability of the affected child to live a relatively independent and normal life. Behavioral therapy is the most successful strategies of treatment, in which the therapist teaches the child some skills, and improves his ability to communicate. In addition the child can benefit from speech therapy, as attending regular pronunciation sessions especially at a young age may help the child to learn to speak. There is no successful pharmacological treatment for autism spectrum disease, but the doctor can prescribe some medications for symptoms of depression, stress or difficulty of sleep that usually accompany the autism spectrum, and there is still no successful way to prevent the risk of infection, as it affects 1% of children. Treating autism needs a very long period of time and it must be emphasized that the autism spectrum is a chronic and incurable disease, and that the purpose of treatment is to try to improve the child’s ability to communicate and live as an independent person.

Here are many strategies that can be followed by the parents of the autistic child to meet the challenges & coexist with them; the most important strategies are the following: Knowledge of the disease: It is important that parents care about educating themselves about autism disorder, learning how to deal with it, and understanding the therapeutic methods available to help control autism. Accept the autistic child: Instead of comparing him with his peers, and focusing on the difference between

them, care should be taken to encourage him and show joy and pleasure to celebrate his achievements, the child’s feelings of love and acceptance of his parents will be the main supporter for him to overcome autism. Not to surrender: By pushing the feelings of despair and anxiety about the future of the child aside, and remembering that the autistic still has a whole life to develop and develop his skills.

Commitment to a daily routine for the child: People with autism improve their response and performance if a daily schedule and routine are identified and adhered to, such as setting organized times for sleep, eating, undergoing treatment, and learning. Praise for good behavior: It is important to praise the child or reward him when he learns a new skill or performs a good behavior.

Providing a safe home environment: It is important to provide a safe environment for the child at home, and to remove harmful objects from his reach, especially if the child is exposed to bouts of anger or likely to carry out acts that hurt himself.

To find non-verbal means of communicating with the child: Communicating with the autistic child may be difficult in some cases, but it is not necessary to communicate with him directly or to touch him to understand his needs, so parents are advised to pay attention to the expressions of the child’s face or tone of voice, or any other aids he or she makes. Devote time to play: A child with autism needs time to play and have fun like other children, so it is necessary to devote time and activities that the child plays and enjoys with his parents away from treatment sessions

Dr. Abeer Mahmoud Ahmed Eissa Consultant Psychiatrist at Al Ahli Hospital and education.

Attention to the impact of external stimuli on the child: Some children with autism get nervous or react violently to some external influences, such as some sounds, or light sources, so it is important to take attention to any stimuli that will strain the child, on the other hand, to exploit any influences or factors that comfort him or to notify him of rest and reassurance. Finding child’s strengths: It is important that parents look at the child’s strengths and try to discover the best way in which the child learns whether it is practical, touching or looking, and exploiting and focusing on it during his education.

Access to support and assistance: It is normal for parents to feel stress while caring for their autistic child, in such a case they can consult a doctor and ask him about qualified people who can help them.

Parents devote time to themselves: In the end, parents must not forget the need to give themselves time to rest and stay away from stress, such as allocating time to enjoy with family or friends.

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Ectopic pregnancy or ectopic minded cases free blood in Douglas pouch and the abdominal cavity can be seen.

Common sites of Ectopic pregnancy Most commonly it is located in Fallopian tubes, but it can be in Douglas pouch, ovaries, cervix, Cornual part of the uterus and in rare cases in the Omentum or the intestine. Recently due to increased incidence of cesarean sections, ectopic pregnancy can occur at the scar of the previous cesarean section.

Causes of ectopic pregnancy

ctopic pregnancy is a common complication and leading cause of maternal morbidity and mortality early in pregnancy. Ectopic pregnancy is defined as implantation of the fertilized ovum away from the normal site which is the endometrium lining of the upper uterine segment.

Diagnosis Clinically, diagnosis of ectopic pregnancy is sometimes confusing and challenging as no ectopic is like another ectopic, the differential diagnosis of ectopic pregnancy should be always in the mind of the physician dealing with early pregnancy, i.e. Physician should exclude ectopic pregnancy in every woman in reproductive period, coming for the first antenatal visit or coming with vaginal bleeding and abdominal pain.

The diagnosis is made based on: First: taking detailed medical, surgical, obstetrical and gynecological history. Second: symptoms; including missed period, irregular vaginal

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bleeding, lower abdominal pain which sometimes refers to the back and shoulder, associated with fainting attacks and dizziness, pain can also be felt lower in the perineum and anus. Third: signs; including lower abdominal tenderness, guarding and rebound tenderness, pain on moving the cervix, and sense of fullness of Douglas pouch, while doing a vaginal examination. Fourth: Laboratory tests; BHCG (pregnancy hormone) is essential in the diagnosis of pregnancy, in normally growing pregnancy, BHCG hormone should double every 48 hours, so if it fails to show doubling, it is an indication of embryonic demise whether intra or extrauterine. Fifth: Then comes the role of ultrasound to locate the site of the ectopic, so High BHCG level with an empty uterine cavity is considered diagnostic of ectopic pregnancy. In addition to other findings such as Adnexal mass or hematoma, presence of adnexal gestational sac with an embryo with or without heartbeats and in severe

Any reason that will make the journey of the fertilized ovum longer than 7 days, from the time of fertilization at the lateral third of the fallopian tube till implantation in the upper part of the uterus, will cause ectopic pregnancy. So, infections and adhesions in fallopian tubes will distort the pathway preventing the fertilized ovum from reaching its destination at the proper time subsequently it will start implantation in an abnormal place. The adverse effect of hormones on the movements of the fallopian tubes and the cilia lining the inside the tubes is well known. So, slowing of the peristaltic movement of the tubes under the effect of exogenous sex hormones may result in ectopic pregnancy.

Who are at risk of having an ectopic pregnancy? Women with a previous history of ectopic pregnancy, history of Invitro fertilization and assisted reproductive techniques, those using progesterone intrauterine devices and those with a history of pelvic inflammatory diseases and salpingitis are considered at high risk of having an ectopic pregnancy.

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Treatment of Ectopic pregnancy

expectant treatment, patients should be completely vitally stable, free of symptoms, showing understanding of the symptoms and signs as the disease progresses, has full access to the medical care in case of emergency, level of BHCG should not exceed 1000 IU, and the size of the adnexal mass should not exceed 3 cm.

Since the clinical picture differs from one woman to another the treatment will also vary based on the severity of the clinical symptoms, signs and the wish of the woman to preserve her fertility as possible. Type of treatment depends also on the degree of cooperation of the woman and the feasibility to follow her up close. Another determinant is the availability of certain equipment and laboratory tests, so the physicians in rural poorly equipped parts of the world or in conflict areas may proceed into surgical options rather than a conservative one. In other words, management should be tailored for each woman individually, the plan of management and the impact of this plan on the woman ‘s fertility should be extensively discussed and explained in detail to the woman. So, treatment can be; Expectant conservative, Medical conservative, or Surgical. The physician should be flexible in changing the plan according to the progress of the disease and the response of the patient to each type of treatment.

Medical treatment: This is another way to avoid surgical intervention and preserve fertility as possible while treating ectopic pregnancy. The drug of choice is the Methotrexate injections in single or multiple shots following a certain algorithm with close follow up of the patient till BHCG is again zero. The idea behind is to stop trophoblasts from growing and invading blood vessels in a tissue which is not prepared for implantation, like expectant management the patient should be followed closely with BHCG not more than 5000 IU, and the size of the adnexal mass not more than 4 cm, without cardiac activity; again, the patient should be absolutely vitally stable with minimal tolerable symptoms.

Expectant management: No

Surgical treatment: Mostly done

medical or surgical intervention will be done there will be only close follow up of the symptoms, signs, general condition of the woman and serial measurement of BHCG level in serum every forty-eight hours and repeated ultrasounds till BHCG is zero. The idea behind expectant management is that ectopic pregnancy will be aborted from the tubal end into the peritoneal cavity with minimal bleeding that will be absorbed by a peritoneal cavity, resembling early intrauterine pregnancy demise which will be aborted with minimal bleeding, To be able to implement such

through laparoscopy but in a certain situation could also be done by minimal laparotomy. It aims to excise the ectopic pregnancy and damaged tissue and to stop bleeding. Again, the affected tube can be removed completely (salpingectomy) or incised to remove the ectopic pregnancy leaving the tube in place after proper hemostasis (salpingostomy). However, the studies showed no real difference in both techniques when it comes to future fertility.

Surgical treatment is mandatory whenever: •

The vital signs are not stable with

Dr. Asmaa Abdulsalam Consultant of Obstetrics and Gynecology at Al Ahli Hospital the deterioration of the general condition of the woman showing hypotension and tachycardia. • If the patient is complaining of severe abdominal pain. • When the ultrasound shows living embryo outside the uterine cavity or adnexal mass of more than 4 cm. • BHCG level is above 5000 - 10000 IU. • The presence of active intraperitoneal bleeding. • Increase of BHCG level of 50% per 48 hours, or continues rise of BHCG level in spite of giving Methotrexate. Again, BHCG follow-up is mandatory till BHCG is zero.

Conclusion Ectopic pregnancy is a serious complication and leading cause of maternal morbidity and mortality in the first trimester of pregnancy. The key to early diagnosis and treatment is to always work on and to exclude the possibility of ectopic pregnancy whenever dealing with women in the reproductive age group.

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Healthy teeth in children

ealthy teeth are essential for a child’s full health. Some believe that dental care for children begins when they start teething. This is of course a big mistake, because dental care takes two directions:

1. First: Taking care during the formation of teeth. 2. Second: Taking care of the cleanliness of teeth once they erupt. When talking about the first aspect which is the formation of the teeth, the mother is the primary responsibility for this, and perhaps should start to pay attention since the beginning of pregnancy such as taking care of the food; mothers should eat balanced food, healthy and diverse options which include all the nutrients like fresh fruits , vegetables, milk, mineral salts and vitamins, which must enter the body either by food or medicine, because the formation of the teeth begins since the fourth month in the uterus and continue after that. First teeth to erupt through the

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gums are the lower middle incisors followed shortly by the upper central incisors, until all of 20 primary teeth are usually completed at the age of almost three years where the child has reached the end of the formation of the roots of the canines. When the child is born, the permanent teeth begin to form. I advise mothers to take care of the child’s food, diversify it, take care of the cleanliness of his teeth once they erupt and familiarize him with the dentist’s visit periodically to follow up on the health of his mouth and teeth. As I said, children’s teeth begin to form before birth, but they differ in the speed and order of eruption, you should begin to care for oral health after the baby is born shortly, you should clean the gums after each feeding, and you can start brushing your child’s teeth as soon as they appear. As for the second stage, which is the care of cleaning of teeth once they erupt; always clean the gums of your child after each feeding, by wiping the gums with a piece of cloth or

Dr. Reem Adnan Al-Kilan Dental Gen. Practitioner at Al Ahli Hospital gauze which is clean and wet, and parents has to brush their children’s teeth daily using a soft toothbrush and a small amount of toothpaste Which has a fluoride and the mount should do not exceed the size of the pea. If you need to give your baby a bottle for napping or sleeping at night, you should not fill the bottle with natural or artificial milk or juices to prevent early necrosis of the child’s teeth. But instead fill it up with water. We recommend that you visit your dentist when you reach the age of 3 years. Your dentist may recommend regular fluoride treatment sessions at regular intervals to strengthen the enamel and resist the necrosis of your child’s teeth. This procedure is repeated every six months in conjunction with dental cleaning at the clinic during periodic examinations of the mouth. Acquiring healthy habits at an early age can help the child maintain healthy teeth for a lifetime. We wish you and your children clean and healthy mouth always.

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NEWS MEDICAL INSTITUTIONS

In vitro fertilization New applications in the field of in vitro fertilization

Professor Hasan Faruk Buyru, M.D Head of Reproductive Health and Infertility Center Acıbadem Fulya Hospital

he developments in the field of in vitro fertilization, which is considered to be the only method for many couples to have children,

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have significantly increased the rate of success for the treatment. In Turkey, the history of in vitro fertilization begins over 30 years ago. The method, which was applied in 1978 in England for the first time, was also put to use in Turkey after a short while. The innovations and improvements in the field of in vitro fertilization, which was received with great amazement and has been regarded to be a miracle from the very first day, increase the rate of success for the treatment. Currently, the possibility of having a child through this treatment is over 50%, depending on the mother’s age and ovarian reserve. Professor Faruk Buyru, a gynecologist - obstetrician and head of Reproductive Health and Infertility Center of Acıbadem Fulya Hospital, has shared with us information on the new application in the field of in vitro fertilization.

The only option on some cases In vitro fertilization is regarded as the last resort for couples who cannot have children due to certain conditions in the mother or the father, or inexplicable infertility. Stating that, this method was primarily invented as a solution for women with blocked fallopian tubes, and says: “The fallopian tubes constitute the environment in which the sperm and the egg are joined and conception occurs. In the past, specialists tried to open the blocked fallopian tubes through surgery. However, the rate of success for this method was not very high. The method of in vitro fertilization was invented when research on achieving conception outside the body yielded successful results. While the method is mainly regarded as the solution for women with blocked fallopian tubes, it can also be used in unexplained infertility cases and cases in which

conception does not occur due to the male factor or other reasons”. The method is also used in cases where artificial insemination does not yield successful results. The ovarian reserve of women starts to decrease after the age of 35 and the rate of decrease becomes higher after the age of 38. Therefore, women who wish to have children are warned against waiting until later ages. Professor Buyru categorizes the innovations in the field of in vitro fertilization under the following sections:

Lower drug doses Currently, the dose of drugs that are used before in vitro fertilization is lower. It is now known that overstimulating ovaries has certain adverse effects. Production of 8 to 15 eggs is considered to be ideal. Therefore, specialists prescribe a lower number of drugs with lower doses and ensure for the patient to undergo a treatment in which she will have less difficulty. In other words, drug doses and durations of drug use have decreased considerably when compared to the

past. Normally, a woman produces one or two eggs per month. One or two eggs can be sufficient for artificial insemination but in vitro fertilization requires at least five or six eggs. In the past, a higher amount of drugs was used. More than one embryo was transferred and this led to multiple pregnancies. It is now known that multiple pregnancies are risky for both mothers and babies.

Blastocyst transfer This method involves placement of embryos in the uterus on the fifth day of development instead of the third, which is the normal procedure. This method is referred to as “blastocyst transfer”. The possibility of an embryo to lead to pregnancy is higher on day five. However, waiting until the fifth day may not be possible for all women. It is essential for specialists to decide on the day of transfer in accordance with the condition of each patient.

Embryo cryopreservation Rapid freezing of blastocysts on the fifth day and transfer of these after revival at a later period is associated with possibility of pregnancy as high as that of fresh embryo transfer. Therefore, there are claims that it is better to transfer embryos after one or few months following the stimulation of ovaries instead of transferring these right away. The new method’s popularity increases with each passing day. There are multiple reasons behind this. For instance, it is possible for the potential mother’s increasing hormones to have an adverse effect in the uterus and decrease the possibility

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for pregnancy. When ovaries are overstimulated, problems such as bloating, ascites (accumulation of fluid in the abdominal cavity), decrease in urine output and coagulation risk arise. In such cases, embryo cryopreservation yields better results. This method protects the womanâ&#x20AC;&#x2122;s health and is associated with a higher pregnancy rate. During the period of cryopreservation, the pregnancy rate continues to be higher in comparison to other methods even if the potential mother becomes older.

Single embryo transfer The regulations that became effective in 2011 have brought restrictions to the number of embryos that can be transferred to a woman in a single application. The number of embryos that can be transferred is one for women under the age of 35 and two at most for older women. These restrictions are intended to decrease the possibility of multiple pregnancies because multiple pregnancies can result in miscarriages or premature births. Such cases can affect both the babies to be born and the pregnancy

period. Therefore, multiple pregnancies are no longer accepted as success in treatment and single pregnancy has become the goal in recent years.

and inconvenient. Drugs that are administered vaginally and more conveniently are preferred over these.

Post-transfer drugs

Before transfer, the genetic structures of embryos are analyzed. Preimplantation genetic diagnosis and screening methods make it possible for healthy embryos to be chosen. This increases the rate of pregnancy. The embryos are screened on the fifth day instead of the third day, which allows for a higher number of chromosomes to be examined.

The injections which used to be the norm for application of post-transfer drugs are now replaced by vaginal administration. This is because the progesterone injections that are used after embryo transfer are very painful

Genetic diagnosis

Laboratory conditions There are also improvements in the environment in which embryos are developed. These also increase the pregnancy rate. Furthermore, it is possible for embryos to be observed with embryoscopes, through a camera in devices referred to as incubators without having to bring these into normal room conditions. The development of embryos is tracked more closely via photographs and avoiding exposure of embryos to room temperatures on a frequent basis.

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NEWS

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Project Management for Medical & Healthcare Sector: What Clinicians and Healthcare Professionals Need to Know? Professor Mukhtar AL-Hashimi / Ahlia University â&#x20AC;&#x201C; Bahrain

odayâ&#x20AC;&#x2122;s healthcare sector is facing numerous challenges, due to the growing pressure to meet the stringent demands of healthcare regulators, while having to mitigate reduction in revenue and manage increasing operational costs, in addition to providing high-quality healthcare and meeting patient satisfaction. To respond to these challenges effectively, healthcare leaders must appreciate the value of project management. In particular, they must strive to align the organizational strategy with the best portfolio management practices in order to yield the greatest value to the organization while improving patient outcomes. Within the healthcare industry, projects are initiated

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when a real need is identified, such as eliminating paper-based medical records by introducing computerized electronic medical records, or service enhancement by introducing new clinical treatments or replacing outdated equipment with modern imaging and diagnostic tools. Such projects may also include introduction of communication systems (PACS) or opening new medical units, such as cosmetic surgery, in anticipation of market needs. Project management involves many activities, depending on the project scale and type, such as opening a new clinic, medical center or hospital, or expanding on the current resources; developing new medical

training program; improving healthcare delivery for achieving quality accreditation; or conducting clinical research. While healthcare projects may vary, they also share some common characteristics that are unique to this sector, namely the aims and drivers of the project, such as care quality, cost containment, and meeting external agency expectations. These elements underline the need for a designated project team with the requisite expertise in the healthcare industry, along with multiple skillsets, including understanding the healthcare domain, processes and procedures. Each team member must also be able to collaborate with different entities and stakeholders and make appro-

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priate decisions to ensure successful project completion. As the number of projects in the healthcare sector has increased substantially over the recent decades, there is a growing demand for healthcare professionals with project management skills and experience, creating new job opportunities, as well a new career path for healthcare professionals with aptitude for management. Once the project is selected, and it scope, budget, and deadline are determined, it has to be delivered in line with these parameters. Empirical evidence indicates that organizations that invest in projects that are aligned with their strategic plans and are willing to engage stakeholders in the project management process are more likely to succeed and become more competitive in their industry. In most healthcare projects, the clinical and executive group are the main stakeholders. The clinical group comprises of medical personnel directly involved in patient care delivery. Their involvement is essential, as doctors and nurses can ensure that the project is patient-centric and will lead to the best quality of care. On the other hand, the executive group should focus on the aspects of the project that will result in the organization being more competitive and sustainable. In addition to delivering successful and financially sound projects that would improve patient care and safety, while enhancing staff productivity, the management team must also ensure that the project complies with regulatory demands and meets the expectations of all stakeholders, including the senior management and clinical experts. Therefore, a healthcare project manager is expected to possess the clinical expertise and be able to recognize that the clinician’s view of project success is different from that

portrayed by the traditional measures focusing on the scope, time, and cost. The clinicians will deem a project successful when it improves patient safety and increases the workflow efficiency, as this ultimately translates to delivering better patient care outcomes. It is also important not to confuse projects with ordinary daily work, as explained in the PMBOK guide for managing projects titled The Project Management Body of Knowledge. In this highly useful resource, project management is defined as “a temporary endeavor undertaken to create a unique product, service or result”. Another useful definition of project management is “a complicated, no routine, one-time effort limited by time, budget, resources, and performance specifications designed to meet customer needs”. Generally, projects can be classified into four categories. The first category is referred to as derivative projects which are initiated in order to replace current form, offering or practice aimed at obtaining efficiency, effectiveness or economic gain by introducing a new version or by lowering costs. An example of a derivative project could be introducing new laboratory equipment to expedite clinical analyses. The second category is referred to as platform projects as such initiatives serve as a step toward further projects, such as opening a dental clinic with the view of later adding other specialties such as cosmetic surgery. Breakthrough projects comprise the third category and are initiated to benefit from breakthrough technology and innovation, such as telemedicine, RFID, or availability of new medical treatments and drugs, or an unmet need for cosmetic or weight loss treatments. Finally, research and development (R&D) projects are in the fourth cate-

gory and their aim is to advance the scientific knowledge through research and clinical trials in order to improve clinical outcomes. Regardless of the project category, for a project to be considered successful, it has to be delivered within the expected scope, budget and timeframe. For example, if the aim of the project is to set up pharmacy kiosks at 12 locations, allowing patients to self-dispense over-thecounter drugs, it would be necessary to identify patients wishing to sign up for the service, select the appropriate medication or pharmacy accessories, as well as offer the means of collecting payments. All these elements must function as specified in order for the project to be deemed successful, while meeting the budgetary and time constraints. It is also noteworthy that each such project must be aligned with the strategic vision of the organization, which is ensured through the establishment of project portfolio, executive-level council sponsorship, well designed project charter, effective project management, efficient project team working toward specified goal, and practical

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project manager skills and leadership. It is widely established that most projects fail due to misalignment with the organizational strategy, inadequate and unrealistic scope, lack of stakeholders and top sponsorship, lack of project management skills and experience, and inability of those involved to overcome personal and organizational conflicts. To overcome these issues, project managers need to gain the required skills and apply the project management knowledge in practice to achieve optimal results and deliver the project successfully. In sum, they must possess not only leadership, team building and motivational skills, but also budget skills, conflict management skills, negotiation and influencing skills, planning and organizational skills, as well as written and oral communication skills. The main contribution of project managers stems from their ability to understand the circumstances, reasons, and motives behind each project, as this will allow them to address the real need for the project. For example, if the project aim is to establish a blood donation drive, the project manager needs to understand whether the motive for this project is blood shortage or the desire to enhance the hospital image in terms of social responsibility or marketing aims, since these would translate to different project objectives and would require bespoke strategy. Project management literature reveals that the organizational culture and structure are also key determinants of project success. In this context, it is important to differentiate among the traditional centralized, functional, and matrix organizations. In the case of an organization with a highly centralized structure, all projects are submitted, selected and

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assessed through the central body resulting in unified reporting. The drawbacks are slow response time to project requests and possible lack of specialty knowledge and experience required for advanced projects. In organizations that adopt the functional structure, each unit manages projects independently of the other units, since each has its unique needs that require specific skills to solve technical project issues. However, it could be challenging to make significant investments in equipment and facilities needed to support a given project for each unit. In addition, this approach to project management could lead to different reporting systems and resource duplication due to high unit independence. To overcome these challenges, some organizations adopt matrix project management style, as a part of which project team members are selected from different departments based on their competency for meeting specific project demands. However, this may result in

some team members serving on more than one project, and thus reporting to different project managers, as well as their department manager. Finally, the project manager has to recognize that all projects are executed in phases, referred to as project management cycle, consisting of the definition, planning, implementation, and delivery. In the definition phase, the project goal, specification, scope, responsibilities, and teams are determined. The planning phase includes project work breakdown structure, budgets, resources, project risks, and project schedule. In the implementation phase, the project status reports are generated, and any changes to scope or process are documented, along with quality audits, and contingencies. In the final phase, user training is provided, while the project manager is also required to transfer documents, release resources, reassign staff, and finally ponder on lessons learned.

ARTICLE FEATURES . Leukemia

Leukemia

Uncontrolled growth of abnormal blood cells

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ARTICLE FEATURES . Leukemia

cientists haven’t found out yet the direct cause of cancer including leukemia; however, this did not discourage scientists from reaching effective and targeted treatments that increased the cure rate of some types of leukemia and control some other conditions contributing to the prolongation of patients’ lives. The exact cause of leukemia is not known, but it is thought to involve a combination of genetic and environmental factors. Leukemia cells have acquired mutations in their DNA that cause them to grow abnormally and lose functions of typical white blood cells. It is not clear what causes these mutations to occur.

This causes the blood cells to grow and divide continuously, so that there are too many. Healthy blood cells die after a while and are replaced by new cells, which are produced in the bone marrow. The abnormal blood cells do not die when they should. They accumulate, occupying more space. As more cancer cells are produced, they stop the healthy white blood cells from growing and functioning normally, by crowding out space in the blood.

There are some risk factors that may increase your risk of developing some types of leukemia including: •

Causes of leukemia Certain abnormalities cause the cell to grow and divide more rapidly and to continue living when normal cells would die. Over time, these abnormal cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood cells, red blood cells and platelets, causing the signs and symptoms of leukemia. Over time, the leukemia cells crowd out or suppress the development of normal cells. The rate at which leukemia progresses and how the cells replace the normal blood and marrow cells are different with each type of leukemia. In this context, we should explain that the blood contains 3 types of components including red blood cells, which carry oxygen, white blood cells, which fight infection and platelets, which help with blood clotting in addition to plasma, a liquid component of blood that normally holds the blood cells in whole blood in suspension and contains 90% of water. Leukemia happens when the DNA of immature blood cells, mainly white cells, becomes damaged in some way.

•

Previous cancer treatment: People who’ve had certain types of chemotherapy and radiation therapy for other cancers have an increased risk of developing certain types of leukemia. Genetic disorders: Genetic abnormalities seem to play a role in the development of leukemia. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of leukemia. Exposure to certain chemicals: Exposure to certain chemicals, such as benzene — which is found in gasoline and is used by the chemical industry — is linked to an increased risk of some kinds of leukemia. Smoking: Smoking cigarettes increases the risk of acute myelogenous leukemia. Family history of leukemia: If members of your family have been diagnosed with leukemia, your risk of the disease may be increased.

Acute and chronic leukemia Acute leukemia: During its lifes-

pan, a white blood cell goes through several stages. In acute leukemia immature, useless cells develop rapidly and collect in the marrow and blood. They are squeezed out of the bone marrow too early and are not functional. • The two most common types of acute leukemia are: • Acute Lymphoblastic Leukemia (ALL) • Acute Myeloid Leukemia (AML) Chronic leukemia develops slowly and gradually, and symptoms may take a lot of time to develop. Sometimes chronic leukemia is diagnosed (through routine screening) before any symptoms develop. This is because the cancer cells in this condition are mature enough to perform their functions like normal white blood cells, before they begin to worsen. There are two main types of chronic leukemia: • Chronic Lymphocytic Leukemia (CLL) • Chronic Myeloid Leukemia (CML)

Symptoms Leukemia symptoms vary, depending on the type of leukemia. Common leukemia signs and symptoms include: • Frequent fever or chills • Persistent fatigue, weakness • Frequent or severe infections • Unexplained appetite loss or recent weight loss. • Swollen lymph nodes, enlarged liver or spleen • Easy bleeding or bruising • Recurrent nosebleeds, bleeding from the gums or rectum, more frequent bruising, or very heavy menstrual bleeding. • Tiny red spots in your skin

ARTICLE FEATURES . Leukemia

• •

(petechiae) Excessive sweating, especially at night Bone pain or tenderness

Evolution of treatments There are a number of different medical approaches to the treatment of leukemia. Treatment will typically depend upon the type of leukemia, the patient’s age and health status, as well as whether or not the leukemia cells have spread to the cerebrospinal fluid. The genetic changes or specific characteristics of the leukemia cells as determined in the laboratory can also determine the type of treatment that may be most appropriate. Treatments for leukemia include chemotherapy, radiation therapy, biological therapy, targeted therapy, and stem cell transplant. Combinations of these treatments may be used. Surgical removal of the spleen can be a part of treatment if the spleen is enlarged. Acute leukemia needs to be treated when it is diagnosed, with the

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goal of inducing a remission (absence of leukemia cells in the body). After remission is achieved, therapy may be given to prevent a relapse of the leukemia. This is called consolidation or maintenance therapy. Acute leukemias can often be cured with treatment. Treatment of most children with acute myeloid leukemia (AML) is divided into 2 main phases of chemotherapy: Induction and consolidation (intensification). In the induction phase, the chemo drugs most often used to treat AML are given for several days in a row. The treatment schedule may be repeated in 10 days or 2 weeks, depending on how intense doctors want the treatment to be. A shorter time between treatments can be more effective in killing leukemia cells, but it can also cause more severe side effects. Treatment with these drugs is repeated until the bone marrow shows no more leukemia cells. This usually occurs after 2 or 3 cycles of treatment.

Most children with AML will also get intrathecal chemotherapy (given directly into the cerebrospinal fluid, or CSF) to help prevent leukemia from relapsing in the brain or spinal cord. Radiation therapy to the brain is used less often. In the consolidation (intensification) phase, about 85% to 90% of children with AML go into remission after induction therapy. This means no signs of leukemia are detected using standard lab tests, but it does not necessarily mean that the leukemia has been cured. Consolidation (intensification) begins after the induction phase. The purpose is to kill any remaining leukemia cells by using more intensive treatment. Chronic leukemias are unlikely to be cured with treatment, but treatments are often able to control the cancer and manage symptoms. Some people with chronic leukemia may be candidates for stem cell transplantation, which does offer a chance for cure.

ARTICLE FEATURES . Medical Education in the Arab World

Medical Education in the Arab World Prestigious medical schools in accordance with the latest educational curriculum

he Arab world has been able to establish universities and colleges to study medicine in accordance with the latest and most advanced educational curricula, as the Gulf countries and the Middle East have attracted prestigious and reputable universities. Medical schools in the Arab world are keen to provide students with a range of skills and to encourage them to develop their talents in various fields, which has positively reflected on raising the level of higher educa-

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tion in the Middle East and the Gulf. Medical students in the region no longer need to endure the hassle of traveling to European and American countries to study medicine and graduate from those universities, especially thanks to the exchange of relationships and cooperation at the level of educational staff or at the level of scientific research so that the exchange of expertise will benefit the student as if he is traveling to study abroad. Agreements have been signed with educational

institutions from all over the world to establish branches that provide those who wish to study medicine to obtain equal opportunities without traveling overseas while receiving the same level of efficiency and quality of education.

Latest Educational Curriculum Faculties of Medicine in the Arab World are working in accordance with the latest educational curricula in order to graduate professional doctors capable of treating all diseases, while

ARTICLE FEATURES . Medical Education in the Arab World

taking into account the continuing medical education and the necessity of keeping abreast of the endless latest developments in this field through medical curricula that meet the modern need for development. Medical schools in the Arab world, along with the advanced curricula, are characterized by professional ethics and moral values that promote the doctor-patient relationship with the commitment to providing medical care according to the scientific and professional bases, which also boosts the student’s professional competence. Medical schools have succeeded in creating a healthy learning environment that develops creative abilities and mental skills by adopting advanced educational curricula aimed at developing thought, promoting the culture of scientific research, integrating scientific research skills into the curricula and enhancing students’ extracurricular abilities.

Continuing medical education The profession of medicine is characterized by the need for continuous follow-up on developments to be applied during the professional life for the benefit of the health of the patient and society as a whole. Hence, the idea of continuing medical education was created; it is the principle of teaching

adopted in various medical schools in the Arab world where the student should keep up with conferences and seminars while participating in training workshops in order to always stay up-to-date with the latest advances, especially that developments in this profession are endless. Continuing medical education contributes to maintaining students and employees’ abilities as well as their medical skills. It also helps them to learn about all the latest breakthroughs in the field in addition to the medical aspects that develop and progress rapidly. Activities with this kind of education include scientific meetings, workshops, publishing scientific papers and audiovisuals in addition to online medical courses. From the beginning, the Gulf States and the Middle East realized the importance of continuing medical education for students or professionals and medical staff as it is an urgent need and the most important element of sustainable development, which urged governments and ministries of health to enact laws in this regard to determine the system of hours to renew the license for practicing the profession, whether for doctors, medical staff or medical students. All this aims to improve their medical knowledge and skills to keep up with the latest

developments in their field, which is considered by health sector officials an urgent interest for all working parties and healthcare organizations throughout the world. Medical schools in the region are making exceptional efforts to enhance the opportunities of voluntary training for students through bilateral agreements with hospitals and training centers both inside and outside the country, as well as activating the program of academic guidance for students to develop mechanisms to encourage them to carry out scientific research given their important in the student’s course of study. All of which is based on their understanding of the importance of creating a sound learning environment in which the student finds all that will enhance his studies throughout his years of study in medicine. Medical schools have succeeded in creating a healthy learning environment that develops creative abilities and mental skills by adopting advanced educational curricula aimed at developing thought, promoting the culture of scientific research, integrating scientific research skills into the curricula and enhancing students’ extracurricular abilities. There are huge budgets that have been harnessed by governments and medical schools, to demonstrate their strong presence on the academic scene. Today, they are making extraordinary efforts to graduate distinguished doctors who are able to meet the requirements of any community in which they are present, locally or globally. Today, the Arab world is full of high-quality educational activities that meet the educational needs and enable them to continuously renew knowledge and develop the necessary skills to provide advanced patient care. The same applies to professionals and medical staff working to meet the needs of the work environment.

MEDICAL INSTITUTIONS

Creating a smiling future together! Become one of the first dentists educated within the Qatari healthcare system and join the new program for dental medicine this Fall

WHY DENTISTRY?

The new College of Dental Medicine will: •

•

Follow a high-quality curriculum, which will be in line with international standards and combine multiple teaching methodologies to prepare you best for your future workplace. Combine subject-oriented learning, especially during the first year, with organ-centered modular teaching and clinical skills training, to ensure a full integration of all relevant knowledge and skill domains. Apply advanced e-learning and learning technologies to foster active learning and

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•

critical thinking. Use the strong collaboration with Hamad Medical Corporation (HMC) and the Primary Health Care Corporation (PHCC), to offer you early clinical experience in state-of-theart facilities, including a dental simulation clinic and academic dental hospital at HMC. Offer student-tailored Electives, community-based education, and research possibilities. Be the fourth college under QU Health and provide substantial opportunities for inter-professional learning and exchange between different health professional programs.

•

Be routed within the national healthcare system to educate dentists who will be capable to address local challenges in oral health and to support the further development of the Qatari healthcare system.

Vision To be the leading College of Dental Medicine, preparing healthcare providers in providing comprehensive care through collaboration, and committed to advancing knowledge for the service and benefit of our community.

Mission The College of Dental Medicine strives to provide comprehensive, integrated and collaborative best

MEDICAL INSTITUTIONS

practice education and patient care to be the dental college of choice for Qatari students. With our passionate, dedicated faculty and students and a state-of-the-art academic dental hospital, we prepare competent students to be healthcare providers for the future and health of the nation. Our mission is aligned with the university’s goals to continuously expand knowledge through education and research opportunities.

Core Values To provide support in alignment with the mission of Qatar University and build on the strengths of the University. • Integrate education and patient care for individuals and groups. • To inspire students to learn through humanistic comprehensive models of education incorporating individual and collective critical thinking that is evidence-based. • Incorporating innovative and supportive education methods that showcase dentistry at the forefront. • Enhance community health through patient-centered care supporting a healthy community. • Provide quality and best-practice integrated education. • Provide quality patient care in the art and science of health and oral health, and the integration between health and oral health. • Collaborative translational research to improve the oral health of the nation.

•

To support an educational and patient care environment in which faculty and students can excel professionally benefitting the public and the organized profession. Be fiscally responsible in leadership and management

ADMISSION REQUIREMENTS Admission to the College of Dental Medicine is competitive for Qatari and non-Qatari applicants. Due to the limited number of 25 seats, students with the minimum requirements are not automatically guaranteed acceptance to the College.

Minimum Requirements for high school applicants: • • • •

•

High school GPA* of 85% English**: IELTS = 5.5 TOEFL = 500 Mathematics**: SAT = 500 ACT = 21 Completion of 2 out of 3 science subject classes in high school (biology, chemistry &/ or physics). Having biology courses in high school is highly recommended. Supporting evidence of previous volunteering experience in the healthcare sector, medical or scientific internships, or community work (recommended). Passing a personal interview with the College Admission Committee (where relevant).

* For international curriculum schools, letter grades will be equalized to

percent numbers by QU Admission Department. Please refer to QU Admission for further information. ** Test scores for English and Mathematics must be submitted to the QU Testing Center prior to the start of the applications. Late scores will affect the assessment of the application.

CURRICULUM OVERVIEW •

•

• •

•

Structure: 6-year program leading to a Doctor of Dental Medicine Year 1: Joined Common First Year with all students at QU Health Single entry, multiple exit Innovative and flexible Global Learning Experience; early clinical exposure Years 2-3.5: Integrated Pre-clinical and Clinical Learning across disciplines (including simulation training) Years 3.5-6: Final Clinical Phase to prepare competent students to provide dental care on graduation No internship is required following graduation as it is embedded in the undergraduate training

Contact Us: For further clarification and enquiries, please contact us on: College of Dental Medicine Tel: (+974) 4403-7876 P. O. Box: 2713 Email: dentistry@qu.edu.qa Location: College of Medicine H12 Office 143

MEDICAL INSTITUTIONS

Weill Cornell Medicine-Qatar (WCM-Q) boosts local expertise in medical simulation-based learning

wo leading experts in simulation-based learning visited Weill Cornell Medicine-Qatar (WCM-Q) to provide training in the latest methodologies and techniques in the discipline. Course directors Dr. Stefan Gisin, Director of Simulation at University Hospital Basel in Switzerland and Dr. Ralf Krage, Director of the Amsterdam Simulation Centre (ADAM) at VU University Medical Center Amsterdam delivered the three-day EuSim Level 1 Simulation Instructor Course at WCMQâ&#x20AC;&#x2122;s Clinical Skills and Simulation Lab

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(CSSL). The course imparted a wealth of specialist knowledge and skills to the participants, such as how to create safe learning environments, how to give instructive debriefing feedback after simulated learning exercises, using video to inform debriefing sessions and how to steer simulated scenarios to maximize learning outcomes, among other competencies. Simulation-based learning is increasingly used in medical schools to give students the chance to gain a variety of essential skills by practicing them in recreated real-world sce-

narios. Instructors utilize a range of techniques and tools to create these scenarios, ranging from low-tech methods like role-play with standardized patients (actors trained to play patients) to state-of-the-art medical manikins that can be programmed to exhibit a wide variety of symptoms. Explaining the strengths of simulation-based learning, Dr. Gisin said: â&#x20AC;&#x153;One of the key advantages is that we are able to replicate learning opportunities we do not have often enough in daily clinical work, for example rare diseases or very stressful or difficult

MEDICAL INSTITUTIONS

relatively new modality. This course provided educators with an excellent opportunity to experience simulation from both the perspective of learner as well as educator.”

situations where there is a great deal of time pressure and urgency. Similarly, simulation-based learning allows us to train in large, multi-disciplinary teams.” The training course also demonstrated how to write and follow scripts for simulated scenarios, how to develop a simulation-based course, and how to act competently when playing a part in a role-play. The group of 16 participants who completed the course comprised physician educators, nursing educators, simulation-based learning specialists and a medical sociologist.

what was learnt, how the participants felt about the experience and how they can improve.”

Dr. Stella Major, Associate Professor of Family Medicine in Clinical Medicine, and Director of the CSSL said: “This course was a continuation of our efforts to provide education for simulation educators in Qatar. With the inauguration of the annual symposium, Optimizing Health Professions Education with Simulation-Based Learning in September 2017, the WCM-Q CSSL recognizes the importance of investing in developing educators’ skillsets with the new experiential teaching modalities offered by simulation-based learning.”

Joshua Vognsen, Simulation Education Specialist, said: “Simulation-based education has expanded rapidly over the past twenty-plus years, challenging educators to become comfortable teaching using this

The course was accredited locally by the Qatar Council for Healthcare Practitioners-Accreditation Department (QCHP-AD) and internationally by the Accreditation Council for Continuing Medical Education (ACCME).

Dr. Krage said: “The most important thing is to clearly define what are the learning goals that the instructor wants to teach. They also need to understand their target group and create clinical scenarios that are relevant for them. While the learning objectives must be clear, the instructor should not tell the learners what or what not to do but should observe and then create a discussion about

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Cook Children’s Health Care System The renowned pediatric specialty hospital in Fort Worth, Texas extends its services to patients in the middle east Middle East expansion

ook Children’s Health Care System is a non-profit organization working towards improving the health of every child. They are based in Fort Worth, Texas and they offer international programs for patients all around the world. The organization has been operating for nearly 100 years and they currently have over 60 primary, specialty and urgent care locations throughout the state of Texas, where children from all around the globe are receiving top quality treatment.

International accreditation A basis of Cook Children’s prominent reputation is the recognition and acclaim by US news and World Reports for many specialties including Neurology, Endocrinology, Hematology, Orthopedics and Cardiology. In 2016, Cook Children’s Medical Centre achieved Magnet designation once again for nursing excellence and outstanding patient care. The medical center had achieved this designation previously in the years 2006 and 2011. It is important

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to note that less than 8% of hospitals have been given this honor, and less than 1% of hospitals achieved this designation 3 consecutive timex. This achievement evidently places Cook Children’s among the best in pediatric services. In addition, US News & World Report included Cook Children’s Medical Centre in the list of Best Children’s Hospitals in Cardiology & Heart Surgery, Neurology & Neurosurgery, and Orthopedics.

Exceptional talent and facilities Cook Children’s has some of the best pediatrics specialists and practitioners in the country. With specialists from many different medical backgrounds and fields, the medical center holds one of the most diverse pediatric physician networks in the country. Provided that, Cook Children’s employs an elite class of nurses with exceptional qualities that ensure the patients’ comfort. Moreover, the highly qualified physicians are present with break-through technologies and facilities that enable the most efficient treatments for the children.

Cook Children’s have recently expanded their efforts to the Middle East, with ongoing visits and partnerships with hospitals in countries like Kuwait and UAE. Cook Children’s are excited to share their expertise and services to patients suffering from rare and complex pediatric diseases in countries around the region with the help of local officials and health entities. Cook Children’s offer an exceptional international program ideal for patients living miles away from the medical center. The international patient service department is equipped to provide the best experience for the patient and the family. The international team includes multilingual members who can help with all details so families can enjoy a comforting stay. This team works hard to facilitate every individual family’s needs, including travel plans, accommodations and any other service. International patients arriving in Texas will enjoy an encouraging and comforting atmosphere in the Cook Children’s Medical Centre. The facility is huge, and the child’s family will always be close to him/her. Not to mention, the staff members are very friendly and are equipped to satisfy all needs. For more information, please visit cookchildrensinternational.org Phone: +1-682-885-4685 E-mail: international@cookchildrens. org

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Cook Children’s Specialty Programs Cook Children’s Medical Centre has a diverse list of specialty programs that are set to treat cancer patients that suffer from rare or common cases

quipped with highly qualified Doctors trained to treat patients with the most extreme cases, Cook Children’s programs are one of the best in the country.

Oncology Cancer is uncommon in kids, adolescents and young adults, and certain kinds of childhood cancers are highly uncommon. It is literally a life- altering choice to find an experienced team that has handled these cancers. Cook Children’s oncology program is one of only a handful of southwest pediatric cancer programs and one of only four in Texas that is a part of the Children’s Oncology Group. Furthermore, Cook Children’s physicist-researcher team is among the country’s most respected. What this means for you and your baby today is access to the medicines and cures of tomorrow. Cook Children’s oncology program is accessible to any kid from infancy through young adulthood suspected of cancer, diagnosed with cancer, or who wants a second opinion. Patients vary in age from newborn to early 20s, and sometimes even older if they are one of the only nearby facilities that treats their sort of cancer.

Genetic Oncology Cook Children's Hematology and Oncology Center offers a Genetic Oncology Clinic that provides genetic predisposition to cancer care and counseling for children and their families. It is one of the few Genetic Oncol-

ogy clinics in the country. The strategy is a cooperation between pediatric oncologists, geneticists, and genetic counselors that provides education, advice, treatment, and routine cancer surveillance surveys when stated for cancer-prone kids.

Neuro Oncology Cook Children’s program for neuro-oncology has grown to become one of Southwest’s biggest pediatric neuro-oncology programs. The distinguished team of neuro-oncology is extremely considered for their active role in domestic and global clinical research studies and their constant search for cures. These doctors are devoted specialists in brain, optic tract, and spine tumor care and therapy, as well as neurofibromatosis, vascular malformations, dermoid lesions, and more. Advances in the diagnosis and treatment of brain, spine and nervous system tumors in kids and young individuals are taking place at what feels like warp speed. As a consequence, new neurosurgical techniques, approaches to radiation treatment, chemotherapy strategies, and the interaction of these incredible breakthroughs lead to better and better results for kids, adolescents, and young adults — and eventually their families. Cook Children’s neuro-oncology specialists have gained their position at the forefront of incredible breakthroughs. They are actively engaged in domestic and international study programs and clinical trials and their

science submissions and presentations of conferences have gained the recognition of their colleagues and organizations around the world.

Life After Cancer Cancer often leaves physical and emotional scars and, after treatment, carries a new normal that is filled with hope and sometimes anxiety about the aftereffects. The Life After Cancer (LACP) program is designed from the ground up to address the myriad of medical, psychological and social issues that arise. Over the past 20 years, this program has obtained therapy from more than 1,800 cancer survivors at Cook Children’s. Cook Children’s offers medical care for these patients for monitoring the after-effects of therapy, mental and social assistance to help with diagnosis. Pediatric Hematologist / Oncologist, Internal Medicine, Family and Pediatric Nurse Practitioners, Social Workers, Nurses, Educators, and Dietitians are involved in the team experience. Their objective is to provide interventions to improve life by providing medical care, education and lifestyle. The team are actively involved in local, national and global study efforts to know more about survivors of cancer and methods of promoting health. Cook Children’s Life After Cancer Program is here to help ensure that patients have the support they need to enjoy after cancer a full and rewarding life.

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IHF celebrates 90th Anniversary

s ambassador of the global healthcare community, the International Hospital Federation (IHF) celebrated its 90th anniversary on 13 to 15 June 2019. Several activities were lined up to share and extend this occasion to the Federation’s global community.

International Health Organizations. Under favourable circumstances, the YEL initiative will continue to screen and qualify candidates year by year to provide young leaders a supportive venue to conceptualize and breed hospital and healthcare innovations from a fresh perspective.

New Initiative: Young Executive Leaders (YEL)

43rd World Hospital Congress in Muscat, November

Early this year, the IHF launched a new initiative involving young leaders to form a group similar to the CEO Circle. The Young Executive Leaders – YEL – is a team of candidates from full members of IHF who have proven outstanding merit in healthcare management. YELs are enjoying a valuable chance of interacting with talented industry leaders from around the world and working at an international level. Currently a team of 19, the YELs are working together on a topic related to challenges in health service provision for the future. A session at the IHF annual conference will present the results of the YELs’ collaborative work. Outcomes will also be published and disseminated globally to the community of IHF Members and the

This year, the Federation will once again host the 43rd World Hospital Congress in Muscat in November, co-presented by the Ministry of Health of the Sultanate of Oman. The IHF stands firm in its advocacy for efficient management, governance, and leadership to achieve greater health benefits; thus, the dedication to providing to worldwide healthcare organizations a platform for the harvest and exchange of knowledge, strategic experiences and best practices in a global scope. Preparations for the congress are up and running; early bird registration has been announced open.

Sharing the celebration Also in celebration of 90 years in the service of the global health-

care community, the Federation has released its official 90th Anniversary video reiterating its vital roles to its members. “It’s beautiful to see that over the world, there are capable, intentioned people that can work every day to make healthcare safer, more effective, and more sustainable,” said Dr. Francisco Balestrin, Board Member of ANAHP Brazil and IHF President 2017 to 2019. True to its vision and mission, the Federation continues to work for excellence in healthcare. “The IHF goal is to be at the cutting edge of innovation in healthcare and most important, to be instrumental for the hospital work to provide better care for their patients,” shared Dr. Balestrin. Past IHF Presidents and IHF members’ leaders have also shared their experiences with IHF being an organization they are part of, as a way to celebrate the Federation’s 90th anniversary. The IHF invites everyone to listen to more testimonials made available on the IHF website. Previous congresses’ galleries are also available for viewing.

IHF assembles leading healthcare thinkers for the 43rd World Hospital Congress

he 43rd World Hospital Congress of the International Hospital Federation has invited thought leaders, experts and top-level professionals to explore how health services can be better provided during peace and crisis. Topics have been lined up to explore how health services can be: • More responsive through

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• •

better resilience. Supportive through appropriate health investments. Prospective through health impactful innovations.

The World Hospital Congress is a unique global forum where leaders of national and international hospital

and healthcare organizations convene to share knowledge, expertise, experiences and best practices in leadership in hospital and healthcare management and service delivery. Hosted by the Ministry of Health of the Sultanate of Oman on 6 to 9 November in Muscat, the Congress will feature more than 100 present-

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ers in 40 sessions, poster displays, pre-conference session, hospital site visits, healthcare exhibition, special events and networking opportunities in three transformative days which will give delegates opportunities to learn, exchange, and engage with peers.

Keynote speakers include the following thought leaders and experts: 1. Hon. Yuthar Mohammed Al Rawahy, Founder & Honorary Life President of the Oman Cancer Association will share her perspectives on the role of patients in time of peace and crisis from self- empowerment to social mobilization. 2. Sir Andrew Dillon CBE, Chief Executive of the National Institute for Health and Care

Excellence will share how to align the ambition of health systems and the life sciences industry for successful adoption of new health technologies. 3. Dr. Melinda Estes, President and CEO of Saint Luke’s Health System and Chair-elect of the American Hospital Association will provide insights on how hospitals and health systems are driving community health and prosperity. 4. Dr. Agnés Soucat, Director for Health Systems Governance and Financing at the World Health Organization will discuss the role of hospitals and health services in support to population wellbeing.

Besides keynote presentations, panel discussions with leading industry professionals and patient representatives will examine a range of topics including: • The role of hospitals in time of crisis. • Patient and community voice in time of peace and crisis. • Health service providers contributing to health and prosperity. • Health services in support to better well-being. • Taking the innovation to the service. Early bird registration to the Congress closes on 15 August 2019. For more information, visit www.worldhospitalcongress.org or contact congress@ihf-fih.org.

ARTICLE FEATURES . Smart and Digital Hospitals

Smart and Digital Hospitals Hospitals of the future: Smart patient rooms and digital laboratories

he endless medical developments warn that we are heading for a new era in healthcare that affects all types of health services through â&#x20AC;&#x153;smart hospitalsâ&#x20AC;? that offer integrated health services and digital diagnostics in the era of scientific and technological revolution. The Gulf States and the region began to take this approach and benefited from the technological development within their hospitals. They also started digitizing medical services and using artificial intelligence techniques to identify many diseases, as they provide integrated solutions through extensive medical equipment within the framework of smart technology

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and robotic products. The development in the digitization of medical services that we are currently witnessing reflects the improvement in the quality of services, innovations in healthcare and artificial intelligence that keep abreast of international developments and enhance health services. Hospitals of the future promise to offer a leading global model based on sustainability in smart healthcare using nanotechnology and telemedicine while providing smart medical solutions around the clock. This will also rely on wearable devices that provide quick treatment according to standard measures tailored to the specific needs of each patient.

In addition to the establishment of innovative laboratories using smart technology in the fields of health and therapeutic services as well as artificial intelligence in accordance with the best practices, in addition to providing sustainable treatment solutions for chronic diseases, and keeping up with the latest developments in personalized medicine to enable patients to manage their own therapeutic services. The future is expected to see the creation of smart hospitals in the future based on the use of the robot in the health sector, bringing the latest advanced technologies to the Middle East to ensure the best services in healthcare. Global surgical robots mar-

ARTICLE FEATURES . Smart and Digital Hospitals

ket is $ 11.4 billion, and is expected to increase by 22.2 percent by 2020, noting that despite the development of the robot in the medical sector, it only assists the doctor in the operating room because it is eventually a machine that works according to what the doctor wants.

Smart Patient Rooms It is a pioneering step adopted by many hospitals as part of their efforts to convert into smart hospitals. The medical devices are electronically connected to the patient’s room with the patient’s file, in addition to linking the technical and medical aspects while improving the workflow among the medical staff. In the smart pa-

tient rooms, advanced and modern techniques are available to improve treatment and medical care, thereby boosting the level of healthcare provided to patients by providing smart ways of communicating with health service providers and others. Smart rooms also feature automatic medical device connectivity with electronic health information system, as well as vital signs equipment, scales, infant’s vital signs monitors, infusion pumps, breathing and respiratory equipment where signs are automatically recorded in the system without intervention by the nursing staff. In each room there are tablets (iPad) enabling the treating physician or nurse to view alert signs and indica-

tors of the medical condition on the electronic screen for each patient.

Medical Imaging… Advanced Digital Applications In addition to the robot, there are many leading and promising digital applications in healthcare that will change the direction of medicine in the coming years. We are expected to see further achievements in this regard as technology and the Internet are evolving. In smart hospitals, sophisticated artificial intelligence techniques can provide a new vision about diseases through the use of patient data before radiological devices. This rapid development bodes well for a better

ARTICLE FEATURES . Smart and Digital Hospitals

future in which artificial intelligence plays an important role in radiology and medical image analysis so that the field of reading and interpretation of images can be used quickly and accurately at the same time. The digital revolution has currently reached its peak with the introduction of three-dimensional and four-dimensional medical imaging techniques. This technology has become essential in the field of radiology because of its high-quality diagnostic features and clarity in a short time.

Digitization of Medical Laboratories

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Digital hospitals of the future are already digital in all their details, and blood laboratories are an essential part of them. This is a clear reflection of the medical developments and we hear about the digitization of medical laboratories as the advanced technologies have provided the opportunity in many countries to establish automated laboratories with minimal human intervention. Digital labs rely on automated sampling without human intervention, which helps to improve the accuracy of the results and examine as many samples as possible in record time.

In the digital laboratory, a special system is available to tell the doctor if the patient is at risk of developing a disease. For instance, the system contains global risk indicators that predict a heart attack. Once the results of medical and diagnostic tests are introduced into the system, the doctor is warned that the patient is at risk. This type of modern technology in the digital medical labs analyzes the information regarding the diagnostic tests carried out by the patient from images, blood tests and other analyzes, which were entered into the electronic record with the aim to alert the patient if there is a specific risk.

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