HOSPITALS Magazine issue 49 by The Arab Hospital Magazine

Issue 49 / 159 NOV-DEC 2019

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

Rethink Obesity

Type 2 diabetes Sleep apnoea

Dyslipidaemia

Cardiovascular disease • Hypertension

Gallbladder disease

• Coronary artery disease • Congestive heart failure • Pulmonary embolism

Cancer (various)

• Stroke

Osteoarthritis

Obesity (BMI ≥40 kg/m2) may reduce life expectancy by 8 to 10 years. BMI=body mass index.

Publisher Arab Health Media Communication

Medical Innovations & the Hope of Tomorrow

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

Innovation in the medical field is rapidly shifting the sector towards better patient service and greater efficiency for medical institutions in dealing with the methods of care provided. The Global Innovation Index 2019 examined how medical innovations will transform the delivery of healthcare through the use of artificial intelligence (AI), genomics and health apps for mobile phones. Among the new inventions are many that use artificial intelligence (AI), sensors or Internet of Things (IoT) connectivity to do a host of ground-breaking tasks, from detecting Alzheimer’s disease from the sound of one’s voice to telling breast cancer patients, in real-time, if their chemotherapy treatment is working. This system will allow hospitals to store high-resolution MRI and CT scans and other 3D images on its network, without having to compress them. At Boston University, researchers created a technology aimed at making it easy to collect health and motion data in a non-intrusive way to monitor conditions such as Parkinson’s, multiple sclerosis or even sleep apnea so that doctors can adjust medications as needed. If this heralds a brighter future for medicine, the concomitant development of hospital administrations, raising the efficiency of medical teams on the one hand, and upgrading the services provided on the other hand reassure that the world is on the right track, and the Arab countries - especially the Gulf countries – are at the center of this journey. 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

NOV . DEC 2019

NEWS

6 OKI Europe Limited to Showcase DICOM Medical Printers at Arab Health 2020 8 First three providers, Danat Al Emarat Hospital, HealthPlus and Oasis Hospital start full utilisation of Malaffi 10 Malaffi becomes a key part of the important healthcare conversations in UAE 12 Planetree International Awards Saudi German Hospital-Dubai 14 German Ambassador inaugurates Boehringer Ingelheim new Cairo office 16 Beirut Breast Imaging Masterclass 2019 (BIM) at Hôtel-Dieu de France 22 SEHA Aspires for Regional Excellence with New Ethics and Compliance Awareness Conference 28 UAE Obesity Masterclass V.2 kicked off in Dubai under Emirati chairwomanship

FEATURES

94 88 Cervical Cancer 92 Life after Stroke

ARTICLES

18 How medical printing will add marketing value to sterile healthcare organisations?

30 Sentimag® - Magseed® 40 Learn to Love, And To Challenge, Your Medical Device Vendor

72 Revolutionary surgical camera system now available in the UAE

98 Alzheimer’s Disease 100 Deep Vein Thrombosis and Pregnancy

INTERVIEWS

52 Osama Alswailem, MD, MA 54 Zia Sayed and Romel Khalife 56 Mr. Ahmad Nasrallah, Ms. Eman Abdul-Sater, Mr. Akram Sami and Mr. John Dunn

46 Healthy Lifestyle: the path towards fighting obesity 50 Obesity Contributes to the development of cancer 60 Medical Tourism in Saudi Arabia 64 Nuclear medicine 68 When is Breast Cancer hereditary? 74 When to Consider IVF? 78 Osteoporosis 84 Memory Disorders

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Endomag®, Sentimag® and Magseed® are registered European Union Trademarks of Endomagnetics Ltd · www.endomag.com Magtrace® is a registered Trademark of Endomagnetics Ltd in the United Kingdom · www.endomag.com

Sentimag ® – Magseed® ®

Magnetic lesion and lymph node localisation

www.sysmex-mea.com

NEWS

OKI Europe Limited to Showcase DICOM Medical Printers at Arab Health 2020 Exhibiting the award-winning technology with fully integrated DICOM print servers, OKI printers to push the boundaries where the world of healthcare meets

improved through personalised A4 and A3 patient leaflets and brochures. They will also learn how OKI devices save medical and healthcare businesses time and money in medical imaging and standard office printing. The devices on display will include OKI’s ES6410DMe and the ES8431DMe A4/A3 respectively colour and mono printers which combines LED technology with embedded DICOM software, and the Pro9431DMe a versatile DICOM embedded printer. OKI Europe delivers unbeatable accuracy and precision printing for the medical industry by removing the requirement for additional hardware that enables DICOM imaging and streamlining support through a single point of contact with a lower cost of ownership. OKI’s embedded DICOM solution provides superior “near” diagnostic image quality with DMe (DICOM Enhanced) and higher quality mono printing for x-ray and ultrasound with its DMe (DICOM enhanced) printers.

KI Europe Limited has announced its participation in Arab Health Exhibition 2020, where it will showcase the revolutionary print solutions in the medical and healthcare sectors. The exhibition will take place at Dubai World Trade Center, starting on the 27th till the 30th of January 2020, being the largest gathering of healthcare professionals in the region. During the conference, OKI will exhibit the first in digital printer technol-

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ogy; combining high-quality output of an LED printer with DICOM embedded software. This allows the DICOM printers to talk directly with the medical imaging equipment, presenting many opportunities for printing high-quality, non-diagnostic images in High Definition mono and colour on a wide range of media. Delegates visiting OKI Europe at Stand S3.F50 will have the opportunity to preview a completely new innovation to revolutionise their medical imaging as well as discovering how customer satisfaction can be

“We are delighted to announce our participation at Arab Health 2020,” said Carine Haddad, Healthcare Manager - MEIT, OKI Europe Ltd. “We are excited to showcase the diverse benefits of our printers which can be used to support patient care and non-diagnostic medical imaging without the need for additional hardware or software. These devices can also be used for day-to-day office printing, reducing the number of devices required by businesses in this thriving sector.”

NEWS

First three providers, Danat Al Emarat Hospital, HealthPlus and Oasis Hospital start full utilisation of Malaffi

alaffi, the region’s first Health Information Exchange (HIE) platform, created as part of an initiative from the Department of Health – Abu Dhabi (DOH) and Injazat Data Systems, has announced that Danat Al Emarat Hospital and Clinic, HealthPlus Network of Specialty Centers and Oasis Hospital, are the first three healthcare providers whose entire care teams now have access to Malaffi, and are fully utilising the system including all hospitals and clinics across SEHA and Cleveland Clinic Abu Dhabi. This comes just ten months after Malaffi’s launch earlier this year. With Malaffi being directly and seamlessly integrated into the providers’ EMR system, over 1,000 doctors and members of care

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teams can now source and access their patients Malaffi files, from the centralised database of unified patient records.

healthcare system. Collectively we are working towards achieving truly world-class care across Abu Dhabi and championing a healthy nation.”

H.E Mohammed Hamad Al Hameli, Undersecretary of the Department of Health - Abu Dhabi, said: “Today signals a significant step forward in our plans to further elevate our progressive healthcare system in Abu Dhabi. We fully back the success of Malaffi and encourage all providers to align with the Malaffi schedule, as this will also be part of our facility licensing requirements. Universal Emirate-wide implementation of Malaffi will enable better patient outcomes that result from a more well-connected and well-informed

MALAFFI IS NOW DIRECTLY AND SEAMLESSLY INTEGRATED INTO THE ELECTRONIC MEDICAL RECORD (EMR) SYSTEMS OF THREE PROVIDERS IN ABU DHABI AND IS UTILISED BY MORE THAN 1,000 END-USERS “Malaffi enables the meaningful, real-time exchange of important patient health information between the different healthcare providers in the Emirate which will enhance the quality of healthcare delivery and patient outcomes for the people of

NEWS

Abu Dhabi. Challenges in the efficient coordination of care exist and persist in the absence of a unified database that ensures important patient health information is shared timely, safely and securely between different healthcare providers. Malaffi is here to overcome current challenges and revolutionise the delivery of healthcare within the Emirate of Abu Dhabi. Currently, the Malaffi database contains more than 35 million patient records for more than 3 million patients, and every time a provider joins, it becomes even more robust and effective in improving the speed, quality, safety and cost of patient care,” said Atif Al Braiki, the Chief Executive Officer of Abu Dhabi Health Data Services, the operator of Malaffi.

CURRENTLY, THE MALAFFI DATABASE CONTAINS MORE THAN 35 MILLION PATIENT RECORDS FOR MORE THAN 3 MILLION PATIENTS The region’s first HIE platform initiative has also gained the seal of approval from the public as shown by a recent public survey, conducted by Malaffi, with 1,000 respondents from Abu Dhabi, representative of the Emirate’s demographics. The survey* highlighted that 82% of respondents believe that Malaffi will improve patient experiences. The survey also quantified that 91% of people are proud of Abu Dhabi being the first Emirate to develop such an advanced system. As part of Malaffi’s onboarding

process, healthcare providers are required to undertake several stages before they can begin to utilise the platform fully. To facilitate a smooth and steady transition and ensure the quality of healthcare delivered is not compromised, Malaffi’s team has worked closely with the teams of Danat Al Emarat Hospital and Clinic, HealthPlus Network of Specialty Centers, and Oasis Hospital, to support their onboarding journey.

A RECENT SURVEY*, HIGHLIGHTED THAT 82% OF PEOPLE ARE AWARE OF THE BENEFITS OF MALAFFI AND THAT IT WILL IMPROVE THE OVERALL PATIENT EXPERIENCE Mr. Mohammed Ali Al Shorafa Al Hammadi, CEO & Managing Director of United Eastern Medical Services (UEMedical), said, “Having UEMedical’s facilities including Danat Al Emarat Hospital and Clinic, and HealthPlus Centers as the first healthcare network to be fully integrated with Malaffi, is a great testament to our commitment towards an ever-improving patient experience. We are already starting to see the benefits of Malaffi amongst our clinicians and patients. The real-time exchange of information through Malaffi enables Danat Al Emarat and HealthPlus to exchange information, which is very important for the continuum of care we provide at United Eastern Medical Services (UEMedical) Group. This improves our business process and allows our teams to focus on treating and healing our patients, elevating our patients

experience. We are looking forward to more providers onboarding Malaffi that will allow us all to significantly improve the way care is delivered in the Emirate of Abu Dhabi.” “The onboarding to Malaffi has been a remarkably smooth transition for Oasis Hospital, and an important journey that the entire team are proud to be a part of. The reliable sharing of patient health information facilitates better care coordination and informed decision-making at the point of care. Having access to Malaffi is exceptionally beneficial for us as a high-risk maternity referral hospital. For example, our team is able to respond effectively to any pregnancy-related emergency situation, whether the patient is visiting us for the first time or not, thanks to having instant access to all of that patient’s important health information, including the history of past visits with their gynecologist, recorded allergies, past laboratory results amongst others. In an emergency, when every second counts, this is invaluable,” noted Alex Jankuloski, Chief Executive Officer of Oasis Hospital. *The survey was conducted by YouGov. YouGov is a leading market research company, with the largest research online panel in the Middle East, North Africa and South Asia, with hundreds of thousands of people enrolled in their surveys across 21 countries. The survey, which was commissioned by Malaffi in 2019, surveyed 1,000 respondents based in Abu Dhabi, representative of the Emirate’s demographics.

NEWS

Malaffi becomes a key part of the important healthcare conversations in UAE

he dynamic healthcare landscape in UAE is populated with many industry events that offer a platform for the healthcare community to come together, discuss, exchange experiences and share knowledge. These discussions drive innovation and shape the future of healthcare in the UAE and region. This event season in the UAE saw Malaffi thought leaders contribute to conversations shaping the industry

NOV.DEC 2019

and become an important part of this dialogue. On October 3rd and 4th, Malaffi supported the AHIMA International Healthcare Information Summit, an event that gathered many of Abu Dhabi’s health informatics professionals. During the conference, Atif Al Braiki, CEO of Malaffi, delivered a keynote speech on the topic of “United Health Information Exchange Platform, Practices and

Implementation”, alongside Dr. Sanji de Sylva, Head of Clinical Adoption at Malaffi, who spoke on the topic of “Malaffi and HIE Best Practices” during the event workshops. On the second day, Malaffi’s SVP of Operations and Technology, Robert Denson, shared his experiences from the USA and UAE in the panel discussion on the topic of “Healthcare Ecosystem and Lessons Around the World.” As a Health Information Exchange

NEWS

(HIE) platform that will connect all healthcare providers in Abu Dhabi, Malaffi plays an important role in enhancing the interoperability of the sector, which further improves patient care and safety. Elaborating more on this topic, Atif Al Braiki, CEO at Malaffi, contributed to the knowledge exchange on the first day of the 3rd Abu Dhabi Ambulatory Healthcare International Congress (ADAHIC), held in Abu Dhabi from 16th-19th October. Recognising the importance of the conference, Al Braiki said “Malaffi will empower primary care practitioners in Abu Dhabi to better triage, refer and coordinate care for their patients, as

well as make more efficient and wellinformed decisions. Strong primary care is very important for any healthcare system, and in this regard, ADAHIC is a significant facilitator of discussions and ideas that will contribute to its improved delivery in Abu Dhabi.” By increasing the overall quality of healthcare and patient outcomes, Malaffi supports the strategic goal of Abu Dhabi to become the region’s leading medical tourism destination. Elaborating further on this topic, Malaffi’s Vice President of Policy and Compliance, Erik Koornneef, PhD, participated at a panel discussion during the World Medical Tourism &

Global Healthcare Conference in Abu Dhabi, on October 16th. As a result of the efforts to digitally transform healthcare in the UAE and the region, there is an immediate need to create a robust and competent eHealth workforce, by building skills and competencies, and attracting talent. This was the focus of the GCC eHealth Workforce Development Conference held on November 2nd and 3rd in Dubai. During the HIE forum, the CEO of Malaffi, Atif Al Braiki, shared his up close experience with the planning, founding and operating Malaffi, as the region’s first Health Information Exchange platform.

NEWS

Planetree International Awards Saudi German Hospital-Dubai its Highest Level of Achievement for Excellence in Person-Centered Care

audi German Hospital-Dubai has been awarded Gold Certification for Excellence in Person-Centered Care by Planetree International on October 30, 2019 during the conference at Orlando Florida, USA. This Person-Centered Care Certification® recognizes the organization’s achievement and innovation in the delivery of person-centered care. Saudi German Hospital-Dubai is one of only 134 healthcare organizations worldwide to earn this prestigious award, and the only organization in UAE . SGH Dubai achieved this milestone with 99% of rating, which is the highest ranking in the history of Planetree International. Gold Certification for Excellence in Person-Centered Care represents the highest level of achievement in person-centered care, based on evidence and standards. Person-centered healthcare prioritizes the active participation of patients, residents,

NOV.DEC 2019

and their families throughout the healthcare process with an emphasis on partnership, compassion, transparency, inclusion, and quality. “We are proud and honored to be recognized for our commitment to person-centered care,” said Dr. Reem Osman – Group CEO – Saudi German Hospital Group - UAE. “We strive every day to raise the bar in the care and support we provide to our patients, our community and our staff of caregivers. Gold Certification from Planetree gives us confidence to change the face of healthcare by partnering with patients and their caregivers to improve not just the health of our community, but its overall well-being.” The criteria that Saudi German Hospital-Dubai satisfied to achieve Planetree Gold Certification reflect what patients, residents, family members and healthcare professionals in

hundreds of focus groups say matters most to them during a healthcare experience. This qualitative data aligns with the growing evidence-base for person-centered care, and establishes the Person-Centered Care Certification Program as a concrete framework for defining and measuring excellence in person-centeredness. The criteria address components of a person-centered healthcare experience, including the quality of patient-provider interactions, access to information, family involvement and the physical environment of care. Importantly, the criteria also focus on how the organization supports staff, opportunities for staff, patients, and families to have a voice in the way care is delivered, and the ways that Saudi German Hospital-Dubai is reaching beyond its walls to care for its community. As part of the Certification process — which included a site visit by representatives from Planetree — discussion with Saudi German Hospital-Dubai patients, families and current staff validated that specific person-centered policies are in place, including non-restrictive visiting hours and a shared medical record policy; that staff members at all levels are involved in the implementation of person-centered care; and that the organization’s physical environment supports patient and family engagement in their care. The process also included a review of the organization’s performance on patient experience and quality of care measures, and how measurement of these indicators improves organizational outcomes.

Up To %80 of strokes are preventable by lifestyle adjustments 1

EVERY 30 MINUTES

Patients loose about

Nearly %50

a stroke patients dies or is disabled not because of stroke, but because they were not receiving the standard of treatment a specialized stroke 3 unit provides

of Strokes Patients in the UAE are

Under 45

120 MILLION BRAIN CELLS within 1 hour of suffering from a stroke incident 4

What is stroke?

IN THE UAE,

Affected Area

there are more than

10,000

Blood Clot

stroke cases per year.

Blood Flow

A stroke occurs when the Artery blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, 5 brain cells begin to die.

Atrial fibrillation (AF) is the commonest persistent cardiac arrhythmia 6 (irregular heartbeat) and is an important cause of stroke.

SECOND CAUSE OF DEATH

EVERY HOUR ONE PERSON GETS A STROKE

RAPID TREATMENT LEADS TO REDUCED MORTALITY, DISABILITY, COMPLICATIONS AND THE LENGTH OF 11 HOSPITAL STAY

According to the World Health Organisation (WHO) worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability, followed by cardiac diseases 8 A patient needs to receive treatment in less than 60 minutes (Golden Hour) to reduce the chances of 10 further complications

NORMAL

HIGH

CHOLESTEROL

RISK FACTORS

Risk factors include uncontrolled high blood pressure, uncontrolled diabetes, comparatively high levels of 7 obesity, smoking and high cholesterol

MINUTES

Symptoms- Remember FAST

999

Face drooping.

Arm weakness.

Speech impairment.

Does one side of the face droop or is it numb?

is one arm weak or numb?

is speech slurred and the person unable to speak or hard to understand

Prevention

Greater awareness and widespread adoption of healthy lifestyles could help reduce the incidence of strokes in the next generation

Lower blood pressure

Control your cholesterol and diabetes

Stop smoking

German Neuroscience center | St roke and Heart Attack Statistics 2017 | http://www.gncdubai.com/european-cardiovascular-disease-statistics2017-/ https://www.clevelandclinicabudhabi.ae/en/media-center/news/pages/reducing-the-number-of-strokes-key-healthcare-goal-for-the-uae-say-doctors.aspx European Stroke Organization | Improving Acute Stroke Care | https://eso-stroke.org/angels-initiative/ 4 https://www.ahajournals.org/doi/full/01/10.1161.str.0000196957.55928.ab 5 Mayo Clinic | Strokes | https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc203501136 https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc203506247 https://www.clevelandclinicabudhabi.ae/en/media-center/news/pages/reducing-the-number-of-strokes-key-healthcare-goal-for-the-uae-say-doctors.aspx 8 https://www.who.int/bulletin/volumes/181636-16/9/94/en/ 9 https://www.dha.gov.ae/en/DHANews/pages/dhanews2016-10-25-198498631.aspx 10 https://www.researchgate.net/publication/282337476_The_Effect_of_a_Golden_Hour_Policy_on_the_Morbidity_and_Mortality_of_Combat_Casualties 11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040254/ 12 https://www.stroke.org/en/about-stroke/stroke-symptoms 13 https://www.health.harvard.edu/womens-health/-8things-you-can-do-to-prevent-a-stroke 1 2 3

Time to call for support

Be physically active

Eat a healthy diet

NEWS

German Ambassador inaugurates Boehringer Ingelheim new Cairo office Boehringer Ingelheim achieved net sales of around 17.5 billion euros worldwide at the end of 2018

ith the attendance of His Excellency Cyrill Nunn, Ambassador to the German Missions in the Arab Republic of Egypt as well as members of local medical associations gathered officially to inaugurate the new office, Boehringer Ingelheim, one of the world’s leading pharmaceutical companies, during its press conference, located at the heart of the 5th Settlement. The company has had a presence in Egypt through a scientific office, and today’s event marks the launch of its new commercial legal entity across the country. The attendees noted that the new office opening marks an important milestone in Boehringer Ingelheim’s longstanding history

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in Egypt, and at the same time, is a reflection of the country’s robust infrastructure, accessibility and central regional prominence. Yasser Farghali, Boehringer Ingelheim’s General Manager and Head of Human Pharma for Egypt and the LINEA (Levant, Iraq, Near East Africa ) said, “The launch of the new office and second legal entity marks a new chapter in our journey in Egypt, a country where Boehringer Ingelheim has had a longstanding legacy that dates back to 1961. The opening of our new office mirrors the continued upward growth strategy the country is experiencing, by providing a strategic platform for expanding access to our

key therapeutic innovations in human and animal health. It will further harness the recent economic and regulatory reforms that are benefitting the entire healthcare ecosystem to support the neighboring region.” “Egypt is a crucial market in the region, and an important hub in our global network. We are focused on delivering international best practices, innovative medical trends, while also ramping up our research and development capabilities, to address the diverse needs of patients in the country and region. The future is promising. We look forward to continuing delivering on our promise by increasing the scale of our commitment towards driving more innovative solutions in our main

NEWS

therapy areas, while also continue building on our leadership position across the animal health business by becoming a center of excellence in Egypt and the wider region,” added Farghali. Some of the key notable achievements of Boehringer Ingelheim in Egypt include the roll out its Angel’s Initiative which aims to improve and maintain the quality of existing stroke centers. Together with the local medical community, the Angel’s Initiative is focused on building a network of not less than 500 stroke-ready centers to improve care management protocols. To spread awareness, Boehringer Ingelheim facilitated key initiatives that included a national awareness program with the endorsement of prominent medical and social figures, as well as driving an ambulance team training and bridging the knowledge gap by reaching out to universities and shedding light on key stroke management innovations. In human health, the company pioneers in driving key innovative medical solutions across cardiometabolic including diabetes type 2, anti-coagulations, stroke management, hypertension as well as respiratory diseases from Egypt to support the surrounding region. Furthermore, the company continues to focus on providing a holistic approach to type 2 diabetes management by driving access to key innovations that document

cardiovascular protection, which reduces cardiac events in patients with type 2 diabetes. Boehringer Ingelheim is planning more launches in the coming year in Egypt to complement its current portfolio and help people living with type 2 diabetes live healthier and safer lives. In Animal Health, Boehringer Ingelheim enjoys a leadership market position. As a leader in animal health management, Boehringer Ingelheim has introduced key innovations and training curriculums that aim to increase knowledge around vaccine handling, storage, preparation and applications, together with key local solutions and applications. The company supplies more than 11% of the Egyptian market animal health vaccination needs and solutions with

a premium position in poultry and veterinary public health. In specific, Boehringer Ingelheim Animal Health has introduced the InOvo Jector, as a strategic initiative for its poultry business in Egypt. This is a landmark milestone and is fully in line with the company’s goal to provide the best services to hatcheries as vaccination equipment is an integral part of its value proposition. Egypt represents a cornerstone in Boehringer Ingelheim’s operations. The company’s story, which began more than five decades ago, has evolved into sheer dedication towards building a robust business that is in line with the country’s strong infrastructure, accessibility and central regional prominence.

NEWS

Beirut Breast Imaging Masterclass 2019 (BIM) at Hôtel-Dieu de France

reast cancer is the most common cancer among women and the leading cause of death for women aging between 40 and 60 years. One in eight women is at risk of developing breast cancer during her lifetime. However, detection at an early stage offers a recovery chance of more than 90%. Routine screening should be done regularly before any symptoms appear. Mammography is the annual screening tool from the age of 40 or even before that if there are precedents in the medical history of the family. This mammography screening policy has been applied in Lebanon as an almost free national campaign for more than a decade. These campaigns, the first of their kind in the Arab world, have proven effective in reducing breast cancer mortality. Diagnosis through mammography not only increases the chances for successful treatment, but also ensures

NOV.DEC 2019

positive results thanks to a simple surgical procedure and other complementary treatments that are often well tolerated by patients. This surgery does not cause any deformity if it is performed at an early stage and it often consists of a simple breast conservative tumorectomy while maintaining the shape of the breast. Even the axillary lymph node dissection has become easier as it only consists of removing a limited number of nodes while avoiding the swelling of the arms. This breast and axillary surgery respects a woman’s body and its femininity and requires only a short hospital stay of 24 to 48 hours. Radiotherapy, for the breast that has been operated on, is often prescribed solely for prevention. Thanks to modern technologies, this treatment has become harmless and leaves no toxicity nor does it cause any deformity. Sometimes, a few sessions of chemotherapy can also be prescribed post-surgery as a preventive

measure. A genetic test on the surgical specimen can also be performed as of recently, allowing a large number of women to avoid chemotherapy. One daily pill of prophylactic hormone taken for a few years is generally prescribed with no noticeable effects. Therefore, the annual participation in the breast cancer campaign through breast screening greatly helps women and saves their lives through a mild treatment that does not affect them in any way and allows them to pursue their normal lives. As part of this annual campaign, Hôtel-Dieu de France - Saint-Joseph University Medical Center, the American University of Beirut, the Curie Institute in Paris, and in collaboration with Centre Leon Berard (Lyon, France) and several Lebanese medical societies, especially those concerned with cancer, gynecology and women’s imaging, organized a conference on October 4 and 5, 2019, entitled “ Beirut Breast Imaging Masterclass 2019” at Hôtel-Dieu de France. This Masterclass was dedicated to breast imaging radiologists, surgeons, oncologists, pathologists, radiologic technologists, and other physicians and healthcare providers dedicated to breast care. The Masterclass provided comprehensive and interdisciplinary lectures, ranging from basic breast courses to more advanced courses discussing the newest imaging techniques and current guidelines in breast imaging. Furthermore, two industry workshops were offered to provide an opportunity for acquiring skills in the interpretation of Digital Breast Tomosynthesis (DBT) cases through training on dedicated DBT workstations and in performing ultrasound-guided biopsies.

ARTICLE

How medical printing will add marketing value to sterile healthcare organisations? Personalised medical imaging could increase patient satisfaction in the healthcare industry says Javier Lopez, General Manager, Vertical Solutions, OKI Europe Ltd

oing to the doctor can be daunting; waiting in a sterile reception surrounded by people feeling unwell just adds to your anxiety. Now imagine how much more daunting the experience would be if you were receiving abrupt, impersonal service. Simple measures, such as a friendly, personal service make all the difference for patients and custom-

SEPT.OCT 2019

ers, and if those measures were reflected in the medical results and documentation supplied to patients, medical organisations could benefit from increased confidence and patient satisfaction. Businesses and healthcare organisations offering radiology services, such as cardiologists, gynaecologists, medicine centres and others with X-Ray facilities, must rely on medical imaging manufacturers to produce informative, easy-to-digest

images. Not only are these essential in enabling medical staff to recognise medical complications and assert the best course of action, but they help patients understand complex issues that are often difficult to accept.

Building Patient Trust For medical imaging manufacturers, there is a clear opportunity to help those radiology-based organisations build trust with their patients

ARTICLE

while reducing time spent describing those complex issues. Presenting patients with sharp, high-quality colour images will undoubtedly increase the ease of describing issues and treatments. For patients, this creates a friendlier more personalised and satisfying experience that will provide a valued level of comfort during an otherwise daunting experience.

The ease of integration between medical imaging equipment and DICOM printers, and the continuous evolution this communication standard has experienced over the years, has achieved a nearly universal level of acceptance among vendors of radiological equipment. However, the benefits of DICOM are only recognised by medical imaging manufacturers and medical staff. While this means that patients receive correct diagnoses and treatments, the benefits of actually being able to keep or reference DICOM printed images have not been experienced by patients, or clients of private medical businesses. Traditionally, this has been due to the fact that DICOM image files are not easy to share with patients. While other image file formats such as JPEG, PNG or TIFF files are recognised and easily read by personal computers, DICOM files are not recognised by the standard home PC or laptop running Windows or iOS operating systems. While medical organisations could ex-

plore the option of sharing the images via email, the patient would require additional software in the form of a DICOM viewer to access the file, and even then, the patient would need additional information in the email content or in a separate text file to explain the findings in the image.

Personalising the Patient Experience This is where medical imaging manufacturers can provide a simple yet effective solution in the form of personalised booklets, providing a referenceable take-home source of information for patients, including detailed, high-quality images. To maximise their marketing value, the booklets should include relevant information alongside the images, explaining the findings of the scan or X-Ray, or detailing proposed surgery in booklets that present visual renderings of potential cosmetic procedures. Through variable data printing, the booklets can be further personalised with the patientâ&#x20AC;&#x2122;s name, surname and date of birth clearly displayed on the front cover. This level of personalisation will bolster patient confidentiality by ensuring medical staff pass the right documents to the correct patients. Linked reports and other relevant documentation, such as a post-diagnosis radiology report, can also be included, providing all of the relevant information for both doctor and patient in one easily referenceable booklet. A patient requiring cosmetic surgery could be presented with an A3 colour booklet during the consultation stage, prior to making a decision on whether to go ahead with the surgery. Having the personalised booklet detailing the proposal of treatment, the

course of surgery and follow-up treatment, including before and after images, will enable the patient to make an informed decision in their own time. For patients requiring successive treatments for example for dental care, the personalised booklet will help to keep them up to date with the course of treatment, and new booklets printed periodically during the course of treatment will increase patient satisfaction by highlighting the patientâ&#x20AC;&#x2122;s progress on the road to recovery. Personalised booklets will also be of great value to expecting parents, presenting high-quality ultrasound scans that will provide a lasting keepsake which can be shared with friends and family members. For medical organisations, there is a clear opportunity to increase marketing value through increased satisfaction in a highly personalised experience. In turn, this creates a clear opportunity for medical imaging manufacturers that can provide high-quality personalised booklets in a flexible range of formats and sizes that include sharp, colourful images that will inform and placate medical patients in an age of high expectations.

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Dubai Government Workshop provides mobile maintenance workshop services to people of determination

he Dubai Government Workshop (DGW) provided a complete range of services for the people of determination, including the repair and maintenance of their wheelchairs, during a mobile maintenance workshop at the Al Thiqah Club for Handicapped. This initiative was an essential step to help the people of determination in the UAE to save time, effort, and money and give them easy access to fast services. It took place as part of the social and humanitarian responsibilities of DGW, which aims to help enhance the level of services provided to various vital sectors and all segments of society, especially the people of determination. Fahad Ahmed Al-Raeesi, Deputy Executive Director of DGW, said that the event was aligned with the leadership’s directives to improve the quality of life of the people of determination, protect them, and enable them to in-

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tegrate effectively into the community. Al-Raeesi added that DGW believes in their pivotal role in the country’s growth and development as productive members of local communities. He also stressed the importance

of instilling the value of social responsibility in employees and members of society at large, in keeping with the Dubai Government’s approach to promote social inclusion, tolerance, respect, and communication. Al-Raeesi added: “Providing wheelchair maintenance and repair services to the people of determination is part of our strategic plan for 2019-2023, which has been developed in line with the Dubai Government’s drive to promote excellence, innovation, and a culture of improvement in all areas of government work. It is also aligned with the goals of Dubai Plan 2021 to create a pioneering and innovative government that delivers superior services according to the people’s needs. For our part, we will continue to engage with the community to bring happiness to the people and ensure the community’s overall well-being.”

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SEHA Aspires for Regional Excellence with New Ethics and Compliance Awareness Conference

bu Dhabi Health Services Company (SEHA), the largest healthcare network in the UAE conducted a series of workshops and sessions for its senior management as part of SEHA’s Ethics and Compliance Awareness Campaign, the first of its kind in the region. Hosted at the Yas Rotana Hotel in Abu Dhabi, the event titled, “Lead with Ethics” focused on four significant concepts, namely Integrity, Standards of Conduct, Conflicts of Interest, and Anti-fraud and Misconduct. As part of this conference, SEHA announced that it will launch a new whistleblowing helpline for staff to report misconduct, aimed at improving SEHA’s emphasis on quality patient care. The campaign is designed to provide the SEHA leadership team with the tools and knowledge to create internal programs to further educate its 18,000 strong employees. This campaign aims to set a benchmark for best business practice within large public organisations. Dr. Gareth Goodier, SEHA Group Chief Executive Officer, said: “Yesterday, SEHA conducted its first Ethics and Compliance Awareness

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conference, aimed at educating our senior C-suite leaders across all SEHA healthcare facilities. I am proud that our organization is taking on-board new ideas to reinforce ethics and compliance in the healthcare sector. The sessions and panel discussions addressed key topics in support of a culture of integrity and honesty”. Rashed Al Qubaisi Group Deputy CEO of SEHA: “Having completed SEHA’s Ethics and Compliance Awareness training; my leadership team and I are confident that we know how to deal with potentially business-critical issues. More importantly, I’m energized by the impact that this campaign can have on an organisation, so over the next few months I’ll be working closely with my team to engage every staff member at SEHA and its facilities, raising awareness of this important conference.” Also speaking at the event was Col. Matar Al Mohairi, Director of Anti-Corruption Department, Abu Dhabi Police where he highlighted the importance of whistleblowing and the role of employees to prevent

ethical challenges for businesses. Jacob Elberg, professor at Seton hall Law school and ex-Chief of the Office of Healthcare and Government Fraud Unit, spoke on “International Perspectives on Compliance and Ethics” and mentioned “Ethics is the key to success and sustainability for organisations in the 21st century.”

SEHA LAUNCHES A NEW WHISTLEBLOWING HELPLINE FOR STAFF TO IMPROVE PATIENT OUTCOMES A panel discussion was held at the end of the seminar - to exchange views on ethical challenges and to learn “to know how” from the SEHA Conformity and Ethics team. The Ethics and Compliance Awareness Conference is in line with SEHA’s commitment to continually improving customer service at recognized international standards. Providing Abu Dhabi with world-class healthcare – SEHA treats more than five million outpatients a year, 100,000 inpatients annually and conducts over 41,000 surgeries in 12 hospitals across the Emirate.

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Ministry of Health and Prevention launches the first blockchain-based system

he Ministry of Health and Prevention (MoHAP) has launched the first blockchain-based system to save and share assessment information of health professionals, including doctors, pharmacists and technicians, with local licensing health authorities.

THE SMART SYSTEM COMES IN LINE WITH EMIRATES BLOCKCHAIN STRATEGY 2021 The smart system, which will cover healthcare workers in public and private health facilities overseen by the Ministry, will help reduce resource consumption in terms of time and cost, and improve efficiency and data integrity. Awad Saghir Al Ketbi, Assistant Undersecretary of the Support Services Sector, said: “The Ministry has successfully developed the necessary infrastructure for a blockchain-based decentralized database. In the first stage, we will link the evaluation of health workers system with public and private health authorities and other relevant institutions to create a single digital platform with an access to the portfolio of health professionals. “The sophisticated platform comes in line with the ministry’s strategy to develop smart systems, provide the best smart e-services, ensure the happiness of customers and implement TRA standards, smart government enablers, and the United Nations E–Government Development Index” Al Ketbi added.

Emirates Blockchain Strategy He stressed that the innovative

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project will support the Emirates Blockchain Strategy 2021, which aims to capitalise on the blockchain technology to transform 50 per cent of government transactions into a blockchain-based platform by 2021. This can be done through recording and documenting digital transactions using blockchain technology, besides allocating a distinctive imprint of digital data that cannot be hacked or changed. This huge development would increase the level of digital security of national data, reduce operational costs, paper transactions, and speed up the decision-making process, enhance the safety of patients and provide effective and efficient healthcare services.

THE SOPHISTICATED PLATFORM TO CREATE UNHACKABLE & UNCHANGEABLE DISTINCTIVE IMPRINT OF DIGITAL DATA Keeping abreast of developments in digital health technologies For her part, Mubaraka Ibrahim, Director of Information Technology at the ministry said: “The blockchain technology offers a variety of benefits and advantages, including a decentralized database in which the stored data becomes unchangeable. The decentralized database delivers a high security level, in addition to an encryption feature to verify the authenticity and reliability of transactions, as data cannot be deleted, modified or lost. “It will also help improve data and information validation and consistency, which in turn provides a high level of transparency and trust in the

healthcare services sector. With immutable data, all health providers can access reliable information and help take appropriate decisions, automate workflow processes electronically, improve customer and employee experience, and boost operational performance” Mubaraka Ibrahim highlighted.

Smart government enablers’ index She added that the ministry is working to develop e-health services according to the smart government enablers’ index. It is mapping out operational plans to integrate digital technologies with smart applications, and improve the quality, safety and efficiency of healthcare, based on the big data management, predictive models and blockchain technologies. “The Information Technology department at the ministry is looking forward to further improvements and developments to enhance the role of blockchain in licensing health professionals, and updating health workers’ data when obtaining a new certificate or practice. The blockchain technology can also be used to create a blacklist of doctors who violated the standards of the profession, in addition to building a register of medicines licensed and other features that contribute to improving the digital healthcare system”, Mubaraka Ibrahim concluded.

THE UNMATCHED SYSTEM REDUCES OPERATIONAL COSTS AND PAPER TRANSACTIONS, UPGRADES THE DIGITAL SECURITY OF NATIONAL DATA

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UAE Obesity Masterclass V.2 kicked off in Dubai under Emirati chairwomanship

he UAE Obesity Masterclass V.2 kicked off on Friday, September 13, with the participation of leading UAE experts, healthcare professionals as well as specialists from various public and private health bodies, at the Intercontinental Festival City. Chaired by a senior Emirati official, the 2nd edition of the event is organized by Novo Nordisk, the global healthcare leader with more than 95 years of innovation and leadership in diabetes and obesity care, in collaboration with the World Obesity Federation. The conference brought together an elite group of doctors and specialists from the country’s public and private sector, in addition to speakers and specialists from the UAE, Canada and Denmark. The participants held a series of dialogues and panel discussions to identify opportunities and challenges, and highlight the latest global practices and mechanisms used in the treatment of obesity.

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Dr. Fatheya Al Awadi, Chairwoman of UAE Obesity Masterclass, Head of the Endocrine Department-Dubai Hospital and President of the Emirates Diabetes Society, stressed on the significance of the obesity masterclass which acts as a platform bringing together some of the best global and local obesity experts in the medical community.” She added: “Obesity is one of the biggest challenges facing healthcare systems in the world. For UAE in particular, this is even more significant considering the high prevalence of obesity.” Dr. Ayman Hassan, Vice President and UAE General Manager at Novo Nordisk said: “We support the UAE’s efforts to reduce the prevalence of obesity in the longer term, in line with the UAE Vision 2021 National Agenda, and the National Program to Combat Obesity. Today, obesity is one of the most chronic health problems in our society and a major cause of chronic diseases.” “The UAE Obesity Masterclass will reinforce the com-

pany’s commitment to supporting obesity clinics, health practitioners and specialists, so as to provide a comprehensive and integrated treatment journey for patients. In the past year, we have started implementing a project to develop obesity clinics in the UAE to ensure that most of patients with obesity receive care”, he further said.

THE EVENT BROUGHT TOGETHER SOME OF THE TOP SPECIALISTS FROM GOVERNMENTAL HEALTH AUTHORITIES AND PRIVATE MEDICAL FACILITIES Interestingly, Novo Nordisk launched a one-year initiative to support 50 children with type 1 diabetes in the country last year. The initiative was implemented in cooperation with the Friends of Diabetes Association, one of the health-promoting organizations under the Health Education Department of the Supreme Council for Family Affairs in Sharjah and the Emirates Red Crescent (ERC).

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Sentimag® - Magseed® Simpler. Faster. More precise. Next-generation lesion localisation

ue to improvements in screening and patient awareness, approximately 50% of breast lesions are impalpable at the time of diagnosis. The current gold standard to assist the surgeon in finding an impalpable lesion is a hookwire, or guidewire. These are usually placed on the morning of surgery. Wire-guided localisations (WGL) have been used since the 1960s and have several limitations, including migration of the wire, scheduling conflicts and patient dissatisfaction.

Magseed® has been specifically developed to overcome these issues. It promotes seamless operating room (OR) scheduling, accurate lesion localisation and patient satisfaction. Our system consists of the Sentimag® probe and the Magseed® magnetic marker. First, the marker is placed under ultrasound or X-ray guidance up to 30 days before surgery. In the OR, the surgeon uses Sentimag® to precisely localise Magseed® and therefore the lesion.

•

oncoplastic approach. Patient-centric approach: no radioactivity, reduced stress, minimal invasiveness Sentimag® and Magseed® are FDA-cleared and CE-marked for lesion localisation.

Clinical Results. Simple to place, easy to remove The Sentimag® and Magseed® marker were developed in the clinic with direct input and feedback from both surgeons and radiologists. Since it was launched in 2016, the system has been used to treat over 2,000 patients and has found a strong base of support among clinicians. When compared to wire localisation, seed localisation is generally more accurate, less painful and hence less stressful for the patient.

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Feedback from 100+ Surgeons

Magseed® is more convenient, can reduce scheduling delays and improve efficiency in the OR. Adopting Magseed® as standard of care has the potential to drive cost savings in addition to its clinical benefits. The results below represent feedback from over 200 surgeons and radiologists having used Magseed® in over 350 procedures. Seeds were used to mark invasive and benign lesions, as well as surgical biopsies. The overall impression is that Magseed® is simple to place and easy to remove. Importantly, radiologists were able to place the seed where intended in 98 % of cases and found placing the needle to be very easy. In 99 % of cases seeds could be detected by the surgeon pre-incision and later on intra-operative X-ray.

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16 to 18 January 2020 Sheraton Grand Doha Resort & Convention Hotel, Doha, Qatar Organized by Hamad Medical Corporation in collaboration with the Ministry of Public Health in preparation for the 2022 FIFA World Cup that will be hosted in Qatar. The conference offers delegates the opportunity to learn about healthcare in the context of mass gatherings as well as emergency and disaster management. The CPD point allocation process is underway with the Qatar Council of Healthcare Practitioners (QCHP) and will be announced shortly. For more information and to register, visit: https://www.hamad.qa/qatarhealth2020.

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New Treatment for Patients Diagnosed with Type 2 Diabetes in Lebanon A development based on Ertugliflozin, effective in controlling blood sugar levels

ith a new development that holds out hope for patients with type 2 diabetes (T2DM), MSD added a new discovery to its ongoing efforts to secure the latest innovations for the management of type 2 diabetes.

This new discovery is based on Ertugliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor indicated to improve glycemic control in adults aged 18 years and older with type 2 diabetes. It can be used as monotherapy or in combination therapy. Ertugliflozin demonstrated excellent glycemic control and reductions in blood pressure and weight, offering an additional treatment choice for people with type 2 diabetes. It has been studied as first-line therapy in addition to diet and exercise and as add-on to metformin in patients inadequately controlled on metformin. In both cases, ertugliflozin 5 mg and 15 mg produced significant reductions in HbA1c and body weight and numeri-

cal reductions in systolic and diastolic blood pressure (DBP) compared with placebo. “At MSD, we have remained committed to efforts in providing treatment options for patients impacted by type 2 diabetes. We have a longstanding history in the research of treatments for diabetes and continue to further advance the care of people impacted by this disease. Our goal is to provide effective therapies to allow patients to reach their treatments goals.” said Adrian Sieberhagen, the Medical Director of MSD Levant. On the other hand, Mr. Wissam Salibi, Managing Director of MSD – Lebanon , stated that diabetes is one of their top priorities. He added: “We have a long-term commitment and we continue to make efforts to enhance the healthcare of people with diabetes. The latter affects each patient differently and we continue to focus on treatments that will help limit its complications.

Dr. Paola Atallah, president of the Lebanese Society of Endocrinology, Diabetes and Lipids, stressed on the importance of the regular communication between the physician and the patient to help control the patient’s diabetes, while continuing to raise awareness and search for treatments. “Diabetes is a chronic disease that can lead to health complications if neglected. According to the International Diabetes Federation (IDF), the number of people with diabetes continues to rise globally at high rates. In 2017, there were 425 million adults between the ages of 20 to 79 years with diabetes worldwide, including 212 million undiagnosed cases of type 1 and 2 diabetes. In Lebanon, the number of people with diabetes in 2017, according to the Federation, consists of 585,400 cases, with 251,400 estimated undiagnosed cases. The number of people with diabetes in Lebanon is likely to increase if the necessary measures are not taken.”

New Treatment Falls under the Umbrella of the National Social Security Fund

he National Social Security Fund (NSSF) has recently announced the reimbursement of new Multiple Sclerosis medication by 95%. The new product will further help control this challenging disease. MS is an autoimmune disease that affects the central nervous system when immune cells in the body begin to attack parts of the brain and the system itself, damaging the myelin sheaths that cover the neurons in the brain and spinal cord. The new product is characterized for its short treatment period and long-term benefit, helping patients overcome the burden of the disease.

NOV.DEC 2019

Highest Ranked in Houston When it comes to neuroscience, it’s about collaborating with a leading academic institution like Baylor College of Medicine to revolutionize surgical approaches, find innovative uses for technology, and navigate new frontiers. It’s about the confidence in having some of the best brains in neuroscience by your side, managing your care while developing new treatments for tomorrow. StLukesInternational.org international@stlukeshealth.org Tel: +1 832.355.3350 Texas Medical Center, Houston, Texas–U.S.A.

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Saudi healthcare spending expected to increase to US$ 160 billion by 2030 world almost 18% of the population over 20 years with diabesity, 35% with obesity, and over 23% suffering from hypertension so, a great deal of focus will be on preventing lifestyle diseases. The largest increase will be felt in the over 60 category which is expected to grow from 1.8 million in 2018 to five million in 2030, driving demand for geriatric services such as long-term care, rehabilitation and home care.

Mansoor Ahmed

Ross Williams

rab Health, the largest exhibition for healthcare and trade professionals in the MENA region, has revealed Saudi Arabia’s healthcare spending has grown at a Compound Annual Growth Rate (CAGR) of 12.1% in the last nine years to US$45.9 billion, and is expected to increase to US$160 billion by 2030. The report by Colliers International, titled: “Saudi Arabia Healthcare Sector – Country in Transformation”, which forms part of the Arab Health Market Series, highlighted population growth at a CAGR of 2.5% to 45 million by 2030 as one of the key factors fuelling the demand for healthcare services. The research also outlined an increase in healthcare spending between 2011 to 2019 of US$18.4 billion, at CAGR of 12.1%. Ross Williams, Exhibition Director of Arab Health, which takes place from 27 – 30 January 2020, said: “As a pioneer and innovator of the healthcare industry, Arab Health has an integral role in developing the industry across the GCC and internationally. We provide the perfect platform for

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representatives from the region to explore the latest technologies and innovations in the sector, to keep pace from a global perspective, while also showcasing the many opportunities for investing in the Kingdom and the rest of the GCC.” Population growth, in addition to a rise in life expectancy, urbanisation and a growing prevalence of chronic/ lifestyle diseases including diabetes, coronary problems and other obesity-related illnesses, are driving demand for healthcare services in the Kingdom even further. The report also outlined the impact the composition of the population is having on future healthcare requirements. The age group newborn to 19 is expected to increase to 13.7 million by 2030, creating demand for facilities and services relating to mother and childcare such as obstetrics, gynaecology and paediatrics. Meanwhile, population growth in the 20 to 39-year demographic is expected to increase to 13.8 million by 2030. With one of the highest prevalence of lifestyle diseases in the

Colliers International’s Mansoor Ahmed, Director (MENA Region) Valuation & Advisory – Healthcare and speaker at the Arab Health Healthcare Investment Forum, said: “With the changing population composition alongside advancements in treatment technology, the provision of healthcare services in Saudi Arabia will undoubtedly change considerably. We anticipate, in line with many other developed nations, a realignment of treatment through the establishment of specialised Centres of Excellence (CoE) instead of clinics and general hospitals, providing further opportunities for operators and investors.” With the introduction of several legal and economic incentives, including 100% foreign ownership, the healthcare sector is amongst the most attractive sectors in the Kingdom. In line with the growth of the Saudi Arabian healthcare industry, Arab Health witnessed a 20% increase in visitors form the Kingdom during the 2019 edition while exhibitors are forecasted to increase by 20% in 2020 with Saudi General Investment Authority, Dr Sulaiman Al Habib Medical Group, Lean Business Services, and Balsam United confirmed.

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Learn to Love, And To Challenge, Your Medical Device Vendor James Waterson. RN, M.Med.Ed. Medication Safety Manager, Medical Affairs. Becton Dickinson. Eastern Europe, Middle East and Africa. James.waterson@bd.com

edical device companies make profits from healthcare. By virtue of this, the relationship between healthcare providers and these companies has often been an uneasy one. This said, it is important to remember that device manufacturers have a vested interest in the wellness of patients. Medical devices

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Larry Neal. Regional Marketing Manager, Medication Management Solutions. Becton Dickinson. Eastern Europe, Middle East and Africa.

that fail to deliver results and improve the lives of patients (and clinicians!) are short-lived in the market and damage their maker’s reputation. Bringing a medical device to market requires extensive consultation with customers to acquire ‘Voice of Customer’ (VOC) insights. Without

consulting the expertise and acumen of clinicians and biomedical staff there is a very real risk of creating a device which has multiple features but no real application to the customers’ challenges. A simple example of an apparently ‘impressive’ but pointless feature would be a manufacturer producing an IV pump that claims to

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deliver 0.01 ml/hr for continuous infusions. A simple VOC exercise would soon make it clear to the manufacturer that such a device, running at 0.01 ml/hr, would take over 30 hours just to clear the dead space in even a small gauge cannula before true drug delivery takes place! [https://www.ncbi.nlm.nih.gov/ pubmed/23057436] VOC therefore helps medical device companies to create devices and processes that deliver efficient, effective and above all, safe care to patients. Answers from VOC surveys help manufacturers decide how pre-existing environmental,

technological, and organisational cultural barriers to safe, effective, and economical care can be overcome through innovative device design. One of the goals of the Becton Dickinson Middle East and Africa office in the near term is to ensure that a more significant component of global VOC consultation takes place in our territory. This reflects the trend towards ever higher standards of leadership on patient safety, automation, technology utilisation, and innovation that we see in the region. The large-scale use of VOC also ensures that medical device companies have extensive global experience of how facilities have solved patient care problems using their products, and of how customers have undertaken integrations of these products into their risk management and patient treatment strategies. These can of course be shared, and essentially a medical device company can be the coordinator of a global community of its users to promote and to disseminate best practice in the use of its products. Examples of this are sharing best practice nursing audit processes for infusion pump pressure alarm setting to reduce extravasation injury risk in neonates [https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-0150521-6] and the hosting of region-wide and global teleconference seminars, face-to-face meetings, and expert panels for pharmacists and risk-managers to discuss and create strategies for hazard reduction in high-risk medication prescription, compounding, dispensing, and administration. A more formal example of the kind of coordination that medical de-

vice manufacturers undertake is creating advisory boards of advanced users of their products, and directing the activity of Key Opinion Leaders (KOLs) towards solving issues for the larger healthcare community. A key component of this process is â&#x20AC;&#x2DC;spreading the wordâ&#x20AC;&#x2122; from KOLs and advisory panels about new, or previously under-recognised, healthcare and risk management challenges and solutions to a global audience. Medical device companies may be uniquely positioned to undertake such dissemination as they are often large corporations that are globalised, interactive, and connected to locations throughout the world. Medical device companies should have extensive Medical Affairs and Health Economics Outcomes Departments. These departments are dedicated to ensuring that products that come to market meet the needs of organisations, patients and end-users, and are used optimally by clinicians to deliver real value. These departments are therefore a perfect partner for any facility or healthcare professional looking to create research or undertake quality projects within their facility, as they have access to large volumes of data taken from devices, specialist services for interpretation of data and results, and, often, experience of similar projects undertaken by other customers even though these customers may be in other parts of the world. Examples of this from our own region include an extensive engagement by BD with the NICU of University Hospital Antwerp in Belgium to identify and to improve issues of alarm fatigue and clinician response to critical infusion alarms

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[http://www.jpnim.com/index.php/ jpnim/article/download/060248/485] and a large scale assessment of data from infusion pumps from every part of Europe, Middle East and Africa, with 1,600,832 separate infusions and over 2.2 Million alarms analysed. Such work is time consuming and exhausting for individual clinicians to undertake, but is important. The Antwerp NICU study included changes to the way infusion pumps were used and how their alarms were monitored. These changes led to a 56% reduction in key alarms overall and to a 31% improvement in clinician reaction time to critical infusion alarms. The large-scale cross-regional study mentioned above has identified how ‘Right Maintenance’ of critical short half-life infusions is both a previously under-reported potential area of risk for patient safety, and has identified areas in which technology may help mitigate the risk of prolonged

interruption of delivery for critical drugs such as Epinephrine in increasingly understaffed and over-extended critical care areas. [https://humanfactors.jmir.org/2019/3/e14123/] Creating regional case studies to show how products that are used globally can be ‘localised’ is an important part of the work of any regional Medical Affairs department and requires partnering with key centres of excellence at a national level. We are fortunate in the Middle East in having so many top-level institutions to undertake this work with, and to show how automation and medication management systems can be employed to solve problems such as high turnover demand in outpatients and in emergency departments. Regional Medical Affairs departments, backed by the technical and IT resources of large medical device companies, can also offer expert advice on

existing technologies in facilities, and in particular, on complex issues such as infusion interoperability with Hospital Information Systems (HIS). An example of this is the ‘clinical walkthrough’ to assess the readiness of a facility to undertake bar-code IV medication administration with medication orders being sent directly to smart IV pumps from the HIS. The walkthrough includes assessment of existing hardware, pharmacy and nursing resources, and clinical workflows, and is followed by a technical assessment of the networks and server infrastructure required for such integrations. Medical Affairs departments can also assist with solution planning to meet accreditation requirements, and can help customers by focusing on specific areas such as Medication Management and Usage (MMU) and Quality Improvement and Patient Safety (QPS) where data aggregation and analysis, and evidence of Failure Mode Effect Analysis (FMEA) processes are required by agencies such as Joint Commission International. Medical device vendors need a strong engagement with customers, in order to learn from them, and to continue to learn more about our own devices and their full ‘real world’ potential. Equally customers should engage with manufacturers to gain valuable support if they are to realise the full value of their investment in these technologies for patients and clinicians.

SO, LEARN TO LOVE YOUR MEDICAL DEVICE VENDOR, BUT, OF COURSE, PUT THEM TO WORK AND ENSURE THAT THEY DESERVE YOUR LOVE. Join BD at Arab Health Hall 3, booth S3/D50 to learn how BD can support your facility in enhancing a culture of safety, driving better outcomes and mitigating cost pressures or visit us at bd.com/MM-Arab.

NOV.DEC 2019

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Cleveland Clinic-led Research Team Develops New Genetic-based Epilepsy Risk Scores “The fact that we can now identify people at high risk for epilepsy, and even start to distinguish between the two main types of epilepsy, based on genetic scores is really exciting,” said Dr. Dennis Lal, the study’s lead author. “These landmark results set the stage for an entirely new direction of epilepsy research.”

n international team of researchers led by US-based Cleveland Clinic has developed new genetic-based epilepsy risk scores, which may lay the foundation for a more personalized method of epilepsy diagnosis and treatment. This analysis is the largest study of epilepsy genetics to date, as well as the largest study of epilepsy using human samples. Published in the journal Brain, the research team, led by Dennis Lal, Ph.D., a researcher in Cleveland Clinic’s Genomic Medicine Institute, calculated for the first time quantitative scores that reflect overall genetic risk for epilepsy, called polygenic risk scores. They showed that these scores can accurately distinguish on a cohort level between healthy patients and those with epilepsy, as well as between patients with generalized and focal epilepsies. After the first seizure, it can be difficult for clinicians to predict which patients will go on to develop epilepsy. Development of these novel genetic risk scores could help clinicians to intervene and treat patients earlier.

NOV.DEC 2019

Up to 40% of cases of rare neurological disorders that present with seizures can be explained by a single rare disease-causing genetic variant. Personalized therapies are in development to treat patients with many of these genes. In contrast, up until this point, the role genetic factors play in common forms of epilepsy have not guided disease management and treatment plans. While genome-wide association studies (GWAS) have identified several common genetic variants for epilepsy, it is challenging to quantify an individual patient’s genetic risk based on these variants due to small effect size (an indicator of the strength of an association). Additionally, analyzing a single common genetic risk variant does not take into consideration the effect other variants may have on overall epilepsy risk. To address this unmet clinical need, Dr. Lal and collaborators combined all known common genetic variants identified from several large GWAS cohorts, which included more than 12,000 people with epilepsy and 24,000 healthy controls, to calculate the polygenic risk scores in more than 8,000 people with epilepsy and 622,000 population controls. By combining the effect sizes of thousands of common genetic variants, these scores can be used to determine an

individual’s risk for epilepsy. Polygenic risk scores have been shown to have predictive and diagnostic power in a variety of medical conditions, including myocardial infarction, diabetes, and breast cancer. This study was the first to examine them in the context of epilepsy. The research team showed that the predictive power of the polygenic risk scores developed in this study performed as well when applied to patients receiving routine clinical care. “While additional research is necessary, we believe these findings will lay the groundwork for one day using genetic risk assessments in the clinic to diagnose common epilepsies and guide precision treatment earlier in the disease process,” said Imad Najm, M.D., director of Cleveland Clinic’s Epilepsy Center and co-author on the study. According to the World Health Organization, around 50 million of the world’s population have epilepsy, which is typically diagnosed after a patient experiences two unprovoked seizures. The two main epilepsy syndromes are generalized epilepsy (involves both cerebral hemispheres) and focal epilepsy (originates in one cerebral hemisphere), and they account for a combined 94% of incident epilepsies. Lal led the work with first author Costin Leu, Ph.D., a computational biologist on Lal’s research team at Cleveland Clinic’s Genomic Medicine Institute. The genetic data used in this study came from Cleveland Clinic’s Epilepsy Center, Epi25 Collaborative (the largest epilepsy research network in the world), and additional sites around the world. The study was funded by the National Institutes of Health.

ARTICLE FEATURES . Obesity

Healthy Lifestyle:

THE PATH TOWARDS FIGHTING OBESITY

hysical activity and a balanced diet go hand in hand in fight against obesity, which often occurs as a result of wrong behaviors and unhealthy dietary patterns. The global trend today is to prevent obesity given its association with many diseases such as diabetes, heart disease, cancer, bone and joint problems and many others. In order to reach the desired goal, the concerned authorities including ministries of health and international organizations in cooperation with reputable medical companies are focusing on launching awareness campaigns urging community members of all ages to make any physical activity because of its importance in the fight against obesity on one hand and for the prevention of many diseases and reducing the risks of becoming obese. Since a healthy and balance diet is key, it is important to focus on healthy eating patterns that, if combined with exercise, will yield amazing results.

First, what is obesity? What causes it? Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. The BMI is the body weight (kilograms) divided by height squared (meters).

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ARTICLE FEATURES . Obesity

A BMI of 18.5-24.9 indicates that you are at a healthy weight for your height. The following table shows the classification of results after dividing the weight by height. The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Bad eating habits are one of the main causes of obesity including junk food, sugary drinks accompanied with lack of physical activity and sedentary lifestyle. Obesity tends to run in families

and is also one of the most common causes. One study found that 80% of the offspring of two obese parents were obese in contrast to less than 10% of the offspring of two parents who were of normal weight. Hypothyroidism, or low levels of thyroid hormone, is a hormonal cause of obesity. It slows your metabolism and decreases growth or repair of many parts of the body. Mental well-being is also another cause for obesity and people who are depressed tend to eat more when they feel down. Obesity is often associated with emotional issues, such as sadness, anxiety, and depression.

Physical activity to prevent obesity Regular physical activity is important for good health, and it’s especially important if you’re trying to lose weight or to maintain a healthy weight. In addition to helping you reach and maintain a healthy weight, staying active and eating better may lower your chances of developing numerous diseases. If you’re not active enough, you do not use the energy provided by the food you eat, and the extra energy you consume is stored by the body as fat. Eating a well-balanced diet can help you get the calories and nutrients

ANYONE WHO WANTS TO KNOW IF THEIR WEIGHT GAIN IS HEALTHY SHOULD KNOW THEIR BMI: Body Mass Index (BMI)

Nutritional Status

Below 18.5

Underweight

18.5–24.9

Normal weight

25.0–29.9

Pre-obesity

30.0–34.9

Obesity class I

35.0–39.9

Obesity class II

Above 40

Obesity class III

ARTICLE FEATURES . Obesity

you need to fuel your daily activities, including regular exercise. Exercise can boost your metabolism. Building lean muscle mass by exercising can slightly increase your resting metabolic rate. In addition, vigorous exercise can increase your metabolic rate for hours after exercise. Exercise therefore increases the chances of long-term weight loss due to its role in accelerating metabolism, building muscle mass and eliminating the accumulated fat, especially if accompanied by a low-calorie diet. The WHO has recommended doing any kind of physical activity daily for at least an hour as part of its global action plan on physical activity 2018–2030: More active people for a healthier world. It urged people to the need of reducing sedentary lifestyles in order promote health and fitness for all. Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including the world’s major non-communicable diseases (NCDs) of coronary heart disease (CHD), type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Experts in this field agree that the

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main goal isn’t just exercise but always getting rid of sedentary lifestyle. Meeting your goal may be as simple as an extra five-minute walk, or even parking a few cars further away at the supermarket, depending on your speed and stride.

A Balanced Diet The real key to safe and successful weight loss is to adopt a healthy lifestyle that suits your individual needs and that you can maintain for life. When you reach the desired weight, the person should maintain his weight loss by following a healthy lifestyle consisting of a balanced diet and regular exercise. Physical activity plus diet produces better results than either diet or physical activity alone. Changing bad dietary habits and exercising regularly are the most important part of a weight-loss plan. To remain in balance and maintain your body weight, the calories consumed from foods must be balanced by the calories used in normal body functions, daily activities and exercise. Many factors can affect your weight, including genetics, age, gender, lifestyle, family habits and culture,

sleep, and even where you live and work. Some of these factors can make it hard to lose weight or keep weight off. But being active and choosing healthy foods has health benefits for everyone—no matter your age or weight. It’s important to choose nutrient-dense foods and be active at least 150 minutes per week. Fiber is found in healthy foods including vegetables, fruits, beans and whole grains. Some studies have shown that simply eating more fiber-rich foods may help you lose weight and keep it off. Increasing your intake is as easy as adding beans to your salad, eating oats for breakfast or snacking on fiber-rich nuts and seeds. Including protein-rich foods like eggs in your breakfast has been shown to benefit weight loss. Increasing protein intake in the morning may also help you avoid unhealthy snacking and improve appetite control throughout the day. Focus on hydrating with water to minimize the number of calories you drink throughout the day. Refined carbs include sugars and grains that have had their fiber and other nutrients removed. These types of foods are low in fiber, are digested quickly and only keep you full for a short pe-

ARTICLE FEATURES . Obesity

riod of time. Instead, choose sources of complex carbohydrates like oats, ancient grains like quinoa and barley, or veggies like carrots and potatoes. Theyâ&#x20AC;&#x2122;ll help keep you fuller for longer and contain many more nutrients than refined sources of carbohydrates. Snacking on unhealthy foods can cause weight gain. An easy way to help shed pounds or maintain a healthy weight is to make an effort to have healthy snacks available at home, in your car and at your place of work.

Diseases caused by obesity and treated by exercise With a significant uncontrolled weight gain and trying to lose weight over time, health problems will begin to emerge. Obesity increases respiratory problems; people who are obese cannot breathe normally, especially during sleep, and are unable to move easily. There is also an increased risk of developing osteoporosis, heart disease, diabetes, stress and fertility problems. Obesity also affects self-esteem and causes feelings of severe depression due to a difficulty in coping with obesity. Regular exercise can help fight atherosclerosis by reducing the amount of fat in your blood, lowering your blood pressure and cholesterol, and controlling your weight. Physical activity contributes to strengthening the muscles, and thus maintaining bone strength, which helps in the prevention of osteoporosis. There are a few ways that exercise lowers blood sugar: Insulin sensitivity is increased, so your muscle cells are better able to use any available insulin to take up glucose during and after activity. When your muscles contract during activity, your cells are able to take up glucose and use it for energy whether insulin is available or not. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you

control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. Doing moderate exercise is among the steps that should be taken including taking regular walks or doing other light sports that contribute to burning fat and getting rid of excess calorie over time. Diet and exercise are both key components of a successful strategy to beat or manage diabetes. Studies show that diet and exercise can sharply lower the likelihood of diabetes, even in people who are at high risk of developing it. Other studies also show that lifestyle interventions can improve insulin sensitivity and blood lipid profiles and help lower high blood sugar levels. Cardiovascular health and diabetes are also intricately linked. Committing to a better diet and daily exercise promotes better blood sugar levels, blood lipid control, and mood. It also leads to higher energy levels, which

makes it easier to exercise. Daily exercise helps keep blood vessels healthy, makes you feel better about yourself, and may aide in weight loss. Regular exercise also helps to keep arteries and other blood vessels flexible, ensuring good blood flow and normal blood pressure. It is an important way to lower your risk of heart disease. Exercising for 30 minutes or more on most days can help you lose weight, improve your cholesterol, and even lower your blood pressure. Obesity is also associated with an increased risk of sudden cardiac death. Obesity is a potent risk factor for the development of kidney disease. The increase in intraglomerular pressure can damage the kidney structure and raise the risk of developing chronic kidney disease in the long term. Hence, maintaining optimal weight and avoiding obesity while following a healthy lifestyle is the best way to prevent chronic kidney disease in the future.

ARTICLE FEATURES . Obesity

Obesity Contributes to the DEVELOPMENT OF CANCER but can be avoided

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ARTICLE FEATURES . Obesity

here is an increased awareness about the dangers of obesity and the serious illnesses related to it; studies have shown the relationship between obesity and the development of some diseases. Obesity has also been linked to an increased risk of developing and dying from cancer.

Researchers were able to determine the relationship between the body mass index (BMI) and the risk of disease development, after excluding the genes that contribute to obesity and the formation of tumors. Being overweight or obese increases the risk of 13 types of cancer. Extra fat in the body is active, sending out signals to the rest of your body. These signals can tell cells in our body to divide more often, which can lead to cancer. Obesity not only increases the risk of cancer, but is often associated with other health complications, such as type 2 diabetes, infertility, heart and liver disease as well as arthritis. Obesity has been shown to increase the risk of cancer because fat cells are active in the body and release hormones and electrical signals that encourage cells to divide and grow. Cancer occurs as a result of an error in cell division, which leads to uncontrolled growth of cancer cells leading them to accumulate. The International Agency for Research on Cancer (IARC), based in France, had prepared a study on how genetic measurements of body weight affect the risk of cancer. The study focused on seven types of cancer such as cancer of the intestines, kidneys, pancreas, ovaries, endometrium, esophagus and breast. In this study, the risk of kidney cancer, for instance, increased from 30 to 59 percent. The risk of endometrial cancer increased from 50 to 106 percent, from 6 to 13 percent for ovarian cancer and from 48 to 110 percent

for esophageal cancer. Regarding pancreatic cancer, the increased risk of obesity has changed from 10 to 47 percent, and the risk of bowel cancer has increased from 5 to 44 percent.

The link between obesity and cancers Obese people are at higher risk of developing cancer, as research has shown that many cancers are more common in people who are overweight or obese, including cancers of the breast, intestines, uterus, esophagus, pancreas, kidneys, liver, stomach, gall bladder, ovaries and thyroid. Excess body fat stimulates cells to divide more rapidly than normal, increasing the risk of developing cancer. The body produces hormones and proteins that nourish and activate fat cells, which spread through blood circulation. Excess fat can alter levels of sex hormones, such as estrogen and testosterone in the body, which may increase your risk of cancer. In addition, the main actions that insulin has are to allow glucose to enter cells to be used as energy and to maintain the amount of glucose found in the bloodstream within normal levels. Hence, insulin affects the levels of growth factors available to cells. Abdominal fat can cause severe damage to the intestines, kidneys, esophagus and pancreas.

Rising cancer and obesity incidence There will be 18.1 million new cases of cancer and 9.6 million people will die with the disease this year worldwide, a report predicts. The rise, from 14.1 million cases and 8.2 million deaths in 2012, is partly due to a growing and ageing population. The figures suggest one in five men and one in six women will develop the disease in their lifetime. The latest report suggests lung cancer, female breast cancer, and bowel cancer are responsible for a third of all cancer cases and deaths worldwide. Worldwide obesity has nearly tripled in the last four decades. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese. 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese. On the other hand, in addition to obesity and its direct link to thirteen types of cancer, it is also believed that physical inactivity and lack of exercise increase the risk of cancer, not only by causing weight gain, but due to their negative impact on the immune system as well as on the endocrine system in the body, and the hormones produced by those glands, which have numerous and diverse biological and physiological effects.

INTERVIEW

Chief Information Officer, King Faisal Specialist Hospital and Research Centre (KFSH&RC)

Osama Alswailem, MD, MA “Technology is what will challenge and finally break the ‘iron triangle’ of healthcare”

ing Faisal Specialist Hospital & Research Centre (KFSH & RC) provides the highest level of specialized healthcare in an integrated educational and research setting and Cerner Middle East & Africa is a global leader in healthcare information. “Hospitals” magazine had the privilege to meet with Osama Alswailem, Chief Information Officer, King Faisal Specialist Hospital & Research Centre and Mr. Alaa Adel, General Manager – Saudi Arabia & Egypt, Cerner Middle East & Africa to talk about the technologies and solutions they have installed, their adoption of smart room technologies among others. Below is the full interview:

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INTERVIEW

What technologies and solutions have you installed through the KFSH&RC Smart Room project with Cerner? Our goal was interoperability, not just integration. We wanted real-time data exchange between our real-time location system, IP nurse call, wireless mobile device, Cerner Smart Room, Interactive Patient Care, bedside medical device integration (BMDI), etc. The solution was one of the most challenging and rewarding as we were able to create a smart room with more than nine hardware devices integrated with more than 10 software solutions with all activities and data feeding into the patient’s electronic health record.

Please provide examples of how adopting the smart room technologies has helped KFSH&RC improve the patient experience and enhance communication? Patients are all connected to mobile devices in one way or another and have access to services (F&B, Government to Citizen, Financial, Aviation, etc.) that are a few clicks away. Healthcare needs to adapt to these new expectations with the smart room technologies as the medium. The patient is now able to communicate with room service, assess their pain without intermediaries, view prescribed education material, communicate with hospital staff as/when needed and provide medication related information, etc. This technology has also provided KFSH&RC the analytical data needed to improve quality of care, compliance metrics, dashboards/reporting, which all align with the organization’s Zero Harm goal.

To what extent smart technology is a must in hospitals today to achieve the best patient experience and the highest level of specialized healthcare? I believe we have seen more technological adoptions in the previous two decades than ever before. The adoption cycle of this technology and its early use shows the

disruptive effects on every sector, more so healthcare. Over the past years, almost 50 percent of the top emerging technologies have been related to health or will have a major impact on the healthcare delivery model: next generation robotics, genomic sequencing, artificial intelligence, etc.

General Manager – Saudi Arabia & Egypt, Cerner Middle East & Africa

Alaa Adel

What are the main projects that Cerner will implement at KFSH&RC and what are the benefits for patients and caregivers? It is an honor for Cerner to partner with KFSH&RC today and since we began our organizations’ journeys together in the early 1990’s. Cerner strives to relentlessly advance the success of KFSH&RC and is committed to enabling future achievements in the Kingdom and beyond. KFSH&RC and Cerner collaboratively maintain a strategic roadmap which is aligned to the KFSH&RC organizational goals and multi-year strategic plan. To name just a few projects on our immediate roadmap together, we are targeting safer and more efficient delivery of oncology and obstetric care, barcoding of medication administration to eliminate medication errors, enhanced integration with the current ERP Supply Chain system to reduce waste and centralize data, and to increase caregiver efficiency and satisfaction with the EMR through a major systems upgrade and workflow modernization. We will be supporting the KFSH&RC team through other projects in their master plan, including expansion projects in Madinah and Jeddah. These projects are aligned with KFSH&RC’s goals and strategic plan, which are aligned with the IHI Quadruple Aim of improving the patient experience and well-being of the care team while reducing costs and managing the health of the populations they serve.

INTERVIEW

Chief Information Officer, King’s College Hospital London

Client Accountable Executive, Cerner Middle East and Africa

Zia Sayed

Romel Khalife

The UAE is witnessing a growth in the private healthcare sector. What does King’s College Hospital Dubai offer that makes them unique in their sector? Zia: King’s College Hospital Dubai (KCH) is a world-renowned teaching hospital in London with over 175 years’ experience, that is now present in the UAE. Our state-of-theart multi-specialty medical centers are based in Jumeirah and Marina; and our new 100-bed multi-specialty tertiary hospital in the Dubai Hills estate. Our facilities offer an extraordinary care experience that is aligned with the Dubai Health authorities and Kings London guidelines. We have a shared medical committee with our UK based clinical teams and our second

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opinion program delivers a seamless care for our UAE patients. We have a robust family medicine practice bringing a focus on holistic health and wellness programs in the UAE. The care provided is using the British standards as per national institute for health and care excellence in UK. Our practice, vision and mission is aligned with the UAE healthcare vision 2021 in many aspects where we aim to be the most trusted private health care facility aligned with the worldclass system in the UAE. We aim to provide coordinated care focused on improving patient outcomes, avoiding duplicate treatment and reducing costs while at the same time providing the best quality in health care. Our visiting Doctor’s program brings to the

region the best expertise for the very specialized care services.

What does the patient experience at KCH look like and what are the current and future plans? Zia: Our patients and their families receive the best of British care, treated with the utmost dignity, respect and confidence. They truly are our number one priority. At the time of the arrival at the facility, patients are warmly welcomed and accompanied by caring Kingsman, to make sure they have a seamless journey at the hospital. Our great partnerships and investment in pharmacy, imaging, medical record and smart technologies are here to support the patient journey within our facility. By bringing world-leading

INTERVIEW

experts in their field to the UAE every few weeks, we are able to offer patients world-class treatment and procedures in high prevalence areas. Our doctors are measured by the quality of care they provide. To further enhance our patient experience at KCH we will soon implement Emirates ID reader technology, which will assist us to reduce the patient waiting time at registration desk. In addition, soon we will have an integrated call center management system with traditional telephonic as well as social media channels touch points, which allows us to better answer any question that our callers may have. Our future plans is to integrate Cerner with wearable devices, so that we can proactively participate in general population health and wellness.

How does the digital transformation journey play a key role in aiming an extraordinary patient experience? Romel: The digital transformation journey at KCH has recently witnessed new aspects of hospital care to enhance the patient experience by deploying an electronic health record and other Smart technologies. As an intersection of innovation and partnerships, Cerner and KCH worked together to incorporate technology and workflow solutions to enhance patient care and introduce clinical efficiencies. The deployed technologies allow the hospitalized patients to be engaged throughout the care journey. The hospital is equipped with an infotainment system that is

fully integrated with Cerner; offering patients entertainment, up-to-date interactive information and education about their condition, all at the touch of their fingertips. The visiting patients can benefit from a Pharmacy end-to-end automated medication management process. This automated dispensing technology will only allow the dispense of a pharmacy product that was ordered by the physician for a specific patient. The barcode medication administration will allow the nurse to administer the prescribed medication to the right patient. The electronic prescribing ensures medication management is optimized and prescription is sent to the eRx platform with the prescription number in case the patient is willing to get it dispensed from any pharmacy in Dubai. The combination of automated dispensing, barcoded medication administration and electronic prescribing made the medication management process safe, fully traceable and paperless at the point of care. In addition, KCH is also the first facility to have an automated medication management solution in the operating theatres, contributing towards patient safety. The electronic signature in a fully automated paperless environment reduce the time spent on handling administration of documents and streamline the patient admission and registration process.

In your opinion, how does innovation and interoperability help advance the health care sector?

Romel: As healthcare organizations face unprecedented challenges to improve quality, reduce harm, improve access, increase efficiency, eliminate waste, and lower costs, innovation and interoperability are becoming a major focus once again. Innovation also means that new ways of service provision need to be established provide the tools, services, and visionary leadership in advancing this in an all-encompassing way, from population health management, over artificial intelligence, and towards providing the consumer with platforms to proactively manage their life and well-being. Additionally, industry is moving towards data-driven healthcare that can be defined as the effective use of vast amounts of data collected in the process of managing the health and wellbeing of millions of patients in a continuous effort to improve the quality, efficacy, and cost of care. The second main pillar in advancing the healthcare sector is interoperability, where exchange of information in healthcare, as with all other facets of modern life, is critical to our advancement. Interoperability addresses that need while simultaneously increasing the quality of care received, improving healthcare efficiency and even financial incentivization. Not having access to data points due to the lack of integrated healthcare IT systems is unsafe in terms of clinicians taking decisions without having access to the entire patient data at most and at the least extremely inconvenient for the patient.

INTERVIEW

erner Middle East & Africa is a global leader in health care information, and Dar Al Shifa Hospital (DASH), which was established as the first private hospital in the State of Kuwait, is a leading health care organization in the region. “Hospitals” magazine had the honor to meet with Mr. Ahmad Nasrallah, CEO, Dar Al Shifa Hospital, Ms. Eman Abdul-Sater, HIM Manager, Dar Al Shifa Hospital, Mr. Akram Sami, General Manager, Cerner Middle East & Africa and Mr. John Dunn, Client Accountable Executive, Cerner Middle East & Africa to discuss the future of Kuwait’s health care industry in the medium and long term and talk about the initiatives that have been put in place with Cerner. Below is the full interview:

What do you think of the future of Kuwait’s health care industry in the medium and long term?

CEO, Dar Al Shifa Hospital

Mr. Ahmad Nasrallah The future of the health care industry in Kuwait shows a lot of promise, both at the medium and long-term level. At the medium level, the past decade has shown significant growth in both public and private sectors, which has been fueled by the increasing health care needs of

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the population at large. Prevalence of chronic diseases and obesity are on the rise, putting pressure on health care organizations to effectively and efficiently treat the growing number of patients. On the public sector end, the government is currently implementing a very aggressive plan to expand Kuwait’s health care infrastructure, which includes the replacement of old beds and addition of new ones, totaling 6,000-7,000; many of which are already available. In addition, the Government’s increasing reliance to deliver an extended range of services within private and public hospitals, is part of its overall strategy to provide more specialized treatment within the country, by limiting

INTERVIEW

the number of people going abroad for medical treatment. These factors have created the perfect recipe for Kuwait’s health care industry to flourish in the past decade and will continue to do so in the decades to come. Given this, we are continuously striving at Dar Al Shifa Hospital to deliver a holistic, high quality of care to patients. This strategic direction has successfully positioned us as a health care leader in Kuwait market. We are the first hospital to acquire International Accreditation in both the public and private sectors, reconfirming our commitment to patient quality and safety. Our consistent approach in introducing new service lines to help manage the rising preventive and chronic health care needs of the population is evidenced by more than 25 specialties currently available. Now, Dar Al Shifa is regarded by the Kuwait Community as a top leader in the private sector; so much so that our patient demand has led to an expansion project that will double our bed capacity and significantly increase the number of outpatient clinics and Emergency Department beds in the very near future.

What initiatives have been put in place with Cerner where you have seen the greatest impact on patient and caregivers?

HIM Manager, Dar Al Shifa Hospital

Ms. Eman Abdul-Sater Dar Al Shifa Hospital is among the first hospitals in Kuwait to implement a hospital-wide EMR system. The full-scale Cerner implementation in late 2017 provided clinicians an integrated system, giving our care teams near real-time access to vital patient information. This was coupled with the simultaneous implementation of our patient portal, Sehaty Online, which gave patients 24/7 access to necessary health information which they can view, download or share at their discretion. The patient portal also allows patients to securely message certain care teams, providing another venue for patients to communicate with DASH physicians. Aside from adopting standardized documentation templates, clinicians have embraced the use of care plans in the inpatient setting. The 300+ electronic templates not

only reduce the ordering time of physicians, but aid in maintaining an evidence-based treatment practices within the specialties. Our nursing care team’s adoption of medication barcode scanning safeguards the five patient rights; while strategically-placed alerts to physicians and nurses assure patient safety risk is mitigated through timely interventions. Dar Al Shifa’s commitment to preventive health is being leveraged by Cerner’s electronic health record (EHR) functionalities, which allow us to identify populations in need of screenings, such as breast, cervical and colorectal cancer in the adult population; and hip sonar screening for newborns. Moreover, BMI data is extracted and provided to relevant specialties to improve referrals for dietary services, as well as utilized to drive community outreach activities. In the near future, chronic disease management programs will be activated to improve patient awareness and improve patient compliance rates. The Cerner EHR implementation for Dar Al Shifa was a stepping stone to its greater strategic objective of becoming a paperless hospital. For this reason, a three-year, multi-phased device integration roadmap was developed earlier this year and has already resulted in integration of devices in Critical Care areas and inpatient areas; allowing care teams to get accurate and timely patient information to facilitate treatment. Additionally, integration is currently underway in the maternity specialty, which will allow Obstetricians to monitor patients’ labor progress anywhere within the hospital or remotely. All of the above is supplemented by an EHR project management team that provides around-the-clock field support, timely resolution to issues through a measurable ticketing tool, and a change control process to ensure an informed decision-making process about EHR localizations and customizations is achieved.

How can technology be a key driver for growth and modernization of the health care sector in this region?

General Manager, Cerner Middle East & Africa

Mr. Akram Sami

The Gulf Cooperation Council (GCC) health care sector has grown tremendously in recent years, with huge invest-

INTERVIEW

ments in people, buildings, equipment, and technology. Hundreds of hospitals have been built and transformed with the goal of providing better health care outcomes to its citizens. At Cerner, we believe that the usage of integrated systems, with structured workflows and Clinical Decision Support systems centered around the patient, is key to efficient operations, enhanced clinical outcomes, and better innovation. The GCC, especially Saudi Arabia, United Arab Emirates, and Qatar have embraced this notion and embarked on utilizing technology to achieve their critical and strategic goals in optimizing health care delivery. Kuwait in the next five years will witness rapid growth in the health care sector, reflecting heavy investment in the country’s health care infrastructure and systems. An effective and rich hospital information system should be at the core of hospital operations for the successful delivery of patient care and enhanced health care outcomes. Clinicians who embrace and adopt these systems and information for health care delivery can prevent adverse drug interactions, allow for faster recovery and use data for epidemiological and research purposes. Clinical Decision Support systems are at the heart of improving patient care with a multidisciplinary approach and proactive leadership to drive positive change.

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What do you consider sets Cerner apart from others?

Client Accountable Executive, Cerner Middle East & Africa

Mr. John Dunn

For Cerner, we are committed to the region and are lucky to have partners like Dar Al Shifa in Kuwait. We’ve been in the region for the last 28 years and I would say our strength comes from our strong presence in the region and commitment to our clients’ success. We’re very passionate about helping our clients succeed, but most of the time we see ourselves as enablers to help clients achieve their goals. There is a huge opportunity to harness modern technology in health care to ensure people’s health and wellbeing, to enable hospitals to provide safer care, improve support to the care givers and allow hospitals to operate more efficiently. It’s our mission to relentlessly seek breakthrough innovation that will shape health care of tomorrow. And we believe that what we do doesn’t just impact health care – it impacts the world. It’s why, more than ever, health care is too important to stay the same.

ARTICLE FEATURES . KSA Health Tourism

Medical Tourism in Saudi Arabia A bright future, distinctive tourist destinations and state-of-the-art hospitals

he Kingdom of Saudi Arabia has become part of the countries that encourage medical tourism due to the availability of some elements that promise a bright future for the Kingdom in this field in light of the unprecedented support provided by the government in addition to encouraging further investments in this regard to become one of the active countries in the field of traveling for treatment. Medical tourism and

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hospitalization are one of the national tourism patterns stated in the National Tourism Development Strategy adopted by the Council of Ministers. Experts in this field confirm that the coming years will witness a tangible development and medical tourism will take another direction, which will help it become one of the most important countries on the medical tourism map in addition to the medical sectorâ&#x20AC;&#x2122;s distinguished international reputation

that helps promote both medical tourism as well as tourism investment. Today, medical tourism is one of the important investments that yield significant revenues with the availability of natural resources and high medical potential in Saudi Arabia, which helps in the success of this type of tourism. There are also important opportunities that can be harnessed by the Kingdom in order to benefit from medical tourism as it has distinc-

ARTICLE FEATURES . KSA Health Tourism

tive tourist destinations and state-ofthe-art hospitals.

Visa Cancellation The Government of Saudi Arabia places the greatest emphasis on boosting the tourism sector in general. Visa cancellation for foreign visitors to the Kingdom from 50 countries was a great step for upgrading this sector as visas are available both online and on arrival. The tourist visa duration is 90 days and can be obtained through the visa platform of the Saudi Foreign Ministry website, the self-service machine at the arrival halls in the Kingdomâ&#x20AC;&#x2122;s international airports, or through the airport passport office. Through

this step, Saudi Arabia will succeed to attract tourists from diverse categories and medical tourism will certainly have a big share. Promoting the medical tourism sector is part of the Saudi Vision 2030, which was launched three years ago and seeks to reduce dependence on oil and diversify sources of income. Saudi Arabia boasts great beaches, ancient historical sites, theme parks and luxury hotels, as well as prestigious hospitals that provide world-class medical services using the latest medical equipment and an experienced team of healthcare providers. Saudi Arabia can provide unique tourism through its natural and archaeological sites that have not yet

been unveiled, in addition to intellectual and literary landmarks in addition to the potential tourism of the Red Sea islands. Today, efforts are being made in the Kingdom with the aim to encourage investors and companies working in the tourism sector to invest in the medical tourism field, which is one of the most important tourism investments that can yield significant revenues within the Kingdom, especially with the availability of natural resources and high medical potential in Saudi Arabia. The Kingdom of Saudi Arabia is currently witnessing a growth in the health sector that needs to be utilized through activating medical tourism and attracting skilled international experts, which will contribute to increasing the percentage of employment in Saudi hospitals on the one hand and reducing the travel of Saudis abroad to receive treatment on the other hand. The Minister of Health has recently announced that the health sector in the Kingdom is the largest among all Middle Eastern countries with an expenditure of over $40 billion (about SR 150 billion). The Minister of Health also talked about the readiness of 19 health projects, including hospitals and medical towers, some of which were inaugurated during the past year, and others this year, in a number of regions and governorates of the country, which would be a distinctive addition to the health services system, and will contribute to the improvement of these services, and the advancement of the health work in the country.

Factors & elements of attraction The Kingdom of Saudi Arabia has some elements and factors of attraction, namely the presence of a

ARTICLE FEATURES . KSA Health Tourism

system of specialized hospitals in all medical fields that are equipped to the highest standards in terms of medical technology, hotels and rehabilitation with the presence of local and foreign medical staff with extensive medical experience. On the other hand, Saudi cities and the capital certainly offer furnished apartments and residential hotels at competitive prices that allow patients and their families to stay comfortably and quietly within walking distance of the hospital. The elements of medical tourism and hospitalization in Saudi Arabia include: • Local and foreign medical competencies from different medical specialties. • Distinguished hospitals with top-notch technical equipment in all the cities of the Kingdom. • Regionally reputable specialized hospitals in the treatment of a number of chronic

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diseases. Geographical diversity and availability of natural resources such as mountains, seas, etc. The presence of the Two Holy Mosques and their spiritual importance to Muslims. Speaking widely in Arabic and English in the Kingdom’s hospitals. Affordable cost compared to Western countries.

Coordination and integration between the public and private sectors The remarkable development of the medical sector over the past decades has been instrumental in highlighting the elements of medical tourism in the Kingdom, especially in light of the integration between the public and private sectors and full coordination in the level of health services provided.

This synergy between the public and private sectors for the development of medical tourism and hospitalization began to take shape through the investment activities of the two sectors in this field, as the Kingdom is currently witnessing major growth in its health and medical sector, which requires taking advantage of this opportunity through activating health tourism and hospitalization, and the importance of attracting international experts and exploring experiences to develop this sector. Saudi Arabia has realized that medical tourism is one of the most important types of tourism that the countries are interested in for economic returns, especially in light of the available medical capabilities and natural resources that will help the success of this type of tourism. It also targets hospitals, private medical centers and tour operators licensed by the Authority in the region, hotels and resorts where hospital services are available.

ARTICLE FEATURES . KSA Health Tourism

Health projects that meet tourists’ needs The various regions and governorates in Saudi Arabia are witnessing remarkable developments in the level of health facilities available, in terms of introducing amendments and developments in existing hospitals and medical centers or in terms of opening new top-notch projects and departments to serve the largest number possible of citizens and residents in the Kingdom according to the highest levels. The Ministry of Health explained that these projects constitute a new turning point in health services in Hafr Al-Batin after the operation of new specialties that did not exist in the province hospitals, which have a capacity of 1000

beds, and will contribute to reducing the transfer of medical cases requiring these specialties outside the province. On the other hand, in a qualitative leap within the Saudi Vision 2030 and in a record time not exceeding two months and in order to enable modern technology and the latest technology in health services, the Ministry of Health has recently announced the expansion of its services in telemedicine to cover the application of “SEHA” which provides visual medical consultations and allows all citizens from anywhere to get faceto-face medical consultations with their doctors in all Saudi regions. The Kingdom seeks to optimize the use of hospitals and medical cen-

ters by continuously striving to improve the quality of both preventive and curative health services, in addition to the public sector focusing on the provision of preventive medicine for citizens and encouraging them to benefit from primary healthcare as a first step in their treatment plan. Healthcare is one of the most important elements mentioned in the “Saudi Vision 2030” that would put the Kingdom at the forefront of the world. “Our ambition is for the long term. It goes beyond replenishing sources of income that have weakened or preserving what we have already achieved. We are determined to build a thriving country in which all citizens can fulfill their dreams, hopes and ambitions.”

ARTICLE FEATURES . Nuclear Medicine

NUCLEAR MEDICINE

Diagnostic & therapeutic uses

uclear medicine is a highly multi-disciplinary specialty that uses radioactive tracers (radiopharmaceuticals) to assess bodily functions and to non-invasively diagnose, stage and treat diseases thanks to the gamma camera which gives the most accurate results in CT images.

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ARTICLE FEATURES . Nuclear Medicine

Nuclear medicine involves giving a patient a small amount of radioactive medication, called a radiopharmaceutical, making the body slightly radioactive for a short time. A special nuclear medicine camera detects the radiation, which is emitted from the body, and takes images or pictures of how the inside of the body is working. The nuclear medicine is considered one of the newest technology applications in the medical field because it gives information on the anatomy and function of the organ to be examined. Among the most prominent diseases that can be detected by nuclear medicine are kidney disease, heart disease, arthritis and bone inflammation, central nervous system infections, liver and spleen disease, gallbladder, lung and respiratory diseases. Nuclear medicine is characterized by its ability to safely diagnose organs that conventional imaging methods cannot easily pinpoint such as the liver, spleen and thyroid, due to lowdose radiation. Nuclear medicine imaging is very safe and painless. The actual dose of radiation you receive is quite low and stays in your body for a short time. Drinking plenty of fluids after your scan will help to eliminate the radioactive material from your system. Nuclear medicine imaging uses small amounts of low-level radioactive compounds, which are given as an injection or by mouth (swallowed). These compounds are attracted to specific organs, bones or tissues, which absorb the radioactive material. Once an organ or tissue has absorbed the radioactive material, it produces emissions, which can be detected by a special camera, or scanner. The scanner works with a computer to convert the emissions into an image. The doctor can view the images and look

for areas that appear abnormal. The dose of radioactive compound depends on the type of examination and the age of the patient. The most common tests done in nuclear medicine are for the bones, kidneys, thyroid, heart, lungs, brain and lymphatic system. Nuclear medicine techniques provide clinical information to the physician using low-dose radiation. The dose is significantly lower than that received during a conventional chest X-ray because most of the radiation is removed from the body. Depending on the area of the body and the type of scan, you will receive a small dose of radioactive material as an injection, or you will be given a solution to swallow. During the scan itself, you will be asked to lie down on a special table. The nuclear medicine imaging camera will be placed over the area to be examined. All you need to do is relax and stay calm during the scan. You will not feel anything during the test, which can last from 15 minutes to one hour. After the scan is completed, you will be allowed to go home. It is noteworthy that each radiation dose is determined very precisely and is calculated for the duration of its survival in the body. Radiation doses used in nuclear medicine are very safe, even lower than some conventional imaging tests and often the entire radioactive material is flushed out of the body within 24 hours.

New hope for diagnosis and treatment Nuclear imaging has contributed to a highly accurate diagnosis, as well as the treatment of tumors and heart disease. It also contributes to detecting a number of pathological changes in a way that was previously unavailable. Nuclear imaging is characterized

by providing accurate diagnosis for a large number of diseases that are difficult to diagnose and treat by conventional means using a small amount of radiation compared to X-ray tests. The importance of nuclear imaging is not only limited to the follow-up of the medical condition and its response to treatment but it also involves the control of tumors and the diagnosis of many diseases, inflammations and pain such as: • Kidney functions • Pulmonary embolism • Thyroid diseases especially the thyroid gland • Coronary artery disease and chest pain • Imaging of the heart muscle during effort and comfort • Bone pain and the spread of tumors to determine whether there is inflammation or fractures or tumors. • Liver and gallbladder diseases to determine whether there is an inflammation or a defect There are a number of different radiation detection devices. The scintillation counter is by far the most widely used in nuclear medicine. Nuclear medicine uses radioactive isotopes in a variety of ways. One of the most common uses is as a tracer in which a radioisotope is taken orally or is injected or is inhaled into the body. The radioisotope then circulates through the body or is taken up only by certain tissues. The emitted radiation can be captured by various imaging techniques, such SPECT or PET, depending on the radioisotope used. Through such imaging, physicians are able to examine blood flow to specific organs and assess organ function or bone growth. Radioisotopes typically have short half-lives and typically decay before their emitted radioactivity can

ARTICLE FEATURES . Nuclear Medicine

cause damage to the patientâ&#x20AC;&#x2122;s body. A thyroid scan is a type of nuclear medicine imaging. It provides information about the structure and function of the thyroid. The thyroid scan is used to determine the size, shape and position of the thyroid gland. The thyroid uptake is performed to evaluate the function of the gland. A whole-body thyroid scan is typically performed

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on people who have or had thyroid cancer. Nuclear imaging accurately monitors the development of the disease, determines the effectiveness and impact of medications in the treatment of diseases, as well as follows up on the results of surgeries in some medical conditions. Nuclear imaging mainly relies on the detection of an organ dysfunction

as a result of certain chemical changes, which contributes to the diagnosis of the disease in its early stages before becoming difficult to treat. Nuclear medicine imaging provides unique information that often cannot be obtained using other imaging procedures. Nuclear medicine tests differ from most other imaging modal-

ARTICLE FEATURES . Nuclear Medicine

ities in that diagnostic tests primarily show the physiological function of the system being investigated as opposed to traditional anatomical imaging such as CT or MRI. Nuclear medicine imaging studies are generally more organ-, tissue- or disease-specific than those in conventional radiology imaging, which focus on a particular section of the body (e.g.: chest X-ray, abdomen/pelvis CT scan, head CT scan, etc.). An MIBG scan is a nuclear medicine scan that involves an injection of a radioactive medication. The radiopharmaceutical is injected into a vein usually on the inside of the elbow. It is commonly used for detection of

neuroendocrine tumors. It can also aid in the detection of carcinoid and medullary thyroid carcinoma. Nuclear medicine scans provide information about various organ functions by imaging the concentration of specially formulated radioactive chemical compounds in selected parts of the body. These compounds, or radioisotopes, are administered to patients in small amounts in order to evaluate for functional abnormalities in bone, liver, lungs, heart, brain, kidneys and the endocrine system. Myocardial perfusion (or nuclear stress test) is an imaging test that can be done as well to show how

well blood flows through the heart muscle. For therapeutic services, nuclear medicine is used in the treatment of thyroid tumors, lymphatic cancer, endocrine cancer, liver tumors, hemarthrosis and others. Nuclear therapy can be also used to treat thyroid disease and function as well as its malignant tumors, liver tumors and blood diseases such as lymphoma. It also alleviates bone pain and treats benign inflammation of the joints. The side effects of nuclear therapy are less compared to radiation therapy and chemotherapy. It does not cause hair loss, skin damage or fatigue to the patient.

ARTICLE FEATURES . Breast Cancer

When is Breast Cancer

HEREDITARY? A

woman’s risk of developing breast cancer increases if she has a mother or a sister who has had breast cancer; thus, family history affects breast cancer. Hereditary breast cancer is associated with a mutation in the BRCA1 (breast cancer gene 1) or BRCA2 (breast cancer gene 2) genes. According to the World Health Organization statistics, if the woman has the gene mutation, she is 3 times more likely to develop breast cancer. Approximately 10% of detected breast cancer cases are attributed to the genetic factor. Both men and women can inherit a mutated BRCA gene from either their mother or father. Once these mutations are detected, surveillance and surgery options are available to reduce the risk of cancer. Women with these inherited mutations also have a higher risk of developing breast or ovarian cancer at some point in their life because the BRCA1 and BRCA2 genes are the most common genes that cause these hereditary cancers. The problem is that breast cancers associated with these mutations affect women at a young age in most cases and often both breasts. Women with these inherited mutations are also at risk of developing other cancers, especially ovarian cancer. If a first-degree relative develops breast cancer, this requires periodic check-ups for breast and ovarian cancer at an early age; women with mutations in the BRCA gene are at

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increased risk of developing these cancers compared to other women. The problem of hereditary breast cancer is that it is more aggressive than other cancers, it does not respond much to chemotherapy and hormone therapy, it spreads really fast, and it occurs at an early age.

When a genetic test should be done? BRCA1 and BRCA2 genetic test is necessary for early detection in the case of a genetic factor. It is based on the DNA test to determine harmful mutations in any of these genes that reveal the genetic susceptibility to breast and ovarian cancer. The BRCA gene test determines whether the woman is carrying an inherited BRCA mutation or not. Who are the women who have to do the BRCA genetic test? A woman is more likely to have a mutation in a BRCA gene if she has: • A personal history of breast or ovarian cancer • A family history of breast or ovarian cancer • Two or more relatives with pancreatic cancer • A male relative with breast cancer • A relative who did the genetic test and found a mutation in one of the BRCA genes Therefore, women who have relatives with breast or ovarian cancer are advised to do this genetic test to detect the possibility of developing these cancers. This test allows the

ARTICLE FEATURES . Breast Cancer

woman to know whether she is carrying the mutated gene that is responsible for the disease or not. Genes are fragments of the DNA transmitted from the parents. They carry information that identify the unique features of the person and are responsible for certain health conditions. BRCA1 and BRCA2 genes protect cells by producing proteins that help prevent tumors from forming. They are tumor suppressor genes that help regulate cell growth by reducing or stopping it. When mutations of tumor suppressor genes occur, cells reproduce wildly causing cancer. The presence of normal copies of these genes prevents cancers from developing. Women who have a mutation in the BRCA gene are more likely to develop breast or ovarian cancer, whereas men who have a mutation in the BRCA gene are more likely to develop breast or prostate cancer. Although inheriting the BRCA1 or BRCA2 gene mutation is not the

only cause of cancer, its presence along with other lifestyle factors, such as obesity, may increase the risk of cancer, making women more susceptible. If the genetic test is positive, the patient should be referred to a geneticist to review the family history and carry out further appropriate genetic tests, knowing that harmful genetic mutations can be inherited from either the mother or father. This means that if one parent has the mutation in 1 of the 2 copies of the BRCA gene, a child has a 50% chance of inheriting the gene mutation. The effects of mutations in the BRCA1 and BRCA2 genes are seen even when the second copy of the gene is normal. About 12% of women generally have breast cancer at some point in their life. On the other hand, according to the latest estimates, 55-65% of women who inherit the harmful BRCA1 mutation and 45% of women who inherit the harmful BRCA2 mutation develop breast cancer before

ARTICLE FEATURES . Breast Cancer age 70. In case of a personal and family history, the woman should start performing diagnostic tests at the age of 25. It is necessary to perform the breast self-examination monthly and preferable to conduct an annual MRI and not only a mammogram. The genetic test involves taking a blood or saliva sample and checking for changes in the BRCA1 and BRCA2 genes known to cause hereditary breast-ovarian cancer (HBOC) syndrome. This test is carried out in special laboratories.

The Mechanism of Treatment Before starting the treatment journey, genetic counseling should be obtained from a doctor specializing in genetic diseases to understand the changes in the BRCA gene in order to help the medical team to develop an appropriate treatment protocol. Treatment in such cases is individualized according to the medical condition. It requires a greater effort by doctors specializing in the diagnosis and treatment of cancer. Treatment interventions vary according to the type of cancer, the stage of the disease, the tumor size, the types of cancer patterns, the presence and absence of certain symptoms, the age and general health of the patient, and other factors. The treating physician, the genetic counselor, and the medical team members set the treatment plan while consulting the patient and discussing the complications, potential benefits, expected side effects, long-term effects, patient preferences, and other appropriate factors. Some women who have mutations in BRCA1 and BRCA2 may choose prophylactic mastectomy as a preventive measure.

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ARTICLE

Revolutionary surgical camera system now available in the UAE Launched throughout the UAE, the technology is now available for the first time in the Middle East and Africa

lympus, the market-leading medical optics and instruments company, announced the launch onto the regional market of its pioneering surgical orbital camera system, ORBEYE â&#x20AC;&#x201C; for microsurgical pro-

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cedures. The newly introduced tool, now installed in hospitals, is expected to greatly enhance microsurgical procedures for neurosurgeons who at present rely on traditional microscopes for their precision surgeries.

The launch of the ORBEYE Camera System into the regional market from Olympusâ&#x20AC;&#x2122;s UAE MEA headquarters aims to ease operational processes for surgeons and to provide them with clearer viewing capabilities, with

ARTICLE

the incorporation of the new instrument into surgery aimed at ultimately improving patient outcomes. The Ministry of Health in the UAE has identified brain cancer as ranking amongst the top five leading cancer variants affecting adult males in the country and aims to reduce cancer-related deaths by 18% within two years. In order to meet such targets, the UAE encourages innovation in the field, driven by the need for instruments with advanced optical capabilities. ORBEYE aims to help surgeons meet this goal with its advanced capabilities. In addition to facilitating surgery on tumours, ORBEYE addresses a variety of other medical issues pertaining to the brain, with patients requiring neurosurgery who are based outside the UAE able to take advantage of it by flying in for procedures, thanks to the UAE’s high level of connectivity. The adoption of the ORBEYE Camera System provides a host of advantages to neurosurgeons which will in turn translate into better patient outcomes not only in the MEA region but also across the world. Through the use of this ground-breaking technology, neurosurgeons have access to an enlarged stereoscopic visual field of the surgical site, which improves surgical accuracy”, shared Professor Jan Regelsberger, Vice Chairman of the Neurochirurgische Klinik, Hamburg, Germany. He goes on to add, “Furthermore, the clearer viewing

capabilities resulting from its usage, not only augment procedural accuracy but also allow for more efficient training and consulting opportunities with additional surgeons.” ORBEYE is the first optical technology system to utilise a 4K and 3D camera, with the advanced features serving to augment surgical visibility in the field of neurosurgery through immersive imaging. By using this innovative instrument, neurosurgeons are presented with a more ergonomic solution to surgeries stemming from the removal of ocular lenses, with other consulting surgeons also able to join the procedure and enable multi-expert procedures. This feature also gives rise to the suitability of the ORBEYE for training and education, as all procedures are clearly visible on the large screen. Developer and manufacturer Olympus - internationally-recognised as a leading source of optical and digital precision technology - will launch ORBEYE to countries across the MEA region after the UAE. “We are delighted to introduce ORBEYE to the UAE as a groundbreaking addition to the field of neurosurgical equipment and technology. We foresee a strong reception in the regional market, given that it frees surgeons from the constraints of ocular based microscopes, and enhances operational accuracy”, shared Maurice Faber, Regional Managing Director at Olympus MEA. He further commented, “We are grateful to the local authorities for their support and

look forward to contributing to building a healthier community through the regional launch of ORBEYE in line with our 100-year anniversary.” The use of traditional microscopes in medicine over the years has resulted in successful surgical procedures, but the equipment does have drawbacks such as only the operating surgeon is able to fully understand the nuances of the ongoing procedure, with no room for opinions from consulting doctors. In addition, given the long hours and high levels of focus that are required, it becomes physically and mentally taxing for neurosurgeons to continually view the procedures they are engaged in through a traditional microscope. The magnified feed on the ORBEYE screen lends itself to a better understanding of the patient’s physical condition, while consulting doctors can also advise in live time, thereby augmenting the effectiveness of the procedure. ORBEYE also becomes instrumental in teaching young medical professionals, as now a significantly larger number of students can participate in surgery without being at the surgical table. Students can view and follow the steps of the surgery each step of the way, thanks to an immersive 4K and realistic 3D image on a large 55’ monitor. Enhancing these advantages, ORBEYE is also functionally beneficial, being both simple to set up and manoeuvre, within the operating room, while occupying far less space than its predecessor.

ARTICLE FEATURES . In Vitro Fertilization

When to Consider

IVF?

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ARTICLE FEATURES . In Vitro Fertilization

n Vitro Fertilization (IVF) have brought hope to couples who suffer from infertility or late pregnancy without a clear medical reason. This kind of medical development created a qualitative shift in the medical world. Over the years, its success rate has significantly increased due to the steps taken before and during the procedure in terms of better preparing the woman, the growth of the embryo(s), or the sperm.

•

• Doctors define IVF as an insemination outside the uterus. The doctor gives the patient specific medications to increase the production of eggs and then retrieves them from the ovaries in order to fertilize them with sperm in the laboratory under a microscope. The fertilized eggs develop from 3 to 5 days in a special incubator until the embryonic cells divide, and are then transferred into the woman’s uterus. After a period of two weeks, the woman undergoes a pregnancy test after consulting the doctor.

•

• •

When do couples turn to ivf? There are some cases where couples turn to IVF for no reason. It is enough for a woman to be over 38 or 39 years of age to directly turn to IVF without the need to wait for a period of time after marriage. One of the reasons that urge doctors to resort directly to IVF is not being able to get pregnant after a year or more of marriage with no apparent reason. Some cases of infertility and failure to treat them are one of the most important reasons that push both the couple and the doctor to perform IVF.

Some of the main reasons of these cases are:

Fallopian tube damage that makes it difficult for an egg to be fertilized. Endometriosis that is one of the main causes of infertility and is caused by the growth of the endometrium outside of the uterus, leading to reproductive problems. Ovulation disorders that appear in women with hormonal problems. Benign fibroids that may grow in the uterus and fallopian tubes. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. Ovarian cysts and menstrual cycle disorders. Intrauterine problems such as uterine malformation, the presence of any type of dimple, or the presence of an obstacle that prevents pregnancy.

•

What Are the Steps of IVF?

•

In the beginning, the doctor must identify the cause of infertility and try treating it by the available methods. In the event of failure, the doctor will then proceed to IVF, which will first require performing thorough examinations. After the blood testing is done for the couple, the doctor examines the uterus, fallopian tubes, and sperm. The success of the IVF requires that both spouses be able to produce the egg and the sperm, even in a small number.

•

First, the woman will be given hormonal drugs, whether by

injection or pills, in order to produce the largest possible number of eggs to increase the likelihood of the formation of a greater number of fertilized eggs, leading to an increased success rate. The doctor follows up on the treatment response with a sonar device to determine the number and size of eggs and whether they are good for fertilization. When the eggs become mature, they are removed from the follicles through the vaginal sonar device, provided that the patient is prepared an hour earlier and has been given anesthetic and analgesic drugs. The vagina is cleaned with sterile material and the device is inserted into it. The eggs are then gradually retrieved from one of the ovaries. Enough sperm of good quality are collected and then separated from the semen fluid. In the IVF laboratory, the eggs and sperm are placed in a special incubator for fertilization. The doctor continuously monitors the process and the stages of the development of the embryo(s). Embryo transfer usually takes place five days after egg retrieval. Here lies the accuracy of the process to ensure its success: the doctor must take into account the difference in temperature between the incubator and the room and the speed of transfer that should not exceed a few sec-

ARTICLE FEATURES . In Vitro Fertilization

•

onds. The faster the transfer, the greater the chance of success. Advanced medical devices help to keep the temperature constant during the embryo transfer. There are modern and innovative scientific methods in which the embryos are loaded into the catheter. Two weeks after the embryo transfer with the absence of a menstrual cycle, the woman should visit the doctor to conduct a hormonal blood test to confirm the incidence of pregnancy that can be seen through the sonar device three weeks after the embryo transfer. To ensure the continuation of the pregnancy, the woman is given pregnancy stabilizer drugs that are compensatory hormones and special supplements that ensure the presence of the hormone responsible for the growth of the embryonic cells. The placenta then forms and begins to feed the embryo(s).

What is the difference between ivf and icsi? Doctors depend on IVF if sperm are in good condition. When either sperm count or mobility is abnormally low, the doctor turns to Intracytoplasmic Sperm Injection (ICSI). This procedure, that is often adopted, involves the injection of a single sperm directly into a mature egg by means of a very thin needle to ensure the success of the fertilization process. In more details, the eggs are

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examined under a microscope about four hours after being retrieved to determine their maturity. The semen is then prepared. Mobile sperm and mature eggs are placed together inside the incubator at 37°C with a humidified atmosphere and certain gases to allow them to naturally fertilize. In this case, reliance is placed on the sperm’s ability to fertilize the egg. After 18 hours, the eggs are examined to see if they have been fertilized or not. Fertilization is monitored under the microscope. Two nuclei must be detected, one from the egg and the other from the sperm. Fertilized eggs are transferred to other Petri dishes according to the needs of the fertilized egg. After 24 hours, they are examined to determine if the cell division has taken place and the embryo(s) started forming. After successful fertilization, the eggs grow in special incubators for 48-72 hours. During this period, the fertilized egg divides into two, four, and eight cells. The last step is to transfer the embryo(s) into the woman’s womb on the third day after the procedure. The pregnancy occurs then. To increase the success rate, the doctor should avoid twisting the catheter inside the cervix, examine the length and angle of inclination between the body and the cervix, and choose the appropriate catheter for each case before the procedure. After inserting the catheter into the uterine cavity, the embryos are injected and the catheter is then withdrawn. The woman must remain in the hospital for at least five to six hours before going home pro-

vided that she does not make any effort during at least the first three months.

What is the success rate? Recent years have witnessed an increase in the success rate of this type of procedure thanks to the impressive developments in medicine. However, the success of IVF depends primarily on the cause of infertility, the age of the woman, and the accuracy of the procedure.

The success factors of the procedure are: •

•

The age: The success rate is greater for women under the age of 40, but that does not mean that women over 40 don’t have a chance. There are some modern and effective scientific methods to improve the quality of eggs and sperm. The cause of infertility: Some of these causes reduce the chances of this procedure’s success such as endometriosis and uterine fibroids. Acceptable sperm mobility and activity as well as less oddly shaped sperm. The general health of the couple and the absence of general or hereditary diseases that lead to the failure of fertilization or continuous abortion. The absence of diseases in the reproductive system and the pelvis to ensure the efficiency of ovulation, vitality of the eggs, and the possibility of collecting a sufficient number of them.

ARTICLE FEATURES . In Vitro Fertilization

ARTICLE FEATURES . Osteoporosis

Osteoporosis

Causes and Prevention

steoporosis is a condition characterized by weak bones and low bone mass, making fractures more likely to happen. This occurs more frequently in older people, especially if they donâ&#x20AC;&#x2122;t follow the necessary guidance and advice to maintain bone health and increase bone density at young age. The main factor of osteoporosis is the process

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of regeneration of bone tissue, i.e. the imbalance between bone tissue loss and the creation of new bone. Osteoporosis affects women and men, but women who are past menopause are more susceptible. This is due to the absence of female hormones that served as a protection from this condition.

This disease is characterized by the presence of pores in the bones that result in loss of bone density and strength. Bone consists of collagen fibers and noncollagenous proteins, on which mineral salts deposit to give the bone its rigidity. Bone is a constantly renewed living tissue characterized by its rigidity and hardness and is the structure that supports the

ARTICLE FEATURES . Osteoporosis

whole body. The structure and composition of bone tissue are subject to constant changes over the years. Different physical and hormonal factors that activate or inhibit bone cells lead to changes in bone density and structure. Osteoporosis is often called a silent disease because people may not be aware they have it until they break a bone due to its fragility. Attention should be paid to symptoms such as weakness, joint pain, and motor system. These symptoms are severe and sudden and appear with age where people tend to fall more often and break a bone. Most fractures happen in the pelvis, spine, and thigh.

The likelihood of osteoporosis depends on the amount of bone mass people attain in their youth. The more a person is able to follow the correct practices to strengthen bone mass, the more this contributes to the avoidance of osteoporosis with age. Hence, it is necessary to adopt a healthy lifestyle in the 20s and 30s, such as exercising, eating healthy foods, avoiding smoking and soft drinks, and not taking too much salt, because these are risk factors for osteoporosis. The most important element for bone protection is sports or any kind of physical activity. The gravity of the disease is related to the speed at which a person loses bone tissue beyond the age of forty and to the amount of bone tissue accumulated in the body between 25 and 35 years old. In this phase, the amount of bone tissue reaches its peak. The larger the size of the bone mass, the greater the stock of bone mass and the lower the risk of osteoporosis.

The Most Important Vitamins for Strong Bones As is well known, vitamin D and calcium are important for strong bones and any deficiency in them makes people more likely to get osteoporosis and have weak bones. Things get worse over the years and if a healthy lifestyle is not adopted.

What are the vitamins that affect human bones? Vitamin D It is the most important vitamin for bones and it is necessary for calcium absorption and bone growth. Exposure to sunlight helps the body to produce vitamin D. It is enough to put the hands and feet for 20 minutes in

ARTICLE FEATURES . Osteoporosis

the sun in the morning twice a week to get the bodyâ&#x20AC;&#x2122;s need for this vitamin. Supplements are required if a person has severe vitamin D deficiency. Osteoporosis will lead to fractures in the bones in older people who donâ&#x20AC;&#x2122;t get enough vitamin D. The normal percentage of vitamin D in the human body ranges from 20 to 50 ng/ml. A level less than 20 ng/ml indicates vitamin D deficiency. It is also dangerous to have a level higher than 50 ng/ml. In case of deficiency, the patient should take a dose of vitamin D to prevent its increase by taking 600 IU per day for adults and 800 IU for older people.

Calcium Calcium is very important to build bones and reduce the loss of its density. It is one of the most important

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substances the human body needs to maintain bone health, apart from its many other benefits. A low-calcium diet leads to a reduction in bone mass and an increased chance of fractures. Calcium-rich foods include dairy products, eggs, and vegetables such as spinach, jute mallow, cauliflower, cabbage, broccoli, and turnip. Nuts also contain a good percentage of calcium, most notably almonds, hazelnuts, walnuts, and cashews.

Vitamin A It is one of the vitamins necessary for bone health. Beta-carotene is converted in the body to vitamin A, which maintains bone health and reduces bone problems. It should be noted that a high amount of vitamin A can lead to congenital defects, and over the long term can cause serious

damage to the liver where this vitamin is stored. However, this cannot happen when vitamin A is obtained from beta-carotene. It is also essential for overall body health especially for the immune system, growth, and vision. Animal sources, food, supplements, beta-carotene, and other carotenoids found in vegetables and fruits are rich in vitamin A.

Vitamin K Vitamin K helps build bones and make them grow healthily by activating 3 proteins essential for bone health. One of these proteins, matrix Gla protein, promotes bone growth while healthily storing cartilaginous tissue, and another protein, osteocalcin, helps bind calcium and incorporate it into new bone tissue. In addition, vitamin K also activates 1/3 of the

ARTICLE FEATURES . Osteoporosis

proteins in bone cells known as protein-S. Hence, this vitamin enhances bone health and maintains its density.

Vitamin C Vitamin C helps promote the synthesis of collagen, which is essential for keeping bones healthy and strong, as well as teeth health. It is a component of collagen-rich connective tissues that help in bone formation. Low vitamin C levels negatively affect bone and dental health.

What Factors Affect Bone Health? Bones are affected by lifestyle in general and some bad daily practices, whether in the diet or physical activity, especially after the age of forty where the bone mass begins to decrease and the risk of fractures and osteoporosis increases.

Factors affecting bone health include: Lack of vitamin D and calcium Vitamin D and calcium are among the most important vitamins to build strong bones. Any deficiency in them will inevitably lead to osteoporosis and fractures. Vitamin D helps the body to properly absorb calcium. In case of vitamin D deficiency, the body cannot absorb the amount of calcium needed even if the person is eating calcium-rich foods. Daily exposure to sunlight for at least 15 minutes in the early morning provides the body with vitamin D, in addition to eating certain foods such as fish, salmon, tuna, and other foods. Calcium can be obtained from dairy products, spinach, cabbage, jute mallow, nuts such as almonds, walnuts, and cashews, and legumes such as cowpea, beans, chickpeas, lentils, and other foods.

Too much salt intake Excessive daily salt intake contributes over time to the development of osteoporosis because it increases the loss of calcium through the urine, and therefore the body does not get the necessary amount of calcium that benefits the bones. Therefore, nutritionists and orthopedists recommend limiting salt intake.

Smoking Smoking is one of the bad habits that destroy bones because it prevents blood from reaching them. The large amount of nicotine inhaled absorbs calcium from the body, making the bones less dense and more prone to problems and injuries.

Lack of exercise Lack of physical activity increases the risk of osteoporosis. Sports are essential to maintain health in general and bone health in particular because they increase joint flexibility and bone density and maintain optimal physical fitness and weight, thereby reducing the risk of osteoporosis.

Drinking a lot of soft drinks Soft drinks have many negative effects on the body in general and

on bones in particular. Studies have shown a strong relation between the excessive intake of soft drinks and weak bones and osteoporosis, because these drinks prevent the absorption of calcium in the body.

Lack of sleep Especially in childhood because the body grows during sleep and sleep helps to support the strength of the bone marrow, which is the fundamental material that helps in the formation of bones. Therefore, the number of hours of sleep should not be less than 6-8 hours a day.

Unhealthy daily habits Some daily bad practices and habits negatively affect bone health. Repeating them for a long time with the presence of negative factors make it worse. These habits include standing for long periods, wrong sitting position, wrong sleeping position, carrying heavy weights, etc.

Taking some medications Taking medications for cancer, pneumonia, and depression for example also affects bones. If the patient has to take this type of medications, supplements containing vitamins

ARTICLE FEATURES . Osteoporosis

such as calcium, vitamin D, and others should be taken to make up for their lack in the body due to the effects of these medications.

How is bone density measured? Bone density is measured by doing a Dual-energy X-ray absorptiometry (DEXA) scan. This name describes the mechanism of work of the device. Two X-ray beams, with different energy levels, are aimed at the patientâ&#x20AC;&#x2122;s bones. This test helps detect osteoporosis and see if the person is susceptible to it. Bone density is measured through the scan by calculating the number of grams of calcium and other minerals in the bone. This test measures bone mineral density, bone hardness, fracture potential, and the progress in treating osteoporosis. It can be performed to scan the body completely and sometimes to diagnose bone pain without any cause or for cancer patients after chemotherapy. It can

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also measure the bone density of the lower spine bones (lumbar vertebrae), narrow neck of the thighbone (femur), and bones in the forearm. The higher the rates of these minerals are, the higher the bone density, and the higher the bone density is, the stronger the bones and the less the risk of fractures. This test provides very accurate results and is the best to detect osteoporosis. As for how to perform it, the patient lies on the exam table. The technician will place an imaging device above them and an X-ray generator below them. Very small doses of X-rays are emitted which is nothing the patient should be worried about. The generator produces two X-ray beams with different energy levels, one low and one high. The contrast between the two enables us to differentiate between bones and other tissues. The results of a DEXA scan use a system called T-score. A T-score of -2.5 or lower means a diagnosis of

osteoporosis. A T-score of -1.1 to -2.4 indicates osteopenia, or low bone density.

Prevention Steps Prevention of osteoporosis consists of eating healthy food and exercising during the period of bone remodeling which is a continuous process of bone resorption and formation that takes about 3 months. Before the age of forty, the body makes new bone faster than it breaks down old bone. The bone mass is constantly increasing in young people and reaches its peak in the middle of the third decade of life. At the age of forty, this process stops and begins to decrease at the age of fifty, especially in women who are past menopause due to the absence of female hormones. Building a strong bone mass in youth reduces the risk of osteoporosis with age. Good nutrition and regular exercise are essential to maintain bone health throughout life.

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ARTICLE FEATURES . Memory Disorders

NOV.DEC 2019

ARTICLE FEATURES . Memory Disorders

emory disorders can range from mild to severe, but they all result from some kind of neurological damage to the structures of the brain, thus hindering the storage, retention and recollection of memories. Symptoms appear in the form of difficulties in learning information or remembering new events. Human memory is one of the distinctive brain abilities that allows information to be stored and retrieved. Memory loss may be due to many conditions such as small strokes in the brain, diabetes, high blood pressure, nutritional deficiencies, reactions to medications and alcoholism. Even depression can cause symptoms similar to dementia. Memory loss itself does not mean you have dementia. Memory is divided into two parts, short-term and long-term; research suggests that the storage capacity of the human brain is almost limitless, and researchers believe that humans can remember between 20,000 to 100,000 words. Short-term memory is the temporary recall of the information which is being processed at any point in time, and has been referred to as “the brain’s Post-it note”. It can be thought of as the ability to remember and process information at the same time. Long-term memory is, obviously enough, intended for storage of information over a long period of time, and the recall of information after months or even years. Memory is the ability to take in information, store it, and recall it at a later time. In psychology, memory is broken into three stages: encoding, storage, and retrieval. Encoding (or registration) is the

process of receiving, processing, and combining information. Encoding allows information from the outside world to reach our senses in the forms of chemical and physical stimuli. In this first stage we must change the information so that we may put the memory into the encoding process. Storage is the creation of a permanent record of the encoded information. Storage is the second memory stage or process in which we maintain information over periods of time. Retrieval (or recall, or recognition) is the calling back of stored information in response to some cue for use in

a process or activity. The third process is the retrieval of information that we have stored. We must locate it and return it to our consciousness. Some retrieval attempts may be effortless due to the type of information. Problems can occur at any stage of the process, leading to anything from forgetfulness to amnesia. Distraction can prevent us from encoding information initially; information might not be stored properly, or might not move from short-term to long-term storage; and/or we might not be able to retrieve the information once it’s stored.

Causes Brain damage occurs when a person’s brain is injured due to traumatic injury, such as a fall or car accident, or non-traumatic injury, such as a stroke. The type of the disorder depends on which part of the brain has been damaged. Possible causes of reversible memory loss include: • Medications: Certain medications or a combination of medications can cause forgetfulness or confusion. • Minor head trauma or injury: A head injury from a fall or accident — even if you don’t lose consciousness — can cause memory problems. • Emotional disorders: Stress, anxiety or depression can cause forgetfulness, confusion, difficulty concentrating and other problems that disrupt daily activities. • Alcoholism: Chronic alcoholism can seriously impair mental abilities. Alcohol can also cause memory loss by interacting with medications. • Vitamin B-12 deficiency: Vitamin B-12 helps maintain healthy nerve cells and red blood cells. A vitamin B-12 deficiency — common in older adults — can cause memory problems. • Hypothyroidism: An underactive thyroid gland (hypothyroidism) can result in forgetfulness and other thinking problems. • Brain diseases: A tumor or infection in the brain can cause memory problems or other dementia-like symptoms. The symptoms of the patient depend on the cause of the disorder; usually the patient has difficulty in acquiring new information or remembering new events or even remember events in the distant past and has lost track of time and space.

Diseases and their impact on memory Some diseases significantly affect the brain function and memory. These include Alzheimer’s disease caused by cerebral atrophy responsible for upper brain functions, especially those

ARTICLE FEATURES . Memory Disorders

related to memory and concentration, language, awareness, knowledge and ability to deal with events. Over time, people who have Alzheimer’s lose their memory and ability to concentrate. Orientation in space and time become increasingly difficult, and it is also harder for them to manage on their own in everyday life. Those affected need more support as the disease progresses. Radical treatment for Alzheimer’s disease is still not available, but the treatments available today may reduce the prevalence of symptoms and help control them as much as possible; doctors also recommend a healthy lifestyle in terms of food, sports, reading, social activities and interaction with others. Dementia is also a disease that affects memory and the symptoms of

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this disease include difficulty in thinking; in this case the patient suffers from memory weakness and changes in thinking skills and communication with others, in addition to lack of concentration and lack of attention. Dementia is a syndrome in which there is deterioration in memory, thinking, behavior and the ability to perform everyday activities. It is one of the major causes of disability and dependency among older people worldwide. It has a physical, psychological, social, and economic impact, not only on people with dementia, but also on their families and society at large. Dementia is one of the most difficult health problems in the elderly. It is caused by several diseases that damage brain cells. The most common is Alzheimer’s disease, leading to a persistent and irreparable deterioration in

thinking abilities and brain functions. The risk of dementia increases with age, brain cell damage, and diseases such as Alzheimer’s, Parkinson, and Huntington, and each causes damage to certain cells in the brain. There are a number of tests for the diagnosis of dementia, including some blood tests and brain examination, as well as psychological assessment and neuropsychological test. Strokes greatly affect the brain and its functions and there are two types. Conventional stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.

ARTICLE FEATURES . Memory Disorders

The second type is the silent stroke, which is hard to recognize. That’s because a silent stroke disrupts blood supply to a part of your brain that doesn’t control any visible functions like speaking or moving, so you might never know a stroke occurred. The way most people find out they had a silent stroke is when they have an MRI or CT scan for another condition and doctors notice that small areas of the brain have been damaged.

Aging and Memory Problems Some scientific research suggests that memory tends to be less efficient with age due to the change in the way the brain stores information, making the process of remembering information more difficult. Generally, with age, the body begins to produce fewer chemicals needed for brain cells to function. These changes have a greater impact on memory. There is a greater likelihood that a person’s memory will be affected and the person will forget recent events that occurred during the last short period. The areas responsible for emotions and memory, especially the memory of recent events are affected and their efficiency is clearly reduced, as these areas lose a greater percentage of their neurons with age. Therefore, we see an old person talking about details and memories dating back 40 years and forgets what happened with him in the morning. There are also some other areas of the brain affected with age, such as pineal gland, which secretes the hormone melatonin, which regulates the process of sleep and wakefulness; so we find that as you age, you sleep less during the night.

Treatment and Prevention The sooner the treatment begins, the better the results, as it is possible to stop brain cell damage once you know the cause and work to treat it. However, there are effective steps to prevent memory disorders related to the daily lifestyle, which negatively or positively affect the pace of disease development and can possibly get rid of it for good. To stimulate and train the memory, experts emphasize the need to read and do brain-training puzzles, especially those based on numbers. Regular exercise greatly contributes to stimulating circulation in the brain and body as a whole. Exercise regularly at least three times a week for a minimum of 30 minutes. Good sleep significantly affects the brain cells, while lack of sleep and rest will result in brain atrophy, thus the patient begins to forget and will suffer from a permanent feeling of fatigue and exhaustion with the inability to carry out daily activities. Sleeping every night for about 6 to 8 hours straight is required, more than that causes memory problems. Good nutrition is key in preserving the brain’s abilities and preventing memory problems as research suggests that what we eat might have an impact on our ability to remember and our likelihood of developing dementia as we age. Eating fruits, vegetables and leafy greens have a major role in giving the body its essential needs of vitamin B12, as it can be obtained from eggs, meat, fish, poultry and low-fat dairy products.

ARTICLE FEATURES . Cervical Cancer

Cervical Cancer

The 4th most common cancer among women worldwide NOV.DEC 2019

ARTICLE FEATURES . Cervical Cancer

tatements issued by the World Health Organization’s International Agency for Research on Cancer showed an estimated 570,000 new cases of cervical cancer were diagnosed worldwide in 2018, making it the 4th most common cancer among women globally. Every year, more than 310,000 women die from cervical cancer and as a result of not receiving the HPV vaccine, which is highly effective in preventing the most common types of human papillomavirus (HPV). HPV is responsible for cervical cancer that usually develops very slowly, which means that early detection makes treatment more effective as the disease is still in its early stages. Cervical cancer is the most common HPV-related disease, and almost all cases can be attributed to this virus. Early detection guarantees cure by up to 96%, while neglecting symptoms and late detection increase the severity of the disease and the cure rate drops to only 5%. The problem here is that the symptoms appear in advanced stages, making the cure difficult. Global organizations, governments, and ministries of health encourage people to perform periodic examinations for early detection to reduce the spread of the disease.

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menstruation, the woman should therefore consult a doctor. Pain during sexual intercourse or urination is also a warning sign. Watery, bloody vaginal discharge that have a foul odor. Feelings of tiredness and lethargy are not among the first important symptoms, but are part of a long list of symptoms of health problems including cervical cancer. Desire to urinate permanently is one of the symptoms associated with cervical cancer due to changes in the urethra.

HPV Infection At first, it should be noted that there are more than one hundred types of HPV but not all of them are cancerous. HPV is a virus transmitted through genital contact. The appearance of warts in the genital area is an indication of inflammation as a result of getting the virus. Genital warts vary

significantly in size and shape. They may persist for a few weeks, sometimes even a few months, after having sexual intercourse with a person with HPV. That person may not be aware of the fact that they got infected and are responsible for spreading HPV. Some types of HPV may be the cause of cervical cancer. If the person is infected with one of them, it is possible to develop precancerous changes in cells and tissues without any symptoms. Medical development succeeded in creating a vaccine that would protect against the most common types of the virus that cause 70% of cervical cancer cases. The vaccine has the potential to prevent most cases of vaginal and vulva cancer, as well as genital warts. HPV vaccination is recommended to girls and boys at age 11 or 12 years, and it is important to be vaccinated before having any sexual intercourse and being exposed to HPV. Once the virus makes its way in the body, the vaccine may be ineffective. If they are not fully vaccinated at age

Signs of advanced stages of cervical cancer are: •

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Heavy period, bleeding after menopause, or unusual vaginal bleeding which is the most common symptom associated with cervical cancer and usually happens between two menstrual cycles or after sexual intercourse. Pelvic pain ranging from acute to moderate pain. If it’s a new symptom and not related to

ARTICLE FEATURES . Cervical Cancer

11 or 12 years, the Centers for Disease Control and Prevention (CDC) recommends that it be given to girls and women at age 26 and to boys and men at age 21. The vaccine is injected in three doses over six months. The second dose is given one or two months after the first one and the third dose is given six months after the first one.

Pap Smear It is one of the methods that help detect cervical cancer early. Every woman should periodically have a Pap smear as it is the most effective test for cervical cancer. Approximately 80% of women get HPV at some time in their life. Therefore, women are required to perform periodic cervical cancer screening by Pap smear. This test along with the HPV vaccine is an effective means of prevention from and early detection of cervical infections that, if not detected in time, can turn into cancer. The Pap smear looks for the DNA of HPV that is likely to cause cancer in cervical cells. Periodic examination is a necessity to prevent and detect the disease before it develops and reaches advanced stages. The Pap smear detects abnormal cervical cells which may eventually lead to cancer in the future. Thus, it contributes to halting the possible development of cancer and treating the patient fast in case cancer started developing. As for the examination, the doctor slowly inserts the speculum into the vagina, and then scrapes a small sample of cervical cells. Most women feel a sensation of pressure during the procedure. The sample is sent to a laboratory where it is examined to look for abnormal cells. After the test, the woman may feel mild pain or a little cramping. Light vaginal bleeding can also occur directly after the examination. If abnormal cells are discovered,

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this does not mean the patient has cervical cancer, but simply that there are abnormal cervical cells, some of which may be precancerous and need more tests to determine their nature. Depending on the test results, the doctor may recommend doing the Pap smear more often, or closely examining the cervical tissue through a procedure called colposcopy. In some cases, the doctor may also take a sample of the cervical tissue.

Diagnosis and Treatment A woman with cervical cancer starts a new phase in her life where she needs to carry out further diagnostic tests to determine the stage and extent of the disease and the treatment plan.

The stages of cervical cancer are as follows: •

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Stage 0 means that the cancer is present only on the surface of the cervix. Stage I means that the cancer is within the neck of the cervix. Stage II means that the cancer has grown beyond the cervix and uterus but has not reached the walls of the pelvis or the lower part of the vagina. Stage III means that the cancer has spread to the lower part of the vagina or the walls of the pelvis.

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Stage IV means that the cancer has spread to nearby organs such as the bladder or rectum or to other parts of the body such as the lungs, liver, or bones.

The treatment depends on the extent and stage of the disease, taking into account the age of the patient and her general health condition. Hysterectomy is one of the treatment options in advanced stages and is adopted especially by post-reproductive women. On the other hand, if the woman is still fertile and wants to have children, a clear discussion with the medical team is required to determine the possibility of keeping the uterus. Chemotherapy is also an option but consideration should be given to the damage that may happen to the ovary or other parts of the reproductive system causing difficulty in pregnancy or in the birth process. However, there is still a possibility that a woman may become pregnant after having chemotherapy by undergoing fertility treatments. Radiotherapy can also cause reproductive damage, and may sometimes be done in a way that somehow protects the reproductive system. This may be difficult however in the case of uterine cancer. Using hormones to fight cancer, rather than chemotherapy or radiotherapy, could be a more conservative approach, especially for women who want to maintain their fertility levels.

ARTICLE FEATURES . Cervical Cancer

ARTICLE FEATURES . Stroke Rehabilitation

Life after Stroke Rehabilitation is the first way to treat the effects of stroke through developing the bodyâ&#x20AC;&#x2122;s abilities

troke patients should realize that their life after stroke is not the same as before, for there have been changes that affect the patientâ&#x20AC;&#x2122;s autonomy and lifestyle. In turn, these changes can be fully or partially treated by attending physiotherapy and rehabilitation sessions so that improvement depends on the severity of the stroke and the affected areas of the brain. Physical therapy is one of the most important therapeutic ways to rehabilitate stroke patients. It aims to teach patients how to cope with their new health condition and live normally until they fully recover, and is the first way to treat the effects of stroke

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through developing the capabilities and functions of the body via many programs. The most important thing is the strong determination and will of the patient because they will help him respond quickly to physical therapy. When a stroke usually occurs, the nerves responsible for the movement of the limbs are pressed at different levels. Partial or complete paralysis can occur, and in most cases the stroke is accompanied by numbness and trouble with speaking. Once the health condition is stable and the extent of brain damage is assessed, specialists in physical

ARTICLE FEATURES . Stroke Rehabilitation

medicine and rehabilitation, in collaboration with the treating physician, develop a comprehensive treatment program that includes many aspects such as treating speech disorders and improving the patient’s ability to move and walk. The cooperation of the patient and the family members positively affects the success of the treatment plan.

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Physical therapy stages include:

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Physiotherapy to strengthen the muscles and improve the ability to walk. Speech therapy to re-teach the patient speaking, understanding, and writing. Teaching the patient alternative ways of doing different daily activities and practices.

Physiotherapy Physiotherapy for stroke patients aims to improve the patient’s ability to walk and relax the tensed muscles in the leg or arm. The patient undergoes several exercise sessions a day to become stronger and improve as much as possible the disabilities caused by the stroke. Doctors advise to start physiotherapy immediately after the stabilization of the health condition as it will give good results during the first six months and fewer results during the next six months. Therefore, they usually advise to follow a physiotherapy program for one year after the stroke. There are many approaches to physiotherapy in post-stroke rehabilitation. The rehabilitation plan will depend on the part of the body affected by the stroke.

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Mobility training that might require mobility aids such as a walker, wheelchair, or leg supports that help stabilize and strengthen the leg. Constraint-induced therapy where the unaffected limb is restrained while the affected limb is being trained to move in order to help improve its function. Range-of-motion therapy where some exercises and treatment can ease muscle tension (spasticity) and help regain range of motion.

Physicians and physiotherapists may use prosthetic devices during treatment to restore muscle control. Patients with hemiplegia have specific positions for sleeping on the unaffected side, the affected side, and the back, sitting on the bed or chair, moving from lying down to sitting and from sitting to standing, transporting the patient using a standup technique, and for the arm while lying down.

Physical activities might include: •

Motor-skill exercises that help improve muscle strength and coordination.

ARTICLE FEATURES . Stroke Rehabilitation

Negative movement exercises for the affected side are carried out by the therapist or a family member who accompanies the patient. Some of these exercises include raising the leg to the hip while lying down, lifting the leg in the direction of the hip in the bending position, opening the hip, and moving the ankle up and down. These exercises should be repeated in sets of 10-20 times. As for the unaffected lower limb exercises, stretching exercises should be carried out before and after any strengthening program and according to the instructions of the therapist, bearing in mind that the posture is important during the exercise to reach the best results. The patient should stand in front of a mirror to watch the posture and do only the exercises prepared by the therapist, remembering the importance of breathing well while doing difficult exercises. It is important for the therapist to observe the patient’s exercises to ensure proper posture and technique. As for the long-arch quad exercise, the patient should keep the legs close together, extend the entire leg for 10 seconds, rest it, and repeat it 10 times in a row 3 times a day. There is also the straight leg raise exercise where the patient should lie on the back, raise the leg, extend it at 45 degrees, keep it as well for 10 seconds, and repeat it 10 times in a row 3 times a day.

Patient’s Autonomy The therapeutic program of each patient focuses on the importance of restoring mobility and teaching parents the exercises that the patient should perform. The physiotherapist also teaches parents how to help the patient during the day and alerts them not to over-assist the patient to avoid losing his ability to support himself.

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Among the tasks entrusted to the physiotherapist is to teach the patient autonomy in daily activities, the correct positions of sleeping or sitting, and how to maintain joint movement and muscle flexibility with exercise, to increase awareness of the affected part of the body, and to improve balance while sitting and walking. Over time, and in cooperation between the patient and his family along with the physiotherapist, the patient learns how to be autonomous after having strengthened the weak muscles and reduced the muscular cramps. The patient gradually regains his ability to walk even though with the help of the walker at first.

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stroke in the right side of the brain, especially when the left side is more dominant. Extent of brain tissue affected: If the stroke affects a large part of the brain, people are more likely to have difficulties in understanding and expressing than those who have a small part affected. Stroke type: A hemorrhagic stroke causes more severe difficulties in understanding and expressing than a stroke caused by temporary blockage of the artery (ischemic stroke) that supplies blood to the brain.

Speech Therapy Speech therapy helps the patient improve memory, deal with numbers, and gain the ability to speak, read, understand, and write, and. The rehabilitation program must begin when the patient’s health condition is stable. Its success often depends on the readiness of the patient and his parents to do daily exercises. Speech therapy depends on the patient doing a number of exercises several times a day to strengthen these activities in his brain. Some stroke patients have difficulty speaking, expressing, or understanding. Some studies suggest that 74% of patients may show improved speech skills and at 44% of patients may completely recover within 4-12 weeks after stroke onset.

Factors that should be taken into consideration to predict the impact of stroke on speech and communication: •

Location of injury: If the stroke occurs in the left side of the brain, people are more likely to have difficulties in understanding and expressing than people who have a

In this case, the treating physician refers the patient to a speech pathologist to perform the necessary tests such as examining the functions of speech organs, the patient’s mental abilities, and the patient’s abilities of understanding and expressing in order to identify the problem. During the examination, the speech pathologist asks the patient to answer specific questions, respond to simple commands, name things from memory, or use picture cards. The examination also includes assessing the patient’s ability to write and read. Specific tests to examine the language of people who have had a stroke include the collection of speech samples from the patient and testing his ability to understand, express, write, and read. These tests help to identify the nature and severity of the patient’s linguistic problem and estimate the benefits of the treatment. The pathologist develops a specific training program after having accurately diagnosed the condition in order to follow therapeutic methods that are appropriate to the nature of the speech disorder. The patient undergoes intensive therapeutic ses-

ARTICLE FEATURES . Life after Stroke

sions that might take weeks, months, or years. These sessions aim to help the patient communicate with others through visual and auditory gestures at the beginning of the treatment. For example, when the patient is asked to name some fruits, he can provide a photo of that fruit as an aid, or pronounce the first letters of the word so that he can complete the word using that aid. When the patient’s speech performance rises, the therapist reduces the number of visual and auditory aids so that the patient can perform without any help. It is the duty of the therapist to raise the awareness of the patient and his relatives about the importance of continuing the treatment and not giving up no matter how long it takes.

Swallowing Problems One of the problems that a stroke patient may experience after the stabilization of his health condition is the ability to swallow. The patient may have difficulty swallowing which can be described as follows: • Difficulty in eating foods that require chewing. • Difficulty in containing fluid or food inside the mouth due to weakness of the muscles of the mouth, tongue, and jaw. • Food leaking out of the mouth when chewing. • Food running down into the pharynx before swallowing. • The presence of food fragments in the mouth after swallowing, especially in the

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weak side of the mouth. The presence of food fragments in the pharynx after swallowing. Food fragments coming up to the mouth. Choking when drinking liquids such as water and orange or apple juice.

Here comes the role of the speech pathologist for examining the muscles of the mouth, tongue, and jaw and for conducting the necessary clinical examination of the patient by watching him when eating, conducting an ultrasound for swallowing, and assessing the effect of auditory and visual stimuli on swallowing, the impact of the position of the head and body on

ARTICLE FEATURES . Stroke Rehabilitation

swallowing, and the patient’s ability to swallow and eat foods with different characteristics in terms of texture, flavor, temperature, and viscosity. As for treating swallowing problems, the speech pathologist may train the stroke patient to adopt therapeutic methods that help to eat foods in a safe and effective way. For some advanced cases, patients who have esophagus disorders are treated with drugs, while those who suffer from a gastroesophageal reflux require a surgery. In advanced cases, the doctor looks for alternatives if oral intake is not possible. One of these alternatives is eating through the nasogastric tube (NGT) which is inserted through the nose past the throat and down into the stomach. The NGT is properly fixed on the face with a tape. This tube is used as an initial step for up to three months to meet the patient’s nutritional needs. Keeping it for a long period of time is not recommended because it’s not comfortable, has negative impact on natural swallowing, and contributes to the irritation of the nasal and oral mucous membrane linings, in addition to being

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fixed on the face. This type of tube needs to be changed often to avoid inflammations and infections. Orogastric tube (OG) is another type of tube that is inserted into the mouth, down the throat into the esophagus and end rests in the stomach without a surgery. In advanced cases, doctors resort to the gastric tube (G tube) that is inserted into the outer wall of the stomach through an incision using an endoscope and mild sedation, or to the jejunostomy tube (J tube) for patients with digestive problems such as bowel obstruction or a failure in bowel and stomach functions. The patient gets special foods that meet his nutritional needs through blood vessels.

Occupational Therapy Occupational therapy improves the daily life skills of stroke patients who have physical, neurological, or cognitive problems. Over time, the patient’s physical, mental, and social performance improves in order to develop his personal, social, and professional autonomy. An occupational therapist is one of a multidisciplinary team that reha-

bilitates stroke patients. He develops a treatment program that takes into account the needs of the patient and includes a rehabilitation program after having assessed the individual abilities that are necessary to perform the daily life tasks and functions. The program should include teaching the patient how to shower and maintain personal hygiene, how to wear clothes without the help of anyone, and how to stand, sit, go to bed, and eat independently. The occupational therapist also assesses cognitive skills, i.e., the patient’s ability to pay attention, focus, remember, and think, as well as motor skills such as arm and hand movement, muscle coordination, visual motor coordination, ability to balance, and the level of impact of the stroke on carrying out life tasks and functions. The specialist sets the objectives of the therapeutic program according to the results of the assessment and summarizes in general the functional activities of the patient depending on the areas affected by the stroke in order to improve functional performance and raise the level of autonomy while providing the equipment and aids.

ARTICLE FEATURES . Life after Stroke

ARTICLE

Alzheimerâ&#x20AC;&#x2122;s Disease

od blessed humans by giving them brain, while animals live by their instinct. Human uses their brain for many functions that help him to live better life like thinking, understanding, reasoning, speaking, and making instruments and others. These processes carried

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out by having huge number of highly specialized cells that have interconnections to yield a perfect brain function.

What is Alzheimerâ&#x20AC;&#x2122;s disease (AD)? It is a disease affecting the brain,

resulting from replacement of the highly specialized brain cells with nonfunctioning proteins of unknown source causing decrease in number of effective cells and gradual loss in their capabilities and function performance leading to increasing disabilities and difficulty in performing daily life activities.

ARTICLE

Who are liable to get AD? AD can affect all ages, but most commonly seen after the age of 65 years, it is estimated that people above age of 70 will have 10% affected with AD, and it increases to 20-40% for those above 80 years.

Does AD affect certain people more than others? AD studies show that it can affect both sexes and all races equally and there is no difference among people living in different social class or mode of life or life standards.

Are there any diseases that interfere with AD outcome? Many diseases can alter and fasten the course and symptoms of AD like hypertension, hyperlipidemia, diabetes mellitus, and cerebrovascular accidents. ItMany studies also found that low fruit diet, low education level, low social class, and heavy metal poisoning like mercury all might speed up of disease development.

Is there any genetic predisposition for AD? Probability of having AD increases in families with first-degree relative having the disease, they also found that genetic factors transmit the disease in 2% of AD patients.

What are the signs and symptoms of AD? The earliest symptom is the complaint of recent memory loss, the patient notices forgetting recent events like where he kept his keys, or mobile phone, or where he parked his car, or got lost in streets or if he took his medicine. Then with time, he starts to forget bigger things like names and dates, and starts to have

inability to recognize things visually and spatially (by touch) like remote control. Also found difficulty using household materials like knives. He might experience language difficulties in speaking, writing and reading, with difficulty of taking care of himself like changing clothes and bathing, or eating by himself. In addition, he might show psychiatric symptoms like depression, anxiety, tension, and he may start to have abnormal thoughts that somebody is trying to hurt him or trying to assault him.

What is the usual disease course? Usually it takes around 3 – 4 years for the disease to progress from diagnosis to have the full picture. At first, the patient and his family are looking for medical advice then with time they accept the patient’s condition and continue to take care of him at home and limit his activities.

How to diagnose AD? Diagnosis takes place by history and clinical examination, investigations done to assess the accompanying diseases and how to control them like brain MRI, fasting blood sugar, liver and kidney tests, cholesterol level and hemoglobin.

How to treat AD? No effective therapy is found at present time to stop or treat AD; medicines are used to improve symptoms and make patient’s life better or to control psychiatric issues , they do so by changing the neurotransmitters concentrations in the brain specially acetyl choline. FDA approved medicines are rivastigmin, donepezil, galantamine, memontum. Nevertheless, they

Dr. Fathi Abdal Qader Ahmed Consultant Internal Medicine at Al Ahli Hospital will not alter the progression of the disease.

What advice is given to the patient’s family? The patient’s family should be instructed about their patient care and safety. The patient should not be irritated by using words that makes him angry like disabled, useless, worthless and insignificant. Other measures taken to protect him from harm like removing sharp objects, locking doors properly, stairs safety, secure electronic devices and avoiding chances of slips and falls. It is good to benefit from sharing of social health organizations, which can provide home care and encourage them to visit AD patient at home, for proper follow-up and health assessment with monitoring the patient’s condition and providing training for the patient’s family on how to take care of the patient. Recent studies show new information about medications that are promising for AD which need further analysis before use, so we should not stop hoping to find a cure of the disease soon.

ARTICLE

Deep Vein Thrombosis and Pregnancy

eep vein thrombosis is defined as clot formation inside the veins mainly of the lower limbs but could also be in pelvic veins and pulmonary arteries. It is a serious illness and one the main causes of maternal mortality and morbidity in developed countries. It comes after bleeding, infections and preeclampsia in less developed countries as a cause of near miss.

Why Deep vein Thrombosis happens? It is Virchowâ&#x20AC;&#x2122; triad which is composed of: Stasis of blood flow, Endothelial injury and Hypercoagulability, so if one or more of these factors happen thrombosis will start to form. In normal situation; Blood usually coagulates once it comes outside the blood vessels due to injuries as protection mechanism to prevent

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blood loss till death, in other words, blood should remain liquid inside the intact blood vessels as long as the endothelium lining of the blood vessels is heathy and smooth, once endothelium is damaged for example by atherosclerosis ,thrombus formation will be triggered . Normal blood flow speed is another factor to prevent thrombus formation, accordingly stagnation of blood due to pressure on the veins from outside, will help initiating mechanism of thrombus formation. This pressure is very likely to occur during pregnancy by the pressure of pregnant uterus on the pelvic veins and subsequently on lower limbs veins ,another occasion is when lying in bed for long period by the time of normal delivery or cesarean section where the speed of the blood inside lower limb veins slow down by low

lower limb muscle tone and pressure of bed on the calf veins. A third common occasion when travelling for long distance, sitting with legs in lower level for long time without movement. Normal concentration of coagulation factors (proteins) in blood is another factor of keeping intravascular blood fluidy, during pregnancy the coagulation factors synthesis including fibrinogen will increase under effect of pregnancy hormones as preparation for delivery to be able to stop bleeding but meanwhile carries risk of intravascular thrombosis if associated with other factors.

Who Are at increased risk of Deep Vein Thrombosis? 1. Those with past history of thrombosis. 2. Those with family history of

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thrombosis. 3. Protein C &S deficiency (Anti phospholipid Syndrome). 4. Hospitalization for a long time with immobilization as when treating fractures, or traveling for long distances. 5. Pregnancy, puerperium (increase risk by 20 times) and cesarean section. 6. Cancer cases, obesity. 7. Age above 35 years. Smoking 8. Contraceptive hormones 9. Those with twin or multiple pregnancy, medical disorders complicating pregnancy like Thalassemia, Sickle cell anemia, Thrombophilia, preeclampsia, obesity, heart diseases, severe hyperemesis gravidarum ovarian hyperstimulation syndrome, systemic lupus erythematosus and inflammatory bowel diseases.

Why Deep Vein Thrombosis is risky? Formation of clot in the deep veins of the lower limb may extend to reach the pelvic veins then inferior Vana cava from which shower of emboli will go to the lungs causing infarction, not only this, but also embolus may also reach the brain causing cerebrovascular stroke with subsequent brain damage of different degrees up to death.

Diagnosis Diagnosis will be made upon taking proper personal and family history from the patient, in addition to symptoms including inability to walk or stand due to pain, swelling of one leg or both, redness on the back of the leg.

On clinical examination, there is pain and tenderness on pressing the calf muscles, lower limb edema one or both sides and positive Homans sign which is pain on flexing foot on the leg. The golden tool for diagnosis of DVT is the Compression duplex ultrasound to check the blood flow velocity inside veins and venography to check the size and site of the present clot Pulmonary embolization will present itself in the form of chest pain, tightness, dyspnea, inability and shortness of breath, tachycardia and blood streaked sputum.in acute phase ECG and Chest X-ray should be done. Ventilation /perfusion lung scan or Computerized tomography pulmonary angiogram are valid tools for diagnosis of pulmonary embolization. CT-Scan carries slight increase risk of future childhood cancer and low risk for breast cancer however the absolute risk is very small, anyhow informed consent should be taken before any procedure. D-Dimer should not be done in the investigation of acute vein thrombosis in pregnancy.

Treatment The key stone of treatment should be prevention .

Prophylaxis strategy depends on 1. Routine estimation of the risk of having thrombosis early in antenatal visits, delivery and puerperium 2. Advise pregnant women to keep ambulating 3. Use of elastic stockings, drink a lot of water 4. Start prophylactic Heparin

Dr Asmaa Abdulsalam Consultant of Obstetrics and Gynecology at Al Ahli Hospital

for intermediate and high-risk groups. 5. Stop clot from getting bigger and help clot to dissolve in the body. 6. Reduce the risk of future clots

Therapeutic strategy: 1. Once thrombosis is diagnosed, it is a multi-disciplinary approach by obstetrician, hematologist, Radiologist and Physician. 2. When deep vein thrombosis or pulmonary embolization are clinically suspected anticoagulants should be initiated immediately to prevent formation of more thrombi and prevent the existing one from getting bigger, treatment should continue till the diagnosis is either excluded

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or confirmed by different investigations unless anticoagulants are strongly contraindicated. 3. Heparin is the drug of choice and considered safe during pregnancy because it does not pass to the placenta, acts fast and its half-life is short and should be started upon any suspicion. However before staring Heparin the following laboratory tests should be done: Coagulation profile, complete blood count, urea and electrolytes, but Thrombophilia screen is not recommended. 4. Dose of Heparin will be calculated upon patient weight and given in single dose or two divided doses. 5. After starting heparin rou-

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tine laboratory test should not be done except for extreme body weights or renal impairment. 6. Thrombolysis can be considered in massive pulmonary embolization or collapsing woman. 7. Legs should be kept elevated with graduated elastic compression; mobilization should also be encouraged. 8. Once a pregnant woman starts having labor pains, Heparin should be stopped till 8 hours after delivery, then to be resumed again after delivery if there is no bleeding, same applies to the pregnant woman on Heparin prepared for elective cesarean section. Pregnant women with past

history of thrombosis or pulmonary embolization during past pregnancy can get pregnant again but prophylaxis Heparin should be started as early as possible during new pregnancy and should continue throughout pregnancy after delivery and during puerperium.

In conclusion Deep vein thrombosis is one of the most serious causes of maternal mortality and morbidity, yet it is a preventable and avoidable factor simply by practicing routine proper estimation of the risk factors for getting thrombosis for every pregnant woman and subsequently providing prophylaxis measurements including Heparin injections. It is of great importance to educate women about warning signs and symptoms so they can seek help as soon as possible.

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Sheikh Shakhbout Medical City is one of the largest hospitals in the UAE It is equipped with the surgical robot which allows doctors to perform many types of complex procedures with precision, efficiency and speed

aed Jaber Al-Kuwaiti, head of operation committee at Sheikh Shakhbout Medical City, confirmed that the launch of the hospital is part of government of Abu Dhabi’s policy which seeks to develop the health service to a global level, in line with Abu Dhabi Vision 2030 and SEHA vision which aims to advance healthcare through skills and innovation. His statement came out during a tour organised by SEHA at Sheikh Shakhbout Medical City for a group of press and media people to show the hospital sections and advanced facilities. Saed Jaber Al-Kuwaiti said SEHA Company introduced the artificial intelligence in several operations, since IT and AI play a vital role in the development of the healthcare within SEHA’s facilities. SEHA’s policy focuses

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on providing high-quality care centered on patient. This is to comply with the vision of the leadership in offering world-class healthcare for all citizens and residents of Emirate of Abu Dhabi. He added, SEHA is cane to develop the healthcare to all population of Emirate of Abu Dhabi through four areas which are: prompt access to healthcare, positive results, stable cost and patients’ satisfication. SEHA aims to cut the waiting time shorter for both check-visits and appointments for hospital admission. SEHA’s adnavced care system looks after patients equally during hospitalized time and after discharge. He pointed out that Sheikh Shakhbout Medical City City is one of the largest hospitals in the UAE and part of SEHA’s network. The hospital will partially open for public in November

the third of 2019. He also said, the hospital area is three hundred thousand square meter and has 732 inpatient beds with a strategic location close to each of Abu Dhabi, Al-Ain and Dhafra area together, around 50 minute distance by car. The hospital has four wings which are emergency & intensive care, acute surgical, maternity and children and outpatient services, in addition to several sepcialised areas such as vascular surgery, burns and trauma treatment, Pulmonology and orthopaedic & plastic surgery along side with neonatology. He explained that the first launch would include adult cardiology, adult neurological, ear, nose & throat, gastrointestinal & hepatobiliary and ophthalmology clinics. While the second stage of launching will take place towards the end of the current year or beginning of the next year.

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The tour for press and media people covered operational chamber, surgery wards, neonatal unit and patients rest ward as they noticed the final preparation for launching. The press and media people were introduced to the very advanced & high-tech equipment including robotic surgeon which allows dectors to perfom many type of complex pro-

edures with precision, effectiveness and speed which shortens the time of surgery into one-fifth and reduces the healing time, not to mention the higher percentage of success. The hospital implemented the smart pharmacy system which offers service to customers via eighteen windows simultaneously, prescriptions are dispensed automatically which

reduces error rate to nil. Operating room has the best equipment auto-controlled in all stages and also has an advanced audiovisual communication system. The outpatient clinics accommodate about 2500 vistors daily. The neonatal unit has 26 beds, very advanced equipment and attractive location which brings calm and happiness to both staff and patients.

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Ajman Opens the Largest Private Academic Hospital in the Region The largest private academic hospital in the region, Thumbay University Hospital features state-of-the-art healthcare delivery systems with a 350-bed capacity in the first phase Italy and Korea.” Commenting on the hospital’s state-of-the-art facilities, Mr. Akbar Moideen Thumbay said, “Thumbay University Hospital is the first and only hospital of its kind in the region, equipped with the latest technology and expert healthcare professionals. As a quaternary care facility, it is a referral hospital to which primary and secondary care hospitals and clinics refer their complex cases. We are confident that the hospital would complement the world-class amenities at Thumbay Medicity and set new standards of quality and innovation in healthcare.”

humbay Group on Monday, 7th October 2019, opened its latest academic hospital, Thumbay University Hospital at Thumbay Medicity, Ajman. The new hospital is the largest private academic hospital in the region, with a capacity of 350 beds in the first phase. The soft opening was announced by Dr. Thumbay Moideen – the Founder President of Thumbay Group, in the presence of Mr. Akbar Moideen Thumbay - Vice President of the Healthcare Division of Thumbay Group, Mr. Akram Moideen Thumbay - Director Operations of the Construction and Renovation Division and Director of Thumbay Technologies, and other members of Thumbay Group’s administrative team, with a cake-cutting ceremony. The event also included the opening of the first robotics pharmacy under the Thumbay Pharmacy network by Mr. Faizal E. Kottikollon - Founder & Chairman of KEF Holdings and a

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new outlet of Zo & Mo Opticals, the network of optical retail stores under Thumbay Group’s Retail Division by Mrs. Shabana Faizal, Vice Chairperson of KEF Holdings. Speaking about the new hospital, Dr. Thumbay Moideen said, “With the opening of the region’s largest private academic hospital, Ajman has now become a landmark. Located at Thumbay Medicity – the futuristic hub of medical education, healthcare and research, the hospital is perfectly positioned to serve a large population, at the same time further advancing our efforts to transform the country and the region into a global medical tourism destination. The main pillars of our business are Education, Healthcare and Research. In line with Thumbay Group’s vision to expand our global strategic network, the new hospital has established international collaborations with leading international centers of excellence in the USA, France, Spain,

Prof. Hossam Hamdy, the Chancellor of Gulf Medical University said, “We are very glad and proud of the opening of Thumbay University Hospital under the Gulf Medical University Academic Health System, the first private academic health system in the region. The hospital will be a center for clinical training of the students of Gulf Medical University. In addition to the state-of-the-art medical technology, it has been designed as a university hospital, in such a way as to accommodate academic activities, with lecture halls, academic departments, special physical facilities etc., creating a learning environment. Even the hospital’s food court has been designed as a ‘Live & Learn’ environment, facilitating the exchange of knowledge and information and promoting seamless learning.” Opened along with the hospital, the new Thumbay Pharmcy is the biggest robotic pharmacy in the country

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with automated robotic technology to prepare and dispense medicines. The smart pharmacy ensures zero dispensing errors and achieves considerable reduction in waiting times. Spread across 4700 sq. ft. area, it is equipped with robotic and pneumatic tube system, and has been designed for high density storage up to 42,000 units and hassle-free retrieval of medications. It is equipped with medication safety bar-code scanning, ensuring that the medications and strengths are correct during both the carousel stocking and dispensing process. It will also serve as a training site for the students of the ACPE-recognized PharmD program offered by the College of Pharmacy, Gulf Medical University. The hospital will be offering free consultations across all OPD specialties during the first 15 days of operations.

Thumbay University Hospital: Salient Features •

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A one-stop family healthcare destination comprising Thumbay University Hospital, Thumbay Physical Therapy & Rehabilitation Hospital and Thumbay Dental Hospital. Over one hundred consultation clinics. 100 beds dedicated for long term care and rehabilitation. More than 40 beds for intensive care including ICU, CCU, NICU, PICU, etc. 3000+ outpatients expected daily. Centre for Oncology equipped with PET-CT scan, the first of its kind in Ajman. State-Of-the-art imaging technology: 3 Tesla MRI, 256 Slice CT, X-ray, Fluoroscopy, Mammogram, Ultrasound etc. The hospital’s diagnostic lab is

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connected to the central reference lab of Thumbay Labs through a pneumatic tube system; the largest of its kind in the country. Modern surgical suites for all major specialties including Neurosurgery, Open Heart surgery, Urology, Orthopedic surgery, Laparoscopic Gynecology and surgery, Plastic and Restorative surgery and Bariatric surgery. Dedicated 10-bed dialysis unit for Nephrology with extended facility for transplant surgery (Renal and Liver) serving the GCC region and Africa. Cutting-edge Cath Lab facilities for Interventional Cardiology, Electrophysiological Studies, Pacemaker Implantation and Intracardiac devices like TAVI. ‘Therapeutic Garden’ for better relaxation and holistic recovery of in-patients. Marhaba Services – personalized fast track services for patients, Presidential Suite

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Rooms, VIP Rooms, Private Rooms etc. Dedicated medical tourism department for serving medical tourists. Wide range of amenities for patients and visitors, such as a multi-restaurant food court, movie theatre, coffee shops, health club, 1000+ free parking spaces etc. Professional workforce of 25 different nationalities, serving patients in 50 different languages. International collaborations with renowned global centers of excellence: Villa Beretta, Facility of the Valduce Hospital in Como – Italy; Children’s Mercy Hospitals and Clinics – Kansas City, US; IMO – Spain; Gruppo Ospedaliero – San Donato, Italy; Hopitaux Universitaries – Paris Sud, France; Hopital Universitaire Mere Enfant – France; Hopital Paul Brousse – France; Institut Cochin – France; BK Plastic Surgery – Korea.

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Orion Health Delivers the First Health Information Exchange (HIE) in the Middle East

irst go-live for the Malaffi HIE achieved six-months after contract-sign, giving clinicians in four leading Abu Dhabi healthcare providers access to important patient information. Further roll-outs, including a patient portal and analytics services will follow next year. The first Health Information Exchange (HIE) in the Middle East, Malaffi, went live at the end of July just six months after contracts were signed between the project company, Abu Dhabi Health Data Services

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(ADHDS), and technology provider Orion Health. ADHDS, the operator of Malaffi, was established as a Public Private Partnership (PPP) between the Department of Health – Abu Dhabi (DOH) and Injazat Data Systems, a subsidiary of Mubadala Investment Company. Clinicians at four leading healthcare providers encompassing hundreds of facilities in Abu Dhabi can now exchange and access more information about their patients, thanks to the go-live of the Malaffi HIE.

Abu Dhabi has an insurance-based healthcare system, with a mixture of public and private hospitals. They use Electronic Medical Records (EMRs) from different national and international vendors that, until now, have not been able to share information with each other. Over the rest of this year, Malaffi (Arabic for “My File”) will see more providers and facilities also be brought on board and more information will be added to the platform, while a patient portal and analytics services are also planned for next year.

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Atif Al Braiki, CEO of Abu Dhabi Health Data Services “Having successfully gone live with Malaffi within such a short period of time is a remarkable achievement given the significance of this first-of-its-kind platform in the region. We are continuously rolling out added enhancements and onboarding more providers within the Emirate in the unwavering pursuit of putting the patient experience firmly at the heart of diagnoses and treatment. Malaffi’s centralised database of unified patient records is already facilitating the greater and safer exchange of patient health information between Abu Dhabi’s hospitals, clinics, doctors and care teams. Through Malaffi, they will be more informed and more empowered to deliver the highest quality of healthcare,” said Atif Al Braiki, CEO of Abu Dhabi Health Data Services. “Malaffi will also provide access to population health information to help

Ian McCrae, the founder and chief executive of Orion Health

The initial go-live for Malaffi is enabling selected clinicians at four healthcare organisations, SEHA, Cleveland Clinic Abu Dhabi (CCAD), Danat El Emarat, and Oasis Hospital, to exchange information and access demographic data of about 2.3 million patients as well as to access 33 million encounters, procedures, problems and allergy records, going back five-years.

benefit clinicians and patients, and we look forward to working on further releases of the project that are so important for the people of Abu Dhabi. “Malaffi is also the first health information exchange to go-live in the Middle East, where there is a dynamic health tech market showing considerable interest in population health management. We fully expect to see further health information exchanges developed in the region, and hope to be able to contribute our leading software solutions and expertise to them.”

Ian McCrae, the founder and chief executive of Orion Health, said: “The speed at which Malaffi has moved from contract to go-live is a tribute to everybody involved. There is no doubt that the information sharing that it will make possible will

The Malaffi HIE has been built around Orion Health’s Amadeus Platform, which includes a data repository, the Nextgate MatchMetrix master patient index to match data with patients and a provider portal among other components.

inform policymakers, which we expect to be of much benefit to the current and future health of Abu Dhabi.”

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SEHA hosts 3rd International Conference on Prevention and Control of Infection

bu Dhabi Health Services Company (SEHA), the largest health services network in the UAE, has announced the 3rd International Conference on Infection Prevention and Control of Infection in collaboration with The Association for Professionals in Infection Control and Epidemiology in the UAE. The event, held under the theme; “Innovate, Prevent and Save Lives”, seeks to raise awareness for healthcare professionals in the field of infection prevention and equip attendees with global best practices.

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The three day conference was held at the Grand Hyatt Hotel in Abu Dhabi from 31 October to 2 November, with infection prevention specialists, doctors, microbiologists and interested healthcare professionals in attendance. Dr Gareth Goodier, Group Chief Executive at SEHA said: “Simple good hand hygiene practice and immunization can help reduce the spread of infections, protecting not only our patients, but also ourselves, our families and those around us. Breakthrough innovations are also contrib-

uting to the prevention and control of infections. Using data from epidemiology outbreaks and modern genetic sequencing techniques continue to model and predict the way organisms spread amongst patients.” Commenting on the lecture, Dr Gareth Said: “Healthcare organizations across the globe are adopting innovation to enhance patient care and delivery. With the accelerating demand for healthcare globally, because of an aging, growing and increasingly unhealthy population with more chronic diseases, healthcare innovation plays a key role in coping

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with such rising demands for access to healthcare. Innovations such as artificial intelligence, interactive patient portals, robotic surgery, genomics and personalized medicine, as well as digital pills, medical wearables, devices and implantables are reshaping the healthcare industry. Adoption of such innovations help improve efficiencies, all while enhancing the quality of patient care and experience, and reducing associated healthcare costs.” Dr. Nawal Al Kaabi, a specialist in children’s infectious diseases at SEHA has been appointed President of the Conference. Dr Al Kaabi has held senior leadership positions both in the UAE and internationally, including as Chairwoman of the Central Committee for Infection Prevention & Control, and in her current role as Chief Medical Officer at SEHA’s Sheikh Khalifa Medical City. Commenting on the conference, Dr. Nawal Al Kaabi said: “By hosting this important international conference in Abu Dhabi, we are reflecting the Emirate’s regional leadership position and the continued development of the healthcare system, aligned with the vision of Abu Dhabi’s leadership. In addition to discussing SEHA policies and quality control, the conference will also address new viruses and diseases that medical practitioners should be aware of as well as the specialist treatment available. We hope this will be an instructive and engaging event, and we look forward to sharing knowledge and experience with peers from around the world.” The program is designed to shed light on the development of infection control through a series of lectures, training courses and workshops cov-

ering three core topics, providing 75 worksheets and scientific lectures. Additionally, the conference will provide 14 workshops and training sessions, during which 30 scientific posters will be displayed over the first two days. Competitions for the best awareness film to prevent and control infection will also be scheduled. During the third day, the American Society for Microbiology will also conduct a training course to prepare the infection control specialists for the American Board Examination. Abeer Mohammed Khalaf, Manager of Prevention and Control of Infection department at Sheikh Khalifa Medical City and Chair of the Conference, commented: “The conference will welcome prominent national and international speakers and leading experts in the field from America, Europe, the Middle East and the Arabian Gulf. We will share up-todate research-based answers to the

most frequent questions that arise on prevention and control of infection in everyday practice.” This conference is an important achievement for SEHA and a unique opportunity to spread the culture of prevention and infection control through evidence-based best practice. In addition, the conference also enables SEHA to connect healthcare leaders and providers to achieve better integration and cooperation on the issues raised. The conference is accredited with 20 hours of continuing medical education from the European Accreditation Council for Continuing Medical Education (EACCME). On the third day, the American Medical Quality Examination will take place, with Abu Dhabi the only city outside the United States where this examination can be taken. This will be the fourth time SEHA has organized for this exam to be conducted in Abu Dhabi.

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Kuwait Images Diagnostic Center first in region to introduce

GE Healthcare’s AI-based MRI solution to better diagnose heart disease

E Healthcare and its partner, Advanced Technology Company (ATC), marked an important milestone in the provision of advanced diagnostic services in Kuwait with the launch of the region’s first Artificial Intelligence cloud-based MRI post-processing solution at Images Diagnostic Center. Images Diagnostic Center recently became the first official GE Magnetic Resonance Imaging show site in the Middle East. With the introduction of GE Healthcare’s advanced ViosWorks,

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powered by ArterysTM, Images Diagnostic Center highlights the superior breadth of its diagnostic services that are now available for patients and healthcare practitioners. According to the World Health Organization*, non-communicable diseases are estimated to account for 72% of all deaths in Kuwait. Nearly 41% of the total NCD deaths can be attributed to cardiovascular diseases. Cardiac MRI is a non-invasive medical test that allows physicians to see if the heart has been damaged from a heart attack, or if there is a lack of blood

flow to the heart muscle because of narrowed or blocked arteries. The new ViosWorks extends cardiac MR assessment beyond the anatomy by providing a comprehensive cardiovascular solution in a fraction of the time of conventional cardiac scans. Providing 3D cardiac anatomy, function, and flow in 1-free breathing, the 8-minute scan with cloud-based, real-time processing of images in resolutions that were previously unattainable alters cardiac imaging dramatically with excellent diagnostic results. It is a simplified solution for patients,

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technologists and clinicians. Images Diagnostic Center has always strived to be the first to offer state-of-the-art diagnostic services to patients in Kuwait. It started with the introduction of the GE Optima 450 32 channel system, a wide-bore platform enabled with noise reduction technology that improves patient experience and accessibility. Today, the Center owns four GE MR systems with the latest platforms in 1.5T and 3.0T: SIGNA Architect, SIGNA Pioneer, SIGNA Artist, and SIGNA Voyager. Tamer Khalaf, Marketing & Applications Director, Magnetic Resonance (MR), GE Healthcare in the Eastern Growth Markets, said: “Through our industry-leading technology we are helping redefine the patient care experience and advancing the precision of diagnostics services. The introduction of ViosWorks, a path-breaking

innovation to Kuwait at the Images Diagnostics Center, will enhance cardiovascular diagnostics and enable practitioners to identify critical medical conditions at an early stage. Our aim is to deliver the MR solutions of ‘tomorrow… today’ and as an early adopter of cutting-edge technology, Images Diagnostic Center is setting the standard of healthcare diagnostics in Kuwait.” Dr. Yahya Slaiman, owner of Images Diagnostic Center, said: “Since our inception, we have prioritized the introduction of next generation technology in our practice to ensure that our patients and the wider healthcare community can benefit from timely and accurate diagnosis. The addition of GE Healthcare’s advanced MR solutions help us deliver better patient care, and we will continue to invest in advanced solutions that

ensure we continue to serve as center of excellence for diagnostic care in the region.” Ghassan M. Mamlouk, CEO, Advanced Technology Company added: “Images Diagnostic Center is a true healthcare pioneer in Kuwait’s private sector, passionate about delivering the most timely, accurate diagnostic services to patients. It is rare to have both GE MRI with ViosWorks in one facility; it is a clear indication of the commitment the Center to scaling up its resources and delivering high-quality service.” GE Healthcare has a strong history of presence in Kuwait, having delivered the range of advanced healthcare technologies including healthcare IT systems, CT and MRI devices to public and private hospitals in the country.

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Health leaders from around the world gather in Muscat for the 43rd World Hospital Congress

he 43rd IHF World Hospital Congress kicked off at the Oman Convention and Exhibition Centre for four days of insightful discussions and knowledge exchange among health leaders from 59 countries, all gathered together to improve the way we deliver healthcare. Hosted by the Ministry of Health of the Sultanate of Oman, the World Hospital Congress, under the umbrella of the International Hospital Federation (IHF), is a unique global forum that brings health leaders from across the globe together annually to share views and experiences, network and promote excellence in healthcare and hospital leadership. “The Ministry of Health of the Sultanate of Oman is delighted to host the 43rd World Hospital Congress and welcome delegates from different countries and cultures to Muscat”, said Dr Qasem Ahmed Al Salmi, Chair of the 2019 World Hospital Congress Organizing Committee. “In the next four days, we will hear accounts about resiliency, investments, and innovations; and understand better the interconnected roles of hospitals, patients, and communities in times of peace and

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crisis”, said IHF President, Dr Francisco Balestrin. “On November 8, we will recognize hospitals and healthcare organizations from around the world for their outstanding and innovative programs to improve patient experience and outcomes during the 2019 IHF Awards Ceremony.” Six keynote presentations will feature world-renowned speakers followed by insightful panel discussions. There are 130 speakers to offer fresh perspectives and strategies from their experiences, as well as examples of current innovations and digital transformations in healthcare from different regions in the world. “If you are interested in resilient health services, you can hear about the challenges of refugee crisis in Palestine from Dr. Akihiro Seita, Director of Health Programme of UNRWA. You can attend sessions covering terrorist attack situations, response and mitigation plans, and how to maintain quality in healthcare even in the most challenging of times,” offered Dr Balestrin. Topics on health investment for prosperity are spread throughout the four days. Keynote presentations by Dr. Melinda Estes, President and CEO of Saint Luke’s Health System in the USA, and Dr. Agnés Soucat, Direc-

tor of Health Systems Governance and Financing at WHO Switzerland, will tackle the roles of hospitals, health systems and health services in driving prosperity and in support of population well-being. More sessions under this sub-theme will cover how local hospitals are reinventing themselves and rethinking their plans to improve population health. “If you are keen about innovation for health impact, a keynote session with Sir Andrew Dillon CBE, Chief Executive of the National Institute for Health and Care Excellence (NICE) in the UK, will discuss about the innovation pathway being an alignment between ambition and successful adoption of new health technologies. You can also listen to sessions sharing about the digital ecosystem of Catalonia, the Asian perspective of digital transformation pathway, as well as a presentation of Oman’s e-health achievements”, invited Dr Balestrin. “This is a great opportunity to learn from each other and share ideas over these four days in the conversation on how we can make healthcare more responsive, supportive and prospective in times of peace and crisis,” commented Dr. Al Salmi.

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WELCOME TO MALAFFI CONNECTING HEALTHCARE

Malaffi, the Abu Dhabi Health Information Exchange, will connect all public and private healthcare providers in the Emirate of Abu Dhabi, to create a unified patient file and to improve healthcare quality and patient outcomes.

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