HOSPITALS Magazine issue 54 by The Arab Hospital Magazine

Issue 57/ 168 SEPT - OCT 2020

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

A WEIGHT LOSS UNIT THAT TRANSFORMS AYMAN HARAKEH, MD MAYA BARAKE, MD

BEYOND HEALTHCARE.

Publisher Arab Health Media Communication

VACCINES ARE JUST AROUND THE CORNER How will the world be after novel COVID-19? The question that preoccupies the world today is whether researchers have reached a successful vaccine for the novel coronavirus? While researchers are preoccupied by whether the upcoming vaccines have side effects or not? According to the World Health Organization, around 180 potential vaccines are being currently tested worldwide. But last week, final clinical trials for a coronavirus vaccine, developed by Oxford University, have been put on hold after a participant had a suspected adverse reaction in the UK. The outcome of vaccine trials is being closely watched around the world. As a result, it was found that trials are moving steadily, and carry great hope for a future breakthrough. Indeed, days after Oxford's first announcement, it was announced again that vaccine trials would be resumed. An Oxford University spokesman said that in the big experiments, some people contract diseases by accident, so that they should be independently reviewed to verify them closely. The researchers considered the situation safe enough to continue the experiments. Based on what is revealed in other countries and global sites working on developing the appropriate vaccine, the issue has come a long way, and the world is in the final stages of its battle with the disease. Whatever obstacles this process may witness; the path is known. Perhaps what we should look forward to today is careful preparation for the post-Covid-19 phase: medical centers and authorities, hospitals, programs and behaviors, and more in order for the medical sector to be fully prepared for the next stage. This seems to be happening so far with great efficiency. Publisher

General Manager Simon Chammas schammas@tahmag.com Creative Department Roula Haddad - Georges Habka Creative Director: Jessy E. Hajj Photographer Hanna Nehme Copy Editor Jessica Achkar Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa 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

SEPT . OCT 2020

32Clemenceau Medical Center A Weight Loss Unit That Transforms

COVER STORY

32 Clemenceau Medical Center (CMC) Dubai - Weight loss Unit

NEWS

8 Global healthcare needs to speak a common language to tackle the challenge of COVID-19 10 Department of Health celebrates the first ‘go-live’ anniversary of Malaffi with more than 60% of Abu Dhabibased hospitals now connected 12 LINET: 30 Years With You 12 The COVID-19 Fight with LINET 14 Philips Foundation deploys field hospital to support Lebanon in a time of need 16 DHA becomes first healthcare authority in the UAE to integrate UpToDate within an electronic medical record 18 Clinical Trial Demonstrates Positive Top-Line Results in Reducing the Risk for Cardiovascular Death or Hospitalisation due to Heart Failure 20 Innovative Treatments can Help Control Psoriasis, Says

SEPT.OCT 2020

Cleveland Clinic Expert 26 Convalescent Plasma Associated with Reduced COVID-19 Mortality in 35,000-Plus Hospitalized Patients 30 Weill Cornell Medicine-Qatar research reveals underlying mechanisms of aggressive breast cancers 76 King Faisal Specialist Hospital & Research Centre progresses transformation program by virtually upgrading its Integrated Clinical Information System 90 SEHA kidney care continues to provide world-class clinical services throughout COVID-19 92 Thumbay University Hospital now empanelled with all leading health insurance providers

INTERVIEWS

62 Fatima Barbar-Smiley, Clinician educator at Nationwide Children’s Hospital and an Assistant Professor of Pediatrics at The Ohio State University 68 Mr. Stefano Urbani, Founder of TMI – Turismo Medico Italia and Italian Healthcare

Innovative Patient Care The Multicare Bed with Automatic Lateral Therapy Automatic Lateral Therapy for Pulmonary Complications The effect of Automatic Lateral Therapy (ALT) on the Multicare bed is through the promotion of ventilation distribution. Safe and radiation-free “Continuous, Individualised Ventilation Care” is based on a combination of framebased lateral tilt and Electrical Impedance Tomography.

The strength of the unique platform-based lateral tilt assists nurses with turning patients.

30° of rotation 24 hours

A combination of the open architecture of the Multicare bed and its features such as lateral tilt and the Ergoframe® allows for the overall management of pressure area care.

Follow LINET MEA on LinkedIn and Facebook

The Early Mobilization with LINET program uses the recommended procedures from the AACN and enhances them by applying the unique Multicare features.

www.linet.ae

SEPT . OCT 2020

34 Hospitals beds ARTICLES

42 Baylor St. Luke's Medical Center: Can COVID-19 Cause Irreversible Lung Damage? 58 Advancing Medication Safety: A Summary Report of the 1st Middle East Advisory Board Meeting for Medication Management and Safety. Dubai, February 2020. 64 Baylor St. Luke's Medical Center: Do Patients Ever Fully Recover From COVID-19? 66 Dr. Prem Jagyasi: Covid-19, the catalyst towards transformative healthcare 72 Al Ahli Hospital: Role of Nutrition in Mental Healthcare 78 Al Ahli Hospital: Alzheimer's Disease 86 Al Ahli Hospital: Ectopic pregnancy 88 Al Ahli Hospital: Postnatal depression 96 Al Ahli Hospital: Our results are equivalent to the international records, if not better 98 Are you affected by Digital Eye Strain?

46 Cardiac Catheterization SEPT.OCT 2020

36 Robots in hospitals MEDICAL INSTITUTIONS

44 Acibadem International: Miracles during pandemic 50 Acibadem International, Cardiovascular: The TAVI era in repair of aortic valves! 52 The Department of Cardiology at HĂ´tel-Dieu de France: Years of Expertise Alongside Modern Technologies

FEATURES

34 Hospitals beds during the COVID-19 pandemic 36 Robots in hospitals 40 Virtual Healthcare vs. Telemedicine 46 Cardiac Catheterization 53 Heart Arrhythmia 80 What is an Antibody Test? How Can Previous Coronavirus Infections be Detected? 84 What Is Plasma from Recovered Covid-19 Patients?

80 What is an Antibody Test?

NEWS

Global healthcare needs to speak a common language to tackle the challenge of COVID-19 Atif Al Braiki, Abu Dhabi Health Data Services, Chief Executive Officer

OVID-19 has revealed a lot about the world we live in. It has reinforced the possibilities that open when we collaborate and come together, united towards a common cause; in this case, of defeating the spread of SARSCoV-2. The pandemic has drawn attention toward the inadequacies of the worldâ&#x20AC;&#x2122;s data sharing frameworks. It has highlighted the lack of interoperability (the ability of computer systems to exchange information and operate in conjunction with each other) of many medical systems used by public and private providers, laboratories, and pharmacies globally. As a result, data exchange within a healthcare system, which utilises different data sharing frameworks, is not as streamlined as it should be. From the number of beds to the level of occupancy, the world is struggling to pool data from disparate and complex systems into one centralised location. By reshaping the way this crucial data is collated, analysed and disseminated into a coherent and easily accessible system we will give healthcare professionals the tools they need to tackle the current crisis and any we may face in the future.

Speaking the same language THROUGH MALAFFI, WE HAVE BEEN ABLE TO HELP TACKLE THE COVID-19 PANDEMIC BY GAINING BETTER INSIGHTS ABOUT THE SPREAD OF THE DISEASE IN ABU DHABI.

Effective communication is the road network that transports information between locations. By speaking the same language, important data can move and lead to solutions much faster. Introducing better data standardisation will allow the health industry to speak a common language, with all the parameters used and understood in the same way. The Emirates ID, for example, is critical to our lives in the UAE. For our essential services to function effectively, it is imperative that we are all able to record and read the Emirates ID data in the same way. If there is no common standard set between different entities, data sharing becomes a challenge.

SEPT.OCT 2020

Systems must be interoperable; however, data sharing must also be governed. We can learn much from the vast experience of our colleagues in the banking sector in this regard. Modern banking technology allows us to easily transfer money across borders from one bank to another in the knowledge that the required security and controls are in place to enable this to happen. In addition to governance that allows the exchange, the systems are interoperable. This vital element is sometimes lacking in the healthcare sector. Transferring encrypted personal medical data from one healthcare provider to another within a secure network, can be challenging, because data is not always recorded in a way that it can be allow an easy exchange of medical records in a universal clinical language. During a pandemic, as we witnessed, information needs to be shared efficiently, for the authorities to be able to make quick and scientifically sound decisions based on accurate data. In Abu Dhabi, the Department of Health (DOH) and Malaffi have started the journey of making the exchange of data possible. Malaffi, the regionâ&#x20AC;&#x2122;s first Health Information Exchange (HIE) platform, is on its way to connect all public and private healthcare providers in the Emirate, allowing them to exchange in real-time important patient health information. The platform has a strong foundation. Through Malaffi, we have been able to help tackle the COVID-19 pandemic by gaining better insights about the spread of the disease in Abu Dhabi. This centralised platform has enabled the DOH to strengthen its COVID-19 response. It has allowed the identification and tracing of newly diagnosed cases in real-time and helped policymakers to more efficiently allocate resources for better capacity utilisation and care coordination in the Emirate. Yet this is only the first step; the standardisation of clinical data sets will help improve the interoperability and exchange of information between the different systems through Malaffi.

NEWS

Taking standardisation further Today, there are some data sets that are properly standardised, while others do not have a standardised coding system. This seriously hinders interoperability. For example, in the UAE, laboratories use different coding systems for orders and results, which are a combination of CPT codes (Current Procedural Terminology) and their own local codes. The CPT is a procedural code used by healthcare providers or laboratories to bill insurance companies for procedures or medical tests rendered to patients. While CPT codes can be used to refer to laboratory services, the LOINC coding system is more appropriate to specifically describe lab results. LOINC (Logical Observation Identifiers Names and Codes) is the world's most widely used terminology standard for lab tests and results1. By fostering this kind of interoperability, LOINC can help healthcare organisations achieve better patient care and improved revenue in the years to come. In the near future, laboratories should adopt the LOINC terminology. Another example of standardisation is how EMR (electronic medical records) systems capture allergies. This is important to enhancing the quality of documentation and data. Some EMR systems will have a free text field for the recording of allergies instead of providing a drop-down menu of standardised allergy terminology, which is much easier to match and exchange. Recording allergies in the HIE platform in a standardised way brings immeasurable value. Having this information is critical to making all the difference between prescribing medicines that might cause an allergic reaction and others that won’t, which can ultimately save lives, especially in an emergency. In Abu Dhabi, diagnoses are linked to a coding standard in the healthcare industry, known as ICD. This coding standard is used by healthcare providers to refer to diagnoses when sharing patients’ medical claims with insurance companies. However, for medical procedures providers use a different coding system, called CPT, in insurance claims to communicate information relating to the procedures.

Chronic problems Now, during a pandemic, it is also important

for doctors to have access to patients’ medical history in order to be able to assess the risk level of the COVID-19 positive patients. This is where the standardised recording of chronic problems in patients’ HIE file becomes more important than ever. Currently, the market is using a combination of ICD10 and SNOMED codes, but there are also a number of EMRs which don’t support recording of chronic conditions as structured and coded data elements. The accuracy of the reported pandemic’s indicators is by all means affected by the above – in other words, the better the data standards are, and the more accurate and qualitative the HIE data, the better standard of patient care and more reliable reporting to authorities are. Mandating coding standards needs to come from the authorities, and we have the support of the DOH who has taken steps to tackle these challenges. During the pandemic the DOH have mandated for all labs to capture a patient’s Emirates ID details and key demographic information for each sample they test, so that the record of the patient can be easily matched within Malaffi. The long-term plan is to support the DOH and work with them to have standards, such as SNOMED, across the Emirate.

We’re all in this together Data standardisation is not the onus of one entity or institution or organisation. The regulatory bodies will need to mandate it, however the change cannot happen on its own unless everyone is on board and collaborates. Bottom line: it is critical for all of these systems to be interoperable for data to be easily shared between different systems. This pandemic has opened up the discussion of having more interoperable systems to allow the easy exchange of data for specific uses and scenarios where it is needed. The big question that the healthcare sector around the world now faces is: Are we ready to take the big steps that will allow us to truly collaborate in the best interests of humankind?

IN ABU DHABI, DIAGNOSES ARE LINKED TO A CODING STANDARD IN THE HEALTHCARE INDUSTRY, KNOWN AS ICD. THIS CODING STANDARD IS USED BY HEALTHCARE PROVIDERS TO REFER TO DIAGNOSES WHEN SHARING PATIENTS’ MEDICAL CLAIMS WITH INSURANCE COMPANIES. HOWEVER, FOR MEDICAL PROCEDURES PROVIDERS USE A DIFFERENT CODING SYSTEM, CALLED CPT, IN INSURANCE CLAIMS TO COMMUNICATE INFORMATION RELATING TO THE PROCEDURES.

--------------------1. https://qcnet.com/Education/QCArticles/5ThingsYouNeedtoKnowaboutLOINC/tabid/7698/language/en-US/Default.aspx

NEWS

Department of Health celebrates the first ‘go-live’ anniversary of Malaffi with more than 60% of Abu Dhabi-based hospitals now connected

alaffi, the region’s first Health Information Exchange (HIE) platform, one of the key initiatives of the Department of Health – Abu Dhabi (DOH), has announced that almost one year from the first go-live milestone, more than 60% of all hospitals in the Emirate of Abu Dhabi have connected to Malaffi. These include SEHA Emirates Hospital, Emirates International Hospital, Dar Al Shifaa Hospital, Bareen Hospital and Cambridge Medical & Rehabilitation Hospital, amongst other healthcare providers. This marks great progress in bringing the Emirate of Abu Dhabi closer to its goal of connecting all of Abu Dhabi’s healthcare providers. Speaking about this important milestone for Abu Dhabi, especially during the current situation, H.E Dr. Jamal Mohammed Al Kaabi, Acting Undersecretary of the Department of Health – Abu Dhabi, said: “Transforming Abu Dhabi’s healthcare sector and delivering the best care possible is at the heart of everything we do. Connecting healthcare and having better data is an integral part of that. This is a time like no other. We are seeing people living longer than ever before, the rise of chronic diseases with hospitals operating at full capacity, and new diseases – such as COVID-19 – have demonstrated the need for innovative platforms such as Malaffi, that serve the healthcare sector in Abu Dhabi and enable the provision of high-quality health services to residents . The Platform is enhancing the value of information in the system and speed of connectivity, to help us build a stronger, more resilient and cohesive, knowledge-founded healthcare system that provides better care for everyone.” H.E Dr. Al Kaabi, added: “The Malaffi platform, which was launched a year ago, reflects the forward-thinking approach of the Abu Dhabi government, to harness technology to unify the efforts of the government and private sectors and increase their impact, especially in the critical healthcare sector. By enabling healthcare

SEPT.OCT 2020

The onboarding of these healthcare providers means that almost 25,923 doctors, nurses and other members of the care teams have access to Malaffi and are able to make better informed decisions by safely and securely accessing vital medical information, such as patient visits, medical problems, allergies, procedures, lab results, radiology reports and medications, in 107 million clinical records from 16 different Electronic Medical Records (EMR) systems operated by over 500 connected healthcare facilities.

HAVING QUICK ACCESS TO COVID-19 RESULTS THROUGH MALAFFI HAS ALLOWED DOCTORS TO IMMEDIATELY RESPOND TO PATIENTS’ NEEDS AND EASE THE ANXIETY FROM WAITING FOR TEST RESULTS.

providers to quickly access all required information about their patients, Malaffi is a clear reflection of the leaders’ drive to provide high-quality healthcare to all segments of society.” Currently, Malaffi connects 35 healthcare groups and a total of 40 hospitals and 403 clinics, which are now exchanging medical information through the HIE platform. Atif Al Braiki, the Chief Executive Officer of Abu Dhabi Health Data Services, the operator of Malaffi, said: “We have been on an ambitious and important journey of connecting healthcare in Abu Dhabi, from the smaller providers – medical centres, dental clinics and pharmacies – to the larger, multi-specialty, cutting-edge hospitals. Witnessing the lifesaving benefits that Malaffi is already providing to the industry, especially in times like these, makes me immensely proud of all we have achieved together, and I stress together. We can’t achieve this without each another. Together we are stronger, and we will continue to go from strength to strength as the final providers join Malaffi and connectivity becomes part of Abu Dhabi’s DNA.” During the COVID-19 pandemic, the DOH was better set to evaluate and implement response measures, based on real-time pandemic indicators from the centralised database of all COVID-19 results in Abu Dhabi, which was urgently deployed by Malaffi. Furthermore, front-liners were allowed urgent access to Malaffi to access test results and vital medical history information which has been critical in their clinical decision-making process. Dr. Kumaraswamy R. C. Gadari, Internal Medicine Doctor at NMC Specialty Hospital in Abu Dhabi which is one of the top users of Malaffi, said: “As we did not have an in-house testing facility for COVID-19, it used to take four to five working days to get PCR reports. With access to Malaffi, this time was reduced to 48 hours.”

An upstart on the global stage. A consistent leader in the U.S. Here in Columbus, Ohio, we have it all: world-class cultural attractions, cuisine and pediatric specialty care that makes us a leading destination for patients from around the world. From advanced, minimally invasive neurosurgical procedures to the most complex, life-changing craniofacial reconstructions, our surgical and medical experts run internationally recognized programs. Add that to our novel therapies for pediatric cancers and our renowned gene therapy research — aimed at making neuromuscular disorders a thing of the past — and it’s clear that our commitment to innovative clinical research makes an unmistakable impact on care quality. Reach out to our Global Patient Services team to learn more about our unique combination of a welcoming city and remarkable care. Learn more, refer a patient or plan a trip: NationwideChildrens.org/Global-Patient-Services GlobalPatientServices@NationwideChildrens.org +1 614 362 9127 Nationwide Children’s Hospital, Columbus, Ohio - USA

W205735

AMERICA’S SECOND

LARGEST CHILDREN’S HOSPITAL

* Based on CHA survey of utilization and financial indicators

NEWS

LINET: 30 Years With You

his year is quite special for LINET. Our company was able to respond to the extreme demands of the COVID-19 pandemic under difficult conditions. To meet the growing needs of healthcare, we have begun 24-hour production in our facility for the first time in our 30-year history.

Jitka Stranska, Managing Director LINET MEA

A unifying aspect of all three decades since the founding of LINET, which we celebrate this year, has been continuous development, and one of our strongest achievements is the establishment of partnerships and a presence in the health care systems of the MEA region. We are honored that mutual interaction and inspiration allow LINET to look for new ways to

The COVID-19 Fight with LINET

SEPT.OCT 2020

move forward far and wide. LINET is expanding and changing, but our basic goal remains the same â&#x20AC;&#x201C; deliver innovative solutions that respond to the real needs of healthcare, such as the current growing need for the effective care of patients with ARDS and pulmonary complications. Therefore, we want to enhance the effects of therapy with an emphasis on our unique benefits - frame-based lateral tilt and automatic lateral therapy. Together with this, it is a priority for us to provide front-line healthcare professionals with a safe and ergonomic platform for their dedicated work. Thank you all for helping us create an exceptional LINET story. Our mutual story.

NEWS

ACWA Power, Field hospital /MOH, Madinah, Saudi Arabia Sentida beds that are specially adapted for on COVID-19 requirements have been delivered and installed in the KSA for the first time. Al Eman General Hospital MOH, Riyadh, Saudi Arabia Eleganza 2 and Multicare beds, together with other equipment, were installed.

he fight against the pandemic is not over and the need for medical equipment and supplies has been extreme for several months. In these difficult conditions, which include restrictions, quarantines, and supply chain outages, LINET has managed to maintain production and even increase its capacity. This allows LINET to continue to support healthcare professionals with their daily responsibilities. The first quarter of 2020 marked one of the strongest periods in the history of LINET, for example, LINET practically doubled its performance compared to last year. Even during the extreme conditions of a world pandemic, the expected revenue will be around €90 million. "LINET is currently a trusted supplier. We are one of the few companies that succeeded in maintaining production and sales without any downtime," said Petr Foit, Global Sales Director Export LINET Group. "Accelerating and increasing production capacity has become an

important factor for the strengthening of our position," he added. Since the beginning of June, the production line has been producing Multicare beds and other beds with integrated scales in three-shift operation 24 hours a day. This is the first time in LINET's history that production has been "running" non-stop due to customer needs and the enormously increased demand in connection with the COVID-19 pandemic. This has resulted in a record number of beds being manufactured, including the 7,545 beds that left the lines in June alone.

New MICU at Madinat Zayed Hospital, Al Dhafra Hospitals – SEHA LINET assisted with the new ICU expansion by delivering highend lateral tiltable Multicare beds.

The enormous increase in production and sales is mainly due to the needs of the most affected parts of the world as well as continuing to meet the needs of customers from the Middle East and Africa. We are proud to have been able to contribute to increasing the medical capacity of the MEA region.

NEWS

Philips Foundation deploys field hospital to support Lebanon in a time of need

hilips Foundation, with its mission to provide access to quality healthcare for disadvantaged communities, has deployed a modular field hospital consisting of 20 beds that will provide much-needed additional capacity for victims of the recent explosion in Beirut. Philips Foundation, together with Philips Lebanon, is working with the Lebanese Army to set up the unit next to the military hospital in Beirut. The field hospital aims to expand medical care and ease pressure on the healthcare infrastructure in and around the capital. This support is much needed as Lebanon reels from the recent catastrophe, which came on top of existing humanitarian crises, including the COVID-19 pandemic and the ongoing refugee situation. The 20-bed inflatable modular tent can be equipped to deal with various types of disaster relief, including the provision of first aid and the support of patient hospitalization.

“We are deeply saddened by the hundreds of thousands of people affected by the explosion in Lebanon. Such times make our commitment to continuously improving people’s lives even more important,” Vincenzo Ventricelli, CEO, Philips Middle East and Turkey, commented. “We are honored to be working with the Philips Foundation and the Lebanese Army to deploy an impactful solution that can help make quality healthcare accessible to as many people as possible during this difficult period. The field hospital can be customized to serve multiple purposes, and we are happy that it will

SEPT.OCT 2020

also be beneficial over the longer term, helping COVID-19 patients as well as refugees.”

IN LINE WITH ITS MISSION TO MAKE QUALITY HEALTHCARE ACCESSIBLE TO ALL, PHILIPS FOUNDATION WILL ALSO MAKE THE HOSPITAL AVAILABLE FOR THE TREATMENT OF COVID-19 PATIENTS. DEPENDING ON THE URGENCY, THE TENT CAN ALSO BE USED FOR REFUGEES IN NEED OF CRITICAL CARE.

The Philips Foundation worked closely with the EU Civil Protection and Humanitarian Aid (ECHO) in transport and coordination of the field hospital, enabling much-needed access to critical care to those who are impacted by the catastrophes Lebanon is facing. “This action reflects Philips Foundation’s commitment to providing healthcare access, even in times of crisis,” said Margot Cooijmans, Director of the Philips Foundation. “Working with the Lebanese Army and the European Commission, which has overseen the unprecedented emergency in Lebanon from the outset, underlines the importance and relevance of cooperation with partners in enabling this essential emergency response.” The mobile care unit is part of a broader international project by the coalition of Philips Foundation, AFAS Foundation and Noaber Foundation. The project already procured and deployed five temporary 20-bed hospitals, with an initial focus on areas heavily impacted by the COVID-19 pandemic. In addition to this, Philips Middle East and the Philips Foundation earlier announced their donation of ultrasound devices and defibrillators to the Lebanese Red Cross equipping ambulance service. These medical devices are primarily for the management of emergency care across the country to address the COVID-19 pandemic.

NEWS

Artificial Intelligence Topics of the 11th Term for Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences

Since its establishment in 1999, the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences has been a significant and creative initiative in establishing the principles of excellence and supporting communication between academic and health institutions in the public and private sectors. His Highness Sheikh Hamdan bin Rashid Al Maktoum, Deputy Ruler of Dubai and Minister of Finance, the patron of the Award, has always envisioned upgrading medical services systems at the local, regional and international levels, adopting the excellent world-class standards. This vision is reflected in the Awardâ&#x20AC;&#x2122;s role in shedding light on innovative and breakthrough concepts, in line with the UAE strategic plans for continuously developing the health sector and fostering the latest technologies, such as Artificial intelligence in diagnosis and treatment. Hence, Artificial intelligence in Healthcare was chosen as the topic of the eleventh term, in collaboration with the UAE National Program for Artificial Intelligence. Grand Hamdan International Award (AI in Healthcare) Artificial intelligence is making a quantum leap in the decision-making process in the health sector, and it is

expected that applications of artificial intelligence will reduce the financial burden of treating diseases. Hamdan Award for Medical Research Excellence: (Artificial Intelligence in Genomics) The efficiency of AI applications relies on the increase in databases volume. However, such data is difficult to access due to privacy concerns. Scientists and regulatory bodies are working on addressing these challenges. AI in Diagnostics Nowadays, the predictions of machine learning models can be used to support the diagnostic decision-making process of clinicians. AI in Therapeutics AI supports the development of new drugs, assists in identifying the patients for clinical trials and increase clinical success by matching drugs to the right patient. The aim of adopting artificial intelligence technology in healthcare is to enable doctors to make more accurate and prompt decisions to serve their patients. The health authorities had recognized this reality early enough. They worked hard to introduce modern technologies to improve healthcare services.

The United Arab Emirates, approach in stimulating innovation has succeeded in creating a fertile environment for excellence and prosperity for its citizens in all fields. This approach culminated in making the country a hub for innovative ideas and bright minds launching UAE world ranking in a record time exceeding all expectations. Indeed, this is not peculiar to our government as throughout this challenging era that is replete of accomplishments, the medical sector has been a top priority in UAE

The Dubai International Conference for Medical Sciences

The conference will be organized in late 2020, and will discuss Artificial intelligence in Healthcare with a focus on Genomics, Therapeutics and Diagnostics. The chosen topic is aligned with the UAE strategy and will focus on the best practices in AI. Hopefully, the conferenceâ&#x20AC;&#x2122;s modules will participate in the efforts to regulate or a minimum to put the appropriate road map for the field in UAE.

HE Abdul Rahman Al Owais

Minister of Health & Prevention Chairman of the Board of Trustees

Grand Hamdan International Award

Artificial Intelligence in Healthcare

AWARD TOPICS

Artificial Intelligence in Genomics

2019 - 2020

Artificial Intelligence in Diagnostics

Hamdan Award for Medical Research Excellence

Artificial Intelligence in Therapeutics

NEWS

DHA becomes first healthcare authority in the UAE to integrate UpToDate within an electronic medical record by doctors equipped with UpToDate was 2% compared with an error rate of 24% for doctors who did not use the resource. Researchers at Singapore’s National University also found that use of UpToDate changed important patient care decisions 37% of the time. In a survey of clinicians using UpToDate in their EMR, 93% said that accessing the resource via an EMR is important to patient care and 91% confirmed that having UpToDate available in the EMR enhanced their satisfaction with the EMR system¹.

olters Kluwer, Health announced that Dubai Health Authority (DHA) has become the first healthcare authority in the UAE to integrate its flagship clinical decision support resource UpToDate® with an electronic medical record (EMR). The initiative allows doctors, nurses and pharmacists across 18 DHA sites to access UpToDate from within the Salama EMR to make evidence-based clinical decisions for their patients and keep their medical knowledge up to date in a more seamless way. The UpToDate CME platform is accredited by DHA and enables clinicians to gain CME credits while applying their learning from UpToDate searches during clinical practice. UpToDate is used by over 1.9 million clinicians around the world and is the only clinical decision support resource associated with improved patient outcomes and hospital performance. Over 100 independent studies evidence the benefit to patients, clinical teams and healthcare systems in terms of improving length of stay, efficiency and patient outcomes, and reducing error rates and healthcare costs. An academic study in Japan on the effectiveness of CDS for reducing diagnostic errors showed that the error rate for patients seen

SEPT.OCT 2020

OVER 100 INDEPENDENT STUDIES EVIDENCE THE BENEFIT TO PATIENTS, CLINICAL TEAMS AND HEALTHCARE SYSTEMS IN TERMS OF IMPROVING LENGTH OF STAY, EFFICIENCY AND PATIENT OUTCOMES, AND REDUCING ERROR RATES AND HEALTHCARE COSTS.

Denise Basow, MD, President & CEO for Clinical Effectiveness at Wolters Kluwer, Health, said, “We are delighted to support Dubai Health Authority in their vision to provide world-class healthcare across Dubai. Providing evidence-based clinical decision support in the clinical workflow is critical for driving consistent, standardized and high-quality care throughout a patient’s care journey.” Dr Younis Kazim, Dubai Healthcare Corporation CEO, Dubai Health Authority, said, “Patient Safety is DHA’s number one priority and our goal is to be at the forefront of healthcare innovation that delivers significant benefits to patients. Making UpToDate accessible through the Salama EMR will support busy clinicians at the point of care to drive consistently high-quality care, minimize errors and improve hospital efficiency. We are pleased to partner with Wolters Kluwer on this mission.” Dr. Wadeia Sharief, Medical Education and Research Department Director, Dubai Health Authority, said, “As a resource for medical education and daily practices, UpToDate at the point of care for all DHA Healthcare Professionals can be accessed through the library platform and smart devices. Integrating UpToDate into Salama showed light after great efforts from the library and Salama team to obtain and gain return on investment in patient care.” ¹July 2015 Clinician Survey, N=2,526

YOUR HEALTH

IS A LOT OF THINGS. THE ONE THING IT ISN’T,

IS ON HOLD.

No virus can weaken our mission.

At Baylor St. Luke’s , we’re resuming the scheduling of appointments and procedures. And we’re doing it safely. Our thorough approach determines which procedures can safely be performed, where, and when. These are the steps we’re taking to make it happen:

• • • • • •

Cleaning all our facilities to an enhanced extent Limiting the number of visitors Requiring masks for all patients and staff Screening everyone entering our care sites Enforcing social distancing inside Requiring COVID-19 testing prior to procedures

Staying on top of your health has never been more important, whether it’s an ongoing health concern, a routine checkup, or a procedure. Don’t let social distancing stop you and don’t wait until it becomes an emergency. Talk with your doctor about scheduling an appointment. For more information, visit us online at stlukesinternational.org

stlukesinternational.org international@stlukeshealth.org Tel: +1 832-355-3350 Texas Medical Center, Houston, Texas – U.S.A.

NEWS

Clinical Trial Demonstrates Positive Top-Line Results in Reducing the Risk for Cardiovascular Death or Hospitalisation due to Heart Failure

oehringer Ingelheim - one of the world’s leading pharmaceutical companies has announced positive top-line results from the EMPEROR-Reduced Phase III trial in adults with chronic heart failure with reduced ejection fraction. The trial met its primary endpoint, demonstrating superiority empagliflozin (10mg) versus placebo on top of standard of care, in reducing the risk for cardiovascular death or hospitalisation due to heart failure.

Many Middle Eastern countries have observed increases in the prevalence of risk factors for heart failure, which is seen to develop in their populations at least 10 years earlier than in Western counterpart populations1. The risk factors include diabetes mellitus, obesity, and hypertension2. Heart failure with reduced ejection fraction occurs when the heart muscle does not contract effectively and pumps out less blood to the body compared to a normally functioning heart3. Symptoms associated with heart failure include breathlessness and fatigue, which can severely impact upon quality of life4. There remains a high unmet need in the treatment of heart failure, as approximately 50 percent of all those diagnosed with the condition die within five years5. The EMPEROR-Reduced clinical trials form part of the EMPOWER clinical programme, one of the broadest, most comprehensive trials of any SGLT2 inhibitor, exploring the impact of treatments across cardio-renal-metabolic conditions. Building on findings from EMPA-REG OUTCOME®, these positive results demonstrate that empagliflozin has the potential to fill unmet

SEPT.OCT 2020

therapeutic needs for people with this highly prevalent condition. Full results from the EMPEROR-Reduced trial will be presented in a hot line session at the European Society of Cardiology (ESC) congress 2020, which is being held 29 August. A second trial, EMPEROR-Preserved, the results of which are expected in 2021, will explore the effect of empagliflozin on cardiovascular death and hospitalisation for heart failure in adults with heart failure with preserved ejection fraction6 - an area of high unmet need as there are currently no treatment options available for people with this form of heart failure7. References: 1. Al-Shamiri, Mostafa Q. “Heart failure in the Middle East.” Current cardiology reviews vol. 9,2 (2013): 174-8. doi:10.2174/1573403x11309020009 2. Al-Shamiri, Mostafa Q. “Heart failure in the Middle East.” Current cardiology reviews vol. 9,2 (2013): 174-8. doi:10.2174/1573403x11309020009 3. American Heart Association. Ejection Fraction Heart Failure Measurement. Available at: https://www.heart. org/en/health-topics/heart-failure/diagnosing-heart-failure/ejection-fraction-heart-failure-measurement. Accessed July 2020. 4. American Heart Association. Warning Signs of Heart Failure. Available at: https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure. Accessed July 2020. 5. Ponikowski P, Anker SD, AlHabib KF. Heart Failure: preventing disease and death worldwide. ESC Heart Fail. 2014;1(1):4–25. 6. ClinicalTrials.gov. EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved). Available at: https://clinicaltrials.gov/ct2/show/NCT03057951. Accessed July 2020. 7. Harper A, Patel H, Lyon A. Heart failure with preserved ejection fraction. Clin Med (Lond). 2018;18(Suppl 2): s24– s29.

MANY MIDDLE EASTERN COUNTRIES HAVE OBSERVED INCREASES IN THE PREVALENCE OF RISK FACTORS FOR HEART FAILURE, WHICH IS SEEN TO DEVELOP IN THEIR POPULATIONS AT LEAST 10 YEARS EARLIER THAN IN WESTERN COUNTERPART POPULATIONS. THE RISK FACTORS INCLUDE DIABETES MELLITUS, OBESITY, AND HYPERTENSION. HEART FAILURE WITH REDUCED EJECTION FRACTION OCCURS WHEN THE HEART MUSCLE DOES NOT CONTRACT EFFECTIVELY AND PUMPS OUT LESS BLOOD TO THE BODY COMPARED TO A NORMALLY FUNCTIONING HEART.

NEWS

Innovative Treatments can Help Control Psoriasis, Says Cleveland Clinic Expert If left untreated, psoriasis can cause major issues including cardiovascular disease and arthritis, warns leading hospital during World Psoriasis Awareness Month

ore than 125 million psoriasis patients worldwide can now keep their autoimmune skin disease under control, thanks to rapid advancements in medical treatments, argues an expert from Cleveland Clinic on the occasion of World Psoriasis Awareness Month.

should be on the lookout for rashes and joint pain that could be symptoms of psoriasis or psoriatic arthritis. One-third of psoriasis patients will eventually develop psoriatic arthritis -- which could permanent destroy joints if not treated properly.”

Dr Anthony Fernandez, M.D., Ph.D., Director of Medical and Inpatient Dermatology at Cleveland Clinic said: “Psoriasis is one of the more common but misunderstood autoimmune diseases. While the skin disorder is not contagious, moderate to severe cases are associated with systemic inflammation that can trigger major damage to internal organs, joints, and decrease lifespan if left untreated. However with recent advancements, almost all patients can now keep their psoriasis under control – from topical ointments on fingers to biologic therapies for full-body psoriasis.”

Many patients may have only mild disease, which can often be treated by seeing a dermatologist who can recommend topical medications such as steroids, moisturizers, or coal tar. However, at Cleveland Clinic, a large percentage of their psoriasis patients have moderate to severe psoriasis – defined as more than “three palms” of the scaly rash. Moderate to severe psoriasis can be treated with phototherapy using ultraviolet light B (UVB), Vitamin A-related drugs called retinoids, methotrexate that can also treat arthritis, and the immunosuppressant cyclosporine. Cleveland Clinic physicians are seeing most moderate to severe cases come under adequate control within three months – and significantly improving quality of life for patients. Breakthrough advancements in medical research have driven the development of new treatments such as TNF inhibitors, other injectable biologic therapies, and small molecule immune modulating pills.

Psoriasis is a commonplace skin disorder of thick and itchy patches and plaques of skin with silvery scales, afflicting more than 8 million Americans, according to the National Psoriasis Foundation, and 125 million people worldwide, according to the International Federation of Psoriasis Associations. There is no one way to prevent psoriasis – the causes are likely genetic with an external trigger such as cuts, stress, strep infections, or medications for blood pressure or anti-malarials. Still, experts advise patients to maintain a healthy lifestyle and to avoid risk factors such as smoking or obesity. “Psoriasis is a disease of chronic inflammation, which can also have effects throughout the entire vascular system potentially leading to cardiovascular disease, inflammatory bowel disease, and inflammatory arthritis,” added Dr. Fernandez. “While people in their 20s are the most common age group for psoriasis, seniors

SEPT.OCT 2020

Dr Anthony Fernandez, M.D., Ph.D., Director of Medical and Inpatient Dermatology at Cleveland Clinic

THERE IS NO ONE WAY TO PREVENT PSORIASIS – THE CAUSES ARE LIKELY GENETIC WITH AN EXTERNAL TRIGGER SUCH AS CUTS, STRESS, STREP INFECTIONS, OR MEDICATIONS FOR BLOOD PRESSURE OR ANTIMALARIALS.

“Biologic medications have revolutionized our ability to adequately control moderate to severe psoriasis. Currently, medical researchers are trying to identify blood markers that could predict the likelihood that patients with psoriasis will develop psoriatic arthritis and identifying the immunologic cells of origin in psoriasis whose destruction could one day lead to a cure for psoriasis,” concluded Dr. Anthony Fernandez. “While we’re in the very early stages of this research, I’m hopeful that further advancements will lead to even better treatments, and possibly a cure in the coming decades.”

- Cardiology & Cardiac Surgery - Dental center - Chiropractic - Pediatrics - Obstetrics & Gynecology - Neurology - Internal medicine - Physiotherapy and Rehabilitation - Endocrinology - Ophthalmology - Anesthesiology - General Surgery - Dermatology - Travel Clinic - Emergency - Rheumatology - Coronary Care Unit (CCU) - Intensive Care Unit (ICU) - Neonatal Care Unit (NICU) - Gastroenterology - Speech Therapy - Pulmonary & chest - Dietary - Nephrology - Psychiatry - Hearing & Balance - Urology - ENT surgery - Orthopedic and Traumatology - Hemodialysis Unit

For more information please call :

+974 44898888 or +974 44898000

NEWS

Convalescent Plasma Associated with Reduced COVID-19 Mortality in 35,000-Plus Hospitalized Patients

ayo Clinic and collaborators have published a preprint that identifies two main signals of efficacy that can inform future clinical trials on plasma therapy on COVID-19 patients. The data are extracted from the Mayo-led national Expanded Access Program (EAP) for convalescent plasma for the treatment of hospitalized patients with COVID-19.

The researchers report in “Effect of Convalescent Plasma on Hospitalized Patients with COVID-19: Initial Three-Month Experience” that the timing of plasma transfusions in a cohort of 35,322 patients were associated with lower mortality. The cohort included a high proportion of critically ill patients, with 52.3% in the intensive care unit (ICU) and 27.5% receiving mechanical ventilation at the time of plasma transfusion. They also report that in a subset of the cohort (3,082 patients), they found lower mortality associated with plasma transfusions that contained higher levels of antibodies against the virus that causes COVID-19. Specifically: • The seven-day mortality rate was reduced in patients transfused within three days of COVID-19 diagnosis compared with patients transfused four or more days after COVID-19 diagnosis. Similar trends were seen for 30-day mortality rate. • The use of convalescent plasma with higher antibody levels was associated with reduced seven-day and 30-day mortality. The overall cohort included a diverse representation of participants by age, gender, weight, race and ethnicity. Study participants included approximately 40% females; 38% Hispanic/Latinos; 19% African American; and 4% Asian. This study includes adult participants enrolled in the U.S. Convalescent Plasma EAP program between April 4 and July 4 who were hospitalized with (or at risk of) severe or life-threatening acute COVID-19 respiratory syndrome. It is important to note that the EAP is not and was not intended to be a clinical trial to determine the efficacy of convalescent plasma. It was

SEPT.OCT 2020

established by the FDA as a program to increase access to plasma to help severely ill patients at the height of the pandemic and to determine the safety of plasma transfusions. The current observations might indicate factors that may impact effect of treatment and help direct the randomized clinical trials that are needed to establish efficacy. The intent was to offer a procedure that had a history of use at a time when there was no known treatment for this deadly condition.

The researchers point out additional limits to the study: No data existed as to what dose might be appropriate. Inclusionary criteria were broad; exclusionary minimal. There was no standardized treatment protocol. Enrollment sites were very diverse, from university hospitals to community hospitals. Personnel training was minimal as was the fine detail of data reported. This project has been funded in part with federal funds from the Biomedical Advanced Research and Development Authority, part of the Office of the Assistant Secretary for Preparedness and Response of the U.S. Department of Health and Human Services, under Contract No. 75A50120C00096. Additionally, this study was supported in part by National Center for Advancing Translational Sciences (NCATS) grant UL1TR002377; National Heart, Lung, and Blood Institute (NHLBI) grant 5R35HL139854; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 5T32DK07352; Natural Sciences and Engineering Research Council of Canada (NSERC) PDF532926-2019; National Institute of Allergy and Infectious Disease (NIAID) grants R21 AI145356, R21 AI152318 and R21 AI154927; R01 AI152078 9; National Heart Lung and Blood Institute RO1 HL059842; National Institute of Aging (NIA) U54AG044170; Schwab Charitable Fund (Eric E. Schmidt, Wendy Schmidt donors); United Health Group, National Basketball Association (NBA); Millennium Pharmaceuticals, Octapharma USA Inc.; and the Mayo Clinic.

THE RESEARCHERS REPORT IN “EFFECT OF CONVALESCENT PLASMA ON HOSPITALIZED PATIENTS WITH COVID-19: INITIAL THREE-MONTH EXPERIENCE” THAT THE TIMING OF PLASMA TRANSFUSIONS IN A COHORT OF 35,322 PATIENTS WERE ASSOCIATED WITH LOWER MORTALITY.

The study’s launch was followed by a national convalescent plasma donation campaign, The Fight Is In Us, supported by the CoVIg-19 Plasma Alliance, American Association of Blood Banks, American Red Cross, Grifols, Bill and Melinda Gates Foundation, Mayo Clinic, Michigan State University, Uber, and many more and promoted by celebrities, including Dwayne “The Rock” Johnson, Helen Mirren, Samuel L. Jackson, Awkwafina, Ken Jeong, Daniel Dae Kim, and Ryan Tedder.

For the tireless, the selfless, the brave

You mean the world Whether you are working on the frontlines or are the last line of defense in the fight against COVID-19, you are making a world of difference for so many. Thank you.

ONLINE

www.fleming.events

LIVE TRAINING COURSE

Key topics:  Predictive machine learning (Supervised)  Exploratory machine learning (Unsupervised)  Image recognition  Internet of things and big data ecosystem  Main AI solutions for pharma/ healthcare industry

Meet the training leader: Walid Semaan Matrix TRC "Data Science and AI Academy Founder and President

Data Science & AI in Pharma & Healthcare 24 - 26 November 2020 14:00 – 18:00 CET

NEWS

Weill Cornell Medicine-Qatar research reveals underlying mechanisms of aggressive breast cancers

esearchers at Weill Cornell Medicine-Qatar (WCM-Q) have unveiled the key role played by a specific protein in the growth of the most aggressive, treatment-resistant forms of breast cancer. A multi-institutional international study led by WCM-Q’s Dr. Lotfi Chouchane, Professor of Genetic Medicine, Microbiology and Immunology, found that the effects of a protein named STXBP6 are profoundly suppressed in triple-negative breast cancers (TNBCs), which are known to relapse early and tend to spread to other organs despite intensive treatments with surgery, chemotherapy and radiotherapy. TNBCs account for around 15-20 percent of all breast cancers and are associated with the poorest patient outcomes. While many other forms of breast cancer can now be treated relatively successfully, there is currently no effective therapy that specifically targets TNBCs. The study showed that the STXBP6 protein helps regulate and promote a natural cellular process called autophagy in which old and damaged cells are metabolized or ‘killed off’ in order to allow newer, healthier ones to grow. In cancer cells, autophagy suppresses tumor growth by inhibiting cancer cell survival and inducing cell death. When autophagy is suppressed in certain circumstances, cancer cells are more able to grow and proliferate. Dr. Lotfi Chouchane said: “There is a real need to develop new therapies that specifically target triple-negative breast cancers because they do not respond well to existing treatments. In this study, we were able to significantly enhance our understanding of the mechanisms that make TNBCs so aggressive and treatment-resistant, which we hope will provide targets for the development of effective new therapies for TNBCs to significantly improve patient outcomes.” Triple-negative breast cancers are so called because the cancer cells do not have estrogen or progesterone receptors (which are targets for hormone-based therapies) and because they do

SEPT.OCT 2020

not make a protein called HER2 (which is a target for antibody-based therapies) like some other forms of breast cancer.

Research led by Dr. Lotfi Chouchane of Weill Cornell MedicineQatar (WCM-Q) has revealed the role of a specific protein in the growth of the most aggressive, treatmentresistant forms of breast cancer.

The study, titled ‘STXBP6, reciprocally regulated with autophagy, reduces triple negative breast cancer aggressiveness’, also involved researchers at Weill Cornell Medicine in New York, Sidra Medicine and Hamad Medical Corporation in Doha, and the University of Groningen in the Netherlands. The research has been published in Clinical and Translational Medicine, a prestigious medical journal.

Dr. Chouchane explained that laboratory analysis showed the STXBP6 protein interacting with another protein, named SNX27, which is known to play a key role in autophagy. Furthermore, the researchers found that increased function of the STXBP6 protein significantly reduced TNBC cells’ migratory ability in cell-based in vitro experiments and also reduced tumor metastasis in mouse model-based in vivo testing. However, while autophagy appears to be heavily involved in maintaining cellular health and preventing tumor initiation, the process has a paradoxical dual role and in other circumstances can actually facilitate tumor survival, depending on a variety of factors such as cancer type and stage. Dr. Chouchane added: “This multi-institutional study represents a new paradigm in our understanding of the role of autophagy in breast cancers, but it is an extremely complex and multifaceted process. We believe much more research is needed to understand in detail the role of autophagy throughout the many different development stages of cancer in order to create a new class of therapeutic strategies that are truly effective and safe.” The study was supported by funding from the Biomedical Research Program of WCM-Q and by a grant from the Qatar National Research Fund (NPRP9-459-3-090). Dr. Khaled Machaca, WCM-Q Professor of Physiology and Biophysics/Senior Associate Dean for Research, Innovations, and Commercialization, said: “This cutting-edge research paves the way for further investigations into the cellular processes that allow triple-negative breast cancers to resist current therapeutic strategies. Furthermore, the study provides extremely useful targets to aid the design of new, more effective cancer drugs in the future. These are very positive developments toward applying our research findings to improve healthcare delivery in Qatar in the long term.”

‫َر ْبط الصحة‬ ‫والتعليم‬ ‫والبحوث‬ Linking health, education and research

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

www.hamad.qa

COVER STORY

"After years of conflict, on-off diet, you still have not lost the weight that has been disturbing you, and you suffer with obesity-related illness like high blood pressure, high cholesterol, diabetes, heart disease, obstructive sleep apnea, osteoathritis, fatty liver, etc.

t Clemenceau Medical Center (CMC) Dubai - Weight loss Unit, we believe in a multidisciplinary approach by qualified nutritionists to follow up and assess body composition, by specialized nurses and by endocrinologists who will perform the metabolic assessment prior to surgery and the post-operation follow-up. Cardiologist, pulmonologist, with the specialized Bariatric surgeons, all must work together to ensure that you receive the best care possible whether medical or surgical. Bariatric surgery is a weight-Loss solution that can enable you to improve your quality of life. In our new CMC Dubai Weight loss Center, we assess your body and investigate your surgical options to determine which procedure is best for you (Sleeve gastrectomy, Gastric Bypass...). We will assess the risks of having surgery and explain that these procedures are just one step in the whole weight loss process... CMC Dubai Weight loss Center is established to discuss each level of care in the obesity treatment. Our expert team will provide special education for our patients, this will help the post-operation recovery process and the post-operation nutrition support. CMC Dubai Weight loss Center is committed to making your experience with all disciplines as safe and effective as possible.

CMC DUBAI WEIGHT LOSS CENTER IS COMMITTED TO MAKING YOUR EXPERIENCE WITH ALL DISCIPLINES AS SAFE AND EFFECTIVE AS POSSIBLE.

ADDRESS:

Dubai Healthcare City phase 2 - Al Jaddaf PHONE:

800 262 392 www.cmcdubai.ae

SEPT.OCT 2020

COVER STORY

ARTICLE FEATURES . Hospitals Beds

Increasing the number of hospital beds to accommodate patients

Hospitals beds during the COVID-19 pandemic

here is a great need to provide more hospital beds in order to meet the growing need and raise hospital capacity given the significant increase of COVID-19 patients around the world and their need to stay in hospitals or ICUs, and with the efforts of governments to equip a greater number of hospitals designated to receive this category of patients. The production companies of medical beds have shown a great response in dealing with the

SEPT.OCT 2020

THIS URGED THE MANUFACTURERS OF HOSPITAL BEDS TO MEET THIS GROWING DEMAND AND INTRODUCE NEW SPECIFICATIONS TO THE BEDS.

global health crisis, so they have worked hard since the beginning of the COVID-19 pandemic to increase production capacity in line with the occupational health and safety as there are state-of-the-art models of hospital beds that provide the necessary and effective comfort and protection in response to emergencies and increase the ability of hospitals to treat patients suffering from the virus. Therefore, companies produced thousands of beds, which contributed to boosting the market's growth.

ARTICLE FEATURES . Hospitals Beds

The companies producing hospital beds have been very responsive to introducing modern solutions to meet these challenges and help enhance the health of patients and the medical team. They also activated the mechanism for cleaning and sterilizing the bed through “automated reprocessing”, to ensure a smooth transition from one patient to another and make the bed clean and available again after disinfection and sterilization. Equipping hospitals with the appropriate medical supplies to fight against the COVID-19 has opened new horizons in the hospital bed market in order to meet the unique requirements in understanding hospital beds industry in multiple ways, according to research conducted on the hospital bed market, especially in light of the trend towards increasing hospital capacity by increasing the number of hospital beds and equipping them with specifications that comply with dealing with COVID-19 patients. This urged the manufacturers of hospital beds to meet this growing demand and introduce new specifications to the beds in a way that ensures the safety of the patient and healthcare providers alike. These companies did not hesitate to produce beds capable of fighting germs and viruses by providing hygiene features with international standards to reduce the spread of infection in the hospital wards.

Beds and infection control Infection control is an important part of the culture in all hospitals, and environmental cleaning and disinfection is a key component of a comprehensive plan. Rigorous cleaning methods are required to ensure that rooms and equipment are safe for patients. The hygiene that can be relied upon in a hospital bed plays a fundamental role in reducing the spread of infection; this was introduced in the bed designs in terms of comprehensive cleaning, sterilization and disinfection, either manually or by optional automatic washing. The production companies provide beds with high-quality specifications and features in terms of infection control and sterilization, to ensure that dirt does not accumulate or remain on surfaces. With the “push of a button” that the patient finds on the control panel near

him on the bed, he can operate it to perform automatic washing to clean and sterilize the bed with the possibility of providing special protection from moisture. This mechanism provides a powerful weapon against insects, bacteria and viruses that can settle on the bed, in the mattress, or even on the sides of the bed. The automatic sterilization system also extends to the mattress. In this context, it is necessary to emphasize the importance of the hospital bed’s role in providing the necessary protection from viruses, especially in light of reducing the length of hospital stay, and thus the increasing number of patients who use the same bed. Perhaps the spread of the novel coronavirus and the great challenges it imposed in terms of sterilization and infection control highlighted the importance of bed cleaning and automatic washing in order to ensure that they can be used again faster and are highly safe.

Smart Beds THE SMART BEDS ARE DESIGNED TO FACILITATE PATIENT MOVEMENT AND MAKE HIM REGAIN NORMAL MOVEMENT FASTER. THE PATIENT MOVEMENT DURING HIS STAY IN THE INTENSIVE CARE ROOMS CONTRIBUTES TO THE SPEED OF HIS RECOVERY AND HIS EARLY DISCHARGE FROM THE HOSPITAL.

The advanced technology has greatly affected hospital beds, which contributed to raising their efficiency and improving the level of services in them, thus reducing medical errors. Healthcare providers also benefit from smart beds as they are relieved from the trouble of changing the patient’s position every now and then, which helps them reduce the risk of injuries they are exposed to because the bed technology keeps the patient in optimal positions while moving the bed. There are also sensitive sensor chips that monitor the patient's vital functions while he is in bed such as heart rate, temperature, breathing, etc. The medical staff in the supervising physician’s room receives the patient’s information via a private computer with full clarification of the data and alerts in the event of a sudden deterioration of the condition, such as the incidence of a stroke or heart attack, and other emergencies that require immediate medical intervention. Smart beds also can determine if the bed is vacant, or if the patient is trying to get up. It may also adjust itself to ensure proper tension and support for the patient.

ARTICLE FEATURES . Robots in hospitals

SEPT.OCT 2020

ARTICLE FEATURES . Robots in hospitals

Robots in hospitals

Better care and greater productivity

he world of medicine has been witnessing rapid changes and hospitals are seeking to keep pace with technological development to enter the world of medical technologies given their importance for years, and even decades to come. This is by adopting modern solutions and means in providing service to patients in light of healthcare tech companies’ developments and achievements. This is while taking into account the challenges posed by the COVID-19 outbreak and the need to maintain social distancing, health isolation and other precautionary measures that will apparently accompany us in the coming period at a time when the number of patients who need medical care is rising. In light of the novel coronavirus outbreak, which has claimed thousands of lives all over the world, as well as the infection of many doctors and healthcare workers in several countries, robots have played an important role in helping medical staff in hospitals. But in this context, robots cannot replace doctors, but they provide them with the necessary protection when dealing with patients with highly infectious diseases. On the one hand, it is now possible to integrate a set of advanced technologies that help the medical staff in providing healthcare that exceeded patients' expectations. On the other hand, we have witnessed an increasing number of patients who need healthcare more efficiently and in a comfortable and healthy environment at a time when the spread of coronavirus is increasing along the social distancing and isolation it imposes, which contributed to changing the nature of the services provided to patients so that the smart autonomous robot can do it. The novel coronavirus drove the expanded use of the autonomous robot in several countries in order to reduce direct contact between the nursing staff and the patient in the isolation room. The robot can perform medical logistic services such as providing medicines to patients and delivering food, which reduces contact between pharmacy staff, doctors and patients. In some countries, hospitals are now equipped with robots that feature screens to conduct video consultations without the need to enter the patient's room, which allows more frequent contact with patients without the need

to wear the full protective gear. The autonomous robot is able to be near the patient safely, and this robot can also work throughout the day in hospital corridors and inside patient rooms to reduce human contact in the first place. In addition, this robot is able to work for long hours, which reduces the burden on the medical staff and the stress they are exposed to during working hours, so they are able to perform tasks that take longer than the most urgent responsibilities, and thus reduce the error rate in the medical work. Technology in medicine and automated applications in hospitals are witnessing a great diversity. Today, there are surgical robots, robots that provide care by the patient bed, robots that disinfect rooms and others to take laboratory samples, transfer and analyze them, as well as prepare drug doses.

Robot Nurse The nursing staff are the first to meet the coronavirus patients and communicate with them, which puts them at greater risk of catching the infection, in addition to the role assigned to them and the exhausting fatigue due to the long working hours. Hence the idea of robot nurses that are designed to assist nurses, not replace them. The robots are “alternatives to human contact to diminish risks for providers,” who are caring for patients with infectious diseases. The robot nurse enters the patient’s room, fills the required papers digitally, monitors the patient’s general condition, and takes vital signs from blood pressure, temperature and

ARTICLE FEATURES . Robots in hospitals

heart rate, thus minimizing the risk of infection of healthcare workers. Among the tasks assigned to him is to provide food and medicine to patients in hospitals, especially in the coronavirus departments. It is sterilized again before helping other patients, to reduce the risk of cross-infection. The frequent rounds of the robot nurse in patient rooms make it necessary to sterilize it frequently between visits, which is done automatically, minimizing the risk of virus spreading and providing preventive protection tools in hospitals. These robots can roam the hospital without assistance, because they are equipped with software that recognizes the corridors and a map of the building. The robot nurse is widely used in countries where the coronavirus has spread, such as China and Italy, and despite the importance of this achievement and its role in reducing human contact and protecting the medical and nursing staff, humans and personal contact with the patient cannot be replaced. Some patients haven’t accepted the contact with the machine, but in such circumstances, there is an urgent need for this type of device. China was one of the countries that benefited from the robot nurse in light of the pandemic outbreak, due to its ability to examine 10 people at a time, and detect cases of infection within 40 minutes. These robots have benefits that

SEPT.OCT 2020

outweigh shortening the time or speed of work, and one of its most important benefits is reducing human contact, which leads to a decrease in the coronavirus infection rate. Robots roam patients' rooms to provide them with food without any direct contact with the nurses or fear of disease transmission to them. These robots monitor parameters from equipment in the room, relaying them to hospital staff. They have touch-screen faces that allow patients to record messages and send them to doctors. Most importantly, they allow the hospital to limit the amount of direct contact doctors and nurses have with patients, thus reducing the risk of infection. As for the robot that delivers meals, as soon as it reaches the door of the patient room, it automatically calls the patient’s name and tells him that his meal is ready. The patient goes out to meet the robot, where he picks up his meal and presses the “FINISH” button. Immediately after that, the robot moves to the next room to do the same job. All patients receive an oral message asking them not to have any contact for fear of transmission, and then it wishes them a speedy recovery. In short, the robot nurse covers a logistics aspect of the medical work, allowing teams working in hospitals and clinics to focus on patient care. It moves in hospital corridors and between rooms on wheels while relying on its memory that saves the hospital map.

ROBOTS ROAM PATIENTS' ROOMS TO PROVIDE THEM WITH FOOD WITHOUT ANY DIRECT CONTACT WITH THE NURSES OR FEAR OF DISEASE TRANSMISSION TO THEM.

ARTICLE FEATURES . Robots in hospitals

Sterilization Robot Hospitals are in need of cleaning and sterilization during the coronavirus outbreak, which have been successfully carried out by some types of robots. Many countries where the pandemic has spread have resorted to robots that are able to eliminate germs and sterilize rooms from viruses and bacteria in coronavirus isolation wards within a few minutes. The robot moves autonomously through a room, using ultraviolet-C light to destroy the RNA in a virus and DNA in bacteria, effectively gutting the virusâ&#x20AC;&#x2122; ability to infect people and multiply. This robot kills 99.99 percent of viruses, bacteria and fungal spores.

ARTICLE FEATURES . Virtual Healthcare

Virtual Healthcare vs. Telemedicine

irtual healthcare is a new reality that has recently itself, as visits between doctors and patients are made virtually. With the help of live video, audio, and instant messaging, patients can now interface with healthcare providers from the comfort of their own home in light of the coronavirus pandemic and the changes it imposed on peopleâ&#x20AC;&#x2122;s lives.

SEPT.OCT 2020

TELEMEDICINE REFERS TO THE TREATMENT OF VARIOUS MEDICAL CONDITIONS WITHOUT SEEING THE PATIENT IN PERSON.

The term telemedicine refers specifically to the treatment of various medical conditions without seeing the patient in person. Healthcare providers may use telehealth platforms like live video, audio, or instant messaging to address a patientâ&#x20AC;&#x2122;s concerns and diagnose their condition remotely. This may include giving medical advice, walking them through at-home

ARTICLE FEATURES . Virtual Healthcare

exercises, or recommending them to a local provider or facility. The emergence of telemedicine apps gives patients access to care right from their phones or tablets. Doctors, health systems and hospitals in general around the world are competing to adopt virtual healthcare methods that avoid human contact. Some people may think that virtual healthcare is the same as telehealth or telemedicine, but they are actually different concepts. In fact, virtual healthcare, a component of telemedicine, is a broad term that encompasses all the ways healthcare providers remotely interact with their patients. The difference is the result of some development in naming the different types of technologies.

The Difference between Telemedicine and Virtual Healthcare Telemedicine refers to the treatment of various medical conditions without seeing the patient in person. It allows healthcare professionals to evaluate, diagnose and treat patients

VIRTUAL HEALTHCARE IS A BROAD TERM THAT ENCOMPASSES ALL THE WAYS HEALTHCARE PROVIDERS REMOTELY INTERACT WITH THEIR PATIENTS.

at a distance using telecommunication technology. Virtual healthcare is a broad term that encompasses all the ways healthcare providers remotely interact with their patients. In addition to treating patients via telemedicine, providers may use live video, audio, and instant messaging to communicate with their patients remotely. This may include checking in after an in-person visit, monitoring vitals after surgery, or responding to any questions about their diagnosis, condition or treatment plan. Simply put, the term virtual care is a way of talking about all the ways patients and doctors can use digital tools to communicate in real-time. While telemedicine refers to long-distance patient care, virtual healthcare is a much broader term that refers to a variety of digital healthcare services. That the terms are so often confused indicates how integral virtual healthcare is to telehealth delivery. Either way, demand is growing for a means to avoid the expense, burden and time spent traveling to and from clinics or doctor’s offices. And in rural areas struggling to attract physicians and practitioners at all, eliminating the need for transportation isn’t just a matter of convenience but also of basic access — especially for those unable to drive. When discussing the digitization of healthcare, it’s usually best to use the term virtual care instead of telemedicine. The latter has a more limited definition, while virtual care paints a more comprehensive picture of the modern healthcare landscape, which includes more than just telemedicine. During the new pandemic outbreak, some figures showed a decrease in the number of patient visits who require primary healthcare and behavioral health, which indicates the possibility of continuing to using the camera or video to receive virtual healthcare that achieves the desired goals in many cases. Virtual healthcare has the ability to provide medical services to patients and their access to quality care through the use of digital technology, as Internet applications, e-mails and online means of communication provide a model for obtaining primary healthcare such as a general practitioner, family doctor or primary healthcare provider.

ARTICLE

Can COVID-19 Cause Irreversible Lung Damage?

n severe cases, COVID-19 can cause lung failure, and when this occurs, those patients may be considered for a lung transplant evaluation. We spoke with Dr. Gabriel Loor, Surgical Director of the Lung Transplant Program at Baylor St. Luke's Medical Center, and Dr. Puneet Garcha, Medical Director of Lung Transplantation at Baylor St. Luke’s Medical Center, for insight on the need for lung transplants in COVID-19 patients.

When Are COVID-19 Patients Evaluated for Lung Transplants? Lungs are the organ system that is most affected by COVID-19, but the majority of infected patients are asymptomatic or have mild symptoms, allowing them to recover at home. However, a very small percentage of COVID-19 patients experience severe symptoms and require hospitalization in intensive care units. If these patients do not respond positively to advanced medical care and experience lung failure, they may be evaluated for a lung transplantation.

What Is the Lung Transplant Program at Baylor St. Luke’s Like? Designated as part of Optum's Centers of Excellence networks, which is affiliated with

SEPT.OCT 2020

MY SUSPICION IS THAT WE WILL BOTH DIRECTLY AND INDIRECTLY DEAL WITH HEALTH CONSEQUENCES FROM COVID-19. AS DISCUSSED ABOVE, RECOVERY FROM ILLNESS MAY HAVE CHRONIC EFFECTS FROM THE DAMAGE.

United Healthcare plans, our lung transplant program is one of the busiest in the country. We’ve performed over 50 lung transplants in the last 12 months, and we leverage several state-of-the-art procedures and technologies that set us apart from other transplant centers. Additionally, Baylor St. Luke’s is consistently recognized as high-performing in pulmonology and lung surgery by U.S. News & World Report. Although COVID-19 created new challenges for the healthcare industry, we’ve continued to perform lung transplants during the crisis at about the usual pre-pandemic rate. By implementing a rigorous screening protocol that has resulted in no transmission of the COVID-19 virus and a 100% patient survival rate, we’re able to safely and compassionately continue conducting transplants through this unprecedented crisis. As the national leaders in breathing lung technology, and the first to utilize the portable organ care system in Texas, we can transport lungs from anywhere in the country using a device that keeps the lungs “breathing” with blood pumping through the vessels during transport. This ensures a greater supply of donor lungs for our patients. Our staff has conducted over 1,000 lung

ARTICLE

transplants, and we have some of the most experienced surgeons and pulmonologists in the country. Furthermore, we’re constantly looking at ways to make our transplants even safer, and several members of our staff are national and international leaders in a variety of clinical trials considering ways to improve outcomes with lung transplantation.

What Should Someone Do If They’re Diagnosed With COVID-19?

a transplant workup. Most patients will recover from the virus, but after recovering, they’ll need to pay close attention to their bodies during physical activities. If you experience more shortness of breath than usual after being physically active, follow up with a pulmonologist to check for evidence of irreversible lung damage from COVID-19.

If you’re diagnosed with COVID-19, self-isolate to prevent spreading the virus. If you experience trouble breathing or develop worsening symptoms, call 911 and seek emergency care immediately. In the event of lung failure, your doctors can guide you toward a referral and transfer to Baylor St. Luke’s Medical Center for

If there are signs of irreparable damage, consider requesting a consultation with Baylor St. Luke’s Medical Center’s lung transplant program. You can contact our program via email at LungTeam@sleh.com or by calling 832-3559494, option 4.

MEDICAL INSITUTIONS

MIRACLES DURING PANDEMIC

BABY KUZEY – A LITTLE HERO OF BIG DISEASE

hree-year-old Kuzey, the son of Şengezer Couple, residing in Adana, sought medical attention for fever. The family presented to Acıbadem Adana Hospital and their son, Kuzey, was diagnosed with “Acute Lymphoblastic Leukemia” in the light of the tests and the real marathon started thereafter. Acute Lymphoblastic Leukemia, abbreviated as ALL, is somewhat cancer of blood and bone marrow. It originates from the bone marrow and involves the white blood cells. It is the most common type of childhood cancers. Symptoms are characterized with sudden-onset and ALL progresses rapidly. For the patients diagnosed with ALL,

SEPT.OCT 2020

PROFESSOR BÜLENT ANTMET, DIRECTOR OF PEDIATRIC BONE MARROW CENTER IN ACIBADEM ADANA HOSPITAL, AND HIS TEAM STARTED KUZEY ON TREATMENT IMMEDIATELY.

starting the treatment immediately is very critical to prevent progression. Professor Bülent Antmet, Director of Pediatric Bone Marrow Center in Acıbadem Adana Hospital, and his team started Kuzey on treatment immediately. First, Kuzey received chemotherapy, but he required Bone Marrow Transplantation – the only curative option for ALL. Bone marrow screening was started first in TÜRKÖK and then worldwide. A match donor (90%), Andreas residing in Chania City of Crete Island in Greek, was found in early April, 2020. However, bone marrow

MEDICAL INSITUTIONS

could not be obtained since all flights have been cancelled due to the coronavirus pandemic. Efforts of stem cell banks in Istanbul and Athens were supported by the Ministry of Health and thus, bone marrow could be taken from the 35-year-old donor residing in Crete and transferred to Istanbul followed by Adana by land based on a special approval. Stem cell were stored at -170 C and transplanted to Kuzey in a procedure that lasted for

EFFORTS OF STEM CELL BANKS IN ISTANBUL AND ATHENS WERE SUPPORTED BY THE MINISTRY OF HEALTH.

1.5 hours by Professor of Pediatric Hematology and Oncology Bülent Antmen and his team at Acıbadem Adana Hospital on May 20th after the donor was quarantined and Covid-19 was tested negative. Staying at the hospital for 2 months following the transplantation, Kuzey was discharged in healthy status in early July. Considering the risk of relapse, Kuzey will befollowed up by Bülent Antmen and his team for 3 years.

SEREEN – MY DAD, MY HERO

ereen Amirah, a 5-year-old from Jordan, was lately diagnosed with Biliary Atresia. Also known as extrahepatic ductopenia, this syndrome is a childhood disease of the liver in which one or more bile ducts are abnormally narrow, blocked or absent. If this condition is not diagnosed early, it will lead to liver failure.

Unfortunately, this is what happened with Sereen, and the only effective treatment for her is a liver transplant. At the time of coronavirus pandemic, Sereen and her family had to apply for a special permission to travel to Turkey in order to perform the surgery. The team of Organ Transplant Center in Acıbadem Atakent University Hospital in Istanbul has completed successfully the surgery on July 21. Sereen and her father, Mr. Salman Jameel Hassan who donated a piece of his liver to save his daughter are healthy and will stay some days in the hospital for routine control.

ARTICLE FEATURES . Cardiac Catheterization

Cardiac Catheterization Between diagnosis and treatment, it remains the first option

he technological development reflected on the practices of diagnostic and therapeutic catheterization, which have been widely spread and were introduced to various medical specialties, to become today a safe alternative to many surgeries.

Today, cardiac catheterizations are carried out according to the latest technologies, equipment and medical supplies. Most hospitals in the region are keen to establish integrated departments to perform cardiac catheterizations in accordance with the highest levels and best professional practices.

SEPT.OCT 2020

THE USE OF ROBOTS IN CARDIAC CATHETERIZATION MARKED A PARADIGM SHIFT IN CARDIOLOGY.

The spectacular advances in medical equipment and modern technologies have helped cardiologists get an accurate diagnosis through the use of cutting-edge technology in innovative digital imaging. There are also new and advanced types of cardiac stents that play a major role in sparing surgeries. Today, doctors can see the inside of the arteries with a detailed anatomy of the heart and a clear view of the finest blood vessels in the body, which allows them to determine the location, quantity and length of the blockage. Â This amazing progress placed doctors in front of a new challenge and a major respon-

ARTICLE FEATURES . Cardiac Catheterization sibility that requires them to keep abreast of the medical and technological developments in order to provide the latest therapeutic interventions for patients, and this progress also posed another challenge to medical suppliers and developers of technologies, supplies and accurate health equipment to perform cardiac catheterization with the necessary accuracy.

Robotic Catheter

The robotic catheter is characterized by several features including high precision in the insertion of small stents in addition to performing accurate tasks in a very small space without allowing the doctorsâ&#x20AC;&#x2122; fingers to tremble when they are tired. This field has evolved to the point of the emergence of a new generation of robotic catheters, as there is a new device based on the use of artificial intelligence that is available today in hospitals in the region, which is the latest finding in the field of robotic catheters. One of the advantages of modern robotic catheter is to reduce the amount of radiation that the patient and doctor get exposed to by 30% in addition to reducing surgery duration and extreme accuracy by controlling the catheter tube to less than a millimeter. The new robot system for cardiac catheterizations is characterized by the presence of a third robotic arm that did not exist in the past in addition to an increase in the accuracy of performance and the speed at which the stent is implanted. With the use of robots in catheterization procedures, the risk of X-ray and dye exposure is 95%, which put the doctor and medical team at risk of cancer. The most widely used clinical robotic surgical system includes a camera arm and mechanical arms with surgical instruments attached to them. The surgeon controls the arms while seated at a computer console near the operating table. The console gives the surgeon a high-definition, magnified, 3-D view of the surgical site. The surgeon leads other team members who assist during the operation.

Catheter-based valve replacement Catheter-based heart valve therapies have become an established therapy as an alternative to conventional surgical treatment for heart valves. Catheter-based procedures can be used for certain types of heart valve disease - and

THE DEVELOPMENT OF CARDIAC CATHETERIZATION IN TERMS OF DIAGNOSIS AND TREATMENT URGED MEDICAL SUPPLIES COMPANIES AND TECHNOLOGY DEVELOPERS TO PROVIDE STATE-OFTHE-ART MEDICAL EQUIPMENT IN ORDER TO PROVIDE THE BEST PROFESSIONAL PRACTICES BY CARDIOLOGISTS.

may sometimes be able to eliminate the need for open surgery altogether. The procedure is similar to that of other catheter-based procedures, in that a catheter made of synthetic material is inserted via a blood vessel in the groin and advanced to the heart. These types of procedures are particularly suitable for treating heart valve disease affecting the left side of the heart (aortic valve and mitral valve). TAVI stands for Transcatheter Aortic Valve Implantation, a minimally-invasive catheter-based procedure that is used for the implantation of prosthetic tissue valves. In contrast to aortic valve replacement, this procedure does not involve the removal of the diseased valve. For patients who are at an increased risk of surgical complications due to their age or concomitant disease, transcatheter aortic valve implantation (TAVI) offers a catheter-based alternative to open-heart valve replacement surgery.

Nowadays, catheter-based heart valve procedures are used mainly in patients with the following conditions: â&#x20AC;˘

Narrowing of the aortic valve (aortic valve stenosis).

ARTICLE FEATURES . Cardiac Catheterization

â&#x20AC;˘ â&#x20AC;˘

Leakiness of the mitral valve (mitral valve regurgitation). Narrowing of the mitral valve (mitral valve stenosis).

Benefits of such operations include faster recovery, shorter hospitalization, less pain, and fewer complications as compared to open-heart surgery. Aortic stenosis (AS) is the most prevalent form of cardiovascular disease in the world. Its incidence increases with age, and if left untreated, patients have a 50% risk of dying within two years. Percutaneous or catheter-based procedures are done without any incisions in the chest or stopping the heart. Instead, a thin flexible tube called a catheter is inserted into a blood vessel in your groin or arm and then threaded through the blood vessels into your heart. Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgical valve replacement procedure that is used to treat symptomatic aortic valve stenosis, with two key

THE USE OF A ROBOT HELPS TO ACCURATELY DETERMINE AND ASSESS THE ARTERIAL BLOCKAGE OF THE HEART.

differences from traditional valve replacement surgery. Rather than opening up the chest, TAVI is done through small incisions in the groin or chest. Instead of repairing, or removing and replacing the damaged aortic valve, a new aortic valve is implanted directly on top of the damaged one. Using ultrasound and chest x-rays, the catheter is guided to the correct position in the heart and the new valve is implanted and expanded. Once the new valve is in place, it starts to control blood flow immediately. Risk factors of aortic valve stenosis include older age, certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve, history of infections that can affect the heart, having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure.

Catheter Ablation Cardiac ablation is a procedure that can correct heart rhythm problems (arrhythmias).

CATHETER

ALTERNATIVE SITE NARROWED ARTERY ON X-RAY IMAGE

CATHETER INSERTION SITE

SEPT.OCT 2020

ARTICLE FEATURES . Cardiac Catheterization

Cardiac ablation works by scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart and, thus, stops the arrhythmia. Cardiac ablation usually uses long, flexible tubes (catheters) inserted through a vein or artery in your groin and threaded to your heart to deliver energy in the form of heat or extreme cold to modify the tissues in your heart that cause an arrhythmia. Cardiac ablation is sometimes done through open-heart surgery, but it's often done using catheters, making the procedure less invasive and shortening recovery times. During catheter ablation, a specialist will insert an intravenous line into your forearm or hand, and you'll be given a sedative to help you relax. After your sedative takes effect, your doctor or another specialist will numb a small area near a vein on your groin, neck or forearm. Your doctor will insert a needle into the vein and place a tube (sheath) through the needle. Your

CARDIAC ABLATION IS A PROCEDURE THAT CAN CORRECT HEART RHYTHM PROBLEMS (ARRHYTHMIAS). CARDIAC ABLATION WORKS BY SCARRING OR DESTROYING TISSUE IN YOUR HEART THAT TRIGGERS OR SUSTAINS AN ABNORMAL HEART RHYTHM.

doctor will thread catheters through the sheath and guide them to several places within your heart. He may inject dye into the catheter, which helps your care team see your blood vessels and heart using X-ray imaging. The catheters have electrodes at the tips that can be used to send electrical impulses to your heart and record your heart's electrical activity. This process of using imaging and other tests to determine what's causing your arrhythmia is called an electrophysiology (EP) study. An EP study is usually done before cardiac ablation in order to determine the most effective way to treat your arrhythmia. Once the abnormal heart tissue that's causing the arrhythmia is identified, your doctor will aim the catheter tips at the area of abnormal heart tissue. Energy will travel through the catheter tips to create a scar or destroy the tissue that triggers your arrhythmia. In some cases, ablation blocks the electrical signals traveling through your heart to stop the abnormal rhythm and allow signals to travel over a normal pathway instead.

MEDICAL INSITUTIONS

CARDIOVASCULAR:

The TAVI era in repair of aortic valves! PROFESSOR SINAN DAĞDELEN, HEAD OF CARDIOLOGY DEPARTMENT AT ACIBADEM UNIVERSITY AND ACIBADEM ALTUNIZADE HOSPITAL, STATES THAT THIS IS FOLLOWED BY CANCELLING OUT THE OLD VALVE AND IMPLANTATION OF A NEW ONE INSIDE IT.

he TAVI method, of which the use has started to be more common throughout the world as a result of technological developments and an approach that prioritizes patient comfort, makes it possible for aortic valve diseases to be treated without any need for open surgery. Until a few years ago, patients with aortic valve calcification or stenosis (narrowing) could only be treated through open surgery. It involved removal of the aortic valve after opening the ribcage and sewing of a new valve in its place. Patients experienced the complications related to the surgery for days and, sometimes, weeks. Now, however, a more modern treatment method has come under the spotlight and it’s referred to as TAVI (Transcatheter Aortic

SEPT.OCT 2020

AFTER THE DIAGNOSIS PROCESS, THE OPTION OF TAVI IS CHOSEN TO TREAT PATIENTS OF OLD AGE, FOR WHOM OPEN SURGERY IS RISKY. STATING THAT THE METHOD WAS NOT AS TECHNICALLY ADVANCED AS DESIRED DURING THE INITIAL STAGES.

Valve Implantation). The aorta is accessed through the artery in groin or another blood vessel in the body, without requiring any incisions. Professor Sinan Dağdelen, head of cardiology department at Acıbadem University and Acıbadem Altunizade Hospital, states that this is followed by cancelling out the old valve and implantation of a new one inside it.

Patients return to their normal lives within a few days Aortic valve stenosis, which is usually started to be encountered in people who are in their mid-60s, is among diseases that progress slowly. It is an acquired diseases and occur at serious levels after age 75 or 80, and progresses rapidly with increasing age. Patients who are in early stages experience symptoms such as dizziness right after standing up, as well as balance issues that lead to staggering or even go so far as to cause the patient to faint. Since blood supply to the brain and other organs decreases to low amounts in cases of aortic valve stenosis, patients tend to get tired more quickly and start experiencing shortness of breath and chest pain. Patients who consult a specialist with these complaints undergo certain tests. After the diagnosis process, the option of TAVI is chosen to treat patients of old age, for whom open surgery is risky. Stating that the method was not as technically advanced as desired during the initial stages, Professor Dağdelen underlines the fact that the current developments and the increase in the experience that has accumulated in regard to the procedure have reduced the mortality and disability risk to very low levels: “The risk rates are around 1 to 2%. Furthermore, the risk of bleeding, paralysis, infection or harm to the lungs is much lower in comparison to open heart surgery. The intensive care period lasts only a few hours. Unless the patient has a particular lung problem, anemia or kidney disease, he is taken to a normal room af-

MEDICAL INSITUTIONS

ter intensive care. In some cases, it is possible for the patient to remain in intensive care for one night. In addition to prioritizing patient comfort, the method also ensures for the patient to stand up, go to the bathroom, and eat, which are activities of a normal life, in only a few hours after the operation. After spending two days under supervision at the hospital, the patients are discharged unless there are any complications.”

An 83-year-old patient who recovered her health through TAVI Many factors, such as age, presence of systemic diseases and risk in open surgery require application of the TAVI method. This was also the case for 83-year-old Leman Emine Bostancı who was treated by Professor Sinan Dağdelen through this method. Ms. Leman had a medical history involving a by-pass operation and hypertension, as well as many organ conditions, particularly in her kidneys and lungs. She also had age-related calcification in her cardiac valves. Professor Dağdelen says, “This patient, who had blockage in the veins that supply blood to the heart in addition to her heart valve condition, was also suffering from aortic stenosis. While another open heart surgery was required due to calcification, such an operation under these conditions was very risky” and explains the case of this patient as follows: “Ms. Leman consulted us with symptoms of serious difficulty in breathing, weakness, fatigue and inability to maintain vital functions. After certain examinations, we decided to use the TAVI method. The operation, which was performed with entry through the femoral artery, lasted approximately 40 minutes. We made use of all the advantages of the method and completed the treatment of our 83-year-old patient, who was discharged from the hospital after 3 days.”

THE METHOD CAN BE APPLIED IN TWO DIFFERENT WAYS. THE TRANSFEMORAL METHOD INVOLVES ENTRY FORM THE FEMORAL ARTERY, IN A SIMILAR FASHION TO AN ANGIOGRAM. THE VALVE, WHICH IS INSERTED INTO THE BODY THROUGH THE ARTERY, IS PLACED INSIDE THE HEART THROUGH POSITIONING INSIDE THE PATIENT’S OWN AORTIC VALVE.

ing behind the treatment. Professor Sinan Dağdelen notes that before the treatment is performed, they discuss many factors ranging from the heart condition and vascular structure of the patient to the anesthesia method to be chosen, and make decisions together with many specialist from fields such as anesthesiology, radiology and cardiovascular surgery.

The heart valve is delivered through blood vessels Professor Dağdelen shares the following information on the TAVI method which is used to treat valve diseases without requiring open surgery: “The method can be applied in two different ways. The transfemoral method involves entry form the femoral artery, in a similar fashion to an angiogram. The valve, which is inserted into the body through the artery, is placed inside the heart through positioning inside the patient’s own aortic valve. However, it is possible for the femoral artery to be blocked in some patients. In such cases, the transapical application is used. This also does not require surgery and involves implantation of the new valve through a blood vessel in the shoulder, neck or chest after a small incision is made. If the patient is suitable to undergo transfemoral TAVI, which requires for the transfemoral artery to be unclogged, it is usually preferred over the other method since it is more convenient and practical.”

The treatment is performed with a multidisciplinary approach While the TAVI method is applied by cardiologists due to the group of diseases associated with it, there is a multidisciplinary understand-

MEDICAL INSITUTIONS

The Department of Cardiology at H么tel-Dieu de France: Years of Expertise Alongside Modern Technologies

n 1922, General Gouraud laid the foundation stone of H么tel-Dieu de France hospital and so the construction began. It was his successor, General Weygand, who inaugurated in 1923 the hospital that is considered today a reference medical center renowned for its pioneering approach and its high-end healthcare services that place it at the forefront of this field. Cardiology made its debut at H么tel-Dieu de France hospital with Prof. Elie Saliby who

JULY.AUG 2020

was known for carrying his own ECG machine from one hospital to another. Then came Prof. Edmond Fakhri, who graduated in France and was appointed as Head of the Department of Cardiology until 1978, when he emigrated from Lebanon for security reasons. He was followed by Prof. Elie Checrallah until his retirement in 2001, then by Prof. Roland Kassab until 2013, and finally, by Prof. Rabih Azar who is still on duty as the current Head of the Department at H么tel-Dieu.

THE CARDIOLOGISTS OF HDF ALSO PARTICIPATE IN THE MOST PRESTIGIOUS MEDICAL CONFERENCES ORGANIZED AROUND THE WORLD.

MEDICAL INSITUTIONS The Department of Cardiology at Hôtel-Dieu has progressively acquired cutting-edge technologies and coupled it with excellent human capital trained at the most prestigious universities and hospitals in Europe and the United States. Today, the Department of Cardiology at Hôtel-Dieu is able to perform the following medical explorations and procedures: • Invasive hemodynamic tests: coronary angiograms, coronary angioplasties with insertion of different types of stents, FFR and IVUS, percutaneous treatment of coronary chronic total occlusion (CTO). • Percutaneous treatment of heart valve diseases: transcatheter aortic valve implantation (TAVI) for severe aortic stenosis and MitraClip for severe mitral regurgitation. • Percutaneous left atrial appendage occlusion using Watchman or Amulet device. • Ablative techniques in heart rhythmology: supraventricular tachycardia (in particular atrial fibrillation) or ventricular tachycardia, atrioventricular node and accessory bundles. • Electrophysiological explorations in rhytmology with cardiac cartography, implantation of different types of Pacemakers, single, dual or triple chamber, with or without implantable defibrillator. • All types of echocardiography: transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), stress echocardiography (through exercise or Dobutamine), 3D echocardiography, echocardiogram with contrast, Tissue Doppler imaging, Strain. • Other non-invasive explorations: stress test, 24-hour or 48-hour Holter monitoring the heart’s rhythm or blood pressure, ventricular late potentials (signal average ECG).

high-quality treatments to severe cases admitted. The Department of Cardiology at Hôtel-Dieu also comprises a highly active research unit that plays a very effective role. It has published many papers in high-level international journals focusing on various fields such as new therapies, new paraclinical tests and cutting-edge technologies. In addition, the Department organizes every year one of the most important and largest conferences attended by specialists from Lebanon and all over the world, focusing on innovations in cardiology. The cardiologists of HDF also participate in the most prestigious medical conferences organized around the world, in which they frequently deliver oral presentations, thus sharing their latest research work and achievements with the world. The progress the Department of Cardiology has made over the years makes it today a leading cardiovascular institution in terms of welcoming patients, offering them the best cardiovascular treatments and providing continuous medical education to health professionals and the community.

THE DEPARTMENT OF CARDIOLOGY AT HÔTEL-DIEU ALSO COMPRISES A HIGHLY ACTIVE RESEARCH UNIT THAT PLAYS A VERY EFFECTIVE ROLE. IT HAS PUBLISHED MANY PAPERS IN HIGH-LEVEL INTERNATIONAL JOURNALS FOCUSING ON VARIOUS FIELDS SUCH AS NEW THERAPIES, NEW PARACLINICAL TESTS AND CUTTING-EDGE TECHNOLOGIES.

Moreover, the Department has established a perfectly equipped coronary care unit with state-of-the-art technologies providing

ARTICLE FEATURES . Heart Arrhythmia

Heart Arrhythmia What are the causes and how can they be treated?

n a healthy heart, a normal resting heart rate is 60 to 100 beats a minute. An arrhythmia describes an irregular heartbeat - the heart may beat too fast, too slowly, too early, or irregularly. Arrhythmias occur when the electrical signals to the heart that coordinate heartbeats are not working properly. For instance, some people experience irregular heartbeats, which may feel like a racing heart or fluttering. Many heart arrhythmias are harmless; however, if they are particularly abnormal, or result from a weak or damaged heart, arrhythmias can cause serious and even potentially fatal symp-

SEPT.OCT 2020

YOUR RISK OF DEVELOPING CORONARY ARTERY DISEASE AND HIGH BLOOD PRESSURE GREATLY INCREASES WITH UNCONTROLLED DIABETES.

toms. Some patients need a quick and accurate medical intervention to assess the condition, determine the cause, identify the type of palpitations, and look for the cause because it may be indicative of a medical problem, including a current or previous heart attack, or constriction in the arteries of the heart that has reached an advanced stage in a way that obstructs blood flow to nourish the heart muscle. Many things can lead to, or cause, an arrhythmia, including a heart attack that's occurring right now, scarring of heart tissue from a prior heart attack, changes to your heart's structure, such as from cardiomyopathy, blocked arteries in

ARTICLE FEATURES . Heart Arrhythmia

Diabetes: Your risk of developing coronary

your heart (coronary artery disease), high blood pressure, overactive thyroid gland (hyperthyroidism), underactive thyroid gland (hypothyroidism), smoking, drinking too much alcohol or caffeine, drug abuse, stress, certain medications and supplements, including over-the-counter cold and allergy drugs and nutritional supplements, diabetes, sleep apnea and genetics.

Certain factors may increase your risk of developing an arrhythmia. These include: Coronary artery disease, other heart problems and previous heart surgery: Narrowed heart arteries, a heart attack, abnormal heart valves, prior heart surgery, heart failure, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia. High blood pressure: This increases your risk of developing coronary artery disease. It may also cause the walls of your left ventricle to become stiff and thick, which can change how electrical impulses travel through your heart. Congenital heart disease: Being born with a heart abnormality may affect your heart's rhythm. Thyroid problems: Having an overactive or underactive thyroid gland can raise your risk of arrhythmias. Drugs and supplements: Certain over-thecounter cough and cold medicines and certain prescription drugs may contribute to arrhythmia development.

NARROWED HEART ARTERIES, A HEART ATTACK, ABNORMAL HEART VALVES, PRIOR HEART SURGERY, HEART FAILURE, CARDIOMYOPATHY AND OTHER HEART DAMAGE ARE RISK FACTORS FOR ALMOST ANY KIND OF ARRHYTHMIA..

artery disease and high blood pressure greatly increases with uncontrolled diabetes. Obstructive sleep apnea: This disorder, in which your breathing is interrupted during sleep, can increase your risk of bradycardia, atrial fibrillation and other arrhythmias. Electrolyte imbalance: Substances in your blood called electrolytes â&#x20AC;&#x201D; such as potassium, sodium, calcium and magnesium â&#x20AC;&#x201D; help trigger and conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart's electrical impulses and contribute to arrhythmia development. Drinking too much alcohol: Drinking too much alcohol can affect the electrical impulses in your heart and can increase the chance of developing atrial fibrillation. Caffeine or nicotine use: Caffeine, nicotine and other stimulants can cause your heart to beat faster and may contribute to the development of more-serious arrhythmias. Illegal drugs, such as amphetamines and cocaine, may profoundly affect the heart and lead to many types of arrhythmias or to sudden death due to ventricular fibrillation.

Diagnosis Cardiac arrhythmias are sometimes classified according to their origin as either ventricular arrhythmias (originating in the ventricles) or supraventricular arrhythmias (originating in heart areas above the ventricles, typically the atria). They also can be classified according to

ARTICLE FEATURES . Heart Arrhythmia

their effect on the heart rate, with bradycardia indicating a heart rate of less than 60 beats per minute and tachycardia indicating a heart rate of more than 100 beats per minute. Your doctor will ask about your family history of coronary artery disease, cardiac arrhythmias, fainting spells or sudden death from heart problems. Your doctor also will review your personal medical history, including any possible risk factors for cardiac arrhythmias (such as coronary artery disease, cardiomyopathy, thyroid disorders, and medications). You will be asked to describe your specific cardiac symptoms, including any possible triggers for those symptoms. During the physical examination, your doctor will check your heart rate and rhythm, together with your pulses. This is because certain cardiac arrhythmias cause a mismatch of the pulse and the heart sounds. Your doctor also will check for physical signs of an enlarged heart and for heart murmurs, one sign of a heart valve problem. A test called an electrocardiogram (EKG) often can confirm the diagnosis of a cardiac arrhythmia. However, because cardiac arrhythmias may come and go, a one-time office EKG may be normal. If this is the case, an ambulatory EKG may be required. During an ambulatory EKG, the patient wears a portable EKG machine called a Holter monitor, usually for 24 hours, but sometimes much longer. You will be taught to press a button to record the EKG reading whenever you experience symptoms. This approach is especially useful if your symptoms are infrequent. But abnormal heart rhythms and cardiac symptoms may come and go. The main purpose of an event monitor is to record your heart rate and rhythm during a symptom (“event”). They work only when a person turns on the device. Your doctor may recommend an event monitor when symptoms are infrequent – less than daily. A treadmill test, sometimes called a stress test or an exercise stress test, can help diagnose people whose suspected arrhythmias are exercise-related. Electrophysiologic testing can reveal suspected arrhythmias. In this procedure,

SEPT.OCT 2020

ARTICLE FEATURES . Heart Arrhythmia

performed under local anesthesia, temporary electrode catheters are threaded through peripheral veins (or arteries) into the heart using a fluoroscope. These electrode catheters are positioned in the atria, ventricles or both. They record the heart’s electrical signals and “map” the path of electrical impulses during each heartbeat. Esophageal electrophysiologic procedure is a procedure in which a thin, flexible catheter is inserted into your nostril and positioned in the esophagus (the tube that connects the mouth and stomach). The catheter’s lead performs an electrocardiogram (EKG). The catheter’s proximity to the heart allows for more accurate results than a conventional EKG. An echocardiogram uses ultrasound waves to reveal your heart’s size, structure and motion. A painless procedure, an echocardiogram often provides valuable information about a heart with an arrhythmia. The most common type of echocardiogram is transthoracic echocardiography (TTE).

Treatment Treatment for arrhythmia is only required if the condition is putting the patient at risk of a more serious arrhythmia or a complication, or if the symptoms are very severe. If bradycardia is caused by an underlying condition, that condition needs to be treated first. If no underlying problem is found, the doctor may advise

TREATMENT FOR ARRHYTHMIA IS ONLY REQUIRED IF THE CONDITION IS PUTTING THE PATIENT AT RISK OF A MORE SERIOUS ARRHYTHMIA OR A COMPLICATION, OR IF THE SYMPTOMS ARE VERY SEVERE.

implanting a pacemaker. A pacemaker is a small device that is placed under the skin of the chest or abdomen to help control abnormal heart rhythms. Pacemakers use electrical pulses to prompt the heart to beat at a normal minimum rate. Determining treatment requires first looking for the underlying cause and following a healthier lifestyle, which makes the treatment more successful such as quitting smoking and limiting caffeine intake, avoiding stress and situations that cause extreme fear in addition to avoiding medications that cause heartbeat disorders. Your doctor may recommend an implantable cardioverter-defibrillator (ICD) if you're at high risk of developing a dangerously fast or irregular heartbeat in the lower half of your heart (ventricular tachycardia or ventricular fibrillation). If you have had sudden cardiac arrest or have certain heart conditions that increase your risk of sudden cardiac arrest, your doctor may also recommend an ICD. For many types of tachycardia, you may be prescribed medication to control your heart rate or restore a normal heart rhythm. It's very important to take any anti-arrhythmic medication exactly as directed by your doctor in order to minimize complications. If you have atrial fibrillation, your doctor may prescribe blood-thinning medications to help keep dangerous blood clots from forming.

ARTICLE

Advancing Medication Safety: A Summary Report of the 1st Middle East Advisory Board Meeting for Medication Management and Safety. Dubai, February 2020.

Dr Ulfat Usta: Chief Pharmacist at American University of Beirut Medical Centre, Beirut, Lebanon. Rania Al-Jaber: Pharmacy Automation and Support Specialist, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia. Maher Mominah: Manager, Pharmacy Automation and Support Service, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia. Khalid Dayem: Senior Automation and Informatics Manager, Cleveland Clinic Abu Dhabi, UAE. Rabih Dabliz: Senior Manager, Quality & Medication Safety Services, Cleveland Clinic Abu Dhabi, UAE. Ahmad Chaker: Manager, Sterile Preparation Center, Cleveland Clinic Abu Dhabi, UAE. Sajjad Ahmad: Clinical Pharmacist & Pharmacy Informatics Lead, Al Ain Hospital, Abu Dhabi, UAE.

he Board for Medication Management and Safety set itself the following objectives during its first meeting: • Review the region’s current medication management landscape, identify specific challenges, and propose solutions. • Assess the impact of tools that may add transparency, and safety to the medication chain. • Discuss opportunities to create a regional data consortium, to publish findings, and create educational materials for dissemination across the region.

JULY.AUG 2020

The Board is composed of individuals with a wide scope of experience, and we quickly found that there are common themes running through our current interests and areas that we feel will be important for Medication Management and Safety in the near future:

A Broader Definition of Medication Error: The group adopted a working position that the most useful definition of medication error for our examination of end-to-end medication management and safety in the region is that of

PATIENT ENGAGEMENT IS A KEY ASPECT OF MEDICATION SAFETY.

ARTICLE

‘To Err is Human’ and Bridging the Gap:

the National Coordinating Council for Medication Error Reporting and Prevention (www. nccmerp.org) which defines medication error as, ‘any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer… including prescribing, order communication, product labelling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use’. This definition is felt to be particularly useful as it has a taxonomy of error type, and categorisation of error cause. The group reached a consensus that medication errors can occur throughout the whole of the process, from supply issues requiring substitution medications through to administration, and that any change in process allows an opportunity for deviation from administration practice and for medication error. Deep integration of medication management processes with the Electronic Health Record (EHR) and the use of ‘exceptions’ or medication ‘enrolment’ first on the EHR core system (to act as the true reference for the change) and only then on the Computerised Prescriber Order Entry (CPOE) system’s formulary, and the formularies of Automated Dispensing Cabinets (ADC) and Smart Pumps is suggested by the group as the optimum option for managing substitutions and dose unit changes.

Medication Management, despite technology application, remains a human process and we recognise that unsanctioned workarounds to established processes from anyone in the medication chain can very quickly become a potentially dangerous and unauthorised ‘standard practice’. With this in mind, ‘transparency’, and how systems we create for Medication Safety and Management can both uncover and catch discrepancies between what is prescribed, dispensed and administered, was reviewed. Key features of a transparent system are: • Verification of all prescription orders in the pharmacy. • Control and tracking of high-value and high-risk medications via the EHR. • For opiates it is suggested that system-wide order sets, and EHR protocols that use morphine-equivalency measures during prescription and reassessment of pharmacotherapy regimens are of value, with an integrated ADC’s single unit-dose dispensing facility, and low-dose single administration units (e.g Morphine 5mg prefilled syringe) acting as controls on administration • Employment of the technology of GTIN/ GS1 barcoding in tracking medication usage allows serial, batch, and lot numbers to be identified throughout the medication chain, down to administration to the patient. Integration of medication inventory systems into the EHR also allows accurate tracking of medications entering the organisation, and whilst not all medications sourced in the Middle East are GTIN/GS1, it is our experience that over 70% and up to 100% of the medications entering our facilities are. The potential impact this has for reducing expired medication waste in a facility is very large.

RETURNING TO THE THEME THAT MEDICATION SAFETY AND MANAGEMENT IS ‘HUMAN’ THE BOARD RECOMMENDS REACHING OUT TO PATIENTS VIA PERSONAL HEALTH RECORDS HELD IN PART BY THE PATIENT, SUCH AS MALAFFI (‘MY FILE) IN ABU DHABI’S HEALTH AUTHORITY, AND THROUGH OTHER PATIENT APPLICATIONS TO IMPROVE REPORTING OF ISSUES BY PATIENTS AND TO HELP OUR UNDERSTANDING OF ADVERSE DRUG EVENTS IN OUTPATIENTS AND OUTSIDE OF THE HOSPITAL.

Engaging the Patient: Returning to the theme that Medication Safety and Management is ‘human’ the Board recommends reaching out to patients via personal health records held in part by the patient,

ARTICLE

such as Malaffi (‘my file’) in Abu Dhabi’s Health Authority, and through other patient applications to improve reporting of issues by patients and to help our understanding of Adverse Drug Events in outpatients and outside of the hospital. Patient engagement is a key aspect of medication safety and has the potential for making a significant contribution to improving compliance with medication regimens and with medication reconciliation processes. In terms of patient compliance and satisfaction, we suggest the following as useful initial strategies drawn on the experience in our facilities: • Reducing times between refills by reducing the dispensed amounts at each visit. • Texts to remind patients for medication self-administration, appointments, and tests. • Delivery of medications to homes.

The Engine Room of the Hospital: Turning to IV Medication Safety and Management, we first reviewed compounding, and the pressure faced by pharmacies supplying up to 600 batches of IV medications daily in larger facilities. Batching is commonly undertaken by technicians supervised by a cleanroom pharmacist, and the technician follows a ‘recipe’ from the EHR. The pharmacist checks the ingredients, and the technicians proceed to create a batch of doses with these ingredients. We feel the weakness here is that the technicians may not achieve the correct dose in each batch, with under/overdosing possibly occurring in each individual dose made. It was a common experience among board members that batching forces multi-tasking pharmacists into a position of witnessing only complex steps and accepting that simple steps will not be witnessed for lack of time. In terms of cost/waste, any error made in batch preparation, even if found in only one prepared medication, requires that the entire batch be destroyed and started over. We recognise that physical and mental fatigue among pharmacy technicians is a very real reason for medication error, again medication

JULY.AUG 2020

management is a human process. With this in mind it is vital that technology we deploy in the cleanroom, as in all medication safety systems right down to the bedside, must help the user but also STOP the user from continuing in a dangerous manner. Lack of knowledge is not commonly the cause of medication error, most errors are ‘performance slips.’ Technology generated Hard Stops are therefore vital.

IV Medication Administration Safety: Moving out of the central pharmacy, we believe it is possible for senior pharmacists to continue to influence medication safety across the facility through technology and through human systems such as planning and therapeutics committees, with specialist groups for specific areas such as neonatology, oncology, pediatrics, and elderly care. Engaging with physicians, nursing staff, and clinical pharmacists and the sharing of results and achievements in medication safety across the organisation through these inter-disciplinary alliances is vital. In terms of IV medication safety we strongly advocate a cascade of medication safety from the core EHR IV formulary acting again as the central reference. This requires rapid update and alignment with the central formulary of smart pump medication libraries, and the use of dosing Hard Limits that cannot be overridden, rather than Soft Limits by the end user for IV medication dosing. We suggest that the use of Soft Limits should be restricted, to avoid nuisance alarms, as a reduction in extra alarms that are not of value to the end-user increases compliance across the organisation in our experience. The cascade from the core EHR formulary to the patient’s bedside should also include IV medication labelling, with appropriate warnings for high-risk medications that match the same medication’s alerts on the ADC, with the clinical advisory on the IV smart pump, and on the patient’s EHR medication administration record. Even in a ‘joined-up’ and well-integrated IV medication safety system it is important to recognise that new errors can be introduced into the medication safeguarding chain by these same systems; an example being the non-sepa-

LOOKING FORWARD TO AREAS THAT WE FEEL WILL BE IMPORTANT FOR MEDICATION MANAGEMENT AND SAFETY IN THE NEAR FUTURE, WE FEEL THAT ARTIFICIAL INTELLIGENCE (AI) SYSTEMS THAT CONSTANTLY CHECK THE SYSTEM’S EFFECTIVENESS AGAINST PARALLEL DATA MAY BE A ‘REAL-TIME’ SOLUTION FOR DISCOVERING GAPS IN MEDICATION SAFETY SYSTEMS.

ARTICLE

IT IS IMPORTANT TO LOOK AT HOW OTHER SYSTEMIC PROCESSES OPERATING WITHIN THE FACILITY MAY GIVE US INFORMATION ON HOW WELL OUR MEDICATION SAFETY AND MANAGEMENT SYSTEM IS FUNCTIONING.

ration of active treatment in some EHR medication records from medication regimens that have been discontinued. It is therefore vital, at all times, to: • Consistently ascertain if the system is functioning correctly and responding rapidly to changes in treatment and medication supply needs in the facility. • Review how partial, or unfinished integration may be causing more problems than having stand-alone systems with other safety gates. • It is also important to look at how other systemic processes operating within the facility may give us information on how well our medication safety and management system is functioning. • Financial and charge systems operating within EHRs can, for example, act as an effective double-check on administration and as a discrepancy check - as the charges in the patient record would be less than expected if the drug has been dispensed but not administered.

be important for Medication Management and Safety in the near future, we feel that Artificial Intelligence (AI) systems that constantly check the system’s effectiveness against parallel data may be a ‘real-time’ solution for discovering gaps in medication safety systems, and that these should include review at any point in time of antimicrobial usage, prescribing trends, availability within the hospital group and region of medications, and the total stock available within the facility.

Looking to the Future: Looking forward to areas that we feel will

INTERVIEW

Clinician educator at Nationwide Children’s Hospital and an Assistant Professor of Pediatrics at The Ohio State University

Fatima Barbar-Smiley, MD, MPH, FAAP “My goal is to help each and every patient achieve the best health outcomes. I partner with parents and guardians to assist our patients through their chronic illness journey”

ationwide Children’s Hospital is one of the largest pediatric hospitals and research institutes in the United States. In recent years, it has consistently been ranked among America’s top 10 children’s hospitals by U.S. News & World Report, the recognized authority on hospital rankings. "Hospitals" magazine recently interviewed Fatima Barbar-Smiley, MD, MPH, FAAP, about her work in the Division of Rheumatology at Nationwide Children’s Hospital.

How and why did you come to join Nationwide Children’s Hospital as their clinician educator and a pediatric rheumatologist? Originally from Lebanon, I obtained my medical degree at Beirut Arab University. I completed two pediatric residencies, the first in Lebanon at Hammoud Hospital University Medical Center, and the second at Nationwide Children’s Hospital. My Pediatric Rheumatology fellowship training was also at Nationwide Children’s Hospital, and I joined the pediatric rheumatology team here in 2016. In addition to clinical practice, I’m actively engaged in clinical research with a focus on juvenile arthritis, uveitis and lupus. The research environment and technology systems at Nationwide Children’s Hospital are incredibly supportive and advanced, and the focus on outstanding patient care is second to none. My

SEPT.OCT 2020

goal as a physician and researcher is to improve outcomes and access to healthcare for children with rheumatic diseases, and I felt Nationwide Children’s Hospital was the best place to do this. The hospital shares my goals.

The number of children with arthritis and other rheumatologic diseases is very low compared to adults. How do you conduct research? I believe collaboration is key for high-quality clinical research to improve care and outcomes. It is critical to establish a broad research network and form a strong connection between the pediatric rheumatologist community and patients. Our team has built solid partnerships with the Childhood Arthritis and Rheumatology Research Alliance (CARRA), the Pediatric Rheumatology Collaborative Study Group (PRCSG) and the Pediatric Rheumatology Care and

I BELIEVE COLLABORATION IS KEY FOR HIGHQUALITY CLINICAL RESEARCH TO IMPROVE CARE AND OUTCOMES.

INTERVIEW

Outcomes Improvement Network (PR-COIN). Our efforts collectively focus on clinical research and improving the quality of medical care within the field.

What are some recent advancements in pediatric rheumatology that you feel are important? Recent literature has described numerous advances in the field of pediatric and adolescent rheumatology. In 2019, the American College of Rheumatology/Arthritis Foundation (ACR/ AF) published guidelines for the management of children with juvenile idiopathic arthritis (JIA), the most common rheumatic disease of childhood. The guidelines suggest treatment approaches for non-systemic polyarthritis, sacroiliitis and enthesitis. They recommend a limited course of oral glucocorticoids (<3 months) may be used as bridging therapy for patients with significant disease activity, but not for those with low disease activity. However, regardless of disease activity, the ACR/AF strongly recommended against adding chronic low-dose glucocorticoids in this population, given the long-term adverse effects in children. Another highlight pertains to treatment of JIA cases with sacroiliitis who fail non-steroidal anti-inflammatory medications (NSAIDs). They recommend against use of methotrexate monotherapy, and strongly suggest starting a biologic therapy such as a tumor necrosis factor alpha inhibitor (TNFi). The ACR expects to release additional JIA guidelines in 2021, which will be important to our patients’ medical treatment.

In the practice of pediatric rheumatology, what makes Nationwide Children’s Hospital different from others? At Nationwide Children’s Hospital, we are committed to providing the best quality of medical care to children and adolescents with rheumatic diseases. We have a team of multidisciplinary providers, including seven pediatric rheumatologists, two nurse practitioners, three pediatric rheumatology fellows, a team of rheu-

matology nurses, a specialty pharmacist, a psychologist, a social worker, a quality improvement specialist, a dedicated research coordinator and registration staff. Together, we provide comprehensive care to our patients through inpatient, outpatient, infusion and even telehealth visits. We work closely with other specialty centers at Nationwide Children’s Hospital, such as ophthalmology, gastroenterology and pain management. We also offer interdisciplinary diagnosis, treatment and management through specialty clinics for lupus, arthritis, hypermobility and other rheumatic conditions. Children with arthritis can benefit from our diagnostic and therapeutic musculoskeletal ultrasound clinic, for example. We treat the whole patient by ensuring that we are meeting all of their individualized medical and psychosocial needs.

How do you interact with parents and prepare them to take part in their children’s treatment journey?

AS A TEAM, WE STRIVE TO SIMPLIFY COMPLEX TREATMENT REGIMENS WHENEVER POSSIBLE TO MAKE IT EASY FOR THE FAMILY AND PATIENT TO BE SUCCESSFUL ON THERAPY. WE ASSIST THE FAMILY UNIT BY PROVIDING NEEDED EDUCATION AND PSYCHOSOCIAL SUPPORT THROUGHOUT THEIR JOURNEY, FROM PREDIAGNOSIS THROUGH TO FOLLOW-UP CARE.

My goal is to help each and every patient achieve the best health outcomes. As part of this goal, I partner with parents and guardians to assist our patients through their chronic illness journey. We describe the experience as a journey that starts with a shared understanding of the patient’s medical and psychosocial needs, and we look at it in the context of a family’s resources. We develop a personalized care plan that will best serve the patient. We then provide treatment recommendations based on the best available evidence and partner with the patient and family to facilitate truly shared decision-making. As a team, we strive to simplify complex treatment regimens whenever possible to make it easy for the family and patient to be successful on therapy. We assist the family unit by providing needed education and psychosocial support throughout their journey, from pre-diagnosis through to follow-up care. To learn more about Nationwide Children’s Hospital and Dr. Barbar-Smiley, visit NationwideChildrens.org/Specialties/Rheumatology.

ARTICLE

Do Patients Ever Fully Recover From COVID-19?

t this stage of the pandemic, many are aware of the acute dangers of COVID-19. But are patients truly in the clear after recovery? We asked Dr. R. Taylor Ripley, director of the Mesothelioma Treatment Center at Baylor St. Luke’s Medical Center’s Lung Institute, to provide insight into the long-term consequences of COVID-19.

How does COVID-19 damage organs? The virus, SARS-Cov-2, attaches to the body’s cells and enters those cells — called “hosts.” The virus cannot grow on its own, so it takes over the host’s machinery to produce more virus and spread to additional cells and other organs. This virus damages the organs directly by infecting the cells of the organs, but it also causes severe inflammation that affects the whole body. Many of the effects of this virus in patients with critical illness may actually be secondary to the severe inflammation.

Which organs are most affected by COVID-19? The lungs are the most affected. For patients with mild symptoms, shortness of breath and cough are common. As the disease gets worse, shortness of breath and decrease in oxygen in the blood occurs. Once patients experi-

SEPT.OCT 2020

MY SUSPICION IS THAT WE WILL BOTH DIRECTLY AND INDIRECTLY DEAL WITH HEALTH CONSEQUENCES FROM COVID-19. AS DISCUSSED ABOVE, RECOVERY FROM ILLNESS MAY HAVE CHRONIC EFFECTS FROM THE DAMAGE.

ence these more moderate symptoms, they are more likely to come to the hospital or doctor’s office. The other organs are more affected as the disease progresses to severe symptoms. Our patients have experienced heart and kidney failure as well as lung failure. Once major organs are severely affected, these patients are critically ill and often in the ICU.

Can damage to one organ cause the failure of other organs? Absolutely. When organs such as the lungs, heart, kidneys, brain, and liver start to fail, they affect one another. For example, if the heart does not pump blood well, then the blood with oxygen and nutrients is not delivered well enough to other organs. Additionally, if the lungs do not absorb enough oxygen from the air, then that’ll affect all organs. The kidneys clear toxins, so if they do not work, the toxins in blood build up, causing damage to other organs.

Who is most vulnerable to lung damage due to the virus? Patients who are most vulnerable to the severe effects of COVID-19 have underlying medical conditions, such as severe heart disease, chronic kidney disease, emphysema or COPD, both type I and type II diabetes. Additionally, patients with cancer, sickle cell

ARTICLE

disease, and organ transplantation are at high risk. Evidence for other conditions, such as high blood pressure, smoking, and asthma, is more limited, but patients with these conditions may also be at risk.

and esophageal cancer, that mild, daily aerobic exercise is the best prevention of clots. Walking, swimming, or the exercise bike five days per week may have more health benefits than most medications. The blood pools in the legs and pumps back up the body by moving the muscles of the legs. Walking helps prevent clots from forming in the lower legs.

Doctors have witnessed an increase in blood clots in COVID-19 patients. How do these clots affect patients? Infection with the novel coronavirus has been associated with increased inflammatory states that likely causes increased clots. The components of blood are dynamic and respond to injury by clotting to prevent bleeding. When this response is not appropriate, those clots can block vessels that need to supply blood to the body. When blood flow to the lungs is blocked, which is called a pulmonary embolism, the lungs are unable to transfer oxygen from the air to the blood and the body. This situation causes extreme difficulty breathing and is treated by ventilators. Ventilators are a limited resource, which is why flattening the curve is so critical, to make sure that enough ventilators are available for patients. Every part of the body needs blood because blood supplies oxygen and nutrients to all organs, therefore, lack of blood flow can really affect every part of the body.

Can these blood clots be prevented? Doctors have become much more experienced with patients with COVID-19. We are particularly grateful to our colleagues, especially in New York, who dealt with this disease first. They communicated with many of us around the country about their experiences, which has helped us tremendously. From that experience, we have learned to be proactive about anticoagulation medicine for patients in the hospital and especially in the ICU. For patients who are not hospitalized or not sick at all, preventing blood clots with medication is uncertain and normal recommendations should be followed. First, I would not recommend taking medication to prevent clots unless prescribed by your doctor. Second, I tell all my patients, especially with cancers such as mesothelioma, lung cancer,

Are there any other long-term complications of the virus? Right now, the long-term damage is unknown, but we are certainly concerned that this disease could have chronic effects for patients. Given the little information on this topic, the best method to deal with these issues is to avoid infection if at all possible. That is why social distancing and masks are so important. Eventually, a vaccine that prevents the disease will be the best management to avoid ever dealing with these complications.

Do you think our nation will witness an increase in future health concerns due to this pandemic? WE ENCOURAGE YOU TO CONTINUE PRACTICING THE PROPER PRECAUTIONS TO PREVENT THE SPREAD OF COVID-19 WHILE ALSO MAINTAINING YOUR HEALTH THROUGH REGULAR CHECKUPS AND SCREENINGS. NOW IS THE TIME TO TAKE CARE OF YOUR FUTURE HEALTH. WEâ&#x20AC;&#x2122;RE OPEN FOR YOU, SAFELY.

My suspicion is that we will both directly and indirectly deal with health consequences from COVID-19. As discussed above, recovery from illness may have chronic effects from the damage. Indirectly, we have seen a significant decrease in patients presenting to the hospitals or clinics with routine diseases such as cancer or heart disease. If patients stay home with mild symptoms, such as chest pain in which they would normally come for care, they may have heart disease that progresses. In this situation, when they eventually do seek care, their disease may be worse and harder to manage. Similarly, patients should still seek care for mild symptoms or undergo routine screening, such as colonoscopy, mammograms, and possible CT tests to look for colon cancer, breast cancer, and lung cancer, based on normal recommendations. If the screening is delayed, these cancers may progress.

ARTICLE

Covid-19, the catalyst towards transformative healthcare By Dr. Prem Jagyasi, a globally acclaimed, award-winning strategic leader and speaker and world renowned medical tourism consultant.

he brutal Covid-19 assault has laid this bare – over decades we have nurtured faulty healthcare systems and practices that failed to make us resilient to diseases. Revolutionary breakthroughs and advancements in modern medicine could not save lives. Healthcare systems need to be transformed in all aspects- organization, distribution, approach and delivery. It needs to evolve beyond digitalization. Global healthcare burden has been touching new highs even before the pandemic struck. The Covid-19 has been enforced to revisit existing systems and fix the flaws at the root.

Our lifestyle and environment skyrocketing illness

COVID-19 PERHAPS TAUGHT US TO VIEW HEALTHCARE FROM BOTH PREVENTIVE AND CURATIVE PERSPECTIVES. DESPITE KNOWING THE BENEFICIAL SIDE OF PREVENTIVE MEDICINE, GLOBAL HEALTHCARE HAS LAGGED IN MAKING IT ADOPT AS A GENERAL PRACTICE.

The world population has fallen prey to its own activities; Covid-19 is just a catalyst. The massive immune-compromised population gave easy access to the virus. The following research findings provide enough support to this: • External factors and environment including our surroundings, healthcare system, education, culture, and practices contribute to 80-90% of our health outcomes. • According to the American Psychological Association (APA), loneliness and social isolation are twice as harmful to physical and mental health as equivalent to obesity. • APA research also shows stress can have a bad impact on immunity. • The UN warns of a looming global mental health crisis due to Covid-19 causing more deaths from despair. • Preventable non-communicable diseases (NCDs) like hypertension, diabetes, obesity, kidney problems, lung disorder, and cancer contribute most to the global healthcare burden that kills 41

SEPT.OCT 2020

•

million people every year equivalent to 7 of 10 global deaths. A CDC report suggests 94% of Covid-19 deaths had some co-morbid conditions with diabetes and cardiovascular diseases contributing more to the death count. Urbanization and unhealthy lifestyles have fuelled the NCD crisis causing 15 million premature deaths (before the age of 70) every year.

Resetting the conventional healthcare Preventive measures are discussed more than treatments. Covid-19 perhaps taught us to view healthcare from both preventive and curative perspectives. Despite knowing the beneficial side of preventive medicine, global healthcare has lagged in making it adopt as a general practice. • Only 4% of the global health expenses are on public or community health, risk reduction, and prevention. • CDC studies say, chronic conditions preventable through proper care services account for 75% of America’s healthcare expenditure, lowering the economic output by $260 billion every year. • Proper administration of the recommended preventive care to everyone could save 100,000 lives per year. It is an accepted norm to spend trillions on treating the sick. The environment, lifestyle, and socioeconomic factors contributing to general health are not counted which increases the vulnerability to chronic diseases.

Mending the broken healthcare with a paradigm shift in approach Without a sound preventive healthcare system in practice, the global population will continue to face the worst causing more severe impact on lives and the economy. It is not that Covid-19 will be the last and worst of the pandemics. The following measures could help in

ARTICLE improving the resilience of healthcare systems saving more lives in the future:

Acknowledge social-determinants of health and wellness Dense and overcrowded places invite more diseases. Government-induced regulations in buildings, dwellings, town planning, sanitization standards and other health protocols will facilitate better health. People irrespective of social standing should have access to basic healthcare and living standards.

Taking an integrative approach with Social prescriptions It should not be about prescribing pills to reduce specific symptoms but a holistic approach to diagnosis. Social prescriptions need to be suggested more where people can opt for natural healing activities instead of solely depending on prescription medicines.

Encourage studies and research on preventive medicine

EVEN BEFORE THE PANDEMIC HIT US, TELEHEALTH SERVICES WERE ALREADY IN USE. THE COVID CRISIS ACCELERATED IT FURTHER RIGHT FROM LARGESCALE PRE-VISIT SCREENING AND TRIAGE ASSESSMENT TO ROUTINE PATIENT MONITORING AND AFTERCARE. APART FROM PATIENT CONVENIENCE, REMOTE HEALTHCARE HAS THE POTENTIAL TO ADDRESS CAPACITY CHALLENGES.

Healthcare needs more evidence-based outcomes of preventive medicine. Global bodies need to encourage and support wide-scale studies and research to establish best practices. More importance should be on screening, testing and follow-ups ensuring treatment compliance of patients.

Shifting to remote care Even before the pandemic hit us, telehealth services were already in use. The Covid crisis accelerated it further right from large-scale pre-visit screening and triage assessment to routine patient monitoring and aftercare. Apart from patient convenience, remote healthcare has the potential to address capacity challenges.

Wider application of Big Data and analytics Big data and analytics have helped in predicting and analyzing the pandemic and develop effective treatments. Healthcare systems need to align their operations to enable better collection for assessing risk-factors and incidences of various diseases within a population.

Educate and empower people to be health compliant

Taking conscious efforts is the key to health and wellness. Healthcare systems need to include engaging programs to educate and support people to make healthy choices. Healthcare tech could play a vital role in this.

Need for better preparedness Surely, global healthcare was caught unprepared. Efficient collaboration creating networks with clinical laboratories, hospitals, clinics, and academic organizations is the key to effective crisis management. Healthcare systems need to be more proactive in quick resource mobilization and reduce response times to meet unprecedented service demands.

Creating more trained and skilled professionals Healthcare has been struggling with an acute workforce shortage long before the Covid pandemic struck. Newer education and training strategies are required not only to create more physicians and specialists but also to build a robust paramedic force for efficient crisis management.

Restructuring primary healthcare and making affordable secondary and tertiary care Governments need to step up primary healthcare facilities with increased spending. Innovative financial solutions are needed to make secondary and tertiary care affordable. Future contagions and other healthcare emergencies are inevitable in this highly-interconnected world. A catastrophe of this magnitude helps to revisit the existing systems and mend the flaws. Healthcare tech advancements are a boon to the current changes that could be leveraged significantly to improve the healthcare operations and delivery effectively connecting with the masses.

Dr Prem Jagyasi has authored Medical Tourism Guidebook and Wellness Tourism Guidebook. He has also delivered numerous keynote speeches and focused corporate workshops in 45+ countries. More than 150 international organizations have benefited from his expertise through conferences, expert training, consultancy and brand management services. http://drprem.com

INTERVIEW

Founder of TMI – Turismo Medico Italia and Italian Healthcare

Mr. Stefano Urbani “By completely innovating the strategy in accordance with the new market trends and taking great care in doing so, while remaining within the constraints that the pandemic currently imposes on the health tourism market.”

tefano is the founder of TMI, Turismo Medico Italia. The first innovative Italian startup in the market of medical tourism, providing medical services for incoming to Italy foreign patients seeking for life treatments, medical check-ups or wellness and SPA, and providing an outbound to over ten countries in the world for Italian patients seeking for a no-life treatment abroad. As a medical tourism & international healthcare expert, he also provides advisory services to medical providers for international business development. Trained as a management engineer in the Politecnico di Milano with an Executive MBA, he also studied Global Business Management in Boston College and Negotiation in Audencia Business School. He also has professional experience as a Management Consultant and Corporate experience in Business Development in Italian regions, Europe, CIS and Arabic countries, Organizational and HR management, Operations, Procurement. As You know, Italy was one of the most affected countries even before the WHO declared the pandemic on 11 March 2020, managing

SEPT.OCT 2020

effectively but with great difficulty and commitment of the population the circulation of the virus Covid-19. We interviewed Stefano asking him some questions on how the medical tourism market is moving and what are his forecasts in this regard.

As travel markets start to thaw from a deep freeze, what about health tourism? Travel market and health tourism are two very different markets for two specific reasons: a) The market value – Travel market has earned between $5.29 trillion (1) and $8.27 trillion (2) in 2017, while health tourism has achieved between $53,768 million (3) and $439 billion (4) during the same year. As you see, there is a comprehensive deviation between the amounts in travel market (+/-20%), while this deviation in medical tourism is phenomenally high. And secondly, travel market has gained approximately thousand times more than health tourism. This means that if we have sufficient indicative data for the tourism market for medical tourism there are no reliable data; b) The market choice lever and the target. Tourists are travelling for pleasure,

HEALTHCARE PROFESSIONALS’ EXPERTISE, HEALTH CARE WORKERS’ PAY, AND TRAVEL DISTANCES ARE BEING RECOGNIZED AS FACTORS OF A HIGHER VALUE, MEANWHILE VACCINATION RATES, ORGAN DONORS AND ORGAN TRANSPLANTS, ROAD ACCIDENTS AND GENDER ARE NOT AS CRUCIAL ANYMORE.

INTERVIEW

patients are travelling for health reasons; they are searching for a medical service that can save their life or that it can make them feel better, in the body and in the spirit. Because of these two reasons, linking the two markets is not appropriate (except for some wellness tourism services). However, it is undisputed to say that to be cured a patient must travel and, therefore, use the tourism market as a tool. This is the reason why we can assume that, in this world pandemic situation, the trends of travel market can be consequently compared to the trends of health tourism market.

Will medical tourism ever "return to normal"? Social distancing, masks, disinfected transport, quarantine have to be taken into consideration when traveling abroad... the world as we know it has completely changed: the healthcare industry and medical tourism are no exception. Healthcare professionals’ expertise, healthcare workers’ pay, and travel distances are being recognized as factors of a higher value, meanwhile vaccination rates, organ donors and organ transplants, road accidents and gender are not as crucial anymore (5). With these few words, the great changes that we can hypothesize about are already significant: increase of students in medical universities, reduction of medical visits for fear of going out of the country or localized lock-downs, reduction of the organ transplant segment and the orthopedic segment, and finally an increase in the segment of medically assisted procreation. You can only imagine how many other variables are involved and their consequences for the market. For this reason, if by "normal" we mean before the pandemic, I believe that the medical tourism market will never go back to the way it was before. Certainly not during the pandemic, but perhaps once the entire population will be immune and the virus will be defeated.

Which travelers will return? What will be their concerns, and what services will they seek? Patients who return to travel will be seeking the same medical services they were looking for

prior to the pandemic. The substantial differences will be linked to the percentage shares of each of the segments and to the reasons that will push a person to seek treatment abroad. Complementary services (administration, accountability, logistics etc.) will be more important from the patient's point of view. Concerns will be linked to the travel, the local pandemic situation in the destination country, the possibility of being reimbursed in the event of a lock-down in one's country of origin or in the country of destination. The variables are many and the complexity has increased. As for the services, it is interesting to see an increase of medical check-ups linked to the touristic journey and the increase of the local medical tourism, within the own country.

While travel is resuming, how can providers and destinations prepare for business activity in the health, wellness, dental & medical tourism markets? I agree with Manfred F. R. Kets de Vries (6) when he said that despite the enormous number of jobs lost, the pandemic could be an opportunity to direct our attention to other kinds of activities. What parts of the economy would we like to restore, and what parts could we do without? Given the increasing concern about our planet and the disastrous effects of global warming, do we really need all this commuting, all this air travel? Daily downloads of the Zoom app have increased 30x year-over-year. Zoom said daily users spiked up to 200 million in March 2020, from 10 million in December 2019. Telemedicine during the coronavirus epidemic has been the doctors’ first line of defense to slow the spread of the coronavirus, keeping the social distancing and providing services by phone or videoconferencing for mild cases, to focus personal care and limited supplies to the most urgent ones. The number of people connected is booming. Health tourism must consider that there will be a strong growth of second opinions through telemedicine tools and that people will be less inclined to travel. It just feels that we are getting ready to take a giant leap tomorrow. During the pandemic we

PATIENTS WHO RETURN TO TRAVEL WILL BE SEEKING THE SAME MEDICAL SERVICES THEY WERE LOOKING FOR PRIOR TO THE PANDEMIC. THE SUBSTANTIAL DIFFERENCES WILL BE LINKED TO THE PERCENTAGE SHARES OF EACH OF THE SEGMENTS AND TO THE REASONS THAT WILL PUSH A PERSON TO SEEK TREATMENT ABROAD.

INTERVIEW

have been able to carve out so many amazing strategies which were just not possible with fast pace routine. Providers should invest more in technology and telemedicine, set-up their strategy with the new market rules, launch wellness documentaries, restructure and recycle entire guides and magazines and get ready for more engaging content, check and update the list of medical services to be in line with the future requests, establish new market area about international target etc.. However, I am not optimistic about destinations intended as countries. Each country will have to invest to reduce the economic impact of the pandemic internally, so I strongly doubt the government’s actions will aim at marketing its brand as a country in the health tourism market. In any case, Dr. Prem updates weekly how each country is trying to reintroduce itself in the medical sector with communication and investment actions to support incoming tourists and health tourists (7).

Which segments of these markets will return first? Already today we are witnessing a trend that links the travel market to the medical tourism regarding preventive check-ups or second opinion check-ups. In August 2020 we received dozens of requests from Russian patients interested in check-ups both in Rome and in Milan, combining a few days with sightseeing and leisure activities... this is probably one of the markets which is being established. We are starting to receive some questions from Italian patients interested in dental care, aesthetic plastic surgery and hair transplantation, and finally, medically assisted procreation in the European countries, as well as other countries in the world which we work with. However, they are very few compared to January 2020, before the lockdown, and the few who call us feel very insecure and anxious about traveling. I just recently came back from an educational trip to the Thermal SPA of Abano Terme, place well known around the World for its salso-bromo-iodic water, which we are working with in the wellness market and at the moment the foreign patients, who make up more than

SEPT.OCT 2020

50% of the total, are still not present. There are no reservations for the next few months, but I believe that this sector will be one of those that will start again first, because with the pandemic the awareness of prevention has increased. On the other hand, I am not so optimistic about life-saving treatments, such as cardio-surgical or oncological treatments, or major interventions such as orthopedic and neuro-surgical. As long as we have to live with Covid-19, there will be less cases of this type compared to before.

Among healthcare systems, now that the immediate challenges of the pandemic have passed, how difficult will it be to resume elective and ambulatory procedures? In Italy, some elective and ambulatory procedures have already begun, such as check-ups for foreign patients. The issue will be to plan these procedures in accordance with each country’s regulations in force that oversee quarantine. The difficulty that I see entering the perimeter is the reduction in the timing between the patient's request and the moment of delivery of the procedure, as it is not possible to plan over a medium or long term. To better manage this problem, we have broken the patient management process, which we call "All Around You", into two phases: I. Taking charge of the request until the treatment plan and the estimate quotation are issued; II. Time programming. Clearly separating these two macro-activities allows the patient to calmly start his request for treatment abroad and to manage all the actors involved in the supply chain in accordance with the developments of the pandemic situation. Obviously, this methodology is valid only for minor cases.

For resorts, spas and other operators focused on the wellness markets, will they be able to resume “normal” business? I believe it will be challenging before the end of pandemic and disappearance of the virus.

DAILY DOWNLOADS OF THE ZOOM APP HAVE INCREASED 30X YEAR-OVERYEAR. ZOOM SAID DAILY USERS SPIKED UP TO 200 MILLION IN MARCH 2020, FROM 10 MILLION IN DECEMBER 2019. TELEMEDICINE DURING THE CORONAVIRUS EPIDEMIC HAS BEEN THE DOCTORS’ FIRST LINE OF DEFENSE TO SLOW THE SPREAD OF THE CORONAVIRUS, KEEPING THE SOCIAL DISTANCING AND PROVIDING SERVICES BY PHONE OR VIDEOCONFERENCING FOR MILD CASES, TO FOCUS PERSONAL CARE AND LIMITED SUPPLIES TO THE MOST URGENT ONES..

INTERVIEW

And since it seems that the period of coronavirus 19 disease will continue for some time, I suspect that the travelers’ habits will have consequently changed, and it will not be possible to apply pre-covid game schemes anymore.

How can health tourism providers and destination management organizations plan for the future? By completely innovating the strategy in accordance with the new market trends and taking great care in doing so, while remaining within the constraints that the pandemic currently imposes on the health tourism market. In addition to this, the new model will have to be flexible and prepared to attack the market at the end of the pandemic both quickly and effectively.

With respect to your specific business, how did you experience the onset of the pandemic and the lock-down in Italy? As medical travel consultants and medical tourism startup we are small and market sensitive. We have limited budgets and cash flow, and we are most sensitive to fluctuations in medical travel flow caused by ‘COVpanic’. We cut back on marketing and dismissed personnel, and there is a high risk to disappear from the market. We had to open a second round of investment to restart our business after the COVID-19 crisis.

What strategies are you putting in place to survive? We are focusing on providing services for Italian patients interested in medically assisted procreation treatments abroad, as well as dentistry, aesthetic plastic surgery and hair transplantation. We have contracts with hospitals and clinics in over ten countries but now we have also started to activate the services of Italy to Italy (intra-regional). As for foreign patients who come to Italy, we are focusing on check-ups, second opinions and wellness, thermal baths and spas. In the meantime, we are trying to tie ourselves exclusively to a well-known Italian health group to have an economic strength to withstand the devastating impact of this global crisis. Footnotes (1) Oxford Economics Global Travel Market Study (2) World Travel and Tourism Council (WTTC) (3) PR Newswire (4) Medical Tourism Association, MTA (5) 2020 The New York Times Company (6) Distinguished Professor of Leadership Development and Organisational Change at INSEAD. (7) https://drprem.com/medical-tourism/ medical-tourism-updates-in-covid-crisis?fbclid=IwAR3GofAUGP85rziwwMFIj3VIFJ7BuQI2js80jCGT9IHDYiEptN5ZBfBvDrw and https://drprem. com/wellness/wellness-tourism-news-updates-and-trends-in-covid-19-crisis/?fbclid=IwAR1J-AiNbH56Ca4xjOrK4LYRtdDjftgVEMuvsDOAy1dGFRklcoo_ J0OE19E

ARTICLE

Role of Nutrition in Mental Healthcare

M Afaa Mohammed Al-Masry Dietitian at Al Ahli Hospital

ental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. As countries introduce measures to restrict movement as part of efforts to reduce the number of people infected with COVID-19, more and more of us are making huge changes to our daily routines. The new realities of working from home,

SEPT.OCT 2020

temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues take time to get used to. Adapting to lifestyle changes such as these, and managing the fear of contracting the virus and worry about people close to us who are particularly vulnerable, are challenging for all of us. They can be particularly difficult for people with mental health conditions. Mental health remains a neglected part of public health agendas, even though mental health conditions account for nearly

ARTICLE

20% of years of life lost due to disability and are associated with up to US$ 1 trillion per year in economic losses. Over 300 million people worldwide suffer from depression (and almost the same number from anxiety disorders), while global suicide (up to 800 000 deaths per year) is a leading cause of death in young people. The statistics for common mental disorders are increasing because populations are growing, and more people live to the age when depression and anxiety most commonly occur. Mental health problems have a big health and social impact on societies. It has recently been estimated that mental, neurological and substance-use disorders (i.e. schizophrenia, depression, epilepsy, dementia, alcohol dependence) account for 13 % of the global burden of disease placing mental illness as the greatest burden, exceeding both CVD and cancer. While sobering, these figures are perhaps unsurprising since there is now one new case of dementia diagnosed every 4 s, or 7•7 million cases per year. More than 300 million people are now living with depression, an increase of more than 18 % between 2005 and 2015. By 2020, it is estimated that between 15 and 30 million people will attempt suicide and approximately 1•5 million per year will die by suicide each year. Depression is ranked by WHO as the single largest contributor to global disability (7.5% of all years lived with disability in 2015). Mental health problems are believed to be the result of a combination of factors, including age, genetics and environmental factors. One of the most obvious, yet under-recognized factors in the development of major trends in mental health is the role of nutrition. The treatment implications of research into nutrition and mental health have rarely been acknowledged by mainstream medicine, yet the potential returns are enormous.

The role of diet in relation to mood and mental wellbeing Just like the heart, stomach and liver, the brain is an organ that is acutely sensitive to what we eat and drink. To remain healthy, it needs different amounts of complex carbohydrates, essential fatty acids, amino acids,

vitamins and minerals, and water. Anyone who has ever smoked, drank alcohol, tea or coffee or eaten chocolate knows that such products can improve one’s mood, at least a little and temporarily. What seems to be less common is an understanding that some foods can have a lasting influence on mood and mental wellbeing because of the impact they have on the structure and function of the brain. The last fifty years have witnessed remarkable alterations to what we eat, how we process and refine it, food additives, use of pesticides and the alteration of animal fats through intensive farming. Diets high in refined sugars, for example, are harmful to the brain. In addition to worsening your body’s regulation of insulin, they also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function — and even a worsening of symptoms of mood disorders, such as depression. It makes sense. If your brain is deprived of good-quality nutrition, or if free radicals or damaging inflammatory cells are circulating within the brain’s enclosed space, further contributing to brain tissue injury, consequences are to be expected.

MENTAL HEALTH PROBLEMS ARE BELIEVED TO BE THE RESULT OF A COMBINATION OF FACTORS, INCLUDING AGE, GENETICS AND ENVIRONMENTAL FACTORS. ONE OF THE MOST OBVIOUS, YET UNDER-RECOGNIZED FACTORS IN THE DEVELOPMENT OF MAJOR TRENDS IN MENTAL HEALTH IS THE ROLE OF NUTRITION.

How fats and amino acids work in our brains Because the ‘dry weight’ of the brain is composed of about 60% fat, the fats we eat directly affect the structure and substance of the brain cell membranes. Saturated fats – those that are hard at room temperature, like lard – make the cell membranes in our brain and body tissue less flexible. Twenty per cent of the fat in our brain is made from the essential fatty acids omega-3 and omega-6. Each fatty acid performs vital functions in the structuring of brain cells (or neurons), ensuring that smooth communication is possible within the brain. Both are found in equal amounts in the brain, and it is believed they should be eaten in equal amounts. Unequal intakes of omega-3 and omega-6 fats are implicated in a number of mental health problems, including depression, and concentration and memory problems. The

ARTICLE

recent and widespread appearance of transfat in the diet raises great concern, primarily because these fats assume the same position as essential fatty acids (EFAs) in the brain, meaning vital nutrients are not able to assume their rightful position for the brain to function effectively. Trans-fats are prevalent and pervasive, found in processed foods like commercially-made cakes, crisps and ready meals.

Amino Acids are the building blocks for Neurotransmitters Neurotransmitters are messengers passed back and forth within the brain. They allow neurons to communicate information amongst themselves. Neurotransmitters are made from amino acids, which often must be derived directly from the diet. For example, the neurotransmitter serotonin, which is associated with feelings of contentment, is made from the amino acid tryptophan. Adrenaline and dopamine, the ‘motivating’ neurotransmitters, are made from phenylalanine. A sufficient balance of neurotransmitters is essential for good mental health, as they are influential in the feelings of contentment and anxiety, memory function and cognitive function. Some foods are perfect at temporarily promoting the neurotransmitter that we lack and, as we crave and then consume them, they ‘trick’ us into feeling better, for a while. By making the brain less sensitive to its own transmitters and less able to produce healthy patterns of brain activity, these substances encourage the brain to down-regulate. Down-regulation is the brain’s instinctive mechanism for achieving homeostasis: when the brain is ‘flooded’ by an artificial influx of a neurotransmitter (for example, adrenaline triggered by a strong coffee), the brain’s receptors respond by ‘closing down’ until the excess is metabolized away. This can create a vicious circle, where the brain down-regulates in response to certain substances, which in turn prompt the individual to increase their intake of those substances to get the release of the neurotransmitter that their brain is lacking. This is one reason why people sometimes crave certain products. Acetylcholine is a neurotransmitter that, if

SEPT.OCT 2020

deficient, causes deterioration of memory and imagination, fewer dreams, increased confusion, forgetfulness and disorganization. In order to ensure getting enough from this neurotransmitter, we need to avoid sugar, deep-fried food, Junk foods, refined and processed foods, Cigarettes and Alcohol. We get good levels of Acetylcholine through consuming organic/ free-range eggs, organic or wild fish – especially salmon, mackerel, sardines and fresh tuna. Serotonin is a neurotransmitter that helps regulate sleep and appetite, mediate moods, and inhibit pain. Since about 95% of your serotonin is produced in your gastrointestinal tract, and your gastrointestinal tract is lined with a hundred million nerve cells, or neurons, it makes sense that the inner workings of your digestive system don’t just help you digest food, but also guide your emotions. What’s more, the function of these neurons — and the production of neurotransmitters like serotonin — is highly influenced by the billions of “good” bacteria that make up your intestinal microbiome. These bacteria play an essential role in your health. They protect the lining of your intestines and ensure they provide a strong barrier against toxins and “bad” bacteria; they limit inflammation; they improve how well you absorb nutrients from your food; and they activate neural pathways that travel directly between the gut and the brain. Serotonin deficiency affects the body by lowering the mood, inducing insomnia, feeling ‘disconnected’ and lacking joy. Consuming Alcohol decreases the amount of serotonin in the brain, whereas taking more fish, fruits, Eggs, avocado, wheat germ, Low-fat cheese Lean, and organic poultry increases its level. Dopamine deficiency symptoms include lacking drive, motivation and/or enthusiasm, and to crave stimulants. To ensure getting enough amount we need to avoid or limit consumption of Tea & coffee, caffeinated drinks & pills. While eating regular, balanced meals, increasing fruits and vegetables that are high in Vitamin C, Wheat germ and Yeast spread in our diet ensures that we are getting enough of this neurotransmitter. Last one is GABA, its deficiency in the brain

NEUROTRANSMITTERS ARE MESSENGERS PASSED BACK AND FORTH WITHIN THE BRAIN. THEY ALLOW NEURONS TO COMMUNICATE INFORMATION AMONGST THEMSELVES. NEUROTRANSMITTERS ARE MADE FROM AMINO ACIDS, WHICH OFTEN MUST BE DERIVED DIRECTLY FROM THE DIET.

ARTICLE

makes the person hard to relax, can’t switch off, anxious about things, Irritable, and self-critical, deficiency might be induced if we consume high amounts of sugar, alcohol, tea & coffee and caffeinated drinks. This neurotransmitter availability increases if we consume more dark green vegetables, seeds & nuts, potatoes, bananas and Eggs. Deficiencies in vitamins and minerals are sometimes implicated in a number of mental health problems. On occasions, the first symptom that a body is deficient in a certain micronutrient is psychological. In addition, some vitamins work as anti-oxidants, which protect the brain from the damaging process of oxidation. Vitamins and minerals also play a crucial part in the conversion of carbohydrates into glucose, fatty acids into healthy brain cells and amino acids into neurotransmitters. As such, they are vital in promoting and maintaining positive mental health. Vitamin B1 (Thiamin) deficiency causes poor concentration and attention, it is available in wholegrains and vegetables, whereas Vitamin B3 deficiency causes depression, but it can be avoided if we consume more from the wholegrains and vegetables, soymilk, and watermelon. Vitamin B5 deficiency is related to poor memory and stress, B5 is highly available in chicken, whole grains, broccoli, avocados, and mushrooms as well. If Vitamin B6 (pyridoxine) is deficient, it causes irritability, poor memory, stress as well

as depression. B6 is available in wholegrains, meat, fish, poultry, legumes, tofu and other soy products, and bananas Vitamin B12 deficiency causes confusion, poor memory, and psychosis. B12 is found in Meat, poultry, fish, milk, cheese, fortified soymilk and cereals. Vitamin C limited consumption causes depression but it can easily avoided if we consume Citrus fruit, potatoes, broccoli, bell peppers, spinach, strawberries, tomatoes, Brussels sprouts that are considered as very good sources. The last vitamin we will mention is Folic acid that is highly available in fortified grains and cereals, asparagus, spinach, broccoli, legumes (black-eyed peas and chickpeas), orange juice, but if deficient in the body it will cause anxiety, depression and psychosis. From all the essential minerals, three are more related to mental health which are Magnesium, Selenium and Zinc. Magnesium deficiency causes irritability insomnia and depression, it is found in rich sources are Spinach, broccoli, legumes, seeds, whole-wheat bread. Also Selenium deficiency is related to irritability and depression, Selenium is found in organ meat, fish, and seafood, walnuts, wheat germ, brewer’s yeast, liver, garlic, sunflower seeds, Brazil nuts, and wholegrains. The last mineral is Zinc, once deficient it will cause confusion, blank mind, depression, loss of appetite, and lack of motivation. We can get enough Zinc from meat, shellfish, legumes, whole grains, oysters, nuts, seeds and fish.

REFERENCES: 1. World Health Organization (2020) Mental Health. 2. Mental health and psychosocial considerations during the COVID-19 outbreak 18 March 2020 3. World Health Organization (2012) Dementia: a Public Health Priority. World Health Organization. 4. The role of diet and nutrition on mental health and wellbeing, Proceedings of the Nutrition Society (2017), 76, 425–426 5. Dr. Andrew McCulloch, Chief Executive. Feeding Minds, The impact of food on mental health. The Mental Health Foundation. 6. Eva Selhub MD, Contributing Editor .Nutritional psychiatry: Your brain on food. Harvard Health Blog. Posted November, 2015, updated March, 2020. Matthew Solan. Executive Editor, Harvard Men's Health Watch. 7. The best foods for vitamins and minerals, Published: September, 2016. Updated: February 6, 2019.

NEWS

King Faisal Specialist Hospital & Research Centre progresses transformation program by virtually upgrading its Integrated Clinical Information System

ing Faisal Specialist Hospital & Research Centre (KFSH&RC) has collaborated with Cerner during the COVID-19 pandemic to fully upgrade its Integrated Clinical Information System (ICIS) to the latest available Cerner software version. The conversion of this code upgrade broke new ground by being supported entirely by virtual means; ushering in a world class patient experience.

SEPT.OCT 2020

KFSH&RC manages three facilities in the Kingdom of Saudi Arabia and plays the role of a tertiary healthcare provider for specialized medicine services such as oncology, cardiology, transplants and fertility, with approximately one million outpatient visits each year. This strategic upgrade will enable KFSH&RC to continue innovating care delivery and hospital operations. In addition, it has yielded significant

KFSH&RC MANAGES THREE FACILITIES IN THE KINGDOM OF SAUDI ARABIA.

NEWS

enhancements in the system performance of KFSH&RC’s ICIS with the Cerner Millennium® electronic health record. “This pandemic has forcefully disrupted the day-to-day operations of healthcare organizations and put pressure on all providers to create novel ways in keeping patients at the center of healthcare. Physical distancing and staff safety combined with the value realization and impact this upgrade would have on KFSH&RC’s healthcare delivery model forced us to rise to the challenge,” said Osama Al Swailem, MD, MA, Chief Information Officer of KFSH&RC. “We had confidence that our healthcare IT staff, clinical department leaders and Cerner would come up with an innovative approach in getting our system upgraded with minimal downtime.” “This virtual upgrade has exposed the KFSH&RC informatics staff to a new delivery model,” Al Swailem explained. “In addition to the hardware and software enhancements we had with the upgrade, this project aimed at continually enhancing the patient and caregiver experiences, increasing safety, reducing cost and the elimination of manual processes . I have challenged all that were involved in continuing this innovative way of thinking to help define the new-norm in healthcare.”

The upgrade has introduced more than 500 software enhancements, including: •

•

• •

•

automation of oncology documentation and computerized physician order entry to enable better management of oncology care, digitization of transplant documentation, including integration with national and international transplant registries, barcoding of medication administration, blood products and supply usage, deployment of the Pharmacy Patient Monitor to improve Clinical Pharmacist usability; a full printing technology upgrade to

•

enable faster printing at higher quality and with greater formatting flexibility; a new viewer for staff to view patient records during planned and unplanned downtimes, device connectivity advancements to enable better bedside medical device integration, improved system connectivity and performance by approximately 49% for KFSH&RC staff; and new revenue cycle management capabilities related to billing and insurance claims.

Moreover, the KFSH&RC roadmap projects will significantly increase the availability of valuable data for analytics, such as chemotherapy timings, oncology protocol compliance, transplants survival rates, medication administration information through bar coding and integration with supply chain systems. This will empower KFSH&RC to further personalize care plans and proactively manage the health of its patients. “With more than 200 go-live team members, KFSH&RC and Cerner combined efforts to ensure a well-planned communication, an execution plan of the implementation process and a clear strategic roadmap for the next journey post the upgrade,” said Alaa Adel, Managing Director of Cerner Middle East and Africa. “We are honored to have been part of another key milestone at KFSH&RC and looking forward to more successes in the near future.”

THE KFSH&RC ROADMAP PROJECTS WILL SIGNIFICANTLY INCREASE THE AVAILABILITY OF VALUABLE DATA FOR ANALYTICS, SUCH AS CHEMOTHERAPY TIMINGS, ONCOLOGY PROTOCOL COMPLIANCE, TRANSPLANTS SURVIVAL RATES, MEDICATION ADMINISTRATION INFORMATION THROUGH BAR CODING AND INTEGRATION WITH SUPPLY CHAIN SYSTEMS.

As part of the Kingdom of Saudi Arabia’s Vision 2030, KFSH&RC is undergoing a significant transformation program aligned with its strategic vision of becoming a not-for-profit independent foundation and a world leader in healthcare through excellence and innovation. The program will provide the autonomy and flexibility needed to develop the organization’s existing services and resources as well as explore new opportunities.

ARTICLE

Alzheimer's Disease

G Dr. Fathi Abdal Qader Ahmed Consultant Internal Medicine at Al Ahli Hospital

od blessed humans by giving them the brain, while animals live by their instinct. Human uses their brain for many functions that help him to live a better life like thinking, understanding, reasoning, speaking, and making instruments and others. These processes carried out by having a huge number of highly specialized cells that have interconnections to yield a perfect brain function.

What is Alzheimer's disease (AD)? It is a disease affecting the brain, resulting

SEPT.OCT 2020

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

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 the age of 70 will have 10%

ARTICLE

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 classes or modes 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, it also found in many studies that low fruit diet, low education level, low social class, and heavy metal poisoning like mercury all might fasten the speed of disease development.

Is there any genetic predisposition for AD? The probability of having an AD increase in families with the first-degree relatives 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 notice forgetting recent events like where he kept his keys or mobile, or where he parks his car, or get lost in the streets, or did he take his medicine. Then with time start to forget bigger things like names and dates, and start to have the inability to recognize things visually and spatially (by touch) like remote control, also found difficulty in the use of household materials like knives. Lately, he might experience language difficulty in speaking, writing and reading, with theÂ difficulty of taking care of himself like changing clothes and bathing or take food 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 â&#x20AC;&#x201C; 4 years for the disease to progress from diagnosis to have the full picture. At first 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 their activities.

How to diagnose AD? Diagnosis takes place by history and clinical examination, investigations are 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 found at present time to stop or treat AD; medicines used to improve symptoms and make patients' lives better or to control psychiatric issues, they do so by changing the concentrations of the neurotransmitters in the brain especially acetylcholine. FDA approved medicine are rivastigmine, donepezil, galantamine, memontum. Nevertheless, they will not alter the disease progress.

NO EFFECTIVE THERAPY FOUND AT PRESENT TIME TO STOP OR TREAT AD; MEDICINES USED TO IMPROVE SYMPTOMS AND MAKE PATIENTS' LIVES BETTER OR TO CONTROL PSYCHIATRIC ISSUES, THEY DO SO BY CHANGING THE CONCENTRATIONS OF THE NEUROTRANSMITTERS IN THE BRAIN ESPECIALLY ACETYLCHOLINE.

What advice given to the patient family? The patient family should be instructed about their patient care and safety. The patient should not be irritated by using words that make him angry like disabled, useless, worthless and insignificant. Other measures are taken to protect him from harm like removing sharp objects, locking doors properly, stairs safety, secure electronic devices and avoiding chances of slip and falls. It is good to benefit from the sharing of social health organizations, which can provide home care and encourage them to visit AD patients at home, for proper follow-up and health assessment with monitoring patient conditions and give training for the patient 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 the cure for the disease soon.

ARTICLE FEATURES . Antibody Test

What is an Antibody Test? How Can Previous Coronavirus Infections be Detected?

edical laboratories are currently doing blood tests to detect the presence of antibodies, which determine whether there has been a previous Covid-19 infection. In fact, the test consists in detecting the presence of antibodies in a blood sample to determine if the person has previously been infected with the virus, and thus has developed components to fight a future infection.

SEPT.OCT 2020

ARTICLE FEATURES . Antibody Test

The antibody test is a screening for what is known as “antibodies” in the blood, which are developed by the body when fighting any viral infection such as Covid-19. This technique is known as ELISA and is an enzyme immunoassay that shows whether the person has previously been infected with the virus. Antibodies are proteins produced by the body to protect itself from any foreign body it is exposed to, i.e. when fighting an infection. The test requires taking a blood sample by a specialized laboratory expert. The sample is then placed on a dish that contains the specific antigen to be detected. If the blood contains antibodies to this antigen, the two will bind together, and then a change in the color will be noted. In turn, the change in color is measured to give an impression of the quantity of antibodies present in the body, and then the result is sent to the specialist doctor to be read and to diagnose the condition. Whenever a virus enters the body, the immune system works on fighting it by developing antibodies. A blood sample is therefore taken and placed in a thin plate, along with a chemical solution, and it is analyzed. The antibody test indicates the number of people who previously contracted Covid-19 and recovered from it, including asymptomatic people, which helps determine persons who developed an immunity against it. However, it is still unknown how strong and persistent that immunity is. To reveal the presence of a previous infection with the novel coronavirus, the doctor determines one or two types of antibodies to search for, i.e. the antibodies to SARS-CoV-2, which is the virus that causes COVID-19. If the antibodies – called IgM and IgG – are indeed present, the color of the sample changes, which means that this person was infected with the virus and had immunity to it. IgM antibodies appear at an early stage of the infection. IgG antibodies are likely to appear at a later stage and are more like a long-term memory – in the sense that the immune system preserves them, and in the event of exposure to infection in the future, it will be able to fight it. However, doctors and researchers have yet

THE IMPORTANCE OF THE TEST IS THE FACT THAT IT HELPS KNOW WHETHER THE PERSON IS NOT INFECTED WITH THE VIRUS AT THE TIME OF THE TEST OR IF THEY ARE INFECTED AND THEIR IMMUNE SYSTEM HAS DEVELOPED ANTIBODIES TO FIGHT THE VIRUS. MOREOVER, THE TEST HELPS KNOW IF A PERSON WAS INFECTED WITH THE VIRUS AND RECOVERED, SINCE HE WOULD HAVE DEVELOPED ANTIBODIES THAT WOULD FIGHT ANY POTENTIAL NEW INFECTION, WHICH MEANS HE DOES NOT HAVE TO DEVELOP IMMUNITY OR PREVENTION AGAIN

to know how long this takes in the case of novel coronavirus. The importance of this test lies in determining three possibilities: whether the person is not infected, whether they are currently infected and have a type of antibody developed by their immune system fighting the virus, and the third possibility is that they had been infected with the virus and recovered from it. The third scenario means they have antibodies that can fight infection again without achieving immunity and prevention from a new infection. These antibodies remember the virus during a possible second exposure. They mobilize the immune system to halt the disease again. However, what needs to be known is that it has not been established how effective these antibodies are at fighting a second infection, how many antibodies the body needs for a successful immune response and for how long the antibodies will stay with you – will they be kept for a few months or for years? The answers to these questions need more time as we try to understand this novel virus. The benefit of this test lies in the fact that people who have recovered from Covid-19 may be eligible to donate blood plasma to treat other people whose condition is critical, so that their ability to fight the virus is enhanced. The issue here needs more tests to determine the effectiveness of treating patients with the plasma of recovered patients. Among the benefits of the test is also helping researchers and scientists detect the characteristics of the virus, and to understand if recovered patients are immune to the virus or not. It also helps epidemiologists to know the number of people who were infected in the past and were not counted in official statistics, and it helps to know whether the numbers indicate access to a type of herd immunity in the community. This helps decision-makers in countries to take appropriate measures to ease or tighten the imposed restrictions. The antibody test also helps in the vaccine tests run on volunteers to follow the reaction of their immune system, and through this test, it is possible to follow up the immune system of people who have already been infected with the coronavirus and have been cured of it.

NEWS

Byondis Initiates Phase I Study of Antibody-Drug Conjugate SYD1875

yondis B.V. (formerly Synthon Biopharmaceuticals B.V.) announced that the first cancer patients have started treatment with its investigational antibody-drug conjugate (ADC) SYD1875. The First-in-Human Dose-Escalation and Expansion Study with the Antibody-Drug Conjugate SYD1875 will evaluate the safety, pharmacokinetics and preliminary efficacy of SYD1875 in patients with 5T4-expressing, locally advanced or metastatic solid tumors. While 5T4 plays an important role in the development of cancer, there are currently no drugs that target this specific tumor antigen. Patients are currently being enrolled in leading European oncology centers: Institut Jules Bordet in Brussels, Belgium; Institut Bergonié in Bordeaux, France; and Centre Oscar Lambret in Lille, France. “It is exciting and gratifying to know that SYD1875 has progressed to the clinical study phase, giving us the opportunity to explore the potential of another promising antibody-drug conjugate,” said Byondis CEO Marco Timmers, Ph.D. “Our ADC technologies aim to outsmart relentless cancers and improve patient outcomes by offering better tumor-killing properties with lower side effects.” SYD1875 is the second Byondis ADC to progress to clinical studies. The company’s anti-HER2 ADC [vic-]trastuzumab duocarmazine (SYD985) is its most advanced ADC, targeting a range of HER2-expressing cancers such as metastatic breast cancer and endometrial (uterine) cancer.

More on the SYD1875.001 Study The SYD1875.001 study will recruit roughly 90 patients, aged 18 and over, with histologically-confirmed, locally advanced or metastatic cancers that have progressed on standard therapy or for which no standard therapy exists.

SEPT.OCT 2020

The study will be conducted in two parts: Dose Escalation and Dose Expansion. Part 1, Dose Escalation, will enroll patients with any tumor type to determine the Maximum Tolerated Dose (MTD) and Recommended Dose for Expansion (RDE). Part 2, Dose Expansion, will enroll groups of patients with one of three types of cancers. These patients will receive the RDE determined in Part 1 to evaluate the efficacy and safety of SYD1875 in these cohorts. All patients in both parts of the study will receive SYD1875 infusions every three weeks until cancer progression or unacceptable toxicity.

DRIVEN TO IMPROVE PATIENTS’ LIVES, BYONDIS IS AN INDEPENDENT BIOPHARMACEUTICAL RESEARCH AND DEVELOPMENT COMPANY CREATING INNOVATIVE PRECISION MEDICINES TARGETING INTRACTABLE CANCERS AND AUTOIMMUNE DISEASES.

About SYD1875, a Next Generation Antibody-Drug Conjugate SYD1875 uses Byondis’ unique, proprietary linker-drug (LD) and site-specific conjugation technologies. Although marketed ADCs have improved therapeutic indices compared to classical non-targeted chemotherapeutic agents, there is still room for improvement. SYD1875 is a next generation ADC, comprised of a humanized IgG1 mAb (monoclonal antibody), and a cleavable linker-drug called valine-citrulline-seco-DUocarmycin-hydroxyBenzamide-Azaindole (vc-seco-DUBA), targeting the 5T4 oncofetal antigen employing the site-specific conjugation of HC-41C. The antibody part of SYD1875 binds to 5T4 on the surface of the cancer cell and the ADC is internalized by the cell. After proteolytic cleavage of the linker, the inactive cytotoxin is activated and DNA damage is induced, resulting in tumor cell death. SYD1875 can be considered a form of targeted chemotherapy. For the manufacturing of SYD1875, this ADC is relying on a single-step, selective reduction of the engineered cysteines, instead of a two-step reduction/ oxidation protocol that is commonly used for these types of ADCs and that can lead to undesired side-products.

SYD1875 is the second Byondis ADC to progress to clinical studies. The company’s anti-HER2 ADC [vic-]trastuzumab duocarmazine (SYD985) is its most advanced ADC, targeting a range of HER2-expressing cancers such as metastatic breast cancer and endometrial (uterine) cancer.

Shaping the industry, keeping the patient first.

NEWS

NEXT GENERATION ADC USES PROPRIETARY TECHNOLOGIES AIMED AT ENHANCING CANCER THERAPY EFFICACY AND SAFETY.

A unified voice for the regionâ&#x20AC;&#x2122;s MedTech industry. Add your voice by joining the Mecomed Medical Technology Association Middle East & Africa

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

www.mecomed.com

ARTICLE FEATURES . Plasma Therapy

What Is Plasma from Recovered Covid-19 Patients? How Does It Treat Patients with Novel Coronavirus?

hen infected with the novel coronavirus or other viral diseases, the immune system produces antibodies that attack the virus. Over time, the amount of antibodies known as "blood plasma" or as â&#x20AC;&#x153;the liquid component of the bloodâ&#x20AC;? increases. Extracting plasma from recovered Covid-19 patients means that their plasma contains antibodies that will give an immune boost and help other patients fight coronavirus. Antibodies are proteins in the blood that bind to parts of the viruses, which contributes to the reduction of the infection and warns the white blood cells to stay alert when the virus enters the body so they attack and eliminate it. In many cases, if the body encounters the same virus again, the immune system has antibodies that remember the previous infection.

SEPT.OCT 2020

ANTIBODIES ARE PROTEINS IN THE BLOOD THAT BIND TO PARTS OF THE VIRUSES, WHICH CONTRIBUTES TO THE REDUCTION OF THE INFECTION AND WARNS THE WHITE BLOOD CELLS TO STAY ALERT WHEN THE VIRUS ENTERS THE BODY SO THEY ATTACK AND ELIMINATE IT.

As soon as a new virus enters the body, the latter quickly starts producing antibodies, which takes a few weeks. The plasma therapy gives some Covid-19 patients hope that those antibodies will be transferred to them from recovered patients to help them fight the virus. According to scientists in this field, it is more likely that plasma will be more effective in those who have just had contact with infected people, which is the stage in which the body is trying to eradicate the infection.

Blood consists of four main components: 1. Red blood cells carry oxygen throughout the body. 2. White blood cells function in immune response.

ARTICLE FEATURES . Plasma Therapy

3. Platelets are responsible for blood clotting. 4. Plasma accounts for a little more than 50% of the blood volume. Plasma helps to distribute proteins, nutrients, and hormones throughout the body. Scientists today are showing great interest in plasma therapy for Covid-19 because it contains "post-infection antibodies," which are generally protective proteins that can bind to the surface of attacking microbes and help the immune system to destroy them. Blood plasma helps stimulate the immune system and create antibodies that generally contribute to reducing the duration and severity of the disease by decreasing the viral load, which often doubles with the length of the disease. Plasma therapy may prevent respiratory system damage and complications, such as severe shortness of breath, noting that the body does not produce antibodies until two to three weeks after being infected with coronavirus. Plasma cells release large amounts of antibody into the body, protecting it from the virus in two ways. First, antibodies can bind to antigens on the outside of the pathogen to stop it from entering the cells. This is extremely important, particularly for viruses, which replicate only inside the cells (so we do not get sick if the virus is stopped from entering our cells). Second, by binding to antigens, antibodies signal other white blood cells known as phagocytic cells, which engulf and destroy the pathogen. So, antibodies can both neutralize the virus and mark it for destruction. Is it a safe and effective treatment? Studies in this regard did not reach a conclusive and definitive answer. However, the results are somewhat encouraging, and all experts agree that more clinical trials are needed to compare plasma therapy with standard care methods. Another study from the Mayo Clinic suggested that plasma helped reduce death rates among patients when given early and when the antibody levels were high. But the study, which was not a clinical trial, has not yet been peer reviewed and does not use a placebo, which means that more trials are needed to confirm the effectiveness of the plasma.

PLASMA HELPS TO DISTRIBUTE PROTEINS, NUTRIENTS, AND HORMONES THROUGHOUT THE BODY. SCIENTISTS TODAY ARE SHOWING GREAT INTEREST IN PLASMA THERAPY FOR COVID-19 BECAUSE IT CONTAINS "POST-INFECTION ANTIBODIES," WHICH ARE GENERALLY PROTECTIVE PROTEINS THAT CAN BIND TO THE SURFACE OF ATTACKING MICROBES AND HELP THE IMMUNE SYSTEM TO DESTROY THEM.

The World Health Organization confirmed that international trials to treat coronavirus using blood plasma are still not conclusive, and called for evaluating the side effects of plasma therapy for Covid-19. It also warns using plasma taken from the blood of patients who have recovered from Covid-19 remains an experimental treatment, and that the initial results that show it may work are still inconclusive. The timing of testing greatly affects the accuracy of the results, as the body does not begin producing antibodies until at least about two weeks after the onset of symptoms, which means that performing a plasma test is useless in the early stage of infection. However, continuous studies in this field unanimously agree that a plasma test should be performed after complete recovery from the virus. In case the test confirms the presence of antibodies in the blood, this means that there was a previous infection with Covid-19 and the immune system was able to produce antibodies to fight it. Despite this, there is not enough evidence that the presence of antibodies means that the person is immune to infection because the level and duration of immunity are still unknown. More data and studies are required in this regard. The benefit of antibody testing is that people who have recovered from Covid-19 may be eligible to donate plasma, which can be used to treat other people with severe symptoms and enhance their ability to fight the virus.

ARTICLE

Ectopic pregnancy or ectopic minded

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

Diagnosis

Dr. Asmaa Abdulsalam Consultant of Obstetrics and gynecology at Al Ahli Hospital

Clinically, diagnosis of ectopic pregnancy is sometimes confusing and challenging as no ectopic is like another ectopic, the differential diagnosis of ectopic pregnancy should be always in the mind of the physician dealing with early pregnancy, i.e. Physician should exclude ectopic pregnancy in every woman in reproductive period, coming for the first antenatal visit or coming with vaginal bleeding and abdominal pain. The diagnosis is made based on: First: Taking detailed medical, surgical, obstetrical and gynecological history. Second: Symptoms: including missed period, irregular vaginal bleeding, lower abdominal pain which sometimes refers to the back and shoulder, associated with fainting attacks and dizziness, pain can be also felt lower in the perineum and anus. Third: Signs: including lower abdominal tenderness, guarding and rebound tenderness, pain on moving the cervix, and sense of fullness of Douglas pouch, while doing vaginal examination. Fourth: Laboratory tests; BHCG (pregnancy hormone) is essential in diagnosis of pregnancy, in normally growing pregnancy, BHCG hormone should double every 48 hours, so if it fails to show doubling, it is an indication of embryonic demise whether intra or extra uterine. Fifth: Then comes the role of ultrasound to locate the site of the ectopic, so High BHCG level with empty uterine cavity is considered diagnostic of ectopic pregnancy. In addition to other findings such as Adnexal mass or hematoma, presence of adnexal gestational sac with embryo with or without heart beats and in severe cases free blood in Douglas pouch and abdominal cavity can be seen.

SEPT.OCT 2020

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

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

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

Treatment of ectopic pregnancy Since the clinical picture differs from one woman to another the treatment will also vary based on the severity of the clinical symptoms, signs and the wish of the woman to preserve her fertility as possible. Type of treatment depends also on the degree of cooperation of the woman and the feasibility to follow her up closely. Another de-

ARTICLE

terminant is the availability of certain equipment and laboratory tests, so the physicians in rural poorly equipped parts of the world or in conflict areas may proceed into surgical options rather than conservative one. In other words, management should be tailored for each woman individually, the plan of management and the impact of this plan on the woman â&#x20AC;&#x2DC;s fertility should be extensively discussed and explained in details to the woman. So, treatment can be; Expectant conservative, Medical conservative, or Surgical. The physician should be flexible in changing the plan according to the progress of the disease and response of the patient to each type of treatment. Expectant management: No medical or surgical intervention will be done there will be only close follow up of the symptoms, signs , general condition of the woman and serial measurement of BHCG level in serum every forty-eight hours and repeated ultrasounds till BHCG is zero. The idea behind expectant management is that ectopic pregnancy will be aborted from the tubal end into peritoneal cavity with minimal bleeding that will be absorbed by peritoneal cavity, resembling early intrauterine pregnancy demise which will be aborted with minimal bleeding, To be able to implement such expectant treatment, patient should be completely vitally stable, free of symptoms, showing understanding of the symptoms and signs as the disease progress, has full access to the medical care in case of emergency, level of BHCG should not exceed 1000 IU, and the size of the adnexal mass should not exceed 3 cm. Medical treatment: This is another way to avoid surgical intervention and preserve fertility as possible while treating ectopic pregnancy. The drug of choice is the Methotrexate injections in single or multiple shots following certain algorithm with close follow-up of the patient till BHCG is again zero. The idea behind is to stop trophoblasts from growing and invading blood vessels in a tissue which is not prepared for implantation, like

expectant management the patient should be followed closely with BHCG not more than 5000 IU, and the size of the adnexal mass not more 4 cm, without cardiac activity; again, the patient should be absolutely vitally stable with minimal tolerable symptoms. Surgical treatment: Mostly done through laparoscopy but in certain situation could also be done by minimal laparotomy. It aims to excise the ectopic pregnancy and damaged tissue and to stop bleeding. Again, the affected tube can be removed completely (salpingectomy) or incised to remove the ectopic pregnancy leaving the tube in place after proper hemostasis (salpingostomy). However, the studies showed no real difference in both techniques when it comes to future fertility.

Surgical treatment is mandatory whenever: 1. The vital signs are not stable with deterioration of the general condition of the woman showing hypotension and tachycardia. 2. If the patient is complaining of severe abdominal pain. 3. When the ultrasound shows living embryo outside the uterine cavity or adnexal mass of more than 4 cm. 4. BHCG level is above 5000 - 10000 IU. 5. The presence of active intraperitoneal bleeding. 6. Increase of BHCG level of 50% per 48 hours, or continues rise of BHCG level in spite of giving Methotrexate. Again, BHCG follow up is mandatory till BHCG is zero.

CLINICALLY, DIAGNOSIS OF ECTOPIC PREGNANCY IS SOMETIMES CONFUSING AND CHALLENGING AS NO ECTOPIC IS LIKE ANOTHER ECTOPIC, THE DIFFERENTIAL DIAGNOSIS OF ECTOPIC PREGNANCY SHOULD BE ALWAYS IN THE MIND OF THE PHYSICIAN DEALING WITH EARLY PREGNANCY, I.E.

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

ARTICLE

Postnatal depression Dr. Abeer Mahmoud Eissa Consultant Psychiatrist, Department of Mental health at Al Ahli Hospital

ostnatal depression is a type of depression that many parents experience after having a baby. It's a common problem, affecting more than 1 in every 10 women within a year of giving birth. It can also affect fathers and partners. It's important to seek help as soon as possible if you think you might be depressed, as your symptoms could last

SEPT.OCT 2020

months or get worse and have a significant impact on you, your baby and your family. With the right support, which can include self-help strategies and therapy, most women make a full recovery.

SymptomsÂ of postnatal depression Many women feel a bit down, tearful or

ARTICLE

anxious in the first week after giving birth. This is often called the "baby blues" and is so common don’t last for more than two weeks after giving birth. If your symptoms last longer or start later, you could have postnatal depression. Postnatal depression can start any time in the first year after giving birth.

Signs of postnatal depression occur gradually and include: • • • • • • • •

Persistent feeling of sadness. lack of enjoyment and loss of interest in the wider world Lack of energy and feeling tired all the time Trouble sleeping at night and feeling sleepy during the day Difficulty bonding with your baby Withdrawing from contact with other people Problems concentrating and making decisions Frightening thoughts – for example, about hurting your baby

Getting help for postnatal depression Don't struggle alone hoping that the problem will go away. Remember that: • A range of help and support is available, including therapy • Depression is an illness like any other • It's not your fault you're depressed – it can happen to anyone • Being depressed doesn't mean you're a bad parent • It doesn’t mean you’re going mad

Treatments for postnatal depression Postnatal depression can be lonely, distressing and frightening, but support and effective treatments are available, these include: • Self-help – things you can try yourself include: talking to your family and friends about your feelings and what they can do to help; making time for yourself to do things you enjoy; resting whenever you get the chance and getting as much sleep as you can at night; exercising

• •

regularly; eating a healthy diet Psychological therapy such as cognitive behavioral therapy (CBT) Antidepressants – these may be recommended if your depression is more severe or other treatments haven't helped.

What causes postnatal depression? The cause of postnatal depression isn't completely clear. Some of the factors it has been associated with include: • A history of mental health problems, particularly depression, earlier in life • A history of mental health problems during pregnancy • Having no close family or friends to support you • A poor relationship with your partner • Recent stressful life events, such as a bereavement • Experiencing the "baby blues" Even if you don't have any of these symptoms, having a baby is a life-changing event that can sometimes trigger depression. It often takes time to adapt to becoming a new parent. Looking after a small baby can be stressful and exhausting.

MANY WOMEN FEEL A BIT DOWN, TEARFUL OR ANXIOUS IN THE FIRST WEEK AFTER GIVING BIRTH. THIS IS OFTEN CALLED THE "BABY BLUES" AND IS SO COMMON DON’T LAST FOR MORE THAN TWO WEEKS AFTER GIVING BIRTH. IF YOUR SYMPTOMS LAST LONGER OR START LATER, YOU COULD HAVE POSTNATAL DEPRESSION. POSTNATAL DEPRESSION CAN START ANY TIME IN THE FIRST YEAR AFTER GIVING BIRTH.

Can postnatal depression be prevented? Although there have been several studies into preventing postnatal depression, there is no evidence that there’s anything specific you can do to prevent the condition developing, apart from maintaining as healthy a lifestyle as you can for yourself. However, if you have a history of depression or mental health problems, or if you have a family history of mental health problems after childbirth, tell your doctor if you’re pregnant or thinking of having a baby. This is so they can offer you appropriate monitoring and treatment, if necessary. If you have had a mental health problem while pregnant, your doctor should arrange for you to be seen regularly in the first few weeks after birth.

NEWS

SEHA kidney care continues to provide world-class clinical services throughout COVID-19

EHA Kidney Care, a facility affiliated with Abu Dhabi Health Services Company (SEHA), the UAE’s largest healthcare provider, has remained committed to delivering world-class clinical services to patients with kidney diseases. Treatments such as kidney dialysis are readily available to patients and are delivered according to international standards of clinical care, using the most advanced diagnostics. SEHA recently rolled out additional safety and precautionary measures to protect the safety of patients and employees across its network. SEHA Kidney Care delivered hemodialysis sessions thrice weekly since the beginning of March. From the start of March to the end of August 2020, over 77,314 follow-up patients were treated, it’s over 34,646 patients at SEHA’s Kidney Care headquarters in Al Mafraq, 18,225 patients at Sheikh Khalifa Medical City and 20,879 patients at Tawam Kidney Care Center, Al Ain, and 3,663 at Al Dhafra Kidney Care Center. Patients undergoing treatment at all SEHA Kidney Care centers strictly adhered to international and local safety guidelines such as the use of face masks, the practice of social distancing and continuous hand washing and sanitiza-

SEPT.OCT 2020

tion. Simultaneously, all employees including operational, administrative, and medical were equipped with Personal Protective Equipment (PPE) and were provided with additional training in preventive measures to limit the spread of the virus. In addition, the surfaces of all Kidney Care facilities were sanitized and sterilized with disinfectants regularly to provide a safe and comfortable environment for all patients and employees. Patients receiving treatment at SEHA Kidney Care centers were isolated and separated from COVID-19 patients who were also receiving kidney dialysis services. Clinical professionals such as nurses and doctors were also well-equipped to manage the treatment of COVID-19 patients with kidney disease or those undergoing kidney dialysis, in addition to dedicating medical equipment for both groups of patients. Stephan Geoffrey Holtsteven, Chief Executive Officer, SEHA Kidney Care, said, “In alignment with SEHA’s patient-centric approach to delivering healthcare, we remain committed to delivering a consistent level of world-class healthcare services to our kidney disease patients across all our facilities. At SEHA, we are

SINCE MARCH 2020, SEHA KIDNEY CARE CENTERS HAVE PROVIDED KIDNEY DISEASE THERAPY TO 77,314+ PATIENTS.

NEWS equipped with experienced and internationally accredited professionals, as well as advanced technologies that serve our vision of enhancing patient experience and elevating the delivery of healthcare in the UAE. Building on our successful track record and extensive industry experience, we are proud to contribute to the development of the UAE’s health sector, ensuring we are up-to-date with world-leading, latest medical technologies and breakthroughs.” “SEHA Kidney Care provides a comprehensive scope of services and treatments including, peritoneal dialysis, hemodialysis, kidney transplantations, and kidney disease prevention. We are continuously looking to bolster our services and offer integrated clinical programs to achieve the highest levels of patient satisfaction. Similarly, we are improving the patient experience in line with wider initiatives launched by SEHA through the enhancement of routine services, increased public awareness of risks associated with kidney disease, and readily available treatment plans to aid early detection and diagnosis of renal diseases. Furthermore, our SEHA Dialysis Services continue to invest in research and the development of our teams and resources, to support our vision of providing excellent health care services to the community of Abu Dhabi. Together, with our talented and highly skilled team of medical professionals, we are playing an integral role in achieving the objectives underpinned by SEHA’s overall strategy, whilst upholding safety and quality as key elements,” he added. SEHA Kidney Care centers are among the world's most advanced medical centers. All centers feature cutting-edge technology and the latest diagnostic devices. Its team of experienced and highly qualified medical teams have performed approximately 260 kidney transplants. Every month, the team completes approximately six kidney transplants, with high success rates ranging from 95% to 98% in the first year, and up to 85% after five years from the surgery’s completion. Success rates are measured by the number of patients whose bodies do not reject a donor’s kidney. Renal therapy procedures such as the Surfacer Inside-Out Access Catheter System and HeRO Graft hemodialysis are available exclusive-

ly at the SEHA Kidney Care center in Abu Dhabi. Nephrology specialists at the center are licensed to train other practitioners on both procedures in the UAE and across the MENA region. The Surfacer Inside-Out Access Catheter System is a renal procedure incorporating a high level of radiation therapy, which lasts about 20 minutes and only requires local anesthesia to perform. Patients are discharged on the same day of the operation. The HeRO Graft hemodialysis is performed by interventional radiologists and vascular surgeons and requires between one hour to an hour and a half, with the patient under general anesthesia. Within Abu Dhabi’s SEHA Kidney Care center is the Pediatric Dialysis Unit. The unit is equipped with nine dialysis units which accommodate 27 patients per day, and four dialysis sessions per week for each child. Dialysis sessions usually last for approximately four hours. Other treatments offered at the unit include therapy for Hemolytic uremic syndrome (HUS) – a condition that can occur when the small blood vessels in kidneys become damaged and inflamed. HUS is one of the most critical kidney diseases affecting children and may lead to a rapid decline in renal functions, without early detection. SEHA Kidney Care specializes in the disease and has successfully treated several children, preventing kidney failure. The Pediatric Dialysis Unit also features a peritoneal dialysis room, isolation room, examination clinics, and nursing room, in addition to a reception hall for patients and their families. This special unit is designed according to international best practices, whilst remaining suitable and comfortable for children receiving treatment.

DOCTORS AND NURSES ALSO CONTINUED DELIVERING HOME KIDNEY CARE SERVICES, SUCH AS KIDNEY DIALYSIS, AND CONSULTED WITH PATIENTS VIA SEHA’S VIRTUAL OUTPATIENT CLINIC TO ENSURE THE SEAMLESS CONTINUATION OF TREATMENT. PATIENTS, PARTICULARLY SENIOR CITIZENS AND RESIDENTS WERE ABLE TO RECEIVE MEDICAL CARE FROM THE SAFETY OF THEIR HOMES, WITH PRESCRIBED MEDICATION DELIVERED TO THEIR DOORSTEP.

NEWS

Thumbay University Hospital now empanelled with all leading health insurance providers

humbay University Hospital, Ajman - the family-friendly healthcare destination - has announced that it has begun accepting all major health insurance policies in a move that greatly benefits patients at the private hospital that opened its doors less than a year ago. “By partnering with the network of leading health insurance companies and health service providers in the UAE, we are now able to provide our patients with a complete range of world-class treatments and services via direct billing for health insurance policies and convenient cashless services” said Mr. Akbar Moideen Thumbay, Vice President of the Healthcare Division of Thumbay Group. “Our state-of-the-art 350-bed hospital operates a full-fledged insurance department that is committed to patient friendliness and quick and efficient approvals of medical insurance claims”, added Mr. Akbar Moideen Thumbay. Adhering to its family-friendly status, the hospital has also launched a ‘Special Delivery

SEPT.OCT 2020

Package’, an exclusive initiative for maternity patients even as the hospital’s dedicated Center for Obstetrics and Gynaecology recently celebrated the milestone of over 1,000 births, within only a year of its opening. The hospital’s family-friendliness culture extends beyond regular healthcare services, with amenities including a multi-restaurant food court, coffee shops, therapeutic garden, health club and movie theatre, while a Marhaba Lounge provides premium, personalised fast-track services for patients. In keeping with its aim of offering patients world-class service, Thumbay University Hospital excels in offering telehealth services. Thus, patients can call the hospital’s telehealth number (054 9955415) to access services such as follow-up consultations, review of reports, refill of medicines, etc., as well as for getting home delivery of medicines and home collection of diagnostic samples. Patients can also consult their regular doctors through video conferencing. These particular services enable people to avoid non-essential physical visits to the hospital.

FAMILY-FRIENDLY HOSPITAL STRENGTHENS PATIENT SERVICES. OFFERS FASTER INSURANCE APPROVALS, STRONGER TELEHEALTH SERVICES, HOME SAMPLE COLLECTION, MEDICINE DELIVERY AND MUCH MORE.

NEWS

“Thumbay Group has maintained the hospital as a COVID-free hospital and has never tested, treated or admitted any COVID-19 patients. As soon as the UAE government and its health authorities issued detailed guidelines for hospitals to comply with precautionary measures in the wake of COVID-19, Thumbay University Hospital rapidly introduced a series of whole measures to limit the spread of the virus” commented Dr. Manvir Singh Walia, COO of Thumbay University Hospital, Ajman. “The steps include restricting movement of people in the hospital, social distancing arrangements and enhanced telehealth services” added Dr. Walia. Additional measures to prevent the spread of the virus in the hospital include a unique fever clinic to treat patients with fever and screening them for COVID-19 symptoms, regular and detailed sanitisation protocols, chronic medication refill for patients via a simple phone call, 24-hour drive-through pharmacy service at the hospital premises, home collection of diagnostic samples, temperature monitoring of all patients, visitors and staff, emphasising hand hygiene and wearing masks, hand sanitiser dispensers throughout the hospital, and constant monitoring of staff health. Steps are also in place to avoid overcrowding at the hospital by encourag-

ing patients to plan their hospital visit with prior appointment only. Once they are at the hospital, patients are attended to quickly. Besides, the hospital operates dedicated lifts for access to and from the maternity ward, as well as dedicated operation theatres for patients requiring C-section. Since 2014, health insurance in the UAE has witnessed the fastest growth pertaining to the government's roll out of a three-year plan, to cover the health needs of all workers in the country, including that of foreign workers who constitute about 80% of the entire working population in the country. Thumbay University Hospital is the largest private academic hospital in the Middle East region. Located in Thumbay Medicity, Al Jurf, Ajman, UAE, the hospital is part of the academic hospital network of Thumbay Group, which has a professional workforce of 30 different nationalities serving patients in 50 different languages and serving patients from over 175 countries. Thumbay University Hospital features a dedicated 100-bed long term care and rehabilitation unit, Centre for Oncology equipped with PET-CT scan, 10 modern surgical suites for all major specialties, Center for Imaging, Cath Lab, ICU/CCU/NICU/PICU, 10-bed dialysis unit, etc. The hospital also has 10 labour and delivery rooms, NICU, SCBU and Well Baby Unit.

THE HEALTHCARE DESTINATION FEATURES AMENITIES SUCH AS A MULTIRESTAURANT FOOD COURT, COFFEE SHOPS, THERAPEUTIC GARDEN, HEALTH CLUB AND MOVIE THEATRE, WHILE A MARHABA LOUNGE PROVIDES PREMIUM, PERSONALISED FASTTRACK SERVICES FOR PATIENTS.

Al-Ahli Hospital / Doha - Qatar Orthopaedic and Traumatology Center

Weâ&#x20AC;&#x2122;re Back!

to serve you in full range of our Orthopedic Center services.

+974 44898000 or +974 44898888 Doha - Qatar

ARTICLE

OUR RESULTS ARE EQUIVALENT TO THE INTERNATIONAL RECORDS, IF NOT BETTER "We deal successfully with cases of shinbone ablation, cruciate ligament replacement, and meniscus repair" Dr. Maher Yousef Consultant Orthopedic Surgery at Al Ahli Hospital

SEPT.OCT 2020

ARTICLE

n this current time and with the great and accelerating scientific progress the world is witnessing, it has become difficult and even impossible to fully understand all aspects of any science, so it has become necessary to specialize in a narrower and more accurate field, focus on that field and be familiar with all its new developments and updates. There is no doubt that this will reflect positively on the patient, as the doctor will be more knowledgeable and informed in his specialty, and he will have accumulated experience in the specialization that no other has, and this is what is unique to the orthopedic clinics in Al-Ahli Hospital, as it has the capabilities and equipment that has enabled it to achieve Several successes. Dr. Maher Yousef, Consultant Orthopedic Surgery at Al-Ahli Hospital, talked about these clinics and the successes they have achieved. Dr. Maher Yousef, Consultant Orthopedic Surgery, is highly specialized in total knee and hip-joint replacement surgery and sports injuries of the knee, such as anterior cruciate ligament injuries, tear of meniscus, and other knee injuries, as well as treatment of injuries and fractures for all age groups. Here, the distinction of those with a sub-specialty is distinguished by outstanding results represented in the rapid recovery from surgeries in the near term and the persistence of these results for decades over the internationally sanctioned level, or even better.

Outstanding Success He said: "We are proud that I had performed an artificial knee joint or hip replacement surgery on patients who had undergone a similar surgery of an artificial knee joint or hip replacement of the other side in another hospital, and they were able to compare the two experiences, where everyone confirmed that there is a vast and wide difference between the two experiences, that their last operation was accompanied by much less pain than the

first, and that recovery from the last operation was much faster than the first operation." He added: "There is also the accurate diagnostic aspect that distinguishes us from the rest of the medical centers. We are also distinguished in orthopedic clinics at Al-Ahli Hospital, by using the latest technologies and joints available that give the patient the best results, such as bending the knee fully, the ability to sit on the ground and the ability to pray on the ground, as is the case of a healthy, natural joint. The latest technologies and joints also give the patient the longest sustainability for his new joint".

Global Level

WE DEAL SUCCESSFULLY WITH CASES OF SHINBONE ABLATION, CRUCIATE LIGAMENT REPLACEMENT, AND MENISCUS REPAIR.

Moreover, he continued: "According to the British and Scandinavian records, more than 90% of the patients who underwent knee joint replacement surgeries, on which 20 years have passed, their joints are still in good condition. With an experience of more than thirty years in this field, I acknowledge that our results are equivalent to the global records mentioned above, if not better. Sometimes the patient's condition becomes very critical, with which parts of the bone are lost due to neglect of the patient and being left for a long time, which constitutes a challenge with which we deal Successfully in our hospital."

Many Cases He concluded by saying: "There are many cases that have been dealt with successfully, such as the removal of tumors from the shinbone, and bone transplant with supporting the locality with metal plates, and there are also sports injuries of the knee occur to the younger youth group, which may result in tearing of the anterior cruciate ligament, tear of cartilagines falcatae on both sides, and possibly other parts of the knee, which require dealing with all these injuries simultaneously, by replacing the cruciate ligament and repairing the cartilagines falcatae, all through speculum, using the most modern methods used globally.

ARTICLE

Are you affected by Digital Eye Strain? Experts at Moorfield’s Eye Hospital Dubai weigh in on Digital Eye Strain By Dr. Luisa M. Sastre, MD, PhD Specialist Ophthalmologist in Medical Retina and Cataract Surgery

s technology advances, people are spending more and more time in front of screens. According to a study by Hootsuite in 2019, UAE residents spent an average of 4 hours of screen time per day. While this figure is unsettling, recent restrictions due to COVID-19 ushered in a new digital way of life that has inevitability increased screen time. Whether people are working from home or e-learning, work, school, and social life have moved almost entirely online this year. The increased screen time can contribute to Digital Eye Strain (DES), a group of eye and vision-related problems that stem from viewing digital screens for prolonged periods. Digital-related eye strain affects people of all ages. If you spend hours a day using digital devices, you might notice that your vision blurs, and your eyes feel itchy and tired. You may also find your eyes become dry and watery. While in our current digital climate technology is unavoidable, understanding the symptoms and preventative measures for Digital Eye Strain can help patients limit their likelihood of developing the related ailments.

Symptoms of Computer Vision Syndrome There are two groups of symptoms linked with DES, those associated with reduced blinking and dry eyes and others related to lens focus. Reduced blinking and dry eye can result in irritation, burning sensations, eye strain, headaches-remove headaches here, tired eyes, sensitivity to light, and those that are associated with focusing include blurred vision at the near and far distances and headaches after using a digital device. These symptoms can be triggered by poor lighting, glare, and improper viewing distances.

SEPT.OCT 2020

Diagnosing Computer Vision Syndrome

DIGITAL-RELATED DES can be diagnosed through a compreEYE STRAIN hensive eye examination. Testing, with emphaAFFECTS PEOPLE sis on visual requirements at the computer or OF ALL AGES. IF YOU SPEND HOURS digital device working distance, may include an assessment of patient history, visual acuity, and A DAY USING refraction test to confirm the correct lens power DIGITAL DEVICES, YOU MIGHT NOTICE needed to compensate for any refractive errors. THAT YOUR VISION BLURS, AND YOUR Treating Digital Eye Strain EYES FEEL ITCHY While solutions to digital screen-related AND TIRED. YOU vision problems are varied, they can usually be MAY ALSO FIND alleviated by obtaining regular eye care and YOUR EYES BECOME making changes in how and the amount of time DRY AND WATERY. you view a screen. In some cases, individuals who do not require the use of eyeglasses for other daily activities may benefit from glasses prescribed specifically for computer use, and persons already wearing glasses may require a fine-tuned prescription to compensate for digital screen complications. In these cases, we advise patients to invest in a specialised lens that may help to maximize visual abilities and comfort while using technology. Keeping the eye refreshed and lubricated is also essential to alleviate and reduce the chances of developing DES. Increasing the number of times you blink (the eye’s way of getting the moisture it needs on its surface), using artificial tears and a humidifier can help maintain optimal eyes moisturise. Additionally, when viewing screens, adjusting brightness and contrast to a comfortable setting, reducing the glare, and sitting an arm’s length away from your computer can be beneficial. Lastly, we recommend patients follow the 20-20-20 rule, which advises patients to take a 20-second break to view something 20 feet away every 20 minutes when using a digital screen.

NEWS

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.

www.malaffi.ae SEPT.OCT 2020

100

/Malaffi