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Publisher Arab Health Media Communication
SUDAN RECOVERED Promising opportunities for a rise in the near future Since 2018, Sudan has been looking to increase investments in the health sector, and to compensate for what had been missing during the sanctions period. On that day, the Sudanese Minister of Health Bahr Idriss Abu Garda revealed that his ministry was the most affected by the US sanctions, and that the implementation of the strategy of tapping opportunities that were unavailable had begun in order to maximize the health service and make the sector attractive for investors. The lifting of sanctions opened a window for health technology acquisition, and the possibility of continuing to manufacture and import medicines and advanced medical devices. It is known that the decision to lift the sanctions dates back to the 1990s, and then lifting Sudan from Sponsors of Terrorism List, opened the door to exempting the country from foreign debts worth $ 60 billion. After Washington and Khartoum signed a bilateral agreement last month to settle cases brought against Sudan in U.S courts, a new window had been opened, making the country's health sector the largest beneficiary of these developments, and to experience great growth opportunities on many levels. Sudan is a resource-rich country, but on the other hand it suffers from the spread of diseases, such as AIDS in the past and Covid-19 now, amid a shortage of medicines and medical supplies due to sanctions. Therefore, experts expect that removing Sudan from the Terrorism List is an opportunity to revive the health sector, whether in terms of increasing investments, or improving the sector and raising its level, and providing better health services and care to citizens. The first steps in this journey have begun, and with the officials’ efforts and adequate circumstances, the future of the health sector in Sudan will be promising and will strive to catch up with the achievements of its counterparts in the Arab countries.
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NOV . DEC 2020
34 Hospital Accreditation International programs improve the process of care
NEWS
12 OGT expands NGS cancer panel offering 14 More than 1,000 people participated in info series by Middle East Arthritis Foundation hosted to mark World Arthritis Day 18 The first batch of 50 Trained COVID-19 "Safety Officers" completed their training from Gulf Medical University in the face of the COVID-19 pandemic 20 University Hospital of Sharjah successfully performs surgery on 4-year-old patient to treat rare vertical squint condition 24 H.H. Sheikh Hamdan bin Rashid approves the list of winners of the 11th term of the Hamdan Medical Award 26 Aster DM Healthcare honoured with prestigious awards for its CSR and COVID – 19 efforts 28 Digital mental health tools not a future luxury but an urgent necessity, says WISH 2020 Report 32 BD Announces Assay for Immune Assessment of
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COVID-19 Patients Now Available in Europe 104 Doctors remove cancerous mass the weight of an average house cat from patient’s pancreas
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38 Mrs. Salma Jaouni 50 Rhonda Collins 54 Maher Elhassan 66 Mr. Osama Otabashi 78 Dr. Bashar Balish and Dr. Yasir Khan 82 Nadeem Khan 84 Dr. Zartash Khan
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34 Hospitals Accreditation 46 Stroke 48 What does Covid-19 do to the brain? 62 Smart Pharmacy
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70 Online medical platforms 74 Medical supplies and products in hospitals 86 Diabetes, Obesity and COVID-19 96 Chronic Obstructive Pulmonary Disease
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42 The ‘new normal’ of stroke awareness and why we must act FAST By Nurgul Vatansever, Vice President at Medtronic CEMA 52 Royal National Orthopaedic Hospital Decommissions Pagers, Unifies Clinical
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Communication Amidst Pandemic 58 Bone Marrow Transplant made safer and available to all 76 How Has Deep Brain Stimulation Benefitted Patients With Parkinson’s Disease? 92 Colonic Diverticular Disease 94 Common Questions about Public Resuscitation and AED for Cardiac Arrest 100 COVID-19: Do face masks offer protection? 102 Things to know before getting porcelain veneers 103 Cutaneous manifestation during lockdown and using sanitizer and hand cleansers
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OGT expands NGS cancer panel offering Launch of two NGS panels enables comprehensive detection of genetic abnormalities involved in breast and ovarian cancer, and myeloid disorders MPL, as well as covering regions containing hardto-detect structural variants such as FLT3-ITDs and KMT2A-PTDs. It provides researchers with a single NGS approach to get a comprehensive picture of the key genes involved in myeloid disorders.
O
xford Gene Technology (OGT), a Sysmex Group Company, has today announced the expansion of its SureSeq™ range of next generation sequencing (NGS) panels to facilitate the interrogation of genes involved in breast and ovarian cancer, and myeloid disorders. The two new panels include a comprehensive 70-gene myeloid panel and a 7-gene breast and ovarian cancer panel that incorporates copy number variation (CNV) detection. Both have been designed based on the most recent literature and with input from recognised cancer experts to detect key variants and so help advance cancer research. The SureSeq Pan-Myeloid panel builds upon OGT’s established position as a frontrunner in developing predesigned and customisable NGS panels for myeloid disorders. Based on the latest research, the new panel includes 70 key genes implicated in a wide range of myeloid disorders, including acute myeloid leukaemia (AML), myeloproliferative neoplasms (MPNs) and myelodysplastic syndrome (MDS). Facilitated by OGT’s expert bait design and complimentary Interpret NGS analysis software, the SureSeq Pan-Myeloid panel provides excellent coverage uniformity to detect clinically relevant single nucleotide variants (SNVs) and indels down to 1% variant allele frequency (VAF). The panel includes genes such as CEBPA, JAK2, CALR and
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FACILITATED BY OGT’S EXPERT BAIT DESIGN AND COMPLIMENTARY INTERPRET NGS ANALYSIS SOFTWARE, THE SURESEQ PANMYELOID PANEL PROVIDES EXCELLENT COVERAGE UNIFORMITY TO DETECT CLINICALLY RELEVANT SINGLE NUCLEOTIDE VARIANTS (SNVS) AND INDELS DOWN TO 1% VARIANT ALLELE FREQUENCY (VAF).
For comprehensive detection of abnormalities, including CNVs, in key genes implicated in breast and ovarian cancer, OGT now offers the SureSeq Breast Cancer + CNV panel. Full interrogation of the BRCA genes traditionally requires multiple tests to find indels, SNVs and CNVs. Saving both time and cost, the new SureSeq Breast Cancer + CNV panel simplifies this process with a single assay that detects all these variants and offers 100% concordance with multiplex ligation-dependent probe amplification (MLPA). In addition to BRCA1 and BRCA2, the new panel also targets ATM, TP53, CHEK2, PALB2, and PTEN, and is able to detect CNVs ranging from single exons to full gene deletions and duplications in these genes as well. For customers interested in a larger breast or ovarian cancer panel OGT offers customisation through the SureSeq myPanelTM range of pre-optimised panel content, which can be added to the Breast Cancer + CNV Panel. “These two new NGS panels highlight our commitment to providing comprehensive assays for research into cancer genetics with the most up-to-date content based on input from our customers,” said John Anson, CEO at OGT. “Our long-standing expertise in hybridisation enrichment, bait design and NGS analysis software means that we can deliver highly reliable ways of finding abnormalities, even in difficult-to-sequence genes where other assays struggle. Furthermore, the fact that we offer a complete NGS solution consisting of library preparation kits, sequencing panels and popular, intuitive analysis software provides an additional layer of convenience and confidence—our products consistently deliver the reliable, reproducible data quality that our customers need.”
Being ranked nationally in adult specialties means a lot to us. And it could mean a lot to you.
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StLukesInternational.org international@stlukeshealth.org Tel: +1 832-355-3350 Texas Medical Center, Houston, Texas – U.S.A
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More than 1,000 people participated in info series by Middle East Arthritis Foundation hosted to mark World Arthritis Day
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o mark the World Arthritis Day that annually falls on October 12th, Middle East Arthritis Foundation hosted a series of webinars dedicated to raising awareness about the debilitating disease set to become the fourth most common cause of physical disability across the globe. The comprehensive, seven-day program brought together a host of leading experts from across the region to discuss the best-practice strategies and initiatives for improving quality person-centred care amidst the pandemic and across multiple settings, while also shedding light on the latest research, therapies and treatments, innovation, and technologies from around the world. Dr. Humeira Badsha, Founding Member of the Middle East Arthritis Foundation stated, “With 350 million people globally affected by some or the other form of arthritis and with 92.1 million adults having been diagnosed with arthritis or reporting some arthritis symptoms in 2019 alone, it is imperative we educate the masses with the symptoms to look out for early diagnosis and with practical tips and advice from the right doctors to help them live a fulfilling life and even reduce the burden on the healthcare industry.” The event was a huge success in tackling the common myths and misconceptions associated with arthritis and it gave individuals a chance to reach out to various specialists including rheumatologists, movement experts, nutrition specialists, psychologists amongst others to address their general and specific concerns in the wake of Covid-19. Participants engaged with experts in real time, so they could deepen their knowledge on the topic and get valuable tips to effectively care for themselves or loved ones diagnosed with arthritis.
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Dr. Humeira Badsha, Consultant Rheumatologist Board Member, MEAF
“With the introduction of the lockdown and restrictions required to combat Covid-19, we were continuously addressing concerns of our patients on how they can exercise at home safely, the diet they need to follow, additional precautions they should adhere to, it was absolutely necessary for us to increase public awareness and the e-series helped us reach out to a wider audience within the UAE and across the region,” added Dr. Badsha. Recent studies have shown a delay in diagnosis of 12 months in the UAE alone due to the lack of awareness accompanied by misconceptions that arthritis can affect only adults, which is far from the truth. The Foundation is grateful to partners Lilly, Novartis, Jannsen, Pfizer, UpJohn, Sandoz, Abbvie, Newbridge and Amgen for their support in helping create public awareness for the greater good of the community. The Middle East Arthritis Foundation (MEAF) supports people of all ages living with arthritis and hosts various events across the year to support arthritis warriors and raise awareness for the effective management and treatment of this chronic condition.
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
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NEWS
The first batch of 50 Trained COVID-19 "Safety Officers" completed their training from Gulf Medical University in the face of the COVID-19 pandemic
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ulf Medical University, specializing in medical education, has yet again demonstrated its student’s engagement initiative and commitment to saving the community. The university recently concluded a training program that involved a group of students and faculty members who received extensive scientific information and practical guidance about the ongoing coronavirus COVID-19 pandemic and how to handle it and restrict it from spreading, while protecting the university environment and the community at large. Commenting on the subject, Professor Hussam Hamdy, Director of Gulf Medical University, said: “We believe that each one of us (students and faculty) has a role to play serving the society during the current situation of COVID-19 pandemic, also considering that the students are back at the university, the most important issue is health and safety of the university environment. We developed a training program for our students and faculty to ensure having safe environment by training them on several aspects to prevent spreading within the university and also the community at large." Professor Hamdy also added: “With students and faculty members returning to the university, it was essential to emphasize the implementation of all procedures, directives and instructions set by the Ministry of Health and the Ministry of Higher Education in the country to contain the pandemic, which we remain committed to and will continue to contribute towards fulfilling our duty. We not only played these two roles but also studied the current
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THERE IS NO DOUBT THAT THIS IS A PIONEERING INITIATIVE BY GULF MEDICAL UNIVERSITY, WHICH AFFIRMS IN THIS CONTEXT ITS FULL READINESS TO CONTRIBUTE AND SUPPORT OTHER UNIVERSITIES WHO WISH TO OBTAIN DETAILS ABOUT THIS INTENSIVE COURSE, WHICH GOES FAR BEYOND THE INFORMATION CIRCULATED OR THE CURRENTLY RECOGNIZED MEASURES, TO BENEFIT THE STUDENTS AND PROFESSORS OF OTHER UNIVERSITIES AND ALSO THE MEMBERS OF SOCIETY. PROFESSOR HUSSAM HAMDY
situation while taking into account the available data and arrived at a decision to form a more specialized group that is equipped with more scientific information and can keep pace with the various research and studies carried out by medical references and research centers in various parts of the country, as well as other parts of the world, and is well-informed about every development about the current issue. At the end of this course, we would have a group of students possessing information and skills that exceed those of the other ordinary or non-specialist students, especially since they are all pursuing different medical specialties." The first group to undergo this specialized course consisted of 35 students across different medical and health colleges at the university, in addition to 15 members of the teaching staff representing various faculties. They received extensive training information from the university experts about dealing with personal safety and the necessity to adhere to social distancing and the importance of sterilization. They also learned about the field procedures to be taken upon discovering a positive case among students, faculty members, or their contacts, and how to classify the protected contacts from the transmission of the virus, and those unprotected contacts who are vulnerable to infection and transmission to others, in addition to dealing with different cases while ensuring everyone's safety. Professor Hamdy, while highlighting the commitment of the participants during this intensive course and their keenness to follow its details with great interest, said: “Now, we have about 50 “Safety Officers” across various facilities of the university in the corridors visiting the training centers, hospitals, and health and educational centers that are affiliated, armed with ample information on how to deal with any suspected case of Coronavirus infection. They are fully trained to take appropriate measures to isolate the infected patients and secure the safety of those in contact with them.
NEWS
University Hospital of Sharjah successfully performs surgery on 4-year-old patient to treat rare vertical squint condition
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he University Hospital of Sharjah has successfully performed a critical surgery on a four-year-old kid who was suffering from vertical squint, a rare medical case that is challenging to diagnose and treat. The successful surgical procedure led by Dr. Qasem Mubarak AlHammouri, Consultant - Pediatric Ophthalmology, has paved the way for the child to enjoy a healthy vision and live a normal life. Dr. Qasem AlHammouri explained that the condition of the child named Youssef was the rare vertical squint, which can obstruct the vision apart from impacting a patient’s mental health. He also said that Youssef recovered quickly after his operation, allowing him to attend his kindergarten class again and enjoy a normal childhood. Despite the difficulty and complexity of Youssef’s case, Dr. AlHammouri went ahead with the surgery after the results of diagnostic research and tests performed using the latest medical devices in ophthalmology showed that the young patient could undergo the procedure. Dr. Ali Obaid Al Ali, UHS Chief Executive Officer and Member of the Board of Trustees, said: “At the University Hospital of Sharjah, we use the latest medical devices and equipment across all specialties, including ophthalmology, to achieve the best outcomes, and, in this case, because we believe in the value and the blessing of sight. Our team utilized modern technologies to diagnose and treat the patient, and we will continue to invest in advanced medical tools and in the skills of our specialists to enable them to better handle complex and delicate surgeries. This commitment is aligned with our goal to provide superior healthcare treatments according to the best international practices and bring happiness and satisfaction to all our patients.” “We are proud of our distinguished doctors with subspecialties in ophthalmology. Apart from treating various eye disorders afflicting children and adults, we also offer treatments for
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Dr. Qasem Mubarak AlHammouri, Consultant - Pediatric Ophthalmology
retina damage, especially for diabetic patients, corneal diseases and other visual defects; cataract and glaucoma surgeries; and other medical and cosmetic eyelid surgeries. The recently successful surgery has been made possible due to the dedication and commitment to excellence of our doctors and nurses who only aim to deliver the best possible results. To optimally serve our patients, we have partnered with all insurance companies in the UAE to reduce the financial burden on our patients, as part of our social responsibility and commitment to providing value-added healthcare services to the communities of Sharjah and the UAE.” Dr. Al Ali added. According to Dr. AlHammouri, squint is a medical condition resulting from the misalignment of the eyes, which is evident when an individual is looking forward or to the sides. It can be a constant, permanent or changing condition at different times. It can affect the vision of both eyes and in some cases, lead to double vision. He added: "Squint is a medical condition that requires immediate treatment. If left untreated, it can result in major complications such as lazy eye arising from neglecting the vision of one eye. In addition, vertical squint leads to psychological disorders secondary to its association with the aesthetic image of the face." The condition may appear at various stages of life although, in most cases, it can manifest itself during childhood. Infantile esotropia may appear during the first months of the child's life; whereas accommodative esotropia develops in children aged two to three as a result of hyperopia. The types of strabismus differ according to the direction of the deviation of the eye. The three types are accommodative esotropia, with both internal and external aspects; vertical squint, which is the least common and most difficult to diagnose and treat; and squint, which is the result of the paralysis of the eye nerves.
ARTICLE
Every day, as a diabetes educator, your supportive words turn plans into action and doubts into decisions. You meet setbacks with encouragement, celebrate the progress made and share in your patient’s personal success. Diabetes is a lifelong journey and your commitment, patience and most of all, your shared conversations, make a difference every day. BD is pleased to support you in advancing the world of health through our extensive experience with partnerships, insights and portfolio of solutions. From all of us at BD, thank you.
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NEWS
H.H. Sheikh Hamdan bin Rashid approves the list of winners of the 11th term of the Hamdan Medical Award
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.H. Sheikh Hamdan bin Rashid Al Maktoum, Deputy Ruler of Dubai, UAE Minister of Finance, and Patron of the Hamdan Medical Award received H.E. Abdul Rahman Al Owais, UAE Minister of Health and Prevention and Chairman of the Award’s Board of Trustees, and HE. Abdullah Bin Souqat, Executive Director of the Award. During the meeting, H.H. Sheikh Hamdan approved the names of 10 winners of the Award’s 11th term (2019-2020), which is mainly centered on Artificial Intelligence (AI) in healthcare. In line with the UAE strategic plans for the continuous development of the health sector and fostering the latest technologies in diagnosis and treatment, ‘Artificial Intelligence in Healthcare’ was chosen as the topic of the eleventh term, in collaboration with the UAE National Program for Artificial Intelligence. During the meeting which was held at Zabeel Palace, H.H. Sheikh Hamdan Bin Rashid
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IN LINE WITH THE UAE STRATEGIC PLANS FOR THE CONTINUOUS DEVELOPMENT OF THE HEALTH SECTOR AND FOSTERING THE LATEST TECHNOLOGIES IN DIAGNOSIS AND TREATMENT, ‘ARTIFICIAL INTELLIGENCE IN HEALTHCARE’ WAS CHOSEN AS THE TOPIC OF THE ELEVENTH TERM.
was briefed on the winners of the International Awards, Arab World Awards, and UAE awards. H.H. Sheikh Hamdan praised the transparency and impartiality in selecting the winners, which is the harvest of the great efforts by the members of the Award’s scientific committees, General Secretariat, and Board of Trustees, during the previous two years. On the other hand, H.E Abdul Rahman Al Owis thanked H.H. Sheikh Hamdan bin Rashid Al Maktoum for his generous and continuous support for the health and medical sectors. He also praised the important role played by the Award in achieving medical excellence locally, regionally and internationally. He also thanked His Excellency Omar Sultan Al Olama, Minister of State for Artificial Intelligence, for his directives in direct work with the Scientific Committee. It is worth mentioning that the official announcement of the winners will be among the activities of the ceremony that will be organized by the Award during November 2020. The ceremony will be held virtually, in line with the UAE`S strategy to maintain social distancing to limit the spread of the novel COVID-19 virus. The Awards carry a total value of AED 2 million and 800 thousand. The category of the International awards includes the Grand Hamdan Award, Hamdan Award for Medical Research Excellence, and the Hamdan Award for Volunteers in Humanitarian Medical Services. As for the Arab World Awards, it includes Hamdan Award for the Best Medical College / Institute or Center in the Arab world, and Hamdan Award for Honoring Distinguished Personalities from the Arab World. The UAE awards include Hamdan Award for the Best Medical Department in the Government Sector in the UAE, Hamdan Award for Distinguished Medical Personalities, and Hamdan Award for the Best Research Published in the Journal of Medical Sciences.
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 Award’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 conference’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
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NEWS
Aster DM Healthcare honoured with prestigious awards for its CSR and COVID – 19 efforts
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ster DM Healthcare has been honoured with two prestigious awards for its CSR and sustainability efforts as well as for its contributions towards tackling the COVID – 19 pandemic in the Middle East and North Africa by The Dubai Chamber and the Arabia CSR Network, to applaud the group’s ongoing efforts to serve the community. Aster DM Healthcare’s social initiatives through Aster Volunteers, the CSR arm of the group, as well as its efforts to serve as many people as possible since the beginning of the pandemic, has been applauded and the group has been conferred with the Dubai Chamber CSR Label for H1 Cycle 2020, the highest level of recognition for CSR efforts by businesses built on international standards while ensuring local relevance. In addition, to its CSR efforts and contribution towards the COVID – 19 pandemic, the group has also been recognised for undertaking various sustainable initiatives aimed to provide energy efficient world-class healthcare, by the Arabia CSR Network. The group was presented with the Winner Award in the healthcare category at the 13th Arabia CSR Awards ceremony. Through its cycles, the Arabia CSR Awards has received more than 1,200 registered applications from more than a thousand organisations across 42 industries from 14 countries. Hailed as the sustainability benchmark of the Arab region, it is recognised by global and regional bodies such as the United Nations Global Compact, the United Nations Environment Programme and the League of Arab States.
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WITH OVER 19,800 EMPLOYEES SPREAD ACROSS 380 ESTABLISHMENTS IN 7 COUNTRIES, ASTER AIMS TO PROVIDE WORLDCLASS HEALTHCARE FACILITIES BY DEVELOPING ENERGY & WATER EFFICIENT INFRASTRUCTURE AS PART OF ITS SUSTAINABILITY STRATEGY.
Talking about these accomplishments, Dr Azad Moopen, Founder Chairman and Managing Director, Aster DM Healthcare said, “As a responsible corporate, we believe in staying connected to the community and give back wherever possible. Aster Volunteers has been able to touch more than 2 million lives through various initiatives in a short period. We also stay at the forefront of tackling the COVID – 19 pandemic, while offering affordable and accessible healthcare through sustainable efforts. We thank Dubai Chambers and The Arabia CSR Network for recognising our efforts which further motivates us to continue our efforts towards building a sustainable and responsible society.” Ms Alisha Moopen, Deputy Managing Director, Aster DM Healthcare, added, “By receiving these awards, we feel immensely appreciated for all the work we have done. Aster DM Healthcare, is in a sector that is there to serve and we feel honoured to have received an opportunity to serve the communities we are in. This inspires and motivates us to keep doing more. We will continue to imbibe UN sustainable development goals in our objectives, to aid with healthcare, education, climate change, gender equality and sustainability, and to work towards making the world a better place.” The group has also been at the forefront of battling the threat of COVID-19 since the beginning of the pandemic. As a result of their initiatives, 318,490 lives have been impacted by supplying of food and ration kits, 29,539 individuals screened through medical camps, 450,384 people reached through 43 awareness webinars, 15,486 personal protection equipment, masks, gloves, sanitizers, face shields have been distributed, 16,697 distress calls have been received at the entity's dedicated helpline, and 456 COVID-19 patients have been transported by the Aster Volunteers Mobile Medical Services team in Dubai. Aster has also managed COVID-19 camps in Al Warsan and Jebel Ali with more than 1,750 isolation beds.
NEWS
Digital mental health tools not a future luxury but an urgent necessity, says WISH 2020 Report
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for All’s Jonty Roland and Research Fellow Dr. Emma Lawrence of Imperial College London, the new report will offer a set of policy recommendations based on case studies, exploring ways in which governments, investors, businesses, schools, and health leaders can all play a role.
forthcoming WISH 2020 report titled The Digital Mental Health Revolution: Transforming Care Through Innovation and Scale-Up will claim that digital tools designed to address mental health needs are not just a future luxury for modern health systems, but an urgent necessity. The full report will be released during the upcoming World Innovation Summit for Health (WISH), which will take place virtually from November 15-19. Working with research partners and leading experts, the WISH 2020 conference, which is free to attend, will be placing a major focus on discussing mental health in general, and especially among children and adolescents. The new report has been produced by an international group led by Professor Helen Christensen, Director and Chief Scientist of the Australia-based Black Dog Institute, a not-forprofit facility and medical research institute that investigates mental health across the lifespan, and by Dr. Tom Insel, a leading American expert in mental health research, policy, and technology and co-founder and chair of Humanest Care, a clinically augmented, community-based online emotional support system. One of the most critical health needs, mental health disorders affect one in three people worldwide at some point in their life – they are among the leading causes of disability and account for nearly eight million deaths annually (almost a million of which are by suicide). The report finds that the gap between the treatment people need and what current health systems can deliver in high-, middle- and low-income countries is currently so great that ‘only a revolution in access, quality, and engagement through technology’ can meaningfully address it. The experience of professionals and service users during the COVID-19 pandemic has strengthened the consensus for a need to create a ‘next generation’ of digital mental health innovations. With collaboration from leading experts in digital mental health, such as Health
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Prof. Helen Christensen, Director and Chief Scientist of the Australia-based Black Dog Institute
Dr. Tom Insel, leading American expert in mental health research, policy, and technology and co-founder and chair of Humanest Care, a clinically augmented, community-based online emotional support system
Prof. Helen Christensen said: “Even before COVID-19 struck the world, mental health services were struggling in every country. We know that mental health, and drug and alcohol problems are the leading cause of disability across the world and now with COVID-19, 75% of the population is reporting psychological distress. To cope with this, massive interventions that reach millions of people are needed. Digital interventions and digital-first services are the way to do this and it’s an issue that faces every government in every country. “We need to bring together the digital innovations that are already in use by consumers with key insights and evidence on their effectiveness from science. Our report aims to understand the ways that digital models have worked and the ways we can best support the development of digital technologies for mental health into the future.” Among the policy briefings that will guide summit discussions in November, Child and Adolescent Mental Health touches on barriers to the accessibility of high-quality mental healthcare for children and adolescents. WISH has also partnered with The BMJ, one of the world's oldest and most cited general medical journals, on a report titled Toxic Stress: Mitigating Childhood Adversity that Affects Lifelong Physical and Mental Health, in the hope that the evidence-based recommendations will guide researchers and policymakers in tackling this critical issue. With WISH expected to bring thousands of healthcare leaders and frontline workers into the discussion, the summit is a critical opportunity to consider robust solutions that will contribute to meeting a key UN Sustainable Development Goal (SDG).
َ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.
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BD Announces Assay for Immune Assessment of COVID-19 Patients Now Available in Europe
B
D (Becton, Dickinson and Company) (NYSE: BDX), announced the CE mark and European availability of a product for assessing immune function in COVID-19 patients. The BD Multitest™ 6-Color TBNK Reagent with BD Trucount™ Tubes has been CE marked with expanded clinical application for the identification and enumeration of T-cell subtypes in COVID-19 patients, an innovation in helping clinicians better understand patient immune response to COVID-19 disease. Data from the first global wave of COVID-19 have shown that patients typically exhibit a remarkable decrease of CD4 and/or CD8 lymphocyte counts with increasing disease severity. Accurate counts of T-cell subsets may be critical in informing the clinical course of action because T-cells are essential for viral killing and antibody response. The BD Multitest™ 6-Color TBNK Reagent with BD Trucount™ Tubes leverages time-tested technology for immune assessment and enables clinicians to go beyond the complete blood count (CBC) to better understand the underlying mechanisms for severity in COVID-19 patients, especially those with co-morbidities. This test has been used for more than a decade to assess immune function in HIV patients and may now also help clinicians better understand COVID-19 patient immune response, and when used in conjunction with clinical findings and laboratory testing, inform patient treatment plans and prioritize precious resources. “The availability of this product with the expanded clinical application in COVID-19 patients is an important step in helping clinicians better understand how patient immune systems are responding to COVID-19 infection,” said Puneet Sarin, worldwide president, Biosciences at BD, “BD is a trusted partner in immunology research and clinical care with a long history helping clinicians and patients better understand immune function to make
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patient care decisions. Bringing this expertise to clinicians treating COVID-19 patients presents a great opportunity to enable deeper immune assessment of patients, which could lead to improved uses of precious resources within a hospital while helping get patients on the right clinical path.” The BD Multitest™ 6-Color TBNK Reagent with BD Trucount™ Tubes is used in conjunction with the BD FACSLyric™ and BD FACSCanto™ II Clinical Flow Cytometers and the BD FACSLyric™/BD FACSDuet™ Sample-to-Answer Solution, which enables automated processing of samples, removing any unnecessary exposure to lab personnel.
About the BD Multitest™ 6-Color TBNK Reagent with BD Trucount™ Tubes The BD Multitest™ 6-Color TBNK Reagent with BD Trucount™ Tubes is CE marked and is only available in the EU for COVID-19 Clinical Application. The BD Multitest™ 6-Color TBNK Reagent with optional BD Trucount™ Tubes is a 6-color direct immunofluorescence reagent for use with a suitably equipped BD flow cytometer to identify and determine the percentages and absolute counts of T, B and natural killer (NK) cells, as well as the CD4 and CD8 subpopulations of T cells in peripheral blood. The BD Multitest™ 6-Color TBNK Reagent with BD Trucount™ Tubes can be used with the BD FACS™ Loader and the BD FACS™ Universal Loader.
Clinical Application Determining counts of CD3+CD4+ and/ or CD3+CD8+ lymphocytes may be useful in the immunological assessment of SARS-CoV-2 infected individuals with COVID-19 disease. Individuals with COVID-19 disease typically exhibit a decrease of CD3+CD4+ and/or CD3+CD8+ lymphocyte counts with increasing disease severity. For more information, visit www.bdbiosciences. com/Covid19-Tcell.
BD MULTITEST™ 6-COLOR TBNK REAGENT WITH BD TRUCOUNT™ TUBES BRINGS TIMETESTED IMMUNE ASSESSMENT SOLUTION TO EUROPEAN CLINICIANS TREATING COVID-19 PATIENTS.
ARTICLE FEATURES . International Hospital Accreditations
H
ospitals and health facilities in the regional states have succeeded in applying international standards and requirements that deal with quality standards of medical services stipulated by international healthcare accreditations. Although some health facilities have been affected by the pandemic outbreak, many of them have proven their competence in infection control and preventing the spread of the pandemic among healthcare providers and workers in light of the application of global accreditation standards and adherence to correct health practices.
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ARTICLE FEATURES . International Hospital Accreditations
It was clear that hospitals with local and global accreditation certificates worked hard to improve quality, develop policies, programs, plans and continuing education, which led to improving the level of emergency response such as the one we are currently witnessing in light of the outbreak, while maintaining the provision of safer care and high-quality services despite the hardships. Despite the challenges that have burdened hospitals, they, in many countries, have succeeded in implementing a set of important measures to protect their medical staff and others from coronavirus. In light of the spread of the pandemic in most countries of the world, the importance of infection control has emerged in hospitals and in the departments dedicated for coronavirus patients, urging doctors and nurses to follow the highest protection standards with the aim of preventing cross-infection. At this critical stage, accurate infection control measures in hospitals are very necessary to preserve the safety of the healthcare team, and it is extremely important to fight the pandemic because any complacency would threaten everyone and turn hospitals into places of cross-contamination. Hospitals obtaining international accreditations confirm their commitment to applying the highest international practices that are internationally approved in terms of clinical service quality, patient safety, and the competence of medical and administrative staff, while estab-
HOSPITALS HAVE ADOPTED A WORKING METHODOLOGY FOR INFECTION CONTROL THAT IS BASED ON SEVERAL PRINCIPLES, NAMELY, RISK ASSESSMENT AND CONTROL, SETTING POLICIES AND PROCEDURES TO PREVENT ITS SPREAD AND PROVIDING THE INFRASTRUCTURE IN A WAY THAT ENSURES THE SAFETY OF HIGHRISK PROCEDURES.
lishing a system that governs quality performance and makes a qualitative leap in providing excellent healthcare to patients in accordance with the finest international protocols. The infection control policies adopted in hospitals aim to prevent the occurrence or transmission of infection between patients, healthcare providers and visitors. Full adherence to these procedures are obvious when dealing with patients or equipment, provided that the environment surrounding the patient while in the hospital is completely safe and clean while ensuring the reduction of microbial or viral growth and transmission. There are multiple and various infection control methods that are complementary and are applied flawlessly and with high precision in order to ensure the provision of a sterile environment. Perhaps what most of the region’s hospitals have achieved in obtaining international accreditations repeatedly, has contributed to strengthening the health sector’s achievements and renewing global confidence in quality health services in the Arab world. The accreditation standards were a roadmap adopted by hospitals in managing the pandemic.
In light of the pandemic outbreak, it became clear that the internationally accredited hospitals have: • •
Programs and departments dedicated for infection control and prevention. Effective disaster management and raising
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ARTICLE FEATURES . International Hospital Accreditations
•
•
•
the readiness level s to better manage coronavirus cases. Speed in dealing with emergency cases by forming committees that follow up on coronavirus cases and monitor their source. Continuous training for workers on how to deal with patients according to international protocols. An internal system for quality control, data collection, patient records and data.
International standards and protocols International institutions have worked on developing protocols that are proven by scientific evidence that recommend the application of international medical standards and practices to ensure quality and high performance. The majority of hospitals in the countries of the region have succeeded in applying these protocols by following preventive measures that are like daily precautionary steps that are applied by all healthcare providers within the hospital. They aim at controlling infection and are primarily related to patient safety. These measures aim to prevent and control infection to protect those who may be at risk of acquiring infection while receiving healthcare.
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Infection control within hospital departments is a top priority and is applied according to several procedures and policies within the best international practices and standards in order to obtain the best prevention methods, ensure customer safety and security, and enhance the patient's confidence in the health system.
The problem is that every patient who stays in the hospital for more than ten days have an increased risk of contracting coronavirus, especially those who suffer from weak immunity. Washing hands regularly and wearing a mask or face shield while not touching the patient's body without gloves and taking them off when moving from one patient to another are one of the most important measures stipulated in international health policies. They are applied by hospitals to ensure the continuity of obtaining international health accreditations, while also being aware of the great risks that this infection can cause in healthcare facilities. Since any of the hospital employees may be exposed to this infection, hospitals have adopted a working methodology for infection control that is based on several principles, namely, risk assessment and control, setting policies and procedures to prevent its spread and providing the infrastructure in a way that ensures the safety of high-risk procedures while focusing on spreading policies and procedures with the aim of improving the expertise of the personnel in order to reduce risks within performance indicators that rise to the highest global levels through systems that monitor infection and identify the most severe coronavirus cases.
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4th Summit IAPMT & MedTourClub
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Medical tourism in terms of modern opportunities - an international networking Broadcast language – English There will be a professional audience from all over the world! 9+ hours of the information and invaluable knowledge! Networking and blitz presentation. Current projects and fresh ideas! “Country brand in medical tourism” - TOP-speaker from the USA
2020.medhub.top/en/
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INTERVIEW
CEO of HCAC in Jordan
Mrs. Salma Jaouni “Accredited Healthcare Institutions have better Readiness to Deal with COVID-19”
S
ince the emergence of the COVID-19 breakout, Health Care Accreditation Council (HCAC) has taken strong measures, and pledged to be a voice of reference for patients, healthcare providers, and healthcare institutions. ‘Hospitals’ magazine met HCAC CEO, Mrs. Salma Jaouni to talk about Accreditation and the Pandemic.
What is the role and impact of accreditation on the preparedness of healthcare organizations to face the current pandemic? Now more than ever, healthcare institutions need to be equipped with the proper quality and patient safety tools to navigate the unprecedented and stormy health environment we face. Accreditation and external evaluation programs have helped ensure that this extraordinary need, to prioritize quality systems, to ensure resilient, adaptable, well-prepared healthcare institutions that can face the emerging turbulence in healthcare environment, is properly and systematically addressed. For the past thirteen years, the Health Care Accreditation Council (HCAC) has been working
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closely with an array of healthcare institutions in Jordan and beyond, on addressing identified gaps and promoting improvements in relation to quality and patient safety. This ranges from emergency preparedness infection control, medication management, patient care and flow, to environmental safety among other critical areas in the provision of safe and comprehensive care. Based on research done during Jordan’s national lockdown (mid-March to mid-June 2020), the HCAC team found that accredited healthcare institutions have better capabilities and readiness to respond to and deal with the COVID-19 new norm; specifically in areas of: 1. Emergency preparedness; 2. Infection control;
(HCAC) HAS BEEN WORKING CLOSELY WITH AN ARRAY OF HEALTHCARE INSTITUTIONS IN JORDAN AND BEYOND, ON ADDRESSING IDENTIFIED GAPS AND PROMOTING IMPROVEMENTS IN RELATION TO QUALITY AND PATIENT SAFETY.
INTERVIEW
3. Capacity building; 4. Case management; 5. communication; 6. Laboratory services. The accreditation journey has had an outstanding impact and supported those enrolled in it in many ways– the pillars to good response were in place or were readily activated – such as: • A well-structured Infection Prevention and Control (IPC) Program, • A stronger ability and skills to design and upgrade disaster management plans to manage COVID-19 cases. • Availability and activation of responsive committees, • Complete policies and procedures that reference HCAC standards and support accurate and timely communication and decision-making, • Trained staff, and an inherent culture and internal systems for quality monitoring, including data collection, performance indicators, proper documentation of patient records and clinical data.
HCAC Laboratory Readiness Checklist
ence to quality services and safe practices in emergency situations.
A user-friendly Resource Hub HCAC’s internal multi-disciplinary team of experts, designed, developed and published a repository of reliable scientific resources and a readiness toolkit in both English and Arabic, comprising practical and scientifically proven
HCAC DESIGNED AND HOSTED WORKSHOPS FOR DELIVERING UPDATED INFORMATION, AND KNOWLEDGE ON HOW TO MANAGE AND CO-EXIST WITH THE COVID-19. SEVEN ONLINE SESSIONS WERE ORGANIZED AND DELIVERED THROUGH EJAWDA, HCAC’S ONLINE TRAINING PLATFORM.
Accredited hospitals reported that they were sought after for guidance and advice on how to jumpstart systems and plans; a testament that accreditation standards served as a catalyst and roadmap during the management of COVID-19.
How did HCAC situate itself during the pandemic, and what was your role in promoting health and safety? Since the emergence of the COVID-19 breakout, HCAC has taken strong measures, and pledged to be a voice of reference for patients, healthcare providers, and healthcare institutions.
Communication is key HCAC took immediate steps towards spreading awareness, by launching a social media and digital campaign “Be Ready Be Safe” aimed at ensuring healthcare organizations, service providers and the public have continuous access to information and guidance pertaining to the COVID-19 pandemic, to promote adher-
“Be Ready, Be Safe” Awareness Campaign
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INTERVIEW
guidance and tools to ensure provider readiness in emergency situations. The resources were then later culminated into two main valuable products: A Manual for COVID-19 Readiness, and an associated Quality Improvement Toolkitall of which were made available free-of-charge to Jordan and the world.
Guidance not only for healthcare Institutions In order to enable healthcare facilities to navigate their way through the crisis, HCAC also developed Readiness Programs and Checklists for both healthcare and non-healthcare facilities, such as hospitals, healthcare centers, labs, schools, nurseries, restaurants, food outlets, etc. to strengthen infection prevention and control procedures, design and implement their risk plans, abide by government and international guidance for COVID-19 safety and have well-learned staff on safety requirements and expected behaviour.
Capacity Building and Knowledge Sharing at the Core HCAC also designed and hosted workshops for delivering updated information, and knowledge on how to manage and co-exist with the COVID-19. Seven online sessions were organized and delivered through Ejawda, HCAC’s online training platform. The sessions included many topics such as: infection control, case management for COVID-19, critical care management for COVID-19, neonatal care for infected or suspected mothers, emergency preparedness, dental care during the pandemic, breastfeeding during the pandemic. These workshops were delivered free-of-charge and attended by more than 850 participants. Additionally, and with the aim to maintain engagement with the public community, key stakeholders, healthcare institutions, and frontline healthcare providers, HCAC launched 2 series of webinars and participated in international webinars that tackled a variety of topics related to COVID-19 readiness and response. The first series consisted of 4 policy webinars presented in the form of Q&As and interviews with the CEO on areas such as family medicine, private sector role, the quality and safety in the pandemic, and mental health all in the realm of COVID19. The second series was dedicated to online discussions with accredited healthcare institutions highlighting their practices and reflected on their experience with COVID-19.
What is your take on Telehealth, is it going to be the new normal in our health systems?
Infection Prevention & Control Workshop
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COVID-19 outbreak has propelled the world into new and alternative forms of making business, delivering education as well as promoting and providing healthcare services. Virtual practices in healthcare, including telemedicine and telehealth has been around for years, and has rapidly transitioned in the last 6 months from being desirable, to a key requisite in healthcare future planning. We have seen many barriers to access to healthcare broken down by the use of technology. Though it will never replace the face-to-
COVID-19 OUTBREAK HAS PROPELLED THE WORLD INTO NEW AND ALTERNATIVE FORMS OF MAKING BUSINESS, DELIVERING EDUCATION AS WELL AS PROMOTING AND PROVIDING HEALTHCARE SERVICES. VIRTUAL PRACTICES IN HEALTHCARE, INCLUDING TELEMEDICINE AND TELEHEALTH HAS BEEN AROUND FOR YEARS, AND HAS RAPIDLY TRANSITIONED IN THE LAST 6 MONTHS FROM BEING DESIRABLE, TO A KEY REQUISITE IN HEALTHCARE FUTURE PLANNING.
INTERVIEW
face health promotion and healthcare delivery, it should and will continue to evolve as a key component in driving healthcare and better health. In Jordan, great initiatives that are functional and effective emerged and were fast tracked because of the restrictions imposed by the pandemic. I am sure however that they will keep developing. Such an example would be the electronic platform “e-Med Hakeem” that was set up to address the healthcare needs of patients with chronic diseases and meet the prescription refill needs. However, adopting telemedicine requires evolving patient care workflows and potentially redefining the patient encounter. They will require proper guidelines and standards as well which HCAC will be ready to put forth...
What is HCAC’s roadmap to navigate through the pandemic and move forward beyond COVID-19? Moving forward, HCAC will continue with its mission to ensure that healthcare institutions are in continuous readiness and emergency preparedness for pandemic-like situations and post
COVID-19 timely delivery of healthcare services. The continuity of care is at the core of what we are now advocating for. Additionally, HCAC is working on reinforcing and expanding the requirements of emergency preparedness in its accreditation standards while ensuring the latest guidelines on infection prevention and control, case management, and emergency management are updated throughout all of its standards revision cycles. HCAC has also adapted to the current restrictions by designing and undertaking a virtual survey model to ensure that accreditation services are continued and that the cycle of improvement and quality evaluation is uninterrupted. This will continue to evolve into our methodologies of work and services offered. Amidst the uncertainty, we have a long way to go. However, HCAC is equipped with an unwavering drive, technical competence, and situational awareness that allows us to tackle challenges in health systems in different sectors and countries. We are here and will always be, to serve patient safety and uphold quality at all times.
HCAC’S INTERNAL MULTI-DISCIPLINARY TEAM OF EXPERTS, DESIGNED, DEVELOPED AND PUBLISHED A REPOSITORY OF RELIABLE SCIENTIFIC RESOURCES AND A READINESS TOOLKIT IN BOTH ENGLISH AND ARABIC, COMPRISING PRACTICAL AND SCIENTIFICALLY PROVEN GUIDANCE AND TOOLS TO ENSURE PROVIDER READINESS IN EMERGENCY SITUATIONS.
HCAC webinars
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The ‘new normal’ of stroke awareness and why we must act FAST By Nurgul Vatansever, Vice President at Medtronic CEMA to 12,000 cases are being recorded each year2, while in Egypt the annual amount of cases is around 150,000 to 210,0003. Despite these alarming numbers, the most severe effects of stroke are preventable and treatable, with 80 million people having survived a stroke4. Identifying the signs of stroke are vitally important and could save thousands of lives every day and prevent permanent disability. Recognizing these signs and acting fast can save up to two million neurons per minute and help give patients the best possible chance of recovery. To help aid stroke patients’ in their race against time, the use of “F.A.S.T.” can help spot the signs of a stroke and seek help quickly. By recognizing any Face drooping, Arm weakness, Speech slurring, and then acting in Time to call emergency services, people can save countless lives. It is understood that 1 in 4 people will rely on those closest to them to tell they are having a stroke and call emergency services.
Supporting the region
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lthough World Stroke Day, which happens every year on the 29th October, has been and gone, the fight to raise awareness and increase prevention of stroke must continue all year round. This year alone, 14.5 million people worldwide will have a stroke, with 5.5 million people expected to die as a result. This needs to change.
This serious issue has been compounded by the COVID-19 pandemic with many patients worldwide reporting their symptoms, on average, a few days after the onset. This will not only have a significant effect on their chances of recovery, but it also affects those around them, the need for intensive care, and the overall healthcare system. More than ever, we all must be stroke aware. As the second leading cause of death and third leading cause of disability worldwide1, stroke is having a devastating effect closer to home and greatly affecting people across the Middle East. In the UAE, approximately 10,000
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At Medtronic, our main focus is to increase access to stroke care and effective stroke treatment by providing innovative medical technology to local governments and their specialized stroke centers. As a trusted partner, we are also working intently with key stakeholders to optimize the processes and resources across the four different stages of the patient pathway, and through our efforts across infrastructure development, therapy awareness, and training, we aim to ensure more patients are getting the best care possible, as quickly as possible. One way that we are doing this is by providing highly trained consultants to support hospitals and governments to create Centers of Excellence, a structured onsite networking opportunity that connects patients with an experienced stroke center that provides for discussion, benchmarking, and best practice sharing.
Technology and education Time is the difference between a good or bad medical outcome for a stroke patient. As
STROKE IS HAVING A DEVASTATING EFFECT CLOSER TO HOME AND GREATLY AFFECTING PEOPLE ACROSS THE MIDDLE EAST. IN THE UAE, APPROXIMATELY 10,000 TO 12,000 CASES ARE BEING RECORDED EACH YEAR2, WHILE IN EGYPT THE ANNUAL AMOUNT OF CASES IS AROUND 150,000 TO 210,000.
ARTICLE
TRANSFORMING THE STROKE CARE CONTINUUM TOGETHER STROKE
SYSTEMS OF CARE PATIENT SUPPORT AND FOLLOW UP IN-HOSPITAL WORKFLOW THERAPY TREATMENT POST STROKE MONITORING LONG TERM PATIENT MANAGEMENT
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hub for the whole region to train interventional neuro-radiologists, neurologists, nurses and ER doctors on how to optimize stroke management in their hospital and therefore helping to elevate stroke pathways.
Providing holistic care
FACE ARM drooping weakness
SPEECH TIME to call slurring emergency
a result, Medtronic is utilizing Artificial Intelligence to help decrease the diagnosis time and increase patient outcomes. The launch of our RAPID software, which is an artificial intelligence-powered imaging software, allows doctors and first responders to quickly identify brain events, and most importantly, speed up the treatment of patients suspected of having ischemic strokes. In Saudi Arabia, where studies show an incidence rate of first-time stroke of 57.64 per 100,000 people5, Medtronic is optimizing the stroke pathways at Sulaiman Al-Habib Hospitals’ Network by providing them with innovative technology, like RAPID, and leveraging Medtronic’s expertise to support stroke teams in establishing a strong referral network. Sulaiman Al-Habib Hospitals’ Network has also opened six hospitals in three different regions of the Kingdom with immediate evaluation for every stroke code. In addition to the standard of care for acute stroke, IV alteplase, an injection used to treat blood clots in the lungs, and mechanical thrombectomy, a minimally invasive procedure, are also offered to all eligible patients. As technology and techniques evolve, it is essential that health staff also have access to quality education and training. To continue improving and extending the lives of stroke patients, Medtronic provides learning resources and healthcare professional training programs for local stroke teams in the region. In the UAE, for example, Medtronic is partnering with the stroke team at Rashid Hospital to help transform their center into a training
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We are also focused on helping to provide a holistic experience and ongoing support for our patients by increasing awareness and improving their entire treatment process through our innovative therapies to help improve their quality of life. Through the use of quality surgical tools, in Egypt we have been able to enhance stroke care pathways and significantly improve the impact on patient outcomes. Solitaire™ X is a new generation revascularization device for Acute Ischemic Stroke with a unique technology that allows physicians to draw clots out of the patient, and therefore alleviates pain and improves their lives. Post-treatment care is also a priority, which is why Medtronic also sponsors clinical registries to improve post-stroke treatment, and as a result we have been able to make a measurable impact by reducing recurrence rates and lasting health problems for local patients. In addition, we are also looking to improve the outcomes and lives of as many patients as we can by providing consultancy services to enhance the patient experience across pre, inter, and in hospital phases. As a leading healthcare and medical technology company, we recognize the incredibly important role we play in improving stroke care efficiency throughout the Middle East, and we remain strongly committed to alleviating pain, restoring health and extending the life of our patients by harnessing the power of technologies and people. It is imperative that we continue working as a trusted partner alongside local governments, organizations, and patient societies to not only offer stroke patients the quality of care that they deserve, but also to raise much needed awareness around the impact of stroke on our region and ways that we can help to prevent serious outcomes and save lives. In the era of COVID-19, this has never been more important; we need to keep this conversation going.
REFERENCES 1. Johnson, W., Onuma, O., Owolabi, M., & Sachdev, S. (2016). Stroke: a global response is needed. Bulletin of the World Health Organization, 94(9), 634-634A. https:// doi.org/10.2471/ blt.16.181636 2. https://gulfnews. com/uae/health/ asians-in-the-uae-athigh-risk-of-suffering-astroke-1.67445374#:~:text=The%20UAE%20 is%20known%20 to,third%20leading%20 cause%20of%20mortality. 3. https://www. researchgate.net/publication/263814127_Burden_of_stroke_in_ Egypt_Current_status_ and_opportunities 4. Why stroke matters. (n.d.). Retrieved from https://www.worldstroke.org/worldstroke-day-campaign/ why-stroke-matters 5. https://www. hindawi.com/journals/ nri/2019/8502758/
ARTICLE FEATURES . Stroke
STROKE
A frequent complication among Covid-19 patients NOV.DEC 2020
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ARTICLE FEATURES . Stroke
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n World Stroke Day, which falls on the 29th of October each year, researchers in this field indicate that having the seasonal flu or the novel coronavirus can increase the risk of stroke that occur as a result of a long disease process. A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications. But of course, not all coronavirus patients are susceptible to this. There are long-term risk factors, i.e. chronic diseases such as diabetes, hypertension and high levels of cholesterol that have negative effects on the blood vessels. With a lack of exercise, failure to follow a healthy diet, the inability to control diabetes and blood pressure, and if the patient also suffers from the novel coronavirus, the negative factors will accumulate to eventually lead to a blockage in the blood vessels by a clot or fat accumulation called plaques. According to medical reports from several countries, the coronavirus that causes (COVID-19) can increase the risk of stroke and the reason is that infection and inflammation can stimulate the blood clotting process, which results in blood clots and blockages. If one of the clots succeeds in penetrating the brain through the vessels, it may cause a decrease in blood flow to the brain and thus a stroke. It is true that the novel virus directly affects the respiratory system and lungs, but neuroscientists and neurologists around the world have been able to collect evidence showing the virus’s impact on the brain, which raises concern. This virus has the ability to multiply inside the brain; it is not clear yet how widely it can spread, while its presence deprives brain cells from oxygen.
IT IS TRUE THAT THE NOVEL VIRUS DIRECTLY AFFECTS THE RESPIRATORY SYSTEM AND LUNGS, BUT NEUROSCIENTISTS AND NEUROLOGISTS AROUND THE WORLD HAVE BEEN ABLE TO COLLECT EVIDENCE SHOWING THE VIRUS’S IMPACT ON THE BRAIN, WHICH RAISES CONCERN.
an unhealthy lifestyle. There are many factors that may contribute to blood clotting in coronavirus patients: Modern medical and scientific research indicates that clotting occurs when the COVID-19 attacks the cells that line blood vessels by penetrating the ACE2 receptor located in the endothelial cell membrane, and once it binds to the receptors, the blood vessels release the proteins that cause blood clots. ACE2 receptors are present in the neural cortex and brain stem, but it’s not known under what circumstances the virus penetrates the brain and interacts with these receptors. Blood clots are gel-like collections of blood that form in your veins or arteries when blood changes from liquid to partially solid. Clotting is a normal function that stops your body from bleeding too much when you get hurt. However, blood clots that form in some places and don’t dissolve on their own can be dangerous to your health. Research indicates that COVID-19 patients face an increased risk of developing dangerous blood clots, which greatly exacerbates the outcome and makes them more likely to be admitted to the intensive care unit. Studies from around the world also indicate the prevalence of symptoms of neurological disorders among coronavirus patients, including mild symptoms such as headache, loss of smell and tingling, and acute symptoms such as loss of speech, stroke and seizures. So far, it is estimated that about 50 percent of people infected with the novel coronavirus suffer from neurological disorders.
Risk Factors Of course, the risk of stroke increases in cases of severe infection with the virus, and even among the elderly, who are overweight or suffer from diabetes, high blood pressure, or lead
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ARTICLE FEATURES . What does Covid-19 do to the brain?
What does Covid-19 do to the brain? NOV.DEC 2020
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ARTICLE FEATURES . What does Covid-19 do to the brain?
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he world is still learning more and more about the effects of the novel coronavirus on the human body, as researchers, doctors and healthcare providers put their main focus on monitoring patients at the various stages they go through during and after infection with this novel virus. Among the negative effects that have begun to unfold over time are the virus’ impact on the brain and nervous system.
When the virus enters the human body, it penetrates into the cells with the help of the angiotensin-converting enzyme 2 (ACE2). Perhaps what has prompted scientists and doctors to search for the reasons behind the presence of ACE2 in other places of the body is the ability of the novel virus SARS-CoV-2 to cause complications in organs and systems other than the respiratory system. The novel coronavirus 2019 (2019-nCoV) uses the SARS-coronavirus receptor ACE2, and the cellular protease TMPRSS2 for entry into target cells1. Since identifying the possible route of infection has major implications for understanding the pathogenesis and future treatment strategies for SARS, the present study investigated the localization of ACE2 protein in various human organs (oral and nasal mucosa, nasopharynx, lung, stomach, small intestine, colon, skin, lymph nodes, thymus, bone marrow, spleen, liver, kidney, and brain)2. It is found on the surface of the cell in the brain3 as well as the lungs and other organs of the body. The presence of little virus on the surface of the cell is enough to penetrate the nerve tissue and cause problems in the brain. The novel coronavirus usually attacks the lungs, causing symptoms such as coughing and difficulty breathing, but doctors are now starting to worry about another organ — the brain. As research has evolved, we’ve seen the novel coronavirus can cause microthrombi — or small blood clots — which can develop and travel through the body. This can cause an obstruction of blood flow to the brain and cause ischemic stroke4. Cases around the world show that patients with COVID-19 can have a variety of conditions related to the brain, including confusion, loss of consciousness, seizures, stroke, loss of smell and
THE NOVEL CORONAVIRUS USUALLY ATTACKS THE LUNGS, CAUSING SYMPTOMS SUCH AS COUGHING AND DIFFICULTY BREATHING, BUT DOCTORS ARE NOW STARTING TO WORRY ABOUT ANOTHER ORGAN — THE BRAIN. AS RESEARCH HAS EVOLVED, WE’VE SEEN THE NOVEL CORONAVIRUS CAN CAUSE MICROTHROMBI — OR SMALL BLOOD CLOTS — WHICH CAN DEVELOP AND TRAVEL THROUGH THE BODY.
taste, headaches, trouble focusing and changes in behavior5. According to doctors from the Johns Hopkins University School of Medicine in Maryland, it is possible that this virus has the ability to enter the brain and cause sudden and severe infection. The cases reported in China and Japan found the genetic material of the virus in the spinal fluid, in addition to a case in Florida that showed the presence of viral particles in brain cells. This may happen due to the virus entering the bloodstream or nerve endings. The analyses revealed that both ACE2 and TMPRSS2 are expressed by cells in the olfactory epithelium—a specialized tissue in the roof of the nasal cavity responsible for odor detection that houses olfactory sensory neurons and a variety of supporting cells. Data suggest that COVID-19-related anosmia may arise from a temporary loss of function of supporting cells in the olfactory epithelium, which indirectly causes changes to olfactory sensory neurons6. The coronavirus targets the lungs foremost, but also the kidneys, liver and blood vessels. Still, about half of patients report neurological symptoms, including headaches, confusion and delirium, suggesting the virus may also attack the brain. REFERENCES 1. 4. Hoffmann M, Kleine-Weber H, Krüger N, Müller M, Drosten C, Pöhlmann S. The novel coronavirus 2019 (2019-nCoV) uses the SARS-coronavirus receptor ACE2 and the cellular protease TMPRSS2 for entry into target cells. bioRxiv 2020:2020.01.31.929042. 2. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis 3. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC7214348/ Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights 4. https://news.llu.edu/health-wellness/connection-between-coronavirus-strokes-and-young-patientsThe connection between coronavirus, strokes, and young patients By Janelle Ringer 5. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain- How Does Coronavirus Affect the Brain? Robert Stevens, M.D 6. https://hms.harvard.edu/news/how-covid-19causes-loss-smell - How COVID-19 Causes Loss of Smell - By KEVIN JIANG July 24, 2020 Research
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INTERVIEW
COGNITIVE OVERLOAD, MEDICAL ERRORS, AND CLINICAL COMMUNICATION STRATEGY Chief Nursing Officer Vocera Communications Inc.
Rhonda Collins, DNP, RN, FAAN “Offload clinicians’ burden of retrieving, retaining, and recording information, and simplify communication” NOV.DEC 2020
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ore than a quarter of a million medical errors occur in the U.S. each year and they are the third leading cause of death behind heart disease and cancer. Communication problems and clinician cognitive overload have been associated with medical errors; communication problems are the most common root cause. Hospitals can help reduce medical errors with a communication strategy that helps reduce clinicians’ cognitive load.
What is the connection between cognitive overload and medical errors? Humans parse and make sense of what is going on around us through the act of segmenting information. As a clinician in a hospital environment, you constantly segment what is important and urgent. When you receive too many pieces of information at once, you become overloaded and have difficulty segmenting. This can lead to mistakes. You are also constantly splitting your attention among multiple sources and having to pay attention to too many things at once. This can lead to cognitive overload and may leave you unable to focus on a critical patient care task.
How do you explain cognitive load in the context of the clinical environment? A clinician responsible for four or six patients simultaneously encounters a constant influx of information. The cognitive processing of it is an ongoing act of sensemaking and of learning. Learning theory identifies three types of cognitive load: intrinsic, extrinsic, and germane. Intrinsic cognitive load is about the level of cognitive effort you expend to complete a problem or task. As a clinician, your intrinsic load is affected by stress factors that diminish your working memory, like lack of sleep or a sick child at home. Intrinsic load can be compounded by larger, deeper emotions such as shame, guilt, or grief. Extrinsic cognitive load is about the level of cognitive effort the clinical environment demands of you. You have little control over the extrinsic cognitive load placed upon you. If you’re bombarded with information and you can’t control how it’s coming at you, you can have a heavy extrinsic load. Germane cognitive load is the effort you have to expend to make sense of new informa-
tion. If you receive a lab value with no context and have to go to another system and retrieve past values and other related information in order to understand the complete picture, your germane cognitive load is heavy.
What are some of the key problems hospitals need to solve to help reduce clinicians’ cognitive load and overload? One problem is how clinicians are so often put in the position of having to solve complex problems without full context. You might have a small piece of standalone information, such as a lab value, but you’re unable to slot that information into any file system in your head that makes sense to you. A second problem is the way clinicians often have to split attention between multiple sources of information and pay attention to too many things concurrently. A third challenge is clinicians’ struggle to fundamentally communicate with each other. They are hindered by barriers such as multiple standards, conflicting protocols, and disparate communication tools. The difficulty of communicating is a drain on working memory. A fourth problem is the pervasive need for redundant documentation. When you have to write the same information three or four times in three or four different places while you’re busy and juggling information about four to six different patients, you’re likely to make a mistake. A fifth problem is nuisance notifications. Perhaps a nurse doesn’t need to receive a patient’s vital signs every ten minutes if a patient is stable, or be notified that a patient’s Sp02 has dropped down to 88% when that patient has a normal O2 saturation at 88%.
How can hospitals solve these challenges? A hospital that’s standardized on a single clinical communication and collaboration (CC&C) platform for all clinicians is positioned to employ strategies to address cognitive overload. Working memory is limited in capacity and duration. Hospitals need to offload clinicians’ need to retrieve, retain, and record information, and make it easier to communicate. A comprehensive CC&C platform can make all the difference.
HUMANS PARSE AND MAKE SENSE OF WHAT IS GOING ON AROUND US THROUGH THE ACT OF SEGMENTING INFORMATION. AS A CLINICIAN IN A HOSPITAL ENVIRONMENT, YOU CONSTANTLY SEGMENT WHAT IS IMPORTANT AND URGENT. WHEN YOU RECEIVE TOO MANY PIECES OF INFORMATION AT ONCE, YOU BECOME OVERLOADED AND HAVE DIFFICULTY SEGMENTING.
Discover how you can develop communication strategies to help reduce cognitive overload in Dr Collin’s 2020 CNO Perspective report - download it now at vocera. com/me/cnoperspective-2020 or call 800-0182438.
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Royal National Orthopaedic Hospital Decommissions Pagers, Unifies Clinical Communication Amidst Pandemic The Largest Specialist Orthopaedic Hospital in the United Kingdom Responds to COVID-19 with a Robust Communication Strategy – and Nobody Misses the Pagers
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n December 2018, the Royal National Orthopaedic Hospital (RNOH) NHS Trust opened its new, state-of-the-art Stanmore Building. Its older facility was no longer suitable for the high-quality care and excellent clinical outcomes RNOH strives to provide. The hospital layout went from having Nightingale wards – large rooms without subdivisions for multi-patient occupancy – to modern wards with single patient rooms offering more privacy. Staff were accustomed to working and communicating with clear lines of visibility. Some were concerned they wouldn’t be able to communicate with
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each other efficiently in the new hospital building, due to the reduced lines of sight and new layout. In February 2019, two months after RNOH opened the new facility, Health Secretary Matt Hancock issued his order for all NHS hospitals to remove archaic technology including pagers, for non-emergency communications before the end of 2021. The hospital quickly began the process to decommission pagers and replaced them with a communication platform from Vocera® that would unify staff.
ARTICLE RNOH leadership chose the Vocera Platform, an intelligent ecosystem that connects all the people and information needed to deliver patient care, for their modern facility. Vocera stood out as the best vendor to meet RNOH’s needs and was selected because the Platform provides simplicity, rapid hands-free communication, and allows users to choose the device that works best for their role. Before implementing Vocera technology in the 100-acre hospital, care team members would receive pager notifications initiated through a complex workflow. Clinicians that received notifications were tasked with finding a phone, calling the switchboard operator, writing down the message, repeating it back to the operator, and responding accordingly.
performing elective surgeries to preparing for and managing patient surges. “In a 10-day period we turned our quiet, elective surgery hospital into the orthopaedic trauma centre for a large portion of north central London,” said Matt Phillips, Lead Clinical Practitioner, Acute Intervention Team at RNOH. “We suddenly went from caring for pre-assessed elective patients, to having multiple trauma-related cases per week.”
“We needed a faster, more reliable communication system,” said Bela Haria, Information Management and Technology Senior Project Manager. “Pagers were falling to bits and had to be held together with tape. Additionally, some areas in the hospital didn’t have pager coverage.”
A global leader in orthopaedic and spinal surgery, RNOH turned its private patient unit into a respiratory therapy unit where most of the COVID-19 patients were treated. The hospital equipped runners with wearable Vocera Badges to bring necessary supplies to clinicians treating patients in the make-shift isolations rooms. Runners could communicate with clinicians without having to enter the rooms, eliminating the need for the runner to don personal protective equipment (PPE).
RNOH reported an 84% improvement in care team response times after replacing pagers with the Vocera smartphone app and hands-free communication badge. After deploying the Vocera solutions, mobilising the cardiac arrest team at the 220-bed hospital went from an average of two minutes to 20 seconds.
“Vocera technology sped up communication and coordination during the peak of the COVID-19 crisis,” said Pauline Robertson, Head of Nursing for the Medicine and Therapies. “It helped us provide seamless patient care without risking infection, and we were able to conserve precious PPE.”
When the UK began to see cases of COVID-19 earlier this year, RNOH had to rapidly shift priorities and prepare for the impending patient surge. “If I were to give anyone advice when planning for a pandemic or impending patient surge, it would be to unify your communications now,” explained Matt Phillips, Lead Clinical Practitioner, Acute Intervention.
Vocera technology also helped staff stay connected to team members outside the hospital during the pandemic. Clinicians working in pop-up testing tents that the British Army set up in the hospital’s car park were equipped with Vocera Badges.
During the peak of COVID-19, RNOH extended its pager replacement program, utilising the full potential of the Vocera communication platform. The hospital went from a controlled roll out to relying completely on Vocera solutions for all pagers, including all crash calls. The hospital also quickly shifted from focusing on and
RNOH LEADERSHIP CHOSE THE VOCERA PLATFORM, AN INTELLIGENT ECOSYSTEM THAT CONNECTS ALL THE PEOPLE AND INFORMATION NEEDED TO DELIVER PATIENT CARE, FOR THEIR MODERN FACILITY. VOCERA STOOD OUT AS THE BEST VENDOR TO MEET RNOH’S NEEDS AND WAS SELECTED BECAUSE THE PLATFORM PROVIDES SIMPLICITY, RAPID HANDS-FREE COMMUNICATION, AND ALLOWS USERS TO CHOOSE THE DEVICE THAT WORKS BEST FOR THEIR ROLE.
“If it weren’t for Vocera, we wouldn’t have had a way to quickly and easily communicate with staff working in our testing tents,” Matt Phillips said. “Vocera technology was brilliant because we didn't have to worry about anything related to communication. We gave staff a badge, and we were instantly at peace knowing they had a secure means to communicate with each other and with the rest of hospital staff.”
For more resources and information on how Vocera can help you improve clinical communication and workflows, visit: www.vocera.compagerreplacementsolutions
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INTERVIEW
Vice President & General Manager BD Middle East & North Africa
Maher Elhassan “We were recognized for rapid response in addressing the pandemic�
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D has been named to Fortune’s Change the World list in 2020 for addressing critical healthcare needs during the novel coronavirus pandemic. ‘Hospitals’ magazine had the pleasure to meet Maher Elhassan, Vice President & General Manager, BD Middle East and North Africa, to highlight the initiatives and activities of BD during the pandemic.
BD has been named to Fortune’s Change the World list in 2020 for addressing critical healthcare needs during the novel coronavirus pandemic. What is the importance of this honorable recognition for the 4th time in 6 years? The COVID-19 pandemic brought an unprecedented crisis to the world this year. In addition to ensuring health and safety, we saw governments and communities facing significant challenges while looking for ways to accelerate testing and diagnosis to prevent spread of the outbreak and attend to those affected. As such, with our purpose of advancing the world of health by improving medical discovery, diagnostics and the delivery of care, we doubled down on what we do best — tapping our deep resources to help solve healthcare’s biggest problems; working with urgency to innovate and ensure the front lines have what they need to address this crisis; and making an impact on lives around the world. In essence, our role evolved to become the first responder to the first responders. This year, we were recognized for our early, rapid response in addressing the pandemic by quickly mobilizing and working with urgency and purpose to react to the critical needs of the healthcare sector.
Can you brief us about your initiatives and activities during the pandemic? How did you respond rapidly to the critical needs of healthcare systems and patients during the virus? How was your team able to mobilize efforts and work to match with the needs of the pandemic from diagnosis to the delivery of care, and discovery of innovation? As one of the largest global medical tech-
nology companies in the world, we are deploying our capabilities, expertise and scale to address critical health needs related to coronavirus – from our diagnostic offerings to identify COVID-19, to real-time informatics and electronic surveillance technology, to essential medical devices to support patient care. Some of our efforts include: • Being a critical supplier of swabs and other sample collection products for COVID-19, we launched multiple molecular tests, enabling clinicians to know if a patient currently has COVID-19. These molecular tests in a clinical lab, provided rapid results in two to three hours only. BD worldwide has recently launched another rapid 15-minute POC antigen test for faster COVID-19 testing, which can increase mass surveillance with faster results. • We worked closely on helping to secure access to critical devices for patient care in ICUs and field hospitals by scaling up manufacturing of necessary products, some of which saw an increase in manufacturing production of 100 folds. We also supported patient management in the ICUs through facilitating complex care with systems such as medication management, infusion pumps and sets, IV access, IV Care and Maintenance, Foley Catheters, as well as surveillance and analytics. • The rapid challenges and increased burden on healthcare systems identified the need for providing new training on infection control practices. Therefore, BD provided comprehensive digital education tools and training in infection prevention to frontline personnel that were involved in direct patient care including physicians, nurses, pharmacists, and laboratory technicians. • We also worked on accelerating discovery of potential therapies. Our solutions, instruments, and data analysis platforms have played an integral role in helping helping researchers rapidly deepen our understanding of COVID
THIS YEAR, WE WERE RECOGNIZED FOR OUR EARLY, RAPID RESPONSE IN ADDRESSING THE PANDEMIC BY QUICKLY MOBILIZING AND WORKING WITH URGENCY AND PURPOSE TO REACT TO THE CRITICAL NEEDS OF THE HEALTHCARE SECTOR.
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at a cellular level, specifically in clarifying our picture of the body’s immune system response. To prepare for mass vaccination, BD has been working to ensure the availability and safe administration of treatment. As researchers move into clinical trials, we have a full suite of medication delivery devices to meet the needs of each potential drug. We have been in conversations with governments around the world to understand needs and scale up production. And we are already working to provide more than 500 million needles and syringes to support vaccination campaigns around the world, most of which will be supplied before early next year. We have also stepped up to respond to the needs of communities through philanthropic and volunteer support. BD and the BD Foundation have issued nearly $2.5 million in philanthropic grants and product donations to non-profit partners that are working to protect the most vulnerable communities and individuals from the pandemic’s spread and negative impacts. And BD volunteers are heeding the call, too.
What were your efforts in addressing and combatting antimicrobial resistance as last year where you were named to Fortune’s Change for this? To slow the spread of antimicrobial resistance (AMR) and to help ensure that the right drug is delivered to the right patient at the right time, a multifaceted approach to AMR was needed. And appropriate use of medical technology can help to reduce spread of infections in healthcare facilities, while diagnostic testing can enable the cause of infections to be more precisely identified, supporting effective treatment decisions. BD mobilized a company-wide AMR strategy team comprised of 40 employees from across our businesses, countries, and corporate functions. This team aligned and executed the various components of our AMR strategy. These included:
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Training programs. One of the most important steps to curbing the spread of antimicrobial resistance is to curb infections, as resistant infections spread easily among patients in healthcare facilities. This makes it imperative for hospitals to implement effective infection prevention and control programs. Therefore, we offered training programs for customers centered around its products and solutions that are often used in environments where healthcare associated infections (HAIs) are common (i.e., vascular access procedures, general surgery and urinary drainage procedures). In addition to deploying these programs at an individual health facility level, we also worked in collaboration with national governments in multiple countries, including the U.S., China, Kenya, Cambodia and India, via public-private partnerships to improve infection prevention and control capabilities in hospitals.
Diagnostic testing. With diagnostics playing a key role in identifying infection types, it helps ensure the right drug is prescribed. To address this BD partnered with the U.S. Department of State, U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. CDC to advance the capacity and capabilities of labs in Africa and India to diagnose infectious disease. The program, Labs for Life, has been acclaimed as being among the most successful public-private partnerships, and also improved the diagnosis of the resistant form of tuberculosis (TB), which is presently associated with approximately one-third of the 700,000 annual deaths presently attributed to AMR worldwide. BD assays are developed with feedbacks from local surveys, to ensure specific antibiotics are tested according to local epidemiology and local practices. The unique assays for antibiotic susceptibility testing as per WHO criteria, enables the labs for rapid cost-effective testing to combat AMR.
Surveillance and reporting. Control of AMR requires use of surveillance tools to ensure that the appropriate therapy
BASED ON THE FUNDAMENTAL PREMISE THAT A CHALLENGE AND THREAT AS LARGE AND ENCOMPASSING AS AMR CANNOT EVER BE ADDRESSED BY ONE SECTOR ALONE, BD HAS ENGAGED IN EXTENSIVE CROSS-SECTOR COLLABORATION WITH LEADING HEALTH AGENCIES, FOUNDATIONS AND OTHER ORGANIZATIONS AROUND THE WORLD, UNDERPINNED BY COMMON MOTIVES AND GOALS.
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is provided to patients. The tools can also help identify patients at greatest risk of contracting a resistant infection by incorporating information from a variety of sources as part of routine care. And the near real-time availability of data allows clinicians to make more targeted decisions to optimize the use of antibiotics. In addition, surveillance tools can be used to create an early warning system to detect infections before an outbreak occurs, so that action can be taken to prevent or gain rapid control of an outbreak. Electronic surveillance systems enable healthcare facilities to transmit data to public health authorities to monitor local, regional and national trends. By providing hospitals with surveillance tools, BD empowered clinicians identify and re-
port healthcare associated infections, and assess AMR risks within their facilities.
Global impact. Based on the fundamental premise that a challenge and threat as large and encompassing as AMR cannot ever be addressed by one sector alone, BD has engaged in extensive cross-sector collaboration with leading health agencies, foundations and other organizations around the world, underpinned by common motives and goals. We engaged directly with countries around the world to support infection prevention and control programs in hospitals and to advance laboratory practices, tailoring its approach to the stage of development of each country and the level of sophistication among hospitals in being able to combat AMR.
BD PROVIDED COMPREHENSIVE DIGITAL EDUCATION TOOLS & TRAINING IN INFECTION PREVENTION TO FRONTLINE PERSONNEL.
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BONE MARROW TRANSPLANT MADE SAFER AND AVAILABLE TO ALL “Not every patient is lucky to have a fully matched donor. New methods give us a chance to cure the patients, give them a chance to live longer and healthier.” methods give us a chance to cure the patients, give them a chance to live longer and healthier,” says hematology expert Professor Siret Ratip M.D., Head of Adult Bone Marrow Transplant Center in Acıbadem Altunizade Hospital in Turkey. These methods are called haploidentical transplantation and matched unrelated donor transplantation (MUD).
Life-saving option for patients with blood cancers
B
one marrow transplant, also known as stem cell transplant, has become a remedy for today's most difficult blood and tissue cancers. For the success of bone marrow transplantation, physicians have been looking for fully compatible donors for years. Unfortunately, most of the patients did not have perfect matched donors, and therefore, they could not benefit from bone marrow transplantations. However, this situation has changed with the recent developments in technology and cell engineering. Nowadays, in a limited number of advanced medical centers worldwide, patients who need a bone marrow transplant can be successfully transplanted from non-fully compatible donors. “Not every patient is lucky to have a fully matched sibling or donor. New
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THE BEST ALTERNATIVE FOR ALLOGENEIC BONE MARROW TRANSPLANTATION IN ACUTE LEUKEMIA PATIENTS WITH HIGH-RISK FACTORS IS A FULL-MATCH TRANSPLANT FROM A BROTHER OR SISTER.
Bone marrow is the soft tissue inside the bones, containing stem cells that turn into blood cells, like red blood cells, white blood cells, and platelets. When it is damaged for any reason, the body does not produce enough healthy cells for blood and immune system. Certain types of cancer like leukemia, lymphoma and multiple myeloma, as well as some aggressive cancer treatments, like high doses of chemotherapy or radiation, can destroy the bone marrow. In these cases, a bone marrow transplant is needed to restore key functions. This method is usually applied in the treatment of cancers that develop in the lymph nodes, blood and some solid organs, as well as bone marrow failure and certain genetic diseases. Depending on the patient’s case, it can be performed either with own cells (autologous transplant) or using healthy cells from a donor (allogeneic transplant). The autologous transplantation, however, has a limited scope of application. For allogeneic transplantation, the perfect match between the donor and the recipient was the primary condition for success for many years.
Only 30% of patients have fullmatched relatives Prof. Siret Ratip states that the best alternative for allogeneic bone marrow transplantation in acute leukemia patients with high-risk factors
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is a full-match transplant from a brother or sister. An allogeneic transplant requires matching the patient's tissue type, specifically their human leukocyte antigen (HLA), with that of the donor. The closer the HLA match between a donor and recipient, the greater is the chance for the transplant to be successful. If the HLA match is not close enough, the immune system recognizes the HLA mismatch and attacks the foreign tissues. This process is known as graft versus host disease (GVHD). HLA types are inherited so siblings can sometimes be a good match for each other. But only about 30% of the patients have a full matched brother or sister, says Prof. Siret Ratip. Today, there are still good options for those who cannot benefit from fullmatch transplantation: they can receive healthy cells either from a matched unrelated donor from national or international bone marrow banks, or from haploidentical donors such as half-matched brother or sister, mother or father, or even patients’ child.
Matched unrelated donor might be the alternative Matched unrelated donor, shortly MUD, is an alternative option for patients without a family donor. Prof. Siret Ratip explains: “At Acıbadem, we also perform matched unrelated donor transplantation for patients who do not have a full matched donor. Initially, we start searching
ACIBADEM HEALTHCARE GROUP IN TURKEY IS ONE OF THE FEW CENTERS AROUND THE WORLD THAT PROVIDES ADVANCED TRANSPLANT OPTIONS FOR AUTOLOGOUS, ALLOGENEIC AND HAPLOIDENTICAL TRANSPLANTATIONS, BOTH FOR ADULT AND PEDIATRIC PATIENTS. BONE MARROW TRANSPLANTATION CENTERS ARE SUPPORTED BY ACIBADEM INFRASTRUCTURE AND EQUIPMENT FOR TRANSPLANTATION.
at the national bone marrow banks which usually takes about 2-3 days. If there are no compatible donors, we can go on searching the international banks which takes much longer.” An international donor search is a time-consuming process and it may take 4 months or longer from initiation to actual transplant. For those who do not have a full-matched family donor and cannot wait enough for a matched unrelated donor, a haploidentical transplant might be the solution.
Half-matched transplantation is now possible “The new advances in technology allow us to perform haploidentical transplants with similar outcome and risks as unrelated donor transplantation,” says Prof. Siret Ratip. It is also called a half-matched or partially-matched transplant because the donor is a half match for the patient, usually a family member – it could be mother, father, son, daughter or sibling. They can all be haploidentical donors. Haploidentical transplant is a new and advanced type of bone marrow transplantation that needs an expert team, know-how and equipment. Prof. Siret Ratip explains that haploidentical transplantation can be performed by two methods. The unmanipulated method uses high doses of chemotherapy and immunosuppressives to prevent rejection of the graft. Unfortunately,
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it often leads to severe infections and organ damage. The second method suggests special cell processing, where alpha-beta T-cells responsible for potentially lethal graft versus host disease (GVHD) are depleted from the donor graft. “In Acıbadem, the manupulated method with high technology is used. Not only alpha-beta T-cells are removed from the donor cells, but also the cells that harbor the Epstein-Barr virus CD 19+ are removed. Furthermore, we infuse mesenchymal stem cells to prevent fatal GVHD, and also we manipulate the donor T-cells and infuse useful antiviral T-cells of the donor to the patient to allow better immune reconstitution following transplantation.”
Why Acıbadem Bone Marrow Transplant Center? Bone marrow transplant is one of the most complicated medical procedures today, which requires advanced equipment and extensive experience. Acıbadem Healthcare Group in Turkey is one of the few centers around the world that provide advanced transplant options for autologous, allogeneic and haploidentical transplantations, both for adult and pediatric patients. Bone Marrow Transplantation Centers are supported by Acıbadem infrastructure and equipment for transplantation. Collection of bone marrow and stem cells and the selection
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THE NEW ADVANCES IN TECHNOLOGY ALLOW US TO PERFORM HAPLOIDENTICAL TRANSPLANTS WITH SIMILAR OUTCOME AND RISKS AS UNRELATED DONOR TRANSPLANTATION.
and processing of the collected stem cells are carried out in the cGMP-accredited laboratories of Acıbadem Labcell, which have been designed specifically for these purposes. All services in the centers are offered in line with international standards and in sterile settings. Acıbadem units specialize in haploidentical transplants which eliminate the need of searching for an unrelated matched donor from bone marrow banks and lead to a valuable gain in time. Acıbadem utilizes the latest transplant technologies and with the aid of an experienced clinical team, provides the patient with the best chance of survival.
ARTICLE FEATURES . Smart Pharmacy
Smart Pharmacy Advanced software solutions for the automation of pharmaceutical services according to the latest innovative technologies
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ARTICLE FEATURES . Smart Pharmacy
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he smart pharmacy is considered one of the highest standards of technology and automation that is in line with the technological development witnessed by the health sector in general thanks to modern technologies and robots in order to provide excellent and high-quality healthcare. The experience in smart pharmacy has yielded positive outcomes in terms of speed and accuracy in dispensing medication to patients. Among the most important advantages is the reduced waiting times and no medication errors, thus improving patient safety and enhancing their experience.
The concept of smart pharmacy has occupied an important place in the world in the past few years after it had proven highly effective in achieving patient satisfaction through the process of dispensing and distributing medicines through an integrated health system. Today, it has become one of the best solutions for drug management. The smart pharmacy helps improve the pharmacists’ access to the right medicine in no time, in a way that ensures that patients receive medicines in a timely manner, while providing greater drug safety and reducing medication errors. The smart pharmacy reflects aspects of modern medicine in terms of dealing with patients based on personalized medicine to reach the best possible outcomes through the combination of innovation and high-quality specialized care, as every patient or medical prescription is dealt with separately by providing smart and innovative drug management services. The dispensing of medicines in the smart pharmacy is done by the robot that picks up the medicine and prints the label that carries the patient's information and prescription, and then delivers it to the pharmacy window in a matter of seconds where the robot takes over the technical tasks of dispensing the medicines in the pharmacy. It has been shown that the pharmacist spends most of the time manually classifying and regulating medicines according to the needs of patients as well as a lot of traditional pharmaceutical business and practices,
but the smart pharmacy and the robot provided the opportunity to carry out all these activities with the least possible time and less human intervention possible with the same accuracy. At the touch of a button, medicines are dispensed without any possibility of any errors; Smart pharmacy is one of the magic solutions to protect patients from drug dispensing errors. The Robot is able to store tens of thousands of medicines using specified barcode per box. The robot dispensing process is paperless as the robot will prepare and dispense the e-prescription as soon as the doctor documents it electronically.
THE COMPANIES SPECIALIZED IN PREPARING AND OPERATING INTEGRATED AND CENTRAL SOFTWARE SOLUTIONS FOR THE OPERATION OF SMART PHARMACIES HAVE SUCCEEDED, THUS PROVING HIGH EFFICIENCY IN THE WORKFLOW WITHIN Software solutions in the THE PHARMACY. smart pharmacy
The success of the smart pharmacy requires a high level programming system in order to achieve the desired goals of operating the pharmacy according to advanced technologies with minimum medical errors. Hence, the achievement of companies specialized in preparing integrated software solutions to create a fully automated smart pharmacy is evident. These systems are able to provide innovative solutions to automate work in the pharma-
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cy by providing advanced software solutions for all the obstacles witnessed by the pharmacist in his work, so that the pharmaceutical sector witnesses a digital turning point for business management, taking into account the continuous development and the possibility of electronic connectivity to improve workflow and raise productivity within flexible business steps and procedures. The companies specialized in preparing and operating integrated and central software systems for the operation of smart pharmacies have succeeded, thus proving high efficiency in the workflow within the pharmacy. The experience of working with the software solutions dedicated to smart pharmacies contributed to reducing the time required to explain the prescription, avoiding errors and distributing medicines, thus saving time and effort for both the patient and the pharmacist. It can be said that the software solutions dedicated to automating pharmacies have proven successful and highly effective in enhancing pharmaceutical services through state-of-the-art techniques aimed at accurately determining the quality, quantity and method of storing the drug, which decreases the error rate in dispensing medicines, and significantly reduces the time required for the medicine to leave from the storage shelves to the dispensing window. In turn, inventory management has become easier and more accurate due to the documented follow-up provided by this system. Despite the great importance and numerous advantages of this advanced software solution, the pharmacist can never be replaced as he plays a major role in terms of following up on the workflow and his personal communication with the patient while confirming the prescription’s authenticity, explaining to the patient how to take the medication, among other important matters. This system reduces the burden of the daily routine work performed by the pharmacist, helping achieve greater productivity and more accurate work.
Smart Pharmacy Advantages Hospitals and pharmacies benefit from
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the use of robots in what has become known as a “smart pharmacy” through many advantages such as increased effectiveness, reduced prescription errors, adherence to prescribed doses, dispensing numerous prescriptions in a short time, as well as reducing patient waiting times. Unlike a regular human pharmacist, a robot can fill and organize a large number of medicines without the need for any human intervention and without any errors. The medications are securely stored in dispensing machines. With tight access controls, these machines can be operated only by pharmacist who have the required access control. With such tight security, the chances of medicine theft or error reduce dramatically. In short, one of the most important features of smart pharmacy is reducing time and getting the medicine in a very short time unlike what was happening in the past due to the enormous pressure. This time-reducing allows the robot to dispense thousands of prescriptions per day, reducing waiting time and increasing patient satisfaction.
SMART PHARMACY HAS PROVEN HIGHLY EFFECTIVE IN ACHIEVING PATIENT SATISFACTION THROUGH THE PROCESS OF DISPENSING AND DISTRIBUTING MEDICINES THROUGH AN INTEGRATED SOFTWARE SOLUTIONS.
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Pharmacy Workflow & Automation Management Solution
INTERVIEW
CEO of ‘Future Gate Healthcare Solutions’
Mr. Osama Otabashi “We strive to continue as a pioneer in providing smart pharmacy solutions”
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uture Gate Healthcare Solutions is specified in providing smart pharmacy solutions empowered by expertise, technology and innovation in this field. ‘Hospitals’ had the pleasure to meet Mr. Osama Otabashi, CEO of ‘Future Gate Healthcare Solutions’ to shed the light on activities of the company and its achievements in the last few years.
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At the beginning, please give us an overview about Future Gate Healthcare Solutions and how was it able to meet the requirements of the smart pharmacy automation? In light of the increasing global demand for pharmacy automation using the robotic systems along with latest information technology, our company, for many years, implemented its strategy to invest early in this field to become one of the leading and fastest growing companies in the Middle East and North Africa region in the field of managing and automating work in pharmacies using the latest technologies. Along with its strategic partnership with Becton, Dickinson and Company (BD) , the global medical technology company, PharmaFlow solution helps to automate and manage workload in outpatient pharmacies and to eliminate medication dispensing errors. We focus on designing an efficient pharmacy environment, using highly innovative automation, strong process management, latest technologies and proven solutions. We strive to continue as a pioneer in providing smart pharmacy solutions and the best services to patients, empowered by expertise, technology and innovation in this field to achieve the following: • Pharmacy digital transformation • Smart automated solution • Unique competitive features
The system promotes safety and productivity, tracking 100% of the processed prescription by: • Medication barcode verification • Clinical verification • Prescription fill tracking
How the automated systems can increase the workflow efficiency? Undoubtedly, this is one of the most significant benefits of technology. Be it pharmacy or any other industry, technology helps increase efficiency to a great extent and helps counter low productivity that may occur due to the nature of the task being monotonous. Using machines, tasks are completed much more quickly which means more tasks can be completed in a shorter span of time. PharmaFlow enhances the workflow efficiency, simplifies processes and promotes greater systems control!
THE FUTURE OF PHARMACY IS ABOUT THE PATIENT EXPERIENCE, PHARMAFLOW SOLUTIONS HELP PHARMACIES TO BECOME SMART, AUTOMATED AND FULLY INTEGRATED WHICH ULTIMATELY INCREASES THE PATIENT SATISFACTION.
It also provides the flexibility required to support many different pharmacy workflows by: • e-Prescription Processing • Flexible, best-practice and automated workflow • Patient queue management and monitoring • Patient counselling and e-Signature capture
This modular solution can always adapt and grow based on your unique requirements with real-time and seamless integration capabilities We offer multiple options meant to accommodate almost any requirement. PharmaFlow™ has user-friendly interfaces for improved workflow and productivity. It enhances efficiency in every single step and displays a real-time inventory management. The solution ensure that the values added are unique to all users.
How PharmaFlow™ helps in enhancing the patient safety? Patient safety is one of our top priorities and an approach to eliminate medication errors.
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Biometric verification for narcotics and controlled items HIPPA compliance
What about the patient experience? The future of pharmacy is about the patient experience, PharmaFlow solutions help pharmacies to become smart, automated and fully integrated which ultimately increases the patient satisfaction including: • Reduced waiting time • More time for patient care • Innovative communication channels • e-Refill requests and delivery management • Self-service medication dispensing kiosk
What about the inventory management capabilities? In fact, the inventory management process has become easier and more accurate than ever before, with documented tracking and matching capabilities that fulfill corporate audit requirements by: • Real-time stock tracking • Inventory level monitoring • Barcode management
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Reduce inventory cost Automated storage management Manage drug expiry Manage fast moving items Improve process quality Inventory forecasting
How PharmaFlow™ reduce the cost and wastage? One of the biggest challenges faced by the pharmacy industry is controlling wastage. Using automated storage machines will automatically do what’s needed i.e. expiry management of the inventory of the medication, by giving the priority to those near expiry in dispensing. This reduces wastage and costs simultaneously in the long run.
PHARMACY AUTOMATION HAS OPENED MANY DOORS OF OPPORTUNITIES FOR COMPANIES AS WELL AS SMALL AND BIG PHARMACIES, WHICH IS WHY IT IS GROWING BY LEAPS AND BOUNDS.
How does the system help in tracking and documenting drug storage and dispensing? Pharmacists are legally and organizationally responsible for ensuring that medication dispensing is adequately controlled as well as for documenting the use of these drugs and treatments within a healthcare facility. PharmaFlow ™ system provides options for
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INTERVIEW
queuing systems, therefore the right solution should have the needed integration capabilities and smart functionalities to maximize efficiency and safety for the pharmacy
Training is needed Humans are needed to operate the machines. This means that the staff has to be given proper training to work with the complex machines which can be costly and time-consuming. Additionally, some staff members may not be comfortable working with machines which can lead to workflow problems. tracking and documenting medications storage and dispensing at the batch / lot number level and even at the serial number level for each single pack, with the ability to integrate with governmental medication track & trace systems, such as the one used currently the Kingdom of Saudi Arabia, in addition to calculate consumption rates and balance of refill prescriptions for patients with chronic diseases and a lot of statistical information that supports the pharmacy management.
Does the system support large health facilities such as medical cities, hospitals and chain pharmacies? Yes, the solution centrally manages multiple sites and has the capability to scale over time as business grows. It also uses business intelligence to generate succinct data that help leadership in taking decisions. It provides the following: • Multi-sites and central system management • Scalable enterprise architecture • Highly interactive dashboards • Comprehensive report sets
What are the main challenges and difficulties that you face in implementing your projects? Integration difficulties with the hospital systems: The main challenge faced by hospital pharmacies is integrating the robotic dispensing machines with other systems in the hospital such as the HIS, ERP, billing, patient portal, and
Finally, how do you see the future of smart pharmacies in our Arab region? Pharmacy automation has opened many doors of opportunities for companies as well as small and big pharmacies, which is why it is growing by leaps and bounds. The increasing use of automation has caused a debate over whether automated systems will replace pharmacists completely. Many people believe that automation poses a potential threat to human jobs, but this is not true. As mentioned earlier, machines need humans to supervise them and feed instructions. Without humans, they cannot operate. Moreover, automated systems lack the depth of human understanding and the ability to carry out nuanced tasks. Even after continuous development, there are some tasks, such as patients counseling, that machines cannot carry out. As for our Arab region, especially in the GCC countries, it has kept pace with this development and we have been able to implement more than 12 successful smart pharmacy projects in five Arab countries in all governmental, military and private sectors, and we have many projects that we are currently working on and will see the light soon. Overall, automation may seem overwhelming at first, but it holds the key to greater productivity, improved medication adherence and an overall improvement in the system.
PHARMAFLOW ™ SYSTEM PROVIDES OPTIONS FOR TRACKING AND DOCUMENTING MEDICATIONS STORAGE AND DISPENSING AT THE BATCH / LOT NUMBER LEVEL AND EVEN AT THE SERIAL NUMBER LEVEL FOR EACH SINGLE PACK, WITH THE ABILITY TO INTEGRATE WITH GOVERNMENTAL MEDICATION TRACK & TRACE SYSTEMS.
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ARTICLE FEATURES . Online Medical Platforms
Online medical platforms attract more users during Covid19
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nline medical platforms witnessed a remarkable boom at the beginning of this year with the spread of the novel coronavirus and the imposed home quarantine and social distancing. Therefore, this pandemic was like a “silver platter” for those platforms, as the turnout increased at an unprecedented rate due to the patients having a difficulty accessing doctors' clinics and hospitals, which in turn focused on “telemedicine” in compliance with the precautionary measures. Today, much of the health sector investments in various countries of the world are being employed in “digitization” and virtual healthcare because of its active role and several advantages that have evolved more during coronavirus. Patients and doctors have
realized the danger of the virus and have accepted the idea of communicating remotely to face this danger and avoid waiting in clinics and hospitals, as well as the difficulty in getting an appointment and transportation problems. Doctors, health systems and hospitals in general, around the world are competing to adopt virtual treatment methods that avoid human contact. The novel coronavirus was the reason for lifting all the barriers that were placed in front of virtual healthcare, so online medical platforms were the alternative as they took it upon themselves to book an appointment with the doctor and communicate smoothly with him in various ways and without any complications, whether through video technology or text messages.
www.doctory.me
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DOCTORS, HEALTH SYSTEMS AND HOSPITALS IN GENERAL, AROUND THE WORLD ARE COMPETING TO ADOPT VIRTUAL TREATMENT METHODS THAT AVOID HUMAN CONTACT.
ARTICLE FEATURES . Online Medical Platforms
Telemedicine and access to virtual healthcare are today a powerful tool to provide the necessary care for patients and maintain their safety and the safety of hospital workers and healthcare providers in light of the COVID-19 outbreak and its rapid spread. During these times, governments realized the importance of these platforms and worked to encourage them in many countries, while some laws and public policies that support their work were issued in line with the changes that occurred in the health sector during the pandemic, as it was necessary to reduce the pressure on the human staff working in hospitals and limit the commute of patients that may expose them to the risk of infection.
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ARTICLE FEATURES . Online Medical Platforms
These platforms have provided an alternative solution that helped doctors and medical personnel to stay in contact with patients and reduce the burden that the COVID-19 pandemic has created on hospitals and health centers, and adhere to home quarantine. These platforms can be likened to a virtual visit that the patient takes from home to his doctor in order to meet him via video with the aim of facing the increasing coronavirus cases.
The benefits of telemedicine via online medical platforms include: •
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Patient Privacy The various online medical platforms in all countries of the world were keen to preserve patient privacy and confidentiality through the encrypted messaging system in a way that no one can access it, which is unanimously agreed upon by all the experts and those in charge of this type of platforms. The platforms that offer consulting services and remote doctor’s appointments provide restrictions and controls for the purpose of privacy and confidentiality, which includes examinations and evaluations of patients and beneficiaries of these services in general and even conversations between the doctor and the patient. This virtual relationship between the doctor and the
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patient is documented and confidential, just as it happens inside doctors' clinics, so no one is authorized to have access to it.
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Minimizing contact between people and patients, thus reducing the risk of cross-infection that may occur in the crowded waiting rooms. Providing the necessary advice and care for those suffering from chronic diseases such as diabetes, high blood pressure, cholesterol and heart disease. These patients as well as seniors should avoid leaving their house as they are the most vulnerable to coronavirus. Caring for urgent cases in a timely manner. Providing remote consultation for non-emergency cases such as adjusting drug dosage and diet in addition to renewing medical prescription after informing the doctor in details about the patient’s condition. The possibility of diagnosing some conditions that suffer from mild symptoms
TELEMEDICINE THROUGH ONLINE MEDICAL PLATFORMS ALLOWS THE DOCTOR TO EVALUATE THE PATIENT'S CONDITION IN ORDER TO DIAGNOSE THE DISEASE AND DETECT FLUCTUATIONS AND COMPLICATIONS THAT MAY OCCUR, SO THE DOCTOR EITHER MODIFIES HIS PRESCRIPTION OR KEEPS IT AS IS.
ARTICLE FEATURES . Online Medical Platforms
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and dealing with them according to priority. Urging patients to stay home to limit the risk of coronavirus infection. Saving time, effort and hassle of commuting to get to the doctor's office or hospital.
Use of online medical platforms Telemedicine might be the new norm after the coronavirus crisis. Although the coronavirus outbreak has fundamentally transformed our lives and communities, however, the pandemic has generated some silver linings, including the widespread adoption of telehealth that has helped to mitigate the risk of community spread by reducing unnecessary hospital visits and ensuring real-time access to medical providers for millions of people around the world. Sometimes, the doctor might need to examine the patient clinically as it would be the only way to determine his medical condition. And if the need arises, the patient must follow precautionary measures while commuting to the doctor's office, who in turn provides the patient with the necessary protection to do what is needed and
then follows up on his condition and supervises it remotely later on. But what are the main uses of telemedicine currently available through these platforms? Obtaining medical advice and some treatment solutions without the need to leave the house, and perhaps the patients who live in remote areas and villages and need a long time to reach the clinic or hospital are those who benefit the most from these platforms. When the patient cannot reach his destination, the doctor can extend a helping hand by supervising critical cases and informing the patient or those around him about the appropriate behavior or treatment for his condition, with the ability to follow up on his condition and monitor the patient's new complications. Telemedicine through online medical platforms allows the doctor to evaluate the patient's condition in order to diagnose the disease and detect fluctuations and complications that may occur, so the doctor either modifies his prescription or keeps it as is. Health education and giving the patient the necessary guidance and advice are also at the heart of the use of online medical platforms.
THE VARIOUS ONLINE MEDICAL PLATFORMS IN ALL COUNTRIES OF THE WORLD WERE KEEN TO PRESERVE PATIENT PRIVACY AND CONFIDENTIALITY THROUGH THE ENCRYPTED MESSAGING SYSTEM IN A WAY THAT NO ONE CAN ACCESS IT, WHICH IS UNANIMOUSLY AGREED UPON BY ALL THE EXPERTS AND THOSE IN CHARGE OF THIS TYPE OF PLATFORMS.
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ARTICLE FEATURES . Medical supplies and products in hospitals
Medical supplies and products in hospitals Single-use and no-touch products are golden standards for a safe health service in light of the coronavirus pandemic
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he medical supplies and products industry has witnessed a tremendous boom in recent years, as international companies are competing with each other to provide the best, whether for healthcare providers in hospitals or for the patient, according to the latest international standards and advanced machinery and equipment. The goal is to provide healthcare institutions with the best possible solutions in order to offer safe health services.
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SINGLE-USE MEDICAL SUPPLIES AND PRODUCTS CONTRIBUTE TO LIMITING CROSSCONTAMINATION IN HOSPITALS.
With the onset of the coronavirus pandemic and the new reality it imposed on the medical sector, single-use medical supplies have gained unparalleled popularity as companies working in this field have been actively producing everything that can facilitate the work of the nurses and doctors while preserving the patient’s health in order to prevent the risk of cross-contamination. The coronavirus pandemic imposed a new type of investment for companies spe-
ARTICLE FEATURES . Medical supplies and products in hospitals
cialized in the medical supplies and protection equipment such as clothing, single-use covers, N95 masks, surgical masks, gloves, respirators and patient monitoring devices that constitute today the majority of medical equipment use in hospitals. The main trend in the manufacture of these supplies is the “single-use” principle so that they are thrown away immediately after each use, which ensures that they are not transferred with the nurse or doctor from one room to another, thus reducing cross-contamination within the hospital environment.
ADOPTING THE NOTOUCH PRINCIPLE IN THE PRODUCTION OF MEDICAL SUPPLIES REDUCES HUMAN INTERACTION AND THE RISK OF CROSSCONTAMINATION.
No touch Adopting the no-touch principle in the production of medical supplies reduces human interaction and the risk of cross-contamination. Medical equipment and medical supplies manufacturers abide by the international quality standards and specifications in the manufacturing and production process in a way that ensures the application of the no-touch principle during usage given its importance in light of the coronavirus outbreak. Adherence to the no-touch principle eliminates any human interaction in transporting medical equipment and supplies, which means that there is no more risk of contamination that may occur during the handling of surgical instruments, syringes, blood needles etc. Today, the production of single-use or disposable medical supplies market is witnessing a remarkable increase across the world in light of the healthcare providers’ focus on containing
the risks that could threaten their lives due to cross-contamination in the departments designated for coronavirus patients. The use of these products plays a vital role in managing the infection within the hospital; the high rates of infectious diseases and the disproportionate pace of growth in the healthcare infrastructure has led to a high risk of cross-contamination, which has forced the use of disposable medical supplies as a preventive measure for patients and doctors. The increasing demand for this type of supplies has gained steam due to the increased awareness of the use of these products, but on the other hand, the awareness of the use of products related to the delivery of medicines and patient room supplies increased in a way that guarantees patient and hospital staff safety. This increased demand is linked to the high infection rate with the novel coronavirus and other life-threatening infectious diseases. In the context of manufacturing these materials, the producing companies realized the importance of this type of supplies and were keen to manufacture them according to the highest international quality standards. They used biodegradable materials in a way that facilitates the recycling process and thus reduces the environmental impact, so they entered into partnerships with hospitals and healthcare centers to produce these supplies, reprocess and recycle them in light of the current high demand for these medical supplies.
PROVIDING SAFE, SECURE & COMFORTABLE IV APPLICATIONS
The IV Glove simply slips on to the patient’s hand and is fastened without the use of adhesives. The IV Glove was designed to address stabilization issues with peripheral IV applications. FOR MENA REGION INQUIRIES AND PARTNERSHIP REQUEST PLEASE CONTACT WWW.IVGLOVE.COM
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How Has Deep Brain Stimulation Benefitted Patients With Parkinson’s Disease?
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r. Sameer Sheth, neurosurgeon at Baylor St. Luke’s Medical Center, uses deep brain stimulation (DBS) as an alternative to medication for treating disorders such as Parkinson’s disease and essential tremor. DBS involves placing a device called a neurostimulator that sends electrical impulses through implanted electrodes to specific targets in the brain.
What Is Deep Brain Stimulation and How Does It Work? “DBS is a therapy that we have for various neurological conditions,” said Dr. Sheth. “It's a system that you can think of like a pacemaker. But rather than being a pacemaker for the heart, it's for the brain.” Dr. Sheth describes the brain as having many circuits that govern everything we do, including how we move. “If the movement circuit is not working properly, we may have a movement disorder like Parkinson's,” he said. “If we can identify the circuit within the brain that is not working properly, we can use this device to reset the rhythms in the brain and restore the balance so that our
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movements can be better controlled or without a tremor.”
THOUGH DBS IS CONSIDERED AN How Effective Is DBS Therapy? ALTERNATIVE, IT’S A Though DBS is considered an alternative, it’s WELL-ESTABLISHED, a well-established, FDA-approved technique that FDA-APPROVED has been used to treat Parkinson’s and essential TECHNIQUE THAT HAS BEEN USED TO TREAT tremor for 30+ years. “There's been a lot of studies over the PARKINSON’S AND ESSENTIAL TREMOR years,” said Dr. Sheth. “Randomized trials have FOR 30+ YEARS been presented in the top medical journals that show that for the appropriately chosen patient, DBS is more effective than the best medical therapy. So, in that appropriately chosen patient, DBS can be very successful at improving tremor for essential tremor and tremor stiffness, rigidity, and those other motor symptoms of Parkinson's disease.” One patient who has found success with DBS is Rudy Hardy. “It’s made a profound difference in my life,” said Hardy. A professional sports photographer and professor of criminal justice, Hardy’s life was controlled by Parkinson’s. He tried medication initially, and though it seemed to work for a while, his tremors eventually worsened. Since
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undergoing DBS, Hardy’s symptoms are now almost completely undetectable. Watch Hardy talk about his experience with DBS below.
How Does DBS Compare to Other Methods of Treatment for Parkinson’s Disease? As in Hardy’s case, every patient’s treatment begins with medication until it is determined that they can benefit from DBS. “Medications are always tried first. Unfortunately, we can only get so far with medications. Oftentimes, many patients try them, and they may work for a little while,” said Dr. Sheth. “But at some point, oftentimes the medications stop working as much because the disorder tends to progress over the years. It could get worse, and the medicines may not be able to keep up. Many of the medicines themselves have their own side effects. So, you get to a point where perhaps the medicines are helping to a degree, but they're causing their own side effects, and exactly when we get to that point is when we introduce the idea of a surgical therapy like DBS.”
DBS IS A THERAPY THAT WE HAVE FOR VARIOUS NEUROLOGICAL CONDITIONS. IT’S A SYSTEM THAT YOU CAN THINK OF LIKE A PACEMAKER. BUT RATHER THAN BEING A PACEMAKER FOR THE HEART, IT'S FOR THE BRAIN.
How Common Is DBS? Dr. Sheth describes DBS as a very standard treatment. “These are procedures that we do week in and week out,” he said. “It's not investigational or experimental.” Around the world, more than 150,000 patients have had DBS for Parkinson's or tremor with a success rate of 95%. “Patients need to know that there are these alternatives. They need to know that they're not necessarily stuck with these symptoms, that there may be a different way to get better control. That discussion is, of course, individual-specific, but the availability of these types of surgical treatments is important for patients to know about.” As Houston’s leader in neurology and neurosurgery, the Neuroscience Institute at Baylor St. Luke’s Medical Center is continually working to find better treatments for neurological conditions to help patients get back their lives. Visit a neurologist to see if you are a candidate for deep brain stimulation.
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CERNER IS ONE OF THE PIONEER COMPANIES THAT BELIEVES IN THE TRANSFORMATION OF HEALTHCARE
Dr. Bashar Balish Senior Director and Client Leader
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OSPITALS Magazine had the pleasure to interview Dr. Bashar Balish, Senior Director and Client Leader, and Dr. Yasir Khan, Senior Physician Executive, to discuss Cerner’s perspective on digital transformation and the new norms post-COVID-19. Cerner connects people and systems around the world by offering a range of intelligent solutions and tools that support the clinical, financial and operational needs of health care organizations.
What is digital health and how is it linked to modalities such as electronic health records, mobile health and digital transformation? Dr. Khan: With the prevalence of comprehensive health information technology solutions, these terminologies are being used interchangeably even though they are quite distinct. Digital health is using technology to help improve individuals' health and wellness. It's a
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Dr. Yasir Khan Senior Physician Executive
broad concept covering everything from wearable gadgets to robotic surgeons, from mobile health apps to artificial intelligence. It’s a vision of digitally transform health care provision through implementation and democratization of disruptive technologies. Modern electronic health records (EHRs) like Cerner Millennium® are key enablers for digital health, without which an organization’s digital health care transformation vision cannot be accomplished. In addition to providing the latest technology to create solutions that let communities and people engage in their own health, we work with our clients to create a service modernization and quality improvement strategy. Clinical information flow and its high availability provides the foundation for all other technologies to integrate, synchronize and function seamlessly. Contextual clinical decision support and advanced analytics are essential elements of modern comprehensive electronic
MODERN ELECTRONIC MEDICAL RECORDS LIKE CERNER’S MILLENNIUM ARE KEY ENABLERS FOR DIGITAL HEALTH WITHOUT WHICH THIS VISION CANNOT BE ACCOMPLISHED. THEY ARE NOT JUST A SOFTWARE TOOLS BUT A SERVICE MODERNIZATION AND QUALITY IMPROVEMENT STRATEGY. DR. KHAN
INTERVIEW
medical records and are already proving vital for reimagining health and care.
We know that information technology has revolutionized other industries. Why has the health care industry recognized this at a later stage? Dr. Bashar: Until recently, the health care industry has resisted modernization and the main reason is the complexity and the nature of this industry dealing with people’s lives. It is true that health care has been late to the advanced digital world; however, it is taking a very speedy progress. Embracing new technologies, digitalization and automation for a better health management represent the way forward. Using technology innovations has become the way to lead to the desired outcomes with optimal consumer satisfaction. IT is no longer the driver of the process, it is one of the main players, facilitator and the tool to achieve clinical value outcome. It is just a matter of time where all countries will be adopting and building their health care systems around technology, utilizing it to improve people’s lives.
The latest studies show the different ways countries responded to this pandemic was due to their access to quality data. In your opinion, how accurate is it? Dr. Khan: Yes, it is true, A clear need for better data collection and sharing has been witnessed like never before during the COVID-19 pandemic. Some of the differences in how governments and health authorities have responded to the pandemic were largely impacted by their ability to access and use data. Relying on a scientific data-backed approach has helped many countries to identify cases earlier, track test results, make decisions, and take action to slow and contain the spread of the disease. As one can imagine, COVID took health care providers by surprise. Little was known about the disease pattern, its prevention and treatments that will be effective. Providers had to improvise and test various interventions quickly. Health information technology became a key tool to capture the associated data and find
patterns of efficacy. Similarly, data was able to identify high-risk patients earlier so they can be better attended to. As the health care system became overwhelmed with sick patients, health care provision naturally spilled into community institutions with multiple field facilities commissioned. Data enabled providers to monitor patients remotely through automated intelligent algorithms allowing services to scale up quickly and smoothly. Through faster adoption of new modalities, health care systems are finding new ways to deal with the crisis by creating new services while transforming existing ones. Dr. Bashar: I believe that leveraging data will allow us to improve the quality of care, enable our clinicians to make better decisions and ultimately predict the outcomes of tomorrow. The use of technology to analyze and understand data during this challenging year will transform health care, probably more than in any other industry. I truly believe data will be one of the key drivers in advancing the future of health and care. Cerner will continue to rely on data to improve our clients’ experiences and to support their organizations. We’ve been using and will continue to use data to navigate the pandemic, develop workflows, tools and content, in addition to applying artificial intelligence and informatics to drive improvements in the health of communities.
EMBRACING NEW TECHNOLOGIES, DIGITALIZATION AND AUTOMATION FOR A BETTER HEALTH MANAGEMENT IS THE WAY FORWARD. USING TECHNOLOGY INNOVATIONS WILL BE ABLE TO ACHIEVE THE DESIRED OUTCOMES WITH OPTIMAL CONSUMER SATISFACTION. IT IS JUST A MATTER OF TIME WHERE ALL COUNTRIES WILL BE ADOPTING AND BUILDING THEIR HEALTHCARE SYSTEMS AROUND TECHNOLOGY UTILIZING IT TO IMPROVE PEOPLE’S LIVES. DR. BASHAR
We know that the UAE’s COVID-19 strategies are being ranked among the top countries in the world. How have data analytics and artificial intelligence helped in slowing the spread of the disease in many countries? Dr. Bashar: I think the UAE experience is a very good example of the best utilization of IT solutions and data-driven strategy. COVID-19 was a shock to everyone and I don’t think anybody was ready to face such a crisis. What sets the UAE apart from many countries is the strong leadership, vision and data governance that the UAE implemented a long time ago. The country established a culture that values the use of data and digital technologies, which
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helped them set a global strategy to track COVID-19 case reports, identify cases early, track test results and evaluate the response of the country to the pandemic.
Social transformation is key to implement smart health. How has the end-user attitude changed towards new health care services? Dr. Bashar: I believe the end-user's perception of technology has drastically changed. Today, consumers are embracing digital services in many industries. COVID-19 has shifted gears in the health care industry, where one-to-one physical interactions with physicians are not a necessity in many non-urgent cases. It has reshaped the relationship with the patients, health care providers and the overall health system. Technology will continue to play a crucial role in improving the quality of care as well as preventing and reducing the spread of diseases.
How do you foresee the future of health care information technology and what are the lessons learned from the COVID-19 pandemic? Dr. Khan: A few years from now, we will look back and see a clear distinction between the pre- and post-COVID eras when it comes to modernization of the health care delivery. From a health care information technology perspective, we are truly at a turning point where the industry is primed for disruption and COVID is proving to be the catalyst for change. Heath care providers around the world had to rely on health information technology to
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reach out to patients and provide services away from hospitals. They observed that by challenging the established norms, they were able to provide services efficiently and more conveniently. New delivery models emerged that ranged from video appointments to home delivery of medications. Health information technology was able to support this shift towards community-based care while supporting integration of entire health care systems. There is renewed interest in virtual health, personalized care enabled by big data, interoperability and predictive analytics. These will hugely change the way care is delivered around the world. Dr. Bashar: I second Dr Yasir’s thoughts. The COVID pandemic has opened new doors for us, including the opportunity to collaborate beyond our region. Every health care organization is dealing with the same problem and has the same end goal of keeping patients at the heart of everything we do. The pandemic is also pushing us to come together and rethink health care delivery, which will create new opportunities to improve health and care and accelerate the next era of transformation.
Can you tell us about Cerner’s vision for health care? Dr. Bashar: Cerner is one of the pioneering companies that believes in the transformation of health care. Our mission to relentlessly seek breakthrough innovation that will shape health care of tomorrow. We focus on people not technology and believe that what we do doesn’t just impact health care – it impacts the world.
OUR MAIN FOCUS WILL BE TO CONSTANTLY IMPROVE TECHNOLOGIES IN ORDER TO IMPROVE HEALTH CARE DELIVERY AND ULTIMATELY PEOPLE’S LIVES. DR. BASHAR
NEWS
Innovative Patient Care The Multicare® Bed with Automatic Lateral Therapy Precise and Individualized Control of Ventilation Acute respiratory distress syndrome (ARDS) is the most serious manifestation of pulmonary involvement. It has many causes and reaches up to a 30-60% mortality rate with severe lung involvement.(1, 2) In some patients, COVID-19 occurs in the form of very severe ARDS.(3) To assist patients the Multicare® bed with platformbased rotation tilts as far as 30° to help promote ventilation distribution. The Multicare® also has Automatic Lateral Therapy which is programable and allows up to a 30° turn to each side to provide an individualized prevention or treatment plan.
The strength of the unique platform-based lateral tilt assists nurses with turning patients.
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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.
30° of rotation 24 hours
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The Early Mobilization with LINET program uses the recommended procedures from the AACN and enhances them by applying the unique Multicare® features.
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(1) ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33 (2) Villar J, Blanco J, Kacmarek RM. Current incidence and outcome of the acute respiratory distress syndrome. Curr Opin Crit Care. 2016;22(1):1-6. (3) Ramanathan K, Antognini D, Combes A, et al. Planning and provision of ECMO services for severe ARDS during the) COVID-19 pandemic and other outbreaks of emerging infectious diseases [published online ahead of print, 2020 Mar 20]. Lancet Respir Med. 2020; S2213-2600(20)30121-1. doi:10.1016/S2213-2600(2030121-1
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INTERVIEW
Nationwide Children’s Hospital
Nadeem Khan, MD “We are committed to providing the highest quality care to children and families”
H
OSPITALS Magazine had the privilege to interview Nadeem Khan, MD the Medical Director of the Pediatric Intensive Care Unit at Nationwide Children's Hospital.
Can you tell us about yourself and when did you join Nationwide Children’s Hopsital?
one month of age till adult age meaning young men and women in their early 20’s.
I am a pediatric critical care intensivist in Columbus, OH. and the Medical Director of the Pediatric Intensive Care Unit at Nationwide Children’s Hospital. I joined the hospital, 22 years ago on August 1998. We have come a long way since, we started with 4 pediatricians back then, now we are more than 22 critical care pediatricians specialized in pediatric critical care medicine where we take care of children, infants and adolescents through the four key periods of growth.
What is the main difference between adult ICU and Pediatric ICU?
What is PICU; Pediatric Intensive care Unit?
Who takes care of children in PICU and are special staff needed for that?
Pediatric Intensive Care Unit is a division of ICU that provides continuous treatment for children who are seriously sick or critically injured and children patients who had major operations like liver transplant or any other kinds of surgery. Our ICUs are divided into different kind; we have Neonatal ICU, cardiac ICU we have approximately 20 beds and our PICU that treats children from
In our PICU we have very highly trained staff who cares about children. Nurses and doctors are trained to deal with the sickest children. And the nurses in PICU are more flexible and have more time to take care of the kids. Our pediatric intensivists are doctors who, after completing their medical education do extra 3 years of just pediatric residency and
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The main difference is the reason of admission. In general adults have more health problems that need medical intensive care than children. It can be stressful whenever a child is admitted in a hospital and even more stressful when he needs intensive care, so the PICU provides sick children with the highest level of medical care, and provides them with therapies that might not be available in adult ICUs.
WE HAVE COME A LONG WAY SINCE, WE STARTED WITH 4 PEDIATRICIANS BACK THEN, NOW WE ARE MORE THAN 22 CRITICAL CARE PEDIATRICIANS SPECIALIZED IN PEDIATRIC CRITICAL CARE MEDICINE WHERE WE TAKE CARE OF CHILDREN, INFANTS AND ADOLESCENTS THROUGH THE FOUR KEY PERIODS OF GROWTH.
INTERVIEW
another 3 to 4 years to take care of critical ill children. Our PICU is one of the biggest in the United States we have about 54 beds so we take care of about approximate 3000 children patients per year. The experience our physicians get is much higher than anywhere else.
What are the extra care services that children need during their time in the PICU? We have many other subspecialties that might be needed during the child stay in PICU, Like cardiologists, neurosurgeons, depending on the child need. Also we have physical therapists, nutritionists and pharmacist to cover all aspects of care needed during the child stay in the PICU. What also differentiates PICU from adult ICU is that we have rules that allow parents to
stay with their children 24 hours; we have within the same room a place where they can sleep. So we try to be a family-centered patient care facility where our staff provide the child and his parents the best care needed.
What sets Nationwide Children's Hospital from other similar hospitals? Our main belief is that no sick child should be left without the highest care possible. We are committed to providing the highest quality care to children and families who face very stressful times when one of their members is sick. Our staff is driven by passion and care; we always invest in research programs and training to ensure that we are always at the forefront of the healthcare's latest discoveries to better serve sick children. We always strive to make our hospital the best pediatric hospital in the world.
WE ARE COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE FOR CHILDREN AND FAMILIES WHO FACE VERY STRESSFUL TIMES WHEN ONE OF THEIR MEMBERS IS SICK.
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INTERVIEW
Infectious Disease Specialist at CMC Dubai
Dr. Zartash Khan “Antibiotic resistance leads to difficulty in treatments of infections”
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orld Antimicrobial Awareness Week (18-24 November) – (WAAW) is a global campaign that aims to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers and policy-makers to slow the development and spread of drug-resistant infections. ‘Hospitals’ had the pleasure to interview Dr. Zartash Khan, Infectious Disease Specialist at Clemenceau Medical Center in Dubai - CMC Dubai to highlight the importance of Antimicrobial Awareness.
With reference to the ‘World Antimicrobial Awareness Week' (18-24 November), what is the scale of this problem? Antibiotics are becoming increasingly ineffective as drug-resistance spreads globally leading to more difficult to treat infections and deaths. 300 Million deaths are projected to be attributed to anti-microbial resistant infections by the year 2050. It is speculated that antimicrobial resistant infections will cost the global health economy about 100 Trillion USD by the year 2050 (Ref PMID 27227291). WHO has declared that AMR is one of the top 10 global public health threats facing humanity. WAAW was previously called the World Antibiotic Awareness Week. From 2020, it will be called the World Antimicrobial Awareness Week. This will reflect the broadened scope of WAAW to include all antimicrobials including antibiotics, antifungals, antiparasitics and antivirals. Held annually since 2015, WAAW is a global campaign that aims to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health
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workers and policy-makers to slow the development and spread of drug-resistant infections. The Tripartite Executive Committee decided to set all future WAAW dates as 18 to 24 November, starting with WAAW 2020. The overarching slogan used for the last 5 years was “Antibiotics: Handle with Care.” This has been changed to “Antimicrobials: Handle with Care” in 2020.
Antibiotic resistance is accelerated by the misuse and overuse of antibiotics. What is the scope of this problem worldwide? Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens. The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, continues to threaten our ability to treat common infections. Especially alarming is the rapid global spread of multi- and pan-resistant bacteria (also known as “superbugs”) that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics. The clinical pipeline of new antimicrobials
BY TAKING ANTIBIOTIC SMARTLY. DON’T TAKE THEM FOR A VIRAL INFECTION. ONLY TAKE THE ONES YOUR DOCTOR HAS PRESCRIBED FOR YOU. TAKE THEM AS DIRECTED. DON’T SKIP DOSES. TAKE THEM FOR THE FULL NUMBER OF DAYS YOUR DOCTOR PRESCRIBES. DON’T SAVE THEM FOR LATER.
INTERVIEW
is dry. In 2019 WHO identified 32 antibiotics in clinical development that address the WHO list of priority pathogens, of which only six were classified as innovative. Furthermore, a lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries of all levels of development and especially in healthcare systems. For common bacterial infections, including urinary tract infections, sepsis, sexually transmitted infections, and some forms of diarrhea, high rates of resistance against antibiotics frequently used to treat these infections have been observed worldwide, indicating that we are running out of effective antibiotics. For example, the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for Escherichia coliand from 4.1% to 79.4% for Klebsiella pneumoniae in countries reporting to the Global Antimicrobial Resistance and Use Surveillance System (GLASS). The bacteria Staphlylococcus aureus are part of our skin flora and are also a common cause of infection both in the community and in health-care facilities. People with methicillin-resistant Staphylococcus aureus (MRSA) infections are 64% more likely to die than people with drug-sensitive infections.
How can taking antibiotics contribute to antibiotic resistance? Over the course of time, bacteria evolve and adapt to the environment that they live in. In case of repeated exposure to antibiotics mutational adaptations of existing genes, acquisition of new genetic material from other strains or species occur. Antibiotic resistance can occur by introducing chemical changes to the antimicrobial molecule and making it ineffective, by producing enzymes that result in antibiotic breakdown (such as beta- lactamase), by decreasing antibiotic penetration (thickening of bacterial cell wall), by causing efflux of antibiotic (increase cell wall permeability), and by modification of target sites.
What are the side effects? Antibiotic resistance leads to difficulty in
treatments of infections. It leads to treatment failures and causes premature and otherwise avoidable deaths. It puts a huge burden on global economy.
How do we fight it? How can we avoid it? We must recognize the gravity of this global threat. Each of us should take responsibility. Physicians must use their best judgment. Learn to master your skills and when in doubt seek expert opinion. In some cases, healthcare professionals feel obligated to prescribe an antibiotic for patient’s satisfaction. Please talk to your doctor and develop trust.
How do we tackle antibiotic resistance? By taking antibiotic smartly. Don’t take them for a viral infection. Only take the ones your doctor has prescribed for you. Take them as directed. Don’t skip doses. Take them for the full number of days your doctor prescribes. Don’t save them for later.
Are general public health workers and policy-makers able to avoid drug-resistant infections? All major health authorities such as World Health Organization, Centers for Disease Control and Joint Commission International have enforced antimicrobial stewardship programs to be implemented in healthcare organizations. One purpose of the programs is to facilitate proper use of antibiotics. WHO is recommending that farmers and the food industry stop using antibiotics routinely to promote growth and prevent disease in healthy animals. Many countries have already taken action to reduce the use of antibiotics in food-producing animals. For example, since 2006, the European Union has banned the use of antibiotics for growth promotion. Consumers are also driving the demand for meat raised without routine use of antibiotics, with some major food chains adopting “antibiotic-free” policies for their meat supplies. Alternative options to using antibiotics for disease prevention in animals include improving hygiene, better use of vaccination, and changes in animal housing and husbandry practices.
ANTIBIOTIC RESISTANCE CAN OCCUR BY INTRODUCING CHEMICAL CHANGES TO THE ANTIMICROBIAL MOLECULE AND MAKING IT INEFFECTIVE, BY PRODUCING ENZYMES THAT RESULT IN ANTIBIOTIC BREAKDOWN (SUCH AS BETALACTAMASE), BY DECREASING ANTIBIOTIC PENETRATION (THICKENING OF BACTERIAL CELL WALL), BY CAUSING EFFLUX OF ANTIBIOTIC (INCREASE CELL WALL PERMEABILITY), AND BY MODIFICATION OF TARGET SITES.
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ARTICLE FEATURES . Diabetes, Obesity and COVID-19
Diabetes, Obesity and COVID-19 A complex interaction
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onths after the spread of the coronavirus pandemic, research has shown that it is much harder for patients with diabetes and obesity to recover from the coronavirus as they are the most vulnerable due to the reduced ability of their weakened immune system to fight the virus and thus they have a higher risk of being exposed to infections that harm the body's vital systems. High blood sugar levels lead to an increase in the incidence of lung infections in COVID-19 patients. The collision between the COVID-19 pandemic and the current diabesity epidemic has highlighted that obese and diabetic patients have a worse prognosis due to the impairment of the immune response to infections and due to the mechanical limits that make the management of the hospitalized patients with severe obesity more difficult.
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DIABETICS WITH UNCONTROLLED BLOOD SUGAR LEVELS ARE MORE LIKELY TO HAVE SEVERE SYMPTOMS, LEADING TO PROLONGED HOSPITALIZATION AND A HIGHER MORTALITY RISK.
Research in this field unanimously states that there is a double risk in patients with diabesity when they are infected with COVID-19, as the symptoms are more acute and severe, and the response to treatment is less effective due to their weakened immune system.
Diabetes and Coronavirus Diabetics with uncontrolled blood sugar levels are more likely to have severe symptoms, leading to prolonged hospitalization and a higher mortality risk. In addition, patients with diabetes or obesity have a higher risk of developing a serious disease caused by COVID-19 if there are other pre-existing medical conditions such as high blood pressure, cardiovascular disease and chronic kidney disease. When people with diabetes cannot control their blood sugar levels, they are more likely to develop a number of complications related to diabetes over the years. When
ARTICLE FEATURES . Diabetes, Obesity and COVID-19
they are exposed to a viral infection, they may experience dangerous symptoms because high blood sugar levels reduce the response of the immune system to face any external danger, therefore, it becomes difficult to effectively fight the virus, so it grows steadily and worsens in the body faster. Patients with underlying health conditions such as high blood pressure and diabetes are considered as the high-risk group for catching the novel coronavirus. Furthermore, it is considered that such patients are likely to suffer further complications and the risk of death from COVID-19 is higher in this group. COVID-19 also has indirect effects on people with underlying health conditions. Hence, experts believe that diabetes is one of the health conditions that expose people to a greater risk of developing more severe coronavirus symptoms, according to the findings of most studies in this regard. The coronavirus greatly increases the production of immune cells in the lungs, which poses a danger to diabetics. Also, people with high blood sugar levels have a much higher risk of contracting more powerful strains of the virus. Coronavirus increases the risk of “cytokine storm� that can both sicken and kill patients who are infected with certain strains of flu virus. A cytokine storm is an overproduction of immune cells and their activating compounds (cytokines), which, in a flu infection, is often associated with a surge of activated immune cells into the lungs. The resulting lung inflammation and fluid buildup can lead to respiratory distress and can be contaminated by a secondary bacterial pneumonia, often enhancing the mortality in patients. On the other hand, prevention and treatment regularity is the way to save the patient, as studies have found that patients who used insulin and other treatments to adjust their blood sugar levels were not more likely to develop a more severe case of coronavirus, and this means that diabetics must continue to use these treatments.
PATIENTS WITH UNDERLYING HEALTH CONDITIONS SUCH AS HIGH BLOOD PRESSURE AND DIABETES ARE CONSIDERED AS THE HIGHRISK GROUP FOR CATCHING THE NOVEL CORONAVIRUS. FURTHERMORE, IT IS CONSIDERED THAT SUCH PATIENTS ARE LIKELY TO SUFFER FURTHER COMPLICATIONS AND THE RISK OF DEATH FROM COVID-19 IS HIGHER IN THIS GROUP.
obesity increases the risk of severe illness from COVID-19. People who are overweight may also be at increased risk, having obesity may triple the risk of hospitalization due to a COVID-19 infection, obesity is linked to impaired immune function and decreases lung capacity and reserve and can make ventilation more difficult. As BMI increases, the risk of death from COVID-19 increases. Moreover, obesity in the upper part of the body increases deep breathing difficulty and the distribution of oxygen to the body. In such cases, the coronavirus can be fatal if it spreads deep into the lungs, causing serious complications. People who are obese often develop respiratory problems, from simple shortness of breath to a potentially life-threatening condition known as obesity hypoventilation syndrome (OHS). Obesity causes mechanical compression of the diaphragm, lungs, and chest cavity, which can lead to restrictive pulmonary damage. Furthermore, excess fat decreases total respiratory system compliance, increases pulmonary resistance, and reduces respiratory muscle strength. People with obesity are more likely than normal-weight people to have other diseases that are independent risk factors for severe COVID-19, including heart disease, lung disease, and diabetes. Excess weight put people at greater risk of needing hospital admission or inten-
Obesity and Coronavirus Adults with excess weight are at even greater risk during the COVID-19 pandemic; having
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ARTICLE FEATURES . Diabetes, Obesity and COVID-19
sive care. Excess weight and obesity are a major risk factor for coronavirus infection, because excess weight decreases oxygen in the blood, which leads to a rapid deterioration in the patients’ condition, requiring them to receive artificial respiration. Overweight patients are seven times more likely to be admitted to the reanimation department and undergo artificial respiration. Individuals with obesity are also more likely to experience physical ailments that make fighting this disease harder, such as sleep apnea, which increases pulmonary hypertension, or a body mass index that increases difficulties in a hospital setting with intubation.
What are the preventive measures that should be taken? •
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Controlling the blood sugar level because not managing diabetes increases the risk of severe complications. The blood sugar level should be checked regularly throughout the day to ensure that the blood sugar levels are within the normal range. Losing excess weight by following an appropriate diet prescribed by a nutritionist to be appropriate for the health condition, accompanied by a special exercise program that ensures weight/ fat loss over time.
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PREVENTION AND TREATMENT REGULARITY IS THE WAY TO SAVE THE PATIENT, AS STUDIES HAVE FOUND THAT PATIENTS WHO USED INSULIN AND OTHER TREATMENTS TO ADJUST THEIR BLOOD SUGAR LEVELS WERE NOT MORE LIKELY TO DEVELOP A MORE SEVERE CASE OF CORONAVIRUS, AND THIS MEANS THAT DIABETICS MUST CONTINUE TO USE THESE TREATMENTS.
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•
•
•
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Providing all diabetes supplies in sufficient quantity, such as medicines, insulin injections, a blood glucose meter, etc. Adherence to home quarantine and maintaining a safe distance of at least one and a half or two meters, and not mingling with others, especially sick patients or those who do not abide by preventive measures. Washing hands frequently with soap and water and making sure to rub well the fingers, the palm of the hand and under the nails, while paying attention not to touch the face, eyes, or nose before washing hands. Using a hand sanitizer when you are unable to wash your hands, especially after touching any external surface such as elevator buttons, door handles, or shopping cart; Alcohol-based hand sanitizers that contain at least 60% alcohol should be used. When an obese diabetic patient is forced to leave the house, he must follow the highest standards of personal protection; wearing a face mask is the first step that protects him from catching the virus, with the necessity to maintain social distancing, wear disposable gloves and avoid touching external surfaces.
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Al-Ahli Hospital / Doha - Qatar Orthopaedic and Traumatology Center
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+974 44898000 or +974 44898888 Doha - Qatar
ARTICLE
Colonic Diverticular Disease
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iverticular disease is a clinical term used to describe the presence of symptomatic diverticula. Diverticulitis refers to inflammation and infection associated with diverticula.
Dr. Bakhos Al-Haddad Specialist General Surgeon at Al Ahli Hospital
The majority of colonic diverticula are false diverticula in which the mucosa and muscularis mucosa have herniated through the colonic wall. They are thought to be pulsion diverticula resulting from high intraluminal pressure. True diverticula, which comprise all layers of the bowel wall, are rare and are usually congenital in origin. Diverticulosis is extremely common in the United States and Europe. It is estimated that half of the population older than age 50 years has colonic diverticula. The sigmoid colon is the most common site of diverticulosis. Diverticulosis is thought to be an acquired disorder. The most accepted theory is that a lack of dietary fiber results in smaller stool volume, requiring high intraluminal pressure and high colonic wall tension for propulsion. Chronic contraction then results in muscular hypertrophy and development of the process of segmentation in which the colon acts like
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separate segments instead of functioning as a continuous tube. As segmentation progresses, the high pressures are directed radially toward the colon wall rather than to development of propulsive waves that move stool distally. The high radial pressures directed against the bowel wall create pulsion diverticula. Although none of these theories has been proven, a high-fiber diet does appear to decrease the incidence of diverticulosis. Although diverticulosis is common, most cases are asymptomatic, and complications occur in the minority of people with this condition.
Inflammatory Complications (Diverticulitis) Diverticulitis refers to inflammation and infection associated with a diverticulum and is estimated to occur in 10% to 25% of people with diverticulosis. Peridiverticular and pericolic infection results from a perforation (either macroscopic or microscopic) of a diverticulum, which leads to contamination, inflammation, and infection. The spectrum of disease ranges from mild, uncomplicated diverticulitis that can be treated
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in the outpatient setting, to free perforation and diffuse peritonitis that requires emergency laparotomy. Most patients present with left-sided abdominal pain, with or without fever, and leukocytosis. CT scan is extremely useful for defining pericolic inflammation, phlegmon, or abscess. Contrast enemas and/or endoscopy are relatively contraindicated because of the risk of perforation.
Uncomplicated Diverticulitis Uncomplicated diverticulitis is characterized by left lower quadrant pain and tenderness. CT findings include pericolic soft tissue stranding, colonic wall thickening, and/or phlegmon. Most patients with uncomplicated diverticulitis will respond to outpatient therapy with broad-spectrum oral antibiotics and a low-residue diet. Antibiotics should be continued for 7 to 10 days. About 10% to 20% of patients with more severe pain, tenderness, fever, and leukocytosis are treated in the hospital with parenteral antibiotics and bowel rest. Most patients improve within 48 to 72 hours. Failure to improve may suggest abscess formation. CT can be extremely useful in this setting. Deterioration in a patient’s clinical condition and the development of peritonitis are indications for laparotomy. Most patients with uncomplicated diverticulitis will recover without surgery, and 50% to 70% will have no further episodes. It has long been believed that the risk of complications increases with recurrent disease. For this reason, elective sigmoid colectomy has often been recommended after the second episode of diverticulitis, especially if the patient has required hospitalization. More recent studies suggest that the risk of complications and/or need for emergent resection does not increase with recurrent disease. Many surgeons now will not advise colectomy even after two documented episodes of diverticulitis assuming the patient is completely asymptomatic and that carcinoma has been
excluded by colonoscopy. Immunosuppressed patients are generally still advised to undergo colectomy after a single episode of documented diverticulitis. Colonoscopy is recommended 4 to 6 weeks after recovery.
Complicated Diverticulitis Complicated diverticulitis includes diverticulitis with abscess, obstruction, diffuse peritonitis (free perforation), or fistulas between the colon and adjacent structures. The Hinchey staging system is often used to describe the severity of complicated diverticulitis: Stage I includes colonic inflammation with an associated pericolic abscess; stage II includes colonic inflammation with a retroperitoneal or pelvic abscess; stage III is associated with purulent peritonitis; and stage IV is associated with fecal peritonitis. Treatment depends on the patient’s overall clinical condition and the degree of peritoneal contamination and infection. Small abscesses (<2 cm in diameter) may be treated with parenteral antibiotics. Larger abscesses are best treated with CT-guided percutaneous drainage and antibiotics. Many of these patients will ultimately require resection, but percutaneous drainage may allow a one-stage, elective procedure and may obviate the need for colectomy if full recovery follows the drainage. Urgent or emergent laparotomy may be required if an abscess is inaccessible to percutaneous drainage, if the patient’s condition deteriorates or fails to improve, or if the patient presents with free intra-abdominal air or peritonitis. Obstructive symptoms occur in approximately 67% of patients who develop acute diverticulitis, and complete obstruction occurs in 10%. Approximately 5% of patients with complicated diverticulitis develop fistulas between the colon and an adjacent organ.
THE HINCHEY STAGING SYSTEM IS OFTEN USED TO DESCRIBE THE SEVERITY OF COMPLICATED DIVERTICULITIS: STAGE I INCLUDES COLONIC INFLAMMATION WITH AN ASSOCIATED PERICOLIC ABSCESS; STAGE II INCLUDES COLONIC INFLAMMATION WITH A RETROPERITONEAL OR PELVIC ABSCESS; STAGE III IS ASSOCIATED WITH PURULENT PERITONITIS; AND STAGE IV IS ASSOCIATED WITH FECAL PERITONITIS.
In the end, it must be said that the treatment of colonic diverticulitis remains one of the most important challenges that surgeons face in terms of choosing the appropriate treatment mechanism for each patient individually.
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ARTICLE
Common Questions about Public Resuscitation and AED for Cardiac Arrest
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hy should I get trained in Resuscitation (CPR)?. You may not believe it, but you can save somebodyâ&#x20AC;&#x2122;s life and that somebody could be a very dear person to you too. Where does Sudden Cardiac Death happen most often? Statistics show that 70% of Sudden Cardiac Death happens at home. What does that mean?. It means that the person you might save is most likely a father or a mother or a spouse.
Dr. Abdurrazzak Gehani Consultant Interventional Cardiologist Chairman at Al Ahli Hospital
Why do I have to do resuscitation at home, if I can call an ambulance and professional paramedics can do that? Yes, you must call an ambulance, but if you also start resuscitation immediately at home, the chance of survival is at least 2 to 3 times higher. Why do minutes count in cardiac arrest? Because the brain cannot stay without blood and oxygen supply for more than a few minutes,
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then it will start to deteriorate quickly leading to death. Is CPR training difficult? No, it is very easy and straightforward. The main points you will learn are: How to do good Chest Compression and how to use the AED. Both are safe practices and usually it takes half to one day. Can I harm a patient if I give chest compression, but they have simply fainted and not had cardiac arrest? The answer is No. It is more harmful if you do not resuscitate a patient who had cardiac arrest because they are frightened to harm them by chest compression. Can the AED get it wrong and give shock to somebody who does not need shock? The answer again is No.. Well extensive trials have shown that AEDs are very accurate and they very rarely give a shock if it is not the right rhythm to do
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so. Is it useless to resuscitate if I cannot give mouth-to-mouth breathing because I am not comfortable doing that?. The answer is No. Chest compression is far more important than giving mouth to mouth breaths. So, please have good chest compression at a rate of around 100 per minute and you will probably save life. Do I need to do anything else while giving chest compression? Yes, make sure that somebody calls the ambulance and gets back to help you, because you may get tired. Can I break somebody's ribs if I do strong chest compression? It is unlikely, but can happen. Still the patient will appreciate more being alive with some broken ribs than dead with healthy ribs. So give good chest compression and do not worry. Can I harm somebody by giving chest compression when simply fainted not had real cardiac arrest? People who simply faint will usually wake up once you start chest compression. What is the number to ring if I identify somebody who lost consciousness and may have cardiac arrest? If you are inside Al Ahli hospital it is 4498….., but if you are outside, anywhere in Qatar, the national number is 999 Can I get shocked by the AED when it is delivering the shock to the victim? That chance is small, and that is why the AED will tell you, loud and clear, do not touch the patient.
What do I do if the patient starts vomiting after resuscitation? Just turn them on their side, so they do not inhale the vomit into their lungs. What is important if a victim falls unconscious because they are struck by electricity? Do not touch the patient until you are sure that there is no live electric current still going through their body, because you may be stuck too, and there will be two victims, you are one of them. How do I know if somebody lost consciousness because of real cardiac arrest or simply fainted and his heart is still working? Not all unconscious patients are in cardiac arrest. There are other causes of loss of consciousness, apart from cardiac arrest, like seizures (epilepsy), brain stroke, low blood sugar and even bad news. If the patient has “normal” breathing then they are unlikely to be in cardiac arrest. If their pulse can be felt, again cardiac arrest is clearly not the cause. However, it is not always easy to assess the breathing, and even more difficult to assess the pulse, because you may feel your own pulse and think it is there. That is some professional Resuscitating Councils recommend that you start compression in any patient who is unconscious. As we said before, if it is only a fainting attack, they will wake up and stop you. It is better to resuscitate to turn not to have been needed, than not to resuscitate and lose a life.
STATISTICS SHOW THAT 70% OF SUDDEN CARDIAC DEATH HAPPENS AT HOME. WHAT DOES THAT MEAN?. IT MEANS THAT THE PERSON YOU MIGHT SAVE IS MOST LIKELY A FATHER OR A MOTHER OR A SPOUSE.
How do I know that the patient has survived? Many patients will stay unconscious even if their heart starts working again, but many will start coughing, fighting, vomiting or even sitting up. Can I harm the victim if I continue chest compression if the heart starts pumping again? As we said, some patients may remain unconscious, even when the heart starts pumping again, and this patient you will not know. However, it is unlikely that you will cause them harm if you continue chest compression.
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ARTICLE FEATURES . Chronic Obstructive Pulmonary Disease
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Comprehensive approach to treatment
C
hronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. Chronic obstructive pulmonary disease, commonly referred to as COPD, is a group of progressive lung diseases. The most common are emphysema and chronic bronchitis. Many people with COPD have both of these conditions.
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IN COPD, THE AIRWAYS OF THE LUNGS (BRONCHIAL TUBES) BECOME INFLAMED AND NARROWED.
Emphysema slowly destroys air sacs in your lungs, which interferes with outward air flow. Bronchitis causes inflammation and narrowing of the bronchial tubes, which allows mucus to build up. The development in understanding the disease helped in reaching more advanced treatments that work on controlling the condition, at a time when the patient's education about his disease has increased and he became able to manage it and smoothly cope with it. Glob-
ARTICLE FEATURES . Chronic Obstructive Pulmonary Disease al research that has always been in full swing, yielding a wide choice of treatments, along with patient culture, has led to the exploration of a comprehensive approach to treatment and disease management. COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. The patient may experience shortness of breath, a chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish, frequent respiratory infections, lack of energy and general weakness. In COPD, the airways of the lungs (bronchial tubes) become inflamed and narrowed. They tend to collapse when you breathe out and can become clogged with mucus1.
Signs and symptoms of COPD may include: • • • • • •
Shortness of breath, especially during physical activities. Chest tightness. A chronic cough that may produce mucus (sputum). Frequent respiratory infections. Lack of energy. Wheezing2.
Diagnosis of COPD To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you've had to lung irritants — especially cigarette smoke. Your doctor may order several tests to diagnose your condition. Tests may include pulmonary function tests; these tests measure the amount of air you can inhale and exhale, and whether your lungs deliver enough oxygen to your blood. During the most common test, called spirometry, you blow into a large tube connected to a small machine to measure how much air your lungs can hold and how fast you can blow the air out of your lungs3. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure. While a CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD.
A BRONCHODILATOR Disease Management Although COPD is a progressive disease that IS A MEDICATION THAT RELAXES AND gets worse over time, the patient should learn OPENS THE AIRWAYS, how to cope with it. With time, the patient will OR BRONCHI, IN THE learn what worsens his condition so he can avoid LUNGS. TAKING A it and learn how to control it4. BRONCHODILATOR The past years were sufficient to underHELPS DILATE OR stand the disease more than ever before, given WIDEN THE AIRWAYS, the set of modern treatments that helped WHICH MAKES IT patients cope with their disease while experiEASIER TO BREATHE. encing the least complications possible as well SHORT-ACTING as severe coughing or shortness of breath. BRONCHODILATORS Coping with the disease primarily requires WORK QUICKLY, the patient to receive appropriate treatment USUALLY WITHIN A FEW MINUTES. on a regular basis while following a healthy lifestyle, which limits the aggravation of the disease, which often becomes worse with time. Some exercise help improve breathing and reduce the shortness of breath that patients often suffer from. Exercise, along with a healthy and balanced diet will further contribute to controlling the condition. Eating right is an important way to keep your body and your immune system strong. Sometimes, people with advanced COPD don’t get the proper nutrition they need to stay healthy. It may be helpful to eat smaller meals, more often. Getting rid of excess weight or obesity plays a crucial role in reducing acute episodes of the disease. Studies in this area have shown a clear paradox in the relationship between obe-
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ARTICLE FEATURES . Chronic Obstructive Pulmonary Disease
TO PREVENT SYMPTOMS FROM DEVELOPING. CLASSIFICATIONS OF BRONCHODILATORS INCLUDE BETA 2-AGONISTS, ANTICHOLINERGICS, AND XANTHINE DERIVATIVES. THESE MEDICATIONS OPEN THE AIRWAYS, BUT THEY WORK ON DIFFERENT RECEPTORS IN THE BODY.
sity and chronic obstructive pulmonary disease, in addition to moderate obesity associated with improved survival rate and reduced lung functions5. Studies in this regard indicate that obesity negatively affects the respiratory system, and difficulty breathing is a common complaint among obese individuals, as it increases the activity of this system, along with increased airway resistance and strength of the respiratory muscles. Therefore, losing weight helps improve lung function and relieve disease symptoms. Several studies have shown strong links between obesity and chronic obstructive pulmonary disease, given that the two diseases worsen with age, but although there is no evidence suggesting that a high body mass index would increase the risk of developing chronic obstructive pulmonary disease, obesity in itself, is a risk factor for shortness of breath and decreased lung function, which are symptoms of chronic obstructive pulmonary disease6. Disease management primarily requires the elimination of the direct cause, and since smoking is the main cause of COPD, quitting smoking of all kinds and being careful not to be exposed to pollutants or secondhand smoke is the beginning of treatment.
Wide choice of advanced treatments Tests may include pulmonary function tests; these tests measure the amount of air you can inhale and exhale, and whether your lungs deliver enough oxygen to your blood. During the most common test, called spirometry, you blow into a large tube connected to a small machine to measure how much air your lungs can hold and how fast you can blow the air out of your lungs3.
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Continuous studies have led to a better understanding of the disease with the availability of accurate diagnosis of the condition, and the result was the emergence of a new generation of effective treatments that help the patient reduce the worsening of his condition and thus better manage the disease. But everyone agrees that managing the disease and peacefully coping with it requires lifestyle changes. In short, the healthier the lifestyle, the more the patient will be able to control his medical condition, especially if he is regularly following the appropriate treatment plan. The aim of the advanced treatments today is to improve the patient's quality of life and enable him to live a more independent life. The companies active in the field of respiratory diseases realized the risks of this type of disease and proceeded to offer a wide range of treatments that help the patient
ARTICLE FEATURES . Chronic Obstructive Pulmonary Disease to have an independent life. Doctors usually use long-term treatments to control the condition. Approved treatments include short-acting and long-acting bronchodilators, short-acting anticholinergics, inhaled steroids, and long-acting inhaled anticholinergics7. A bronchodilator is a medication that relaxes and opens the airways, or bronchi, in the lungs. Taking a bronchodilator helps dilate or widen the airways, which makes it easier to breathe. Short-acting bronchodilators work quickly, usually within a few minutes. Although they work fast, the therapeutic effects generally only last 4â&#x20AC;&#x201C;5 hours. Short-acting bronchodilators treat sudden symptoms, and people do not need to use them when they are symptom-free. Long-acting bronchodilators do not work as quickly as short-acting bronchodilators and do not treat acute or sudden symptoms. The effects typically last for 12â&#x20AC;&#x201C;24 hours, and people take them daily to prevent symptoms from developing. Classifications of bronchodilators include beta 2-agonists, anticholinergics, and xanthine derivatives. These medications open the airways, but they work on different receptors in the body. Beta 2-agonists stimulate beta-adrenoceptors in the airway. This class of bronchodilator causes the smooth muscles surrounding the airways to relax. This improves airflow and reduces symptoms, such as shortness of breath.
GETTING RID OF EXCESS WEIGHT OR OBESITY PLAYS A CRUCIAL ROLE IN REDUCING ACUTE EPISODES OF THE DISEASE. STUDIES IN THIS AREA HAVE SHOWN A CLEAR PARADOX IN THE RELATIONSHIP BETWEEN OBESITY AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE, IN ADDITION TO MODERATE OBESITY ASSOCIATED WITH IMPROVED SURVIVAL RATE AND REDUCED LUNG FUNCTIONS5
Anticholinergic bronchodilators block the action of acetylcholine, a chemical released by the nerves that can lead to tightening of the bronchial tubes. By blocking the chemical, anticholinergic bronchodilators cause the airways to relax and open. In addition, the management of chronic obstructive pulmonary disease may require oxygen therapy in some cases, so the doctor may resort to it in case of hypoxaemia. There are some disease cases that require the combination of two or more types of treatments to get the desired result, of course, in addition to quitting smoking and following a healthy diet, as these steps together help improve disease management and control the disease. REFERENCES 1. https://www.healthline.com/health/copd 2. https://www.cdc.gov/copd/basics-about.html 3. https://www.mayoclinic.org/diseases-conditions/ copd/diagnosis-treatment/drc-20353685 4. https://www.lung.org/lung-health-diseases/ lung-disease-lookup/copd/living-with-copd 5. http://www.rjdnmd.org/index.php/RJDNMD/ article/view/586 6. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd-associated-comorbidities-risk-factors/contents/risk-factors-associated-with-copd 7. https://www.mayoclinic.org/diseases-conditions/ copd/diagnosis-treatment/drc-20353685
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COVID-19: Do face masks offer protection?
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Dr. Hassan Sawaf Pulmonary Consultant at Al Ahli Hospital
et answers to your questions about face masks, including how to use them properly. Do face masks help to reduce the spread of the coronavirus that causes COVID-19? In reality , other preventive measures, such as frequent hand-washing and social distancing, with face masks help slow the spread of the virus. These discoveries led public health to do an about-face on face masks. The World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC) now include face masks in their recommendations for slowing the spread of the virus. The CDC recommends cloth face masks for the public and not the surgical and N95 masks needed by healthcare providers. What are the types of masks?
N95 masks Respirator type, an N95 mask offers more protection than a surgical mask does because
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it can filter out both large and small particles when the wearer inhales. As the name indicates, the mask is designed to block 95% of very small particles. Some N95 masks have valves that make them easier to breathe through. With this type of mask, unfiltered air is released when the wearer exhales. Healthcare providers must be trained and pass a fit test to confirm a proper seal before using an N95 respirator in the workplace. Like surgical masks, N95 masks are intended to be disposable. However, researchers are testing ways to disinfect N95 masks so they can be reused. Some N95 masks, and even some cloth masks, have one-way valves that make them easier to breathe through. But because the valve releases unfiltered air when the wearer breathes out, this type of mask doesn't prevent the wearer from spreading the virus. For this reason, some places have banned them.
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Surgical masks Also called a medical mask, a surgical mask is a loose-fitting disposable mask that protects the wearer's nose and mouth from contact with droplets, splashes and sprays that may contain germs. A surgical mask also filters out large particles in the air. Surgical masks may protect others by reducing exposure to the saliva and respiratory secretions of the mask wearer. At this time, the U.S. Food and Drug Administration has not approved any type of surgical mask specifically for protection against the coronavirus, but these masks may provide some protection when N95 masks are not available.
Cloth masks A cloth mask is intended to trap droplets that are released when the wearer talks, coughs or sneezes. Asking everyone to wear cloth masks can help reduce the spread of the virus by people who have COVID-19 but don't realize it. Cloth face coverings are most likely to reduce the spread of the COVID-19 virus when they are widely used by people in public settings. And countries that require face masks, testing, isolation and social distancing early in the pandemic have successfully slowed the spread of the virus. While surgical and N95 masks may be in short supply and should be reserved for healthcare providers, cloth face coverings and masks are easy to find or make, and can be washed and reused. Masks can be made from common materials, such as sheets made of tightly woven cotton. Instructions are easy to find online. Cloth masks should include multiple layers of fabric. The CDC website even includes directions for nosew masks made from bandannas and T-shirts. .
Tips for adjusting to a face mask It can be challenging to get used to wearing a face mask. Here are some tips for making the transition: • Start slow. Wear your mask at home for a short time, such as while watching television. Then wear it during a short walk. Slowly increase the time until you feel more comfortable. • Find your fit. If your mask isn't com-
fortable or is too difficult to breathe through, consider other options. Masks come in a variety of styles and sizes. If these tips don't help or you have concerns about wearing a mask, talk with your doctor about how to protect yourself and others during the pandemic.
How to wear a cloth face mask •
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• • • • •
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The CDC recommends that you wear a cloth face mask when you're around people who don't live with you and in public settings when social distancing is difficult. Here are a few pointers for putting on and taking off a cloth mask: Wash or sanitize your hands before and after putting on and taking off your mask. Place your mask over your mouth and nose. Tie it behind your head or use ear loops and make sure it's snug. Don't touch your mask while wearing it. If you accidentally touch your mask, wash or sanitize your hands. If your mask becomes wet or dirty, switch to a clean one. Put the used mask in a sealable bag until you can wash it. Remove the mask by untying it or lifting off the ear loops without touching the front of the mask or your face. Wash your hands immediately after removing your mask. Regularly wash your mask with soap and water by hand or in the washing machine. It's fine to launder it with other clothes.
HEALTHCARE PROVIDERS MUST BE TRAINED AND PASS A FIT TEST TO CONFIRM A PROPER SEAL BEFORE USING AN N95 RESPIRATOR IN THE WORKPLACE. LIKE SURGICAL MASKS, N95 MASKS ARE INTENDED TO BE DISPOSABLE. HOWEVER, RESEARCHERS ARE TESTING WAYS TO DISINFECT N95 MASKS SO THEY CAN BE REUSED.
And, here are a few face mask precautions: •
• •
Don't put masks on anyone who has trouble breathing, or is unconscious or otherwise unable to remove the mask without help. Don't put masks on children under 2 years of age. Don't use face masks as a substitute for social distancing
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Things to know before getting porcelain veneers
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or years Porcelain Veneers are giving people stunning look under the concept of Hollywood smile and at the same time restoring the structure of moderately broken down teeth, crooked, heavily stained or discolored teeth from several old wearing down or chipped fillings also can be perfect solution for restoring decayed front teeth by using this hard porcelain shell.
Dr. Rabab Maziad Jaber Specialist In Fixed and Removable Prosthetic Dentistry at Al Ahli Hospital
There are specific indications for having porcelain veneers whether they are for full mouth or one jaw or single tooth, several steps should follow before starting the case in addition to important instructions after placing meant for extending their longevity. Important point to know that porcelain veneers should be over vital teeth but not devitalized ones. For such remarkable makeover we need to follow in our hospital necessarily basic phases to receive the perfect, healthy & naturally Bright Hollywood Smile:
1. A Panoramic X-ray is essential before treatment commences. It will detect if any of the teeth to be veneered has any form of pathology such as infections & periodontal disease.
give the guest the clear idea and perception of the final desired result.
7. Make an assessment of full occlusion & checking if the teeth have any deformation in their position as: crowding, gaps or rotated, according to this important & essential evaluation will be referred the case for Orthodontist for straightening the teeth in their perfect alignment which will save a lot of teeth structure cutting down for veneers preparation & will give the finest final result targeting for. 8. Gum lifts (gingivectomy) for crown lengthening in case when uneven gum margin occurs or a gummy smile by utilizing a laser. The laser ‘carved’ out the excess gum tissue, resulting in longer teeth and shorter gums giving a much more pleasing smile. 9. Starting the case and selecting the appropriate shade color & suitable shape of the Porcelain Veneers taking in consideration the guest preferences & according to many factors like: Gender, Age, The whites of the eyes for guidance, skin tan & face shape.
2.Clinical examination of the general oral hygiene, if the gums bleed, a trip to the hygienist is a must or for more advanced cases, treatment by a periodontist is needed.
3. Precise examination looking for decayed teeth which need fillings or infected ones which may need root canal treatment and full crowning instead of veneers later. 4. Preoperative Dento-facial Photographs needed at rest and full smile from all sides. 5. In-clinic direct Mock-up for giving an approximate imagine about the new look 6. Initial full mouth Impressions for preoperative study case to be prepared on wax up (through the lab technician which will be received next visit) before starting the case to NOV.DEC 2020
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10. After finalizing and cementing the case, the specialist has to give his clear guidelines for prolonging their durability which if followed can make his pretty healthy & bright smile last for more than 15 years as per the following: • Hygienic side to be followed at home as per the specialist instructions(brushing, flossing & waterjet) • To be controlled every 6 months by visiting the specialist for general checkup & cleaning • Be gentle to them and aware about the kind & way of food consumed In conclusion, it is a must to seek an experienced opinion to check if your case forms a good candidate for dental veneers(Hollywood smile), and always bear in mind that other alternatives, such as whitening, contouring and orthodontic treatments could be lighter & less aggressive options that can give you satisfying results in some cases.
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Cutaneous manifestation during lockdown and using sanitizer and hand cleansers
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ecently during the COVID-19 pandemic and the frequent instructions that stress the use of face masks, sanitizers and handwash.
We noticed an increased frequency of many skin manifestations such: • • • • • •
Dr. Raed Mahmoud Alsmadi Consultant Dermatologist at Al Ahli Hospital
Xerosis cutis Irritant hand dermatitis Flaring of already AD and hand eczema Perioral dermatitis More irritant contact dermatitis Occasional burn due to the use of harsh and strong sanitizers
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All these manifestations can be reduced or eliminated by: • • • • •
All those manifestations are mostly due to: • • •
Frequent use of the handwash and sanitizer Use of very strong sanitizer sometimes acids e.g. (glacial acetic acid) Strong concentrated ALCOHOL
Low-quality face masks that have microfiber which causes irritation and perioral dermatitis Certain patients with facial dermatosis like rosacea and inflammatory acne.
Avoiding the overuse of sanitizer and if needed those of 60% alcohol and above. Frequent use of moisturizer Gentle cleanser Good quality masks that have 100% cotton and minimal fibers And following the mandatory instruction of keeping 2 meters distancing
All efforts and people acting as one team to clear this pandemic with the least damages and ALLAH keep you all safe and well.
NEWS
Doctors remove cancerous mass the weight of an average house cat from patient’s pancreas
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preserve the main vessels that supply the gut. We then removed the cancer completely and reconstructed the vessels around the pancreas,” says Dr. Ahmed.
This aggressive form of cancer has very few symptoms until it is in its advanced stage. The patient began experiencing symptoms, including a loss of appetite and diarrhea that had caused a drop in weight, fatigue, and excessive bloating a year back. The tumor continued to grow, causing an unnatural abdomen bulge that made it difficult for her to sleep or carry out daily chores. When the problem persisted, she got it investigated with a biopsy that confirmed pancreatic adenocarcinoma, a cancer that starts in the ducts of the pancreas.
The patient is now undergoing chemotherapy and will require ongoing medical checks by an oncologist to monitor and prevent a recurrence. The patient says that she suffered for seven months with the disease. “My life had changed completely. I could not sleep and felt uncomfortable all the time. It was debilitating.” She says that Cleveland Clinic Abu Dhabi was the only place that gave her hope. “After visiting so many hospitals with no solution, I had almost given up. Cleveland Clinic Abu Dhabi has made my journey so much easier. Everyone was so supportive and knew exactly what to do to make me better. I am so happy and am recovering very well.”
octors at Cleveland Clinic Abu Dhabi have successfully removed a massive cancerous tumor growing in the pancreas of a 50-year-old woman after she was turned away from several other hospitals due to the size of the mass.
“The complexity involved in removing a 3.5kg mass meant that the other hospitals she visited found it challenging to handle the surgery. She was finally referred to Cleveland Clinic Abu Dhabi as her best hope,” says Dr. Naveed Ahmed, a surgeon in the Digestive Disease Institute at Cleveland Clinic Abu Dhabi who was part of the multidisciplinary care team involved in the curative procedure to resect all the cancer. “She was very weak when she arrived at the hospital and her stomach had expanded to an extent that she felt pregnant. This is because the large mass kept growing inside the abdomen and was intimately attached to the major vessels supplying the abdomen, liver and intestine. Another two to three months without treatment and it would have been too late.” Doctors at the hospital performed a near total pancreatectomy in which a large incision was made in the abdomen to remove most of the pancreas and reconstructed the vessels around it. “The size did pose a challenge and we had to alter our usual technique of resection to
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Dr. Naveed Ahmed, A surgeon in the Digestive Disease Institute at Cleveland Clinic Abu Dhabi
The Digestive Disease Institute, one of the six Centers of Excellence at Cleveland Clinic Abu Dhabi, provides the most advanced level of medical and surgical care for disorders of the gastrointestinal tract, ranging from irritable bowel syndrome to gastrointestinal oncology. The hospital continues to expand its range of cancer services as it prepares to open its dedicated oncology center. Modelled on Cleveland Clinic’s Taussig Cancer Center in the USA, the facility will provide a full range of advanced treatments in a central location and house support services designed to make patients as comfortable as possible as they receive their care.
NEWS NEWS
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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.
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/Malaffi