Protected and connected Restoring humanity in

Protected and connected

Restoring humanity in healthcare for health workers and their patients

Frontline healthcare workers across the world are facing unimaginable challenges, pushing on to deliver care after 18 grueling months entrenched in the pandemic.

Bridget Dufy, MD — Chief Medical Ofcer of Vocera Communications — has witnessed harrowing scenes in the US health system and is working to determine what healthcare leaders, governments and technology companies can do to protect the physical, emotional and psychological wellbeing of nurses, doctors and other frontline healthcare workers.

“Healthcare workers are exhausted, burnt out and fearful of bringing COVID-19 home to their families,” Dr Dufy said. “Nurses in particular are at risk— they have the most direct, hands-on patient contact, and face the greatest risk of infection of all healthcare workers. In many scenarios, PPE has been inadequate, leaving nurses feeling unsafe in their working environment. “The fatigue that is setting in is not good. There was a public health crisis of burnout and cognitive overload before the pandemic — now it is amplifed. We will see people with post-COVID stress disorder syndrome, it is real, and this is a global issue.”

One of Dr Dufy’s major concerns is that people will choose to leave the healthcare profession in droves and people will choose to not enter nursing or medical school.

“If we don’t fx the system issues, we will lose a generation of practitioners and that will cripple healthcare systems around the globe. We need to remove the preventable trauma and deploy technology that keeps people safe and enables them to do their jobs more easily, and we need to do it now.”

If there’s anything positive to come from the pandemic, it’s the drive that propels the industry to move faster to design environments that protect and connect the healthcare workforce and restore joy amongst those in the profession. Dr Dufy explained that a new declaration of safety is being drafted to safeguard the physical and psychological safety of healthcare workers. The standard should focus on PPE as well as technology (PPET) that enables healthcare staf to communicate safely with colleagues, creating a connected care team through voice.

“We need some basic standards around protecting the physical safety of our healthcare workforce, as well as those that ensure psychological and emotional wellbeing.” “We’re going to need to rebuild trust and put in assurances that we can protect the physical safety of healthcare workers. This is why the new Vocera Smartbadge has a dedicated panic button with real-time location and broadcast capabilities — if a nurse is subjected to violence, he or she can hit the panic button, which will broadcast to the local hospital security or the police,” Dr Dufy explained.

“We want nurses and other front-line team VOICE-ACTIVATED, HANDS-FREE TECHNOLOGY WOULD ENABLE THEM TO STAY SAFE, CONNECTED TO THEIR CARE TEAM AND AT THE BEDSIDE PROVIDING THE BEST POSSIBLE CARE TO PATIENTS.

members to go to work with this device knowing they are safe. Having the badge means that a health worker is never alone, when they are isolated in a patient’s room or elsewhere within the hospital.”

Communication is at the core of safety, so PPE needs to include technology that keeps people safe. According to Dr Dufy, the greatest risk to healthcare staf is taking on and of their PPE to contact a colleague or get the supplies they need to do their job. They should not have to risk contamination to reach their colleagues.

“Voice-activated, hands-free technology would enable them to stay safe, connected to their care team and at the bedside providing the best possible care to patients.”

Historically, psychological wellbeing has been seen as a ‘soft’ concern. Dr Dufy explained that, as a result of the pandemic, most institutions in the US are appointing senior roles to address the wellbeing of staf. One U.S. hospital implemented a distress index to help measure and monitor staf wellbeing. The index, powered by human-centered technology, allows staf to record on a scale of one to fve, how distressed they are on a given day. A high distress response is immediately routed to a support system. Health workers are witnessing numerous traumas every day, so it is vital that support and resources are available to them.

“The pandemic has forced us to separate loved ones at their greatest time of need. There are technologies that can restore humanity at the bedside by connecting the patient with their loved ones. We now have technology that allows us to take video and photos and connect families in a secure way.”

Dr Dufy explained that Vocera can broadcast to a whole family simultaneously, creating a connected community around the patient.

“It is our hope to restore humanity through improved smart communication that creates a connected care team inside and outside the walls of the hospital. “With a connected care team, features like our panic button, and a smart workfow management system that alleviates cognitive overload, we can design a healing healthcare ecosystem in which people will want to work and where patients will receive the compassionate care they deserve.”

First published in Hospital + Healthcare THE NEW VOCERA SMARTBADGE HAS A DEDICATED PANIC BUTTON WITH REAL-TIME LOCATION AND BROADCAST CAPABILITIES — IF A NURSE IS SUBJECTED TO VIOLENCE, HE OR SHE CAN HIT THE PANIC BUTTON, WHICH WILL BROADCAST TO THE LOCAL HOSPITAL SECURITY OR THE POLICE.

www.vocera.com/me

INNOVATION AND TECHNOLOGY LAUNCH HEALTH SERVICES INTO A NEW ERA

MHSA Programme Coordinator at the University of Nicosia Medical School Dr. Neophytos Karamanos

Interview by Constandinos Tsindas

The pandemic has forced professionals to look at more efective, faster collective management methods and realise that multi-dimensionality must be part of a modern healthcare system. Dr Neophytos Karamanos, Programme Coordinator of the Master of Science in Health Services Administration (MHSA) at the University of Nicosia Medical School, believes that innovation and technology can place patients where they should be; right at the heart of services.

These are dynamic times for the Health Services Administration Sector as a result of the pandemic and technological change. Can professionals in the feld rise to the occasion and propose more effective ways of making the system work for people?

INNOVATION MANAGEMENT IS EXTREMELY DIFFICULT.

We live in very challenging times as far as the entire health services sector is concerned. New innovative approaches and technologies are fundamentally reshaping the sector. Telemedicine, artifcial intelligence and big data analysis, real-time patient monitoring through wearables and blockchain are merely examples of the new technologies being introduced.

The pandemic, among other factors, accelerated the rate of change and has highlighted the need for efective crisis management. Knowledge on how pandemics spread within a population, evaluation of measures which could limit such spread, an understanding of how hospital settings and facilities should be structured to increase efectiveness and ensure the safety of both patients and healthcare practitioners, an understanding of how technology could be of assistance, even basic skills about drawing up crisis management plans and redistributing resources are all essential competencies needed in order to efectively cope with the pandemic.

When there is so much change and a need for new competencies, it is a signal to return to

education and facilitate personal development to meet the greater needs of the public. And this is exactly where the novel and modern MHSA programme aims to improve: providing the essential skills to health services professionals in these critical, developing areas.

Where does innovation come in when it comes to cooperation across different disciplines?

Innovation management is extremely difcult. You need to achieve the collaboration of several partners (e.g. hospitals, healthcare groups, insurances, universities, research centres, biotech and government) in order to develop new innovations. The real challenge however remains to embed new innovations in the processes and systems of your organization and turn them into everyday practice. The new MHSA programme places special emphasis on innovation management and entrepreneurship. It also challenges students to pursue advanced initiatives to address existing problems in their current work environments through the development of business plans and the implementation of feld projects.

What is the role of emerging technologies and innovation in building those working relationships towards a more patient-centred health services system?

I would say that developments here are truly exciting. New technologies and innovations enable a more personalized approach for patients and also individuals managing their wellness. The emphasis continues on treatment and increasingly on preventive medicine. The ability to collect real-time information about a person’s health and physical condition, dietary habits, the monitoring of someone’s biomarkers including genetic predisposition, all enable healthcare services to provide more personalized treatment, counselling and coaching towards improving health and well-being. The ability to collect, analyse and cross-relate extensive patient health data, including relating this information with the data of the larger population, enables the calculation of health risks and scores at an individual basis, leading to corrective actions and improvement.

How has technology use altered the health service sector, considering the pandemic?

The pandemic has manifested how new technologies have the potential to transform health services. Telehealth usage rose sharply and mobile apps were used for social distancing and contact detection. Artifcial Intelligence applications aided treatment discovery eforts.

When it comes to the MHSA programme, this course is ofered fully online beneftting from UNIC’s experience as the frst university globally to receive triple accreditation for its online learning quality. Harnessing global experience in the digital platform is an essential part of the MHSA so that students beneft from leaders and experts with real-life experience in combating pandemics.

What is your own background and what do you think this experience brings to the University of Nicosia MHSA?

I come from a business and technological background, with experience on how organizations can innovate and transform themselves during periods of dramatic change, such as this one. The very design of the MHSA places signifcant emphasis on how change can be practically embedded into organizations through innovation and entrepreneurship.

How does e-learning work in practical terms for a degree as Health Services Administration?

The e-learning mode of programme delivery presents several advantages for the busy professionals who will be interested to pursue an MHSA degree. Firstly, there is no location constraint and the programme can be attended from anywhere in the world. The majority of the programme’s activities are asynchronous and the students can undertake them when their schedule permits. The few synchronous activities are also recorded and can be attended ofine. Interactivity (teacher-to-students, stuNEW TECHNOLOGIES AND INNOVATIONS ENABLE A MORE PERSONALIZED APPROACH FOR PATIENTS AND ALSO INDIVIDUALS MANAGING THEIR WELLNESS. THE EMPHASIS CONTINUES ON TREATMENT AND INCREASINGLY ON PREVENTIVE MEDICINE.

dent-to-student and student-to-material) is continuously built into the programme’s activities and webinars so that group learning and sharing of experiences is achieved.

What are the advantages of the Medical School online programmes?

The University of Nicosia is a regional leader in distance learning education at the Bachelor and Master level. It is the frst university in Europe to have received a triple recognition for excellence in online education by: • QS Stars (5 stars): It is one of only 14 universities in the world to-date that has been awarded a 5-Star rating • The European Association of Distance Teaching Universities (EADTU): The university is a recipient of the E-xcellence label • The European Foundation for Quality in e-Learning (EFQUEL)

The University ofers students a state-ofthe-art online platform, supported by experienced academics who employ the latest pedagogical approaches for online learning. The learning platform is supported by engineers who work to provide timely support. The 2020 Times Higher Education (THE) University Impact Rankings, ranked the University of Nicosia (UNIC) as the number 42 university in the world in the core area of Quality Education,

Looking to the future, what are the lessons to be learned, and how can we prevent the same mistakes?

The future will be inevitably be diferent from the past as the whole health services sector is being radically transformed by new technologies and approaches. Yet the past and its lessons are also critical. Take the pandemic; humanity has witnessed a number of pandemics like, for instance, the Spanish infuenza which taught us the value of wearing masks, social distancing, school closures, prohibition of social gatherings. Yet, in responding to Covid-19, many countries were late to implement efective measures while early warning signals were ignored. The world is more vulnerable today due to global connectivity.

The importance of providing timely and accurate information to the public must also be stressed. Contradictory views (even from experts) traversed instantly across the globe adding to the public’s confusion. The role of WHO and other formal health bodies is critical towards coordinating the protection eforts and providing accurate information.

How can we implement health services management for the people?

The ongoing developments in the sector allow placing patients and individuals at the centre of services. Working in the health services, our role is to continue to innovate to meet the varying needs of patients, as technology and research expands globally.

Treatment will be complimented by prevention and lifestyle medicine with increasingly personalized services through collection and correlation of a massive amounts of patient data, including data collected from wearable health devices. We can anticipate expanded use of a person’s biomarkers including genetic predisposition and enabling of behaviour change to reduce health risk. All of these point towards a brighter health-related future.

For more information about the MHSA programme at the University of Nicosia Medical School visit www.med.unic.ac.cy/education/master-health-administration-mhsa/ THE E-LEARNING MODE OF PROGRAMME DELIVERY PRESENTS SEVERAL ADVANTAGES FOR THE BUSY PROFESSIONALS WHO WILL BE INTERESTED TO PURSUE AN MHSA DEGREE. FIRSTLY, THERE IS NO LOCATION CONSTRAINT AND THE PROGRAMME CAN BE ATTENDED FROM ANYWHERE IN THE WORLD.

Single-use medical devices

To improve patient safety by reducing the risk of cross-contamination

Single-use medical devices are medical equipment and instruments that are used only once in a hospital or clinic and then disposed. Some medical devices are difcult to sterilize or reprocess to make them safe to use on another patient, so the alternative was single-use devices.

Using disposable items improves patient safety by eliminating the risk of patient-to-patient contamination because the item is discarded and not used on another patient. The most important single-use devices are syringe needles, scalpel blades, gauze and others.

The goal of using single-use medical supplies is to prevent germs and viruses from spreading from one patient to another, which is essential in infection control.

These medical devices have become popular in the world with the spread of the coronavirus pandemic and the need to limit its spread, so the focus was on single-use medical devices and their disposal after each use, as part of the global eforts to break the cycle of spreading the virus from one patient to another. Single-use devices or equipment should not be reused, and they should only be used on one patient during a medical intervention or a single medical procedure and then disposed and should not be used again even on the same patient. Reusing it afects its efcacy and the safety of the medical procedure itself, exposing the patient and the doctor to unnecessary health risks.

This type of medical supplies is a reliable option to ensure that all devices are not contaminated and that germs and microbes are not transferred from one patient to another, which reduces the chances of cross-contamination.

Single-use medical devices in hospitals and health facilities instead of those that are used again after sterilization have numerous benefts.

Improving patient safety

The main priority for all health workers is to eliminate preventable diseases during the proviTHESE MEDICAL DEVICES HAVE BECOME POPULAR IN THE WORLD WITH THE SPREAD OF THE CORONAVIRUS PANDEMIC AND THE NEED TO LIMIT ITS SPREAD, SO THE FOCUS WAS ON SINGLE-USE MEDICAL DEVICES AND THEIR DISPOSAL AFTER EACH USE, AS PART OF THE GLOBAL EFFORTS TO BREAK THE CYCLE OF SPREADING THE VIRUS FROM ONE PATIENT TO ANOTHER.

sion of healthcare that may develop in patients while receiving medical services, which increases the need for safe and efective tools.

Single-use medical devices reduce the risk of cross-contamination, including infections during surgery and those that can be transmitted during medical procedures. Thus, these single-use medical supplies can alleviate healthcare providers' concerns regarding the cleanliness of their surgical instruments. With reduced risk of contamination and increased infection control, single-use devices can improve patient safety and overall quality of care.

Saving time

Single-use medical supplies reduce the burden of sterilization and disinfection after any medical intervention, which saves time because they are disposed immediately after use and there is no need to clean them after each use. Hospital workers and healthcare providers don't have to spend time decontaminating and sterilizing the way they do with reusable devices.

Saving time with minimal preparations or work that follows any medical intervention, all factors increase the efciency of medical facilities and allow them the opportunity to serve more patients. Healthcare facilities can easily adhere to scheduling and avoid any kind of incidents.

Reducing cost

Although single-use medical supplies may be more expensive than reused ones, the long-term benefts remain the most important for healthcare providers, especially in terms of reducing cross-contamination.

In addition, relying on this type of supplies eliminates the cost of reprocessing, sterilization, and maintenance of the machines used for this purpose, as well as saving time. All these benefts make it difcult to calculate the fnancial cost as these tools simplify the medical procedure for healthcare providers. Therefore, we can say that over time, reusable supplies provide the same quality of services as single-use supplies.

New Advances in Fetal-Maternal Medicine

By Dr. Asmaa Abdulsalam, Consultant of Obstetrics and Gynecology at Al-Ahli Hospital / Qatar

Fetal-Maternal medicine has achieved a lot of progress in the last three decades looking for better prognosis for both the mother and the newborn by looking for early detection of any abnormalities related to the mother and the fetus so all precautions could be taken to prevent and to treat these disorders. Fetal-maternal medicine does not start with onset of pregnancy but starts even before, preparing the mother to coop at the best with her pregnancy

Pre-conception care

Mother should start folic acid at least 3 months before getting pregnant to minimize and prevent neural tubal, defects in the fetus like Anencephaly. Hydro- Cephalus and Spina Bifda. A woman who is known to have past history of gestational diabetes mellitus should control her blood glucose at least 3 months before pregnancy to avoid miscarriages and minimize risk of congenital abnormalities in addition to minimizing fetal and maternal morbidity and mortality during pregnancy and delivery.

This also applies to other medical problems like auto-immune diseases, hypertension, cardiac disorders, iron and vitamins defciency, obesity and metabolic disorders not only this but the woman also should be psychologically stable and ready for getting pregnant. Every efort should be done to prevent unwanted, unplanned pregnancy to avoid unsafe abortion and to minimize the stress on the mother which subsequently will be refected on her and the newborn's health.

Post-conception

Once a woman gets pregnant and pregnancy is confrmed by BHCG (Pregnancy Hormone) and during the frst three months of pregnancy, it is essential to screen for congenital abnormalities WOMAN KNOWN TO HAVE PAST HISTORY OF GESTATIONAL DIABETES MELLITUS SHOULD CONTROL HER BLOOD GLUCOSE AT LEAST 3 MONTHS BEFORE PREGNANCY TO AVOID MISCARRIAGES AND MINIMIZE RISK OF CONGENITAL ABNORMALITIES.

using the ultrasound to check for the nuchal translucency and nasal bones as a predicting test for trisomy, recently with new advanced ultrasound machines combined with proper training, many other congenital abnormalities could be detected as early as 11-13 weeks.

To increase the predictability of detecting trisomy. Recently, by the ultrasound, fetal measurements combined with level of certain hormones and proteins in the mother blood can can, through specifc computer programs, calculate the risk of having trisomy what is called Double and Triple tests. Another predicting test is the PANORAMA test where the fetal cells are separated from maternal blood and submitted to chromosomal tests. It can also predict the trisomy and other genetic disorders with high accuracy. If the predictive tests proved to be at high risk for fetal abnormalities, more certain and invasive tests can be done - if the parents give consent - like Chorionic villous biopsy and amniocentesis.

Uterine artery doppler is another test that can be done early in pregnancy to predict pre-eclampsia, recently a new test has been developed which combines uterine artery doppler readings together with many predicting factors like medical, family history of chronic hypertension, renal disorders, autoimmune diseases,

pre-eclampsia together with specifc hormonal levels in maternal blood, the result of this test is reliable in determining those who are at high risk for developing pre-eclampsia before 34 week. Accordingly, high-risk group should start Aspirin of 100 mg tablet daily before 16 weeks pregnancy and continuously taken till 34 weeks, this prophylactic treatment is efective by 97% in preventing pre-eclampsia subsequently decreasing maternal and fetal morbidity signifcantly and proving to be cost-efective.

Ultrasound in the second trimester has also achieved a huge progress with the development of the skills of the obstetricians and the accuracy of the machines that can detect a lot of morphological abnormalities of the fetus including the heart, brain and fetal circulation and cervical length of the uterus.

In the last trimester, ultrasound is a useful tool in the diagnosis of intrauterine growth restrictions and small for gestational age and to decide on the time of delivery based on umbilical artery and middle cerebral artery doppler. It can also diagnose with great accuracy the placental situation and its relation to the cervix, previous scars and degree of penetration in the endometrium and myometrium in other words ultrasound can diagnose diferent degrees placenta previa, accreta and scar pregnancy.

Ultrasound During labor

Obstetricians are now active in using ultrasound during labor to examine the progress of labor during frst and second stage of labor and in properly diagnosing malpresentation of the fetal head before application of the forceps or vaccum so minimizing the fetal injuries. Intrapartum ultrasound can assess the presenting part and its relation to maternal pelvis, station and degree of engagement of the head using angle of progression, fetal perineum distance. Fetal head -Symphysis pubis distance and attitude of the fetal head in the pelvic curve as parameters of progress of labor, it can also assist the dilatation and efacement of the cervix without digital examination which is more convenient and less stressful and painful to the delivering woman. UTERINE ARTERY DOPPLER IS ANOTHER TEST THAT CAN BE DONE EARLY IN PREGNANCY TO PREDICT PREECLAMPSIA.

And the most important is to standardize the examination to minimize the human errors and diferences in estimation between diferent care givers in the labor room

Intrauterine surgery became a routine in certain centers all the world to correct the congenital abnormalities before delivery like Spina Bifda repair which is closing of a defect in the back of the fetus by 20 weeks gestation through direct open surgery or fetoscope. This operation is successful in correction of the defect and protecting the baby from complications of neural tubal defects after delivery. However, intra uterine surgery is not always benefcial with other congenital abnormalities correction and should be done only when the beneft exceeds harms.