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THE ARAB HOSPIT HOSPITAL PITTAL AL including uding

MIDDLE EAST HOSPIT HOSPITAL SPITTAL

The definitive guide to Hospitals and Healthcar Healthcare e in the Middle East

Outstanding Contribution to Healthcare in the Middle East

Special feature:

Philips Healthcare

Specialist article on home dialysis by Dr. R N Greenwood

www.middleeasthospital.com www .middleeastho dd eeast o osp ta co ospital.com


www.boltons.co.uk

Sales Office +44 (0)114 240 4400 Fax

+44 (0)114 257 6555

Email

sales@boltons.co.uk

Bolton Surgical Ltd, Churchill House, 16 Churchill Way, Chapeltown, Sheffield. S35 2PY


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Editor’s introduction

February 2010 contents:

For exporters to the Gulf and wider Middle East markets Arab Health is the key trade show of the year, and early reports suggest it was a great success for many companies. Despite the global economic crisis finally being felt in the Gulf, and particularly in Dubai, the healthcare market here remains robust. Spending of around $100billion has already been allocated across the region, as new hospitals and healthcare projects flourish.

MEH Health and Innovation Awards winners

At Arab Health 2010 MEH held its inaugural Health and Innovation Awards ceremony, recognising companies that have contributed to healthcare in the Middle East region, and rewarding the introduction of innovative new products to the market. We at MEH were particularly honoured that the internationally renowned surgeon and UK business ambassador Lord Darzi agreed to present our awards, which made the occasion even more special for the winners. In this issue there is extensive coverage of the awards winners and their products.

Philips Continuous Medical Education academy Dubai

The magazine has a special report on some of the institutions and companies that are contributing to medical education and training in the Gulf. We look at the

pg. 4-10

Healthcare industry news pg. 12-13

Special feature: Medical Education and Training in the Gulf Imperial College London Diabetes Centre Abu Dhabi pg. 14-16

Cleveland Clinic and IIR

Lord Darzi

pg. 18-19

pg. 20-21

Weill Cornell Medical College Qatar pg. 22-24

Specialist article: the rejuvination of home dialysis- clinical and financial considerations, by Dr RN Greenwood pg. 26-29

Continuous Medical Education schemes being implemented by important healthcare organisations such as Philips, Cleveland Clinic, and Weill Cornell. We also have a look at the rise of home dialysis in an article by Dr Greenwood of the Renal Unit at Lister Hospital, Stevenage.

Students at WCMC-Q

In next month’s issue we will have an in depth review of Arab Health 2010, hearing from the companies that attended both large and small. British companies dominated the MEH awards and we will shine a light on British healthcare excellence on display at the show, and in the Gulf region. Guy Rowland, Editor

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MEH Health and Innovation Awards The Arab region’s leading healthcare monthly, Middle East Hospital magazine (MEH), presented their inaugural Health and Innovation Awards at an awards ceremony today at Arab Health 2010 in Dubai. The awards, for suppliers of medical equipment to the Middle East region, were presented by the renowned surgeon and UK Government healthcare ambassador Lord Darzi.

best of UK innovation and excellence. Their work will save lives and improve the quality of life for people around the world. I congratulate these pioneering firms on the recognition they have achieved.”

The editor of MEH, Guy Rowland, said, “these awards recognise the contribution of companies from across the globe to healthcare services in the Middle East, and the benefits their products have provided for hospitals, clinicians and patients in the region. The Arab countries import the vast majority of their medical devices and healthcare products, and the introduction of high quality, innovative new technologies by medical equipment manufacturers has played a major role in the ongoing revolution in healthcare provision taking place in the Middle East.”

British success story Kimal won an innovation award for the NxStage System One home haemodialysis machine, which was unveiled at Arab Health by Lord Darzi, and also bagged the prestigious prize of British Middle East Lord Darzi of Denham Exporter of the Year for 2009 for their impressive recent growth in an amazing 42% to over £6.5m. It was during this year that also saw the region. sales manager Brian Deane becoming the first Kimal sales perKimal plc has been operating in the Middle East region for 30 son to achieve the £5m personal years, initially developing busi- sales milestone. ness from its UK base and then opening dedicated regional of- “Most notably for the ME operation is the level of new business fices in the UAE during 2001. created in the region. Based on Corporate Marketing Manager, an excellent order book the comKen Findlay, said, “The Middle pany expects new business to hit East operation has gone from over half a million pounds by 31st strength to strength in the past March 2010. This is an amazing two years with total sales at the 460% increase from the same peend of March 2009 increasing by riod in the previous year. Not only

Commenting on the UK-based award winners Lord Darzi said, “These firms represent the very

NxStage One from Kimal

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Award winners Most innovative product for export category Kimal for the NxStage System One home haemodialysis machine Surgins for range of stainless steel and titanium surgical instruments Medibord Limited for the Medibord MRI, CT and radiotherapy compatible material Mirage Health Group for the Propulse NG Ear Irrigator Bedfont Scientific for their range of exhaled breath carbon monoxide monitors NuTec Medical Ltd/A-Z Innovations for the Paraskate cylinder trolley safety range Bolton Surgical for their colo-rectal range Sanitas for healthcare innovation in the field of hygiene promotion Outstanding contribution to healthcare in the Middle East category Gene Profiling for MammaPrint Adam, Rouilly for the Venepuncture and Infusion Arm Malem Medical for their range of enuresis alarms American Middle East exporter of the year Welch Allyn British Middle East exporter of the year Kimal German Middle East exporter of the year Karl Storz Special award for outstanding contribution and commitment to healthcare in the Middle East Philips Healthcare International award for outstanding Middle East export achievement of the year Steve Spurgin of Downs Surgical/B-Braun Special Award for outstanding contribution to British Healthcare Exports Theresa Ashford (ABHI ) for the International e-newswire Award for outstanding International contribution to pediatric healthcare Children's Hospital Boston

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L-R: Dr Hilal Malem (Malem Medical), Peter Bolton (Bolton Surgical), Steve Spurgin (Downs Surgical), Dr Peter Briggs (Health Audit International), Jenny White (Adam, Rouilly), Theresa Ashford (ABHI), Dr Rizwan Qureshi (Surgins), Lord Darzi, Alan Press (Kimal), Jonathon Richards (Medibord), Samir Zreik (Gene Profiling/Agendia), Mike Tanousis (MEH) that but it is also a mind blowing 3614% increase on the new business figure as at 31st March 2008. Actual new business sales in the region at the end of December showed a brilliant 227% increase on the same period in 2008-09.� It is fitting that in this, their 30th year operating in the Middle East that Kimal are leading from the front in developing UK healthcare business and are reaping the rewards of the continued effort and expertise in supporting and developing this ever important market for UK companies.

Ken Findlay, Brian Deane and Alan Press of Best UK Middle East Exporter winner Kimal, wih Lord Darzi

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MEH Health and Innovation Awards: A closer look at the winning products and companies Medibord Limited- Innovation in medical composites

Medibord CEO Jonathan Richards

Medibord Ltd, from Nottingham in the UK, have launched the world’s first fully x-ray translucent and non-conductive material for a range of couch tops and patient positioning devices. Medibord™ is a unique and innovative MRI, CT and radiotherapy compatible material. Unlike carbon fibre alternatives, Medibord has been designed to be fully x-ray translucent and non-conductive ensuring no heating occurs with MRI giving no artefacts and enabling accurate software image overlay. «For a new business such as Medibord, it is a great honour to be acknowledged for our innovative range of products and we are delighted to receive such a prestigious award from the highly esteemed Middle East Hospital Award Panel», said CEO Jonathan Richards, «Medibord is yet another step closer to developing a significant market share in the MRI/CT scanner accessory product field».

Bolton Surgical- Sheffield steel surgical instruments Bolton manufacture theatre quality surgical instruments covering all disciplines of surgery and are the market leaders in the development of instruments for Colo Rectal surgery. This range has been developed in conjunction with Europes leading Colorectal surgeons over the last 10 years. Peter Bolton told MEH, «We have over the last decade designed and developed an extensive range of instruments for the Colorectal surgeon. Our Colo Kraft range is now recognised worldwide and to receive an award was a wonderful accolade. The team at Bolton Surgical will all take pleasure at the recognition and we would like to thank all responsible for the nomination.»

Adam, Rouilly- medical training tools Adam, Rouilly produce a range of medical training tools from brain models and heart models to skeletons and anatomical charts; from venipuncture training tools and instruments to resuscitation simulators. Sales and Marketing Manager GrahamFowler says, “The success of Adam,Rouilly’s export sales is due to the hard work of our dedicated sales team. In 2009 we achieved 50% of our total sales in export markets with significant sales in the Middle East. The advent of clinical skills training in hospitals in the Middle East is a major factor in these achievements. Attending Arab Health since 2004 has enabled us to regularly meet many of our customers, and the sales reflect the confidence our dealers have in the products, quality and service that Adam,Rouilly offers to Healthcare Education.”

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Malem Medical- Enuresis alarms

Mike Tanousis of MEH presents the award to Dr Hilal Malem

For 30 years Malem Medical have been manufacturing the world’s best and largest range of Enuresis Alarms and Vibrating Watches for the treatment and permanent cure of Nocturnal as well as Diurnal Enuresis. Malem Enuresis Alarms (bedwetting alarms) are designed to maximize success in the treatment and cure of bedwetting and provide a safe, efficient, economical and permanent cure for bedwetting in contrast to the short term relief offered by expensive and potentially dangerous drugs. Dr HiIal Malem said, “I wish to express our pride and appreciation in being awarded the Health & Innovation Award. We will treasure and value it forever. It is good to be acknowledged for the work over the last 30 years. We are continuously working on new products to fulfill the needs and improve the quality of life of people.”

Sanitas Healthcare plc- unique swine flu hygiene pack CEO Rob Gros said: “Building on our recent success in the UK we are increasing our efforts in the Middle East where the response from Saudi Arabian, Libyan and Kuwaiti distributors in particular has been highly encouraging. At Arab Health we launched a new addition to the FluPak family - TravelPak the hygiene kit which has been developed for people on the move by air, by sea or on land. “The complete range of Sanitas products empowers people to actively protect themselves against viruses such as swine flu and avian flu, and pathogens such as MRSA, Norvirus and E.coli etc by sanitising their environment and reducing the risk of infection.”

Surgins- a surgeon’s vision

Dr Rizwan Qureshi of Surgins

Surgins is one of the fastest growing stainless-steel and titanium surgical instruments companies based in the United Kingdom. It aims to develop a global reputation for surgical Instrumentation of outstanding quality, precision and cost-effectiveness- on basis of profound surgical knowledge. Dr Qureshi explains, “Surgins philosophy is to provide such a “Surgeons’ Platform” where surgical instruments should be manufactured, developed, customized and innovated as per surgeons’ wisdom & vision. Surgins believe that providing surgeons with the surgical instruments that surgeons want is the key to successful surgery, which will facilitate the treatment of diseases across the globe.”

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Bedfont Scentific- exhaled breath monitors

COmpact smokerlyser

Bedfont Scientific Limited specialises in the manufacture of exhaled breath and gas monitoring instruments for medical, scientific and industrial markets throughout the world. Andrew Shephard, Export Sales Executive, says, “Airway inflammation is a central process in asthma and other lung diseases. Being able to measure this inflammation and monitor the patient’s reaction to medication is regarded as a gold standard in the management of respiratory diseases. It is increasingly recognised that the measurement of Fractional Exhaled Nitric Oxide (FENO) in particular constitutes a novel way to monitor separate aspects of diseases. These include asthma, COPD and interstitial lung diseases,that are not assessed by other means, such as lung function.”

NuTech Medical/A-Z Innovations- the Paraskate range An elegantly simple mechanical clip that exploits the force of gravity to safeguard tall, heavy gas bottles from the danger of toppling over is capturing avid attention from prospective healthcare customers across the UK and around the world. This unique clipping system, named Paragrip is the invention of Robin More, Managing Director of NuTec Medical Ltd, a Southendbased research and development company. «Gas bottles are in widespread use in the healthcare industry and they are tall, thin and heavy. The dangers their instability poses while they are being moved and in use are considerable, and this is a worldwide problem. Previous systems to keep gas bottles in place simply do not work effectively. But by using Paragrip and its counterpart Paraskate, a simple mini-trolley, stability of bottles is greatly increased both in use and in transit.»

Propulse NG Ear Irrigator

The Paragrip

Mirage- ear care specialists Mirage Health Group specialises in the provision of ear care products which allow clinicians to carry out safe and effective ear care in accordance with today's guidelines. The unique Propulse ear irrigation range has been supplied to the UK primary care market since 1997. David Caldwell, General Manager – Sales and Operations, told MEH, “Mirage is committed to working with clinicians to provide the tools they need to carry out safe and succesful ear care for patients.The Propulse Ear Irrigator has been the clinicians favourite for over 10 years. Over that time, the Propulse range of products has developed to include good value, high quality instruments designed specifically for ear care.

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medibord.com

World First Technology Medibord™ The Medibord™ has been designed to enable the development of innovative solutions for radiotherapy and MRI compatible medical devices and clinical use. ,WXVHVLWVXQLTXHIXVLRQPHWKRGRIPDQXIDFWXUHWRRIIHUWKHIROORZLQJEHQH¿WV • Lightweight – less than 4.5kg/m² • Rigid – impressive strength to weight ratio • Robust – high impact resistance offers superb durability • Ecological – 100% recyclable • MRI Compatible – uniquely magneto-radio translucent • Modular – ability to form and offer 2D for shaping cost effective ancillaries

Successful clinical trials carried out by Nottingham University Hospitals have proved the Medibord™ to be a revolutionary material for the use in radiotherapy and MRI scans DQGWUHDWPHQW8QOLNHFDUERQÂżEUHSURGXFWV0HGLERUGÂŒGRHVQRWFRQGXFWHOHFWULFLW\ eliminating heat and the resultant image artefacts. 0HGLERUGÂŒFDQEHXVHGLQDQXPEHURIDSSOLFDWLRQVLQFOXGLQJ • Oncology couch tops • Patient positioning boards and devices • Patient transfer systems • Emergency and temporary partitioning • Clinical waste applications

Most Innovative Product for Export

For more information and to arrange for a clinical trial please contact us.

0HGLERUGÂŒ%LRFLW\3HQQ\IRRW6WUHHW1RWWLQJKDP1**) •7HO• info@medibord.com


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Healthcare Industry News Medical tourism industry growing in KSA Health tourism accounted for over SR800 million out of the total spending by both citizens and expatriates for domestic tourism in 2007, a recent report from the Supreme Commission for Tourism and Antiquities (SCTA) said, also noting that foreign tourists spent over SR400 million to undergo treatment in the Kingdom during this period. The SCTA report showed that there are several medical firms and centers to promote medical tourism in the main cities of the Kingdom. These include Prince Sultan City for Humanitarian Services, Dr. Sulaiman Al-Habeeb Center, Kingdom Hospital, Dallah

Hospital, Ibn Rushd Hospital, Saudi German Hospital, Qari Medical Center for Blood Diseases and Tumors, Dr Abdul Rahman Baksh Hospitals, and Eid Clinic. There are several other clinics springing up in various regions of the Kingdom. Abdul Rahman AlJassas, SCTA’s executive director for tourism development in the Riyadh region, said that Saudi Arabia is also making giant strides in business and conference tourism. “Riyadh hosted more than 50 percent of these types of tourism activities Kingdom-wide during the last year,” he said.

DHA hospitals get accreditation from the Arab Board of Medical Specializations The Arab Board of Medical Specializations has granted accreditation to two DHA hospitals to train newly qualified graduates (residents) in general surgery. The two hospitals are Dubai Hospital and Rashid Hospital. Dr Khalil Qayed, Director of the Medical Education Department at the DHA said, “This is a significant step for us and this accreditation reflects the high-level of quality services we provide in our hospitals. The medical field is everevolving and at the DHA it is our endeavour to provide our doctors with opportunities where they can

receive training in the latest advances in medicine. “This accreditation means that our doctors can now receive training in general surgery within the DHA hospitals itself and since the training is recognised by the board, our doctors will be eligible to give their Arab Board examinations once they have completed their five-year training with us. This provides a tremendous boost for our doctors and makes it more convenient for them to undertake the examinations and receive their certification in general surgery.”

Samsung Medical Centre opens in Dubai Dubai Health Authority has announced the opening of the first Samsung Medical Centre in the Middle East in Dubai next March under the patronage of Dubai Health Authority and in collaboration with INDEX Holding as the first center of its kind outside Korea. The centre will have highly specialised medical and nursing personnel in addition to the medical visits by consultants from Samsung Medical Centres and Hospitals in Korea. Samsung Medical Centre Dubai provides specialized medical services in the treatment of Cancer, Cardiology, Nephrology, Urology, Gastroenterology, Women Health and Family Medicine. The centre aims at attracting medical tourism to the region and to facilitate the exchange of knowledge and experiences. “We are pleased that a worldclass center like Samsung Medical Center has decided to open its first medical center in the region in Dubai. The decision reflects the investors’ trust in Dubai, the United Arab Emirates and in the vision of the wise leadership of His Highness Sheikh Mohammed Bin Rashid Al Maktoum Vice President, Prime Minister of UAE and Ruler of Dubai” said His Excellency Qadhi Saeed Al Murooshid, Director General, Dubai Health Authority.

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New ProPlus Digital Wheelchair Scales 1600KL and 2610KL added to the H e a lt h o m e t e r Professional Line The maker of the world's most recognized brand in clinical weighing, Health o meter Professional scales, announced last month the addition of new 1600KL (700 lb/ 310 kg capacity) and 2610KL (dual ramp, folding, 1000 lb / 454 kg capacity) models to the ProPlus® digital wheelchair scale line. Both models include EMR connectivity through USB and serial ports and swivel display indicators that are easy to use and easy to read. Each scale is manufactured to ISO13485:2003 standards of

Seward sees 7500th Stomacher® 400 Circulator Paddle Blender sale Seward Limited, manufacturer and developer of the world leading, patented Stomacher Paddle Blender range for over 40 years, has recently achieved its 7500th global sale of its Stomacher 400 Circulator. This success can be attributed to its growing US-based sales and technical support office, opened in Long Island, New York in September 2008, backed up by Seward’s global Headquarters in the UK, where all Stomacher blender systems are manufactured. Over 8 million food samples a day are now reproducibly homogenised using Stomacher® 400 paddle blender units and as-

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quality and includes 270 Patient memory, multiple data ports, exclusive tare functionality, customizable display options, user-friendly data screens, motion-sensing technology to compensate for patient movement and troubleshooting diagnostics. These scales are the latest addition to the ProPlus wheelchair line--all factory calibrated with patented features that allow for a low cost of ownership. Commitment to dependability, dedication to customers and eight decades of technical expertise allows Health o meter Professional weighing instruments to continually provide innovation to a greater scale.”

sociated Stomacher bags worldwide. Sample preparation is a critical step in all microbiological analyses and Stomacher paddle blenders guarantee reliable and consistent homogenising performance through industrial strength, power and build quality. The global success of the Stomacher® range of paddle blenders

and bags is also demonstrated by the fact that Stomacher is the most highly referenced brand name in food safety and life science sample preparation. “We are extremely proud of the long history and excellent reputation of our Stomacher trademarked products, some of which are still in reliable routine use after 25 years,” said Stuart Ray, Technical Director, Seward Ltd. “The 7500th global sale of our Stomacher 400 Circulator system further highlights the world leading status of our Stomacher brand. «Due to its unique patented paddle design the Stomacher 400 Circulator blender enhances microorganism recovery over square paddle designed laboratory blenders.»

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MEH Special feature:

Medical Education and Training in the Gulf Imperial College London Diabetes Centre Abu Dhabi In 2004, Mubadala Development Company signed a framework agreement with the UK’s Imperial College London for mutual cooperation in the fields of education, healthcare, research & development and industrial development. The first initiative to come out of this partnership is the establishment of the Imperial College London Diabetes Centre in Abu Dhabi. This state-of-the-art specialized Centre was opened in mid August 2006 next to the city’s Zayed Military Hospital. The treatment at the Centre allows the highest level of specialized patient care from first diagnosis to the management of all the complications associated with diabetes. This is achieved by in-house comprehensive diagnostic facilities including digital retinal photography, retinal laser machines, and the latest in cardiac echocardiographic imaging and stress testing to detect the earliest signs of heart disease. Research conducted at the Centre encompasses epidemiological, basic, clinical and genetic

ŠWoods Bagot - Imperial College London

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©Woods Bagot - Imperial College London

research focusing on diabetes in the UAE. One of the Centre’s leading priorities will be to provide continuing education for health professionals and the general public.

ing healthcare issues in the region by harnessing the worldrenowned medical expertise of Imperial College London and creating a centre of excellence for Abu Dhabi.

Imperial College London’s history and expertise in the study of diabetes brings one of the leading medical academic institutions in the world to Abu Dhabi as a core working partner.

Since it opened in 2006, ICLDC has treated over 20,000 patients and reached out to countless others through its cutting-edge research, awareness campaigns, and community outreach programs. By raising knowledge and awareness about the condition and through ongoing research, ICLDC is paving the way both to improve the quality of life for those living with diabetes and ultimately to reduce its prevalence in the region.

Imperial College London Diabetes Centre (ICLDC) was one of the first facilities to be established as part of Mubadala Healthcare’s vision to create a world-class healthcare network in Abu Dhabi. The Centre is a prime example of how this vision is being realised addressing one of the most press-

ICLDC recognised as a quality medical provider In December 2009 ICLDC was awarded an accreditation with commendation by the Joint Commission International (JCI). Dr Maha Taysir Barakat, ICLDC’s Medical & Research Director and Consultant Endocrinologist, said, “The Centre is dedicated to the world-class treatment and research of diabetes in the UAE, and the greater region. The internationally-recognised JCI accreditation provides quantifiable benchmarks that focus on the quality of patient care and patient safety.” She added that these guidelines mirror the criteria set by ICLDC from the outset, with many of the elements encouraging the efficient use of information technology.

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©Woods Bagot - Imperial College London

”The Centre is equipped with specialist equipment that directly interfaces with each patient’s medical record and minimizes transcription errors, avoids lost reports and delayed receipt of results. “At every consultation, our patients are provided with a printout that shows results in full, and shares the doctors’ recommendations,” Dr Maha advised. In tandem, an automated internal check on the individual doctor’s performance is initiated, and is merged with an on-going audit that continuously drives quality at ICLDC. Dr Maha also said that there is a popup signal that prompts the doctor’s attention when results appear to be off target, and she stressed that patient confidentiality is at the core of all doc-

tor-patient communication. ICLDC’s IT system operates by a strict accesscontrolled, patient-centric mechanism, that also ensures a seamless patient interface, right through to the management of appointment times to minimize waiting. “Our processes are fully automated and paperless. One of our aims has been to lessen the administration burden of the doctor, ensuring that maximum time is dedicated to patient interaction, conversation and counsel. Dr Maha added, “Our successful accreditation by JCI sends a clear signal tothe region’s community that ICLDC is committed to quality in patient care. We will continue to deliver superior treatment to patients, as well as offer on-going medical training to health-

care professionals through our Continuing Medical Education programme (CME).” The Joint Commission International (JCI) works with health care organisations, ministries of health, and global organisations in more than 80 countries. Since 1994, the organisation has focused on improving the safety of patient care through the provision of accreditation and certification services as well as through advisory and educational services aimed at helping organisations implement practical and sustainable solutions. (www.icldc.ae)

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MEH Special feature: Medical Education and Training in the Gulf

Cleveland Clinic and IIR Middle East enable delegates to gain CME accreditation at Arab Health Conference and Exhibition To remain certified, doctors must regularly update their skills, knowledge and practical knowhow to provide the best service to their patients and to ensure their license to practise does not lapse. For many in the GCC this represents a significant financial investment and time cost as only limited CME (Continuing Medical Education) accredited courses are available in the region forcing practitioners to travel abroad. At Arab Health 2010, IIR Middle East and the Cleveland Clinic’s Center for Continuing Education collaborated to significantly expand continuing medical education activities in the Middle East by giving medical professionals an opportunity to gain CME accreditation by attending the multitrack conference and exhibition, reducing travel costs and time spent away from their practice. Delegates who attended received an accreditation certificate that can be used towards maintaining their annual quota of continuing medical education credits, which are now necessary to renew medical practicing licenses in the UAE. “By ensuring that our conferences are accredited and our speakers are leading experts in their fields,

IIR Middle East is committed to providing the best possible medical education available in the reg i o n , ” commented Simon Page, Group Director of Life Sciences Division, IIR Middle East. “Our partnership with Cleveland Clinic sets an unprecedented standard and we continue our work as an international provider of specialist information and services for the academic and scientific, professional and commercial business communities.” Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multispecialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s

Best Hospitals” survey. Approximately 1,800 full-time salaried physicians and researchers at Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2008, there were 3.6 million outpatient visits to Cleveland Clinic and 48,300 hospital admissions. Patients came for treatment from every state and from more than 80 countries. Its Lerner Research Institute is one of the country's leaders in NIH-funded research. Its Education Institute sponsors one of the largest physician graduate training programs. The Cleveland Clinic Lerner College of Medicine accepted its first class in 2004. It combines education and research

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in an innovative program that will graduate 32 medical students each year who are mentored to become physician-scientists. At Arab Health, the Cleveland Clinic will sponsor medical education meetings and certify them for AMA PRA Category 1 Credit™ which will broaden accredited post-graduate education in the Middle East. The American Medical Association (AMA) Physician’s Recognition Award (PRA) has recognised physician participation in continuing medical education (CME) for more than 35 years. AMA only authorises organisations that are accredited by the Accreditation Council for Continuing Medical Education (ACCME) to designate and award AMA PRA Category 1 Credit™ to physicians. As an accredited provider, Cleveland Clinic ensures all educational activities complete a rigorous certification process to comply with guidelines and policies developed by AMA and ACCME. These activities maintain, develop, or increase the knowledge, skills, and professional performance of healthcare professional in a biasfree, evidence-based manner. Activities certified for AMA PRA Category 1 Credit are ensured integrity of the content. The Cleveland Clinic’s relationship with IIR Middle East ensures that over 20 medical meetings annually, such as Arab Health, the Abu Dhabi Medical Congress and Sight 2009 will be accredited and sponsored by the Cleveland

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Clinic. For Arab Health, there will be substantial incorporation of the Cleveland Clinic faculty and Cleveland Clinic directed content will feature at the medical congress. The congress will be able to utilise the Cleveland Clinic CME infrastructure and there will also be significant integration with the Cleveland Clinic Abu Dhabi and the Sheikh Khalifa Medical Centre. William Carey, MD, Director of the Cleveland Clinic Centre for Continuing Education believes the ongoing relationship with IIR Middle East and the Cleveland Clinic will ensure quality education for medical professionals in the region.

AMA PRA Category 1 Credit™ will significantly expand accredited post-graduate education in the Middle East and we are pleased to provide CME credits for 14 conferences during Arab Health Congress.”

“The collaboration between the Cleveland Clinic Center for Continuing Education and the International Institute of Research (IIR) Middle East allows us to broaden quality continuing medical edu c a t i o n activities benefiting the local medical community as well as the region and beyond,” said Dr Carey. “Providing

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MEH Special feature: Medical Education and Training in the Gulf

Continuous Medical Education academy of excellence to open in Dubai Dubai Healthcare Authority (DHA), Active-M Group and Royal Philips Electronics have announced a joint venture to develop a strategic framework for delivering and marketing a worldclass Continuous Medical Education (CME) academy of excellence. The academy, based in Dubai, will offer both international and local accredited courses for all medical practitioners in the United Arab Emirates (UAE) and the States of the Gulf Cooperating Counsel (GCC). All the parties of the joint venture are very keen to make sure that the Dubai Academy for Continuous Medical Education opens its doors in maximum six months. The academy’s mission is to enhance the quality and effectiveness of patient care through innovative delivery and support of continuing professional development programs for health care professionals. The Academy partners with medical education and communication companies and other organizations to provide certified continuing education for health care professionals. The academy will deliver firstclass accredited medical education to ensure up-to date knowledge and skill development

for the community of regional medical practitioners at large. The academy is an answer to the increasing demand for continuous medical education in the GCC region due to permanent influx of expat personnel requiring calibration of knowledge and training.

The Dubai Healthcare Authority, being a pioneer in introducing best practices in healthcare in the region, will provide the joint venture their premises to conduct the medical courses, define the topics of the courses and workshops

Seated from left to right: Dr. Khalil Qayed - Director of Medical Education, Dubai Health Authority, Ms. Salam Saadeh - CEO, Active-M Group, Mr. Louis Hakim – VP of Royal Philips Electronics and CEO of Philips Middle East. Standing from left to right: His Excellency Qadhi Saeed Al Murooshid – Director General, Dubai Health Authority, Dr. Gottfried Dutine – Executive VP, Global Head of Markets & Innovation, Royal Philips Electronics, Mr. Tony El Zoghbi – Project Manager, Dubai Health Authority

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that are fully in line with the demand in the UAE and the GCC arena at large, and grant accreditation to participants according to the rules and regulations applicable in the UAE.Dr. Khalil Qayed, Director of Medical Education at the Dubai Health Authority said, “This is a great opportunity for the medical community to upgrade their knowledge and skills and to get in touch with high caliber scientists and experts to exchange their expertise. Such a platform whereby the private and the public sector work together for the benefit of the medical community is part of the DHA’s strategy as we believe that the private sector is one of our key stakeholders.” Active-M, a venture capital investment and advisory company with a special focus on the healthcare services segment in the region will finance and fully manage the joint venture. Active-M will coordinate

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between the different parties to ensure delivery on the agreed strategy. “We live in a highly demanding healthcare services community due to the high population growth, rapid ageing of the population, fast growth in chronic diseases, and chronic lack of medical personnel; among other things. As such we, at Active-M, are very pleased to work alongside DHA and Philips on this exciting project that will aim to maintain and increase the quality of individual healthcare service through providing continuing education for the medical body”, said Ms. Salam Saadeh, Founder and CEO of the Active-M Group. “Philips, being a global leader in healthcare services and solutions will leverage its world-wide network with academic bodies for the benefit of the joint venture”, commented Louis Hakim, VP of Royal

Philips Electronics and CEO of Philips Middle East. “Philips will also provide curriculum for topics that need regional development, in line with topics identified by the DHA clinical expertise”, added Louis. Dubai Health Authority The Dubai Health Authority (DHA) is the strategic health authority for the Emirate of Dubai. It has been empowered to set policy and strategy for health, and to assure the application of that health policy and strategy. The DHA leads an integrated approach across the spectrum of health, anticipating our future needs and being responsive to users. It will stimulate growth and innovation in the health market, ensuring value for money and quality of services through effective regulation. About Active M-Group Active- M Investments LLC is a Venture Capital Investments and Advisory firm with the key objective of helping entrepreneurs across the region start new and successful business ventures. Active-M’s strength lies in providing back office support, funding and guidance for entrepreneurs in order for them to focus on what is important and materialize their dreams. Active-M has a portfolio of projects underway particularly within the healthcare and education services sectors. Active-M also offers management, financial advisory and consultancy services to early stage companies and small to medium enterprises (SME).

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MEH Special feature: Medical Education and Training in the Gulf

Established in 2001 as a partnership between Cornell University and Qatar Foundation, WCMC-Q is part of Weill Cornell Medical College in New York and shares its mission of dedication to excellence in education, patient care and research. The first medical school in Qatar and a pioneer of co-education at university level, WCMC-Q offers an integrated program of premedical and medical studies leading to the Cornell University M.D. degree. Teaching is by Cornell and Weill Cornell faculty, including physicians at Hamad Medical Corporation (HMC) who hold Weill Cornell appointments. Enrollment has grown rapidly from 25 first year pre-medical students in fall 2002 to over 200 students from more than 30 countries by September 2007. In the clinical arena, WCMC-Q is already making a contribution to the community in Qatar. Medical faculty members licensed and credentialed to practice see patients as part of their teaching assignments in HMC facilities. There are exchanges of expertise with faculty-physicians from New York - Presbyterian/Weill Cornell Medical Center, particularly in the

Dr. Mohamud Verjee and class of 2010 in Clinical Skills Centre planning phase of Qatar Foundation’s Sidra Medical and Research Center. Collaborative biomedical research projects are underway between Weill Cornell in the U.S. and Qatar, and HMC, and a major research program is now on the anvil. WCMC-Q students have opportunities to take part in biomedical investigations: The Summer Research Program enables selected students to travel to the U.S. and work under the mentorship of leading investigators at Cornell and Weill Cornell. Meanwhile, a growing number are par-

ticipating in projects in Qatar, guided by WCMC-Q faculty and funded by the Undergraduate Research Experience Program of Qatar National Research Fund. Following the landmark year of the graduation of the Class of 2008, Qatar's first 'home-grown' doctors, Javaid I. Sheikh [MD, MBA] Interim Dean said, “Exciting future developments include the role WCMC-Q will play as part of a world-class academic medical center on completion of Qatar Foundation’s Sidra Medical and Research Center, currently

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under construction on the Education City campus. Working together, WCMC-Q, Sidra and HMC will implement "one program in multiple institutions," achieving strength through collaborative effort.” WCMC-Q Takes Part in Qatar’s First Health Congress Around 200 health care professionals from more than 20 countries gathered at Doha’s exhibition center recently to speak about advances in medicine. Among them were five physicians from WCMCQ. Their lectures were part of the first of its kind, five-day “Qatar Health 2009” congress, which featured 13 tracks of medical presentations and workshops. “This event, with its number of tracks and eminent international and local speakers, provided rich material for the ongoing education of all health professionals in Qatar and the region,” said Dr. Marcellina Mian, adjunct professor of pediatrics at WCMC-Q. “I commend the organizing committee for putting together such an ambitious project.” The event, organized by Hamad Medical Corporation and the Supreme Council of Health, was designed to showcase advances in the Qatar’s health care system and drew a large number of delegates from the medical sector and the general public. Further, local professionals and international speakers had a chance to meet, Dr. Mian said, making the week a pleasant and gratifying experience for those in the health care field. Overall, Qatar Health 2009

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was a chance for the country to host multi-track presentations at the leading edge of health care’s global evolution. Contributing to the obstetrics and gynecology track, Dr. Arash Rafii Tabrizi, assistant professor of genetic medicine in obstetrics and gynecology at WCMC-Q, spoke about “Laparoscopy in Gyneco-

logic Oncology.” Dr. Nady E. Nady-Mohamed, assistant professor of obstetrics and gynecology at WCMC-Q. spoke along the same track about “Laparoscopic Management of Large Ovarian Cysts During the Second Trimester of Pregnancy.” Along the pediatrics track, Dr. Mian spoke about “Child Protec-

Dr. Kevin Smith

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Dr Verjee in the Clinical Skills Centre

tion in Western Cultures: Difficulties and Challenges.” And Dr. Ahmed Teebi, professor of pediatrics and genetic medicine at WCMC-Q, spoke about “Inherited Disorders: Proposed Strategy for Prevention.” In addition, WCMC-Q hosted two pediatrics-track workshops—on the “Art of Pediatric Medical Education” and “Sharing the Light: Simple Strategies for Success in Teaching”—overseen by Dr. Mian and Dr. Amal Khidir, assistant professor of pediatrics at WCMC-Q. Dr. Khidir also provided final recommendations at a pediatrics workshop entitled “Promoting

Family-Centered Care,” which took place at the Intercontinental Hotel. Contributing to the Rehabilitation and Physical Medicine track, Dr. Leopold Streletz, associate professor of neurology at WCMC-Q, spoke about “Physical Activity and Brain Plasticity.” Within the same track, Dr. Basim Uthman, professor of neurology at WCMC-Q, spoke on “Management of Spasticity in Complex Neuro Disability.” Additionally, WCMC-Q increased its local presence as it joined 100 exhibitors of the latest medical equipment, technology and serv-

ices—the medical school’s booth—shared with health care and research partner Sidra Medical and Research Center—provided attendants with information about the curriculum and entrance requirements.

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The Royal Buckinghamshire Hospital

World Class Rehabilitation Centre www.royalbucks.co.uk Telephone: +44 (0) 1296 678800 Fax: +44 (0) 1296 399875 The Royal Buckinghamshire Hospital, Buckingham Road, Aylesbury, Bucks, HP19 9AB, U.K.


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Specialist article: The Rejuvenation of Home Dialysis – Clinical and Financial Considerations by Dr R N Greenwood Haemodialysis has been established as a successful life sustaining treatment in patients with renal failure for over 40 years. Through a mix of financial pressures and convenience for patients, the number of hours patients spent dialysing has fallen gradually. Thrice weekly treatment for approximately 4 hours carried out in renal centres has now become the normal experience for the vast majority. It is increasingly recognised, however, that thrice weekly haemodialysis, which most often totals 12 hours per week, ‘replaces’ only approximately 10-15 % lost kidney function, and has limited impact on quality of life and survival in people with kidney failure. Essentially patients continue to live with chronic kidney disease equivalent to CKD 4/5. More frequent treatment, particularly if the 2-day ‘long break’ is avoided, not only allows for a relaxation of dietary and fluid restrictions it can also deliver much more dialysis. Impressive improvements in wellbeing and measurable clinical outcomes are being reported with enhanced, frequent haemodialysis. In practice, this therapy is best carried out in the home or in a community setting by patients trained in selfcare. After many years of decline the number of patients opting for

Patient Robert Downer dialysing during the NxStage initial trials self care haemodialysis is now growing in some countries, with most patients who have opted for self-care choosing to dialyse more frequently than thrice weekly. In the UK, the National Institute of Clinical Excellence (NICE), a body charged with advising the NHS about the efficacy and affordability of new therapies, produced a guideline (2002) which envisaged up to 15% haemodialysis patients self-caring at home. While in the 1960s and 70s, close to 100% UK patients were self caring at home, NICE recognised that were were several legitimate reasons why home haemodialysis (HHD) had largely given way to peritoneal dailsysis (PD) and HD treatment in renal centres and satellites (CHD). The NICE rec-

ommendation created little movement in practice and, while there are occasional examples of success, less than 2% HD patients in the UK are currently self-caring on HHD. Peritoneal dialysis remains the preferred home therapy although the numbers on this successful therapy are also dwindling - currently 19% dialysis patients. One of the barriers to the rejuvenation of HHD has been the lack of a dialysis machine which is mobile and would allow self-caring patients to travel and to dialyse away from the home base. A further difficulty has been the capital cost of converting a patient’s home to accommodate standard machines which typically have a high demand for water, preprocessed by reverse osmosis, and adequate drainage.

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Patient Marina Ridley with Nephrologist Dr R N Greenwood and Kay Deck of Nx Stage NxStage in the US addressed these needs and designed a dialysis machine specifically for home use and travel. The NxStage System 0ne is a small compact dialysis system which employs a simple keypad operation and a “drop in” cartridge to replace the complex blood tubing setup found on traditional machines. The system which is designed for 5 or 6 ‘short’ sessions weekly uses preprepared bags of dialysis solution (as in automated PD) or produces batches of sterile fluid from a domestic cold water supply. Home conversion costs associated with traditional installations are thus averted. The machine has

been in clinical use in the USA since 2006 and there are currently over 5000 patients using the system with over 6,500 patient years clinical experience accumulated. Kimal, the commercial partner to NxStage in the UK worked with Dr Roger Greenwood, a consultant nephrologist at Lister hospital in Stevenage to bring this system into the UK and to enable the dialysis community to benefit from this technology, the first country in Europe and outside the US. In January 2009 the system attained CE approval (a legal requirement in Europe).

The Lister renal unit (LRU) is a large dialysis provider serving the populations of Hertfordshire, Befordshire and parts of Essex (population circa 1.2 M). At the beginning of 2009 there were 365 patients treated in haemodialysis centres located in Stevenage, Luton and St Albans, 38 patients at home on PD but no patients on home haemodialysis. The LRU was one of 25 centres in the UK with no HHD programme. The accumulating evidence regarding the benefits of frequent treatment and the availability of the NxStage mobile system were the spurs to establishing a home programme based on free choice for patients

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to choose their preferred technology and treatment schedule. Four patients were trained on NxStage beween July and November 2009 as part of a locally agreed pilot to assess the effectiveness of the technology and to assess whether the 5x or 6x weekly sessions could be afforded within the cost envelopes agreed with local commissioners. All four were trained, mastering the ‘button-hole’ needling technique and sent home within 28 days with excellent clinical outcome and patient satisfaction. There were significant benefits in blood pressure control and sense of wellbeing in all four patients, 2 of whom currently dialyse 5x weekly and 2 dialyse 6x weekly. Following this 4-patient pilot study it was necessary to prepare a business plan around the aspiration to have 10% HD patients selfcaring at home by 2015 for approval by the host NHS Trust (East and North Herts) and local commissioners. The outline business case (OBC) compared the costs around a growth of home HD to 10% with a second scenario in which the Lister renal service remained heavily weighted towards in-centre HD. Projected savings in pathology, pharmacy, travel and holiday dialysis were considered. The OBC showed that the higher disposables and machine lease costs associated with high frequency HHD were offset by savings in staffing and by deferring the capital, running and depreciation costs of new renal units. The comparison suggested that a

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The Lister Renal Unit team with Kay Deck of NxStage & Helen Totman, clinical nurse specialist of Kimal surge towards more home therapy would not only result in a healthier dialysis population but cost saving of about £1/3M over a 5 year period. Unfortunately, in most health care systems, re-imbursement has fossilised around standard 3x weekly in-centre HD and home therapy by HD has always been regarded as less expensive than CHD and has been remunerated as such. With the current system of re-imbursement, the low ‘tariff’ for HHD is a disincentive to pursue these health gains and costs savings. To influence the Department of Health to encourage local commissioners to set reimbursement levels which recognise that the majority who choose HHD will be dialysing up to 6x sessions weekly and to incentivise HHD is the challenge of the moment.

There are encouraging signs that the NHS will indeed support those patients motivated to optimise their health prospects through self-care, to remain well and to stay out of hospital. NxStage is proving a popular choice among new patients and those currently on dialysis who wish to become independent and free to travel. Being ‘custom-designed’ for the job this device is likely to be a major catalyst in rejuvenating self-care.

Author: Dr R N Greenwood, Consultant Nephrologist, Lister Hospital, Stevenage Further details on NxStage can be gained by visiting www.kimal.co,uk or contacting Kimal direct on nxstage@kimal.co.uk

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Middle East Hospital magazine February 2010  

Middle East Hospital magazine February 2010

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