HOSPITALS Magazine issue 66

P UT T IN G PA TI ENT EX P E RI EN CE FIR S

The View Hospital is a new state-of-the-art healthcare facility in Qatar Committed to delivering high value care for patients, the hospital aims to advance integrated and team-delivered care and will offer a seamless experience through a wide range of medical signature services including women’s health, heart health, diabetes care, executive health, wellness and family health.

HEALTH SECTORS Facing the crisis and achieving development

The Human Development Index, a measure of countries’ life expectancies, education and health levels as well as standards of living, has declined for two consecutive years straight in 2020 and 2021, and returned to what it was in 2016. This is the first time since its creation thirty years ago, according to the UN Development Programme (UNDP), which explained in a report that this “massive decline” includes more than ninety percent of the countries of the world.

The report warned that back-to-back global crises have set back human de velopment by five years. The international organization expressed its fear that wars and continuous tensions, including the war in Ukraine, would exacerbate the situation further.

However, medical reports from various organizations around the world con firmed the ability of the “large” health sectors to face crises on the one hand, and to quickly recover from the crises’ repercussions on the other hand. The health sectors increased their healthcare spending and set plans with the aim of not only maintaining their level of development, but also achieving quantum leap while expecting to get over the effects of the crisis in record time.

By the end of this year, we will have witnessed the opening of more stateof-the-art hospitals in the Arab world and worldwide. The health sector would have more hospotels, environmentally friendly hospitals and smart hospitals, and would have renewed its equipment and business strategies in order to pro vide better health to people and make the world a better place.

Publisher Arab Health Media Communication

President Simon Chammas schammas@tahmag.com

Executive Vice President Mirna Khairallah mirna@tahmag.com

Senior Editor Elham Najem editorial@tahmag.com

Content Executive Jessica Achkar editorial@tahmag.com

Editors

Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa

Content Marketing Manager Jessie Chlela jessie@tahmag.com

Creative Director Rania Khalil rania@tahmag.com

Business Development Manager Wadih Chammas wadih@tahmag.com

IT Manager Elie Yammine elie@tahmag.com

Photographer Hanna Nehme

Advertising advertising@thearabhospital.com

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22 The View Hospital in Affiliation with Cedars Sinai aims to provide an outstanding patient experience

NEWS

8 UAE Healthcare Leader Burjeel Holdings Appoints Shah Rukh Khan as Brand Ambassador

10 Aster Hospitals adopts 3M’s AI-powered speech recogni tion solution across its facilities in the UAE

14 The laboratories of the University Hospital Sharjah exam ine more than 50,000 tests per month

16 World Leukemia Day: CAR T-cell therapy offers hope to leukemia patients, even where other treatments have failed

20 MEDICA 2022 + COMPAMED 2022: Medical technology industry needs strong platforms in unchanged challenging times

30 Pure Health, UAE’s largest healthcare platform, signs a deal with Equity Group Investments to invest half a billion dollars in a U.S. healthcare company

34 Lytix Biopharma appoints Stephen Worsley as Chief Business Officer

34 Newborn’s hearing loss identified, restored in Al Ain

38 World-leading experts on vaccine innovation to speak at QF's WISH 2022 Summit

40 Freudenberg Performance Materials awarded EcoVadis Silver Medal

42 Saudi Jordanian Investment Fund to develop USD400m project in Jordan’s healthcare sector

INTERVIEWS

50 Dr. Allen Hanouka, Co-Founder and Joint CEO of GAMA

Healthcare, the infection prevention specialist

62 Libor Votruba, Founder of the NEO Center network of international therapeutic clinics in Prague, the capital of the Czech Republic

94 Pfizer. Evolution of COVID-19 and high-risk awareness

CDC Medical Director, Dr. Muna Almaslamani

96 Dr. Ali Chaari, Director of a new online webinar series offered by the Division of Continuing Professional Develop ment at WCM-Q

100 Dr. Joanna Azar, Endodontics Specialist at Marble Medical Center

104 Dr. Ravinder Mamtani, Vice Dean for Population Health and Lifestyle Medicine at Weill Cornell Medicine-Qatar (WCM-Q)

108 Deborah Mukherji, MD, MBBS, FRCP, Consultant Medi cal Oncologist at Clemenceau Medical Dubai

110 Dr. Kaisa Stroher, Prosthodontics at Marble Medical Center

MEDICAL INSTITUTIONS

81 Precision oncology: Advancing cancer care through new theranostics approaches

Provided by UChicago Medicine

88 U.S. News & World Report Names Baylor St. Luke’s Medi cal Center Among the Best in Hospitals in the United States

90 Exceptional psychotherapy from the Czech Republic… A network of NEO Center clinics

102 Neo Center's partner clinic is the unique private clinic RósGlas in Ireland

MEDICAL EQUIPMENTS

84 Gama Healthcare: Clean air, when & where you need it

ARTICLES

60 How remote healthcare technologies can tackle climate crisis by Ehab Zawaideh - General Manager | Middle East, GE Healthcare

70 Becton Dickinson: Pain is the Fifth Vital Sign, and Pain Management is Vital to Quality Patient Care

78 A Framework for Achieving your Smart, Connected Hospital Vision by Benjamin Kanter, MD, FCCP, Chief Medical Information Officer, Vocera

92 Digital maturity in health: Comparison with other in dustries by Dr. Yasir Khan, Lead Physician Executive, Oracle Cerner in the Middle East and Africa

FEATURES

54 Green Hospitals

Treating the sick and protecting the healthy

66 Patient Safety

The cornerstone of top-notch healthcare

112 Childhood Obesity

A serious condition that causes several diseases later in life

116 Strabismus in children; Types, causes and treatment

54 Green Hospitals

84 Gama Healthcare

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Several interactive medication safety tools, such as our drug interactions and drug ID tools.

Answers to medication-related questions that arise when dispensing drugs, monitoring patients’ drug therapies, advising interventions, and informing of any potential side effects.

UAE Healthcare Leader Burjeel Holdings Appoints Shah Rukh Khan as Brand Ambassador

Burjeel Holdings, a leading private health care services provider in the MENA region and one of the largest in the UAE, has partnered with superstar Shah Rukh Khan as its new Brand Ambassador.

The partnership was confirmed during a cer emony held in Abu Dhabi. The Indian actor will appear in a region-wide, multi-platform advertis ing campaign for the healthcare Group that will be unveiled in the coming weeks.

The partnership with Burjeel Holdings marks the first healthcare ambassador role for Mr. Shah Rukh Khan. Burjeel Holdings, which operates 39 hospitals and medical centers across the MENA region, hopes to leverage the immense populari ty and credibility the actor enjoys internationally as it connects with an increasing number of peo ple travelling to the UAE for their medical needs and also expands its global research partnerships while growing its operations across the GCC.

“Healthcare is an industry we can all relate to and one we’ve all had experiences with. Visiting Burjeel Medical City and listening to Dr. Sham sheer Vayalil was both insightful and inspirational.

Meeting employees and witnessing the immense passion and pride they have in their work was humbling. They really live the value of being for the people, by the people, and I’m excited to be a part of that story,” said Mr. Shah Rukh Khan.

Burjeel Holdings’ Founder and CEO Dr. Shamsheer Vayalil, said, “Mr. Shah Rukh Khan embodies excellence and, as a global superstar, has won the hearts of millions across the region. Burjeel Holdings and Mr. Shah Rukh Khan share a common desire to enrich and transform people's lives. His personality and principles strongly res onate with the Burjeel Holdings brand. This part nership reflects our core values and inspires us to keep serving the community through world-class healthcare in the region and beyond.”

Burjeel Holdings’ partnership with Shah Rukh Khan follows the recent announcement of its planned expansion into the Kingdom of Saudi Arabia (KSA). The company has signed a Mem orandum of Understanding (MoU) with KSA’s Ministry of Investment, which will see it seek opportunities to invest up to USD $1 billion in the Kingdom by 2030.

THE PARTNERSHIP WITH BURJEEL HOLDINGS MARKS THE FIRST HEALTHCARE AMBASSADOR ROLE FOR MR. SHAH RUKH KHAN. BURJEEL HOLDINGS, WHICH OPERATES 39 HOSPITALS AND MEDICAL CENTERS ACROSS THE MENA REGION, HOPES TO LEVERAGE THE IMMENSE POPULARITY AND CREDIBILITY THE ACTOR ENJOYS INTERNATIONALLY AS IT CONNECTS WITH AN INCREASING NUMBER OF PEOPLE TRAVELLING TO THE UAE FOR THEIR MEDICAL NEEDS AND ALSO EXPANDS ITS GLOBAL RESEARCH PARTNERSHIPS WHILE GROWING ITS OPERATIONS ACROSS THE GCC.

Aster Hospitals adopts 3M’s AI-powered speech recognition solution across its facilities in the UAE

people’s lives and communities. Through this solution, we are helping healthcare professionals to improve documentation processes and focus on improving the patient experience by allowing them more time to care for their patient.”

The technology uses AI to deliver proactive nudges to clinicians as they document patient encounters in the electronic health records, which enables them to proactively address any common documentation deficiencies, at the time of note creation. This will improve the quality of documentation, enable more accurate coding and appropriate reimbursement, in addi tion to improving patient safety.

Aster Hospitals in a strategic collaboration with 3M (NYSE:MMM), announced it has successfully adopted 3M™ M*Modal Fluency Direct, the latest speech and AI-pow ered technology. The technology went live across Aster’s facilities in the UAE last month. The all-in-one solution will enable physicians of any medical specialty to conversationally create, review, edit and sign clinical notes directly with in electronic health records. This technology will ensure standardization and acceleration of clinical documentation processes across Aster hospitals and will reduce the administrative burden on healthcare professionals. Further more, it will help to improve the clinician and patient experience and drive productivity in the healthcare sector.

Commenting on the technology, Laszlo Svinger, Vice President and Managing Director at 3M Middle East & Africa said: “At 3M, we apply science and innovation to make a real impact in

LATEST TECHNOLOGY ASSISTS HEALTHCARE PROFESSIONALS TO IMPROVE PATIENT CARE AND DOCUMENTATION QUALITY.

Mohamed Al Holibi, Regional Business Man ager at 3M Health Information Systems added: “We are extremely proud of our partnership with Aster Hospitals and are happy to see how 3M™ M*Modal Fluency Direct is creating time for physicians; and making a positive impact both on physicians’ and patients’ experiences. This technology is helping clinicians in all care settings to capture the complete and accurate patient story while simultaneously focusing on deliver ing high-quality patient care.”

Padam Kafle, Head of IT and Automation at Aster Hospitals said: “At Aster, we are constantly seeking opportunities to set new yardsticks to take healthcare to the next level of excellence. We believe that 3M Fluency Direct will help us ensure standardization and acceleration of clinical documentation processes across all Aster facilities. At the same time, this technology will reduce the administrative burden on our physi cians, giving them some time back to spend with their patients.”

Earlier this year, Emirates Health Services (EHS) and Sheikh Shakhbout Medical City (SSMC) adopted this technology and it was showcased at EHS’s booth during Arab Health 2022, the MENA region’s leading exhibition for the healthcare industry.

The laboratories of the University Hospital Sharjah examine more than 50,000 tests per month

THE UNIVERSITY HOSPITAL OF SHARJAH ANNOUNCED THAT ITS LABORATORIES EXAMINE MORE THAN 50,000 TESTS AND RESEARCH PER MONTH, AFTER OBTAINING THE ACCREDITATION OF THE COLLEGE OF AMERICAN PATHOLOGISTS “CAP”.

trace elements in the blood for a large group in cluding zinc. The hospital is currently heading to have all its laboratories operate automatically, to reduce the interference of the human factor. This will soon cover microscopic examinations.”

In the same context, Dr. Fadwa Saeed Ab del Azim, the Director of Hematology Depart ment and Assistant Professor of Medical Analy sis, said: “The most common types of anemia are the geriatric anemia of chronic diseases, genetic inherited anemias such as Sickle Cell Anemia and Thalassemia and anemia of blood clotting which is related to some drugs in which we use modern technology of viscosity research.”

Dr.Fadwa Said AbdelAzimDr.Noura Al Khayyal

Dr. Noura Ali Al-Khayal, the Head of Lab oratory Departments at University Hos pital of Sharjah, said: “After we obtained the accreditation of the College of American Pathologists (CAP) at the end of last year and after the laboratory departments obtained the accreditation of the American Joint Commission International (JCIA) as part of it’s obtaining by the hospital, we are now working with a mod ern concept of healthcare that puts the highest quality standards at the forefront.”

She added, “We have various departments, most notably the haematology department, the blood bank, advanced immune tests and allergic diseases tests. In addition to parasitic and bacterial diseases tests, Histopathological research, cancerous diseases and biochemistry tests. The hospital also provides modern tech nology for quick results of Covid 19 research, and it provides access to an accurate result of the PCR swap within one hour, as well as testing for antibodies of the Covid 19 virus."

She continued: “The hospital also provides integrated allergy tests for more than 100 allergens, including insect bites and foods such as fruits, nuts and vegetables, there are tests for

She added: “The hospital's blood bank provides all blood groups and its specific com ponents for leukemia, anemia and hemorrhagic diseases such as blood, plasma or platelets, and we provide them in a fast, standard way for emergencies. We have cooperation and part nership with the main blood bank in Sharjah. In addition, we have recent research for leukemia that includes Genetics for diagnosis and target ed therapy according to modern standards.”

Moreover, Dr. Ali Obaid Al Ali, CEO and member of the Board of Trustees of the Univer sity Hospital in Sharjah, said: “Quick and correct treatment for all diseases requires modern and integrated diagnostic services. Therefore, we pay great attention to laboratory departments, where we choose preferential medical staff and the latest versions of technology to obtain accurate and fast results based on international standards for the quality of medical tests, which currently exceeds more than 50,000 per month.”

World Leukemia Day: CAR T-cell therapy offers hope to leukemia patients, even where other treatments have failed

side effects. This limits access to treatment as the therapy needs to be administered on an inpatient basis at a specialized facility where the side effects can be managed. We are working with Cleveland’s Case Western Reserve Univer sity and other parties and collaborating with various manufacturers to address issues such as accessibility, safety and costs,” he says.

Dr. Melenhorst and his team are also aiming to improve the efficacy of existing CAR T-cell therapies while developing new versions for a wide range of blood and other cancers.

As World Leukemia Day approaches on 4 September, experts from global health system Cleveland Clinic are working on new immunotherapy treatments for blood cancers such as leukemia, expanding treatment options and bringing hope to patients for whom other treatments have failed.

According to Jan Joseph Melenhorst, PhD, a translational immunologist who is Director of Cleveland Clinic’s recently established Cell Therapy and Immuno-Engineering Program, chimeric antigen receptor (CAR) T-cell therapy is profoundly changing the treatment landscape, bringing the promise of durable remission for many patients with blood cancers such as leuke mia. “CAR T-cell therapy is a specialized treat ment using a patient’s own T-cells – a type of white blood cell that forms part of the immune system. The T-cells are extracted and genetically modified so that they can recognize and destroy cancer cells, before being multiplied and infused back into the bloodstream,” explains Dr. Melen horst, who is also Vice Chair of the Center for Immunotherapy and Precision Immuno-Oncol ogy at Cleveland Clinic. He adds that while CAR T-cell therapy has brought new hope for many patients, there are currently several challenges to overcome in administering the treatment. “In particular, it may be more expensive than other therapies. Additionally, it has potentially serious

Their colleague, Craig Sauter, MD, is a hematologist and Director of Blood and Marrow Transplant at Cleveland Clinic who has been using CAR T-cell therapy to successfully treat patients with leukemia and other blood cancers where other treatments have failed.

“The standard of care in initial therapy for many acute leukemia patients remains cytotoxic chemotherapy, with the aim of achieving re mission. In cases where first-line chemotherapy or other treatments have failed, however, CAR T-cells provide another potential treatment op tion for patients with B-cell acute lymphoblastic leukemia. In the FDA-approved indications, it has proved much more effective than the previous standard, which was a further round of chemo therapy,” he says. Explaining how the procedure works in practice, Dr. Sauter says the first step is to extract the patients’ lymphocytes and insert an inactive virus that delivers new genetic instructions to the T-cells to start producing chi meric antigen receptors targeting proteins that live on the malignant cells. Researchers take a small batch of these newly altered CAR T-cells and induce them to grow and multiply until there are enough to effectively target cancer cells. The CAR T-cells are frozen and stored until the patient is ready to receive them. To prepare for the infusion, the patient receives a mild form of chemotherapy to prevent the immune system from rejecting the CAR T-cells.

LEUKEMIA IS A GROUP OF CANCERS CHARACTERIZED BY RAPID, UNCONTROLLED GROWTH OF ABNORMAL BLOOD CELLS CALLED LEUKEMIA CELLS. IT CAN OCCUR IN CHILDREN AND ADULTS AND ACCORDING TO THE WORLD CANCER RESEARCH FUND INTERNATIONAL, IT IS THE 13TH MOST PREVALENT CANCER GLOBALLY

Jan Joseph Melenhorst Dr. Craig Sauter

Medical technology industry needs strong platforms in unchanged challenging times

MEDICA 2022 + COMPAMED 2022:

Planning for the world's leading medical trade fair, MEDICA 2022 (14 - 17 Novem ber) in Düsseldorf, as well as the parallel No. 1 trade fair for the supplier sector of the medical technology industry, COMPAMED 2022, is gathering momentum. The course of exhibitor registrations so far indicates that participation will be above last year's level (MEDICA 2021: 3033 participations, COMPAMED 2021: 490).

"The medical technology industry needs MEDICA and COMPAMED right now as strong platforms for cross-border exchange, cooperation and business. Because the market is on the move. In certain areas there is increased demand in the wake of the pandemic, for example with regard to point-of-care diagnostics. In addition, companies have an increased need for coordination with sup ply and manufacturing partners to ensure their own ability to deliver in times of sharply rising prices and scarce components," says Christian Grosser, Director Health & Medical Technologies at Messe Düsseldorf, listing important reasons for participation in the two leading industry events.

The main segments of the MEDICA trade fair are: Laboratory Technology and Diagnostics, Medical Technology and Electromedicine (Im aging and Diagnostics/ Medical Equipment and Devices), Consumer Goods and Consumables, Physiotherapy and Orthopaedic Technology as well as IT Systems and IT Solutions.

THE INDUSTRY PORTALS MEDICA. DE AND COMPAMED. DE OFFER A WIDE RANGE OF DIGITAL SERVICES FOR PREPARING AND ORGANISING AN EFFECTIVE STAY ON SITE (E.G. INTERACTIVE HALL PLANS), FOR NETWORKING WITH COMPANIES, AS WELL AS EXTENSIVE REPORTING ON THE EVENTS DURING THEIR RUNTIME.

Formats that fit together: trade fair, forums and conferences

The forums integrated into the individual thematic segments of the trade fair provide a link to the exhibitors' innovations and best prac tices for their application in everyday medical practice. These include the MEDICA CONNECTED HEALTHCARE FORUM (on digital networking), the MEDICA HEALTH IT FORUM (on IT topics), the MEDICA TECH FORUM (trends in medical technology) and the MEDICA LABMED FORUM (innovations in laboratory medicine). The MED ICA conference programme also provides a link to the trend themes of the market and the trade fair. This applies, for example, to the 45th German Hospital Conference as the leading event for the top management of German hospitals, the DiMiMED conference for disaster and defence medicine and the MEDICA MEDICINE + SPORTS CONFERENCE for the international specialist scene in sports medicine and sports science.

Must-attend event for trend updates in the supplier sector

COMPAMED is and will remain the must-at tend event in the diaries of all those who want to keep up to date with trends in the upstream development or production stages of the med ical technology industry. This is where supplier companies present themselves with a wealth of high-tech and service solutions. Components, microsystems technology, material processing and coatings, additive manufacturing/ 3D print ing, manufacturing technology and machines, packaging and services are the main topics, which are also reflected by the programmes of two integrated specialist forums. In their globally unique combination, MEDICA 2022 and COM PAMED 2022 will once again reflect the entire value and process chain of medical technology and a complete range of medical products, devices and instruments. Both events counted a total of 46,000 trade visitors in 2021 (73 percent international share).

WWW.MEDICA-TRADEFAIR.COM

WWW.COMPAMED-TRADEFAIR.COM

Elegancia Healthcare, a subsidiary of Estithmar Holding, is set to provide integrated highquality healthcare services with the upcoming inauguration of The View Hospital, a unique state-of-the-art healthcare facility in Qatar, located in the prestigious Al Qutaifiya area, in the vicinity of The Pearl.

The View Hospital will offer comprehensive programs and services that meet healthcare needs and help maintain healthy lifestyles for the community. Committed to delivering high-value care for patients and offering a wide range of medical and surgical specialties, the hospital consists of 240 beds, 62 VIP suites and 3 Royal suites and offers several specialties and centers of excellence in medical departments.

Elegancia Healthcare is working together with Cedars-Sinai — a California-based health system that was recently voted the #2 hospi tal in the United States by U.S. News & World Report — to create a facility that meets the highest international quality standards. Since its founding in 1902, Cedars-Sinai has evolved to meet the healthcare needs of one of the most diverse regions, continually setting new stan

dards in quality and innovation in patient care, research, teaching and community service.

The hospital aims to offer patient-privileged access to ground-breaking treatments in a pre mium environment where safety, comfort, con venience, compassion and medical ethics come together to go beyond traditional healthcare. The View Hospital is set to raise the standards of patient experience in Qatar.

Henrik Christiansen, CEO of Estithmar Holding, said: “We are committed to keeping pace with the increasing demand for healthcare services in Qatar as it focuses on a transforma tion from heavy dependency of the public sec tor to an engaged private sector involvement.

The demand for private healthcare facilities is expected to increase following the recently

THE VIEW HOSPITAL WILL PROVIDE A COMPREHENSIVE, NEW LEVEL OF EXPERT, PERSONALLY ATTENTIVE HEALTHCARE ALL AT ONE PREMIUM LOCATION, PROVIDING PATIENTS AND THEIR FAMILIES WITH AN EXCEPTIONAL EXPERIENCE AND PEACE OF MIND.

issued mandatory health insurance law in Qatar. Our aim is to advance integrated and team-de livered care at The View Hospital to patients in Qatar and the region.”

To cater to the major services patients usually seek abroad, The View Hospital will offer complex care specialty services and internation al expertise, bringing top-tier medical profes sionals and advanced technology to deliver a unique and positive patient experience in Qatar.

Bassam Sayad, CEO of Elegancia Health care, said: “The View Hospital will provide com prehensive inpatient and outpatient programs, with specialized clinical centers equipped with the latest technology. We are committed to expanding access to high-quality healthcare lo cally so as many people as possible can receive the best care close to home and family. Our affiliation with world-renowned Cedars-Sinai gives us an advantage to serve the interests of patients to meet their needs throughout

the country without the need to travel and get treatment abroad.”

The iconic 15-floor hospital will offer a wide range medical services utilising multidisciplinary approach with an effective system of service delivery, integration and coordination of care and adopting the highest standards and best practices in patient care. Signature services will be focused on women’s health, heart health, diabetes care, executive health, wellness and family health.

Aided with advanced equipment, the hospital will provide medical services in pain management, cardiology, dentistry, dermatolo gy, diabetes care, diagnostic imaging, endocri nology, ENT, gastroenterology, general surgery, maternity (Obstetrics & Gynaecology), neonatol ogy and NICU, nephrology, neurology, ophthal mology, orthopaedics, paediatrics, physiothera py & rehabilitation, plastic surgery, primary care, pulmonology and rheumatology services.

The View Hospital will provide a comprehen sive, new level of expert, personally attentive healthcare all at one premium location, provid ing patients and their families with an exception al experience and peace of mind.

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Pure Health, UAE’s largest healthcare platform, signs a deal with Equity Group Investments to invest half a billion dollars in a U.S. healthcare company

hospitals and more than 200 sites of care across six states, and approximately 26,000 employees. Pure Health would achieve a minority equity investment by purchasing an interest in Ardent from Equity Group Investments (EGI), a Chica go-based private investment firm and majority owner of Ardent.

As part of its investment, Pure Health would receive board observer rights but would not have a seat on Ardent’s board of directors. The investment does not include plans for either the expansion of Ardent’s physical footprint or collaboration between Ardent and Pure Health in the delivery of care.

Equity Group Investments hosted a signing ceremony, which included Farhan Malik, CEO of Pure Health, Sam Zell, Founder and Chairman of EGI, and Marty Bonick, President and Chief Executive Officer of Ardent.

“One of EGI’s strengths is partnering with like-minded individuals with the experience and passion for how we approach investment opportunities. We look forward to developing a productive relationship with Pure Health as they continue to explore the various dynamics of the U.S. healthcare system,” said Sam Zell.

Alpha Dhabi Holding subsidiary, Pure Health, the largest integrated healthcare platform of the United Arab Emirates (UAE), announced that it has entered into a definitive purchase agreement to acquire a minority equity investment in Ardent Health Services (Ardent), a leading U.S. healthcare provider based in Nashville, Tennessee, for a total investment of $500 million. The investment is subject to customary closing conditions and will be finalized after receipt of all necessary U.S. regulatory approvals.

Ardent is the fourth largest privately held acute care hospital operator in the U.S., with 30

ARDENT HEALTH SERVICES IS THE FOURTH LARGEST PRIVATE HOSPITAL OPERATOR IN THE UNITED STATES WITH OPERATIONS ACROSS SIX STATES.

Commenting on the major investment an nouncement, Farhan Malik said, “This landmark investment agreement marks a quantum leap for the UAE and the global healthcare industry.” “This is an exciting opportunity for Pure Health, as we continue to build relationships with leading U.S. healthcare providers to leverage the highest standards and best clinical practices to provide an unrivalled healthcare experience for patients in the UAE,” said Malik. “Ardent has a strong track record of delivering outstanding services across the United States, and we look forward to gaining additional knowledge to support our north star of advancing the science of longevity and unlocking time for humanity.”

Lytix Biopharma appoints Stephen Worsley as Chief Business Officer

Lytix Biopharma (“Lytix”) (Euronext Growth Oslo: LYTIX), a Norwegian immune-oncolo gy company, announces the appointment of Stephen Worsley as Chief Business Officer (CBO). Stephen Worsley is a pharmaceutical executive with over 25 years of experience in business development leadership in roles of increasing impact and in executing high-valua tion strategic deals in the biopharmaceutical and drug discovery/development market. As a busi ness development executive, Worsley has led ne gotiation of transformative and award-winning technology and product partnerships for leading therapeutics companies.

Most recently, Stephen Worsley served as the Vice President Strategic Business Development at Redwood Biosciences/Catalent Pharma Services. Prior to that, he was CBO at Sutro Biopharma, Sr. Vice President Business Development at IndiMo lecular and Vice President of Business Develop ment at Peregrine Pharmaceutical (dba Avid Phar ma Services) amongst other roles in his career.

“As we plan for continued progress to reach several important milestones in our development

programs at Lytix, we are excited to welcome Stephen Worsley to our management team at Lytix Biopharma”, says Øystein Rekdal, CEO of Lytix. “His extensive experience in business development where he has led various strategic partnerships, acquisitions, equity investments, clinical collaborations, and out-licensing transac tions will play a central role as we advance our exciting pipeline of immuno-activating drugs for cancer through further clinical development and towards market, with several potential partnering opportunities along the way”.

Stephen will enter his leading position at Lytix at September 6. With the position as CBO, he will join Lytix’ executive management team.

"I am very pleased to be joining the Lytix team at an exciting time for the company as we develop a very promising new class of immu no-activating drugs for the treatment of cancer” said Stephen Worsley. "There is growing interest in the platform and evolving clinical outcomes which will allow Lytix to consider several value creating business development opportunities in the months and years ahead."

Newborn’s hearing loss identified, restored in Al Ain

Anewborn baby’s hearing has been suc cessfully restored in Abu Dhabi as part of the emirate’s newborn screening pro gramme. In a statement, the Abu Dhabi Health Services Company (Seha) said Baby Ishal, who was born on January 3, was first diagnosed with hearing loss after she underwent a screening at a facility under the Ambulatory Healthcare Services (AHS), Seha’s outpatient clinic network. Ishal’s parents were immediately referred for further diagnostic audiology procedures in order to arrive at a conclusive diagnosis and possible treatment options.

“Through our integrated and referral approach, we were able to give Baby Ishal her

hearing back. We pride ourselves on being a part of the Seha network, utilising world-class services throughout our facilities and develop ing a bespoke diagnostics and treatment plan for every patient that comes into our care. In Ishal’s case, we referred her to Tawam Hospital to perform the required audiology test before concluding the treatment required for hearing loss management,” said Thahira Kallumurikkal, audiologist at the AHS’ Oud Al Touba Diagnostic and Screening Centre.

... The family was submitted as a case to obtain free hearing aids, and Ishal is currently undergoing speech and language therapy for better communication.

MOST RECENTLY, STEPHEN WORSLEY SERVED AS THE VICE PRESIDENT STRATEGIC BUSINESS DEVELOPMENT AT REDWOOD BIOSCIENCES/ CATALENT PHARMA SERVICES. PRIOR TO THAT, HE WAS CBO AT SUTRO BIOPHARMA, SR. VICE PRESIDENT BUSINESS DEVELOPMENT AT INDIMOLECULAR AND VICE PRESIDENT OF BUSINESS DEVELOPMENT AT PEREGRINE PHARMACEUTICAL (DBA AVID PHARMA SERVICES) AMONGST OTHER ROLES IN HIS CAREER.

THE AUDIOLOGY TEAM AT TAWAM CONFIRMED HEARING LOSS IN BOTH EARS, AND ALSO ADVISED THE FITTING OF HEARING AIDS AS EARLY AS POSSIBLE IN ORDER TO AVOID ANY DELAY IN SPEECH AND LANGUAGE DEVELOPMENT

NEVER STOP LEARNING. NEVER STOP GROWING.

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World-leading experts on vaccine innovation to speak at QF's WISH 2022 Summit

research and has worked throughout her career to translate research into impactful programs. At WHO, she ensures that the organization stays ahead of the curve and leverages advances in science and technology for public health and clinical care, and is able to translate new knowl edge into meaningful impact on population health worldwide.

Some of the world’s leading experts on vaccines will discuss vaccine innovation at this year’s World Innovation Summit for Health, taking place in Doha, Qatar, in a hybrid format (physical and virtual attendance) on October 4-6, 2022.

Dr. Soumya Swaminathan, Chief Scientist at World Health Organization (WHO); Dr. Jerome Kim, Director General of the International Vaccine Institute (IVI); and Professor Dame Sarah Gilbert, Professor of Vaccinology at the University of Oxford and co-founder of Vaccitech, are among those who will take the stage throughout the three-day event. The panelists will explore the role of innovation in developing COVID-19 vac cines, and the impact this will have on the devel opment of vaccines that work against new COVID variants, as well as other viral infectious diseases.

Traditionally it takes around 10 years – from Phase 1 testing to approval – for a new drug to reach the market. The COVID-19 pandemic turned this timeline on its head, with multiple vaccines receiving emergency use approval in a fraction of this time. Professor Sarah Gilbert was at the forefront of this achievement and is credited with saving millions of lives, having co-developed the Oxford AstraZeneca COVID-19 vaccine; one of the first vaccines made available for use around the world, with more than two billion doses having been distributed to at least 170 countries.

Dr. Swaminathan, a Pediatrician and globally recognized researcher on tuberculosis and HIV, has 30 years of experience in clinical care and

HEALTHCARE LEADERS FROM WHO AND INTERNATIONAL VACCINE INSTITUTE WILL JOIN THE DEVELOPER OF THE OXFORD ASTRAZENECA COVID-19 VACCINE TO DISCUSS THE FUTURE OF VACCINE DEVELOPMENT AT THE EVENT ON OCTOBER 4-6.

A medical doctor by training, Dr. Kim is a recognized leader in HIV research and vaccine development. He has been listed among the 50 most influential persons in vaccines and led the US Army's RV144 HIV vaccine trial in Thailand, the first demonstration that a HIV vaccine could prevent human infection. During his tenure, IVI had a hand in the development of the oral cholera vaccine.

“At WISH, we recognize the profound nega tive physical and psychological effects on health posed by issues such as pandemics, and believe that dialogue between stakeholders, practi tioners and policymakers, as well as innovation, are essential in mitigating future health emer gencies,” said Sultana Afdhal, CEO of WISH.

WISH, Qatar Founda tion’s global health initiative, is committed to gathering healthcare experts, policymakers and innovators to unite in the goal of building a healthier world. The goal of the biennial WISH Summit is to showcase WISH’s evi dence-based research and discuss how to translate these findings into practical, poli cy-driven solutions that help transform global healthcare delivery.

WWW.WISH.ORG.QA

“Over the past couple of years, we have all been reminded of just how vital vaccine research and development is, and why innovation in this area is fundamental to safeguarding the health of populations. We are honored to host the world’s brightest minds in vaccine innovation at WISH 2022, and we look forward to hearing them share their knowledge and learnings from responding to the COVID-19 pandemic.”

Each of the topics discussed at WISH 2022 is underpinned by an evidence-based policy report – drafted under the direction of a Forum Advisory Group made up of global health experts – that offers concrete policy recommendations. The WISH Vaccine Innovation Forum will release a re port around the summit to review the enablers of pharmaceutical innovation, from advancements in technology to operational excellence and clinical trial design, and provide policy recommendations to build on this progress for future vaccines.

Dr. Jerome Kim

Sultana AfdhalProfessor Dame Sarah Gilbert

Freudenberg Performance Materials awarded EcoVadis Silver Medal

Compostable wound pad

Freudenberg Performance Materials (Freudenberg) has been awarded its first EcoVadis Silver Medal for its two UK facili ties in Ebbw Vale and Littleborough. The company manufactures solutions for advanced wound care and ostomy products at these two locations. With the award, EcoVadis recognizes the company’s performance in the categories of environment, ethics, labor and human rights, and sustainable procurement. The award means that Freudenberg Performance Materials LP with its two facilities in Ebbw Vale and Littleborough ranks among the best 25% of companies rated by EcoVadis.

“The good EcoVadis rating confirms our consistent implementation of our sustainability strategy. We are working systematically to mini mize our footprint and maximize our handprint,” said Dr. Henk Randau, General Manager and SVP of the Global Business Division Healthcare at Freudenberg Performance Materials. “That means we are continuously improving our ener gy efficiency and use of resources while at the same time supporting our customers in the med ical products industry to make their processes more efficient and roll out sustainable products," Randau added.

WITH THE AWARD, ECOVADIS RECOGNIZES THE COMPANY’S PERFORMANCE IN THE CATEGORIES OF ENVIRONMENT, ETHICS, LABOR AND HUMAN RIGHTS, AND SUSTAINABLE PROCUREMENT. THE AWARD MEANS THAT FREUDENBERG PERFORMANCE MATERIALS LP WITH ITS TWO FACILITIES IN EBBW VALE AND LITTLEBOROUGH RANKS AMONG THE BEST 25% OF COMPANIES RATED BY ECOVADIS.

Only recently, the bio-based M 1714 wound pad with superior absorption for more challeng ing wounds was endorsed with the ECO-CHECK label. The dressing consists of a mix of bio-based fibers derived from natural sources and exhibits a smooth wound contact layer. The product has been evaluated for industrial compostability and conforms to ISO 13432.

Fewer processing steps for hydrophilic PU foam

A hydrophilic foam with a direct coating of silicone adhesives offers a significant sustainabil ity benefit for advanced wound care. A smaller number of production and processing steps reduces complexity and energy consumption for both manufacturer and customer. Moreover, the Freudenberg solution works without additional layers of film or other liners with acrylic adhesive, which is required as a silicone carrier in conven tional products.

Reduction in CO2 emissions

In 2021, Freudenberg achieved a significant year-on-year reduction in CO2 emissions at the Ebbw Vale and Littleborough locations alone. The key factor for this achievement was the switch to green power. It is planned to imple ment further energy efficiency measures on a yearly basis. Currently, the focus lies on installing heat exchanger technology.

Columbus, Ohio, may feel like a world away, but our faculty, researchers and facility have earned international reputations for expertise in rare and complex conditions. Our Cardiovascular team is leading groundbreaking development of a biodegradable tissue-engineered vascular graft for children with congenital heart defects. Our multidisciplinary Center for Colorectal and Pelvic Reconstruction excels in advanced care for even the rarest congenital disorders, motility issues, fecal incontinence concerns and more, for patients in more than 60 countries. And the powerhouse team at the helm of our Neurosurgery and Neuro-Oncology programs excels in both leadership and collaboration in multinational cancer research. When you’re here, you are the center of our attention. Come to Nationwide Children’s —nothing but the best in care, in an accessible, cosmopolitan city.

Reach out to our Global Patient Services team to find out why we should be your new global destination for complex 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

Saudi Jordanian Investment Fund to develop USD400m project in Jordan’s healthcare sector

The Jordan Investment Fund (JIF) and the Saudi Jordanian Investment Fund (SJIF) signed an investment and development agreement to implement a project worth USD 400 million in the healthcare and medical educa tion sectors. During an event held at the Prime Ministry, a lease agreement for the project site, a land area of about 187 dunums, was also signed between SJIF and Amman Vision Investment and Development Company, which is a company fully owned by the Greater Amman Municipality (GAM) as its investment arm.

The agreements were signed by SJIF chair man Mr. Hisham Attar, SJIF CEO Mr. Omar Alwir, Amman Mayor Dr. Yousef Al Shawarbeh, who is also the chairman of Amman Vision Investment and Development Company, JIF Director Mr. Zaher Qatarneh, and acting CEO of Amman Vision Investment and Development Company Ala’a-Eddin Beano.

The project will be implemented based on a build-operate-transfer (BOT) model, as owner ship of the project will be transferred to the Jor danian Government after the end of the invest ment period, as the project is included under the provisions of Jordan Investment Fund Law No. (16) of 2016 as per the decision of the Jordanian Cabinet issued on October 18, 2020.

The healthcare project will consist of a uni versity hospital with 300 beds, and more than 60 outpatient clinics, an ambulatory care building, and a medical school with a total capacity for 600 students, with a projected annual student intake of 100 students. The project is expected to cre ate more than 5,000 employment opportunities.

The project will be strategically located on the airport road, near Ghamadan area, providing access to patients from across Jordan.

It will be implemented in partnership with two of the most prestigious global institutions in the fields of healthcare and medical edu cation; the University College London (UCL) Medical School, as the academic partner, and UCLA Health in Los Angeles, California, as the clinical partner.

During the signing ceremony, Prime Min ister Dr. Bisher Khasawneh emphasized the deep-rooted relations between Jordan and Saudi Arabia, and the keenness to boost cooperation between the two countries in all fields, partic ularly in the economic and investment areas, reflecting the visions of the leaderships of both countries and their close partnership.

At the event, SJIF Chairman Hisham Attar expressed his appreciation for the efforts of the Jordanian government in supporting and attract ing investments, reiterating the commitment of SJIF to continue working with the government and the private sector to explore and implement sustainable and value-added investments in Jor dan. Attar indicated that one of the main objec tives of SJIF is to contribute to economic growth in Jordan through the long-term investments in key strategic sectors, reflecting the vision of the Custodian of the Two Holy Mosques King Salman Bin Abdulaziz Al-Saud, and His Majesty King Abdullah II, to boost economic and investment collaboration between the two countries. He pointed out to the objectives of the Saudi Vision 2030 and the strategy of the Public Investment Fund of Saudi Arabia that seek to achieve region al economic integration, stressing that SJIF seeks to be a leader in impactful investments in Jordan.

THE AGREEMENTS WERE SIGNED BY SJIF CHAIRMAN MR. HISHAM ATTAR, SJIF CEO MR. OMAR ALWIR, AMMAN MAYOR DR. YOUSEF AL SHAWARBEH, WHO IS ALSO THE CHAIRMAN OF AMMAN VISION INVESTMENT AND DEVELOPMENT COMPANY, JIF DIRECTOR MR. ZAHER QATARNEH, AND ACTING CEO OF AMMAN VISION INVESTMENT AND DEVELOPMENT COMPANY ALA’AEDDIN BEANO.

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SJIF CEO Omar Alwir indicated that the project seeks to bring global knowledge and expertise into Jordan, contribute to improving the health sector in the country, strengthen the model of accountable care, provide high-qual ity healthcare services, and stimulate medical tourism and boost Jordan’s position in this field. By providing access to distinguished medical ed ucation, the project also seeks to build medical competencies aimed at graduating a new gener ation of doctors, researchers and future leaders in medicine, Alwir said.

Alwir stressed that the partnership with two leading global medical and educational institu tions, will play a vital role in realizing the project’s vision in adding value to the healthcare and med ical education sectors in Jordan. “We’re proud to collaborate with UCLA Health, one of the top healthcare providers in the United States, and with UCL Medical School, which is ranked among the top 10 institutions in medicine worldwide”, Alwir stated.

UCL, founded in 1826, is ranked eighth in the world (QS World University Rankings 2022), second in the UK for research power (REF 2021) and has 30 Nobel Prize Laureates among its alumni and current or former staff to date. UCL is a culturally diverse university with more than 43,000 students representing over 150 nation alities. UCL Medical School (UCLMS) is a rec ognized international center of excellence for medical education. The teaching of medicine has been an integral part of UCL since 1834. UCLMS is associated, and works closely with, several major teaching hospitals. UCL is ranked 9th in the world in the QS World University Rank ings (2021) for Medicine.

Professor Mahmoud Sarhan, CEO of SJIF’s Healthcare Project said the project will include five medical centers of excellence, focused on providing expertise around the most common, and fastest-growing, non-communica ble diseases in Jordan and the region, including cardiology, oncology, neurology, gastroenterolo gy, and orthopedics.

Another major goal, he added, is to focus on advanced scientific research through estab

lishing four scientific research centers in the fields of genomics and precision medicine, stem cells and regenerative medicine, health systems and public health, and Bioinformatics.

Saudi Ambassador to Jordan Naif bin Bandar Al-Sudairi pointed out to the distin guished relations between Saudi Arabia and Jordan across all fields, expressing his appreci ation of the efforts exerted towards launching this flagship project in Jordan by SJIF. The ambassador added that Saudi Arabia is Jordan’s largest trade partner and has always been eager to explore investment opportunities aiming at boosting economic cooperation between both countries.

In his remarks, the U.S. Ambassador Henry Wooster highlighted the importance of this project and its contribution to the economic growth by creating thousands of jobs for Jorda nians. “I am thrilled of the role UCLA Health will play in the design and operational phases of the new hospital.” He added, this kind of technolo gy transfer and exchange of knowhow rep resents the best the United States has to offer.

British Ambassador to Jordan Bridget Brind stated “I am delighted that the UK in Jor dan has been able to support the establishment of this major long-term partnership between the Saudi Jordanian Investment Fund (SJIF) and University College London (UCL), one of the top universities in the UK and internationally, alongside UCLA. This significant project, worth $400 million in total, will contribute positively to the vital sectors of healthcare and educa tion in Jordan, as well as to the economy and it is expected to create around 5000 jobs, the ambassador added.

Construction works for the healthcare proj ect are expected to start following the comple tion of the design works, expected to be ready in the second half of this year.

The signing ceremony was attended by several ministers, high-ranking officials, and the ambassadors of the Kingdom of Saudi Arabia, the United Kingdom, and the United States of America in Jordan.

ONE OF THE MOST IMPORTANT CHARACTERISTICS OF THE PROJECT IS ITS FOCUS ON SCIENTIFIC RESEARCH AND DEVELOPMENT IN THE MEDICAL FIELDS, AS UP TO 7.5% OF THE PROJECT’S REVENUE WILL BE DEDICATED TO R&D IN JORDAN.

The Saudi Jordanian Investment Fund (SJIF) is a Jordanian Limited Public Shareholding Company formed in 2017 as a partnership between the Public In vestment Fund of Saudi Arabia, which owns around 92% of the company, and 16 con ventional and Islamic Jordanian banks, which own the remaining 8%. The company was registered per Jordan Investment Fund Law number 16 for 2016, and its formation is an outcome of the Jorda nian Saudi Cooperation Council and a MOU signed between the Public Investment Fund of Saudi Arabia and the Jordan Investment Fund on August 25, 2016.

INTERVIEW

Co-Founder and Joint CEO of GAMA Healthcare, the infection prevention specialist

INTERVIEW

We sat with Dr. Allen Hanouka, co-founder and joint CEO of GAMA Healthcare, to discuss their priorities and solutions around patient solutions within healthcare. Before co-founding GAMA with Dr Guy Braverman, Allen was an Ophthalmol ogist at the Royal Free Hospital, London. Guy and Allen left clinical practice to start GAMA in 2004, which, 17 years later, has become an internationally recognised infection prevention specialist.

Including our head office in Hemel Hemp stead, UK, we now have offices in six cities across three continents. Since we developed the world’s first universal disinfectant wipe under the Clinell brand, we have become the largest wet wipes supplier to hospitals in the UK and Australia, and export our products to over 70 countries worldwide.

During the early days of our practice, we were conscious of the lack of hygiene practised at key touchpoints within the hospital. This led us to invent our first breakthrough product in 2006, Clinell Universal Wipes, which is still a best seller and is used by over 91% of NHS hospitals in the UK.

Our products focus on the different touch points throughout a patient’s journey when inside a hospital, from the surfaces that the patient interacts with– whether it is the hospital infrastructure or instruments used by GPs and surgeons. Surface disinfection is now a corner stone of infection prevention policies.

Patients are the most common source of microorganisms in a hospital setting. Infected and colonised patients (and hospital staff) shed bacteria, viruses, and spores into the hospital environment1. Studies have shown that with in 48hrs of admission, 39% of patients have at least one hospital-associated pathogen on their hands2. Our antimicrobial hand wipes for cleaning and disinfecting hands have a patented formula that kills 99.999% of microorganisms without needing soap and water.

PATIENTS ARE THE MOST COMMON SOURCE OF MICROORGANISMS IN A HOSPITAL SETTING. INFECTED AND COLONISED PATIENTS (AND HOSPITAL STAFF) SHED BACTERIA, VIRUSES, AND SPORES INTO THE HOSPITAL ENVIRONMENT1 STUDIES HAVE SHOWN THAT WITHIN 48HRS OF ADMISSION, 39% OF PATIENTS HAVE AT LEAST ONE HOSPITALASSOCIATED PATHOGEN ON THEIR HANDS2.

Our recent focus has been on reducing the spread of infections via air transmission. That’s why we created Rediroom, the world’s first pop-up isolation room, designed to combat the spread of healthcare-associated infections (HCAIs) within healthcare environments.

Rediroom is a temporary, single-patient, isolation room designed to isolate infectious patients under contact of droplet precautions. It’s a cost and time-effective method of isolating infectious patients. We’ve also invested in pro ducing an instant air purification device, Rediair, that makes poorly ventilated areas safer.

Pathogens, particulates and odours linger in poorly ventilated spaces. Breathing, talking, and coughing can spread pathogens such as influen za or coronavirus via the generation of aerosols or droplets, which can remain in the air for over an hour3. That’s why we created Rediair to trap the airborne contaminants right away.

Nearly three years on from the start of the pandemic, how has patient safety changed?

The COVID-19 pandemic has reinforced the importance of IPC. Specifically, the funda mentals such as hand hygiene, environmental decontamination, use of PPE and patient isolation have been reinforced to reduce the risk of transmission of various infectious diseases. There’s a wealth of evidence supporting how IPC fundamentals can reduce the risk of trans mission of infections.

Recently, the spotlight has been shone on ventilation and how good ventilation can play a role in reducing the risk of airborne transmis sion of infections. Poor ventilation has been highlighted as a risk factor for the transmis sion of various respiratory pathogens (such as SARS-CoV-2 and influenza) as infectious aerosols (which are expelled when people breathe or cough) can build up in poorly ventilated areas4.

Improving ventilation has been a significant challenge for healthcare providers, workplac es, and homes across the globe. Still, it can be achieved through natural means (opening of windows) and mechanical means (use of air filtration units for example).

Could you tell us about your company’s products or solutions that enhance patient safety?

INTERVIEW

Could you shed light on any future plans?

We have a large R&D centre called the Fellows Research Centre (FRC), based in Halifax, West Yorkshire, that is permanently engaged in discovering and developing new innovative products and improving existing ones. This enables us to find practical solutions and remain at the forefront of infection prevention innova tion. Our upcoming products include Redihood, which protects the staff and aims to reduce the risk of spreading infections via the medical practitioner. We plan to increase our market share across all our brands while accelerating the growth of the categories we operate in.

Anything else you would like to add?

The Middle East & Africa are one of GAMA’s central growth regions. We’ve increased our investments by adding resources to this under served market, and we’ll be providing training and clinical education for our customers in the area. GAMA will deliver best practices gained from years of experience in Infection Preven tion and share clinical studies to gain valuable insights for our customers to learn and improve their practices.

GAMA Healthcare is an infection prevention expert working to reduce the risk of infection to help save and improve lives. For more information about our business and products, please visit WWW.GAMAHEALTHCARE.COM

1. Lai J, Coleman KK, Sheldon Tai SH, et al. Evolution of SARS-CoV-2 Shedding in Ex haled Breath Aerosols. medRxiv. Published on line January 1, 2022:2022.07.27.22278121. doi:10.1101/2022.07.27.22278121

2. Loveday HP, Tingle A, Wilson JA. Using a multi modal strategy to improve patient hand hygiene. Amer ican Journal of Infection Control. 2021;49(6):740-745. doi:10.1016/j.ajic.2020.12.011

3. Wilson NM, Norton A, Young FP, Collins DW. Airborne transmission of severe acute respiratory syn drome coronavirus-2 to healthcare workers: a narrative review. Anaesthesia. 2020;75(8):1086-1095. doi:10.1111/ anae.15093

4. Pirkle S, Bozarth S, Robinson N, et al. Evaluat ing and contextualizing the efficacy of portable HEPA filtration units in small exam rooms. American Journal of Infection Control. 2021;49(12):1506-1510. doi:10.1016/j. ajic.2021.08.003

THE MIDDLE EAST & AFRICA ARE ONE OF GAMA’S CENTRAL GROWTH REGIONS. WE’VE INCREASED OUR INVESTMENTS BY ADDING RESOURCES TO THIS UNDERSERVED MARKET, & WE’LL BE PROVIDING TRAINING AND CLINICAL EDUCATION FOR OUR CUSTOMERS IN THE AREA.

INTERVIEW

Green Hospitals Treating the sick and protecting the healthy

Ahospital provides treatment to patients based on their medical condition so they can resume their normal activity following the treatment. It does not aim to turn healthy people into sick ones. Hence, the green hospital concept was established, which is a hospital that promotes public health by continuously reducing its environmental impact and ultimate ly eliminating its contribution to the burden of disease. Green hospitals aim to save energy, con serve resources and be environmentally friendly. The focus is mainly on keeping people healthy, not just treating them when they are sick.

Mines, various facilities and heavy industries started searching for ways to mitigate the dam age resulting from their work in order to protect humans and the environment. Consequently, the “Green Hospital” concept emerged and it

THE “GREEN HOSPITAL” CONCEPT EMERGED AND IT AIMS TO REDEFINE HOW HEALTHCARE FACILITIES ARE BUILT TO PROTECT THE ENVIRONMENT WHILE SAVING HUMAN LIVES.

aims to redefine how healthcare facilities are built to protect the environment while saving human lives.

The “Green Hospital” concept is based on providing healthcare without causing any harm to the environment and the healthcare worker. The importance of the green hospital lies in the fact that caring for the environment is no less than caring for the safety and well-being of pa tients. Thus, the idea of health safety expanded beyond the hospital in order to protect healthy people in their homes, workplace and parks, before they turned into patients, and then they will have to treat them with drugs and surgeries at an inestimable financial and moral cost.

Motives and Goals

In the health sector, the “Green Hospital” is a concept that is beginning to redefine how

healthcare facilities are built to protect the envi ronment while saving human lives. The greater the amount of energy consumed in a hospital, the greater the release of toxic wastes to the environment, causing damage which may put human lives at risk of other diseases and death.

What is the motive and purpose behind transforming hospitals into green hospitals?

The transformation of hospitals into eco-friendly buildings began by displaying the hazardous healthcare waste as well as harmful effects and then treating them one by one to reach the desired goal. This aims to ensure phys ical and psychological safety.

Hence began the sanitary disposal of med ical waste and the effects resulting from the operation process on the one hand, and mod ifying practices in workplaces, patient rooms and hospital surroundings, in a way that brings psychological comfort to the patient without harming the healthy.

The shift to constructing sustainable health

care facilities is largely centered on reducing the carbon burden in hospitals while ensuring that the occupants - staff and patients - are kept safe. More and more hospital administrators are beginning to involve architects in incorporating green concepts into hospital design.

In fact, according to a report by SBI Energy, green building renovations will experience a significant increase. Hospitals utilize more re sources and produce more waste materials than most other commercial buildings of a similar size. Healthcare facilities consume more than 315 gallons of water per bed every day and an average US hospital consumes 103.600 Btu of natural gas per square foot annually.

Several design features have been initiated to achieve a green working environment. One of such features is the use of a low-flow plumb ing system in a bid to save three million gallons of water every year for the state of California, which many experts have said may experience a long period of drought.

In a typical healthcare centre, lighting, water heating and space heating account for more

than 65% of the energy consumption. There fore, it remains fundamental for the construc tion of healthcare facilities to involve incorpo ration of green designs and concepts into the process to reduce the impact on the environ ment, cut down operational costs and increase energy efficiency. Hospital administrations have teamed up with designers, architects and con struction companies to achieve the Leadership in Energy and Environmental Design, also called LEED. It is a system developed by the United States Green Building Council to rate a building and certify it as “green” based on design, con struction and operations of the building.

Initiatives to achieve safety

Core measures adopted for green buildings include the use of energy-efficient lighting

systems and medical equipment and use of tech-enhanced renewable energy systems. In addition to using energy more efficiently, hospitals are looking at how to create designs that allow more daylight exposure and natural ventilation into the environment. Improving the air quality is an essential element of designing a green hospital. Hospitals are exploring efficient ways of reducing the air content of toxins and contaminants across all corners of the building. The California Pacific Medical Center (CPMC), for example, has initiated several design features to achieve a green working environment.

Some international companies have started implementing an initiative to capture rainwater from the roof and use it to irrigate the land scaping, a measure, which they say, would save 180,000 gallons of drinkable water every year.

HOSPITAL ADMINISTRATIONS HAVE TEAMED UP WITH DESIGNERS, ARCHITECTS AND CONSTRUCTION COMPANIES TO ACHIEVE THE LEADERSHIP IN ENERGY AND ENVIRONMENTAL DESIGN, ALSO CALLED LEED.

Green Hospitals

In addition, the collected rainwater will also be used to operate cooling towers which the hospi tal uses for their air conditioning system.

For energy efficiency, CPMC has imple mented a number of green design initiatives to achieve energy consumption at a level, 14 percent less than that of the average US hospital. Some of these design features include use of high-efficiency windows, super insulated roofs, use of sensors which automatically turn the lights off or on in a room depending on whether it is occupied. In addition to these, the patient rooms have been redesigned to allow more exposure to natural light and ventilation.

The Children's Hospital of Pittsburgh, a division of the University of Pittsburgh Medical Center, has also adopted ways to cut energy consumption and minimize environmental pollutants in two of its buildings for which it received the LEED certification. The Children's Hospital achieved this structural shift largely by using green materials and design instead of con ventional systems. Some of the adopted green designs include systems for monitoring carbon dioxide levels in the atmosphere, use of wood products and renewable materials in its research building, water-efficient landscaping, minimizing on-site light pollution, elimination of hydrochlo rofluorocarbons (HCFCs) and halons, and use of local and regional construction material to re duce transport burden. Hospital operations were also modified in light of the green initiative.

Some of the best operational practices adopted by the hospital to make it sustainable include the use of non-toxic cleaning chemicals and microfiber mops, discontinuation of use of mercury-containing solutions and medical devices, and use of paper products made from recycled material. The hospital also established a recycling program for lab chemical wastes of toxic solutions, as well as for paper, plastic waste, light bulbs, batteries, and cardboard.

Benefits and Returns

The World Green Building Council groups the benefits of green buildings into three - envi ronmental, economic, and social benefits.

According to a report by the council, green buildings in Australia which received the “Green

STUDIES HAVE SHOWN THAT WORKERS IN GREEN BUILDINGS REPORTED A 101 PERCENT IMPROVEMENT IN COGNITIVE SCORES. IN ADDITION, EMPLOYEES IN GREEN BUILDINGS WITH WELLVENTILATED OFFICES REPORTED SLEEPING AN AVERAGE OF 46 MINUTES MORE EVERY NIGHT

star certification” by the Green Building Council of Australia led to a 62% reduction in green house gas emissions when compared with the average Australian building. On a global level, green buildings will save as much as 84 giga tonnes of carbon dioxide by 2050.

Green building also offers a lot of economic benefits globally, on a country level, and on a building level. Some of the benefits include cost savings on utility bills, lower costs of construc tion, a higher property value for estate develop ers, and job creation.

Building owners note, as reported in a report by Dodge Data & Analytics, that green buildings - whether newly constructed or ren ovated - created a 7 percent increase in asset value compared to traditional buildings.

Socially, the green building offers a number of benefits to occupants. Studies have shown that workers in green buildings reported a 101 percent improvement in cognitive scores.

In addition, employees in green buildings with well-ventilated offices reported sleeping an average of 46 minutes more every night. As healthcare evolves and administrators and providers explore strategies to promote better healthcare and lower administrative costs, con structing or renovating hospitals using green building design initiatives remains one of the core strategies, which no doubt has immense benefits not only for the hospital and immedi ate environment but for the world at large.

In this context, it is necessary to address the hospitals in the Gulf countries, where the existing ones are rapidly transforming into environmentally and human-friendly, and the ones under construction are adopting advanced construction strategies that take into account the health, aesthetics, technical and econom ic aspects, as they have become pioneering models for the future health and hospitalization concepts.

How to achieve this?

In order to achieve this paradigm shift to building green hospitals, hospitals have devel oped their business as well as their engineering methods. In Peru, for instance, more than 40 healthcare facilities are receiving training to join

SOME OF THE BEST OPERATIONAL PRACTICES ADOPTED BY THE HOSPITAL TO MAKE IT SUSTAINABLE INCLUDE THE USE OF NONTOXIC CLEANING CHEMICALS AND MICROFIBER MOPS, DISCONTINUATION OF USE OF MERCURYCONTAINING SOLUTIONS AND MEDICAL DEVICES, AND USE OF PAPER PRODUCTS MADE FROM RECYCLED MATERIAL

the Global Green and Healthy Hospital Network.

In a joint effort with the General Director ate of Disaster Risk Management and National Defense in Health (DIGERD) of the Ministry of Health of Peru, a total of 41 health establish ments in that country began the process to join the Global Green and Healthy Hospitals (GGHH) network with the aim of lowering their green house gas emissions and reducing their environ mental footprint.

During three days, the Health Care Without Harm team in Latin America provided informa tion on the different tools and resources that they can access as members of GGHH and the initiatives that they can join as part of the trans formative process they are starting.

It is noteworthy that the education and engagement of people who work in the sector is integral to success. It should be noted that this training program seeks to offer technical assis tance to the government of Peru in fulfilling its decarbonization commitments under the COP26 Health Program.

An agreement was also made between the Ministry of Health and Social Protection of Columbia and Health Care Without Harm to pro mote decarbonization of the Colombian health system. After signing a memorandum of under standing, they will work on a project for estimat ing the carbon footprint of health facilities.

The Ministry of Health and Social Protection of the Republic of Colombia and Health Care Without Harm announced the signing of a mem

orandum of understanding to carry out a project that will allow estimating the climate footprint of the Colombian national health system at the facility level.

The project focused on three main pillars:

1. The identification of a representative sample of hospitals and health centers of the Colombian health system

2. Training the teams of those estab lishments to use the Climate Impact Checkup tool developed by Health Care Without Harm

3. Technical support so that the estab lishments that make up the sample can determine the size and composition of their climate footprint.

With the analysis of the data obtained from this exercise, an estimate was made of green house gas emissions from the Colombian health sector at the national level. Based on these findings, a series of specific recommendations will be prepared, which will serve as input for the process of preparing the Comprehensive Sectoral Climate Change Management Plan (PIGCCS) for the Colombian health sector.

It is worth noting that with this project, Colombia will become the first South American country to carry out a comprehensive exercise to estimate the carbon footprint of its national health system, including both public and private establishments. More than 50 countries from different regions have committed to developing climate-resilient, sustainable and low-carbon health systems. Work is underway to design a schedule of activities and advance the imple mentation of the project to transform hospitals into environmentally friendly. The results are expected in early 2023.

... Thus, it is becoming evident day after day how great is the process of transforming hospitals into green buildings and how com mon this has become around the world after everyone noticed its human and material importance on health institutions, individuals and the entire world.

BY MAKING THIS PROJECT SUCCESSFUL, WE CAN HELP PAVE THE WAY FOR OTHER NATIONAL AND SUBNATIONAL GOVERNMENTS TO DO THE SAME. Josh Karliner, International Director of Program and Strategy of Health Care Without Harm

How remote healthcare technologies can tackle climate crisis

by Ehab Zawaideh - General Manager | Middle East, GE Healthcare

With the 27th session of the Conference of the Parties (COP 27) to the UNFCCC around the corner, the global health care community’s voices need to be heard at the climate negotiations. Companies can – and must – play a crucial role to address climate change by fulfilling their purpose and following through on their ESG commitments. This has never been more important than it is right now with the growing threat of climate change, systemic inequality and global health disparities posing a real threat to people, communities, and the planet.

The healthcare sector is responsible for 4.44.6% of worldwide greenhouse gas emissions. If the global healthcare sector were a country, it would be the fifth-largest greenhouse gas emit ter on the planet, according to a report by Health Care Without Harm in collaboration with Arup. As such, it is imperative we turn our attention to healthcare technologies that can contribute to enabling earlier, better, and faster diagnosis

AS A LEADING MEDICAL TECHNOLOGY AND DIAGNOSTICS INNOVATOR, WE ARE DEVELOPING EFFICIENCY FEATURES AND LEVERAGING DIGITAL TO TURN EVEN THE LARGEST PIECES OF MEDICAL EQUIPMENT INTO DEVICES THAT MAKE A SMALLER MARK ON OUR PLANET.

and treatment for more people in need, while reducing or eliminating our impact on the environment. One of the many ways to tackle the ongoing climate crisis is to improve access to healthcare globally, especially to the half of the world’s population that is underserved and cannot access essential health services through digital and remote healthcare solutions.

To support a more sustainable future in the healthcare sector, we must look for ways to help health systems improve efficiency and reduce waste. With staffing shortages and an increasing number of patients intensified by the pandemic, the healthcare industry must find ways to better use existing resources to deliver care to more patients. Digital and remote healthcare technol ogies is positively contributing to environmental change by removing the ‘care miles’ of patients traveling to and from healthcare facilities as well as reducing the need for single-use personal protective equipment that has a high global warming potential.

As a leading medical technology and diag nostics innovator, we are developing efficiency features and leveraging digital to turn even the largest pieces of medical equipment into devices that make a smaller mark on our planet. We are supporting the Middle East’s healthcare industry with solutions that provide a real-time,

comprehensive view of patients' status across a selected care area, hospital, or the entire health system. By doing so, we are enabling the health care industry to reduce its carbon footprint and support countries to achieve their climate goals while also helping clinical teams to deliver responsive, timely, and compliant care.

In remote and rural hospitals of the Middle East, for example, ICU patients are benefiting from 24/7 monitoring with advanced software that gathers patient data from multiple sources and continually watches for signs the patient is in trouble. If any deterioration is detected, an alert is sent to a specialized tele-ICU team, which contacts the hospital’s bedside team and sup ports them in immediately delivering the right care. This tele-ICU solution has been deployed in Saudi Arabia and is supporting the Kingdom to reach net zero by 2060. The remote consulting solution is also in use in other countries such as Qatar and Turkey.

From a maintenance and repair perspective, our existing remote service technologies kept healthcare equipment running throughout the pandemic and continues to do so today. Across Middle East, Northeast Africa and Turkey (ME NEAT), there are more than 250 GE Healthcare field service engineers supporting the growing demands of the region’s healthcare industry, who have resolved approximately one-third of service issues remotely.

In other instances, the power of remote monitoring can be seen in the case of cardiac patients being transported by ambulance to the hospital. An ECG exam can be done while on the road and immediately transmitted to the receiv ing facility and doctor, for quick evaluation of the patient’s condition, supporting decision-making on the appropriate treatment.

Remote solutions also address the issue of application training limitations, which played a critical role during the pandemic. Our Digital Expert solution, which is a new approach to application training with live and customized face-to-face sessions, was delivered through a

mobile tablet that easily connected to the system.

For years, we have focused its efforts on developing medical equipment with best-in-class image quality and advanced software to increase diagnostic confidence, but we are challenging ourselves to be better. One example is the development of a new magnetic resonance system, which is designed to lower the use of helium in the system, a scarce and non-renew able resource, by up to 67%. The current version of the magnet is 2 tons lighter than its predeces sor. We have also enabled medical staff to easily decrease the power consumption of the MR and reduce scan time by up to 50%, saving both resources and improving the patient experience.

With emissions from the healthcare industry exacerbating climate change and its negative health impacts, it is important to find sustain able solutions and adopt more green initiatives to move the needle on climate change. For healthcare systems to successfully become more sustainable, public and private sector collabora tion must become the norm. Without this, the full potential of remote healthcare technologies cannot be realized.

AT GE HEALTHCARE, CLIMATE ACTION IS AN INTEGRAL PART OF OUR MISSION TO IMPROVE OUTCOMES FOR PATIENTS, HEALTHCARE PROVIDERS AND RESEARCHERS AROUND THE WORLD, AND IT IS OUR RESPONSIBILITY TO INTENSIFY OUR ACTIONS TO FURTHER REDUCE OUR EMISSIONS.

At GE Healthcare, climate action is an inte gral part of our mission to improve outcomes for patients, healthcare providers and researchers around the world, and it is our responsibility to intensify our actions to further reduce our emis sions. To support the healthcare sector in the re gion to meet its sustainability ambitions, we have committed to the Science Based Targets Initiative (SBTi) and setting ambitious Scope 1 and 2 targets for our own operations in addition to developing develop Scope 3 targets that align with limiting global warming to below 1.5 degrees Celsius.

With the ongoing pandemic and other health concerns continuing to impact global healthcare industry, certain actions to protect people and the planet will take longer to realize. However, changing the way healthcare is cur rently delivered around the world will contribute to a more sustainable future for all.

INTERVIEW

Founder of the NEO Center network of international therapeutic clinics in Prague, the capital of the Czech Republic

"I want to help people to get back on their feet, to be able to devote themselves to their work and their children and not endanger themselves or those around them. Like I managed to do it."

Libor Votruba founded two residential and one outpatient clinic NEO Center, which also provides services in English. Libor Votruba went through a turbulent period ten years ago. The owner of the company Taiko has been organizing world-renowned Christmas markets in Prague for several years. He compen sated for the work pressure and high demand to perform with the short-term pleasant feelings that alcohol and later drugs brought him. His high achievements and demanding lifestyle began to take their toll in the form of several addictions. Before the final mental and physical exhaustion, he realized that he was not going to get out of it on his own. However, at that time he could not find a clinic in the Czech Republic that would meet his needs and requirements for treatment. It was only at a clinic in South Africa that he found a healing process, during which he decided that he wanted to offer something similar in Central Europe, in his native Prague.

What was crucial for you when you founded NEO Centrum?

Place and quality therapists. We managed to find beautiful, quiet buildings with breathing history, where our clients find enough peace and anonymity in a small group of people. With the support of our therapists, they can fully work on their treatment in a clean environment above the Vltava River. We reconstructed the first villa for these purposes. Later we found another villa in close proximity to the first one. Both have swimming pools. The opposite archi tecture is our outpatient clinic, which is in a truly modern environment closer to the city center.

You mentioned quality therapists. How difficult was it to find the perfect team?

Finding the best therapists to provide pro fessional services is not easy. We managed to create a team of people who are eager to learn and who enjoy their work. That's why today we are able to offer great therapists, psychologists, psychiatrists, and addictologists who are ready to help everyone on their journey to recovery. They also work great as a team. We can there fore offer comprehensive care, starting from a young age, specifically from the age of 13.

FINDING THE BEST THERAPISTS TO PROVIDE PROFESSIONAL SERVICES IS NOT EASY. WE MANAGED TO CREATE A TEAM OF PEOPLE WHO ARE EAGER TO LEARN AND WHO ENJOY THEIR WORK. THAT'S WHY TODAY WE ARE ABLE TO OFFER GREAT THERAPISTS, PSYCHOLOGISTS, PSYCHIATRISTS, AND ADDICTOLOGISTS WHO ARE READY TO HELP EVERYONE ON THEIR JOURNEY TO RECOVERY. THEY ALSO WORK GREAT AS A TEAM.

Why did you find clinics paid from health insurance inappropriate?

Although I believed they had capable doc tors and therapists, I was looking for something more intimate, private with 100% discretion and anonymity, which was not possible. There were many people at the clinics, different types of addictive behavior were mixed there, and I was one of the well-known Prague businessmen at the time, and of course, I didn't want the infor mation to spread more because of my family and employees. I also received similar feedback from people whose positions were much more public, such as athletes or artists. I could not find any clinic in Central Europe that met such criteria.

The Covid-19 pandemic has caused increased interest in psychologists and therapists worldwide. The numbers of addictions, depression, anxiety, and other conditions that people did not experience so much three years ago have also increased. There are long waiting times everywhere. How is it in NEO Centers?

We try to respond as quickly as possible. I myself know that when a person decides to do something about their addiction or psycholog ical problem, it is necessary to do so as soon as possible. So that person doesn't have time to think about it too much or give a chance to someone from outside to influence him/her. The advantage of the NEO Center is therefore quick and targeted help without a long wait for the start of the treatment. It takes time for an addict to admit to themselves that they need help, if they get to that point and seek help, that's great and should be taken advantage of for further treatment. That is why we immedi ately started helping the largest Czech state university hospital, Motol, during the COVID-19 pandemic. The hospital was overcrowded with patients. Some doctors and nurses were unable to cope with the enormous psychological burden during the most difficult moments of

INTERVIEW

their careers. NEO Centrum provided them with free space to regain strength in their admirable profession.

How did such a special collaboration with the largest state hospital come to life?

My friend, the artist Pavel Šťastný, painted dozens of artworks for the clinics at that time. Painting can also be a form of therapy, not only for the one who is creating it but also for the one who is looking at it. He just exhibited the ex hibition Helpful Art in Covid at the Motol hospi tal under the title "Art is part of positive therapy and it heals". He created the entire project with Dr. Martin Holcát, Deputy Director of the Motol University Hospital in Prague for curative and preventive care and former Minister of Health of the Czech Republic. He told me about the psychological pressure on doctors and nurses. We responded immediately and offered to help. Pavel Šťastný connected with us and within a week the nurses and doctors were meeting with us for the first therapies. Pavel and I are also starting to deal with the Art Therapy program. He deals with the creation of logos, advertising, marketing, and exhibitions, which is demand ing and sometimes quite stressful work. The process of creating images relaxes him. It's the same for our clients. I visited Oman with Pavel and I hope to return to that beautiful country soon. His paintings are in the Parliament of the Sultanate of Oman and at Muscat Airport. In the Middle East, Pavel started collaborating on the design of hospital beds for the Czech company Linet, which are, for example, in the UAE and Qatar, and he created the logo for the Czech pavilion at EXPO in Dubai.

How do people look at you when they find out you've gone through treatment?

Of course, it depends on who. Recently, however, it seems to me that this view is chang ing, and this is also the goal of my clinic. For example, people who are addicted to alcohol are usually viewed by the public as it’s their own fault and they need to be punished in some way, but a person who is addicted to anything is sick and needs help. I see my experience with addiction as very important in helping others. In

MY FRIEND, THE ARTIST PAVEL ŠŤASTNÝ, PAINTED DOZENS OF ARTWORKS FOR THE CLINICS AT THAT TIME.

search of myself, I also went to Thailand, where I learned to meditate. I then supported the es tablishment of the Tīsaranā meditation center in Prague. Today, Thai meditation programs are also part of our treatment programs at the Neo Center.

How long do you recommend using the services of your residential clinics?

We recommend the programs chosen indi vidually, but it is often four or six weeks. Shorter stays work for people who are experiencing burnout or major anxiety and depression, for

INTERVIEW

example. The capacity of one house is a maxi mum of eleven people. This fulfills our vision of anonymity, peace, and privacy.

Do you work with clients individually?

Our therapists work individually and in group therapies. A psychiatrist and an internist are also available. The main pillars are psy chotherapy, meditation, and the twelve-step program of Alcoholics Anonymous and Narcotics Anonymous.

What happens after they go through the treatment? Do they come to the outpatient clinic?

Preparing them for what happens after they leave the clinic is very important. We slow them down and teach them to look at themselves, not to run away from themselves, as every addict does. We teach them to be able to go through the painful situations that life brings without getting drunk or taking drugs. Our outpatient clinic is of course available to them as part of follow-up treatment. Not only from personal experience, but we also recommend everyone to attend meetings of Alcoholics and Narcotics Anonymous. Every success and a happy, healthy patient gives us strength for further work.

THE ADVANTAGE OF THE NEO CENTER IS THEREFORE QUICK AND TARGETED HELP WITHOUT A LONG WAIT FOR THE START OF THE TREATMENT. IT TAKES TIME FOR AN ADDICT TO ADMIT TO THEMSELVES THAT THEY NEED HELP, IF THEY GET TO THAT POINT AND SEEK HELP, THAT'S GREAT AND SHOULD BE TAKEN ADVANTAGE OF FOR FURTHER TREATMENT.

Patient safety in health facilities has evolved with the development of health care systems and has become essential to provide high-quality health services, in order to reduce the risks and prevent medical errors that patients may encounter while receiving people-centered effective, safe and integrated healthcare.

The implementation of patient safety princi ples and strategies requires clear policies based on healthcare providers' experiences and the active patient participation. The patient goes to the hospital to receive the necessary treatment for his condition, but this condition may worsen or he may contract an infection, if the medical staff does not take the necessary precautions to prevent any medical error that may occur. However, this has been under control recently, and the concerned authorities have worked to reduce medical errors and maintain patient safety. Quality certificates have focused their

PATIENT SAFETY IS THE AVOIDANCE OF UNINTENDED OR UNEXPECTED HARM TO PEOPLE DURING THE PROVISION OF HEALTHCARE AND MOVING TOWARDS FURTHER IMPROVEMENTS AT THE LEVEL OF SAFETY AND QUALITY, SO THAT THE PATIENT RECEIVES THE NECESSARY TREATMENT IN A SAFE ENVIRONMENT.

attention in this field; today, hospitals adopt all the standards and policies that seek to provide the patient with top-notch healthcare services, which led to a significant decrease in medical er rors and hospital-acquired infections. Safety of patients during the provision of health services that are safe and of high quality is a prerequisite for strengthening healthcare systems and mak ing progress towards effective universal health coverage (UHC) under Sustainable Development Goals to promote health and well-being for all.

Patient safety is the avoidance of unintend ed or unexpected harm to people during the provision of healthcare and moving towards further improvements at the level of safety and quality, so that the patient receives the neces sary treatment in a safe environment.

In order to reach the desired goal, health care providers of all types should be supported and empowered on how to avoid medical errors by providing them with skills and mechanisms to improve safety.

Steps to maintain patient safety while receiving healthcare

Maintaining patient safety and avoiding medical errors that lead to life-threatening complications require taking several steps and following precautionary measures in every step they take, especially the nursing staff who works directly with patients.

Steps that should be taken:

• Preventing bloodstream infections during the insertion of intravenous catheters or blood sample collection. In order to achieve this, hands must be washed and sterilized before making any intervention and the skin must be cleaned with chlorhexidine solution.

• Reducing the risk of developing thrombophlebitis, an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs. Causes of thrombophlebitis include physical injury, surgery, or prolonged inactivity; therefore, the patient should wear compression stockings after every operation that requires bed rest.

• Educating patients about the use of bloodthinning medications, as the majority of patients take this type of medication after surgery and leave the hospital to prevent dangerous blood clots. If blood-thinning drugs are used incorrectly, it can lead to uncontrollable bleeding.

• Medical and nursing staff should not stay at work for long hours because the burnout makes them more likely to make mistakes.

• Designing the hospital in general and the patient rooms in particular in a way that brings comfort. Evidence shows that being in a comfortable environment positively reflects on the patient’s health in the first place and motivates healthcare providers to work better. It is recommended to establish decentralized nursing stations that allow easy access to patients.

• Reducing infection by providing single rooms, improving air filtration systems and providing multiple handwashing stations.

MAINTAINING PATIENT SAFETY AND AVOIDING MEDICAL ERRORS THAT LEAD TO LIFE-THREATENING COMPLICATIONS REQUIRE TAKING SEVERAL STEPS AND FOLLOWING PRECAUTIONARY MEASURES IN EVERY STEP THEY TAKE, ESPECIALLY THE NURSING STAFF WHO WORKS DIRECTLY WITH PATIENTS.

• The staff in the operating room must be fully aware of their responsibility regarding infection control policies and practices. Unusable and unused instruments and equipment should be disposed of from operating rooms.

• Reducing medication errors through automated pharmacies that reduce the burden on the pharmacist and give him enough time to talk with the patient and understand his condition. This also gives him enough time to smoothly complete other pharmacy work. Administering the right medication at the right time is one of the public safety foundations, as this contributes to improving the drug treatment service, promoting health and wellness, as well as preventing diseases. Hospitals follow specific policies and procedures based on scientific studies.

• Training the health facility staff to communicate effectively and respond quickly to patient requirements in order to enhance patient safety. Today, smart technologies are available to give the nurse the opportunity to follow up closely on the patient’s case without the need to move from one room to another. As soon as they notice any change in the patient’s vital signs, the nursing staff is alerted right away.

. Patient Safety

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Reducing hospital admissions as some cases can be followed up with medication and regular visits to the clinic and setting a schedule for that.

Advanced technology has enabled patient safety practices such as the use of simulators, coding tape, computerized provider order entry (CPOE), resource management, electronic health records and other practices and work strategies to avoid patient safety errors and improve healthcare operations.

It is noteworthy that this does not eliminate direct human intervention, and these practices are only means to help the medical staff fully perform their tasks.

Clean healthy environment

Hygiene is the main step that hospitals and

HYGIENE IS THE MAIN STEP THAT HOSPITALS AND HEALTH FACILITIES HAVE BEEN KEEN TO IMPLEMENT IN ORDER TO ENSURE THE PATIENT’S PRESENCE IN A HEALTHY AND CLEAN ENVIRONMENT THAT REDUCES THE RISK OF CROSSCONTAMINATION

health facilities have been keen to implement in order to ensure the patient’s presence in a healthy and clean environment that reduces the risk of cross-contamination. Maintaining patient safety and keeping him healthy during his hospi tal stay requires creating a clean healthy environ ment and applying the latest mechanisms and strategies to prevent the spread of infection or its presence in the hospital environment.

The main patient safety steps include isolation, thorough handwashing, dealing with acquired infections and epidemics, disinfec tion and sterilization of surgical machines and devices, dealing with and disposal of laboratory samples and blood transfusions, infection con trol rules for preparing intravenous solutions, instructions for cleaning and disinfecting isola tion rooms, operating rooms and intensive care rooms among others.

Pain is the Fifth Vital Sign, and Pain Management is Vital to Quality Patient Care

Ece Aydinc. RN. Clinical Resource Consultant. Becton Dickinson, Medication Management Solutions. Turkey. Natalie Samuda. RM, BSc. Senior Clinical Resource Consultant. Becton Dickinson, Medication Management Solutions. Middle East, North Africa, and Turkey.

Lisa Gangol. RN, BSN. Senior Clinical Resource Consultant. Becton Dickinson, Medication Management Solutions. Middle East, North Africa, and Turkey.

James Waterson. RN, M.Med.Ed. MHEc. Medical Affairs Manager. Becton Dickinson, Medication Management Solutions. Middle East and Africa.

Background

The relief of suffering is central to the role of every clinician, freedom from pain is crucial to the quality of life of patients and an optimized and safe pain control strategy is an essential part of the patient experience in every health care encounter.

A major problem with pain is that it is incredibly diverse. It can range widely in in tensity, quality, and duration and has diverse pathophysiologic mechanisms and meanings. As healthcare students we are often told, ‘pain is what the patient says it is’, and this is a useful starting point because pain is very hard to define. As the International Association for the Study of Pain (IASP) states, it is ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.’1 Of course, many patients including those most in need of pain control cannot actually ‘say what it is’, including those with debilitated by disease, those who are too young to be able to vocalize their needs, and those who are too fearful of the consequences of pain therapy itself, and how it might limit their freedoms and ability to engage in society to reveal their suffering.

Therefore, defining the concept of pain in a concise and precise manner presents a chal lenge, and its diversity and presence in virtually every discipline across healthcare means that we need to employ multiple approaches to its detection, management and to the evaluation of the effectiveness and safety of the strategies

we deploy. Nothing in healthcare is risk-free, and every intervention has a risk-benefit offset. The benefits of effective analgesia for acute pain in avoiding the development of chronic pain2 are well-documented. Furthermore, when post-op erative pain is not well managed a substantial number of patients will go on to develop chronic postoperative pain, impaired function, delayed recovery from surgery, reduced quality of life, prolonged opioid use, and increased medical costs.3 The increased medical costs are com monly directly attributable to complications of poor mobility including iatrogenic pneumonias and venous thrombosis.4 In complex patients un dergoing surgery there is evidence that specific analgesia therapies such as epidural infusion, combined with pharmaceutical and mechanical prophylaxis may substantially reduce the risk of post-operative thromboembolic events.5

As noted above, all therapies have a risk-benefit offset. Much of the risk from Patient-Controlled Analgesia (PCA) and Patient Controlled Epidural Analgesia (PCEA) comes from ‘simple’ programming errors during the set up of the therapy, but there are risk-mitiga tion technologies which, when integrated into well-constructed Failure Mode Effect Analysis (FMEA)6,7 processes, can reduce this risk. Smart PCA pumps with dose-error reduction software that can alert clinicians of unsafe dose settings and potential programming errors and reporting software from smart PCA pumps can help teams improve the efficacy of the analgesia provided and improve safety.

A MAJOR PROBLEM WITH PAIN IS THAT IT IS INCREDIBLY DIVERSE. IT CAN RANGE WIDELY IN INTENSITY, QUALITY, AND DURATION AND HAS DIVERSE PATHOPHYSIOLOGIC MECHANISMS AND MEANINGS.

AS HEALTHCARE STUDENTS WE ARE OFTEN TOLD, ‘PAIN IS WHAT THE PATIENT SAYS IT IS’, AND THIS IS A USEFUL STARTING POINT BECAUSE PAIN IS VERY HARD TO DEFINE.

Extending into homecare, in palliative care and the management of chronic pain the gener al rule still remains, By the Clock, By the Mouth, By the Ladder8 but when we reach the top of the analgesic ladder or when oral administration is no longer possible and pain control needs to be continuous and escalated by patient demand or bolus then there is a definite place for par enteral therapy (either intravenous or subcuta neous routes) in strategies to relieve suffering and to maximize patients’ social productivity. Indeed, there is mounting evidence that early in troduction or ‘anticipatory’ syringe pump usage improves the quality of palliative care.9

Below we will discuss strategies, and the technology that supports these approaches for safer management of pain both in and out of hospital. Below we will review, specifically:

• The use of data from smart PCA and PCEA pumps to assess the efficacy of strategies for pain control.

• Acute post-operative pain management via PCA, and monitoring technology to maintain safety.

• Management of acute post-operative pain and for maternity care via PCEA.

• Regional block analgesia infusions.

• Managing patients in the community via ambulatory PCA and lightweight syringe devices.

Data-driven pain management and strategy reviews and FMEA pumpbased protocols:

Pain is a vital sign, in fact pain has been called the fifth vital sign. We measure vital signs via hemodynamic monitoring to obtain the most accurate measures, and we apply numerical scales to pain in order to allow for objective analysis of what is essentially a subjective experi ence both for the patient (remembering that ‘pain is what the patient says it is’) and for the clinician attempting to rate the patient’s level of pain.10 Bedside clinicians use assessment tools such as the Visual Analogue Scale (VAS), and the Numerical Pain Scale,11 and in patients unable to communicate their distress tools such as Wong-Baker,12 and assessments of physiological data13 to objectively ‘measure’ pain- a truly indi vidual and highly subjective phenomenon.

Pain assessment uses tools such as the VAS and Wong-Baker, and this can be enhanced by physiological data

Clinicians can compare their assessments of the patient’s pain and activity to the patient’s analgesia history as presented on PCA and PCEA smart pumps.14 This history should include, at a minimum, the information given in Table 1.

Table 1: Typical PCA values and observations for adults and pediatrics

This process allows the clinicians to decide if the patient’s pain needs are being met or if the pain control regimen needs to be altered to ensure effective analgesia for patient recovery, mobilization, rest, comfort and social engage ment. The PCA or PCEA pump presents this information on the screen for immediate review and action, for example a pain score of 7 and no patient demands being recorded may indicate a misunderstanding from the patient over how to activate this extra dose, and a clinician administered bolus might be indicated, as well as re-education of the patient. Equally, if the pump history shows several unmet patient de mands, where the patient has requested a dose from the pump during the lockout period, and a high pain score this might require an immediate clinician delivered bolus, and changes to back ground rates and lockout times. These features; boluses and regimen changes are commonly protected by user codes or ‘privileges’ which only certain individuals in the organization can access and these privileges should be defined in the FMEA plan7. For PCA and PCEA devices, a privilege system might look like the one repre sented in Table 2.

means that we have rich data17 from which we can begin to form, or reform, pain strategies and to review the effectiveness of our initial planning to meet patient needs. Pain score recording has also moved, in many facilities, into the patient’s Electronic Medical Record (EMR), and we can use data analysis to map via entity resolution processes18,19 these recordings (and patient activity at the time of scoring) to the analgesia regimen deployed via the pump event log. On a philosophical level this is vital, as in true real world evidence creation we focus on multiple patient events, and on having substan tial volumes of data to prove significance.20

At a facility level, we can use the same techniques of analysis on a broader front to in terrogate the data for the specific regimens we have put in place against subsequent clinician in terventions that have been required to manage patients’ pain needs. For example, we might see a substantial number of clinician boluses being used or increases to background rates or reduc tions in lockout times being required. This may indicate that our established baseline pain care strategies need review. They may be too conser vative overall or do not meet the evolving needs of changes to patient management such as ear lier mobilization and changes in physiotherapy approaches for post-surgical patients.21,22

Such extensive data can also help address difficult questions such as whether larger patients, particularly bariatric patients, would benefit from mg/kg/hr dosing and mg/kg bolus doses via their PCA instead of a more standard mg/hr regimen. Weight-based dosing has be come the standard in pediatric care.16

Children can benefit from weightbased PCA regimens; education of the child and family and the use of an appropriate assessment tool such as FLACC or COMFORT for children unable to state their needs is vital

THE FACT THAT SMART PCA AND PCEA PUMPS RETAIN VAST AMOUNTS OF INFORMATION FROM MULTIPLE PATIENT EVENTS IN THEIR EVENT LOGS MEANS THAT WE HAVE RICH DATA17 FROM WHICH WE CAN BEGIN TO FORM, OR REFORM, PAIN STRATEGIES AND TO REVIEW THE EFFECTIVENESS OF OUR INITIAL PLANNING TO MEET PATIENT NEEDS. PAIN SCORE RECORDING HAS ALSO MOVED, IN MANY FACILITIES, INTO THE PATIENT’S ELECTRONIC MEDICAL RECORD (EMR), AND WE CAN USE DATA ANALYSIS TO MAP VIA ENTITY RESOLUTION PROCESSES18,19 THESE RECORDINGS (AND PATIENT ACTIVITY AT THE TIME OF SCORING) TO THE ANALGESIA REGIMEN DEPLOYED VIA THE PUMP EVENT LOG.

We might view these immediate changes to regimens and the clinicians’ responses to the pain score and the analgesia pump history as pain tactics. The fact that Smart PCA and PCEA pumps retain vast amounts of information from multiple patient events in their event logs

As we learn more about regional pain management, a review of strategies including optimal background rates, and whether patient boluses have value can also be tackled.

A retrospective review of data and scoring against pain charts could also enable us to more fully evaluate larger questions, such as the

Table 2: Privileges are a key component of the FMEA plan to deliver safe pain therapy

question of the effectiveness of PCA and PCEA ‘auto-bolus’ regimens. We discuss both these techniques in more detail below. For a consider able amount of time, we have been using ‘big’ data generated from general smart pumps to improve medication safety strategies, it is now time to apply the same techniques to improve patient comfort and satisfaction, whilst main taining the safety of acute pain control.

Regional Analgesia Infusion

In terms of delivering analgesia to meet acute pain needs both peri-operatively and post-surgery, Regional Nerve Block infusion analgesia delivered via smart analgesia pumps is beginning to show significant advantages over general anesthesia and traditional peri-opera tive and post-operative analgesia regimes. In one recent study, patients undergoing upper limb surgeries showed significantly higher satisfaction scores than those who received general anesthesia23 and the technique has been preferred at other centres for lower limb sur gery as it has lower operating room duration per case than general anesthesia24 with comparable results for pain control as general anesthesia.

In terms of patient safety, the technique can be useful for patients who might be considered to be high risk for respiratory depression, but as

we will see below there are ways of protecting patients from the effects of opiates whilst main taining one of the key attributes of PCA therapy: patient mobility.

PCA Monitoring with continuous End-Tidal Carbon Dioxide (EtCO2) Monitoring

Opioid analgesia remains the primary pharmacologic intervention for managing pain in hospitalized patients; however, as with any medication, opioids can cause adverse effects. Unintended advancing sedation and respiratory depression are among the most serious.25

The Joint Commission reported in 2010 that opioid related events resulting in death or permanent loss of function accounted for 0.25% of all events reviewed between 2004 and 2010, and of these 58% of incidents were the result of improper monitoring.26

Patient sensitivity to opiates and opioids is hard to predict, and post-operative respiratory failure has been suggested to have multiple determinants.27 Using SpO2 monitoring for impending respiratory failure or depression is problematic as with supplemental oxygen ad ministration the patient may retain acceptable oxygen saturations even while deteriorating. Non-invasive monitoring with an EtCO2 Module

IN TERMS OF DELIVERING ANALGESIA TO MEET ACUTE PAIN NEEDS BOTH PERIOPERATIVELY AND POST-SURGERY, REGIONAL NERVE BLOCK INFUSION ANALGESIA DELIVERED VIA SMART ANALGESIA PUMPS IS BEGINNING TO SHOW SIGNIFICANT ADVANTAGES OVER GENERAL ANESTHESIA AND TRADITIONAL PERIOPERATIVE AND POST-OPERATIVE ANALGESIA REGIMES.

on the PCA itself, rather than using wall-mount ed monitors allows for patient mobilization, and allows for a ‘pause protocol’, which adds anoth er level of safety. The EtCO2 alarm responds to lowered respiration rates and to hypercapnia to alert the clinician, and automatically pauses the PCA infusion. EtCO2 monitoring also adds to our information about the patient. Rises in respira tory rate, and drops in EtCO2, can correlate with patients experiencing pain. An EtCO2 Module with the option to display EtCO2 readings as a waveform can be used to monitor a patient’s clinical status. Waveform analysis can expand the patient assessment to identify possible cases of overmedication or inadequate pain con trol. Smart pump alarms can therefore be set to reflect both patient safety concerns and quality of analgesia delivered.

Patients at risk of opioid-induced respiratory depression may benefit from continuous EtCO2 monitoring, the module adds to bedside clinical information about the patients pain state and physiological stability

It may be possible to recoup investment in such technology by a reduction in Critical Care bed usage by high-risk COPD and post-bariatric surgery patients.

Continuous EtCO2 monitoring can be used for early identification of declining physiological status leading to early intervention and could help avoid urgent transfers to critical care.

The availability of respiratory and dosing trend data together can improve clinical assess ments of patients receiving PCA, leading to pa tients with better controlled pain and improved safety, while averting costly adverse events.

Typical values for a PCA smart pump with

CONTINUOUS EtCO2 MONITORING CAN BE USED FOR EARLY IDENTIFICATION OF DECLINING PHYSIOLOGICAL STATUS LEADING TO EARLY INTERVENTION AND COULD HELP AVOID URGENT TRANSFERS TO CRITICAL CARE. THE AVAILABILITY OF RESPIRATORY AND DOSING TREND DATA TOGETHER CAN IMPROVE CLINICAL ASSESSMENTS OF PATIENTS RECEIVING PCA, LEADING TO PATIENTS WITH BETTER CONTROLLED PAIN AND IMPROVED SAFETY, WHILE AVERTING COSTLY ADVERSE EVENTS.

EtCO2 are given below, but all parameters must be editable for specific patient groups.

Epidural management of Acute Pain

To reduce the risk of incorrect connections and injections, the ISO 80369 series of standards was issued in 2016. It defines a separate, incom patible connection for epidural and regional block anesthesia and analgesia.

In simple terms, an intravenous adminis tration line or standard syringe will not fit an NRFit® epidural cannula, and an NRFit® epidural administration set will not fit onto an intrave nous cannula.

Epidural administration line safety goes beyond the connector, however. The Institute for Safe Medication Practice and ECRI state that facilities should always, ‘use yellow-lined tubing without injection ports for epidural infusions to set its appearance apart from typical IV tubing, and never use yellow-lined tubing for anything other than epidural administration.’28

The Faculty of Pain Medicine of the United Kingdom in its ‘Best Practice in the Manage ment of Epidural Analgesia in the Hospital Setting’ recommends the use of yellow tubing to differentiate epidural/spinal lines from ar terial (red), enteral (purple) and regional (grey) infusions.29

It is usual for facilities to set pre-pro grammed epidural therapy protocols for maternity units and for surgical units. Each protocol would specify background rate, lockout time and patient bolus, clinician bolus and PIEB (Programmed Intermittent Epidural Bolus). The protocols are commonly set as total dose per hour, total volume per hour, and can be set as weight-based, by dose/kg.

Extra boluses may be delivered at the clini cian’s discretion, with soft and hard dose limits applied to these doses and to the background rate, patient doses and any PIEB settings. A ‘classic’ Patient Controlled Epidural Analgesia (PCEA) maternity unit regimen without PIEB is described below, drawn from a metanalysis of

over 2,000 patient events:30

In PIEB the pump delivers an intermittent dose of analgesia on a set cycle, whilst main taining the background infusion and allowing patient boluses which are regulated by a lockout period. There have been some studies that indicate shorter duration of labor and improved patient satisfaction with PIEB.31

The theory behind PIEB is that the auto mated bolus improves the spread of anesthetic solution within the epidural space, and there fore enhances the sensory blockade. 32

Smart Epidural Pumps are capable of delivering Programmed Intermittent Epidural Bolus (PIEB) regimens with an intermittent dose of analgesia being delivered on a set cycle, whilst maintaining the background infusion and allowing patient boluses which are regulated by a lockout period

PCA Management Strategies in Palliative care

Palliative care is an interdisciplinary ap proach that includes specialized medical and nursing care that improves the quality of life of patients (adults and children) and their families when they face problems with life-limiting dis eases33. Pain is one of the most frequent and se rious symptoms experienced by patients in need of palliative care. Pain is associated with both the disease as well as treatment, and management is essential from the onset of early disease through long-term survivorship or end-of-life care34 .

Patient Controlled Analgesia (PCA) is an effective and frequently preferred treatment method at home and in the hospital for the treatment of chronic pain symptoms in palliative care patients.

PCA allows for faster relief of episodic incident and breakthrough pain and can give patients a greater sense of personal control over their pain. The primary indication for PCA is the patient who requires parenteral analgesia due to severe pain and the oral/transdermal/ rectal route not being practical, and who has incident pain or other pain patterns that are not predictable.35,36

PCAs which are small, light and mobile can increase the patient's mobility. Long battery life and adjustable and varied infusion modes are key to meeting the needs of the patient or clinic. The available modes should include continuous only, bolus only, continuous and bolus, and automatic intermittent bolus. When setting the PCA the patient dose interval (minutes of ‘lockout’) should be set in consultation with the patient and carers. The continuous dose is set in either mg/hr or mcg/hr and may be expected to be higher than the doses used in acute care as the patient may have developed tolerance to the medication and has entered a chronic pain cycle. The ‘rate and time limit’ that determines the maximum amount of drug to be dispensed in a given period of time is usually set to provide three to five times the estimated required hourly dose including patient boluses within one-, four-, or twenty-four-hour limits. How ever, because of the need for frequent dose adjustments in palliative care, this limit may be set with a great deal of ‘elasticity’ by the skilled

practitioner. Most palliative care patients will need both PCA demand and continuous infusion dosing.35,36

In addition to intravenous drug administra tion used to maintain symptom control in pain management, continuous subcutaneous infu sion (CSCI) delivered by syringe pump is a useful administration method.37 There is evidence that drug therapy with continuous subcutaneous infusions (CSCI) over 24 to 48 hours have several benefits, both in patient care and in the applica tion of healthcare resources.38

Strategies for palliative care and ambulatory chronic pain regimens can be reviewed and opti mized through the mapping of pump-log data to patient self-reports on comfort and effectiveness. The PCA’s safety software, which should also have the ability to be set for weight-based dosing is enhanced in community settings by security sys tems such as lockboxes as a physical control over accidental or unauthorized modification of the program. Accessories such as carry packs and bags enhance patient mobility and allow for increased social interaction and quality of life.

Palliative care is not just about alleviating symptoms, it should begin long before the pa tient receives end-of-life care in order for such care to improve their quality of life and enable them to do more, even though their disease is in a palliative stage. Indeed, there is increasing evidence that early administration or ‘anticipat ed’ syringe pump use improves the quality of palliative care.9

Accessories such as ambulatory bags and lockboxes can improve patient autonomy and allow them opportunities for greater social interaction

PCA ALLOWS FOR FASTER RELIEF OF EPISODIC INCIDENT AND BREAKTHROUGH PAIN AND CAN GIVE PATIENTS A GREATER SENSE OF PERSONAL CONTROL OVER THEIR PAIN. THE PRIMARY INDICATION FOR PCA IS THE PATIENT WHO REQUIRES PARENTERAL ANALGESIA DUE TO SEVERE PAIN AND THE ORAL/ TRANSDERMAL/ RECTAL ROUTE NOT BEING PRACTICAL, AND WHO HAS INCIDENT PAIN OR OTHER PAIN PATTERNS THAT ARE NOT PREDICTABLE.35,36

References:

1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. The revised Inter national Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020 Sep 1;161(9):1976-1982. doi: 10.1097/j.pain.0000000000001939. PMID: 32694387; PMCID: PMC7680716.

2. Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010 Dec;11(12):1859-71. doi: 10.1111/j.1526-4637.2010.00983.x. Epub 2010 Oct 28. PMID: 21040438.

3. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017 Sep 25;10:2287-2298. doi: 10.2147/JPR.S144066. PMID: 29026331; PMCID: PMC5626380.

4. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017 Mar 1;118(3):317-334. doi: 10.1093/bja/aex002. PMID: 28186222.

5. Shouhed D, Amersi F, Sibert T, Sibert K, Hemaya E, Silberman AW. Thromboprophylaxis and major oncologic surgery performed with epidural analgesia. JAMA Surg. 2013 Jan;148(1):81-4. doi: 10.1001/2013.jamasurg.5. PMID: 22987072.

6. Stamatis D. Failure mode and effects analysis: FMEA from theory to execution. Milwaukee, WI: ASQC Quality Press; 1995.

7. Cronrath P, Lynch TW, Gilson LJ, Nishida C, Sembar MC, Spencer PJ, West DF. PCA oversedation: application of Healthcare Failure Mode Effect (HFMEA) Analysis. Nurs Econ. 2011 MarApr;29(2):79-87. PMID: 21667674.

8. Ventafridda V, Saita L, Ripamonti C, De Conno F. WHO guidelines for the use of analgesics in cancer pain. Int J Tissue React. 1985;7(1):93-6. PMID: 2409039.

9. Bowers B, Pollock K, Dickman A, Ryan R, Barclay S. Anticipatory syringe pumps: benefits and risks. BMJ Support Palliat Care. 2021 Sep;11(3):303-304. doi: 10.1136/bmjsp care-2020-002735. Epub 2021 Jan 19. PMID: 33468505; PMCID: PMC8380901.

10. Grissinger M. Safety and patient-controlled analgesia: part 2: how to prevent errors. P T. 2008 Jan;33(1):8-9. PMID: 19749992; PMCID: PMC2730066.

11. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001 Dec;8(12):1153-7. doi: 10.1111/j.1553-2712.2001.tb01132.x. PMID: 11733293.

12. Garra G, Singer AJ, Taira BR, Chohan J, Cardoz H, Chisena E, Thode HC Jr. Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Acad Emerg Med. 2010 Jan;17(1):50-4. doi: 10.1111/j.1553-2712.2009.00620.x. Epub 2009 Dec 9. PMID: 20003121.

13. Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2016 Jul 16;7(7):CD001069. doi: 10.1002/14651858.CD001069.pub5. PMID: 27420164; PMCID: PMC6457867.

14. Chumbley G, Mountford L. Patient-controlled analgesia infusion pumps for adults. Nurs Stand. 2010 Oct 27-Nov 2;25(8):35-40. doi: 10.7748/ns2010.10.25.8.35.c8067. PMID: 21140774.

15. Taketomo et Al. Pediatric Dosing Handbook. 2008.

16. Drug Doses: Frank Shann- RCH Melbourne. http://www.drugdoses.net/ Accessed 22 July 2022. Also available via iOS and Android Applications.

17. Kuo IT, Chang KY, Juan DF, Hsu SJ, Chan CT, Tsou MY. Time-dependent analysis of dosage delivery information for patient-controlled analgesia services. PLoS One. 2018 Mar 15;13(3):e0194140. doi: 10.1371/journal.pone.0194140. PMID: 29543837; PMCID: PMC5854274.

18. Christen P. Data Matching: concepts and techniques for record linkage, entity resolution and duplicate detection. Springer, Berlin, Heidelberg; 2012.

19. Talburt JR. Principles of entity resolution. Entity Resolution and Information Quality. Morgan Kaufmann; 2011. 1–37.

20. Sherman RE, Anderson SA, Dal Pan GJ, Gray GW, Gross T, Hunter NL, LaVange L, Marinac-Dabic D, Marks PW, Robb MA, Shuren J, Temple R, Woodcock J, Yue LQ, Califf RM. Real-World Evidence - What Is It and What Can It Tell Us? N Engl J Med. 2016 Dec 8;375(23):2293-2297. doi: 10.1056/NEJMsb1609216. PMID: 27959688.

21. Guerra ML, Singh PJ, Taylor NF. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clin Rehabil. 2015 Sep;29(9):844-54. doi: 10.1177/0269215514558641. Epub 2014 Dec 1. PMID: 25452634.

22. Hu Y, McArthur A, Yu Z. Early postoperative mobilization in patients undergoing abdominal surgery: a best practice implementation project. JBI Database System Rev Implement Rep. 2019 Dec;17(12):2591-2611. doi: 10.11124/JBISRIR-D-19-00063. PMID: 31725070.

23. Suresh P, Mukherjee A. Patient satisfaction with regional anaesthesia and general anaesthesia in upper limb surgeries: An open label, cross-sectional, prospective, observational clinical comparative study. Indian J Anaesth. 2021 Mar;65(3):191-196. doi: 10.4103/ija.IJA_1121_20. Epub 2021 Mar 13. PMID: 33776108; PMCID: PMC7989486.

24. Neal-Smith G, Hopley E, Gourbault L, Watts DT, Abrahams H, Wilson K, Athanassoglou V. General Versus Regional Anaesthesia for Lower Limb Arthroplasty and Associated Patient Satis faction Levels: A Prospective Service Evaluation in the Oxford University Hospitals. Cureus. 2021 Aug 9;13(8):e17024. doi: 10.7759/cureus.17024. PMID: 34522505; PMCID: PMC8425506.

25. Jarzyna D, Jungquist CR, Pasero C, Willens JS, Nisbet A, Oakes L, Dempsey SJ, Santangelo D, Polomano RC. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011 Sep;12(3):118-145.e10. doi: 10.1016/j.pmn.2011.06.008. PMID: 21893302.

26. Joint Commission (2010). Comprehensive accreditation manual for hospitals. Oak Brook, IL: Joint Commission.

27. Johnson RG, Arozullah AM, Neumayer L, Henderson WG, Hosokawa P, Khuri SF. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007 Jun;204(6):1188-98. doi: 10.1016/j.jamcollsurg.2007.02.070. PMID: 17544077.

28. https://www.ismp.org/resources/epidural-iv-route-mix-ups-reducing-risk-deadly-errors

29. https://fpm.ac.uk/sites/fpm/files/documents/2020-09/Epidural-AUG-2020-FINAL.pdf

30. Guo S, Li B, Gao C, Tian Y. Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor: A Meta-Analysis. Medicine (Baltimore). 2015 Jun;94(23):e880. doi: 10.1097/MD.0000000000000880. PMID: 26061307; PMCID: PMC4616487.

31. George RB, Allen TK, Habib AS. Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesth Analg. 2013 Jan;116(1):133-44. doi: 10.1213/ANE.0b013e3182713b26. Epub 2012 Dec 7. Erratum in: Anesth Analg. 2013 Jun;116(6):1385. PMID: 23223119.

32. Riley ET, Carvalho B. Programmed Intermittent Epidural Boluses (PIEB) for Maintenance of Labor Analgesia: A Superior Technique to Continuous Epidural Infusion? Turk J Anaesthesiol Reanim. 2017 Apr;45(2):65-66. doi: 10.5152/TJAR.2017.09031. Epub 2017 Apr 1. PMID: 28439433; PMCID: PMC5396898.

33. https://www.who.int/news-room/fact-sheets/detail/palliative-care. Accessed 22 August 2022.

34. https://doi.org/10.3322/caac.20112 Accessed 22 August 2022.

35. McCaffery M, Pasero C, eds. Pain: Clinical Manual. 2nd Ed. St Louis, MO: Mosby; 1999.

36. Caraceni, Augusto, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. The Lancet Oncology 2012; 13.2: e58-e68.

37. Dickman A, Bickerstaff M, Jackson R, Schneider J, Mason S and Ellershaw J, Identification of drug combinations administered by continuous subcutaneous infusion that require analysis for compatibility and stability, Dickman et al. BMC Palliative Care. 2017.

38. Baker J, Dickman A, Mason S, Bickerstaff R, McArdle A, Lawrence I, Stephenson F, Paton N, Kirk J, Waters B and Ellershaw J, An evaluation of continuous subcutaneous infusions across seven NHS acute hospitals: is there potential for 48-hour infusions? BMC Palliative Care. 2020.

Small syringe pumps are used in palliative care where a continuous dose and clinician bolus strategy for pain control is planned

A Framework for Achieving your Smart, Connected Hospital Vision

by Benjamin Kanter, MD, FCCP, Chief Medical Information Officer, Vocera

Hospital IT leaders have made massive investments over the last 20 years on digital technologies. They’ve built an electronic health record infrastructure. They’ve deployed digital technologies like wireless nurse call, digital radiology, and more.

And yet, too often, they’ve received too little value in return when these digital technologies are not connected and integrated within the clinical ecosystem.

To realize optimal value from digital data sources, a hospital needs to be “smart.” In other words, digital technologies need to be integrat

WE DEVELOPED A SMART, CONNECTED HOSPITAL FRAMEWORK TO HELP IT LEADERS VISUALIZE HOW TO MAKE THE MOST OF INVESTMENTS IN THEIR EHR INFRASTRUCTURE AND CLINICAL AND OPERATIONAL SYSTEMS.

ed within the clinical ecosystem through an intel ligent clinical communication and collaboration (CC&C) platform.

A smart hospital is one that leverages data from connected systems in near real-time. This is what enables nurses and physicians to rapidly de rive insight and value from data sources so they can recognize and respond optimally to patient issues and provide better care.

In contrast, siloed technologies create workflow complexity for frontline care teams, who must focus more on dealing with the tools than on the work of patient care. Fragmented clinical communication and workflows have become untenable in the face of staffing short ages. And if the problem remains unchecked, complications will negatively affect patient safety and outcomes.

Smart, connected hospital framework

We developed a smart, connected hospital framework to help IT leaders visualize how to make the most of investments in their EHR in frastructure and clinical and operational systems – while improving the care team experience, patient safety and other outcomes. The frame work illustrates how different types of interop erability work together in the clinical ecosystem starting with interconnected data sources and feeding upward into the end-user experience.

By connecting digital technologies within the clinical ecosystem and enabling deep in teroperability, IT leaders can:

• Unify healthcare teams and the entire enterprise, tying together the clinical and administrative IT systems that are sources of data, information and knowledge.

• Align IT initiatives with a predeter mined, well-constructed plan rather than managing clinical communication systems that grow organically without strategic governance or direction.

• Create a better work environment and experience for nurses, doctors and the

A SMART HOSPITAL IS ONE THAT LEVERAGES DATA FROM CONNECTED SYSTEMS IN NEAR REAL-TIME. THIS IS WHAT ENABLES NURSES AND PHYSICIANS TO RAPIDLY DERIVE INSIGHT AND VALUE FROM DATA SOURCES SO THEY CAN RECOGNIZE AND RESPOND OPTIMALLY TO PATIENT ISSUES AND PROVIDE BETTER CARE.

extended care team – enabling a better experience for patients and families.

Deep interoperability and continuous process improvement

The smart, connected hospital framework consists of four layers which enable deep interoperability and continuous process im provement:

1. Input layer features data interoperability between clinical and operational systems such as the electronic health record, patient monitoring equipment, connected beds and medical devices. Data interoperability creates the foundation for connectedness.

2. Aggregation and intelligent processing layer includes intelligent middleware that enables routing, escalation and prioritization of clinical communications and alarm notifications at scale, delivered with associated context about the patient, event and care team.

3. Experience layer, where workflow interoperability enables people to receive information from multiple systems that has been aggregated and intelligently processed. End-user clinical communication devices reside at this layer and have bearing on how smart a hospital can be.

4. Analytics layer, where IT leaders measure clinical and economic outcomes and gauge the value they’re receiving from digital technology investments. For example, measure the average time to acceptance for bed exit alarms and set goals to drive down average response time. Continuous process improvement is a cornerstone in the development of a smart institution.

Download the ‘Smart, connect hospital framework’ whitepaper at www.vocera.com

Xavier Keutgen, MD, right, talks with Daniel Appelbaum, MD

PRECISION ONCOLOGY: ADVANCING CANCER CARE THROUGH NEW THERANOSTICS APPROACHES

Provided by UChicago Medicine

When Russell Szmulewitz, MD, describes an emerging tool used to diagnose and treat certain cancers, he can sound more like an Army general than an on cologist specializing in prostate cancer. Such is the precision of theranostics, however, that the analogy fits.

“It’s sort of a smart bomb that goes spe cifically to the cancer target, and we can see where it's going based on the imaging piece,” said Russell Szmulewitz, Director of the Geni tourinary Oncology Program at the University of Chicago Medicine.

Cancer theranostics – the word is a blend of "therapy" and "diagnostics" – involves the use of radioactive isotopes to diagnose and treat cancer. Physicians have been using radioactive isotopes like technetium-99 and strontium-89 to diagnose and treat cancer patients for years. Theranostics, however, uses radiotracers made up of two components: a biological component engineered to latch on to a specific protein on a cancer cell, and interchangeable radioactive isotopes that can alternatively make that cell visible on a PET scan and then kill it.

“Theranostics is sort of the ultimate in precision oncology because we can visualize the target within the patient, then give radio active-targeted medicine that we know will go where we think we want it to,” Szmulewtiz said.

Diagnosis and treatment with theranostics do not occur all at once; patients first receive an IV infusion with the diagnostic radiotracer, then get one or a series of IV infusions with the radiotracer treatment a short time later.

CANCER THERANOSTICS

– THE WORD IS A BLEND OF "THERAPY" AND "DIAGNOSTICS" –INVOLVES THE USE OF RADIOACTIVE ISOTOPES TO DIAGNOSE AND TREAT CANCER. PHYSICIANS HAVE BEEN USING RADIOACTIVE ISOTOPES LIKE TECHNETIUM-99 AND STRONTIUM-89 TO DIAGNOSE AND TREAT CANCER PATIENTS FOR YEARS.

“Then, a few months after your treatment, you might go back to get another scan with that diagnostic version of the tracer to see how the treatment worked,” said radiologist Daniel Appelbaum, MD, Chief of Nuclear Medicine and PET at UChicago Medicine.

The concept behind theranostics is not new. Radioactive iodine, for example, has been used for decades to both diagnose and treat thyroid cancer. (Rather than being guided to the cancer by a specific cancer cell-searching drug com ponent, the iodine is absorbed naturally by the thyroid cells.)

New theranostics options offer new hope for our patients, helping them live longer and with better quality of life.

In recent years, physicians have been incorporating this more advanced iteration of theranostics to diagnose and treat certain neu roendocrine tumors (NETs), a rare type of cancer that begins in neuroendocrine cells, which are present in organs throughout the body. Xavier Keutgen, MD, Director of the Neuroendocrine Tumor Program, and Chih-Yi "Andy" Liao, MD, Associate Director of the Gastrointestinal Oncol ogy Program, have been leading this effort.

“New theranostics options offer new hope for our patients, helping them live longer and with better quality of life,” Liao said.

Gallium-68 dotatate, copper-64 dotatate and lutetium-177 dotatate are all FDA-approved theranostic radiotracers that target somatosta tin receptor 2, a protein that is over-expressed on the surface of NETs.

“From a diagnostic perspective, many studies have shown that gallium-68 dotatate or copper-64 dotatate PET-CT is vastly superior to any imaging modality for well-differentiated NETs,” said Xavier Keutgen, MD, an endocrine and neuroendocrine surgeon who directs the neuroendocrine tumor program. “When it comes to treatment with lutetium-177 dotatate, we’re talking about a benefit of several years in life expectancy for patients with NETs.”

Physicians are also hopeful about the use of theranostics for prostate cancer, a common cancer that affects one in eight men in their lifetime. UChicago Medicine was involved in the clinical trials for both piflufolastat F-18 and lutetium-177 PSMA-617. The FDA approved use of the former last year to diagnose certain pros tate cancers and is expected to soon approve lutetium-177 PSMA-617 to treat metastatic, castration-resistant prostate cancer. Both of these radiotracers, along with diagnostic tracer gallium-68 PSMA-11, target prostate specific membrane antigen (PSMA), a protein on the surface of prostate cancer cells.

There are, of course, caveats with theranos tics: Patients are exposed to radiation that may occasionally lead to developing other types of cancer, and the treatments are expensive and are typically not a cure. Cancer is clever, Appel baum said, and the radiotracer doctors select to diagnose or treat a patient may not work on all of their cancer cells.

“You can have multiple metastases which behave differently in the same patient – they can have different genetic profiles,” said Appelbaum.

With the only academic health system cyclo tron in Illinois capable of producing novel radio active agents and in collaboration with Argonne National Laboratory, UChicago Medicine scientists are working to develop better theranostics that build off of those currently or soon available. Chin-Tu Chen, PhD, the scientific director of the UChicago Medicine Cyclotron Facility, is leading several studies, including one examining the ef fectiveness of using the same element, scandium, for both diagnosing and treating cancers.

“There are certain potential advantages to using scandium-43 and scandium-47 as a theranostic pair compared to gallium-68 and lu tetium-177,” said Chen. “It’s the same element, so the pharmacokinetics will most likely be the same, and part of our research will be determin ing whether that's clinically important or not.” Chen is working with Szmulewitz, Keutgen and Appelbaum and a team of other experts to see if they can increase the number of cancer cell targets at which novel theranostics can take aim.

THERE ARE, OF COURSE, CAVEATS WITH THERANOSTICS: PATIENTS ARE EXPOSED TO RADIATION THAT MAY OCCASIONALLY LEAD TO DEVELOPING OTHER TYPES OF CANCER, AND THE TREATMENTS ARE EXPENSIVE AND ARE TYPICALLY NOT A CURE. CANCER IS CLEVER, APPELBAUM SAID, AND THE RADIOTRACER DOCTORS SELECT TO DIAGNOSE OR TREAT A PATIENT MAY NOT WORK ON ALL OF THEIR CANCER CELLS.

MEDICAL

“We are still at the very early stages of theranostics, but we have the right people here, from basic scientists in chemistry work ing on new biomarkers, all the way to clinicians, and everybody's within two blocks,” said Chen. “This is the model of team science.”

MORE INFORMATION, VISIT WWW.UCHICAGOMEDICINE.ORG/GLOBAL

Chin-Tu Chen, PhD, is the scientific director of the UChicago Medicine Cyclotron Facility

Why is air filtration so important?

Environmental decontamination and hand hygiene are universally recognised to reduce the risk of infections and keep people safe. However, adequate ventilation is vital for ensur ing the air within hospitals is safe.

Aerosols and droplets carry infectious micro organisms in the air that can spread infections

A PORTABLE AIR PURIFICATION DEVICE.

more easily within poorly ventilated spaces1

Effective air filtration devices can help remove these microorganisms and particulates from the air.

Air filtration devices draw the air through the machine, trap the contaminants within a HEPA filter and blow clean air back into the room, significantly increasing the air quality.

MEDICAL EQUIPMENT

Aerosol & droplet transmission

We constantly release bacteria, viruses and fungi into the air around us. Pathogens like Mycobacterium tuberculosis, influenza, RSV and coronaviruses are found in droplets and aerosols expelled when we talk, cough or even breathe, potentially infecting other people or landing on and contaminating surfaces.

Until recently, it has been accepted that Droplets are particles above 5 micrometres (µm) in diameter that typically settle within 2 metres, while aerosols are smaller particles (below 5µm) that remain airborne longer and spread over large distances.

There is currently a growing body of evi dence to suggest that this might not be true.2

Infectious aerosols can be inhaled, deposited on our susceptible mucous membranes or trans ferred to our mucous membranes by contami nated hands.

HEALTHCARE FACILITIES SUCH AS OPERATING THEATRES OR INTENSIVE CARE UNITS WILL ALREADY HAVE SPECIALISED FIXED MECHANICAL VENTILATION SYSTEMS INSTALLED.

Benefits of air filtration

Portable HEPA filters can reduce the risk of inhaling viable pathogens within a poorly ventilated area1. Unlike traditional air filtration systems found in shared spaces, portable air filtration devices give you the flexibility to pro vide clean air where & when you need it.

Air filtration devices can capture a variety of contaminants such as:

• Airborne pathogens (bacteria, fungi & viral aerosols)

Fine and ultra-fine particles

• Dust

• Mites

• Odours

• Pet dander

Air filtration in healthcare Healthcare facilities such as operating

theatres or intensive care units will already have specialised fixed mechanical ventilation systems installed. However, in open wards & shared spaces, hospitals might lack effective air filtration and installing cumbersome, fixed mechanical systems can be difficult.

Rediair

Designed by infection prevention experts, Rediair is a portable air purification device that captures particles as small as 0.3m and has a CADR rate of up to 600m3/hr.

Dual HEPA 14 filtration

At the heart of Rediair are two carbon com posite HEPA 14 filters that work in tandem with the dual centrifugal intake fans and easy-toclean nylon pre-filters to capture particulates, odours and 99.995% of airborne pathogens.

High clean air delivery rate

Due to its dual-intake filtration system, Re diair has an exceptionally high clean air delivery rate (CADR) of up to 600m3/h. Despite its small form factor, a single unit provides effective ventilation for rooms up to 120m3.

Ultra-low noise

Rediair is surprisingly quiet when in normal use. Featuring many different settings and speeds, Rediair is a powerful air filtration unit designed to operate without causing distraction.

Rediair’s four different operating modes and a small form factor allow Rediair to be used almost anywhere from waiting rooms & open wards to offices and triage rooms.

Flexible filtration

Rediair’s dual HEPA 14 & carbon cloth com posite filters decontaminate a room’s air almost instantly. Plug in, select your mode and let Rediair do the rest; it’s that simple. Adaptable to many different situations, Rediair has four operating modes to choose from:

Automatic mode

When set to automatic mode, Rediair uses intelligent particulate sensing to detect air quality

REDIAIR IS AN INCREDIBLY SUBTLE AIR FILTRATION DEVICE; ULTRAQUIET FANS AND LIGHT REDUCTION SETTINGS MEAN THAT REDIAIR CAN OPERATE WITHOUT DISTRACTION. WHILE THE INTERNAL MECHANISMS ARE COMPLEX, USING REDIAIR IS QUITE THE OPPOSITE.

and automatically adjusts the fan speed to effec tively remove contaminants whilst displaying the current air quality via its LED air quality indicator.

Manual Mode

Rediair’s manual mode offers complete control and allows you to tailor its operating parameters to whatever situation you need. Navigating through its simple digital display to select fan speeds, operating times and light modes, Rediair offers you quick and simple to use air purification.

Turbo Mode

Turbo mode spins both centrifugal intake fans at top speed, significantly increasing its clean air delivery rate (CADR) up to 600m3/h, removing contaminants more quickly and effectively.

Night mode

When set to night mode, Rediair uses its builtin light sensor to monitor the room’s light. Rediair will switch off all LEDs & displays and lower fan speeds when light levels fall to provide near-silent decontamination throughout the night.

Rediair is an incredibly subtle air filtration device; ultra-quiet fans and light reduction settings mean that Rediair can operate without distraction. While the internal mechanisms are complex, using Rediair is quite the opposite. The intelligent air quality indicator can read the quality of the surrounding air and start decon tamination within seconds of activation.

GAMA Healthcare is an infection prevention expert working to reduce the risk of infection to help save and improve lives. For more information about our business and products, please visit WWW.GAMAHEALTHCARE.COM

1. Pirkle S, Bozarth S, Robinson N, et al. Evaluat ing and contextualizing the efficacy of portable HEPA filtration units in small exam rooms. American Journal of Infection Control. 2021;49(12):1506-1510. doi:10.1016/j. ajic.2021.08.003

2. Dancer SJ, Tang JW, Marr LC, Miller S, Morawska L, Jimenez JL. Putting a balance on the aerosolization debate around SARS-CoV-2. Journal of Hospital Infection. 2020;105(3):569-570. doi:10.1016/j.jhin.2020.05.014

U.S. News & World Report Names Baylor St. Luke’s Medical Center Among the Best in Hospitals in the United States

Baylor St. Luke’s Medical Center is an 881bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and St. Luke’s Health. Located in the Texas Medical Center, the hos pital is the home of the Texas Heart Institute, a cardiovascular research and education institu tion founded in 1962 by Denton A. Cooley, MD.

The hospital was the first in Texas and the Southwest designated a Magnet Recognition Program hospital for Nursing Excellence by the American Nurses Credentialing Center, receiv ing the award five consecutive times. Baylor St. Luke’s also has three community emergency centers offering adult and pediatric care for the Greater Houston area.

Baylor St. Luke’s Medical Center was recog nized as the Best Hospital for 2022-23 by U.S. News & World Report. The annual Best Hospitals rankings and ratings, now in their 34th year, are designed to provide data-driven decision sup port to patients and their families so they, with their doctors, can make informed choices about where to seek care for specific hospital services.

In addition to being ranked as the Best Hospital, Baylor St. Luke’s was ranked as one of the top hospitals in the following six specialties:

• Cancer (Dan L Duncan Comprehensive Cancer Center)

• Cardiology & Heart Surgery (Texas Heart Institute)

• Gastroenterology & GI Surgery

• Geriatrics

• Neurology & Neurosurgery

• Urology

Baylor St. Luke’s also earned “High Perform ing” ratings in Pulmonology & Lung Surgery and the following procedures and conditions: abdominal aortic aneurysm repair, aortic valve surgery, chronic obstructive pulmonary disease (COPD), colon cancer surgery, diabetes, heart

attack, heart bypass surgery, heart failure, acute kidney failure, lung cancer surgery, pneumonia, stroke, and transcatheter aortic valve replace ment (TAVR).

“Continued recognition as the Best Hospital by U.S. News is a testament to the devotion of our expert clinical teams in delivering ad vanced treatments that promote the health and well-being of our patients,” said Liz Young blood, SVP/COO of St. Luke's Health and presi dent of Baylor St. Luke’s Medical Center. “People in Houston and beyond should know that Baylor St. Luke’s is committed to highly specialized, high-quality care, and the associated outcomes that patients expect and deserve.”

“Now in its eighth year, the joint venture be tween Baylor College of Medicine and St. Luke’s Health continues to showcase itself as a phe nomenal partnership,”said Paul Klotman, M.D., President & CEO and Executive Dean of Baylor College of Medicine. “Baylor St. Luke’s Medical Center is delivering quality care and outstanding outcomes while training the next generation of physicians and health professionals.”

“With Baylor St. Luke’s Medical Center as our academic flagship, St. Luke’s Health brings advanced care, world-class clinicians, and exten sive research to patients in need of medically complex care,” said Doug Lawson, Ph.D., Chief Executive Officer of St. Luke’s Health. “It’s a priv ilege to again be recognized as a Best Hospital by U.S. News and bring high-value, high-quality care to Houston and beyond.”

For the 2022-23 rankings and ratings, U.S. News evaluated more than 4,500 hospitals In the U.S. in 15 specialties and 20 procedures and conditions. In the 15 specialty areas, 164 hospi tals were ranked in at least one specialty.

The U.S. News Best Hospitals methodologies in most areas of care are based largely on objec

Liz Youngblood

Paul Klotman

Doug Lawson

tive measures such as risk-adjusted survival and discharge-to-home rates, volume, and quality of nursing, among other care-related indicators. Best Hospitals was produced by U.S. News with RTI International, a leading research organization based in Research Triangle Park, N.C.

For more information about the 202223 rankings and ratings, please visit usnews. com. The rankings will be published in the U.S.

FOR THE 2022-23 RANKINGS AND RATINGS, U.S. NEWS EVALUATED MORE THAN 4,500 HOSPITALS IN THE U.S.

News “Best Hospitals 2023” guidebook (ISBN 9781931469999), available for pre-order now from the U.S. News Online Store and for pur chase at other bookstores later this year.

For more information, visit Best Hospitals and use #BestHospitals on Facebook and Twitter. https://about.stlukeshealth.org/bslmcinternational international@stlukeshealth.org +1.832.355.3350

Exceptional psychotherapy from the Czech Republic

A network of NEO Center clinics

The Covid 19 pandemic has caused in creased interest in psychologists and ther apists worldwide. The numbers of addic tions, depression, anxiety, and other conditions that people did not experience so much three years ago have also increased. Neo Center clinics help clients from all over the world. During Covid, they helped doctors and medical staff from the largest Czech state university hospital, Motol, to overcome these mentally demanding days for free. Today, the NEO Center network of private clinics has two residential clinics and one outpatient clinic in Prague. Proud to have

a team of professional therapists, a family approach, quality services, and 100% discretion that you’d hardly find elsewhere. Neo Center's partner clinic is the unique private clinic RósGlas in Ireland.

After more than five years of operation, NEO Center already has a strong position and public awareness. It cooperates with leading experts in the addiction field, its representatives participate in psychological conferences, and cooperates with the largest Czech state universi ty hospital Motol.

PSYCHOTHERAPY GETS YOU BACK TO LIFE QUICKLY, WITH DIGNITY AND FULL STRENGTH.

The demand for therapists has been grow ing for the past two years. Mental disorders, poor mental health, and addictions are on the rise in the post-covid era. People put more and more pressure on themselves, which they then struggle to balance. This is one of the reasons why Libor Votruba founded this therapy clinic, which offers above-standard services from top therapists under 100% anonymity.

The private clinic recommended by the state health sector

During the COVID-19 pandemic, NEO Center cooperated with the largest and most prestigious Czech state university hospital, Motol, which annually hospitalizes up to 80,000 patients. The NEO Center became the place where doctors and nurses came during the most difficult moments of their careers. NEO Center provided them with free space to regain strength in their admirable profession. Hospital employees used outpatient therapy services or several-day stays in clinics. NEO prides itself on a high success feedback rate of treatment processes.

The collaboration was established on the basis of an agreement with Dr. Martin Holcát, Deputy Director of the Motol University Hospital in Prague for curative and preventive care and former Minister of Health of the Czech Republic. The help system was linked to the exhibition and the Helpful Art in Covid project, on which Martin Holcát collaborated with the artist Pavel Šťastný. The exhibition maps over 2,000 works of art from 90 countries with the theme of COVID-19 and was exhibited in Motol hospital under the title "Art is part of positive therapy and it heals”.

The most common problems the clinic's pa tients deal with are addictions, phobias, depres sion, anxiety, and crises of various kinds. NEO Center therapists noticed an increase mainly in connection with the covid period, and until today people are still dealing with the aftermath in various forms. Therapists are able to react quickly and treat patients practically immediate ly after they decide to go with the treatment.

They offer individual and group therapy, psychiatric consultations, the globally recog nized 12-step method of Alcoholics Anonymous, family and couple therapy, as well as relapse

INDIVIDUAL CARE, DISCRETION, AND QUALITY SERVICES ARE THE BASE PILLARS OF THE NEO CENTER IN PRAGUE.

prevention - preventing risky situations and effectively dealing with failure.

Therapy can be arranged online or visit the clinic in Prague - Libeň.

WWW.NEOCENTRUM.CZ

Digital maturity in health: Comparison with other industries

by Dr. Yasir Khan, Lead Physician Executive, Oracle Cerner in the Middle East and Africa

decisions. Numerous examples support the digitalization of healthcare today, including AI-powered medical devices, telemedicine, blockchain, remote patient monitoring and electronic health records. The primary goal of healthcare innovation is to speed the work of medical professionals, enhance medical software systems, eliminate human errors, im prove patient outcomes, and reduce costs by integrating physical and digital experiences.

Over the course of the past two decades, a concerted effort has been observed to shift from paper-based records to electronic re cords by boosting the adoption of technology. However, to the frustration of policymakers, this did not fundamentally change how busi ness is conducted and care is delivered.

Senior healthcare professionals and in dustry observers have long believed that the healthcare business is behind other industries in adopting new technology and undergoing digital transformation. McKinsey has published a digital index1 comparing the matu rity of different industries, which demonstrates healthcare among the least advanced sectors in digitalization, particularly regarding transactions, digital spending on employees and digital capi tal. However, exactly how far behind schedule is the healthcare system?

The reality is more complicated. Digital maturity in the healthcare industry was found to be placed third in a recent survey of six different industries, with healthcare compa nies on average being a decade behind other sectors in implementing business technology that can improve consumer interaction.

Digitalization in healthcare

The rise of healthcare digitalization has transformed how we communicate with healthcare providers, exchange medical data, and make treatment and outcome-related

Comparison of digital maturity in healthcare with other industries

Virtusa, an international digital engineer ing and IT outsourcing company, surveyed the digital maturity of companies throughout the world2. They commissioned Forrester Consult ing to undertake research in September 2017 to assess the state of digital transformation in six key industries:

• Banking

• Healthcare

• Insurance

• Media

• Retail

• Telecommunications

The study was used to create involvement from more than 600 digitization policymakers in North America and Western Europe, and 101 healthcare companies. Across all three catego ries, retail excels over other industries, setting the norm for innovative and digitally driven customer experiences. One of the leading causes of the decade-long delay for health care is that these organizations are subject to

AT ORACLE CERNER, THE GAP BETWEEN CLIENTS’ EXPECTATIONS OF BUSINESS TRANSFORMATION AND THE CURRENT STATE OF CONSERVATIVE DIGITIZATION IN HEALTHCARE IS NOT LOST ON US. THIS HAS LED TO A NUMBER OF INTERNAL AND CLIENT-FACING INITIATIVES AIMED AT REIMAGINING CLINICAL WORKFLOWS, REMOVING REDUNDANT LEGACY PROCESSES, IMPROVING INFORMATION FLOW AND ITS AVAILABILITY, AND INTRODUCING NEWER, OUTCOMEFOCUSED MODELS OF CARE DELIVERY THAT LEVERAGE TECHNOLOGY AND AUTOMATION.

several different rules regarding the handling of patient data.

According to the survey, healthcare was ranked second in data optimization but came in last in self-service, online marketing and their ability to adapt to new business models. These organizations ranked fourth and fifth for customer service and business innovation, respectively. According to the report, the healthcare industry's conservative and highly regulated market places security above patient interaction. According to a new study, "health firms have made gains to survive in managing the data security – but most of their technol ogy investments have been centered more on business operations and record-keeping at the cost of investments that tie directly to discov ering new aspects of the customer (patient) engagement and innovation".

At Oracle Cerner, the gap between clients’ expectations of business transformation and the current state of conservative digitization in healthcare is not lost on us. This has led to a number of internal and client-facing initia tives aimed at reimagining clinical workflows, removing redundant legacy processes, improv ing information flow and its availability, and introducing newer, outcome-focused models of care delivery that leverage technology and automation.

Comprehensive information systems, like Cerner Millennium®, cover the end-to-end patient journey and hence hold terabytes of rich data from admission to discharge and every thing in between.

However, according to some studies, less than 3% of this data is actually utilized for effective decision-making, while the remaining 97% is retained for record-keeping and safe storage. Organizations looking to climb the digital maturity model must focus their ener gies on reversing the above-mentioned ratio. Every click, every patient interaction and every diagnostic information entered into the system is potentially a crucial piece of a bigger puzzle for understanding disease patterns for a patient or population we serve.

Across the digital healthcare paradigm, ef forts are underway to ensure organizations can see a clear path from digitization (introducing the digital equivalent of manual processes) to digital transformation (newer business models of service delivery). Some of the great examples are ‘reimagining workshops’ to highlight the impact of organizational inertia and legacy pro cesses and try to challenge the status quo with an eye on creating efficiencies, patient centricity and convenience.

Conclusion

Healthcare's progress toward digital transformation has been gradual and unevenly distributed. Even so, it is unclear if such invest ments are making a difference in the world. Oth er industries face significantly less bureaucracy and regulation when it comes to integrating new digital capabilities. If healthcare executives focus on digital transformation rather than just digitizing current models, new ideas, regulations and cross-sector partnerships could begin to change that. There is a need to acknowledge the various unique challenges healthcare faces for digital transformation and employ collabo rative strategies to counter them. Even though the healthcare industry has been sluggish in accepting new technologies, there have been notable examples of development and innova tion, providing some cause for optimism about the future of healthcare technology.

References:

1.https://www.mckinsey.com/ industries/healthcare-sys tems-and-services/our-insights/ digital-is-reshaping-us-health-in surance-winners-are-moving-fast

2. https://www.busi nesswire.com/news/ home/20180322005685/en/ Independent-Study-Commis sioned-by-Virtusa-Finds-85-Per cent-of-Businesses-Plan-to-In vest-in-Digital-Transforma tion-in-2018

THE RISE OF HEALTHCARE DIGITALIZATION HAS TRANSFORMED HOW WE COMMUNICATE WITH HEALTHCARE PROVIDERS, EXCHANGE MEDICAL DATA, AND MAKE TREATMENT AND OUTCOME-RELATED DECISIONS.

INTERVIEW

Pfizer. Evolution of COVID-19 and high-risk awareness

CDC Medical Director, Dr. Muna Almaslamani

must be mindful however that the number of confirmed cases is lower than the true number of infections due to more people now conduct ing at-home tests, or limited/infrequent testing.

Evolving and circulating variants are a reminder that the virus continues to evolve and remains highly unpredictable. And, as long as it remains unpredictable, it remains a risk.

What do you think are the factors that are contributing to the rise of infections?

There are several reasons that have most likely contributed to the surge in cases.

One being new variants of concern, which I touched upon earlier. Since the start of the pandemic, we have identified, monitored, or classified approximately 40 variants1

When someone who is vaccinated and/ or has a booster dose gets infected with the virus that causes COVID-19, it is referred to as a “vaccine breakthrough infection” (as per the CDC – Centers for Dis ease Control and Prevention). Those who get breakthrough infections can spread the virus to other people. "Hospitals" magazine recently interviewed Dr. Muna Almaslamani, CDC Medi cal Director, who talked about the Evolution of COVID-19 and high-risk awareness.

What is the current average number of cases in the country? Is there a rise in the number of cases per day?

Generally, case numbers continue to fluctu ate, although the most recent Omicron subvari ants have led to a rise in cases. We experienced a spike through mid-to-end of July and are now recording some 600+ cases among community members within 24 hours*. That means we have approximately 5,000+ current active cases*. We

THE VIRUS’S ABILITY TO EVOLVE AND MUTATE MEANS THAT THE VIRUS IS TAKING ADVANTAGE OF DIFFERENT ENVIRONMENTS, THEN EMERGING AND ADAPTING; BE IT JUMPING TO A DIFFERENT HOST OR REMAINING WITHIN A PATIENT FOR AN EXTENDED TIME. THIS ALLOWS THE VIRUS SPREAD MORE EFFECTIVELY.

The virus’s ability to evolve and mutate means that the virus is taking advantage of different environments, then emerging and adapting; be it jumping to a different host or remaining within a patient for an extended time. This allows the virus spread more effectively.

Secondly, we have the issue of vaccination uptake and compliance. As of June 2022, at least 65.7 per cent of the world’s population have received at least one dose of the COVID-19 vaccine2. However, large portions of the popula tion remain unvaccinated or partially vaccinated. The challenge here is that despite immunization, and being boosted, infections can still occur due to evolving variants, which is a factor towards rising numbers.

Lastly, we’ve seen the easing of COVID-19 restrictions globally. While these are welcome by many, the freedom in movement, as well as the in crease in international travel, has exacerbated the spread, particularly over the past few months.

How do you explain the surge of infections to your patient’s post-vaccinations?

When someone who is vaccinated and/ or has a booster dose gets infected with the virus that causes COVID-19, it is referred to as

INTERVIEW

a “vaccine breakthrough infection” (as per the CDC – Centers for Disease Control and Preven tion). Those who get breakthrough infections can spread the virus to other people.

This typically happens because of the evolv ing strains, which means the virus mutates to outcompete those before it (infecting people who were immune to previous strains). And, sec ondly, because there are patients that are more susceptible to risk. Patients with one or more risk factors are vulnerable as are those that are immunocompromised.

The important thing to note, and the reason why we stress the importance of being vaccinat ed is because should people who have been vac cinated get COVID-19, they are much less likely to experience severe symptoms than people who are unvaccinated. Locally, as of 7 August 2022, 95.5 per cent of the population has been fully vaccinated which helps to reduce the risk of severe infection and hospitalization.

What type of patients are particularly at high risk of COVID-19 infections? What is your advice for them in terms of testing and management of COVID-19 symptoms?

According to the WHO and the CDC, highrisk people — typically defined as those who have existing or underlying health conditions and/or meet one of the following criteria: 60+ years old, pregnant, diabetic, hyperten sive, obese, high cholesterol, smokers, cancer patients, chronic kidney, lung or liver disease, sickle cell disease, heart conditions, HIV infec tion, neurodevelopmental disorders, or are immunocompromised, on immunosuppressive treatment, or have medical-related techno logical dependance, among others3,4 — face a greater threat of COVID-19 progressing to a serious illness. A person’s risk of severe illness from COVID-19 also increases in direct pro portion to the greater number of underlying medical conditions they have.

It is estimated that at present, 40-50 per cent of the global population are considered high-risk, which means that they could become seriously ill or hospitalized should they become infected with the COVID-19 virus.

AS HEALTHCARE PROVIDERS, IT IS OUR RESPONSIBILITY TO HELP PROTECT LIVES AND IDENTIFY HIGH-RISK PATIENTS, ENSURING WE PROVIDE THE RISK GUIDANCE AND ADVICE TO PROTECT THEM AS BEST AS WE CAN. WE ENCOURAGE PATIENTS TO GET TESTED AT THE EARLIEST SIGNS OF COVID-19 SYMPTOMS. EVEN IF SYMPTOMS MAY APPEAR MILD, LIKE A RUNNY NOSE OR SORE THROAT, IT IS IMPORTANT TO TEST AS IT COULD PROGRESS TO A MORE SERIOUS DISEASE, PARTICULARLY IF THE PATIENT IS WITHIN ONE OR MORE RISK CATEGORIES.

For example, cancer patients are much more likely to get very sick if infected with COVID-19 — because the treatment they may be receiving (such as chemotherapy) for a par ticular type of cancer can weaken the immune system and therefore weaken their body’s ability to fight off the virus.

Similarly, diabetics are also more likely to suffer from COVID-19 complications as high blood sugar weakens the immune system and makes it less able to fight off infections. Viral infections can also increase inflammation, or internal swelling, in people with diabetes. This can also be a result of above-target blood sug ars, which leads to inflammation that could lead to more severe complications.

As healthcare providers, it is our responsi bility to help protect lives and identify high-risk patients, ensuring we provide the risk guid ance and advice to protect them as best as we can. We encourage patients to get tested at the earliest signs of COVID-19 symptoms. Even if symptoms may appear mild, like a runny nose or sore throat, it is important to test as it could progress to a more serious disease, particularly if the patient is within one or more risk categories.

From our end, we’re tracking all reported positive cases in the country on a daily basis and have a triage system in place that allows us to identify risk factors and the severeness of symptoms and consequently prioritize the patients’ care based on the urgency of their condition. We then decide the appropriate treatment based on protocol advised by the Hamad Medical Corporation – Communicable Disease Center — which is the principal health care provider in the State.

*Accurate at the time of publishing.

1 ECDC. SARS-CoV-2 variants of concern as of 21 April 2022. Available at: https:// www.ecdc.europa.eu/en/covid-19/variants-concern. Accessed: April 2022

2 Our World in Data. Coronavirus (COVID-19) Vaccinations. Available at: https:// ourworldindata.org/covid-vaccinations. Accessed: June 2022

3 World Health Organization. Available at: https://www.who.int/images/de fault-source/wpro/health-topic/covid-19/severity-slide5.png?sfvrsn=7fbef143_7. Accessed May 2022

4 Centers for Disease Control and Prevention. COVID-19 Information for Specific Groups of People.

Available at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/ index.html. Accessed May 2022.

INTERVIEW

Dr. Ali Chaari

Dr. Ali Chaari is a Biochemist who obtained his degree in engineering biology from the National Engineering School in Tunisia and his PhD in Biochemistry and Cellular Biology from the University of Versailles, France. He is currently an Assistant Professor of Biology at Weill Cornell Medicine-Qatar (WCM-Q), where he teaches Biochemistry in the pre-medical divi sion. Dr. Chaari has been a Pl and co-Pl on inter nally and externally funded projects and has also participated in a host of other projects. This has led to several publications involving pre-medical and medical students. His two active research areas are 1) the study of amyloid proteins mod ulation in neurodegenerative diseases and type 2 diabetes (T2D) and 2) the role of Microbiome Therapy on health promotion and disease. Dr.

THE SERIES RUNS UNTIL OCTOBER 25, 2023.

Chaari is also the Director of a new online webi nar series offered by the Division of Continuing Professional Development at WCM-Q, titled Protein Misfolding Diseases and Neurodegener ation: From Experimental Approach to Clinical Therapy. The series runs until October 25, 2023. The launch of the series has been timed to co incide with World Alzheimer’s Day to help raise awareness of this important disease.

Who is the target audience for your new webinar course and what is the benefit of healthcare professionals undertaking this training?

The target audience for the new webinar series will be all healthcare professionals across multiple disciplines, including medical students, researchers, and educators. This is because the presentations are organized in a way that explain the basic pathogenesis, causes of onset and development, as well as the most recent advancements in diagnostic and therapeutic capabilities associated with neurodegenerative diseases. This will help the participants to pro mote a better understanding of the healthcare management options for neurodegenerative diseases, both now and into the future.

What are the most prevalent forms of neurodegenerative disease?

Neurodegenerative diseases affect mil lions of people worldwide. Alzheimer's disease (AD) and Parkinson's disease (PD) are the most common neurodegenerative diseases. As an example, the prevalence of AD is roughly 30% among people 85 years and older. With prom inent strides in medical science and a gradual increase in overall life expectancy, the global

Director of a new online webinar series offered by the Division of Continuing Professional Development at WCM-Q

“ The webinar series will aim to assess and address current gaps in knowledge regarding neurodegenerative diseases in Qatar, the Middle East and North Africa (MENA) region, and beyond."

prevalence of dementia, a primary pathology associated with many such disorders, is expect ed to increase from 57.4 million in 2019 to 152.8 million by 2050, while the prevalence across the US is to almost double in the same time period.

What is protein misfolding and how does it lead to neurodegenerative disease?

The misfolding of proteins and disruption of protein homeostasis are linked to the accumula tion of amyloid fibrils or amorphous aggregates. When this happens in vulnerable neural cells, the resulting neurotoxicity and stress (with the help of the host’s immune cells and associated inflammatory mechanisms) lie behind the prima ry pathogenesis of the most prevalent age-as sociated neurodegenerative diseases, including Alzheimer’s disease, Huntington’s Disease (HD), Parkinson’s disease, Amyotrophic Lateral Scle rosis (ALS), and multiple prion diseases such as Creutzfeldt – Jakob disease (CJD). Despite the existence of some similarities between neurode generative diseases, the origin of the causes may differ. Protein aggregation and misfolding are also the subjects of discussion of the patho genesis of non-neurological disorders such as systemic amyloidosis, dialysis-related amyloido sis, type 2 diabetes, and cataract.

Why are neurodegenerative diseases becoming more common?

Neurodegenerative diseases represent a major threat to human health. These age-de pendent disorders are becoming increasingly prevalent, in part because the elderly popula tion has increased in recent years. In fact, one in ten individuals aged ≥65 years has AD, and its prevalence continues to increase with increasing age. Also, the change in lifestyle and losing good habits such as a balanced diet, a certain level of physical activity, as well as increased risk of certain diseases such as hypertension and T2D, lead to the increased prevalence of neurodegen erative diseases.

What are the risk factors for neurodegenerative disease?

Aging is the main risk factor for most neurodegenerative diseases. Besides aging, the combination of a person’s genes and environ

THE SERIES WILL ENABLE THE AUDIENCE TO UNDERSTAND THE MECHANISM OF PROTEIN MISFOLDING AND AMYLOID FORMATION BEHIND THE MOST COMMON NEURODEGENERATIVE DISEASES AND LEARN ABOUT THE MOST RECENT ADVANCEMENTS IN THEIR POTENTIAL TREATMENT MODALITIES TO PROMOTE A BETTER UNDERSTANDING OF THE HEALTHCARE MANAGEMENT OPTIONS NOW AND IN THE FUTURE.

ment contributes to their risk of developing a neurodegenerative disease. In fact, the existence of certain genetic polymorphisms can increase the susceptibility of a person to have the associ ated neurodegenerative disease. For example, someone might have a gene that makes them more susceptible to AD or PD disease, but their environmental exposures can affect whether, when, and how severely they are affected. This is without neglecting the effect of other possi ble contributing factors, including gender, poor education, and health conditions. For instance, the susceptibility to have neurodegenerative dis eases increases with people having one of these conditions: oxidative stress, inflammation, stroke, hypertension, diabetes, smoking, head trauma, depression, infection, tumors, vitamin deficien cies and immune and metabolic conditions.

How do neurological diseases affect populations in the MENA region?

Studies of Arab countries, including those of the MENA region, found neurodegenerative diseases to be prevalent regionally, ranging be tween 1.1-2.3% in the ≥ 50 years population and this percentage is increasing with age to reach 13.5-18.5% in the ≥ 80 years population. The im portance of this number, which may increase in the coming years may be explained by the high prevalence of hypertension as well as T2D in the Arab countries.

How do sleep and physical activity affect cognitive function in older adults?

First, recognizing that a neurodegenerative disease is a condition that affects neurons in the brain, causing symptoms such as memory loss, moodiness, anxiety, depression, and agitation, helps explain how sleep and physical activity affect cognitive function in older adults, who are more susceptible than other groups to neurode generative disease.

Getting a good sleep, which is defined by getting enough hours of high-quality sleep, increases attention-span and concentration. Sleep also supports numerous other aspects of

INTERVIEW

thinking, including memory, problem-solving, creativity, emotional processing, and judgment. Related to this, many studies linked poor sleep with longer-term cognitive decline, including the development of dementia and Alzheimer’s disease. Research demonstrates that exercise can boost memory and thinking by reducing stress and anxiety as well as improving mood and sleep. In this regard, research demonstrat ed that increased levels of physical activity in elderly subjects was associated with an increase in their hippocampal volume, which can lead to improved memory performance.

What can individuals do to reduce their risk of developing neurodegenerative disease?

Several studies indicate that a person can try to reduce the risk of developing neurode generative diseases by exercising regularly, getting plenty of high-quality sleep, eating a healthy and balanced diet, staying mentally and socially active, reducing stress, taking control of their health, and managing chronic conditions.

How is neurodegenerative disease diagnosed and treated?

Previously, some structural neuroimaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) were used for diagnosis, but due to very low speci ficity, they have been replaced by new neuro imaging techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Despite signif icant attempts to find drugs that can treat the symptoms of many neurodegenerative diseases, still there are no effective therapeutics to treat neurodegenerative diseases. The treatments available only manage the symptoms or halt the progression of the disease.

What does the future hold for the diagnosis and treatment of neurodegenerative disease in the light of new research?

Firstly, we should emphasize the impact of neurodegenerative diseases on the economy since this may justify any high research cost. Taking into consideration Alzheimer’s diseases

AI CAN BE USED TO PREDICT COGNITIVE IMPAIRMENT AND TO ANTICIPATE HOW SEVERE SOME SYMPTOMS WILL BE OVER TIME, SUCH AS THE DECLINE OF MOTOR SKILLS. THIS CAN HELP ACCELERATE PATIENT DIAGNOSIS SO THE PROCESS OF MANAGING THE PROGRESSION OF SYMPTOMS CAN BEGIN EARLIER.

as an example of neurodegenerative disease, we should note that the average duration of AD is between two and 10 years and this is predicted to cost about $1 trillion per annum in the US alone by 2050. With this in mind, even a therapy that could delay the symptoms of this kind of dis ease would have a significant positive influence on individuals, families, societies, and economies.

Besides this, we should emphasize that the the etiology of neurodegenerative diseases is still not completely understood, and that most of the medication only treats symptoms. With life expectancy increasing, it is important to enhance our understanding of these diseases, their diag nosis, and their mechanisms in order to develop novel therapies. Currently, biological assays, including aggregation, cell viability and cytotox icity to better understand the modification of neuronal death, signaling assays and neuron func tion, and the study of new biomarkers that might allow early diagnosis, are vital in helping scientists in better understanding of the underlying mecha nisms of these conditions, in addition to discover ing promising therapies. Further to this, advances in the technologies that allow for the imaging of pathological protein assemblies are one of the important areas of research to focus on.

How is the increasing sophistication of AI changing the research paradigm for neurodegenerative diseases and protein misfolding?

To combat the increased prevalence of protein misfolding, amyloid formation and neu rodegenerative diseases, many studies focus on artificial intelligence (AI). In fact, AI can be used to predict cognitive impairment and to anticipate how severe some symptoms will be over time, such as the decline of motor skills. This can help accelerate patient diagnosis so the process of managing the progression of symptoms can begin earlier. Also, researchers can use AI to discover potential drugs and new biomarkers or biological targets that could lead to better treatments.

What action can policymakers and healthcare and research leaders in the MENA region take to address the increasing prevalence of neurological diseases?

INTERVIEW

In my opinion, the first thing that should be done is to increase awareness of neurodegener ative diseases, the causes that may increase the prevalence of these diseases, and what we as individuals can do to reduce our risk of develop ing neurodegenerative disease.

In this regard, and as a part of the National Health Strategy (2018-2022), the Ministry of Public Health in Qatar (MoPH) and its connected networks acknowledge the challenge of demen tia, a common complication of Alzheimer’s Dis ease (AD), through the adoption of the extensive Qatar National Dementia Plan (2018-2022). This plan identifies various gaps, such as a lack of re gion-specific epidemiological statistics regarding incidence and prevalence, the lack of universal treatment guidelines and legislation, and a lack of adequately trained staff to address demand in the region (Ministry of Public Health, 2018). The MoPH also emphasizes the importance of “healthy ageing” through improving coordina tion of healthcare to the ever-increasing elderly population in the country (Ministry of Public Health, 2018). To empower this aging population with regards to the management and improve ment of their own health and independence, their healthcare personnel should have a basic understanding of the pathogenies and treat ment modalities for neurodegenerative diseases that disproportionately affect this group.

How does working with WCM-Q's Division of Continuing Professional Development help drive progress in the research, diagnosis and treatment of neurodegenerative diseases?

Working with WCM-Q's Division of Continuing Professional Development to develop the webi nar series can help contribute to the goals set out in the National Health Strategy (2018-2022) to in crease awareness of neurodegenerative diseases. The webinar series will aim to assess and address current gaps in knowledge regarding neurode generative diseases in Qatar, the Middle East and North Africa (MENA) region, and beyond.

Working with the division of CPD on this series allows us to highlight various knowledge gaps related to neurodegenerative diseases and associated disorders. To address some of these gaps, the series will enable the audience to

WITH PROMINENT STRIDES IN MEDICAL SCIENCE AND A GRADUAL INCREASE IN OVERALL LIFE EXPECTANCY, THE GLOBAL PREVALENCE OF DEMENTIA, A PRIMARY PATHOLOGY ASSOCIATED WITH MANY SUCH DISORDERS, IS EXPECTED TO INCREASE FROM 57.4 MILLION IN 2019 TO 152.8 MILLION BY 2050.

understand the mechanism of protein misfold ing and amyloid formation behind the most common neurodegenerative diseases and learn about the most recent advancements in their potential treatment modalities to promote a better understanding of the healthcare manage ment options now and in the future.

A survey was conducted to recognize the needed assessment before we proposed this CPD series. The results showed very significant de mand for a webinar series that complements the knowledge and competence of healthcare prac titioners with regards to managing and caring for patients with neurodegenerative disease and its disorders. This survey will lead to a paper, which is currently in preparation, titled Knowledge and At titude Towards Neurodegenerative Diseases and Associated Disorders: A Cross-Sectional Survey of Healthcare Professionals Across Qatar”.

Another, more research-oriented survey, with a focus on 1) the level of knowledge of Alzheimer’s disease and dementia, 2) atti tudes towards dementia patients, as well as 3) confidence and self-efficacy about dementia patients, is also in preparation.

How do you envision the future development of this activity?

We are confident of the potential success of this series of webinars because it is based on an identified need. The next step will be to expand the series into an annual conference and a series of workshops to further meet the needs of the local and global healthcare community. This will allow us to attract well-recognized healthcare practitioners as well as researchers in the field of neurodegenerative diseases, which will benefit not only the healthcare professionals and re searchers in Qatar but also the students. Alto gether, this will accord with the goals of National Health Strategy (2018-2022) and Qatar National Vision 2030. We hope this webinar series will provide a great opportunity for WCM-Q to participate as an institution to raising awareness of the disease, as well as dementia, common symptoms, and risk factors attached to it.

Endodontics Specialist at Marble Medical Center – Qatar

Dental nerve gives the vitality of the tooth

Dental nerve travels in branches inside each root of the tooth. Its presence gives the vitality of the tooth although this doesn’t mean that its removal affects its function. What are the main causes of dental nerve damages and how can it be treated?

Dr Joanna Azar, Endodontics Specialist at Marble Medical Center – Qatar answers all these questions in the following interview with “Hospi tals” magazine.

What is the dental nerve? Where is it found?

The dental nerve is a collection of veins, arteries, and nerve endings. Its bigger part is in the crown of the tooth and is called the pulp chamber.

Then it travels in branches inside each root or “leg” of the tooth until it reaches its ending or as we call it apex or” tip”.

NERVE DAMAGE CAN BE TREATED BY A PROCEDURE CALLED ROOT CANAL TREATMENT AND IT IS RECOMMENDED TO BE DONE BY A ROOT CANAL SPECIALIST.

Dr. Joanna Azar, Endodontics Specialist at Marble Medical Center

What is its function?

The function of the dental nerve is essen tially sensory. It conducts the sensation of heat, cold and pain in the tooth to the central nervous system or “brain”.

Its presence gives the vitality of the tooth although this doesn’t mean that its removal affects its function.

What are the symptoms of dental verve damage?

The symptoms of a dental nerve damage are: acute, continuous, and spontaneous pain.

It increases when exposed to heat and cold and can be intolerable.

The pain is pulse-like. It can get excruciating especially at night time, accompanied by sleep deprivation and is also rebellious to all kind of pain killers.

What causes dental nerve damage?

The main cause of dental nerve damage is deep dental decays reaching that nerve. In ad dition, a trauma to the tooth can cause an injury to the nerve as well.

It is also important to mention that in both cases, the symptoms can be silent and diag nosed fortuitously years later.

What can you do for a nerve pain?

The nerve pain cannot be treated at home. The patient must come urgently to the dentist to soothe the pain. This is done by opening the pulp chamber to relieve the pressure caused by the swelling of blood vessels responding to the aggression of the decay.

If not treated, the pain could subside but would leave place to the formation of a chronic infection: necrosis of the pulp tissue and formation of an abscess in the future only diagnosed with X-rays. If and abscess shows on the gum, this means that the nerve has died long time ago.

How do you treat nerve damage?

Nerve damage can be treated by a pro cedure called Root Canal Treatment and it is recommended to be done by a Root Canal Specialist. This procedure is harmless and is

done under anesthesia. Once the pulp chamber is opened, we will have access to the branch ing canals by using special tools to go through them. This doesn’t consist of removing the nerve only, but to clean the canals from the dead nerve and its surrounding tissues until the tip or apex.

This is done by cleaning mechanically (using tools) and chemically (using solutions to wash off the residues).

The purpose of the RCT is to give the roots a conical shape or triangle in 3D. Then we seal the now empty canals with a paste called “Gutta-Percha”. This paste is biocompatible and harmless, and it will occupy the nerve’s place inside the canal for good.

Neo Center's partner clinic is the unique private clinic RósGlas in Ireland

What makes RósGlas unique is the ratio of staff to guests, an average of 15-20 staff per client. A team of experienced mental health specialists with a 24-hour therapist is solely focused on treat ing their single guest in their stunning luxury residence equipped with a personal chef, maid, and chauffeur.

From arrival at the airport, throughout the stay, the core values of comfort, confidentiality, and privacy are truly fulfilled in this picturesque, peaceful part of Ireland.

The founder and clinical director of Rosglas Recovery have extensive experience in the 'one client at a time' model of care. He was one of the pioneers of this work and helped develop this approach when he was Clinical Director of the

FROM ARRIVAL AT THE AIRPORT, THROUGHOUT THE STAY, THE CORE VALUES OF COMFORT, CONFIDENTIALITY, AND PRIVACY ARE TRULY FULFILLED IN THIS PICTURESQUE, PEACEFUL PART OF IRELAND.

Pradeep Rosglas

Kusnacht Practice in Zurich for 4 years. In 2016, he left Switzerland to found Rosglas Recovery.

Using expertise and experience, the RósGlas team first identifies the underlying psycholog ical, biochemical, and social causes of anxiety unique to each individual.

The recovery path is then tailored to the specific needs of each guest. This distrac tion-free, single-guest approach to treatment allows for significant progress in a relatively short period of time.

Individualized continuing care plans are offered to each guest for their return home.

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USING EXPERTISE AND EXPERIENCE, THE RÓSGLAS TEAM FIRST IDENTIFIES THE UNDERLYING PSYCHOLOGICAL, BIOCHEMICAL, AND SOCIAL CAUSES OF ANXIETY UNIQUE TO EACH INDIVIDUAL.

MARTIN MALÝ, A SOBER ALCOHOLIC

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Dr. Ravinder Mamtani

Dr. Ravinder Mamtani is Vice Dean for Population Health and Lifestyle Medicine at Weill Cornell Medicine-Qatar (WCM-Q). A passionate advocate for preventive medicine, Dr. Mamtani heads the Institute for Population Health (IPH) at WCM-Q, which has just launched a new certificate program to equip professionals working in the health sector with key skills and knowledge to promote public health and en hance the physical, mental, and social wellbeing of people in the MENA region and beyond.

The new Certificate in Population Health and Wellbeing is a 60-hour multidisciplinary and collaborative course that provides training in the domains of population health, health care delivery, health policy, evidence-based approaches to health promotion, disease causation and prevention, communicable and non-communicable diseases, lifestyle medicine, crisis management, pandemics, and digital health. The course is delivered in hybrid form, with both in-person and online elements, and has been designed to be highly interactive, fea turing a mixture of lectures, classroom-based workshops, panel discussions, and Q&A ses sions. The program is open to all interested healthcare professionals. Dr. Mamtani also holds the positions of Professor of Population Health Sciences and Professor of Medicine (Center for Global Health) at WCM-Q.

What motivated the creation of the new Certificate in Population Health and Wellbeing?

Vice Dean for Population Health and Lifestyle Medicine at Weill Cornell Medicine-Qatar (WCM-Q)

“ We think everyone deserves to have knowledge and skills related to population health and lifestyle medicine. We feel all health professionals - a nurse, a physician, an educator, a researcher, a health administrator and so on – will benefit and help improve and promote health."

INTERVIEW

There are many reasons and factors that prompted us to create this new certificate program. Perhaps the most pertinent factor has to do with COVID-19, which was a wakeup call for all of us on this planet. The pandemic showed us that as a global community we were ill-prepared to deal with the pandemic but that there was also a great deal of difficulty in reaching consensus on the best way to address the situation.

And so, the new program will have a strong focus on skills and knowledge that will help healthcare practitioners understand the basics of population health, pandemics, and diseases burden, plus quantitative research skills, health care delivery models, evidence-based approach es to care, crisis management, and preventive medicine. The program participants will also be exposed to contemporary topics such as preci sion health, planetary health, and sustainability.

Looking beyond COVID-19, the data on chronic illness over the past 20 to 25 years show us that we have a serious health crisis in this area. Indeed, this can be understood as a pandemic of chronic illness. We know that people are experiencing premature mortality, they are dying earlier due to heart disease, cancer, and other chronic problems; this is not acceptable. The new certificate aims to pro vide health enthusiasts - who can contribute to the physical, mental, and social wellbeing of people in the Middle East and beyond – with the foundational knowledge of these issues so that they can serve as ‘health agents’ to promote good health.

Please tell us about the role of lifestyle medicine in the Certificate of Population Health and Wellbeing.

We now know from lots of very good data from high-quality research that many of the chronic illnesses we see relate to unhealthy lifestyles. As such, there is a great potential for reducing premature death by using lifestyle medicine approaches like healthy diet, physical activity, healthy sleep patterns, and so on.

The greatest impetus for us is that we al

THE NEW CERTIFICATE IN POPULATION HEALTH AND WELLBEING IS A 60-HOUR MULTIDISCIPLINARY AND COLLABORATIVE COURSE THAT PROVIDES TRAINING IN THE DOMAINS OF POPULATION HEALTH, HEALTHCARE DELIVERY, HEALTH POLICY, EVIDENCEBASED APPROACHES TO HEALTH PROMOTION, DISEASE CAUSATION AND PREVENTION, COMMUNICABLE AND NONCOMMUNICABLE DISEASES, LIFESTYLE MEDICINE, CRISIS MANAGEMENT, PANDEMICS, AND DIGITAL HEALTH.

ready know these lifestyle medicine approaches are effective. We have ways to help people live longer and to be healthier as they age. So we feel a very strong moral obligation to promote this approach, and view this as a great opportu nity to improve health, wellbeing and quality of life for a great many people.

Why does the new certificate address social conditions as a determinant of health?

It has become apparent that there are not just medical or clinical reasons that determine who suffers from various health problems –there are social determinants, too. And so, we felt it would be good to bring in a discus sion on social determinants such as inequity, inadequate literacy, and lack of access to basic healthcare.

Why should basic healthcare not be avail able to everyone regardless of their economic or social status?

I am reminded of US President Franklin Roosevelt’s quote: “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.”

What is the role of education in population health and wellbeing?

From our own research at IPH and review of literature, we have noted that public health topics such as lifestyle medicine, environmental health, social determinants of health and health policy do not get addressed in health curric ula of medical schools around the world (at WCM-Q, we have included various population health and preventive medicine topics in our own curriculum).

This means that many physicians and other healthcare practitioners treating patients all over the world have not had the benefit of

INTERVIEW

formal instruction and training in various com ponents and subject areas of public/population health. This certificate program aims to address this knowledge gap.

What is to be understood by the terms ‘wellbeing’ and ‘being healthy’, which are used so frequently?

According to the Centers for Disease Control in the US, “well-being is a positive outcome that is meaningful for people and for many sectors of society, because it tells us that people perceive that their lives are going well.” When the World Health Organization came up with their definition of health, they spoke about physical, mental, social, and spiritual health, not just about absence of disease or infirmity. I don’t see how you can separate physical and so cial health from mental health. So wellbeing is a holistic concept whereby we understand health to have many interacting components rather than compartmentalizing the various elements of health and treating them individually.

What is the economic argument for promoting population health and wellbeing?

This was nicely summarized in a UK journal (The Journal of Epidemiology and Community Health). What they said was very important: that the return on investment for public health interventions is 14; i.e., for every dollar, riyal, pound, or euro you spend, you will get a return of 14 dollars, pounds, et cetera. When you look at something like this how can you not pay attention to public health (i.e., population health) and wellbeing? This is such a striking observation, and we really think it is time to pay attention to this aspect of healthcare costs. Ap propriate use of the available resources at the present time will free up funds – in the futurefor use in other areas of healthcare and devel opment, leading to better health outcomes overall in any given society.

What are some of the obstacles to population health and lifestyle

medicine approaches becoming more widely adopted to address global health challenges?

We live in a culture where we are looking for instant gratification and quick fixes; there is a great emphasis on developing new medicines and treatments that can easily fix health prob lems without us having to change our lifestyles or think long-term. That is not to denigrate existing conventional therapies or the process of developing new drugs, which clearly play a crucial role in healthcare, but that mindset is so pervasive and dominant that there is a tenden cy to disregard alternative effective options that take a little longer to deliver the health benefits we wish to see.

Of course, it takes a little longer for a posi tive lifestyle change to deliver improved health but the long-term results in most cases are superior. Also, it is not necessarily an either/or scenario; it is usually the case that someone suf fering from heart disease or type 2 diabetes for example, will benefit from taking a prescribed medication and also making positive lifestyle changes such as improving their diet, quitting smoking and beginning to exercise regularly. Ignoring lifestyle health is not an option.

I think in general, healthcare professionals don’t receive much education or training in pub lic health and lifestyle health. If you don’t cover that in medical curricula, how can we expect healthcare professionals to be up-to-date on public health and lifestyle medicine matters or to advocate for these approaches?

Who can participate in the new certificate program?

All healthcare practitioners or profession als are welcome to join this program. We think everyone deserves to have knowledge and skills related to population health and lifestyle med icine. We feel all health professionals - a nurse, a physician, an educator, a researcher, a health administrator and so on – will benefit and help improve and promote health. We want to broaden this so that it reaches as many profes sionals as possible. We believe this Certificate

in Population Health will do that. And we are ready to take the lead.

What material will be studied in the Certificate Program and how will it be presented?

One of our key objectives is to make the program as interactive as possible. There will be thematic discussions/seminars and we will also allow participants to ask questions and share their experiences. It is great for experts to share their knowledge but it is also important for participants - who may have a great deal of extremely relevant experience from the front line of healthcare delivery and from real life - to be able to contribute, too. Otherwise we would be shutting ourselves off from very useful and pertinent knowledge. As such, there will also be panel discussions with experts answering questions asked by participants and engaging in discussions with participants. In addition, there is an online component to the program with supplementary materials such as video lectures, worksheets and quizzes that will be available for the participants. The combination of these elements together makes our program very effective.

The program has several modules. The first module will address basic concepts in health and disease, population health and preventive medicine. The second module will consist of instruction on quantitative research and evidence-based approach to medicine and health. The third module will deal with delivery of healthcare. Recently we saw with COVID-19 how healthcare was disrupted completely and how the established health delivery methods broke down. Having a good understanding of different healthcare delivery models is there fore useful, especially in a crisis.

The fourth module is about the existing dis ease burden (both communicable and non-com municable) and the associated challenges we face.

The final module addresses the optimiza tion of health and wellbeing with a perspective that looks into the future, so there will be

ARE YOU A NUTRITIONIST? A PHYSICIAN OR A NURSE? RESEARCHER? HEALTH ADMINISTRATOR? A PHYSICAL THERAPIST? DO YOU WANT TO COME AND TALK TO US ABOUT YOUR INTEREST IN POPULATION HEALTH AND YOUR THOUGHTS ABOUT THESE ISSUES? COME, ENROLL IN THE PROGRAM, WE WANT TO HEAR FROM YOU.

discussion on topics such as climate change, sustainability, on humanizing healthcare, on digital health, the potential role of artificial intelligence in healthcare, and healthcare com munication.

Why have you adopted such an inclusive approach to this Certificate Program?

Health and disease paradigms are driven by a variety of factors. Our program provides a platform for exchange of ideas and information among professionals with variable backgrounds. We want to hear and learn from people work ing in health and related institutions. Anyone involved in healthcare can join this program. Are you a nutritionist? A physician or a nurse? Researcher? Health administrator? A physical therapist? Do you want to come and talk to us about your interest in population health and your thoughts about these issues? Come, enroll in the program, we want to hear from you. The same goes for counselors, psychologists and other health professionals. Come on over, join us and help improve health of people in the region and beyond.

This opportunity is a significant, additional step towards establishing Qatar’s position in setting high standards of health and well-being in the region and beyond.

Deborah Mukherji, MD, MBBS, FRCP

Consultant Medical Oncologist at Clemenceau Medical Dubai

“Dostarlimab has shown very promising results of a rare type of rectal cancer "

Cancer is a general term to describe the uncontrolled or abnormal growth of cells in the body. The approach to cancer treatment depends on many factors including the tissue in which the cancer started (cancer type) and where it has spread in the body (cancer stage). ‘Hospitals’ magazine interviewed Dr. Deborah Mukherji, Consultant Medical Oncologist-CMC Dubai- who talked about the new approaches and procedures for cancer treatment.

What are the new approaches and procedures for cancer treatment?

For cancers that are detected at an early stage before they have spread to other parts of the body, treatment is usually aimed to cure the disease and may include surgery, radiation therapy, hormone therapy, chemotherapy and sometimes immunotherapy or targeted therapy.

For cancers that have spread, surgery may not be possible; however, treatment such as chemotherapy, hormone therapy, targeted ther apy and immunotherapy may be able to control the disease and improve symptoms.

What is the importance of personalized medicine in treating cancer patient?

Can you explain to our readers what is personalized medicine?

Personalized medicine in cancer treatment re fers to testing cancer cells for specific mutations or targets that can be treated by specific medica tions. An example of this is testing lung cancers for mutations that can be targeted by tablet therapies more effectively than chemotherapy.

Can you combine chemotherapy and immunotherapy? When do you need to do that?

Immunotherapy is a relatively new treat ment for certain cancers that allows the body’s own immune cells to recognize and kill cancer cells. This treatment can be combined with chemotherapy for some types of cancer such as lung cancer and certain types of breast cancer.

Let’s talk about Dostarlimab. What can you tell us about this breakthrough?

PERSONALIZED MEDICINE IN CANCER TREATMENT REFERS TO TESTING CANCER CELLS FOR SPECIFIC MUTATIONS OR TARGETS THAT CAN BE TREATED BY SPECIFIC MEDICATIONS. AN EXAMPLE OF THIS IS TESTING LUNG CANCERS FOR MUTATIONS THAT CAN BE TARGETED BY TABLET THERAPIES MORE EFFECTIVELY THAN CHEMOTHERAPY.

Dostarlimab is a type of immunotherapy that has shown very promising results in a recent trial of a rare type of rectal cancer. In cancers that form due to an error in repairing DNA known as defective mismatch repair, tumor cells have multiple mutations that make them responsive to treatment with immunotherapy including Dostarlimab.

In a small clinical trial of 14 patients with rectal cancer due to defective mismatch repair, treatment with Dostarlimab was shown to elim inate 100% of these tumors without the need for radiation, chemotherapy or surgery which are the standard treatments.

This is a significant breakthrough; how ever, there hasn’t been enough follow-up with patients to know if their cancer has been completely cured with the treatment. It is also important to know that less than 15% of cancers have defective mismatch repair and would po tentially be responsive to this treatment.

Giving a young and healthy smile means a lot about your care for yourself

The purpose of cosmetic dentistry is to improve visual appearance using modern advances in dentistry, cosmetic proce dures. “Hospitals” magazine interviewed Dr. Kaisa Stroher, Prosthodontics at Marble Medical Center – Qatar.

What is cosmetic dentistry?

It primarily focuses on improvement in dental aesthetics in color, position, shape, size, alignment and overall smile appearance.

GIVING A YOUNG AND HEALTHY SMILE MEANS A LOT ABOUT YOUR CARE FOR YOURSELF.

Dr. Kaisa Stroher, Prosthodontics at Marble Medical Center

Smile enhancement can have dramatic re sults on your overall appearance; even the small est step can boost your confidence, self-esteem, and make you want to smile more. With modern advances in dentistry, cosmetic procedures can range from a basic color correction to replacing missing teeth, and everything in between.

What Does a Cosmetic Dentist do?

Dentists are now using more conservative techniques to preserve as much of your natural tooth structure as possible, depending on your specific clinical situation. Dental work can be made entirely of porcelain or composite mate rials that more closely mimic the appearance of natural tooth structure. These tooth-colored materials are bonded to the underlying tooth structure with resin adhesives. The American Dental Association does not recognize cosmetic dentistry as a specialty. Prosthodontics is the only dental specialty under which the concentra tion of cosmetic/esthetic dentistry falls.

One example is a case of Full Mouth Rehabilitation:

• Some x-ray and others imaging exams are made first.

• Some photos and videos must be done.

• A study cast model from patient mount ed in an articulator semi-adjustable will be sent to the laboratory and a diagnos tic wax will be made digitally, your fu ture smile design will be made accord ing to aesthetics parameters combined with your facial characteristics.

• A mock up to try in the future smile, dentist and patient are able to observe the final result even before starting treatment.

What are examples of cosmetic dentistry available at Marble Medical Center?

• Teeth Whitening

• Dental Veneers and Composite Veneers

• Dental Crowns

• Dental Implants

• Smile Design

• Full Mouth Reconstruction

Who benefits from cosmetic dentistry?

Some indications are:

1- Close Spaces between teeth

2- Chipped or broken teeth

3- Crowded and malpositioned teeth

4- Replacement of Missing teeth

5- Short teeth

6- Improving teeth color, contour and shape

7- Correction of the anterior teeth guid

ance to equilibrate the function and protect the whole system ( teeth, muscle, articulation), offering long-lasting results.

Giving a young and healthy smile means a lot about your care for yourself. The condition of your teeth, gums, supporting bone structure and occlusion has an impact on the longevity of any dental procedure. You may require additional care for these conditions before cosmetic treatment begins. In some cases, a full mouth reconstruction may be part of your procedure plan.

What about the difference between cosmetic and general Dentistry?

The main difference between cosmetic dentistry and general dentistry is that if you are concerned about how your teeth look, visiting a cosmetic dentist will provide you with your highest-quality aesthetic results.

The purpose of restorative dentistry is to restore function, while the purpose of cosmetic dentistry is to improve visual appearance.

Can restorative dental procedures also offer cosmetic benefits?

Cosmetic dentistry and restorative dentistry are two similar practices of dentistry aimed at improving the health of the teeth and gums as well as their appearance. If you are thinking of undergoing a cosmetic procedure, ask your den tist if you will need some restorative work done before the procedure.

Childhood Obesity

Childhood Obesity

Childhood obesity is on the rise in various countries of the world. Lifestyle issues, too little activity and too many calorie intake, are the main contributors to childhood obesity. However, genetic and hormonal factors might play a role as well.

It's particularly troubling because the extra pounds often lead children to develop obesi ty-related health problems such as diabetes, high blood pressure and high cholesterol.

Childhood obesity is far from being an aesthetic problem, or a passing stage in a child's life that goes away with his growth and develop ment. It can profoundly affect children's physical health, social, and emotional well-being, and self-esteem. It has been reported that children with obesity are more likely to suffer from anxiety and depressive symptoms compared to peers of normal weight.

How to calculate obesity in children?

Body mass index (BMI) is commonly used to determine childhood weight status. BMI is calcu lated by dividing a person's weight in kilograms by the square of height in meters. For children and teens, BMI is age- and sex-specific and is often referred to as BMI-for-age.

The BMI-for-age charts are used as a screening tool to evaluate overweight and un derweight in children and adolescents. Growth charts consist of a series of percentile curves that illustrate the distribution of selected body measurements in children. Pediatric growth charts have been used by pediatricians, nurses, and parents to track the growth of infants, chil dren, and adolescents.

However, growth charts are not a sole diag nostic tool but should be used along other tools as well. Growth charts are frequently used to educate parents about their children’s growth. The standard BMI is calculated based on the child's height and weight, but the index does not measure body fat but rather the volume

THE BMI-FOR-AGE CHARTS ARE USED AS A SCREENING TOOL TO EVALUATE OVERWEIGHT AND UNDERWEIGHT IN CHILDREN AND ADOLESCENTS. GROWTH CHARTS CONSIST OF A SERIES OF PERCENTILE CURVES THAT ILLUSTRATE THE DISTRIBUTION OF SELECTED BODY MEASUREMENTS IN CHILDREN. PEDIATRIC GROWTH CHARTS HAVE BEEN USED BY PEDIATRICIANS, NURSES, AND PARENTS TO TRACK THE GROWTH OF INFANTS, CHILDREN, AND ADOLESCENTS.

of tissue including muscle, fat and bone in the child. BMI is a screening tool that can indicate whether a person is underweight or if they have a healthy weight, excess weight, or obesity.

Causes and risk factors

There are many causes and factors that lead to obesity including genetic factors, where the risk of obesity increases in a child whose parents are obese. Psychological factors such as person al, parental and family stress can also increase the child's risk of obesity and weight problems.

An unbalanced diet, lack of exercise and certain medications are all factors that lead to weight gain and obesity in children.

A serious condition that causes several diseases later in life

ARTICLE FEATURES . Childhood Obesity

The main causes include:

• Diet: Regularly eating high-calorie and unhealthy foods can cause your child to gain weight. Candy, desserts and sugary drinks can also cause weight gain.

• Lack of exercise: Children who don't exercise much are more likely to gain weight. Too much time spent in sed entary activities, such as watching television or playing video games, also contributes to the problem.

• Psychological factors: Personal, parental and family stress can increase a child's risk of obesity. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom.

• Genetic factors: They cause childhood obesity by affecting the eating pattern and metabolism, and there are genes that make the child more likely to be come obese.

Also, secondary obesity means that you have a medical condition that has caused you to gain weight. These diseases include endocrine disorders such as hypothyroidism, polycystic ovary syndrome (PCOS), hypothalamic disorders and some congenital conditions in addition to some chromosomal syndromes such as Turner's syndrome and Laurence-Moon-Biedl syndrome. Long-term treatment with corticosteroids also leads to secondary obesity.

Your child's doctor might order blood tests that may include a cholesterol test, a blood sugar test and other blood tests to check for hormone imbalances or other conditions associ ated with obesity.

YOUR CHILD'S DOCTOR MIGHT ORDER BLOOD TESTS THAT MAY INCLUDE A CHOLESTEROL TEST, A BLOOD SUGAR TEST AND OTHER BLOOD TESTS TO CHECK FOR HORMONE IMBALANCES OR OTHER CONDITIONS ASSOCIATED WITH OBESITY.

Complications

Physical complications of childhood obesity may include:

• Type 2 diabetes: This chronic condi tion affects the way your child's body uses glucose. Obesity and a sedentary lifestyle increase the risk of type 2 diabetes.

• High cholesterol and high blood pressure: A poor diet can cause your child to develop one or both of these conditions. These factors can contribute to the buildup of plaques in the arter ies, which can cause arteries to narrow and harden, possibly leading to a heart attack or stroke later in life.

• Joint pain: Extra weight causes extra stress on hips and knees. Childhood obesity can cause pain and sometimes injuries in the hips, knees and back.

• Breathing problems: Asthma is more common in children who are over weight. These children are also more likely to develop obstructive sleep apnea, a potentially serious disorder in which a child's breathing repeatedly stops and starts during sleep.

• Social and emotional complications: Children who have obesity may experi ence teasing or bullying by their peers. This can result in a loss of self-esteem and an increased risk of depression and anxiety.

Treatment

Treatment for childhood obesity is based on your child's age and whether he has other medical conditions. Medical conditions such as hypothyroidism can cause obesity and can be treated with drugs that include the thyroxine hormone, which plays a crucial role in metabo lism and muscle control.

The doctor develops the appropriate treat ment plan based on physical activity and healthy food. He makes radical lifestyle changes, pro vided that this is done little by little, taking into account the child’s age and nutritional needs to maintain proper growth.

Parents can contribute to their children's

health and reduce childhood obesity by help ing their children maintain an active lifestyle and eat a healthy diet. They should focus on serving their children whole foods like fruits, vegetables, whole grains, seeds, nuts and lean proteins. Cut back on processed and conve nience foods like cookies, crackers, fast food, and prepared meals, all of which can be high in sugar, fat and calories.

Children should be encouraged to increase their physical activity and limit screen time in or

der to prevent a sedentary lifestyle. In addition to burning calories, physical activity strengthens children’s bones and muscles, helps them fall asleep and get good quality rest, and can boost their mood and energy.

Psychological support during treatment is key, as the child needs support and encourage ment to lose weight.

He must also participate in recreational and entertaining activities that keep him busy and prevent boredom eating.

CHILDREN SHOULD BE ENCOURAGED TO INCREASE THEIR PHYSICAL ACTIVITY AND LIMIT SCREEN TIME IN ORDER TO PREVENT A SEDENTARY LIFESTYLE

Strabismus is a common eye condition among children. It is when the eyes are not lined up properly and they point in different directions. One or both of your child's eyes may turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). Kids can be born with strabismus or develop it in childhood. It can be constant or intermittent.

Strabismus can be congenital if it appears in an infant before the age of six months, and acquired in childhood if it begins after the age of two or three years, and sometimes it may develop in adulthood. It is not easy for parents to detect the condition, especially if the child suffers from a mild squint, therefore, regular examination with the pediatrician is the first step towards diagnosis, then the child will be re ferred to a pediatric ophthalmologist to assess his condition.

By the age of 3 to 4 months, an infant's eyes should be able to focus on small objects and the eyes should be straight and well-aligned. A 6-month-old infant should be able to focus on objects both near and far.

Strabismus usually appears in infants and young children, and most often by the time a child is 3 years old. The most prominent symp tom of strabismus is misaligned eyes.

Children with strabismus may turn their heads to help them focus their dominant eye on things they see. They may also squint in moder ate light or have problems judging distance.

Amblyopia (or lazy eye) can happen when strabismus isn't treated — the brain starts to ig nore what the weaker eye sees, which can make vision blurry, cause double vision, and affect a kid's depth perception. These problems can become permanent if they're not treated.

What causes strabismus?

Strabismus can occur for several reasons, including:

• Congenital causes, which appear imme diately after birth or during the first six months of life.

• Vision defects, or long-sightedness, which appears in children after age 4 or 5.

• Lazy eye

• Neurological problems and hydroceph alus

• Paralytic squint, which is the inability of the eye muscles to move the eye due to muscle paralysis.

In children under 6 months of age, risk factors for strabismus include family history of strabismus, genetic disorders (such as Down syndrome), prenatal drug exposure (including alcohol), prematurity, birth defects of the eyes, and cerebral palsy.

In children 6 months of age or older, strabis mus is often caused by a refractive error (exces sive farsightedness - hyperopia) or an imbalance

IN CHILDREN UNDER 6 MONTHS OF AGE, RISK FACTORS FOR STRABISMUS INCLUDE FAMILY HISTORY OF STRABISMUS, GENETIC DISORDERS (SUCH AS DOWN SYNDROME), PRENATAL DRUG EXPOSURE (INCLUDING ALCOHOL), PREMATURITY, BIRTH DEFECTS OF THE EYES, AND CEREBRAL PALSY.

in the pull of muscles that control the position of the eyes. Severe vision loss in one eye (due to refractive error or less common disorders such as cataracts) can cause strabismus because it interferes with the brain’s ability to maintain the alignment of the eyes. Other causes include retinoblastoma (a type of eye cancer) and neu rologic conditions such as cerebral palsy, spina bifida, weakness of cranial nerves that control eye movement, head injury, and viral infection of the brain (encephalitis). Sometimes a frac ture of the eye socket can block movement of the eye and cause strabismus.

The most common types of strabismus:

• Congenital strabismus: It appears at birth and genetic factors play an important role. It appears clearly at the age of six months. Often the strabis mus disappears or occurs intermit tently, sometimes in the right eye and sometimes in the left eye. Treatment is surgery, wearing glasses, or a combina tion of the two.

• Accommodative esotropia: This often occurs in cases of uncorrected farsight edness and a genetic predisposition (family history) for the eyes to turn in. Because the ability to focus is linked to where the eyes are pointing, the extra focusing effort needed to keep distant objects in clear focus may cause the eyes to turn inward. This condition is usually treated with bifocal or multi focal glasses, but may also require eye patching and/or surgery on the muscles of one or both eyes.

• Intermittent exotropia: In this type of strabismus, one eye will fixate on a target while the other eye is pointing outward. Intermittent exotropia can happen at any age. Treatment may involve glasses, patching, eye exercises and/or surgery on the muscles of one or both eyes.

Strabismus in Children

Diagnosis

Parents play an important role in the early detection of the condition. Anyone older than four months of age who appears to have strabis mus should have a complete eye examination by a pediatric ophthalmologist, with extra time spent examining how the eyes focus and move. For most patients, an office visit alone is enough to diagnose their eye conditions and provide a treat ment plan. Each child undergoes a careful history and clinical evaluation. When examining the child's eyes, the ophthalmologist can tell whether the patient suffers from strabismus or not. In cas es of pseudostrabismus, the eyes are well aligned but appear to be misaligned. Pseudostrabismus does not require treatment and the appearance tends to improve with time as facial grows.

Treatment options

The younger the patient, the more effective the treatment, as there are multiple treatment options that lead to excellent results. It is import ant to diagnose and treat a lazy eye before initiat ing the treatment of strabismus, as the doctor can determine the degree of laziness and the degree of visual impairment by measuring the visual acui ty of the child even in the first months of life using the latest optic nerve imaging devices.

WHEN EXAMINING THE CHILD'S EYES, THE OPHTHALMOLOGIST CAN TELL WHETHER THE PATIENT SUFFERS FROM STRABISMUS OR NOT. IN CASES OF PSEUDOSTRABISMUS, THE EYES ARE WELL ALIGNED BUT APPEAR TO BE MISALIGNED. PSEUDOSTRABISMUS DOES NOT REQUIRE TREATMENT AND THE APPEARANCE TENDS TO IMPROVE WITH TIME AS FACIAL GROWS

Among the treatment options available:

• Eyeglasses or contact lenses

• Prism lenses: Special lenses that can bend light entering the eye and help reduce the amount of turning the eye must do to look at objects.

• Orthoptics (eye exercises): May work on some types of strabismus, especially convergence insufficiency (a form of exotropia).

• Medications: Eye drops or ointments.

• Patching: To treat amblyopia (lazy eye), if the patient has it at the same time as strabismus. The improvement of vision may also improve control of eye misalignment.

• Eye muscle surgery: Surgery changes the length or position of eye muscles so that the eyes are aligned correctly.

Some cases require surgery to straighten the eye muscles after resorting to all alternative treatment methods. In some other cases, sur gery is the only effective treatment solution.

All strabismus surgeries in children are performed under general anesthesia as well as in some adult patients, but local anesthesia is also an option.

AND HEAR FROM OUR ESTEEMED KEYNOTE SPEAKERS

Prof. Antonio Hardan Chief Division of Child and Adolescent Psychiatry Stanford University

Prof. Helen Egger CEO Little Otter

Prof. Valsamma Eapen Chair, Infant, Child and Adolescent Psychiatry University of New South Wales (UNSW)

Qatar’s universities provide world-class education for students in the region

International degrees that can be attained close to home

university’s home campus, while remaining close to the region’s culture. Qatar’s tradition and modernity combination is difficult to find elsewhere. The country celebrates its heritage, but still offers students modern amenities, new hotels and a mix of international cultures, cuisines and lifestyles.

Dr. Eiman Mustafawi

Qatar Tourism in collaboration with Qatar Foundation and Qatar Univer sity launched an education campaign to showcase to students, parents, counsellors and educators in the GCC region the country’s esteemed university offering and the benefits of choosing to study in Qatar.

A young and multi-faceted country, Qatar recognises the role of education in creating thriving communities. Qatar has established one of the world’s most cross-disciplinary education hubs where students can graduate with interna tionally recognised degrees from leading univer sities and institutions in a warm and hospitable environment.

As one of the safest countries in the world, with a diverse economy and society, Qatar offers students a unique environment of learn ing. It brings together a wide array of top-level international partner universities, in addition to highly rated homegrown universities, research centres, incubators for innovation and entre preneurship, and exciting and transformative opportunities for involvement in community activities and programs.

Only a short flight away from all parts of the region, students and their parents can remain in close proximity during the duration of their studies. Qatar offers students the opportunity to obtain the same degree as that from the

AS PART OF THE CAMPAIGN, CNN, ONE OF THE MOST WIDELY DISTRIBUTED NEWS CHANNELS IN THE WORLD, VISITED QATAR TO FILM ITS EDUCATIONAL INSTITUTES AND INTERVIEW CURRENT STUDENTS - THIS WILL BE FEATURED IN 30 AND 60 SECOND VIDEOS ON THE NEWS CHANNEL AND DIGITAL PLATFORM.

As part of the campaign, CNN, one of the most widely distributed news channels in the world, visited Qatar to film its educational insti tutes and interview current students - this will be featured in 30 and 60 second videos on the news channel and digital platform.

Commenting on the campaign, Berthold Trenkel, Qatar Tourism, COO, said: “Qatar has always understood the power of Education and has therefore heavily invested to ensure the educational landscape in the country is international, cutting-edge, and diverse. Qatar has a dynamic university offering, and through this campaign, we will be able to highlight what makes Qatar the right choice for university education. Qatar uniquely combines globally renowned education with a rich culture, safe en vironment, world-class facilities, social stability, and excellent employment opportunities.”

Qatar Foundation (QF) has created a glob ally unique, multidisciplinary ecosystem of edu cation, comprising branch campuses of seven of the world’s leading universities, as well as QF’s homegrown Hamad Bin Khalifa University. These universities offer degrees in areas ranging from medicine, engineering, communications, inter national affairs, computer science, and art and design to Islamic studies, law and public policy, humanities and social sciences, cybersecurity, and sustainability.

With these institutions being located just yards from each other at QF’s Education City, students can cross-register for courses at different universities, enrol in joint academic programs, and experience a flexible and highly

Berthold Trenkel

Francisco Marmolejo

personalised education, while gaining real-world research and innovation experience and bene fiting from sports and community facilities and opportunities for cross-cultural interaction in a safe and respectful environment.

“Our multiversity approach - making it pos sible for students to maximize their educational experience by preparing them not only for a profession, but for life- is the best formula for the future of our region,” said Francisco Mar molejo, QF’s President of Higher Education.

“At Qatar Foundation, we work towards unlocking the potential of all our students to become well-rounded and value-driven gradu ates who are truly committed and dedicated to leading and shaping their communities. The Edu cation City ecosystem is a place where students become globally able citizens who are strongly rooted in the values and traditions of the region, while retaining a strong sense of community service.”

Additionally, Qatar University (QU) contin ues to serve as the country’s primary institution of higher education. QU has eleven colleges and 94 different programs and offers quality educa tion to more than 25,000 multinational students at the undergraduate and graduate levels.

QATAR UNIVERSITY CONTINUES TO SERVE AS THE COUNTRY’S PRIMARY INSTITUTION OF HIGHER EDUCATION.

Qatar University has a substantial pool of skilled and in-demand graduates, a rising number of highly-regarded specialised Masters and Ph.D. programs and numerous noteworthy research accomplishments.

Dr. Eiman Mustafawi, Vice President for Student Affairs at Qatar University said, “We continue to put forth the effort and commit ment necessary to offering a student-centered educational experience that supports our stu dents' academic success and personal develop ment, in alignment with Qatar's higher educa tion standards which are as competitive as those of renowned universities around the world.”

“Qatar University stands today as an icon of academic excellence and as the fastest growing university in research in the region. Qatar Uni versity’s graduates are professional and com petent. It is worth mentioning that each year Qatar University recruits thousands of students, including international students, who comprise no less than 30% of the student population at Qatar University,” Dr. Eiman added.

To learn more about Qatar’s educational offering, visit: https://www.visitqatar.qa/intlen/things-to-do/education