HOSPITALS Magazine issue 42 by The Arab Hospital Magazine

Issue 42 / 144 SEPT- OCT 2018

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

The people, products and programmes of Hill-Rom work towards one mission:

EVERY DAY, AROUND THE WORLD, WE ENHANCE OUTCOMES FOR PATIENTS AND THEIR CAREGIVERS

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NEWS

Publisher Arab Health Media Communication

A QUALITATIVE LEAP IN THE HEALTH SECTOR:

Better Classification and Fewer Diseases

The health sector in the world is witnessing a major step that adds to the progress that has been achieved. The new step is the WHO release of the 11th Revision of the International Classification of Diseases (ICD) which is a culmination of health trends and statistics worldwide, containing almost 55,000 unique codes for injuries, diseases and causes of death. The ICD is also used by health insurers whose reimbursements depend on ICD coding; national health program managers; data collection specialists; and others who track progress in global health and determine the allocation of health resources. This is an important development, adding to the discoveries made by medical studies around the world that contribute to better health and less disease. ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come into effect on 1 January 2022. A key principle in this revision was to simplify the coding structure and electronic tooling. The new ICD-11 reflects progress in medicine and advances in scientific understanding. It is also able to better capture data regarding safety in healthcare, which means that unnecessary events that may harm health – such as unsafe workflows in hospitals - can be identified and reduced. While the ICD is the cornerstone of health information, such qualitative health interventions around the world are expected to provide further opportunities for disease reduction, sophisticated behaviors for the medical sectors and better health for people, which is our ultimate goal. The Publisher

General Manager Simon Chammas schammas@tahmag.com Creative Department Roula Haddad - Georges Habka Creative Director: Jessy E. Hajj Photographer Hanna Nehme Copy Editor Jessica Achkar Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa Advertising & Marketing advertising@tahmag.com Mirna Khayrallah mirna@tahmag.com Business Development Manager Ralph Rahal tahmag@tahmag.com Offices & Adresses AHMC, Lebanon Mansourieh High way, Jihad Wakim center, 3rd floor. T/F: +961 4 53 40 58 M: +961 3 60 61 00 tahmag@tahmag.com Simon Chammas schammas@tahmag.com Dubai Schammas@tahmag.com +967 50 2971007 KSA Moussa ALHAKIM - KSA Market Manager POBox 116197, Fahd Bin Zaghir Road Al Zahraa - Jeddah 21391 – Saudi Arabia T +966 55 600 88 60

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SEPTEMBER . OCTOBER 2018

40 52

56 36

74 46

NEWS

36 Transasia Bio-Medicals Ltd.

graces 72 Independence Day celebrations at Andhra Pradesh Medtech Zone (AMTZ) 38 American University of Beirut Medical Center Performs the First Transseptal Percutaneous Mitral Valve in Valve in the Middle East

6 Endoscopic technique allows removal of thyroid and parathyroid with no visible scar 8 Collaborative leadership essential to building a world-class healthcare system in the region 10 IVI Fertility Muscat clinic to offer couples FREE First IVF consultation for one full month 14 30,000 Families to Benefit from a Unique New Hospital The European Maternity Hospital construction launch took place in Abu Dhabi 16 Ministry of Health & Prevention - UAE hosts ‘Art for Health 2018’ awards 28 The 1st DHA accredited fetal medicine facility in the UAE 30 Aster DM Healthcare first in Asia to perform liver transplant using pioneering technology 32 Zebra Technologies Enhances Patient Care with New Healthcare Printing Solutions 34 A surgery that lead to two little girls’ freedom

SEPTEMBER.OCTOBER 2018

86 46 nd

COVER STORY

Hill-Rom 19 Patient safety and mobility solutions 21 Patient assessment and monitoring solutions 22 Respiratory care 23 Surgical solutions 24 Hill-Rom acquiring mortara instrument

FEATURES

40 The Saudi Healthcare National Transformation Program 58 Shipping in the medical sector 74 Infection Control in Hospitals 78 Serotonin 84 Diabetic Neuropathy

86 Helicobacter Pylori 94 ADHD

ARTICLES

48 Caring for our health, vision 2030 52 Sysmex Middle East A market leader in automated urinalysis solutions 62 contact forte by BHM 64 The private healthcare sectors: the case of bahrain 68 Internet addiction in the Our Lives and Workplace 70 The changing healthcare scenario 80 Antenatal Classes 82 Placenta Accreta, Increta, Percreta syndrome

INTERVIEWS

12 Nadine Hachach-Haram, British Empire Medal for Proximieco-Founder 46 Jiří Plecitý, Managing Director LINET MEA 54 Mr. Alaa Adel, Senior Director and Country General Manager – Saudi Arabia and Egypt, Cerner Middle East and Africa

‫ديسمبر ‪December 2018‬‬

‫‪ORTHOPEDIC MECHANICS‬‬

‫مـيكانيـكـيا تـقـويم العظام‬

‫‪ORTHOPEDICS‬‬

‫جراحة العـظـام‬

‫‪RHEUMATOLOGICAL DISORDERS‬‬

‫أمـــــــــــــــــــراض المفـــــــــــــــــــــــاصل‬

‫‪MUSCULOSKELETAL DISORDERS‬‬

‫اضطرابات الجهاز العضلي الهيكلي‬

‫‪NEWS‬‬

NEWS

Endoscopic technique

allows removal of thyroid and parathyroid with no visible scar

new procedure that allows surgeons to access and remove the thyroid and parathyroid glands through small incisions on the inside of the mouth provides successful results with no visible scarring on the neck. Dr. Raymon Grogan, Associate Professor in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, describes how the procedure works and outlines its benefits.

techniques that are used to remove the gallbladder, appendix or colon. Cancers less than 2 centimeters and benign nodules under 6 centimeters can be removed using this procedure. He conducts these surgeries at Baylor St. Luke’s Medical Center, where he is section chief of endocrine surgery. In this procedure, three small incisions are made on the inside of the lower lip. Through these incisions, the surgeon is able to place endoscopic instruments between the jaw and the skin to open up the working space needed to remove the gland, which is a short distance from the incision site. The procedure is performed under general anesthesia and patients are required to stay in the hospital overnight. Numerous other procedures have been developed to reduce the size of the incision on the neck or to get rid of it entirely. “This approach is the culmination of work that has been done over the last 20 to 30 years internationally as well as in the United States,” Grogan said.

The thyroid gland releases hormones to control metabolism. Parathyroid glands are found next to or behind the thyroid glands and control calcium levels in the blood and bones. If cancer or benign nodules are found, or if these glands become overactive, the affected gland needs to be removed. Traditionally, surgeons remove the thyroid and parathyroid glands using a small horizontal incision in the center of the neck. The scar size depends on the size of the gland, with the average size being 4 to 6 centimeters long. The procedure that Grogan performs, transoral endocrine surgery, applies the same laparoscopic or endoscopic

However, the other ‘scarless’ procedures that have been tried involve going through the armpit, the hairline in the back of the neck or even the nipples, meaning that the patient would still have a scar, just not on the neck. The transoral endocrine procedure is the only procedure where there are no visible incisions. In addition, with the transoral procedure the lower lip incisions are very close to the target anatomy, so there is minimal increase in dissection relative to the traditional approach. This is in contrast to the other ‘scarless’ techniques where the incisions are made much further from the target anatomy. This is important since

Dr. Raymon Grogan

larger dissections can lead to increased pain, complications and recovery time. The incisions on the inside of the lip are minimally painful, and patients usually take pain medication for a day or two after the surgery before switching to anti-inflammatory medication. Grogan recommends staying on a liquid diet for the first day after the surgery and then switching to soft foods for the following couple of days. Patients are encouraged not to drive while they are on pain medication or if they have a stiff neck. They can experience bruising, swelling, tingling and temporary numbness of the lower lip, chin and upper neck, which should only last one to two weeks. Grogan usually recommends one week off from work after the procedure. The recovery time is similar to the traditional open approach. As for the risks, published data from a series of cases done internationally has found that the complication rates for this procedure are comparable to the traditional open approach. These known complication risks include injury to the recurrent laryngeal nerve and injury to the parathyroids. There has been one surgical site infection in over 1,500 cases to date. The additional possible risk for this procedure is numbness of the chin or lip, which has been found in 1 in 1,500 of the cases studied in the international population so far. Grogan said that it is possible that anatomic differences between an American population and the international population could alter that risk profile, therefore more data need to be collected to see how these data in an international population compares to the U.S. population.

FOR MORE INFORMATION CONTACT INTERNATIONAL SERVICES AT BAYLOR ST LUKE’S MEDICAL CENTER Via email at international@stlukeshealth.org or call +1 832 355 3350 or visit StLukesInternational.org Texas Medical Center, Houston, Texas - USA SEPTEMBER.OCTOBER 2018

NEWS

Collaborative leadership essential

to building a world-class healthcare system in the region model to public-private partnerships, focuses on wellness and prevention rather than sickness, and integrates digital technology and other innovations (from automation to Artificial Intelligence) to help improve patient care and safety, whilst managing costs. A profound transformation in a conservative and sensitive environment such as patient care will always present significant leadership and organizational challenges. However, leadership is an essential component for success across all healthcare systems, individual institutions and at every departmental level, clinical and administrative, and always with a clear focus on the patient. Collective leadership must build the capacity and capability of the people within the healthcare system through improved skills and the development of appropriate behaviors. The focus should be on how a leader leads within a collective healthcare system, always putting the patient first. Healthcare leaders who are unable to adapt to the changing industry needs will continue to face the same difficulties of cost, quality and access, with patients remaining isolated from the leadership decisions and practices. The concept of the patient ‘as leader’

ealthcare – arguably the world’s largest industry – is undergoing a dramatic global transformation, including within the Middle East. The GCC healthcare sector continues to expand to meet the rising demand for care from a growing and aging population of citizens, residents (and visitors), which is also facing the chronic lifestyle-related conditions that pose significant public health challenges, from diabetes to obesity and cardiovascular disease. But according to Alpen Capital’s GCC Healthcare Industry report 2018, the regional industry also faces rising costs and a lack of availability of healthcare professionals – the skilled physicians and nurses who provide the patient care at the heart of the industry. To this list of skilled professionals, we should add the essential healthcare leaders who are needed to lead the regional industry through its transformation as it continues to build new capacity, shifts the care delivery

SEPTEMBER.OCTOBER 2018

is already starting to emerge. Every healthcare system across the world faces the same four major global leadership challenges - universal access to different levels of healthcare in a timely, cost-effective and seamless manner; giving prevention as much priority as treatment and recognising long-term benefits; delivering healthcare across a range of public/private and hybrid systems; integrating care across diverse primary, secondary and tertiary providers. These four leadership challenges are the focus of a new MSc International Healthcare Leadership programme delivered in a part-time blended learning format for experienced clinicians and managers already in general management; leaders in healthcare who need to enhance their leadership skills; and managers who need practical preparation before moving into clinical, project, specialist or business leadership positions. It is designed to equip leaders and managers with the latest knowledge and global healthcare best practice and to help facilitate experienced managers transfer their skills into the healthcare economy, while they continue to work. The flexible study programme can be completed in two years and also includes regular face to face workshops in Dubai.

INSURED BY VICTOIRE

T R AV E L

SAFE

NEWS

IVI Fertility Muscat clinic

to offer couples FREE First IVF consultation for one full month

nfertility is not an unheard of phenomenon. At a time when one in five couples run into difficulties conceiving a child, IVF is a ray of hope for millions of couples that look forward to having their own families. And over the last few years, there has been a notable IVF baby boom. The science has helped realize the dream of many couples including those who had completely given up hope. The recognition of this science, world over, is celebrated as the IVF World Day. An international committee monitoring progress in assisted reproduction reported that the global total of babies born as a result of IVF and other advanced fertility treatments is more than 8 million.

pregnancy to latest IVF treatments for both men and women the science has witnessed incredible innovations. The costs are affordable and the advanced processes have delivered results. With an aim to continue this positive momentum, we are celebrating World IVF Day through free first consultations that will help patients struggling with infertility at least understand the cause and then plan the course of action,” said Dr Francisco Ruiz, Medical Director, IVI Middle East Fertility Clinic in Muscat. The healthiest age to have babies is between 20 and 35. And while it is a proven fact that after 35, women’s fertility gradually declines, it is imperative to go for an expert consultation without losing time. This will at least help identify the cause and address the problem at the right stage, if any. The first free consultation at IVI Middle East Fertility Clinic offered couples a chance to talk to global doctors and seek opinion. In addition, the free consultation offered couples meaningful lifestyle advice for improv-

In recognition of the World IVF Day, IVI Middle East Fertility Clinic offered couples Free First IVF consultation at its renowned clinic in Muscat from 22nd July to 20th August 2018. “IVF has advanced substantially in the last few years. From genetic testing for healthy embryos that greatly enhance the chances of a healthy

ing fertility and also offered insights on how the couple can plan ahead for the future. It is indeed an achievement how quickly it has been accepted. The central component of any IVF treatment is the embryology lab and at IVI Middle East Fertility Clinic, we have the most advanced facilities to achieve the best results in fertility treatments that lead to higher pregnancy rates. While the free consultation offered patients easy access to globally renowned IVF doctors, it also helped them get a better understanding on how IVI Fertility is their best chance of starting a family. With an excellent team of over doctors, embryologists, counsellors and nursing staff, IVI Fertility delivers a success rate of over 72 percent, the highest in the Middle East. IVI Fertility has three clinics in the Middle East – Abu Dhabi, Dubai and Muscat, which strive to offer patients fertility treatments that are honest, transparent and customised to their medical conditions coupled with the best clinical practices.

Abington Hospital

Receives Prestigious Baby-Friendly Designation

bington Hospital – Jefferson Health has been recognized as a Baby-Friendly hospital by Baby-Friendly USA, Inc. This designation recognizes Abington Hospital for the optimal level of care it provides breastfeeding mothers and their babies.

tive (BFHI) in 1991. This initiative is centered around the Ten Steps to Successful Breastfeeding; a plan developed by global experts. Hospitals that provide mothers with the information, skills and confidence they need to successfully initiate and continue breastfeeding are recognized as Baby-Friendly. The World Alliance for Breastfeeding Action (WABA) coordinates World Breastfeeding Week, which is recognized annually August 1 to 7, to protect,

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initia-

SEPTEMBER.OCTOBER 2018

promote and support breastfeeding mothers worldwide. “We are committed to providing new mothers with the information and skills needed to confidently feed their babies,” says Dr. Steven Shapiro, Chair, Department of Pediatrics. “Abington Hospital is so proud to have achieved this designation which reflects the great efforts of our doctors, nurses and staff.” In order to be considered for designation, Abington Hospital completed a rigorous on-site survey.

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When the bed is equipped with the Protega safety sides, it can also be optionally fitted with integrated control panels. These panels face inward with a simple and clear display for the patient and outward with additional control options for care staff.

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INTERVIEWS

British Empire Medal for Proximie co-Founder

Nadine Hachach-Haram “Arab world is keeping up with the fast pace of technological developments”

adine Hachach-Haram, Proximie co-Founder, has received a British Empire Medal which is one of a number of honors bestowed upon people by the Queen for their achievements. “Hospitals” met with Nadine Hachach-Haram, a London-based surgeon and founder of Proximie, a developer of augmented reality tools for surgery.

about innovation in healthcare and how we can leverage technology to improve the care patients receive across the world. This award is recognition for the work that Proximie is fulfilling with the aim of providing access to high-quality healthcare as a fundamental right of every individual wherever they live. The most exciting thing today is that with emerging technologies like augmented reality and virtual reality that right doesn’t have to be something that is out of reach. We can really make it happen.

First, we would like to extend our warmest congratulations and we hope that you accomplish further achievements and win more prizes.

We would like to know more about your professional career and the stages you went through until you founded Proximie. I started my undergraduate degree at AUB and completed my B.Sc. in Biochemistry at San Diego. I then continued my education and trained to be a surgeon in the UK, specializing in plastic surgery within the NHS. At the same time, I undertook a number of surgical innovation and charitable roles, and it was through these that I was inspired to co-found Proximie.

“Proximie” is a comprehensive electronic platform, a developer of augmented reality tools for surgery. Can you tell us more about this platform? What is the mechanism of action adopted?

Can you tell us about the prize that you have recently received? How important is it to you?

Proximie is an augmented reality (AR) healthcare solution enabling remote medical and surgical care, consultations and teaching. It allows two people in remote locations to interact virtually in a way which mimics what they would experience if they were collaborating in the same room. It means one doctor can annotate and actually show the other where to make an incision, or use gestures

The British Empire Medal is one of a number of honors bestowed upon people by the Queen for their achievements in public life and recognizes the contribution they have made to help others, the community and Britain as a whole. I am incredibly proud and humbled to have received this award so early on in my career. I’m passionate

SEPTEMBER.OCTOBER 2018

to illustrate a technique, rather than just talking about it. All it requires is an ordinary device - a laptop, tablet or smartphone - and an Internet connection.

What is the added value provided by this platform in the surgical work, whether for the surgeon or the patient? It is a pioneering technology within the field of healthcare as its use of AR means that the sharing of medical expertise is no longer confined to specific locations. Ultimately, access is increased and expertise is scaled. For example, specialist services are opened up to all, without the patient having to travel, by allowing doctors to see and treat their patients even if they are in different locations. This increases productivity and addresses inefficiencies in care as doctors can remain in one location but still see more patients. It also tackles the shortage of doctors globally by allowing knowledge translation and expertise to be shared by a greater number simultaneously. Via Proximie, trainees can have an interactive experience of the operating room, increasing our ability to train, but also enabling the sharing of expertise

INTERVIEWS

between peers so we can harness the latest techniques from anywhere in the world and thus provide patients with the best experience possible.

How has this platform changed the face of advanced surgical procedures to benefit from technology in the medical field? Proximie through its AR technology offers powerful solutions to many healthcare challenges; breaking down barriers of time and distance to improve access and efficiency and train doctors in greater numbers through expert real-time collaboration to equip them with the very best, and most cutting-edge skills and techniques.

Based on the fact that you are working between Beirut, London

and Boston, where are we today in the Arab world in terms of global medical and technological developments whether in medical technology or professional human resources? I’m proud to say that the Arab world is, in fact, keeping up with the fast pace of technological developments and with the recruitment of professional human resources. In fact, Arabs are pioneering many technologies and some institutions in the region have been very keen to adopt and integrate such valuable technologies into their medical centers in order to increase access, to teach, to leverage more expertise and to perform advanced surgeries. I hope this continues to become a trend for other centers and puts the

Middle East on the map for advanced delivery of healthcare. I believe we are just scratching the surface with the Middle East and are very excited about the future and working with leading institutions in the Arab world.

Technology has entered the world of medicine, which was the sector that benefited the most from this development. How do you assess that as you are an active member in this field? Through digital technology, and by means of ordinary, everyday devices we now take for granted, we can do miraculous things. I believe we are only just getting started in discovering what technology can really achieve in the fields of medicine and global health.

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NEWS

30,000 Families to Benefit from a Unique New Hospital The European Maternity Hospital construction launch took place in Abu Dhabi

he construction of a brand new state-of-the-art healthcare facility in Abu Dhabi’s Khalifa City was officially launched with a groundbreaking ceremony.

would benefit from our specialized services. There are over 30,000 families living in the vicinity, and currently there is no specialized hospital in the area that focuses purely on the needs of women and young children. The UAE houses some of the best medical facilities on an international level and we aim to build upon those standards by offering families our expertise in maternity care. The European Maternity Hospital is a hospital for the community and a hospital for the future.”

The European Maternity Hospital is the first facility of its kind in the area, and will provide top of the range maternity services for families, women and infants. As well as being the only hospital of its nature in the surrounding area, the European Maternity Hospital is set to become one of the UAE’s top hospital solely dedicated to the healthcare of women and babies.

With the European Maternity Hospital scheduled to launch in 2021, Peter Obrist, CEO of Project Management firm Swiss PMC explained the significance of the construction launch timing, and how the hospital is contributing to the ‘UAE Vision 2021’ by stating: “As providers of healthcare we consider it our duty to produce a premium facility and to provide for the community while increasing the

Mr. Mohamed B. Hamad, CEO of the European Hospital LLC stated: “The European Maternity Hospital will assist many families for generations to come. We purposely searched to have the hospital in Khalifa City in order to maximize the number of families that

SEPTEMBER.OCTOBER 2018

quality of life standards of the people cared for. We see the European Maternity Hospital as an added value component to the UAE Vision 2021 while providing world-class healthcare. We are eager to open our doors to the community and show this outstanding hospital to the UAE population and the world”. The European Maternity Hospital is being developed in alignment to the UAE’s leadership directive for the supply of premium healthcare facilities to service the community. The hospital received its license from the Abu Dhabi Municipality and the Department of Health gaining approval for its location and staffing. It’s expected to house few dozen consultants and doctors, few hundred nurses, several technical support staff and management officers. The hospital has a capacity of 120 beds, plus ICU, postnatal and antenatal beds.

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NEWS

Ministry of Health & Prevention - UAE hosts ‘Art for Health 2018’ awards

hensive health coverage based on the highest international standards. The award comes in line with the UAE’s commitment to the National Agenda 2030 of Sustainable Development and the achievement of excellence in the implementation by ensuring healthy lifestyles and well-being.

he Ministry of Health and Prevention (MOHAP) held the closing ceremony of the ‘Art for Health 2018’ competition. The winners were awarded in the presence of H.E. Dr. Hussein Abdul Rahman Rand, Assistant Undersecretary for Health Centers and Clinics; and Dr. Fadila Sharif, Director of Education and Health Promotion Department.

in the country through presenting health issues in a creative way to unify efforts and synergies. The use of art as a new form of communication to convey the Ministry’s messages is aimed at improving the health of present and future generations.” He pointed out that this year’s competition focused on three indicators within the national agenda, which included tackling obesity in children and adolescents in the age group of 5-17 years; reducing the mortality rates of cardiovascular diseases; and reducing the incidence of diabetes in the country. He pointed out that the launch of the ‘Art for Health’ awards forms part of the Ministry’s strategy to promote healthy lifestyles in the UAE community and to provide comprehensive and integrated healthcare in innovative and sustainable ways to ensure community’s protection against diseases. It also supports the Ministry’s and its partners’ efforts in the UAE to develop the National Strategy for Combating Noncommunicable Diseases (2017-2021), in line with the National Agenda 2021 to develop a health system and to provide compre-

Dr. Rand thanked the attendees and youth especially for contributing towards building an effective communication bridge with the wise leadership. This in turn ensures the achievement of a better future built on the capabilities and accomplishments of young people and further establishes the UAE’s leadership in the fields of competitiveness and indicators of international excellence. H.E. added: “I am delighted to be a part of the closing ceremony of ‘Art for Health 2018,’ which was launched by the Ministry of Health and Prevention to raise awareness of the community members about the importance of healthy lifestyles and utilizing young people’s capabilities to take on the health-related challenges

SEPTEMBER.OCTOBER 2018

Dr. Fadila Sherif explained that the ‘Art for Health’ award has four categories - Film, Animation, Photography and Drawing. The best three posts were selected in each category and the results were announced. She pointed out that the goal of the ‘Art for Health’ competition is to encourage young people in the UAE to create artworks that highlight the most important health challenges in the society from an innovative perspective to make a positive difference. She added that all initiatives by the Ministry in the field of health education are aimed at building a healthy society by enabling people to adopt healthy lifestyles that contribute to reducing the spread of noncommunicable diseases. This contributes to improving the national index of healthy quality of life by providing the highest levels of healthcare that meets the needs of individuals.

NEWS

COVER STORY

ill-Rom helps healthcare providers navigate a complicated healthcare environment and overcome barriers that make it difficult to achieve your goals. Our innovative solutions enable you to provide high-quality patient care, in light of financial realities, both inside and outside of the hospital. We partner with healthcare providers in more than 100 countries by focusing on patient care solutions that improve clinical and economic outcomes: Patient Safety and Mobility Solutions, Patient Assessment and Monitoring Solutions, Respiratory Care Solutions, and Surgical Solutions. In addition, Hill-Rom provides best-in-class service to ensure reliable and safe products to help you provide exceptional, high-quality care for your patients.

SEPTEMBER.OCTOBER 2018

COVER STORY

PATIENT SAFETY AND MOBILITY SOLUTIONS Get your most challenging patients better, sooner Harms and complications in the ICU can extend length of stay and add to costs. The longer the patient is in the ICU and immobile, the higher risk they are for the potential complications such as respiratory infections and pressure injuries. Hill-Rom partners with our customers to implement an integrated mobility program that leverages innovative ICU products (such as advanced beds, patient handling lifts, and respiratory therapy devices) to reduce ICU length of stay by decreasing patient ventilator days, delirium and pressure injuries.

Improve patient safety and satisfaction while managing costs In today’s Med-Surg units, healthcare providers are faced with sicker patients, while also being asked to increase quality of care and patient satisfaction. At the same time, patients, and their families, are more involved in their care than ever before. Hill-Rom can help you improve patient satisfaction and patient safety with a robust solution of products and clinical programs including smart beds that communicate directly with our nurse call system, patient monitoring solutions, and a Falls Prevention clinical program that can integrate into your existing clinical protocols.

COVER STORY

SEPTEMBER.OCTOBER 2018

COVER STORY

PATIENT ASSESSMENT AND MONITORING SOLUTIONS Protecting patients by anticipating careSM Data is everywhere in hospitals today, but too often it is not being leveraged to solve clinical problems. This is one of the reasons why preventable conditions like falls and infections continue to occur that cost our system billions of dollars. Hill-Rom Clinical Workflow Solutions can help via our innovative software platform and products. First, we help you collect the information that matters as not all of the information holds equal weight at all times. We then use algorithms to help you identify opportunities to improve care and deliver that actionable insight to you in real-time, giving you the confidence that you’ll receive the information you need, when you need it, to enhance outcomes.

Helping to eradicate the leading causes of preventable blindness

Delivering more advanced and comprehensive care with practical diagnostic tools The role of primary care has evolved from an independent function to a key linkage of information to support the overall clinical decision-making process. This change has created a greater need to coordinate information sharing across the care continuum and has also produced new workflow challenges for clinicians. Welch Allyn provides the integration of vital signs management and physical assessment tools in one system. Helping to eliminate frustrating and time-consuming searches for individual pieces of equipment allows clinicians to immediately view all necessary patient data, then sends it directly to an EMR/EHR. This streamlined workflow leads to improved operational efficiency within the office and throughout the health system.

Welch Allyn delivers simple and affordable screening solutions in primary care settings to help eradicate some of the leading causes of preventable blindness. Diabetic retinopathy is the leading cause of blindness among working-age adults. With early detection, 95% of vision loss cases can be prevented, while also achieving up to 90% patient compliance with potentially vision-saving diabetic retinopathy exams. One in four school-age children suffer from a vision disorder. Welch Allyn provides technology that can screen for five amblyoptic risk factors in just seconds.

COVER STORY

RESPIRATORY CARE Advancing respiratory health through innovative therapies Retained secretions in the airways may lead to increased infection, hospitalization, and reduced lung function. Airway clearance therapy has been shown to improve lung function. With reported adherence to therapy in the 50% range, collaboration tools that increase visibility to therapy patterns can aid HCT coaching and motivation. Hill-Româ€™s Respiratory Care products work to improve airway clearance and remove secretions from the upper airways. This connected care provides opportunities for enhanced discussions and early interventions, which may lead to a reduction in respiratory infections, hospitalizations and medical costs.

SEPTEMBER.OCTOBER 2018

COVER STORY

SURGICAL SOLUTIONS Effective and efficient OR utilization Operating rooms can be one of the most costly departments in a hospital. More and more, hospitals rely on important metrics for OR efficiency and utilization. These metrics may range from first-case start times and turnover times to percent of rooms used and, of course, patient outcomes. Hill-Rom Surgical Solutions provide high-quality surgical equipment, surgical instruments and medical supplies to help you improve such metrics. The unparalleled breadth of our surgical table offering and innovative technologies bridge general and multidisciplinary applications to bariatric and advanced specialty procedures, as well as integrated intraoperative and robotic-assisted surgeries.

COVER STORY

HILL ROM ACQUIRING MORTARA INSTRUMENT COMPLEMENTARY COMBINATION STRENGTHENS CLINICAL FOCUS ON DIAGNOSTIC CARDIOLOGY AND PATIENT MONITORING Mortara’s innovative portfolio of diagnostic cardiology devices is designed to serve the full continuum of clinical care, from acute care to primary care and clinical research organizations. Mortara’s comprehensive range of products, operating under the Mortara, Quinton® and Burdick® brands, include resting electrocardiography, cardiac stress exercise, Holter monitoring, ambulatory blood

SEPTEMBER.OCTOBER 2018

pressure monitoring, and cardiac and pulmonary rehabilitation and multi-parameter patient monitoring.

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Strengthening clinical focus on diagnostic cardiology and patient monitoring across the combined portfolio Leveraging deep relation-

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NEWS

The 1st DHA accredited fetal medicine facility in the UAE Facility to offer specialist services and technology within the Medcare Women and Children’s Hospital spot issues as early as 12 weeks’, so that we can plan the safe management of the rest of the pregnancy. We are committed to taking care of highrisk pregnancies.”

edcare announced the opening of the first DHA accredited Fetal Medicine Unit in the UAE. Situated in the heart of the Women and Children Hospital on Sheikh Zayed road, the facility is equipped and dedicated to serving the pregnant population of the UAE. The new facility will offer a wide range of fetal therapies, including management of high-risk pregnancies, multiple pregnancies, counselling, and invasive procedures. Specialist services including Utero Fetal Transfusion and Laser Treatment for Twin Transfusion Syndrome will be available at the facility, for the first time in the UAE. Ms Alisha Moopen, Executive Director and CEO of Hospitals and Clinics, GCC, at Aster DM Healthcare said, “I am delighted to announce the opening of the Medcare Fetal Medi-

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cine Facility. With our commitment to providing the best healthcare services to society, we have both diversified and fortified our portfolio to strengthen healthcare infrastructure in the UAE. This clinic, situated within our well-established Medcare Women and Children Hospital, is a perfect example of this commitment.” Dr. Shamsa Bin Hammad, Chief Operation Officer of Medcare Women & Children hospital commented on the launch, “With such a diverse population in the UAE, and a baby born every 6 seconds, a specialist facility that meets the needs of this diverse patient base is a must. As a mother, I know how exciting the pregnancy journey can be, but as a Doctor, I am acutely aware of the risks as well. Each pregnancy is unique, and our team of specialists are highly trained to offer the best care possible. Our aim is: ‘To

The facility will help detect and diagnose problems in the baby at the earliest stage. Currently, there are several standard prenatal tests that must be performed at regular intervals. While blood and urine tests are mandatory routine tests that every mother-to-be should have, Medcare recommends undergoing the following to ensure a more informed pregnancy: The Glucose test, to detect gestational diabetes; Chronic Villus Sampling; Amniocentesis (or AFT); Maternal Serum Screening; and the NIPT test. These will help to diagnose any chromosomal abnormalities, generic disorders or fetal infections during different time periods. All of these tests and more are available in the new Medcare Fetal Medicine Facility.

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NEWS

Aster DM Healthcare

first in Asia to perform liver transplant using pioneering technology

ster DM Healthcare, a leading private healthcare services provider in GCC and an emerging player in India, announced that it has performed Asia’s first-ever liver transplant using Normothermic Machine Perfusion, a process which can keep a liver alive outside the body for up to 24 hours by maintaining it at body temperature. The surgery - considered the next important step forward in liver transplantation - was successfully performed at Aster CMI Hospital in Bangalore using OrganOx Metra device technology. Aster CMI has become the first hospital in India and the wider Asia region to use the perfusion technique as part of its standard clinical practice which allows physicians to test how well a liver is functioning before transplant, boosting the chances that the procedure will be a success. The announcement comes at a time when the demand-supply disparity in India for organ transplant remains a critical issue, which is primarily attributed to lack of awareness and infrastructure. Furthermore, the organ transplant success rate in India is low compared to developed nations in the West, and often this is due to the functionality of organs deteriorating during the preservation stage that lasts up to 12-14 hours. Mr. Ashwath, a 53-year-old patient who was suffering from end stage liver disease, became the first person in Asia to receive a liver transplant using this state-of-the-art technology. Dr. Sonal Asthana, Senior Hepatobiliary and Transplant Surgeon, at

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Aster CMI Hospital said: “Livers are usually stored in ice and preservation solution in a small sized box, where they can be kept for 12 to 14 hours before transplant. Sometimes, those less suitable for transplant do not survive the cold and begin to deteriorate, and this severely impacts the success rate of the organ transplant. The introduction of normothermic machine will change the way we preserve organs and allow us to check the functionality of organs before transplantation. Also, organs which are donated in far off parts of the country can now be transported to transplant centers and utilised safely.” The new device has created a system that allows blood to circulate through the liver. When the organ is in the device that mimics the body, doctors can monitor the blood flow and letting out bile and can better tell how it might work in a patient. The technology has only been available in Europe and the US so far, and this is the first time it has been used in Asia at Aster CMI Hospital in Bangalore. Dr. Rajiv Lochan, Senior. Consultant - Hepato-pancreato-biliary & Transplant Surgery, Aster CMI Hospital, said: “This new technology essentially allows for the liver to be kept alive and warm outside the human body, for us to test it to ascertain its health. In Mr. Ashwath’s case, it was important to reduce the preservation time to a minimum as he had previous operations on his abdomen, that would have resulted in a long operation time to remove the old liver and the liver graft could have deteriorated while being preserved in cold preservation fluid, which is the currently

practiced traditional method of organ preservation. In addition, these livers can be treated to make them better while on the machine and numerous studies of these techniques are being performed. This new technology of machine perfusion is exciting and will indeed change the liver transplantation landscape not only in India but across the world. The Integrated Liver Care medical experts at Aster Hospitals specialize in all aspects of liver care such as liver transplantation, liver anesthesia, and liver pathology among others. The team has special training and extensive experience resulting from a collective expertise of over 2000 liver transplants and over 4000 major liver and pancreatic surgeries in major hospitals around the world.

Aster DM Healthcare Aster DM Healthcare Limited is one of the largest private healthcare service providers operating in multiple GCC states and is an emerging healthcare player in India. With an inherent emphasis on clinical excellence the company is one of the few entities in the world with a strong presence across primary, secondary, tertiary and quaternary healthcare through its 19 hospitals, 101 clinics and 207 pharmacies. These are manned by our 17,300+ employees from across the geographies that we are present in, delivering on a simple yet strong promise to its people: “We’ll treat you well.” We reach out to all economic segments in the GCC states through our differentiated healthcare services across the “Aster”, “Medcare” and “Access” brands.

NEWS

Zebra Technologies Enhances Patient Care with New Healthcare Printing Solutions

ebra Technologies Corporation (NASDAQ: ZBRA), the market leader in rugged mobile computers, barcode scanners and barcode printers enhanced with software and services to enable real-time enterprise visibility, announced two new healthcare barcode printing solutions that can identify patients and specimens at the point of care. Zebra’s ZQ600-Healthcare series label printers and ZD510-HC direct thermal wristband printer enable the production of highly durable labels and patient identification wristbands used to accurately and efficiently pair patients to the correct medical records, care staff, medication and specimens. Both printers include Zebra’s Print DNA suite of applications, utilities and developer tools - powered by the Link-OS® operating system - which provides healthcare IT departments with a better printing experience through stronger security, easier integration and simplified remote management.

ZQ600 Healthcare • The ZQ600-Healthcare mobile printer is designed for high-volume specimen labeling at the point-of-care and helps reduce patient lab diagnos-

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tic errors while also allowing nurses to spend more time at the bedside. • The small, lightweight format allows it to be easily carried on a clinician’s belt clip or placed on a cart. It also features an easy-to-read color display that can clearly identify signal alerts, printer status and errors to quickly resolve issues. • Its high-capacity battery works with Zebra’s patented Power Smart Print technology (PSPT), which maximizes battery efficiency by calculating and delivering the exact amount of power required for hospital staff to print during their entire shift. • It also includes the industry’s only instant wake over Wi-Fi feature, which automatically wakes up the printer if it goes into sleep mode when idle and enables clinicians to instantly print labels. • Zebra’s IQ Color Specimen Collection Labels automate the identification of STAT specimens, eliminating the manual process of marking the label with a marker which reduces errors and speeds up operations. The labels meet the Clinical Laboratory Standard Institute’s (CLSI) specimen collection label format standard.

ZD510 HC • The new ZD510-HC direct thermal wristband printer is ideal for pro-

ducing high-grade wristbands used for positive patient identification and works with leading admission, discharge and transfer systems. • Its innovative cartridge technology enables fast-loading of wristband cartridges and includes a smart chip that automatically configures printer settings and identifies adult and pediatric-sized wristbands. This virtually eliminates training and significantly increases staff efficiency. The printer is also backwards compatible with existing Zebra wristband cartridges. • Zebra’s Z-Band® Wristbands contain an antimicrobial coating and are up to six times more durable than leading thermal healthcare wristbands when exposed to common solvents used in hospitals. Z-Band wristbands are available in a variety of colors and sizes to meet different patient identification needs.

NEWS

A surgery that led to two little girls’ freedom After a successful separation of two conjoined twins at Shanghai Children’s Medical Center in China

fter a successful separation of two conjoined twins at Shanghai Children’s Medical Center in China, the little girls still faced critical conditions. But thanks to the skills of the medical team and Getinge’s NAVA technology they survived, as two separate individuals. As a leading children’s specialist hospital in China, the Shanghai Children’s Medical Center is exposed to all kinds of incurable diseases every day. But one day, they stood in front of something that is quite rare even for them – two 4-month-old conjoined twins who needed to be separated. The twins were actually found to be conjoined already during a prenatal checkup, but their parents had no doubts in their hearts; they immediately decided to keep the twins, but under close advice and monitoring by local doctors. Shanghai Children’s Medical Center “At the time of birth, the daughters weighed just close to 5 kilograms. The names that the parents picked for them were inspired by the meaning of feeling safe and relieved, as they were hoping that the sisters would have a chance to overcome the difficulties and grow up healthily”, says Prof. Jinfen Liu who was leading the medical team executing the surgery. Magnetic resonance imaging, computed tomography scan and echocardiography showed that the sisters were connected from the chest to the abdomen, with a length of 17cm of the skin from the second sternum to the lower level of the kidneys. “They shared a common liver, but the hepatic vasculatures and gallbladders were independent. They also shared one pericardium, but fortunately they had their own independent hearts. A carbon-chip experiment showed that the digestive systems were independent, which gave us a good foundation to do the separation”, says Prof. Jinfen Liu. With the collaboration of various departments at the Shanghai Children’s Medical Center, the conjoined twin girls survived the separation and took the first step toward independence and freedom. However, despite the success of the surgery, all organs of the two infants were still fragile. Postoperative care and treatment became crucial for survival. “The quality of the girls’ future lives was at that point going to be determined by how well we could prevent lung infection while reducing lung damage and effectively

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carrying out respiratory function exercises”, Dr. Limin Zhu, the intensivist of these two girls, remembers. Due to lack of synchronization, the conventional mechanical ventilation mode of treatment risked to increase the airway pressure and cause fatal damage to the babies’ lungs, as well as increasing the risk of man-machine confrontation. SERVOn“Fortunately, with Getinge’s NAVA technology, these problems were effectively avoided. The application of this technology also reduces machine time, as the withdrawal time is 3-5 days shorter than that of the traditional mechanical ventilation”, says Dr. Limin Zhu. After months of effective treatment and care, the sisters were finally discharged from the hospital to thrive just like other little ones, in the care and companionship of their parents. “The skills of our medical team and the amazing NAVA technology helped making a true lifesaving difference here. We are glad that we could help give the twins a chance to continue their lives in freedom, as separate individuals”, says Dr. Limin Zhu.

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NEWS

Aster Volunteers and ERC Bring Children Together Through Educational Activities at Aster Hospital Qusais

n August 17th and 18th, Aster Hospital, Qusais hosted a two-day event that brought children together through art workshops, interactive games and team-building exercises. The “Chapter One – Life Lessons For Future Leaders” saw the involvement of more than 30 children from areas surrounding Aster Hospital Qusais as they joined 30 children from Emirates Red Crescent. Created to encourage a sense of inclusiveness and compassion among the youth, the Aster Volunteers initiative included tree-planting activities around the hospital’s premises. The children also took part in art sessions developed to promote creativity, self-expression, and cooperation. Guided by a team of professionals, the children paired up to craft individual figurines. Before day’s end, the children assembled the pieces together in a grand finale installation. Speaking on the occasion, Dr. Sherbaz Bichu, CEO Aster Hospitals, said: “It is with great pride that we invite children from different walks of life to take part in these workshops. Our aim in creating this program was to teach children the value in every person’s contributions; to show them how

each piece of the puzzle can fit together to create something truly extraordinary. At Aster Hospital Qusais, we strive to enable the growth of a society that embraces its differences and comes together to create a healthier and brighter future for all.” This event is the second in an ongoing series of events organized by Aster Hospital Qusais to promote the physical, cognitive, and social development of children. Earlier this month, children were invited to be a part of “Digital Detox Sessions” that encouraged them to detach from their digital devices and take part in activities that included art, music, yoga & meditation.

Transasia Bio-Medicals Ltd. graces 72nd Independence Day celebrations at Andhra Pradesh Medtech Zone (AMTZ)

aluting the spirit of independence and Make in India initiative, Mr. Suresh Vazirani and Mrs. Mala Vazirani of Transasia Bio-Medicals Ltd., pioneers of Indian In-vitro Diagnostic industry, delivered a lecture at Andhra Pradesh Medtech Zone Ltd. (AMTZ) on the occasion of 72nd Independence Day celebrations. The function started with the unfurling of the national flag through the hands of Dr. Jitendar Sharma, MD & CEO of AMTZ, and Mr. Vazirani. The ceremony took place in the presence of a large gathering of representatives from AMTZ as well as Transasia Bio-Medicals Ltd.

Later during the day, Mr. Suresh Vazirani, Chairman & Managing Director, Transasia Bio-Medicals Ltd. addressed the gathering on how he made manufacturing in India a reality. He emphasized on the need to manufacture medical devices in India to counter the dependency on imports. “I feel proud to be a citizen of a progressive nation and I am glad that I am able to contribute to the health of this coun-

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try. I started Transasia with a conviction that someday India would have its own indigenously manufactured medical devices that would meet the diagnostic needs of the country. I am happy that as India’s leading IVD Company, we have been successful in setting up four manufacturing facilities in India and provide employment to many,” he said. Mrs. Mala Vazirani, Executive Director, Transasia Bio-Medicals Ltd., further added, “ When we started off, we had a tough time convincing doctors, that an Indian manufactured instrument could work as efficiently as any other. In the last 40 years, we have come a long way, both of us, our senior management team and every member of the Transasia family. Today, with over 65,000 installations across India and the largest field force comprising sales and service experts, I am honored that Transasia is recognized as a trusted name not only in the country but also globally. We are glad to be associated with AMTZ in further strengthening the Make in India initiative.” The session concluded with felicitation of Mr. Suresh Vazirani and Mrs. Mala Vazirani by Dr. Jitendar Sharma.

NEWS

American University of Beirut Medical Center (AUBMC) Performs the First Transseptal Percutaneous Mitral Valve in Valve in the Middle East

he structural cardiology team at the American University of Beirut Medical Center (AUBMC), Department of Internal Medicine, performed the first transseptal percutaneous non-surgical mitral valve in valve replacement (Mitral VIV) in the region, on an elderly lady with severe mitral bioprosthesis stenosis. The patient had no surgical options and was not a candidate for redo conventional mitral valve replacement. The procedure was performed by the director of the structural program, Division of Cardiology, Dr. Fadi Sawaya in conjunction with a multidisciplinary team consisting of Dr. Ziyad Ghazzal, Founding Director of the Heart and Vascular Clinical Center of Excellence, Dr. Bernard Abi-Saleh, Associate Professor of Clinical Medicine, Dr. Hussain Isma’eel, Associate Professor of Clinical Medicine, and Dr. Jean Beresian, Assistant Professor of Anesthesiology. Dr. Fadi Sawaya said: “The percutaneous mitral valve in valve replacement through the transseptal approach is a unique and advanced procedure that offers a new option to patients that are unable to tolerate a

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repeat open heart surgery.” He added, “We continue to strive to bring the most sophisticated techniques and cutting-edge technologies in cardiovascular care to our patients at AUBMC and Lebanon so that they receive the most advanced therapies.” Mitral valve in valve is a minimally invasive transcatheter mitral valve replacement (TMVR) procedure for patients who have had previous open heart valve surgery to replace the mitral valve with a bioprosthetic (tissue) valve and the tissue valve is now failing. Instead of the failing mitral tissue valve being replaced during another open heart mitral valve surgery, the failing mitral tissue valve is fixed by placing a TAVI valve inside the failing mitral tissue valve. Under sedation, a catheter is inserted into the vein of the groin area and threaded through right side of the heart. A hole is then performed to cross into the left side of the heart and deliver a catheter across the old surgical mitral valve into the left ventricle. An Edwards TAVI Sapien S3 Valve is then implanted in the reverse position across the rail created and in inflated inside the old valve under 3D Echocar-

diography guidance. Once the new valve is set in position and expanded, it pushes the surgical valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood. Transcatheter techniques like those used in TMVR allow the procedure to be performed while the patient’s heart is still beating, eliminating the need for a “bypass” machine and its associated risks. Dr. Sawaya said, “This first-of-itskind procedure in Lebanon and the region is a great proof that AUBMC has a team of highly trained, qualified, and nationally recognized cardiologists who have established a legacy of excellence in cardiovascular medicine. We would like to thank Dr. Alexandre F. Khoury Cardiologist at Bhannes Medical Center who referred this patient and gave her a chance to improve her quality of life.” The operation is another proof of AUBMC being on track of achieving its 2020 Vision, being the leading Medical Center in Lebanon, the Middle East, and Asia in using state-of-the-art procedures that help in saving lives.

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ARTICLE FEATURES . Saudi Healthcare

audi Arabia is home to the largest healthcare sector in the Gulf, accounting for about 48% of total Gulf governmentsâ€™ spending on healthcare at a cost expected to reach $ 40 billion by 2020. KSA also plans to set up medical cities and allocated 4.3 billion dollars for this purpose, which indicates the huge budget provided by the government to promote this vital sector. The health sector budget was about $ 25 billion last year.

Saudi Vision 2030 focuses on engaging the private sector, especially in the health sector. In this context, the Ministry of Health confirms that the core of the Saudi Healthcare National Transformation Program is to build a health system based on a new healthcare model, through which healthcare is provided in accordance with principles and concepts that are important to its success. Partnering with the private sector is the main focus within Saudi Healthcare National Transformation Program, in addition to other important tools such as institutional

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transformation and e-health, building new mechanisms for financing and purchasing services, and others. The Saudi Healthcare National Transformation Program wants to enable a new healthcare model in Saudi Arabia through these tools. Saudi Arabia strives to optimize the utilization of hospitals and medical centers by continuously seeking to improve the quality of both preventive and curative health services. The public sector also focuses on providing preventive medicine to citizens

and encouraging them to benefit from primary healthcare as a first step in their treatment plan. Healthcare is considered one of the most important elements mentioned in the Saudi Vision 2030, which will put Saudi Arabia at the forefront of the world. Saudi Vision states â€œOur ambition is for the long term. It goes beyond replenishing sources of income that have weakened or preserving what we have already achieved. We are determined to build a thriving country in which all citizens can fulfil their dreams, hopes and ambitions.

ARTICLE FEATURES . Saudi Healthcare

Therefore, we will not rest until our nation is a leader in providing opportunities for all through education and training, and high quality services such as employment initiatives, health, housing, and entertainment.” Vision 2030 is an unprecedented opportunity to develop the health sector with a wise approach that allows for the provision of distinguished health services, through sophisticated business models that ensure sustainability and achieve the highest levels of efficiency. The target of Vision 2030 is greater participation of the private sector within the economy and especially in healthcare while increasing private healthcare expenditure to 35%, in line with the Saudi Vision 2030 to provide unparalleled opportunities for the development of the health sector and the provision of distinguished health services.

health facilities will also be enhanced, in addition to increasing the training of doctors and providing better training for treating chronic diseases such as diabetes, heart disease and cancer.

The Ministry of Health focuses on: •

• •

Increasing private sector share of spending through alternative financing methods and service providers. Increasing the efficient utilisation of existing resources Improving the efficiency and effectiveness of healthcare with information

•

• •

technology and digital transformation. Increasing training and development both locally and internationally. Increasing the attractiveness of nursing and medical support staff. Developing the primary care. Improving the infrastructure, facility management and safety standards in healthcare facilities.

Primary Initiatives The Saudi Ministry of Health has recently announced the launch of three primary initiatives to stimulate private

Saudi Vision 2030 focuses on several issues for the development of healthcare by promoting a healthy lifestyle and focusing on reducing epidemics and infectious diseases as well as fostering preventive medicine. The Ministry of Health had confirmed its support for the primary healthcare system and encourages citizens to benefit from it. The quality of health services, patient safety and

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ARTICLE FEATURES . Saudi Healthcare

sector enterprises in the Kingdom to convert into joint-stock companies. Through the stimulus package program for private sector enterprises, under the umbrella of the Financial Sector Development Program, one of the 12 programs previously announced by the Council of Economic and Development Affairs (CEDA) to achieve Vision 2030, packages of incentives and comparative advantages will be introduced for public joint-stock companies as compared to other private sector enterprises.

The three initiatives are: 1. First: T he initiative to grant the listed companies preferential access to training programs provided by MOH. All national companies listed in the Saudi stock market will be given preferential access to training programs provided by MOH, with special privileges including incentives fees for the program. 2. Second: The initiative to grant the listed companies preferential access to medical reports and database. Through this initiative all national companies listed in the Saudi stock market will be given preferential access to additional information about statistical data and reports and to the medical database, as well as information and data provided by MOH’s Portal. The companies will be able to get the information they need as soon as they are available. 3. Third: The initiative to grant the listed companies the privileges of speaking and advertising during MOH’s prominent events.

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Telemedicine In a qualitative shift with the Saudi 2030 Vision, and in a record time of no more than two months, using the cutting-edge technology in health services, the Ministry of Health (MoH) is expanding its telemedicine services. In so doing, the (e-health) - Seha - App will cover all the Kingdom. The App provides visual medical consultations and allows all citizens anywhere to have face-toface medical consultations with their doctors across the Kingdom. MoH seeks to secure more users of the App to enable them more significantly to access visual medical consultations on their smartphones. Also, MoH endeavors to employ cutting-edge technologies to enhance effective communication with service-beneficiaries, and to allow them get the needed specialized medical consultations. The App is designed to enable audio-video communication from 8 a.m. to 12 a.m. during working days, as well as weekends from 4 p.m. to 12 a.m. Accordingly, users can login into the application, communicate directly with a specialist, and have their cases diagnosed through the application. Hence, the specialist answers users’ inquiries, and then provides the needed medical consultation as well as the necessary medical procedure.

The core of the Saudi Healthcare National Transformation Program is to build a health system based on a new healthcare model Saudi Vision 2030 focuses on several axes in the development of healthcare

ARTICLE FEATURES . Saudi Healthcare

Developmental Projects The various regions and governorates in the Kingdom of Saudi Arabia are witnessing remarkable developments in their health facilities, in terms of introducing modifications and developments in existing hospitals and medical centers or in the opening of new and developed projects and departments in order to serve the largest number of citizens and residents in KSA according to the highest standards. The Eastern Region has witnessed a series of construction and development health projects that are working to raise the level of services as well as expand them, which aims to serve the beneficiaries and improve performance quality. All projects seek to develop the work environment and achieve a qualitative leap in the level of health

services in order to meet the aspirations of officials in the Ministry of Health and citizens. The seven projects that are underway include the design, construction and equipping of the modern NICU at the Maternity and Childrenâ€™s Hospital in Dammam at a cost of SAR 70,270,860; each stage of the project will take 8 months to be completed, in addition to the development and equipping of the 18-bed cardiac intensive care unit at Saud Al-Babtain Cardiac Centre in Dammam; the project will be completed in 6 months at a total cost of SAR 26,118,541. Also, the project of developing sterilization facilities in the governmental hospitals in the Eastern Region, and the duration of the project is 6 months, in addition to the development of the

old Ambulance Building at Dammam Medical Complex and the duration of the project is two months at a cost of SAR 739,000, the development project of the Regional Poison Control Center, Dammam for a period of three months at a total cost of SAR 462,000, the development project of the Eastern Region Health Affairs General Directorate for a period of two months at a total cost of SAR 651,000 and the rehabilitation project of the Health Directorate building in the Eastern Region; the duration of the contract implementation is 4 months at a total cost of SAR 5,485,770. These projects reflect the diligent work of the Ministry of Health in keeping up with the Saudi Vision 2030. It is keen to invest all the financial allocations for the projects and to

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ARTICLE FEATURES . Saudi Healthcare

make optimal use of them in order to achieve the development of services and quality, reflecting positively on meeting the needs of citizens and services of patients. Among the development projects, H.E. the Minister of Health Dr. Tawfiq Al-Rabiah has recently inaugurated 12 health projects in Hafr Al-Batin at a total cost of SAR 44 million. The projects included the Maternity and Pediatric Hospitals, King Khaled Hospital, Central Hospital, Al-Qaisoma Hospital as well as inaugurating the Regional Laboratory, Central Blood Bank in addition to laying the foundation stone for a cardiac catheterization unit project.

Turning Point According to the Ministry of Health, these projects represent a new turning point in the health services in Hafr Al-Batin after operating new quality specialties for the first time in Al-Batin hospitals (with a capacity of 1000 beds). They will contribute to reducing the referral of cases to hospitals outside. The new health projects that were launched included the Maternity and Children’s Hospital, the pediatric renal unit that serves children with chronic kidney disease and follows them up regularly, as well as children with chronic peritoneal dialysis while providing them with necessary medicines and solutions. Projects also included the “installation and operation of the magnetic resonance imaging system” with the aim of improving inpatient radiology services, by using digital technology in hospitals in order to provide high-quality medical services to beneficiaries while reducing patient wait times. The project of activating family role in healthcare at Neonatal Intensive Care Unit (Adaa) is among the projects launched by the Min-

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ister of Health, where parents can play a bigger role in caring for the newborn; hence, reducing the baby hospitalization period. In addition, the intravenous feeding unit which is one of the developmental work aiming to improve the service by providing integrated intravenous feeding for patients who are unable to feed themselves and cannot endure feeding tube for a long period of time, as well as newborns with low birthweight and cancer patients. In addition to bariatric surgery unit at King Khaled General Hospital which was enhanced with qualified medical and technical staff and cutting-edge medical appliances. The magnetic resonance device (MRI) was installed at King Khaled General Hospital to improve radiology services provided in hospitals, and reduce the patient’s waiting time. Hafr Al-Batin Central Hospital Nuclear Medicine - is one of the most important sections in the health field, for diagnosing different medical cases, through which we can detect and treat some types of cancers such as thyroid cancer. The hospital nuclear medicine department will render its services to a large segment in Hafr Al-Batin province and its affiliated villages and hamlets, in addition to other adjacent areas. A kidney center with a capacity of 11 beds was opened at Al-Qaisumah Hospital, which is enhanced with required medical equipment and qualified staff and state-of-the–art dialysis devices at the expense of Meznah Suleiman Al-Rajhi, May Allah rest her soul in peace. The Affairs also completed expansion of outpatient clinic with a special entrance, a reception office and 3 rest room for patients, and development of the emergency section at Al-Qaisoma Hospital, with

the provision of car park (for person with special needs), 6 rest rooms for emergency patients and a reception area enhanced with the-state-of-theart devices. Moreover, the Affairs established the regional laboratory and central blood bank to meet the patients’ needs for blood bags, platelets and plasma at the highest international standards. The 2-storey building consists of sections, one for men including a waiting room, donor room (one of the new services in the city). It also includes men donor room (with 5 chairs) post-donation care room, in addition to two clinics for examining donors and ensuring their safety before donation. A female section was also established including waiting room, donor room (with 3 chairs), post-donation care room, a clinic to examine the donors as well as administration offices and a meeting room. The blood bank’s first floor features 7 laboratories equipped with the latest devices to secure blood bags and receive blood samples from blood banks all over the region, and diagnose them, using PCR technique, against all infectious diseases such as AIDS, Hepatitis C, B and syphilis, Lymphocytes, and bacterial screenings in platelets. Also, the Health Minister has laid the foundation stone of a cardiac surgery and catheterization unit, the first-of-its-kind in the city, with the aim of ending the suffering of patients as a result of being transferred to reference hospitals outside the region to get advanced medical care. A specialized unit has been allocated for serving citizens of the province and nearby villages and areas. All open heart surgeries and catheterization procedure (diagnostic and therapeutic) will be performed.

ARTICLE FEATURES . Saudi Healthcare

SafetyMonitor makes LINET smart beds a part of Internet of Medical Things www.linet.ae

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Smart beds are changing the reality of healthcare They make hospital care safer and more effective such as hospitalisation function virtually spontaneously, precisely, without error and ultimately are cheaper. This is crucial as healthcare costs are rising particularly due to an aging population.

he Internet of Medical Things (IoMT) is currently one of the fastest growing segments of smart technology. Various types of hospital equipment are becoming a part of it and this includes hospital beds. Managing Director LINET MEA Jiří Plecitý describes how smart LINET beds work and how they can change patient care in hospitals and in the home environment of senior care. Hospital beds are important for care, but why do they have to be online and contain smart applications? Five years ago few people knew about smart cities, houses and cars, today this includes hospital equipment which is becoming “smarter”. Currently it is estimated that 3.7 million medical devices form a part of IoMT and this number is growing organically. This year is considered by experts to be the year of IoMT, marking a dramatic development of smart technologies in medicine. But our beds have been “smart” since 2011, and we are, of course, constantly expanding and upgrading the system. The main argument “for” is certainly safety. Smart healthcare is safer because IoMT limits human error. Smart technologies in medicine are effective, thanks to them processes

Can you describe how a smart bed works? LINET beds have integrated sensors, a control unit (computer), user applications and are, of course, online and compatible with hospital systems. The LINET system is called SafetyMonitor and is principally designed to increase safety. In speciﬁc terms, this means stopping patients from falling and not having accidents while in bed and in a room. Falls are common and mean extended hospitalisation. They can have a fatal outcome, are costly and destroy an image. Applications can provide active and effective prevention. They display alerts of high-risk situations and statuses, such as if a bed’s settings are secure. A nurse can see everything online on monitors in the nurse station or from any point on a mobile. Thanks to this timely and preventive intervention can be provided where it is really needed. LINET beds contain an entire system of applications which, for example, know how to weigh a patient and assess the weight. Can these technologies be used only in hospitals? They are primarily designed for them, but we also see a great potential for home care, particularly of seniors. According to current trends there will be 1.2 billion people of a senior age in 2025 which is the equivalent of the total population of India. The aging population is a global trend, phenomenon while health care and care for seniors is one of the most visible and burning issues which society has to address in this context. Smart beds can monitor the presence of a person on a bed and assess situations that can lead to a fall or accident. The system processes the information and communicates it to a telephone or central system. The

senior patient on the bed is safe as the smart bed de facto monitors him or her and, in case of need, calls for timely help and assistance. A big topic in connection with smart technologies is the management and reduction of costs, so what do smart beds bring in this respect? The economic effect of the SafetyMonitor is immediate, the incidence of adverse events falls as do the related costs and further negative consequences. The value from the long-term prospect is information management. As a part of hospital systems the SafetyMonitor provides a very practical tool of how to assess investments made in beds in terms of their effectiveness and utilisation. For example, the system knows how to determine the precise location of the bed. Did you know that up to 8% of beds cannot be located in hospitals? This means that either they are in other departments where they may not be meeting their proper function or in places which nobody knows about. Thanks to the SafetyMonitor, you have an overview of the investments and can assess them. For instance, it measures how full capacity is over time, monitors and processes further information for total cost management. A separate chapter is service applications for problem-free and safe bed operation. What sort of responses do you have to smart beds? I am really proud that within our global LINET Group, it is the MEA region where our SafetyMonitor is the most successful. We have equipped hospitals in Dubai, Qatar and lastly in Saudi Arabia with smart beds and I hope that in mutual interaction and cooperation with our customers we will be able to continue to develop the SafetyMonitor for the speedy recovery, safety and comfort of patients which, above all else, is what quality hospital care is about.

www.linet.ae

360 care around you

LINET Group provides a complete patient care solution. The innovative beds, mattresses and other equipment are designed to support the treatment and convalescence of the patient as well as safe, ergonomic and less physically demanding nursing.

4 R&D teams, c. 100 specialists 10,000 beds monthly

3 production plants in Europe

www.linet.ae

ARTICLE

Caring for our health By Dr. Sedeek El Hakeem Sawa Health platform founder - Goodreads Auther - Health Insurance advisor AI investorl MBBS, TQM, IFCE, cert.CII,TOT

ur healthcare system has benefited from substantive investment in recent decades. As a result, we now have 2.2 hospital beds for every 1,000 people, world-class medical specialists with average life expectancy rising from 66 years to 74 years in the past three decades. We are determined to optimize and better utilize the capacity of our hospitals and healthcare centers, and enhance the quality of our preventive and therapeutic healthcare services.

The public sector will focus on promoting preventive care, reducing

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infectious diseases and encouraging citizens to make use of primary care as a first step. It will deepen collaboration and integration between health and social care, as well as supporting families to provide home care when necessary for their relatives. The public sector will focus on its planning, regulatory and supervisory roles in healthcare. We intend to provide our healthcare through public corporations both to enhance its quality and to prepare for the benefits of privatization in the longer term. We will work towards developing private medical insurance to improve access to medical services and reduce waiting times for appointments with

specialists and consultants. Our doctors will be given better training to improve treatment for chronic diseases such as heart disease, diabetes and cancer that threaten our nation’s health.

Focus on Healthcare A target of Vision 2030 is greater participation of the private sector within the economy and this is especially so of healthcare. There is a definite move towards privatisation with a stated objective in the National Transformation Program 2020 (“NTP”) NTP of increasing private healthcare expenditure from the current 25 per cent to 35 per cent of total expendi-

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ture by 2020. This represents a projected increase in revenue generated from 3 Billion SAR to 4 Billion SAR. In addition to this, the Ministry of Health plans to spend over 23 Billion SAR on new initiatives over the next 5 years. The NTP has identified the following strategic objectives for the Ministry of Health and the Saudi Food & Drug Authority (‘SFDA’):

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Increasing private sector share of spending through alternative financing methods and service providers; Increasing the efficient utilisation of available resources; Improve the efficiency and effectiveness of the healthcare sector through the use of information technology and digital transformation; Increasing training and development both locally and internationally; Increasing the attractiveness of nursing and medical support staff as a preferred career path; Improving healthcare provision before hospitalisation and in the main hospitals (ER & ICU); Improving integration and continuity in service provision by developing the primary care; Improving the infrastructure, facility management and safety standards in healthcare facilities; Attaining acceptable waiting times across all stages of service delivery; Improving governance in the health system in order to enhance accountability with regards to quality issues and

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patient safety; Adopting a national plan for emergency response to public threats in line with international standards; Identifying additional sources of revenues; Improving public health services with focus on obesity and smoking; Improving the quality of life and healthcare service provided to patients outside hospitals; Improving quality and safety principles as well as skills of service providers.

SFDA •

Ensuring sufficient supply of basic medicines.

These objectives are based on the targets laid down in Vision 2030. The main aims being the improvement of the quality of healthcare services, the expansion of the privatisation of government services and finally the creation of an attractive environment for both local and international investors. The strategic objectives stated for healthcare in the NTP are extensive and in order to successfully meet them the initiatives will be launched this year at the following ministries and authorities:

Ministry of Health • •

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Reform and restructuring of primary healthcare; Encouraging the pursuit of nursing and clinical health professions through amendment of some policies and the participation of such by all community segments; Private-public partnership through the privatisation of one of the medical cities and

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localisation of the pharmaceutical industry; Increasing the capacity and quality of healthcare education (through partnership with the Ministry of Education); Health Insurance & medical services purchase schemes; Increasing the number of trained health practitioners and improving their training

SAGIA •

Development and execution of a plan for localizing the healthcare industry and services sector

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Establishment of a Centre for Standardisation of Medical Products and Equipment Establishment of a Unified Electronic System

Opportunities for the Foreign Investor Vision 2030 offers many opportunities in healthcare for the foreign investor in key areas which can be identified in the NTP as follows: • Additional private medical facilities; • Increased medical insurance; • Increased use of information technology; • Healthcare Education; • Provision of improved training facilities; • Enhanced professional development; • Local manufacture of pharmaceuticals. Foreigners are able to own and manage hospitals in Saudi Arabia but are unable to own or manage other

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healthcare institutions. It is envisaged that foreign participation and investment in new hospitals will take place through public-private partnerships and joint ventures with Saudi-owned entities. Medical insurance is already compulsory for expatriates and Saudi nationals (and their dependents) working within the private sector. Citizens working within the public sector currently receive free coverage in government healthcare centres and public hospitals. It is not known at this stage how medical insurance will develop however as more public services are privatized and public-private partnerships are entered into the provision of healthcare will naturally transfer to the private sector. In anticipation of this, we understand that current medical insurance providers are developing products that cater for public sector employees to meet future requirements. Digital healthcare innovations are key for supporting Vision 2030 as the Ministry of Health is aiming for at least 70 percent of Saudi citizens to have unified digital records by 2020. In addition, information technology solutions will improve the performance and productivity of healthcare providers and will enable a better quality of service to be provided. Software that assists with the treatment of medical issues such as

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the diagnostic process is considered a medical device whereas other software used with the healthcare sector is not. We have assisted a number of healthcare technology providers looking to carry out business in Saudi Arabia either directly or through a distributor and expect this to continue as the opportunities for investment here are recognised more and more. In addition, we are seeing an increasing interest in telemedicine which enables providers to offer services within the country under the supervision of locally registered physicians on a consultancy basis. The NTP places a great deal of emphasis on healthcare education and training. There is a recognised need for qualified Saudi healthcare practitioners and support staff as healthcare requirements increase and currently the sector is mostly supported by expatriate workers. The increased education and training needs will be catered for domestically and internationally potentially with links to world renowned institutions and public-private partnerships. Furthermore, this increased need could also be catered for through management and operational arrangements with internationally recognised service providers. Saudi Arabia is mostly dependent on imports for its pharmaceutical requirements and there is a desired

need for pharmaceuticals to be manufactured locally to ensure an adequate supply of medicines. Foreign pharmaceutical manufacturers are being actively encouraged to establish plants in Saudi Arabia through public-private partnerships and joint ventures with national entities. Incentives are being offered in the form of preferential treatment in future volume tenders. As an additional incentive, foreignowned manufacturers within Saudi Arabia are able to distribute and sell pharmaceuticals within the country whereas all imported pharmaceuticals can only be distributed through a Saudi distributor. The SAGIA website lists the manufacture of medical devices and equipment as an investment opportunity for foreign investors. Currently the majority of medical devices and equipment are manufactured abroad and are imported into the country. The Ministry of Health is supporting local manufactures by partnering multinationals with Saudi companies with the incentive of guaranteed volumes for Ministry of Health purchases and preferential treatment in future volume tenders. Furthermore, foreign-owned manufacturers within Saudi Arabia have the additional benefit of being able to distribute and sell medical devices within the country without the need of a local distributor.Â Â

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MOH INITIATIVES 2030 The MOH Initiatives Related to the NTP 2020 and Saudi Vision 2030 The Ministry of Health (MOH) is seeking to launch several health initiatives related to the National Transformation Program (NTP) 2020 and the Saudi Vision 2030, which come as part of its series of initiatives (totaling more than 40), scheduled to be announced later. It has become necessary for us to introduce a new health system that fully accommodates our current and future needs, and to be based on non-traditional methods in terms of financing, managing, evaluating and developing it. Therefore, the most important components of the health transformation is the institutionalization of this system, as well as redrafting the method of finance, so as to be independent and flexible depending on payment against service not on the budget system, in an endeavor to increase the effectiveness of the exerted efforts and finance. The establishment of this system must be compatible with the current data, meanwhile prospecting for the future data, to come up with a healthy system that meets all our needs for years to come and maintains the health and safety of everyone. The MOH has carried out many achievements across its different sectors and services over the past period. As for the primary healthcare domain, which is reckoned the most important component in our health system, more than 80 primary healthcare centers have been inaugurated all over the Kingdom, bringing the total number to more than 2,390 healthcare centers for providing the services of primary healthcare and vaccina-

tions, as well as dealing with chronic diseases and maternity and children care to more than 52 million patients. During the past year, more than 2 million persons have been vaccinated against influenza, and the number of health centers working for 16 hours a day increased by 100%. Thus, we have a number of 152 health centers working with the extended system and a number of 498 on-call centers, and the emergency care centers increased by 50%, bringing the total number to 107 centers. Besides, the number of counseling clinics which provide primary mental healthcare has been doubled to reach 55 clinics and counseling clinics have been added to 82 health centers throughout the Kingdom’s regions, in addition to that anti-smoking clinics that increased by 160% to reach 160 clinics. Also, a number of 55 healthcare centers have obtained the accreditation certificate on the quality of healthcare services from the Saudi Central Board for Accreditation of Healthcare Institute (CBAHI). The health sector has witnessed over the current year the launch of the Demographic and Health Survey (DHS) Project, with the participation of 9,300 medical and healthcare teams from healthcare centers. This project targets around 50,000 families across the different regions of the Kingdom, with a view to developing an accurate database about the health status in the Kingdom. Regarding the public health programs, the MOH keeps on the implementation of several programs and activities, such as the education health campaigns and the health promotion campaigns that witnessed the interaction of more than 3 million targeted

persons and covered many important health topics, including those health awareness campaigns about diabetes, breast cancer detection, colon cancer, breast cancer, malaria, influenza, kidneys, tuberculosis, heart, arthritis, osteoporosis, antibiotics, AIDS and others. Also, the MOH has exerted great efforts to improve the work mechanism of the 937 center, whereas more than 100,000 medical consultations have been provided, in addition to more than 15,000 medical consultations via social media platforms. As for the therapeutic services domain, we have more than 279 hospitals (with more than 42,000-bed capacity), receiving more than 16 million patients at their outpatient clinics annually, while emergency sections receive more than 18 million emergency cases and 21 million injuries. Furthermore, the MOH’s hospitals have conducted more than 500,000 surgeries and more than 240,000 deliveries, in addition to the achievements of the Newborn Early Screening Program (NNSP). Over the past four years, a number of 720,000 cases have been detected, of which a number of 622 cases were in need of therapeutic intervention, and the rate of hearing tests increased by 89% and that of newborn cardiac screenings by 90%. Yet, there are other achievements which focused on raising the operational efficiency and developing the administrative performance and work environment, as well as qualifying the cadres of various specialties and categories. Over and above, work is constantly underway to keep pace with the ever-increasing need for healthcare services, in terms of quantity and quality.

ARTICLE

Sysmex Middle East A market leader in automated urinalysis solutions

SEPTEMBER.OCTOBER 2018

ARTICLE

ysmex Middle East FZ - LLC offers fully automated urinalysis workflow solutions on a premium level. Analysing native urine without any pre-treatment prevents the known sources of error inherent in conventional urinary sediment analysis. Full automation means unattended analysis with ample walk-away time, increasing your lab’s productivity. Check out The UF5000/4000, based on Sysmex’s globally renowned fluorescence flow cytometry (FFC), represents the latest in urinalysis technology.

UF-5000/4000 •

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Modular concept for a fully automated urinalysis workflow. UTI information and bacteria differentiation in less than a minute. Body fluid mode always on board. Blue laser for better differentiation of particles.

Fully automated flow cytometer The UF-5000, based on Sysmex’s globally renowned fluorescence flow cytometry (FFC), represents the latest in urinalysis technology. It can be used as a standalone analyser, or as part

of the modular UN-Series for a truly walkaway, seamless urinalysis workplace solution from sample loading to the final digital image

Body Fluids The new technology opens up many previously closed diagnostic avenues. The integrated body fluid mode is available at the flick of a switch and delivers seven diagnostic parameters in BF mode. Meningitis with low cell-/ bacterial counts can be detected, and the differentiation into bacterial or viral infections is possible through the WBC differentiation and bacterial count. Further diagnostic significance is obtained thanks to the new blue laser, which ensures better bacterial detection. Bacteria are addressed further with the new RFID dye reagents, thanks to more accurate measurement and differentiation.

UTI infections The new Gram pos / Gram negative flag provides valuable information as to which antibiotic to prescribe to the patient with a UTI infection. The UF offers a faster and far easier way than the classic gram staining to provide the same information. You can now identify UTIs fast and reliably, as well as indicate the right choice of antibiotics.

Haematuria In the past it has been tricky to differentiate RBC and crystals. This is solved thanks to the depolarised side scatter light in the FFC so that you can better determine whether the patient is suffering from haematuria, and if so, to which degree. The analyser will now also differentiate epithelial cells and casts. It offers a total of seventeen parameters in urine mode.

Modular Although of course the UF-5000 can be used as an excellent standalone analyser, it truly lives up to its potential as an integral part of the UN-Series in a load and leave configuration. Place the samples in the rack, and simply let the overall configuration do its work. If the samples are negative, all the better. If they need a closer look, you can receive digital images from our UD-10.

Modular concept solution Easy to combine with other members of the UN-Series (UC-3500 and UD-10) for a fully automated urinalysis workflow. With the introduction of the Urinalysis Work Area Information Management System (U-WAM), we can improve the workflow efficiency of the new urinalysis series.

INTERVIEWS

Senior Director and Country General Manager – Saudi Arabia and Egypt, Cerner Middle East and Africa

Mr. Alaa Adel “We live and work in the countries we serve, so we are more determined to transform healthcare for the better”

erner healthcare is one of the largest suppliers of health information technology solutions in the world. In 2018, its products were in use in more than 27000 facilities worldwide. Hospitals had the privilege to meet with its Senior Director and Country General Manager – Saudi Arabia and Egypt, Cerner Middle East and Africa Mr. Alaa Adel, and here is the full interview:

SEPTEMBER.OCTOBER 2018

INTERVIEWS

In terms of your own background, how long have you held your position at your company? I have been with Cerner for almost 10 years where I have held various roles. I am currently the senior director and country general manager for Saudi Arabia and Egypt at Cerner Middle East and Africa. My day-to-day responsibilities are to ensure our clients and partners are well equipped to achieve their goals and achieve value through their collaboration with Cerner.

As we all know, Cerner is a global leader in healthcare technologies. What are your latest innovations? Cerner is a key driver in the journey toward smarter, consumer-led healthcare provision in the Middle East. For more than 26 years, we have connected people and systems at healthcare organisations of all sizes, supporting key clinical, financial and operational needs. The Cerner Millennium® electronic health record (EHR) platform stores data for millions of people across the region, provisioning a single patient database that can be accessed instantly by participating healthcare providers. HealtheIntentSM, our big data platform, takes modern possibilities further, with potentially industry-changing results. For example, in a hospital or clinic setting, you give your doctor information that is logged into your EHR. But let’s say that you go home, and you’re on your scale, or perhaps you’re diabetic and

you take a glucose reading: where does that information go? Currently, such data is lost, trapped in an ‘information silo.’ You want it to go to the same place – your health record. This platform collects and collates medical and socioeconomic data from a range of sources. Instead of being limited to what is entered within hospitals and clinics, this system can take data from consumer sources such as smart watches, electronic scales, diet apps, as well as clinical sources such as health information exchanges (HIEs), pharmacy benefit managers and more.. This information could provide clinicians with a more accurate, well-rounded assessment of a patient’s health, which may speed up diagnostics, improve accuracy and support them to provide the best possible care. I foresee the Middle East being uniquely positioned to deliver a smart population health management system, with Cerner playing a key role in linking up institutions and their pools of data.

Cerner is a leader in healthcare technologies and your systems are widely used, but what sets you apart from your competition? Our company is not just a software provider or consultancy group with a single set of strategies to help our clients. We have a set of best practices and guidelines that help guide clinicians toward the best health outcomes for patients, but we also know that no two patients are

alike. A certain degree of flexibility is needed to obtain optimal adoption. We also believe that you need a software solution that is always on, always thinking and always analyzing the situation and providing advice and guidance to everyone that it touches. Cerner has been around for nearly four decades. We are leveraging all the experience we have across the company to support our clients, both public and private, to hit their objectives. We have many clients that we are proud to collaborate with, and that network is helping to transform healthcare in the region. Cerner wants to make the Middle East’s government visions on healthcare a reality. Cerner plays a pivotal role in establishing the level of trust required to fully realize the benefits of new data sharing health systems across the region. Central to this cornerstone of our business is a pool of medical expertise, both in-house and in collaboration with clients. Not only does Cerner provision its own EHR and its consultants’ analytical skills, but we also support clients to make the most of the data contained within both its own and other providers’ systems. Our strong Middle East presence is what sets us apart from other providers, facilitated by a recruitment policy that, over the past five to seven years, has strongly favoured locals over expats. We live and work in the countries we serve, so we are even more determined to transform healthcare for the better.

INTERVIEWS

Do you think governments in the region are helping in taking healthcare to another level? Each country is at a different stage in their healthcare journey, but they are all working to create healthier communities and populations. With a demographic shift where the population above the age of 60 is expected to rise considerably in the next decade, increased private sector participation and health insurance coverage are amongst some of the chief factors raising the stakes for high growth opportunities in the healthcare sector in the Middle East. In addition, we see countries creating ambitious national visions, such as Saudi Vision 2030 and National Transformation Program 2020 (NTP) to improve the quality of healthcare services and facilities while optimizing available resources thereby boosting opportunities for increased private sector participation. That’s why, I believe that effective regulatory frameworks will help facilitate the flow of private investment and the encouragement of public-private partnerships will sustain growth even in the face of long-term challenges. In this respect, technology is playing a big role in our lives across all industries and healthcare is no exception. With a strong IT infrastructure and the mindset to take it a level higher, the foundation will be built to allow information to flow freely. In Saudi Arabia, for example, healthcare stakeholders are welcom-

SEPTEMBER.OCTOBER 2018

ing digital disruption to transform the sector in the coming years. For example, in many cases where the need for physician opinion or consultation is urgent but does not require a personal meeting, physician e-visits can be done over the phone or through video conferencing. These types of visits can be more efficient and convenient for both the patient and the physician and lead to better results as opportunities for complications can be reduced (if the patient waits to seek treatment). In addition, a virtual waiting room can help prevent infection between patients that could occur at a physical waiting room. Also, the sharing of data across facilities and the possibility of having a single patient file across providers is a game changer, as it negates the need for unnecessary examinations and conflict of treatments which arise from fragmented care.

Tell us about your vision and any exciting new developments coming up that will shape the consumer’s healthcare experience. Cerner’s mission will always be to connect people, knowledge and resources in a way to achieve the best health outcome. The largest upcoming shift in the healthcare market will be the impact of the consumer as they become more empowered to take control of their health and have more requirements of how they want

that to be done. As the consumer is asked to pay for even more of the healthcare service they receive, they will begin to make different choices. New ways to provide healthcare (virtual reality visits, home visits, etc) will begin to take the place of traditional clinic visits. These types of visits will create massive disruption to the current market and providers who are slow to act will be out of business quickly. This shift will be as swift as what Uber or Careem were to the taxi industry or what AirBnB was to the hotel industry. Healthcare providers will no longer have an unlimited supply of new patients as new customer service will take over. Gaining patient loyalty will be key in continued success of medical providers. This shift will create the need for new software solutions, new consultancies and new ways of doing business. I am personally excited by the new market that is being formed today, as Cerner has been preparing for this day for quite some time now. We have already created the Internet of Health and Life, which is a cloudbased system that allows for the import of all patient data and access of this data based upon permissions controlled by the patient. This system will not only have data from the legacy EHRs but will also have access to data that can be collected by the patient’s clothes, their wearables, their visits to the gym, the food they consume and their vitals 24 hours a day and the like.

ARTICLE FEATURES . Medical Shipping

SEPTEMBER.OCTOBER 2018

ARTICLE FEATURES . Medical Shipping

accine and drug delivery services are expected to rise to $ 10.2 billion by 2018. This is based on a marginal market from which there was little hope in the mid1990s. New technologies in patient and medical equipment transport provide better service at lower price and higher quality. This has led to a significant growth in the above-mentioned market, which had a major impact both on the medical sector and patient service, in addition to the economic sector as well as increasing the employment rate of other related sectors. Companies, innovations and developed services around the world have been active, so how did the medical sector benefit from this revolution and how did it affect the economy? With the expansion of international relations and human communication around the world, new sectors have emerged and others have expanded, including those related to medicine, health and pharmaceutical industries. This expansion led to the activation of the trade movement and shipping by land, sea and air. But due to medical conditions’ requirements and the importance of time in rescuing patients, the air cargo industry has experienced great progress and achieved impressive results.

Transportation, Shipping and Ambulance Historically, medical air transport dates back to World War I, but its role was greatly expanded during internal Korean conflicts and the Vietnam War; helicopters were used to transport patients to hospitals and later developed into medical conditions, traffic accidents and disasters. While wing aircraft are used for long-distance transportation.

Medical air transport moves patients in critical condition to and from health facilities over long distances, when time is of the essence. It is a good option for travelers, or for people who live in remote or hard-toaccess areas. It can also be an excellent idea for patients who may need to reach specialized medical facilities quickly in case of emergency. When choosing between medical air transport companies, there are important differences to consider first. For instance, only some companies accept people with pre-existing conditions. Furthermore, while certain companies mandate “medical necessity” before rendering services, others do not. Most medical air transport providers require that healthcare professionals travel with patients, but their level of training varies. Some use professionals with special instruction for air ambulances, others simply use staff with standard training, and others require EMT or paramedic preparation. Remember to always compare quotes from different companies before making a final decision. If the patient has insurance coverage, learn the facts about what air medical transport costs are included and under what specific circumstances. Are there regional restrictions? Is there financial limit to coverage? If abroad, will the company be able to provide medical transportation back to the member’s home country? How long is the initial waiting period? The more comprehensive memberships offer worldwide coverage (with some restrictions), handle all of the transportation arrangements for you, and will bring you to the hospital of your choice in your home country, regardless of the severity of

your medical condition or how much it costs. While more limited memberships have regional restrictions, may fly you to the hospital of their choice, or have a limit to how much they’ll cover, or limit the circumstances eligible for transport. Due to its nature, medical cargo needs to be transported quickly and efficiently to where it is most needed, and air transportation certainly offers that advantage. However, according to the Seabury Group, just 0.5 million tons of pharmaceutical products are transported by air every year, compared to 3.5 million tons by sea. The air cargo share of global pharma products transport has declined from 17% in 2000 to 11% in 2013, the International Air Transport Association (IATA) notes.

Expanding requirements To tackle these challenges, in March last year Brussels Airport and Miami Airport announced the launch of a new organization, Pharma.Aero. The ultimate aim is to create a safe, standardized pathway for the transport of pharma products by air. Due to its nature, medical cargo needs to be transported quickly and efficiently to where it is most needed, and air transportation certainly offers that advantage. Annual product losses associated with these problems range from $2.5-$12.5bn, a figure that IATA describes as “unacceptably high in a $300 billion a year market.” At Brussels Airport for example, the supply chain is composed of four elements: the company that forwards the goods to the airport; the forwarding agent that organizes the global air transport on behalf of the shippers; the airline flying the cargo; and the handling agent that works on behalf of the airline and ensures the actual transport.

ARTICLE FEATURES . Medical Shipping

In 2014, Brussels Airport partnered with IATA to create the Center of Excellence for Independent Validators (CEIV) in pharmaceutical logistics, a global quality standard based on the good distribution guidelines. Today, CEIV is the most widely recognized certification in the world. In October, the association brought in new members, including Singapore’s Changi Airport, Sharjah Airport in the United Arab Emirates, as well as Brussels Airlines, Singapore Airlines and Brink’s Life Sciences.

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Changi and Sharjah are the first two airports to join as strategic members in Asia and the Middle East, respectively. Air Ambulance International provides patient transportation on Commercial and Charter flights worldwide. In service since 1996 - patient can be transported by Air from UAE - Dubai or Abu Dhabi to destinations like India, Sri Lanka, Nepal, Bhutan, China, Philippines, Indonesia, Malaysia, Myanmar, Thailand and Middle east countries like Oman, Kuwait, Saudi Arabia, Qatar, Yemen, Bahrain

and other GCC countries. We have regular planned and emergency transportation from Dubai and Abu Dhabi to Germany, United Kingdom and the United States. The aircrafts are fully equipped with stretcher, oxygen and lifesaving medical equipment including cardiac monitors, pulse oximeters, ventilators, suction machine, BIPAP, blood glucose monitoring devices and have a medical escort team for doctor, nurses and paramedics to accompany the patient.

ARTICLE FEATURES . Medical Shipping

Air transport services offer a wide range of medical assistance that is fast, efficient and reliable, and has successfully treated countless medical conditions under the supervision of a doctor specialized in the treatment of mass casualty incidents. Services include domestic and international air transport, flights, local search and rescue, booking of airline tickets, helicopter transport, medical reports, domestic and international medical escort, transportation of newborns, assistance in obtaining visas, in addition to arrival and departure assistance at the airport. All this aims to facilitate medical transport issues and provide better service to patients and injured people.

Air Ambulance Developments For instance, AMR Air Ambulance provides air ambulance services for countries all across the world, the only exception being countries enduring military conflict within their borders. AMR Air Ambulance assures safe travel for anyone facing medical emergencies by fixed-wing aircraft, the same means of transportation for our domestic flight. On-board intensive care units and equipment are provided as well. In addition, AMR Air Ambulance provides VIP services with its new ICU-equipped Challenger Aircraft. The plane can fly non-stop from the Middle East to the United States. Air Ambulance uses fixed-wing planes or helicopters in order to transfer critically ill patients from and to healthcare facilities for better treatment. The idea of adopting air ambulance in the Arab world has been gradually and rapidly expanding, which will ensure full reliability on this sector in the field of ambulances and transporting patients under the best

security and safety conditions. In this field, air fleets have started providing these services and are fully equipped with the latest medical tools and are under the supervision of the most skilled specialist doctors and their assistants who are highly trained to ensure the safety of the patient and the comfort of his family. Many are unaware of the fact that patientsâ€™ medical care in air transport is less dangerous for the patient than in hospital. Death and disability due to severe injuries, heart attacks, strokes, medical and surgical complications, and other time-dependent conditions can be often avoided if adequate care is provided quickly enough. Air medical services are therefore a means of overcoming obstacles and risks of geography and time. Today, financial pressures, insurance issues, change of federal regulations and competition, as well as changes in many cases impose reducing services or closing of emergency departments, hospitals and specialist doctors. These factors have contributed to the increased use of the AMS to transfer patients to specialized centers, particularly from remote areas. Medical transport services provide: cardiac care including heart attacks, cerebrovascular symptoms, strokes, pregnancy complications, children health problems, complex surgical and medical conditions and mass injuries.

Double Economic Impact With all these medical features, there are those who are asking about the economic feasibility of such services and their impact on the sector. The transportation of pharmaceutical products is a highly profitable business including land, sea and air

modes. But the absence of an organization that sets unified standards for the sector has affected the industry in general. Experts believe that the flourishing of the global pharmaceutical industry has helped increase supply, and that reliability and safety are important to increase this traffic and thus benefit from it. This has in turn led to a booming pharmaceutical industry at the global level. The basic concept of the so-called â€œdouble impactâ€? in the economy is that the initial purchase of a good or service generates an additional economic activity that is related to expenditure on former suppliers and employment of subsequent users. In regard to the shipping sector and the transportation of equipment, medicines and patients, it shows day after day how big and important its impact is whether to improve medical services and provide them with maximum speed, or to influence the activation of economic activity. Helicopters and fixed wing aircraft cost millions of dollars to purchase or lease, operate, house and maintain. Highly trained crews available on a 24-hour/7 days per week basis, and the infrastructure which governs, trains, funds, supports, and links them and their service to the EMS system, are also expensive. As few systems are publicly funded, maintaining the availability of this essential resource inevitably translates into a single patient mission charge that seems expensive in comparison with a lower-priced ground ambulance for the same mission. It has proven a mistake, however, to make such an isolated comparison and to equate the lower charge with cost-effectiveness and the higher charge with cost-prohibitiveness.

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contact forte the next generation of hearing systems

njoy outstanding hearing – provided with the latest technology on the market. For BHM, innovation and the satisfaction of customers are the most important things. BHM’s requirements remain forever the same: to restore significant quality of life to people with impaired hearing, using state-of-theart hearing systems. Continuously developed and upgraded by BHM to be in line with the latest technology.

contact mini... especially for children …but adults can benefit too! In order to provide timely and adequate assistance to children with a hearing impairment, BHM has developed the contact mini as the world’s first digital miniature bone conduction system. Particularly for children, swift intervention with acoustic support is much in demand as speech development is inextricably linked with the ability to hear. Hearing-impaired adults who play a lot of sport will also find the contact mini extremely useful. This system can be used to provide optimal support for language development, social exchange and comprehension, as conventional hearing systems or surgical intervention in young children are often complicated, irksome and do not always achieve the desired results. This discreet and completely straightforward high-tech product is particularly recommended in cases of aural atresia as well as anomalies in the auditory canal (microtia, anotia). Our child-friendly bone conduction hearing product consists of an electronic casing with a miniature vibration

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receiver. It transmits sound through direct contact with the head, where it is transformed into a nerve impulse in the inner ear. The contact mini can be incorporated into a wide range of headpieces, hair bands and headbands in colourful designs with decorative motifs. Increasing numbers of adults are also discovering the advantages of this hearing system: particularly for sports enthusiasts, the contact mini is a practical companion for example when walking or skiing, and can easily be added to sports caps and ski helmets. The contact mini is a quality product – “Made in Austria”.

High-end technology for best hearing support: contact forte The next generation of bone conduction hearing systems will be on the market at the beginning of 2019.

The new device will come with improved technology, which will be state-of-the art. Wireless connection to various communication devices, for example via Bluetooth, will be possible. Therefore, you can connect your device with your mobile phone and use it as remote control with the associated app. Whether you want to listen to your favourite music or call a friend, the Bluetooth function enables you to hear more clearly. The new contact forte will also have numerous carrying options. You can wear it on a softband, with your glasses on a spectacles adapter or on a headband or a plastic headband. In addition, the innovative hearing system can be stuck directly behind the ear using an adhesive tape - without any additional accessories! So the high-end system stays securely in place. This innovation allows its user freedom of movement in all situations. The water

resistance up to 1 metre protects the hearing aid during bathing, showering and other water-related activities. Furthermore, the contact forte will be prepared for magnet implants. So BHM will bring the best device of its kind to the market.

Quality made in Austria BHM is a specialist in non-surgical solutions using bone conduction technology. The Austrian specialist manufacturer offers full range of hearing systems – from miniature bone conduction hearing aid up to a power pocket hearing device that can be adapted – due to being extremely flexible – to the individual needs of each wearer. BHM develops sophisticated hearing systems that are manufactured exclusively in Austria and marketed worldwide. Its wealth of experience and commitment to perfection make BHM a globally respected specialist in bone and air conduction hearing devices. BHM thus offers its customers the best technology for an unrivaled listening experience - without the risk of surgery!

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he healthcare ecosystem and delivery model in Bahrain are presently one of the most challenging service sectors in the country. It is, however, changing rapidly due to the growing healthcare costs. To remain viable, while providing excellent services to the patients, both government and private healthcare organizations need to operate at greater economies of scale, which demands increased efficiency and effectiveness as a means to achieve optimal profitability.

Consequently, healthcare professionals need to be aware of these trends and challenges and develop healthcare strategic frameworks for creating sustainable medical facilities. These strategic frameworks must focus on Patient-Centric Quality Service indicators, which can serve as a measure of the level of competitiveness and sustainability of each healthcare organization. This ambitious strategy can be viewed as an effort to disrupt status quo in order to build sustainable healthcare services for the future. When reflecting on the healthcare model in Bahrain, one has to appreciate the government contributions and

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effort in building one of the most widely appraised integrated healthcare delivery models worldwide. Since the 1970s in particular, significant investments have been made in the healthcare infrastructure, facilities, and skills of the professionals working within the healthcare sector. As access to healthcare services is often seen as universal right, the government is usually responsible for establishing, financing and training the healthcare professionals to meet the healthcare needs of the nationâ€™s population. When reflecting on the status of the healthcare in Bahrain, it is important to recognize that the countryâ€™s population has increased by 63.5% in the last 25 years. Presently, more than

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1.5 million individuals (about 50% of whom are Bahraini nationals) are served by seven government hospitals, with 28 healthcare centers that provide both inpatient and outpatient services. Official statistics reveal that, in the 2000âˆ’2012 period, the government has spent approximately BD 1.677 billion (including projects) on healthcare. In 2013, the healthcare budget (including projects) for Ministry of Health comprised 7.6% of the total government budget. In 2015, the health spending reached 1.82 USD bn and it is estimated that it will increase to 2.269 USD bn in 2018. In addition, the government healthcare is facing considerable pressure in terms of rising costs and limited resources, as the national and non-national population is rapidly aging, while the occurrence of Noncommunicable diseases (NCD) is expected to increase. Since the early 1990s, the government has facilitated alternative access to healthcare providers by introducing the Limited Private Practices within the Ministry of Health facilities. This initiative was followed by the opening of independent private clinics operated by qualified Bahraini healthcare professionals. Positive results yielded by these strategies have encouraged a group of Bahraini healthcare professionals to form private healthcare centers, while some opened private hospitals. A comparison of the government and private facilities portfolios has revealed that most of the Bahraini residents are served by the government sector, as these healthcare facilities have superior capacities in terms of a number of hospital beds and healthcare professionals, as well as the wider scope of specialties, in highly specialized medical areas in particular. Although the aforementioned measures did yield better access to health providers, the government remains the primary contributor to the healthcare sector. Consequently, this situation still poses a significant economic burden on government healthcare expenditure, especially when there are issues related to appropriate utilization of resources, efficiency and effectiveness of the government delivery model. On the other hand, it is worth mentioning that, during the last 15 years, the Bahraini government has encountered difficulties in accommodating the escalating healthcare expenditure experienced by many nations due to the aging population, and has decided to introduce national healthcare insurance. Implementing the national healthcare insurance will change the healthcare financing model from the government being solely responsible, to the one that offers more health financing options, which will lead to more

efficient and effective utilization of resources. Moreover, this more competitive model will decrease the burden on the Ministry of Health, while providing greater choice to patients in selecting their healthcare provider. Assessment of the national private healthcare infrastructure has revealed that it is unable to accommodate patient needs and demands, while the private sector is still not ready to adopt healthcare insurance in terms of capacity, service quality, and coverage of medical specialties that the government is offering. In reaction to this finding, the government has decided to open the healthcare market to foreign investors and encourage them to fill the existing gap in an effort to set the pace for implementing the healthcare reform. This has resulted in a marked increase in the number of foreign healthcare investors, associated with the adoption of globalization, free trade agreement and pressure from the World Bank to encourage healthcare privatization. This phenomenon has resulted in an increase in the number of healthcare facilities at all levels, but has also led to a price war among the healthcare providers, and thus a reduction in revenue. In addition, many of the foreign healthcare investments are similar in terms of medical services and specialties and are not highly specialized, which has led to saturation or duplication of the private services in the country. This rapid expansion in the number of healthcare providers and facilities has resulted in the segmentation of national private healthcare sector into (1) small independent clinics and medical centers and (2) national healthcare providers forming hospitals, even though they are in minority. Most of the time, the national healthcare providers are directly involved in the daily operational activities of their facilities, while ignoring their strategic vision, because they lack the skills necessary for long-term strategic planning. In contrast, international healthcare investors are more aware of the importance of strategic planning and are developing their healthcare models to ensure that they capture greater market share. They are also better prepared to meet the requirements of healthcare regulators. When assessing the current healthcare competition, several issues emerge, namely: (1) local healthcare establishments are facing growing competition from the large incoming international cooperate healthcare investors; (2) the government needs to restructure its healthcare delivery model; (3) healthcare regulators must enforce regulations; (4) increase in overhead operating and taxation fees; (5) external environment (including economic factors); (6) internal

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environment (including corporate culture); (7) operating outpatient vs. inpatient costs; (8) compliance and quality,; and (9) professional retention. Owing to the poor economic performance of the country, most patients have weak purchasing power, which leads to further revenue reduction. Moreover, in the last two years, the government has rapidly increased the energy utility fees, as well as government and regulation fees, which has resulted in high operating expenses for the private healthcare facilities. Today, many healthcare facilities, especially the national healthcare providers, are facing higher operating costs that, when combined with lower patient purchasing power, make their survival questionable due to the unplanned expansion and price war strategy by the new healthcare investors. Faced with this situation, many will find it difficult to cover their operating costs and meet all financial commitments. More recently, additional compliance requirements were imposed by the healthcare regulator in different areas, such as accreditation and contracts with other bodies, such as hospitals, emergency ambulance services, medical equipment providers, maintenance, utility providers, and many others. These costs are compounded by the increased cost of salaries due to the changes in labor market regulations. Today, private healthcare facilities have additional financial commitments and expenses due to the requirement by healthcare regulators that all healthcare facilities obtain the accreditation or be otherwise subject to closure. Typically, additional costs could be associated with the accreditation process, which includes quality management consultancy, information technologies, medical equipment, modifications in the infrastructure, and necessary training and adjustments to meet the accreditation certificate. It is important to point out that the healthcare regulators have demonstrated an outstanding effort in ensuring and forcing quality healthcare standards not only at the facilities levels but also at the professional development level, by mandating that every healthcare professional continues medical education. Without a doubt, this will enhance the knowledge and skills of the healthcare professionals and expose them to the latest trends and knowledge. Today, for private healthcare facilities to remain competitive, they need to develop or reassess their strategic planning to become more aware of the internal and external forces. They also need to be more creative and innovative in reducing their operating costs and maximizing the

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utilization of their resources while improving on the quality of service they offer, in accordance with the healthcare regulatory requirements and accreditation. It is important to track the costs of their services and benchmark them against the competitors. When developing strategic plans, it is necessary to address different dimensions, such as corporate culture, strategic planning, core competencies and competitive analysis, environmental evaluation, strategic choices, and strategy to develop a competitive advantage. The strategic framework has to incorporate performance measurement and control mechanisms, such as balanced scorecards.

The future outlook It will be more promising, as the implementation of the accreditation and other healthcare regulatory requirements, along with the classification of healthcare facilities, will reduce the size of the existing private healthcare market, while making room for the highly qualified and accredited healthcare facilities to regain their market position and recover revenue. Within the next three years, mergers, acquisitions or joint ventures between the facilities will also likely be prominent. In sum, in the future, the private healthcare will look promising for those healthcare facilities that maintain strong reputation and overcome the current difficulties by enhancing their innovation and management skills in maintaining and developing strategy to encourage small healthcare providers to join under their facilities as joint venture or merger, resulting in building healthcare provider groups under preferred healthcare provider facility. In the future, small clinics and medical centers will mostly disappear, and some international investors will not be able to sustain the operating costs of the new healthcare model. As a result, their market share will become available to others that meet the accreditation requirements and overcome the current transitional period. Todayâ€™s healthcare organizations need to operate at greater economies of scale, which can result in increased profitability. At this time, the healthcare facilities need to gain the trust and support of their current partners, as this will get them through this transitional period, ensuring that they position themselves strongly in the market. Finally, healthcare strategists may consider different models of ownership in order to remain competitive in the market, while building quality service branding through creativity and innovation.

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INTERNET ADDICTION in the Our Lives and Workplace Professor Mukhtar Al-Hashimi Ahlia University – Bahrain

nternet use has become essential in our lives, as it facilitates communication, expedites information access and promotes social interaction. It has become so ubiquitous that may would argue that we could not function without the Internet. However, it is essential to limit the use of electronic devices, as they can create dependency, and in some cases lead to Internet addiction disorder. According to “The Mobile Economy Middle East and North Africa 2017” report compiled by the GSMA (which is an organization that covers the interests of the mobile operators

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globally), the Middle East mobile market is diverse, with some countries below the global average mobile penetration rates, while others exceed the global average, such as the Arab Gulf States. This variation in the penetration rate is attributed to the high income per capita within the Arab Gulf States, which impact the affordability of mobile services among the residents and business units. According to the report, 76% of the GCC population are mobile subscribers, with subscriber penetration rates above 90%, while the regional average is 46%. The term “addiction” is used to refer to a loss of control over one’s behaviors, usually with negative con-

sequences. In the past, the word “addiction” was associated with alcohol or drug abuse, or gambling; however, today, the obsessive and compulsive usage of information technologies and increasing advancement in smart devices, such as computers, handheld tablets, and smartphones, has resulted in addictive behavior referred to as “Internet addiction.” Internet addiction can affect any individual at any age, and can be manifested in different settings, such as school, university, home and workplace. Internet addiction reflects an impulsive behavior, in which the user forms emotional attachment to online interactions and a wide range of activities, such as chatting with friends, surfing the web, using the apps, interacting on social media, etc. In real life, there are different kinds of addiction, such as pathological gambling and substance abuse, all of which have negative impact on the person. In summary, Internet ad-

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diction is a behavioral addiction, often defined as “individuals’ incapability of controlling their internet usage, which in due course causes psychological, social, school and/or work difficulties in their life”. IT addiction usually manifests through six symptoms: (1) salience, which indicates that IT dominates a person’s behavior; (2) withdrawal, which indicates release of negative emotions when a person ceases using smartphone for a period of time; (3) conflict, which suggests that because of using IT other tasks or activities are affected negatively. Individuals with Internet addiction spend most of their time in isolation, leaving less time for interacting with real people in their lives. Some studies suggest that individuals suffering from internet addiction may have low self-esteem, feelings of inadequacy, and fear of disapproval. If they continue ignoring the Internet addiction, this could lead to medical problems, such as sleep disturbance, dry eyes, severe headaches, backaches, pain and numbness in hands, eating irregularities, and poor personal hygiene. In addition, withdrawal tends to produce mood swings, depression and anxiety. On the basis of behaviors and impulse control problems, Internet addiction can be classified into different types, namely: (1) online friendship and relationship addiction over the Internet; (2) Internet activity addiction, like online gaming; (3) gambling and shopping; (4) online information searching and content management; (5) online crime and cyberbullying; and (6) online pornography and sexual activities. Similar to other types of addiction, Internet addiction is also associated with a number of problems, such as little sleep, loss of appetite, limited physical activity and lack of concentration.

Today, Internet use has become pervasive and essential in our daily lives. We use it at home for socializing with family and friends, while driving and at workplace. As this can compromise productivity and focus, employees’ Internet addiction could affect their work performance, whether directly or indirectly, via: (1) Change in sleep patterns, since employees who are addicted to the Internet spend long hours using it at night, staying up until the early morning and sleeping only a few hours; (2) Demand for privacy as, if they are disturbed or interrupted when online, they clearly seem to react angrily. This sort of privacy may affect their group involvement at workplace, when they extend their Internet usage to the working hours. Clearly, their willingness for teamwork is lower and this may adversely affect the overall work performance and productivity; (3) Other responsibilities are ignored, especially when an employee creates a new friendship or relationship online, as this creates some sort of excitement and novelty, which could interfere with the real responsibilities and tasks the person ought to accomplish. When Internet usage is prohibited at workplace, the user feels irritated and restless away from his or her smartphone, seeking to always check the mail and communicate with the online friends, which, in turn, affects the work responsibilities. That is why many companies are increasingly implementing measures and regulations to prevent Internet usage within workplace to assure good performance of their employees and to achieve customer satisfaction, along with good quality of the services provided. In order to investigate the impact of Internet addiction in the workplace on the performance of

employees, a survey was conducted using a questionnaire completed by 292 participants, who reported on their Internet addiction level. The study sample comprised of 52% Bahraini nationals. In addition, 52% of the participants were male, and majority was aged 18−50 years. Moreover, 12% worked in the industrial sector, 23% in the trade and services sector, 31% in the healthcare sector, and 22% in the educational sector. Majority of the respondents hold at least one university degree, and 45% of the participants work 8 to 10 hours a day. The most commonly used social media by the participants are WhatsApp (87%), YouTube (51%), Instagram (50%), and Snapchat (35%), while Twitter (19%) and Viber (7%) are the least popular. About two thirds of the participants (69%) reported that they stay online more than they intended on a daily basis. In addition, about one third reported that they use apps during their work hours and establish new relationships online. They also lose sleep due to staying online late at night. The participants reported that their Internet usage has increased in the last three months, which made them feel depressed, moody, restless and irritable when offline or unable to use their smartphone. Finally, majority disapprove of the idea that companies should control the employees’ Internet access and smartphone use at work. Finally, from this study, several recommendations can be made for organizations. First, there should be an Internet use policy at workplace and it should be supervised to endorse compliance. Second, there should be technology experts who are capable of filtering the Internet sites available at workplace to restrict the kind of sites employees could get access to at work.

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the changing healthcare scenario

in GCC creating new opportunities in medical tourism Dr. Prem Jagyasi An award-winning strategic leader, renowned author, publisher and highly acclaimed global speaker.

reverse trend in medical tourism is being observed in the GCC region with the rise in the number of inbound medical travelers. Outbound medical tourism prevailed in this region but the reversal of scenario is generating new opportunities in medical tourism.

expatriates making up 49% of it. Increased life expectancy is contributing to the growth of senior population, and the estimated population is likely to cross 50 million by 2025 reports Health Beyond Borders. Along with, the rising incidences of cardiovascular diseases, diabetes, obesity and cancer have overburdened the GCC healthcare forcing the governments to think otherwise.

The entire gulf is witnessing an exponential population growth with

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Inadequacy in healthcare led to outbound medical tourism: The situation was different sometime back when beyond the border healthcare of GCC nationals was funded by the government. Inadequacy of specialized care especially in oncology and cardiology spurted outbound medical travel. People relied more on the evolved healthcare system of Germany, UK, US and other Asian nations.

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Among the GCC nationals surveyed in 2011, Kuwaitis showed the highest inclination towards abroad medical care and Saudis seemed to be least inclined reports Gallup Survey.

Initiatives to curb public healthcare expenditure burden – the need of the hour: GCC spending in abroad medical care stands approximately $7.2 billion to 12 billion USD of which 80% accounting for government spending. UAE alone spends $2 billion closely followed by Kuwait government’s $1.8 billion spend as per Kleos Health Analysis Survey on Middle-East Healthcare. The Gallup survey further showed that although most of the GCC nationals were satisfied with domestic medical care, government expenditure for outbound medical tourism still posed a severe burden. Funding abroad medical expenses have been a huge drainage in the country’s exchequer which needed to be checked. The region has felt the dire necessity to revamp the healthcare infrastructure to build the confidence among its citizens about its quality medical care and support.

Creating new opportunities in medical tourism: The GCC countries realized the potential of medical tourism as an important driver of the economy and have been focusing to grab a bigger share of the pie. Considerable public and private investments in expanding and upgrading the existing healthcare infrastructure have reversed outbound medical tourism by offering affordable high-quality treatments and services. The introduction of MHI (Mandatory Health Insurance) to shift a part of healthcare expenditure burden to the private sector has fostered the rapid growth of private facilities

helping in further expansion of healthcare facilities and services. Trimetric’s Construction Intelligence Center (CIC) database gives an interesting figure about the speedy development of GCC healthcare infrastructure running 119 active projects worth $46 billion.

GCC gaining position as a medical tourism destination with UAE and Saudi Arabia leading the pack: According to Alpen Capital, UAE’s medical tourism market was valued at $1.6 billion in 2012. Dubai is the first emirate to include medical travel in its policy goal. As reported by Business Monitor International (BMI), the risk-reward ratio in this sector in the UAE is 62.5 as in Q216 making it the most attractive medical tourism market in the MENA region. Saudi Arabia stands next with 59.7. The Dubai Healthcare City (DHCC) launched in 2002 as the world’s largest healthcare free economic zone, aimed towards developing the region as a prime health and wellness destination has caught the attention of global health travelers. Dubai enjoys a special geographical advantage that has boosted its potential to grow as a medical tourism hub. Its proximity to other Gulf nations and Africa, cultural affinity, tourism attractions and the growing perception of the availability of state-of-the-art healthcare facilities and services have contributed to its emergence as a medical tourism hub. A melting pot of different cultures, Dubai stands as one of the pronounced cosmopolitan metropolia in the world. Medical travelers from the MENA region, Russia and CIS countries are crowding Dubai to avail a plethora of specialized treatments and services.

The city witnessed the footfall of approximately 300,000 medical travelers from outside the UAE in 2015 growing stupendously from almost 107, 000 in 2012 as stated by Forbes Middle East. In 2016, Dubai health facilities received 325,000 medical tourists registering an overall growth of 9.5 % in the number as reported in Khaleej Times. The Dubai Health Authority (DHA) is targeting 500,000 medical travelers by 2020.

Saudi Arabia unraveling its medical tourism prospects: The Kingdom of Saudi Arabia (KSA), the largest country in the Arabian Peninsula popularly known as the Land of Two Mosques, is fast gaining pace in medical tourism. Riding on religious tourism, KSA has the potential of attracting not only 1.6 billion Muslim population but also others from different parts of the world. The government is bent on revamping the healthcare infrastructure by encouraging construction of stateof-the-art treatment facilities through self-funding and help from private players. In the entire GCC region, the KSA has the highest value of healthcare projects worth nearly $14 billion (SAR 52.5 billion) according to BMI’s Infrastructure Key Projects Database. The country’s growth in medical

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tourism is evident from 220,000 foreign travelers from different corners of the world seeking treatment in 2011 as reported by the Private Health Association (PHA). The Journal of Saudi Arabia reports that foreigners spent over 400 million Riyals for medical treatment in 2010. Travelers from UK, France, Germany, USA and Iraq do consider the KSA for medical tourism.

Challenges in GCC medical tourism: •

•

get positioned in the global medical tourism map.

If opportunities are in plentiful, challenges are no less either. The long-standing mindset of GCC nationals regarding heavy reliance on abroad medical facilities may still cause a hindrance in domestic healthcare development. More state-of-the-art secondary and tertiary care facilities need to run full-scale operation considering the rising incidences of critical noncommunicable diseases. Low hospital bed penetration compared to the rest of the world and limited availability of trained medical professionals and qualified physicians are still major areas of concern. Over-reliance on expatriate medical professionals may invite bigger problems in future. If they leave the country, it would be not easy to find a replacement. Stringent immigration laws causing visa restrictions is another major impediment to medical tourism. Lack of proper marketing strategy and initiatives to

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Need to partner and promote through smart product and packaging: Developing unique products according to the preferences of targeted medical tourists and packaging them smartly is the key to drive in more medical travelers. The GCC nations need to concentrate seriously on this. A medical tourism product needs to be incorporated with core values pertaining to quality, safety, consistency and special features to make it stand out from others. One such step is JCI accreditation, which certainly enhances the value of medical tourism products. UAE leads globally with 192 JCI accredited organizations whereas KSA has 103. All the core features should be presented in a package which is mainly a well-conceived web portal.

DHX – Dubai Health Experience an exemplary medical tourism packaging: Launched in April 2016, DHX stands as the gateway of information for prospective medical tourists from every corner of the world. The website offers a wealth of informa-

tion related to treatments, cost, visa, travel, accommodation booking, insurance and Dubai itself. The prospective medical travelers can plan a well-balanced itinerary combining treatment and tourism.

Forging strategic partnerships in medical tourism: Forging strategic partnerships with recognized hotels, travel agencies, travel companies, healthcare organizations, clinics and other associated service providers is crucial to promote medical tourism of the region. These are the initial contact points of the prospective medical travelers. The DHX is playing an important role in helping patients with customized travel packages from registered travel agencies ensuring the patient and accompanying members a rejuvenating and fruitful medical tourism experience. The DHX Group has partnered with 45 leading healthcare providers including top grade hospitals, specialized clinics and day care centers. Given the opportunities, medical tourism is poised to be the next big thing in the GCC region. It is to be watched what extraordinary initiatives GCC nations would take to build up the highly prospective medical tourism industry.

ARTICLE FEATURES . Infection Control in Hospitals

ospitals and health institutions are aware of the importance of fighting infection, and only had to abide by the international standards in this regard and were keen to reduce the spread of infection among patients in hospital rooms or in operating rooms. The Infection Control Unit in hospitals has key clinical priorities to protect patients, visitors and staff from the risk of healthcare-associated infections caused by bacteria (germs).

immunity. Every hospital must develop a clear plan for cleaning, disinfecting and decontamination with the need to commit to this plan by working as a team between the doctors, hospital management and nursing staff. Hence, the Infection Control Unit was established in every health facility and its primary mission is to support the hospitalâ€™s health system to care for patients, reduce and prevent healthcare-associated infections, spread health awareness and enhance patient safety by reducing health risks. The objectives of the Infection Control Unit are to implement policies and procedures for standard infection control precautions as well as precautions based on methods of disease transmission. It is also the duty of Infection Control Units to fully adhere to the policy of antibiotic treatment and ensure compliance with the approved guide of policies and procedures for isolation precautions in health facilities and all policies of other departments, as well as providing facilities and equipment that allow healthcare providers and nurses to maintain good infection control practice. The educational aspect is very important in this regard, whether for healthcare providers, hospital staff, patients or even visitors. Thus, it is the responsibility of the Infection Control Unit supervisors to prepare publications or brochures explaining the importance of infection control and how to maintain general hygiene and sterilization, while providing workshops and training courses for various departments in order to train them on some modern means of infection control.

Today, most hospitals in the Gulf States and the Middle East region have received international accreditation and certification for following guidelines on infection prevention and control after carefully abiding by specific policies to ensure the best level of disease prevention and infection control for doctors, nurses and patients. Hence, the principle of infection control requires specific policies with an organizational structure to be supervised by specialists in this field, in addition to conducting necessary training for the medical staff and team in order to achieve this purpose. Infection prevention and control programs are one of the main pillars of health institutions. All countries are developing their capacities in this field since infection prevention and control depends on developing coordination with all the medical staff, healthcare providers, medical laboratories and others. Every health facility is obliged to establish monitoring systems for hospital infections and to identify serious conditions, especially in patients who spend more than ten days in the hospital as well as ICUs or patients with low weak

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ARTICLE FEATURES . Infection Control in Hospitals

Methods of Infection Control The adopted procedures and policies are primarily intended to prevent infection or its transmission among patients, healthcare providers and visitors. Hospitals must strictly comply with these procedures when dealing with patients or equipment in order to ensure a clean, sterile and infection-free environment surrounding the patient and provide a completely safe and clean environment that ensures the prevention of microbial growth. There are various infection control methods that are integrated and should be applied with high accuracy in order to ensure a sterile environment. The easiest and most effective way to reduceÂ the spread of infection isÂ good hand hygiene, this means washing hands regularly throughout the day with soap and water. Healthcare staff, including ambulance crews practice hand hygiene when caring for patients to prevent and control infections. Some basic hygiene procedures include ensuring all staff have access to single-use disposable gloves, making sure all staff can easily access hand washing facilities or hand sanitizer and safe disposal of clinical waste, blood and other body fluids. The healthcare worker should assess the level of risk of splashes or sprays of blood or body fluids, and secretions or excretions involved in the procedure being undertaken and wear appropriate apparel, ie. plastic apron, gown, mask, goggles, face shield. All healthcare workers must take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices. The adoption of safe work practices and correct disposal is incumbent on all who use sharps. The maintenance of a safe environment for patients incorporates the basic requirement that the area a patient is nursed in, and equipment used on the patient is hygienically clean. Factors that increase cross-infections may include lack of hand washing facilities, patients close together or sharing rooms, understaffing, preparation of IVs on the unit, lack of isolation facilities, no separation of clean and dirty areas, excessive antibiotic use, inadequate decontamination of items and equipment and inadequate cleaning of environment.

ARTICLE FEATURES . Infection Control in Hospitals

The health of hospital staff is fundamental to prevent the transmission of infection, through the following steps: •

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Regular and pre-employment health checkups in order to ensure that the employee is free from any medical condition. Tests HIV (For AIDS), SGPT (For Liver), Cholesterol (Heart), HBsAg (Hepatitis) and Creatinine (Kidney) Healthcare workers who are at risk for exposure to serious, and sometimes deadly, diseases should get appropriate vaccines to reduce the chance that you will get or spread vaccine-preventable diseases by making sure they are up-to-date with recommended vaccines that include Hepatitis B, MMR (Measles, Mumps and Rubella), Varicella (chickenpox), Tdap and meningococcal. Educating employees about the infection control program while focusing on specific sections such as surgery, operating rooms, sterilization, hygiene, food preparation and maintenance services because of their direct contact with patients. Attaching great importance to the role of laboratories in the infection control program in terms of infection diagnosis. Labs should cooperate with other departments.

gy (gloves, sharps covers, air exchanges), none of these aids work without constant vigilance on the part of healthcare workers. Caution is especially critical in the intensive care unit (ICU). We see more infections in this population due to the length of time they may be in a unit; those infections can be due to the number of invasive lines, mechanical ventilation, or other parameters specific to ICU patients. However, the practices to reduce infections remain the same as for all patients. Patients in the ICU are severely ill and often bed-ridden, they also tend to have many invasive devices such as Foley catheters to measure output, central lines for fluids and monitoring, arterial lines to measure pressures, endotracheal tubes for assisted ventilation, etc., that patients in other parts of the hospital don’t have. The presence of an invasive device automatically increases the risk of infection because it provides a ready means of entry by bacteria into a normally clean space. Although these patients can be particularly susceptible to infections, hand hygiene guidelines remain the same everywhere. Handwashing is required before and after each patient encounter and the use of antimicrobial agents

Intensive Care Units and Infection Control Intensive Care Units are one of the most important departments in hospitals. Although many issues of infection control can be countered by technolo-

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prior to invasive procedures. The use of alcohol-based waterless products can improve adherence with hand hygiene practices due to ease of use and less time required for effective disinfection. Hand hygiene, environmental cleaning, and appropriate hospital staffing can impact ICU infection rates. Continuing staff education, minimizing risk factors, and implementing guidelines is necessary to decrease infections such as catheter-related bloodstream infections, urinary tract infections, ventilator-associated pneumonia, etc. The strategy for prevention may include hand washing, use of gloves to prevent contamination of the hands when handling respiratory secretions, wear gloves and gowns during all contact with patients and fomites potentially contaminated with respiratory secretions and use of aseptic technique. The staff should clean and decontaminate all equipment after use, sterilize or use high-level disinfection for all items that come into direct or indirect contact with mucous membranes, rinse and dry items that have been chemically disinfected, package and store items to prevent contamination before use and keep environment clean, dry and dust-free.

ARTICLE FEATURES . Infection Control in Hospitals

7 steps to perform handwashing properly Keeping hands clean is one of the most important ways to prevent the spread of infection and illness. In healthcare settings, hand hygiene can prevent potentially fatal infections from spreading from patient to patient and from patient to healthcare worker and vice-versa. The adoption of safe work practices and correct disposal is incumbent on all who use sharps. The maintenance of a safe environment for patients incorporates the basic requirement that the area a patient is nursed in, and equipment used on the patient is hygienically clean. Medical teams and healthcare providers follow the seven-step handwashing technique in order to ensure that the hands have been thoroughly cleaned and sterilized.

The 7 steps of handwashing include: 1. 2. 3. 4. 5. 6. 7.

Wet your hands and apply enough soap Rub your palms together. Rub the back of each hand. Rub both your hands while interlocking your fingers. Rub the back of your fingers. Rub the tips of your fingers. Rub your thumbs and the ends of your wrists then rinse both hands properly with water.

ARTICLE FEATURES . Serotonin

SEROTONIN THE HAPPY HORMONE It improves mood and prevents depression

he feeling of happiness, satisfaction and mood stability are signs of stable serotonin levels, a hormone that is also classified as a neurotransmitter, which sends or transmits nerve impulses to the brain. Serotonin plays a major role in mood disorders, especially depression. When the balance of neurotransmitters, specifically serotonin, is altered, it will affect mood.

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The lower the level of serotonin in the brain, the greater the risk is for developing a depressive disorder. Serotonin is necessary for the regulation of many functions within the body, and when you do not have enough of it you can develop serotonin deficiency syndrome, which brings with it several symptoms. Symptoms of low serotonin levels include depression,

insomnia, anxiety, negative thinking, obesity, pain and migraine headaches.

Symptoms of normal serotonin level in the brain include: • • • • •

ood stability M Feeling happy and satisfied Prevention of headaches Anxiety control Prevention of premenstrual syndrome

ARTICLE FEATURES . Serotonin

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Regular and comfortable sleep Healthy sex drive

Serotonin is mainly found in the brain, nervous system and blood platelets in addition to the digestive system. It is a neurotransmitter involved in the transmission of nerve impulses. Serotonin is considered a natural mood stabilizer. It is the chemical that helps with sleeping, eating, digesting and helps control your bowel movements and function. Generally, the normal range for serotonin levels in your blood is 101–283 nanograms per milliliter (ng/ mL), and may vary slightly depending on the measurements and samples that have been tested. Causes of low serotonin include nutritional deficiencies, poor diet, hormone imbalances, inadequate sunlight, lack of exercise, stress, digestive problems, infections, inflammation, blood sugar imbalances, excessive caffeine consumption, smoking and alcohol use. Although there are chemical ways to boost serotonin levels in the body, there are also many natural ways to do so.

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because it lowers serotonin level in the body, thus leads to bad mood The following foods could also boost your serotonin: Some fruits such as pineapples, bananas and kiwis. Nuts including walnuts, pistachios and almonds. Magnesium-rich foods such as dark leafy vegetables, fish, beans and bananas, help to treat depression and achieve happiness. Protein-rich foods such as chicken, liver and meat. Colored veggies such as carrots, okra, spinach and pumpkin.

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ish, especially fatty fish such F as salmon, fish oil and foods high in omega-3 protein, contain high levels of serotonin. Dark chocolate boosts serotonin. Carbohydrates-rich foods because they stimulate the secretion of serotonin. Eggs increase serotonin because they are rich in omega-3 fats. Whey Protein improves blood sugar levels, strengthens the body immunity and increases the levels of serotonin. Bran, flaxseed, and flaxseed oil improve the mood and boost serotonin level in the body.

There are some ways that contribute to the increase of serotonin, namely: •

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xposure to sunlight for at E least 20-30 minutes every morning or afternoon Exercise regularly to help produce serotonin Indulge in relaxation, meditation and remembering happy memories, which will help produce serotonin Take vitamin B, B6, B12 and vitamin C; evidence has shown the ability of vitamin supplements to treat depression and increase happiness Reduce sugar consumption

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Antenatal Classes

ntenatal care (ANC) can be defined as the care provided by skilled health-care professionals to pregnant women in order to ensure the best health conditions for both mother and baby during pregnancy.

Health education of pregnant woman is well known and evidenced to have a better prognosis, more satisfaction, happier experience and less complication. Education is an important component of prenatal care, particularly for women who are pregnant for the first time. There were many studies done which found that educated women have better pregnancy outcomes compared with uneducated women and that education during the antenatal period can reduce pregnancy and delivery complications.

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LEARN TO RECOGNIZE SIGNS AND SYMPTOMS OF LABOR AND LEARN WHEN TO CALL THE HOSPITAL What are the component of antenatal classes: •

When to start? The proper time to start antenatal class is by 18-20 weeks.

Why? It’s advisable to start antenatal classes as early as 18-20 weeks.

Because: •

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During this period musculoskeletal changes and fetal movements can be felt. Common minor problems occur which includes tiredness and lack of sleep. To provide ways of comfort to pregnant women such as relaxation techniques, stress management as well as the medicinal and nonmedicinal type of pain reliefs. To give pregnant women

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information about diet (to prevent diabetes). To keep healthy and fit. Prepare muscles of hips and abdomen for labor and birth.

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Exercises: yoga, physical and breathing: Maintaining a regular exercise routine throughout your pregnancy can help you stay healthy and feel your best. Regular exercise during pregnancy can improve your posture and decrease some common discomforts such as backaches and fatigue. There is evidence that physical activity may prevent gestational diabetes (diabetes that develops during pregnancy), relieve stress, and build more stamina needed for labor and delivery. Regular activity helps keep you fit during pregnancy and may improve your ability to cope with labor. This will make it easier for you to get back in shape after your baby is born. Breathing exercises help in easy labor and shortness of breath due to the uterus keeps expanding that puts pressure on the diaphragm and the lungs get cramped. It gives a good amount of oxygen in the bloodstream that is needed for the well-being of both mom and the baby. Proper explanation about the signs and symptoms of labor:

As labor approaches, your body starts to pepare itself for the task ahead and you may notice various physical symptoms and signs that labor is about to start. Not every woman experiences labor in the same way and certain signs can occur either before labor starts or during labor.

Some simple information should be given to the pregnant woman so she should know: There is no way to precisely predict when labor will begin. In the first stage of labor, the cervix dilates and effects (thins out). Once contractions begin they will usually increase in strength, duration, and frequency. The second stage of labor begins when the cervix is completely (i.e. 10 centimeters) dilated. It ends when, following expulsive efforts (pushing) by the mother, the infant is delivered. During the third stage of labor, the placenta and membranes are delivered.

Explanation about pain management Labour is painful, so it’s important to learn and educate yourself about your options for pain management during labor and to decide which methods will best fit your needs. Keep in mind that your best bet is to be well informed and flexible in your options because you don’t know how painful labor will be until you actually experience it. Work with your doctor or midwife to decide which types of pain relief you are interested in so that there is no confusion once you are in labor. It’s also helpful for whoever is going to be with you during your labor to know

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about the different options, as well as how they can support you.

mother’s exertion which may otherwise harm her.

Explanation of normal delivery vs assisted delivery and cesarean section

Birth plan and tour in the hospital

Giving birth to a new life is empowering and enchanting. Learning about various delivery methods will only help you feel well-equipped, making the experience more magical. Babies can enter this world in two ways: a pregnant woman can have either vaginal birth or a surgical delivery by Cesarean section, but the ultimate goal of both delivery methods is to safely give birth to a healthy baby. In some cases, C-sections are planned for medical reasons that make a vaginal birth too risky. A woman may know in advance that she will need a C-section and schedule it because she is expecting twins or other multiples, or because she may have a medical condition, such as uncontrolled diabetes or high blood pressure. Normally, in vaginal delivery, the baby comes out head first and a delivery is complete only when the placenta and membranes delivered completely, the uterus contracts and the bleeding stops. The head is the largest part of the baby to be delivered, followed by shoulders and the rest of the body. Sometimes, during a normal delivery, when the mother finds it difficult to push the baby out she might need external help. This comes in the form of forceps or a small amount of suction applied to the baby’s head. The delivery occurs through the vagina as the healthcare provider gently assists the baby’s head through the birth canal. It helps reduce the

Preparing a birth plan is important and helpful in the course of safe birthing. A birth plan is a short-page statement of your preference during and after the birth of your child. It would provide an effective opportunity for everyone involved in the birth to understand your hopes and desires for the most memorable and life-changing event in your life- giving birth. It may contain your wishes during labor including pain management, your choice of companion and the assertion of you right to skin-to-skin mother-baby contact. You may also state in your birth plan how you would like your baby to be treated after the birth and the things you want to happen in case of unanticipated events. Hospital tours can help parents know what to expect, learn what options are available to them can even help parents better visualize their birth experience. It provides ample opportunities to ask questions about birth plans, policies and procedures. This is a good time to see if your birth desires line up with what this particular hospital offers new parents.

Breastfeeding and baby care With newborn comes to a lot of responsibilities and it can cause some nervousness for most new moms, especially those who have not spent a lot of time around newborns. In fact, many new parents feel unprepared when it’s time to bring their new baby home from the hospital.

Faten Jabnouni Midwife, Breastfeeding counselor Al Ahli Hospital The first few months of baby’s life is a joyful time, but there is also a lot for new parents to learn about feeding a newborn, getting him to sleep and regular care and safety. Caring for a new baby can be overwhelming at first. The decision to breastfeed your baby is one of the best gifts you can give to your newborn. Breast milk has many health benefits, including strengthening your baby’s immunity. When it comes to breastfeeding, a good latch is important, since improper latching can cause breast discomfort. A good latch means the baby’s mouth covers both your nipple and the areola. This way, the baby’s mouth, tongue and lips will massage the milk out of your milk glands. Scientific studies have shown that breastfeeding is good for the mother’s health too.

Conclusion Attending antenatal classes have been proved to be beneficial to pregnant women at the antenatal period, during labor and postnatal period. So it’s advisable to attend these classes.

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Placenta Accreta, Increta, Percreta Syndrome High-risk syndrome due to repeated cesarean sections

t is a high-risk condition which causes severe maternal morbidity and mortality at the time of delivery. Placenta accreta is defined as an abnormal direct attachment of the placental trophoblast to the uterine myometrium without normal intervening decidua or basalis layer, Decidua protects the myometrium from being invaded by placental villi. Based on the degree of invasion of placental trophoblast into the myometrium, placenta accreta syndrome can be classified as accreta if invasion is simple and not deep in the myometrium, placenta increta when trophoblasts invade deeply in the myometrium and percreta when placenta invades the whole myometrium thickness reaching the outer surface of the uterus and invading the adjacent bladed or intestine. Further categorization based on the amount of placenta is involved, so if the whole placenta involved then it is total accreta but if only cotyledon or areas of cotyledons are involved then it is partial or focal placenta accreta.

Most important risk factors for placenta accreta are: 1. When the placenta is abnormally implanted on the lower uterine segment; placenta previa. 2. The more the number of previous cesarean sections the more the incidence of placenta accreta. 3. Having both placenta previa and previous cesarean section together will have the highest risk for placenta accreta. 4. In-vitro fertilization

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5. Previous surgical intervention on the myometrium like surgical resection of fibroid uterus or embolization, endometrial ablation, the presence of intrauterine adhesions or congenital abnormalities of the uterus. The cornerstone in the management of placenta accreta is the high early prediction and detection. As early as the first trimester of pregnancy. Ultrasound abdominally and vaginally is the best tool for diagnosis, CT Scan and MRI are also used to confirm the diagnosis in special cases. There is strong evidence that confirmed cases of placenta accreta should be selectively delivered between 34 and 35+6 weeks of gestation rather than to wait till beyond 36 weeks and waiting for uterine contractions. In fact, it is a balance between maternal versus fetal mortality and morbidity. Under no circumstances, the pregnant woman should be left to start labor pains and contractions and to let her go into emergency surgical intervention by the unprepared team just to achieve fetal lung maturity. Surgical intervention on placenta accreta should be exclusively done in high excellence centers with wellequipped laboratory, unlimited blood bank services ready for massive blood transfusion, have a well-trained team composed of senior obstetrician, surgeon, urologist, vascular surgeon, interventional radiologist capable of uterine artery catheterization and embolization to stop bleeding in case surgeons fail to stop bleeding which may reach up to two to three liters

Dr. Asmaa Abdulsalam Consultant of Obstetrics & Gynecology / Al Ahli Hospital in few minutes. The golden rule in treating placenta accreta is a cesarean section to extract the fetus than to be followed by a subtotal hysterectomy. Conservative treatment should be preserved to well-selected cases where the fertility is highly needed. Conservative treatment could be either by leaving the whole placenta in place without any attempt to remove it, leaving it to necrotize, shrink and slough by itself, however, there is a risk of secondary hemorrhage or infection with the necessity for hysterectomy. In case of partial placenta accreta with only one cotyledon invading the myometrium, it is possible to resect the adherent part of the placenta with the overlying myometrium followed by uterine repair. In conclusion, placenta accreta syndrome is a high-risk obstetrical condition complicating pregnancy, it is of importance to detect and diagnose it as early as possible based on high-suspicious past medical and obstetrical history, and surgical intervention should be between 34-35 weeks gestation in high excellence centers.

ARTICLE FEATURES . Diabetic Neuropathy

Diabetic Neuropathy Strong relationship between diabetes mellitus and neuropathy

iabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar can injure nerves throughout your body. Diabetic neuropathy most often damages nerves in your legs and feet.

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Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your legs and feet to problems with your digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for

others, diabetic neuropathy can be quite painful and disabling. Over time, high blood glucose and high levels of fats, such as triglycerides, in the blood from diabetes can damage your nerves and the small blood vessels that nourish your nerves, leading to

ARTICLE FEATURES . Diabetic Neuropathy

peripheral neuropathy. Poor blood sugar control is a major risk factor for diabetic neuropathy; uncontrolled blood sugar puts you at risk of every diabetes complication, including nerve damage. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn’t well-controlled. Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage. Being overweight may increase your risk of diabetic neuropathy while smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal and damages the peripheral nerves. The type of condition and symptoms depend on which type of diabetic neuropathy you have. The condition may be chronic as most neurodegenerative disorders are chronic and develop over time. Guillain-Barré syndrome is the most common acquired inflammatory neuropathy. Some peripheral neuropathy cases may take years before their symptoms begin to appear, while some patients may experience symptoms hours or days after their diagnosis.

Complications Diabetic neuropathy can cause a number of serious complications, including loss of a toe, foot or leg; nerve damage can make you lose feeling in your feet. Foot sores and cuts may silently become severely infected or turn into ulcers. Even minor foot sores that don’t heal can turn into ulcers. In severe cases, infection can spread to the bone, and ulcers can lead to tissue death (gangrene). Amputation of a toe, foot or even the lower leg may be

necessary. Nerve damage can cause a joint to deteriorate, causing a condition called Charcot joint. This usually occurs in the small joints in the feet. Symptoms include loss of sensation and joint swelling, instability and sometimes joint deformity. Prompt treatment can help you heal and prevent further joint damage. Urinary tract infections and urinary incontinence may also develop. If the nerves that control your bladder are damaged, you may be unable to fully empty your bladder. Bacteria can build up in the bladder and kidneys, causing urinary tract infections. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine, leading to leakage (incontinence). Low blood sugar normally causes shakiness, sweating and a fast heartbeat. But if you have autonomic neuropathy, you may not notice these warning signs. Damage to the nerves that control blood flow can affect your body’s ability to adjust blood pressure. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension), which may lead to dizziness and fainting. If nerve damage strikes your digestive tract, you can have constipation or diarrhea, or bouts of both. Diabetes-related nerve damage can lead to gastroparesis, a condition in which the stomach empties too slowly

or not at all. This can interfere with digestion and severely affect blood sugar levels and nutrition. Signs and symptoms include nausea, vomiting and bloating. Nerve damage can disrupt how your sweat glands work and make it difficult for your body to control its temperature properly. Some people with autonomic neuropathy have excessive sweating, particularly at night or while eating. Too little or no sweating at all can be life-threatening.

Prevention You can prevent or delay diabetic neuropathy and its complications by keeping tight control of your blood sugar and taking good care of your feet. Use an at-home blood sugar monitor to check your blood sugar and make sure it consistently stays within target range. It’s important to do this on schedule. Shifts in blood sugar levels can accelerate nerve damage. It is very important to follow your doctor’s recommendations for good foot care. Foot problems, including sores that don’t heal, ulcers and even amputation, are a common complication of diabetic neuropathy. But you can prevent many of these problems by having a comprehensive foot exam at least once a year, having your doctor check your feet at each office visit and taking good care of your feet at home.

ARTICLE FEATURES . Helicobacter Pylori

H. Pylori Responsible for many gastric diseases

. pylori are a common type of bacteria that grows in the digestive tract and has a tendency to attack the stomach lining. H. pylori infections are usually harmless, but theyâ€™re responsible for the majority of ulcers in the stomach and small intestine. H. pylori often infect your stomach during childhood. While infections with this strain of bacteria typically donâ€™t cause symptoms, they can lead to diseases in some people, including peptic ulcers, and an inflammatory condition inside your stomach known as gastritis. The World Health Organization classified H. pylori as a carcinogen, or cancer-causing agent, in humans. More than 95% of all duodenal ulcers and about 75% of gastric ulcers are Hp-positive. Helicobacter pylori are spiral-shaped bacteria that can attach to the lining of the stomach or small intestine and thrive and multiply in that environment. H. pylori infection occurs when the bacteria release toxins. Helicobacter pylori infection is the leading cause of stomach ulcers (e.g., peptic ulcers) and gastritis (inflammation in the stomach). Treatment

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ARTICLE FEATURES . Helicobacter Pylori

usually is quite effective. Ulcers often heal completely, resulting in a lower risk for recurrence. Left untreated, H. pylori infection can lead to stomach cancer. The exact way H. pylori infects someone is still unknown. H. pylori bacteria may be passed from person to person through direct contact with saliva, vomit or fecal matter. H. pylori may also be spread through contaminated food or water. Signs and symptoms of H. pylori may include severe or persistent abdominal pain, nausea and vomiting that may include vomiting blood, bloody or black tarry stools, fatigue, anemia, decreased appetite and diarrhea. Although H. pylori are widely spread among people in the Middle East, their early treatment and diagnosis contribute to the reduction of complications that may result from gastrointestinal diseases or non-ulcer dyspepsia. In some extreme and very rare cases, they may cause stomach cancer.

Is it contagious? H. pylori are commonly transmitted person-to-person by saliva. The bacteria can also be spread by fecal contamination of food or water. In developing countries, a combination of untreated water, crowded conditions, and poor hygiene contributes to higher H. pylori prevalence. Most people become infected as children, and parents and siblings seem to play a primary role in transmission. H. pylori can be transmitted due to: • Poor personal hygiene • Crowded places • From flies that have been in contact with H. pylori-infected faeces • Contaminated water

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Sneezing and coughing Handshakes with infected persons

Symptoms This infection causes many symptoms that are similar to other medical conditions, which necessitates the need for careful diagnosis and seeking medical advice to find out the cause of the disease and be able to treat it properly in order to avoid any complications. H. pylori are adapted to live in the harsh, acidic environment of the stomach. These bacteria can change the environment around them and reduce its acidity so they can survive. The spiral shape of H. pylori allows them to penetrate your stomach lining, where they’re protected by mucus and your body’s immune cells are not able to reach them. The bacteria can interfere with your immune response and ensure that they’re not destroyed. This can lead to stomach problems. A number of other symptoms may be associated with H. pylori infection, including: • Excessive burping • Severe stomach pain accompanied by severe bloating even when eating light snacks • Feeling bloated • Nausea • Heartburn • Lack of appetite, or anorexia • Unexplained weight loss • Dizziness and fainting in severe cases • Shortness of breath and pale skin in severe cases • Fatigue and exhaustion

Diagnosis Your doctor will ask about your medical history and family history of

disease. Be sure to tell your doctor about any medications you’re taking, including any vitamins or supplements. Your doctor may also perform many other tests and procedures to help confirm their diagnosis: During a physical exam, your doctor will examine your stomach to check for signs of bloating, tenderness, or pain. They’ll also listen for any sounds within the abdomen. Tests and procedures used to determine whether you have an H. pylori infection include blood test; analysis of a blood sample may reveal evidence of an active or previous H. pylori infection in your body. In addition to a stool test that looks for foreign proteins (antigens) associated with H. pylori infection in your stool. Diagnostic tests for H. pylori infection include: • CMV antibodies test • Stool test: A laboratory test called a stool antigen test looks for foreign proteins (antigens) associated with H. pylori infection in your stool. • Breath test: If you have a breath test, you’ll swallow a preparation containing urea. If H. pylori bacteria are present, they will release an enzyme that breaks down this combination and will release carbon dioxide, which a special device then detects. • Endoscopy: If you have an endoscopy, your doctor will insert a long, thin instrument called an endoscope into your mouth and down into your stomach and duodenum to make sure H. pylori bacteria are present. • Barium X-rays: In some hospitals, Barium X-rays are used to diagnose H. pylori infection.

ARTICLE FEATURES . Helicobacter Pylori

Treatment H. pylori infections are usually treated with at least two different antibiotics at once, to help prevent the bacteria from developing a resistance to one particular antibiotic. Your doctor also will prescribe or recommend an acid-suppressing drug, to help your stomach lining heal. Treatment involves antibiotics, which are most effective if you have H. pylori and an ulcer. Although they aren’t a “cure all,” certain foods may help minimize your symptoms. For best results, seek guidance from your doctor or dietitian before changing your diet. Your doctor may recommend that you undergo testing for H. pylori at least four weeks after your treatment. If the tests show the treatment was unsuccessful, you may undergo another round of treatment with a different combination of antibiotic medications. Helicobacter pylori bacteria are present in contaminated food and water. Therefore, it is important to avoid these sources (e.g., floodwater, raw sewage.) Washing the hands thoroughly with warm soapy water after using the restroom and before eating also may help prevent infection. Eating utensils and drinking glasses should never be shared, since the bacteria can be spread through saliva. Fruits are rich sources of antioxidants, which support your body’s ability to resist and heal from infections, and fibre, which may help ease ulcer pain. A high-fibre diet may also reduce gastritis symptoms. Vegetables, like artichokes, peas, broccoli, spinach and sweet potatoes, also provide ample fibre and rich amounts of antioxidants. Because whole grains contain all parts of the grain, they supply more antioxidants

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and fibre compared to refined grains. Fatty foods delay stomach emptying, increasing your risk for gastritis pain and inflammation. To avoid these risks, choose lean protein-rich foods such as low-fat dairy products, lean meats, fish, beans and lentils, instead of high-fat meats and cheeses. Both caffeinated and decaffeinat-

ed coffee can increase acid production and exacerbate symptoms in individuals with ulcer disease. Alcoholic beverages can erode the protective mucosal lining along the gastrointestinal tract and lead to further inflammation and bleeding. To minimize symptoms, individuals with ulcer disease should avoid or limit both coffee and alcohol.

ARTICLE FEATURES . Helicobacter Pylori

NEWS

Bellevue Medical Center (BMC) Becomes First Hospital in Lebanon Awarded Gold Certification for Excellence in Person-Centered Care by Planetree International

ellevue Medical Center (BMC) has received the Gold Certification for Excellence in Person-Centered Care by Planetree International, a not-for-profit organization that has been at the forefront of the movement to transform healthcare from the perspective of patients for 40 years. The ceremony was attended by Mr. Elie Zeitouni, representing Lebanese Minister of Public Health, Ghassan Hasbani, and a large crowd of prominent political, religious and social figures, in addition to the hospital’s specialists, administrative staff and media representatives.

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BMC is one of only 85 healthcare organizations worldwide to receive the Person-Centered Care Gold Certification since the program’s launch in 2007, the second in the MENA region and the first in Lebanon. This Person-Centered Care Certification recognizes BMC’s achievement and innovation in the delivery of person-centered care, including the quality of patient-provider interactions, access to information, family involvement and the physical environment of care. Importantly, the criteria that BMC satisfied to achieve

the certification also focus on how it supports staff and grants the opportunity for staff, patients, and families to have a voice in the way care is delivered. It is also about the ways BMC is reaching beyond its walls to care for its community. Mr. Elie Zeitouni, the representative of the Minister of Public Health, expressed his appreciation to Bellevue Medical Center, saying: “The most remarkable thing for me today at this event is the approach to the care of the individual which provides joy and accelerates the healing process for

NEWS

the patient at this hospital. I hope that the Ministry will be supporting the hospitals further, to continue the journey that has made Lebanon the number one in healthcare in the Middle East and the 32nd worldwide. This achievement is a result of the work of the hospitals, doctors, nurses and administrative staff in our healthcare system. I hope that the standards we are working on with the Syndicate of Hospitals and Order of Physicians will always match the global standards to portraybetterunderstanding of healthcare and quality of work.” “At Bellevue Medical Center, we want to make healthcare a better place. The management of the patient’s care is very special; it is innovative, as it looks at the patient as a whole person.

This achievement is one step further to reach our vision of being a leading hospital in Lebanon and the MENA region in the provision of compassionate and person-centered care delivered in a safe, healing and state-of-the-art facility,” said Mrs. Remie Maalouf, Executive Manager and Planetree and Person-Centered care coordinator. The President of Planetree International, Susan B. Frampton addressed BMC saying: “It is indeed an important milestone to celebrate the very first gold-certified organization in Lebanon, and I thank you for your dedication and hard work. Your leadership will no doubt inspire others to follow in your footsteps, and help to continue to advance excellence in patient-centered care globally.”

As part of the certification process - which included a site visit by representatives from Planetree - discussion with recent BMC patients, families and current staff validated that specific person-centered policies are in place, including non-restrictive visiting hours and a shared medical record policy; that staff members at all levels are involved in the implementation of person-centered care; and that the hospital’s physical environment supports patient and family engagement in their care. The process also included a review of the BMC’s performance on patient experience and quality of care measures, and how the measurement of these indicators improves the hospital’s outcomes.

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International architecture and design firm

H+A is designing a $60m proton beam therapy cancer treatment center in Abu Dhabi, the first in the Middle East

roton Partners International Healthcare Investments has appointed architect and design firm H+A to design its $60 million proton beam therapy cancer treatment center in Abu Dhabi. The first facility of its kind in the region, the Abu Dhabi Proton Centre (ADPC) will be part of the existing Gulf International Cancer Centre (GICC) in Abu Dhabi. It will be situated on a site provided by SBK Holding LLC, the Holding Company of HH Sheikh Dr. Sultan Bin Khalifa Bin Zayed Al Nahyan, advisor to the President of the UAE. H+A says it has been tasked with designing the center to house the compact Proton Therapy (PT) solution and other facilities including a café, anesthetic rooms, treatment rooms, zen gardens to aid recovery of cancer patients, dosimetry facili-

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ty; a conference facility which seats 200 for regular meetings, offices for consulting specialists, interior design, landscaping and additional parking. It will also include the introduction of a new MRI suite and linear accelerator (LINAC) as an extension of the GICC. The center is expected to be able to treat over 1,300 patients annually, opening in 2019. “This was a very complicated project dealing with such advanced equipment,” said Stas Louca, H+A’s managing director. “We had to work with a number of design specialists for the radiation screening bunker to protect staff and patients. The radiation shielding blocks will be imported from the U.S by Veritas and the equipment is provided by IBA from Belgium. The technology for the shielding blocks in a unique innovation and a first for the region.

“We’ve also created a patient experience with a high-end hospitality feel. We looked at everything from materials and colors to lighting, all of which affect healing time. This is truly a contemporary and modern piece of architecture. We used glass for better light and views and the quality of materials are low maintenance, sustainable and high performing to surpass insulation criteria. It was an exceptionally fast design, using BIM. We used an integration of software tools, including augmented reality, to meet project timelines. The most exciting part for us was not many healthcare architects have ever designed a proton beam facility, and to be the very first in the region has been a privilege.” “We are delighted to have our expertise in the healthcare sector recognized with our appointment to

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design the first ever treatment center with this technology in the region. It is wonderful to be part of such an important phase in the UAE’s plans to revolutionize cancer treatment, aiming to provide world-class medical treatment for all cancer patients, making this country a prime destination for medical tourists.” While cancer is the third leading cause of death in the UAE behind cardiovascular disease and accidents, approximately 4,500 new cases are reported each year and the UAE government has vowed to lower the number of fatalities from cancer by 2021 with programs encouraging regular screenings and the building of more modern facilities like the GICC. “The introduction of proton beam therapy marks an important phase

in our plans to revolutionize cancer treatment in the UAE and with works officially started, our vision will soon be a reality,” commented Mike Moran, CEO of Proton Partners International.

“Currently, there are no centers which offer proton beam therapy in the Middle East, so we are proud that Proton Partners will be part of the team to be bringing it to the UAE.”

ARTICLE FEATURES . Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder Excessive movement, difficulty controlling behavior and inability to remain focused

ttention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed mental disorder of children. Children with ADHD may be hyperactive and unable control their impulses or they may have trouble paying attention. These behaviors interfere with school and home life. A child with ADHD often squirms, fidgets, or bounces when sitting, doesn’t stay seated, has trouble playing quietly, is always moving, such as running or climbing on things, talks excessively and is always “on the go” as if “driven by a motor”.

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ARTICLE FEATURES . Attention Deficit Hyperactivity Disorder

It is not a psychiatric illness but a disorder that accompanies the patient at various stages of his development; it can be controlled and mitigated by combining behavioral and psychological therapies in addition to drug therapy. Studies have shown that about 80% of people with this disorder continue to have it until they reach their teens, and 60% of the people who continue to receive treatment for life after adolescence, however, symptoms decrease significantly with time. Therefore, Attention Deficit Hyperactivity Disorder (ADHD) is neither like the diseases that can be treated radically, nor like some mental illnesses that can be treated in psychoanalytic sessions, but is a disorder that accompanies the person throughout the various stages of development, but in some cases it may disappear over time. It can be mitigated and controlled by behavioral therapy or with some medications administered by the treating physician. The cause of ADHD isn’t known. Researchers say several things may lead to it, including heredity, as AHDH tends to run in families, chemical imbalance, brain chemicals in people with ADHD may be out of balance, areas of the brain that control attention are less active in children with ADHD. Poor nutrition, infections, smoking, drinking, and substance abuse during pregnancy, these things can affect a baby’s brain development. Toxins, such as lead may affect a child’s brain development and a brain injury or a brain disorder can cause problems with controlling impulses and emotions. Like many other illnesses, a number of factors can contribute to ADHD, such as genes, cigarette smoking, alcohol use, or drug use during pregnancy, exposure to environmental toxins during pregnancy, exposure to environmental toxins, such as high levels of lead, at a young age, low

birth weight and brain injuries. Toddler-aged children from 2 to 3 years old can display symptoms of ADHD. According to the NIH, these are the three main signs of the condition in kids over age 3 including inattention, hyperactivity and impulsivity. These behaviors also occur in children without ADHD. Your child won’t be diagnosed with the condition unless symptoms continue for more than six months and affect their ability to participate in age-appropriate activities. Great care needs to be taken in diagnosing a child under 5 with ADHD, particularly if medication is being considered. A diagnosis at this young age is best made by a child psychiatrist or a pediatrician specializing in behavior and development. Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition.

Symptoms There are a number of behaviors that can indicate your child has problems with attention, a key sign of ADHD. In school-age children these include inability to focus on one activity, trouble completing tasks before getting bored, difficulty listening as a result of distraction and problems following instructions and processing information. Symptoms also include: • Lack of focus • Trouble staying in one place for a long time

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Trouble getting organized Having difficulty controlling their emotions Fidgetiness Problems playing quietly The person might procrastinate, not complete tasks like homework or chores, or frequently move from one uncompleted activity to another. Avoidance of tasks needing extended mental effort Have trouble staying on topic while talking, not listening to others, and not following social rules Problems following instructions and processing information Displaying extreme impatience with others Refusing to wait their turn when playing with other children Interrupting when others are talking

Treatment While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.

Behavioral therapy It is a type of psychotherapy that aims to help a person change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to monitor his or her own behavior and give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting. Parents, teachers, and family members also can give posi-

ARTICLE FEATURES . Attention Deficit Hyperactivity Disorder

tive or negative feedback for certain behaviors and help establish clear rules, chore lists, and other structured routines to help a person control his or her behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

Psychotherapy Older children with this disorder need psychotherapy to talk about issues that bother them, explore negative behavioral patterns, and learn about ways to deal with their symptoms. It is possible that the child may develop psychological problems or issues in their social relations because of their condition, and psychotherapy helps the child overcome these problems.

Medication For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.

Common misconceptions ADHD is a disorder that involves problems in focusing, attention, controlling behavior, and being hyperactive. Researchers aren’t entirely sure what leads to ADHD, but they believe it might have to do with genes or the environment, or a mixture of both. Perhaps what makes it even more difficult to live with ADHD is the

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amount of misinformation and negative stereotypes that surround the diagnosis. ADHD patients are often written off as over-diagnosed, undisciplined, or simply lazy. The list below examines some of these myths:

Being too young to have ADHD Many parents believe that ADHD is a problem of school-aged children. But, in fact, the symptoms of ADHD, and the diagnosis of the condition, can occur as early as the preschool years. Although a young child may normally have characteristics like impulsive or hyperactive behavior, these can be symptoms of ADHD as well.

The child is just lazy and unmotivated A child who finds it nearly impossible to stay focused in class, or to complete a lengthy task such as writing a long essay, may try to save face by acting as though he does not want to do it or is too lazy to finish. This behavior may look like laziness or lack of motivation, but it stems from real difficulty in functioning. All children want to succeed and get praised for their good work.

Treatment for ADHD will cure it. The goal is to get off medication as soon as possible ADHD is a chronic condition that often does not entirely go away, but instead changes form over time. Many older adolescents and adults are able to organize their lives and use techniques that allow them to forego medical treatment, although a significant number continue various forms of treatment and support throughout their life spans. The true goal is to function well at each stage of childhood and adolescence, and as an adult, rather than to stop any or all treatments as soon as possible.

The child focuses on his video games for hours. He can’t have ADHD For the most part, ADHD poses problems with tasks that require focused attention over long periods, not so much for activities that are highly engaging or stimulating. School can be especially challenging for a person with ADHD because the typical classroom lecture, compared with a video game, can be relatively unstimulating in terms of visuals, sound, and physical activity. Most children with ADHD are diagnosed during their school years precisely because the academic, social, and behavioral demands during these years are so difficult for them.

ADHD is caused by poor parental discipline ADHD is not a result of poor discipline—although behaviors that stem from ADHD can challenge otherwise effective parenting styles. Inconsistent limit-setting and other ineffective parenting practices can, however, worsen its expression. You will find a number of proven parenting techniques that can help children with ADHD manage their behavior.

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