HOSPITALS Magazine: Issue 44

NEWS 360 care around you Early Mobilization with LINET Improve Early Mobility in your unit Level 1 Level 2 Level 3 Level 4 Many ICU patients suffer Immobile ICU patients can Sitting on the side of the bed On average, there is a 2–3% from orthostatic hypotension. experience trunk or core is an important part of the daily loss of muscle mass over This hemodynamic instability weakness, reducing their ability mobilization process. It can help the first 10 days. The may cause a delay in turning to support themselves in an to assess muscle strength and Mobi-Lift® and Lateral Tilt and repositioning, and may upright position. The full chair hemodynamic stability before provide safe and effective contribute to the formation and reverse Trendelenburg ambulating patients. support in mobilization. This of pressure ulcers and higher positions help with muscle may help to prevent an adverse risk of VAP. Micro-shifting and strengthening exercises as event such as orthostatic Automatic Lateral Therapy well as hemodynamic and hypotension or patient falls. can assist in reducing these orthostatic training. complications. Join us at booth #S1.G30 www.linet.ae

NEWS Cardiovascular disease is the number one cause of death in Saudi Arabia MSD discusses the relation between Cholesterol & heart disease Cardiovascular disease is the num- Extra fat in the blood accumulates in ing elevated cholesterol are family ber one cause of death in Saudi the walls of the blood vessels. This can history, diabetes, obesity, unhealthy Arabia. Atherscerosis disease lead to the formation of clots in the diets, lack of exercise, smoking, kidney accounts for 45 per cent of all cardio- arteries that can cause heart attacks, disease, or hypothyroidism”. “Maintain- vascular deaths. Atherscerosis occurs strokes and narrowing of the blood ing low levels of cholesterol decreases when there high levels of cholesterol vessels into the limbs. Early diagnosis the risk for developing heart disease in the blood which can damage the and treatment of high cholesterol can which may lead to death, therefore it arteries that carry blood from the decrease the risk for CVDs.” is crucial for patients to adhere to their heart to the rest of the body. Once medication,” added Dr. Al Shaikh. the damage starts, the LDL-C builds “Excess weight may modestly up in the artery walls as plaque, which increase your LDL (bad) cholesterol The WHO projects that cardiovas- starts to block the flow of blood. This level therefore, losing weight may cular diseases will remain the leading blockage may result in a heart attack if subsequently lower LDL-C and raise cause of death worldwide in future not detected early on. HDL cholesterol levels. Cholesterol years, with deaths estimated to in- is raising higher prevalence rates in crease 23.6 million by 2030. MSD, a leading global biophar- KSA. The overall prevalence of high maceutical company, recently held an cholesterol is 54 per cent of the total Globally, a third of ischaemic heart event with regional medical profes- adult Saudi population. Urgent public disease is attributable to high choles- sionals to focus on the relationship health measures such as education, terol. Overall, elevated cholesterol is between cholesterol and cardiovascu- case finding and further screening estimated to cause 2.6 million deaths lar diseases across Saudi Arabia, and programs are required. (4.5 per cent of total). Elevated total the wider region. cholesterol is a major cause of disease “The high prevalence of diabe- burden in both the developed and During the event, leading cardiol- tes, obesity and high cholesterol in developing world as a risk factor for ogists from the region focused on the Saudi Arabia and the region increases ischemic heart disease and stroke. increased prevalence of heart disease the risk of heart attacks in younger that results from high cholesterol and patients and controlling weight, blood the importance of managing low-den- sugar and cholesterol are critical in sity lipoprotein cholesterol or LDL-C. prevention of heart disease,” Profes- Prominent speakers noted that in sor Arafah added. Saudi Arabia, cardiovascular diseases represent a major health challenge Dr Abdulrahman Al Shaikh, con- across the Saudi population. Pro- sultant Internal Medicine at Soliman grammed community-based screen- Fakeeh Hospital said, “Education and ing is needed for all cardiovascular awareness are key components to un- risk factors in the Kingdom. derstanding how cholesterol is directly associated with the rise of CVDs – not Professor Mohammed Rudwan only in Saudi Arabia, but across the Arafah, President of Saudi Heart As- region as a whole. High cholesterol sociation and Consultant Cardiologist itself does not cause any symptoms, at the King Khalid University Hospital so many people are unaware that their in Riyadh noted, “High cholesterol cholesterol levels are too high. There- and other fat producing products in fore, it is important to regularly check the blood can put a person at risk of your cholesterol (LDL-C) especially if developing heart disease, blood-ves- you have other risk factors that can sel disease and circulation problems. lead to cardiovascular diseases. The risk factors that may lead to develop- JANUARY.FEBRUARY 2019 48



NEWS The new tube holder from Greiner Organ donor registry Bio-One impresses thanks to its versatility set to come into force The new VACUETTE® branded SAFELINK tube holder facilitates quick and The groundbreaking procedures easy blood collection. The tube can be used in combination with all medical marked the biggest strides in products that have a standard female luer lock connection, such as winged health care in the emirate of Abu cannulae. Above all, it stands out thanks to its simple handling. Dhabi. This year will continue to build on those achievements, just as a raft of Tube holder with potential regulations introduced by the health- care regulator, the Department of The luer lock feature sets the VACUETTE® SAFELINK apart from the conven- Health, should help improve standards tional Greiner Bio- One tube holders and makes it particularly suitable for blood in the sector. collection from venous access devices according to guideline recommendations. Furthermore, tests show that the secure connection withstands pressures of up The UAE had long allowed to 185mmHg. This, along with the functional design and practical handling could organ transplants. Kidneys had been make a significant contribution to efficiency in everyday healthcare situations. transplanted between living donors for nearly a decade. In addition, the Secure screw connection between holder and collection product first solid organ transplant from a deceased donor — that of a kidney — The simple screw connection ensures safe and successful blood collection. was performed in 2013. A heart from With a controlled threading movement, the single-use product connects safely and a deceased donor was transplanted in smoothly to the respective medical device. The VACUETTE® SAFELINK is manufac- 2017 after a presidential decree clari- tured from unbreakable plastic, and does not contain natural rubber latex. fying the concept of brain death came into effect. But it was 2018 that trans- Regular improvements and innovations at Greiner Bio-One formed the field of organ transplanta- tion in the country. In total, more than Greiner Bio-One uses targeted market monitoring as the basis for imple- 25 ailing people in the UAE benefited menting ongoing en- hancements, so its product portfolio is regularly optimized last year alone after receiving organs and expanded. The range of accessories already includes various tube holders, from deceased donors. In most cases, from the standard holder through to the safety version. The VACUETTE® SAFE- multiple organs were harvested from LINK holder is a perfect addition to the product line with its screw system for a the deceased and transplanted into secure connection. more than one ailing patient. Successful transplants at the Cleveland Clinic Abu Dhabi, including the first transplant of a liver from a deceased donor and a lung from a de- ceased donor, meant that the country gained its first multi-organ transplant centre. Surgeons at the renowned hospital also went on to perform a double-lung transplant, a complex five-and-a half-hour procedure that gave a 45-year-old Arab woman a new lease on life. Meanwhile, the Depart- ment of Health’s focus on tackling childhood obesity in Abu Dhabi is expected to push for new initiatives to tackle the problem. JANUARY.FEBRUARY 2019 50



NEWS The Saudi Ministry of Health organized its annual meeting for Obesity Surgery Program at King Saud Medical City (KSMC) Riyadh Dr. Haitham Al-Falah obesity centers across the Kingdom. be one of the major healthcare chal- Dr. Haitham Al-Falah, director of the lenges in the Kingdom and worldwide During the meeting, accredita- obesity center at KSMC, said he was according to recent statistics. He also tion certificates were distrib- pleased to have reached this number stressed that the massive number of uted by the deputy minister of of accreditation in the Kingdom and obese individuals in the community health for therapeutic services to 14 is looking forward to having six more are exposed to chronic diseases such accreditations in the near future. as diabetes, hypertension, arterioscle- Dr. Al-Falah stated that enormous rosis and others. efforts are being made to increase the quality of these centers and facil- Therefore, this makes a serious itate its services according to patient indicator for healthcare stakeholders safety standards. to find effective solutions to reduce such phenomenon. Dr. Al-Falah indicated that the obesity surgery program is consid- The Obesity Center at KSMC is ered to be the largest in the Middle certified by the International Society East in terms of its distribution and for Obesity Surgery as an accredited conducted operations for all types of international center. It is also consid- categories within the community. ered to be the first center under the Ministry of Health that is recognized Obesity, said Dr. Al-Falah, is set to globally. King Salman bin Abdulaziz decisions to improve healthcare in KSA Custodian of the Two Holy stakeholders to develop an integrat- well-equipped to handle such cases. Mosques King Salman bin ed system of rules and regulations. Dr. Al-Azimi said regarding oncology Abdulaziz approved a num- services in the Kingdom, specialized ber of decisions taken by the Saudi The secretary-general of the Sau- hospitals and medical cities have been Health Council including the estab- di Health Council, Dr. Nahar Al-Azimi, directed to activate a hub-and-spoke lishment of the National Center for thanked King Salman for approving cooperation program. He said it will Evidence-based Health Practice to the decisions of the council. He said be implemented in two phases: In improve healthcare services in the the approval reflects King Salman the first phase, oncology units in Kingdom. The center will work to and Crown Prince Mohammed bin Arar, Madinah and Asir regions will be consolidate an evidence-based work Salman’s keenness to improve the linked to specialized hospitals, and in culture in the Saudi health sector. quality of life of the people of Saudi the second phase, specialized hospi- Arabia. Dr. Al-Azimi also thanked tals will provide other health facilities The decisions are aimed at im- Saudi Health Minister Dr. Tawfiq — with the most referrals — with proving the quality of health services Al-Rabiah, who is also president of the studies and relevant work plans. and raising the standard of the Saudi council, and other council members health sector. It has been decided for their support and encouragement. The health council is also planning to unify codes for lab measurement to implement a unified referral sys- units across the Kingdom. The ex- Under new rules, hospitals are not tem to all services’ providers, whether ecutive plan of the program will be allowed to reject heart-related cases governmental or nongovernmental implemented in cooperation with all transported by the Saudi Red Cres- bodies, to benefit from the referral cent provided the health facilities are program (Ihalati). JANUARY.FEBRUARY 2019 52

NEWS Please join Hill-Rom at our 2019 Arab Health stand Location: World Trade Center Stand: Saeed Hall 3 – S3B30 Date: 28 - 31 January

NEWS MEDLAB explores “Lab of the Future” as the UAE prepares to adopt the use of Artificial Intelligence in the medical laboratory MEDLAB, the MENA region’s at MEDLAB, Dr P. K. Menon, Director added. Globally, a number of transfor- largest medical laboratory and COO of UAE-based Thumbay Labs, mative advancements are being made exhibition and congress, has said: “The medical laboratory has been by the adoption of revolutionary AI announced the launch of its inaugu- one of the earliest to adapt robotics technologies in the medical laboratory. ral Artificial Intelligence (AI) confer- and AI into its workflow. As early as Earlier this year, scientists at the Mayo ence taking place during the 18th edi- 1984, the EXPERT consultation sys- Clinic submitted a bloodless blood test tion of the show, which will run from tem-building tool, a knowledge-based for approval to the U.S. Food and Drug 4–7 February 2019 at the Dubai World AI programme, was developed at Administration (FDA) in order to create Trade Centre, Dubai, United Arab Rutgers University for enabling a test that people could do at home, Emirates. The conference will explore sequential laboratory testing and without drawing blood. the potential for AI to transform the interpretation. Now, with the stagger- medical laboratory industry in the ing increase in the volume of patient The algorithm can determine UAE through improved efficiencies healthcare data, a constant increase serum potassium levels in the blood by and how diagnosis can be revolution- in patient expectations and scarcity of monitoring small changes in electro- ized through futuristic technologies resources, AI will be the engine driving cardiogram (ECG) waves. In the UAE, such as data robots and “bloodless improvements across the care contin- Abu Dhabi-headquartered National blood tests”. With AI predicted to uum.” “Today’s clinical labs are already Reference Laboratory (NRL) is plan- add US$182 billion to UAE’s economy using advanced robotics to test minute ning to adopt AI methodologies in the by 2035 and the healthcare industry volumes of blood, serum and other near future as an essential component taking a US$22 billion slice of the gains bodily fluids from thousands of sam- of NRL’s molecular diagnostic labora- in its gross value added (GVA), medical ples in a day to give highly accurate tory services, and, with that, be at the laboratories across the country are and reproducible answers to clinical forefront of using advanced technolo- preparing for the “AI lab of the future”. questions, in scales almost difficult to gy to improve patient outcomes in the emulate humanly. UAE and the region. Adding to this, the UAE Strategy for Artificial Intelligence - launched in In the future, robots used in “It is anticipated that with the aid 2017 – and the appointment of the the clinical laboratory will be heuris- of AI, there will be an acceleration country’s first UAE Minister of State tic (self-learning), using inferential in novel gene discovery, therefore for Artificial Intelligence, aims to make processes, with numerous ways to ending the diagnostic odyssey for the country a world leader in the field derive the best decision possible - even many undiagnosed genetic diseases. of AI investments in healthcare in allowing for missing information. AI AI will have a pivotal role in translat- order to minimize chronic and danger- programmes will change the way our ing genomic research into actionable ous diseases. Commenting as Chair of laboratories generate and display bedside applications that will benefit the Artificial Intelligence conference clinical information in the future,” he both providers and patients, and help in the fulfillment of the promise of precision medicine in the region,” said Dr Val Zvereff, Technical Director of Molecular Genetics at NRL. Along with the Artificial Intelli- gence conference, the 2019 edition of MEDLAB will see the introduction of two more new tracks - Immunology and Cytogenetics & IVF - bringing the total number of CME-accredited con- ferences to 11. JANUARY.FEBRUARY 2019 54

4-7 FEB 2019 DWTC, DUBAI Further your knowledge by attending up to 11 CME accredited conferences 4 February 5 February 6 February 7 February Laboratory Clinical Chemistry Microbiology Haematology & Management Blood Transfusion Artificial Intelligence Histopathology & Molecular Diagnostics Point of Care Testing Cytology & Genetics Immunology Laboratory Cytogenetics & IVF Informatics Hear from internationally acclaimed laboratory champions Dr Patrick Godbey Glen Fine Dr Ali Hajeer Prof Martin L.Olsson Dr Harpreet S Sood Brunswick Wayne King Abdulaziz Medical City Lund University University College Hospital Lund, Sweden London, United Kingdom Georgia, USA Pennsylvania, USA Riyadh, KSA Register and earn up [email protected] to 31.5 CME credits medlabme.com/congress Provided by: In compliance with: Supported by: Organised by: Upload by: alizzy.deviantart.com

NMEEWDISCAL INSTITUTIONS ACIBADEM HEALTHCARE GROUP TURKEY An ECOSYSTEM that sets an example for the world in healthcare service… Developing rapidly since 1991, Acıbadem Healthcare Group became one of the leading institutions in Turkey in the field of private healthcare services, and now moves forward globally with its partner IHH Healthcare Berhad, one of the biggest groups in the Far East, in 2012. Comprised of 21 hospitals and 16 medical centers, Acıbadem has become a part of the world’s second largest Healthcare Chain with this agreement under the auspices of IHH Healthcare Berhad. Each year, many patients from different parts of the world choose Turkey to receive treatment, and they prefer Acıbadem which provides services using the most advanced technology worldwide featuring an expert team meeting international quality standards. Its quality of the services also supported by independent institutions; Joint Commission International (JCI) and “ISO 15189 Clinical Laboratory Accreditation Certificate”. Globally competitive integrated healthcare services in Healthcare Apart from hospitals and medical centers, Acıbadem Healthcare Group offers a worldwide example setting integrat- ed special healthcare system model, and includes various healthcare support institutions. JANUARY.FEBRUARY 2019 56

MEDICAL INSTITUTNIEOWNS Multidisciplinary Centers of Excellence All of the hospitals within ACIBADEM Group that meet the global standards, also stand out with the Centers of Excel- lence: 16 Heartcare Centers (pediatric and adult cardiology and cardiac surgery), 13 In Vitro Fertilization Centers (infer- tility - IVF), 11 Cancer Centers (surgery, radiotherapy, chemotherapy), 10 Organ & Tissue Transplantation Centers (liver, kidney, bone marrow), 9 Spine & Neurosurgery Centers, 6 Robotic-assisted Surgery Centers and 1 Sports Medicine Center accredited by FIFA are all among the nationally and internationally accredited and qualified centers due to their advanced technology equipment and experts that have significant experience in their own fields. 57

MNEEWDISCAL INSTITUTIONS Acibadem Maslak Hospital in Turkey introduces next generation cancer care with MRIdian MR Image-guided radiation therapy the state-of-the-art radiotherapy device to cancer patients. On table and continuous soft tissue imaging enables plan adaptation to reshape radiation doses based on the ana- tomical changes which occur from one day of treatment to the next. Using a novel streaming video perspective, the technology also allows oncologists to visualize and automatically control beam delivery based on the real-time position of the tumor and surrounding organs. MR Linac is the newest technology that combined MRI We are pleased to have commenced Turkey’s first and Linac for the first time in the world and Acibadem MRI-guided radiation therapy program and believe it Maslak Hospital in Istanbul in Turkey has begun treating offers cancer patients in Turkey a number of distinct patients with it. benefits over traditional radiation therapy,” said Prof. Enis Ozyar, M.D., the Chief of Acibadem Mehmet Ali With this technology, radiation oncologist can treat Aydınlar University, School of Medicine, Department of the patient as a surgeon, because this device enables the Radiation Oncology. physicians to see tumour precisely, even in soft tissues. “Most importantly, MRIdian allows for clinical improve- Acıbadem Maslak Hospital is the ninth MR Linac center ments in visualization and precision daily plan adaptation, in the world. MRIdian, MRI-guided radiotherapy, presents and it provides us with the tools to deliver higher and poten- tially more effective radiation doses.” Turkey is currently one of the leading countries in health tourism due to the country’s advanced diagnostic and treat- ment services offered. JANUARY.FEBRUARY 2019 58

MEDICAL INSTITUTNIEOWNS 9th CENTER IN THE WORLD 3rd CENTER IN EUROPE With MRIdian SEE THE INVISIBLE NEW ERA IN CANCER TREATMENT MRIdian, the newest smart radiotherapy, can deliver precise and accurate radiation to cancerous tumors. Combined MRI, provides real time and continuous imaging and is spares surrounding tissues from radiation beams. +90 216 544 46 64 59 acibademinternational.com

NEWS Changing face of healthcare placed in expert focus through qf’s ‘Education City Speaker Series’ Its talks, which are free to attend and open to all, reflect QF’s commitment to encouraging dialogue, discourse, so- cial interaction, and critical thinking. During his career, US physician Zeiger has developed the Google Flu Trends service and ‘Smart Patients’, which enables patients and carers to share their healthcare experiences and knowledge, and has also served as a clinical instructor of medicine at Stan- ford University School of Medicine. Key themes surrounding the community and the wider public about “This is the most exciting time to be impact of technology on global ‘How Technology Is Changing Health- in healthcare,” Zeiger said. “Advances in healthcare have been explored care’ during the event at Qatar Na- robotic surgery, targeted therapy, and by US physician and innovator Roni tional Library (QNL), at Education City, the use of AI to analyze medical data Zeiger through the ‘Education City before answering questions posed are all transforming healthcare. “We Speaker Series’, launched by Qatar by the audience. The Education City still have much to do. Not only do we Foundation (QF) as a platform for Speaker Series is designed to provide have to continue to conduct biomedical knowledge-sharing and public interac- the community in Qatar with an oppor- research and look for breakthroughs, tion with experts. tunity to benefit from the perspectives we must also do the basics, which of experts and thought-leaders across means designing healthcare systems The former Chief Health Strategist a range of fields, while sharing their holistically so they best serve society.” at Google spoke to members of QF’s own views and opening up discussions. Further talks in the Education City Speaker Series will be announced in due course. JANUARY.FEBRUARY 2019 60

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NEWS Al-Ahli Hospital’s Participation in the World Innovation Summit for Health (WISH) As an official sponsor, Al-Ahli Hos- the work of private healthcare WISH. Such events included awareness pital participated in the 2-day service provider. The private sector raising of the nursing profession and WISH 2018. Through its location provides substantial services in the the legal midwifery profession and at WISH’s exhibition, Al-Ahli Hospital health sector, but more effort for their importance. The nursing section reached out to representatives of the the development of performance is was visited by school students for WHO and representatives of other anticipated. The second part of this encouraging them to abide by the var- health sectors from all over the world. Summit addressed how can gov- ious healthy practices and for raising ernments promote a conducive and the awareness of the students. The Summit aimed at highlighting enabling environment for providers the importance of overcoming the of the ready “comprehensive health Al-Ahli Hospital targets 2 age healthcare challenges by promoting coverage” by meeting the leaders of groups: from 4 to 5 years and from 14 international relations with local 6 major governmental bodies in the to 15 years. and international organizations by countries which provide comprehen- the medical sector in Qatar. As a sive health coverage. Nurses tried to raise the aware- representative of the private sector ness of the students about the in Qatar, Mr. Khaled Al-Emadi, Chief “As the public sector provides a negative effects of social media com- Executive Officer of Medicare Group free comprehensive healthcare in rich pared to their positive effects. They and Al-Ahli Hospital, participated in countries, such as Qatar; hence, for explained that they are considered the summit and addressed the role of the purpose of providing a better ser- double-edged weapons; when abused the private sector in health care. vice for the patient, the private sector and addicted, social media cause should invest in the health sector to isolation and loneliness. This Summit focused on the cope with the (governmental) public method of establishing more effec- sector without limits” added Mr. They also adversely affect school tive and extensive cooperation be- Al-Emadi in praise of the role of the performance and cause poor language tween the public and private sectors private sector. and pronunciation, in addition to sleep to provide the required comprehen- disorders arising out of usages of elec- sive health care services. It focused Al-Ahli Hospital organized aware- tronic devices, such as mobile phones, on the importance of developing ness events under the umbrella of tablets, and laptops. Furthermore, social media may expose people to a violation of privacy. JANUARY.FEBRUARY 2019 62

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MEDICAL INSTITUTIONS NMG Modular Design-Build Turnkey Solutions Pre-manufactured The NMG Modular Design-Build Concept All necessary mechanical, electrical, plumbing, and medical NMG is an American based design-build company that is at the forefront when it comes to modular interior design gas is integrated into the modular walls. and construction. Future flexibility We have established ourselves as the leading force in designing and building highly functional, flexible, and Installed tiles are simply clicked on and off the structure, sustainable healthcare facilities with focus on operation- al efficiency, as well as creating a healing environment, without any fixed drilling needed, allowing for future in- promoting enhanced well-being for patients, families and caregivers alike. Our passion and dedication is to change spection and maintenance to be done within minutes. the way healthcare facilities are designed and built, in- cluding complete modular ICU, PICU & NICU departments, Integrated technology customized head-walls and foot-walls for patient rooms, dialysis suites, outpatient clinics, waiting areas & interac- Technology is integrated into the system for quality tive pediatric departments. assurance and infection control, while contributing to the appealing environment. Fast Installation Fast installation is ensured as the system arrives on site ready to be assembled, saving both time and cost during construction. JANUARY.FEBRUARY 2019 64

MEDICAL INSTITUTIONS The Future-Proof Facility ence for patients and their families. It is highly important to utilize what research has shown when it comes to health- As technology begins to play a larger role in patient care design. Using evidence-based design principles, care delivery, healthcare facilities must be designed from neuroscience and psychology to architecture and with adaptability in mind. The continuous change in the behavioral economics, will enhance the patient experience healthcare industry, driven by technological advancements, and satisfaction and lead to faster recovery. This includes requires healthcare operators to constantly reinvent and elements such as choosing the relevant color hues for dif- renovate their facilities. Over the next few years, the ferent areas, ensuring exposure to natural light, incorpo- healthcare industry will experience a significant change, rating contact with nature and positive distractions. with more emphasis on utilizing technology such as the internet of things and artificial intelligence. Our modular Our modular system is designed with elements to system allows new technology to be easily integrated into enhance the infection prevention and control where tech- the overall solution, providing complete sustainability. nology is integrated behind back-painted glass and highly advanced medical fillers are used to seal extrusions, leading Allowing facility managers and engineers to access the to reduced rate of infection for patients during their stay. cavities of the wall system for necessary inspection and Our highly experienced designers are dedicated to creating maintenance, in addition to incorporating new technology the perfect patient-family centered healing environment. in the future, within matter of minutes and with minimum The extensive range of advanced and appealing solutions disruption for the facility, will result in enhanced efficiency contribute to the patients’ well-being, exceed visitors’ and better operational outcome. Only the most advanced expectations, and results in higher satisfaction among and true future-proof modular system, where the ultimate patients, their families, and caregivers alike. flexibility is provided, a system that is designed to ensure adaptability for future needs, allows healthcare operators The Bottom Line to be prepared for the forthcoming facility requirements. This is what we, at NMG, provide for our clients. There is no better return on investment than a quickly and accurately built hospital with sustainable, highly The Healing Environment functional, and charming environment. This can only be accomplished with our state-of-the-art solutions. Over the The healthcare research literature has demonstrated course of only few years of operation, the financial benefits how properly designed facilities can impact patients’ recov- of investing in NMG’s solutions are evident. ery and general well-being. Yet healthcare facilities tend to be designed and built in a relatively cold and raw manner, www.nmg.us.com adding to the already uncomfortable and stressful experi- 65

NEWS Project Communications at Messe Düsseldorf Readjust: Dietmar Thomas appointed Head of Trade Fair Press Department 1January 2019 saw Dietmar Messe Düsseldorf: 1 January 2019 Thomas comes to this new role Thomas (51) take the helm in saw Dietmar Thomas take office as from the Publicis group of agencies Messe Düsseldorf’s trade fair the new head of the trade fair press where he has established and man- press department – which, alongside department. In this role Thomas will aged the editorial department focused Corporate Communications and Mar- be in charge of communications for all on content marketing in Düsseldorf keting Services, forms one of the three trade fair projects. He will strengthen since 2016. Prior to this position, he communication pillars of the company. the standing of the individual trade served as a press spokesman in charge In this post Thomas will be in charge fairs in the mediascape and their per- of marketing for brand companies and of trade fair communications for the ception in their relevant target groups taking care of global product commu- individual projects. and drive digital transformation of the nications and held several executive project and trade fair communication. positions at magazines and agencies in The mediascape will now have a Dietmar Thomas reports to Dr. Chris- Germany and abroad. Thomas studied new main contact for the events of tian Plenge, Division Director of Digital modern communication and learnt Strategy and Communication. script and creative writing for film and TV at the “School of Theater, Film and Wolfram Diener, operative Man- Television” of the University of Califor- aging Director responsible in charge of nia in Los Angeles. Digital Strategy and Communication at Messe Düsseldorf, delights at filling “I look forward to using my 30 this key position: “Our trade fairs are years of communication experience the global hubs and hinge points for for Messe Düsseldorf, a company that their respective industries. In times organizes numerous exciting and suc- of digital change it is all the more cessful global No. 1 trade fairs. One of important to reach the sectors’ target my key aims is to strategically develop groups in an up-to-date, effective way further its project communication as and strengthen trade fairs as their part of digital transformation,” says Di- first point of contact – also beyond etmar Thomas, who follows on from the duration of the trade fairs proper.” Eva Rugenstein. In December 2018, Dietmar Thomas, he adds, is the right this former head of the trade press de- person to do so as an experienced partment retired after serving in this expert in communications. role for 25 years at Messe Düsseldorf. Tanzanian Conjoined Twins separated in Riyadh The separation surgery of Tanza- Hospital in King Abdul Aziz Medical Crown Prince Mohammed bin Salman nian conjoined twins Anishia and City in Riyadh. for their humanitarian initiative and Milanese has been successful, wished his team every success for the said Dr. Abdullah Al-Rabeeah, super- The decision to go ahead and operation. visor general of King Salman Human- operate was taken after a meeting itarian Aid and Relief Center and an chaired by team leader Dr. Al-Rabee- The procedure made Anishia and adviser to the royal court. ah. It followed extensive examination Milanese the 48th set of conjoined of the twins, and of their suitability twins to be separated in the Kingdom. The procedure was carried out at for the procedure. Their mother has been with the twins the King Abdullah Specialist Children’s in Riyadh since before their operation. He thanked King Salman and JANUARY.FEBRUARY 2019 66

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INTERVIEW Chief Executive Officer, JANUARY.FEBRUARY 2019 68 Medcare Andre Daoud “Medcare is a very strong premium brand that is easily expandable and as we continue to provide high-quality and patient- centric healthcare, expansion will always be part of our future plans” With more than 15 years of experience in the healthcare field, Andre Daoud has been appointed as the New CEO for Med- care group. Hospitals Magazine, had the chance to meet with Mr. Daoud to discuss the future of Medcare and his role on how to implement new strat- egies for further business growth and development. Also, how his passion in delivering the highest standard in patient care will lead to a world-class healthcare delivery. You have extensive experience spanning over 15 years in the healthcare field, can you please give us an overview about your professional life? How will your expertise benefit Medcare? Prior to being part of the health- care sector, I had the chance to work in various fields such as e-commerce, finance and digital solutions. I shifted to the healthcare industry specifically in the insurance field 15 years ago with a focus on technical, operations, strategy and business development.

INTERVIEW I worked in the public and private care support across a number of operate? Do you have any sectors delivering healthcare solutions medical practices. Innovation is a core expansion plans in the future? in various countries at different levels component of our daily activities, and ranging from strategic partnerships, we continue to leverage the power We have three multi-specialty international patient services to estab- of digital and health technologies to hospitals, Medcare Hospital Safa Park lishing national healthcare schemes. streamline our operations. Dubai and Medcare Hospital Sharjah, A major milestone was working with one facility that is exclusively for wom- Dubai Heath Authority on creating, im- What are the initiatives en and children and another hospital plementing and managing the Dubai you will be putting in place that is uniquely dedicated for ortho- National Health Scheme “Saada” and to provide premium healthcare pedics and spine care. enabling, for the first time in the re- of international standards in gion, the introduction of the national the UAE? Under the Medcare brand, we ID as a primary means of accessing operate three specialty centers and 12 healthcare. My professional journey Quality healthcare is more than multi-specialty centers in key locations has been quite an exciting one so far, just a popular phrase in our Medcare across Dubai and Sharjah. filled with learnings and discovery of culture. We are committed to provid- the complex healthcare ecosystem ing high-quality, personalized med- Medcare is a very strong premium from its different perspectives. Having ical care to every patient no matter brand that is easily expandable and as combined all this experience, I come what their medical need is. Quality in we continue to provide high-quality to put it into practice from the side of healthcare means providing the care and patient-centric healthcare, expan- healthcare providers. the patient needs when the patient sion will always be part of our future needs it, in a safe and effective man- plans. This will help us further provide This experience gives me a great ner. Quality healthcare also means what is expected from us as an organi- edge and enables me to create a engaging and involving the patient, so zation that strives to meet the future different experience for the Medcare he takes ownership in preventive care healthcare needs in the best way pos- patient, one that is quite unique, and in the treatment of diagnosed sible and provide the most advanced seamless and digitally driven. Along conditions. We find it to be a collabo- possible care to our patients. with the organization’s vision which rative effort that involves the patient, primarily focuses on clinical excellence the physician, the patient’s family, and Medcare is a major and patient safety, I am confident the community as a whole. healthcare provider in the UAE. I will be able to further digitalize What are the specialties that the patient experience and create a Medcare is a premium healthcare you pride yourself on offering? sustainable model that enables the network, and part of the wider Aster How do you evaluate the qual- highest possible standards of care DM Healthcare, a global healthcare ity of these specialties? delivery to patients who need it. group with 317 medical establish- ments across 9 countries, including Medcare is a group of multi-spe- You have recently taken the the GCC, India and Africa. Our aim at cialty facilities, offering an extensive role of Group CEO at Medcare, Medcare is to leverage international range of healthcare that aims to add what are the steps you are medical practices across a number more value to patients across the taking to further the strategic of areas that add value to the overall UAE. Some of the specialties we treat planning for the Group? care delivery process. We have been include cardiology, orthopedics, gen- successful in bringing an exceptional eral and specialized surgery, dentistry, In my current capacity, I bring to multi-cultural, multi-lingual team of emergency, gastroenterology, neo- Medcare an integrated cultural un- doctors who have received extensive natology, audiology, endocrinology, derstanding and a strong digital focus training from some of the top medical hematology, neurosurgery, pediatrics, with the aim of enhancing customer institutes in the United States, United urology, pulmonology, obstetrics and experience and supporting operation- Kingdom, India, France, Greece, Aus- gynecology and many more. al efficiency. This includes managing tralia, Africa and the Middle East. day-to-day operations, working with Medcare Orthopedic & Spine Hos- a superb team of healthcare profes- How many hospitals and pital is one the most technologically sionals to deliver optimum patient medical centres does Medcare advanced facilities of its kind in the UAE. The world-class team of doctors provides specialized, protocol-based care for bones, joints, ligaments, 69

INTERVIEW tendons, spine, spinal cord and feet, in patients, with the support of trained How do you see the healthcare both adults and children. Our doctors nurses, dieticians, rehabilitation thera- industry evolving in light of are capable of handling the most com- pists and technologists. the government support in the plicated cases, including orthopedic UAE? How did Medcare benefit and spine trauma. Being one of the largest from this support? providers of healthcare, what In addition, the hospital has a full- is the added value of Medcare The U.A.E. healthcare sector is fledged physiotherapy and rehab wing to the healthcare industry in expanding rapidly to meet both the that provides high-quality inpatient the UAE? evolving needs of a growing popula- and outpatient physical rehabilitation tion and the nation’s ambition to be- services. Medcare Women & Chil- In today’s world, technology plays come a regional medical tourism hub. dren Hospital is an exclusive haven an important role in every industry as This rapid expansion is challenging the for women and children where they well as in our personal lives. Out of all ability of the UAE to both provide ad- receive exceptional care from experts the industries that technology plays a equate medical personnel and contain in pediatric and women’s healthcare, crucial role in, healthcare is definite- costs. However, the government has in a modern and state-of-the-art ly one of the most important. This adopted a series of long-term initia- facility that offers a wide range of merger is responsible for improving tives, above all Vision 2021, to address facilities including obstetrics, gynecol- and saving countless lives all around these challenges and guide the sus- ogy, plastic surgery, breast surgery, the world. tainable growth of this sector. neonatal, dermatology and other care services under the same roof. The aim Healthcare is one of the fast- Vision 2021 emphasizes the is to deliver a holistic medical service est-growing sectors in the world and is importance of preventive medicine to patients across the UAE through a key contributor to the UAE econo- and seeks to reduce cancer and dedicated hospitals and multi-special- my. The UAE’s healthcare market is lifestyle-related diseases such as ty clinics. expected to reach Dh71.5 billion in diabetes and cardiovascular diseases 2020 at an average annual growth to ensure a longer, healthy life.In Improving patient care has rate of 12.7 per cent from 2015. addition to adopting ambitious plans become a priority for all to revamp and drive better healthcare healthcare providers with the We have a role to play in advanc- infrastructures. We remain commit- overall objective of achieving ing the healthcare field in the UAE, ted to maintaining a strong growth a high degree of patient and medical technology will help us trajectory in the region by introducing satisfaction. What are the sustain health. innovative initiatives that cater to strategic steps you are plan- serving patients and achieving better ning to implement to achieve Moreover, Medcare is a brand that treatment outcomes. this? Doctors credentials? strives to create a new benchmark in Advanced technology? healthcare delivery in the UAE, with In your opinion, how is every new project it comes up with. technology contributing to a Patients are at the core of what To begin with, we’ve made sure that better patient journey? Do you we do. Medical excellence is what de- our hospitals don’t look like hospitals. foresee artificial intelligence fines Medcare’s day-to-day operations. Designed with a keen eye for detail, taking over the role of doctors in Our team of 300 plus expert doctors our patient-care spaces are designed the future? And to what extent? ensures great care and personalized to create an ambience that is condu- attention, with the support of our cive to healing. The healthcare industry, both very efficient team of nurses and across the MENA region and around ancillary staff. Our facilities are world-class the world, is experiencing new periods in every sense of the word as they of change that includes disruption Medcare’s doctors take time to combine the best of talent, technol- and rapid innovation that are driven listen to patients, understand their ogy, facilities and care. We have 19 primarily by the adoption of technol- medical problems holistically and rec- establishments under Medcare right ogy, which has become, as we have ommend the best way forward. Multi- now, with a very strong team of 300 witnessed, an integral component in disciplinary in approach, they provide plus doctors. We are passionate about shaping the healthcare industry. optimal, guideline-based treatment to the discovery and development of in- novative methods to support patients’ Advancements in technology are clinical outcomes. JANUARY.FEBRUARY 2019 70

INTERVIEW transforming the entire healthcare Its transformative nature means that and overall conditions. There is still a industry. From wearable tracking it will help increase collaboration and growing need for intelligent solutions devices to patient-centered care mod- drive training programs. to help address major challenges ules to increased data security are all in improving outcomes, simplifying examples of how the healthcare sec- The healthcare industry as a data and insights gathering, lowering tor is embracing technology to deliver whole is adopting integrated ap- the cost of healthcare delivery. The optimum results to patients. proaches that place patients at the widespread use of technology is also heart of their initiatives and services, changing the way healthcare profes- There is a clear understanding who now have far more access to sionals provide care and how patients that AI enhances our general progress data that is used to finding the right can connect with the industry. and performance on multiple levels. care modules tailored to their needs 71

INTERVIEW Associate Director For Healthcare, AECOM Middle East: King Hussein Medical City Curtis Laitinen “The legacy companies that joined to form AECOM had a long history of work in the UAE and the Middle East, going back over 50 years, and included healthcare projects” Curtis Laitinen, Associate Director ed healthcare projects. Integrating evidence-based design (EBD). This is for Healthcare at AECOM in the the teams into a single company had where statistical studies on human Middle East, is a highly experi- already occurred, but taking the lead behaviour, and the psychological enced Medical Planner. He has been role in managing design projects and effects of healthcare environments on leading AECOM’s healthcare design doing the complete design was new patient outcomes and staff effective- team, based in Abu Dhabi, UAE, for for this office. Bringing a world-class ness are used to enhance the patient the past five years. During this time, team of experts from each discipline, experience . Wayfinding is now an AECOM has established a fully-in- combining them with project manag- important component of a facility’s tegrated design practice, including ers that had deep knowledge of the design and is considered from the ear- architecture, medical planning and local markets, and basing this team in ly concept stage. This is a key element interior design with a complete build- a regional “design hub” was a first. This of reducing patient stress. There is ing engineering team as well as fire gives clients the best of both worlds: also an increased emphasis on patient and life safety, cost consulting, project knowledge of global best practices as privacy, which has affected the design management, sustainability, and well as direct and frequent access to of public spaces, acoustics, lines-of- construction services for healthcare. the design team. It also allows them to sight, and the separation of busier Working with private and government get a tailored team for their project, public areas from treatment areas. clients, this practice has grown to take with a single point of responsibility for on some of the region’s most ambi- all aspects of the design. Infection prevention is better tious healthcare projects, including, understood, and has become more so- most recently, the soon-to-be-ten- Of course, having many of the dis- phisticated. There are many new prod- dered King Hussein Hospital, the new ciplines sitting near each other, in the ucts using materials with anti-bac- centerpiece at King Hussein Medical same office, also improves commu- terial properties. Lessons learned City, for the Royal Jordanian Armed nication and collaboration, resulting from high-tech industries, including Forces. Below is the full interview: in faster, more innovative problem pharmaceutical and computer chip solving and more refined, better coor- manufacturing have led to the intro- What do you mean, “Fully dinated buildings. duction of HEPA filters and ultra-clean integrated design practice”? modular environments such as ceilings What changes have you seen that integrate lighting, equipment and The legacy companies that joined in healthcare design? utilities. The variety of design options to form AECOM had a long history of associated with these systems has work in the UAE and the Middle East, Over my career, I have seen been rapidly improving, and they are going back over 50 years, and includ- enormous changes in hospital design. now common in surgery, intensive Most notably is the application of JANUARY.FEBRUARY 2019 72

INTERVIEW care and central sterile departments. even if it means new ways of working clinics can engage with health edu- From the world of commercial office and even whole new departments. cation and enhance the surrounding design, manufacturers have been community by providing accessible expanding their offerings to include What are some other keys to public spaces, resource stewardship healthcare-specific solutions. Herman good healthcare design? and generally being the central com- Miller and DIRTT for example offer ponent of healthy cities. solutions for outpatient clinic exam- At a basic level, the first principle ination and treatment rooms. We have of healthcare design is the same as How can a well-designed planned for these systems in the triage the primary mission for all doctors, healthcare centre improve the areas of the Emergency Department with their Hippocratic Oath, which is well-being of patients? at King Hussein Medical City, in Am- “First, do no harm”. And in a hospital, man, Jordan, which is currently being where it can be a matter of life and The movement towards evi- designed. death, that is no small thing. But, dence-based design (EBD) has had a there are less obvious ways that this huge influence. It has introduced to There have also been interesting is important. For example, this means the design space statistical studies on developments with healthcare de- having a safe building, keeping things human behaviour, and the psychologi- signers introducing best practice from clean, and preventing infections cal effects of healthcare environments the hospitality industry to healthcare. from spreading from one person to on patient outcomes and staff effec- This has affected the organisation of another. That starts with each patient, tiveness. This in turn has improved departments, behind the scenes, as and then takes in the wider context of the quality of the hospital environ- well as the more visible and interactive the caregiving staff, and the patient ment, making spaces more pleasant elements of the patient and visitor care environment within the building, and comfortable, and with positive experience. It has evolved now to the and the wider environment. But, in a distractions, such as views of nature point where hospital interiors are con- more positive way, healthcare design and uplifting artwork. This reduction ceived as part of a brand identity and is about creating a ‘healing environ- in environmental stressors has created given amenity ratings similar to hotels. ment’ that promotes wellness and what are termed ‘healing environ- Our team has applied this approach improves the lives of the people who ments’, which result in faster recover- with Clemenceau Medical Interna- use it. Healthcare facilities are witness ies and improved patient outcomes. tional for two of their hospitals in the to major life moments. Hospitals and region, both of which are currently A well-designed facility also pro- under construction. Add in computers, electronic medical records, digital imaging and robotic surgery and it’s clear that the pace of change is not slowing down. With gene therapy, bio-technology, nano-technology, 3D printing of tissues and organs, and more, I expect we’ll see even more change over the next 20 years. This constant change and increasing complexity is why it is important to design hospitals to be flexible. This “design for flexibility” means planning a hospital’s infrastruc- ture not just to work with today’s technologies, but for the integration of whatever innovations come next, 73

INTERVIEW vides a less-stressful, more welcoming JANUARY.FEBRUARY 2019 74 experience for the patients’ families and other visitors. The family is an active part of a patient’s care, and an important component of the heal- ing process, so the above strategies can help them too. Family-centred design includes providing adequate spaces, with proper amenities, such as seating, access to Wi-Fi, and a place to get a healthy snack when they are spending many hours in a hospital. These considerations start at the front door continuing all the way to the patient room. In King Hussein Medical City, for example, the public areas include plenty of seating, both indoors and on outdoor rooftop terraces; and a coffee shop and public cafeteria on different levels. All of these will take advantage of the hilltop location to provide what should be some remark- able views of the city of Amman. EBD has also improved the en- vironment for the people who work in these facilities every day, making their work flows more efficient and providing a lower-stress environment. For example, there is evidence that providing healthcare staff with a win- dow in their workroom significantly reduces the number of medical errors. Environments such as the Emergency Department can be high-stress and a coffee break with a view helps staff clear their head and return to work more focussed on the task at hand. Tell us about your current work. You mentioned the new King Hussein Hospital, in Am- man Jordan. The current King Hussein Hospital is the general hospital at the centre of King Hussein Medical City, which has several other specialty hospitals

INTERVIEW and outpatient clinics. It is run by the need to be, taking them back again, Visitor-friendly? How so? Royal Jordanian Medical Services, figuring out what’s wrong, providing Please elaborate a bit. and is the largest medical centre for treatment, and keeping them comfort- the Royal Jordanian Armed Forces. able and relaxed at every step of the Way-finding is one factor that While primarily serving the armed way. That is the essence of healthcare. had to be considered from the early forces personnel and their families, it concept design stage. We had to is also one of the main public hospitals With King Hussein Hospital, the make the organisation of a building’s for the city of Amman. It has a long first challenge is its size. It will have form and services visually obvious and history and a great reputation in the 940 beds, including 144 intensive care intuitive to everyone who interacts region. Following their master plan, beds and a new 16-bed burn unit; 43 with it. the new King Hussein Hospital is to be operating theatres, and the country’s the first of several phases, beginning main Level-1 trauma centre, with 125 Good wayfinding is a key element the transformation of the campus, treatment/exam rooms. There will be of reducing stress. Examples include: and ensuring that it remains a leading some outpatient services, but most of medical centre into the 21st Century. the clinics are to be in future phases. • Good visibility for the ap- It is going to be a very large general proach to the hospital. Of What were the biggest hospital. Including staff parking, it course the tower can be seen challenges in the spatial will cover a little over 330,000 square at a distance, but also, the planning of the new King meters. The next challenge is that it is large expanses of glass call Hussein Hospital? a very tall hospital. out the main entry lobby and other public spaces With any hospital, there are some The city of Amman has grown significant factors: around the campus, so available land • Long, covered areas for arrival is scarce. The replacement hospital and drop-off, accommodating Change: We can’t just think about had to be high-rise, to free up land on many cars for both scheduled the day the hospital opens. Technolo- the campus for future phases. With and emergency patients. gy changes, equipment needs replac- 30 stories up to the helipad, it will be ing, new treatments are developed a major change from their current • Straightening out corridors, and successful organisations grow. All campus, which is mostly two to four so the inside of a hospital is of this means that healthcare planners stories high. less like a maze. should think ahead and design the building infrastructure for flexibility, A third challenge was the steeply • Using views to the outside to to accommodate change and fu- sloping hilltop site, which provides help people orient. ture-proof the client’s investment. for fantastic views of the surrounding city, but which creates challenges for • Referencing internal land- Complexity: Hospitals, as a build- arrival and departure of patients who marks to help people remem- ing type, require a lot of engineering may have limited mobility. We were ber their route. to support all of the equipment, peo- able to work with the terrain, using it ple and activities that occupy them. to our advantage, with large drop-off • Using multiple visual cues for And those activities mean getting areas running along the hillside, to al- visitors, such as themes, ma- patients, staff, supplies, medications low on-grade entry on multiple levels terials and colour, to define and information to the right place, at departments and zones. the right time, in an efficient way. So, what we have is a very urban project, reflecting contemporary • Avoiding having to go People: A hospital is not a factory. Amman: a big general hospital, with through one department Aside from the engineering systems, very large departments, stacked high. to access another. This also hospitals are about people. The pa- What we had to do was keep it organ- reduces through traffic and tient is at the centre of every process. ised, efficient, easy to maintain, easy noise, and increases patient The spatial planning of a hospital is to navigate, and visitor-friendly. privacy. about getting patients to where they • Integrating technology to sup- port wayfinding and patient flow. For example, digital sig- nage, and electronic manage- ment of patient movement through the facility. 75

INTERVIEW While conveniently-located acoustically separated from the adult are better for infection control. In all information kiosks are important, spaces but within easy sight of the rooms, there is an area near the win- incorporating wayfinding into the parents. Technology has also been dows for family, with seating that is design of public spaces makes signage used to improve convenience. Patient out of the way of the nurses and doc- almost secondary. How to accommo- tracking screens will let the patient tors. 100% of the patient rooms, and date the patient’s family is too often know when they can expect to be their en-suite toilets are accessible, overlooked. Typically they are under a seen. Families can be contacted by as per the American ADA Guidelines; lot of stress, and want to be as close mobile phones when a procedure is except for one 24-bed ward, which is to the patient as possible. It is import- done. Video screens can provide pro- specially designed to accommodate ant that the hospital provides places grammed videos and music to create a very large “Bariatric” patients, who where they can wait, which are nearby calming environment. Part of our chal- have their own unique requirements. and comfortable, but not in the way lenge as designers is to anticipate the Keeping supplies, equipment, charting of the staff. This space may be in the needs of the people that the facility areas and waste disposal nearby is patient’s room, or in nearby family will treat, or is trying to appeal to. part of the planning challenge. waiting areas, which might have views outside, artworks and other positive And, what about the patient Being a military hospital, the distractions.Separating public areas rooms? What factors in their finishes need to be very practical, from the hustle and bustle of the design contribute to patient durable and easy to clean. When an “back of house” activities also allows wellness? exam is being done, a patient room for a more pleasant visitor experience. requires high light levels, with colour One very nice feature of the exist- temperature that gives good colour For family and visitors, waiting ing hospital is that the patient wards rendering of the skin. areas are one of their primary experi- are pavilions, surrounded by garden ences in the hospital. Durability and courtyards. Views of nature have been Overall, the interior design of the cleanliness are certainly necessary. statistically proven to improve patient new KHMC patient room reflects the But transport terminal-style hospital outcomes. In the new King Hussein state-of-the-art healthcare to be de- waiting areas, with rows of bench- Hospital, the idea of patient rooms livered, a contemporary international es or stacking chairs, are long gone with views was central. All rooms style, incorporating elements and ma- thankfully. Today, patients and their in the new facility will be single-bed terials that will make patients feel at families seek divisions of space that rooms, with a view out over the city, home; mixing clean, bright materials offer smaller groupings of seating for or a rooftop terrace. The single bed with natural accents for contrast and better privacy and comfort. rooms also allow for better privacy, depth; and referencing the diverse are more restful for the patient, and natural landscape and rich cultural There is no single chair or seating heritage of Jordan. type that suits everyone. Also, using the hospitality industry as a design reference, people like choice. As such it was important to create a variety of smaller areas, allowing for a range of options that appeal to different ages, personalities and physical needs. For example, waiting areas include quiet lounge areas. There are also a couple of public spaces with café seating, where parents can have a drink and surf the internet on their laptop, as well as children’s areas, which have playful child-scale furniture and are JANUARY.FEBRUARY 2019 76



ARTICLE FEATURES . Artificial Intelligence in Healthcare ARTIFICIAL INTELLIGENCE IN HEALTHCARE JANUARY.FEBRUARY 2019 78

ARTICLE FEATURES . Artificial Intelligence in Healthcare The world has been witnessing disease that has suddenly emerged, or patterns in blood tests, and the subtle radical changes and successive suggest new medicines. abnormalities that cells display as a developments in various fields. disease begins takes hold. Time and The medical field is one of the most AI systems are found to pick up again, AI systems are found to pick up challenging for doctors and healthcare signs of illness that are unknown to signs of illness that are unknown to providers to keep up with year after doctors, making the AIs more accurate doctors, making the AIs more accurate year. Artificial intelligence in medicine as a result. Fortunately, researchers as a result. Earlier this year, research- aims to explore the human body and have found that AI is able to detect ers at Nottingham University trained find successful ways to overcome dis- cancer and other diseases earlier than several AIs to spot people at risk of eases that are still killing people. possible through standard diagnostic heart attack and found that all of methods, which could be lifesaving for them performed better than doctors. Artificial intelligence in medicine is future patients. Another AI built at Stanford University a modern concept in the diagnosis and in California has learned to spot breast treatment of diseases in a smart man- Collaboration between cancer in biopsy tissues. ner according to the highest technical doctors and AI techniques standards and the latest technological Robot and Artificial practices, and is like a revolution in the According to experts’ expecta- Intelligence in Medicine health sector aiming to serve patients tions, the collaboration between in the health sector according to the artificial intelligence techniques and The medical sector can significant- highest technological standards in the physicians will contribute to improving ly benefit from artificial intelligence field of artificial intelligence. treatment options and health services that simulates the human mind. A as well as the possibility of curing robot, for instance, is a machine that However, we should emphasize some of the most intractable diseases. acts like a human, responds to some that artificial intelligence techniques of the sound effects and stores infor- and their use in the medical field will At the moment, medical compa- mation. Robots are also used during not replace doctors at all, according nies are developing new technologies surgery, called “robotic surgery”. It is to recent studies, but they will help in that focus on diagnosing certain an advanced form of minimally inva- providing accurate diagnosis and clin- diseases so that devices recognize the sive or laparoscopic (small incision) ical care. Of course, doctors are very medical image and then determine surgery where surgeons use a com- important because the device cannot the type of disease expected accord- puter-controlled robot to assist them provide the psychological support ing to results and analysis using artifi- in certain surgical procedures. The and sympathy provided by the doctor cial intelligence techniques, which will robot’s “hands” have a high degree through his ability to relieve tension help doctors get a faster diagnosis of of dexterity, allowing surgeons the and anxiety; the machine is also un- diseases and thus increase chances of ability to operate in very tight spaces able to introduce new ideas for a new cure. On a related note, artificial in- in the body that would otherwise telligence can diagnose diseases from telltale groups of symptoms, strange 79

ARTICLE FEATURES . Artificial Intelligence in Healthcare only be accessible through open (long patient’s symptoms, the robot provides will assist human doctors rather than C incision) surgery. Remote surgery (or checklists for the patient and medi- replace them. For China’s medical insti- M telesurgery) is the ability for a doctor cal advice based on the results. Then tutions especially those in poor areas, Y to perform surgery on a patient even the therapy will be verified by human AI would be a good assistant. CM though they are not physically in the doctors. The software consists of MY same location. It requires the avail- diagnostic models involving more than On the other hand, the hospitals’ CY ability of the latest communication 30 diseases, such as Tuberculosis and management and databases benefited CMY technology and the effective exchange depression, which are likely to be misdi- greatly from the work organization and K of management information systems. agnosed. Based on trial tests in several improved management by providing Other future applications include the hospitals, the AI “doctor’s” successful the possibility of collecting informa- implementation of microprocessors or diagnosis rate is 20 percent higher than tion about patients and their histories, secondary treatments in the body to human doctors. The self-learning AI which helps in having an accurate diag- perform medical and surgical functions, “doctor” can constantly learn medical nosis after the doctor gets informed as well as the use of biological sensors knowledge, experience and diagnosis about the medical condition in full de- that can read and convert respons- process. It has a big database consisting tails through the patient’s medical file. es to natural and chemical changes of tens of millions of clinical cases. It is These advanced systems in hospitals for patients with chronic diseases. A designed to be a general practitioner. have contributed to enhancing the abili- China-made AI-based software made Every one or two weeks, it can learn ty to have an accurate diagnosis and its debut in China. After listening to the diagnosing a new disease. The AI doctor avoid random drug prescription as well as adverse reactions that may occur. JANUARY.FEBRUARY 2019 80

Shaping the industry, keeping the patient first. A unified voice for the region’s www.mecomed.com MedTech industry. Add your voice by joining the Mecomed Medical Technology Association Middle East & Africa For enquiries please contact: +971 4 513 6977 | [email protected]

MEDICAL INSTITUTIONS MEDSBLA A communications system for the doctors of the future MedLab Media Group dealing with private and sensitive also provides the Act of Transfer and information. The modification of the Responsibility of Medical Insurance in Recently there has been much European Data Protection Directive the USA (HIPAA). With regulations set talk about the new data protection has opened up new ways to ensure in place that guarantee the confiden- rules. As a doctor, it is in your interests the confidentiality and security of the tiality of data and a secure exchange to comply with the ever-changing data. Information regarding health of information, Europe and the United regulations that may affect your and patient diagnosis is particularly States have taken the initial steps to professional life. On the other hand, sensitive and does not escape the pro- extend the protection of their citizens you may need to quickly exchange visions added by the European Data and service providers. This initiative to information with colleagues. This Protection Regulation (RGPD), which protect citizen information, especially becomes problematic as you are JANUARY.FEBRUARY 2019 82

MEDICAL INSTITUTIONS their own groups. Both share the basic characteristic of a messaging system, as well as multiple tools: a pharmacological guide, medical calculators, a 3D anatomy system (BioDigital), a section of updated med- ical news by specialty and an online congress that will bring the user closer to the medicine of the future. in terms of health, has taken hold in The app allows healthcare profession- “We realized that doctors had a the Middle Eastern countries. Like als to separate their personal commu- very important and unrealized all Western countries, they seek to nications from the professional with a need: to be able to exchange ensure the security of private informa- guaranteed secure network. sensitive information with their tion. Despite the spike of conversation colleagues. We wanted to create in recent months about these regula- The messaging system is based on a secure platform and reliable tions, many doctors are not yet aware a two-pronged approach. Firstly, the messaging system that would of the implications of resolving issues global system, in which any user can allow them to be agile in the through applications that do not work exchange information with the rest day-to-day professional life. We under RGPD and HIPAA. of the medical community. The initial have achieved it; our app offers step is the free download of the ap- them the safe environment Best way to communicate plication on any mobile device, either they were looking for.” iOS or Android to register. Addition- In lieu of the recent conversa- ally, the user can access on the web Alberto Cueto, Product Owner tions regarding data protection, the browser (www.medsbla.com). of MedsBla MedsBla platform is about to revolu- tionize doctor-to-doctor communica- Secondly, the MedBla’s private Why should I download tions. MedsBla is a messaging system license. The private channel is a MedsBla? that groups together different roles: payment option for hospitals, clinics, doctors, health professionals, patients, medical center of different types of Despite being experienced medi- medical students, and administrators organizations, societies, schools, or cal professionals, doctors often need (i.e. all workers within a hospital or foundations, whose members want second opinions and need to be able clinic who manage private accounts). to communicate privately and create to consult with colleagues on highly specific matters. And the most im- portant thing must not be forgotten: the information shared is private and sensitive, needing a secure network to pass along. By downloading and using MedsBla, you can be assured that the law is behind you. The information 83

MEDICAL INSTITUTIONS allowing health organizations to be more effective and efficient. “In the United States, hospitals preferred asolated messaging systems to their environment because they did not have a global solution. MedsBla is now the global solution.” Oleg Vorontsov, CEO of MMG you share on MedsBla is protected speed; medical calculators; BioDig- Doctors will remain vulnerable and complies with current regulations. ital, a 3D anatomy system which is unless there is a firm commitment to Simply go to Google Play or Apple constantly being updated; or vade- the protection of health information. App Store, search for MedsBla and mecum, a pharmological guide in As Kaspersky Laboratory analysts download it. Once installed, fill in which you will find information about acknowledge, there is currently a the required fields. From this point medications. high amount of unprotected medical onwards, you can start creating your information and patient data stored in personal network of contacts. MedLab Media Group the connected healthcare infrastruc- protects the doctor ture. In an investigation carried out by The app facilitates communication this security company, it was detected with health authorities and establishes The Spanish start-up MedLab that more than 1,500 devices used to a direct chanel of communication be- Media Group (MMG) created Meds- process images of patients had their tween a hospital and other parties (i.e. Bla to democratize the practice and access open. They also identified that pharmacies or insurance companies). create a more innovative and safe a significant amount of medical soft- In addition, users can make video calls medical practice. ware and web applications had vul- 1 to 1 like other communication sys- nerabilities for which exploits already tems but MedsBla also offers multiple As MMG explains, it is about existed (i.e. a series of commands or people videocalls (up to 15 users at providing the healthcare profession- actions that are used to take advan- the same time). al with a secured work space, a way tage of security vulnerability in an to be in contact with other profes- information system and thus achieve More than a sionals, exchange knowledge, and unwanted behavior of it). messaging system guarantee absolute confidentiality and security. This same report states that as The app not only makes it easier long as health organizations do not for you to communicate with others, MMG satisfies the need expressed take action in this matter, the un- but it gives you access to a multitude by healthcare professionals. With the encrypted information that health of tools- the MedsBla tools. design of this app, the company re- systems have will continue to attract sponds to the necessity of the sector, cybercriminals, interested in inter- Once you click on this option, you which until now has been working in cepting data that circulates unprotect- will find a range of features: Deep- legal helplessness, using tools ex- ed. We all remember the impact of AIMed, the intelligent search engine posed to possible cyber-attacks. WannaCry, an attack that Kaspersky for medical terms; news classified by Laboratory places in the top 5 of the specialties and updated at lightning MedsBla protects the healthcare most memorable cyber-attacks. professional and the patient, while For 4 days, WannaCry managed to disable more than 200,000 computers in 150 countries, including critical in- frastructures. In some hospitals, Wan- naCry encrypted all devices, including medical equipment, and some facto- ries were forced to stop production. JANUARY.FEBRUARY 2019 84

MEDICAL INSTITUTIONS Sensitive data within the committing an illegal act by sharing As Ricardo de Lorenzo y Aparici, reach of cybercriminals sensitive data because they live in managing partner of the New Tech- past eras. Many of these messaging nologies Area of De Lorenzo Aboga- The ease of access to many services are global platforms exposed dos, explains: “If you want to use an communication tools not as secure as to a wide variety of computer attacks. instant messaging service to commu- MedsBla has caused some health pro- Last July, the personal data of at least nicate with other health professionals, fessionals to make their consultations 1.5 million Singaporeans (more than a when it comes to obtaining the pa- through mobile phones and share in- quarter of the total population) were tient’s consent, you must be informed formation with their colleagues with- “hacked”. Among the pirated infor- in detail about the possible partici- out realizing that these systems do mation were medication reports from pants who will have access to personal not guarantee the security of the data 160,000 patients. The cyberattack data, being prohibited the transfer and may have ethical implications. managed to access the database of of data to subjects who do not need national health institutions and get access to the information depending It cannot be denied that the hold of all this sensitive information. on the purpose of the provision”. introduction of information and As the Ponemon Institute report communication technologies has reveals, digital medical records are De Lorenzo affirms that applica- been a great advance for Medicine, particularly attractive to cybercrimi- tions such as WhatsApp “are highly but it is advisable to be cautious with nals: they have a black market value topical because of the sanctions it the use we make of it. Instantaneous 50 times higher than credit card data. is receiving from the Spanish Data communication systems or messaging The latest report published by this Protection Agency (AEPD) due to services allow immediacy and speed institute confirms that, for the eighth non-consented transfers of personal but making a medical consultation consecutive year, health care organiza- data that exist between this tool and through this route lacks a precise tions had the highest costs associated Facebook, both owned by the same assessment judgment and evidences a with data theft, with a cost of $408 person responsible”. lack of professional ethics. per lost or stolen record, nearly three times higher than the industry aver- The AEPD managed more than Juan José Rodríguez Sendín, age of $148. 10,500 claims in 2017 and has im- President of the Deontological Com- posed historical sanctions such as the mission of the Organización Médica In this context, health organiza- one imposed on Google for 900,000 Colegial de España (OMC), said: “This tions should consider the need to join euros for infringements of the LOPD is a very clear question: Deontology the European and U.S. initiatives, and (law prior to the RGDP) and the one does not make a medium safe or strengthen the security in the ex- imposed on WhatsApp and Facebook unsafe, but every doctor knows that change of information, because not to for ceding personal data without con- clinical information is highly sensitive do so the consequences are not only sent for 1.2 million euros. so using tools that do not guarantee for health professionals or patients, the protection of these data is assum- but also affect the management of To register, just follow this link: ing a risk that is condemned. It is not the organizations themselves generat- www.medsbla.com justified deontologically”. Rodríguez ing high additional costs. Sendín acknowledges that sometimes doctors are unaware that they are 85

ARTICLE Global Healthcare innovations likely to gain ground in 2019 By Dr Prem Jagyasi 2018 was exciting for global medical care and support. Following more value-based care by enhancing healthcare with innovations are the anticipated global healthcare patient engagement. This technolo- making regular news headlines. innovations in 2019: gy is estimated to make a savings of So what we can expect in 2019? Will $100-$150 billion per year in almost we see a greater acceptance of block- 1. Stepping up to blockchain every aspect of healthcare. Ethere- chain technology? Or will AI (Artificial technology: um, a block-chain platform and Viant Intelligence) and Machine Learning have already partnered with GSK to bring some radical changes in pa- This unique peer-to-peer shared increase the pace of blockchain appli- tient-centric care? ledger technology is set to be the cations. game changer in global healthcare by Consumers are more aware of allowing secured data and information 2. Evolution of Artificial their health and are engaging in sharing among disparate systems. The Intelligence (AI) and Machine decision-making. The coming year is system assures transparency in health- Learning: likely to focus more on value-based care operations ruling enabling timely care with improved integration of medical intervention and substantially Artificial Intelligence has already IT and healthcare services ensuring reducing healthcare costs. become an integral part of our daily better accessibility and affordability of lives and 2019 global healthcare is With blockchain technology, the poised to witness more of its amazing providers would be able to deliver JANUARY.FEBRUARY 2019 86

ARTICLE applications. In a recent innovation, AI Uber and Lyft have partnered genetic is likely to gain more impor- tools will help in predicting post-sur- with healthcare organizations offer- tance as health-conscious consumers gery infection risks enabling doctors ing rideshare services through their would be seeking more effective to take pre-emptive measures. API platforms Uber Healthcare and cost-saving treatments. Lyft Concierge. Patients can schedule For patients with severely restrict- their rides through their smartphones With enhanced access to genetic ed mobility, AI integrated Robotic using the Uber dashboard. Even if the testing in 2019, Pharmacogenomics wheelchairs can function with the patients do not have smartphones, or customized medication is poised help of facial recognition. The coming the healthcare providers can schedule to make greater inroads. Significant year will see more use of AI-induced the appointment and adjust the billing collaborations among leading biotech robotic assistants that would help with the Uber dashboard. companies are on the way to develop them in detecting illness and suggest new treatments on human genetics. medications and fix appointments 5. Data science and with the physicians. predictive analytics: Genome editing tool CRISPR is likely to create new breakthroughs By 2020, the European Union Data science and predictive anal- to prevent inheritance of diseases. plans to invest $24 billion in AI and ysis is helping healthcare providers in It is likely to find more applications cloud-based services. The tech giant analyzing huge information generated in cancer immunotherapy, which has Google has launched an AI-based by the growing number of patients. recently received the FDA nod. eye-screening program in Thailand to Feeding the information in AI-based detect diabetic eye disease, one of the systems, physicians can make quicker 8. 3D Printing technology: major causes of blindness. decisions. Further advancements in predictive analysis will help physicians Healthcare sector is poised to 3. Innovative remote address ailments endemic to a partic- be the second largest industry in robotic surgery: ular region, families and communities. 3D printing technology. 3D printed More integration of data from IoMT devices matching anatomical features Modern healthcare is welcoming is expected to create further detailed of patients are better accepted by the minimally invasive surgeries resulting models to identify high-risk patients body minimizing the risk of compli- in faster recovery. Robots are perfect and reduce the chance of negative cations. Significant advancements solutions to it. They are guiding phy- outcomes. in 3D printing technology have been sicians in performing high-precision observed in external prosthetics, surgeries with maximum accuracy 6. Pre-hospital diagnosis of orthopedic implants, customized involving least procedural time. With stroke with Visor: airways for stents, complex cardiac high-speed internet and improvement surgeries and even in total face trans- in time-lag, telesurgery or remote ro- Medical professionals are using plant recently conducted in Cleveland botic surgery is considered viable and Visor, an effective scanning tool to Clinic. 3D printed drugs are likely to absolutely safe. Surgeons can perform detect hemorrhage in brain before generate more attention as research operation hundreds and thousands of hospitalization for quicker inter- is underway to create polypill effec- miles away from the operating room vention of treatment. Hemorrhagic tive in treating multiple diseases. with robots. strokes account for 40% of deaths from stroke. Visor enables a faster 9. Biometrics to usher in a 4. Customized patient diagnosis of hemorrhagic bleeding new era: transportation services: saving the brain from further dam- age like uncontrolled bleeding and Identifying patients with 100% In non-emergency medical swelling which may lead to permanent accuracy is imperative in healthcare to situations, transporting patients disability or death. prevent duplication of medical records to and from the clinic is a big issue and reduce time-killing redundant worldwide. Lack of transportation 7. Pharmacogenomics tasks. It will help clinicians for correct has resulted in missing/ rescheduling and CRISPR: diagnosis and treatment based on doctor’s appointment for 25% low-in- patients’ previous medical history. The come group patients costing the US Precision medicine or medicine new era of biometrics will enable iden- healthcare system $150 billion on an customized according to the patient’s tities shared in cloud accessible only average every year. to the authenticated users. 87

ARTICLE Therefore, whether the patient is hospitalization cost: 12. Advancement of health at home, in an emergency department wearables: or physician’s office, the healthcare • By 2020, about 17% of the provider will be confident of his/her American population will turn Health awareness is driving more identity and provide treatment based 65 exponentially shooting up people to advanced wearables for on previous medical records. More the demand for home health- tracking health status. The advent of biometrics are used more are benefits care services. Apple Watch Series 4, the first wear- for organizations and patients lead- able capable of recording ECG has ing to high patient satisfaction and • Mobile-assisted health devic- given a new turn in this sector. healthier outcomes. es are offering smart care by remotely monitoring patients’ The device already approved by 10. Improved tools for health- vital parameters and sharing FDA will not require any prescription care record management: it real-time with the health- for purchase. The leading health wear- care providers to take quick able player Fit Bit in partnership with The EHR (Electronic Health Re- actions. Google is exploring the possibility cords) market is estimated to grow at of developing consumer and enter- a CAGR of 6% per year from 2018-22. • E lderly patients will be en- prise health solutions. Its acquisition Fragmented patient data existing in abled with Alarm Integration of Twine Health, a HIPAA-compliant silos create obstacles for healthcare technology installed in their platform has already enhanced its providers in improving treatment appliances. These sensors business outcomes with the integra- outcomes. The situation becomes can track the activity of pa- tion of a coaching platform empower- more chaotic if the patient avails both tients and send alerts to the ing consumers to access better health private and public healthcare service. caregivers to take necessary outcomes. action as and when required. Health App from the tech giant 13. Internet of Medical Apple has helped in integrating pa- • Passive sensing technology Things (IoMT): tient data in the encrypted form in the would find more applications iphones of the users. Apple has part- in monitoring deteriorating Internet of Things (IoT) in health- nered with many leading hospitals and clinical conditions (DCC) care is the Internet of Medical Things clinics like Johns Hopkins Medicine, where physiological assess- (IoMT) integrating healthcare tech, UC San Diego Health, Cleveland Clinic, ment can be made without wearables, apps and telemedicine. As Penn Medicine and others who have touching the patient. Wire- remote patient monitoring is gaining implemented this technology. Patients less patient-worn solutions popularity, IoMT has been experi- can view their medical records from all in miniature-sized reusable encing significant growth since last the providers from a single platform. monitors or disposable units couple of years. In 2019, it is likely similar to band-aid will help to see more innovative features and 11. Smarter home in assessing vital parameters expanded usage. healthcare services to reduce like ECG, heart rate, blood pressure, SPO2, temperature Leveraging the connected and motion. devices, it is also possible to monitor high-risk patients alerting them as required. Patients aware of this con- tinuous monitoring are likely to follow a regulated lifestyle. An estimated 30 billion IoMT devices are likely to be deployed globally by 2020. 14. AR/VR/MR: Augmented Reality, Virtual Reality and Mixed Reality are changing the modes of treatment with innovative therapies for better patient experi- JANUARY.FEBRUARY 2019 88

ARTICLE ences. Luna, a Virtual Reality Therapist 15. Telehealth: gram Updates, telemedicine services available on VRHealth Platform from are given heavy importance to provide early next year would help in reduc- Telehealth is growing in leaps different access points to patients. ing hot flashes in women. Improved and bounds as modern age consum- applications of AR/VR are likely to be ers prefer digitally driven healthcare Emergency Department Teletri- in emergency response, prevention services for enhanced access to age, Teleophthalmology, improving and diagnosis, medical education, healthcare from a distance. In the population health by preventing low surgery, elder care and rehabilitation recently proposed 2019 Medicare and birth-weight babies and expanding and emotional recovery. Medicaid guidelines for Physician Fee access to specialty services are likely Schedule and Qualified Payment Pro- to feature more in 2019 telehealth. About Dr. Prem Jagyasi Dr Prem is an award-winning strategic leader, renowned author, publisher and highly acclaimed global speaker. Aside from publishing a bevy of life-improvement guides, Dr Prem runs a network of 50 niche websites that attracts millions of readers across the globe. Thus far, Dr Prem has traveled to more than 65 countries, addressed numerous international conferences and offered his expert services to more than 150 international organizations. He also owns, operates and leads a web services and technology business, supervised and managed by his eminent team. Dr Prem further takes great delight in travel photography. Please visit him at http://drprem.com/ 89

ARTICLE FEATURES . Telemedicine TELEMEDICINE FOR WOUND CARE MANAGEMENT What, Why and How of Tele-wound Care Dr Saira Baloch MD Dr Suhail Chughtai FRCS Dr Samer Ellahham MD Medical Director & Physician: Orthopaedic Surgeon & Medico Senior Cardiovascular Consultant: Wound Care & Hyperbaric Medicine legal Examiner: M L Professionals, Har- Cleveland Clinic Abu Dhabi, UAE. Clinic, Texas Health Allen Hospital, ley Street Clinic, London, UK. Microsoft Regional Chair Middle East: Patient Dallas USA. Advisory Board Member: Certified Specialist & Telehealth Expert, Safety Movement Foundation Cleve- Medical City Online, UK Chairman: Medical City Online UK land Clinic Care Giver JANUARY.FEBRUARY 2019 90

ARTICLE FEATURES . Telemedicine Examining and treating wounds or smart medical gadgets to record from distance using a specialized BP, Pulse, Blood Glucose, Single lead form of Telemedicine is reviewed EKG etc is carried out via a connect- in this article referring to a portal ed Healthcare system. The recorded that meets most the requirements findings are interpreted during Virtual for such clinical practice. The authors or Physical Consultations. Telecare can using their experience in Wound Care, be a standalone service or be part of Telemedicine and Patient Safety, Telemedicine portal. outline the advantages and disadvan- tages they regard as significant in the What is the commonest light their respective experience. The mode of communication for Tele-wound Care Software design is Healthcare over Internet? referred to and compared with one suitable model available. Nowadays, Two Way Live Online Video is embedded in as much as What is Telehealth? 72% of all Telehealth Care facilities within web-based solutions. Deliv- The Telecare Services Associa- ering Healthcare Services using Live tion regards Telehealth as “Delivery Video over internet is one of the most of Healthcare Services remotely innovative technological revolutions by means of Telecommunications of the current era. It is no longer a Technology”. Telehealth is defined as question of “if” Telehealth Care Ser- “the transmission of data of patients vices improve the healthcare outcome (documents, images, audio, video etc) since over the last decade, there is between separate physical locations a growing evidence to confirm this to diagnose and monitor suitable statement. Telemedicine’s efficacy in medical conditions remotely”. The bringing a positive change in health- term is used synonymously for a care quality, patient engagement and range of portals working together to cost- effectiveness is well proven in a facilitate healthcare, promote public growing number of medical articles health and deliver health education and studies. via telecommunications technologies. TELEMEDICINE FOR WOUND What is Telemedicine? CARE MANAGEMENT (TELE-WOUND CARE) Telemedicine is “the process of delivering Healthcare services over How is Tele-wound one or multiple channels of Telecom- Care defined? munication connecting a healthcare provider (a doctor, therapist or nurse) Tele-wound Care is defined as with a patient without a physical meet- managing a wound from distance ing”. In short, it is the process of Virtu- using digital imagery and/or live video al Medical Consultation over Internet technology. Live Video is the means of with care receiver and care giver at choice for Tele-wound Care. two different physical locations. What are the types of Tele- What is Telecare? wound Care Management? Telecare is defined as providing Synchronous - Real-Time Wound healthcare services via remote mon- Care using two-way Live Online Video itoring utilizing equipment, gadgets Interface between the patient & the and telecommunication technology”. wound care specialist or nurse where would is examined over live web cam Remote monitoring via modern 91

ARTICLE FEATURES . Telemedicine or similar device for taking a manage- care by enabling a timely • Decreases utilization of ment decision. intervention. resources. • Enhanced quality of life by Asynchronous - Store & Forward reducing the hassles attached • Minimizes space requirement type where the patient uploads Digital to visiting a clinic. for expanding practices. Still Images or Video Clips for wound • Decreases risk of infections evaluation by the specialist subse- by reducing number of visits • Improves patient satisfaction quently for taking a management • Decrease in number of visits and trust in healthcare system decision and relaying it back to the to accident department. patient or nurse coordinator. • Proven improved clinical CHALLENGES AND DIFFICUL- outcomes. TIES FACED IN ADOPTING TO Hybrid - Have features of Syn- • Can provide patient edu- TELE-WOUND CARE chronous and Asynchronous types cation on wound care and such as patients uploading images for self-dressing via videos. Disadvantages to the Patient evaluation get involved in a Live Tele- consultation for a timely management Advantages to Wound Care • Broadband Internet and Com- plan review. Providers puter dependency. TELE-WOUND CARE • Decreases burden of back and • Getting used to the Software ADDING VALUE TO WOUND forth correspondence. Interface. HEALTHCARE SERVICES • Provides “Virtual Triage” cover. • Limitations posed for patients Advantages to Patients need- • Helps streamline care plan & with disabilities such as vision, ing Wound Care hearing impairment or ability delivery. to access the wound them- • Increases patient access to • Increases practice volume. selves for displaying through care. • Minimizes staff burn out Med- the camera. • Less effort and pain for pa- ical City Online October 2018. Disadvantages to the Wound tient (ride to appointment, no • Helps monitoring patient in Care Provider clinic wait time). underserved areas. • Lack of hands-on wound as- • Cost effective for patient • Improves clinical outcomes. sessment (palpation, depth). (no transportation, caregiver • Enables them to educate escort, no gas money etc). • Inability to detect odor. patients effectively via online • Margin of Diagnostic Inaccu- • Improves patient satisfaction video clips. (one-to-one patient physician racy (decreasing with increas- interaction, patients feel Advantages to the Wound ing usage). more engaged in their plan of Care Industry • • Possible learning curve with care). technology depending up the • Cost-effective for Hospitals tech-awareness. • Improves overall quality of and Insurance Companies. • Complex wounds still need to be referred for debridement, JANUARY.FEBRUARY 2019 92

ARTICLE FEATURES . Telemedicine procedures, etc. such as infection, blister, Forms receiving data. • Issue with Fair compensation changing color of discharge, • Data Mining and Analytics swelling around the wound / reimbursement in a fee for etc. available. service environment. • Malignant / complex wounds • Safe, Secure and Scalable. in patients on palliative care. • Reliable and Accurate Out- Disadvantages to the Wound Care Industry TELE-WOUND CARE come Tracking. METHODOLOGY - HOW • Compliant to regulations. • Ethical and legal issues (evolv- ing and streamlining due to Technology requirements of CONNECTING VIA A TELE- increasing usage). an appropriate Tele-wound WOUND CARE SOFTWARE Care Software • Enforcement of standards The registration and then login (evolving and streamlining • The software is to be avail- process should be simple. Once the due to increasing usage). able on Desktop (Windows doctor and patient login at the portal, or Mac), Mobile Handheld the sequence of screens and naviga- • Overutilization of service due devices with inter-platform tion through the software should re- to convenience offered. compatibility. main self-explanatory and jargon free. TYPES OF WOUNDS • Standard Internet bandwidth • Both care receiver and care MANAGEABLE VIA TELE- used for domestic connec- giver would need to be con- WOUND CARE PORTALS tions should be sufficient to nected to routinely available convey live video. Internet connected devices. Most of the wound which do not need surgical intervention can be man- • In the absence of Internet • A desktop PC, a laptop or a aged through a suitable Tele-wound connection, a 3-G mobile mobile device (smart phone care portal. Having a Nurse Coordina- device data connection should or tablet). tor present at the patient end is not be sufficient for a basic live necessary in most situations though video consultation. • Live two-way video via HD for some scenarios, it is a major advan- webcam, mic and speakers or tage to have a nurse coordinator work • Minimum required upload mobile device camera. with the patient working along with a Internet speed for Live Video wound care specialist calling in from should not exceed that of a Patient’s side distance, yet in sync with the nurse routinely available domestic coordinator to improve outcome. Internet connection. • Wound Care Devices are Following wounds can be managed via optional, e.g.: Special Light, a suitable Tele-wound Care portal: • Desktop Software is to be Dermatoscope etc. cloud-based without needing • Diabetic ulcers. to download any file. • Can add a second camera such • Venous ulcers. as a mobile phone to show • Pressure ulcers. • The Tele-wound Care Website the wound while staying con- • Arterial ulcers. must be SSL (Secure Socket nected through the web cam. • Complicated trauma wounds. Layer) certified. • Chronic non-healing surgical • Patients to have access to • HIPPA and GDPR Compliance teaching videos within the wounds. to be mandatory depending software prepared or ar- • Burns wound follow-up. upon location. ranged by the Wound Special- • Follow-up after skin graft / ist for providing education on • Point-to-point Live Video self-dressing. flap. Latency should not exceed • Wounds on negative pressure 0.5 sec. Wound Care Provider’s side (at a distance) wound therapy. Other required attributes • Recently discharged patients • Can engage a local nurse • Easy to use, without distrac- coordinator for wound care in from hospital.. tions with minimal learning an additional video window to • Patients with wounds under curve. examine the wound together and leave specific instructions. Home Health Service. • Customizable Templates and • Wounds with urgent concerns • Wound care provider can 93

ARTICLE FEATURES . Telemedicine show images or pre-recorded Medical Records tance would take the patient through videos during the live consult a step-by-step approach while review- to illustrate a concept or Such can be directly pulled in from ing the gathered information through instruction. an existing EMR via an API or may be a shared area on the screen. The pat- uploaded in the form of pdf or jpg tern of review should be as follows: PATIENT’S SIDE - WORK files for situations where connection FLOW FOR A TELE-WOUND to EMR is not a requirement. • Patient & Wound History CARE CONSULTATION along with relevant comorbid- Lab Results and ities via the forms filled by the The patient after having made an Radiological Images patient. appointment with the care-provider will need to provide information to Similarly, lab results and radio- • Wound images or short video help the clinician reach a management logical images can be uploaded as clip uploaded by the patient decision. Such information is best split attached files or pulled in from an in relevant forms which are incorpo- existing EMR via an API. • Lab results and radiological rated in the software as customizable images uploaded by the templates to match the requirements Vital Parameters and patient. of the Healthcare System or Service Observations provider. The filling of information • Vital observations or any rele- is made easy by simple ticks or even Recording of arterial pulse, blood vant information recorded by voice controlled plugin can be added pressure, temperature, single lead the smart gadgets or manual- if required. EKG can be done by the patient using ly entered by the patient. home gadgets. The values are entered Patient History & Bio Form into the portal automatically if such REFLECTION OF THE CARE PRO- gadgets have a bluetooth connection VIDER (WOUND SPECIALIST OR This template gathers information which will then update the patient’s WOUND CARE NURSE) about lifestyle-related to wound care records automatically for the next management which is standardized consultation whether virtual or For a non-live or Asynchronous via a form. physical. Entering such information Teleconsultation, the care provider manually also needs to be available in would go straight to set of tools for Wound History Form a Tele-wound care portal. reflecting on the available information to set up a management plan. The patient provides information SYNCHRONOUS OR about location, appearance, progress ASYNCHRONOUS TELE- For a Live or Synchronous Tele- of size, associated symptoms etc while CONSULTATION consultation, the clinician or the nurse completing the history of the wound. after having gathered the uploaded Once the patient’s data is avail- information will now turn to the Comorbidities Form able including images or a short visual examination. The Live Visual recorded video of the wound, the Examination can be done through the The care provider needs to know Tele-consultation can be Synchronous Web cam being used in the Telecon- about other medical conditions that (via Live Two-way Video) or Asynchro- sultation or the patient can add an can have a role in the aetiology or nous (Store and Forward). The asyn- additional camera such as a mobile management of the wound. chronous teleconsultation is suitable phone camera to easily show the area where patient and doctor cannot of the wound while staying connect- Wound Images or Short match consultation times or there is ed on the web cam. The option of Video Clips an issue of internet service otherwise, having a dermatoscope is practical if most patients would prefer a Live a nurse coordinator is present with Visual information in the form of Teleconsultation. the patient as she can carry a laptop daily or series of images of the wound connected to a dermatoscope with or is valuable information for the clini- CARE PROVIDER’S WORK without special light source. cian. Having such information archived FLOW DURING A LIVE TELE- adds further significance for retro- CONSULTATION The clinician can now reflect on spective review of not only individual the information gathered to set up a case but also as collective data for a The Wound Care Specialist or the management plan as the set of tabs given group of patients. Nurse Coordinator working from dis- available on the screen match his/her care plan template: • Findings of the Wound Exam- JANUARY.FEBRUARY 2019 94

ARTICLE FEATURES . Telemedicine ination via a templated form. Educating the patient Medical Literature Support to the article • • Suggesting a diagnosis with 1. Treatment of diabetic foot ulcers Throughout the Live Teleconsul- comments. tation, the care provider can explain in the home: video consultations as an • Medical City Online October the patient on any of the blocks of alternative to outpatient hospital care, information as both are viewing it Jane Clemensen, Simon B. Larsen, Marit 2018. simultaneously on a shared screen Kirkevold and Nieles Eiskiaer. International • Request further Lab investiga- area while talking to each other on Journal of Telemedicine and Applications Live Video. Moreover, additional and Research Article (6 pages) Article ID tions or Radiological Images information in the form of educational 132890, vol 2008 with electronic connectivity images or short videos should be kept direct to the local labs. available in the portal which can be 2. L. Kobza and A. Scheurrich, “The • Prescribe medications with either shown during the Live Telecon- impact of telemedicine on outcomes of electronic connectivity direct sultation (permitted time) or can be chronic wounds in the home care setting,” to the local pharmacies. referred to for subsequent viewing of Ostomy//Wound Management, vol. 46 no. • Wound Dressing Instructions the patient. 10, pp. 48-53, 2000 added. • Surgical procedure recom- SUMMARY 3. R. Wootton, “Recent advances: tele- mendation – Referral letter to medicine, “British Medical Journal, vol. 323, appropriate center. The attributes of a Tele-wound no. 7312, pp. 557- 560, 2011. • Follow-up appointment given Care Portal are summed up above with at the end of the consultation a view to simulate as much as possible 4. L. S. Halstead, T. Dang, M. Elrod, R. J. with the Wound Care. to a physical consultation. Given the Convit, M. J. Rosen, and S. Woods, “Teleas- • Specialist or Nurse Coordina- advantages of a virtual consultation, sessment compared with live assessment tor. the authors believe that the above laid of pressure ulcers in a wound clinic: a pilot • Referral to another Special- out attributes would justify use of a study,” Advances in Skin & wound Care, vol. ist if necessary, through the Tele-wound Care Portal. A good virtual 16, no. 2, pp. 91-96, 2003. software. teleconsultation system for wound care should enable timely review 5. S. E. Gardner, R. A. Frantz, J. K. The care provider can review a of the wound but will increase the Specht et al., “How accurate are chronic summary of the Teleconsultation as patient satisfaction and confidence wound assessments using interactive video an auto-generated and downloadable into the healthcare system by making technology?” Journal of Gerontological file is created. For an Asynchronous a clinician readily available for making Nursing, vol. 27, no. 1, pp. 15-20, 2001. Teleconsultation, patient will not be effective management decisions. The available in real time though informa- value of educating a patient using 6. C. H. Hsieh, H. H. Tsai, J. W. Yin, C. Y. tion provided earlier would help the the electronic means has additional Chen, J. C. Yang and S. F. Jeng, “Telecon- clinician make wound management value and would also help improve the sultation with the mobile camera-phone in decisions which will be stored in the outcome by increasing patient compli- digital soft-tissue injury: a feasibility study,” system for execution by the patient ance once they are engaged into the Plastic and Reconstructive Surgery, vol. 114, or the nurse coordinator as they login process of management. no. 7, pp. 1776-1782, 2004. next time. A. C. Roth, J. C, Reid, and M. Concan- non, “Diagnostic quality of low resolution images for tele-wound care,” in Proceedings of the AMIA Symposium, pp. 917-920, Phila- delphia, Pa, USA, May 1998. 7. F. Mair and P. Whitten, “Systematic review of studies of patient satisfaction with telemedicine,” British Medical Journal, vol. 320, no. 7248, pp. 1517-1520, 2000. 8. W. A. Wilbright, J. A. Birke, C. A. Patout, M. Varnado, and R. Horswell, “The use of telemedicine in the management of diabetes-related foot ulceration: a pilot study,” Advances in Skin & Wound Care, vol. 17, no. 5, pp. 232-238, 2004. 9. D. C. Visco, T. Shalley, S. J. Wren et al., “Use of telehealth for chronic wound care: a case study,” Journal of Wound, Osto- my and Continence Nursing, vol. 28, no. 2, pp. 89-95, 2001. 10. Do Telemedicine Wound Care Specialist Consults Meet the Needs of the Referring Physician? A Survey of Primary Care Providers, Marek K. Dobke Dhaval Bha- vasar, and Fernando Herrera. International Journal of Telemedicine and Applications. Research Articles (6 pages), Article ID 321376, Volume 2011 11. Telemedicine in wound care: a re- view by Chanussot-Deprez C, et al. Adv Skin Wound Care. 2013 Feb:26(2):78-82. doi: 10.1097/01. ASW.0000426717. 59326.5 Medical City Online October 2018 95

ARTICLE FEATURES . Alzheimer’s Disease ALZHEIMER’S DISEASE It destroys memory and other important mental functions With the increasing number of day activities. Alzheimer’s disease is brain’s nerve cells. In a healthy brain, people with Alzheimer’s dis- the most common cause of dementia these protein fragments are broken ease, we have seen interna- and possibly contributes to up to 70% down and eliminated. In Alzheimer’s tional efforts from the World Health of cases. Dementia can be caused by a disease, the fragments accumulate to Organization and communities calling number of progressive disorders that form hard, insoluble plaques. for early detection and prevention of affect memory, thinking, behavior the disease, especially after the WHO and the ability to perform everyday Neurofibrillary tangles are insol- stated that last year, around 50 million activities. Although doctors have yet uble twisted fibers found inside the people have dementia worldwide. to fully understand the causes of brain’s cells. These tangles consist The number of dementia patients is Alzheimer’s disease, ongoing research primarily of a protein called tau, which increasing rapidly, with increase in has shown that it is caused by brain forms part of a structure called a life expectancy, according to World cell death. It is a neurodegenerative microtubule. The microtubule helps Health Organization (WHO). disease, which means there is progres- transport nutrients and other import- sive brain cell death that happens over ant substances from one part of the While Alzheimer’s is the 6th lead- a course of time. The total brain size nerve cell to another. In Alzheimer’s ing cause of death worldwide, it af- shrinks with Alzheimer’s - the tissue disease, however, the tau protein is fects women more than men because has progressively fewer nerve cells abnormal and the microtubule struc- women tend to live longer and the and connections. Alzheimer’s disease tures collapse. chances of developing Alzheimer’s in- is caused by a combination of genetic, creases with age. The high number of lifestyle and environmental factors Forgetfulness is the cases urged communities and medical that affect the brain over time. most common symptom organizations to intensify their efforts of Alzheimer’s in order to detect and prevent the The formation of amyloid plaques disease at an early stage, as it destroys and neurofibrillary tangles are At first, increasing forgetfulness memory and other important men- thought to contribute to the degra- or mild confusion may be the only tal functions. Dementia is a chronic dation of nerve cells in the brain and symptoms of Alzheimer’s disease that syndrome caused by a variety of brain the subsequent symptoms of Alzhei- you notice. But over time, the disease illnesses that affect memory, thinking, mer’s disease. One of the hallmarks of robs you of more of your memory, behavior and ability to perform every- Alzheimer’s disease is the accumula- especially recent memories. The rate tion of amyloid plaques between the at which symptoms worsen varies from person to person. If you have JANUARY.FEBRUARY 2019 96