Day 2 :
Imperial College London, UK
Keynote: The Clinical Evidence and Challenges of mobile health for Diabetes Management in the Arab Counteries – From Pilotitis to service delivery
Time : 9:00
Professor Robert Istepanian is recognized as one of the leading authorities and pioneer of the area of mobile healthcare and the first scientist to have coined and defined the concept of ‘m-health’. He completed his PhD studies from Loughborough University, UK. Since them has held several academic and research posts in UK and Canada. He lead numerous clinical trials and research studies in the areas of mobile health and diabetes management and is considered a leading authority in the area . He published more than 200 papers and several books in this area.
The alarming prevalence of diabetes is the Middle East and North Africa Region ( MENA) and particulary in the Gulf states is becoming a major health challenge with social and economic impact. According to the latest WHO statistics, the prevalence of diabetes in the Middle East region has seen one of the highest, soaring from 5.9% of adults in 1980 to 13.7% in 2014, with the Gulf counteries including KSA, UAE, Qatar, Kuwait having higher prevalnce rates. According to IDF estimates, healthcare spending on treating diabetes in the Middle East and North Africa region was US$16.8bn in 2014; this is set to reach US$24.7bn by 2035. Clinically, diabetes self management is increasingly beccoming an important approach for better mointoring and management of diabetes both for Type-1 and Type-2. Increasing clinical studies advocated the evidence and benefits of mobile diabetes management using smart phones as viable approach for effective lowering of HbA1c levels particulary for Type-1 and also for Type-2 patients. However, there is dearth of similar studies and clinical work in this region and the Gulf counteries and mostly as small pilot studies.
Considering the tranformative role of mobile health as an important healthcare service delivery mechanism being endorsed from major global institutions such as the WHO, ITU and the World Bank, supported with major investments and support from global mobile and pharmacutical and medical devices industries. This is combined with massive increase and penetration of mobile and Internet usage by the patient population in the region. It is is timley for this lecture and special workshop to discuss the clinical aspects, evidence sofar and the challenges relevant to the diabetes self management. This lecture and workshop will aim bring together leading clinians speakers and from academia, industry from the region to present and discuss these challenges, lessons learnt and relevant critical issues to increase awareness to this important health area.
Khalifa University, UAE
Dr. Kinda Khalaf received her B.S. (Summa Cum Laude with Distinction) and M.S. (Honors) degrees from the Ohio State University, USA. Her Ph.D., also from OSU, is in Biomechanics/Computational Biomechanics, specializing in Biomaterials, and Dynamic modeling and control. Dr. Khalaf has held faculty appointments in Engineering and Medicine at several prestigious universities including the University of Miami and the American University of Beirut, and currently serves as associate chair of the Department of Biomedical Engineering at Khalifa University in Abu Dhabi. She has numerous publications in the areas of Orthopedic Biomechanics, Computational Biomechanics, biomaterials, and neuromusculoskeletal modeling and control Dr. Khalaf is on the list of International Who Is Who of Professionals. She has been awarded various awards and honors including the prestigious National Merit Scholar. She is currently the chairperson of the UAE branch of IEEE, EMBS, in addition to her membership is several professional organizations.
Indiana University, USA
Pandemic viruses like Dengue Fever, H1N1, MERS-CoV and SARS challenge health services to ensure affected populations are adequately prepared and ready to change behaviors necessary to control spread of the disease. This article focuses on the role of affect and efficacy in reducing the impact of pandemics on the global public health. We report findings of a systematic review of 63 studies that apply social-cognitive theory to understand the psychological factors that determine population behavior in response to a pandemic. This evidence-based analysis reveals the importance of information selection, perception of risk and health self-efficacy, and emotional response to the pandemic in determining population health during an outbreak. Results suggest that health literacy development may need to shift toward health skills training and emphasize the importance of affective communication to motivate behavior change required to mitigate spread of the disease. We conclude with implications of study findings for literacy campaigns associated with population health and medical tourism. Finally, we discuss application of evidence-based argumentation analysis, a rhetorical technique for conducting systematic and meta-analytic reviews, to improve healthcare research and healthcare management practice.
- Healthcare and Medical Tourism
Sawsan Halabi Ezzeddine is Dean of the College of Nursing and Health Sciences at the Makassed University of Beirut. Completed BS in Nursing from American University of Beirut in 1980, Masters in 1983 and PhD in Education from the Lebanese Univerity in 2014. President of the Federation of National Nursing Associations for 8 years (1992-2000). Drafted the current Nursing Order Bylaws submitted to the Ministry of Health and approved in 2002. Received the Nurse of the Year Award offered by the WHO and the Order of Nurses in 2007. Participated in many national research projects by the MOH and WHO to promote the nursing profession in Lebanon, and memeber in many professional associations.
Health care delivery settings are making major investments to introduce and promote a culture of “Patient Safety”. Nursing education takes the lead for making essential transformations in order to graduate professionals with high levels of knowledge, skills and attitudes necessary for quality and safe practice. This necessitates that nurse educators and clinical nurse executives collaborate in order to develop nursing curricula with relevant quality and safety content. By exploring the gaps between education and developments in the practice environment, effective partnerships can be developed that address safety and quality needs.
Students may be consciously or unconsciously involved in incidents leading to patients’ harm or injury. It is important that they start their practice training in an environment that encourages openness and transparency about errors, understanding of the difference between blame and systems approach. Health care institutions need to empower students to address safety and quality practice issues scientifically shifting the paradigm from blame and shame to a more supportive learning model.
Education-practice partnerships with clear communication channels, coordination of clinical schedules, and effective preceptorship and mentorship programs are essential for student training. To minimize the education-practice gap, education and practice leaders need to work together to design curricula that prepare nurse graduates for the complex work environment and the importance of inter-professional learning and team work. Nurses can become a driving force for quality improvement when academic-practice partnerships are promoted to teach and model quality and safe practice for students and novice nurses.
Institute for Polymers, Composites and Biomaterials (IPCB CNR) Italy
Prof. Cosimo Carfagna is full Professor of Chemistry at the University of Naples “Federico II”. Since 2001 he is Director of the Institute of Polymers, Composites and Biomaterials of C.N.R. From 2008 to 2010 he has been President of Research Area NA3 of C.N.R. He is member of the International Society of Liquid Crystals, member of the Material Research Society, member of the Academy of Science of New York, member of the Italian Society of Liquid Crystals, member of the Italian Society of Macromolecules, member of Italian Chemical Society, member of the University Committee in the University of Study of Basilicata, member of the Department Council in the Department of Engineering of the Materials and the Production of the University of Napoli, referee of Ministry of Education of Portugal for evaluation of projects in the field of materials science, referee of Ministry of Education and Ministry of Industry of Italian Government for evaluation of research project on polymer technology. Currently Prof. Carfagna’ research interest are focused on Polymer Chemistry and Technology, Polymer functionalization, Polymer synthesis, liquid crystalline polymers, composites and nanocomposites, functional and smart textiles, recycling and processing of plastics, advanced materials for packaging, use of natural products as additive of polymers, nutraceuticals for polymers.
The continuous search of new therapy is requested by a growing resistance to major antimalarials. The sesquiterpene endoperoxide Artemisinin (ART) is currently one of the most effective natural treatment against multidrug resistant Plasmodium species, and ART combination treatments (ACTs) can represent an useful approach to fight resistance, as recommended by the WHO. ART relevance is witnessed by the 2015 Nobel Prize in Physiology or Medicine awarded for one half by Professor Youyou Tu. Since seventies, Youyou Tu and her team focused their efforts to the development of new malarial therapies inspired by the traditional Chinese medicine; they discovered that Artemisinin appeared in several ancient recipes to treat the malarial disease. The mechanism of action of ART is ascribed to the presence of an endoperoxide group inside its molecule. On reacting with iron, the endoperoxide group breaks up, producing free radicals. When formed inside a malaria parasite, the radicals can lead to cellular damage and cell death. In a similar way, it has been found that ART is able to affect cancer cells due to their elevated iron concentration; derivatives of ART have shown promising anticancer effects against multiple cell lines derived from various types of cancers. Besides some evidence of the anticancer potential of ART, the exact mechanism of action of this drug in cancer still remains unclear. However, one of the most crucial and unsolved aspects of DDS containing ART is related to its high level of crystallinity which dramatically reduces its bioavailability due to low solubility. Therefore, inhibition of crystallinity of ART is mandatory to guarantee a proper concentration of drug. In a recent paper some of the authors developed an antinucleating strategy to prevent the crystallization of ART through its solubilization into core-shell nanofibers obtained trough the electrospinning technique. Electrospun nanofibers fibers were constituted by a shell of poly(vinylpyrrolidone) (PVP) and a core of ART dispersed in a hyperbranched poly(buthylene adipate) (HB), acting as crystal suppressant of ART thanks to its highly branched structure, (coded as HA-Pfibers). This communication deals with the use of electrospun nanofibers containing ART as DDS against malaria and prostate cancer. The investigation was carried out considering both the technological and biological aspects. First, the study was focused on the assessment of drug loading and release capability, then in vitro tests were carried out to evaluate the pharmacological activity of encapsulated ART against cancer cell proliferation and malarial parasites (P. falciparum) growth.
Simon Fraser University, Canada
Dan Levitt shepherds the enhancement of social, spiritual and care needs for more than 300 seniors, inspiring a team of over 400 employees and volunteers with a commitment to continuously improving quality of life. Dan is an Adjunct Professor in Gerontology teaching Long Term Care Administration at Simon Fraser University. His adventure exploits have taken him from Africa’s highest peak Mt. Kilimanjaro to the Caribbean Sea’s Planacar Reef, from canoeing across the Yukon to racing in the Boston and New York Marathons. Dan has appeared on television and radio as well as authoring many articles in newspapers and professional journals. His insights on seniors care leadership are sought after at events across Canada, the United States, Europe, Asia, Australia and New Zealand.
An integrated health care system across the continuum of care enables multiple technology platforms and software applications to be connected, communicate, and exchange data. Information exchanged includes orders, therapy documentation, pre-move in data, and census information as well as continuity of care documents using clinical document architecture specifications. An enabling health integration solution brings together a network of healthcare providers and partners to ensure the right information at the right time to make the best care giving decisions for seniors.
Manar Trab has been graduated from Faculty of Medicine, Aleppo, Syria, 1989, as Medical Doctor with the specially of General and vascular surgery from Artztekammer Bilifield, Germany 1996. Presently he has been working at European Vascular Clinic DMCC, Dubai and affiliated to many private Hospitals in Dubai such as American Hospital, Saudi German Hospital, Medcare Hospital, Emirates Hospital and Mediclinic The City Hospital, as Consultant Vascular Surgeon.
Vascular disease treatment is currently an area of great innovation; we are currently at the threshold of a new era in minimally invasive and non invasive imaging of blood vessels and their lesions. Magnetic resonance angiography, spiral computed tomography scanning, colour duplex ultrasonography and intravascular ultrasonography will become better and better. Intraoperative digital cinefluoroscopy will become an essential adjunct for the performance of most standard vascular operations. Another technologic advance involves innovative new devices that greatly expand the horizon of endovascular treatments of vascular lesions. A final technical or scientific advance that will influence vascular surgery is the introduction of better biochemical or genetic methods to prevent or reverse atherosclerosis, intimal hyperplasia and degenerative aneurysms. Cases will be presented in our innovation in Dubai in the field of vascular surgery.
University of Jordan, Jordan
Heba Kalbouneh has completed her PhD at the age of 31 years from Heidelberg University, School of Medicine, Germany. She is an assistant professor at Department of Anatomy and Histology, School of Medicine, University of Jordan. She has published 6 papers since 2012 in reputed journals. She is a member of Alkaptonuria Research Association, Alkarak, Jordan.
Alkaptonuria (AKU) is a rare inborn metabolic disease characterized by accumulation of homogentisic acid (HGA). Excretion of HGA in urine causes darkening of urine and its deposition in connective tissues causes dark pigmentation (ochronosis), early degeneration of articular cartilage, weakening of the tendons, and subsequent rupture. In this case report, we present a rare case of a patient presented with unilateral spontaneous rupture of Achilles tendon due to AKU. The patient developed most of the orthopedic manifestations of the disease earlier than typical presentations. Alkaptonuria patients should avoid strenuous exercises and foot straining especially in patients developing early orthopedic manifestations.
Aga Khan Hospital for Women, Pakistan
Measles is a highly contagious viral illness with a considerable contribution to under- 5 child mortality across the globe. Transmission is both airborne and respiratory. Transmission in the health care setting is well documented in the literature but can be prevented if case isolation is instituted immediately.
Measles patients require isolation. As a community hospital people came for quality care at affordable rates. At AKHW, Garden we have the perception that isolation facility required lots of resources & budgets. However, literature also supports it can be doable by innovative strategies within limited resources in order to provide accessible quality care for population requiring transmission based precautions.
Six sigma DMAIC methodology was used to solve the issue. Meetings with relevant stakeholders were arranged, consulted with AKU IC team on bare minimum isolation room requirement on the basis of which guidelines were developed & implemented. Approval was granted by administration for utilization of 2 private rooms for temporary isolation.
After taking interventions 63 patients with measles were treated and no inter transmission was reported. Designed airborne isolation precaution flyers & displayed for awareness, Ensure availability of proper PPE (N95 masks), and Staff trainings on dealing with patients with these population. Guidelines were developed and shared with the team. Isolation trolley was implemented & staff awareness flyers, airborne precaution flyers were placed outside patient’s room.
Pediatric isolation is relatively new and growing area of secondary care hospital. It is designated for children with suspicious or confirmed case of Measles. This provides effective and efficient management of measles patient.
Gulf Medical University, UAE
Dr Anil Bankar has completed PhD in Medical Tourism from Dr. Babasaheb Ambedkar Marathwada University, Aurangabad (MS) India. At present working as Assistant professor, Gulf Medical University, UAE. He has varied work experience in research, teaching and training medical tourism subjects.
Medical Tourism is an activity that highly beneficial for health improvements and economic development. It creates more jobs, more facilities and people will get access to the latest and greatest services. Medical Tourism is an open area where job opportunities are available in the field of health care as well as tourism sectors. Though medical tourism has a big market, the medical tourism facilitators are struggling for the business and the entire business process is not defined and structured. Worldwide studies revealed shortage of trained manpower in the medical tourism industry and the data in United Arab Emirates (UAE) is not available. In general, medical tourism stakeholders are not getting qualified staff for medical tourism operation and hence it is considered ideal to start medical tourism education. The Knowledge and skill-based specialized medical tourism course is essential to meet the industry’s requirements.
To assess the skills required for the medical tourism facilitator at different level from a stakeholder viewpoint, and to study the perceptions of medical tourism stakeholders towards the medical tourism education.
This research revealed that there is a shortage of trained manpower in the medical tourism industry and most of the stakeholders felt the need for a structured medical tourism program to develop more competent and qualified medical tourism facilitators.
The Aga Khan University Hospital, Pakistan
Dr.Muhammad Tahir Yousuf has been Graduated from Hamdard University of Karachi in the year of 2009 as a Pharmacist with the specialties including Pharmacy, Pharmacology, Pharmaceutics, Quality Assurance, Biopharmaceutics, Medicinal Chemistry, Marketing and Management and Hospital Pharmacy. Clinical Pharmacy Course in Hospital Pharmacy from the Jinnah Post Medical Center (JPMC) then started working at The Liaquat National Hospital as a Clinical and Hospital Pharmacist from 2010 to 2012 where i have continued in inhancing clinical skills. Presently I have been working at the The Aga Khan University Hospital, Karachi as a Senior Pharmacist since 2012.
To excel the Patient/Customer Safety & Satisfaction, reduce Medication Near Miss Errors rate due to the Incomplete Elements of Prescription Orders from consulting from 18% to 10%.
Pharmacist facing difficulties in in dispensing of medication due to Incomplete Elements of Prescription Orders:
Core Benefits of the Projects: -
- Reducing patient waiting time
- Maximize Patient's Safety & Compliance
Continuous quality improvement (CQI) methods were used by a multidisciplinary team to improve and reduce the Medication Near Miss Errors rate and prolonged waiting time of patient at pharmacy and maximize the patient’s safety and compliance. Interventions includes the process of collecting and scanning of Prescription orders, clear criteria for negotiation with Physicians and nursing , process reengineering in reducing of medication errors rate after developing strong coordination between Physician and Pharmacist and awareness sessions daily reviewing process of prescription orders by Senior Pharmacist and other pharmacists and collaboration and discussion with Physicians to emphasis the practices. Strategies were adopted to educate all main stakeholder i.e. Pharmacists Physicians nursing staff.
A CQI process for the reengineering and Quality Care improvement for following complete elements of prescription orders led to the development of clear criteria for Patient Quality, Proper Handwriting of Physician and a patient waiting time at Pharmacy. These changes have been associated with a sustained reduction in Medication Near Miss Errors rate and enhance patient satisfaction in our secondary care institution.
The Aga Khan University Hospital, Pakistan
Rozina Shazad Ramji is working as senior health care professional at The Aga Khan University Hospital, Pakistan.
Patient safety was defined by the IOM as “the prevention of harm to patients.”1 Emphasis is placed on the system of care delivery that (1) prevents errors; (2) learns from the errors that do occur; and (3) is built on a culture of safety that involves health care professionals, organizations, and patients.
Rationale for Selection:
In 2015, each 6 International Patient Safety Goals measured as an key performance indicators against the bench mark of 90 %and it has been identified that SHs has not meeting the targets. In addition in JCIA gap audit the compliances were 4.5/10. These results were took management in to serious action to work on the areas of opportunities.
Project Mission or Goals:
The project aimed to identifying areas of opportunities, to do in -depth analysis of process, designing action plans, execution of plans by implementation of strategies followed by sustainable Plans and strategies.
A multidisciplinary team with representation of all stake holders.
Data Collection Methodology:
The Deming’s cycle was used as project methodology. A multidisciplinary team did focused clinical rounds; based on gap assessment findings, action plan developed and ensured compliances of action plans by project team at regular intervals, followed by sustainable plans and strategies.
Use of Quality Improvement Tools:
Brainstorming sessions were held which provided insight into the problem and revealed defects in the system. The identified causes were displayed using cause and effect diagram (Ishikawa or fish bone).
Objectives define in team and cause and effect diagram developed and based on that action plan developed.
Review training module.
Training will be a part of orientation program.
Now it’s part of orientation. Every eligible health care worker is mandatory to certify for BLS.
Spot check and sensitization.
Discuss issues timely in QICs.
Review policies and develop one new policy for critical result.
User friendly forms developed.
Sticker introduce for verbal & critical result.
Review complains and RCAs.
Monitoring of Action Plan.
Safety Hand book has been developed
Intranet portal develop and all policies are now accessible to users.
Post project sustainability of desired outcomes:
Through this project, challenges were successfully identified and addressed. Implemented strategies resulted improvement in the IPSG compliances.
• Sustainability via ensure compliances of best practices via audits.
• Continuous educational session.
• Provide quality and Pt safety handbook to all newly induct staff.
Patient safety is a new healthcare discipline that emphasizes the preventing, reducing, reporting, and analysis of medical error that often leads to adverse healthcare events. The resulting patient safety knowledge continually informs improvement efforts such as: applying lessons learned from business and industry, adopting innovative technologies, educating providers and consumers, enhancing error reporting systems, and developing new economic incentives.
Shireen Mohammad has done Diploma in Nursing from AKUH, Pakistan. After completing her Diploma in Nursing and serving AKUH in 1993. She re-joined The Aga Khan Hospital for Women, Garden in 2012 as Quality Improvement patient safety officer. In addition to her quality responsibilities she has special interest in quality projects. She has published abstract in ISQUA and IHI and presented quality projects in Brazil on Reducing Surgical Site Infection Rate in Cesarean Cases and Streamlining Reporting System of Critical Neonatal Bilirubin Results in October, 2014. She is also BLS Instructor, member of AKU and CPSP CPR committee, JCIA taskforce committee, Risk management committee and organizer & Secretary of Quality improvement committee.
Healthcare professional’s knowledge and attitudes to ADR and its reporting play vital role to report any cases of ADR. Positive attitudes may favor ADR reporting by healthcare professionals. This project was aimed to investigate the attitudes towards and ways to improve ADR reporting among healthcare professionals working at Aga Khan Hospital for Women Garden. Based on Incident reporting analysis it was identified that only 7 ADRs were reported in 2014 & 2015. However, based on the random spot check as well as through ADR trigger tool file audit it was identified that ADR is a critical issue & not being reported.
Retrospective Study was done for 6 months from Oct, 2015 to March 2016. For the implementation of this project six sigma DMAIC methodology was implemented. Data was measured by filling questionnaire regarding knowledge & attitude of health care workers. Once the data was gathered it was analyzed & further worked on it to improve & control the process with the help of information technology.
ADR reporting form was modified, CMEs were arranged to train all HODs, staffs, Customized IHI ADR trigger tool was developed as well as pharmacist was trained to conduct MR reviews for sustainability, spot checks by HODs to check compliance was done. Pre Project compliance in staff knowledge= 40% Post project compliance in staff knowledge= 94%
Culture of openness should be ensured by regular training and re-enforcement of guidelines for medication management & ADR reporting among health care personnel.
The Aga Khan University Hospital, Pakistan
(Clinical Project): Team Leader: Rozina Shazad Ramji
1. Back ground: Medical records serve many purposes. First and foremost, they document the history of examination, diagnosis and treatment of a patient. This information is vital for all providers involved in a patient’s care and for any subsequent new provider who assumes responsibility for the patient.
2. Significant of the Project: At secondary Hospital it has been identified that significant non compliances in Ambulatory medical records by physician group.
3. Rational for selection of project: In the last two years. It has been observed that ambulatory compliances in the medical Record is not up to the mark. The target of non-compliances is 20% but the actual is above 25% or compliances from 80% to 85% which needs serious attention.
4. Project Mission or Goals: The project aimed to identifying areas of opportunities, to do in -depth analysis of process, designing action plans, execution of plans by implementation of strategies followed by sustainable Plans and strategies.
5. Team Composition: Multidisciplinary team including Administration, Nursing and Security, Led by QPSD team.
6. Data Collection Methodology: Team conducted perito analysis based on file reviewed and identifies areas of opportunities.
7. Use of Quality Improvement Tools: As a tool embedded within Six Sigma methodology DMAIC (Define, Measure, Analyze, Improve, Control) Project Tool was used to examine a process prospectively for possible ways in which failure can occur, and then to redesign the processes so that the new model eliminates the possibility of failure.
8. Significance of Project outcomes: This project enhanced staff (knowledge, attitude, and practice) to prevent from sentinel events. Different strategies were used to overcome issues which include:
ü Develop action plans and monitor timely.
ü Training session has been arranged for physician group.
ü Emphasis in their dept meeting and QICs.
ü Meeting with consultant 1:1 to identify and seek suggestions to improve compliances.
ü Develop user friendly form which was very much appreciated by consultant group.
ü Review Medial Record Audit Tool.
ü Auditor traininghas been done to improve methodology and concept of internal auditor.
ü Flyers pasted for importance and tips of correct documentation.
ü Quality and Patient safety week celebrated to emphasis.
9. Post project sustainability of desired outcomes: Through this project, challenges were successfully identified and addressed. Implemented strategies resulted improvement in the Ambulatory medical record.
• Sustainability via ensure compliances of best practices via audits.
• Continuous educational session.
• Provide quality and Pt safety handbook to all newly induct staff.
Golestan University of Medical Sciences, Iran
Mohammad Reza Hashempour has completed his doctorate at the age of 25 years from Army University of medical sciences and postdoctoral studies from Golestan University School of Medicine in Iran. He has published many papers in many renowned international journals.
The emergence of the virtual world for education has made it available for students to access data and obtains knowledge. Methods based on the Internet Technology Structurally changed the concept of traditional education (old education) and it could correct the old educational system's insufficiencies and was a big change in education. The aim of this study is to represent a successful experience of a surgery resident in Golestan University of medical sciences in Iran between 2014 and 2016.This is an educational case report that studies a second year surgery resident experience about publishing gained clinical knowledge by pictures with regards to the moral principles. For the assessment of the effect of this educational subject, students who visited and followed these pictures on Instagram were used. The experiment of 2 years sharing more than 2100 surgery photos and having more than 16000 followers started in year 2014. It made it available for medical students to have an idea toward different illnesses and different cases without attending any operation room. Findings from the followers' opinions showed that they have a better perception in theoretical studies. In fact showing all of the general surgeries that are not possible to be performed to medical students is a positive point to this study. This educational method is a simple way to alternate scientific data and is a new and creative idea to share scientific opinions. It's easy access and affordability are other reasons for it to be acceptable. Small important points that can be easily learned through pictures may be so hard to be explained with words.