Middle East Hospital Magazine - May/ June 2011

Middle East Hospital

May/June 2011 contents4. COVER FEATURE:

DDC Dolphin - Experts in infection control: providing all-in-one dirty utility room equipment manufacture, installation, testing and servicing

10. MJ Medical: 25 years of hospital design excellencein the Middle East

16. LEEC: Laboratory, funeral and mortuary products

18. Specialist article by Dr

Peter Briggs: Better hospitals for less money

22. Snoring Disorders Centre:

Sleep apnoea diagnosis and treatment clinic

24. The Multidisciplinary

Assessment of Technology

Centre for Healthcare

(MATCH) Tools workshops

28. World Health Care

Congress Middle East:

Adu Dhabi preview

32. Sidhil: New dynamic therapy mattress systems and the Innov8 bed

34. Hospital Build Middle East: Review of Dubai show

36. World Health Organisation:

New report on noncommunicable diseases

39. Hospitalar Brazil: Review of premier Latin American healthcare show

40. How does the nose know?

Research into the geneticsof smell at Weill Cornell Medical College in Qatar

44. Medical research into lung

disease: Healthcare and Bioscience iNet grant enables new research intoCOPD in the UK

46. Unlocking Cronobacter

infections of neonates

using genome

sequencing:

Specialist genetics article by Eva Kucerova and Stephen J. Forsythe

48. Philips Middle East: Latest sleep therapy systems showcased in Dubai

50. MEH Healthcare and

Innovation Awards:

Nominations still open for the 2010 awards, to be presented at the World Health Care Congress in Abu Dhabi

Editor’s intro

Editor: Guy Rowland

Publisher: Mike Tanousis

Associate Publisher: Chris Silk

MEH Publishing LimitedCompany Number 7059215151 Church RdShoeburynessEssex SS3 9EZUnited KingdomTel: 0044 1702 296776Mobile: 0044 0776 1202468Skype -mike.tanousis1

May/June 2011 | 3

MEH France officeGuy RowlandTel : 0033 [email protected]

Features Editor: Emrys Baird Tel 0044 [email protected]

MEH agent for EgyptDr.Amr SalahMillennium International Group(Managing Director)[email protected]: +2 0222736354

Fax: +2 022747691Mobile: +2 0122227209

UAE distributorDr Prem Jagyasi MD & CEOExHealth P. O. Box. 505131Dubai HealthCare City, UAETel:+971 4 437 0170 [email protected] www.ExHealth.com

Abu Dhabu & Bahrain officeMs. Pam PagePO BOX 4652 ABU DHABI

Direct Phone: +971 4 329 1099UAE Mobile: + 971 50 424 0569USA Mobile: +617 943 [email protected]

Agent for GreeceCGM LtdErmou 16, strovolos, 2062Nicosia, CyprusTel: 35722515598Fax: 35722515597

To discuss the submission of anarticle email: [email protected]

In this issue we highlight someof the cutting-edge geneticsresearch currently being carriedout both in the Middle East andthe UK, with two specialistarticles; one from Weill CornellMedical College in Qatar; andthe other from researchers atNottingham Trent University.

We cover the new WHO reporton noncommunicable diseases,and continuing with theresearch theme there is anarticle on lung diseaseresearch, and a look at the roleof the MATCH researchcollaboration in driving medicaldevice innovation anddevelopment in the UK.

Our cover feature introducesDDC Dolphin, a company with20 years experience in dirtyutility room design andmanufacture; and the onlycompany to offer an all-in-oneservice. We also look at thework of hospital planners MJMedical, with a case study oftheir latest project in Iraq.

Also profiled are MEH awardnominees LEEC and Sidhil, andthe leading UK sleep apnoeaclinic; the Snoring DisordersCentre.

Guy Rowland, Editor


May/June 2011 | 4

DDC Dolphin - the sluice room company

DDC Dolphin are dedicated toexcellence and innovation in dirtyutility room design, equipmentmanufacture, installation, testingand servicing. Established for over20 years in the UK, the companyis rapidly expanding internationallythrough a network of experienceddistribution partners.

The company specialises inhygienic dirty utility rooms inhospitals, hospices, care homesand special needs schools. Twentyyears of experience allows them toprovide comprehensive andmeaningful advice and supportthroughout planning, design, andspecification processes for new orexisting facilities.

Designing hospitals for the 21stcentury requires an innovative,informed and cost-effectiveapproach. Incorporating sluicerooms into the architectural designof new hospitals needsconsideration of all factors relatingto, as a minimum, infection control,access, flow of work, and layout.Dirty utility room design must meetor exceed Healthcare AssociatedInfections (HCAI) policies.

A demonstrably integrative andrigorous approach is required thatmeets the specific needs of thehospital design in hand. DDCDolphin pride themselves on beingable to supply all of the needs ofdesign teams at this critical stageof the hospital design process,through the application of theirunique one-stop-shop methodology tosluice room design.

“Our industry-leading technology,such as our newly patentedhands-free equipment andMicrobe safe surfaces, allow us totailor solutions to yourrequirements and enable you tocomply or exceed infection controlstandards”, says the company.

“We are the only manufacturerin the UK to offer the full rangeof dirty utility room products.Our design team has specialistand comprehensive knowledgeof all aspects of dirty utilityroom equipment, and our 'one-stop-shop' approach gives us aunique and valuableperspective that allows us tooffer impartial advice and tailorsolutions to your requirements.Our website provides detailed

specification of each productwe manufacture, along witharchitectural plans for eachunit that are downloadable,allowing direct incorporationinto overall designdocumentation.”

They are the only companythat focuses exclusively on thedesign of effective andhygienic dirty utility rooms, andthe manufacture, installation,


May/June 2011 | 5

and servicing of state of the artproducts to suit, including:

DDC Dolphin are unique indeveloping and manufacturing allDirty Utility technologies.

MEH met with DDC Dolphin Salesand Marketing Director, Rob Elliott.He said, “My remit is thedevelopment of DDC Dolphin intoa truly global business. I have 25years healthcare experience in theUK, and internationally, working forlarge multinational companies.Asked about their business in theGulf, Mr Elliott told MEH, “With thehuge new hospital buildprogramme across the whole

Middle East, we see this as one ofour key development regions.DDC Dolphin are investing in thedevelopment and training ofdistributors across the region. Weare working to establishdistribution partners across wholeregion by end of 2011, and alreadyhave formal distribution

Creating hygiene through innovation

• Pulpmatic Medical Pulpmacerator • Panamatic Bedpan Top & Frontloading washer disinfectors • Incomatic Incontinence waste macerator • Hygenex sanitaryware andconsumable products

arrangements with Al Hayat inUAE, Almura’a in Saudi, and aretalking to others in Qatar, Kuwaitand other key markets. “January2011 saw our first attendance atArab Health as exhibitors, whichwas a great success in terms ofmeeting potential partners, andimportantly the ultimate end users

from hospitals of our equipment. Itwas also useful to hear moreabout building developments in theregion. We see opportunitiesacross the whole region butobviously the Kingdom of SaudiArabia and the Emirates areparticularly important to us”

Mr Elliott explained the companyphilosophy, “We at DDC Dolphinrealised long ago that innovationand development were thefoundation of meeting andexceeding the ever-changingrequirements of our customers ona worldwide basis. We are in aunique and knowledgeableposition to recognise needs in themarketplace, and to address themthrough new technology, andthrough better use of existingtechnology.

“For example, our team of designengineers are working with silver-based anti-microbial materials tobetter control the risk of infectionin dirty utility rooms/sluice rooms.Also, our latest PulpmaticMacerator incorporates newlypatent pending technology withhands-free operation to reduce therisk of infection, short maceratingcycle to reduce power and water

consumption, and larger capacityto increase efficiency of operation”.The company has been nominatedfor an MEH award for theirPulpmatic Macerator.

The combination of two decadesof specialist experience, acommitment to evolution andadvancement, and most

DDC Dolphin - the sluice room company


May/June 2011 |6

importantly listening to theircustomers, have been key factorsin maintaining DDC Dolphin’sposition as market leaders insluice room and dirty utility roomproducts and services throughoutthat time.

www.sluice.co.uk

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Product focus: Pulpmatic+ Macerator

Unique Hands Free Operation

Pulpmatic+ Macerators offer complete hands-free operation by means of a foot plate at the base of themachine and an optical sensor to close and start the machine. The Pulpmatic+ is the only machine withcomplete hands-free operation making it not only more convenient, but also more hygienic to use thanother macerators and reduces the potential for cross contamination.

Efficient and Economical

Pulpmatics offer greater efficiency, made possible by the unique design features including the Nine-blademaceration disc allowing faster and quieter operation. Not only does this help you cope better withworkload peaks, but it translates into significant operating cost savings in terms of staff time and of waterand electrical consumption per item processed.

Dual Antimicrobial Action

In addition to using the latest antimicrobial materials Microbesafe – Silver Nanotechnology in its lidconstruction, the Pulpmatic+ offers automatic disinfection of the internal maceration chamber. Thechamber is rinsed thoroughly, not only with water, but also with DDC disinfectant EcoCleanse+ leavingit clean and smelling fresh.

Environmentally Friendly

The Pulpmatic+ Disposal system uses recycled paper products and offers low water consumption helpingto reduce environmental impact.

Simple to Install

The overall design of the machine and its electrical and water connections make installation a simpleand quick process in almost all situations.

Easy Servicing Programme

Pulpmatic+ after-sales service is handled by a team of fully trained engineers, guaranteeing the verybest in response times and specialist knowledge.

Versatile Operation

Compatible with all makes and manufacturers medical disposable pulp products.

Creating hygiene through innovation

Complete range of disposal technologies

The Spirit of Innovation

Laboratory Products

FuneralProducts

Mortuary Products

World’s first 200°

sterilisation

At LEEC we aim to exceed

customer expectations for

quality, delivery and cost

through continuous

improvement and

customer interaction

LEEC Private Road No. 7, Colwick Industrial Estate,Nottingham NG4 2AJUnited Kingdom Tel: +44 (0)115 961 6222 Fax: +44(0)115 961 6680 Email: [email protected]

www.leec.co.uk


MJ Medical is a leading UK andinternational healthcare consultancy.Their portfolio of consultancyservices spans the continuum ofthe hospital planning, design andmanagement process, frominception to project completion.

Their key services include healthfacility planning, medical equipmentplanning, Room Data Sheet (RDS)Pack management, 1:50 RoomLoaded Drawings, and medicalequipment procurement consultancy(including installation andcommissioning).

MJ Medical’s services are available tocommissioners and developers atany stage of a healthcare facility

project. They employ over 30technical and commercial staff,and have worked on 130 projectsin over 36 countries around theworld.

Established in 1987, MJ Medicalhas a history of successfulconsultancy and procurementprojects both internationally(including projects in Africa, Asia,Middle East, Europe and theAmericas), and within the UK.

Nathaniel Hobbs of MJ Medicaltold MEH, “While our businessbegan as a one man consultancyin the Middle East, we focusedheavily on the UK in the 1990sduring the hospital building boom

that came with the advent of PFI.The Company grew from 6 peopleto 30. We have been re-engagingin the Middle East since the startof major hospital buildingprogrammes in the mid-2000s.

“I came from a development andeconomics background and myrole is to focus on new business inthe Middle East. We built alaboratory in Iraqi Kurdistan justafter the 2003 invasion. We arenow building several 300-400 bedhospitals in Iraq, and two militaryhospitals in Saudi Arabia. We alsohave ongoing projects in Qatar.

“We have over 25 years’ experience ofworking worldwide and continue to be

MJ Medical - cohesive clinical thinking

North Bristol PFI hospital, UK

May/June 2011 | 10


25 years of hospital design excellence

involved in a number of projects acrossthe globe. We understand the focus onexcellence and quality and we providethe necessary International standard ofconsultancy to help deliver world classfacilities.”

MJ Medcial’s services

MJ Medical has developed intoone of the world’s most dynamicand respected healthcareconsultancies. The companyspecialises in hospital and clinicalequipment planning, design andprocurement management in thehealthcare, life sciences andmedical technology sectors.They are working with hospitaloperators around the world to

design facilities that meet modernhealthcare requirements andstandards as well as providingflexibility to accommodate the everchanging needs of healthcareprofessionals. They have aninvaluable insight into the clinicalfunctions and moderntechnological advances ofhospitals and medical equipment.

MJ Medical’s services areavailable to the NHS, Ministries ofHealth, national, regional and localgovernments, voluntary, and privatesector organisations at any stage of ahealthcare facility project. Their team ofexperts have advanced experience ofdesigning and project managinghealthcare facilities combined with

international acuity and first-handknowledge of every region in the world.

Specialist Services

-Health facility planning-Medical equipment planning-Room Data Sheet (RDS) Packmanagement-1:50 Room Loaded Drawings-Medical equipment procurementconsultancy (including installationand commissioning)

Mr Hobbs adds , “We specialise indelivering ambitious andinnovative Health and Social Careprojects that achieve the Client'soperational vision and go on tosuccessfully enhance the patientexperience of the communities

Example of a clinicalflows diagram

May/June 2011 | 11


MJ Medical

who use them every day. We haveplayed a key part in landmarkhealthcare facilities and the healthand equipment planning design ofnew and innovative structures.Our leadership in our service fieldis reflected in our globalcollaboration with leading industrybodies such as the World HealthOrganisation, UK Department.”

The MJ Medial approach

“Our approach places clinicalfunctionality at the forefront ofconsideration for a healthcarefacility, along with commercialrequirements to achieve Value forMoney. We have the flexibility totailor our clinical services andprocesses to reflect thedeliverables for any project”, saysMr Hobbs.

“We can competently undertake alltypes of commissions, comfortablyworking with and co-ordinatingdesign teams and independentconsultants, as well as projectmanaging specialist services forthe most diverse and complexprojects. All of our projects areunderpinned by PRINCE2professional processes andISO9001:2008 accreditation,which forms a cohesive foundationfor our portfolio of services.

“MJ Medical works hard to ensurethat the services we offer to clientsare relevant, responsive andefficient. We understand theinterdependency between eachservice within health facilityprojects and the importance ofcreating cohesive links between them.

We are committed to workingtowards the benefit of the entireproject and not just the success ofthe service for which we arecontracted. By seeing the bigpicture we can ensure our serviceis not only appropriate, but alsoenhances the project as a whole.

“The benefit of the lessons learnedfrom previous projects allows us tocontinually identify risks andimprovements, seek efficiencies,and develop innovation. MJMedical keeps abreast of the latestHealthcare developments andclinical procedures and we haveworked closely with leadinghealthcare research institutions(the Medical and Architectural

Research Unit, and otherinternational health Think Tanksand health advisory groups) onhigh profile agenda items toensure our services are cognisantof future healthcare trends.”www.mjmedical.com

An example of designing a clinical room in 3D using Building InformationModelling (BIM)

Al Mowasat Hospital, Saudi Arabia

May/June 2011 | 12


International Project Case Study

General Teaching Hospitals,

Republic of Iraq

Project Profile

Health care services in Iraq were

not considered to be a priority

during the last 30 years, which

resulted in the progressive

deterioration of the healthcare

system, particularly due to

budgetary allocations not

reflecting population growth.

Health indicators also fell to levels

comparable to some of the least

developed countries. This has led

to great deficiency in the number

of national hospital beds available.

The Ministry of Health, Republic ofIraq aims to improve health careservices by increasing hospitalbeds through constructing 3 newand international standard GeneralTeaching Hospitals each with 400bed capacity all over Iraq.

The US$400m facilities comprise

the following major elements: A&E

(including Trauma), Emergency

Inpatients, Surgical Inpatients,

Theatres, Oncology (including

Tomotherapy), Burns, Outpatient

Clinics, Women’s and Children,

Pathology, and residential blocks

amongst other general hospital

functions. The project is due to be

completed May 2012.

MJ Medical’s role

MJ Medical were appointed byACA Alliance in 2009, as part of acollaborative partnership withinternational stakeholders, toprovide Medical Planningconsultancy services for all threehospitals in the regions ofDiwanya, Diyala and Baghdad.

MJ Medical is responsible forassisting the client develop theoverall strategic brief and goals forthe three schemes, andoverseeing the translation of thisbrief into the operational planningand design of the hospitals.

MJ Medical remains clinicalchampions for the projects as well

Case study: General Teaching Hospitals, Iraq

May/June 2011 | 14

as providing equipment planning,RDS pack management andprocurement management,installation and commissioningworks for all three hospitals.

The equipment planning andprocurement team assigned to theproject included Danny Gibson asProject Executive, Brian Hobbs asClinical Consultant, SimonCuthbertson as Project Manager,and our team of project officers,which included Steven Sharpe,Tim Salmon, Gemma Ham,Jonathan Pert, Michael Carlyonand Timothy Whitman.

Key Deliverables

In order to comply with theMinistry of Health’s brief toprovide a patient centred,modern and restorativeexperience for staff andpatients, our design needed torespond to and counterbalance the hostile siteconditions of the regionallocations as well as the socialand political unrest within thelocal communities.

MJ Medical developedoperational policies, aschedule of accommodationand functional relationshipdiagrams that drew on bothevidence based internationalbest practice as well as a localcultural sensitivities andconsiderations.

This achieved a clinicallyfunctional design conceptrespectful of its context butultimately engineered to createa healing and non-aggressiveenvironment in highly unstableregions of Iraq.

Interview with founder of MJ

Medical, Brian Hobbs

Starting out by giving advice tohospitals on what equipment tobuy, Mr Hobbs then opened aconsultancy company givingadvice on hospital building. “Myfirst contract was working on theplanning and equipment aspectsof the building of the Al Haddadmilitary hospital in Saudi Arabia. Ithen continued to work in Saudi,the largest project being the the AlMowasat hospital, which took twoyears”.

“I then became involved inequipment procurement as well asplanning, and worked with a freightcompany called Martin James,which then became MJ Medical in1987. Due to the high demand for“turnkey” equipment in many partsof the world at that time the workbecame more about the logistictasks of the supply of equipment.

With the advent of PFI in the UK inthe 1990s MJ Medical movedaway from procurement ofequipment, and back toconsultancy, advising newhospitals on what equipment tobuy. The company then began torefocus on the Middle East in theearly 2000s.

“The Middle East tends to be verysophisticated in terms of hospitalplanning, with a forward lookingapproach to the design andbuilding of new hospitals. Thisensures that new equipment canbe adopted and incorporated intothe hospitals as technologyadvances in the future. It isimportant to have relationshipswith the key players in medicalproduct production (such asimaging manufacturers), in orderto be able to predict how theinfrastructure of a new hospital willneed to adapt to house the latest

technologies. We therefore have aclose relationship withmanufacturers, without actuallypromoting their particularproducts.”

The USP of MJ Medical is thatthey provide a comprehensiveservice to clients covering allstages of the process of building anew hospital; from concept,through design, construction, andequipment procurement. Theymake sure the finished hospitalmeets all the needs of the client,staff and users.

“All of our equipment planning,imaging and development isavailable to the client via weblinksthrough our Online StakeholderUpdate (OSU). People can accessthis at any time to see whatequipment is in a particular room,and how it is laid out. They canthen ask questions and makesuggestions about a particularpiece of equipment, and we willknow exactly what they are lookingat and be able to answer in realtime. The rooms can be seenthrough the Room Data Sheet, orby looking at the actual image ofthe room.”

“Through the new BuildingInformation Modeling Systems(BIM), you can now see a room invirtual reality. We are using this oncertain projects at the moment,and in the near future people willbe able to enter a new hospital asa virtual world using this system.”

MJ Medical - cohesive clinical thinking


Brian Hobbs (r) and Jon Pert

May/June 2011 | 15


May/June 2011 | 16

manufacturing laboratory andmortuary equipment. “Our factory is next to ourheadquarters in Nottingham andhouses our greatest asset; highlyskilled engineers. We believe thatthe key elements essential in

achieving our objectives are theprovision of highly skilledpersonnel, the right materials,equipment, clearly definedmethods of working and continualcommunication and the promotionof quality throughout the

LEEC Limited is an independentprivate company which offers thepersonal service and interest thatis so highly valued by all ourcustomers together with theefficiency you expect from atechnologically progressivecompany.

With nearly 60 years of experiencein the design and manufacture oflaboratory incubators and a widerange of other laboratory andmortuary equipment, we remainthe clear leader in the field ofautomatic CO2 cell cultureincubators.

Paul Venners, Managing Directorand owner told MEH, “We employthe latest manufacturing methods,and maintain an excellent recordof technical superiority. Thisconsistent policy ensuresunrivalled reliability in all productswhilst keeping prices competitive.By continuous review andupdating of our products, we areable to take advantage ofadvanced control systems tofurther enhance equipmentperformance. “Strict attention tocustomer service by qualified staffin all departments ensures thehighest standard of after salessupport.”

Mr Venners added, “It is our policyto pursue Customer satisfaction bysupplying Laboratory andMortuary products that are Qualityassured and delivered on time. Inorder to achieve this we mustremain competitive now and in thefuture, through continuous qualityimprovement from our employeesto all aspects of our processes, inaccordance with our Qualitysystems.”

Made in Nottingham

LEEC's factory was built in 1960sand has been going strong eversince. LEEC's factory is one of theUK's market leading facilities for

LEEC - the spirit of innovation

company”, said Mr Venners. “Weat LEEC are committed to thispolicy and are convinced it willlead to pride in workmanship,pride in the company and pride inour accomplishments.”

The LEEC factory contains state ofthe art equipment including : thelatest CNC (computationalnumeric control) machinery,2.6KW laser, CAD (computeraided design). They also have acustom design area for makingincubators for every customer’sneeds. LEEC use high grade 304,316 stainless steel.

Export success in 2011

LEEC has recently securedexport orders for its innovative,state-of-the-art CO2 incubatorswith the support of theHealthcare and BioscienceiNet. Crucial tests to prove thatthe incubators can besuccessfu l ly s ter i l ised pr iorto use have been carr ied outwi th the help of subs id isedinnovat ion support f rom theHeal thcare and Biosc ienceiNet.

The test findings to proveefficacy at 200°C have helpedgenerate over 40 orders for thehigh-spec units. LEECreceived a further iNet grant inJanuary to test at 160°C for theFar East market. Export salesfor the £6.7 million turnovercompany have grown from 15%to 30% in 2010 and thecompany is aiming for 70% ofsales from exports in the next3 years.

www.leec.co.uk


May/June 2011 |17

Laboratory, mortuary, and funeral products

Specialist Article: Better Hospitals for Less Money


May/June 2011 | 18

Patients achieve improved out

comes and hospitals can

reduce costs with smart

thinking and forward thinking

management

Doing better for less can be done.It needs a four pronged attack:

• Use doctors as managers.Give them seasoned managementsupport, not edicts or rigid targets.

• Remember your product isnot one thing. Your ‘factory forhealth’ has many products. Twowould be general surgery andgeneral medicine. Each productneeds your concentration.

• Get modern - use availabletechnology to improve care andsave cash but keep an eye on thecost of IT equipment and people.Telemedicine, treating patients offpremises, involving communitiesat all levels are but some of theoptions.

• Concentrate on specialtieswhich pay their way and are trulyneeded in the community servedby your ‘factory for health’.

Hospital costs are rising throughout theworld. Health demand, ageingpopulations and ever growingspecialisation have, in the UK alone,forced the government to look for£20billion of health savings by 2015.This is dramatic by any standards. Itrequires fewer accident departments,fewer large hospitals.

Not every hospital needs its ownunit for major trauma, strokes orheart attacks. Lower cost care inthe community must be pursuedmore seriously. Telemedicine isbut one option. Hospital beds areexpensive in any country withample scope for fewer of them.They consume money and staff atexcessive rates. Productivity in UKhospitals has gone down in thelast ten years with over-

specialisation, too many beds,unchecked staff growth and payincreases.

Lengths of stay and emergencyadmissions can always bereduced, day surgery can be givenhigher priority. Follow-up care canmore frequently be undertaken inthe community.

Average lengths of stay vary byhospital. New ward basedcomputer systems (see www.realtimehealth.net) can show onone screen the length of stay forany patient that day comparedwith the average expected for theirdiagnosis. Any staff member cansee the efficiency of a ward. Theneed to thumb through a trolley fullof notes on the time honouredward round becomes redundant.

Most hospitals continue to jugglecosts from the top down as if theyare a one product company. Thisignores the simple fact that mostdoctors and senior nursing staffare best positioned to influencetreatment costs. If given financialresponsibility for their specialty(with support) attitudes to costsaving options undoubtedlychange for the better. In the UKsome more enlightened hospitalshave appointed clinical directorswith budgetary responsibility fortheir specialty. There have beenencouraging results.

Most medical care is a provided bya series of clinical pathways forindividual conditions orprocedures. Hundreds of them forexample diabetes, chronic lungdisease, heart failure, routinecardiology usually involvecomplicated and unnecessaryinterventions, frequent hospitalout-patient visits and multiplelaboratory and other tests. Toooften it is normal to use overoverqualified and costly staff forthe procedure in question.

Simplified clinical pathways arethe key to lower costs in allhospitals.

Clinical procedures / pathways canbe simplified, but not from the topdownwards. We need to empowerstaff and give them incentives.Here the first step is budgetarydelegation. Specialties needingtheir own budgets includemedicine, surgery, orthopaedics,maternity, paediatrics, casualty,pathology, radiology, renal, cancerand other services.

Other saving options will alwaysbe necessary. Reduced staffsickness, efficient estatemanagement, better drug andequipment procurement,community based clinics,telemedicine development shouldbe considered.

Keeping hospital costs undercontrol requires innovativemanagement, new ideas and,above all, staff involvement.

• Get with it.• Improve patient care.• Make money.

There is no escaping the oldadage it is never too late to earnand its corollary every new on thehorizon can be helpful.

Peter W Briggs, Director

Health Audit International

www.health-audit.com

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DDC Dolphin LtdThe Fulcrum, Vantage Way, Poole, Dorset BH12 4NU UKtel: +44 (0)1202 [email protected]

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May/June 2011 | 20

Commissioning is a two stage

process: namely a Feasibility

Study followed by actual

Commissioning

The Feasibility Study

Public or private Hospitals

• Public or private sectorhospital – a major difference as apublic hospital needs to fit in withthe countries’ needs in termsof a planned health network tomeet local or country wide needs.A private hospital, by contrast,needs to work in a competitivesituation i.e. is the market there?• A feasibility study has to becompleted first in either case as itdetermines the balance ofspecialties and staff required.Once staff recruitmentcommences big money has to beallocated and subsequentchanges in direction will costmoney i.e. wasted money.

Health Needs

• What are the health needsof the country as a whole bydemography, age breakdown, atrisk groups, specific conditions?• What is the state of healthin the community particularly childhealth, maternity and the elderly?

Government Views

• What is the attitude of bothgovernment and people in generalto health in terms of geographicalconvenience?• What does the relevantgovernment consider its healthneeds to be? What are the healthpolitics of the governmentin question?• What is the availability ofmoney for health in general i.e. %spend of GNP versus othersectors e.g. education,social services, defence etc.

Country Wide Specialty Needs

• What are hospital bedshortfalls in total and by specialty

throughout the country?• Does the proposedhospital facility fill an obvioushealth need or shortfall?

Staff Availability

• What is the availability ofdoctors, nurses and scientific /technical staff in the countryconcerned or near theproposed facility in question?• If there are local staffshortfalls what is the availability oflocal staff resident abroad oralternatively overseas staffwilling to relocate?

Hospital Design and Layout

• If the hospital is alreadyconstructed details will be neededof its construction, its architecturallayout, its bed and servicesdistribution as these may havesome influence on what specialtiescan be physically housed.

Local Politics• What are the local politicsin terms of how welcome thehospital will be among theimmediate local community.

Feasibility Duration

• The above feasibility willfor a large hospital need ‘at least’two man months of time i.e. two

people working togetherfacilitated by a local interpreter ora bilingual senior personnominated by the client. Asmaller hospital would obviouslytake much less time.

Population Health Background

• General health profiles forMiddle East countries areavailable from the Britishgovernment via UKTI –these would need to be veryconsiderably amplified by localcountry sources

Final Report

• The feasibility, whencompleted, will be presented to theclient as a ‘stand alone ‘ report toenable decisions to be made onspecialty mix, commissioningtimetable, cost, ease of staffrecruitment.

Peter W Briggs

www.health-audit.com

Commissioning Hospitals: the Feasibility Study

outstanding contributionto healthcare in the

Middle East

MEH

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Health and Innovation Awa

rd

The Arab region’s leading healthcare monthly, Middle East Hospital magazine (MEH), are proud to announce the opening of nominations for our 2010 Healthcare and Innovation Awards.

Winners will be presented with their awards at Saudi Medicare 2011 by the Saudi Health Minister.

The MEH Healthcare and Innovation awards are presented annually to companies, institutions and individuals who have made an outstanding contribution to healthcare in the Middle East region.

Categories:1. Awards for most innovative products for export

2. Awards for outstanding contribution to healthcare in the Middle East

3. National and regional awards for companies that have most successfully marketed and supplied their products to hospitals in the Middle East

4. MEH excellence in healthcare awards

Middle East Hospital (MEH) magazine is the region’s leading trade publication for the medical sector of the GCC states and the rest of the Arab world.

To enter your company or hospital contact:

[email protected] visit

www.middleeasthospital.com

2010 HEALTH and INNOVATION AWARDSNominations now open

2010 H

TH an HEAL LTH and INNO

AVVA nd INNO

AWWARDSAAWTION AATION

ARDS

The Ara Middle to anno 2010 Healthcare and Innovation A

p g 2010 Healthcare and Innovation A

wards. to healthcar

g e in the Middle Eastto healthcar

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[email protected]

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Winners will be presented with theirawards at the World Health Care

Congress Middle East, held from 11-13December 2011 in Abu Dhabi

treatment used to cure thecondition is not expensive toadminister, and is extremelyeffective, having beenrecommended by the UK NationalInstitute for Health and ClinicalExcellence (NICE) since 2008.

Although about 20% of thepopulation snore, OSA is thoughtto affect between 2 and 4% of thepopulation and is at least twice ascommon in males as females. Inpractice overweight males insedentary occupations (lorry driverfor example) in their 30s and 40sare the group most commonlypresent in the clinics, with a historyof loud snoring and fatigue.

Emphasis on patient satisfactionWhat is important to a patient?According to Snore Centrepatients what they want is: to beseen by a friendly doctor; in atimely manner; in a pleasant andclean environment; and to begiven a high quality service. Thelevel of success in achieving of allthese things by a healthcareprovider is measurable, and ismeasured at the Snore Centreusing the latest interactivetechnology.

Mr Oko said, “At the moment thereis no clear evidence available topatients - when choosing a place

Snoring in the Middle East

Levels of excessive weight gainassociated with wealth,hypertension and heart diseaseare rocketing in the wealthy MiddleEast, mainly due to the modernlife-style.

Being overweight can be a majorcontributory factor in Obstructivesleep apnoea (OSA) in 2/3rds ofcases, when a person temporarilystops breathing many times duringthe night. This deprives people ofdeep REM sleep and results indrowsiness and fatigue the nextday. It’s when we’re tired that wemake mistakes, especially whilstdriving. It may well be a significantcontributory factor to the roadtraffic accidents that are thesecond major cause of deaths inthe UAE.

The Snoring Disorders Centre (orSnore Centre) was founded in2006 by Mr Michael Oko, aconsultant ENT surgeon, todevelop exceptional services topatients for the diagnosis andtreatment of OSA. Mr Oko, hashad great success in treating OSAat his Snoring Disorders Clinicbased in the Pilgrim Hospital(Boston, UK). The ContinuousPositive Airway Pressure (CPAP)

to go for treatment- about thequality of the service they couldexpect to receive. People need tobe given the full picture fromhealthcare providers, whetherpublic or private, and then theycan make an informed choice.Patient satisfaction should be atthe heart of all healthcare.Healthcare is a service industry,but it doesn’t seem to behave likeone. If you’ve got no evidence thatyou are delivering a good serviceto your patients, then it isimpossible to review and improveupon.”

The Jayex QI Interactive systemallows Mr Oko to obtain theinformation that enable him totransform services to specificallymeet the needs of the patient. Bycontinually monitoring patientfeedback all year round in real-time, he can analyse hisperformance on an ongoing basis.

Mr Oko saw 383 patients at theSnoring Disorders Centre fromApril 2010 to April 2011 and onaverage 96% of patients were verysatisfied with the service theyreceived across five categories(understanding, explanations,friendliness, politeness, listening),and 82.5% were very satisfied withthe cleanliness and pleasantnessof the surroundings (with 96.5%satisfied or very satisfied).


May/June 2011 | 22

The Snoring Disorders Centre

Derek, aged 67, discovered hehad sleep apnoea when his wife,a sleep apnoea sufferer of over10 years, noticed his excessivesnoring.

“My wife used to stop breathingduring sleep and was diagnosedwith sleep apnoea at a sleepclinic. She had been receivingtreatment for 6 years. So whenMr Oko opened his clinic inBoston I went to be tested, and

Sleep apnoea and snoring specialists

was also diagnosed with sleepapnoea.

“Now I am receiving treatmentand my quality of life has beentransformed. Mr Oko explainedto me what was happening andworked with me to find theappropriate treatment.

The treatment is a continuousprocess, and Mr Oko ensures Iget 100% from the CPAP

Snore Centre patient case study


May/June 2011 | 23

CPAP FOR SLEEP APNOEA

While you sleep, a CPAP machine delivers oxygen and air at a slightly higher pressure than normal air.

LIFESTYLE CHANGES

Changes to your life alone can enhance your sleep and help prevent sleep apnoeaand snoring.

SURGERY FOR SNORING

Surgery that changes the shape or sizeof the soft tissues within your mouthor ear, nose and throat surgery.

MANDIBULAR DEVICES

Devices to stop your jaw and tongue blocking your airway and causing snoring to wear at night.

Signs of Sleep Apnoea

• Loud snoring • Breath holding at night

(apnoea) • Daytime fatigue • Short term memory loss • Multiple trips to urinate

through the night • Early morning

headaches• Loss of interest in sex

[email protected]

THE SNORING DISORDERS CENTRE IS A NEW AND INNOVATIVE SERVICE LED BY CONSULTANT SURGEON MR MICHAEL OKO.

The centre provides an accurate and prompt diagnosis and treatment of various sleep problems including sleep apnoea and snoring. Problem snoring and sleep apnoea are a more widespread problem than most people think.

AWARD WINNING SERVICESIn 2008 the Snoring Disorders Centre won the NHS East MidlandsHealthcare Award for service transformation. Today, patients travel thelength and breadth of the country for Mr Oko's unique service.

Our aim is to deliver high quality clinical care in a friendly environment.We are looking for partners throughout the region

wwwwww..ssnnoorreecceennttrree..ccoomm mmiicchhaaeellookkoo@@mmee..ccoomm

OUR SERVICES

SLEEPING DISORDERS

machine, and found the bestmask to ensure as comfortableand peaceful sleep as possible.

“Having a local clinic at Bostonhas been a godsend in terms ofgetting access to treatment, andmy wife has also been able totransfer there to continue hertreatment.”

www.snorecentre.com

www.snorecentreblog.net

May/June 2011 | 24

The Multidisciplinary Assessmentof Technology Centre forHealthcare (MATCH) is a well-established research collaborationbetween four leading UKuniversities (Birmingham, Brunel,Nottingham & Ulster) and a cohortof industrial partners, alsosupported by stakeholders fromthe NHS and other public sectororganisations.

MATCH, funded since 2003 by theEngineering and PhysicalSciences Research Council andpartner subscriptions, provides acritical research mass in the fieldof health technology assessment(HTA) in its widest sense, bringingtogether expertise in healtheconomics, engineering and socialsciences.

Through the translation of itsresearch, MATCH supports bothcompanies across the UKhealthcare technology sector anduser communities, deliveringmethods and tools to assess thevalue of medical devices fromconcept through to matureproduct. MATCH aims to transformthe medical device sector through

improved decision-making, so thatcompanies bring better products tomarket more quickly and lessexpensively, whilst healthcareproviders are able to adoptproducts with confidence morerapidly.

By engaging with UK advisorybodies MATCH is also influencingpolicy, and, through its work withprocurement organisations, hasprovided the NHS with bettermethods for buying technology.The focus is on making gooddecisions early in productdevelopment and improvingprocesses for adoption ofinnovations. In support of this, overthe past seven years MATCH hasresearched evidence-gatheringstrategies, early-stage healtheconomics, methods for elicitingthe needs of users, the linkbetween clinical demand andbusiness process, and investmentdecisions.

Inventing and marketing medicaldevices has always been achallenge; a challenge nowheightened by the credit crunch.There is great pressure on SMEs

in terms of market access andfinance for both development andday-to-day running, whilst thethirst of purchasers for value formoney is unabated.

Although there is recognition bythe government that thehealthcare industry is a plus for theeconomy, there are fears ofcutbacks in expenditure on medicatechnologies alongside the belt-tightening forecasts for the NHS.All ofuncertainty in early stagedecisionmakin within developmentand adoption processes, andMATCH maintains that this can beachieved by addressinguncertainty through the use offormal methods and throughmutual understanding of thesemethods by suppliers and buyers.

MATCH has translated theknowledge generated by theresearch outputs of the first sevenyears into tools to support healthtechnology assessment and hasbeen organising ‘Tools andTraining’ workshops around theUK. During the past two years thishas been in collaboration with theregional Medilink organisations,

MATCH Tools Workshops – distilling expertise for health technology innovation

Michael Craven, Alan Brown, Elizabeth Deadman, Jennifer Martin, Peter Taylor and Simon J E Taylor

Multidisciplinary Assessment of Technology Centre


the Association of BritishHealthcare Industries (ABHI) andthe MATCH partner universities.

The half-day events are dedicatedto interactive tools training andhave hosted participants from theNHS, the medical device industryand innovation service providers.Due to attracting a diverseaudience, the events have alsobeen excellent cross-sectornetworking opportunities. We areproud to have received an awardin 2008 for industrial collaborationat the Healthcare BusinessAwards hosted by Medilink EastMidlands.

The workshops

In the workshops we presentparticipants with an introduction totwo of MATCH’s evaluationmethods and the accompanyingtool or guide. We encourageeveryone to work on their ownlaptop, so that any set-up orsoftware installation queries areaddressed on the day as part ofthe learning. Questions areencouraged throughout thesessions and time is madeavailable afterwards for a fruitfulgroup discussion.

Overall feedback from theworkshops has been very positive.Participants leave with a delegatepack, which includes, dependingon the combination of sessions:

1. Case Study/Demonstration –highlighting practical applications;2. a complimentary copy of theHTA tool and training material;3. an opportunity for further‘handson’ use of the HTA tool; and4. a complimentary copy of theMATCH/NPSA User Guide.

Currently MATCH has threetraining sessions:

»» ‘How to Demonstrate the Valueof your Healthcare Technology’;

»» ‘How to Predict Device PricingAccording to Sales Volume’; and»» ‘The Benefits of Involving Usersand Professionals in MedicalDevice Development’.

How to Demonstrate the Value

of your Healthcare Technology

Due to demand from governmentagencies and from for-profit andnot-for-profit private sectorhealthcare organisations, theimportance of HTA has increasedconsiderably in recent years.

In response to this, in order tosecure reimbursement of atechnology, medical devicemanufacturers more often need tosubmit strong cost-effectivenessdata to demonstrate value formoney in addition to evidence ofclinical efficacy and safety. Inparallel to this, and in the UKcontext resulting from theHealthcare Industries Task Force(HITF) initiative of 2003-7, astrategy to take cost-effectivenessinto technology adoption andprocurement processes wasintroduced. This underlined theneed to disseminate HTA methodsto a wider audience in the medicaldevices industry and in the NHS.

MATCH has developed an easy touse Health Economics Evaluatortool that can be deployed at theearly stages of the product

development lifecycle with minimalinput data. This tool is used todemonstrate the value propositionof the innovation in terms of itsimpact on cost and, especiallywhen the innovation costs morethan the existing alternative, toarticulate improvements in patientoutcomes in terms of QALYs – theessential measure of effectivenessin the NICE ‘reference case’.

By speaking the language of HTA,manufacturers are better placed tosell innovative products to theNHS. Likewise, NHS decision-makers are supported in beginningthe adoption process for newproducts, such that improvementin patient outcomes has beenarticulated as clearly as possiblegiven the available data, and theuncertainties are well understood.

The session provides basictraining on health economics anduse of the MATCH tool – whereand how to use it – as well as achance to get some practicalexperience using the software.

How to Predict Device Pricing

According to Sales Volume

This session focuses on how topredict the future pricing of adevice against estimated salesvolume. The core of this is theMATCH online Experience Curvecalculator.

Tools Workshops

May/June 2011 | 25


This allows medical devicemanufacturers to quickly assessthe price trends for their productsand as a result to make a moreinformed judgement about howfast the prices for current andfuture products are likely tochange, with a view to bringingsignificant benefits in strategicplanning and new productassessment.

The session also examines howmedical device purchasers canuse this webbased tool to trackhow the prices ofthe product lineschange with experience and tomake informed decisions in pricenegotiations. Users areencouraged to contribute toresearch and future tooldevelopment by allowing their ownexperience curves to be added tothe MATCH database and byanswering some additionalquestions about the product andthe market. All submitted casestudies are treated in confidence.

The Benefits of Involving Users

and Professionals in Medical

Device Development

This session provides help andadvice on the issues that shouldbe considered when developingmedical devices to ensure that thedevice meets the criteria of itsusers.

The guide, “Design For PatientSafety – User Testing in theDevelopment of Medical Devices”written in conjunction with, andpublished by, the National PatientSafety Agency (NPSA) in March2010, examines each stage ofproduct development and the userissues that should be consideredat each of these.

The guide describes in detail theprocess of planning a userrequirements study and coversissues of sampling, access tousers, applying for ethical approval

and the role of user data inmedical device standards andregulations. A number of examplesof successful user involvement inmedical device development areprovided. A glossary is alsoincluded that provides informationon how research methods can beapplied in a medical environment.

This is aimed at medical devicedesigners, developers andmarketing personnel. It is notprescriptive; rather it providesgeneric advice which developerscan customise to fit the needs oftheir particular device.

The way ahead

The next phase of the workshopshas been advanced with thelaunch of a new partnershipbetween MATCH and Biomaterialsand Tissue Engineering Centre ofIndustrial Collaboration (BITECICLtd), an organisation with arespected track record in helpingthe healthcare industry andcommissioners assess the truevalue of innovative products andservices.

BITECIC and MATCH have joinedforces to bring industry and theNHS easier access to existing andforthcoming tools from the MATCHresearch programme. MATCH andBITECIC have been workingclosely for 18 months and willcontinue to concentrate on supportfor the UK health sector and usercommunities initially, and aim toextend into Europe, USA and Asiawithin two years.

“There’s a clear synergy in thispartnership”, said Professor TerryYoung from Brunel University.“MATCH is a successful developerof approaches and tools forassessing value and economicimpact, while BITECIC providesongoing operational support,especially to SMEs in thehealthcare sector.”

BITECIC Director Dr John Eganagrees. “This is an excitingopportunity for us to lend ourexperience in reaching out to awider set of users who really needto understand and benefit fromMATCH’s tools and guides as theyenter a world that demands costefficiency from new healthtechnologies.”

The partnership has jointly fundeda position that will promoteMATCH and the MATCH training,with the recruitment of Dr MatthewAllsop. Matthew will be facilitatingworkshops and seminars aroundthe UK from the autumn. In themeantime, MATCH has a growingrange of tools and guides and apipeline planning to deliver a fewnew offerings each year.

As the level of workshopsincreases to match the currentdemand, MATCH aims to workwith its partners and the widerbase of stakeholders to ensurethat delivery of methods and toolsare suited to their needs.

For information on future events,sessions and tools, check theMATCH website: www.match.ac.uk

MATCH Tools Workshops

May/June 2011 | 26


World Health Care Congress Middle East


Zaid Al Siksek, CEO HAAD

May/June 2011 | 28

The 2nd Annual World HealthCare Congress Middle East, thepremier event for global healthcare innovation, has announced arobust program of content andpresenters, includingrepresentatives from more than 25countries, including: Victor Dzau,MD, President and CEO, DukeUniversity Health System, UnitedStates; Rt. Hon. Prof. the Lord AraDarzi of Denham KBE, Chairman,Institute of Global HealthInnovation, Imperial College,London, UK; Suhail Al Ansari,Executive Director, MubadalaHealthcare; Marc Harrison, MD,CEO, Cleveland Clinic-Abu Dhabi.

More than 600 health careexecutives representing 25countries will share theirperspectives on best practices forhealth care delivery; with theConference to be held at new AbuDhabi National Exhibition Centre(ADNEC) from 11-13 December2011.

Organized Under the Patronage ofH.H. General Sheikh MohammedBin Zayed Al Nahyan, CrownPrince of Abu Dhabi and DeputySupreme Commander of theUnited Arab Emirates’ ArmedForces and in collaboration withsovereign partners the HealthAuthority-Abu Dhabi (HAAD) andthe Abu Dhabi Tourism Authority(ADTA), the World Health CareCongress Middle East is the mostprestigious health care event,convening global thought leadersand key decision makers from allsectors of health care to promotehealth care through global bestpractices.

The 2011 program will feature newtopics designed to address newinnovations and challenges withinthe health care industry. AbuDhabi, host of WHCC Middle Eastfor the second consecutive year, is

a global center for health careinnovation.

Countries to be representedinclude the United States,Lebanon, Qatar, Saudi Arabia,Switzerland, Canada, UnitedKingdom, Thailand, Singapore,The Netherlands, Belgium, Japan

Australia and the United ArabEmirates.

Key topics for WHCC Middle East2011 include: Middle East andNorthern Africa (MENA) HealthAuthority Dialogue - Health CareStrategies for the Future andEvidence-Informed Health Policies

Featured presenters at WHCC Middle East

H.E. Prof. Mohamed Jawad Khalifeh, Minister of Health, Ministry ofHealth; President, Arab Health Ministers Council, Beirut, Lebanon

Hanan S. Al Kuwari, PhD, Managing Director, Hamad MedicalCorporation, Doha, Qatar

Dr. Manar Al Moneef, Director General, Health Care and LifeSciences, Saudi Arabian General Investment Authority (SAGIA),Riyadh, KSA

Zaid Al Siksek, CEO, Health Authority-Abu Dhabi (HAAD), Abu Dhabi,UAE

Dr. Najeeb Al Shorbaji, Director, Knowledge Management, The WorldHealth Organization (WHO), Geneva, Switzerland

Dr. Cristian Baeza, Director of Health, Nutrition and Population, TheWorld Bank, Washington, DC, USA

Prof. Abdallah S. Daar, Professor, Public Health Sciences; Professor,Surgery, University of Toronto, Canada

Jeff Goldsmith, PhD, President, Health Futures, Inc., Charlottesville,Virginia, USA

Anne Milton, MP, Parliamentary Under Secretary of State for PublicHealth, Department of Health, London, UK

Prof. Tan Ser Kiat, Group Chief Executive Officer, Singapore HealthServices Pte. Ltd., Singapore

Prof. Didier Pittet, MD, MS, CBE, Hospital Epidemiologist, Director,Infection Control Program; WHO


May/June 2011 | 29

Hospital/Health System CEODebate on Global Health CareModels; How Provider Systemsand Technology Companies areResponding to the Implementationof Electronic Health Records(EHR) Systems; Building StrategicPublic Private Partnerships(PPPs); The Promotion of HealthyLifestyles.

The event will also include the 2ndAnnual WHCC Middle East HealthInnovations Poster Exhibit andAwards Program, which will be ondisplay throughout the conference.The poster exhibit is part of theWHCC Health InnovationsInitiative, a year-round programthat features health careinnovations that improve healthcare while reducing costs.

To submit an innovation fordisplay at the conference andaward consideration, visitwww.worldcongress.com/middlee

ast/posters

About the World Health CareCongress Middle EastLaunched in 2010, the WorldHealth Care Congress MiddleEast, is the premier conference tofeature global health careinnovation. It attracts more than600 senior health care thoughtleaders from all industry sectors,including hospitals, healthsystems, employers, governmentagencies, pharma, biotech andindustry suppliers.

WHCC Middle East is organizedwith sovereign partners the HealthAuthority-Abu Dhabi (HAAD) andthe Abu Dhabi Tourism Authority(ADTA). Additional sponsorship iscurrently provided by The AbuDhabi Health Services Company(SEHA) www.seha.ae andChildren’s National Medical Centerwww.childrensnational.org.

www.worldcongress.com/me

11-13 December 2011, Abu Dhabi


WHCC Europe Review

The 7th Annual World Health CareCongress Europe 2011 - 'ManagingBudgetary Constraints WhileMaintaining the Quality of Care',concluded in Brussels, Belgium on14th April. The event convenedhealth care's most seniorinternational executives andgovernment officials to sharebusiness cases, best-practices andactionable solutions to fosterinnovations that improve quality,cost and accountability.

The 2011 Congress featured topindustry influencers including: Dr.James Reilly, Minister of Health,Ireland; The Hon. Joe Cassar, MD,Minister of Health, Malta; NiallDickson, CEO and Registrar,General Medical Council; andGeorge C. Halvorson, Chairmanand CEO, Kaiser Permanente.

The congress convenes leadersfrom all sectors of health care todiscuss and develop actionableitems to provide the highest qualityof care while working underbudgetary constraints. Movingaway from a policy focus, theinternational forum seeks to ensurethat delegates will be able to set inmotion a key action plan in 2011.

Abu Dhabi case study

Speaking at a session on chronicdisease management and caredelivery redesign, Dr Philipp Vetter,Head of Strategy at HealthAuthority Abu Dhabi (HAAD),highlighted the progress made inthis area: “In 2007 healthcareprovision in Abu Dhabi was at thelevel of Afghanistan. The expatpopulation, which represents 80%of the total population of Abu Dhabi,were uninsured. Now everyone hashealth insurance. Our first step inthe redesign of delivery was toregulate the flow of paymentinformation from the 1000 providersand 40 insurers operating there.Introducing a new system of clinical

WHCC: Europe and USA Review

May/June 2011 | 30

coding allowed us to build anaccurate picture of the state ofhealthcare in Abu Dhabi.”

Dr Vetter explained, “In order toimprove public health weincentivized providers by onlypaying them when they succeed inpreventing illness. For example,over 50s in Abu Dhabi have a 50%chance of having diabetes sopreventative measures areessential for tacking and reducingthis very high incidence.

“To do this effectively we have to beable to measure treatment success,and have used morbidity predictionmodels to do this.”

WHCC USA Review

The 8th Annual World Health CareCongress, held in Washinghton DC,gathered more than 1,500 seniorleaders from over 40 countries. Itconcluded in April with a day ofdynamic presenters that included athough-provoking discussion.Whole Foods Market CEO JohnMackey spoke on the status ofhealth in America, and how hiscompany is working to make itsemployees among the healthiest inthe nation.

Mackey, provided a soberinganalysis of health in America,

particularly how obesity rates haveskyrocketed in the past 20 years,leading to dramatic rises in relatedillnesses, such as diabetes andheart diseases. Under Mackey’sleadership, Whole Foods hasimplemented an aggressiveincentive-based wellness programfor its workforce that focuses onrewards for healthy behavior. Whileall Whole Foods employees receivea 20 percent discount at the stores,workers who achieve certainhealthy benchmarks can receive asmuch as 30 percent off purchasesand receive a “platinum” statusreserved for the healthiestemployees.

Mackey was among 200 presentersto share the latest trends in healthcare delivery. Other key topicsincluded the emergence ofAccountable Care Organizations(ACOs), an assessment of howhealth reform is affectingbusinesses and the importance ofencouraging preventative wellnessprograms to reduce the risk ofdiseases that leads to high-costhealth care treatments.

“The 8th Annual World Health CareCongress was a tremendoussuccess,” said WHCC PresidentNicole Garratt. “In addition to ourongoing commitment to bringingtogether the best and brightestmembers of the health carecommunity, we also significantlygrew our international focusthrough hosting the World HealthInnovation Summit. The three-dayevent, which ran in conjunction withWHCC, featured delegates frommore than 40 countries from sixcontinents. Through the summit,WHCC furthered its status as a trulyglobal event.”

WHIS focused on bringing healthinnovations created in thedeveloping world to developedcountries because many can beeffective and affordable.

Dr Philipp Vetter

www.drabdulrahmanalmishari.com.sa

Official Nomineefor 2010 Awards

MEH

201

0 Health and Innovation

MISSION STATEMENT

Dr. Abdul Rahman Al-Mishari Hospital

is committed to Superior Quality and Safety in meeting the

Health care needs of the clients we serve by Fostering Advanced

and Compassionate Health care Services.

VISION STATEMENT

We shall treat each patient like a member of our own family

thus providing Superior Quality Health care Services and to be

recognized as the center of excellence in the Management of

Obstetrics, Gynecology and Pediatrics in the Central Region

of Kingdom of Saudi Arabia.

For 24 years Dr. Abdulrahman Al Mishari Hospital has been providing high quality of Medical Care to its patients.

earor 24 yFviding high quality of Medical Caropr

Abdulrahman .s Drearviding high quality of Medical Car

Al MisharAbdulrahman e to its patients.viding high quality of Medical Car

i Hospital has been Al Mishare to its patients.

i Hospital has been e to its patients.

A concentrated 12 month

programme of research,

planning, testing and product

development has culminated in

Sidhil launching a totally new

range of six dynamic therapy

mattress systems and two

cushions. The products have

been designed to meet a

comprehensive range of clinical

requirements in applications

within acute hospital, nursing

care and community sectors.

Sidhil has made full use of productand application knowledge gainedfrom its current dynamic therapyrange to develop robust and costeffective solutions. These aredesigned around ease of use,hygiene and optimum reliability,combining significant performanceenhancements with competitivepricing levels.

The Harmony and Trio II systems,developed for high/very high riskapplications, are both 3 cellalternating dynamic pressuretherapy, full mattress replacementsystems. Combining Sidhil’srevolutionary “cell in cell” structurefor the highest levels of reliability,they incorporate static head cellsand narrow heel cells and easy touse CPR units. The Harmonysystem features an antimicrobialcover and unique twin compressorcontrol for rapid inflation.

The Plus II and Solo II systems,aimed at medium to high riskapplications, are 2 cell alternatingdynamic pressure therapy, fullmattress replacement systems.The Plus II incorporates a tophinge, positioned to aid profilingand reduce the risk of pinchingcells in the sacral area. Bothfeature Sidhil’s easy to use CPRunit and are ideal for use onprofiling beds.

The SoloXtra is a 2 cell alternatingdynamic pressure therapy overlayreplacement system incorporatinga separate visco foam underlay,developed for medium to high riskapplications. The easy-use digitalcontrol system incorporates bothalternating and static modes withvariable pressure settings.

Sidhil’s bariatric option, theBariatric II, is a 3 cell alternatingdynamic pressure therapy, fullmattress replacement systemcapable of taking a maximum userweight of up to 318kgs (50 stone).

With inflated side supports foradded stability, this systemincorporates Sidhil’s special twincompressor control for rapidinflation and “cell in cell” structurefor reliability.

All systems include an automaticreturn from static to alternatingmode after one hour withoutmanual intervention and bothvisible and audible alarms toindicate low or high pressure,alternating failure and powerdown. A two year warrantycovering both parts and labour isstandard on all dynamic therapyproducts.

Sidhil’s new dynamic therapymattresses are complemented bytwo new dynamic cushions, theSerenade 2 and Serenade 3,developed for medium to high riskapplications. Serenade 2 providesa 2 cell option and Serenade 3 a 3cell system, with 7 upper cellsincluding 1 static front cell and 7static bottom cells. Designed to

May/June 2011 | 32


Sidhil - making it better in the UK

operate with selected mattresspumps to avoid the need to buytwo separate units, the cushionshave a maximum user weight of110kgs (18 stone).

Sidhil’s Independence Innov8

Bed Fits the Bill For Teddington

Alongside stringent regulations interms of safety and operationalcapabilities, increasinglychallenging demands in terms ofbed occupancy make reliability animportant consideration forhospitals considering upgradingtheir bed stock.

The Independence Innov8, theflagship new hospital bed fromSidhil, is already proving its worthacross the UK for applicationsranging from utility ward bedsthrough to high dependencyenvironments. The latestestablishment to select thisversatile product is the inpatientunit at Teddington MemorialHospital, where 50 beds andmattresses are now in useproviding superb ergonomics interms of both manual handling anduser comfort.

Over the past few years, anambitious building project hastransformed what was a smallcottage hospital into a modernfacility providing a range ofinpatient and outpatient services,allowing residents from theborough to access their care closeto home.

When Matron Liz Riedlinger waslooking to upgrade the bed stock,she researched the marketcarefully to select the correctproduct. “One of my key objectiveswas to source beds capable ofmeeting not only the currentrequirements but also anticipateddevelopments into the future,” sheexplained. “We are very satisfiedwith our decision. Sidhil’sIndependence Innov8 beds are

sophisticated products whichcontinue to work well withadvanced levels of reliability. Insupport of this, we have alsoinvested in Sidhil’s annual serviceand maintenance programme togive us peace of mind knowing thebeds are kept in optimum workingorder.”

The Independence Innov8 has theadvantage of being manufacturedby Sidhil in the UK, guaranteeingspeedy and reliable serviceprovision and supply of spareparts. In addition, bespoking tomeet individual requirements isboth manageable and affordable;as an example, the Teddington

models were fitted with specialoversized buffers to preventdamage to walls from beds intransit around the hospital.

Available in three models, theIndependence Innov8 range is theresult of detailed research intocurrent and projectedrequirements, consolidating theinput of professionals includingTVNs, infection control nurses andmanual handling specialists. Thebed is designed around keyprinciples including ease of use,world class infection control andperformance in use.

www.sidhil.com

May/June 2011 | 33


The Independence Innov8 bed


May/June 2011 | 34

Hospital Build Middle East 2011

Quality shortfall in Middle East

hospitals to be addressed at

Hospital Build conference

The increasing healthcareexpenditure in the Middle Easthighlights the need for betterhealthcare infrastructure as well asthe role played by hospitalconsultants in understanding andimplementing quality standardsand accreditation of hospitals. Therace for defining and controllingthe standards for the Middle Eastregion healthcare accreditation isstill yet to be won as Westernguidelines for healthcareaccreditation must be amended tosuit cultural and religious needs ofthe Middle East region.

According to Dr. Rashi Agarwal,Director of Praxis HealthcareConsultancy based in Mumbai,accreditation leads to betterpatient care and inculcates aculture of patient safety and riskreduction practices. Not only doesit improve clinical outcomes, but italso assesses and showsimprovement in all aspects ofmanagement and businessoperations leading to an increasein the bottom line.

Praxis Healthcare Consultancyexhibited at the 3rd Hospital BuildMiddle East Exhibition andCongress which ran from 13 – 15June 2011 at the DubaiInternational Convention andExhibition Centre.

Quality Standards & Accreditationis a three-day conference heldduring Hospital Build 2011 whichwill assess the importance ofsetting the appropriateorganisational structure to achievesuccessful accreditation within anorganisation, address thechallenge of providing client-centered healthcare within theGCC and help to build a culture of

safety to establish reliablehealthcare organisations.

“The cost of poor quality inhospitals and healthcare facilitiesleads to higher infection rates,medical errors, and sickerpatients, which in turn leads tolonger length of stay, lowerproductivity and lower revenues,”says Dr Agarwal. “Tarnishedhospital reputation is another by-product.”

“Acceptability, accessibility,accountability and allocativeefficiency are the biggestchallenges in providing qualityhealthcare, not only in the MiddleEast, but all over the world. Thesecan be overcome only throughcorrect education and training withinvolvement of seniormanagement and clinical staff,”she continues.

Discussing the accreditationjourney, Dr Agarwal explained thatthe best way to start the process isby educating leaders andmanagers of the benefits,advantages, process, timeline, etc.of accreditation.

This is followed by a baselineassessment to evaluate thecurrent status of the hospital withregards to the accreditationstandards and then a detailedaction plan is developed. A mocksurvey is carried out by a thirdparty and corrections are madebefore the final survey. Theaccreditation process will besuccessful only with completecontribution at all levels ofmanagement and participation byclinicians at the hospital.

“Apt education and training is thebest tool for a successful process,”says Dr Agarwal.

The Hospital Build Middle EastCongress offers a multi-track

conference series consisting ofseven leading conferences whichwill address hospital design andupgrade, surgery management,imaging and diagnosticsmanagement, healthcaremanagement, integrating businesswith healthcare technology, andthe flagship Leaders in Healthcareas well as, of course, qualitystandards and accreditation.

The Hospital Build Middle EastExhibition 2011 has doubled insize with more than 100 exhibitorscovering 3,000sqm of exhibitionfloor space, with an estimated3,500 visitors.

“Hospital Build has given a goodplatform to several exhibitors in thepast to display their products andservices and generate relevantbusiness opportunities. We aim touse our experience and our teamof internationally trained experts tocollaborate with healthcarefacilities in the Middle East to bringabout international standards at alllevels of hospital planning,technology and management inareas of architectural design,latest equipment, skilled humanresource and staffing, efficientoperational policies, qualitymarkers, profitable businessmodels, and overall improvedpatient care,” says Dr Agarwal.

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World Health Organisation: report


May/June 2011 | 36

A new WHO report shows

deaths from noncommunicable

diseases are on the rise, with

the developing world hit

hardest.

Noncommunicable diseases arethe leading killer today and are onthe increase, the first WHO Globalstatus report on noncommunicablediseases (NCDs) launched in Aprilconfirms. In 2008, 36.1 millionpeople died from conditions suchas heart disease, strokes, chroniclung diseases, cancers anddiabetes. Nearly 80% of thesedeaths occurred in low- andmiddle-income countries.

"The rise of chronicnoncommunicable diseasespresents an enormous challenge,"says WHO Director-General DrMargaret Chan, who launched thereport during the WHO GlobalForum on addressing thechallenge of noncommunicablediseases, being held today inMoscow, the Russian Federation."For some countries, it is noexaggeration to describe thesituation as an impending disaster;a disaster for health, for society,and most of all for nationaleconomies."

Dr Chan adds: "Chronicnoncommunicable diseasesdeliver a two-punch blow todevelopment. They cause billionsof dollars in losses of nationalincome, and they push millions ofpeople below the poverty line,each and every year."

Millions of deaths can be

prevented

But millions of deaths can beprevented by strongerimplementation of measures thatexist today. These include policiesthat promote government-wideaction against NCDs: strongeranti-tobacco controls andpromoting healthier diets, physical

activity, and reducing harmful useof alcohol; along with improvingpeople's access to essential healthcare.

The Global status report on NCDsprovides global, regional andcountry-specific statistics,evidence, and experiencesneeded to launch a more forcefulresponse to the growing threatposed by chronicnoncommunicable diseases. Itprovides a baseline to chart futureNCD trends and responses incountries, including in terms of itssocioeconomic impacts. Thereport provides advice andrecommendations for all countriesand pays special attention toconditions in low- and middle-income countries which arehardest hit by NCDs.

Cardiovascular diseases accountfor most NCD deaths, or 17 millionpeople annually, followed bycancer (7.6 million), respiratorydisease (4.2 million), and diabetes(1.3 million). These four groups ofdiseases account for around 80%of all NCD deaths, and share fourcommon risk factors: tobacco use;physical inactivity; the harmful useof alcohol; and poor diets.

Not just a problem of affluent

societies

"About 30% of people dying fromNCDs in low- and middle-incomecountries are aged under 60 yearsand are in their most productiveperiod of life. These prematuredeaths are all the more tragicbecause they are largelypreventable," says Dr Ala Alwan,WHO Assistant Director-Generalfor Noncommunicable Diseasesand Mental Health.

"This is a great loss, not just at anindividual level, but alsoprofoundly affect the family and acountry's workforce. For themillions struggling with poverty, avicious circle ensues. Povertycontributes to NCDs and NCDscontribute to poverty. Unless theepidemic of NCDs is aggressivelyconfronted, the global goal ofreducing poverty will be difficult toachieve."

NCDs killed 63% of people whodied worldwide in 2008. Thisequals 36 million and nearly 80%of these NCD deaths - equivalentto 29 million people - occurred inlow- and middle-income countries,dispelling the myth that suchconditions are mainly a problem ofaffluent societies. Without action,


May/June 2011 | 37

the NCD epidemic is projected tokill 52 million people annually by2030.

Country-by-country estimates

of the NCDs

The WHO report provides country-by-country estimates of the NCDsepidemic and their risk factors, thechallenges blocking manycountries from taking effectiveaction, and measures that cansave millions of lives and reducespiralling health-care costs.

Such measures includeimplementing the WHOFramework Convention onTobacco Control, such as raisingtaxes on tobacco, banningtobacco advertising and legislatingto curb smoking in public places.Other measures include reducinglevels of salt in foods, stopping theinappropriate marketing ofunhealthy food and non-alcoholicbeverages to children, andcontrols on harmful alcohol use.

Focus: Tobacco

Tobacco use and exposure comesin both smokeless and smokingforms. Smokeless tobacco isconsumed in un-burnt formsthrough chewing or sniffing andcontains several carcinogenic, or

cancer-causing, compounds.Smokeless tobacco has beenassociated with oral cancer,hypertension, heart disease andother conditions.

Smoking tobacco, by far the mostcommonly used form globally,contains over 4000 chemicals, ofwhich 50 are known to becarcinogenic. There are currentlyabout 1 billion smokers in theworld. Manufactured cigarettesrepresent the major form ofsmoked tobacco. Current smokersare estimated to consume about 6trillion cigarettes annually. Inaddition to cigarettes, other formsof tobacco are also consumed,particularly in Asia, Africa and theMiddle East and to a lesser extentin Europe and the Americas.

Data on these additional forms ofsmoked tobacco are not readilyavailable, but are nonethelesssubstantial. In India alone, about700 billion ‘bidis’ (a type of filter-less hand-rolled cigarette) areconsumed annually.

Risks to health from tobacco useresult not only from directconsumption of tobacco but alsofrom exposure to second-handsmoke. Almost 6 million people die

from tobacco use and exposureeach year, accounting for 6% of allfemale and 12% of all male deathsin the world. Of these deaths, justover 600 000 are attributable tosecond-hand smoke exposureamong non-smokers and morethan 5 million to direct tobacco use(both smoking and smokeless).

By 2020, annual tobacco-relateddeaths are projected to increase to7.5 million, accounting for 10% ofall deaths in that year. Smoking isestimated to cause about 71% ofall lung cancer deaths, 42% ofchronic respiratory disease andnearly 10% of cardiovasculardisease. Smoking is also animportant risk factor forcommunicable diseases such astuberculosis and lower respiratoryinfections.

World No Tobacco Day 2011

On World No Tobacco Day (31May), WHO celebrated the

Noncommunicable diseases

The Middle East

In the WHO region for theEastern Mediterranean (EMR),chronic diseases are projectedto account for 52% of all deaths.

WHO projects that over the next10 years 25 million people in theEMR will die from a chronicdisease. This is an increase of25%, with deaths from diabetesincreasing by 50%.

At least 80% of premature heartdisease, stroke and type 2diabetes, and 40% of cancer,could be prevented throughhealthy diet, regular physicalactivity and avoidance oftobacco.

A 2% annual reduction inchronic disease death rates inthe EMR over the next 10 yearswould save 2 million lives.

WHO Director-General Margaret Chan


successes of the WHOFramework Convention onTobacco Control (WHO FCTC) inthe fight against the epidemic oftobacco use. At the same time,WHO recognised that challengesremain for the public health treatyto reach its full potential as theworld's most powerful tobaccocontrol tool.

Implementing the WHO FCTC

Since it was adopted by the WorldHealth Assembly in 2003, 172countries and the European Unionhave become Parties to the WHOFCTC. Among other measures,the Parties are obliged over timeto:protect people from exposure totobacco smoke; ban tobaccoadvertising and sales to minors;put large health warnings onpackages of tobacco; ban or limitadditives to tobacco products;increase tobacco taxes; andcreate a national coordinatingmechanism for tobacco control.

This year, the tobacco epidemicwill kill nearly 6 million people,including some 600 000nonsmokers who will die fromexposure to tobacco smoke. By2030, it could kill 8 million.

"The treaty's ultimate successagainst the tobacco industrydepends on the extent to which theParties meet all of theirobligations," says the WHODirector-General, Dr MargaretChan. "More needs to be done forthe treaty to achieve its fullpotential. It is not enough tobecome a Party to the treaty.Countries must also pass, orstrengthen, the necessaryimplementing legislation and thenrigorously enforce it."

Tobacco use is one of the biggestcontributors to the epidemic ofnoncommunicable diseases - suchas heart attack, stroke, cancer and

emphysema - which accounts for63% of all deaths, nearly 80% ofwhich occur in low- and middle-income countries. Up to half of alltobacco users will eventually die ofa tobacco-related disease.

Despite progress much moreneeds to be done, as the Partiesown reports indicate. For example,of the 65 Parties that submittedmandatory reports twice, 40reported progress in raisingtobacco taxes, 39 in making publicplaces smoke-free and 35 instrengthening research andsurveillance of tobacco control.

One-third to one-half of the 65Parties reported progress instrengthening health warnings onpackages of tobacco, in banningtobacco advertising, promotionand sponsorship, in helpingsmokers to quit and in protectingpublic health policies from tobaccoindustry interference, among othermeasures.

"The WHO FCTC is the mostpowerful tobacco control tool atour disposal, and countries shouldtake full advantage of it," says theHead of the ConventionSecretariat, Dr Haik Nikogosian.

"The need to fully implement thetreaty is especially great in the low-and middle-income countries,which is where the tobaccoindustry is focusing its marketingefforts. International cooperation tofacilitate Parties' compliance withthe treaty is crucial."

Implementations

Uruguay requires healthwarnings that cover 80% of thesurface of tobacco packages.

Mauritius in 2008 became thefirst African country to mandatepicture warnings on packs.

Ireland in 2004 banned smokingin public places.

Sri Lanka's cigarette taxes areequal to 73% of the retail price.

In 2006, Iran banned all types oftobacco advertising.

In May 2011 China implementeda ban of smoking in public placessuch as restaurants, theaters andbars.

In 2009, Turkey implemented asimilar smoking ban.

May/June 2011 | 38

World Health Organisation

Hospitalar Brazil 2011: Review

Hospitalar Brazil 2011, the

largest specialized event in

Latin America now in it's 18th

year got off to a flying start with

1250 exhibitors and over 91,000

professional visitors attending.

In addition to launching the mostimportant news of the area,Hospitalar also reinforced itself asan important health forum,bringing together hospital officials,professionals and researchers ofhealth.There were over 60simultaneous events, includingconferences, workshops andsectoral meetings, wheredirections and trends in the field ofbusiness management forhealthcare facilities werediscussed.

The show featured productsranging from the mostsophisticated state-of-the-artmedical technology todisposables. Amongst theexhibitors MEH got to visit severalfactories including Fanem whospecialise in exemplary neo natalproducts and are now expandingglobally with a new office openingin Jordan. Baumer andOrtosintese,the two leadingorthopedic implants and hospitalequipment companies were visitedalso.These companies ,mainlyfamily run, have been in thebusiness for many years and arethriving domestically and gaininghuge momentum globally.

Brazil is the largest economy inSouth America with the highestpotential in the healthcare market.Brazil has over 6,400 hospitalsand 15,000 clinics and healthcareestablishments. The Brazilianhealthcare market is over $125billion. Imports account forapproximately 25% of the market,with the U.S. providing 50% of allimports. The medical equipmentmarket is over $1.5 billion. The

continued expansion of theBrazilian private health caresector, particularly in the HMOsector, should create newopportunities for more exporters,particularly for more advancedmedical equipment, disposables,diagnostic devices, implants andcomponents. Brazil’s economy isbooming and Hospitalar 2011featured a 10% increase in thearea occupied by foreigncompanies,bringing the total to525.The expectation is that resultsof this year will far exceed lastyear's sales of US$ 3.32 billion inthe four days of the fair.

Eminent doctor and businessmanWaleska Santos,founder andpresident of Hospitalar,emphasized that the fair hasbecome an "unadvoidable event inthe agenda of employers andhealth care professionalsworldwide:

«It promotes and fosters businessand networking between thesupplying industry and hospital ,clinic directors and health careprofessionals. I'ts the big yearlymeeting point of the sector in theAmericas.»

May/June 2011 | 39



Scientists are discovering that a

lot of what we smell is

determined by a seemingly

random gene selection process,

and understanding it could

reveal secrets about biological

diversity and disease.

The nose isn’t something weusually associate with cutting-edge genetic research. But to Dr.Ben Shykind, assistant professorof cell and developmental biology,and researcher at WCMC-Q, thegenes that give us our sense ofsmell ( olfaction) are the basis ofan entire field of research intobiological diversity and disease.

“Odorant receptor (OR) genescompose the largest gene family inthe whole genome,” Dr. Shykindsaid. “Almost five percent of ourgenes are odorant receptors;to theorder of a thousand genes.”

As smells waft into the nose theypass by millions of specializedcells -olfactory sensory neurons-that work in concert to identifywhat’s in the air. This process iscritical to food foraging, mating,and survival across the animal

kingdom; in humans it is more anaesthetic sense, giving us thepleasure of tasting a meal orsmelling a flower.

The key to detecting a range ofsmells is that each sensory neuroncell differs from its neighbor, andonly oneOR gene out of thethousands in the genome will bechosen for expression by that cell.

This makes for thousands ofdifferent types of nerve cells, andhow this happens is a mysterythat’s creating a hot zone ofgenetic research.

Random RegulationsThe entire genome issequenced, and researchersnow know the genetic locationsrelated to many diseases. Soinvestigators like Dr. Shykindare onto the next big question:cell for cell, what drives geneticdiversity?

“You can think about it like apiano,” he said. “If I go to play apiano with its 88 keys, I can onlyplay chopsticks. But somebodyelse can approach those samekeys and play a Beethoven pianosonata; something incrediblysophisticated. I am interested inhow those combinations occur.This process has an element ofrandomness to it, and this is likelylinked to a field called epi-genetics;whereas genetics is the identity ofthe notes on keyboard, epi-genetics is how the keys areplayed.

Weill Cornell Medical College-Qatar

Specialist Article: How Does the Nose Know?

May/June 2011 | 40


“On a basic level it gets toquestions of what makes ushuman, what gives a cell aparticular identity, and whatgenerates biological complexity.On a medical level, all of theseprocesses have to work correctlyto generate good health.”

As important, or maybe moreimportant, than the genes oneinherits, Dr. Shykind says that thebasic causes of complicateddiseases such as cancer are reallyproblems of how the geneexpression is regulated: turned“on” or “off.” In many cancers, forinstance, the genes responsiblefor keeping cells in check arerandomly shut off; leading to theappearance of cancerous cellsthat no longer obey signals to stoptheir divisions into a tumor.

“How do you turn genes on whenthey should be on, turn them off

when they should be off, and keepgenes that should never be onfrom turning on?” Dr. Shykindpondered. “Something that’sbenign can turn into a cancer if it’saberrantly regulated, so really it’sabout gene regulation.”

With something so important ascell integrity on the line one wouldthink gene regulation would be leftto something more predictablethan chance, but Dr. Shykindsuggests we’d lose more than wegain as higher species if geneselection is fixed.

“The same way that you can role adie -with its limited number ofsides- to randomly generate anoutcome,” he explains, “the cellappears to be able to harnessrandomness and constrain it togenerate diversity for theincreased sophistication of life.”

“An amazing example of this is theimmune system. You can take acomparatively small number ofgene segments that make up theantibodies [key players in theimmune response] that floataround in our blood, shuffle thosearound and create antibodies forthings we’ve never, and maybenever will, come in contact with. Indoing this we make this enormousantibody army to fight againstalmost any possible threat. That isa very good example of the bodyusing randomness to outsmart theworld of pathogens.”

An Evolutionary Perspective

Dr. Shykind oversees three studiesinto olfaction at WCMC-Q and iscurrently involved in severalresearch projects to address twokey questions:how is therandomization process initiatedduring the choice of an OR; and

Weill Cornell Medical College - Qatar

May/June 2011 | 41

once chosen how is theexpression of that unique selectionmaintained for the life of the nervecell?

“So to begin to understand celldiversity, we look into one of themost intriguing examples of genechoice in biology,” Dr. Shykindsaid. “Not only does each neuronpick one gene, but it picks it fromonly one of the two chromosomecopies;we have chromosomesfrom mom and dad, but only onewill get to be used in this case.Now we’re down to half the geneswe had, and there’s a randomcomponent to it.”

One effective way to explore themechanisms of random ORselection is to look at the

evolutionary differences in geneselection across organisms.Simple organisms like flies andworms display less randomizedgene selection, and someorganisms, like frogs -which havedouble the number ofchromosomes as humans- mayuse more complicated modes ofrandom gene choice.

Dr. Shykind is taking advantage ofthis double chromosome numberin frogs as he oversees a projectentitled “Monoallelic Gene Choicein Xenopus laevis and tropicalis”,run by second-year medicalstudents Reem Shawar andBassel Saksouk, and funded bythe Qatar National ResearchFund’s Undergraduate ResearchExperience Program.

The project explores OR geneselection differences between twospecies of frogs carrying two andfour copies of each gene in theirgenomes. In studying how thegenes are selected in an extremecase —where the options aredoubled— Dr. Shykind and histeam hope to gain clarity aboutrandom selection as it relates tothe human genome, and help shedmore light on this intriguing area ofgenetic research.

This article is from the June 2011edition of Weill Cornell MedicalCollege in Qatar's Chroniclemagazine

http://qatar-weill.cornell.edu/

Weill Cornell Medical College - Qatar

May/June 2011 | 42

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May/June 2011 | 44

Healthcare iNet grant enables

Pfizer investment in lung

disease research.

Scientists are shedding new lighton the molecular basis of lungdiseases thanks to a collaborationset up by the Healthcare andBioscience iNet between theUniversities of Leicester andNottingham with the help of a£50,000 iNet CollaborativeResearch and Development(CRD) grant.

Also involved in this collaborationis the Nottingham-basedinternational diagnostic andgenetic analysis company SourceBioScience which is providing itsnext generation sequencingservices. This collaboration,including two internationally-renowned teams of researchers,has attracted new investment tothe two universities worth over£900,000 from pharmaceuticalgiant Pfizer.

The collaboration builds on thework of a consortium, comprising96 scientists from 63 centres ledby Professor Martin Tobin,Professor of Genetic Epidemiologyand Public Health in theDepartment of Health Sciencesand the Department of Genetics atthe University of Leicester andProfessor Ian Hall Dean of theMedical School and Deputydirector of the NottinghamBiomedical Research Unit inRespiratory diseases at theUniversity of Nottingham.

Initial findings in early 2010 reportedfive common genetic variations linkedwith lung function. Spurred on by thisearly success, Professors Tobin andHall have developed a strong EastMidlands collaboration aimed atunderstanding the genetic causes oflung disease, such as chronicobstructive pulmonary disease(COPD) and asthma.

The grant has enabled thispartnership to develop to includemore powerful studies to searchfor common genetic variantsacross the whole human genomeand to investigate in detail themillions of nucleotides (chemicalbases) that comprise the regionsof the human genome so far linkedto lung function.

The research provides hope forbetter treatment for lung diseasessuch as chronic obstructivepulmonary disease. In the past ithas been difficult to develop newtreatments because the molecularpathways that affect the health ofthe lung are not completelyunderstood. It is hoped the newpathways discovered could in thefuture be targeted by drugs,helping to deliver morepersonalised medicine.

This research wouldn’t be possiblewithout access to ultra-fast andsophisticated next generation DNAsequencing techniques. This iswhere Source BioScience comesin; the Group uses the latestgenetics technology platforms inits state-of-the-art laboratory inNottingham. It is one of the fewcompanies in the world with thetechnology and experience to dothis work.

Professor Tobin says: “A largereduction in lung function occurs inchronic obstructive pulmonarydisease, which affects around 1 in10 adults above the age of 40 andis the fourth most common causeof death worldwide. Smoking is themajor risk factor for developmentof COPD. Lung function andCOPD cluster within families,indicating that variations in genesalso predispose individuals toreduced lung function.

“Rapid advances in genetics haveprovided new tools to study thecauses of disease. Studies can

now examine the effects of morethan a million genetic variants ineach study participant. Suchgenome-wide association studieshave led to long-awaitedbreakthroughs in understandingthe genetics of some commondiseases.”

Professor Hall says: “By identifyingthe genes important in determininglung function, we can start tounravel the underlyingmechanisms which control bothlung development and lungdamage. This will lead to a betterunderstanding of diseases such aschronic obstructive pulmonarydisease and asthma. Crucially, itcould open up new opportunitiesto manage and treat patients withlung conditions”.

Dr Nick Ash, CEO of SourceBioScience says: “ We believe ourUK-leading expertise and capacityin ultra-fast DNA sequencing canhelp the teams at Nottingham andLeicester make significant inroadsinto the understanding of lungdisease and, in the long term, leadto the development of targetedand personalised drugs to treatpatients. We look forward toworking with the teams fromLeicester and Nottinghamuniversities on this lung diseasestudy.”

According to recently-publishedresearch by NESTA¹, collaborationimproves the capacity forinnovation, which is critical at atime when the biomedicalindustry’s R&D productivity ratescontinue to fall and pharmaincreasingly looks to externalpartners for it drug discovery.

Dr Ian Barr, director of theHealthcare and Bioscience iNetsays: “If the UK is going to retainits strong international position inhealthcare and bioscienceresearch, we need world-beating

Medical research: Lung disease


collaborations like this one thatcan attract funding from the privatesector. Bringing people togetherfrom different organisations andturning them into effectivecollaborations is not easy but ismore likely to happen throughinitiatives such as the iNet and itsCRD grant.”

The Healthcare and BioscienceiNet is funded by the EastMidlands Development Agency(emda) and the EuropeanRegional Development Fund(ERDF).

Healthcare and Bioscience iNet

helps people in the sector,particularly in East Midlands’businesses and universities, todevelop new technologies,processes, products and servicesin order to build a healthyeconomy.

Innovation is a key strategicpriority for East MidlandsDevelopment Agency (emda).Four sector specific InnovationNetworks (iNets), includingHealthcare and Bioscience, have

been established to help turninnovative ideas in to businessopportunities.

The iNet concept was developedby emda and East MidlandsInnovation (the Regional Scienceand Industry Council) to bringtogether businesses, colleges,universities, public sectorrepresentatives and individualswith a shared interest in a marketor the tecnology that underpins it.

www.eminnovation.org.uk/health

May/June 2011 | 45

Dr Nick Ash, Source Bioscience; Prof Ian Hall, University ofNottingham; Dr Ian Barr, Healthcare and Bioscience iNet;Prof Martin Tobin, University of Leicester


Healthcare and Bioscience iNet


May/June 2011 | 46

The newly designated bacterialgenus, Cronobacter, is composedof Gram negative, facultativeanaerobic rods which are membersof the Enterobacteriaceae familyand closely related to Enterobacterand Citrobacter. It is composed ofC. sakazakii, C. malonaticus,C.turicensis, C. muytjensii, and C.dublinensis, plus a currentlyunnamed sixth species.

The organism has come toprominence due to its associationwith severe neonatal infections;necrotizing enterocolitis,septicaemia and meningitis. Thefatality rate following meningitis is50%, with the survivors beingneurologically damaged for life.Such infections in infants are rare ininfants. However infections occur inall age groups, though fortunatelywith less severe clinical outcomes.This article reviews the latestadvances in our understandingvarious aspects of Cronobacterwhich have been revealed usinggenomic analysis. This illustrateshow an emergent bacterium canquickly be unlocked using ‘state ofthe art’ next generation sequencingand combined with epidemiologicalknowledge and laboratory studieson its physiology, virulence,detection and control.

Cronobacter are an emergentgroup of pathogenic bacteria ofparticular concern in neonatalinfections. About 80% of strainsproduce a non-diffusible, yellowpigment on Tryptone Soya Agar at25°C, and this led to the earlydescription of ‘yellow-pigmentedEnterobacter cloacae’. In the1980’s researchers used DNA-DNAhybridization to show that thesestrains were a unique taxonomicgroup and should be recognised asa separate species ‘Enterobactersakazakii’. The name being tohonour the Japanese bacteriologistRiichi Sakazaki. The organismattaches to surfaces, forming

biofilms that are resistant tocleaning and disinfectant agents,and it has also been found as partof the mixed flora biofilm in enteralfeeding tubes from neonatalintensive care units.

However, since the 1980s, bacterialsystematics has increasingly usedDNA sequencing for its analysisand for determining relatedness.Analysis of both partial 16S rDNAand hsp60 gene sequencesshowed that ‘E. sakazakii’ isolatesformed at least four distinctgenomogroups which could beunique species. However, such ataxonomic revision requiredconsiderable further analysis forsubstantiation. The Cronobactergenus was defined first in 2007 andrevised in 2008. This slowrealisation and recognition ofCronobacter reflects the laboriousand time consuming methods usedin this pre-genomic period forbacterial characterisation.

Cronobacter can grow over a widetemperature range. The lowest isnear refrigeration (~5°C) and themaximum growth temperature (44-47°C) is strain dependent.

The organism’s tolerance to dryinghas been well noted, and it cansurvive for two years desiccated ininfant formula and then rapidly growon reconstitution. It is theoccurrence of the organism inpowdered infant formula which hasbeen highlighted; however,Cronobacter is ubiquitous. It hasbeen isolated from a wide range ofsources, and asymptomatic humancarriage has also been reported.

One probable niche forCronobacter is plant material, as ithas been isolated from cereals,wheat, corn, soy, rice, herbs andspices, vegetables, and salads. Theorganism has been isolated from arange of other foods, includingcheese, meats, milk powder,powdered infant formula and a

large number of food ingredients.The bacterium has been isolatedfrom the hospital environment andclinical samples; cerebrospinalfluid, blood, bone marrow, sputum,urine, inflamed appendix, neonatalenteral feeding tubes andconjunctivae.

Infections due to Cronobacterspecies occur across all agegroups. However neonates,particularly those of low-birthweight, are the major identifiedgroup at risk as the organism cancause meningitis, necrotisingenterocolitis (NEC) and sepsis inneonatal intensive care units with ahigh mortality rate. Although infantinfections of Cronobacter havebeen associated with intrinsic andextrinsic contaminated powderedinfant formula, other environmentalsources are possible and a numberof non-infant formula associatedcases have been reported.

Cronobacter spp. have been shownto invade human intestinal cells,replicate in macrophages, andinvade the blood brain barrier. Fatalinfant infections have followedcases of necrotizing enterocolitis(NEC), septicaemia and meningitis.Infections in older age groups areprincipally bacteraemias as well asurosepsis and wound infections.NEC is noninvasive (and ismultifactorial), whereas insepticaemia and meningitis, theorganism has attached andinvaded, presumably through theintestinal epithelial layer.

In Cronobacter meningitis, there isgross destruction of the brain,leading sadly to either death (40-80% of cases) or severeneurological damage. Thepathogenesis of the meningitis isdifferent to Neisseria meningitidisand neonatal meningitic E. coli, andis similar to that of the closelyrelated bacterium, Citrobacterkoseri.

Unlocking Cronobacter infections of neonates using genome sequencing By Eva Kucerova and Stephen J. Forsythe


May/June 2011 | 47

A number of outbreaks ofCronobacter spp. have beenreported in neonatal intensive careunits. A common feature in some ofthese outbreaks is the opportunityfor temperature abuse of theprepared feed, which would permitbacterial growth.

It is pertinent to note that thebacterium is isolated from thetracheae and has been recoveredfrom the feeding tubes of neonatesfed breast milk and ready-to-feedformula, not infant formula.Therefore, wider sources of theorganism during an outbreak needto be investigated, not just the useof powdered infant formula. Infantscan be colonized by more than onestrain of Cronobacter, and thereforemultiple isolates need to becharacterized in epidemiologicalinvestigations.

Last year we used both wholegenome sequence analysis andcomparative genomic hybridisationbased analysis to describe a rangeof virulence traits in Cronobacter(Ref 1). The strain to be sequencedwas C. sakazakii strain BAA-894.This strain had originally beenisolated from powdered formulaassociated to a fatal Cronobacteroutbreak on a NICU.

The genome comprises a 4.4 Mbchromosome (57% GC content)and two plasmids; 31 kb (51% GC)and 131 kb (56% GC). Thegenome was used to construct a387,000 probe oligonucleotide tilingDNA microarray covering the wholegenome. Comparative genomichybridization (CGH) wasundertaken on five other C.sakazakii strains, andrepresentatives of the four otherCronobacter species. Among 4,382annotated genes inspected in thisstudy, about 55% of genes werecommon to all C. sakazakii strainsand 43% were common to allCronobacter strains, with 10–17%absence of genes. CGH highlighted15 clusters of genes in C. sakazakiiBAA-894 that were divergent orabsent in more than half of the

tested strains; six of these are ofprobable prophage origin. Putativevirulence factors were identified inthese prophage and in othervariable regions.

A number of genes unique toCronobacter species associatedwith neonatal infections (C.sakazakii, C. malonaticus and C.turicensis) were identified. Theseincluded a copper and silverresistance system known to belinked to invasion of the blood-brainbarrier by neonatal meningiticstrains of Escherichia coli. Inaddition, genes encoding formultidrug efflux pumps andadhesins were identified that wereunique to C. sakazakii strains fromoutbreaks in neonatal intensivecare units. OmpA probably has arole in the organism penetrating theblood-brain barrier, though themechanism leading to thedestruction of the brain cells isunknown and could, in part, be ahost response.

The genes that were shared by thethree strains associated with C.sakazakii outbreaks in NICUs werecompared with the C. sakazakiispecies type strain ATCC 29544T,which showed decreased virulenceproperties in tissue culture studies.One hundred and forty four genespresent in the three NICU strainswere absent in the type strain. Inmost of these clusters, genesencoding proteins associated withresistance to different forms ofstress were identified, includingmultidrug efflux systems, genesinvolved in resistance to oxidativestress, and those with a putativefunction in resistance to metals.

Typing Cronobacter to understandits diversity has led to thedevelopment of a multilocussequence typing (MLST) scheme(Ref 2) which is available online(www.pubMLST.org/cronobacter/).The scheme for C. sakazakiirevealed stable clones, some ofwhich could be traced over a 50year period, from a wide range ofcountries and sources. The MLST

scheme is based on 7housekeeping genes (atpD, fusA,glnS, gltB, gyrB, infB, ppsA; 3036 ntconcatenated length). The MLSTscheme currently has 79 definedsequence types covering allCronobacter species and isavailable online athttp://www.pubMLST.org/cronobacter.

Earlier this year (2011) it wasrealised that although the clinicalisolates were in 10/28 STs definedfor C. sakazakii these were notevenly distributed (Ref 3). Ofparticular interest was that half ofthe strains were ST4. This appearsto be a very stable clone as clinicaland non-clinical strains have beenisolated from 7 countries for over 50years. Therefore C. sakazakii ST4appears to be a highly stable clonewith a high propensity for neonatalmeningitis. There our currentresearch is into the genomicanalysis of this life-threateningvariety of Cronobacter sakazakii.

References

Kucerova E, Clifton SW, Xia X-Q,

Long F, Porwollik S. Fulton L. et al.

Genome sequence of Cronobacter

sakazakii BAA-894 and

comparative genomic hybridization

analysis with other Cronobacter

species. PLoS ONE. 2010;5:e9556.

Baldwin A., Loughlin M., Caubilla-

Barron J, Kucerova E, Manning G,

Dowson C et al. Multilocus

sequence typing of Cronobacter

sakazakii and Cronobacter

malonaticus reveals stable clonal

structures with clinical significance

which do not correlate with

biotypes. BMC Microbiol.

2009;9:223.

Joseph, S. and Forsythe, S.

Association of Cronobacter

sakazakii ST4 with neonatal

infections. Emerging Infectious

Disease 2011. In Press.

Contact details: School of Scienceand Technology, Nottingham TrentUniversity, Clifton Lane,Nottingham, UK. NG11 8NS. Tel:+1158483529, Fax: +1158486636

May/June 2011 | 48


Philips Healthcare showcased

its latest innovations in Sleep

Therapy at the 8th

Otolaryngology Exhibition and

Conference in Dubai in May.

At the show Philips demonstrated,for the second year in a row, itsmost recent innovative range ofSleep Diagnostics and TherapySolutions. The event will tookplace in Dubai from the 8th - 10thof May at the Joharah ballroom inMadinat Jumeirah.

Otolaryngology is a branch ofmedicine that deals with diagnosisand treatment of diseases relatedto the ear, larynx, and upperrespiratory tract. Philips’participation comes in line with itsgoal to increase awarenessaround sleep disorders caused bybreathing difficulties.

“There are a number of potentialcauses for a disturbed night’ssleep. These include sleepdisorders such as ObstructiveSleep Apnea (OSA), which affectsapproximately 4 percent of theadult population”, says DiederikZeven, General Manager of PhilipsHealthcare Middle East. “It’s adisorder characterized by airwaycollapse behind the tongue duringsleep, which obstructs breathing. Ifuntreated, it can contribute to thedevelopment of high bloodpressure, diabetes, heart attacks,and strokes”, he adds.

As a global leader in themanagement of sleep disorders,Philips Healthcare has developeda wide range of products andsolutions, from diagnostic toolsthrough patient-centered sleeptherapy devices, to help enhancethe quality of sleep and therebyimprove the health and well-beingof people around the world.

Philip hosted a workshop, duringthe event, on Sleep Therapy

Sleep Diagnostics and Therapy Solutions

Solutions, demonstrating sleepapnea therapy devices and masksto the clinicians and offering thema practical hands-on training.

The Philips Healthcare solutionson display at the 8thOtolaryngology Exhibition andConference were:

• Alice 5™Polysomnography System: a sleeplaboratory system that is suitablefor hospital or institutionalapplications. This systemrepresents the state-of-arttechnology in sleep diagnosticsand combines a total of 55channels to diagnose sleepdisorders in the lab setting.

• Alice PDx™ PortableSleep Diagnostic System: aportable sleep recording device forObstructive Sleep Apneascreening, follow up anddiagnostic assessment of Cardio-Pulmonary Sleep Disorders. TheAlice PDx™ enables clinicians totest their patients outside the lab,at home or clinic, withoutcompromising the study’s results.

• System One SleepTherapy Platform of CPAP &BiPAP: is the latest generationfrom Philips Respironics SleepTherapy Devices for the treatmentof Obstructive Sleep Apnea. Thenew CPAP and BiPAP devicescomes with intelligent technologythat simplifies patientmanagement by monitoringpatients and recognizing whentherapy needs are changing, whileoffering sophisticated comfortenhancements.

• Comfort Gel Nasal & FaceMasks: Philips Respironicsprovides a wide range of patientmasks for the treatment ofObstructive Sleep Apnea.

www.mea.philips.com/index.page

Philips Healthcare Middle East

May/June 2011 | 49



May/June 2011 | 50

Since the opening of nominationsfor our 2010 Healthcare andInnovation Awards for exporters ofmedical equipment to the MiddleEast, and healthcare providers,there has been a high number ofapplications from companies andhealthcare providers from all areasof the industry.

The awards are now in theirsecond year, as is the magazine.The 2009 awards were presentedat Arab Health 2010 by Lord Darzi,the distinguished surgeon and UKbusiness ambassador.

This year the winners will bepresented with their awards at TheWorld Health Care Congress beingheld in Abu Dhabi from 11-13December 2011. The World HealthCare Congress Middle East is themost prestigious health care eventn the region, convening globalthought leaders and key decisionmakers from all sectors of healthcare to share global best practiceson health care innovation andimprovement.

The awards categories covermanufacturers and providers ofhospital equipment, nursingequipment, respiratory devices,preventative solutions, surgicalequipment, and more. Newproducts for export to the MiddleEast are being recognized, as wellas established products that havealready made a significantcontribution to healthcare in theregion.

There is also a section for the bestexporters from the most prolificexporting regions and countries,and awards for hospitals,companies or individuals that havemade outstanding contributions tohealthcare in the Middle Eastregion with awards for excellence inpediatric care, cardiovascular care,orthopedic care, rehabilitative care,respiratory care, cancer care,healthcare recruitment, and

healthcare research. These awardsare intended to recognise thecontribution of companies fromacross the globe to healthcareservices in the Middle East, and thebenefits their products haveprovided for hospitals, cliniciansand patients in the region.

The Arab countries import the vastmajority of their medical devices andhealthcare products, and theintroduction of high quality,

innovative new technologies tothese countries by medicalequipment manufacturers hasplayed a major role in the ongoingrevolution in healthcare provisiontaking place in the Middle East.

Please visit the MEH websitewww.middleeasthospital.com to findout how to put your product,company, or organisation forwardfor an award.

MEH 2010 Health and Innovation Awards

Dirty utility room specialists DDC Dolphin have beennominated for the Pulpmatic+ Macerator

Pulse International: nomiated for their contribution tomedical recruitment in the Middle East

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Documents

Middle East Hospital Magazine - May/ June 2011