Anti-neutrophil cytoplasmic antibodies (ANCA) were originally described in the context of chronic inflammatory diseases. Such antibodies were detected by indirect immunofluorescence (IIF) on ethanol-fixed neutrophilic granulocytes revealing a pattern of perinuclear staining (P-ANCA). Many years later it appeared that these antibodies were commonly present in patients with small-vessel vasculitis, although in these patients two distinct patterns were observed, i.e., the P-ANCA pattern and granular cytoplasmic staining (C-ANCA).

In contrast to the C-ANCA pattern, the P-ANCA pattern appeared to be an artefact due to the fixation with ethanol. Indeed, if the neutrophils were fixed with formalin, the sera that were identified with a P-ANCA pattern on ethanol-fixed neutrophils revealed a C-ANCA pattern on formalin-fixed neutrophils (Figure1). 

Figure 1: ANCA-patterns of indirect immunofluorescence. PR3-ANCA reveal a granular fluorescence in the cytoplasm of ethanol-fixed (C-ANCA, upper-left) and formalin-fixed neutrophils (lower-left). MPO-ANCA, however, reveal a linear fluorescence around the de nucleus of ethanol-fixed neutrophils (P-ANCA, upper-right). This is a fixation artefact because formalin-fixed neutrophils reveal a granular fluorescence in the cytoplasm (C-ANCA, lower-right).

At the end of the ‘80s, the antigens recognised by ANCA in patients with small-vessel vasculitis were identified as myeloperoxidase (MPO) and proteinase 3 (PR3). This enabled the development of antigen-specific immuno-assays that were more specific for vasculitis than IIF. Due to the high sensitivity of IIF, the 1999 international consensus on ANCA testing prescribed that screening for ANCA should be performed by IIF with the follow-up of positive results by solid-phase assays of both MPO- as well as PR3-ANCA. In particular, the combination of C-ANCA/PR3-ANCA and P-ANCA/MPO-ANCA was highly suggestive of the so-called ANCA-associated vasculitis (AAV), consisting of granulomatosis of polyangiitis (GPA, previously Wegener’s granulomatosis), microscopic polyangiitis (MPA), and eosinophilic granulomatosis of polyangiitis (EGPA, previously Churg-Strauss syndrome).

Related: Antibody indices – a growing analysis in the diagnosis of CNS diseases

In the meantime, solid-phase assays gradually improved in terms of test characteristics, and multiple distinct assays, next to the original ELISA, entered the market. Since many of these systems were executed on fully automated analysers, laboratories increasingly abandoned IIF as a screening method, although solid evidence for this approach was not yet available. The multicentre study published in 2017, however, clearly revealed that the current immuno-assays for MPO- and PR3-ANCA outperformed the most optimal IIF strategy, i.e., the combination of ethanol- and formalin-fixed neutrophil substrates. This resulted in a revised international consensus stating that for GPA and MPA detection of ANCA by antigen-specific immuno-assays is to be preferred above screening with IIF. This consensus was subsequently extended to EGPA, although this was an eminent-based consensus because underlying data were lacking. The novel consensus also advised performing a confirmation test if results for MPO- or PR3-ANCA were only low-positive. Again, because antigen-specific assays outperform IIF, confirmation preferentially is performed with antigen-specific immuno-assays.

Based on the above, it might be conceived that ANCA IIF can be completely abandoned. However, several clinical settings may still profit from IIF. First, AAV or clinical mimics may be induced by drugs, one of which is cocaine. This may result in the generation of ANCA directed to human elastase (HLE), which reveals a P-ANCA pattern in IIF. Obviously, such sera may react negatively in antigen-specific assays for MPO- and PR3-ANCA. Many of these sera, however, are also positive for both MPO- as well as PR3-ANCA.

Secondly, ANCA as detected by IIF is not restricted to AAV, but is also encountered in inflammatory bowel disease, in particular ulcerative colitis, and autoimmune liver diseases like autoimmune hepatitis and primary sclerosing cholangitis. The antigens recognised by these ANCA are only poorly defined and, although some assays reveal an increased prevalence of PR3-ANCA in ulcerative colitis and primary sclerosing cholangitis, IIF seems to be the best method of detection.

Finally, ANCA IIF remains relevant in the 2022 classification criteria of the three distinct subtypes of AAV. These criteria are based on a dataset generated from 2011 – 2017, which is before the publication of the revised consensus on ANCA detection. In these criteria, P-ANCA is equivalent to MPO-ANCA while C-ANCA is equivalent to PR3-ANCA. It should be stressed, however, that these criteria should be applied in patients for which a diagnosis of small-vessel vasculitis has been established, but a classification for GPA, MPA, or EGPA has to be made.

Related: Guide to building pharma strategies in oncology

Since ANCA are not only used for diagnosis but also for follow-up of AAV patients, adequate positioning of IIF versus solid-phase assays also holds for this purpose. ANCA detection for follow-up may have three distinct intentions — first, to see if autoantibody levels decline after the start of immunosuppression; second, to determine the risk of relapse at the time clinical remission is achieved; and third, to predict a clinical relapse based on a rise in ANCA.

For the first objective, a decline can be observed equally well by both techniques as long as the end-point titer/level has been determined. For the second objective, it is important to know that this risk evaluation has originally been established by IIF, while more recently it was shown to be less predictive for solid-phase immunoassays. Finally, the added value of serial ANCA measurement for predicting a clinical relapse remains a matter of discussion. However, in general, solid-phase assays perform more accurately than IIF. For this objective, it is crucial that one-and-the same assay is used for follow-up because the results of distinct assays cannot be aligned.

Altogether, it is evident that ANCA IIF has played a very important role in the laboratory diagnostics of small-vessel vasculitis. Although ANCA IIF has recently been included in the criteria to classify the distinct disease entities of AAV, evidence for a multi-centre study clearly indicates that antigen-specific immuno-assays are better for the diagnostic work-up of these diseases. Positioning of IIF in other chronic inflammatory diseases cannot be replaced because the respective antigens are not well known.

Dr. Jan Damoiseaux is the Assistant Professor, Diagnostic Centre, NUTRIM School of Nutrition and Translational Research in Metabolism; Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands. He will be speaking on “ANCA IF Pattern in Current Clinical Practice” at the Immunology Conference on August 18 at Medlab Asia 2023.

Learn more about Medlab Asia and Asia Health and click here to register for the event.

This article appears in Omnia Health magazine. Read the full issue online today.

Back to Laboratory

Rare diseases pose a substantial burden on healthcare systems, particularly in underserved regions such as the Middle East. The lack of access to genomic diagnostic services and personalised management plans exacerbates this challenge. To address this pressing issue, Al Jalila Children’s Specialty Hospital (AJCH) has taken a significant step by establishing a clinical genomics and genetic counseling facility. Housed within a multidisciplinary tertiary paediatric centre in the UAE, our facility is dedicated to diagnosing and managing patients with rare diseases. Standard clinical genomic investigations at our facility include exome-based sequencing, chromosomal microarrays, and/or targeted testing. In my session “Current State of Genomic Diagnostics in Pediatrics” at Medlab Asia 2023, I will summarise our experience including the diagnostic yield and implications for clinical management among this population.

Related: Genomics and its rapid evolution in the Middle East

I will also highlight several new efforts toward enhancing the diagnostic efficacy and earlier identification of patients with rare diseases. These efforts include rapid whole genome sequencing for critically ill patients, newborn genetic screening, and whole genome long read sequencing. According to data from clinical standard testing on 1,000 patients with rare diseases (46.2 per cent females; average age, 4.6 years) representing 47 countries primarily from the Arabian Peninsula, the Levant, Africa, and Asia, the cumulative diagnostic yield was 32.5 per cent (95 per cent CI, 29.7– 35.5 per cent). This was higher for genomic sequencing-based testing than chromosomal microarrays (37.9 per cent versus 17.2 per cent, P = 0.0001) across all indications, consistent with the higher burden of single gene disorders. Of the 221 Mendelian disorders identified in this cohort, the majority (N = 184) were encountered only once, and those with recessive inheritance accounted for ~ 62 per cent of sequencing diagnoses. Of patients with positive genetic findings (N = 325), 67.7 per cent were less than five years of age, and 60 per cent were offered modified management and/or intervention plans.

Interestingly, 24 per cent of patients with positive genetic findings received delayed diagnoses (average age, 12.4 years; range from seven to 37 years), most likely due to a lack of access to genomic investigations in this region. One such genetic finding ended a 15-yearlong diagnostic odyssey, leading to a life-threatening diagnosis in one patient, who was then successfully treated using an experimental allogenic bone marrow transplant.

Related: The role of diagnostics in combatting life-threatening diseases

Finally, we present cases with candidate genes within regions of homozygosity, likely underlying novel recessive disorders. Attendees can look forward to a feasibility study on a newly established pipeline for rapid whole genome sequencing (within 40 hours) for critically ill patients, as well as a discussion on a recent expansion of this pilot study, to include more patients over the next two years and generate evidence (clinical and economic utility) supporting implementation of this technology for patients in NICU/ PICU. I will also show preliminary results from our newborn genetic screening programme on the genetic epidemiology of spinal muscular atrophy (SMA) as a prototype for recessive diseases in the region. Finally, I will highlight the additional benefit of using whole genome long read sequencing in our setting. AJCH believes that early access to genomic diagnostic testing is a tenet to improving clinical outcomes for individuals living with rare diseases.

Facilitating timely and accurate diagnoses enables us to provide tailored treatment and care plans for genetically underrepresented populations in the Middle East. By bringing together advanced technology and expert genetic counseling, our facility strives to improve the quality of life for patients and families facing these medical challenges, fostering hope and empowering them with knowledge and support.

 

Dr. Ahmad Abou Tayoun is the Director of the Genomics Center of Excellence at Al Jalila Children’s Hospital, and an Associate Professor of Genetics at Mohammed Bin Rashid University of Medicine and Health Sciences. He will present his topic “Current Genomic Diagnosis in Paediatrics” at the Molecular Diagnostics and Genomics conference on August 16 at Medlab Asia 2023.

Learn more about Medlab Asia and Asia Health and click here to register for the event.

This article appears in Omnia Health magazine. Read the full issue online today.

Back to Laboratory

Healthcare workers are digital native consumers. The new generation may have grown up without paper, pen and fax, but they know what good service delivery feels like. It is digitally accessible and responsive, self-service and empowering, with transparency of information and choice At the same time, our global health systems are under pressure like never before. The systems we crafted centuries ago to manage battlefield trauma and infectious diseases are not scaling to address the challenges of a population with lifestyleinduced chronic disease. Thanks to modern medical miracles, we are increasingly turning acute conditions like cancer into chronic diseases. In our developed world we simply do not have enough staff, beds and facilities to meet current demand, nor can we scale to meet future projections. Our workforces are increasingly specialised and centralised in metropolitan hubs, while patients are geographically spread. 

We need a new health system paradigm underpinned by new models of care. We need a way to deliver high-quality services that are equitably accessible to patients wherever they are, with the same workforce and ideally at the same or lower cost. We need digital at the core. The good news is that we do not need to imagine the future. It is already here — deployed and delivering the outcomes and results we desperately need. The challenge is turning these pockets of innovation into the default model, as these new models of care include virtual care, self-directed care, preventative care, and precision medicine.

Related: ASEAN region ranks high in healthcare competitiveness

At the same time, we need to make progress beyond eliminating paper and implementing systems of record in healthcare. If all we do is digitise, we may be missing the opportunity to transform care. That means using the data that we capture for insights and ensuring that the experience is modern and intuitive. One of the most promising technologies is artificial intelligence and this has delivered compelling capabilities in the field of machine vision for diagnostic imaging. Now we have trained models that are finding a ready home in radiology, pathology, dermatology, and ophthalmology. Creating an accurate diagnostic model for diagnostic imaging is a matter of clinician input, training data, data science skills, and computing resources, then fine-tuning through reinforcement feedback learning. Beyond medical imaging, however, marshalling these inputs has proven a barrier to the broader application of artificial intelligence in healthcare. 

In the last year, however, generative AI has surfaced to provide an answer to these constraints. Large Language Models (LLMs) have decoded communication, i.e., our human operating system and can infer context and content to produce surprisingly insightful responses even for specialised fields like medicine. Forget the higher-order tasks that clinicians already do well, there is a role for AI to address the estimated 25 per cent of waste baked into how we deliver healthcare today. 

Related: Integrated care models offer seamless access to health services

We can solve our workforce dilemma if we could let clinicians diagnose and treat patients, perform the top-of-license care they are uniquely trained to deliver and get satisfaction from, and leverage AI to mop up the administrative complexity, redundancy, fraud, rework, and error. That is latent productivity. Imagine an extra 25 per cent more staff; if we couple this with outreach technologies to engage patients and virtual care models to meet them where they live, we can then address access and equity It is an exciting time for digital health. Powerful technologies are available to modernise health services, leading to better outcomes for patients and experiences for clinicians. We have validated that these technologies can be delivered safely and effectively as new models of care. Now is the time to create a future health system paradigm that will help us address the challenges of today and the future.

References available on request

Dr. Simon Kos is the Chief Medical Officer at Microsoft, Australia and New Zealand. He will present his topic, ‘AI in Medicine’ at the Committed to the Evolution of Healthcare in Asia conference on August 16 at Asia Health 2023.

Learn more about Medlab Asia and Asia Health and click here to register for the event.

This article appears in Omnia Health magazine. Read the full issue online today.

Back to Technology 

Healthcare in Southeast Asia boasts a decades-long commitment to innovation and advanced medical facilities with a robust infrastructure. These collectively raised its rank as a competitive global destination for high-quality, affordable medical treatment, attracting patients from the region and abroad. Additionally, it has become a state-of-the-art learning hub for professionals in the healthcare business by offering an immersive platform for the exchange of knowledge and technology.

Investments continue to pour in as governments in Southeast Asia allocate a significant portion of their budget to boost the healthcare industry. Healthcare expenditure in Thailand, for instance, is valued at approximately US$25.3 billion, according to the US-based International Trade Administration. These costs are further expected to mark a 10-year compound annual growth rate of 6.6 per cent by 2026 amounting to US$47.9 billion. The Eastern Economic Corridor (EEC) development plan led by the Thai government is set to play a role in raising the country to an innovation-based economy, which in turn is expected to fuel healthcare projects within the provinces covered under the scheme, namely Chachoengsao, Chon Buri, and Rayong. 

This has welcomed special privileges for healthcare businesses ranging from a 17 per cent flat personal income tax, a corporate income tax reduction of 50 per cent, as well as the provision of a five-year work visa to manage operations and retain skilled medical talent.

Related: Taking a closer look at China's health and wellness market through a consumer lens

Exciting times are ahead for the healthcare industry in the ASEAN region as countries turn their attention to preventive care and technological advancements. Geriatric care is also slowly but surely becoming an important focus area as the ageing population is set to increase by 20.3 per cent in 2050, according to recent statistics published by The BMJ, a peer-reviewed medical trade journal by the British Medical Association.

Keeping the region’s healthcare workforce up to speed with the latest trends, technology and business strategies, premier events — Medlab Asia and Asia Health — return for its seventh edition with a refined portfolio of leading medical laboratory and healthcare innovation, as well as networking opportunities for businesses in the healthcare industry. The event, taking place between August 16 and 18 in Bangkok, further infuses the concept of sustainability into various aspects of the business to leave an economic, environmental and social impact — from operations, logistics, conference and networking programmes to laboratory, patient care, community, and future health planning and development. 

The latest edition of the show is home to the region’s only multidisciplinary congress, featuring 13 accredited conferences in various trending sectors, namely laboratory management, molecular diagnostics, haematology, and immunology under Medlab Asia, and emergency medicine, patient safety and infection control, total radiology and nursing under Asia Health. 

The conferences will also feature the voices of leading female leaders in the healthcare industry, from opening remarks for the nursing track by Prof. Dr. Siriorn Sindhu, President of the Nurses Association of Thailand (NAT), and Dr. Associate Prof. Nanthaphan Chinlumprasert as moderator for the ‘Redesigning palliative care in all dimensions for optimum results’ panel. The show will also have inspirational insights from Assistant Prof. Pimpun Kitpoka, Director of Blood Bank at Ramathibodi Hospital, Mahidol University who will speak at the emergency medicine conference, alongside keynotes delivered by Lisa Mckenzie, VP Asia Pacific at the Australia-based Institute for Healthcare Improvement (IHI) and Prof. Le Thi Anh Thu, President of Vietnam Infection Control Society Safety under the patient safety track.

Related: Entering New Markets: Discovering Asia's Untapped Potential

The ‘Doing Business in Thailand’ track, which will take place on August 17 and 18 in partnership with the Thai Medical Device Technology Industry Association (THAIMED), is specially curated to give industry leaders — entrepreneurs and policymakers to investors and decision makers alike — key insights into the country’s dynamic healthcare market and highlight business opportunities and solutions. The two-day agenda will highlight thought-provoking topics such as digitalisation agility in healthcare business, future medical device support for the private sector, good manufacturer distributor practice, and digital health reimbursements, to name a few.

Learn more about Medlab Asia and Asia Health and click here to register for the event

This article appears in Omnia Health magazine. Read the full issue online today.

Back to Management

A substantial demographic shift is underway in the UAE and a significant part of the population is expected to suffer from age-related conditions such as dementia and Alzheimer’s. According to statistics, the year 2050 will see a spike in seniors where approximately 16 per cent of the country’s population — that’s two million people — will be in the age range of 60 and above, adding a burden to healthcare systems.  

Alzheimer’s education and training for caregivers 

A progressive and irreversible neurological disorder, Alzheimer’s is the most common form of dementia, that affects the brain causing memory loss and cognitive decline. In the next three decades, the number of people living with dementia in the UAE could reach 220,000 individuals, according to a study in the Lancet medical journal. These statistics not only make it crucial to increase awareness about the severity of the disease but also require encouraging government entities, healthcare organisations, and medical professionals to focus on addressing the challenges that come with an aging population.  

Related: New drug to slow down Alzheimer’s disease

Healthcare professionals play a significant role in helping educate individuals and communities about the risk factors associated with Alzheimer’s, says Dr. Zemer Wang, Medical Director of Aviv Clinics Dubai. Through periodic screenings and assessments, they can identify early signs and symptoms of cognitive decline, allowing for timely intervention and better management of risk factors contributing to the development of the disease. They can assist with managing symptoms and slow down disease progression by prescribing appropriate medications and recommending lifestyle modifications to individuals previously diagnosed.  

Early intervention can allow medical practitioners effectively connect patients and their families to relevant resources and support services and offer emotional support and counselling to those affected and their families.  

New technology for Alzheimer's  

While education and early intervention have resulted in curbing disease progression, advancements in technology have also increasingly helped in improving communication and tracking in Alzheimer's care. 

Researchers are exploring the use of digital biomarkers, which are objective and quantifiable measures derived from data collected through digital devices. “Biomarkers can provide continuous and remote monitoring of cognitive performance, enabling early detection of changes associated with the disease,” says Dr. Wang.  

He further adds that advanced brain imaging techniques, such as positron emission tomography (PET) scans and magnetic resonance imaging (MRI), have significantly contributed to understanding the progression of Alzheimer's disease. These imaging methods can visualise changes in brain structure, detect amyloid plaques and tau tangles, and assess brain metabolism and blood flow patterns. Integrating artificial intelligence and machine learning algorithms further enhances the analysis and interpretation of these imaging data, aiding in early detection and monitoring. 

Related: Much-awaited breakthrough for treatment of Alzheimer’s

Additionally, applying artificial intelligence and machine learning techniques to large-scale data including electronic health records, genetic profiles, lifestyle data, and imaging data, can help researchers identify patters, risk factors, and predictive markers associated with Alzheimer's disease progression. This could then lead to personalised approaches for monitoring and intervention.  

Ongoing research and clinical trials aim to better understand the underlying mechanisms of Alzheimer's and develop more effective treatments and preventive strategies. 

On the medical treatment front, options like the Hyperbaric Oxygen Therapy (HBOT), in which a patient breathes 100 per cent oxygen in a pressurised chamber have shown notable strides, says Dr. Wang. “The new protocols of HBOT have been proven to induce the generation of new blood vessels, reduce inflammation, and promote the growth of new neurons in the brain and thus reverse some of the core, common elements that are believed to be responsible for the development of Alzheimer's disease and dementia,” he adds. 

The US Food and Drug Administration (FDA) also recently granted approval for a new drug, Leqembi, designed to slow the progression of the Alzheimer’s. Also known as Lecanemab, it is the second major drug introduced for the treatment of the disease and targets a protein called amyloid which builds up in the brain in people with Alzheimer’s. 

Back to Technology 

 

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Central Sterile Services Department (CSSD) in healthcare settings has witnessed significant improvements in workflow efficiency. Automation of sterilisation processes through advanced sterilisers with precise parameters has enhanced consistency and minimised errors, according to Dr. Sherbaz Bichu, Chief Executive Officer of Aster Hospitals and Clinics in the UAE, Oman and Bahrain.  

Emphasising the pivotal role of CSSD and the transformative impact of technological advancements in ensuring patient safety and infection control in healthcare facilities, Dr. Bichu said that CSSD maintains the highest standards of hygiene and prevents healthcare-associated infections (HAIs) in hospital settings. 

CSSD, also known as the Sterile Processing Unit (SPU), is a critical department responsible for the cleaning, sterilisation, and distribution of medical and surgical instruments, equipment, and supplies.  

Related: Highlighting effective elimination of pathogens

“The CSSD is the backbone of infection control in our hospitals. It is a key component of patient safety, ensuring that all reusable medical devices and instruments are decontaminated, sterilised, and prepared for safe use in patient care areas,” said Dr. Bichu. 

Highlighting the significance of CSSD in hospital management, Dr. Bichu said that it plays a crucial role in maintaining infection control, adhering to industry standards and regulations, and ensuring the reliability of medical equipment. 

Dr. Sherbaz Bichu, Chief Executive Officer of Aster Hospitals and Clinics in the UAE, Oman and Bahrain.  

 

“Technological innovations have revolutionised CSSD operations. Automation and sophisticated tracking systems have streamlined the sterilisation process, leading to increased efficiency,” he said. 

In addition, barcode and RFID tracking systems have transformed inventory management, offering real-time visibility and optimising stock levels to minimise stockouts and delays. Electronic documentation and traceability systems have replaced paper-based records, saving time and enhancing compliance with regulatory requirements. 

The CSSD team, comprising highly trained technicians and supervisors, performs a series of essential activities to uphold the highest standards in healthcare practices. Decontamination marks the initial step, where used instruments and equipment undergo meticulous cleaning using specialised agents, ultrasonic cleaners, and mechanical washers. 

“Effective decontamination is the foundation of a successful sterilisation process. Our technicians follow strict protocols to ensure that all organic matter is thoroughly removed, leaving the instruments ready for sterilisation,” he added. 

Related: Environmental cleaning gains prominence for infection control

The sterilisation process follows decontamination and employs various methods, such as steam sterilization (autoclaving), ethylene oxide (ETO) sterilisation, hydrogen peroxide gas plasma sterilisation, or low-temperature sterilisation systems. This ensures complete eradication of any remaining pathogens, minimising the risk of infections. 

After sterilisation, the CSSD team meticulously assembles the instruments into procedural and surgical sets, ensuring they are readily available for immediate use during medical procedures. The department also plays a crucial role in managing sterile supplies, monitoring inventory levels, tracking expiration dates, and coordinating with other hospital departments to meet their specific equipment needs.  

According to Dr. Bichu, communication and collaboration tools have further facilitated effective teamwork, reducing errors and bottlenecks in the workflow. Virtual reality (VR) and augmented reality (AR) technologies have revolutionised training and education, offering immersive learning experiences to CSSD technicians. 

The amalgamation of skilled CSSD professionals and transformative technology continues to drive healthcare facilities towards safer and more effective patient care, he added. 

Back to Management

In the face of a growing mental health crisis, emergency departments around the world are recognising the urgent need for transformation.  

Considering that one in five (22 per cent) people suffer from depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia as a result of war or other conflicts in the previous decade, these once purely physical spaces can no longer turn a blind eye to the silent struggles of those seeking solace from invisible wounds.  

Building a bridge between physical and mental health is the goal of the ongoing effort to improve emergency departments' ability to handle mental health problems. The time when physical illnesses' urgency overshadowed mental health emergencies has long since passed. Medical professionals are paving the way toward specialised training, collaboration, and innovation with a renewed sense of purpose to give those going through a mental health crisis the support and care they so desperately need. 

Related: Reimagining emergency care: from idea to run

According to the definition of ‘health’ by the World Health Organisation (WHO), mental health cannot be separated from the entire human wellbeing. Therefore, the global health workforce needs to collectively work towards enhancing emergency department response to mental health emergencies. This reinforces how vital it is. 

By prioritising mental health, lives can be saved and suffering alleviated. Breaking the stigma surrounding mental health, emergency departments can challenge the notion that mental well-being is secondary to physical health. Through responding effectively to mental health emergencies, emergency rooms contribute to reducing the financial burden on healthcare systems, preventing costly interventions, repeat visits, and ensuring that individuals receive ongoing support beyond immediate crises. 

The following tips and strategies can help the emergency response team be better equipped to address mental health emergencies: 

Dedicated mental health team: Consider creating a dedicated mental health team within the emergency department consisting of psychiatrists, paramedics, psychiatric nurses, and social workers. This team can provide specialised expertise in assessing and treating mental health emergencies. An apt instance is in Thunder Bay, Ontario, a program including the police, the hospital, and mental health professionals is succeeding in how it responds to calls about mental health crises. 

Related: Development and innovation in emergency transfusion

Specialised staff training: This is to ensure the emergency room personnel has received specialised instruction in mental health crisis intervention. This involves instruction in de-escalation methods, assessing suicide risk, providing trauma-informed care, and identifying common mental health disorders. 

Collaborative care: The emergency and mental health departments need to form alliances with organisations and individuals in the mental health field to encourage interaction between emergency room workers and mental health specialists. To ensure that patients receive the proper follow-up care, this collaboration will serve to speed up the assessment and referral process. 

Reduced wait times: The management of healthcare facilities need to create plans to reduce the amount of time people in mental health emergencies must wait. Delays in receiving care can worsen suffering and raise the possibility of unfavorable outcomes. The process can be sped up by putting protocols in place for quick triage, assessment, and intervention. 

Peer support programme: Peer support programmes where people who have firsthand experience with mental health issues can offer support and direction to patients who are experiencing a crisis have been found to be immensely impactful. Peer support professionals can help to lessen stigma, provide sympathetic understanding, and offer insightful advice to improve the standard of care. 

Data collection and analysis on emergencies involving mental health in the emergency room: This data can be used to evaluate initiatives' efficacy, spot patterns, and plan for upcoming healthcare delivery changes. 

Continuous learning and quality enhancement: It is important to encourage continual training, inspiring evidence-based modifications to protocols as well as practices and education for emergency department personnel to keep them up to date on best practices and developments in mental health care.  

Enhancing emergency department response to mental health emergencies is a matter of utmost urgency and compassion. By prioritising mental health, breaking down stigma, and implementing comprehensive strategies, emergency departments can become safe havens of support, healing, and hope for individuals in their most vulnerable moments.  

Through collaboration, specialised care, and a commitment to continuous improvement, we can forge a path toward a future where mental health receives the attention and care it deserves. 

Back to Clinical

Advancements in digital platforms are powering the transformative change in mental health, giving professional data insights to provide customised care and accessibility to patients.

Artificial Intelligence, alongside data analysis, is giving counsellors, psychologists, therapists, mental health nurses, and even clinical social workers the opportunity to understand individual needs better through real-time statistics and data insights and tailor their treatments. AI can further identify patterns and predict potential mental health issues, which allows early intervention and prevention.

AI-driven chatbots and virtual therapists are also emerging as supplementary tools to support individuals in between therapy sessions. These virtual entities can not only offer coping strategies and resources but also lends an ear as a continuous form of support and emotional resilience.

One of the limitations of traditional mental health approaches is the one-size-fits-all model. Every individual's experience, concerns, and mental health needs are unique, and adopting a personalised approach acknowledges this diversity. Personalised mental health recognises that effective care must be tailored to address specific challenges and complement an individual's strengths.

“Unfortunately, therapy services do not always operate in a way that personalises counselling for different individuals,” Naila Al Moosawi, Founder and Chief Counsellor at AMAL — Counselling for a Better Tomorrow highlighted. Technology aside, she added that the first step is to match a patient with the right therapist by conducting a comprehensive assessment. Overall, this improves the overall experience of personalised treatments.

When conducting comprehensive assessments, factors such as personality and past experiences as well as cultural background are also important to note. Tailored interventions further empower patients to actively engage in their therapeutic journeys, which fosters a sense of ownership and empowerment in their mental well-being.

Related: Integrated care models offer seamless access to health services

Enhanced convenience and accessibility through digital platforms

The advent of digital platforms has further ushered in a new era of convenience and accessibility in mental health care. Virtual therapy and counselling services have broken geographical barriers, allowing individuals from remote areas or with mobility challenges to access support that was previously inaccessible.

Moreover, digital platforms enable clients to engage in therapy from the comfort and privacy of their own homes, reducing the stigma that may have hindered seeking help in traditional settings. Online sessions also offer flexibility in scheduling, accommodating busy lifestyles, and promoting continuity of care for clients facing travel or relocation.

Related: How prioritising mental health support can lead to a better work environment

Technology in holistic care and patient empowerment

Beyond personalised counselling, technology plays a pivotal role in promoting holistic well-being by integrating mental health support into individuals' daily lives. Mobile apps and wearable devices are equipped with tools for meditation, stress management, and mood tracking, encouraging users to engage in self-care practices regularly.

Virtual support groups and online communities provide a space for individuals to connect, share experiences, and find solace in the collective understanding of mental health challenges. These digital platforms create a sense of community and reduce feelings of isolation, fostering a supportive environment for those seeking mental health assistance.

Personalised mental health care, facilitated by technology, empowers individuals to take an active role in their mental well-being. The integration of digital platforms fosters a culture of self-awareness and self-compassion, promoting long-term emotional growth and overall wellness.

As technology continues to evolve, the future of mental health is poised to be even more personalised, accessible, and supportive. By harnessing the potential of technology, mental health professionals can continue to prioritise the individuality of each client, offering tailored solutions that promote lasting well-being and emotional fulfilment.

References available on request.

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Back to Technology

Access the must-read eBook on AI here to discover perspectives on its transformative role in the healthcare industry.

Integrated models of care in healthcare systems are characterised by enhanced collaboration and communication between professionals, facilities and support systems to address patient needs and enhance their overall quality of life by providing better outcomes for disease management, diagnosis, and treatment.  

With such models in place, healthcare practitioners, home care professionals, therapists and other medical providers can work together to better understand the needs of the patient and create a comprehensive treatment plan to treat their prevailing conditions. Besides improving access to services, this collaborative approach towards patient care also significantly helps reduce healthcare costs and provides patients with the solutions they need in just a few doctor visits. Information exchange between medical practitioners also helps expedite diagnosis and eliminate the requirement of unnecessary medical tests and exams, further reducing costs to patients and healthcare companies.  

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Dr. Malathi A, Group Chief Medical Officer and Group Chief Quality Officer at Aster DM Healthcare, believes that an integrated healthcare system prioritises preventive care that results in healthier consequences for patients and long-term cost savings for employers and providers. She added that having similar models in place allows employers to stand out from their competition, as it accentuates the importance of employee health to the organisation. The “myAster”, for instance, helps patients book appointments and online consultations and gives access to medical records, prescriptions, and scans for both patients and doctors.  

These models of care help recognise and manage complex underlying pathologies and allow for seamless integration between primary care and acute hospital services to manage high-risk patients with complex and chronic health conditions better. It has also been linked to significant reductions in service utilisation by improving case coordination, enhancing system management and assessing and managing caregiver needs.  

Earlier this year, the UAE health authorities, including the Ministry of Health and Prevention (MoHAP), Department of Health — Abu Dhabi (DoH) and Dubai Health Authority (DHA) announced the successful integration of ‘Riayati’, the National Unified Medical Record (NUMR), ‘Malaffi’, and “Nabidh” platforms. These platforms provide access to significant patient data that allows doctors to make informed decisions regarding their treatment course and allows healthcare companies to develop programmes and initiatives that transform the health of society. The Riayati platform has by far included 1.9 billion medical records for 9.5 million patients, which can be accessed by over 90,000 health service providers in 3,057 medical facilities.  

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According to Dr. Malathi, there is potential for integrated and patient-centred care to improve the timely provision of appropriate care, increase patient attendance, reduce the incidence or potential impact of conflicting clinical advice, decrease cases of unnecessary hospitalisations, and, most importantly, enhance the patient experience.  

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