Along with initiatives such as the World Health Organization’s (WHO) global call to action, awareness around the importance of patient safety; a fundamental principle of healthcare; has significantly increased. According to the WHO, there are around 2.6 million deaths every year that result from adverse events in patient care. Resulting from unsafe care, adverse events are likely to be in the top 10 leading causes of death and disability worldwide. According to recent evidence, around 134 million adverse events occur every year, especially in low-income countries. We are witnessing significant efforts and investments being made by governments across the Middle East to mitigate preventable deaths, such as the formation and establishment of the Saudi Patient Safety Center (SPSC) in Saudi Arabia and the recent partnership between Dubai Healthcare City (DHCC) and global body, the Patient Safety Movement Foundation (PSMF), amongst many others, to champion the cause in the region.

Ensuring patient safety is not only seen as a fundamental principle of healthcare but as an absolute obligation and cornerstone for the pharmaceutical industry. Since our work is directly linked to the safety of patients, one of our main goals is to decrease the amount of harm related to medications, while maximising the benefit we receive from them.

The pharma industry plays a dynamic role in the research, discovery and development of new medicines and patient safety standards. This process requires active engagement from all involved stakeholders (i.e. healthcare practitioners, research institutes, pharmaceutical companies, regulatory authorities, patients) in order to deliver the right medicine to the right patient, at the right time.

Safety aspects

Safety can be a relative concept, so the importance of assessing everyone’s situation is imperative. When it comes to safety aspects of the development cycle for medicine, treatment options need to be assessed against the risks and benefits of other options, the efficacy and safety of pharma products need to be thoroughly investigated during pre-clinical and clinical studies and the correct documentation needs to be submitted to relevant regulatory authorities. The cycle does not end there because pharma companies must continue to evaluate their products, even well after they have been made available to the public through product label updates and communicating directly with HCPs and patients. Employees at Takeda are always guided by company values through every stage of a product’s life cycle and work to ensure a stringent monitoring process right from the beginning, at the research and development (R&D) stage.

At Takeda, these values of integrity, honesty, perseverance and fairness are underpinned by the company’s decision-making framework of ‘Patient – Trust – Reputation – Business’ (in that same order) that acts as a clear guide and hierarchy for deciding our actions and informing our behaviours. Patient well-being is the first consideration, with business outcomes being the last.

Everybody at the company commits to putting patients first; together we all contribute within our own area of expertise, from reporting adverse events to providing patient support and guidance to healthcare providers, support in building healthcare systems, enabling medication access, developing clear labels and delivering high-quality products. We are also taking steps to ensure we never forget the tragedy of previous medication disasters and the suffering of patients who fall victim to them, as well as our social responsibility towards society as a leading pharmaceutical industry pioneer.

Apart from stakeholder alignment, comprehensive guidelines must be implemented with trained professionals who need to be alert during the entire product development cycle and able to react to any risk. When conducting research to create new drugs, we respect the fact that participants in clinical trials are volunteers and we must exercise care to ensure their safety. Takeda has also implemented robust, global quality management systems and governance models to meet the mandatory requirements and expectations of a best-in-standards global pharmaceutical company.

Possessing the scale and expertise of a values-based, research-driven biopharmaceutical company, we continue to implement and improve our pharmacovigilance activities. We are continuously collecting and monitoring safety information from the development phase of new drugs until after their launch in order to sustain high safety standards and efficacy profiles. We continue to combat the issue of counterfeit medicines, proving our commitment to patients and their safety all around the world.

Dr. Toby Shephard

Recently, Boehringer Ingelheim held a regional webinar titled ‘Managing Type 2 Diabetes during COVID-19’ with the participation of leading healthcare professionals who provided the latest updates on type 2 diabetes (T2D) management during the pandemic. The event formed part of the ‘Regional Interchange on Diabetes’ (e-RID) internationally accredited digital programme, organised by Boehringer Ingelheim, targeting more than 5,000 international and regional healthcare professionals in the Middle East, Turkey and Africa region. By hosting prominent international experts from the U.S., Canada and UK, the scientific programme aims at exchanging experiences and practices in managing type 2 diabetes and its complications during COVID-19.

Reportedly, 39 million people are currently living with diabetes in the Middle East and North Africa, and it is estimated that by 2045, around 82 million people will have the condition, according to the International Diabetes Federation. With diabetes being reported as a risk factor for the severity of COVID-19, patients are being encouraged to take precautions to avoid contracting the virus, such as washing hands thoroughly and regularly, cleaning and disinfecting objects and surfaces that are touched frequently, and avoiding contact with anyone showing symptoms of respiratory illness, such as coughing.

Effective diabetes management

Patients living with T2D need to pay extra attention to their glucose levels and monitor them regularly to avoid complications caused by high or low blood glucose levels. Should they display flu-like symptoms, it is vital they consult with a physician immediately for medical support.

“At a time where the world is focused on COVID-19, it is crucial to highlight the diseases affecting the lives of so many patients in our region such as Type 2 Diabetes. We felt committed to providing patients living with T2D, their caregivers and the wider healthcare community credible sources of information related to diabetes management and necessary precautions during the pandemic,” said Mohammed Al-Tawil, Regional Managing Director and Head of Human Pharma at Boehringer Ingelheim.

“People with diabetes and related comorbidities are at a higher risk of complications from COVID-19. In fact, 40 per cent of COVID-19 mortality cases in the UAE and Kuwait as announced had diabetes. It is, therefore, imperative that we educate patients on diabetes self-management and comorbidities at this time,” explained Dr. Mohammed Hassanein, Senior Consultant in Endocrinology and Diabetes at Dubai Hospital. “Patients living with uncontrolled T2D face a higher risk of contracting the virus than patients living with controlled T2D. Our priority is, therefore, to ensure effective type 2 diabetes control at this critical time.”

During the event, Dr. Paola Atallah, Specialist Endocrinologist at Saint George Hospital University Medical Center in Lebanon, focused on medical tips and guidance for patients planning to return to work during COVID-19. “Stress levels and disruptions to diet and physical activity throughout COVID-19 could contribute to worsening outcomes for patients with T2D. It is, therefore, essential that patients regularly follow up with their doctors virtually, maintain a healthy diet and fitness routine, stock up on medical supplies, and have an emergency contact on speed dial in case of dire situations,” she explained.

Dr. Atallah also advised people living with diabetes across the region to continue working remotely and to try to minimise contact with those outside their households: “If patients absolutely have to go back to work, I encourage them to make sure they follow strict social distancing measures, wash their hands frequently, and avoid touching their faces.”

Reducing cardiovascular risk

Cardiovascular disease (CVD) remains the number one killer of people with type 2 diabetes, accounting for around 52 per cent of type 2 diabetes patients worldwide. Diabetes is a known risk factor for CVD, so are conditions such as high blood pressure and obesity, all commonly seen in people with diabetes. Collectively, this means that the risk of death due to CVD is up to four times higher in people diagnosed with T2D.

Reducing cardiovascular risk is an essential component of diabetes management, therefore patients are encouraged to educate themselves on how to modify cardiovascular risk factors in order to benefit from the best chance at improving their CVD outcomes. A patient-centric and holistic approach are needed to guide the choice of pharmacologic agents used in patients diagnosed with T2D due to the chronic nature of the disease. Considerations include efficacy, hypoglycaemia risk, history of CVD, impact on weight, potential side effects, renal effects, delivery method, cost, and patient preferences.

From 20-22 October, the ASEAN healthcare community will be brought together on a scale like never seen before through an experience delivered entirely online. IMPACT Exhibition Management has joined forces with Informa Markets, organiser of world-leading events such as Arab Health, Hospitalar, FIME and Medlab Middle East, to bring the virtual edition of Medlab Asia and Asia Health 2020, an international trade exhibition and congress on medical laboratory and healthcare.

Fresh from the success of Omnia Health Live, a one-of-a-kind virtual event combining networking with conferences, Medlab Asia and Asia Health 2020 will answer the needs of the healthcare and medical laboratory industry during these challenging times by providing unprecedented opportunities for professionals to network and access expert knowledge, wherever they happen to be in the world, ensuring that business goes on amidst the uncertainty.

Requiring no more than a device with a stable internet connection, the free-to-attend event will give attendees access to the online platform to interact daily in virtual meetings and webinars, and much more, all conveniently delivered to their browser.

Powered by Grip, the award-winning online event networking technology, the event will see the participation of top names in the healthcare industry such as Dr Tanarak Plipat from the Department of Disease Control, MOPH, Thailand, Dr Kuljit Singh, President, Association of Private Hospitals of Malaysia, and Dr Lynette Oon, President, Singapore Society of Pathology, among others.

Wouter Molman, Executive Vice President – Healthcare, Informa Markets said: “Due to the ongoing pandemic, we have decided to run Medlab Asia and Asia Health as the largest virtual healthcare tradeshow of its kind in the ASEAN region. Hosted on an AI-powered platform, the event will present the exhibitor list, products, technology, or sessions that match attendee profile preferences. It also attracts buyers and industry professionals in the healthcare industry from across the ASEAN region and around the world to connect through the event.”

Enhancing Thailand and the ASEAN healthcare industry, IMPACT Exhibition Management and Informa Markets envision this year’s virtual edition to provide the industry easy access, new connections and create boundless business opportunities. Attendees can be conveniently connected worldwide with no time constraints. In addition, the business matching platform will provide buyers, both trade and clinicians an opportunity to interact and build long-term relationships. The virtual event is also reinforced with 50 multi-disciplinary CME/CMTE-accredited webinars.

Loy Joon How, General Manager, IMPACT Exhibition Management Co., Ltd., added: “Despite COVID-19, it’s crucial to stay connected. We are consistent in supporting the industry via virtual events, which will benefit industry professionals to connect and network in the digital sphere. Medlab Asia and Asia Health 2020 will feature an extensive buyer programme connecting exhibitors with key decision-makers from ASEAN countries and multi-disciplinary webinars. The event will welcome 3,000 attendees and more than 150 exhibitors.”

For more information, visit www.medlabasia.com/asiahealth/ or register here for free

According to the World Health Organisation (WHO), about one in every 160 children is diagnosed with Autism Spectrum Disorder (ASD). Available scientific evidence suggests that there are probably many factors that make a child more likely to have an ASD, including environmental and genetic factors.

Findings from a recent study published in Autism Research - the journal of the International Society for Autism Research - reveal that, on average, girls are typically diagnosed with autism about a year and a half later than boys.

The study, which was carried out by the Rhode Island Consortium for Autism Research and Treatment (RI‐CART) found that for the first 1,000 participants, with ages ranging from 21 months to 64 years, females received a first diagnosis of ASD at a later age than males, potentially due to more advanced language abilities in females with ASD.

Early intervention is key in autism

Commenting on the findings, Dr Veena Ahuja, a child psychiatrist at Cleveland Clinic Children’s, who did not take part in the study, said girls are likely diagnosed later because autism traits are often more subtle for them.

“When boys come in, often the complaint is that they’re not able to sit in their seat; they’re wandering away, they’re doing things that are, kind of, in people’s faces where you realise it more,” she says. “Girls are definitely more likely to be able to blend in a little bit more until they get to an older age where you start to realise that they’re not interacting as much as their peers.”

As intervention during early childhood is important to promote the optimal development and well-being of people with an ASD, the WHO recommends monitoring of child development as part of routine maternal and child healthcare.

Echoing this sentiment, Dr Ahuja says: “What we know about autism is that early intervention is key. The earlier we can get somebody in there to help the child, the better they’re going to do in the long term. We also know that a lot of the stigma around autism is definitely going away as kids get older.”

According to a recent study published in the British Dental Journal, poor oral hygiene could increase the risk of infection in people, especially those with comorbidities. The study highlighted that bacterial load from the mouth could result in bacterial superinfection and cause complications for COVID-19 patients such as pneumonia, acute respiratory distress syndrome and sepsis.

Omnia Health Insights sat down with Dr. Ricardo AP Persaud, Consultant ENT, Head Neck and Rhinoplastic Surgeon, Head of ENT Department, Al Zahra Hospital, Sharjah, to understand the link between oral hygiene and COVID-19.

How does oral hygiene reduce the risk of viral infections?

Oral hygiene is not the total eradication of viruses, bacterial, and fungi from the oral cavity, as this is practically impossible. It is rather the maintenance of a balance between the non-pathogenic microorganisms in it. Maintaining this balance reduces the risk of viral and other types of infections. This is achieved by regular cleaning by antiseptic mouthwashes and eradicating pockets of high concentrations of microbes in the form of biofilms, whether that is in plaques or the unhealthy crypts and pockets in the tonsils.

Could poor oral hygiene increase the risk of contracting COVID-19?

To simply answer, yes. Viruses like COVID-19 may enter the body through the nose and mouth. They tend to become attached to the lining and subsequently invade the healthy cells through a process called internalization. This results in a sore throat. The nose, back of the nose and throat possess receptors for COVID-19 called ACE2 receptors which causes these areas to act as reservoirs for the virus. The virus then replicates in the nose and throat and is then shed.

Is povidone-iodine an effective virucide in vitro against SARS-CoV and MERS-CoV?

Povidone-iodine (P-I), discovered in the United States in 1955, is an antiseptic agent, which is known to possess virucidal activity (having the capacity or tendency to destroy or inactivate viruses). In various studies, it has shown to be effective against coronaviruses responsible for Sudden Acute Respiratory Syndrome (SARS) (4) and Middle East Respiratory Syndrome (MERS). Very recently, in vitro experiments have demonstrated that P-I is also virucidal against COVID-19.

The antiviral properties of P-I may be exploited in many ways in the fight against COVID-19. To give some perspective, P-I is an active ingredient in several over-the-counter mouthwashes. In general, it can be used as a disinfectant in the nose, pharynx and oral cavity to prevent and control COVID-19 infection as well as transmission. This is because those anatomical regions act as the initial sites of attachment and replication for COVID-19, in both symptomatic patients and asymptomatic carriers.

What is povidone-iodine’s role in reducing cross-infection risk among essential workers?

The application of virucidal P-I in the nose, pharynx and mouth may play a significant role in reducing COVID-19 transmission by decreasing viral replication and shedding take place in the upper respiratory tract (the principal reservoir for COVID-19), during the first phase of infection. Blanket usage of mouthwash/gargle (10mls of 0.5 per cent for at least 60 seconds) and nasal drops containing 0.5 per cent P-I is my own recommendation as an additional adjunct to personal protection equipment (PPE), hand washing, face mask and social distancing to prevent person-to-person transmission. Public Health Authorities and hospitals worldwide should now consider P-I in their preventative protocols or guidelines, as this may not only be the “silver bullet” in the current COVID-19 pandemic but also be applicable to future flu viral pandemics.

What are your tips to maintain an effective oral hygiene regimen?

Daily oral hygiene is the practice of keeping one’s mouth clean and disease-free. Regular brushing of the teeth and tongue are the simplest oral hygiene methods that should be followed at least twice a day. Rinsing and gargling with an antiseptic mouthwash is helpful as well. Sufficient hydration levels from water (not sugary or carbonated drinks) result in a healthy flow of saliva, which wash away many of the harmful organisms and pathogens. Regular check-ups and periodical professional cleanings with your dentist are also necessary and highly recommended.

Dr. Persaud is a British ENT surgeon, trained in the UK and has been an Otolaryngologist for the last 17 years. He chose to specialise in Otolaryngology because it is unique in many ways – it allows him to be a doctor and a surgeon at the same time, and he gets to treat a range of patients, from new-borns to the elderly.

GCC countries are continuing to invest in hospital infrastructure in preparation for the current outbreak of COVID-19. As the recent pandemic that makes strikingly clear, hospital resilience—its flexibility and adaptability in trying circumstances—is more important than ever.

In a recent global panel discussion with 20 healthcare professionals on the topic of hospital resilience, among the ideas to emerge was that resilience means having the ability to anticipate and study the full scope of potential adverse events that can affect a health system, along with the infrastructure to resist, absorb or recover from each crisis. The UAE government is extensively expanding and upgrading its healthcare system to develop a robust world-class healthcare infrastructure.

The region’s healthcare providers best positioned for future extreme demands will be those whose clinical, administrative and operations systems are not operating in silo, but rather use collaborative platforms that address the entire value chain of a hospital from facilities and care delivery to administration. These providers would have the proper digital tools to quickly and effectively respond and adapt to whatever natural or man-made threats come their way.

In our area of focus–the non-clinical realm–this means planning for and working to optimise a built environment and facility operation management infrastructure that can change the normal operations to address the immediate needs while providing the close monitoring and feedback to continually fine-tune as needed. This includes the ability to perform remote monitoring and troubleshooting of systems that drive the organisation’s clinical, administrative and facility operations.

With today’s increasingly smart facility management systems, achieving a high level of hospital resilience is possible. Here, as a guide in thinking about facilities in the short- and long-term, we touch on the seven most important aspects of resilience in healthcare as they pertain to the built environment:

More remote operations

Just as hospitals are transitioning from in-person visits to telehealth to curb the spread of infectious diseases, resilient organisations will expand their capacity to manage and troubleshoot building operations remotely, reducing requirements for an on-site facility management team.

Power reliability and availability

Every health system must have resilience against grid instability. If power is lost from the grid, what redundancies does the system have in place to keep patients safe and clinical systems running without interruption? Organisations will use distributed energy resources, and leverage microgrids and other renewable technologies to ensure energy resilience on a moment’s notice in the event of a power outage.

Enhanced cybersecurity

Health systems tend to focus cybersecurity efforts on patient data, financial information and medical devices, but facility management systems are vulnerable as well. A cyberattack could shut down a facility completely. Resilience requires making sure that an end to end cybersecurity strategy is adopted, that covers both the Information Technology (IT) and all the Operating Technology (OT) environment from products and systems along with continuous monitoring and mitigation actions for any threats.

Increased asset protection

Facility operations are a core function in ensuring the safe and reliable delivery of patient care. An electrical network or building management system failure can stop a hospital’s ability to deliver that care. Resilient organisations will rely increasingly on proactive, predictive monitoring and preventative maintenance to anticipate and pre-emptively address any issues that could put clinical operations at risk.

Improved security management

A health system can’t be resilient if it isn’t secure. It must balance the need to create a welcoming and accessible environment for visitors with security and safety concerns, including the safety of the patients in its care. Resilient organisations will incorporate smart systems that can, for example, identify the movement of an infectious patient in the facility, and whom they have come into contact with, in order to alert appropriate staff to take appropriate action and reduce the spread of infection.

Risk mitigation and compliance

 The more resilient a health system, the more it is focused on reducing risk and complying with the appropriate regulations. Resilience, compliance and risk mitigation work symbiotically together.

Designing for hospital resilience

Resilient health systems will realise the importance of careful decision-making in achieving an effective balance between resilience and cost management. Every patient room in a hospital could be turned into a negative pressure room—but at what cost? Weighing cost considerations against flexibility and adaptability is the art and science of resilient design.

What could be the eighth step but stands alone as it pushes the boundary even further, is leveraging digital twin technologies. These platforms orchestrate data from the built environment with clinical information to create a safer, more comfortable experience for patients while also helping reduce energy spend. Coupled with advanced analytics, it enables the improvement of infrastructure resilience and reliability, while also being able to predict and prevent critical clinical events.

Health systems that incorporate innovations in facility management systems into their existing platforms with cost efficiency in mind will be the organisations that develop the resilience needed to withstand future uncertainty and rapid change.

Marwan Zeidan