With the pandemic, there is no certainty. As countries such as the UK loosen restrictions, with restaurants, pubs, cinemas and more now reopening, there’s a temptation to think that a great hurdle has been overcome and that life can continue on its trajectory back to normality.  A second wave remains a daunting possibility. Temporary hospitals, therefore, are not just a handy safety net, but an absolute necessity in the continued fight against this pandemic.

How can we ensure that field hospitals built to cope with the surge of cases, can handle a potential second wave? In a period of unprecedented change and probably the busiest time for the healthcare community in living memory, it’s vital to ensure that temporary hospitals and their healthcare workers are equipped with the tools to cope with whatever increase of demand is placed upon them.

Mobilising operations can play a huge part in increasing efficiency in temporary hospitals, helping front-line workers handle the increased number of patients, and better arm them.

Changing times

With the number of infected patients placing greater demand on the healthcare industry, and patients with non-COVID-19 ailments asked to stay away (for example, around 50 per cent of the heart attacks and stroke victims normally expected in the UK are currently missing), healthcare practices and processes must now be reviewed. Pre-COVID-19 readiness is no longer enough and striving to maintain the status quo when the status quo doesn’t exist is a recipe for disaster.

As a result, temporary hospitals must review their technology adoption to ensure they are ready to handle the volume of patients, while also having the ability to share data with government agencies as quickly as possible to support decision making around public safety.

Thankfully, mobile technologies can ensure both of these boxes are ticked. Indeed, arming staff with mobile technology, like disinfectant-ready android devices, can help them handle a higher number of patients, allowing them to collaborate, receive and act on real-time patient monitoring alerts, track the use of critical assets, and verify patient identities and health statuses to ensure accurate treatment.

Mobile technologies, from barcode scanners; mobile printers to tablets, can drive the more reliable, accurate and efficient capture and sharing of data in temporary hospitals – the importance of which cannot be understated.

Capture data, save lives

Even prior to the current and fluid situation, the ability to efficiently and accurately capture, share and use data to its maximum benefit was a key factor in helping clinicians and medical staff meet the global demand for healthcare services. Now, with that demand reaching unprecedented heights (the UK’s peak in April resulted in daily hospital admissions of around 3,000 people, according to NHS England) the value of information has soared to even greater heights.

Put simply: in the fight against the pandemic, action can only be taken depending on the information we have available to us. As a result, global leaders, healthcare providers and scientists are in a race against time to gather data.

However, poor data capture has been hindering medical professionals since long before the pandemic. Many European hospitals still record essential patient data in hand-written form, and even during the early stages of the COVID-19 outbreak, manual “clipboard” processes were being used to capture data and create specimen labels. It would be an understatement to say this is less than ideal, with human error easily creeping in during times of great demand. Patients being administered the wrong medicine is just one of the many disastrous outcomes of poorly captured data.

Mobilisation is helping to curtail this and, in temporary hospitals, the use of handheld mobile computers, barcode scanners and tablets is ensuring data capture is reliable. These technologies can allow healthcare workers in temporary hospitals to automate critical workflow actions such as contactless positive patient identification, referral confirmation and electronic health record updates, and even generate properly coded specimen labels using mobile printers.

This will help with the collection and processing of COVID-19 tests and reduce the risk of errors when updating patient records, labelling specimens or reporting results. This is important for current treatment, enabling staff to handle more patients in a safer and more efficient manner, and it can allow medical professionals to share important information with government bodies in almost real-time. In the near term, it’s imperative that healthcare providers have the right systems in place as we move to the next phase of public testing, and mobilisation can play a key role in this.

The mobilisation of temporary hospitals can increase efficiency and improve care for those afflicted with the virus, and in enabling front-line workers to capture and share vital data, making a telling contribution in the battle against COVID-19.

Wayne Miller, Zebra Technologies

With the world in respite from the global pandemic and the socio-economic recovery becoming the new narrative, it’s a fitting time to review our regional health systems. The pandemic was, first and foremost, a health crisis impacting individuals and communities, as well as a test for the health systems that serve them. Although health systems in this region responded well and did not buckle under the pressure, the experience has nonetheless provoked a rethink on how they are set up.

A hospital-centric system is inherently capacity constrained, which during times of crisis necessitates controls on access and consequently causes delays in the treatment of non-urgent cases. Elective cases can always be rescheduled, however, the impact on patients with chronic conditions, requiring long-term care, can be harmful. The population in this region is growing, ageing, and has a higher incidence of non-communicable diseases. Consequently, demand for hospital access will only rise in future. Building more facilities is an overly simple yet unsustainable response; hospitals are the most expensive of all possible care settings and not the most cost-effective choice for long-term care. Left unaddressed, the higher burden on the state and on health insurers will pass on to taxpayers and employers, who may choose to sacrifice access and quality of care for the sake of affordability.

So, what can be done to ensure healthcare remains accessible, affordable and delivers high-quality outcomes? The pandemic has galvanised thinking on how the model of care must be fundamentally redesigned. Fragmented facilities offering stand-alone services must be optimised at a system level, patient encounters better coordinated, and preventative population-level initiatives taken so the system can move from ‘managing sickness’ to ‘managing health and wellness’. In this new model of care, health services can be delivered across multiple platforms and in a variety of care settings, choreographing an ensemble of caregivers. In other words, a health system is needed that is integrated, value-based and outcome-driven, and benefits all stakeholders.

Continuum of care

An integrated health system is at its core a patient-centric model, based on robust primary care and public health management, and organised around care pathways. The hospital plays a supporting or maybe anchoring role but remains part of an overall continuum of care managed across facilities and providers and, where possible, the patients’ home. New treatment regimens, technologies, patient preferences, and payer pressure are already helping hospitals transition inpatient visits to day surgery and outpatient services. Not only does this free up hospital beds and reduce average lengths of stay, but it also reduces the risk of hospital-acquired infections such as MRSA.

By also integrating other caregivers into the pathway, such as from primary and social care, mental health, community nursing and charities, sizeable benefits can ensue. These include less duplication, inefficiencies, and delays, which in turn improves patient experience and cost-effectiveness. These can be furthered by using the group’s scale to capture savings in drug and equipment sourcing. Importantly, it also encourages a holistic view of a patient’s health, which can greatly improve outcomes.

A key feature of integrated health systems is the existence of strong system gatekeepers, manifested in the form of primary care, robust referral mechanisms, and payer approvals that enforce evidence-based diagnosis and treatment. Advanced health systems even enlist pharmacists to the front line through retail clinics, home visits, and medication reviews.

Another enabler is population health management in which educational, therapeutic and behavioural interventions are launched to ensure health services are optimised to the needs of a community. By analysing health needs, patient visits, and epidemiological trends, system managers can identify and close patient care gaps, align system resources, and educate and inform individuals on how to improve their health and avoid disease. Public health awareness and education are vital to the success of an integrated health system. Community screenings, health assessments, and awareness campaigns are just a few ways in which individuals can take greater responsibility for their own health; which in turn can reduce demands on the system.

Connected systems

Successful service line integration is an important step to developing a connected health system. Breaking down silos between departments and facilities and reconfiguring patient flows promotes greater clinical communication and collaboration, eliminates the wasteful duplication of resources, and allows gaps in specialist provision to be closed.

Pooling volumes also creates critical mass, which in turn minimises the risk of patient harm. Aligned services ultimately lead to a smoother patient pathway and the ability to add alternative care settings besides the hospital.

Related to service line integration is the need for consistent clinical coding. By adopting a common coding standard such as ICD-10, facilities and physicians can share patient pathologies, collaborate, and undertake the system-level analysis. Electronic health records (EHR) are the primary vehicle for this data exchange and are an investment many healthcare providers have already completed.

EHRs are just one facet though of the digital transformation needed to establish an integrated health system. One positive from the pandemic has been the willingness of patients and physicians to adopt new technology. While telemedicine has made remote consultations acceptable and viable, web-connected devices for remote monitoring and even drug delivery will in time become the norm, reducing the need for sick patients to travel to hospital for consultation and diagnosis.

In essence, integrated health systems are breaking healthcare out of the hospital by focusing on end-to-end patient needs. The benefits of revolutionising the traditional model are compelling, but the transformation is fraught with challenges, not least organisational, cultural and operational in nature.

Increasing levels of health literacy and re-educating the general population about how and when to access care will also be required. Existing healthcare providers must now define the future role they want to play in an integrated system, the partnerships they need to support their patients across the care continuum, and how these can be formalised such as through joint ventures or mergers and acquisitions. In doing so, they will be better equipped to deliver affordable, accessible and high-quality healthcare in the future and during pandemics.

Farhan Mirza, Alvarez & Marsal Middle East

Saudi Arabia’s successful experience in managing MERS-CoV marks its exceptional agility in responding to public health emergencies. Ensuring the well-being of residents and pilgrims is a primary pillar of Saudi Arabia’s healthcare strategy. 

This was highlighted in the Kingdom’s response to the recent COVID-19 pandemic, with HRH King Salman bin Abdulaziz, the Custodian of the Two Holy Mosques, announcing in March that “a global response” is crucial to address the “COVID-19 pandemic and the challenges to the healthcare systems and the global economy.”

Saudi Arabia walked the talk in this regard: Despite also facing oil price volatility, alongside the challenges of the pandemic, the Kingdom took concerted efforts to overcome the crises from all fronts. The country responded to the pandemic head-on, scoring across all four phases of the preparedness and response framework – prevent, detect, contain and treat.

Overcoming challenges through concerted efforts

Saudi Arabia had one of the most challenging environments in managing the crisis, with some unique circumstances to navigate. In addition to being the most populated nation in the Arabian Gulf, Saudi Arabia also has a large population of expatriates from across the world who live and work in the Kingdom. Any crisis preparedness and response framework, therefore, had to address not just Saudi nationals but this diverse demography.

Second, as the birthplace of Islam, Saudi Arabia welcomes pilgrims from across the world to the two Holy Cities of Makkah and Madinah, which required taking bold and swift measures to ensure the safety of not just residents but also of pilgrims.

Even before a single case of COVID-19 was reported in the Kingdom, Saudi Arabia suspended pilgrimages. Access to the two Holy Cities was barred as early as February 26 – long before many nations had even considered lockdown, and prior to the World Health Organisation (WHO) assessing that COVID-19 could be characterised as a pandemic. As of March 23, almost a month later, 174 countries, territories or areas introduced or updated travel restrictions.

The impact of early travel restrictions has been significant in achieving better outcomes in managing the spread of the virus. A study undertaken on the impact of mobility versus the spread of the pandemic indicates that “the Wuhan travel ban came too late” while in “Europe, travel restrictions were implemented a week after every country reported cases of COVID-19… and as a consequence, no European country was protected from the outbreak.” The foresight of the Kingdom enabled it to be among countries that did not report an uncontrollable outbreak.

Responding to the COVID-19 crisis with a clear plan of action, Saudi Arabia implemented extensive measures, with the Ministry of Health taking the lead on managing the response to the pandemic through reliance on the advanced digital healthcare structure in place, as well as the fast-paced mobilisation of more than 25 hospitals and care resources in the early phases of the pandemic, in order to contain the outbreak and to prevent exponential growth of cases that could burden the healthcare system. Measures were also taken to increase capacities as well as the production of PPE and medical supplies.

Food security was ensured with well-stocked supermarkets, even as reports of hoarding were making headlines in other nations.

Underpinned by decisive policymaking, strong governance and its robust healthcare system serving as the backbone of care, the Kingdom successfully navigated the crisis and is today on the road to the ‘new normal’ with the phased opening of the economy.

Nation-wide detection programme

At the outset of the pandemic, on March 30, HRH King Salman bin Abdulaziz decreed that coronavirus treatment must be available and at no cost to anyone in need of medical care, including those who reside in the Kingdom illegally with no legal ramifications.

Reporting to HRH Prince Mohammad bin Salman bin Abdulaziz, Crown Prince, Deputy Prime Minister and Minister of Defense, a high-level multisectoral committee, headed by the Minister of Health, was established, immediately. The committee continues to meet daily to evaluate the situation and to take timely action, underpinned by the leadership’s hands-on guidance.

Updates were communicated to the public, with the cooperation of other entities, to promote transparency and build trust. The messages were carefully calibrated to reach every segment of the audience – young and old, and all the various nationalities living in the Kingdom.

Initially, the polymerase chain reaction (PCR) testing capacity in the Kingdom was about 1,000 tests per day and has increased to 95,000, with the daily average performed tests reaching 65,000. As of July 21, authorities have conducted over 3.5 million laboratory tests for COVID-19.

The Kingdom also ramped up testing in multiple phases once restrictions on movement were eased by opening free mass testing drive-through test centres in the Kingdom’s largest cities, including Mecca, Medina, Riyadh, Jeddah, Dammam and Aseer, as well as activating (Tetamman) Clinics – functioning as fever clinics – in over 230 locations in Primary Healthcare Centres and hospitals across the Kingdom for patients with symptoms.

In parallel, the National Laboratory at the Saudi Centre for Disease Prevention and Control (SaudiCDC) was the initial reference centre for the advanced clinical laboratory tests. The Kingdom has since expanded its laboratories that provide COVID-19 PCR testing, from 1 to 51 labs covering all regions.

From a capacity perspective, the Kingdom has significantly expanded its ability to admit patients, both critical and non-critical, adding to its intensive care capacity more than 2,500 fully equipped beds in a period of three months, which is more than 30 per cent of the ICU capacity that has been built over the years. 

In parallel, skilled healthcare workers are being recruited and thousands of healthcare workers and volunteers are being trained or retrained to assist with the care of patients if need be. Additionally, clinical and therapeutic protocols are being monitored by dedicated specialised teams to ensure swift and timely updates.

New technologies have also been utilised to care for the critically ill, such as the oxygen helmet and the high flow nasal cannula, which have produced encouraging results, allowing for many patients to avoid intubation and mechanical ventilation.

Saudi Arabia has also started its phase I clinical trial on a vaccine candidate for MERS-CoV as well as the MIRACLE trial, which has been ongoing to evaluate antiviral therapeutics in severely infected MERS patients – now to be expanded to include COVID-19 patients.

The road to the new normal

The Kingdom implemented drastic containment measures, notably the closure of schools, universities and commercial outlets, prohibited public gatherings and suspended operations in many government agencies. Complete lockdowns were imposed on major cities, and, smaller cities were subject to part-time curfews – all the decisions made after public health assessments. Flexible working hours and work-from-home routines, as well as mandating the use of face masks in public continue to support the Kingdom’s focus on pandemic management – all too successful results.

Currently, COVID-19 mortality rates within the kingdom is approximately 0.9 per cent, which is considerably lower than the global rate. At this stage of the pandemic, the observed death rate globally is 4-5 per cent. Variations in the rate of COVID-19 related deaths between countries and regions are not fully understood. However, quick access to healthcare, early intervention, and supportive care seems crucial in reducing COVID-19 related deaths.

Furthermore, the mortality rate, while low, should also be viewed in the context of population risk factors related to lifestyle diseases such as diabetes, obesity and cardiovascular diseases. The diabetes prevalence rate of 18.3 per cent in the Kingdom constitutes a major risk factor for COVID-19 patients. Comorbidity is an additional complexity the Kingdom faced while still managing to sustain low mortality rates.

The success of the approach is highlighted by the Kingdom returning to normalcy in just 73 days. Commercial activities have returned to normal, with all safety protocols in place, and the Ministry of Health assessing the situation, especially in relation to pilgrimage to the Holy Cities, which is being reviewed periodically.

The Kingdom has also lifted the ban on domestic flights. Mosques, malls, recreational facilities and restaurants have opened. This followed the systematic approach of tracking indicators such as readiness of the health system to tackle the pandemic, managing community spread, the efficiency of the healthcare system and performance effectiveness.

The successful response of Saudi Arabia in managing the crisis today serves as a roadmap in healthcare crisis management for the world.

Health and social development are a key sector for the Kingdom of Saudi Arabia’s (KSA) government as it holds 16.4 per cent of the country’s budget expenditure—the third-largest share in 2020. Moreover, the outbreak of COVID-19 has given the necessary impetus to KSA’s ongoing healthcare transformation plan. In an interview with Omnia Health Magazine, Surbhi Gupta, Industry Analyst, Transformational Health Practice, Frost & Sullivan, highlights the main drivers of healthcare in Saudi Arabia and initiatives that will transform healthcare delivery in the country.

What are the main drivers of new demand for quality healthcare in KSA in the medium to long term?

Focus on Wellness and Preventive Care: The Saudi Government has rolled out initiatives (e.g., ‘Quality of Life Program 2020’) focusing on fitness and preventive care. KSA is aiming for a 3 per cent reduction in obesity and a 10 per cent decrease in diabetes prevalence by 2030.

The changing demographic profiles: Changing demographics and lifestyle factors have increased the burden of non-communicable disease (NCDs)  in KSA, creating the need to provide affordable quality healthcare.

Healthcare consumerism: The rise in incomes and strong demand from the younger, more socially conscious, and aware population creates the need for best-in-class speciality care.

Amid falling oil prices and the sluggish global economy, the ongoing economic diversification through privatisation and localisation efforts by the government of KSA have a strong medium to long term outlook.

What are the KSA’s Vision 2030 goals for healthcare? What projects and changes are currently being delivered to achieve these goals?

KSA’s top priorities in the healthcare sector are enhancing the role of the private sector through privatisation of government healthcare services, increasing public-private participation (PPP) healthcare delivery models, scaling up education and training of the local workforce, and boosting the adoption of digital information systems.

There are various projects initiated by the KSA government to achieve these goals such as mandatory insurance for all Saudi and non-Saudi employees and their families in the private sector, increase private sector’s contribution to healthcare spending from 25 to 35 per cent, increase the percentage of patients with a digital health record from 0 to 70 per cent by 2020 and have allocated US$1.5 billion towards healthcare IT and digital transformation programme.

What initiatives have been taken to boost investment in healthcare?

Some of the biggest initiatives include the increase in private player participation through new healthcare financing models, which is a major driver for investment in healthcare.

Moreover, in 2019, 65 ambulatory centres and 10 mobile clinic projects were completed, in addition to four cardiac catheterisation centres, seven oncology centres, three obesity centres, and five growth disorder centres.

What are the major healthcare market segments that are likely to expand in the coming year?

• Domestic pharmaceutical drug production
• Rapid, economical, easy-to-use POCT devices
• Connected devices linking the physical and digital healthcare ecosystems to ensure rapid and efficient diagnosis and treatment
• Remote patient monitoring solutions.

What are the top five predictions for the 2020 KSA healthcare industry?

KSA will be one of the fastest-growing digital health markets in the GCC region: Telehealth adoption is approximately 70 per cent in KSA, and almost 34 per cent of the young physicians in KSA use AI to facilitate diagnoses. The KSA government has allocated ~US$1.5 billion toward healthcare IT and digital transformation programmes. In KSA, the Ministry of Health (MoH) has established an e-Health strategy that will utilise telemedicine to improve the accessibility and quality of care in remote areas where speciality services are not available. COVID-19 have given a boost to the ongoing digital transformation efforts of KSA MoH through the speedy implementation of telemedicine services by healthcare facilities. The MoH is trying to strengthen telemedicine services, making it an excellent investment opportunity.

Focus on wellness and preventive care will catapult investment toward non-hospital settings: By the end of 2020, at least 5 per cent of healthcare service spending will shift to non-hospital care settings. The Saudi government’s US$46.3 billion budget allocation during 2019 will provide the stimulus for the social determinant of health (SDOH) projects.

Demand for speciality clinics and ambulatory care centre will drive privatisation: Due to government policies that favour PPP deals, the number of private hospitals in KSA will exceed 120 by the end of 2020. There will be more than 100 ambulatory centres and mobile clinics in KSA by the end of the year. Despite the presence of several general hospitals, there are supply gaps for several speciality areas, spurring governments to harness PPP models to build speciality clinics for gynaecology, oncology, and cosmetology.

KSA will become the branded generics manufacturing hub of the MENA region: The low level of domestic pharmaceutical drug production (20 to 30 per cent) in the Gulf Cooperation Council (GCC), coupled with the ambition to diversify into non-oil sectors (e.g., bioeconomy) will continue to make the localisation of pharma drug manufacturing a lucrative opportunity in 2020.

KSA healthcare expenditure on diabetes and other lifestyle disorders will increase: During 2020, KSA will spend 25 to 35 per cent of the total healthcare budget on diabetes, obesity, and cardiovascular diseases. With the push for preventive care screening for managing chronic diseases, the number of PHC visits per capita will double in 2020. Non-communicable diseases accounted for 68 per cent of all deaths in KSA; 17.9 per cent of the Saudi adult population has diabetes, and more than 40 per cent of Saudi citizens are obese, which is a major risk factor for chronic diseases such as diabetes, cardiovascular disorders, cancer, and kidney disease.

The private sector has a larger role to play in filling the demand-supply gap in healthcare infrastructure and services. The increasing number of private hospitals will bridge the gap of quality and accessibility of healthcare services in public hospitals, which is a major concern in healthcare delivery. The increase in investments in enterprise healthcare IT solutions and connected medical devices with AI capabilities that drive efficiencies will play a major role in the shift to a performance-based value system. Thus, there are a plethora of opportunities for investors, pharmaceuticals, in-vitro diagnostics (IVD) and MedTech manufacturers, healthcare IT vendors, and support services.

What are some of the current issues the KSA’s healthcare industry faces and what are the possible solutions?

The key challenges KSA’s healthcare industry faces are lack of skilled healthcare workers, increasing cost of healthcare budget, lack of domestic manufacturing, and lack of speciality services.

However, KSA will continue to hold the lion’s share of the MENA life sciences market. The modernisation of healthcare infrastructure and care delivery innovations will continue to drive the demand.

As COVID-19 continues to impact economies across the globe, life sciences companies have been put in the spotlight as the need for Health and Safety has exploded, along with the development and distribution of diagnostic kits. This has led to the industry leveraging the latest technology and collaborating with different sectors to respond to urgent needs at a rapid pace.

In order to cater to this burgeoning market, Leader Life Sciences, part of the Leader Healthcare Group, was established as a legal entity earlier this year to strengthen the knowledge economy and research infrastructure across MENA and APAC regions. Its portfolio spans turnkey solutions for research labs, molecular diagnostics, genomics, health threat intelligence tools, and Artificial Intelligence (AI)-driven decision support systems, among others.

Sukhdeep Sachdev, Global Chief Executive Officer, Leader Healthcare Group, told Omnia Health Magazine: “Leader Healthcare, the parent entity, has always strived to do something new. Life Sciences is all around us and we wanted to probe more into it and that’s how the idea for Leader Life Sciences was born a year ago. We have always talked about precision medicine, which provides a customised way of treating, and how we can prevent the disease, and if the disease is there how can we find ways to cure it better. This whole concept of creativity that we have been thinking about came into shape with Leader Life Sciences, which we launched at Arab Health this year.”

Leader Life Sciences provides end-to-end solutions for world-class academic labs to support research in Genomics, Extreme Medicine, Precision Medicine, Pharmacology, Toxicology, Reproductive Medicine, Biomechanics, Bio-Artificial Tissue Engineering, Biomarker Discovery, Biochemistry, Microbiology and more.

Excellence in research supports higher world university rankings for a nation. Therefore, Leader Life Sciences empowers universities to align with the global momentum towards a knowledge-based economy. A team of scientists, project managers, academicians, biomedical engineers and architects are available in-house to support universities with project planning, execution and delivery.

“Initiatives such as genomics, genetic engineering, research labs, clinical trials, etc., will require a strong infrastructure and that is where Leader Life Sciences comes in as we provide a total end-to-end solution. Our goal is for Leader Life Sciences to emerge as a lead company in providing these solutions,” said Sachdev. “We want to be close to the providers, for example, the scientists and genetic engineers, and want to be part of the solution they are looking for. We have made significant progress in this regard already. Our team comprises of highly skilled individuals who have taken up the challenge of conquering the world of life sciences!”

When it comes to the Life Sciences industry, everything has to be based on a Nation’s objective. Norms and guidelines are set up about how and when clinical trials will happen, and these will all go back to research labs. These labs could be molecular diagnostics, virology labs, biochemistry labs, etc. Leader Life Sciences has identified almost 14 different sub-specialities in research and are going to cater to it and provide complete packages. He added that the company has already signed contracts with leading firms, and these will be gradually announced. “We are cautiously watching this space as to what will help us to synergise those activities.”

Sukhdeep Sachdev (fourth from left) with the Leader Life Sciences team

 

Future of diagnostics

COVID-19 has led to a huge investment in the field of diagnostics. The current race to develop cost-effective point-of-contact test kits and efficient lab techniques have accelerated the pace of diagnostic innovation. Molecular diagnostics and genomics have emerged as the catalyst for preventive, regenerative, predictive and precision medicine.

Leader Life Sciences offers innovative tools for prevention of lung, colorectal, breast, uterus, thyroid, kidney, bladder, and prostate cancers. These AI-driven decision support systems for radiologists and oncologists will help to reduce the rate of missed diagnoses and support initiatives for excellence.

Sachdev highlighted: “Recently, the FDA has approved many drugs for precision testing based on gene-based testing. This space is going to get interesting and our team of researchers are keeping a tab on the situation and looking at what technologies will emerge in the future and how we can bring it closer to the people here in the industry.”

Leader Life Sciences: Enhancing efficiencies

To prepare for the future and remain relevant in the ever-evolving business landscape, companies are increasingly looking for ways to create value. The integration of AI and machine learning approaches within life sciences is making drug discovery and development more innovative, time-effective, and cost-effective. Another trend is a collaboration between biotech, medtech and IT industry to harness the power of IoT, AI, additive manufacturing and augmented reality.

The scope of Leader Life Sciences includes support for clinical trials and associated research. Sachdev explained: “Drug discovery is capital intensive. The development of gene-based therapies adds to the financial burden through a need for region-specific clinical trials. These multinational trials require country- and site-specific expertise such as drug import and sample export regulations. This is another gap addressed by Leader Life Sciences.

“Clinical trial regulations are in place within Jordan, Egypt, Lebanon, Saudi Arabia, and UAE. The Middle East region is home to a varied patient population, with a diversity of profiles and indications. The region is especially suited for late-phase clinical trials in endocrinology, cardiology, neurology, immunology and oncology.”

Technology improvises the processes and efficiencies and the diagnostic capabilities for AI with radiology or research is going to take the treatment, diagnostics, and ultimately patient care, to the next level.

“When we talk about AI from a healthcare perspective, what will happen is that by 2024, most of the operating theatres in the region will be dominated by AI. We are not talking about taking out the human component, but we are talking about how we can enhance the activity of those people,” he stressed.

When asked about future plans, Sachdev shared that Leader Life Sciences’ aim is to consciously grow over the next three to five years and to be the leader in the life sciences space and look at how it can help biotech and pharmaceutical industries as well. The company is looking to consolidate its footprint from UAE to other parts of the Middle East and become a global company.

On a parting note, the CEO shared a message for upcoming entrepreneurs: “Don’t look at COVID-19 as a war, but a mission. Uncertainty is perfectly okay. As an entrepreneur, you must continually recalibrate your organisation’s vision for the future. New tech trends, global events, social changes, and economic shifts have always been the norm.”

An increasing number of youngsters in the UAE are suffering from pelvic floor dysfunction caused by chronic straining from constipation, according to experts at Cleveland Clinic Abu Dhabi, part of Mubadala’s healthcare network.

The pelvic floor is the group of muscles and ligaments that acts as a sling to support the pelvic organs, including the bladder, rectum, and uterus or prostate. Having strong pelvic floor muscles allows for control over the bladder and bowel movement. The inability to correctly control or coordinate the muscles in this area can cause difficulty. Most common causes of weakened pelvic floor muscles are childbirth, surgeries, obesity and straining due to chronic constipation.

Cleveland Clinic Abu Dhabi experts say they are now seeing patients as young as 18 seek treatment for pelvic floor disorders caused due to poor habits. The Pelvic Floor Programme at Cleveland Clinic Abu Dhabi includes colorectal surgeons, gastroenterologists, urologists, physical therapists, radiologists, and nursing staff.

“We often see young patients have poor eating habits with too much junk food and not enough fibre in their diet, lack of exercise and stress, which are common causes of constipation,” says Dr Lameese Tabaja, a colorectal surgeon at Cleveland Clinic Abu Dhabi’s Digestive Disease Institute, who is also part of the multidisciplinary team for the Pelvic Floor Programme at the hospital.

“If this is not addressed early on with a change in lifestyle or medical intervention depending on the severity, over time it can impair relaxation and coordination of pelvic floor and abdominal muscles. We help such patients by educating them about healthy habits, biofeedback training and pelvic floor retraining exercises,”

Treatment options for pelvic floor dysfunction

In about 80 per cent of the cases, Dr Tabaja says, physiotherapy is the solution. Although pelvic floor issues can be a complex problem sometimes the proper treatment can be so simple and comfortable to the patient and make a significant difference.

“Most patients can be treated without surgery. We always start them on specialised pelvic floor physical therapy, and only if that fails, we suggest more aggressive treatments. It is very important that patients be seen by a multidisciplinary team to get an evidence-based solution for their pelvic floor disorders,” Dr Tabaja concludes.

The following article is available in full, including figures and data, on Cleveland Clinic Journal of Medicine June 2020 as part of its COVID-19 Curbside Consults.

COVID-19 is a novel respiratory disease leading to high rates of acute respiratory failure requiring hospital admission. It is unclear if specific patient populations such as lung transplant patients are at higher risk for COVID-19.

Some reports suggest that transplant patients may not be at higher risk if proper social distancing and preventive measures are employed. Efforts to ensure the safety of wait-listed patients, transplant recipients, and healthcare workers are underway. Recommendations for the care of lung transplant patients during the COVID-19 pandemic are discussed and will likely change as the pandemic evolves.

Introduction

COVID-19 is a novel respiratory disease leading to high rates of acute respiratory failure requiring hospital admission. t is still unclear if specific patient populations such as lung transplant patients are at higher risk for COVID-19. Published reports suggest that transplant patients may not be at higher risk if proper social distancing and preventive measures are employed.

Transplant centers, in coordination with several national transplant societies, are rapidly assessing and responding to the pandemic to ensure the safety of wait-listed patients, transplant recipients, and healthcare workers and to facilitate effective stewardship of available hospital resources. Current recommendations for the care of lung transplant patients during the COVID-19 pandemic are summarized below. It is important to note that these recommendations may change as the pandemic evolves.

A patient who had a lung transplant calls with symptoms of a respiratory infection. What should I do?

The recommendation is to have a low threshold for COVID-19 testing in a patient with mild symptoms and also to concomitantly test for other respiratory viruses such as influenza or respiratory syncytial virus. Atypical presentations of COVID-19 infection include the absence of fever and should be considered in a transplant patient.

Local policies and resources will dictate whether COVID-19 testing should be done in the asymptomatic transplant patient. We also recommend notifying the patient’s transplant center as soon as possible for additional guidance on clinical management.

Most transplant centers currently test for COVID-19 infection using polymerase chain reaction on nasopharyngeal or oropharyngeal swabs, similar to the testing protocol used in the general population. Patients with mild symptoms and no shortness of breath or hypoxia should be quarantined at home for 2 weeks and monitored frequently for these symptoms via phone or telehealth visits. Those with signs of moderate symptoms including shortness of breath or hypoxia should be directed to the nearest emergency room and admitted for supportive care and consideration for COVID-19-specific care protocols.

A patient who had a lung transplant is admitted to the hospital with hypoxia from COVID-19. What should I do?

When a patient with COVID-19 and moderate to severe symptoms is admitted, it is important to recognize he or she may rapidly deteriorate. Early endotracheal intubation should be considered, and noninvasive positive pressure ventilation should be limited to avoid spread via aerosolization. However, individual center practices and resources will dictate intubation timing. Concomitant antimicrobial or antifungal therapy may be needed.

Current guidelines recommend holding mycophenolate mofetil or azathioprine in patients with mod erate or severe disease and closely monitoring them for possible graft rejection. In the severely ill, who may have profound refractory hypoxemia or hypercapnia, extracorporeal membrane oxygenation may be needed in addition to invasive ventilation.

Transplant centers are tracking their patients who are positive for COVID-19 and are collecting data to report to registries. This will allow us to identify important clinical trends that can improve how we treat lung transplant patients. Thus, we encourage providers to update the patient’s transplant team so the necessary clinical data can be forwarded to these registries.

Until we have more information specific to lung transplant patients, we recommend using local best practices to manage immunosuppressed patients with acute respiratory failure. There are ongoing national discussions on the development of COVID-19-specific therapies. A history of lung transplant should not preclude a patient from consideration for medications or trials.

What kind of medications do lung transplant patients usually take?

There are two general types of lung transplant medication regimens: immunosuppression and prophylaxis. The doses differ for each patient depending on the transplant center and how recently the transplant was performed.

For immunosuppression, patients may take up to 3 different medications. The first is a calcineurin inhibitor, commonly tacrolimus and sometimes cyclosporine. These medications are usually taken twice a day orally, and tacrolimus has a sublingual option if a patient has no oral access.

Blood levels are often checked to assess for a therapeutic drug level, and the target range will vary depending on the transplant center. Next, patients might be on an antimetabolite such as mycophenolate or azathioprine, and finally an oral steroid such as prednisone.

For prophylaxis, three broad medication areas are typically covered: Pneumocystis prevention, fungal prevention (usually targeting Aspergillus), and cytomegalovirus prevention. We recommend contacting the patient’s transplant center because the medication, duration, and doses in a lung transplant patient will vary.

A patient with end-stage lung disease who does not have COVID-19 may be a candidate for lung transplant. Should I still refer my patient to a transplant center?

If a patient is a candidate for lung transplant, consideration for referral should proceed. At Cleveland Clinic, as at many other centers throughout the country, we review the available medical information and determine the timeline for evaluation and testing depending on the patient’s level of acuity and safety.

What is happening with patients who are wait-listed for lung transplant?

Lung transplants are still ongoing at Cleveland Clinic and across the United States. Each individual transplant center is developing criteria to account for how ill a wait-listed patient is, how soon a patient needs to be transplanted, and if it is better for the patient to wait until the pandemic has passed.

When making these decisions, we also consider the infectious exposure risks of immunosuppressing the patient in the hospital post-transplant, the infectious exposure risks to surgeons who might have to travel to other parts of the country to procure donor organs, and hospital stewardship policies to ensure there are enough hospital beds and personal protective equipment for nontransplant patients who are admitted to the hospital with COVID-19.

To our knowledge, there has been no transmission of COVID-19 from an organ donor to a lung transplant recipient, and this is due in part to the precautions taken by transplant centers and procurement teams around the country.

Conclusion

The care of wait-listed patients and transplant recipients continues, and when these patients are seen in the outpatient or inpatient setting, providers are encouraged to contact the transplant center. The medical literature on COVID-19 is still growing.

While there is not yet a report specific to lung transplant, a recent report of 87 heart transplant recipients in Wuhan, China, noted that social distancing coupled with other preventive measures led to a COVID-19 infection rate no higher than that in the general population. Thus, continued community-based measures will help protect transplant patients.

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