Urinary leakage during exercise, or when coughing, laughing, or sneezing, are not an inevitable result of ageing or pregnancy. Women should feel comfortable discussing these problems with their doctor.

According to Cleveland Clinic Abu Dhabi’s newly appointed female urologist Dr Seema Sheth, women now have a range of treatment options that can help address stress incontinence. These range from behavioural therapies, physical therapy, and various surgical treatments.

Related: Enhancing the role of women in scientific research

“Urinary incontinence is more common in women than men and yet women are likely to suffer in silence. One of the main reasons is the normalisation of it – women believe that it is normal to leak as you get older or once you have had children. But just because something is common, it does not mean that it is normal,” says Dr Sheth.

“Another problem is that there are only a small number of female urologists in the UAE and women are often too embarrassed to share their urological health problems with a male physician,” she adds.

Different types of urinary incontinence

Related: Pandemic impact on women 'devastating' in Africa

Urinary incontinence affects about one in five women between 18 and 44 years of age and about 50 per cent of all women over the age of 65. Lifestyle, obesity, constipation, pregnancy and childbirth, and ageing are some of the common factors that can cause incontinence in women. 

“There are different types of urinary incontinence in women,” Dr Sheth explains. “The most common are urge incontinence and stress incontinence, and they are both treated differently. There is no single treatment that is right for every patient. The most effective treatment is one that is individualised to address the patient’s specific problem.”

Options for treatment of urge incontinence include behavioural changes, weight loss, pelvic floor physical therapy, and office-based procedures like posterior tibial nerve stimulation or Botox injections, and surgical procedures in the operating room. Surgeries include an implantable nerve device called a neurostimulator or even augmentations of the bladder.

For stress incontinence, the options include weight loss, pelvic floor physical therapy, pessaries or other vaginal devices, and different types of surgical procedures. This ranges from minor procedures like urethral bulking, which is like placing a filler into the urethra, or more complicated surgeries based on a complete diagnosis. The most common of which is the sling procedure, where a sling is placed under the urethra for support.

Dr Sheth stresses that these conversations about treatment must begin at the primary care level. “Your primary care physician or gynaecologist should ask about the issue when you have your regular checkup. Screening at these visits is essential because your primary care doctors can facilitate a referral. Patients must know that incontinence is common. They should not feel embarrassed to seek help.”

Tomorrow’s healthcare will bear little resemblance to today's in terms of how it is provided, financed, and regulated. A number of powerful factors are reshaping the industry, including technological changes, more attention to resilience, agility, and productivity, along with treatment of the whole person. These forces of changes are moving the balance of power in healthcare from providers to patients, globally and in the Middle East. Some of these shifts have happened faster than anticipated because of the COVID-19 pandemic.

Those involved in healthcare—such as governments, regulators, and providers—can seize this chance to take the initiative, rather than wait and react. Together they can craft better healthcare for their populations by collaborating on strategy, policy, and regulation; governance and partnerships; funding and financing; and information and communication technology (ICT) to provide the necessary data infrastructure.

Encouraging innovation

Related: Webinar: Top Predictions for GCC Healthcare in 2021

In terms of strategy, policy, and regulation, governments must incorporate healthcare innovation into their national agenda, thereby ensuring support for the work of the healthcare sector. One example is the UAE’s digital health strategy.

Regulations also need to be adopted expeditiously, to keep pace with technological change. Government agencies can encourage innovation by collaborating among themselves to accelerate the creation of frameworks that will underpin future healthcare regulation.

Related: Report: The Evolution of Healthcare – Patient Safety

For their part, healthcare regulators should include patient representatives when they design healthcare policies and delivery mechanisms to increase the patient focus of policies. Meanwhile, healthcare providers must develop strategies that emphasise patient experience, personalisation, and coordinated care.

In terms of governance and partnerships, the pandemic demonstrated that disease does not recognise borders. Governments must look beyond their frontiers or the confines of a single department or agency. One way is active engagement with regional or international organisations or cooperating with countries that have dealt with similar circumstances. The European Commission’s international cancer genome consortium is an example of such a partnership.

For providers, the approach should be to structure governance to centre on patients rather than shape care according to administrative systems or medical specialities. This involves organising care around diseases and organ systems, not by medical discipline. Providers need administrative systems that allow easy switching between care channel, as the situation warrants. Providers also can partner with academic institutions and research centres to encourage the development of new therapies, and with public health authorities to craft prevention programmes.

In terms of funding and financing, governments must support investments in local entities doing healthcare R&D, including start-ups working on technology innovations. That appears to be happening, as global health research and innovation budgets are expected to increase through 2025.

For regulators, this means continuing the shift from reimbursing healthcare spending based on volume to value, offering incentives to providers that adopt preventive and virtual care. For example, the Standards for Telehealth Services that the UAE launched in Dubai requires licensed healthcare facilities in the emirate to offer telehealth services. The programme aims to encourage the adoption of similar online health services throughout the country.

To meet new reimbursement models, providers must improve how they manage costs and risks, which could entail workforce retraining. The Dubai Health Authority’s Awtaad initiative, for example, trains doctors, and other healthcare professionals on change management and culture transformation. Professionals who participate bring what they learn back to their workplaces, with the ultimate goal of improving patient care.

In terms of ICT, governments must prioritise digitising healthcare records. Cross-governmental efforts can promote the development of the infrastructure to digitise and integrate patient data from multiple sources. This infrastructure is vital for care to be based on data, and accessible anywhere, anytime.

Governments must also collaborate to protect healthcare data, including creating protocols for information sharing. The Abu Dhabi Department of Health has already launched the Healthcare Information and Cyber Security Standard, which sets out data privacy and security requirements.

Providers can modernise data collection through unified electronic medical records, which give providers a comprehensive view of a patient’s healthcare information. The UAE hopes to digitise all health records and unify them in a single database by 2022. Providers also should adopt data analytics, building capabilities in-house or through partnerships. The Dubai Health Authority collaborated with IBM to develop an artificial intelligence-based analytics platform that monitors vital signs to predict the rate at which a patient’s health could deteriorate.

There is power in numbers. By working together, stakeholders can craft the strategies and policies needed to take advantage of forces transforming healthcare, create governance and funding to support innovation, and develop the necessary data infrastructure.

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today, covering femtech, AI, IoT and much more.  

Malaffi, the region’s first Health Information Exchange (HIE) platform, one of the key initiatives of the Department of Health – Abu Dhabi (DOH), has announced that 95 per cent of hospitals within Abu Dhabi that use Electronic Medical Records, have connected their systems to Malaffi. Malaffi now safely and securely connects a total of 1075 public and private facilities across the Emirate. Adhering to the highest standards of security and privacy, Malaffi allows the meaningful, real-time exchange of important patient health information between healthcare providers, creating a centralised database of unified patient records. This marks a significant step towards bringing the Emirate of Abu Dhabi closer to its goal of connecting all of Abu Dhabi’s healthcare facilities later in 2021, with all hospital EMRs expected to be connected in the coming months.

This milestone means that over 35,000 doctors, nurses and other members of care teams have access to Malaffi and are able to make better-informed, more efficient and safer decisions thanks to access to important medical information, such as patient visits, medical conditions, allergies, procedures, lab results, radiology reports and medications, collated from 37 different EMR systems.

Related: Report: The Evolution of Healthcare – Patient Safety

H.E Dr. Jamal Mohammed Al Kaabi, Acting Undersecretary of the Department of Health – Abu Dhabi, said: “In Abu Dhabi, we have achieved an important milestone in transforming the healthcare sector by connecting most of the Emirate's hospitals and a large percentage of other healthcare facilities. This will contribute to improving the sector’s performance and providing the best levels of care to residents of the Emirate. Thanks to the directives and support of the wise leadership, innovative platforms such as Malaffi play a prominent and pivotal role in this transformation, the subsequent development of a stronger, more informed, and knowledge founded healthcare system.”

Related: How Malaffi is supporting the coordination and continuity of cancer care

H.E Dr. Jamal Mohammed Al Kaabi

Atif Al Braiki, the Chief Executive Officer of Abu Dhabi Health Data Services, the operator of Malaffi, said: “Reaching this milestone is a truly wonderful achievement for Malaffi. It signifies a key milestone for us that gets us closer to seeing every provider in Abu Dhabi, both public and private being connected. In the last two years, we kept our focus clear on our mission to enable a safe and secure exchange of patient health information to enhance quality healthcare and patient outcomes. We look forward to further successes in 2021.

Atif Al Braiki

“Since launch, we have witnessed significant participation and interest from the medical community, including the Emirate’s largest healthcare groups such as SEHA, Mediclinic, Mubadala Health, NMC, VPS and UEMedical. In a survey of Malaffi users, reduction in duplication of laboratory and radiology investigations, as well as prevention of allergic reactions, were noted among the most valuable benefits of Malaffi. Other benefits recognised by the medical community included Malaffi’s role in improving the speed of diagnosis, supporting clinical decision-making, and reducing medication duplications and errors, together with improving efficiency of the healthcare system.”

Dr. Martin Lascano, Chief Medical Informatics Officer at Cleveland Clinic Abu Dhabi, and member of the Malaffi Clinical Advisory Committee commented: “At Cleveland Clinic Abu Dhabi, our patient-centric model involves multidisciplinary teams, so it is critical that all caregivers know and understand the patient’s needs. Wherever they have received prior treatment in Abu Dhabi, Malaffi now allows our caregivers to have a much clearer picture of the medical history of the patient we are seeing, which improves patient experience and helps us establish a trust-based relationship. We are working closely with the team at Malaffi on continual improvements of the system and maximising its potential in a way that will help us provide better care. Patients are thrilled to know that we now have such a system in Abu Dhabi, and it reassures them that they are taken care of in the best possible way.”

Key to the success of Malaffi is the ease with which the platform has integrated into hospitals’ existing EMR systems. In a survey of healthcare providers by KLAS Research, a company that engages with end-users to gather insights aimed at improving healthcare delivery, Malaffi stakeholders were universally satisfied with the system. They reported seeing positive outcomes in terms of prevention of repetitive testing, higher quality and more accurate care, and easy access to patient data from other providers. Almost 25 per cent reported noticing immediate outcomes and over 50 per cent have seen outcomes within just six months. Organisations confirmed that the data they have access to provides real value and are looking forward to continued feature developments.

From technological advances and new medications to developments in surgical procedures, there was much cause for optimism in the opthalmic industry. Recently, Dr Ammar Safar, who is the Medical Director of Moorfields Eye Hospitals UAE, gave his assessment on medical breakthroughs in his field in 2020 and anticipated advancements this year.

According to Safar, 2020 was an exciting year in terms of technological advancements and surgical techniques. Among the breakthroughs that he found particularly significant were technological advancements in implantable intraocular lenses for cataract surgery as well as refractive lens extractions. In the field of vitreoretinal surgery and specifically involving large and chronic macular hole surgery, significant advancements were introduced to the original surgical technique.

Related: AI, tele-ophthalmology, and IoT to drive ophthalmic diagnostic and monitoring devices market

In terms of medicines used to treat ocular diseases, there were important discussions around recently introduced medications for the management of exudative age-related macular degeneration. A new dry eye medication was also introduced and discussed by a panel of experts in the area.

Innovations

When it comes to medications and procedures in the testing phase, Safar explained that there are multiple medications in phase three trials that are currently being investigated and are expected to be approved in 2021 ahead of clinical use. This is mainly in the area of management of diabetic retinopathy, which is the effect of diabetes on the retina. 

Related: Diabetic eye diseases make up 2 of the top 5 eye problems affecting UAE patients

“Management of diabetic retinopathy is currently dependent on injecting medications in the eye on a regular basis, usually monthly in order to keep the disease under control,” he said. “Several pharmaceutical companies are currently investigating medications that would last longer and hence require much less frequent injections, such as every six months or yearly.”

Another innovative technology is the much-anticipated introduction of a drug delivery device that would be implanted in the patient’s Eye and refilled with medication once every six months period. “This will definitely reduce the treatment burden on the patient and result in the improvement of their functional vision,” he added.

New medications are also expected for the management of glaucoma and age-related macular degeneration. In the area of the retina, there is a new procedure for the closure of large recurrent and chronic macular holes. This is considered a breakthrough in the area of vitreoretinal surgery. 

“New procedures are being performed for the management of glaucoma patients. Interestingly, these show excellent control of the disease with minimal surgery,” said Safar. “The advantage of minimally invasive surgery is that it is a simple procedure done in the office as opposed to an operating room.”

Imagine your child runs into the house crying after falling on their arm while playing outside. You quickly grab the first aid kit and a small portable X-ray system. A few moments later, the system shows a message reading, “No fracture detected. Please continue to monitor the injury.” Instead of rushing to the emergency room, you avoid the stress and potential cost and instead sit the child down with a bag of ice and the peace of mind that the injury is not serious.

This anecdote may seem like fiction; however, at-home medical imaging is not such a distant reality. In recent years, medical imaging has significantly progressed in transitioning out of hospitals and closer to patients. Medical imaging outpatient centres have sprouted up across most developed nations, and point-of-care (POC) ultrasound has changed from a niche market segment to a major application. Between 2017 and 2020, the number of POC ultrasound systems sold grew 72% and is forecast to grow by 49% through 2024. This expansion of diagnostic imaging has many benefits, including improved access and outcomes for patients, as they are more likely to receive medical attention that yields earlier diagnoses. Additionally, POC medicine helps to alleviate strain on hospital resources that are often overburdened, understaffed, and underfunded.

Related: Accelerating AI-based software development in medical imaging

Figure 1: The expansion of the POC segment of the global ultrasound market, 2017–24

Related: Report: Medical Imaging Trends 2020

Source: Omdia

The transition from hospital use to POC is a significant step toward the expansion of medical imaging to the home. Further development of POC medical imaging is the next logical step, with these systems gaining popularity in existing POC settings and expanding into new arenas. This expansion has been enabled by the miniaturization of imaging technology. For example, medical imaging is becoming a mobile technology, with ambulances and military units often equipped with compact or handheld ultrasound systems for quick POC triage and diagnoses.

Additionally, portable X-ray technology, primarily used for industrial purposes, is moving into the medical space, and the handheld ultrasound market is exploding. This is underscored by the recent launch of the semiconductor chip-based handheld ultrasound system, Butterfly iQ, from Butterfly Network and a wireless system, Vscan Air, from GE Healthcare. These product launches have coincided with a significant decline in the price of handheld ultrasound systems, which appeared to be a major barrier to the consumerization of medical imaging. While most medical imaging equipment remains far too expensive for the public, low-cost solutions demonstrate that price may not be as significant a barrier as previously thought.

Figure 2: The global handheld ultrasound equipment market, 2018–25

Source: Omdia

Beyond assessing playground injuries and other first-aid applications, at-home medical imaging could be useful for regularly monitoring various bodily functions. It is feasible that a doctor could instruct a patient suffering from cardiovascular disease to perform regular echocardiograms to detect blood flow issues or a pregnant woman to perform regular sonograms. Such applications would allow individuals to monitor their health from home and increase the likelihood of early diagnosis if health issues were to arise. Meanwhile, hospitals would benefit from lighter workloads.

The idea of people performing scans at home likely raises some eyebrows. Safety, training, and regulation are legitimate concerns and potential barriers to the adoption of at-home medical imaging. It is important to note that Omdia is not suggesting people could use at-home medical imaging for diagnostic purposes. Instead, at-home medical imaging could be used to screen for symptoms, like how a thermometer is used to determine if an individual has a fever, not the flu. In the case that symptoms occur, the individual would require in-person medical attention, likely with high-end medical imaging equipment that can be used to make a formal diagnosis.

Recent technological developments, such as dose reduction, telehealth, and artificial intelligence (AI), have improved the prospect of overcoming adoption barriers. Radiation is an obvious concern related to medical imaging; however, healthcare manufacturers continue to develop technology to reduce the amount of radiation emitted during a scan. Additionally, since at-home systems would be used for screening and not a diagnosis, low power systems that emit lower radiation would be practical. Ultrasound systems do not emit any radiation, making them better suited for at-home use.

During the COVID-19 health crisis, the use of telehealth technology skyrocketed as patients were encouraged to avoid medical facilities. As telehealth technology continues to advance and adoption becomes more commonplace, it can be used to facilitate at-home scans, especially in higher-risk cases. The individual could virtually connect with a technician who could walk them through the scan, and then the image could be sent to a radiologist for review. For more routine procedures, AI could support the process. AI algorithms already exist that can walk an end-user through an ultrasound scan, ensuring the image is properly acquired, and other algorithms have been developed to automatically identify anatomical abnormalities. The combination of these two types of AI would enable easy and efficient screenings at home. Like telehealth, COVID-19 accelerated the development of medical imaging AI as the importance of efficient and effective screening and the diagnosis was elevated, and funding for further development increased.

Medical imaging will not transcend to at-home use in the short term, since further developments in imaging technology, telehealth, AI, and regulation are necessary to further improve usability, reliability, and affordability. Nonetheless, the idea of at-home medical imaging is not so fictitious after all, especially since the momentum it has gained in recent years has been further spurred by the pandemic.

For more insights from Omdia, click here.