Healthcare professionals at the 2^nd Multidisciplinary Lung Cancer Forum called for increased lung cancer screening for high-risk patients to reduce the number of disease-related deaths in the GCC including the UAE. Across the region, lung cancer is the 7^th most commonly diagnosed cancer, making up around 4.6% of all cancer cases¹. In the UAE, lung cancer is the second most common cancer among males and the leading cause of all cancer deaths².

Around 60%-80% of cases in the GCC are currently diagnosed at an advanced stage, with the five-year survival rate as low as 10-20%³. In more than 90% of cases, the tumour has already spread beyond the lung at the point of diagnosis³. Consequently, regular screening for those at high risk is urgently needed for early detection and improved survival⁴.

Across the region, there is a need for more integrated screening programmes to aid earlier diagnosis. While a fast and highly sensitive test to identify possible lung cancer (known as low-dose computerised tomography) is available for people at high risk under the Department of Health Abu Dhabi and Dubai Health Authority screening programmes, screening uptake is low.

Some of the barriers highlighted include a slow cultural shift from curative to preventative health, as well as a need for dedicated awareness programmes about lung cancer screening amongst both the public and primary healthcare professionals. Coordinated systems to ensure high-risk people are called for screening are also important. The Forum also reflected on the impact that COVID has had on screening efforts, with a decrease in referrals and interruptions to acute care pathways noted as worrying challenges.

Promisingly, the development of more cohesive programmes is underway in several countries across the GCC, and technologies such as telemedicine and teleradiology could be transformational in reaching patients in more rural locations, who do not have access to a specialist cancer centre.

For those who are diagnosed with lung cancer, next-generation sequencing (NGS) is becoming more widely available in the GCC. NGS analyses the genetic markers within the tumour that can be targeted by specific medicines and is at the forefront of precision medicine. In line with a move towards more targeted therapies, a new treatment option was recently approved by the UAE Ministry of Health for patients with early-stage epidermal growth factor receptor mutated (EGFRm) Non-Small Cell Lung Cancer (NSCLC), in which a specific genetic mutation helps cancer to spread. During clinical trials, patients with EGFRm NSCLC were given third-generation EGFR tyrosine kinase inhibitors as adjuvant therapy after tumour removal. The treatment was found to reduce the incidence of disease recurrence, a common occurrence in early-stage disease, by 80%, compared to those taking placebo.

Prof. Abdul-Rahman Jazieh, Director of International Programme at Cincinnati Cancer Advisors, Adjunct Professor of Oncology Alfaisal University, and Chair of the Forum, said “The Lung Cancer Forum was initiated following a collective agreement between regional experts to advocate for treatment of advanced lung cancer in the GCC and to improve the overall patient journey from a multidisciplinary perspective. We encourage collaboration, research, knowledge sharing and professional development amongst the GCC lung cancer community and beyond. The availability of accurate data on lung cancer within the region is imperative to successful cancer care and I am delighted to take forward a discussion about the development of a GCC lung cancer registry. This will be invaluable to us all, especially those countries among us whose lung cancer populations are small and would benefit from more comprehensive regional data.”

Dr. Humaid Al Shamsi, Director of Burjeel Cancer Institute, VPS Oncology, UAE, and the President of Emirates Oncology Society, said “Lung cancer is a leading cause of suffering and mortality within the GCC, and that early screening is an important part of the successful management of the disease. In Abu Dhabi, the Department of Health has a clear screening protocol for lung cancer in place, but participation is low, and we do not have as much data available on the uptake as we do for other types of cancer. Access to this sort of information will be key as we address barriers to attending.

“For now, as we embed screening programmes into clinical practice, it is critical to start with the high-risk individuals. New technologies such as blood tests that look for cancer markers – known as a liquid biopsy – will change the way we look at cancer in the next five to ten years. It will become much easier and make screening more accessible to those who might not fit the traditional high-risk profile. In the UAE in particular, whilst our government is introducing tighter regulations aimed at encouraging people to quit smoking, research indicates that lung cancer is actually on the rise amongst young people, so this is very important.”

Peter Raouf, Oncology Business Unit Director, GCC at AstraZeneca, said “Bringing together all of the stakeholders at the Multidisciplinary Lung Cancer Forum is vital if we are to change our approach to cancer care in the GCC. To truly make a significant difference to the lives of those with lung cancer, and to cohesively address the burden of the disease within the GCC, all aspects of the healthcare system must come together. With a collaborative approach, as demonstrated by the forum, together we can directly enrich the region’s medical community, offer our patients better lung cancer care and improve both survival and quality of life.”

The 2nd Multidisciplinary Lung Cancer Forum featured a distinguished faculty of international experts from the Middle East and North Africa, chaired by Dr. Abdul-Rahman Jazieh, Director of International Programme at Cincinnati Cancer Advisors. The agenda included lung cancer screening and early detection, the importance of proper staging and role of surgery in early-stage, new approaches in the management of epidermal growth factor receptor mutated EGFR early-stage NSCLC, survival benefits of immune-oncology after chemoradiotherapy in unresectable patients, and a panel discussion on how to improve lung cancer care in the Middle East. The virtual conference was endorsed by Alfaisal University in Riyadh, Saudi Lung Cancer Association, Emirates Oncology Society, Arab Medical Association Against Cancer, Cincinnati Cancer Advisors and the Royal Hospital National Oncology Center, Oman. The event was sponsored by AstraZeneca.

References

1. Al-Lawati J et al. Epidemiology of Lung Cancer in Oman: 20-Year Trends and Tumor Characteristics, Oman Medical Journal 34, No. 5: 397-403, 2019 http://omjournal.org/PDF/OS-OMJ-D-19-00085%20(04J).pdfAccessed 12-04-2021
2. WHO Cancer Country Profiles: United Arab Emirates. https://www.who.int/cancer/country-profiles/are_en.pdf (last accessed April 2021)
3. Data presented at 2nd Multidisciplinary Lung Cancer Forum, 2-3 April 2021
4. Al Shamsi, H, et al. The State of Cancer Care in the United Arab Emirates in 2020: Challenges and Recommendations, A report by the United Arab Emirates Oncology Taskforce; Gulf Journal of Oncology 32: 71-87, 2020  http://www.gffcc.org/journal/docs/issue32/pp71-87_Humaid_Al-Shamsi.pdf Accessed 22-07-2020

The latest research by Global Market Insights, Inc states that launches of innovative medical furniture are expected to propel the industry’s growth through demand, resulting in the expansion of revenue in the coming years. This increase is primarily due to the escalating global prevalence of chronic diseases such as diabetes and cancer. These chronic diseases are expected to cause severe disabilities, necessitating the use of hospital furniture such as chairs and stretchers for surgical procedures.

Notable developments driving growth in the medical furniture industry include increasing demand for high-quality medical furniture in the Asia Pacific. The rising cost of healthcare in the Asia Pacific has resulted in a steady influx of cash into hospitals, allowing for the installation of advanced hospital furniture. By 2026, the Asia Pacific market is expected to develop at a significant CAGR of 6.7 per cent. Additionally, governments in India and Australia are actively working to ensure the availability of high-quality medical furniture in hospitals and ASCs, fostering the medical furniture industry's development over the study period.

Preferences of the geriatric population who favour home care treatments have been forecasted to bolster an increase in the home healthcare segment within the medical furniture market. Over the course of the prediction, the rising demand for home healthcare services in developed economies is expected to drive segment expansion. A rise in the popularity of plastic furniture has been witnessed and is attributed to the several benefits it holds, such as ease of transportation due to easy availability and being lightweight and the cost-effectiveness over metal and wood furniture. These factors are leading to segment expansion over the forecasted period of growth in the medical furniture market. In 2019, the plastic furniture segment brought in more than US$ 6.2 billion in sales.

Patient safety and satisfaction

Quality healthcare delivery is an essential component in successfully providing patient satisfaction and avoiding injury. According to The Center of Health Design key variables and their correlation with shaping the complex healthcare delivery system drive progress in performance improvement. The lack of close examination of these components and their interrelatedness results in decelerated advancement, which is a challenge faced by the healthcare industry. The Society of Actuaries conducted a medical claims-based report in 2010, which found that 1.5 million avoidable medical errors contributed US$19.5 billion to the national healthcare bill. One of the contributing dormant system conditions is insufficient equipment and medical furniture.

The high-risk healthcare industry expects a wide range of deliverables from these products, including displaying an organisation's logo, offering patient comfort and support during difficult times, allowing staff to function effectively and safely as a team, and, perhaps most importantly, not causing harm to patients, staff, or the organisation. The healthcare industry's emphasis on patient safety, combined with recent attention to medical furniture's effect on sustainability goals, has paved the way to initiate a broader consideration of the role furniture could play in improving patient, staff, and resource outcomes. As a component of a comprehensive plan to improve targeted healthcare outcomes, the Evidence-Based Design Furniture Checklist focused on sanitisation and safety guidelines was created as a tool to facilitate the best healthcare furniture purchases across the facility life cycle.

In conclusion, medical furniture’s positioning in healthcare surpasses its physical attributes, serving as a crucial factor in ensuring patient satisfaction and safety. With an increase in the number of health incidents leading to an increase in the rate of admissions to intensive care units, the medical furniture market size is expected to grow during the assessment period, improving the industry landscape.

Resuscitation of cardiac arrest patients affected by an infectious disease could compromise caregiver safety. The LUCAS chest compression system could help by minimizing the amount of contact between the caregiver and patient. LUCAS provides an extra pair of hands allowing the caregiver to maintain distance and focus on treating the underlying cause.

The European resuscitation council interim guidelines on COVID-19 patients recommend where there is a need for prolonged CPR, to consider the use of a mechanical chest, a compression device for those settings that are familiar with its use.

While the Canadian Cardiovascular Society states: “Limit healthcare providers exposure during cardiac arrests involving known or suspected COVID-19...consider mCPR device such as LUCAS.”

The American Heart Association has incorporated the consideration for mechanical CPR into their ACLS Cardiac Arrest Algorithm for Suspected or Confirmed COVID-19 Patients.

Benefits of LUCAS for the caregiver

Reduce proximity to patient: Manual CPR may be a possible transmission route of COVID-19, as breathing in close proximity to the airway of the patient during an aerobic activity may increase transmission to healthcare professionals.

The increased transmission of SARS-CoV to healthcare workers previously reported during cardiopulmonary resuscitation (CPR) was likely due to virus aerosolisation during BVM ventilation.

Minimize staff exposure: When managing suspected and confirmed cases of COVID-19, the number of individual staff members involved in the resuscitation should be kept to a minimum with no or minimal exchange of staff for the duration of the case, if possible.

References available on request

For more information visit www.lucas-cpr.com

Background

Sudden cardiac arrest is one of the leading causes of death in Europe and in the United States. When the heart suddenly stops pumping, effective and continuous chest compressions are needed to sustain blood circulation until the patient’s own heart function is restored.

For high-quality CPR the ERC and AHA 2015 guidelines recommend the following:

• Compression depth of 5-6 cm / 2.0-2.4 inches

• Rate of 100-120 compressions per minute

• Allow for full chest recoil

• Hands-on time >60 %

It has been shown to be difficult to generate guidelines for consistent chest compression depth when the patient is lying in a bed. When you compress the chest, the mattress receives a large share of the compression, not the patient.

Method

A study was set up to test compression depth during two minutes of chest compressions on a feedback manikin lying on a mattress, with and without a CPR board. To secure high quality manual chest compressions, a special frame with a piston set at 5.3 cm / 2.1 inches depth was used.

These high-quality manual compressions were compared with mechanical chest compressions delivered by the LUCAS® 3 Chest Compression System that delivers a compression depth of 5.3 cm / 2.1 inches. The manikin was placed on a full-size foam Stryker mattress with a thickness of 17.8 cm / 7 inches.

Conclusion

The quality of manual CPR is adversely affected when performed on a mattress with or without a CPR board. The only method tested that delivered chest compressions according to the ERC/AHA guidelines was the LUCAS device.

Take-home messages

• Even when delivering perfect manual chest compressions on a manikin in a bed, the mattress effect results in too shallow chest compressions.

• Adding a CPR board did not overcome the mattress effect when delivering manual CPR. It resulted in too shallow chest compressions in the patient.

• The LUCAS device delivered guidelines-consistent chest compressions, independent on what surface the manikin lied upon, eliminating the mattress effect.

References available on request

Cardiovascular diseases claim the lives of 17.9 million people every year, 31 per cent of all global deaths, according to recent research from the World Health Organization (WHO). Reports have found that in the U.S., the average age for a first heart attack in men is 65. And while coronary artery disease is labelled as an ailment affecting older people, reportedly as many as four to 10 per cent of all heart attacks occur before age 45, and it mostly affects men. In the Middle East too, cardiovascular disease (CVD) remains one of the leading causes of fatality. In 2015, CVD was responsible for 34 per cent of all deaths in the Middle Eastern region.

What causes heart disease?

Cardiovascular diseases are triggered by tobacco and alcohol use, unhealthy diet and physical inactivity, leading to obesity, which can raise blood pressure and elevate blood glucose, which are all detrimental to good heart health. Also, age-related changes to the heart can cause faulty heart valves, one of the common causes of CVD. Diseases such as atherosclerosis (building up of plaque inside arteries) start in youth and, therefore, warning signs should not be ignored, and prevention should start early in life.

Reportedly, nearly all heart attacks in older men are caused by atherosclerotic blockages in coronary arteries. Coronary artery disease (CAD) accounts for almost 80 per cent of heart attacks, while 60 per cent of patients are found to have the disease of one coronary artery, while older patients are more likely to have the disease in two or more arteries. Other causes of heart attacks can be attributed to blood clots, spasm or inflammation of the coronary arteries, radiation therapy for chest tumours, chest trauma, and abuse of drugs.

Valvular heart diseases (VHD) are among the major causes of acute and chronic heart failure. Factors such as aortic stenosis (AS) and mitral regurgitation (MR) are some of the most prevalent aetiologies of severe native VHD, which is associated with congestive heart failure. Due to this, indications for left-sided percutaneous interventions have increased, which allows treating patients who had previously not been deemed suitable for surgery.

Percutaneous interventions offer the benefits of a minimally invasive approach and have reportedly shown better results in patients who are suitable for open-heart surgery too.

An alternative approach to open-heart surgery

One method that has received noteworthy results is Transcatheter Aortic Valve Implantation (TAVI) and is mainly used to correct aortic stenosis, sometimes with aortic regurgitation – conditions that account for 75 per cent of all patients with valve disease. TAVI is also less traumatic than open-heart surgery, especially for patients with existing comorbidities.

A European Society of Cardiology report highlighted that over the last 15 years, there has been a rapid uptake of TAVI. This has been coupled with the advancement in transcatheter valve technologies and the new devices provide benefits such as smaller delivery systems, less incidence of paravalvular leak (PVL) or need for permanent pacemaker implantation (PPI).

In an interview with Omnia Health Insights, Dr Simon Davies, consultant interventional cardiologist at the Royal Brompton & Harefield Hospitals Specialist Care, explained that the aortic valve is one of four valves in the heart and is the outlet valve from the main pumping chamber. It controls the blood flowing out of the heart and around the body with thin leaflets of tissue that open and close when the heart beats to regulate blood flow.

“Aortic stenosis is the most common and serious form of valve disease,” he said. “The condition causes the leaflets to stiffen so that the valve does not open properly, and this narrowing of the valve makes it harder for the heart to pump blood to the body. This causes symptoms including shortness of breath, heart murmur, fainting and fatigue.”

How TAVI works

During the procedure, a catheter is guided through an artery to the heart using imaging equipment, then a new valve placed within the narrowed aortic valve and expanded to relieve the obstruction there.

Dr Davies said: “Imaging is a very important part of the process. The combination of a very low dose X-ray and, where necessary, an echocardiogram, helps to guide the device into position and checks it is working properly. One week before the procedure high-quality computed tomography (CT) scans are taken to provide images of the patient’s aortic valve. This identifies the right size and type of replacement valve.”

What problem does it solve? It corrects a narrowed valve which makes the heart’s work pumping blood around the body harder and which otherwise causes symptoms such as breathlessness, heart murmur, chest pain and fainting.

“Recent clinical trials showed TAVI is as good as conventional surgery in those people. It is being offered more routinely to people in their late 60s and early 70s without other health problems. Patients with failing surgical valves made from tissue, which degenerate in years, are also excellent candidates for TAVI, as younger people would otherwise need several open-heart surgeries in their lifetimes,” he added.

In a recent paper, the Journal of the Saudi Heart Association highlighted that the use of general anaesthesia for the TAVI procedure ensures patient stability. However, a few studies have demonstrated the feasibility of TAVI with the patient under local anaesthesia with conscious sedation. This has the advantage of being less invasive, a shorter procedure time, a shorter intensive care unit stay, an earlier recovery, and a shorter hospital stay.

Local anaesthesia with conscious sedation may be considered as the best anaesthesia technique during the COVID-19 crisis provided that the patient is not in decompensated heart failure, can lie flat in the bed, and not morbidly obese, the paper stressed. However, the anaesthesia team should be prepared to use general anaesthesia at any time during the procedure. This approach is particularly crucial at this crisis, where the majority of TAVI patients will not utilise the intensive care unit for their recovery after the procedure, and this is important as critical care beds will be limited during the COVID-19 crisis in many countries.

Impact of COVID-19 on VHD

The COVID-19 pandemic has caused an unprecedented burden on healthcare resources, which has impacted the treatment of heart failure and VHD. The risk of in-hospital infection and reduced access to hospitals has caused a delay in VHD treatment. Also, most non-urgent surgical or percutaneous procedures for VHD were postponed and most patients cancelled procedures on their own due to fears of them or their families contracting COVID-19.

According to the Journal of the Saudi Heart Association, while COVID-19 is primarily a respiratory infection, it has significant systemic effects, including in the cardiovascular system. Cardiac manifestations of COVID-19 infection including all types of myocardial injury, and arrhythmias have already been reported with COVID-19 disease. Patients with pre-existing cardiovascular conditions represent significant proportions of patients with symptomatic infection and experience disproportionately worse outcomes.

In a recent paper, the European Society of Cardiology stressed that reorganisation of healthcare resources is the need of the hour, including implementing a proper algorithm for patients’ prioritisation, based on the severity of their valve disease, life expectancy, the complexity of the intervention, and the resources available. Moreover, wider use of telemedicine for patients’ selection and follow-up and any measurement that can shorten the duration of the hospital stay must be adopted. Percutaneous procedures, compared to surgery, are associated with a lower risk of infection and a lesser need for in-hospital resources, including a shorter duration of hospital stay and this could favour their adoption when the risk of viral infection is high.

For patients at high risk of admission, the NHS guidance suggests they be considered on a case-by-case basis and that current pathways should be followed where possible. If this is not possible due to a shortage of ICU beds or other constraints, TAVI can be considered as an alternative to surgery in aortic stenosis.

According to the European Society of Cardiology, increased use of TAVI, when feasible, may allow optimal utilisation, of resources by avoiding general anaesthesia and intubation, shortening or preventing stay and accelerating hospital discharge and recovery.

References available on request

Article sponsored by Edwards Lifesciences

The rapid spread of COVID-19 and escalation of complications caused by the infection has had devastating affects worldwide. According to a journal published by the International Anesthesia Research Society in 2020, its grip over low- and middle-income countries has regions suffering dire consequences with shortages of medical support and equipment. Many developing countries struggle with obtaining advanced medical equipment which has been manufactured with the aim of treating patients in the current landscape of the pandemic. Obtaining used medical equipment at a significant price reduction for the purpose of remanufacturing is a solution adapted to combat the shortage of functional medical equipment.

The Journal of Remanufacturing states that majority of the world’s population reside in developing countries, where a high mortality rate exists. This is a result of the lack of necessary technologies required by healthcare professionals to prevent the spread of diseases by monitoring and diagnosing ailments, driving a growing requirement for low-lost medical services and equipment. As healthcare industries cope with providing a wide variety of affordable treatment to patients without compromising on quality, used medical equipment is being selected for remanufacturing and refurbishing purposes.

Role of Refurbished Medical Equipment

Fully refurbished medical equipment is the product of used equipment which is effectively restored and then placed on the market for sale or hire by a different user. Crucial components which are defining factors for sourcing used medical equipment include ease of disinfection and/or sterilisation, inspection and testing, disassembly and handling, cleaning, and adaptability to be upgraded to the latest or appropriate  advancements in technology and recoverability of components.

These are some of the outlining factors for used medical equipment to be considered for remanufacturing and refurbishing. In addition, product design is also pivotal and remanufacturers must ensure that failure diagnoses, quality testing, recovery of parts that can be safely retrieved and overall testing of the final product is conducted to warrant full restoration.  

A forecast on the refurbished medical equipment market by research firm MarketsandMarkets states the global refurbished medical equipment market is projected to reach USD 21.2 billion by 2025 from USD 12.1 billion in 2020, growing at a CAGR of 11.8% from 2020 to 2025; with Polaris market research stating that the medical imagining equipment market will witness prominent growth in the next half decade due to demand for low cost low cost medical imaging equipment by small and mid-level hospitals, diagnostic centres and private medical institutions as there is a lack of enough financial resources. However, this growth is projected to be stagnated due to COVID-19.

The Asia Pacific market is estimated to peak based on huge patient population base, increasing privatization in the healthcare sector, large patient pool in the region and high demand for refurbished medical equipment by low-budget hospitals and clinics. Reported in 2019, key industry players included names such as AGITO Medical, Block Imaging, Everx Pty Ltd, GE Healthcare, Integrity Medical Systems, Radiology Oncology Systems, Radmedical, Siemens Healthineers AG, Soma Technology Inc and Koninklijke Philips N.V. (Netherlands).