Malaffi, the region’s first Health Information Exchange (HIE) platform, a strategic initiative of the Department of Health – Abu Dhabi (DOH), has added a Patient Risk Profile as a new functionality available to all doctors that are authorised to access the platform. The functionality predicts the level of risk for an individual patient to develop certain chronic diseases or suffer an acute event.

The technology behind Malaffi’s risk management solution uses advanced artificial intelligence (AI) technologies and machine learning algorithms, to build predictive risk models based on the available emirate’s population-level demographic and clinical data in Malaffi.

Related: 100 per cent of Abu Dhabi-based hospitals are connected to Malaffi

Abu Dhabi continues to cement its position as a leading global destination in the healthcare sector, and an incubator for innovation in life sciences and digital health in the region. The emirate is moving forward towards attracting and developing the latest innovations within these areas to adapt the highest standards of health and safety for communities, and to raise its position as an attractive destination for investors and specialised healthcare professionals.

In the recent past, predictive models have been in use in several industries and in healthcare predictive analytics support better-informed clinical decision-making and to enable the provision of better-quality healthcare and patient outcomes.

Related: Malaffi to use predictive analytics to improve health of Abu Dhabi residents

The Malaffi Patient Risk Profile displays risk scores for each patient against a list of prevalent chronic conditions such as diabetes, congestive heart failure (CHF), chronic kidney disease (CKD), hypertension; and acute events such as a heart attack, stroke, and others*. Individual risk scores help clinicians make informed decisions and interventions to manage and prevent individuals from developing potential diseases or being admitted to a hospital.

To identify patients at risk, the solution currently utilises clinical data such as diagnoses, chronic conditions and laboratory results. To further improve the accuracy, medication information will be added to the model in future releases. Malaffi connects almost the entire sector in Abu Dhabi, including all hospitals and 2,000 public and private healthcare facilities, and provides access to more than 45,000 authorised users to 900 million patient records for more than seven million patients, according to the highest standards of privacy and information security.

H.E. Dr. Jamal Mohammed Al Kaabi, Undersecretary of the Department of Health – Abu Dhabi, said: “We are committed to developing a healthcare ecosystem that has become among the leading and innovative systems in the world through deploying the latest artificial intelligence digital technologies to improve the quality of healthcare for the residents of Abu Dhabi and the region. Such innovation is pivotal to moving to a preventive-based healthcare approach that will help the transition to value-based care whilst achieving our vision of a healthy Abu Dhabi.”

Robert Denson, Acting CEO of Malaffi, discussed the impact of the new functionality: “We continually strive to improve and expand Malaffi as a platform to serve the needs of the healthcare professionals and patients in Abu Dhabi, while supporting the government’s digital transformation of healthcare. Having connected almost all healthcare facilities, we can now maximise the clinical big data and the population risk platform that is already available to the DOH to deliver further value to the Malaffi users. We are proud to be one of the few HIEs in the world to extend such functionality to the clinicians through the Provider Portal. This will empower providers with actionable insights to improve the health of their patients by proactively and preventively addressing their health needs.”

Dr. Bakr Saadoon Ismail, Informatics Physician, Health Operations Management, Ambulatory Healthcare Services at Abu Dhabi Health Services (SEHA); and Member of the Clinical Advisory Committee of Malaffi, explained the importance of the new functionality: “The Malaffi Patient Risk Profile is an exciting and important new development. As a practising physician, this predictive tool will help us efficiently evaluate the risks for patients individually and help inform decisions regarding treatment, medication and advice specific to their profile. The fact that these risk predictions are based on population-level data from across the emirate combined with a comprehensive record of an individual’s medical encounters and visits to all healthcare facilities, improves the clinical care we provide to our patients.”

Obesity as a chronic disease can be compared to diabetes. Medication will not cure it, and if stopped in a well-controlled patient, the disease will deteriorate. Bariatric surgery is not only the most effective weight loss treatment to date, but also resets the metabolic system. This makes surgery the most powerful treatment for obesity regarding maintenance of weight loss and improvement or cure of obesity-related diseases, such as Type 2 diabetes, cardiovascular diseases including hypertension and high cholesterol, obstructive sleep apnoea syndrome, osteoarthritis, fatty liver disease or polycystic ovarian syndrome.

Among the 800 million adults currently living with obesity, and the number still growing, bariatric surgery is not a first-line treatment option. The standard way people with obesity start their weight loss journey is with a variety of consecutive diets, mostly unsuccessful in the long term and eventually resulting in more weight gain. One of the reasons behind this collective failure of diets has an evolutionary origin; the body fights weight loss to prevent starvation. This same pattern has been used ineffectively for decades, until now.

The power of digital therapeutics

Related: Obesity: a growing and life threatening burden

Technology-assisted healthcare aids people in the most important factor in any weight loss treatment, which is understanding their disease process and making sustainable lifestyle changes. These include a healthy diet, daily exercise, good sleep hygiene and mental well-being. GluCare.Health, for example, uses new technologies and Remote Continuous Data Monitoring (RCDM) to help the team understand patients’ individual response to food better and its effect on their weight and chronic disease management.

The monitoring of new digital biomarkers adds a new dimension to motivational coaching, breaking unsuccessful traditional weight loss practices. Under this platform, engagement with patients is continuous. This model is different from traditional, episodic care where engagement stops the minute the patient leaves the healthcare facility. It is well-documented that increased engagement along with the monitoring of personal data leads to significantly better outcomes when it comes to weight loss post-surgery. Our programme is centred around behavioural change over 12 months. This approach significantly increases the success rate of sustained weight loss.

Related: Bariatric Endoscopy: From development to daily practice in obesity care

As part of the continuous model of care, patients are equipped with wearables, continuous glucose monitors, and smart weight scales to monitor individualised parameters such as glucose, actigraphy and sleep.

Evaluating patients

The question is which patients qualify for bariatric surgery? There are international criteria developed by healthcare professionals and regulators. A body mass index (BMI) over 40 kg/m², a BMI between 35-40 kg/m² with at least one obesity related disease or a BMI 30-35 kg/m² with uncontrolled diabetes qualify for surgery. In Dubai people with obesity also qualify for surgery with a BMI 30-35 kg/m² If there are two or more obesity related diseases.

More important, the decision to offer bariatric surgery to a person living with obesity should be made in a multidisciplinary setting where all treatment modalities are offered. When indicated, bariatric surgery should not be unnecessarily delayed by diets and other treatment modalities, as obesity has a significant impact on quality of life. In addition, bariatric surgery has a very strong impact on the prevention and improvement, or cure of related diseases. The positive effect on Type 2 diabetes, for example, is not only because of weight loss, but after surgery patients immediately show improvement of insulin resistance reflected by an immediate reduction or even cessation of their anti-diabetic medication.

The type of surgery that should be performed is also based on individual choice. In general, surgeries can be divided into restrictive (reducing the food intake) or malabsorptive (reducing the food uptake) or a combination of both. A mainstream restrictive procedure is a gastric sleeve resection where around 70 per cent, of the stomach is removed creating a tube-like vessel. Additionally, there is a positive effect on metabolism reflected by the improvement or cure of obesity related diseases as mentioned before.

Types of bariatric surgeries

Previously, adjustable gastric banding, putting a band around the upper part of the stomach that can be adjusted via a connected reservoir under the skin, was hugely popular. This is used to increase or decrease the diameter of the band and so influencing the degree of restriction. Nowadays the procedure is infrequently performed because of disappointing long-term results.

Another mainstream surgery is gastric bypass (GB), a more metabolic rather than restrictive type of surgery. A small pouch of the upper part of the stomach is created by dividing it from the rest of the stomach. Next the pouch is reconnected to the small intestine. The small intestine is only bypassed for a small portion creating the metabolic effect but not malabsorption. The way the small intestine is reconnected results in a standard gastric bypass (Roux-en Y GB, 2 connections) or one anastomosis gastric bypass (Mini GB, 1 connection).

Finally pure malabsorptive procedures in which a large portion of the small intestine is bypassed (such as biliopancreatic diversion with duodenal Switch (BPD-DS) or single anastomosis duodeno-ileal bypass (SADI) should be performed with care as the risk of malnutrition and severe deficiencies are significantly higher than the previously mentioned procedures. Repeat surgeries for weight regain or complications, after previous bariatric surgeries, are an option but should be performed only in experienced settings with the same multidisciplinary pre- and postoperative follow up and lifestyle coaching.

Nowadays bariatric surgeries are performed in a laparoscopic procedure (keyhole surgery) with advanced anaesthesiology techniques enabling early recovery and reduction of complications. Most patients will start oral intake of liquids immediately once fully awake from anesthesia and stay one night in the hospital. Early mobilisation promotes early recovery, after surgery lifelong supplementation of multivitamins and calcium is recommended to prevent deficiencies and weight regain.

Debunking misconceptions

There are several misconceptions about bariatric surgery. One misconception is that it is dangerous. The risk of a major complication (like a bleed or leak) or even death is extremely low; less than 1 per cent and less than 0.1 per cent respectively. For example, a surgery to remove the gallbladder carries the same risk of death and this is considered a routine surgery.

If one balances the risk of bariatric surgery versus the risk of obesity and its related diseases, bariatric surgery is justified. Another misconception is that the surgery should be reversible. As mentioned before, obesity is a chronic disease and treatment should be lifelong. Technically, gastric bypass is reversible, but this is done in exceptional cases of too much weight loss or malnutrition or if complications necessitate reversal. Sleeve gastrectomy is not reversible, as part of the stomach is removed.

One other misconception is that surgery will change one’s lifestyle. Bariatric surgery is a strong tool to lose weight but if lifestyle is not changed or people fall back into old bad habits, patients will regain weight as the body adapts to the new internal situation. Therefore, the process of lifestyle change should be started before the surgery and continued after. The programme at GluCare Health begins before surgery and continues for long afterwards. This lifelong follow up by expert teams is highly recommended to sustain lifestyle changes and prevent vitamin and mineral deficiencies and weight regain.

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Bart A. van Wagensveld, MD, PhD is a Consultant General, Laparoscopic and Bariatric Surgeon at

GluCare integrated Diabetes Center, Dubai

The role of a start-up within the healthcare ecosystem is a revolutionary one, holding the power to not only fast track lifesaving solutions, but bring innovation to the table. Agile and dedicated to specialising in ultra-specific areas, start-ups have particularly risen to the challenge of finding solutions as the world faced one of its major crises, the pandemic.  

As FIME geared up for its 31st edition, it welcomed not only the new Healthcare Transformation zone that unveiled technological advances, but also Innov8 Talks which has had longstanding success in helping bolster start-ups in healthcare.  

Related: Omnia Health Magazine May - June 2022

We caught up with Jim Stallings, Chief Executive Officer, PS27 Ventures and Pedro Sostre Co- Founder of Navigate, who served as judges at Innov8 to discuss what it takes to break into the industry as a start-up, the present challenges and the importance of diversity and inclusion in the narrative of the present and future. 

Fuelling the launch and scale of early-stage companies 

There has never been a more urgent time to start new companies to find ways to treat diseases and crises, commented Stallings when asked about the importance of fuelling the launch and scale of early-stage companies in healthtech. He explained that even with new approaches and technologies, the world is still undergoing the effects of experiencing one of the biggest pandemics in the past 100 years.  

Related: The future of healthcare will be on display at this year’s Florida International Medical Expo

Jim Stallings, Chief Executive Officer, PS27 Ventures

“It not only exposed us to the virus, but when lives were lost to COVID, it directed us to underlying conditions such as diabetes, heart conditions and lung issues. It also served as a wake-up call to address the lack of preventative care, health dilutions and infrastructure. We need new approaches, and young, talented entrepreneurs are bringing these health technology solutions to the market,” he said.  

Sostre added: “We have seen what happens when corporations like big pharma have control, and prices rise for necessities from $13 to $1,000. I think this exists throughout the medical space, not just in pharma, where hardware is being built and there are all these solutions. From early-stage companies you get innovation and cost savings, whereas big companies must protect their margins. On the other hand, we see start-ups building solutions for $100,000 that would cost big corporations millions to execute. Therefore, it is critical to support the launch of early-stage companies, especially in healthcare where people's lives are at risk and give them the ability to create solutions for problems yet to exist.” 

Empowering entrepreneurs  

Stallings as an internationally recognised business leader, entrepreneur and investor founded PS27 almost 10 years ago after the company invested in their first venture, a wellness space, which was the propellant that made him look at this space. Over time, PS27 evolved and began to invest in health technology among other areas of finance and software solutions.  

Pedro Sostre Co- Founder, Navigate

“From the very beginning, our team has been investing in women-led companies, long before diversity and inclusion initiatives were launched around the world. When we think of diversity at PS27, it is not necessarily about gender, race, or ethnicity, it is the diversity of thought,” he said. 

Sostre, an author, entrepreneur, and angel investor, has led and advised on growth, sales, and marketing for start-ups, corporations, and government agencies. He has driven over $100 million in sales for early-stage companies and launched Navigate, a new founder community and incubator programme.  

“As an entrepreneur for around 20 years, it is frustrating to see that the support needed in the early stages comes from mentorship and frameworks that were used to be successful in the past, and from limited access to networks and capital. Today, few organisations can provide this comprehensive support, and that too, to only one per cent of applicants,” he added. 

According to Sostre, around 90 per cent of start-ups fail due to lack of support, and if one did not attend an IVY league school, they would have a less than 10 per cent chance of being successful. “Navigate was born from the idea of providing that support and delivering it to everyone. Our accelerator programme is not limited, and we accept hundreds of companies at a time. We know that several people can be successful if you give them the right tools. I am very proud of the fact that we have more women than men in the programme, and equal opportunities for people from all backgrounds” he explained. 

Ecosystem of the future  

When it comes to the future, both Sostre and Stallings shared their thoughts on what the future holds for healthcare, and on the horizon are personalised and holistic approaches in medicine.  

“We are in the era of personalised medicine, with health technology leading the way. Several entrepreneurs have been focused on hospitals and the target market for their solution, but what people want is a personal relationship with a doctor, not an institution. The opportunity for an entrepreneur is to bring solutions to physicians and their patients and create a mutual interaction. As an investor, we are looking for new models of communication to track, connect, monitor, and provide solutions. I think we are moving to a model of outcome-driven healthcare,” said Stallings. 

This holds exciting potential for patients as well as investors and promotes an expansion of ideas and solutions across various areas. 

“It takes a lot of money to build medical grade hardware, and what we are seeing now are several hardware solutions in medicine along with a prevalence in holistic medicine as well,” Sostre added. 

On a final note… 

Healthcare is currently the single biggest industry in the US, said Stallings, and the country is only in its first inning of disruption with many markets yet to open. “This is a great moment for health technology entrepreneurs. The capital is there, the energy is there. We are talking about helping humans live longer, better and enjoy a great quality of life, with consumers willing to pay for these services.  I am very excited for it,” he commented. 

With that said, time is of the essence in the start-up race, according to Sostre, and it is necessary for start-ups to seek an advisor or mentor to provide the right guidance and resources. “If you spend two or three years trying to figure things out on your own, you will lose a lot more time, which is something you cannot get back. Many big companies in the healthcare space have a venture arm and an innovation department that are often on the lookout to fund start-up projects,” he said.  

He advises aspiring entrepreneurs to build a map of their industry, track down all the big names in that space, and identify if they have venture funds.  

“Several universities are open to partnering with start-ups and facilitating research or clinical trials. Once you validate an effective solution, you can go to other hospitals, and potentially gain them as clients.” 

Kismet Technologies was crowned winner of FIME's Innov8 competition, stay tuned to read our interview with their co-founders. 

 

FIME runs online until the 29th August 2022 

 

One of the Middle East’s leading health events, the Patient Safety Congress, returns to its pre-pandemic format this year, bringing together top thought leaders in healthcare from September 29 to October 1 at Le Meridien Dubai Hotel and Conference Centre.

Related: Report: The Evolution of Healthcare – Patient Safety in the Post-Pandemic Era

With the aim of changing the face of patient care, the conference is back with a robust list of products and exhibitors that will bring exceptional innovations to the table at the 2022 edition of Patient Safety.

Key participants and sponsors include global healthcare providers such as GAMA Healthcare, Becton Dickinson, Medcare Group of Hospitals, Malaffi, Kiwi Medical Supplies, Al Fahim Supplies, and Bin Ali Medical Supplies.

Related: Importance of patient safety cultures, infection control in healthcare systems post-pandemic

With lectures, workshops, networking, and displays, the event, in its 18th edition, showcases the people and products taking healthcare into the future, addressing critical challenges across the world.

As healthcare remains a global challenge, affected by dire humanitarian crises such as the pandemic, the event is an opportunity for thought leaders across the board to discuss ways of making better, safer healthcare, more accessible all around the world.

“Never before has access to healthcare affected so many people and these kinds of events, bringing together key actors in the sector from decision makers to caregivers, is critical for us to continue working to bring better healthcare to all,” said Tom Coleman, Exhibition Director, Informa Markets. “Whether we are speaking to hospital workers or aid workers out in the midst of humanitarian crises, the issues we are addressing such as patient safety and infection control, remain pivotal, whatever and wherever.”

Appealing to professionals across the sector, from C-Suite to nursing, hospital groups to technology providers, the event is set to be its biggest ever, offering brands the chance to showcase their products and create networking opportunities with fellow professionals from around the world.

Visitors can enjoy industry talks by 110 industry movers and shakers such as Dr. Christine Denis, President of the World Federation for Hospital Sterilisation Sciences (WFHSS); Dr. Jameela Al Salman, Chairperson of the Antibiotic Stewardship Program at the Ministry of Health in Bahrain; and Dr. Jeffrey Chapman, Chief of Quality and Patient Safety, Institute Chair, Pulmonology, Cleveland Clinic Abu Dhabi, to name a few, along with three key conferences across vital industry topics — Infection Control, Patient Safety, and CSSD.

The three-day infection control conference will bring experts together to better understand the challenges facing infection control and to discuss the best ways to fight the spread of infections.

The Patient Safety Conference has been specifically curated and designed to address some of the leading issues, such as medication safety, healthcare worker safety and will assist in the training and education of healthcare staff to enhance care around the region and globally.

The CSSD Conference has been formulated to equip delegates with the knowledge of the standards, complexities, and challenges associated with the vital CSSD function in healthcare affecting everything from small clinics to major hospitals, and the comprehensive skills required to deliver a high standard of care and ensure patient safety.

"We are very glad to finally be back conducting scientific events face to face in person as this is the optimum way to boost the best practice forward,” said Dr. Ashraf Elhoufi, Chairman of Infection Control ICU Committee at Dubai Hospital.

Dr. Nehad Al Shirawi, Consultant Intensivist, Al Fujairah Hospital, MOHAP and Chair of the National UAE Committee for Antimicrobial Stewardship, agreed. “We are excited and very enthusiastic to come back together to hopefully achieve the ultimate benefits and goals of learning and clinical excellence,” she said.

 

Don't miss the Middle East's leading event focused on improving patient care. Register NOW: https://bit.ly/3BSXKEy   For more information, visit: https://www.patientsafety-me.com/en/home.html

 

 

 

Futile surgery can be avoided in patients with pancreatic ductal adenocarcinoma through neoadjuvant therapy, which may act as a tool for patient selection before upfront surgery, an article published in the Scandinavian Journal of Gastroenterology in July says.

Citing recent research that reported a five-year survival still below five per cent, the article highlights that pancreatic ductal adenocarcinoma is associated with one of the lowest survival rates among cancers. Referring to a study on cancer incidence and deaths by 2030 in the United States, the article adds, “Despite that pancreatic cancer is infrequent, the lack of substantial breakthroughs results in the prognosis that pancreatic cancer will be the second cause of death in cancer within a few years. This lack of improvement includes both absence of novel tools for early diagnosis that will render more patients suitable for treatment with curative intent (surgery and chemotherapy) and lack of more effective and goal-directed therapy options.”

Related: Hope with new preventative breast cancer vaccine study

Cross-referring to a study on the use of Folfirinox, the article highlights that marginal improvements have been reached in pancreatic cancer patients receiving palliative chemotherapy with Folfirinox and the combination of gemcitabine and nab-Paclitaxel, adding: “Adjuvant chemotherapy following pancreatic resection has been reported beneficial with increased survival, recently mostly employing Folfirinox or the combination nab-Paclitaxel and gemcitabine, according to the phase III, multicentre, international, open-label, randomised trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma.”

For patients with borderline resectable pancreatic cancers, neoadjuvant treatment resulted in 60 per cent to 90 per cent resectability rates through tumour regression and the treatment of micrometastatic disease, thereby rendering radical (R0) resections possible to a higher extent and longer survival reported as compared with upfront surgery.

Related: Natural breast reconstruction gives women back what cancer had taken away from them

The editorial argues that many consider pancreatic cancer to represent a systemic disease at diagnosis. “There are both potential advantages and disadvantages to consider with neoadjuvant therapy also in patients with resectable pancreatic cancer. By this approach, all patients are guaranteed a chemotherapy option and when receiving neoadjuvant therapy, patients may also be allowed time to improve their clinical and biological performance.”

The article listing a potential advantage explains that progression during neoadjuvant chemotherapy allows a selection of those patients who never will reach surgical resection, adding that existing results are still quite limited. Referring to available outcomes, up to 40 per cent may have disease progression during neoadjuvant treatment due to a more aggressive underlying tumour biology.

“Patients with progressive disease will be found inoperable and also have declining performance status". Referring to a study on early disease progression and disease complication, the article adds that distant metastases during treatment are also frequent in similarity to the fairly frequent development of early distant metastases following upfront surgical resection, in which category also up to 30 per cent of patients never reach adjuvant chemotherapy due to complications or early disease recurrence.

“In patients subjected to neoadjuvant therapy in resectable pancreatic cancer, serum CA 19-9 levels with normalisation or strong decline have been reported associated with a longer median overall survival,” it adds.

As a point of discussion, the article adds the (marginal) value these patients have through a quite aggressive therapy with frequent side effects and not at least associated costs.

“Endoscopic ultrasound with core biopsies may be a methodological platform that allows improvements in precision oncology in pancreatic cancer. Hopefully, the wait-and-see approach will be outperformed by tumour biology staging in the future, directing the choice of a treatment strategy. This should then be done before initiation of any therapy,” it concludes.

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Asma Ali Zain is an independent journalist and a regular contributor at Omnia Health.

COVID-19 lockdowns significantly disrupted the usual operations of the medical system in China. However, government initiatives to reform the medical system continue to move forward. Some initiatives are as follows:

• The Chinese government continues to invest in public hospitals as a crucial part of its medical system reform. In 2020, 2021, and 2022, total budgets allocated to public hospital investment accumulated to 30 billion yuan (US$4.3 billion). 
• Volume-based procurement further expands from drugs to medical devices, including coronary stents, and orthopaedic products like artificial joints. Vendors that successfully secure tenders will see big shipment increases, but heavily squeezed profits. Containing costs to defend profitability becomes crucial for any medical device manufacturer participating in volume-based procurements.
• Despite the official paper issued in October 2021 by China’s Ministry of Finance to ensure foreign suppliers’ fair participation in government procurements, made-in-China is still a common precondition to participating in government procurements.

These initiatives further raise the importance of public hospitals in the Chinese medical device market and pose challenges to international players on market access and profitability. Many multinational MedTech companies have responded with China-specific go-to-market strategies to enable them to play in the high-growing Chinese medical device market.

Accelerated localisation strategy of multinational MedTech giants in China

Localisation has been a buzzword among multinational MedTech giants in China over the past few years. Omdia has recently observed an acceleration of localisation strategies among multinational MedTech giants. Some examples are as follows:

• On June 9, Siemens Healthineers announced its latest localisation strategy, aiming to better contribute to the Healthy China initiative. This strategy includes striving to manufacture all products in China, furthering innovation based on Chinese market needs, and optimising the business practice in China.
• China has the world's largest production base of Siemens Healthineers, with a total construction area of about 180,000 square metres, producing more than 80 products including devices like CT, magnetic resonance imaging, X-ray, ultrasound, as well as other components. Furthermore, the laboratory diagnostics plant in Shanghai, in which Siemens Healthineers invested 3 billion yuan (US$434 million) in 2018, is projected to officially open in 2023. This plant will become Siemens Healthineers’ first in-vitro diagnostic reagent production base in Asia Pacific.
• Echoing Siemens Healthineers’ domestic Chinese production strategy, on July 13, Philips (China) launched its latest made-in-China magnetic resonance product. The launch event was themed “In China for China”.  As per a senior executive from Philips, the company aims to localise the manufacturing of all precision medicine diagnostic products in China by the end of 2022. In another one to three years, the company targets to achieve a 100 per cent made-in-China goal for its ultrasound products including the premium segment. 
• On June 30, Medtronic signed a strategic partnership agreement with Changzhou National High-tech Industrial Development Zone, located in Jiangsu province. The high-profile signing ceremony was attended by top government officials from Jiangsu province and senior executives from Medtronic headquarters. Medtronic’s Changzhou Science and Technology Park will serve the functions of manufacturing, R&D, and an innovation incubator as well as a customer experience centre for its orthopaedic surgery products. 
• In March this year, the president of Boston Scientific’s Great China remarked that in the future the company would further its localised practice in areas of R&D, production, technological transformation, and talent development. In July, Boston Scientific announced that its intravenous ultrasound imaging product made in Shanghai would be launched this September, selling to the global market. This product launch is a highlight of the company’s 25th anniversary in China with a vision of “In China for Global.”

No matter “In China for China” or “In China for Global,” these localisation initiatives demonstrate the rising importance of China to multinational MedTech.

Factors underpinning the localisation strategy 

The size and growth rate of the Chinese medical device market is one of the major reasons for multinational MedTech giants’ continuous investment. China is already the world’s second-largest medical device market with an estimated revenue compound annual growth rate (CAGR) of 10-15 per cent through 2025, more than double the projected pace of growth of the global medical device market. 

• China is seen as a key growth driver for many multinational MedTech companies. For example, China contributed between 13 per cent and 15 per cent of total revenue for Siemens Healthineers, Philips and GE Healthcare in 2021. China is the second largest regional market for all three companies.
• Made-in-China gives multinational MedTech companies a big advantage in accessing the Chinese market. Firstly, a product made in China better qualifies for consideration in government procurement. Secondly, it takes much less time for a made-in-China product to be approved by the local FDA. Thirdly, this created product is usually lower in cost. The growing competitiveness of local brands in all product segments also propels multinational MedTech vendors to expand production in the high-end segment.
• As the world’s factory, despite the growing labour costs, China is still an ideal manufacturing site for many capital-intensive products. The strong business ecosystem, a complete supply chain, government investments, and capacity for high output mean that China’s manufacturing capability is unparalleled. 
• Take Siemens Healthineers for example, the company has built a supply chain network with more than 200 vendors across China. Based on this network, Siemens Healthineers’ production facility in Shanghai can source more than 80 per cent of components (for all equipment produced) in China. About 70 per cent of its products made in China are shipped overseas for the global market.
• Better addressing specific needs of the Chinese healthcare system is another reason for equipment vendor localisation strategies. For example, a doctor in the outpatient department of a typical Chinese public hospital receives about 100 patients per day. This high workload demands medical equipment to be highly efficient, easy to use, and robust. The workflows in Chinese hospitals and medical system infrastructure all demand product features tailored to the Chinese market. 

Multinational MedTech companies are stepping up both the depth and breadth of their practices in China. As per a senior executive from Philips (China): ‘Philips is striving for localisation in China, building an ‘end-to-end’ value chain encompassing R&D, manufacturing, market access, sales, service, and other workflow links, to better serve the Chinese market’.

The localisation strategy reflects the long-termism that multinational MedTech companies hold toward the Chinese market. Many localisation initiatives were launched during covid lockdowns in China. 

While the impact of the Covid pandemic and associated restrictions in China begin to ease, under the pressure of economic deterioration, the Chinese government (at all levels) is taking measures to appease foreign investors by provocatively initiating meetings with foreign companies and offering better business conditions. 

The love-hate relationship between multinational MedTech and domestic Chinese vendors will continue for the foreseeable future.
 

Sally Ye is a health care technology analyst at the Healthcare Technology division of Omdia, a sister research brand of Omnia Health. Located in the US, Europe and China, Omdia’s health care team produces a wide range of syndicated and customised reports, including a monthly China Healthcare Market Update, the Healthcare IT Topical Report, and the Healthcare Equipment Database, as well as in-depth reports and analysis on the medical imaging industry.

Neurodiversity is a concept that emphasises the fact that there are great differences in how people’s brains are wired and work, and that neurological differences should be valued in the same way we value any other human variation. People experience and interact with the world around them in different ways, there is no one ‘right’ way of thinking, learning, and behaving. These differences should not be viewed as deficits.

Although the world’s view on these disabilities or differences has changed a lot, still there are a lot of stigmas attached to them. Many children on the autism spectrum go undetected because their parents or schools fail to recognise their problems or early signs.

Related: Early detection and intervention leads to better outcomes in children with autism spectrum disorder

Sometimes, they are in denial and fear the consequences of diagnosis. When I interact with parents of children with autism spectrum disorder, I emphasise that they should not consider this diagnosis as a disorder, but rather a variation in their perspective, behaviour and social interactions.

Creating a learning and working environment where these kids and adults can also excel equally is what our eventual goal should be as a society. This has given birth to the concept of neurodiversity, encouraging these individuals to lead their lives as neurotypical individuals without being outcasts or rejected from work or social opportunities.

Related: New study reveals girls are often diagnosed with Autism Spectrum Disorders (ASD) at a later age

Let us look at society's view on neurodiversity and the role of each sector in promoting this concept. Neurodiversity as a movement was started in 1990 by an autistic scientist. The point raised was that autistic or dyslexic minds can work differently but with the right help and support, they have the capability to excel in many of the daily tasks.

Neurodivergent workforce

Just like life outside, the workplace is a hugely diverse environment. Our life experiences and preferences shape how we would like to work and get things done. Just one in 10 organisations say that they consider neurodiversity in their people management practices. This is a start, and we as a society, have a long way to go.

These individuals who have some different wiring in their brains may seem weak in some routine skills, but they have other remarkable skills that may benefit their teams. A company with a neurodiverse workforce has a wider perspective of workflow, which in turn increases efficiency and quality. It brings more creativity, innovation, and productivity into the organisation.

As contributing members of our society, we should act as an ‘ally’, someone who may not belong to the ‘people of determination’ group or the under-represented group, but who takes action to support people from the neurodiverse group and helps abolish any external hurdles that may hinder the ability of the differently-abled individual to contribute to the society with their skills and talent.

The concept that there is great diversity in how people’s brains are wired and work, and the fact that neurological differences should be valued in the same way we value any other human variation; should be imbibed and drilled into every organisation’s core ethics.

Here are how companies and the development sector can benefit from neurodiverse employees:

Using their powerful skills

Instead of the differences, the leaders can utilise their best skills for their benefit. For example, autistic individuals are great at mathematics and pattern recognition while ADHD ones are great at communication and idea brainstorming. Similarly, individuals with obsessive-compulsive disorder (OCD) can be great at organising things and documents. So, the manager can use their skills accordingly, which encourages them to work hard and create great models in society.

Giving a comfortable work environment

The organisations and teams must make sure that they provide a comfortable and respectful environment for these individuals too. For autistic and social anxiety disorders a low-light work environment or less noisy and crowded places will do great. Also, they can get them noise-cancelling headphones or gadgets that may help them to adjust to our regular workplaces without any triggers.

Overlooking the differences

Employers must talk, respect, and give chances to all their employees equally. Focusing on the positives and overlooking their breakdown movements or ignoring their slow progress in some domains. This will promote confidence and improve their productivity.

Inclusive approach

To blend in the concept of neurodiversity in society we as individuals and as organisations must work to promote inclusivity in our companies, universities and schools. Every individual has an equal right to academic opportunities or jobs and must not be denied anything unless the reason is merit.
 

Dr. Arif Khan, Paediatric Neurologist and Founder of Neuropedia.
 

The current trend

We have been seeing a demographic shift recently where many companies are showing a sharp increase in the neurodiverse workforce. Individuals with autism, ADHD, Tourette’s syndrome, and dyslexia are being recruited to bring their unique skills to a variety of companies. The unemployment figures in this group are close to 40 per cent but now many organisations are tapping into this pool to build a diverse workforce.

An excellent example is Microsoft, which was one of the earliest companies to launch an official programme for recruiting autistic workers in 2015. They changed the interview process and let job seekers come as they are and show them their strengths. They have hired more than 200 full-time employees through this programme. They have employed them in different departments and not just in coding. Microsoft has helped these individuals to get a career not just a job!

Despite efforts in the advocacy networks, the medical community has unfortunately been slow in embracing this group within their healthcare workforce. We as doctors, nurses and managers need to actively invite neurodiverse individuals to join our clinics, hospitals and centres to experience the work environment. They should then have a training programme to harness their specific skillset, which will help them become an integral part of the organisation and they will continue to refine that skill as they grow their career.

Every established organisation should develop a neurodiversity hiring programme (NHP) where they receive resumes and then selected candidates are invited for assessments to highlight their skills that can then be refined using in-house training programmes. A job coach or mentor can be allocated to them once they are hired.

A better world for everyone

A lot of talent and amazing ideas are still untapped due to our reluctance and the stigma in society related to neurodiverse people. Yenn Purkis a presenter and author with autism, once said: “I don’t suffer from autism, I suffer from others' ignorance, prejudice and ableism”.

We have been great advocates of diversity in race and gender, we need to go further now and include neurodiversity in our agenda.

--
Dr. Arif Khan, Paediatric Neurologist and Founder of Neuropedia.

From clinical applications in medical imaging to non-clinical uses such as transcription, Artificial Intelligence (AI) in healthcare is the future. However, despite the technology’s benefits, half of the healthcare workers in the Middle East believe AI applications are easy enough to adopt, suggesting an opportunity for improvement. 

To uncover attitudes on medical imaging AI among medical imaging professionals across the world, research and advisory group Omdia developed a questionnaire in June 2022 in collaboration with the British Medical Ultrasound Society.

Related: Report: The Evolution of Healthcare – Sharing and Caring

Through the survey, healthcare professionals in the Middle East identified AI’s biggest potential as speeding up workflows — ahead of other benefits including reduced medical costs and more accurate diagnoses. Radiologists were mostly in favour among the surveyed health workers in the region, with 57 per cent strongly agreeing that AI could quicken workflows. 

Indeed, at Arab Health 2022 Congress, Erik Van Hoeymissen, Global Business Development Director Clinician Solutions, 3M, Dubai, highlighted how AI removes significant administrative burdens, adding that it is all about “bringing empathy between doctors and patients. If we can only add a few minutes to bring that to the consultation, the outcome would be great.”

Related: Voice of the Healthcare Industry Market Outlook 2021: Skills gaps and learning objectives

Similarly, Charlotte Graungaard Falkvard, President-Elect, European Federation of Radiographer Societies, speaking at Arab Health described how AI adoption can improve the patient experience. “Technology provides the foundation for us: humanism doesn’t mean anything if we don’t have the technology. They complement each other.”

How training and testing can improve AI adoption

Despite their optimism, 54 per cent of Middle East respondents to the Omdia survey agreed and strongly agreed that it will be sufficiently “easy” for them to adopt AI applications, higher than the worldwide average but still leaving room to grow. 

Published in the midst of the Covid pandemic, a 2021 survey by Omnia Health of 1,600 respondents worldwide, "Voice of the Healthcare Industry Market Outlook," showed AI as a major training opportunity for healthcare professionals, with 21 per cent of respondents naming it a primary learning objective over the next 12 months, second in importance behind digital marketing.
 
Additionally, a May 2022 report from NHS AI Lab and Health Education England, found that “education and training will be essential to improve related knowledge and skills to avoid healthcare workers having inappropriately low or high confidence in AI.”
 
One person who has a keen understanding of training needs and opportunities in the Middle East is Brian de Francesca, Director of Operations for the Hamdan Bin Rashid Charity Cancer Hospital, which is being created by the Al Jalila Foundation in the UAE. 
 
de Francesca also teaches "AI in Healthcare" to healthcare professionals at The Gulf University for Science and Technology in Kuwait, as part of the GUST Healthcare Mini-MBA for healthcare professionals.
 
In his view, “most AI in healthcare discussions get stalled around the possible use of AI models for X-rays, pathological and dermatological images, all of which are viable but subject to regulatory approval and need to be reimbursed for. There is not enough focus on ‘non-clinical’ AI models, of which there are many, that are not subject to stringent regulations nor payer reimbursements.

It is best to take your first steps into the world of AI by testing a few non-clinical AI applications and then explore clinical AI applications once the regulators and payers are up to speed.

For ‘clinical AI’ to become viable, it is imperative that both regulators and payers be brought into the conversation — as there will be little use if it is not reimbursed, and it will not be reimbursed if regulators do not approve it for use.”

Find out more

Discover the latest AI trends in healthcare by attending the upcoming Arab Health 2023 Congress at Dubai World Trade Centre in Dubai from January 30 – February 2, 2023.

The event will offer visitors the option to learn and network with world-renowned experts, innovators and industry leaders discussing the latest innovations in the healthcare sector. Talks at the Transformation Zone will examine the digitalisation of the healthcare industry.

Conference tracks will include Total Radiology, the leading radiology meeting in the Middle East, presenting the latest practices in medical imaging.

A recent study based on the recommendations of the European Society of Cardiology (ESC) guidelines on diabetes and cardiovascular disease (CVD) has emphasised the utility of electrocardiogram (ECG) to predict the association of heart failure in type-2 diabetes (T2D) mellitus.

The study “Diagnostic and prognostic value of the electrocardiogram in stable outpatients with type 2 diabetes” investigated 722 patients to assess whether ECG abnormalities can be used as a diagnostic and prognostic marker of heart failure (HF) in patients with T2D in secondary care diabetes clinics.

T2D is the ninth major cause of death worldwide and the number of patients living with T2D is expected to increase dramatically in the coming decades. Heart failure (HF) in patients with T2D is increasingly receiving attention due to recent cardiovascular (CV) outcome trials and found to be the second most common initial manifestation of cardiovascular disease in T2D in a cohort of 1.9 million people.

In early studies of unselected patients from primary care with suspected chronic heart failure, the presence of a normal ECG was found useful to rule out heart failure with reduced ejection fraction (HFrEF). However, this study, which was conducted with 722 people, confirms that a standard electrocardiogram when normal in stable outpatients with T2D can be used to rule out HFrEF or asymptomatic left ventricular systolic dysfunction (ALVSD).

Commenting on the implications of the study, Dr. Krupal Reddy, Specialist Interventional Cardiologist at Zulekha Hospital, Dubai said that normal ECG has more negative predictive value in ruling out heart failure. “The association of abnormal ECG and heart failure is already known. They should have studied about any specific ECG finding that is suggestive of a particular kind of heart failure,” he said.

With this study, clinicians in secondary diabetes care clinics can use an electrocardiogram to select patients to undergo echocardiography when suspecting HF with reduced ejection fraction.

Dr. Brajesh Mittal, Consultant Interventional Cardiologist at Medcare Hospitals, Dubai explained, “GPs, internists, endocrinologists and cardiologists should get an ECG done for a diabetic patient. If ECG is not normal, then appropriate further work-up such as an echocardiography should be performed,” he explained.

Dr. Mittal said that many patients have reduced heart pumping in the presence of diabetes. “A simple and quick test like ECG has been shown to predict reduced heart pumping and whether or not to proceed with further testing.”

According to the study, echocardiography, which is the gold standard in diagnosing HF, is expensive, time-consuming, and not widely available in diabetes clinics. On the contrary, the ECG is an inexpensive and easily available tool that can assist in identifying individuals with T2D at high CV risk, it said. Furthermore, the ESC recommends a resting ECG in patients with diabetes and diagnosed with hypertension or suspected CVD.

The study also examined the ability of the ECG to rule out HF in a contemporary cohort of patients with T2D. It concluded that overall ECG abnormalities were common and a normal ECG, in general, could be used to rule out HFrEF/ALVSD with a fair sensitivity and a high negative predictive value (NPV), especially in patients reporting dyspnoea.

It also noted that overall, the specificity of the ECG in diagnosing HF was around 80 per cent. The study affirmed that patients with HF had a worse prognosis compared to patients with T2D without HF, especially in the presence of an abnormal ECG. In conclusion, a normal ECG could safely rule out the presence of HfrEF/ALVSD in this population.

The study was published in the Scandinavian Cardiovascular Journal in July 2022.

We live in a truly exciting time for the field of oncology. From artificial intelligence to gene editing, technological innovations have led to breakthroughs in the ways we detect, visualise, understand, and treat cancer. However, the global cancer burden is rising, estimated to reach 28.4 million people in 2040, and access to care is uneven across and within countries.

With cancer being the second leading cause of death in the Middle East and Africa (MEA) region, we need to break through the barriers of access and inequality to deliver cancer care to those who need it most. But we cannot do this alone. It takes powerful partnerships to save lives.

Now, more than ever, we must work across industries and borders, with urgency and one shared goal: to build health care systems that improve equality across early diagnosis, access to care and access to treatment.

How geolocation can affect care

Inequality in cancer care is a global issue, and access to comprehensive cancer treatment can often depend on where one lives. Research shows that comprehensive cancer treatment is available in more than 90 per cent of high-income countries), but in only 15 per cent of low- and middle-income countries (LMICs). Unfortunately, this pattern is consistent across the spectrum of cancer statistics, made even more shocking by the fact that most of the world’s population lives in LMICS, accounting for 70 per cent of the 10 million cancer deaths yearly.

The survival of children diagnosed with cancer is also reported to be more than 80 per cent in high-income countries and less than 30 per cent in LMICs. Breast cancer five-year survival rates are over 80 per cent in most high-income countries, but that drops to just 40 per cent in South Africa^[1]. In MEA, the total cancer incidence is reported to be 1.8 million, with breast and prostate cancer being the most significant burden in the region^[2].

Some countries, such as Jordan, provide cancer at no cost to all Jordanian citizens irrespective of insurance status. But in other countries, the challenges of underreporting the incidence rate and lack of data on mortality and survival still exist.

Championing health care to save lives

As leaders in oncology, AstraZeneca is working to address the barriers to cancer diagnosis and treatment in the MEA region. We work closely with governments and healthcare organisations to develop and build capacity to make our innovations accessible and affordable to all our patients. Only by joining forces with healthcare stakeholders can we achieve our goal of reducing the glaring gaps in equitable care — by driving early detection, diagnosis, and treatment we can transform the outcomes of cancer patients in LMICs.

So how do we do this? It starts with investing in capabilities that improve early screening, detection, and diagnosis. AstraZeneca is fostering the power of collaboration through working with the International Association for the Study of Lung Cancer (IASLC), Guardant Health and the Global Lung Cancer Coalition (GLCC) in the Lung Ambition Alliance (LAA) which has a primary goal to double five-year survival for patients with lung cancer by 2025.

Another crucial collaboration we have entered is with artificial intelligence (AI) solution provider Qure.ai to detect lung cancer earlier by applying algorithms to interpret radiology images. This equitable and affordable approach is active in more than 30 countries worldwide. It has screened more than 250,000 individuals through AI-based X-ray scans, a novel alternative to the gold standard CT scans, which are not broadly available in many LMICs. Over 20,000 X-rays were screened in Turkey and Lebanon in 2021-2022 alone.

We are continuing to expand this programme and committed to screening five million patients globally by 2025 as part of our WEF EDISON Alliance commitment^[3].

AstraZeneca is also part of KINDLE, a real-world evidence study on treatment patterns in Stage 3 lung cancer. It was presented last year at the European Society for Medical Oncology (ESMO) annual congress 2021 and published in a reputed journal this year. It studies the current treatment patterns and gaps and provides solutions for the appropriate management of lung cancer.

We also work closely with MANARA, a group of leading experts who recently issued the first-ever MEA-wide recommendations for lung cancer diagnosis and treatment.

Earlier this year, we marked the launch of Accelerating Change Together (ACT) for Cancer Care at the World Expo 2020 in Dubai, a new coalition of technology, policy, research pioneers and Government stakeholders, which seeks to drive equitable access to innovative treatments and screening programmes to detect cancer earlier. We are also proud to play a part in the Access to Oncology Medicines (ATOM) Coalition, which brings together the biggest pharmaceutical companies in the world to build capacity for cancer diagnosis and treatment. It is this kind of collaboration that will allow us to truly redefine cancer care.

Partnering to improve patient access

The pandemic has taught us important lessons on how global partners can come together and work towards providing agile solutions. The glaring gaps in cancer care can only be closed by forming key partnerships with stakeholders to drive early detection, diagnosis, and treatment and eventually improve patient outcomes. It is everyone’s responsibility in the healthcare sector in the Middle East and Africa, from pharmaceutical companies, healthcare providers and the government, to improve the oncology ecosystem for all.

Viraj Rajadhyaksha is the Area Medical Director, Middle East and Africa, AstraZeneca