Day 1 :
Keynote Forum
Rabi F Sulayman
Chicago Medical School, USA
Keynote: Healthcare in the digital age: Impact on physicians and inpatient care
Time : 10:15-11:05
Biography:
Rabi F Sulayman has completed his MD from the American University of Beirut. He completed his Pediatric Residency at Boston Children’s Hospital, Harvard Medical School and Pediatric Cardiology Fellowship at the University of Chicago. He is credited for the Building and Development of the Advocate Children’s Hospital, Oak Lawn campus. He has demonstrated expertise in the development of Advanced Clinical and Educational Programs at the national and international levels, with collaborative programs in many hospitals in East Africa and China. He is currently the Emeritus Chairman at Advocate Children’s Hospital, Oak Lawn and Professor and Chairman at the Chicago Medical School-Rosalind Franklin University.
Abstract:
Background: The digital revolution has infiltrated every aspect of our lives resulting in the medical transformation of how we obtain and provide healthcare. Physicians today have access to computer-based systems designed to provide diagnostic support
and prevent mistakes. While it has been shown that these systems can be helpful, their actual impact continues to be a subject of debate.
Objective: To demonstrate the impact of Differential Diagnosis Generators (DDX) and Decision Support Systems (DSS) on the
physician’s clinical reasoning, diagnostic capabilities, practice skills and patient outcomes.
Method: Literature review for published evidence and personal interviews with medical students, residents and hospitalists who provide care for most of the hospitalized patients.
Result: The reviewed literature revealed that these systems are a valuable source of information, but none provided a specific diagnosis or prevented diagnostic mistakes. Their impact on care delivery and patient outcomes was marginal and, in some cases,
may have impaired clinical judgement and exposed patients to risk. These negative effects on the physicians were recognized. Out interviews revealed that medical students and residents are more likely to utilize these systems than hospitalists. They found them to be helpful in providing information, but not a diagnosis. It was also reported that use of these systems is cumbersome, time consuming and hence not helpful in emergency situations. Two interviewees reported increased confidence, while one reported being misguided.
Conclusion: Available systems do not provide a diagnosis and do not prevent mistakes. They have a negative impact on the physicians’ performance. Such impact requires further evaluation. Attending physicians rely on memory or obtain information from other sources. Clinical reasoning skills continue to be critical and algorithms are not likely to replace the physician.
Recommendation: Critical thinking must be taught in the pre-clinical years and continue to be exercised in the post-graduate years. Replace the systems with a more accurate diagnostic tool capable of providing structured, system-oriented problem solving and pattern recognition. This will most likely be a paper tool (not electronic) available at the bedside to allow instantaneous recognition of patient progress.
Biography:
Ravi Gutta completed his Internal Medicine residency, MD and Allergy & Immunology Fellowship at Cleveland Clinic, USA. He was proctor for his internal medicine board exams during his residency, chief fellow during his fellowship and graduated in the top ten percent in the country for both his Internal Medicine and Allergy and Immunology board exams. He is American Board Certified in Allergy and Immunology and Internal Medicine.
Abstract:
Food Allergy is a broad category entailing all adverse reactions to food which included IgE mediated true food allergy, oral food pollen syndrome, systemic manifestations of food allergy i.e. cow’s milk protein enterocoloits or proctocolitis, Heiner’s syndrome, food protein induced enterocolitis(FPIES), Atopic dermatitis due to food allergy, Celiac disease and finally food intolerance. It is very important for nutritionists and pediatricians to have thorough understanding of each of these elaboratively about etiopathogenesis, clinical manifestations, natural history, diagnosis, treatment plan. It is important to understand the latest LEAP Study recommendations on demining of introduction of foods to infants. Peanut Allergy is the only allergic condition with 400% increase in incidence and population prevalence is last decade along with increase in other food allergies among general population. A food allergy is when body’s immune system reacts to a food protein, is considered as “food allergen.” The response body has to the food is called an “allergic reaction.” A food allergy diagnosis is life-altering. People can be allergic to any food, but nine foods cause most food allergy reactions in the U.S. They are: milk, egg, peanuts, tree nuts (such as walnuts or pecans), wheat, soy, fish, and shellfish (such as lobster, shrimp or crab), Sesame seed. Unlike a food intolerance, food allergies involve the immune system and can be life-threatening. It is very important for pediatricians and nutritionists to evaluate and identify culprit foods which cause IgE mediated food allergy and completely avoid them in the patient’s diet, educate patient about how to read labels, how to avoid cross contact with allergenic foods, demonstrate to use EpiPen, explain indications for its use storage and shelf life. Finally, it’s very important to explain patient or patient’s parents about anaphylaxis action plan, which entails how to identify various allergic reactions to foods i.e. minor reaction, severe reaction or anaphylactic reaction and treat accordingly based on action plan recommendations.
- Child Developmental Behavioral Disorders | Child Adolescent Obesity | Clinical Nursing | Primary Health Care | Oncology Nursing | Critical Care Ethics
Location: Dubai, UAE
Chair
Tatiania Estapé
Barcelona University, Spain
Co-Chair
Lily Yarney
University of Ghana Business School, Ghana
Session Introduction
Amir A Sepehri
CAPIS Biomedical R&D Department, Belgium
Title: Heart sounds aucultation, past, present and future
Time : 12:15-12:40
Biography:
Amir A Sepehri has received his B S E E from Auburn University, USA and his PhD from Mons University, Belgium on Digital Audio Signal Processing. He has worked on a special research program on ‘Computerized Screening of Congenital Heart Disease for 16 years. He is currently the Director of CAPIS biomedical R&D department, with close R&D co-operation with scientific members of Innovation Design and Technology department of Mälardalen University in Sweden.
Abstract:
Heart sound auscultation has been used as a screening technique for investigating cardiac condition over thousand years. There are evidences showing that this technique was used during ancient Persian and Egyptian civilization to verify heart condition but, the biggest breakthrough came on 1816 when the French physician, René Laennec, invented the first stethoscope by curving a wooden cylinder. After the invention of stethoscope, many diagnostic features of this technique were understood by the physicians and later, the phonocardiography became an important tool for cardiac diagnosis in the 1950s. This tool provides a plot of heart sound recording on a rolling paper. However, after the creation of cardiac ultrasound imaging in Lund, Sweden, phonocardiography became less appreciated by the cardiologists due to the informative graphical representation, provided by echocardiography, which is still recommended by the pertinent associations as the tool with central role in diagnosis. In Doppler echocardiography, disease diagnosis is based on the direct and indirect measurement and calculation of the operator. This attributes a subjectivity to the approach, even though it has been objectively accepted by the cardiology community, which is considered as a drawback of the approach that limits its application to the expert clinicians, and access to such expert clinicians is not easy specially in the rural places. Heart sound auscultation is therefore, employed in all the medical settings as the first screening approach, which is by far a less expensive method. Due to progresses in signal processing and artificial intelligence, many studies aimed to associate intelligence with the heart sound auscultation technique to improve screening accuracy in cardiac auscultation specially, in children, where the accuracy is substantially impaired by innocent murmurs. A study in Johns Hopkins University, USA, showed that the screening accuracy in pediatrics cases is as low as 40% in family doctors, which can be rather improved by using computer-assisted auscultation. An automated tool for screening congenital heart disease in infants and in children is achievable by using our unique processing method, named Arash-Band, that has been internationally patented. Such a processing method was incorporated into appropriate graphical user interface and installed on a portable processing unit, to be employed by the practitioners or nurses in primary healthcare centers for an improved screening. This automated system, which we call it Pouya-Heart, has great compliance with echocardiography for detecting CHD and CCHD. Our proposed digital phonocardiograph is now available on the market. One of the interesting capability of the system is its discrimination power in separating innocent murmurs from the pathological ones. Further efforts have been made to lift applicability of the digital phonocardiograph from the screening to diagnosis by adding intelligent algorithms for the disease detection. The Arash-Band method could be implemented on smartphones and web technology, which will result in a homecare system for pediatric heart disease screening. It is implied that the digital phonocardiograph tends to provide rather diagnostic information in the future and avails echocardiography to those of need, where decision for an appropriate therapeutic is critical.
Farah Hillou
Zayed University, UAE
Title: The role of gut microbiota in childhood obesity
Time : 12:40-13:05
Biography:
Farah Hillou is a Registered Dietitian from the College of Dietitians of Ontario, Canada, as well as with the Commission of Dietetic Registration, USA. She has earned her Undergraduate Degree in nutrition from the University of Nottingham, UK and her Postgraduate Degree in Dietetics and Community Nutrition from McGill University, Canada. She has been involved in academia instructing nutrition and dietetics students in a variety of clinical and public health nutrition courses, in addition to supervising internship students and participating in several research projects related to obesity and children’s health. She has also worked in-corporate health and wellness, where she continues to provide nutrition consultancy to several entities including companies and media. She serves as a member in the Nutrition Task Force, Abu Dhabi Department of Health. Her strong interest is in integrating genetic, environmental and lifestyle factors in addressing physiological imbalances and root causes of chronic disease has led her to seek Certification as an Integrative and Functional Nutrition Practitioner (USA). Her focus lies particularly on gut health, and health conditions linked with the gut microbiome including obesity, autoimmune conditions and chronic disease.
Abstract:
Childhood obesity has reached epidemic proportions worldwide. The causes of obesity are multifactorial and are influenced by interplay of genetic, behavioral and environmental factors. Recent evidence suggests that gut microbiota is involved in energy homeostasis and inflammation, which may play a crucial role in the pathophysiology of obesity. The human gut harbors a diverse collection of microbes involved in metabolic, physiological, nutritional and immunological processes throughout the body. The dynamic composition of the human gut microbiota is determined by multiple factors such as mode of delivery, diet, environment, infections and exposure to antibiotics. Dysbiosis, an imbalance in gut microbiota, has been linked to various diseases in infancy and later life including asthma, obesity, diabetes, gastrointestinal disease and autism spectrum disorders. Currently, various techniques such as dietary manipulation with pre-and probiotics are under investigation and appear to hold promise in the prevention and management of obesity via alterations in gut microbiota composition.
Brankica Vasiljevic
NMC Hospital Dubai, UAE
Title: Preterm infants & complications of prematurity
Time : 14:05-14:30
Biography:
Brankica Vasiljevic, has completed her MD, Clinical Postgraduate Education (Pediatrics and after the neonatology fellowship) and academic postgraduate education (MSc in pediatric and ultrasonography field and PhD in neonatology field) from Belgrade University School of Medicine in Belgrade, Serbia. Currently she is the Head of Maternity and Child Health Services in NMC Hospital DIP in Dubai, UAE. She has pursued different courses in ultrasonography and echocardiography in Serbia and UK, Post Graduate Program in Pediatric Nutrition at Boston University School of Medicine and Visiting scholar and Internships in Greece (Alexandar Hospital, Iaso Hospital and Elena Hospital in Athens), USA (Morgan Children’s Hospital in New York) and Austria (General Hospital of Salzburg in Salzburg and Regional Hospital (LKHLandeskrankenhaus) in Graz). She has won the ESPNIC Educational Grant at 5th World Congress on Pediatric Intensive and Critical Care in Geneva Switzerland (2007). She was a local coordinator for International Neonatal Immunotherapy Study-INIS for Serbia and Montenegro and participated in SIOP 93-01 Study, ITP Study and Twin Birth Study. She has published more than 35 international publications in international indexed journals (100 citations), 5 chapters in various fields of neonatal medicine and has more than 30 presentations in international conferences.
Abstract:
Each year 15 million babies are born preterm (<37 weeks of gestation (GA)) worldwide. Complications of prematurity are the single largest cause of neonatal mortality and the second leading cause of mortality among children under the age of 5. Over 1 million children die each year due to complications of prematurity. Mortality is inversely proportional to birth weight and GA. Advances in neonatal intensive care and during the last decades has decreased mortality in premature babies but morbidity (≥ Grade 3 intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity and chronic lung disease) is still high (20-50%), especially in extreme preterm babies. Recent data show that even moderate/late preterm children are also associated with significant adverse effects, including learning disability and cognitive problems. The major neurodevelopmental morbidities (mental retardation, cerebral palsy, seizure disorders, hydrocephalus, visual or auditory impairment) in extreme preterm babies occur in approximately 20-30% survivors. Preterm infants have a higher rate of rehospitalization (most frequently related to respiratory tract problems) than term infants, especially during the first two years of life. The successful introduction of evidence-based policies related to the interventions to improve prevention preterm birth and neonatal care could prevent or reduce the risk of potential complications of prematurity.
Lily Yarney
University of Ghana Business School, Ghana
Title: Balancing academia with clinical proficiency in the training of nurses at university degree level: The case of Ghana
Time : 14:30-14:55
Biography:
Lily Yarney is a Senior Lecturer in the Department of Public Administration and Health Services Management at the University of Ghana Business School, with specialty in Social Science and Public Health. Before joining academia in 2013, Lily had worked with three international non-governmental organizations as the focal person for HIV/AIDS programming and research. She has published quite several research articles in recognized peer reviewed journals, and continues to conduct research in public health and health services management.
Abstract:
Countries worldwide are encouraging the transition of nursing education from hospital based training in colleges to a University degree level. At the University level, the preparation of student nurses involves acquisition of theoretical knowledge and clinical practice, which if well done can serve as double edged sword for blending theory and practice. We explored the ability, roles and experiences of nurse academics in balancing theory and practice in training nurses. Using an exploratory research with methodical triangulation design, data were collected from nursing lecturers and student nurses using individual interviews with questionnaires and focus group discussions with FGD guide. Findings show that clinical practice is recognized by both lecturers and students as an important measure for enhancing theoretical preparation of nursing students to make them fully qualified and proficient in the delivery of nursing care. The majority of nursing lecturers had short duration of clinical exposure of two to three years before joining academia. Although nursing lecturers recognize the importance of clinical proficiency in training nurses at the degree level, the university academic calendar does not favor the inclusion of clinical practice in their academic programs, making balancing academic work with clinical practice difficult. Some findings were congruent with other studies elsewhere while dissimilarities were also established among Ghanaian nurse educators on their unwillingness to endeavor to blend theory with practice. Although nurse educators in academia are obligated to blend theory and practice in training nurses, challenges are encountered that militate against the attainment of this objective. University curriculam for nursing education should be designed to place priority on clinical practice. Ghanaian universities must therefore give autonomy to the schools of nursing in designing the academic calendar. The Nursing and Midwifery Council of Ghana should put monitoring mechanisms in place to ensure clinical practice competencies of university nursing lecturers.
Farrukh Sheikh
King Faisal Specialist Hospital & Research Centre, KSA
Title: First survey of knowledge of pakistani doctors regarding primary immune deficiency diseases
Time : 14:55-15:20
Biography:
Farrukh Sheikh is Diplomat American Board of Allergy & Immunology and a Fellow of the American Academy of Allergy, Asthma & Immunology. He is currently working as Consultant & Program Director, Adult Allergy & Immunology, Department of Medicine at King Faisal Specialist Hospital & Research Centre, Riyadh, KSA. He has established the first Adult Allergy & Immunology fellowship program in the KSA. He is also trying to establish the first Primary Immune Deficiency Diseases Centre in Pakistan. Sheikh has chaired and presented in many international symposia sessions. Dr. Sheikh regularly publishes in international peer reviewed journals.
Abstract:
Pakistan has one of the largest populations in the whole world. It also has one of the highest Consanguinity rates in the world. Primary immunodeficiencies (PIDs) are a relatively common occurrence where consanguineous marriages are widespread. The aim of the current study was to interview a broad range of physician in Pakistan to assess their knowledge base regarding the diagnosis of primary immune deficiency. This was a cross sectional study. Random physicians were approached from different medical colleges and the attached hospitals in Pakistan. Physicians were asked to fill out a questionnaire regarding PIDs awareness. The 10 warning signs of primary immune deficiency are well-known and well cited and were included in thequestionnaire. Other questions were also asked regarding the family history of PIDs, etc. A total of 141 Healthcare providers took part in the survey. About 55% of the participants had not seen any patients with PIDs. 86% were not aware of the 10 warning signs of PIDs and 97% were not familiar with what kind of questions to ask for a PID family history. About 50% did not offer any treatments to their patients with PIDs. 61% thought that PIDs patients are always seriously ill. 84% thought that patients with PIDs should not receive any live vaccines. Lastly, 55% of those interviewed did not know where to refer a patient with PIDs. There is a great need for healthcare education regarding PIDs in Pakistan which has one of the largest proportions of this disease globally.
Tatiania Estapé
Barcelona University, Spain
Title: Cancer in the elderly: Barriers and challenges
Time : 15:20-15:45
Biography:
Tatiania Estapé completed her Degree in Psychology in 1988, in the Autonomous University of Barcelona. In 1988, she attended the first APT (Adjuvant Psychological Therapy) for cancer patients in the Royal Marsden Hospital, directed by Dr. Maggie Watson, chief of Psychological Medicine Department. She is Clinical Observer in September-October 1988 in the Royal Marsden Hospital. She is Postgrad in Statistical Methods in Health sciences, in 1989, Autonomous University of Barcelona. She is specialized in Clinical Psychology in 1991, in the Psychiatry Department, Clinic Hospital, Barcelona University. From 1992 to 1999 granted in the Oncology Department of the Hospital Clinic. She is de psycho-oncology director in FEFOC Foundation, Barcelona, Spain, from 1992 to present. She is associate professor in Open University of Catalonia, Manresa University and co-director of the Barcelona University Master on Psycho-oncology.
Abstract:
World population is experiencing an aging process. Life expectancy has increased dramatically in recent years. This means challenging social, economic and health. Cancer is much more common in the elderly. The rapid decline in mortality from circulatory problems (2335 per 100,000) causes tumors either the second leading cause of death (2261 per 100,000) and close to the first. The figures that we have about the attitude of this group talk us about more pessimism and less information about cancer, while less knowledge and a passive coping. The fatalism and paternalistic model makes it a group harder to get messages about health issues and monitoring on the attitude of early detection and/or prevention is not considered. We see that a person is 65-70 years ahead enough in how to talk about cancer prevention and valuable to analyze effective strategies for early diagnosis. Given these assumptions we consider the growing problem of elderly is not only quantitative but also qualitative characteristics for meeting the humanitarian big social problem in general and especially when referring to the rising incidence of cancer within this group, their lack of information towards prevention and early diagnosis and poor prognosis observed among the oldest. We interviewed 814 old people, using a semi structured questionnaire created by us for this purpose. Our work focuses knowledge and attitudes to cancer in the elderly in five main areas cancer related: misbelieves and attitudes, prevention and early detection, treatment, research and psychological needs. Our preliminary results points at low knowledge, specially low awareness as a sample more prone to get cancer (only 28% is aware of this), 5% still believe in a punishment causation, only 6% knows the European code against cancer but some statements of this code are well-known (for instance 94% smoking); 84% points at mammography as a tool to early detection but only 44% to PSA; 37% reported that they preferred not to receive treatment if they had cancer because they felt it was not worth for them and 70% would prefer to be fully informed of their diagnosis and prognosis. This is a summary of the work that is presented. The conclusions are that old people, have lack of information and passive attitude towards chances of prevention and have a resignation towards cancer. However, the most streaking figure is the low percentage that feels themselves as a risk population. Much of them think that cancer is not very likely at their age. Further research is done now in two lines: comparing with other countries to ascertain how cultural aspects may be a bias on these results before attributing them completely to age; A clinical trial to find out which is the best tool to improve these results.
Biography:
Abstract:
Title to be updated
- Newborn screening in metabolic diseases