Zynx Health

Clinical improvement solutions set to enhance service provision

Abu Dhabi Health Services Company PJSC (SEHA) is currently working with Zynx Health Middle East Inc. (Zynx Health™), the market leader in the provision of evidence- and experience-based clinical improvement solutions. The partnership will result in a transformation of service provision across all the public hospitals and clinics of the Emirate of Abu Dhabi which together make up the SEHA Health System and will impact upon a population of over 900,000 people. Dr Mehmood Syed, Clinical Programmes Director for Zynx Health Middle East, provides more detail on the project.

Value in healthcare has been defined by the Harvard academic, Michael Porter, as “the outcomes achieved per unit dollar spent on healthcare”[1] and it is the outcomes that patients achieve that should be used to assess the quality of healthcare that is provided, not the inputs. As such the cornerstone of achieving better value from healthcare services, anywhere in the world, is to standardise the care that is delivered, thereby ensuring that patients only receive the best treatments whenever they see a clinician and never receive treatments that either have no effect, or that cause harm.

At present across the world and especially in the Middle East, common experience of healthcare services would suggest that, too often, much of what is delivered is unnecessary and unwarranted by the patient’s medical complaint. The end result is large amounts of money being spent on healthcare services and products that make no material difference to the patient’s health outcomes, and at times, may even be causing harm. Too often the treatments that are prescribed are based purely on the anecdotal experience of the doctor who happens to see the patient that day and often have no supporting medical evidence to justify their use.

SEHA – the Abu Dhabi Health Services Company – recognised this paradigm and as the public provider of Abu Dhabi and an employer of over 15,000 clinicians from every corner of the world, they understood that standardising the care their clinicians provide was going to be a challenge. In order to address this SEHA recruited the assistance of Zynx Health.

Already working in partnership with over 2000 hospitals in the US, Zynx Health is the international market leader in evidence- based clinical improvement solutions at the point of care and were ranked No. 1 in the KLAS “Clinical Decision Support - Order Sets and Care Plans” report[2]. Zynx Health’s principal product – Zynx-Order, predefines for the clinician the most appropriate investigations and management options that a clinician should consider requesting for a given patient, based upon the medical evidence. The net result is that clinicians are directed to order only evidence-based investigations and treatments thereby reducing variation in care delivery and achieving significant improvements in both operational efficiencies and patient health outcomes.

Since 2011, SEHA has been working with ZynxOrder at the Sheikh Khalifa Medical City. Their latest partnership with Zynx Health, expands this programme of quality improvement to develop and release further Order Sets for use in all of SEHA’s 12 hospitals and 66 clinics across the Emirate of Abu Dhabi.

The highly rigorous and independent editorial methodology deployed by Zynx Health, as well as their local presence in the UAE, means the SEHA team are receiving the most up to date, highest quality evidence-based Order Sets in the market and are supported by local Zynx Health clinicians to customize the Order Sets to the specific SEHA context. Zynx Health’s patented Order Set development tools and the seamless bidirectional integration with SEHA’s Cerner-based, hospital information system – ‘Malaffi’ – make this process significantly easier than would otherwise be the case. By December 2014, a suite of 100 Order Sets across multiple clinical specialties are expected to be in place across all SEHA facilities. Thereafter the organisations will continue to work together in partnership to ensure the Order Sets remain relevant, easy to use and updated, as changes in medical evidence inevitably occur.

Speaking of the partnership with SEHA, Jeff Dienhart, Senior Managing Director of Zynx Health commented: “It is a pleasure and a privilege for Zynx Health to be working with SEHA to help shape the vision of healthcare in Abu Dhabi and drive quality and economic improvement. Hospitals using Zynx Order Sets have achieved statistically significant improvements in financial outcomes such as lower costs per case, and in clinical outcomes such as reduced mortality, decreased hospital length of stay, and improved adherence to quality metrics.” Zynx Health is part of the Hearst Health network, which also includes FDB (First Databank), Map of Medicine, MCG (formerly Milliman Care Guidelines). The mission of the Hearst Health network is to help guide the most important care moments by delivering vital information into the hands of everyone who touches a person’s health journey.


1. Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Boston: Harvard Business School Press, 2006 2.


International Modern Hospital

Surgeons offer a scarless solution for thyroid tumour removal

Thyroid disorders are common in women and they would like to have treatment options with a definite cosmetic appeal. Generally when someone is diagnosed with a single nodule or multiple nodules they need to be evaluated by ultrasound scan of neck and if needed fine needle aspiration cytology. The USG features or FNAC is suspicious of a malignancy then surgery is the solution, even at any size of the swelling. Even if the USG and FNAC suggest benign swelling the option of thyroidectomy needs to be sought if the nodule is more than 4 cm. Depending on the physical examination, USG and FNAC findings surgeon decides to offer a hemithyroidectomy (removal of full lobe on the side of lesion and isthmus) or total thyroidectomy.

The surgical solution available in most of the places is open thyroidectomy which involves a large transverse cut across the lower part of the neck. This definitely leads to an unsightly scar which is not acceptable, especially for women. The lateral thyroidectomy by cutting on sides of neck for each side lobe removal – though better than full open surgery – is also not a desirable one. Robotic surgery does not give any advantage on the cosmetic aspect of the thyroid surgery.

The endoscopic thyroidectomy – the keyhole or minimally invasive technique is a very good alternative to other methods. It gives excellent cosmetic outcome especially when done by an axillary approach. It gives equal or even a better surgical outcome as far as the actual thyroid nodule management is considered. There are other less preferred endoscopic approaches like sternal and breast approach.

The procedure of endoscopic thyroidectomy by axillary approach involves the following steps: A 10mm trocar placement in the axilla towards neck for the telescope, which initially helps in creating the plane and visualization of structures with magnification, precision and clarity. Then two 5 mm trocars are introduced in to the dissected space (sub platysmal), which are used as working ports. We generally use a less heat generating energy source the harmonic scalpel instead of cautery for tissue dissection.

Once space is created in the neck the sternomastoids and strap muscles gets exposed. We can open the investing layer in midline and reach the thyroid gland. The gland is mobilized by blunt dissection and vital structures identified. The recurrent laryngeal nerve, the superior laryngeal nerve and parathyroid with their blood supply will be preserved. The vessels are divided and gland detached from trachea. A specimen bag is used to place the thyroid and removed by dilating 10 mm trocar. For a total thyroidectomy one will have to put additional trocars on the opposite side and do the same steps on that side as well.

The investing layer is sutured back, drain is placed and the trocar sites closed. Patient is asked to be in the hospital for 24 hours only and can resume all kinds of activities in a few days.

These patients will have less wound related problem compared to open surgery group. The cosmetic outcome is such excellent that the small wounds in axilla heal with minimal scarring and get covered with small inner-wears.

The earlier belief was that the endoscopic no neck scar option for thyroid swellings are applicable to lesions of less than 4 cm size. But we have observed that swellings of size of even 12 – 15 cm can be tackled very successfully through this method. The only pre-requisite will be a surgeon with good experience, in both laparoscopic surgeries and thyroid surgeries.

The complications of this surgery are very similar to that of open surgery proving that it is a much desirable option. Any kind of pathologies like benign or cancerous nodules, thyroiditis can be safely tackled by endoscopic thyroidectomy. Completion thyroidectomy is much easier with this technique as one do not dissect the other side while performing the opposite side. Lymph node clearance when indicated can also be comfortably performed by this route

The Author:

Dr R. Padmakumar MBBS, DNB, MNAMS, DipALS, FAIS is a Specialist Surgeon at the International Modern Hospital, Dubai. Dr Padamkumar is also a Senior Consultant Surgeon & Medical Director at Sunrise Hospital, Cochin, India. He is a GC Member, Association of Surgeons of India and Vice President of the Indian Hernia Society.

References 1. C. T. K. Tan, W. K. Cheah, and L. Delbridge, “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidencebased review of published techniques,” World Journal of Surgery, vol. 32, no. 7, pp. 1349–1357, 2008. View at Publisher· View at Google Scholar· View at Scopus 2. Y. Ikeda, H. Takami, Y. Sasaki, J. I. Takayama, and H. Kurihara, “Are there significant benefits of minimally invasive endoscopic thyroidectomy?” World Journal of Surgery, vol. 28, no. 11, pp. 1075– 1078, 2004. View at Publisher· View at Google Scholar· View at Scopus 3. M. Gagner, “Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism,” The British Journal of Surgery, vol. 83, no. 6, p. 875, 1996. View at Scopus 4. C. S. Hüscher, S. Chiodini, C. Napolitano, and A. Recher, “Endoscopic right thyroid lobectomy,” Surgical Endoscopy, vol. 11, no. 8, p. 877, 1997. 5. Y. Ikeda, H. Takami, Y. Sasaki, S. Kan, and M. Niimi, “Endoscopic neck surgery by the axillary approach,” Journal of the American College of Surgeons, vol. 191, no. 3, pp. 336–340, 2000. View at Publisher · View at Google Scholar· View at Scopus

International Modern Hospital

Enhancing fertility with laparoscopic surgery and myomectomy


Nowadays around 25-30% of couples who are trying to conceive are unable to do so. Of these couples 40% of the problems are in the male partner 40% in the female partner and 20% account for unexplained infertility. These couples usually immediately choose IVF treatment, as there is a lack of public awareness on the alternative option of fertility enhancing surgery.

The female factor

Laparoscopic and hysteroscopy have come as boon for infertile couples when compared to open surgeries. The benefits of laparoscopy include:

1. Only one-day hospital stay
2. Less pain
3. Minimal blood loss
4. Less expensive
5. Importantly for infertility couples – there is minimal adhesion formation

All-in-all laparoscopic surgeries are a far superior option for the patient and the doctor. Compared to IVF, fertility enhancing surgery is advantageous as it corrects the basic abnormality in the reproductive organs so that the female patient can go on to conceive naturally without any help. IVF is not only more expensive and stressful for the couple, but also needs to be done repeatedly for each pregnancy; hence IVF should only be done as a last resort if fertility enhancing surgery fails.

There are many conditions in infertile couples where fertility enhancing laparoscopic surgery helps.

1. Tubal cannulation: When the tubes are blocked, in 60-10% cases they can be opened with thin wires. Only patients whose tubes which are permanently blocked should opt for IVF.

2. Endometriosis:
Sandwich therapy wherein a primary laparoscopic surgery is done and all abnormalities treated following which the patient is given hormonal therapy for six months after a laparoscopic revision. In several follow-ups we have found that the chances of pregnancy increase by 80% following this treatment compared to couples who had only a 10- 15% chance of conceiving otherwise.

3. Fibroids:
After laparoscopic myomectomy (removal of fibroids) & LUAL (Uterine artery ligation) the pregnancy rate in affected woman is almost equivalent to that of a normal woman.

4. PCOD (polycystic ovary disease): Where other treatments have failed - laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have PCOD

5. Hysteroscopy surgeries: malformations like septum (where there is a wall inside the uterus) or polyps or fibroids (benign growths inside the womb) can be removed easily with hysteroscopy surgery.

Laparoscopic treatment of fibroids (Laparoscopic Myomectomy)

Fibroids deserve a special mention in the UAE as their incidence is on a rise in the country. Fibroids lead to:

1. Symptoms of abnormal menstrual bleeding
2. Increased chance of miscarriage and problems in pregnancy
3. Chronic backache, urinary and bowel symptoms
4. Infertility

Any size of fibroid can be removed laparoscopically without causing any damage to the uterus. A 4.5kg fibroid was removed at our institute in India. Also we practice a procedure called LUAL (Laparoscopic Uterine Artery Ligation) for the prevention of recurrence of fibroids (as fibroids recur frequently after 2 to 3years).

The author

Dr Nikita Trehan, MBBS, DNB, MNAMS, FOGSI, is a Specialist Obstetrics & Gynaecology and laparoscopic surgeon. She has a Diploma in Advanced Gynacological Endoscopy (Sunrise Institute of Medical Sciences, Cochin, Kerala); Diploma in Gynaecological Endoscopy - Kiel Germany; Diploma in Gynaecological Endoscopy – Giessen, Germany. She is a visiting specialist at International Modern Hospital, Dubai.

University of Calgary in Qatar providing world-class nursing education

The only international branch of one Canada’s top research universities, the University of Calgary in Qatar (UCQ) educates worldclass nursing professionals in support of Qatar National Vision 2030 and the National Health Strategy. UCQ Bachelor and Master of Nursing program graduates are poised to do their part to ensure a healthy future for the people of Qatar.

International accreditation for excellence in nursing education

The Canadian Association of Schools of Nursing (CASN) has granted UCQ accreditation for a 7-year term.

“Achieving national accreditation provides students and graduates with assurance that the University of Calgary in Qatar program meets recognized standards of excellence that are applicable to masters programs throughout the world,” states UCQ Dean and CEO Dr Kim Critchley.

“Nursing education programs must continually incorporate new knowledge and be responsive to the changing needs of students and the healthcare environment. Graduates must be prepared to work safely in increasingly complex environments in the context of the constantly changing and growing body of knowledge on which nursing practice is based. One of the ways to ensure this is being done is the CASN accreditation process.”

Interprofessional education

Initiative in healthcare research is one of the key areas in which UCQ demonstrates its commitment to enriching health and wellness in Qatar.

The Interprofessional Education (IPE) project focuses on enhancing the interprofessional and collaborative nature of healthcare delivery. IPE is promoted by the World Health Organization as an important tool to improve healthcare systems.

“We’re using an evidence-based approach to develop an interprofessional education project that is suitable for and fits the Qatari context. We believe it will improve patient outcomes, potentially improve patient safety, in addition to improving staff morale and well-being and a whole other range of potential benefits,” explains Jason Hickey, UCQ nursing instructor and Project Lead. The Qatar Academic Health System is a partner in the project.

Weill Cornell Medical College in Qatar leads the change

Healthcare is going through a dynamic change in Qatar and nowhere is the drive for a world-class health system more apparent than at Weill Cornell Medical College in Qatar (WCMC-Q).

A branch campus of Weill Cornell Medical School in New York –the medical school of the Ivy League Cornell University – WCMC-Q is the only institution to award U.S accredited MD degrees outside of the United States. Since we began teaching operations we have created 147 new doctors and this will be further boosted following this year’s graduation ceremony when a further 34 students will take the Hippocratic Oath and receive their M.D. degrees. Following their residencies at institutions in the U.S and at Hamad Medical Corporation, we fully expect many of our graduates to return to Qatar to take up leadership roles within the medical community and help augment healthcare for future generations.

But WCMC-Q is not just about creating new doctors. We are also creating knowledge, pushing the boundaries of medical science to help create a better future for everyone.

Through programs specially designed to reflect the health issues facing Qatar, we are investigating new treatments for cholesterol, examining the genetics of regional variations in breast cancer, and looking at creating a new, non-invasive test for diabetes.

Not only this, we are taking action to improve the health of the nation today. Though initiatives like Your Health First, a high-profile government-backed campaign, we are providing people with the knowledge they need to make a difference to their health today so they can make a meaningful contribution to the Qatar of tomorrow.

The health of Qatar has never looked better.

CNA-Q to tackle impact of environment on health issues with opening of new research and training laboratory

The lab was officially opened in March this year and has four main responsibilities: to assess human risks from exposure to environmental and chemical hazards; to understand the mechanisms of chemical and radiation induced DNA damage; to initiate a training and research program in biomedical and environmental research programs to build research capacity and finally to create a network of experts within the country and region.

Dr Firouz Darroudi, a leading cancer researcher, will be spearheading the research and training work at the lab. Dr Darroudi has been working with CNA-Q since 2012 as a Research and Training Consultant, working with both CNA-Q students and external stakeholders.

“From our studies we can investigate the causes of cancers, find biomarkers of cancers of different origins and improve the cancer therapy regimens of people who have cancer,” Dr Darroudi explained. “We are incredibly excited about the potential of the lab and the students at CNA-Q I have been working with, and the amazing response we have received from researchers throughout Qatar. We have been very busy working with people from Hamad Medical Corporation, Qatar Foundation, Qatar University and the Ministry of the Environment, and it has been amazing to see the level of interest and collaboration.”

Currently, 11 students from the School of Health Sciences are working with Dr Darroudi. In the past 12 months, he has also held workshops including graduate and post-doctoral students, oncologists and cancer researchers from across the country. The success of the workshops led to the opening of the Radiation Genetics and Chemical Mutagenesis Lab.

“CNA-Q is widely known for its quality training,” noted Dr Mike Long, Chair of the Office of Applied Research. “Our partnership with Dr Darroudi has allowed us to use the talents of a world renowned biomedical researcher to engage in cancer and biomedical research and at the same time develop the skill sets of the research community in Qatar.”

While the lab will be of immediate benefit to CNA-Q students and instructors, Dr Darroudi intends the lab to have a national impact. “Not only will the work being done in this lab help to generate a safer environment and improve human health, it will also serve to initiate joint collaborations with other research centers in Qatar to further develop local knowledge and expertise at international high standards.”

These collaborations will help generate an educational and scientific center in the Middle East on biological, environmental and medical programs, ensuring researchers and practitioners are able to provide the best medical advice for the people of Qatar and the Arab world.

Boston Children’s Hospital

3D printing puts patients in surgeons’ hands

By Tom Ulrich Boston Children’s Hospital

3D printing technology has exploded in the last few years, and it’s already making a mark on medicine. Look to the recent stories of a baby whose windpipe was replaced with a 3D-printed replica, or a U.K. patient who now has a 3D-printed pelvis.

Instead of printing implants, Peter Weinstock, MD, PhD, and his team at Boston Children’s Hospital’s Simulator Program are putting a child’s internal anatomy in surgeons’ hands before going near an operating room. Not your average 3D printer

The service that Weinstock’s team is putting together – along with collaborators like Sanjay Prabhu, MBBS, of Boston Children’s Department of Radiology – has four key features. First, it’s completely in-house, so the team can turn models around quickly. “There are medical 3D printing vendors, but they take weeks to months to send you a model and cost a great deal of money,” says John Meara, MD, DMD. “We gave Weinstock the patient’s image data, and he printed the model for us overnight.”

Second, the printer – provided by the hospital’s Department of Anesthesia, Perioperative and Pain Medicine – has extremely high resolution: down to 16 microns (the size of a droplet in a cloud). This allows models to capture fine details, which can be critical for something as small as a baby’s brain or skull.

Third, the models can be built from multiple plastics, mimicking the physical characteristics of different tissues like bone, skin and blood vessels all in a single model.

Lastly, because the printer uses individual patients’ CT or MRI scans as source data, the models accurately capture the unique anatomy of each individual child.

“We see it as the realization of ultrahigh fidelity simulation,” says Weinstock. “Imagine being able to print an organ and surrounding anatomy, take it into the simulation suite or the operating room and practice on it. Then take that same model you’ve operated on and use it as a guide for treating that child. This could be a game changer in surgical preparedness.”

Your child’s model is ready

Neurosurgeon Joseph Madsen, MD, expresses a similar sentiment as he reaches into his desk and pulls out a printed model of a brain based on one of his epilepsy patients. The model shows her brain’s exact contours, even the placement of her “grid”: the network of electrodes Madsen’s team used to find the focal point of her seizure activity.

“It can be hard to conceptualize and explain an operation just from imaging,” says Madsen, who with engineer Tomer Anor, PhD, is using 3D printing to develop and train neurosurgical robots. “In a case like this, there’s no good way to practice before surgery.”

Except to practice with a model, as Madsen has done for another epilepsy patient who needed to undergo a hemispherectomy (removal or disconnection of one hemisphere of the brain). “Doing a dry run of the case ahead of time using a model from this child’s imaging has certainly helped us,” he says.

Darren Orbach, MD, PhD, and his colleague Edward Smith, MD, are already looking at turning simulation into a regular clinical offering, making 3D-printed models a standard service for every patient who comes to the Cerebrovascular Surgery and Interventions Center.

“It’s very different to hold a model in your hands when you’ve been used to trying to manipulate images on a screen for years,” says Orbach, a neurointerventional radiologist. He thinks that models with hollow veins and arteries could have potential for practicing vascular procedures. “They would let me figure out what approaches and catheter sizes would work and what wouldn’t before going into the catheterization suite.”

Smith, the hospital’s director of cerebrovascular neurosurgery, envisions practicing surgery on a patient’s model and using a scan of that model as a real-time guide in the operating room.

Tool for the next generation

Weinstock’s models also may be important tools for training future specialists.

Meara’s shelves now hold models of skulls purchased from a commercial vendor, each an example of a different craniofacial anomaly. While those models have some training value for new fellows, they don’t capture a breadth of variation. “Each of those models represents an ‘average’ for each anomaly. But every child’s case is different.”

Nor can the bought models be operated on. Made with an older technology, they don’t have the material properties of bone and tissue and can’t be cut or manipulated like Weinstock’s models.

“It’s hard for a trainee to visualize exactly what a severe anomaly looks like,” Meara says. “To give them the opportunity to hold and feel the anatomy lets them train their proprioceptive senses and learn more than they could from imaging.”

Orbach agrees, “If we could make models tailored specific cases and specific trainees, it could be revolutionary.”

“It’s good to see how 3D printing inspires people and gets them to come up with new ideas about how to approach patient care,” says Madsen. “We’re used to thinking about anatomy in one way, and then someone like Peter comes along and says, ‘Let’s print that.’ It brings a new perspective that can help solve old problems.”

Danat Al Emarat Hospital for Women and Children

State-of-the-art women and children’s hospital to open in Abu Dhabi

Danat Al Emarat Hospital for Women and Children (DAE) is expected to open its doors to patients in the second half of 2014. During the first phase, the facility will open 117 beds, 4 major operating theatres, 10 Labour and Delivery rooms, 1 minor operating theatre, 3 adult ICU beds, 2 Paediatric ICU beds and 15 Neonatal ICU beds. All the rooms in the hospital are single bedded with variety ranging from normal in-patient rooms to executive, VIP and Royal suites.

Owned by Abu Dhabi’s United Eastern Medical Group, the leading private healthcare investment company, Danat Al Emarat Hospital for Women and Children is managed by ParkwayHealth which is a premier brand of Parkway Pantai Limited, one of Asia’s largest private healthcare groups with more than 3,500 beds. Their experience in healthcare extends over Singapore, Malaysia, Brunei, India, China and Vietnam.

Danat Al Emarat Hospital is a specialized hospital catering only to Women and Children. Although the hospital will have a full-fledged state-of-the-art maternity department, the facility will offer a whole range of services catering to the needs of women and children. The clinical programmes which will be provided at the hospital will be those covering Obstetrics and Gynaecology, Paediatrics and Neonatology, General Surgery, General and Internal Medicine, Adult and Paediatric Cardiology, Plastic and Reconstructive Surgery, Paediatric Surgery, Paediatric Orthopaedics and others. This extensive service portfolio is furthermore supported by allied services such as an in-house laboratory and radiology facilities.

In the area of the Neonatal ICU (NICU), Danat Al Emarat is the first private hospital in the United Arab Emirates to encompass a Centre of Excellence in Neonatology. There will be 4 beds for Level 3 NICU babies, 2 Isolation rooms which can handle either Level 2 or Level 3 babies and 9 beds for Level 2 babies.

Paediatricians & Neonatologists will be managing Level 3 NICU babies supported by nursing staff qualified and experienced in the respective areas. The other key support staff will include Paediatric Surgeons, Paediatric Ophthalmologists, Paediatric Cardiologists and other sub-specialists as needed.

The hospital will be a “paper-light” facility. Medical and Nursing records will also be input through the use of notebooks and computers. This will allow instant access to the medical records of a particular patient’s condition. Such access will be restricted to only those who are involved in the care of the patient.

As DAE is managed by ParkwayHealth, standards and quality outcomes are a given. Specific clinical outcomes/indicators will be benchmarked against those of the group on a regular basis. Such benchmarking will help DAE to continually improve on its clinical indicators thus making sure that the services provided by the hospital are comparable with internationally accepted standards.

Located in the Officers City area towards the outskirts of Abu Dhabi, the serene and calm surroundings provide plenty of parking spaces and easy access to care. The facility can be reached on +971- 2-5581515 or more information can be found at www.danatalemerat.ae

 Date of upload: 12th May 2014


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