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January 2012 | 3

January 2012 contents

4. mHealth: The Future of Health is Mobile

By Praveen Pillai

12. The Snoring Disorders Centre

Harley Street sleep specialist, consultant Michael Oko, raising awareness of sleep apnoea in the Middle East

16 Arab Health 2012 Preview

23-26 January, Dubai

Preview of the first mHealthplus conference

18. Adam,Rouilly

Serving medical education worldwide

Medical training models

24. TBS Group

Hospital equipment maintenance and telemedicine services

26. The UK Pavilion at Arab Health

The best of British med-tech on display at Arab Health: Exhibitor and product profiles

34. In Search of Perfect Healthcare

Specialist article by Brian de Francesca

36. World Health Care Congress Middle East

10-13 December 2011, Abu Dhabi

Review of the region’s premier event for senior health care executives, with speaker profiles and features

44. Paxman Coolers

Scalp cooling technology for cancer patients

46. Desso

Evidenced-based design for new medical facilities

Editor’s intro

This issue focuses on Arab Health

2012, the biggest medical

technology trade show in the

Middle East. We look at some of

the innovative companies and

outstanding products that are on

display at the show.

mHealth is a newtheme at Arab

Health and a fast growing

phenomenon in the health care

world. Praveen Pillai writes in our

lead feature on the impact that the

trend for delivery of health via

mobile devices is having on all

areas of health care, and the

challenges this creat for health

providers.

Also in this issue we have an

article by international healthcare

management expert Brian de

Francesca, Executive Vice-

President at TBS Group, on his

personal quest for perfect health

care provision.

MEH reviews the 2nd World

Health Care Congress Middle

East, looking at the important

themes and speakers at this high

level meeting of health experts

last December in Abu Dhabi.

mHealth: The Future of Health is Mobile

Middle East Hospital

January 2012 | 4

An apple a day may not keep

the doctor away, but an

increasing number of tech

savvy users want their mobile

phones and remote devices to

do so.

Health does not take place in

hospital or in your doctor’s office

and not even when you are in-

front of your laptop. It happens

every moment of the day, when

you are on the move, going to an

appointment, picking up a sick

child from school, in the foods you

choose to eat, the biometric

device you may be using to

monitor some aspect of your

health or that exercise regime that

you are just beginning. Health

goes where you go; this is why the

future of consumer-driven health

will increasingly rely on mobile

technologies. Needless to say –

the future of Health is Mobile.

Mobile Health or mHealth is the

cover-all term for the delivery of

healthcare services via mobile

communication devices. mHealth

can be broadly defined as the use

of personal mobile phones and

other wireless technology in the

delivery of medical care and

dissemination of health

information.

The advent of the “app economy”

created a brand new interactive

way by which providers,

caregivers and patients have the

opportunity to continuously

monitor health conditions and

access health information outside

of either the physicians’ office or

the patient’s home.

Mobility engagement is creating a

platform which even turns a

mobile into a smart medical

device, capable of even receiving

an ECG data and allowing a

physician to observe heart rhythm

–and perhaps even diagnose a

heart attack. According to a study

published in the Journal of

Medical Systems,

InformationWeek, wireless

sensors that monitor elderly

patients' physiological functions

and physical activities can help

reduce congestive heart failure

symptoms and potentially prevent

hospital readmissions.

While the concept of m-Health

has emerged as an important sub

segment of e-Health (electronic

health record), by definition,

“eHealth” can largely be viewed

as the technology that supports

the functions and delivery of

healthcare, while m-Health rests

largely on providing healthcare

access.

For example, a project labelled

“m-Health” that uses mobile

devices to access data on

HIV/AIDS information would

require an e-Health system to

manage, store, and assess the

data. Thus, “e-Health” projects

many times operate as the

backbone of m-Health projects.

According to a recent published

by healthcare market research

firm Kalorama Information the

healthcare industry is among the

fastest growing handheld device

markets and the total market is

expected to reach $8.8 billion for

2011, a 7 % increase over last

year.

The annual consumer market for

remote/mobile monitoring devices

is projected to increase in 2011

from $7.7 billion to $43 billion*

At the point of care: 40% of

physicians use a digital device

and more than 2 in 5 physicians

go online during patient

consultations, with the majority of

by Praveen Pillai

Middle East Hospital

this time being spent on a

handheld device. 94% of

physicians are using mobile

health consulting apps while on

the job. 63% of physicians are

using personal devices for mobile

health solutions that aren't

connected to their practice. 41%

of new healthcare technology

initiatives by pharmaceutical

companies were mobile apps -

this time and investment shows

that mHealth will work. 10% of all

smartphone users has a health

app on their device - By 2015

33% of all smartphone users will

be running an mHealth app.

mHealth focus areas

Mobile healthcare technologies

are particularly well suited for

disease management across the

continuum through real time

decision support, remote

monitoring of health status,

&treatment compliance, health

awareness through behaviour

change communication (BCC),

data & disease

surveillance,epidemic outbreak

tracking, emergency medical

response, clinical information

transmission, including x rays and

other biometric data.

One of the biggest challenges

faced globally is how to make

high-quality healthcare affordable

and accessible for all. With an

upward trend in chronic diseases

and an ageing population, the key

to minimising long-term

complications is to empower

patients to take preventative

measures to self-manage their

health. The concept of mobility in

healthcare shows great promise

as an optimal platform for

engaging consumers in self-care

by stimulating the concept of

“Participatory Health” - creating a

new personalized health

paradigm, comprised of self-

empowered consumers who are

more connected to and in better

control of their own health (and

their family's) and remotely linked

to the healthcare ecosystem.

Enabled by mHealth, Participatory

Health is transforming healthcare

from a physician and hospital

centric system to one wherein

patient don’t have to be in a

hospital to receive care and their

health trends can be analysed at

a single point in time. Advances in

mobile technology for healthcare,

also promise to make "home

health" technology more user-

friendly, portable, affordable and

real-time. Wireless monitoring of

homebound patients with chronic

health problems can be

performed using wearable

wireless ECG miniature sensor

which continuously tracks the

heart activity and wirelessly

transfers the data whenever they

feel pain in the chest or heart

irregularities. Additionally, the

feeling of being in virtual contact

with the health care professionals

provides a sense of safety,

without the hassles of permanent

monitoring.

When patients are small children

or senior citizens requiring

continuous monitoring and prompt

reactions, mobile devices are

becoming an increasingly

essential tool for an active

population, who are tracked

through their mobile phone and a

web interface, allowing nurses to

send and receive text messages,

make voice calls, and receive

critical care alarms through their

smart phones in an effort to

provide faster response times for

their patients.

The economic driver in using an

m-health is reduction in

unplanned hospital admissions.

January 2012 | 5

Middle East Hospital

GE, Intel and the Mayo Clinic are

jointly coming together to launch

a tele-health home monitoring

project for understanding the

challenges and opportunities in

real-life, with real people. The

project goal is to evaluate the

effectiveness of daily in-home

monitoring technology in terms of

reduced hospital admissions and

reduced visits to the emergency

room.For the project, Intel brings

its Health Guide technology into

the mix; GE offers a

comprehensive portfolio of

medical, digital, and bio/clinical

products; and, Mayo brings its

clinical expertise and, most

importantly, patients with chronic

diseases conditions. The platform

allows for videoconferencing

between the patient at home and

the care team back at Mayo to

permit patient-provider

connectivity.

Researchers at the University of

California-Los Angeles Wireless

Health Institute and the UCLA

School of Nursing used a system

called WANDA -- Weight and

Activity with Blood Pressure

Monitoring -- to track patients'

weight, blood pressure, physical

activity and other data. The

WANDA system: uses sensors to

monitor patient health and collect

relevant measures; transmits

readings to Web servers that

store and analyse data and acts

as a database server for backup

and recovery purposes.

Imagine having an ambulance

equipped with 4G connectivity

that can broadcast live video of

able to take a pill with a

transmitter inside that can send

data to a doctor monitoring

medication in the patient's

system.

A Californian firm is planning the

first clinical trial of the “smart pill"

for tuberculosis which will sendan

electrical signal when it is

swallowed by a patient. The

message is read and stored by

electronic equipment inside a

small bandage worn by the

patient. That information can be

downloaded from time to time, or

beamed wirelessly to a device in

the home that e-mails the

patient’s doctor.

Lot of time, bed space in the

hospitals& doctors time are

wasted for the routine procedures

that can be avoided by remote

monitoring of the patients.

Emerging markets represent

another near-term and meaningful

opportunity for mobile health. In

many countries where little

healthcare infrastructure exists

and large population segments

don’t have access to local medical

care, mobile health solutions have

already shown they can bring

care to regions where it previously

didn’t exist.

They range from simple SMS-

based platforms for patients to

smartphone-based applications

for doctors to reduce child

mortality, improve maternal

health, and combat HIV/AIDS,

malaria, and other diseases. In

Uganda, a SMS-based test result

system has cut infant diagnosis of

HIV from three months to two

weeks. HIV-positive infants at

participating clinics receiving

treatment have more than

doubled, from 40 % to 90%.

Mobility Advantage: Health

Care Made Easier

Half a century ago, in a film called

"Fantastic Voyage", a tiny Raquel

Welch and her team were sent

into a dying patient’s body in a

nano-submarine to save his life.

Technology has still not advanced

quite that far, but today’s

sophisticated devices and

diagnostics are getting ever

closer. Eventually, with 4G

speeds, patients may soon be

mHealth: The Future of Health is Mobile

January 2012 | 6

Middle East Hospital

An increase in physician use of

mobile devices is forcing hospitals

to ensure information security and

protecting patient privacy both

loom large in the context of

devices that can easily walk out

the door.

It's imperative that a hospital

manages not just the medical

devices it issues, but also

personal devices that a clinician

may have brought from home.

The hospital assumes less risk

when it issues the devices

because they can be password

protected, encrypted and, “with

thoughtful planning,” tracked

throughout the building. Most

importantly the devices can be

turned off or the memory can be

wiped off remotely, if there is any

suspicious activity.

If it's a doctor's personal device,

rather than hospital property, it's

going to exit at the end of every

shift. While that lets the doctor

quickly look up medical records

when called at home or at a

restaurant, it also opens up the

possibility that the device will be

left behind on a restaurant table.

But there are some other

technical issues challenging the

widespread use of mobile devices

in medical settings, including the

lack of native support for many

non-windows devices, the inability

to disinfect many mobile devices,

and device overload, where

clinicians are finding themselves

toting around too many of them.

Medically some Doctors even

claim that since brain is an

started talking about talking about

an app that can analyse a

person’s cough. Philips has

already developed a “body-

computing” tool in form of a bed

sheets with metal strands woven

into them to allow a patient’s heart

to be monitored as he sleeps.

Recently an ultrasound probe was

developed at Washington

University in St. Louis that uses

just a half watt of power from a

cell phone. That means that

ultrasound exams could be

conducted nearly anywhere, while

the image is piped to a doctor far

from the scene.

The sophisticated equipment in

Aravind Eye Hospital kiosks in

rural India is run by well-trained

local women, not expensive and

elusive doctors. Once an eye test

is completed, the patient and all

his digitised data are linked by

internet video to a physician at the

main hospital who decides

whether the patient just needs

spectacles (made on the spot) or

has to go to the hospital.

Barriers to mHealth

Structural and regulatory barriers

that continue to exist in the

healthcare industry play a pivotal

role in the evolution of m-Health

as well, with issues like regulatory

compliance, security & safety

concerns, reimbursement

questions etc. affecting the speed

of adoption. Most importantly, the

healthcare industry’s tardiness to

adopt new technologies and lack

of a historically proven ROI to

providers will prove to be the most

substantial barriers to growth.

EMTs treating a patient while on

the way to the hospital. A patient

at St. Francis Hospital in Rosyln,

New York, has become the first

recipient of FDA approved

wireless-enabled pacemaker,

enabling the doctor to finish about

90% of the routine check-up work

before the patient arrives thanks

to the data transmitted from the

pacemaker to its online portal.

A UK-based company is

developing a way to use mobile

phones to monitor the health of

asthma patients. A chip that

contains a nano-senor 100 million

times more sensitive than a

breathalyser is housed in an

ordinary handset. Each day, the

patient breathes on the chip,

which reads the gases in their

breath, and sends the data to a

healthcare professional for

analysis. It is looking for nitric

oxide, which is produced when

the lungs are inflamed. Once the

analysis is complete the patient

receives the results by text

message, email, or a voice call.

If there is a problem, the message

may tell them to adjust their

medication or visit their GP. The

aim is to give the patient a tool to

more effectively manage their

chronic condition, so this will

minimise the number of times

they visit their GP, hopefully

minimise the number of times

they become quite ill.

Pretty soon, it won’t just be calorie

counters and pedometers driving

consumer behaviour in mobile

health, companies have already

mHealth: The Future of Health is Mobile

January 2012 | 8

electrical instrument and the

frequency of radiation produced

by mobile is very close to that

used in the brain, so it's no big

surprise to find a phone is

interfering with that frequency,

causing headaches, nausea,

mood swings, hearing and other

such problems.

Conclusion

The business of healthcare,

whether at a doctor’s office,

hospital, outpatient facility or long-

term care facility, is often a

delicate balancing act of urgency,

accuracy, privacy, regulations and

technology. This balancing act

can make solving issues in the

healthcare industry seem like a

daunting task, but with the right

mobile solution, many

improvements can be seen

quickly and easily.

As smartphones grow more

popular, Smart hospitals are

planning for smartphone

integration to leverage these

devices for maximum impact.

Developing a sound mobility

strategy includes preparing the

infrastructure and incorporating

the necessary workflow changes

to benefit from smartphones. By

developing a clear picture of how

smartphones can help improve

patient care, how doctors and

nurses will use them, and how

they can best be managed,

hospitals can get ready for the

smartphone revolution now.

The Smartphone Application

Market Phenomena houses the

idea that technology integration

within the health sector has the

great potential to enable

policymakers, medical

practitioners and facility operators

to contact large numbers of

people with a high degree of

accuracy, ensuring that specific

health information about

diagnosis or treatment can be

communicated to those who need

it but since mobile health services

are more personal, it requires a

more targeted approach, rather

than a blanket approach that may

be appropriate for some other

services.

Hospitals require a great deal of

agility when it comes to creating a

mobility strategy because not

every device will work in every

situation. So establishing

processes and procedures for

testing new devices is critical to

innovation. If a device or

application works well, it can then

be expanded quickly. On the other

hand, hospital management has

to establish specific policies for

the use of personal mobile

devices. The clinical and

operational segments of mobile

health require the medical

industry’s acceptance for

commercialization. The

relationship between regulators

and the medical and mobile

communities will have to be

reconsidered if an enabling

environment for mobile health is

to be achieved.

Despite all the benefits, many

hospital and healthcare

technologists are still trying to sort

out where the mobile devices fit

into their medical bags. The

bigger concern is that technology

can never be a substitute for

personal responsibility. As per

John Naisbitt, “The most exciting

breakthroughs of the 21st century

will not occur because of

technology but because of an

expanding concept of what it

means to be human”. While the

emerging mobile platforms is still

in its infancy, yet there is no

denying that the m- health has the

potential to empower patients and

give them the tools and data

needed to take charge of their

own health.

mHealth: The Future of Health is Mobile

About the author

Praveen Pillai is a Health care

management professional with

over 11 years of progressive

experience in both national &

international market. He is a

candidate for a doctorate

program in Business

Management. He is a graduate

in Business Economics (MBE)

from School of Economics,

DAVV, INDIA & holds a Masters

diploma in Hospital &

Healthcare management from

Symbiosis INDIA.

Middle East Hospital

January 2012 | 10

Middle East Hospital

Snoring Disorders Centre

New Harley Street Clinic

opened in January 2012

The Snoring Disorders Centre

has opened a new clinic at 150

Harley Street in London. As well

as catering for private patientsin

London and the South Eat of

England the Snoring Disorders

Centre (or Snore Centre) serves a

growing number of international

patients who come for treatment

from all corners of the world,

including the Middle East.

ENT at 150 Ltd provides a

comprehensive range of private

consultations, investigations,

treatment and surgery for ear,

nose and throat complaints and

facial plastics. ENT at 150 offers

a comfortable environment where

patients have many options

available to them.

The team of ENT surgeons will

often work together to

accommodate individual patient

needs and turn out the best

possible outcome. Now Snore

Centre founder Michael Oko has

added his expertise in sleep

disorders to this exceptional pool

of talent.

ENT at 150 has an in-house

Audiology department providing

Tympanometry, Impedance

Testing, Pure Tone Audiometry

and hearing aid provision. They

also have a Cone Beam CT

scanning facility, providing high

resolution CT scans relevant to

the Ear Nose and Throat at a

small fraction of the normal

radiation dose.

Raising global awareness

Mr Oko actively campaigns for

greater awareness of the dangers

of sleep apnoea in regions with

high incidence such as Europe,

the North America, and the Middle

East. In December 2011 Mr Oko

was presented with an award for

his contribution to healthcare in

the Middle East region by Riz

Khan of Al Jazeera at the World

Health Care Congress Middle

East in Abu Dhabi. Ahead of his

address to the WHCC in Abu

Dhabi Mr Oko told MEH:

«Levels of obesity, hypertension

and heart disease are rocketing in

the wealthy Middle East, mainly

due to the life-style. People are

working long hours, eating rich

calorie-laden food, driving

everywhere and not exercising

enough. I believe that the success

Michael Oko receives award from Riz Khan

January 2012 | 12

ENT at 150 Harley Street

I have had in Lincolnshire can be

replicated in the Middle East by

raising awareness of the

condition, and forming long-term

partnerships with local hospitals,

doctors, and government

departments.

«With the low level of awareness

of sleep apnoea in the Middle

East it’s no surprise that road

accident rates out in Dubai and

the UAE are dreadful. In fact road

traffic accidents are the second

major cause of deaths in the UAE.

There are 3500 fatalities per year

from RTAs in Saudi Arabia alone,

and OSA could well be a factor in

many of them.»

Mr Oko aims to form partnerships

with Ministries of Health and

hospitals in the Middle East region

to help them set up sleep apnoea

clinics that would serve the local

population, and introduce a

testing regime that would help to

reduce fatalities on the roads.

The Snore Centre

The service provides accurate

and prompt diagnosis of the

causes of sleep apnoea and

snoring and identifies the most

appropriate treatment for both

NHS and private patients. The

aim is to deliver high quality

clinical care in a friendly

environment.

n 2008 the Snoring Disorders

Centre won the NHS East

Midlands Healthcare Award for

service transformation. In 2010

the Snoring Disorders Centre had

treated over 1500 patients of

which 1200 are on Continuous

Positive Airway Pressure (CPAP)

therapy and this project has

contributed to a significant fall in

the number of road fatalities in

Lincolnshire The Snore Centre

provides rapid access clinics

where they can review patients

who have problems with their

CPAP machines or masks. This is

very important as we understand

that continuity of treatment is

crucial for people suffering from

sleep apnoea and problem

snoring. We use advanced

computing technology to remotely

monitor our patients on therapy to

reduce the number of hospital

visits required.

January 2012 | 13

Middle East Hospital

The Snore Centre at Johnson Hospital

Middle East Hospital

Snoring Disorders Centre

What is sleep apnoea?

Sleep Apnoea is a sleeping

disorder that you might not even

realise you are suffering from,

usually your partner will be more

aware of it than you are. The

problem itself is a disrupted

breathing pattern during sleep

caused by a closing of the upper

airways of your lungs when you

relax and a period of time when

your body stops breathing.

This results in you losing a few

breaths, lasting a period of around

ten to twenty seconds (each

occasion is referred to as an

apnoea). Sometimes this might

wake you up but more often than

not you will simply resume

breathing normally again without

being aware of the disruption and

without realising that you have

woken up for a few seconds and

that your sleep has been

disrupted. Mild sleep apnoea is

when between 5 and 15 episodes

of apnoea occur within an hour,

moderate between 15 to 30 and

severe sleep apnoea is anything

above this.

Who suffers from Sleep

Apnoea?

Sleep Apnoea affects over 4% of

the population, usually these are

men over 40 years of age with a

sedentary job, for example driving

or office work. Women are half as

likely to have/suffer from sleep

apnoea until they go through the

menopaus.

Those who are overweight are the

most at risk of developing sleep

apnoea and about 2/3rd of patient

with the condition are overweight.

This is partly because the extra

weight upon the neck pushes

down and closes the throat whilst

asleep. It is no surprise that most

people who suffer from sleep

apnoea have a larger than normal

neck.

How is Sleep Apnoea treated?

At the Snoring Disorders Centre

you will undergo a series of tests

and assessments before the most

suitable form of treatment is

recommended.

Changing your Lifestyle

Once you have been diagnosed,

Mr Oko and his team can take a

number of steps to change your

lifestyle in order to help prevent

sleep apnoea. You may be

advised to lose weight. This will

reduce the amount of weight on

your neckline so making it less

likely to push down on your

windpipe Alcohol and smoking

can both cause and exacerbate

sleep apnoea and you may be

advised to reduce drinking or to

stop smoking. Sometimes simple

lifestyle changes will not help with

your sleep apnoea and further

measures will need to be taken.

CPAP – Continuous Airway

Pressure

If you suffer from moderate or

severe sleep apnoea and you do

not respond to lifestyle changes

then you might be recommended

a CPAP machine while you sleep.

This is a mask attached to a

machine that helps you to breathe

at night by providing a steady

supply of air. The air is at a

slightly higher pressure than

normal, which enables your throat

to remain clear. This may seem

an odd solution, having to be worn

every night continuously, however

if you persevere with it the CPAP

machine can improve your

sleeping immediately and have a

huge impact on your waking life.

This is the safest and most tried

and tested solution to sleep

apnoea and recommended by

NICE (National Institute of Clinical

Excellence).

January 2012 | 14

Middle East Hospital

The Arab Health Exhibition &

Congress is the largest event of

its kind in the Middle East. Now in

its 37th year, Arab Health provides

an unrivalled platform for the

world’s leading manufacturers,

wholesalers and distributors to

meet the medical and scientific

community from the Middle East

and beyond.

mHealth conference

The first mplushealth conference

will take place in January at Arab

Health this year. Rising costs,

scarce resources and lack of

capacity, coupled with the rise in

lifestyle diseases such as

diabetes and hypertension are all

contributing to a crisis in

healthcare in the Arab World with

a huge burden on the existing

healthcare systems in the region.

Mobile health technology allows

medical professionals to manage

many patients remotely. This

technology can monitor their

conditions in real time and pass

on vital statistical information

between the healthcare provider

and the patient.

mHealth is a new and booming

trend in the healthcare industry,

and is set to become a trillion

dollar industry allowing the

delivery of better healthcare whilst

positively impacting the bottom

line across the range of

stakeholders in the healthcare

industry. The first mplushealth

conference, brought to you by

Arab Health and Ovum, will take

place on 24 January 2012 at the

Arab Health Exhibition &

Congress in Dubai with a view to

forge the future of mobile health in

the Middle East.

Simon Page, Managing Director,

Life Sciences, Informa

Exhibitions, the organiser of Arab

Health, says: “Research has

indicated that the annual

consumer market for mobile

monitoring devices is projected to

increase in 2011 from US$7.7

billion to US$43 billion. Currently,

94% of physicians are using

mobile health consulting apps

while on the job and 63% of

physicians are using personal

devices for mobile health

solutions that aren't connected to

their practice“.

Arab Health 2012 Preview

January 2012 | 16

Middle East Hospital

Dubai 23-26 January

“It is an extremely innovative idea

to bring together the healthcare

community and technology

vendors like us, to see what kind

of solutions we can offer to the

community in bringing mobile

healthcare technology to the

region,” says Santanu Biswas,

Director of eHealth Services at

Du, and Chairman of the

mplushealth conference.

“mHealth is becoming a buzz

word and it is the opportunity to

change the way healthcare is

delivered in the region by making

healthcare more patient-centric.”

According to Mr Biswas, “With

higher bandwidth and faster

networks being brought to smart

phones in the region, mHealth is

becoming an effective way to

deliver healthcare. mplushealth

differentiates itself from other

mHealth conferences by including

a vital stakeholder into the foray of

discussion; the healthcare

professional.

Arab health is a great opportunity

to host a seminar that drives

content suited to these

stakeholders.”

The mplushealth Conference is

the only platform in the region

where healthcare professionals,

insurance providers, government

regulators and tele

communications decision-makers

come together to understand the

future of mobile healthcare in the

Middle East. The conference is

planned around a group of key

sessions that will address not only

what healthcare providers or

professionals want to hear, but

also some of the key critical

issues that healthcare in the

region faces today. Another key

aspect is about technology; the

need to understand standards,

interoperability and integration

between systems and the role

played by telecom operations.

January 2012 | 17

Middle East Hospital

Exhibitor focus: Adam,Rouilly (Stand 7E01)

Adam,Rouilly supplies a

comprehensive range of

medical training aids from

Anatomical Models and

skeletons to Clinical Skills

Simulators and Anatomical

Charts. Adam,Rouilly

celebrated its 90th Anniversary

in 2008 having first supplied

natural bone material and

anatomical models to Hospitals

and medical schools in London

in 1918.

The business rapidly expanded to

all areas of Great Britain and

within ten years a flourishing

export business was established.

The first patient simulator (the

Bedford Hospital Nurse

Demonstration Doll) was

manufactured in 1930 and

continues to be sold to this day.

The name Adam,Rouilly is

recognised throughout the world

by healthcare professionals for

the manufacture and supply of

high quality medical training aids.

From its base in Sittingbourne,

Kent, in the UK, Adam,Rouilly has

been exporting to customers

throughout the world for nearly 80

years and has long established

relationships with many world

famous medical training

institutions, nursing colleges

hospitals and universities

including those from the Middle

East.

Adam,Rouilly has attended Arab

Health since 2004 and is now a

regular exhibitor on the ABHI UK

Pavilion finding it an excellent

platform for meeting distributors.

Tariq Shahab, who recently joined

Adam,Rouilly as Sales and

Marketing Manager, told MEH:

“I am looking forward to furthering

Adam,Rouilly’s presence in the

Middle East as the company has

such an established reputation for

offering quality products and

excellent customer service.

Adam,Rouilly has a very reliable

distributor network in the Middle

January 2012 | 18

East which is a very important

part of our export market. Within

the Middle East we sell into many

hospitals, almost exclusively

through our distributors within the

various countries. We have seen

a considerable increase in both

enquiries and business from

Saudi Arabia, Yemen, Jordan,

UAE and Syria although we

supply most countries in the area

at some time in the year”

Adam,Rouilly’s large range of

products has been carefully

designed, developed and

selected in direct response to

customers’ requirements and

preferences and one such training

simulator is the Diabetic

Retinopathy Trainer.

Studies have highlighted the

prevalence of Diabetes in the

Middle East as being amongst the

highest in the world. Rapid

economic development, changes

in lifestyle resulting in less

exercise, more smoking,

unhealthy nutrition and increased

obesity all lead to an increased

risk of developing diabetes and

eye conditions which can lead to

blurred vision and blindness. One

of the most serious eye problems

caused by diabetes is diabetic

retinopathy which causes damage

to the tiny blood vessels inside the

retina.

The World Health Organization

has predicted that diabetes is

expected to increase by over

200% from the year 2000 to 2030

in countries in the Middles East

and North Africa. Early diagnosis

Diabetic Retinopathy conditions: Background Diabetic

Retinopathy Pre-Proliferative Diabetic Retinopathy, Proliferative

Diabetic Retinopathy, Maculopathy, Photocoagulation and

Ungradable

Common retinal eye conditions: Normal, Glaucoma,

Papilloedema, Optic Atrophy, Medullated Nerve Fibres, Age-related

Macular degeneration – dry, Multiple Retinal Haemorrhages, High

Myopia and Hypertensive Retinopathy.

Less common retinal eye conditions: Macular Scar

(Toxoplasma), Retinal Detachment, Choroidal Naevus,

Cytomegalovirus Retinitis, Central Retinal Vein Occlusion, Central

Retinal Artery Occlusion, Retinal Artery Emblus (Hollenhorst

Plaque), Retinitis pigmentosa, Angioid Streaks, Malignant

Melanoma, Benign Disc Naevus, Macular haemorrhage and

Lipaemia Retinalis

Serving medical education worldwide

Middle East Hospital

January 2012 | 19

placed in either the left or the right

eye and are labelled accordingly.

Mr Shahab continued “We will be

displaying our Diabetic

Retinopathy Trainer and will be

pleased to demonstrate it visitors

to our stand at Arab Health. When

you look at the incidence of

diabetes in the Middle East early

diagnosis is important. If diabetes

is treated effectively as soon as it

is detected, the risk of people

developing a range of serious,

costly and irreversible

complications can be reduced.

This simulator is ideal for use as

part of strategic planning in

diabetes training for medical

professionals. Clinical Skills

Training in Hospitals is expanding

in the Middle East and this

increased demand for skills

training and our broad product

base enables us to help hospitals

who are implementing or

expanding these Clinical Skills

Training facilities. There is an

additional requirement for

anatomical models in the medical

schools at the Universities and we

offer what we believe to be the

highest quality range on the

market.”

The other most popular products

with Adam,Rouilly customers are

the Venepuncture and Infusion

Arm, The Hungry Manikin, X-Ray

Positioning Doll, Rectal

Examination Model, the Bedford

range of Hospital Training Dolls,

Pain Relief Manikin and

Rhinoplasty Model.

www.adam-rouilly.co.uk

and treatment is essential

however studies have shown that

nurses and doctors in many

Middle East countries lack

knowledge about diabetes and

detailed training in the early

detection of diabetic retinopathy is

urgently required.

Adam,Rouilly’s Diabetic

Retinopthy Eye Trainer was

developed in conjunction with a

leading Consultant in diabetes

and offers excellent ‘hands-on’

experience and practice in the

examination of eyes, and the use

of an ophthalmoscope, with the

emphasis on diabetic retinopathy.

This popular model represents an

adult head with eyes, the retinas

of which may be examined

through the pupils using an

ophthalmoscope. It is now

supplied with a completely new

set of images identifying

conditions and diseases of the

retina shown on a set of 28

interchangeable transparencies.

The head is available in white or

black skin tones and is simple to

use and is highly durable.

The slides show a range of

conditions and diseases of the

retina including Diabetic

Retinopathy (According to

National Screening Programmes

in the UK, Europe and the World

Health Organisation) common

and less common retinal eye

conditions. The slides for use in

the retinopathy head can be

Exhibitor focus: Adam,Rouilly (Stand 7E01)

Middle East Hospital

January 2012 | 20

For 20 years TBS has been

helping hospitals across Europe

save money and improve patient

safety related to medical

equipment management (also

referred to as Clinical and

Biomedical Engineering).

In line with integrated technology

development (in both IT and

telematics), the company’s growth

was marked by developments in

Clinical Engineering itself. In fact,

Clinical Engineering was no

longer merely restricted to the

secure and efficient management

of biomedical equipment, but had

expanded to comprise the

integrated management of all

technologies implemented in

hospitals and social and

healthcare facilities (the

convergence of medical device, IT

systems and telecommunication

systems). TBS is the only

company in the world that fully

addresses this convergence and

provides proven integrated

solutions.

TBS Executive Vice-President

Brian de Francesca told MEH,

“throughout the world, healthcare

costs are the most significant item

in public expenditure; they are

growing faster than the GDP and

threatening to become

unsustainable. Technology

accounts for 50% of overall costs.

Proper management can save

money and improve patient

safety.”

The Group’s mission is to develop

outsourced integrated Clinical

Engineering, e-Health and e-

Government services so as to

enhance the safety, effectiveness

and efficiency of technologies

used in hospitals, social and

healthcare facilities as well as in

other local authority entities.

These technologies include

biomedical equipment, additional

medical devices, medical IT

systems and solutions, telecare

and telemedicine systems and

solutions and e-Government

systems and solutions.

TBS Group operates in 13

countries through over 20

companies and employs more

than 2,000 personnel; over 300

workshops on site, subdivided

into 45 Regional Operating

Centres linked to more than 1,000

healthcare structures.

This widespread network of

technicians and skills draws from

an interconnected IT platform and

an impressive database that

enables a continuous exchange

of data, information and

knowledge.

TBS Group also deploys internal

R&D facilities operating in

collaboration with leading

TBS Group

Middle East Hospital

January 2012 | 24

universities and international

research centres. TBS Group is a

young and highly specialized

company with a solid shareholder

base, consisting of leading

banking and financial institutions

such as The Generali Group and

the Group’s own managers.

The headquarters are located at

AREA Science Park (Trieste,

Italy), the science and technology

park of which it has been a tenant

since 1994. Over the last 5 years,

the company’s CAGR in terms of

turnover was 17%. From

December 2009 TBS Group is

listed on AIM Italia (Italian Stock

Exchange segment).

TBS Group operates with two

Business Units: The Medical

Equipment and Devices Division

and the e-Health & e-Government

Division. ‘TBS Group undertakes

its activities while adhering to

three guidelines: quality and

precision in its services; the

preparation and professional

development of its engineers and

technicians and continuous

innovation in design and

technology’, said Mr de

Francesca.

The Group operates onsite at

many hospitals and social

healthcare facilities, setting up

dedicated technical workshops.

Within the current 340 workshops

present in the countries where it

operates and the 45 regional

operating centres, TBS Group has

at its disposal a staff of over 1,600

IT and biomedical engineers, as

well as highly specialised

technicians. There are 26

supporting operating centres.

In addition to significant budgets

invested annually in innovative

projects that create value and

benefits to the customers, the

Company also takes part in

numerous research programmes

by university institutions and

Italian and foreign technical-

scientific associations.

TBS is the global leader in

providing proven solutions that

address the convergence of

various healthcare technology

systems, which improve efficiency

and patient safety.

www.tbsgroup.com

Hospital Equipment Maintenance and Telemedicine Services

Middle East Hospital

January 2012 | 25

Middle East Hospital

Arab Health 2012 Preview

The Association of British

Healthcare Industries (ABHI) is

bringing the largest ever number

of UK healthcare companies to

Arab Health 2012, being held

from 23-26 January in Dubai. The

UK Pavilion (Stand 7E30) will

house 120 of the UK’s most

innovative med-tech companies.

As one of the largest med-tech

trade shows in the world Arab

Health is a great opportunity to

showcase the high quality medical

devices that UK companies

produce to a global audience, and

to enable small companies with

innovative products to reach out

to overseas markets. UK

Business Ambassador, Professor

the Lord Darzi, who will be visiting

the show, said:

“The UK medical technology

industry is dominated by

innovative and dynamic small to

medium-sized enterprises. Med-

tech innovation is supported in the

UK by a strong research and

development base that enables

companies to get their ideas

transformed into cutting-edge

medical technologies. The ABHI

UK Pavilion this year houses

some of the sector’s most

innovative and dynamic

companies, showcasing the latest

cutting-edge medical devices and

equipment that the UK has to offer

the hospitals and healthcare

systems in the Middle East

region.”

Also visiting the UK Pavilion at the

show is HM Consul General, Guy

Warrington, Head of Mission at

the British Embassy in Dubai:“UK

is one of the world's leading Life

Sciences markets and is at the

forefront of technological and

product development worldwide.

Besides UK being the leading

supplier of sutures, sterile surgical

supplies, blood grouping reagents

and electro therapy equipments to

the UAE, it has also enhanced the

UAE healthcare system with stem

January 2012 | 26

Middle East Hospital

Dubai 23-26 January

cell and regenerative

technologies. UK’s Bourn Hall

Clinic, founded by the Nobel

prize-winning physician Robert

Edwards, which has plans to open

its first MENA In-Vitro Fertilisation

Centre in Dubai in early 2012

further demonstrates the

importance of the UK medical

technology sector to the UAE

healthcare system. The UK is

UAE’s crucible for Life Sciences

growth, enabling UK and UAE

companies to drive innovation

through to market success.”

Product launches on the ABHI

UK Pavilion at Arab Health

Benmor Medical (Stand 7C51)

are launching their new “Aurum”

bariatric bed at Arab Health. The

Aurum 4-section electric profiling

bariatric bed has been designed

to facilitate safe and efficient care

of the larger patient whose body

weight and/or size exceeds that of

a standard bed.

Combining functionality and

aesthetics the Aurum is strong

and durable enough for all

bariatric care situations, whilst

providing a comfortable

environment for improved patient

care and tranquillity.

Benmor Medical has been

supporting bariatric care since

1996 and was the first company in

the UK specialising in bariatric

patient handling equipment. As

pioneers within the UK market for

bariatric equipment Benmor

Medical has been at the forefront

of the development of products

and solutions that have helped to

raise the standards of bariatric

care within the UK. Now the

company is taking its range of

innovative bariatric solutions to

the Middle East.

Peter Staddon, Managing

Director, said:

“We are continually driving

innovation and quality within the

bariatric market and have

established a firm reputation for

excellent customer support and

class leading products. Benmor

Medical will be attending Arab

Health for the first time and are

excited at the prospect of

showcasing our innovative new

width expandable bariatric bed -

the Aurum - to a new audience

within the Middle East. We are

confident that our range of

bariatric products will create

significant interest in the Middle

East healthcare market and allow

us to meet companies who share

a passion for our products and

with whom we can develop fruitful

long-term relationships.”

As part of a trade mission

organised by UK Trade and

Investment, Mr Staddon will also

be travelling to Kuwait and Saudi

Arabia after Arab Health in order

to meet with buyers and

distributors interested in their

range of bariatric products.

January 2012 | 27

Middle East Hospital

Arab Health 2012 Preview

Enuresis alarms

For 30 years Malem Medical

(Stand 7E38) have been

manufacturing the world’s best

and largest range of Enuresis

Alarms and Vibrating Watches for

the treatment and permanent cure

of Nocturnal as well as Diurnal

Enuresis.

With the latest Universal Wireless

Alarm you can use up to seven

transmitters, each one of them

can be attached to a different

sensor (such as Enuresis body

worn Sensor; Bed-Mat Enuresis

Sensor; Pressure-Mat; and

Pressure Release Mat) to help

detect patient movement and

prevent dangerous falling or

unauthorised wandering.

One small battery operated

receiver that can be carried by the

carer will communicate with up to

seven Transmitters. This

Universal wireless product is ideal

for nursing/care homes, or for use

at home.

Asked about Malem’s hopes for

Arab Health this year Dr Hilal

Malem told MEH, “Our main aim

in being at Arab Health is to find

local distributors for our products.

Our world famous Enuresis

Alarms offer the only safe,

reliable, tried and tested method

for the treatment and permanent

cure of bedwetting at an

economical cost. Drugs, in the

form of antidiuretic hormone, if

they work at all, provide a

temporary reduction in the

quantity and frequency of

bedwetting as long as the child is

receiving the drug. This could be

for years at a vast monthly cost

that can be twice the cost of one

of our enuresis alarms.“

“Another exciting product is the

Talking Vibro-Watch. You can

programme this watch for up to

twelve (12) specific times and

record a unique message for each

time so that the user will be

reminded at the correct time with

Vibration and a dedicated

message that will be announced.

(Take the blue tablet, Lock/open

the back door, Use the toilet etc.)

The talking vibro-watch

Universal wireless alarm

January 2012 | 28

Middle East Hospital

Hospital Infotainment Arm

Colebrook Bosson Saunders

(Stand 7B57), leading designers

and manufacturers of ergonomic

support products, are launching

their patient infotainment arm:

CBS-Hi1. CBSHi1 has been

developed exclusively for the

healthcare market to meet the

computing and multimedia needs

of hospital patients and staff.

CBS Healthcare views the Arab

Health Exhibition as the perfect

forum to launch their innovative

range of products to the Middle

East healthcare community. Greg

Cranfield, sector specialist at CBS

Healthcare, says: “we’re thrilled to

have the opportunity to bring

these products to this dynamic

and thriving sector. We expect the

high quality design and attention

to detail demonstrated in our

products to be appreciated in this

up to the minute environment.”

CBS Healthcare will exhibit an

original array of new products

seen in the Middle East for the

first time including CBS-Hi1. CBS-

Hi1 enables a screen

(increasingly used for patients’

healthcare, entertainment,

communication and information

needs) to be safely mounted to a

wall and easily adjusted. Amongst

all the flat screen supports on the

market CBS-Hi1 has the strength

and adaptability to carry the

largest spectrum of weights,

ranging from 3.5 to 9KG.

Another new product launch from

CBS Healthcare at Arab Health

will be the ‘CBS-S2S’: the most

minimal wall-mounted workstation

imaginable. The inventive design

enables screen and keyboard tray

to be folded flat against the wall,

thus maximising the space

available for patient care.

CBS-S2S was designed for

healthcare environments where

space is limited; this might be in a

patient’s private room; at a

nursing station or within a ward.

CBS Healthcare have in the past

carried out projects at Great

Ormond Street Children’s

Hospital and The Department of

Health, both in London, UK.

The CBS-S2S screen and

keyboard tray can be adjusted to

allow the user to sit or stand while

maintaining a comfortable

position and good posture. The

flexibility of movement also

CBS-Hi1 Infotainment Arm

CBS-S2S wall-mounted workstation

Dubai 23-26 January

January 2012 | 29

Arab Health 2012 Preview

enables the screen to be

positioned so that clinician and

patient can comfortably share

information on the screen when

required. Data and power can be

supplied within a concealed wall

box and a CPU suspended from a

separate holder will further

minimise space taken up by the

unit. This original new product

exemplifies the approach of CBS

Healthcare to product design:

designing technology to fit around

the person – never the other way

around.

Diagnostic devices

Also on the ABHI UK Pavilion at

Arab Health Max Medical (Stand

7C31) will be displaying their

latest diagnostic devices for the

first time in the Middle East. Max

Medical’s self-monitoring blood

glucose and blood pressure

devices combine a minimal

compact design with accuracy

and ease of use to deliver

maximum efficiency.

Commercial Director, Victoria

Sikopoulis, said:“Over 10% of

people in the UAE suffer from

raised blood glucose, and 27.5%

from high blood pressure. In

Saudi Arabia the figures are even

worse, with 18% of people having

raised blood glucose and a third

with high blood pressure. With

such a high incidence of

cardiovascular disease in the

region it is essential that patients

are able to easily and accurately

monitor their own blood glucose

and blood pressure levels, and

our products make self-monitoring

simple and accurate.”

On display for the first time at

Arab Health will be the Minipro

Self-Monitoring Blood Glucose

System. This is a small, unique,

friendly design, and offers one of

the most minimal blood test

samples on the market. The

device is easy to use with the

large and easy-to-read LCD

making results clear. It delivers

accurate and fast results with a

test time of only 7 seconds.

Also on show for the first time in

the Middle East will be Max

Medical’s range of digital blood

pressure monitors. The MX8 and

MX9 wristwatch models have new

specifications to diagnose blood

pressure with colour indicators on

the monitor (red and blue),

making it easy to read and see

how you are performing against

target or ‘normal’ blood pressure

rates. Features on the MX8 and

MX9 include an LCD display, one

touch automatic measurement, a

power saving mode, and

automatic inflation and air

release. They use Oscillometric

measurement methodology, and a

semiconductor pressure sensor.

With an impressive battery life

allowing for approximately 250

measurements, and a memory

capacity suitable for family use,

the MX8 and MX9 offer optimum

value.

Minipro blood glucose monitor

MX8 blood pressure monitor

Middle East Hospital

January 2012 | 30

Arab Health 2012 Preview

High quality surgical

instruments

A regular exhibitor on the ABHI

UK Pavilion, Bolton Surgical

(Stand 7D19) is a manufacturer

and supplier of the finest quality

surgical instruments and

accessories for use within the

modern theatre environment.

Bolton bring together traditional

manufacturing methods with the

technology you would expect from

a market leader in Surgical

Instrument supply, enabling them

to provide a totally flexible service

tailored to meet the differing and

demanding needs of modern

Theatre and Decontamination

Departments.

Steve Spurgin joined the

company in 2011 as International

Business Director:

“Bolton’s did in excess of £3

million in terms of business at

Arab Health last year and

appointed 8 new distributors in the

region. From a solid base in the

UK we are increasingly looking to

expand our overseas presence in

key markets such as the Gulf.

This will be our 5th consecutive

year at Arab Health so we are still

a relatively new business in the

Middle East.

“Our main objectives for 2012 are

to consolidate existing

partnerships with Middle East

distributors as well as

reacquainting ourselves with

some contacts in key countries

such as Libya as it hopefully

opens up for business again in the

near future.”

The skills and dedication of the

workforce ensure that the name

Bolton Surgical is synonymous

with quality products and British

manufacturing and the company

has been a member of the Guild

of Master Craftsmen for many

years. Products manufactured by

Bolton Surgical are currently on

display at The Royal College of

Surgeons, The Pelican Centre

and St. Marks Hospital in London.

Bolton Surgical has won the

prestigious 2011 Middle East

Hospital magazine’s Health &

Innovation Award for Surgical

Instruments and Outstanding

Contribution to Healthcare in the

Middle East. The award

recognises Bolton’s recent

success in growing its business

across several middle eastern

countries (notably Kuwait, Saudi

Arabia and Egypt) over the past

year, and will be presented at

Arab Health.

Middle East Hospital

January 2012 | 32

Orthopaedic instruments

Innovation Ortholine (Stand

7D59) has an exciting product

portfolio with the enviable

reputation of being able to

manufacture and provide the

orthopaedic surgeon with all

implantable devices for specific

patients needs. Their innovative

and exciting product portfolio is

updated and expanded in line with

technological advances to satisfy

the current and future needs of

both patients and healthcare

professionals.

IOL are currently trading in Egypt

and Syria with government and

private institutions. Dr Mohamed

El Masry said, ‘We are attending

Arab Health to break into new

Arab markets, meet other

companies in our field, and view

the latest orthopaedic innovations

on show. Our implants are very

much in demand in the region due

to the high incidence of road traffic

accidents.’

Breath gas monitors

Bedfont Scientific (Stand 7C22) is

a market leader in breath gas

monitors for medical applications.

They manufacture top of the

range breath gas monitors for

smoking cessation,

gastroenterology and carbon

monoxide poisoning, FEno testing

and a medical gas delivery

system used in Inhaled Nitric

Oxide Therapy.

Winner of Chamber of Commerce

“Business of the year” 2011,

KEIBA 2011 “SME Business of

the Year” and “Science and/or

Technology Business of the Year”,

as well as Middle East Hospital

“Health and Innovation Award”

2011.This year at Arab Health

Bedfont are be showcasing their

Medi-Gas Check range. On the

Bedfont stand product managers

Andy Smith and Hubert Sochaj

will be hapy to discussss possible

distributorship in the Middle East

market.

Dubai 23-26 January

Middle East Hospital

January 2012 | 33

Healthcare is not perfect. In

fact, on the “continuum of

perfection,” with industries

such as Aviation, Automotive,

Hoteling and Energy being

situation closer towards the

perfection end; healthcare can

be found far to the other

extreme, nuzzled up closely

against the Western k-12

educational system – vying for

the title of “Most Dysfunctional

and Inefficient.”

Is it not sadly odd that the two

areas that should be leading in

performance – one that takes

care of our minds and the other

our bodies – are the laggards in

the race? Globally, healthcare

safety, performance and efficiency

is not what it could or should be.

What is going on here and why

are we allowing it to happen?

When dreaming of “Perfect

Healthcare.” I am not talking

about a world of paperless “Leed

certified” 5 Star “Hospitals” that

aspire to be Academic Medical

Centers practicing “World Class

Healthcare.” I am talking about

healthcare that is better, cheaper

and more accessible than we now

have. More evenly distributed

efficient healthcare that performs

at levels on a par with other

industries.

Perfect is unachievable – it is a

continuum – but it provides a

target to strive for. Perfect

healthcare is about a lot more

than buildings. We will not

improve healthcare by

constructing more fancy marble-

clad hospitals, with expensive

over-specified equipment, staffed

with the same sort of people doing

the same things as in the past. To

put things in perspective: The

greatest contributions to

improving healthcare in the

Victorian era came from the

introduction of “clean drinking

water and functional ubiquitous

sewage systems.” Why do the

persons who implement these

sort of massive, ubiquitous

healthcare improvements not

receive the same fawning-over

and deference-to as do our

deified physicians – the gross

positive effect yielded by the

designers and engineers appears

to be equal or greater.

Our performance: On average

and compared to other industries

– Healthcare is not safe, not

efficient, not nice to our

consumers, not accessible, slow

to innovate, does not learn and

share. We healthcare executives

tend to be arrogant poor

performers, believing that we are

better than we are. We can do

much better. Our patients and

their families deserve much

better.

Globally, there are various local

impediments to achieving better

healthcare. These are challenges

and impediments that are

common to all organizations; and

several that are unique to the

mystical and magical world of

healthcare (see inset blue box).

I have met many people who

know specifically what needs to

be done to make healthcare

In Search of Perfect Healthcare

Brian de Francesca

biography

Brian studied at John Hopkins

University and Loyola

University. He joined the John

Hopkins School of Public

Health in 1992 working in

international business

development before spending

12 years in South Asia working

in healthcare management.

Brian worked for Asia Bio

Systems Holding in Singapore

for 10 years, and then as

Deputy Director on Bangkok

Dusit Medical Services.

In 2007 he returned to John

Hopkins and was posted as

the Chief Operating Officer of

Tawam Hospital in Abu Dhabi.

In 2009 he became Executive

Vice President of TBS Group,

the global leader in providing

clinical engineering and

telemedicine services. Brian

is dedicated to the continuous

improvement of healthcare.

Middle East Hospital

January 2012 | 34

better; but when they try to

implement their ideas they fail for

various different reasons. They

know what needs to be done but

are simply not permitted to do it.

After a while they get disillusioned

and stop trying, they cave into the

frustration and join the flock of

disenchanted complainers.

These are my sad comrades in

arms. We know healthcare can

be better and we want to be part

of making it better.

Certainly there are exceptions to

my criticisms, but these are few

and far between. World class

healthcare is not very good. The

average person on the planet is

poor, and the average quality of

healthcare on the planet is equally

poor. We don’t want “World

Class” we want “better.”

All over the world we are saying

that we are trying to change

healthcare for the better, but

change it into what? Until now,

there has not been a model for

what truly exceptional healthcare

would in fact be. What would

“perfect healthcare” look like?

Imagine if we could magically

sweep away all of the

impediments to perfection and

greatness in healthcare. Imagine

if there were no legacy issues to

deal with, no lack of resources, no

constraints of any kind. If you had

a completely blank slate with no

constraints or impediments what

would perfect healthcare look

like? We are allowed this wistful

dreaming in the pleasant world of

“intellectual thought experiments.”

by Brian de Francesca

Impediments to achieving

perfect healthcare

1.Lack of resources (Money,

space, skilled personnel and

more)

2.The deification of physicians:

The origin of medicine –

priests and magicians. Putting

physicians in charge of areas

where they have no training,

experience or even desire to

venture.

3.The litigious environment.

Frivolous claims.

4.Antiquated rules,

regulations, guidelines and

business practices.

5.Legacy everything

6.The lack of standardization

and will to industrialize

processes.

7.Corruption

8.Lack of knowledge

9.Lack of bold and brave

leadership.

10.Reimbursement in general:

How we address pre-existing

conditions, telemedicine,

preventive, home care etc.

11.A chronic inability to identify

and share best practices.

12.Confusion over Public

versus Private role in

healthcare

13.Waste and inefficiency due

to (NHS)

14.Emperor’s clothes; lack of

transparence; lack of following

business methods.

15.Various vested interests

that survive and thrive over the

current imperfect system.

16. ..and more

Once we know what perfect looks

like we can then look at what we

have, which should clearly

illuminate what needs to be

changed. We then would require

brave leaders who are bold

enough to make these changes.

Now is a time for bravery and bold

action.

Middle East Hospital

January 2012 | 35

The 2nd Annual World Health

Care Congress addressed all the

major issues affecting health care,

both in the Middle East and

around the world. A diverse roster

of health care experts participated

in engaging and thought-

provoking discussions.

Highlights included a dialogue

between health authority leaders

from the United Arab Emirates,

including Zaid Al Siksek, Mr. Al

Siksek, CEO Health Authority Abu

Dhabi (HAAD) and Lalia Al

Jassami, CEO-Health Policy &

Strategy Sector, Dubai Health

Authority.

Mr. Al Siksek said Abu Dhabi is

working to address many of the

challenging facing it’s health care

system, including proving

adequate health care services for

a population that is largely

transient. Of the 2.5 million

residents in the emirate, fewer

than 500,000 live here

permanently. Mr. Al Siskek said

acquiring and retaining adequate

medical staff for the local health

care industry is also a challenge

Abu Dhabi must continue to

address.

“Cost is a real issue on

everyone’s agenda — from a

public health perspective, we are

focusing on how we can save and

control costs,” said Zaid al-Siksek,

chief executive of the Abu Dhabi

Health Authority, at the World

Health Congress in Abu Dhabi

last month. “In Abu Dhabi, where

our average age of population is

28 and median age is 19, we

need to be strategically prepared

for the needs of this very young

population in the future and find

ways to manage costs.

"We are therefore working to

develop the ‘ecosystem' for a

robust health-care industry that

includes accurate information

World Health Care Congress Middle East 2011: Review

Middle East Hospital

Zaid Al Siksek, CEO, HAAD

Brian and Casper de Francesca, Yasar Al Ain, HAMAD

Dr Charles Stanford, CEO, Lifeline Hospital

January 2012 | 36

about patients and medical

providers, as well as access to

various health-care services.

Thereafter, we will focus on

enhancing the level of human

capital among medical

professionals in the emirate so

that we are prepared for a time

when the population begins to

age," Al Siksek said.

“Our health care budget is

increasing every year and we still

have to accommodate the

demands of our growing

populations,” Leila al-Jassmi,

chief executive for health policy

and strategy for the Dubai Health

Authority, said during a speech at

the World Health Congress. “We

are obliged to help private

investors navigate this sector, too;

it’s necessary when we look at the

big picture and visualize where

we want to our health care system

to be in 10 years.”

The conference featured nearly

25 panel discussions that each

addressed a unique area of health

care delivery. The World Health

Innovations Summit addressed

the latest in patient-decision

making, mHealth technologies

and why more innovations are

coming from developing countries

and emerging markets.

Presenters included the Lord Ara

Darzi, MD, head of surgery at

Imperial College Hospital in the

United Kingdom; Victor Dzau,

MD, President and CEO, Duke

University Medical Center and

Health System and Prof. Tan Ser

Kiat, Group CEO, Singapore

Health Services.

Abu Dhabi 11-13 December 2011

Middle East Hospital

Elias Saade (Doctors without Borders), Mike Tanousis (MEH Publishing)

January 2012 | 37

Sharing Daman statistics on the

third day of the World Health Care

Congress Middle East 2011 in the

Capital, Dr Rohte said health

insurance players face significant

challenges with profitability due to

medical inflation.

“Medical inflation... is one of the

major challenges in the region,”

he stated. Yet, there currently

lacks proper understanding and

ways to predict this. “What we

saw here in Abu Dhabi ... there is

a lack of understanding and (how)

to predict the medical inflation,”

said the CCO of the largest payer

in the country. Daman has 2.2

million members and covers 28.6

per cent of the Abu Dhabi

residents with health cards.

According to him, medical inflation

is driven by lack of public

information on the proper usage

of insurance, resulting in high

utilisation and even misuse.

“Currently, the perception of the

people, of the companies are that

the hospitals and providers are

not that cost-conscious,” he said.

In addition, some also resort to

abusing the system. “We see a lot

of claims which are not actually

based on facts,” said Dr Rohte.

He noted that a system was in

place for Daman to control and

monitor the providers and identify

“abnormal patterns”.

At the session, several

suggestions were raised on how

to further reduce and control

healthcare cost. These include

the use of home care agencies or

deploying nurses to give care at

Middle East Hospital

encounters. The HAAD figures

showed that out of the 13.1 million

claims processed last year, 98.7

per cent are from outpatients.

Medical inflation

According to the Health Authority

– Abu Dhabi (HAAD), demand for

health services grew in 2010

driven primarily by outpatient

January 2012 | 38

World Health Care Congress Middle East 2011: Review

New clinic open at 150 Harley Street, LondonNew clinic open at 150 Harley Street, London

www.snorecentre.com

Middle East Hospital

Medical Director, Tawam

Molecular Imaging Centre, United

Arab Emirates; Prof Abdallah S.

Daar, Professor, Surgery,

University of Toronto; Anne

Reeler, Chief Technical Officer,

Axios International, France. The

World Health Care Congress Middle East 2011: Review

Michael Oko moderates the keynote panel discussion on advancements in treatment

Michael Oko (Snoring Disorders Centre) Paula Wilson (JCI)Tam McDonald (Harley Street World)

Disease Detection and Treatment

On the panel were Dr Farida Al

Hosani, Section Head,

Communicable Diseases Section,

Public Health & Policies, Health

Authority – Abu Dhabi (HAAD);

Dr. Muhammad Ali Chaudhry MD,

home especially for ventilator-

dependent patients, and

discharging patients early from

hospitals.

Dr Rohte said Daman is looking

“into these innovative services to

bring the cost down (while) finding

the best treatment for the

members”. “This is what you can

expect from us to come (through)

in one to three years,” he added,

noting that by optimising cost, this

will free funds to finance other

specialist services.

Advancements in treatment

Consultant ENT surgeon and

Harley Street sleep specialist,

Michael Oko, moderated the final

day keynote panel on the topic of

Promising Advancements in

January 2012 | 40

Middle East Hospital

ministers, leading government

officials, hospital directors, health

system and hospital providers,

patient safety directors, disease

management professionals and

health and wellness experts, chief

financial leaders, IT and mHealth

innovators, decision makers from

public and private insurance

funds, investment and venture

capital principals, pharmaceutical

and biotech executives and

consulting firm directors.

www.worldcongress.com/me

World Health Care Congress Middle East 2011: Review

Middle East is the most

prestigious health care event,

convening global thought leaders

and key decision makers from all

sectors of health care to promote

health care through global best

practices.

The 3rd World Health Care

Congress Middle East will be held

in Abu Dhabi from 9-11 December

2012. The 2012 WHCC ME

Congress will feature the top

thought leaders and industry

influencers including health

panel discussed the role of

technology in improving the costs

and patient outcomes of chronic

disease management;

Dissemination of health

information through social

innovations; advancements the

industry has provided in the

diagnosis and treatment of NCDs;

improved outcomes via advanced

screening and diagnostic

methods for disease detection

and treatment; and innovative

tools for infectious diseases

surveillance

About WHCC Middle East

WHCC Middle East is organized

with sovereign partners the Health

Authority-Abu Dhabi (HAAD) and

the Abu Dhabi Tourism Authority

(ADTA). Additional sponsorship is

currently provided by The Abu

Dhabi Health Services Company

(SEHA) and Children’s National

Medical Center.

More than 600 health care

executives representing 25

countries shared their

perspectives on best practices for

health care delivery; with the

Conference being held at the new

Abu Dhabi National Exhibition

Centre. Organized Under the

Patronage of H.H. General

Sheikh Mohammed Bin Zayed Al

Nahyan, Crown Prince of Abu

Dhabi and Deputy Supreme

Commander of the United Arab

Emirates’ Armed Forces and in

collaboration with sovereign

partners the Health Authority-Abu

Dhabi (HAAD) and the Abu Dhabi

Tourism Authority (ADTA), the

World Health Care Congress

January 2012 | 42

Middle East Hospital

Paxman Coolers

Paxman Coolers is the World’s

leading manufacturer of a hair

loss prevention device for cancer

patients undergoing

chemotherapy treatment.

Paxman’s innovative system is

the very latest in scalp cooling

technology and has the backing of

leading Oncologists from across

the globe. This revolutionary hair

loss prevention system is

responsible for helping thousands

of people throughout the world to

not only keep their hair but to

maintain their dignity whilst

undergoing chemotherapy.

Scalp cooling works by lowering

the temperature of the head and

scalp immediately before, after

and during the administration of

chemotherapy drugs. This in turn

reduces the blood flow to the hair

follicles, thus preventing or

minimising the damage, meaning

that hair loss is not inevitable.

Hair loss is a well-documented

side effect of many chemotherapy

regimens. It is often devastating

and the fear of hair loss has even

been known to cause patients to

refuse treatment.

The Paxman hair loss prevention

system is currently available in

two models. The Orbis I provides

cooling for a single patient and is

suitable for the small

chemotherapy suite or private

bed. The Orbis II can provide

cooling for one or two patients

simultaneously with each cap

working independently. Both

models operate in the same way

and are identical in size. The

system consists of a small

compact refrigeration unit

containing a coolant which is

circulated at -4°C through coolant

lines to specially designed cooling

caps. The coolant lines are

supported by an adjustable arm

providing maximum patient

comfort.

Consideration and care has gone

into the design of the system in

order to meet the needs of both

the patient and nursing staff. It is

simple to operate with easy to

read touch screen displays. The

compact nature and

manoeuvrability of the system

ensures an efficient use of space.

The system is flexible for patients

and requires minimal nursing

supervision.

Following great success at Arab

Health in recent years the

company has now secured a

significant presence in the Gulf

region, with representation in

Saudi Arabia, Bahrain, UAE,

Kuwait, Syria, Qatar, Lebanon

and Jordan. The profile of the

company and its innovative

product, the Orbis, has further

grown in the region following

recent participation at the UAE

Cancer Congress, 6th SABCS

Conference in Jeddah, KSA. The

product will also be further

showcased at the forthcoming

MENA-NCCN Regional Meeting

in Doha, Qatar from January 26 –

28th 2012.

A recent trial of the Paxman

system at the Al Noor Cancer

Centre in Abu Dhabi, UAE has

reported a success rate of more

than 74% after using the device

on 16 patients. Dr Kassem Alom,

CEO of Al Noor Hospitals Group

said that installing and using the

new device is part of the Group’s

strategy to provide the best

treatment methods to enhance

patients psychological state when

undergoing chemotherapy.

The use of technological

enhancement in healthcare

comes in line with the plans and

programs of the Abu Dhabi Health

Authority, which encourages the

private health sector to develop

January 2012 | 44

Middle East Hospital

and improve the level of services

provided. Dr. Alom added, that the

new device, which has been

installed and running for several

months, has been used for

patients suffering from cancerous

tumours whilst receiving several

sessions of chemotherapy.

Dr. Hala Abdel Latif, Oncology

Specialist at Al Noor Hospital, said

the Paxman Orbis Scalp Cooler is

considered a technological

breakthrough. Al Noor Hospital

was the first hospital in the Gulf

region to introduce this advanced

technology and she added that

the device gives new hope to

cancer patients, and reiterated

that hair loss often causes

psychological problems especially

for ladies. This technology helps

patients to continue their jobs and

social activities while receiving

their treatment, which has the

greatest impact on patient health

and psychological wellbeing.

Dr. Hala echoed the psychological

effects of hair loss mentioning that

the hair loss affects the mood of

the patient in many ways,

including frustration, depression

and gradual introverted

withdrawal from community

activities. She pointed out that

hair loss is one of the main factors

that make patients reluctant to

start chemotherapy treatment, as

it is a major cause for concern

rather than a simple reason, for

some it may be the "last straw".

With the introduction of this

sophisticated device, there is a

great chance that it preserves the

patient’s hair.

Further observational studies of

the Paxman scalp cooler are

ongoing in the Kuwait Cancer

Control Centre and also the

Salmanyah Hospital in Bahrain.

Paxman recently attended the 6th

SABCC conference in Jeddah,

Saudi Arabia and following high

levels of interest have secured

orders for more than 7 Orbis

systems to enable new studies to

commence throughout the

Kingdom and other parts of the

Gulf.

www.paxman-coolers.com

Scalp cooling technology

January 2012 | 45

Middle East Hospital

Desso has been designing and

manufacturing carpet for

almost 80 years. The company

has factories in Europe, is

regionally headquartered in

Dubai, and its products can be

found in commercial and public

buildings worldwide. Andrew

Sibley from Desso examines

the role of carpeting in modern

healthcare facilities.

In recent years, the medical

profession has been adopting

“evidence-based medicine” that

uses research finding to guide

best practice, rather than simply

accept expert opinion, the

traditional and the age-old route

towards clinical decisions.

The same is true in hospital

design, where architects and

interior designers have come to

recognise that a healthcare facility

is more than just its component

parts. It should be a place that

goes beyond mere functionality to

create an environment that

actually aids patient recovery.

That’s pertinent in the Middle

East, home to about 214 million

people, but projected to rise to

233 million by 2015 and 272

million by 2025. That goes hand

in hand with lower mortality and

rising life expectancy which was

only 59 years in 1980 but which,

by 2009, stood at 71 years. All

this is, and will, impact on the

capacity and design of medical

facilities.

According to a report from Al

Masah Capital, the MENA region

spends some 4.3% of GDP,

approximately $66 billion on

healthcare provision, a figure that

is set to rise because of

demographic changes and the

increasing risk of lifestyle

diseases. The report estimates

that there is a shortage of about

Desso: Evidence-based design for new medical facilities

January 2012 | 46

Middle East Hospital

200,000 hospital beds and a

shortage of some 179 medical

staff. But if that is so, what should

medical facilities in the Middle

East look like? Should they be

designed and built for purely

functional – low cost – purpose?

Or should evidence-based design

be incorporated into the process

to reflect that, with higher incomes

and higher aspirations, patients

are increasingly looking for a

better kind of experience when

they are ill.

It’s not a fanciful debate.

Evidence-based design can be

about recognising the importance

of something as simple as natural

light. For example, it’s long been

known that we are all influenced

by circadian rhythms that govern

our performance in numerous

ways – including sensitivity to

drugs, hormone secretion, sleep

patterns and immune responses.

Knowing that is one thing, but

making natural light a key part of

the architectural brief requires

good medical evidence – and

there is now plenty. For example,

a 2005 study (1) that showed that

patients in a brighter area of a

hospital took 22% less analgesic

medicine than patients with the

same medical condition on the

dark side of the hospital. Apart

from the human cost, that

equated to a 21% cost differential.

Patient Experience

Good healthcare design, based

on empirical evidence, aims not

only to make the patient

experience better but to improve

patient outcomes. For architects

and interior designers, it’s about

building complex and expensive

facilities that are designed to work

to best effect, and then testing

every aspect of their design.

A 2009 study in the USA (2)

exemplifies how basic yet how

profound evidence-based

research can be and how, once

bad design is built into the fabric

of a building, undesigning it can

be difficult if not impossible. In

the study, fifty-two physicians

were asked to examine a

standardised patient in two

hospital room settings using a

replica of the proposed

architectural plan. The settings

differed only by the placement of

the alcohol-based hand-rub

dispenser.

The result was that when the

dispenser was in clear view of the

physicians as they observed the

patient, 53.8% washed their

hands. When the dispenser was

not in their line of sight (as it had

been in the original architectural

plan), only 11.5% washed their

hands. Based on these results,

the final architectural plans were

adjusted accordingly. Obvious,

perhaps: but it took research.

The philosophy of patient-centric

care is, of course, not a new one.

It’s what hospitals are there to do:

care for the sick. However,

traditional hospital design has

been largely about functionality.

Compare that with a new private

hospital that opened last year in

the UK. Their view is that a night

in hospital costs more than a night

in a 5-star hotel, so why not make

the experience similar?

Compellingly, the hospital aims to

“give people good health, not an

experience of illness.”

Good hospital design is therefore

about such non-clinical issues as

building in ambient light and

colour, giving patients privacy –

and all aimed at reducing patient

stress and improving outcomes,

not least by reducing the

incidence of medical error. The

New York Times last year

reported that more than 1500

studies have been carried out into

how good design can achieve

those objectives.

Air Quality

At Desso, we also believe in

evidence-based design, because

there is now overwhelming

evidence that good design can

start from the floor upwards. It’s

more than providing a softer floor

for healthcare workers or using

different carpet colours to help

patients find their way around

what can be a bewildering place.

Primarily, in terms of patient

outcomes, it’s about air and noise.

Taking air quality first, the air that

we breathe indoors has been

named and shamed as one of the

top ten health risks of the modern

world, and that’s especially true in

a healthcare environment dealing

with the vulnerable and sick.

The World Health Organization

(WHO) estimates that indoor air

pollution is the 8th most important

by Andrew Sibley

January 2012 | 47

Middle East Hospital

risk factor to health and is

responsible for 2.7% of the global

burden of disease. Asthma, in the

developed and developing world,

is the largest culprit.

The WHO also estimates that, in

2005 alone, some 250,000 people

died from asthma worldwide. It

remains the most common

chronic disease in children, and

its incidence is increasing.

Worldwide, there are some 300

million sufferers, with some 50

million asthma sufferers in the

MENA region costing US$2.5

billion a year in direct medical

costs, time of work and

compromised productivity,

according to a study released at

the 2009 Middle East-Asia Allergy

Asthma Immunology Congress.

In 2001, Dr. Michael Berry wrote

a report entitled Assessment of

Carpet in Sensitive Environments.

In it he examined the findings

from a number of studies that

looked at the relationship between

carpet and indoor air quality (IAQ)

in settings that directly affect the

very young, the very old and

those who are ill.

His research found that “carpet is

a preferred and widely used floor

covering associated with minimal

complaint. Previous claims [that

carpets contribute to IAQ] are not

supported in the scientific

literature. Research to date, some

going back over 30 years,

consistently shows carpet to be a

safe and healthy product

In 1993, a study titled "Global

Strategy for Asthma Management

and Prevention" was published

collaboratively by the US National

Heart, Lung, and Blood Institute

and the World Health

Organization. The 2007 update to

the original report states that there

is no evidence that replacing

carpet with hard surface flooring

has a health benefit.

At Desso, recognising those

potential health benefits, we’ve

gone a significant step further by

introducing a next-generation

Desso: Evidence-based design for new medical facilities

January 2012 | 48

carpet with a unique yarn

structure that captures even more

harmful fine dust from the air –

specifically designed to meet the

requirements of the health sector,

and address the very real

problems posed by poor indoor air

quality.

Acoustics

That, however, was only half the

challenge that we gave ourselves,

because the other problem in a

busy hospital or healthcare facility

is acoustics, and noise can be

distracting, intrusive – and

detrimental to health.

The importance of sound in

healthcare is much better

understood now, although

research continues to

demonstrate that sound levels

remain stubbornly high in many

healthcare environments. A study

for the Centre for Health Design

(3), found that there were two

primary reasons.

First, hospitals and healthcare

facilities generate a range of

background noises – from

telephones and trolleys to staff

conversations and bleepers,

making sound reducing strategies

inevitably complex. However,

and second, the study also found

that the surfaces in hospitals –

floors, walls and ceilings – are

usually hard and reflect sound

rather than absorb it.

That conclusion is backed by

recent US research by John

Hopkins University and the

Georgia Institute of Technology

(4). They found that noise in

hospitals is a significant problem

that is generally getting worse,

even in new construction – and

that high noise levels in hospitals

can potentially contribute to stress

and burnout in hospital staff,

reduced speed of patient wound

healing. The research also found

that there is legitimate concern

that hospital noise can negatively

affect speech communication and

cause an increased number of

medical errors.

The authors state that:

“Conventional acoustical

treatments are used sparingly in

by Andrew Sibley

Middle East Hospital

January 2012 | 49

Middle East Hospital

January 2012 | 50

hospitals because it is believed

that sound absorbing materials

with pores harbour bacteria.

Instead, smooth, hard, flat

surfaces are used because they

are easy to clean. Consequently,

these surfaces are acoustically

reflective and serve to aggravate

existing noise problems.”

Of course, noise can be reduced

in a number of ways. A recent

report in the Wall Street Journal

says that, at least in the USA,

there is a trend towards private

patient rooms, social spaces for

family members, decentralised

nurses’ stations, acoustical tiles –

and carpet to reduce equipment

noise.

Health Benefits

That trend is, of course, based on

evidence-based research. For

example, the Karmanos Cancer

Institute in Detroit, Michigan, saw

a 30% reduction in medical errors

on one unit after it installed

acoustical panels and introduced

decentralised nursing stations.

Additionally, the Methodist

Hospital in Indianapolis, Indiana,

attributes its lowered medical

error rate on a redesign of its

coronary care unit, decentralised

nursing, and carpet in the

hallways.

Reviewing carpet use in the US

healthcare sector, the Centre for

Disease Control found that

carpets have been used in both

public and patient areas for over

thirty years – and that carpets do

not influence hospital acquired

infection rates.

For many health professionals,

the everyday sounds of a hospital

are entirely normal. However, the

experience of patients is quite

different, finding themselves in

unfamiliar and stressful

surroundings. For patients, the

evidence is that reducing sound in

a healthcare environment can

have significant benefits.

For example, and taking one

study from many, research carried

out in Stockholm (5) among

coronary intensive care patients

found that, when sound-reducing

strategies were introduced,

patients slept better, were less

stressed and reported that nurses

gave them better care.

Standard carpet gives impact

sound reduction properties of

between 20 and 30 decibels.

We’ve developed a new carpet

backing, specifically for

environments such as healthcare

facilities, that gives a further

reduction, depending on the

carpet type, of 10 dB or more,

making it the most sound

absorbent option on the market –

and in many cases rendering it

unnecessary to install other sound

reducing strategies such as

ceiling tiles.

We live in an age that has seen,

and will see, huge strides

forwards in healthcare, from new

drug types to new treatments.

Unravelling the genone and the

development of stem cell

research hold out the promise of

medical miracles on the near

horizon. But we shouldn’t forget

that medicine is also holistic, and

that other factors such as natural

light, quietness, and air quality

also have a part to play.

After all, the evidence is now

there.

www.desso.com

Acknowledgements

(1) Walch JM et al

(2) David J Birnbach,

University of Miami Miller School

of Medicine, University of Miami-

Jackson Memorial Hospital

Center for Patient Safety.

(3) Ulrich and Zimring, Centre for

Health Design, 2004.

(4) Noise in Hospitals: Effects

and Cures, 2008.

(5) Blomkvist et al

Desso: Evidence-based design for new medical facilities

About Desso

Desso has a long and rich

history with origins in both the

Netherlands and Belgium. It

began in 1930 with a Belgian

manufacturer that started

producing woven carpets in

Oss, the Netherlands, for

residential and commercial

applications. Desso was

introduced as a brand name in

the early 1950's and in 1960

two other companies located in

Dendermonde and

Waasmunster also became part

of Desso.Today, Desso can look

back on almost 80 years of

proven performance, having

built a reputation as a reliable

partner producing quality

flooring for all types of

applications.

New clinic open at 150 Harley Street, LondonNew clinic open at 150 Harley Street, London

www.snorecentre.com