Day 2 :
Cleveland Clinic Abu Dhabi, UAE
Samer Ellahham has served as the Chief Quality Officer for SKMC. He has worked as a Chief Quality Officer and Global Healthcare Leader, focusing on ensuring that that implementation of the best practices lead to breakthrough improvements in clinical quality and patient safety. He is a Certified Professional in Healthcare Quality (CPHQ) by The National Association for Healthcare Quality (NAHQ). He is certified in Medical Quality (CMQ) by The American Board of Medical Quality (ABMQ). He is the recipient of the Quality Leadership Award from the World Quality Congress and Awards and the Business Leadership Excellence Award from World Leadership Congress.
Cardiovascular diseases are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death. This risk may be reduced by primary Percutaneous Coronary Intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (Door-to-Balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST Segment Elevation Myocardial Infarction (STEMI) who come through the Emergency Department (ED) in a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system. This would have marked impact on patient safety, quality of care and patient experience.
Academia Sinica, Taiwan
Time : 10:00-11:00
Michelle Liou has her expertise in medical statistics, functional BOLD responses and EEG oscillatory activity with an emphasis on image/signal processing and scientific inference. She and her lab members initiated the concept of reproducibility for bridging functional MRI techniques and scientific inference and won the 2003 New Perspective in fMRI Research Award from fMRIDC at the Dartmouth College, USA. She also won the Outstanding Research Award from the National Science Council, Taiwan. She is currently working as a Senior Research Fellow at the Institute of Statistical Science, Academia Sinica and Visiting Professor in the Translational Imaging Research Center, Taipei Medical University
Studies on Heart Rate Variability (HRV) have considered differential gender effects of parasympathetic (or vagal) control on behavioral performance and on functional brain networks. Nonetheless, the intricate relationships among brain oscillations, resting-state HRV, gender and psychological traits in cognitive control tasks have yet to be fully elucidated. We help bridge this research gap by empirically evaluating the relationship between resting-state HRV and EEG reactions as subjects perform tasks involving visual recognition of linguistic ambiguity in Chinese and English sentences. These tasks impose a strong sense of uncertainty in decision-making. It is known that stress or anxiety increases arousal levels particularly under uncertainty situations. A novelty of our study lies in delineation of distinct EEG oscillatory patterns between high and low HRV young women as compared with men by controlling for anxiety effects. Our results revealed a dependency between resting-state HRV and theta/alpha/beta power in individual women. Low HRV women showed stronger theta/alpha/beta de-synchronization compared with their high HRV counterparts, independent of topographic localization. However, low and high HRV men exhibited comparable theta/alpha/beta activity. Trait anxiety scores affected alpha/beta power in the parieto-occipital regions, whereas men with higher scores and women with lower scores showed stronger alpha/beta de-synchronization. We posit that stress-provoking situations may impose additional effects on oscillatory activity in the frontal and temporal regions, a condition in which the interdependency between brain oscillatory activity and resting-state HRV could interact with cognitive control differently in men and women. In other words, the brain networks involved in cognitive control mechanisms differ between men and women, wherein the mechanisms may partially be influenced by female hormones in stressful language tasks.
Figure-1: The average lower-alpha de-synchronization in the 300-600 ms post-onset interval in different scalp regions on the Chinese task in the four groups classified according to gender and the median split of 8 min resting-state SDNN indices.
1. Liou M, Hsich J F, Evans J, Su I, Nayak S, Lee J D and Savostyanov A N (2018) Resting heart rate variability in young women is a predictor of EEG reactions to linguistic ambiguity in sentences. Brain Research; 1701: 1-17.
2. Tsai A, Liou M, Simak M, Cheng P E (2017) On hyperbolic transformations to normality. Computational Statistics and Data Analysis; 115: 250-266.