Prof. Masood Hameed calls for increased collaboration between universities in public and private secto

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PSCTS 9th annual conference at AKUĀ 
Prof. Masood Hameed calls for increased collaboration
between universities in public and private sector

Complete surgical revascularization is the way to go with
advanced cardiac disease - Dr. Hasnat Shareef

Cardiac Surgery is rewarding but challenging and we need to select
Eagles for training in this specialty - Prof.Riaz Anwar Khan

KARACHI: Cardiovascular diseases are the leading cause of morbidity and mortality all over the world. The West has taken care of it by adopting preventive strategies and cardiac diseases there are now coming under control. WHO says that in the next ten years death and debility from Non-Communicable Diseases will increase in the developing world particularly in the Indian sub-continent. It has been proven that complete surgical revascularization is the way to go with advanced cardiac disease. This was stated by Dr. Hasnat Shareef, Head of the Dept. of Cardiac Surgery at Aga Khan University and Chairperson of the organizing committee of 9th annual conference of Pakistan Society of Cardiothoracic Surgeons while speaking in the inaugural session on March 29th 2013.

Mr. Firoz Rasul President AKU presenting mementoe to Prof. Masood
Hameed Khan VC DUHS who was the chief guest at the PSCTS conference.
On right Prof. M. Rehman along with Prof. Riaz Anwar Khan President
of PSCTS chairing one of the sessions during the congress.

The conference attracted a large number of cardiothoracic surgeons and perfusionists from all over the country. Continuing Dr. Hasnat Shareef said that in low income countries like Pakistan, Coronary Artery Bypass Graft Surgery (CABG) costs less than the cost of a stent. We work in a competitive world. Cardiovascular field is internationally driven by the interventional cardiologists. It is important that we follow guidelines of Evidence Based Medicine. Look at the results of various trials. In advanced cardiac disease, CABG is good, it costs much less. Surgical operations are limited in the West because there it costs too much.
Hospitals, Dr. Hasnat Shareef said, exist to provide quality care to the patients and quality can be measured by looking at the database. We must look at our results carefully and database is the tool to look at the quality. Universities bring new knowledge and disseminate knowledge, besides training and mentoring of new generation of specialists. That is why we selected the theme of this conference as Quality Assurance, Education and Training. We had pre conference workshops and live webcast from Bangalore India. Despite some difficulties in the internet, we were able to down load their presentations and have discussions for which the credit goes to the audiovisual team at AKU, he added.
Mr. Firoze Rasul President of the Aga Khan University in his address said that learning should take place at the university and sharing new knowledge is part of the Mission of the universities. Healthcare industry has recently been focusing on delivery of quality healthcare besides research. We should try to overcome deficiencies and improve quality which is of course difficult to define but not so difficult to recognize. AKU is proud of its cardiac sciences training programme. We have also expanded it to Afghanistan by establishing a Paediatric Cardiac Surgery Hospital at Kabul where over one thousand young children and babies have been operated upon so far. We have established Heart and Cancer Center at Nairobi in Kenya and plan to establish a similar center at Darus Salam, he added.
Prof. Masood Hameed Khan, VC DUHS who was the chief guest on this occasion in his speech suggested increased collaboration and co-operation between medical universities in the public and private sector. There is no dearth of talent and manpower. We need to find this missing link of collaboration with which we can do a lot, he remarked. Pakistan, he further stated, has given us everything and now the time has come that we must pay back. This country has a great potential and we must do something for this country individually and collectively. Respect this country Pakistan and do not hear anything bad about it. The total scenario in Pakistan is going to change as the younger generation was much more talented and competent and we should not under estimate their capabilities, he added.
Speaking about the cardiovascular diseases Prof. Masood Hameed Khan said that there is no collaborative effort in primary prevention of Coronary Artery Disease. We must form groups which should design primary prevention strategies and they must include epidemiologists. DUHS has established an Institute of Public Health and hopefully we will come out with some strategies because no country can afford so many interventional cardiology procedures. When I became the VC of DUHS, Mr.Shams Kassim Lakha asked me what were our plans and when I stated, he said it was very ambitious. At this I had stated that let me dream as it was free. On my request he provided us the nursing curriculum which we adopted at our Nursing School. We have started BS and Masters programme and have plans for PhD programme as well. We have introduced Dental Hygienist programme. Let us not compete but complement each other. DUHS is open to collaboration with other institutions. We are aware of our strength as well as weaknesses. We will try to take benefit of strength of other institutions. We have large pathology but we lack in systems to ensure quality. We have started cardiac perfusionists programme as there is a great potential. With collaboration, we can solve the health issues of Pakistan, he remarked.
Dr. El-Nasir Lallani Dean of Research at AKU spoke on databases and registries. He suggested different steps like what did we learn and what we could have done better etc. The canvas, he said, is yours and it can be painted as you wish. We have a unique patient population, unique patient tracking capability. Registries can collaborate to come up with guidelines, preference indicators. This is being extensively used by the management of food companies. We talk too much but we do not publish. Since we have no time to publish, hence we lack behind. He discussed at length the patient care and trends in practice, clinical documentation, Evidence Based Performance and monitoring improvement, resident education and bench marking maintenance, admission reports and billing all of which can be generated through data. We need to produce a new generation of clinicians and do not forget the community. Universities by producing new knowledge can keep the patients away from hospitals.
Continuing Dr. Lallani said that we must define an outcome. Potential clinical outcome should be simple to measure, should be easily acquired, easily validated and easily understood besides being clinically relevant. All those who submit data should have access to the data in some way. He suggested that one should keep the data basic, simple, anticipate future changes, define clear definitions and there should be shared ownership of the data. It is advisable to have early collaboration with hospital administration, health authorities and regulators. It is important that we must have strong clinical leadership, must integrate with clinical work fellows, must provide net benefit to clinicians, must stay within the scope, must have capable stable clinical team, stable capable data team, must audit for completeness, must pre stage submissions and above all must have finances and sustainability plan.
Prof. Rukhsana Zuberi talked about Cardiothoracic Residency Education and its challenges. She highlighted the importance of various competencies like patient care, medical knowledge, professionalism, inter personal and communication skills, practice based learning, and improve problem based learning, system based practice. The residents must have a habit of life long learning and judicious use of resources. The residents, she said, learn at different places and mentioned distant learning, Operation Rooms can be linked, Hospital ORs should be equipped and linked with Audio Video connections. They can be taught basic competency skills at Dry Labs. We can also have mobile skills labs and mobile Mock OR. We must kindle interest in this specialty among the medical students, enhance teaching and learning by using skills labs, guard against training surgical techniques, shorten the overall thoracic surgery education process and evaluate the outcome of resident education rather than graduation.
Prof. Riaz Anwar Khan President of PSCTS in his speech said that cardiovascular diseases were spreading as an epidemic. We have high risk of CAD and Rheumatic Heart Disease is still high in Pakistan. According to a study by Prof.Masood Sadiq 22/1000 children suffer from congenital heart disease. Whenever a new born baby is noted having cyanotic spells, the cardiologist is immediately called in but we have very few surgeons who can operate on these patients.
Pakistan Society of Cardiothoracic Surgeons was formed in 1991 in which Prof.M. Rehman and Prof.Col.Cheema played a vital role. Now we have standard cardiac surgery facilities at many big cities in Pakistan. We are less than hundred cardiac surgeons for a population of over 190 million. Younger generation of doctors thinks that cardiac surgery is going to finish as interventional cardiologists has taken lot of their work. However, he assured the young doctors that they had a bright future in cardiac surgery. CABG is associated with much less cardiac events and it is much superior to PCI. He then referred to various trials and mentioned ASCERT trial which clearly showed that there is great scope for cardiac surgery; hence young doctors should not get disillusioned. We should look for the future. We must look forward including training in robotic surgery. For seniors it may be too late but let them send the juniors to learn robotic surgery. He also talked about Hybrid operating rooms and further stated that AFIC was now ready to start cardiac transplant. We must have Hybrid Ors in all the centers. He laid emphasis on forming Heart Teams for balanced and complementary approach to patient care based on joint shared decisions. These heart teams should consist of imaging specialists, cardiac surgeons, interventional cardiologists, cardiac anesthetists and perfusionists.
Prof.Riaz Anwar Khan also highlighted the importance of intensive care training of nurses, special training for perfusionists, their education and accreditation in ICU. He was happy to note that Pakistan Society of Cardiac Perfusionists has started training programme. We should have Evidence Based Guidelines which could be developed by Evidence Based Groups. We also need to develop our database. PSCTS should have this database but unfortunately people are afraid of putting their results on the database. We should have link between various institutions and juniors, residents should be rotated and also educate the government. Cardiac surgery, he concluded is a specialty which is rewarding but challenging. There is a short fall of residents in cardiac surgery which needs to be looked into. He commented that it is not possible to train sparrows as eagles for that we have to find out and induct Eagles in cardiac surgery training programmes. It is important that we take decisions based on training and educational issues, work with passion and honesty, he concluded.
Prof. Shahid Sami Khan former Head of Cardiac Surgery at AKU offered vote of thanks and stated that while knowledge gives you fruits, research gives wisdom.