The Operating Theatre Journal

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October 2011 Issue No. 253 ISSN 1747-728XThe Leading Independent Journal For ALL Operating Theatre Staff

fi nd out more 02921 680068 • e-mail [email protected] Issue 253 OCTOBER 2011 3

The Next issue copy deadline, Friday 21st October 2011All enquiries: Mr. L.A.Evans Editor/Advertising Manager, Mr. A. Fletcher Graphics Editor. The OTJ Lawrand Ltd,PO Box 51, Pontyclun, CF72 9YY Tel: 02921 680068* Email: [email protected] Website: www.lawrand.comThe Operating Theatre Journal is published twelve times per year. Available in electronic format from the pages of www.otjonline.comand in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription.Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors. All communications in respect of advertising quotations, obtaining a rate card and supplying all editorial communications and pictures to the Editor at the PO Box address. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2011Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD

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£1 million project to improve hip & knee implants

BERTI, a new collaborative research project, is developing new methods of extending the life of knee and hip implants by using advanced innovative coatings which reduce implant wear and combat infection by releasing anti-microbial agents.

Project BERTI; (Biomedical implant with Exceptional Resistance to Tribo-bio-corrosion and with Inherent antimicrobial properties) is expected to lead to new designs of knee and hip implants and substantially reduce the number of costly revision surgeries faced by patients undergoing hip and knee replacements; 163,940 primary hip and knee replacement procedures were carried out in England and Wales alone in 2010. Partners in the project include Corin Plc, [hip implants] http:// www.coringroup.com/medical_professionals/overview/], Tecvac Ltd [knee implants] http:www.tecvac.com], Imperial College London, Charing Cross Hospitals, Queen Mary, University of London and the University of Sheffi eld. The project, valued at £1.1 million over 3 years is co-funded with £577,000 by the government-backed Technology Strategy Board.

“This project has the potential to make a major contribution to improving patient outcomes and reducing cost” commented Dr David Simpson, BERTI project leader & research manager at Corin, and Jonathan Housden, research manager at Tecvac [coat implants ][ www.biomedicalsurfaces.com], “Obviously both patients and medical teams want to experience a hip or knee implant operation once only. But despite the best surgeons and procedures these are still complex operations with attendant risks of infection and adverse patient reactions, Of course any implant must wear eventually so this work to extend implant lifetimes and reduce infections will produce a major resource and cost benefi t by reducing the number of revision surgeries.”

Revision surgery* is especially costly, reaching maybe £25,000 or more for each patient. It often requires a lengthy stay in hospital and may affect one in 75 or more of primary procedures in the following three years.

The number of primary hip & knee procedures ++ is predicted to increase by 673% and 173% for knee and hip replacements respectively by 2030, due to the increasing population and life expectancy. The growth in these procedures is placing a huge burden on the NHS and health services worldwide, as are the relatively small proportion of revision surgeries which are more complex and frequently involve longer stays in hospital.

Around 50% of all revision surgeries result from direct wear of the implant components, and sometimes immune reactions, to wear particles or infections. One of the key BERTI objectives is to develop an innovative joint replacement with a coating that minimises polyethylene and metal wear debris, prevents metal ion release (and related patient reactions) and releases antimicrobial agents to prevent infection.

The BERTI project will also determine a method that establishes drivers for the detrimental responses to wear debris observed in patients. This information will be used to optimise a recently developed PVD coating that minimises wear and tribo-bio-corrosion while delivering an antimicrobial agent. In addition, the project will establish a test for patient susceptibility to metal ions released from implants. The project will utilise translational research methods to identify the best method of improving patient outcomes. This will improve patient selection and help identify patient cohorts who would benefi t most from the novel coated implants, and will deliver to them, and the wider population, a world-leading joint replacement with exceptional biocompatibility, longevity and antimicrobial properties. Project BERTI will ultimately increase the longevity of orthopaedic implants, and reduce the number of revision surgeries, benefi ting the patients, the UK and wider economy, and implant teams worldwide.

*Revision rates after primary hip and knee replacement in England between 2003 and 2006; Sibanda et al.

++ Sibanda, N. et al. (2008) Revision rates after primary hip and knee replacement in England between 2003 and 2006. PLoS Medicine, 5 (9). e179. ISSN 1549-1277

Call for more training to improve blood tests in A&E

Scientists say doctors need better training to avoid mistakes in blood samples taken in hospital A&E departments.The warning from the Association for Clinical Biochemistry follows an audit at Birmingham City Hospital.The trust has put in place extra training, but the ACB says this is a problem across the UK.The College of Emergency Medicine says it is essential that staff use the right technique to collect blood.Blood test results are often key to assessing patients when they arrive in A&E. But staff are frequently working under extreme pressure.The ACB is worried that this contributes to errors when they take blood samples.The concerns are highlighted by the Birmingham audit of samples collected by a range of junior doctors and nurses.Urgent casesIn the study, published in the Annals of Clinical Biochemistry, the researchers followed the collection of 50 samples from some of the most urgent cases, over a two week period.More than half were taken using the wrong equipment. They should normally by collected into vacuum tubes with special needles rather than using syringes which can damage fragile blood cells.The researchers also found that about half the samples were mishandled for testing, raising the risk of contamination.

The trust has arranged extra training and guidance for its A&E staff. The director of pathology at the hospital, Dr Jonathan Berg, who helped to carry out the study, says good technique is vital to ensure the tests refl ect the true status of the patient.“Junior doctors have surprisingly little training in taking blood and have a love of still using syringes which cause major problems and this is very easy to correct with a simple training programme. This is an issue right across the country”.The director of scientifi c affairs at the ACB, Dr Robert Hill, says there is a need for better training.“The compromises to specimen quality made in A&E when attempting to rush through investigations clearly put some patients at risk, so fi xing the problem requires more than just identifying a culprit.“Solutions must include monitoring the competence of those taking blood during their training period and discouraging those whose lack of practice prevents them from doing it properly.”

‘Bread-and-butter’ procedureThe study is being presented at the annual conference of the College of Emergency Medicine, which represents A&E doctors in the UK and the Republic of Ireland.The college’s president, Dr John Heyworth, says the paper is “universally relevant” to all A&E departments.“It sounds a bread-and-butter procedure but it is very important that it is done correctly, safely and consistently. We need to ensure there is the right level of expertise.“I think it is always seen as so routine, there is not enough focus on it as a technique for formal review and training.”The chairman of the BMA’s Junior Doctor Committee, Dr Tom Dolphin, also welcomed the study.“Emergency Departments are high pressure environments where junior doctors have to take blood in an effi cient, timely manner.“Bloods can be taken in a variety of ways and this study highlights some consequences of the choices faced by junior doctors when taking blood.“Incorporating the fi ndings of this research into training for junior doctors and medical students would be helpful if we are to reduce some of the issues that can arise from blood sampling.” Source: BBC Adam Brimelow

4 THE OPERATING THEATRE JOURNAL www.otjonline.com

Stanford team invents stitch-free method to join blood vesselsFor the past century, there’s been little improvement to the tools used to re-connect severed blood vessels: a needle and thread.

Now a team of Stanford researchers has developed an alternative technique that is potentially safer, faster and easier -- using a glue to fuse vessels together.“It’s a very slick way of putting together hollow blood vessels that doesn’t involve sutures,” said team leader Dr. Geoffrey Gurtner, a Stanford University School of Medicine microsurgeon, who has successfully proven the technique in animals and is now seeking support for human testing.

If successful, the new method could help where other once-promising alternatives -- such as staples, magnets and clips -- have disappointed. These tools can be traumatic to blood vessels, leading to failure rates comparable to sutures, according to the team.While surgical techniques have become ever-smaller and more sophisticated, vessel closure remains a stubborn problem.

In 1912, French surgeon Alexis Carrel was awarded the Nobel Prize for developing a way to connect vessels. But there have been few notable advances since then.“This is a novel approach ... that could play a valuable role in microvascular surgery,” said Dr. Frank Sellke, chief of cardiothoracic surgery at Brown University Medical Center, who was not involved in the research. “But it really needs to show that it holds up in clinical trials.”

Problems with suturesThe central challenge faced by anyone trying to join two blood vessels is that they collapse in on themselves, Gurtner said. It’s like trying to join two tubes of soft, limp and overcooked penne pasta; it’s easy to accidentally sew them shut or create a leak.Sometimes vascular cells respond to the trauma of sutures by proliferating or becoming infl amed, leading to vessel narrowing. That may cause blood to clot and block vessels, leading to stroke, heart attack or loss of a limb.

The other big problem with sutures is that they’re diffi cult to use on blood vessels less than one millimeter wide. Some sutures are as thin as a strand of human hair.Since Carrel’s discovery, “we’ve been trying to fi gure out how to better close a blood vessel,” Gurtner said.

The Stanford team solved this problem by exploiting the unusual “thermoreversible” characteristics of a gel called Poloxamer 407, recommended by Stanford chemical engineer Gerald Fuller. The gel was modifi ed for the experiment by Jayakumar Rajadas of Stanford’s Biomaterials and Advanced Drug Delivery Laboratory. In the experiment, the poloxamer started as a liquid that was injected inside the severed blood vessels. Then, under a warm halogen light, it solidifi ed, holding the vessel open. (It acts the opposite of water, which turns liquid when warm but solid when cooled.)

The exterior of the vessels were glued together using Dermabond, a well-known surgical Super Glue-like substance dubbed the “offi cial wound closure product” of the 2008 U.S. Olympic team.

When the gluing was fi nished, the light was turned off, and temperatures cooled slightly. The glue set. The poloxamer dissolved and was merely fl ushed out into the bloodstream.

Five times fasterIn tests on animals, the technique was found to be fi ve times faster than the traditional hand-sewn method, according to the study, published online Sunday in the journal Nature Medicine. It also resulted in less infl ammation and scarring after two years.

The method even worked on extremely slim blood vessels -- those only 0.2 millimeters wide -- which would have been too tiny and delicate for sutures. “That’s where it really shines,” Gurtner said.

The team is now seeking a better glue. Dermabond takes several minutes to set, which is too long for surgery, he said.

But the team is optimistic that a resourceful startup company could create the perfect glue. Polymer chemistry has advanced to the point that glues aren’t only used to close cuts and incisions, but also are being studied for use in healing broken bones, hernias and even brain aneurysms -- a “wound closure” market experts say will be worth $1 billion by 2015.

Gurtner began thinking about alternatives to sutures about a decade ago while practicing at New York City’s Bellevue Hospital, where he had to reattach an infant’s amputated fi nger.

“What struck me was how the whole paradigm of sewing with a needle and thread kind of falls apart at that level of smallness,” he said.

Gurtner believes the new technique could also prove useful in minimally invasive surgeries, where suturing is particularly diffi cult.

“One of the biggest concerns in surgery, when stitching two pieces of blood vessels or intestines together, is that they might leak,” said Stanford surgeon Dr. John Morton, Director of Quality, Surgery and Surgical Sub-Specialties, who was not involved in the study. Particularly for colorectal surgery, “there is a pretty high wound infection rate. If we are able to make the connection without leaks, it would decrease complications.”

“It’s like plumbing,’’ Morton said. “When you put two pieces of pipe together, you want a really good gasket.”

Source: Health & Fitness

Plastic surgeon opens ‘bank’ to save fat removed in liposuction for future cosmetic procedures

A plastic surgeon is opening a ‘fat bank’ that will allow patients to store their own body fat for future use.Dr Jeffrey Hartog, from Seminole County, FL, has developed a process that removes fat from patients by liposuction and then stores it in a super deep freeze.Such is the lucrative potential of the idea, he believes, that he has dubbed the facility the Liquid Gold lipid bank.The frozen fat is held for the patients’ lifetime for use in potential future plastic surgical treatments, where fat is needed as a fi ller, for example.Dr Hartog claims the process sidesteps the need for multiple general anaesthetics to remove fat, or to rely on synthetic fi llers.Body sculpting and wrinkle removal procedures see patients commonly having fat added to the face and breasts straight after it is removed from another part of a patients’ body.The surgeon told the Orlando Sentinel: ‘Fat banking takes this [procedure] to a whole new level.‘We put the patient to sleep once. Do the lipo. Get the fat out once and have as much as we need for later injections.’

He is confi dent that many of his patients will be interested in the new service.

‘I will present it as an option to any patient having liposuction,’ he said of the Liquid Gold bank that is located next to his surgery.

Fat is harvested from patients by liposuction before being drained and cleaned. Protectants are then added to the lipids before being put into a slow freeze that sees the fat’s temperature gradually taken to minus 192C, according to the newspaper.

While fat transfer is not a new concept, freezing and storing human lipids is breaking new ground.

Critics are dubious as to the science behind the patented idea.

Dr Stephen Baker, associate professor of plastic surgery at Georgetown University, told the Florida newspaper that the viability of freezing human fat is not supported by current research. ‘No good data exists to substantiate the fact that frozen fat does well or is metabolically viable,’ said Dr Baker.

‘No good data exists to substantiate the fact that frozen fat does well or is metabolically viable’

Dr Daniel Del Vecchio, of Massachusetts General Hospital, is an expert in fat transfer. He told the Sentinel: ‘Animal data shows that frozen fat doesn’t hold up as well as fresh fat.’

He raises questions over its storage, which he says is ‘a logistical nightmare. There are better solutions.’

The best, he says, is the body itself: ‘You only need 30 to 50 cc’s for a facial procedure. You can always fi nd that somewhere on a woman’s body. And that’s the best bank of all.’

Their concerns may partly explain the current lack of human fat storage facilities - and why Dr Hertog says his lipid bank, which is operated under Food and Drug Administration guidelines, is a unique centre.

‘Even in the best-run tissue banks, which require multiple layers of tissue identifi cation, humans make mistakes. If a patient gets the wrong fat injected, the results could be serious,’ points out Dr Baker.

‘To do this for an elective procedure is really putting yourself at risk. Even if a procedure doesn’t work, it above all has to be safe.’


GIVING CLIENTS THE BIG PICTURE – STARKSTROM LAUNCHES ITS LARGEST EVER TOUCH SCREEN THEATRE CONTROL PANEL

Medical engineering specialist Starkstrom has recently launched its newest generation eTCP (Electronic Touch Screen Membrane Theatre Control Panel), which offers users an impressive 17” touch screen, the only eTCP currently on the market to do so. The larger screen, which has a resolution of 1280 x 1024, increases viewing size by over 260% compared to previous screens, and allows almost all controls to be permanently displayed and therefore intuitively accessed by clinical staff.

Theatre Control Panels are a vital element of any operating theatre, providing a central focus for infrastructure controls as well as alarms and information. Since its launch, the Starkstrom range of TCPs has led the fi eld, offering several options to suits clients’ specifi c needs. Starkstrom’s new eTCP builds on the established benefi ts of its predecessors, whose design offered increased fl exibility, enhanced user interface and a reduction in the risk of hospital acquired infections, and whose cutting edge style and design is much more in keeping with the sleeker, more technology-rich modern operating theatres hospitals now insist upon.

Products from Starkstrom’s Integrated Solutions range, such as the eTCP, can be purchased and installed separately, but it is the company’s ability to provide and install a complete package of integrated operating theatre and critical care equipment, as well as offering the most comprehensive post-installation service provision and warranty, which makes it stand out from the competition. Clients only need to deal with one specialist, experienced supplier, saving time and money and ensuring projects run smoothly and effi ciently. The company also has strategic relationships with other key market leaders in the fi eld, so when it is necessary to out-source elements of a project, it is always able to use established partners. Starkstrom prides itself on providing only the most advanced medical equipment and technology, and is proud of its position at the forefront of operating theatre and critical care area design.

Further information: Starkstrom Tel: 0208 868 3732 Website: www.starkstrom.com Email: [email protected] When responding please quote ‘OTJ’

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Ansell Launches New White Micro-Touch® Nitrile Glove: Optimised Allergy Prevention and Comfort, with Economical Packaging

Powder-free nitrile glove prevents allergies and offers latex-like comfortAnsell Healthcare, a global leader in healthcare barrier protection, recently introduced the Micro-Touch® Nitrile, a new 100% latex-free and powder-free, nitrile examination glove specially targeted at the dental and medical professionals. The Micro-Touch® Nitrile provides effective barrier protection, easy donning and more comfort. Moreover the new exam glove represents an economical alternative to NRL gloves and comes in a cost-effective 150-count packaging with 50% more gloves per dispenser box. Its white colour provides a high-contrast background that reveals soiling and contamination.

Economical and qualitative alternative to latex glovesDue to the continued increases in rubber and latex glove prices (60% over the past 12 months) an important change is taking place in the disposable glove world. Nitrile has become a more economical material and nitrile gloves are now progressively replacing latex gloves. The economic advantage is even greater thanks to the fact that Ansells new Micro-Touch® Nitrile is coming in new dispenser boxes of 150 gloves compared to the usual 100 gloves boxes. This new packaging reduces waste and saves on costs (less time spent replacing dispenser and handling boxes, effi cient stock management, packaging waste reduced) without compromising protection and comfort.

The many benefi ts of using nitrile exam glovesA major advantage of nitrile exam gloves is the prevention of allergic reactions associated with latex gloves. Made of 100% nitrile, Ansells Micro-Touch® Nitrile glove contains no natural rubber latex and is powder-free. The non-sterile glove is suited for all applications requiring latex allergy prevention for healthcare workers and for contact with higher-risk patients such as in oncology and paediatrics. Furthermore, nitrile exam gloves provide both hospital staff and patients an effective barrier protection against a wide range of chemicals. Being a much better barrier to harsh chemicals than NRL, nitriles puncture and tears resistance is far superior to that of latex and all other glove fi lms (for the same thickness).

Another added benefi t that very few other types of exam gloves can compete with is the superior comfort. Manufactured from premium quality nitrile and thermo elastic material that adapts to the hands shape, the Micro-Touch® Nitrile glove assures more dexterity and comfort than a latex glove. The glove itself is soft and supple almost as if the user is wearing a second skin. Designed with special focus on providing a comfortable fi t for the user, the gloves inner polymer coating facilitates donning, while the lack of powder considerably reduces the risk of skin abrasion. Micro-textured fi nger surfaces ensure a good grip on instruments making Micro-Touch® Nitrile the optimal choice for many dental and medical professionals.

Micro-Touch® Nitrile is a registered trademark of Ansell Ltd. http://www.ansell.eu When responding to articles please quote ‘OTJ’

Nation split on how to tackle obesity problemSurvey reveals nearly a third of GB population objects to weight loss surgery on the NHS

The results of a survey out today (28/9/11) have raised interesting questions on how weight loss surgery should be funded. Of those polled, 83% believe that obesity is a burden on the NHS, and 30% object to the NHS funding any weight loss surgery. However, nearly half the population (49%) agree with the idea of the individual and the NHS co-funding surgery, a proposal that is not currently an option for patients undergoing weight loss treatment.

The survey, carried out by YouGov on behalf of Spire Healthcare, looked at public awareness of weight loss surgery, health issues surrounding obesity, and attitudes towards the NHS funding of weight loss treatment. The fi gures show that the nation is in two minds over the role of weight loss surgery in helping those with obesity to lose weight – 44% think it is a good option to help people, but 39% disagree.

One in fi ve regard it as a “lazy way out” for people who do not want to diet or exercise.

As well as mixed views on the importance of surgery in treating obesity, it is clear that there is still a high level of ignorance as to the impact surgery has on a patient’s life. Before weight loss surgery, patients are required to prepare for and plan their nutrition and recovery from surgery, with regular follow-ups for at least a year afterwards to help maintain their new and dramatically reduced eating regime. However, only half of those polled knew that patients can no longer eat large portions after their operation, and only 11% are aware that a person can only drink a very small amount of fi zzy drinks, due to the reduced size of their stomach.

With fi gures from the Foresight report1 estimating that by 2025, 47% of men and 36% of women will be obese, the UK is facing a burgeoning obesity problem.

However, the survey revealed that there is still a lack of understanding of what this might mean for the nation’s health, and the resulting impact on the NHS. While 81% of people polled recognise that obesity increases the risk of heart disease, only 50-60% of people polled know that obesity can increase the risk of sleep problems, fertility problems and some forms of cancer.

However, attitudes to weight loss surgery, for almost half (45%), the last resort in tackling obesity, remain sceptical and knowledge of the procedures involved is limited.

NICE guidelines recommend weight loss surgery for those with a BMI of 40 or more (in some cases 35).

However access to weight loss treatments (including surgery) in the public sector is restricted by NHS requirements to make savings. Only 8% of those questioned said outright that weight loss surgery should be funded in full by the NHS. And yet a report released by the OHE2 in September 2010 found that if just 25% of NICE-eligible patients were to receive weight loss surgery, the total net gain to the economy would be £1.3bn.

“It is very interesting that despite a growing need for it, attitudes towards weight loss surgery, and its place in tackling a health burden in the UK, are still very mixed, and this leads to very varied views on who exactly should be paying for it,” said Dr Jean-Jacques de Gorter, clinical director at Spire Healthcare.

“At Spire, we offer a full range of bariatric procedures for patients, and make it clear to patients that surgery is by no means the easiest or only option available to them. We believe that patients with obesity should have the right to exercise choice in their provider of care and follow-up, and have access to the latest treatments.

It is clear from this survey that there is still a strong requirement for better and greater education about what these treatments involve and entail, and the benefi ts they might bring for not only the individual but in tackling a wider growing health issue.

Perhaps the NHS should look at the different ways that it could fund surgery as it is clear this is not an issue that is going to go away for some time.”

References

1) Tackling Obesities: Future Choices 2nd Edition – Modelling Future Trends in Obesity and Their Impact on Health. Foresight, Government Offi ce for Science, 2007. Available at: www.foresight.gov.uk/Obesity/14.pdf

2) Shedding the Pounds: Obesity Management, NICE Guidance and Bariatric Surgery in England. Available at : http://www.ohe.org/publications/recent-publications/l i s t - by - date -20/deta i l /date////shedding - the - pounds - obes i t y -management-nice-guidance-and-bariatric-surgery-in-england.html

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New datasheet now available on Fukuda Denshi’s LX-7120 transmitterFukuda Denshi is a leading supplier of advanced patient monitoring and user-confi gurable clinical information management systems, as well as cardiac monitoring and imaging technology, and now have available a new technical datasheet on their LX-7120 transmitter.

The technical datasheet details how the small and robust LX-7120 is totally waterproof and is now 25g lighter than its predecessor, weighing only 85g including battery, with a height of 60mm and width of 60.6mm.

The datasheet also explains how the LX-7120 provides up to 7 days continuous operating time using only one battery, making it ideal for monitoring of the electrocardiography and respiratory waveforms.

In addition measurement values and waveforms can be displayed on the LCD, making it easy to check prior to the start of the examination, and the LX-7120 conforms to the waterproof standard IPX8.

Full technical specifi cations are included in the datasheet, along with a list of optional accessories available.

For more information on the Fukuda Denshi LX-7120 or for a copy of the datasheet contact Fukuda Denshi on 01483 728065.

Fukuda Denshi: Healthcare bound by technology.

When responding to articles please quote ‘OTJ’

SAGE PARTNERS WITH WHICH MEDICAL DEVICE

SAGE, the worlds leading independent academic and professional publisher today announced a partnership with Which Medical Device, the only online review site to provide independent, expert opinion and reviews of medical devices.

Launched in 2010, Which Medical Device (www.whichmedicaldevice.com) was created by clinicians for clinicians: it enables medical professionals to search, locate, review and compare medical devices specifi c to their specialities. The site also provides extensive video footage of devices in use. This dynamic site enables members to exchange opinions and insights that will help them to select devices to optimize patient outcomes.

SAGE has partnered to make Which Medical Device the most respected thought-leader in the medical device arena, and to develop and expand its coverage for a broad range of professionals. SAGE publishes more than 675 journals worldwide, including a complementary programme of 150 titles across Health, Medicine and Life Sciences. This collaboration offers a unique opportunity to engage further with clinicians to provide an independent, dynamic and high quality resource for the medical community.

We are thrilled to be able to partner with Which Medical Device to develop this unique site, said Tessa Picknett, Associate Director, SAGE. SAGE continues to actively seek opportunities to creatively engage with the communities for whom we publish, and to develop innovative solutions that support the global medical community. Which Medical Device is the only site where clinicians can read genuinely independent reviews, which are created by highly respected practising clinicians; we are committed to bringing this important endeavour to a global audience.

Steve Walmsley, Business Development Director, Which Medical Device, added SAGE were a natural partner for us, sharing as they do the principles and values we hold important and which have established Which Medical Device as an authoritative voice in the medical device sector. Were very much looking forward to working with the SAGE teams across the globe to establish Which Medical Device as the place to go for device information, review and opinion.

For more information please visit: www.whichmedicaldevice.com


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Unparalleled speed from Fujifi lm’s wireless FPD system – the FDR

D-EVO G35i

Fujifi lm is a pioneer in diagnostic imaging and information systems for healthcare, with a range of constantly evolving, clinically proven, products and technologies designed to assist medical professionals perform effi ciently and effectively.

To improve workfl ow and effi ciency Fujifi lm’s new FDR D-EVO G35i has been launched into the UK. This new DR detector can be used in both wireless and wired modes to provide the user with increased fl exibility.

The lightweight D-EVO G35i weighs just 3.3kg, including battery, and can deliver up to 750 exposures, or 3½ hours of use, on a full battery charge. In wired mode the D-EVO G35i simultaneously charges the battery while in use, ensuring maximum available charge to enable the best use of the wireless mode when required. With only 1 second required to switch between wired and wireless mode, the D-EVO G35i offers a fast and effective general X-ray solution.

The D-EVO G35i has an inbuilt, high speed, wireless LAN interface, and at 35x43cm it is the same size as a standard X-ray Cassette. This makes it suitable for upgrading existing analogue X-ray rooms to digital easily and cost effectively. When used out of the bucky the detector is capable of supporting up to 150kg across its surface.

In addition, the D-EVO G35i incorporates Fujifi lm’s proprietary “Incident Side Sampling (ISS) Technology”, which improves both MTF and DQE when compared to traditional Penetration Side Sampling methods.

Additional battery packs are also available, if required, to help ensure uninterrupted use.

For a copy of the brochure or more information on Fujifi lm’s D-EVO G35i, telephone Fujifi lm on 01234 326780 or visit www.fujimed.co.uk.

Fujifi lm – pioneers in diagnostic imaging and information systems. When responding please quote ‘OTJ’

Further steps along the road to a

clinically led NHS

Plans to hand more power to clinicians and modernise the NHS moved a step closer to reality today (30/9/11) with the latest draft guidance to support emerging clinical commissioning groups.

It is the latest stage in the Government’s ambition to make the NHS world-class by giving patients more power, focussing on quality, and giving frontline clinicians greater freedom and a strong leadership role.

There are now more than 253 groups of GP practices across the country which have come forward to directly commission services, focused on delivering the best results for their patients. Once authorised as Clinical Commissioning Groups they will take on responsibility for health care budgets from April 2013.

The guidance comes as the NHS moves towards a stronger and streamlined management system for the new commissioning arrangements which supports the reduction of administration costs by a third. From next month, the NHS will have moved from ten management teams at SHA level to just four SHA clusters.

This will allow the NHS to operate more effi ciently so that clinical commissioning groups can take on their new responsibilities faster when they are ready to do so and align themselves with the proposed NHS Commissioning Board.

Principally clinical commissioning groups will have a strong clinical focus which will bring together patients, carers and their communities. They will have robust governance requirements which are accountable to patients as well as arrangements for commissioning with other clinical commissioning groups, local authorities and the proposed NHS Commissioning Board.

Health Secretary Andrew Lansley said:

“Clinical commissioning groups are at the heart of our NHS modernisation plans. They will put healthcare professionals in the driving seat so that they have the freedom and responsibility to design services on behalf of their patients - delivering better quality and integrated care.

“We strengthened our plans following the listening exercise to ensure there will be wider clinical leadership within clinical commissioning groups which will lead to stronger collaboration at a local level.

“Above all, our plans will safeguard the future of our NHS so that it is able to meet the challenges of rising demand, an ageing population and the increasing costs of treatment.”

The development of the NHS Commissioning Board shows the end point for all of this - a single, national organisation to oversee the commissioning system and drive better results for patients.

Over the coming months, the shadow NHS Commissioning Board will refi ne the approach and continue to work with emerging clinical commissioning groups and key stakeholders on taking these proposals forward.

You can see a copy of the authorisation guidance at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance


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Brandon Medical light used in conjoined twin miracle

Twins who were born joined at the head have been given life saving surgery by a team of British doctors at Great Ormond Street hospital. It took the surgeons 4 procedures over 3 months to successfully separate the twins and Brandon Medical played a small, but crucial, part.

Brandon Medical’s GQLED operating theatre lights were used during the procedure. This is a special lighting confi guration made up of the Galaxy Ultra HD-LED and Quasar HD-LED surgical lights. Galaxy Ultra emits the perfect cold light which eradicates excess heat during surgical procedures and projects a high intensity illumination of up to 160,000 Lux. Quasar HD-LED produces the biggest, fattest, most powerful light beam of any surgical light. The light intensity is spread evenly across the illuminated fi eld to create a stunningly uniform working area with a high light intensity across the full diameter of the light fi eld, not just in the middle. The GQLED helped create the perfect working surgical environment for the neurosurgeons performing this intense procedure.

The twins operation was funded by the children’s charity Facing the World and they were fl own over to the UK in April. Scans of the twins showed that their brains were separate giving them a chance of survival. The blood fl ow, however, was shared meaning any interruption could cause irreversible brain damage. But thanks to the surgeons careful planning and commitment, the procedure was a great success resulting in two very healthy and happy little girls.

As soon as they are well enough, they will be fl ying back to Sudan to be with the rest of their family.

For more information on any of Brandon Medical products, please visit:www.brandon-medical.com or telephone 0113 277 7393.

Hospitals unique surgery transforms womens lives

A surgeon at Luton and Dunstable Hospital is transforming the lives of women with a unique type of operation which is available at very few hospitals in England. The procedure developed by consultant gynaecologist Mr Abdalla Fayyad has shown remarkable success for women who require reconstructive surgery for vaginal prolapse, which can develop after childbirth but without having to go through the trauma of a hysterectomy.

11% of all women across the UK experience the pain and embarrassment of a prolapsed womb after having children. The problem can be devastating to a womans life, and can affect women still in their 20s. If not successfully treated women suffer a lifetime of discomfort and often incontinence, and it can affect careers and ruin their sex life.

Mr Fayyads unique type of surgery has greater success than traditional treatments which may only partially repair a prolapsed womb or offer the invasive hysterectomy. His skills involve careful positioning of a soft nylon mesh support, done by keyhole surgery which should literally last a lifetime. Keyhole surgery is less invasive and patients have a much quicker recovery time.

Mrs Gail Steed, from Luton, who underwent surgery by Abdalla Fayyad at Luton and Dunstable Hospital early in 2011 is delighted with the results:

I would not have believed it possible to have made such a great recovery. I was devastated to fi nd that I had a prolapsed womb while still in my 20s:I thought that could only happen when you were much older and had completed your family. Mr Fayyad has completely transformed my life. I can do normal everyday activities, and I have been able to resume a normal physical relationship. No other surgeon or hospital was able to offer me such an outstanding result.

Every surgeon strives for success and I wanted to make sure that women dont have a recurrence of a prolapsed womb so that they can get back to a normal lifestyle. Some of my patients have had previous surgery which has failed, and a prolapsed womb can affect any woman following childbirth. explained Abdalla Fayyad.

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EIZO Presents a New Widescreen Monitor for the Operating Room

EIZO today introduces the new RadiForce LX600W, a large widescreen LCD colour monitor with an LED (light-emitting diode) backlight. This 8 megapixel monitor is designed for use in operating rooms (interventional radiology, cardiology, and surgery). The new product expands the EIZO portfolio of widescreen medical monitors with an additional unit that provides a larger image area and improved features.

The RadiForce LX600W widescreen monitor features a 3840 x 2160 pixel native resolution and 60-inch screen. It provides unlimited, fl exible image display and is the ideal solution for modern operating rooms. Increasingly, the integration of different imaging systems and multiple surgical disciplines in the same room (hybrid OR) requires variable solutions.

The new 8 megapixel monitor has an improved contrast ratio of 4000:1 and higher brightness values of 520 cd/m². It is also equipped with an LED backlight. This guarantees optimum working conditions and an extended monitor life.

The RadiForce LX600W utilises the proven safety concept found in the existing model such as redundant critical components. Real-time image display guarantees a safe and stable working environment for the surgeon. Additionally, homogeneous brightness uniformity across the entire screen and 5 integrated, calibrated look-up tables provide the highest display precision to meet the requirements of a broad array of applications.

In addition to the basic version of the monitor, there is also a model with protective glass. It protects the screen surface against damage, scratches and fl uids, and simplifi es cleaning and disinfection of the front of the monitor.

The RadiForce LX600W utilises an improved cooling concept, which means that fewer fans are needed in the unit. This is of particular importance in operating rooms, where air turbulence is to be avoided as much as possible.

AvailabilityProduction of the RadiForce LX600W is planned for the fi rst quarter 2012. Any visitors to Medica 2011 in Düsseldorf, Germany will be able to see the new product for the fi rst time in the EIZO stand, Hall 10, #G41. When responding please quote ‘OTJ’

First Implantable Continuous Glucose Sensor to Achieve High Accuracy

Performance in People With Diabetes

SMSI Study Results Show 96.8% Accuracy

Sensors for Medicine and Science, Inc. (SMSI) announced trecently that data from a human pilot study of its fully-implantable continuous glucose sensor demonstrated high accuracy performance for the fi rst time for an implanted biosensor. The data showed high level of glucose accuracy, with 77.6% and 19.2% of the data in the A and B zones of the Clark Error Grid, respectively. The mean absolute relative difference was 12.2%. The results also support the sensor goal of achieving implant time greater than six months.

“We are pleased to report these fi ndings as a fi rst step to realizing a viable long-life implanted sensor to help millions of people with diabetes manage their glucose better,” said Tim Goodnow, Ph.D., CEO and President. “While still early, the pilot study showed comparable performance as current continuous glucose devices.”

The SMSI system includes a miniaturized sensor and reader. The sensor is implanted into the subcutaneous space in the wrist and is inductively powered and remotely interrogated, requiring no battery and no wires connecting the sensor to an external wristwatch-based reader. After implantation, the sensor functions noninvasively, automatically, and continuously.

In the study, 9 subjects with Type 1 diabetes were implanted with a sensor in each wrist for approximately 29 days. Performance was evaluated by comparing 3,000 sensor values with paired YSI blood glucose values. In a Clarke Error Grid (CEG) analysis, 96.8% of the values fell in zones A or B. The CEG compares readings between a lab reference and a glucose monitoring device and assigned into one 5 clinical zones: A, B, C, D, or E. Zone A values are clinically accurate and most consistent with the lab reference value. B values are clinically acceptable. C, D, and E values are progressively less accurate.

“Based on the promising results obtained, we plan to initiate more clinical trials in the very near future, including pursuing collaboration on artifi cial pancreas research,” said Dr. Goodnow.

The result of the study was presented at the European Association for the Study of Diabetes meeting in Lisbon, Portugal on September 16, 2011.

www.s4ms.com

Women most at risk from poorly performing metal-on-metal hip replacement devices, National Joint Registry Annual Report fi ndsPerformance for the controversial metal-on-metal (MoM) hip replacement devices continues to create cause for concern, particularly in women, according to this years National Joint Registry (NJR) Annual Report.

Revision rates (how likely it is that a patient will need an operation to remove and usually replace a prosthesis) for the devices are by far the highest for the two main categories of MoM hip devices. These two are divided into Resurfacing devices and those known simply as Metal-on-Metal.

For Resurfacing, the report reveals latest revision rates of 11.81% and for Metal-on-Metal as high as 13.61%. Against these, rates for the non-MoM hip prosthesis types ranged from 3.31% to 4.94%. Devices have been monitored on the NJR since 2003. The latest fi gures refl ect the performance on the registry data at one, three and fi ve year intervals (to December 2010).

Further, the year-on-year increase in revision rates for the MoM categories was dramatic. While all of the non-MoM prostheses types reported a less than 1% increase in revision rates, Resurfacing devices increased by 1.93% and the Metal-on-Metal group climbed 4.11%.

For women, the picture is even starker. Gender-based statistics are analysed at one, three and fi ve years after devices are fi rst implanted. At fi ve years, revision rates for a 60-69-year old female with a resurfacing device are 12.01% and it is 7.34% for the general MoM devices. Meanwhile, the same statistics for men came in at 7.06% and 5.48%. Non-metal-on-metal fi ve-year revision rates for females aged 60-69 range from 2.02% to 3.19%. (Note: The overall average age for hip replacement patients is now 67).

In 2010, fi gures from the NJR led to the worldwide recall of the DePuy ASR metal-on-metal device, which had proved particularly poorly performing.

Key Facts From The 8th Annual Report From The National Joint Registry:

• 2010/11 saw the National Joint Registry of England and Wales the largest resource of its kind in the world pass the one million-record mark. The NJR now contains data from more than 1.1m hip, knee and ankle replacement procedures

• 2010/11 saw the largest single-year submissions ever 179,450 records added to the NJR

• Highest-ever rates of patient consent (patients agreeing to have details of their surgery recorded on the registry) 88.6%

• Ankle data included in the report for the fi rst time

Extended information : http://www.hqip.org.uk /women-most-at-r isk-from-metal-on-metal-hip-devices-national-joint-registry-annual-report-fi nds/


Radiometers 1st Automatic ensures positive patient identifi cation and

keeps focus at the bedsideRadiometers 1st Automatic blood gas analysis system is crucial to patient care in the Adult Intensive Care Unit (AICU) at Oxfords John Radcliffe Hospital. Barcoded syringes, plus patient and operator identifi cation, are scanned at the bedside and the data transferred to the analyser by FLEXLINK software. FLEXLINK also sends correctly identifi ed results to, for example, caregivers PDAs and bedside monitors. Clare Williams, CIS Manager/Sister, AICU, explained: The unit handles just over 1000 admissions a year, performing between 125 and 150 tests per day depending on the number of patients and their dependency. Intensive care is all about time saving, and 1st Automatics walk-away capability allows us to obtain results quickly while increasing the amount of time we can spend with our patients.

We have used Radiometer solutions since 2008, when we upgraded to 1st Automatic to gain more fl exibility. The system has really helped streamline our workfl ow by allowing nurses to scan patient wristbands and enter the data directly into the system, keeping the focus at the bedside. We have been able to standardise our sampling technique and, as we have two machines, we now have the potential to analyse six samples simultaneously. For infection control purposes, an aseptic non-touch technique (ANTT) is required when taking blood gases, and 1st Automatic helps this process. The equipment is excellent, particularly the syringes, because there is no contact with blood at all, which improves staff safety.

To fi nd out more, please contact [email protected] or visit http://www.radiometer.co.uk/1stautomatic When responding to articles please quote ‘OTJ’

Online tools aid patient health decisions

Health Secretary Andrew Lansley on 30th September offi cially launched a set of innovative online tools that can help patients make informed decisions about their healthcare.

Eight online Patient Decision Aids (PDAs), commissioned by NHS East of England, give patients information on the pros and cons of different treatment options available to them. As a key product of the Right Care programme, part of the NHS’s work to improve quality, innovation, productivity and prevention, these aids personalise services for patients to make sure they get the right treatment the fi rst time.

Developed by NHS Direct and available on their website for patients to use anywhere across England, the online tools help patients learn more about their condition and the options for tests and treatments on conditions such as cataracts and breast cancer.

Patients are able to see what choices are available to them, input their personal preferences and have an informed discussion with their clinician about their options. These tools do not replace a doctor’s clinical advice but are in addition to help patients prepare for a consultation and any decisions they make afterwards.

Speaking at the launch event in Cambridgeshire, Health Secretary Andrew Lansley said:

“I want the NHS to become a collaborative service, one where the patient is an active participant in their own care, with a clear voice saying ‘no decision about me, without me’.“A modern NHS is one which is focused on the patient and empowers them with a genuine choice about their future. Patients are the greatest untapped resource in healthcare and I want the conversation between doctor and patient to become a meeting between two experts – the clinical expert and the expert on themselves. “These online Patient Decision Aids are an important step towards helping patients make real, informed decision about their care. They are part of the culture change within a personalised NHS that puts patients in control of their health.”Improving the quality of personalised services that patients receive the fi rst time means that effi ciency savings can be reinvested back into frontline care.

Dr Steven Laitner, General Practitioner and National Clinical Lead for Shared Decision Making said:

“These tools have the potential to transform the lives of patients. Patients will of course still want and need to discuss treatment options with their clinicians but they will start from a more informed, more empowered position. We should allow patients to consider their own needs, personal values and priorities when making a decision about their treatment.

“This approach also benefi ts clinicians. Better informed patients can save time in the consultation and patients will be more likely to receive treatments which they highly value. It’s really about improving the experiences and outcomes for everyone involved.”

Jean Hardiman Smith, who suffers from arthritis of the knee used the PDA to fi nd out more about her condition:

“The Patient Decision Aid was like having a long, unhurried session with a top knowledgeable specialist, with the extra benefi t of additional advice from the videos. The Patient Decision Aid allowed me to learn more about my condition and the treatments on offer - to be able to review this in the context of my own life was hugely benefi cial.”

The eight online Patient Decision Aids can be found on the NHS Direct website http://www.nhsdirect.nhs.uk/en/DecisionAids and cover the following conditions:• osteoarthritis of the knee* • enlarged prostate* • localised prostate cancer*• Chorionic Villus Sampling (CVS) /Amniocentesis testing**• breast cancer surgery choices** • Prostate Cancer Screening** • Osteoarthritis of the hip*** • cataract surgery**** Adapted from existing DVD and booklet decision aids developed by the Foundation for Informed Medical Decision Making (FIMDM) and BUPA Health Dialog.** Based on online Decision Support Interventions developed by Cardiff University’s School of Medicine, in partnership with Oxford, Sheffi eld and Swansea Universities, with funding from Cancer Research UK, NHS Cancer Screening Programme.*** Clinical content developed in collaboration with the BMJ Publishing Group

Find out more about Fukuda Denshi’s Central Monitor DS-7700 System

Fukuda Denshi is a leading supplier of advanced patient monitoring and user-confi gurable clinical information management systems, and has recently published a full colour brochure on their Dynascope Central Monitor DS-7700 System.

With its unique dual display design, the DS-7700 System can utilise an optional LC-7019FT, either as a slave monitor, an extended display or as a patient data review screen, providing users with a choice of 11 display confi gurations:

• 1 Bed 8 Waveforms• 4 Beds 2 Waveforms• 6 Beds 3 Waveforms• 12 Beds 2 Waveforms• 2 Beds 4 Waveforms• 4 Beds 4 Waveforms• 8 Beds 1 Waveform• 6 Beds 1 Waveform• 2 Beds 8 Waveforms• 16 Beds 1 Waveform• 8 Beds 3 Waveforms

The brochure details how the patient data transfer or exchange between Central Monitors is quick and easy via the TCP/IP network, making the DS-7700 System an ideal choice for both ICU and general ward use. It also has new arrhythmia analysis software to provide decreased false detection of arrhythmia during noise, as well as improved accuracy of both QRS and VF detection.

Full technical specifi cations of the DS-7700 System are included in the brochure, as well as informative diagrams and images of the various functionalities that help to provide more fl exibility, more precision and more continuity. A helpful example of how users can access vital data from anywhere in the hospital via the web is also included.

For more information on the Fukuda Denshi DS-7700 System or a copy of the new brochure, contact Fukuda Denshi on 01483 728065.Fukuda Denshi: Healthcare bound by technology. When responding please quote ‘OTJ’


ML Electronics triumphs at South Wiltshire Business Awards 2011

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ML Electronics wins Moore Stephens Large Business of the Year Award

ML Electronics, innovators in medical electronics design, today announced that it has won the Moore Stephens Business of the Year 2011 at the South Wiltshire Business of the Year awards. The award recognises that MLE has demonstrated success in overcoming business development challenges and has a clear strategy for the future expansion of the business.

Launched in 2000, the awards recognise local companies for delivering business excellence across South Wiltshire. “MLE’s positive attitude in overcoming specifi c issues during the prevailing economic climate contributed to its continued growth,” commented Ceri Hurford-Jones, Chairman of Judges at the awards. “Harnessing and involving the whole team in all major aspects of its business in a systematic and organised manner was truly inspirational to see.”

Founded in 1995 by, owner-directors Mike and Sharon Lloyd, the company has gone from strength to strength and now has a strong team of 24, consisting of both electronics engineering and production professionals. All are highly experienced and dedicated to electronics and developing innovative products. Such is the quality of the team, that MLE frequently secures repeat business from very satisfi ed customers.

Mike Lloyd, MD of MLE said: “The team are the ones who deserve this. I create the environment but they are the guys that excel at what they do. We want to show people in the community that we are a good company and want to invite people to come and join us.”

Further information: Joycelyn Hampton, ML ElectronicsTel +44 (0)1794 885790 Email: [email protected] www.ml-electronics.co.uk When responding to articles please quote ‘OTJ’

Living Donor Liver Transplantation Improves Survival Over Deceased

Donor Transplants Patients with Liver Cancer and Low MELD Scores May Not Find Similar Benefi t

New research shows liver transplantation candidates without hepatocellular carcinoma (HCC) derive a greater survival benefi t from a living donor liver transplant (LDLT) than waiting for a deceased donor liver transplant (DDLT). The study now available in the October issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases, reports that survival benefi t from LDLT remains signifi cant across the range of model for end-stage liver disease (MELD) scores, but this benefi t was not apparent for low MELD candidates with HCC.

Liver diseases such as hepatitis B and C, nonalcoholic fatty liver disease, and HCC can range in severity from mild to life-threatening liver failure. In end-stage liver disease, when patient life is at risk, transplantation is the recommended option. According to the Organ Procurement and Transplant Network (OPTN), as of September 2011 more than 16,000 Americans are on the waiting list to receive a liver. Between January and June 2011 OPTN reported 3108 liver transplants were performed in the U.S., with roughly 96% being DDLTs and 4% LDLTs.

Previous studies found receipt of LDLT to be associated with improved survival compared with waiting for DDLT, however it remains unclear whether this advantage persists in candidates with low MELD scores (less than 15). In order to better inform liver transplant candidates of survival outcomes, our study investigated the mortality risk of undergoing transplantation using livers from living donors versus waiting to receive a deceased donor organ, explains lead author Carl Berg, M.D., with the University of Virginia Health System.

For the present study, data on liver transplant candidates and potential donors were supplied by transplant centers involved in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study. A total of 868 adult liver transplant candidates were included in the study and were followed for a mean of 4.6 years. Living donors of the study candidates were evaluated between February 2002 and August 2009the period following MELD-based liver allocation. DDLT recipients transplanted at study centers were obtained for comparison during the same time period.

Mortality for LDLT recipients was compared to mortality of candidates remaining on the waiting list or who received DDLT, with categories of MELD score lower or greater than 15, and HCC diagnosis. Researchers reported that of the potential LDLT recipients, 453 had MELD scores lower than 15 and 415 were greater than 15. Transplantation was performed on 712 candidates (406 LDLT; 306 DDLT), 83 died without transplant, and 73 remained without transplant at the fi nal follow-up.

We found that survival was signifi cantly higher for candidates without HCC who underwent LDLT, rather than waiting for DDLT, concluded Dr. Berg. Results showed that LDLT recipients had a 56% lower mortality rate, and among candidates without HCC the mortality benefi t was seen in both patients groupsthose with MELD scores above and below 15. However, researchers did not observe a similar survival benefi t for candidates with HCC who had MELD scores lower than 15.

Dr. Berg and colleagues have provided very valuable new insights that will help answer the important question of optimal time to transplant. However, this study group was comprised of candidates who were deemed appropriate for LDLT and was not a randomized trial, said Julie Heimbach, M.D., an Associate Professor of Surgery with the Mayo Clinic College of Medicine in Minnesota, in her editorial also published in this months issue of Hepatology. “Future studies validating quality of life outcomes following LDLT compared to prolonged wait listing or DDLT would assist physicians in advising patients and families in timing of and donor options for liver transplantation.

Full Citations: Liver Transplant Recipient Survival Benefi t with Living Donation in the MELD Allocation Era. Carl L. Berg, Robert M. Merion, Tempie H. Shearon, Kim M. Olthoff, Robert S. Brown Jr., Talia B. Baker, Gregory T. Everson, Johnny C. Hong, Norah Terrault, Paul H. Hayashi, Robert A. Fisher, James E. Everhart. Hepatology; Published Online: June 17, 2011 (DOI: 10.1002/hep.24494); Print Issue Date: October 2011. http://onlinelibrary.wiley.com/doi/10.1002/hep.24494/abstract.

Editorial: The Benefi t of Living Donor Liver Transplantation: Who and When? Julie K. Heimbach and Russell H. Wiesner. Hepatology; Published Online: July 28, 2011 (DOI: 10.1002/hep.24578); Print Issue Date: October 2011. http://onlinelibrary.wiley.com/doi/10.1002/hep.24578/abstract.


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Quick & easy POC platelet function test delivers cost and patient benefi tsPlateletworks from HORIBA Medical proving highly effective at the Lancashire Cardiac CentreA novel diagnostic screening kit for the measurement of platelet function at the point of care (POC) is being used effectively at the Lancashire Cardiac Centre, located at the Blackpool Victoria Hospital, to deliver cost and patient benefi ts. Cardiothoracic surgeons and anaesthetists are successfully using Plateletworks from HORIBA Medical as a quick and easy test to assess whether there are adequate levels of functioning platelets to facilitate haemostasis. This one simple test, delivering quantitative and qualitative assessments in minutes, allows for informed decision making about the quantities of blood products and drugs needed to treat a patient’s condition.

Surgeons at the Centre started using Plateletworks platelet function kits in 2008 when it was realised that platelet count alone gave insuffi cient information to determine the platelet contribution to coagulation. Mr Nidal Bittar, Consultant Cardiothoracic surgeon explained his use of the kit. “We use Plateletworks to rapidly assess if a lack of functioning platelets is contributing to patient bleeding and hence enable an informed decision to be made on the need for transfusion. We are also able to assess if anti-platelet drugs are proving effective, especially pre-surgery, and if changes to the perfusion system can reduce platelet damage on cardio pulmonary bypass.”

By performing platelet function assessments on patients with post-operative bleeding, this has enabled informed administration of appropriate blood products or drugs needed to treat the patient’s condition. Knowledge of platelet function is also enabling physicians to better assess patients on anti-platelet therapy in need of urgent surgery, meaning that they can be operated on at the earliest safe opportunity.

“By using Plateletworks to rapidly assess platelet function we have noted a reduction in post-operative bleeding take backs,” said Mr Bittar. “We have also been able to improve a patient’s journey, since we can address the cause of bleeding quickly without delay and we need only transfuse if absolutely necessary. Furthermore, we can protect low responders to anti-platelet therapy from risk of embolus during stent insertion procedures, for example.”

The Plateletworks system ensures POC testing is kept as simple and quick as possible for the healthcare worker; whole blood samples are used, requiring no sample preparation. A number of Plateletworks kits are currently available to enable the measurement of platelet function in a variety of clinical settings.

www.horiba.com

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Hospital saves fortune just by swapping rubber glovesThe government hopes smarter procurement can help the NHS in England to save more than £15bn over the next three years - and some hospitals are already proving it can be done.

One of London’s top teaching hospitals has saved the taxpayer more than £300,000 a year - just by changing its order for rubber gloves.

Barts and the London NHS Trust used to buy 20 different types of examination gloves for medical staff.

But by limiting the choice to just two, the trust’s procurement team has nearly halved the bill.

“We spend over £700,000 a year on examination gloves.

“What we have done now is to move to one supplier, and we will be saving £320,000 this year just by standardising to a better value product,” says Zoe Greenwell, who leads the trust’s procurement team.

It is the kind of common-sense saving that the government is hoping all 168 hospital trusts in England will make.

Ministers want to save between £15bn and £20bn from the NHS budget in England over the next three years. And at least £1.2bn of that is expected to come from the hospital procurement budget.

But there is a problem for the government. By 2014 nearly all hospitals will be run as independent foundation trusts, and ministers will have little direct control over their spending priorities.

‘Prize that’s being lost’

A National Audit Offi ce (NAO) report found that there is already a lack of standardisation and bulk buying by NHS trusts when it comes to the everyday consumables that fuel a hospital - everything from A4 paper and rubber gloves to cannulas, the plastic tubing used to administer drips.

“We found that trusts bought 21 different types of A4 paper and 652 different types of rubber gloves… and somewhere over 1,700 different cannulas,” says Mark Davies, director of health value for money studies at the NAO.

Hospitals are also paying a wide range of different prices for exactly the same item, with some paying 50% more than the best performers.

“We estimate that there is something like £500m being lost every year on spending of £4.6bn. It’s the prize that’s being lost by the NHS if only they could get themselves together and procure more effi ciently,” says Mr Davies.

Health minister Simon Burns insists that the waste must stop:

“It is absolutely crazy; this is why we need to get greater transparency into the system, to get better practice and for trusts to look more at how they can bulk purchase,” he says

Hospitals like Barts in London are already successfully collaborating with other trusts in England to compare prices and reduce costs.

But attempts by hospitals to work together to maximize their buying power with suppliers have not always worked.

‘Vicious circle’

Orthopaedic surgeons at the University Hospitals of Leicester tried to secure a better deal on the price of knee joints by banding together with other hospitals in a body called the East Midlands procurement hub.

Figures nationally suggest the price paid by trusts for the same knee joint can vary from £1,400 to £2,500.

Orthopaedic surgeon Andrew Brown’s department is already saving thousands of pounds on knee joints

With Leicester performing 1,600 knee and hip replacements each year, the trust hoped to make signifi cant savings. However, it found that its existing deal was better than the average price the hub was able to deliver.

“It was going to cost an extra £100,000 a year to procure our prostheses via the hub rather than carrying on doing it ourselves because we had already achieved very low costs locally with our suppliers,” says orthopaedic surgeon Andrew Brown.

“My expectation would be that the hub should look at the lowest price currently being paid, and bring everyone to that lowest price, because unless the companies are selling at a loss to ourselves, there’s no reason why everyone else shouldn’t be buying things for the same price as we do.

“What it seemed to end up with was an average cost across what people were paying at that moment, which meant there were always going to be losers within the system.”

Leicester decided to go it alone for orthopaedic supplies, and the East Midlands procurement hub has now folded.

The NAO inquiry concluded that there were too many NHS hubs in the marketplace, says its author, Mark Davies.

“There is no consistent basis for measuring their performance. So you have got this vicious circle that individual trusts don’t know if they’re getting value,” he says.

“They think if they go to a hub that they might get a better deal [but] they don’t really know what a better deal looks like. The hubs may be competing with each other in a not very effective way.

“Our conclusion in the report was that there needed to be a fundamental rationalization of the hubs, because too many of them are doing the same thing not very effectively.”

By not setting procurement as a performance target, the government is banking on trusts taking the initiative.

It hopes a new system of barcoding hospital supplies will help trusts shop more effectively for low-cost, high-value consumable goods, and wants trusts to cooperate more to negotiate the best deals from suppliers.

Health minister Simon Burns insists that the impetus must come from the trusts themselves:

“You can’t lose sight of the fact that the NHS trusts are independent organisations,” he says.

“It is important that they have got the freedom to be able to make the commercial decisions that they believe are right for their community including the products that they buy.

“But what we are doing is working with the existing networks to raise awareness of effi cient procurement practice.

“This is something that needs to be recognized at a trust board level, and we are developing standards for good procurement so they can be understood and brought in throughout the organisation.”

Source: BBC Andy Denwood


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Fly CardiffVoices for improvements at Cardiff airport

Please support our THREE Stage Campaign for ‘ a world class airport for a world class city’ its easy to join in and

will take only a few short minutes to complete.

Visit the ‘Join In’ page at: www.fl y-cardiff.co.uk

Pride of Reading nomination for surgeon Adam Jones

A surgeon who works tirelessly outside his working hours to raise funds to keep a state-of-the-art piece of equipment at Royal Berkshire Hospital (RBH) has been nominated for a Pride of Reading award.

Consultant urologist Adam Jones has been nominated as Health Worker of the Year in recognition of the work he does to promote and raise money for the Robbie the Robot Appeal.

Dr Jones has worked at RBH for eight years and has played a vital role in maintaining the da Vinci robot since it was installed at the hospital in October 2008.

Robbie allows Dr Jones and his fellow surgeons are now able to perform prostate operations using keyhole surgery with all the clinical and technical capabilities of traditional open surgery.

In addition the robot is now used to remove the kidneys and the bladder of cancer patients, as well as being used to good effect by the gynaecology department.

Robbie doesn’t come cheap and Dr Jones, along with other staff at the RBH, has been working hard to keep him at the hospital by raising money for the appeal, which is sponsored by the Reading Post.

They have so far raised more than £750,000 towards the £1.2 million target needed to keep Robbie at the hospital.

Dr Jones has fronted the campaign from the very beginning and has taken part in a number of fundraising events himself to support the appeal, including running 13.1 miles in the Reading Half Marathon.

When he heard that he had been nominated, Dr Jones said: “It’s fantastic, I had no idea but it really is fantastic.

“We got Robbie nearly three years ago so my involvement has been two-fold.“Firstly on the clinical side, while the second side is trying to raise money to keep Robbie in Reading.

“We’ve done a whole range of fundraising things from small things like bring and buy sales to bigger things like the Snowdonia Mountain Marathon.”

Mark Goff, director of the Royal Berks Charity, said: “Adam really is inspirational.

“He has run half marathons and climbed mountains – literally – to help fund Robbie.

“Regularly, after a busy day in the operating theatre, he will remain behind to meet people who are supporting the appeal.

“It doesn’t matter if it is someone coming in with £5 or £50,000, Adam will be there to make sure their efforts are properly appreciated.

“And what always comes across is his passion for making sure that his patients get the best possible treatment and care – that’s what really matters to Adam Jones.”

Reading Post deputy editor Hilary Scott said: “Adam has been such an enthusiastic ambassador for Robbie.

“Obviously he wants Robbie to stay at the RBH as it’s the machine he has been using to operate with.

“But I have seen him give so much time and effort outside his working hours from climbing mountains to writing to business, from dancing at fundraising concerts to putting on demos for potential benefactors.

“So as well as helping to save lives inside work, he’s been doing it outside work too.

“And he really has been an inspiration to other fundraisers.

“To me that is going the extra mile for your patients.”

Source: get reading Laura McCardle

NHS showcases thrifty varicose vein treatment

The VNUS Closure Procedure, which treats varicose veins, is expected to save more than 7,000 patients from further treatment each year due to failed alternative methods. For same cost as conventional treatments, this new procedure allows a further 25,000 patients to be treated earlier and avoid pain or discomfort.

The conventional treatment for varicose veins involves surgery to strip them out. Vein stripping can be painful for the patient, is relatively time-consuming and expensive for the NHS. Full patient recovery after varicose vein surgery can take several weeks with more than a third of patients needing an overnight stay in hospital.

By contrast, the VNUS Closure procedure is minimally-invasive, and carried out under local anaesthetic, usually in a treatment room rather than an operating theatre.

Patients treated using the VNUS Closure procedure require a hospital stay of just a couple of hours as they are not given general anaesthetic. It means a much faster recovery time, with patients usually able to walk out of the treatment room unaided. They are usually able to return home and resume work within a day, with little or no pain.

The major benefi ts for the NHS lie in the fact that this procedure is much less resource-intensive than surgery.

Conventional varicose vein stripping is a common operation, taking-up a great deal of operating theatre time. Because the VNUS Closure procedure can be carried-out in a treatment room, it has the potential to free-up theatre-time, enabling the NHS to treat other serious conditions more quickly and so reduce waiting-times.

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