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April 2012 Issue No. 259 ISSN 1747-728XThe Leading Independent Journal For ALL Operating Theatre Staff

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fi nd out more 02921 680068 e-mail [email protected] Issue 259 April 2012 3

The Next issue copy deadline, Wednesday 25th April 2012All enquiries: To the editorial team, 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. 2012Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD

Health and Social Care Bill gains royal assent

The Health and Social Care Bill gained Royal Assent on 27th March to become the Health and Social Care Act (2012)

The core principles of the Act mean that doctors and nurses will be able to tailor services for their patients, more choice will be given to patients over how they are treated, and bureaucracy in the NHS will be reduced.

The Act will: Devolve power to front-line doctors and nurses: Health professionals will be free to design and tailor local health services for their patients;Drive up quality: Patients will benefi t from a renewed focus on improving quality and outcomes;

Ensure a focus on integration: There will be strong duties on the health service to promote integration of services;

Strengthen public health: Giving responsibility for local public health services to local authorities will ensure that they are able to pull together the work done by the NHS, social care, housing, environmental health, leisure and transport services;

Give patients more information and choice: Patients will have greater information on how the NHS is performing and the range of providers they can choose for their healthcare. And they will have a stronger voice through Healthwatch England and local Healthwatch;

Strengthen local democratic involvement: Power will shift from Whitehall to town hall there will be at least one locally elected councillor and a representative of Healthwatch on every Health and Wellbeing Board, to infl uence and challenge commissioning decisions and promote integrated health and care;

Reduce bureaucracy: Two layers of management - Primary Care Trusts and Strategic Health Authorities - will be removed through the Act, saving 4.5 billion over the lifetime of this Parliament, with every penny being reinvested in patient care.

Andrew Lansley, the Health Secretary, said: The Health and Social Care Act will deliver more power to clinicians, it will put patients at the heart of the NHS, and it will reduce the costs of bureaucracy.We now have an opportunity to secure clinical leadership to deliver improving quality and outcomes; better results for patients is our objective.

Professor Steve Field, chair of the NHS Future Forum, said: It was a tremendous privilege to be able to chair the Independent NHS Future Forum. All the comments and debate that we heard helped improve the Bill. Chairing the Future Forum gave me the rare opportunity to meet a huge variety of patients, the passionate health professionals and organisations that make the NHS what it is. Whats vital now is that the Government continues to work closely with them to put the freedoms the Bill offers into practice.

Dr Nadim Fazlani, a GP and the leader of a Clinical Commissioning Group in Liverpool, said: The new structure of the NHS will give me and my colleagues much more freedom and control to design care around our patients. No decision about me without me is a key concept my colleagues and I will be working directly with patients, giving them a wider choice of where, when and how they receive their healthcare.The implementation of the Act will now enable clinical leaders, patients representatives and local government to all take new and leading roles in shaping more effective services.

Last Hurdle Removed To Scotland Adopting Heart Valve Procedure

TAVI now to be normal in England while still blocked for centres in Scotland

Cardiac specialists are calling on the Scottish Government to give the green light to a heart valve replacement procedure they say would transform the lives of over one hundred patients every year.

Clinicians in England were being told 29th March 2012 by the health assessment body NICE that Transcatheter Aortic Valve Implantation (TAVI) can now be regarded as being under normal arrangements for clinical governance for patients where traditional open heart surgery to replace faulty valves would be too risky. TAVI has been available for selected patients across England, Wales and Northern Ireland for the past four years.

Many patients have already been identifi ed by the cardiothoracic centres in Scotland as suitable for TAVI but very few have undergone the procedure and they have all had to travel to centres in England or Northern Ireland. The Scottish Government had told MSPs that they would await todays NICE report before making a decision on allowing the procedure to be carried out in Scotland.

Clinical Director for Cardiac Services at the Royal Infi rmary of Edinburgh, Dr Neal Uren, says he hopes this leaves the way open for TAVI to be offered to Scottish patients in Scotland:

This is a specialist alternative to surgical valve replacement for people whose aortic heart valve becomes increasingly narrowed, a condition known as aortic stenosis. TAVI is a proven technology giving normal lives back to the people who receive it. There is now very good evidence that it is cost-effective in a carefully selected high-risk population of older people that NICE has been looking at who have been turned down for the traditional surgical approach is too dangerous. NICE examined the procedure in considerable detail and has recommended that cardiologists in England should go ahead and offer TAVI in all suitable cases. We sincerely hope that this will persuade the NHS in Scotland to let us get on and do the same for Scottish patients.

Professor Keith Oldroyd, a Consultant Cardiologist in Glasgow says Scottish centres are several years behind their counterparts in England:

Scotlands track record in adopting innovative technologies in the area of heart disease is poor and needs to be improved. Even a country like Greece with its dire economic situation has initiated a TAVI programme. Across Scotland right now there are around 100 patients who have been deemed suitable for the TAVI procedure, many of whom have been referred by heart surgeons reluctant to perform conventional open heart surgery. Now that English patients in this high risk group will be eligible for it automatically, I cannot see anything in the way of the Scottish Government allowing TAVI to be performed in Scotland

Mrs Christina Fyvie (75) lives in Paisley and has been told TAVI would be the only option for her aortic stenosis as it is too dangerous to repair her aortic valve using conventional surgery:

I feel breathless all the time and walking is a struggle. I can only get out using a wheelchair with my husband helping me. I am pleased for patients in England but also quite angry that I cannot get TAVI because I live here. It seems very strange to me that we have the skills in Scotland to do this but its not being allowed. I hope Nicola Sturgeon will now act to end this cross border divide.

Mrs Violet Buyers (85) lives in the Saughton area of Edinburgh and was told four years ago that open-heart surgery was too risky to replace her aortic heart valve and that she would be in line to be one of the fi rst to have TAVI when it became available.

It seems unfair that if I was living in England I would be almost guaranteed to get the treatment that my specialists tell me would make a big difference, says Mrs Buyers.

At the moment I am confi ned to the house and can only take short trips out if someone can give me a lift from door to door as I cant walk far at all. My doctors are all very apologetic saying they know there is a treatment that will make me much better but they cant give it to me.

Issued by the UK TAVI Forum www.taviforum.orgThe NICE Guidance is at: http://guidance.nice.org.uk/IPG421

4 THE OPERATING THEATRE JOURNAL www.otjonline.com

Fujifi lm are awarded the All Wales PACS Managed Service Solution contractFujifi lm Medical Systems UK is pleased to announce they have been awarded the All Wales PACS Managed Service Solution contract. The Agreement for around 20 million covers a 7 year period from 2012 to 2019 and will enable Welsh Local Health Boards and the Velindre Trust, to benefi t from a common PACS service together with a centralised Vendor Neutral Archive (VNA) and remote back up all being operationally phased in from 2012 to 2014.

This prestigious national contract has been put in place to provide an effi cient and cost-effective Picture Archiving & Communications Service across the whole of Wales. Fujifi lms Synapse PACS system will replace existing legacy PACS systems offering a fully integrated web based solution to manage, store, distribute and retrieve images in an open environment. All images will be available on demand, with a two second response time for in-hospital viewing, providing greater access to patient data when and where required. Comprehensive data security is provided by an SSL (Secure Sockets Layer) network that operates to modern banking standards.

The fi rst operational phase from March to June 2012 will involve the central VNA together with the fi rst of seven Welsh Local Health Boards being established. Betsi Cadwaladr University Health Board (BCU) will be the fi rst authority to implement Fujifi lms Synapse PACS solution. This work will involve three primary sites and will include local servers and new workstations being installed together with various CR and DR solutions.

Commenting on the contract award, Mark van Rossum, General Manager of Fujifi lm Medical Systems UK, said: We already undertake an extensive amount of work within Wales and are pleased to further our national support. Data migration for BCU will begin shortly and we expect to have the data migration, system installation, user training and development completed by June. The remaining Welsh Local Health Boards will then be operationally phased in by 2014. Through using our Synapse PACS system we are offering users the latest in modern architectural solutions.

An NHS Wales Informatics Service spokesperson said: Selection followed a comprehensive tendering and evaluation process. The award of this framework contract demonstrates how working together and doing things once for Wales can achieve signifi cant savings.

For further information on the All Wales PACS Managed Service Solution contract, telephone Fujifi lm on 01234 326780.

Fujifi lm pioneers in diagnostic imaging and information systems.

From left to right Andrew Griffi ths, CIO for Health (NWIS) and Mark van Rossum, General Manager for Fujifi lm at the recent signing of the All Wales PACS Managed Service Solution contract with Fujifi lm.

When responding to articles please quote OTJ

Better integrated care could save the NHS millionsThe NHS could save millions and provide better care by involving more Allied Health Professionals such as podiatrists in patient care.

Physiotherapists, dietitians, podiatrists, speech and language therapists and other Allied Health Professionals can have a dramatic impact on care for people with diabetes, cancer, musculoskeletal problems and stroke survivors.

Using podiatrists to help treat patients with diabetes can lead to a drop in foot ulcers a serious complication for diabetics and distressing foot amputations. There are almost 5,000 leg, foot or toe amputations in England every year each one costs the NHS around 65,000. Investing in providing integrated foot care and bringing this number down could save the NHS almost 300 million.

By working together as a team, physiotherapists, speech and language therapists and dietitians can help stroke survivors regain independence faster and leave hospital and go home sooner. This could save the NHS over 7 million every year.

A new series of online tools, launched recently, will help the NHS identify how therapists can intervene at different stages of a patients condition to improve patient care whilst saving on costs.

Health Minister, Lord Howe said: Allied Health Professionals play a critical role in ensuring patients get integrated care so they recover quickly after treatment or can manage a long term condition successfully. Better integration of care is one of the key elements in the Health and Social Care Bill - not only does it improve the quality of patient care, but it can also save the NHS money.

These online tools highlight some excellent examples of when and how Allied Health Professionals involvement can work and will help commissioners pinpoint opportunities for better integration of care.

Shelia Stringer, Senior Physiotherapist and service manager at the Royal Wolverhampton Hospital NHS Trust said: Although this was developed as a tool for commissioners it is so much more. It is a one stop shop of information and evidence that I hope will promote local discussions amongst all clinicians on how we can improve services for out patients and deliver the savings the NHS needs to achieve.

Richard Evans, Chief Executive of the Society and College of Radiographers said:

AHPs in all their diversity have a vast amount to offer any healthcare system. In the UK it is it is very important that those who buy healthcare for patients fully understand what AHPs can provide in terms of improving the quality of care.

The online tools provide case studies and examples from local NHS services who have made changes to services to optimise savings whilst ensuring the best quality of care for patients. Salford Royal NHS FT reorganised their foot care pathway for people with diabetes which included annual screening, a preventative foot care service for patients and education programmes making a potential saving of more than 1 million over four years. The Stroke REACH Early Discharge Scheme (Stroke REDS) in Camden, London was developed to provide seamless transfer of care from the hospital to the patients home reducing the average length of stay in hospital leading to a potential 307,000 in acute bed day costs.

The toolkits can be seen at:

http://www.networks.nhs.uk/nhs-networks/ahp-networks/ahp-qipp-toolkits

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PROACT awarded NHS Supply Chain Framework agreement for the Cheetah NICOM

PROACT Medical, the offi cial UK distributor of Cheetah NICOM (non-invasive cardiac output monitor) are happy to announce that, NHS hospitals are, for the fi rst time, able to purchase the Cheetah NICOM (non-invasive cardiac output monitor) from PROACT through NHS Supply Chain. The NHS Supply Chain Patient Monitoring framework agreement (FAG 390) covers an initial period of two years, followed by the opportunity to extend for up to a further 2 years.

Cheetahs NICOM system has been used in a broad range of clinical settings that include Fluid Optimisation for high-risk ICU and Theatre patients, quick differential diagnosis in A&E, Haemodialysis monitoring and Exercise Cardiac Output (ECO) for heart failure patients. Importantly, this unique and proprietary technology has been proven to provide accurate and reliable measurements of Cardiac Output on both conscious and unconscious patients, even during patient movement, providing non-invasive, accurate, continuous and real-time information.

Signifi cantly, recent evidence from NICE has suggested that fl uid optimisation can also dramatically reduce the length of hospital stay; see http://publications.nice.org.uk/ for the case study data.

For more information including departmental brochures and case studies, please visit our dedicated NICOM resource centre: (www.proactmedical.co.uk/nicom) or contact Leah Lockwood at NHS Supply Chain on [email protected]

PROACT Medical Ltd Phone: 01536 461981www.proactmedical.co.uk

The New Merivaara Promerix Trust Starkstrom to be appointed sole

distributor for the Merivaara Promerix

A brand new Operating Table, with modular low design, which can be configured to suit ALL surgical procedures. The Promerix offers a unique shoulder section & head attachment, and has full orthopaedic capabilities. Heavy-duty, electro-hydraulic table for both general and specialised surgery. Suitable for heavy weight patients. Motorized 5th Wheel option for reduced moving & handling issues. Easy-to-use modular design that can be easily reconfigured according to clinical requirements. Fulfils X-rays and full length C-arm requirements with a 450mm traversing top - optional modular carbon

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Genetic study shows that infl ammatory protein plays a role in heart disease

Study suggests that anti-infl ammatory drugs could be used to treat cardiovascular disease

A protein involved in infl ammation, the interleukin-6 receptor (IL6R), is a contributing cause in the development of heart disease, new research led by the University of Cambridge has discovered. The research was published recently in the journal The Lancet.

The fi ndings suggest that targeting the IL6R signalling pathway might therefore be an effective way of combatting heart disease.

Dr Adam Butterworth, who co-led the study from the University of Cambridge, said: Typically, it can take many years to make safe and effective drugs to target new disease pathways. However, in this case, drugs have been previously developed due to this pathways involvement in autoimmune disease. In fact, one such drug, Tocilizumab, is already used for treating arthritis, and might therefore be a viable drug for preventing heart disease.

The research, undertaken as part of the IL6R Genetics Consortium and Emerging Risk Factors Collaboration and funded by the British Heart Foundation and the Medical Research Council, analysed human genetic and biomarker data from more than 200,000 participants compiled from 82 previous studies. The research focused on the genetic variant Asp358Ala which is known to affect IL6R signalling pathways involved in the infl ammatory response.

The researchers discovered that people who carry the Ala form of the variant have a reduced risk of coronary heart disease (3.4% for each additional copy of Ala that is inherited). Although this genetic change in risk is small, the potential reduction in an individuals risk of heart disease provided by a drug could be much greater.

Dr Butterworth added: Individuals carrying 358Ala had lower levels of markers of systemic infl ammation, suggesting that this variant dampens the infl ammatory response. As carriers of this variant also had a decreased risk of heart disease, this strongly indicates that IL6R pathways play a causal role in coronary heart disease.

Nearly 200,000 people die from cardiovascular disease in the UK every year, comprising one in three of all deaths.

(Source: British Heart Foundation website).


Two New Surgical Lights Extend the Polaris Family For small budgets: Polaris 100 and Polaris 200 by Drger

Drger is now expanding its range of LED lights with Polaris 100 and 200. The development was concentrated on providing a high quality surgical light without losing sight of the fi nancial concerns of hospitals. The integrated LEDs (light emitting diodes) deliver a homogeneous light with a spectrum similar to that of natural daylight.

With an outer diameter of only 620 mm, the Polaris 200 integrates a total of 66 LEDs and reaches a maximum brightness of up to 160 klux. The 48 LEDs of the Polaris 100 - with the same outer diameter - delivers a brightness of up to 120 klux. Both versions are dimmable to 40 klux. For endoscopic surgical procedures an additional LED provides ambient light, while the major light is switched off.

Homogeneous light Each individual LED is embedded in a special lens refl ector system that bundles the light beams. The result is a homogeneous column of light with 200 mm diameter, providing a depth of illumination of 750 mm (L1+L2 at 60% of maximum strength). Polaris 100 and 200 offer deep cavity illumination with no need for focus adjustment.

True colors At a color temperature of 5,600 K, which corresponds to natural daylight at noon, Polaris 100 and 200 ensure excellent contrast and natural colors. The rendering index R9 of 93 is exceptionally good. The R9 value specifi es the rendering quality of red tones which are crucial for the evaluation of different tissue.

Effi cient thermal management Like all light sources LEDs generate heat which infl uences signifi cantly the life span of LEDs. In order to increase the service life and the effi ciency of the light Drger has developed a thermal management system that protects the components and ensures that the maximal temperature of the upper side of the light head does not exceed 35 degrees Celsius,. With an average of 30,000 operating hours, the LEDs of Polaris 100 and Polaris 200 are effi cient and need almost no maintenance.

These new OR lights feature the well-proven classic round design of the Polaris family with circular handles on the top which allows non-sterile personnel to position the light heads easily. Sterile personnel can adjust the lights by using a sterile central handgrip. All settings are accessible via the intuitive control panel at the light head and the optional wall mounted control unit.

Drger Medical GmbH is the manufacturer of the Polaris 100 and Polaris 200.

Drger. Technology for Life Please visit www.draeger.com for more information. When responding to articles please quote OTJ

New information to help improve patient outcomesNew information that will help put the NHS on the side of patients and improve results for patients has been published recently. As part of the Governments drive to improve results for patients, new detailed information on 20 of the 30 NHS Outcomes Framework indicators, which measure the care patients receive, has been published by the NHS Information Centre.The fi gures provide a regional and local snapshot of how the NHS is performing against the Outcomes Framework. Crucially, they illustrate where there are variations in outcomes highlighting the importance of the Governments approach of concentrating on results, not targets.For example, liver disease mortality rates have increased nationally over the last decade, but have decreased in the last few years in London and the South East, while rates were twice as high in the North West compared to the East of England in 2009.The Government committed to focus on outcomes not process targets in 2010 and announced last year that the NHS would be held increasingly to account for measurable results, including whether a patients treatment was successful, whether they were looked after well by NHS staff, and whether they recovered quickly after treatment. Health Secretary Andrew Lansley said:

The information published today is another step towards shifting the health service towards the benefi ts for people who matter - patients.

Crucially, we arent telling doctors and nurses how to do their job the approached adopted by the previous Government. We are now clear about what the NHS should achieve, not telling the NHS how to do its job. These results will shine a light on results achieved and where performance needs to be improved.The publication of the fi gures today means the NHS can be held to account for all aspects of care that patients receive, and is part of a drive to make the health service more transparent. They provide a basis for driving improvements in the future through the Secretary of States Mandate to the NHS Commissioning Board, expected in the next few months and will allow the NHS to take action where patient outcomes are not as good as they should be.NHS Medical Director Bruce Keogh said:

Patients rightly expect the NHS to provide care that is effective and safe. And one of the things that makes for a positive patient experience is when everything joins up seamlessly as they move from GP surgery to hospital to community clinic or social care provider. So through the Outcomes Framework, and the information released today, the foundations are being laid to achieve just that.

The full data for the NHS Outcomes Framework 2010/11 indicators can be found here: https://indicators.ic.nhs.uk/webview/

To tackle the issue of liver disease, the Government will shortly be publishing a Liver Strategy. Further details on the Alcohol Strategy can be found at: http://www.homeoffi ce.gov.uk/publications/alcohol-drugs/alcohol/alcohol-strategy.

Nuffi eld Staff Celebrate

Qualifi cationsStaff at the Nuffi eld Health Taunton Hospital are celebrating their exam success!

Senior Health Care Assistant Irene Murray, and Healthcare Assistant Fran Cooke, both of Taunton have received their certifi cates in NVQ Levels 2 and 3. The qualifi cations cover a range of subjects in health and social care.

Out Patient Manager Nicky Edwards, of Burnham on Sea, not only manages the team but also is a qualifi ed assessor for NVQ. She said, The course equips the staff with all they need to provide a high quality service to our patients here at the Nuffi eld.

It also allows them to take on more responsibility and further their careers. We are very fortunate at the Nuffi eld to have such committed and expert staff.

Hospital Director Paul Taylor said Nicky has done an excellent job in leading the staff through this training and continuing to develop the outpatient services at the hospital.


Fukuda Denshis new DS-7700 Central Monitor is packed with functionality

Fukuda 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. The companys latest addition to their Dynascope range is the DS-7700 Central Monitor, packed with functionality for more fl exibility, more precision and more continuity.

The DS-7700 has a unique dual display design to provide unparalleled patient data clarity and clear alarm identifi cations. It offers continuous, accurate and clear monitoring of patients with a range of multi-display view options and functionality features.

The DS-7700 offers increased continuity with patient data transfer or exchange between two DS-7700 systems being enabled via the TCP/IP network. Additionally full wired or wireless networking is available and once the system is connected to a DS-LAN, other bedside information from different wards can also be viewed.

Fukuda Denshi have improved the accuracy of arrhythmia analysis by designing new in house databases including AHA, MIT- BIH and CU which are incorporated within the DS-7700. These improve QRS and VF detection whilst decreasing false detection of arrhythmia during noise.

The DS-7700s various functionalities provide comprehensive monitoring by displaying:

Up to 24hrs trendgraph in one screen using the Graph Trend function.

Tabular Trend, displaying up to 48hrs of data.

NIBP List with HR, SpO2 and PR parameters.

ST Measurements.

Up to 200 alarm generated waveforms that have been saved for recall using the Recall function.

Specifi c colour codes to each patient linked to the requirements of each nursing team.

For more information on the DS-7700 Central Station Monitor, call Fukuda Denshi on 01483 728065.Fukuda Denshi: Healthcare bound by technology. When responding to articles please quote OTJ

How ECT helps severely depressed Aberdeen researchers have discovered how a controversial but effective treatment in psychiatry acts on the brain in people who are severely depressed.

Electroconvulsive therapy or ECT - which involves anaesthetising a patient and electrically inducing a seizure - is the most potent treatment option for patients with serious mood disorder.

Despite being used successfully in clinical practice around the world for more than 70 years, the underlying mechanisms of ECT have so far remained unclear.

Now a multidisciplinary team of clinicians and scientists at the University of Aberdeen, Scotland, has shown for the fi rst time that ECT affects the way different parts of the brain involved in depression communicate with each other.

In a paper published in the journal Proceedings of the National Academy of Sciences they show that the treatment appears to turn down an overactive connection between areas of the brain that control mood and the parts responsible for thinking and concentrating.

This stops the overwhelming impact that depression has on sufferers ability to enjoy life and carry out day to day activities.

This decrease in connectivity observed after ECT treatment was accompanied by a signifi cant improvement in the patients depressive symptoms.

Professor Ian Reid, Professor of Psychiatry at the University of Aberdeen and Consultant Psychiatrist at the citys Royal Cornhill Hospital, led the study which involved using functional MRI to scan the brains of nine severely depressed patients before and after ECT and then applying entirely new and complex mathematical analysis to investigate brain connectivity.

The research involved University colleagues Dr Jennifer Perrin, research fellow in mental health, and Professor Christian Schwarzbauer, Chair in Neuroimaging, who devised the new mathematical method for analysing the connectivity data which enabled the fi ndings to be made.

Professor Schwarzbauer said: With this new method we were able to fi nd out to what extent more than 25,000 different brain areas communicated with each other and how the brains internal communication patterns differed before and after ECT treatment in severely depressed patients.

Professor Reid said: ECT is a controversial treatment, and one prominent criticism has been that it is not understood how it works and what it does to the brain.

However we believe weve solved a 70 year old therapeutic riddle because our study reveals that ECT affects the way different parts of the brain involved in depression connect with one another.

For all the debate surrounding ECT, it is one of the most effective treatments not just in psychiatry but in the whole of medicine, because 75% to 85% of patients recover from the symptoms.

Over the last couple of years there has been an emerging new perspective on how depression affects the brain.

This theory has suggested a hyperconnection between the areas of the brain involved in emotional processing and mood change and the parts of the brain involved in thinking and concentrating.

Our key fi nding is that if you compare the connections in the brain before and after ECT, ECT reduces the connection strength between these same areas - it reduces this hyperconnectivity.

For the fi rst time we can point to something that ECT does in the brain that makes sense in the context of what we think is wrong in people who are depressed.

As far as we know no-one has extended that connectivity idea about depression into an arena where you can show a treatment clearly treating depression, changing brain connectivity.

And the change that we see in the brain connections after ECT refl ects the change that we see in the symptom profi le of patients who generally see a big improvement.

Researchers now hope to continue monitoring the patients to see if the depression and hyperconnectivity returns. They also want to compare their ECT fi ndings with the effects of other therapies used to treat depression such as psychotherapy and anti-depressants.

Professor Reid added: Although ECT is extremely effective, it is only used on people who need treatment quickly: either people who are very severely depressed, who are at risk from taking their own life and who perhaps cant look after themselves - or patients who have not responded to other treatments.

The treatment can also affect memory, though for most patients this is short-lived. We monitor the memory function of all our patients receiving ECT in Grampian, and we fi nd that function returns to normal within a few months.

Given the impact of depression itself on memory, it is perhaps unsurprising that such a rapidly acting treatment has this effect: certainly, the patterns of brain changes we have observed are consistent with this.

However if we understand more about how ECT works, we will be in a better position to replace it with something less invasive and more acceptable. At the moment only about 40% of people with depression get better with treatment from their GP.

Our fi ndings may lead to new drug targets which match the effectiveness of ECT without an impact on memory.

Professor Schwarzbauer added: The new method we devised for analysing the brains functional connectivity in depression could be applied to a wide range of other brain disorders such as schizophrenia, autism, or dementia, and may lead to a better understanding of the underlying disease mechanisms and the development of new diagnostic tools.

The study was funded by the Chief Scientist Offi ce.


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INNOVATIVE MEDICAL APPS GIVE INSIGHT INTO JOINT ISSUES

Education app developer 3D4Medical has released new versions of theirinnovative Pro creations for knee, hip, shoulder, ankle & foot, and hand &wrist study.

The new products, from the worlds most successful medical app developer,are designed to help medical and healthcare professionals, physicaltherapists, medical students, and anyone with pain or discomfort in thoseareas to learn more.

Featuring detailed graphics and animations, the apps allow users to cutacross the joint with their fi nger and see mutliple cross-sections.

They can also cut away layers to reveal muscles, blood vessels, nerves andconnective tissue, and see muscles, blood vessels, nerves and connectivetissue, and see examples of disease states and treatments, and muscles andligaments in action.

The developers want to replicate the success of their Muscle System Pro IIIapp, which has been downloaded more than 200000 times and been one of the top fi ve grossing iPad medical apps on the AppStore for the past two years.

Project Manager Breda Jackson said: Anyone with an interest in, or problems with, knees, shoulders, hips, ankles, feet, hands or wrists will fi nd these apps useful.

As well as studying cross-sections, users can zoom in on certain sections,and rotate the entire area. They can also view the joint from variousangles, not just the standard anatomical options.

They provide a unique insight into how the joints work, and potentialcauses for pain and discomfort.

Versions are available for the Mac and iPad through the AppStore. Videodemonstrations are available at www.3d4medical.com.

3D4Medical was established in 2004 and now employs 50 people at theiroffi ces in Ireland and California.

The companys turnover in 2010-11 was 4m and their products have featuredin several Apple iPad advertising campaigns, including the iPad is Amazingand Appendre campaigns from 2011.

Music soothes surgery patientsPlaying music to patients undergoing surgery reduces their anxiety and could improve healing, research suggests.

Easy listening music and chart classics can lessen fear among patients who stay awake during surgery but require a local anaesthetic.

Experts at the Department of Plastic and Reconstructive Surgery at John Radcliffe Hospital in Oxford analysed data from 96 patients split into two groups.

The fi rst group was played music during their surgery while the second were operated on in the usual operating theatre environment.

Both groups included patients undergoing plastic surgery for trauma to their bodies as well as those having planned NHS reconstructive surgery.

Anxiety levels were measured through the patients respiratory rate and asking them to rate their anxiety using an established scale.

Both measurements were fi rst taken when the patient was on the operating table (just before the surgical procedure started) and, secondly, at the end of the operation (while the patient was still on the operating table).

The research, published in the Annals of the Royal College of Surgeons, found the group played music scored around 29% less on anxiety levels and had an average of 11 breaths per minute versus 13 breaths per minute in the other group.

The research is the fi rst to examine the effect of music on patients undergoing both planned and emergency surgical operations whilst awake.

Hazim Sadideen, a plastic surgical registrar who led the study, said: Undergoing surgery can be a stressful experience for patients and fi nding ways of making them more comfortable should be our goal as clinicians.

(UKPA)


Mlnlycke Health Care introduces a new innovative solution for patient warming

Mlnlycke Health Care, one of the worlds leading providers of single-use surgical products, today announces the launch of BARRIER EasyWarm, a new active self-warming blanket that brings simplicity to peri-operative patient warming.

The BARRIER EasyWarm is an innovative yet uncomplicated product for patient warming that is being introduced to hospitals. The blanket is easy to use, for both staff and patients, as once it is opened and unfolded, the air activated blanket self-warms. Unlike current products on the market, there is no need for any extra equipment or devices, and the blanket will maintain its temperature for up to 10 hours which enables it to be used to warm the patient before, during and after surgery.

A patients core body temperature normally drops after the induction of anaesthesia which mean that peri-operative hypothermia is a common side effect of surgical procedures.1 This in turn brings about poor outcomes for patients, including increased risk for complications and distress, leading to elevated treatment costs.2,3 Minimizing the risk of infection also reduces length of hospitalisation. Preventative measures such as preoperative patient warming and active warming during surgery, have been demonstrated to have a good effect on avoiding hypothermia.4

An ordinary blanket isnt very effective and the temperature management products currently used by hospitals are just too complicated, says Dr. Mark Kyker, M.D, a US cardiac anaesthesiologist and the inventor of the active self-warming blanket. This product is the fi rst true easy-to use solution for peri-operative warming.

The results of a clinical study to assess the safety and effi cacy of the BARRIER EasyWarm active self-warming blanket in preventing hypothermia demonstrated that intra-operative temperature was maintained at a stable level for 2.5 hours in the 68 patients evaluated for effi cacy.5 A drop of 0.6 C was recorded, compared to a typical temperature drop of 1-1.5 C on induction of anaesthesia, showing that BARRIER EasyWarm helps to prevent hypothermia. In addition, patients expressed a high level of comfort.

The BARRIER EasyWarm active self-warming blanket will be available in most European markets, starting from Q2 2012.

For more information, visit:www.molnlycke.com

References:1. Barash PG (ed). ASA Refresher Courses in Anesthesiology. 1993; 21:Ch 7.2. Andrea Kurz, M.D. et al, Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization, The New England Journal of Medicine, volume 334, may 9, 1996, number 193. Inadvertant perioperative hypothermia, Costing report Implementing NICE guidance, NICE clinical guideline 65, April 20084.Just B, Trevien V, Delva E, et al. Prevention of intraoperative hypothermia by preoperative skin surface warming. Anesthesiology 1993;79:214-8.5. Study to assess the safety and effi cacy of an active self-warming blanket used to prevent hypothermia. Data onfi le, Mlnlycke Health Care, 2012.

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Inspection changes underwayBeginning April 2012 the Care Quality Commission (CQC) is starting to introduce improvements to the way it inspects health and social care services. The changes follow a consultation by CQC on how it regulates.

The changes, which will be phased in, mean that CQC will inspect most services more often. It will inspect most hospitals, care homes and domiciliary care providers at least once a year. It will inspect dental and other services at least once every two years.

The regulator will continue to re-inspect those services that fail to meet the government standards and will inspect any service at any time if there are concerns about poor care.

Most inspections will continue to be unannounced. To help do this, CQC is recruiting extra inspectors. This means that inspectors will be responsible for a smaller number of services than in the past. They will be able to spend more time getting to know the services, checking the information they have on each, and responding quickly to concerns about the quality of care. Inspectors will be able to spend more time inspecting and less time on paperwork.

Our inspectors have continual oversight of all 16 government standards. Under the new system, inspections for most types of service will focus on a minimum of fi ve, one from each of fi ve chapter headings in CQCs Guidance about Compliance. Which standards they inspect will be tailored to the type of care provided and the information CQC currently has about the service, including the concerns that people have told us about. Inspectors will be able to focus their time and resources on services that are at higher risk of delivering poor care.

We will judge whether or not providers are meeting the standards. We will focus on where providers are not meeting the standards but include positive fi ndings where we see them.

Experts in different aspects of care often join our inspections, including members of the public who have experience of care. We will be making more use of experts in the future.

3.5m Fitzwilliam Hospital extension openA 3.5 million expansion at a hospital in Peterborough, which will increase the number of patients it can treat, was offi cially unveiled on Monday 19 March .

Ramsay Health Care has completed the extension at Fitzwilliam Hospital, in Bretton, creating a new state-of-the-art operating theatre and an ambulatory care unit that will allow more day-surgery patients to be treated.

Currently, Fitzwilliam carries out between 6,000 and 7,000 surgical procedures each year, for a mixture of private and NHS patients.

However, with the building of its third major operating theatre and the new day-surgery unit, it should be able to increase the number of procedures to around 9,000 a year over the next couple of years.

The building was offi cially opened by the Mayor of Peterborough, Cllr Paula Thacker, yesterday morning.

She said she was impressed with what she saw.

Cllr Thacker said: The new facility is excellent. It is spotless and spacious and I was delighted to offi cially open it with the theatre manager and staff.

The hospital deals with NHS patients as well as private so it is an excellent hospital to have in Peterborough.

The hospital has provided private healthcare to the city for the last 29 years, extending its services to NHS patients fi ve years ago.

Currently, around half of the procedures carried out at the hospital are on NHS patients.

The new theatre will provide surgical facilities for complex operations such as joint replacement or major abdominal surgery, while the rest of the project has also included an expanded radiology suite and six new premium care bedrooms.

The hospital is already an Orthopaedic Centre of Excellence and provides pioneering care for those suffering from cartilage problems, with some methods including the use of cell-based therapy.

The new ambulatory suite will give the hospital the ability to deal with more day-surgery patients who can have their procedure and go home without being admitted.

Carl Cottam, general manager of the hospital, said: Were delighted that this major development for the hospital is now complete and fully operational and very grateful to the Mayor of Peterborough for offi cially opening the facility.

The additional capacity will help us to meet the growing demand for theatre space and the changing pattern of operative care.

The new ambulatory care unit will allow more patients to benefi t from the increasingly popular option of day case surgery.

Source: the evening telegraph ADAM UREN

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Wood Green opens Xograph Imaging SuiteWood Green, one of the largest animal re-homing centres in Europe has undergone a 3.6M re-development which includes a new state-of-the-art surgery complex, proudly housing The Xograph Imaging Suite. This modern suite is a self contained diagnostic facility incorporating the very latest digital X-ray equipment for routine, general and dental veterinary imaging.

This prestigious development marks 25 years of animal welfare at the Godmanchester Centre near Huntingdon. The original surgery is over 20 years old with its ageing X-ray equipment compactly positioned in a converted storage room. The spacious Xograph Healthcare Imaging Suite includes the VetView 30, a general purpose X-ray system, with an ImagePilot digital acquisition console along with a dedicated digital intraoral imaging system known as the ProSensor.

Vanessa Cunningham, Head of Veterinary Services at Wood Green says: As an animal welfare charity its really exciting that Xograph Healthcare has helped both in the supply of our new digital X-ray units as well as assisting us with the layout of the facility. Their equipment is simple to use and understand. Joanne Mellor, Xographs area representative is friendly and helpful, showing a real empathy for the Charity, whilst at the same time helping us fi nd the right equipment for our needs. With Xographs support we have been able to exceed our expectations and the new surgery facilities will have modern, up-to-date equipment benefi ting the animals in our care.

Peter Staff, CEO at Xograph Healthcare said I am delighted that we have had the chance to work with such a forward-looking organisation. I am especially impressed with the amount of work that has gone into making the new centre as eco-friendly, effi cient and sustainable as is possible.

www.xograph.com

Picture: Vanessa Cunningham, Head of Veterinary Services at Wood Green, Paul Hunter, Executive Team Manager - Facilities at Wood Green, Dave Morgan, Director of Facilities at Wood Green with Joanne Mellor, Veterinary Territory Manager at Xograph Healthcare Ltd and Peter Staff, CEO at Xograph Healthcare Ltd.


National Institute for Health & Clinical Excellence (NICE) to Develop Medical Technological Guidance for the Revolutionary Ambu aScope

Development of guidance for intubating scope will now commence.

The NICE Medical Technologies Advisory Committee (MTAC) has concluded that the Ambu aScope has met all the selection criteria required to be considered for medical technological development. The selection criteria include the following headings:

* Claimed Additional Patient Benefi t

* Claimed Healthcare System Benefi t

* Patient Population

* Disease Impact

* Cost Considerations

MTAC will now commence development of Medical Technologies Guidance for the Ambu aScope.

aScope disposable intubating scope The Ambu aScope is a disposable, single-patient-use fl exible intubating scope that has a lightweight ergonomic handle, with an easy-to-steer thumb design. It utilises camera technology that ensures a good, clear image which is displayed on the Ambu aScope Monitor. It is indicated for use in the management of unanticipated or anticipated diffi cult airways and for visualisation during percutaneous dilatory tracheostomy (PDT). It can be used in either awake or anaesthetised patients, orally or nasally and it is the fi rst and only single- patient-use device of its kind on the market.

The primary role of an anaesthetist is to maintain the airway. This can often be diffi cult to manage and problems may be anticipated or unanticipated. When a patients airway cannot be managed or maintained, outcomes can be severe, even resulting in death. The ability to visualise anatomy is paramount and the Ambu aScope allows anaesthetists not only to see anatomy clearly, but also to navigate and place breathing tubes accurately.

If an alternative surgical airway is required at the front of neck (e.g. a tracheostomy), the Ambu aScope allows clinicians not only to safeguard whilst performing the procedure, but also to rescue when tracheostomy tubes displace.

Displaced tracheostomy tubes were found to be the biggest cause of death in Intensive Care Units in the National Audit of Major Complications of Airway Management in the UK (NAP4), published by the British Journal of Anaesthesia, March 29th 2011, edited by Dr Tim Cook, Chris Frerk & Dr Nick Woodall. Because of this, the study made the recommendation that all Intensive Care Units should have access to fl exible scopes and the Ambu aScope makes this recommendation entirely achievable.

Availability of airway management equipment The Ambu aScope was launched in October 2009. The motivation to launch such a device was born from evidence that there is a general shortage of fl exible intubation scopes due to the prohibitively high cost of existing technology. The aim of the aScope platform is to address the issue of availability of appropriate airway management equipment, a problem that is extensively highlighted in the NAP4 study. A number of recommendations made by NAP4 relate to making the necessary equipment available. In the executive summary it was stated that:

The project identifi ed numerous cases where awake fi breoptic intubation (AFOI) was indicated but was not used. The project methods did not enable us to determine why AFOI was not used but there were cases suggesting, lack of skills, lack of confi dence, poor judgement and in some cases, lack of suitable equipment being immediately available. This latter problem was prevalent on ICU.

The NAP4 study highlighted the issue of availability in relation to mortality and morbidity within the anaesthesia room and the ICU. Due to the low start-up and ongoing costs of the Ambu aScope, as well as its ease of use, it is now viable to have fl exible scopes in every department or situation where their use may be indicated, making anaesthesia and PDT safer for all.

The decision by NICE to evaluate and develop guidance for this technology will be welcomed by those with an interest in airway management.

There have been calls to increase the availability and use of fl exible scopes from recent high profi le publications and groups such as the National Tracheostomy Safety Project. In the UK over 150 NHS hospitals have bought the Ambu aScope.

Keith McCallum Managing Director Ambu

Statement by Dr Ellen OSullivan, President of the Diffi cult Airway Society, 8th March 2012 This is a positive move forward in addressing the issue of availability of suitable equipment within the area of airway management. Availability of and familiarity with fl exible intubation scopes was a signifi cant and recurring theme in the National Audit into Major Complications of Airway Management in the UK (NAP4). The Diffi cult Airway Society is encouraged to see that NICE is developing guidance within this area Dr Ellen OSullivan, email [email protected]

Contact For further information about Ambu aScope, please contact: David Edwards Sales & Clinical Director, Ambu UK Email: [email protected] Mobile +44 (0)7753 916 879 For more information, please visit www.ambu.co.uk


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Rainforest remedy could spell end of dental pain

First westerner to live with secretive indigenous people aims to bring painkiller plant to the masses

An ancient Incan toothache remedy, for centuries handed down among an indigenous people in the rainforests of Peru, could be on the cusp of revolutionising worldwide dental practice.

The remedy, made from an Amazonian plant species from varieties of Acmella Oleracea and turned into a gel for medical use, has proved hugely successful during the fi rst two phases of clinical trials and may hasten the end of current reliance on local anaesthetics in dental use and Non-Steroid Anti-Infl ammatory Drugs (NSAIDs) in specifi c applications.

Cambridge University anthropologist Dr Franoise Barbira Freedman, the fi rst westerner to be invited to live with the Keshwa Lamas in Amazonian Peru, is leading efforts to bring this wholly natural painkiller to the global marketplace as an organic alternative to synthetic painkillers.

In doing so, the company she founded, Ampika Ltd (a spin-out from Cambridge Enterprise, the Universitys commercialisation arm) will be run according to strict ethical guidelines, and will be able to channel a percentage of any future profi ts back to the Keshwa Lamas community who agreed to share their expertise with her.

With no known side-effects during the past fi ve years of Phase I and II trials, Dr Freedman, who has continued to visit and live among the Keshwa Lamas over the past 30 years, is confi dent the stringent Phase III trials (multi-location trials across a diverse population mix) will be the fi nal hurdle to clear. If successful, Ampikas plan is to bring the product to market in 2014/15.

She said: The story began in 1975 when I fi rst went to live among the indigenous people of Peru. We were trekking through the rainforest and I was having terrible trouble with my wisdom teeth. One of the men with me noticed and prepared a little wad of plants to bite onto. The pain went away.

The Amazonian rainforest plant used in the remedy

When it came back a few hours later, he had foreseen the need and kept plant material in his hunters bag for me.

I forgot all about the wisdom teeth problem for many years until Cambridge-based neuroscientist Dr Mark Treherne asked me to bring some medicinal plant samples back in order to test them for neurological research. Almost as an afterthought I remembered to include the one Id used on my teeth. It was added to the bottom of the list, but somehow the list got reversed and it was the fi rst one tested back in the UK. It was immediately successful and weve never looked back.

During the time I have spent with the Keshwa Lamas Ive learnt all about the different plants and leaves they use for everyday illnesses and ailments. I fi rst went to Peru as a young researcher hoping to learn more about what was a secretive community who were experts in shamanism. Along the way Ive learnt a great deal about natural medicines and remedies; everything from toothache to childbirth.

This treatment for toothache means we could be looking at the end of some injections in the dentists surgery. Weve had really clear result from the tests so far, particularly for peridodontological procedures such as root scaling and planing, and there are many other potential applications. The native forest people described to me exactly how the medicine could and should work and they were absolutely right. There are a range of mucous tissue applications it could benefi t, and may even help bowel complaints such as IBS (irritable bowel syndrome).

The Keshwa Lamas remedy represents the fi rst clinical trial of a natural product in Peru using the International Convention of Clinical Trials, of which Peru is a signatory, the gold-standard for clinical trials that is recognised across the Pacifi c and Atlantic regions.

Dr Freedman, who will visit the Peruvian community again in the coming weeks, has already been able to channel some early funding to the Keshwa Lama to help in the creation of a medicinal plant garden to conserve plants and plant knowledge related to womens health and maternity care with the express aim of preserving wisdom for future generations.

She added: We think the remedy is better than current treatments because NSAID drugs are systemic and have long-term effects; the plant

product is not systemic and does not have any known side-effects. We think people prefer to use natural products and this is particularly the case for baby teething for which, to my knowledge, there is no clinically tested natural alternative.

The dentists who carried out the Phase 2 trial reported a high level of satisfaction among their patients who disliked injections and did not need to use painkillers after the periodontological procedures.

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There was also a higher rate of patient return for further appointments than average for the group with which the plant gel was used. The gel works by blocking nerve endings (sodium channel pathways).

Ampika has a portfolio of plant-based drug development, particularly related to womens health conditions and Type 2 diabetes, which it hopes to develop in the coming years.

http://www.ampika.co.uk

Medical Devices study daySaturday 28 AprilRoyal Bolton Hospital - NHS Foundation TrustOrganised by the Association for Perioperative Practice (AfPP), the study day will offer practitioners a greater insight into the legal and practical requirements of medical device competency assessment. The session will also provide hands-on training on key theatre equipment and a best practice discussion.

Time: 9.30am 4.00pmCost: 25 to AfPP members or 35 to non-members. Student fee 10.Book your place online, or students please contact: Jody Craddock

Email: [email protected]: 01423 882 945Website: www.afpp.org.uk/events


The UK ODP Message GroupJoining is easy, just send an e-mail,stating your name, e-mail address,position and Hospital to:

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STARKSTROM SOLE UK SUPPLIER OF THE MERIVAARA PROMERIX TABLE

As part of its integrated range of operating room and critical care area equipment, medical engineering specialist, Starkstrom, is now able to offer the Merivaara Promerix operating table, suitable for both general and specialised surgery, including bariatric procedures.

The Promerix is a heavy duty, electro-hydraulic mobile operating table, whose modular table top can be confi gured to suit each surgical procedure and patient in the best possible way. Its fl exibility and strength means it can be used for patients weighing over 50 stone. The Promerix features:

Table width extenders and a unique shoulder device and head support A motorised wheel for reduced staff moving and handling issues Detachable carbon fi bre sections that can be confi gured according to the

surgeons requirements, including split legs with footplates for gastric bypass procedures

Excellent access for surgeons Low table height capabilities

The tables electro-hydraulic adjustments are controlled via user-friendly hand or foot control units, or a wireless infra red remote control unit. It comes with a comfortable, soft moulded mattress, and is ergonomic and easy to use and maintain.For further information: www.starkstrom.com [email protected]

Infection Prevention Society Welsh Branch National Conference

Delegate registration is open for the IPS Welsh National Conference. This event is FREE for all attendees.

Further details are below and online: https://www.eventsforce.net/ipswnc2012

Organiser: Infection Prevention SocietyDate and Time: Tuesday 10th July 2012, 8.45am 15.30pmLocation: SWALEC Stadium, CardiffCost: FREE for all delegatesRegistration website: https://www.eventsforce.net/ipswnc2012

Programme: Opening address including details on the IPS strategy: Tracey Cooper Using Root Cause Analysis (RCA): Judy Potter Results of the Point Prevalence Survey 2011 in Wales: Dr Eleri Davies Acinetobacter at UHW: Speaker TBC Pseudomonas in taps (the Gwent experience): Dr Neil Carbarns Lessons from the vomit bowl - surviving and learning from a major outbreak of Norovirus: Tracey Cooper E. coli O157 in a South Wales kebab house: Gemma Northey Discovering NDM1 and implications for infection prevention and control: Professor Timothy Walsh Antimicrobial Stewardship in ABMU Health Board: Sin Davies Catheter association urinary tract infection (CAUTI): Julie Coslett

Aims for the meetingThe conference will have two themes. The fi rst will focus on signifi cant incidents that have occurred across Wales and the lessons that can be learnt from them. The second is on emerging antimicrobial resistance and management. This one day conference represents an important educational activity for the Welsh Branch in an area of current strong clinical and commercial interest.


ISG Delivers New Maternity Suite At Norfolk Hospital

ISG has secured a further project with The Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust, taking a 600,000 scheme to refurbish and modernise the Central Delivery Suite (CDS) in the hospitals maternity unit. The scheme follows ISGs successful delivery of a new Day Surgery Unit and a 1.4 million Aseptic Suite at the hospital last year.

This latest project sees ISG strip out the existing facility and reconfi gure the unit to deliver upgraded accommodation for women who may require the specialist support of healthcare professionals during labour. Mechanical and electrical services will be replaced and upgraded as part of the scheme, which also sees the contractor carry out structural reinforcement of steel columns to support the installation of new state-of-the-art neonatal equipment within the suite.

The fast-track project will be carried out within the hospitals busy maternity unit and robust measures have been put in place to minimise any potential disruption to staff and patients throughout the duration of the works, which are scheduled for completion in the spring.

ISGs Bernard Clarke, managing director - South East, commented: The challenges of live environment working are multiplied when delivering complex hospital refurbishment projects. Experience and specialist expertise are essential attributes of the successful contractor operating within the sector and it is extremely pleasing that ISG continues to generate repeat business opportunities with key healthcare clients like The Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust.For further information about ISG, its companies and its offerings, please visit our website www.isgplc.com

Musgrove Park Hospital To Be A Trauma UnitMusgrove Park Hospital has been designated a Trauma Unit as part of a new network providing emergency care to patients with life threatening injuries.

The Musgrove Park Emergency Department, which treats more than 48,000 patients every year, is part of the new specialist trauma network in the NHS South region which becomes operational on Monday 2 April 2012.

Consultant Dr Cliff Mann, said: The new major trauma network for the south west will ensure patients get the very best specialist care in the right place at the right time.

Here at Musgrove Park patients will benefi t from the skills and technology available to us. As part of the major trauma network we will be able to draw on the resources in our local trauma centres to give our patients every chance of survival and recovery.

More than 150 patients are brought to the emergency department at Musgrove by the Devon and Somerset Air Ambulance every year.

The new network will mean that patients with specifi c specialist needs will be treated at Major Trauma Centres in Plymouth and Bristol.

New theatres open at Abergele HospitalClwyd West Darren Millar AM has welcomed news that brand new operating theatres have been opened at Abergele Hospital.

The hospital, which was earmarked for closure in 2006, has been revamped as part of a 1.5 million hospital development programme. Orthopaedic operations will now take place in new, modern operating theatres at Abergele. Improvements to Glan Clwyd Hospital will see orthopaedics moving from Abergele over the next few months, and ophthalmology services re-locating there from H.M. Stanley Hospital in St Asaph.

Darren said: Im delighted that patients will benefi t from these new state of the art theatre at Abergele Hospital. It just goes to show that the campaign to safeguard the future of the hospital was well worth it.

Abergele Hospital has provided high quality health care to thousands over the years and the investment it has received will help it to care for many thousands more.

He added, The Welsh Labour Governments record breaking cuts to the NHS are putting pressure on frontline services so any investment of this kind is to be welcomed.

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Tried and tested again and again and again

Thames Barrier: Since its inception in 1982, the Thames Barrier has been closed 449 times, either to test the unique mechanism or else to protect London from tidal surge and rainfall/uvial ooding. Dangerous conditions can be forecast up to 36 hours in advance, and a closure will take place just after low tide, or about four hours before the peak of the incoming surge tide reaches the barrier.

ThaThaThaThaThamesmesmesmesmesmes BaBa Ba Ba Barrrthethethethethehe ThTh ThTh ThThameameamamaamem s Bs Bss Btimtimtimtimtimt mmes,eses,ees,s eieieei eie thethetheether rr elselselselselelse te te te te te to po po po po po rotrotoo ececececrairairairairairainfanfanfanfnfnfall/ll/ll/ll///uvuvuvuvuvialialial cancancaancacaann be bebebebbe fo fofooforecrecreceececandandnandandand a aa a cloclocloclooosursurssu eeor or orr aboaboaboaabooa ut ut t foufouuouurrrincincncinincomiomimomomomim ng ng gngngg sursurusus

When uid management really matters,theres only one choice.

The ultimate success of any engineering innovation lies in its ability to withstand multiple variables, multiple uses, and deliver a solution that is uniquely t for purpose.

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Applicability_01

In its medical technology guidance on the CardioQ-ODM, the National Institute for Health and Clinical Excellence (NICE) asserts that this unique technology can be used across the entire surgical population, in people who are having major and high-risk surgery.

And, whilst Pulse Pressure Wave Analysis (PPWA) interventions requiring arterial access can only be applied to approximately 10% of patients, randomised trials of Oesophageal Doppler Monitoring (ODM) therapy have demonstrated that ODM can be used on 99% of surgical patients under general anaesthesia.

The CardioQ-ODM is the only therapy to directly measure blood ow in the central circulation. Minimally invasive, easy to set up and quick to focus, the device generates a low-frequency ultrasound signal, which is highly sensitive to changes in ow, measures them immediately, and enables early uid management intervention.

The NHS National Technology Adoption Centres (NTAC) audit of over 1300 patients in three hospitals clearly showed Doppler Guided Fluid Management to reduce post-operative stay by 3 and a half days. Use of central venous catheters was reduced by 23%, readmission rates were reduced by 29%, reoperations were reduced by 30%, and Level 3 ICU stays were reduced by 5 days.

The NHS Operating Framework 2012 and more recently, the NHS Innovation Wealth & Health report, have called for the implementation of oesophageal Doppler for uid management in surgery. By complying with these high impact innovations by April 2013, NHS organisations pre-qualify for the CQUIN payment scheme, worth 2.5% of their revenue.


A Handbook of Ophthalmic Nursing Standards and ProceduresISBN: 9781905539796 March 2012 M&K Publishing A4 format 160 pages 29.00

Lynn Ring MSc, BSc (Hons), RN1, RNT, IP, ENB 346 Advanced Clinical Nurse Specialist, Ophthalmology, Epsom and St Helier University Hospitals NHS Trust, UKMiriam Okoro MSc, Dip Management, RN, SEN, ONC, 998, Manager of an ophthalmic day case unit, Surrey, UK

This A4 format handbook has been developed to assist the nurse working in an ophthalmic environment and provide the patient with safe and consistent ophthalmic nursing care.

The authors discovered within their own unit that healthcare professionals, both registered and non-registered joining the workforce were often shown slightly different ways of doing things by the more experienced members of the team which led to confusion for the new starter. They felt it was a bit like driving, bad habits can slip into everyday practice and although not unsafe, it was at times contradictory. So they went back to basics and developed standards of care, which act as the benchmark for the ophthalmic practitioner.

All the guidance has been written using the term healthcare professional (HCP) which specifi cally relates to all staff working with ophthalmic patients regardless of registration. Non-registered practitioners are specifi cally highlighted in relation to prescription only medicines (POM) when the reader is reminded to comply with local policy, which may need a countersignature from a registered nurse or other such additional step even following satisfactory competence assessment. It is hoped that using clinical guidance like this helps the HCP to provide effective, effi cient ophthalmic care.

CONTENTS INCLUDE: Communication Visual Acuity Testing Ocular Medications The Ophthalmic Outpatient Department Biometry The Ophthalmic Accident and Emergency Department Slit Lamp and Tonometry a guide for the new ophthalmic nurse Additional Standards Using Specifi c Equipment Next Steps Using Standards

Further information: M&K Publishing (an imprint of M&K Update Ltd) Tel: 01768 773030 [email protected] WWW.MKUPDATE.CO.UK

Preoperative Assessment and Perioperative Management ISBN: 9781905539024 July 2011 M&K Publishing 428pp illustrated Price: 39.00

Edited by: Mark Radford, Divisional Director of Nursing (Surgery) University Hospitals Coventry and Warwickshire NHS Trust, UK Visiting Professor at Birmingham City University, UKAlastair Williamson, Consultant Anaesthetist Good Hope Hospital, Heart of England Foundation Trust, UKClare Evans, Consultant Nurse (Perioperative care) Bristol Royal Infi rmary, University Hospitals Bristol Foundation Trust, UK

Pre operative assessment of the surgical patient is a key part of the perioperative process. However, it is one that cannot be separated from the other aspects of perioperative management, both clinical and administrative, that ensures the safe and effective treatment of surgical patients. There are a number of books on the market that examine perioperative management anaesthesia and surgical nursing that are only able to touch on the pre-operative assessment process. Pre Operative Assessment & Perioperative Management sets out to be different, by bridging the gap between these texts and the evolving and developing area of practice that pre operative assessment has become in modern healthcare.

In order to achieve this Pre Operative Assessment & Perioperative Management has set out to deliver the core clinical aspects of practice, linked to the education and service development needs of a perioperative service. The challenge for such a book is to integrate this knowledge effectively, using the best evidence base, for use in every day practice. The brief to the contributors was to help defi ne pre operative assessment utilising their expertise to draw out some of the leading practices and thoughts of the day. They have achieved this, ensuring that the reader has access to some of the leading experts in international perioperative practice. They have done this in an open and accessible style that will guide the reader though some complex and demanding subjects to enable them to deliver better front line care to surgical patients.

Contents include:Introduction - The evolving role of the Pre Operative Team Assessment of Risk: Perioperative Patient History Taking Clinical Examination Assessment of the airway Pre Operative Assessment of cardiovascular risk in non cardiac surgery and Pre op management of current disease Pre Operative Assessment of pulmonary function and Pre op management of current disease Pre Operative Assessment of endocrine & Renal function and Pre op management of current disease Pre Operative Medication + Pharmacological Opt. For surgery (+ Alternative Med) Pre Op assessment and Management of concurrent neurological disease Pre Op Management of concurrent Haematological disease Blood products and Perioperative transfusion management The Infant & Child Day Case Surgery Preparation for discharge Consent for surgery & anaesthesia Development of a Elective perioperative system The Need for Change: Systems redesign for Perioperative Services Audit and Evaluation of Pre Operative Service Developing a program + competency framework Developing protocol/guidance to support Pre Op services

Further information: M&K Publishing (an imprint of M&K Update Ltd) Tel: 01768 773030 [email protected] WWW.MKUPDATE.CO.UK When responding please quote OTJ

When responding please quote OTJ


Tel: 01303 840 882 Fax: 01303 840 969 [email protected]

www.sophiebellandassociates.co.uk

CAMBRIDGESHIREDEPUTY THEATRE MANAGER

You will be a dynamic individual with a strong character & proven track record to support & develop the team to deliver a first class patient experience. You will be expected to

review, develop, update & implement policies & procedures as well as ensuring compliance by the team to National Care Standards & other legislative requirements. As an experienced practitioner, youll also be hands-on as part of the team & have

good working knowledge across a wide range of procedures. You will have at least 2 years experience as a senior staff member & applications from existing Deputy Theatre

Managers are most welcome.

Tel: 01303 840 882 Fax: 01303 840 969 [email protected]

www.sophiebellandassociates.co.uk

CHESHIRETHEATRE PRACTITIONERS

You will be a skilled Perioperative Practitioner with Scrub & Anaesthetic or Recovery skills to join this busy department. You will be a good team player with several years current experience working in an already established UK team, & will be expected to

provide & maintain a high quality service. Support from a strong management team will be provided as well as the opportunity to work alongside expert clinicians. Ideally you will have comprehensive orthopaedic & general scrub skills & you will be required to provide flexible skills in either Recovery or Anaesthetics. You will work a flexible shift

pattern of 37.5 hours per week, weekends & on call hours will be worked on a rota basis.

Issues in Perioperative and Operating Theatre Management - 2012

13th September 2012 - Manchester

CALL FOR SPEAKERSWe have three slots available and are seeking contact from clinical managers and perioperative health professionals who would be willing to speak at the above planned event. Although it is envisaged the primary target audience will be health professionals, associated managers and workforce planners we are keen to hear from all who have a working and managerial interest in this area.

This event will explore the following key themes:Risk assessment Human factorsCompetency and good practiceProductivityWorkforce planning and future trendsEffi ciency New ways of workingTraining and development New and developing practices

IF YOU WOULD LIKE TO PRESENT AT THIS EVENT WE WOULD LIKE TO HEAR FROM YOU.(Typically this will be a 35 minute presentation followed by a Q&A session)

We are keen to provide an event that offers the latest clinical innovation, ideas and evidence base so that attendees can take data and information back for use at their place of work. Do note we are unable to include course module/programme presentations.

Further information please contact:Mike Roberts, Director, M&K Update LtdThe Old Bakery, St. Johns Street, Keswick, Cumbria, CA12 5AS

[email protected]: 01768 773030 fax: 01768 781099 www.mkupdate.co.uk

Merrick rally backs charityThe organisers of the Merrick Forest Stages Rally are throwing their weight behind a charity founded by competitor and rescue volunteer Rachel Medich.

Rally2Raise supports four charities: Cancer Research UK, the Nystagmus Network, the MS Society and the Joanne Bingley Memorial Foundation for post-natal depression.

Rachel, who lives near Aberdeen and works as an operating department practitioner with the NHS, raises funds through various rally-related actvities, from selling cakes at events, to this year competing in her distinctive yellow and blue Nissan Micra.

The navigator-turned-driver took part in her fi rst championship event, the Snowman Rally, last month, when she drove the Micra as course car on one of the forest stages. She was co-driven by fellow fund-raiser Marieanne Gray.

Rachels next event is the Coltel Granite City Rally on April 14, when Katherine Begg will be making her debut as a navigator.

The Merrick will be offering the Rally2Raise crew free entry to the September 1 event, which will again be based in Wigtown and count as the penultimate round of the MSA Scottish Rally Championship.

Competitors will also be invited to make a donation to the charity when they enter online through the event website.

We are delighted to name Rally2Raise as our nominated charity for this years Merrick, said rally manager Allan Marshall. Rachel and the girls are raising funds for such very good causes. Hopefully our efforts will help them in reaching their target.

Although still six months away, Mr Marshall said planning for the Merrick was already well underway.

The stages have been chosen and we will again be offering competitors one of the most compact routes in the Scottish championship. Were delighted to be basing the event in Wigtown for the third year running, and, and we will be pulling out all the stops tomake the 2012 Merrick one of the best ever.

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Be sure to view the latest vacancies from the following organisations:

Theatre Practitioners Recovery Nurses Anaesthetic Nurses ODPs Scrub Practitioners

Nurse Practitioners Medical Representatives and Clinical Advisers

www.OOperati ngperati ngTTheatreheatreJJobs.comobs.comA one-stop resource for ALL your theatre related Career opportuniti es


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Rigel passes the test in South Africa

Technicians at South Africas National Department of Health are using Rigel Medical analysers for

training purposes.

Rigel Medical analysers have been specifi ed for a ground breaking project in South Africa designed to improve standards of medical device safety and performance inspection.

The Rigel 288 electrical safety analyser, Uni-Pulse defi brillator analyser and Uni-Sim - the fi rst all in one vital signs simulator - are among several precision testers being used by the National Department of Health in Pretoria for its health technology audit and asset management scheme.

This aims to create seven teams of highly trained technicians and equip them with the skills required to understand better the importance of electrical safety testing and how to service and maintain medical equipment properly.

Once qualifi ed, they will be embarking on a programme of safety and performance inspections of biomedical equipment using the Rigel instruments.

The move will improve national safety testing procedures, ensuring more electrically operated equipment such as x-ray machines, ECGs and blood pressure units used at healthcare and hospital facilities throughout South Africa are safe for use by both medical staff and patients.

Rigel Uni-Therm (formerly the 377) electro surgical analyser and Med-eBase PC database software, which provides enhanced electronic recording and management of testing programmes, are also being used to improve the technicians skills.

Ms Ncumisa Ndlovu, director - health technology management from the Department of Health - MP said the Rigel testers offered more advanced features and high specifi cation that meet the department requirements.

Date post:	23-Mar-2016
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