New for Old SME-NHS innovations
Catch a Wave Sonography e-training
The Next Big Thing Nanomedicine in Wales
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Crossing the Borders In the medical sector as in the commercial world at large, innovation now has the status of a cardinal virtue – one that, like many such virtues, is often easier to preach than practise. This is never truer than when confronting the task of getting a new medical device or process into wider use. For that to happen, innovation has to take the hand of its natural partner, collaboration. What does collaboration actually look like, in real life rather than the abstract? The unglamorous answer is that it looks like people in a room, talking to one another: the mundane, laborious but essential business of building trusted working relationships. That working reality is a good deal more difficult to achieve than it might appear. For the right people to come together, occupational borders have to be crossed, within and between commercial, academic and clinical environments. The participants have to find a modus operandi for managing differences not only of expertise but ways of thinking.
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Contents F E AT U R E S New for Old 4 How SMEs and the NHS can best collaborate on innovation adoption
PRODUCT REVIEW Catch a Wave 10 Sonography e-training is bridging the classroom-clinic divide
RESEARCH REVIEW The Next Big Thing 14 Welsh Nanomedicine collaborations are forging ahead
NOTES REVIEW News & Events
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These factors make collaboration by nature a demanding and sometimes discomfiting undertaking. But the rewards of making it work far outstrip the efforts involved, and the ultimate benefit is inarguable: patients getting better treatment in better ways. Improved collaboration between the NHS and SMEs has long been a goal throughout the UK medical sector. In our lead feature we look at how Welsh medical device companies are tackling this, and how effective collaboration can both clarify the true impact of innovation in clinical settings, and foster appropriate innovations. Our product review describes the successful application of advanced IT capabilities to a long-standing clinical training problem; and in our research review, we look at how the collaborative demands of nanomedicine are being translated into action in Welsh institutions.
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In a clinical setting, medical technologies, service delivery and purchasing are so intricately bound together as to be inseparable.
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We will continue to highlight effective collaborative activity in the Welsh medical sector. After our annual ‘Medica Special’ this autumn, the first 2008 issue of the Review will be exploring the work of wound healing in Wales, through both established and emerging collaborations.
Coralie Palmer Editor
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New for Old Coralie Palmer looks at how SMEs and the NHS do and don’t work together to bring in new medical devices, and at the latest efforts to improve their collaboration. Wherever two or three medical device manufacturers are gathered together, there will sooner or later be heard a familiar lament: the Byzantine complexities encountered in trying to get a beneficial, entirely new product adopted by the NHS. It’s long been part of British cultural mythology that we are good at invention and poor at capitalising on it. But when it comes to innovation
adoption – or lack of it – the NHS is a special case. Here innovation is not about ‘consumer choice’ as to the colour of the latest leisure gadget. It is about supporting a system of healthcare free at the point of use. The history of this remarkable ambition has already demonstrated that the demands on it will naturally tend to outstrip the resources available for its supply. Added to that, we’re now at the point where the simple demographics of an ageing population will bring increasing pressure to bear on health and social services.
Here innovative medical devices can make a critical contribution to the future of the NHS. While improving the clinical efficacy of a treatment, or the patient’s safety or quality of life, they can at one and the same time shrink the logistical and financial problems of meeting growing demand throughout the ‘patient pathway’. Aids to early diagnosis, to take one prime example, can shorten recovery time while reducing the cost of treatment. Likewise, technology for self-monitoring can both maximise well-being and reduce outpatient visits. Examples like these occur over the whole range of health interventions. Innovation in medical devices is therefore at a premium in terms of the benefits it can yield to the NHS. Since medical device expenditure constitutes only a very small proportion of NHS costs, promoting the intelligent adoption of new medical devices in the NHS might seem to be an obvious priority. It’s not, alas, as simple as that. Bringing this desirable result to pass calls for productive working relationships across the borders of very disparate entities.
Brain pathways. Coloured 3dimensional 4magnetic resonance imaging (MRI) scan of the white matter pathways of the brain, side view. White matter is composed of myelin-coated nerve cell fibres that carry information between nerve cells in the cerebrum of the brain (top half of image) and the brain stem (bottom centre).
Firstly, the NHS procurement system is designed to supply existing products or services that meet recognised needs at a competitive price. But innovation by nature tackles needs or problems that are either not yet identified or not yet adequately met. Secondly, the bulk – some 85% — of the medical device sector in Britain is made up of SMEs. The NHS on the other hand is one of the biggest
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organisations in Europe, employing some 1.5 million people: compared to which, the average SME is as a gnat to an elephant. Thirdly, the NHS does not of course manufacture. So should it need a new product or process, means must be found for the elephant to be made aware of the gnat, and then for the two – systematically, in a way sympathetic to both parties – to be able to collaborate. There is already a growing awareness of the problem at national, governmental level. The Wanless Report of 20021, looking at the long-term resource requirements for the NHS, highlighted shortcomings in NHS technology adoption – a point reinforced by Sir David Cooksey’s review of publicly-funded health research2, which identified a ‘conservative’ approach to
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innovation as a weakness in the NHS. In 2005 the Health Industries Task Force (HITF), set up as a focal point for government, industry and the healthcare sector to work together, was specifically requested by Lord Warner to develop routes for promoting the faster adoption of medical technologies in UK healthcare. From the perspective of SMEs, the most visible result of this attention has been an ever-more complex ‘innovation landscape’, inhabited by a plethora of acronyms representing organisations both national and regional. All of these, to varying degrees, claim to offer help or guidance to providers in bringing about the adoption of an innovative product by the NHS. It is important to note at this point that as far as innovation in the
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medical sector is concerned, we are not a United Kingdom. Structures and systems are different for England, Scotland, Wales and Northern Ireland. For the SME however, it is the English NHS that is its largest and most influential customer. So it is the English structures and systems that will tend to be the dominant factor in their experience.
Given this background, how do the organisations in the English innovation landscape impact on Welsh SMEs? Of the national organisations, two have developed website portals that enable users to submit details of innovative products for consideration. The Centre for Evidence-based Procurement (CEP)
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was set up by the NHS Purchasing and Supply Agency (PASA) in response to the HITF initiative. Users complete a ‘Pilot Project Proposal Form’ with brief narrative descriptions of their innovation. If sufficiently wide interest is registered on the site, then that will trigger exploration of the product or service as a potential NHS tool. The National Innovation Centre (NIC), part of the NHS Institute for Innovation and Improvement, is an umbrella organisation for the regional NHS Innovation Hubs. Its web portal aims to be a ‘single point of entry’ whereby innovators can submit ideas or products for assessment through a set of 46 questions formatted on the ‘creditscoring’ model. Depending on the stage of development, the response will either signpost the user to the appropriate organisation, or step in with further involvement to support
DTR Medical
Single-use Tumarkin Ear Specula: developed from ENT surgeons’ suggestions, and now a high-volume medical device for ENT Clinics.
DTR Medical
Sterile single-use Tibbs Cannula: developed from requests by Vascular Theatre sisters, to replace traditional re-usable instruments which that block easily during vascular surgery.
the user through the development process. Both sites are, in their different ways, looking at covering the vast territory occupied by the NHS. A web-based tool is certainly one of the more feasible means of ‘horizonscanning’ across all of the organisation’s 500-odd Trusts, and the areas – academic, commercial and clinical – that work with it. But just how sympathetic is this process to the reality of innovation adoption in the workplace? For those of us who work with SMEs, what is striking is the cultural difference between the website approach to crossing the innovation divide, and that taken by SMEs who successfully manage to negotiate it under their own steam. One such is DTR Medical, a company based in Swansea that manufactures and supplies its own range of singleuse sterile disposable instruments. The company has a track record both of developing innovative products, and of seeing through their successful adoption by the NHS enduser. I asked Andrew Davidson, DTR’s Managing Director, how he sees the role of the national website portals in relation to his own experience within an SME. ‘Where we have connections is with one or two of the regional Innovation Hubs,’ he said, ‘and what we sometimes see is that the commercialisation of ideas hasn’t really been thought through. They can tend to focus too soon on contractual IP before establishing whether the concept really can work. So I think there’s merit in the way that the NIC website can help to clarify that.’
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Dr John Dingley demonstrating the ShakerScope with laryngoscope attachment, a novel new medical innovation being developed in Wales, to insert an endotracheal tube.
But as Andrew went on to explain, DTR’s own approach is not one where the web services would apply. It’s based on building direct and close working relationships with the end-users in each region through DTR’s own sales people. Their job is
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Dr John Dingley demonstrating the use of the ShakerScope with otoscope attachment for an ear examination
not simply to sell what DTR has, but to find out what it is that the end users want – and if it’s not available, whether DTR can develop it. ‘The users are surgeons, theatre sisters, sterile services managers, procurement people,’ Andrew explained. ‘Different characters in different situations, but they will all be looking for an instrument that can do a particular job or solve a particular problem. A key phrase we look out for is “Do you do…?” Or “have you got…?” And that is the indicator for examining the potential for a new product.’ The company will then assess the commercial viability for such a product, again using its own network of contacts to help profile the potential market. Its web of regional relationships is now paying dividends for DTR: end-users increasingly initiate contact with their own ideas and needs.
This experience casts an interesting light on the given analysis of innovation adoption in the NHS, which typically distinguishes between ‘technology push’ (suppliers with products to sell) and ‘technology pull’ (health professionals with needs to be met). The web portals represent a laudable attempt to align these forces on a national basis, by acting as a third-party mediator. But DTR’s experience is typical of many SMEs in demonstrating just how close-knit these two forces need to be. They work most effectively off and through each other when in regular proximity, by means of direct relationships between particular people in particular
places, built up over time. A topdown, centralised, national mediating body, whatever its benefits, is not best placed to replicate these conditions. The rapid growth of the regional organisations meanwhile, such as the NHS Innovation Hubs and the Medilink UK network, is proof of their popularity. In the view of Steve Cook, Research and Innovation Consultant for the Association of British Healthcare Industries (ABHI), they are more readily attuned to the needs of SMEs and the realities of how innovation actually works. ‘Everybody agrees that it’s regional organisations that help regionally located firms,’ he said. ‘What you have in these networks is a confederacy of likeminded groups that build strong relationships at the regional level, and I think that’s why they’ve taken off.’
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Steve does however see the national organisations as ideally situated to generate the tools and methodologies needed by
regional groups. ‘The NIC,’ he explained, ‘could for example assess the problems that are common to all the Innovation Hubs and develop a web-based kit to respond to those. But its role would be to design and circulate those tools: it would be for the regions to implement them’. In the same way, the CEP could be developing and circulating agreed evaluation methods for medical technology, rather than actually implementing the evaluations itself. This kind of design calls for the input of both the NHS and the supplier: ‘If you have a truly innovative technology,’ Steve pointed out, ‘then it’s the supplier who will know most about its technological capabilities, in terms of responding to the clinical need CEP is considering.’ Lack of that supplier input is therefore a real stumbling block to properly evaluating radically new devices: hence the importance of mutually agreed evaluation methods. ‘Once they’re established,’ Steve continued, ‘the actual implementation could be handed over to the regional organisations whether they’re NHS-based like the Hubs, or supplier-oriented like Medilinks.’
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The evaluation issue is one example of the factors that make it so laborious – and costly – for SMEs to work their own route through the NHS. At the regional level, there remains a clear need for a systematic way of supporting more sustained
interaction between NHS personnel and suppliers. This needs to happen in the way that’s proven to work: namely, bringing the right people in a region together in one place, so that they can talk to one another.
One of the most interesting models for facilitating direct contact between health professionals and suppliers is the Giebel Round, which was developed in Germany and is now being applied in North Wales. The brainchild of Professor Gerfried Giebel, head physician for accident and restorative surgery at Luedenscheid Clinical Centre, the Giebel Round is a process of regular small meetings between equal numbers of clinicians and
able to move during their eight-hour treatment sessions. Now EU funding has enabled Wrexham County Borough Council to establish its own Giebel Round. Liz Rowlands, Business Counsellor with the Council, organised the highly successful launch conference last November and sits on the project’s Steering Group, which manages with a light touch. ‘We’re fortunate,’ Liz explained, ‘in having the support of clinicians from the North East Wales Trust at the highest level. But we have made it very clear from the outset that this is not about selling and it’s not targetdriven. The process is all about bringing people together, and what the Steering Group – and the Council - ask is that people keep us informed about the partnerships and projects that grow out of that.’ Already four informal partnerships have resulted which are now working on new products. MediWales manager Gwyn Tudor also sits on the Steering Group, and attended both of
DTR Medical
Single-use Fish Hook Retractor with latex-free silicone ties, created in response to needs of neurosurgery theatres in Wales and Scotland. industrialists. A distinctive feature is that meetings are held on active sites at clinical and company premises alternately. These real-life environments demonstrate the different needs and forces at work in the clinical and commercial worlds – the better to recognise and solve the problems involved.
the Giebel Rounds held to date. What his experience of those onsite discussions has made very clear is the interdependence of medical technologies, service delivery and purchasing. In a clinical setting, these factors are so intricately bound together as to be inseparable.
Working in a small group under a simple confidentiality agreement, participants can freely exchange and explore ideas. In Germany, for example, the process resulted in PC Turc, a buckle manufacturer, successfully developing a suspension system that enabled formerly immobilised dialysis patients to be
At the March Giebel Round, a dozen clinical and company staff toured both an operating theatre and a critical care unit at Maelor Hospital. Senior nurses raised a significant problem: the difficulty of shifting and cleaning bulky, unwieldy laparoscopic units that need to be moved between theatres – sometimes during surgery.
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‘From a purchasing angle,’ Gwyn observed, ‘the hospital could look at the cost of an additional unit offset against savings in staff time. Or a high-tech company might see an opportunity to develop smaller, portable technology. But another option is a customised, efficient laparoscope trolley – a reachable solution that’s in the remit of a good ‘metal-bashing’ SME. There’s an infinite number of perspectives on any given problem and when you walk into that real-time environment, it’s possible to see more of those options and to get at what will actually work best.’
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based overwhelmingly on initial acquisition cost. It’s arguable that these perspectives represent a substantial flaw in purchasing strategy, because they do not reflect the true cost implications of innovative technologies. A proper assessment demands analysis of lifetime effect on service delivery within the ‘patient pathway’: the interactions of the technology with staff numbers and time, the use of space, the movement of patients and equipment. In order for that to happen, both buyers and suppliers need to amend
DTR Medical
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direct exchange between suppliers, users and buyers. It’s the regions who can most effectively implement these connections, while national bodies can identify the shared needs of regional groups, and give methodological support and highlevel backing to their initiatives. The Giebel Round is one such example of hands-on collaboration that offers a promising model for further development. coralie.palmer@mediwales.com
Steve Cook Research & Innovation Consultant ABHI 111 Westminster Bridge Road London SE1 7HR Web: www.abhi.org.uk
Negus Aspirating Dissector: re-designed as a single-use instrument following suggestions from an ENT Surgeon in the Midlands. The most recent Giebel Round saw a consensus that the NHS purchasing function should be represented, and Liz Rowlands will be working on this for the next meeting. Ultimately it is this department that will sign off an acquisition or not. By experiencing the full context in which medical devices are developed and used, purchasing staff would be better placed to assess costs and benefits.
The NHS has traditionally viewed procurement in terms of economies of scale and the logistics of movement and storage, rather than as a player in the innovation process – itself more often seen as a burden than an opportunity. The Wanless Report, while noting the capacity of innovation to reduce as well as increase costs, nevertheless concluded that ‘volume pressure’ the capacity of new technologies to treat more people - was a more powerful factor than unit cost reduction. Meanwhile on the ground, the financial pressures on the NHS result in purchasing choices being
their approach. ‘If your company is making a case for its new device,’ said Steve Cook, then you should be able for example to show that it will deliver x amount of savings in staff time or changed educational profile, and that it will recoup the cost in y years’. In Steve’s experience, very few companies work through that kind of data on a new product. By the same token, purchasing departments need to embed those factors into their decision-making analyses. That in turn demands better use of the intelligence available to them from both clinicians and manufacturers, through participation at an earlier stage in the innovation process than the final purchase. Purchasing involvement on this level can also directly affect the feasibility of new product by releasing funding potential. ‘An expression of interest,’ Gwyn Tudor pointed out, ‘can enable capital-raising through the private sector rather than through grants. And this is a central issue for SMEs – much more so than for larger companies.’ The innovation process, from need to product adoption, is therefore a closely woven web of ‘push’ and ‘pull’ forces that is best served by fostering
1 Wanless, D, Securing our Future Health: Taking a Long-term View, Final Report April 2002 (HMSO) 2 Cooksey, D, A Review of UK Health Research Funding, December 2006 (HMSO)
Andrew Davidson Managing Director DTR Medical 17 Clarion Court Clarion Close Enterprise Park Swansea SA6 8RF Tel: 01792 797910 Fax: 01792 797955 Email: info@dtrmedical.com Web: www.dtrmedical.com
Liz Rowlands Business Councillor Wrexham County Borough Council Bersham Enterprise Park Rhostyllen Wrexham LL14 4EG Tel: 01978 366366 Fax: 07812 541495 Email:liz.rowlands@wrexham.gov.uk Web: www.wrexham.gov.uk
National Innovation Centre Web: www.nic.nhs.uk
Centre for Evidence-based Purchasing Web: www.pasa.doh.gov.uk/evaluation
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Catch a Wave New interactive e-learning modules in ultrasound techniques are bridging the gap between classwork and clinical practice, both simplifying and speeding up the traditional route to acquiring the necessary skills. These are the skills of sonography: using ultrasound scanning to obtain internal images of the body, and correlate them with physical symptoms to make a diagnosis. It’s most familiarly associated with images of babies in the womb, but is used by all kinds of specialists from urologists to breast surgeons. Consequently the Europe-wide shortage of skilled sonographers is of great concern to clinicians, and faster, improved training a matter of importance. Trainees need firstly to be able to achieve the requisite images, and then to interpret what they are seeing. Cognitive skills therefore have to act in conjunction with hand and eye movement co-ordination, and textbook images can do very little to assist this process: until now extensive (and time-costly) hands-on experience with patients from a very early stage in the training has been the only answer. And while hospitals as always are balancing the demands of training and service delivery, the training hours available are falling. This conundrum is being successfully tackled by the elearning modules of MedaPhor Ltd.
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The company, which won the prize for best business start-up at last year’s MediWales Innovation Awards, is a joint venture between interactive media specialists, medical educationalists and Cardiff University. Dr Nazar Amso, Senior Lecturer in Gynaecology at Cardiff University, is leading the MedaPhor medical team. ‘It became clear,’ he explained, ‘that you could transfer certain components of the learning process from the clinical environment to the e-learning environment, and this is what the MedaPhor modules do.’
The modules display onscreen animated, virtual images of the relevant anatomy alongside their ultrasound equivalents.
The programme allows trainees to interact with both images to learn how the one relates to the other and to develop their interpretative skills. When trainees then go on to practise with patients, they are no longer complete novices: their competency is on a rising curve. So patient contact, which remains an essential part of the training, is used to greater advantage over less time. Two e-modules are currently available, covering abdominal and transvaginal ultrasound techniques. Available online for PCs in both web-streamed or download formats, they can be purchased for group use by hospitals, clinics and educational institutions, or by individual students and trainees, with the licensing period adjusted to the buyer’s needs.
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The University of the West of England (UWE), for example, organised a day-long session during which MedaPhor supplied simultaneous streaming of emodule material to a class of 12 students. ‘Interactivity meant more
could be covered with less intervention from the supervising lecturer,’ explained Roger Fickling, MedaPhor’s Project Director, ‘but there was still that one-to-one support where it was needed. And all the class members could work at their own pace. So it made for a very rich learning environment.’ MedaPhor’s design process used expert groups to evaluate their work, both locally via a panel within the Cardiff & Vale NHS Trust, and nationally with external reviewers from all over the UK. The current emodules were carefully designed to incorporate recognised learning outcomes. MedaPhor referenced Cardiff University’s MSc course in Obstetrics and Gynaecology during development, and the training protocols developed by both the Royal College of Obstetricians & Gynaecologists (RCOG) and the
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Royal College of Radiology (RCR) include learning outcomes that are almost identical. Both institutions have expressed an interest in the MedaPhor product, and the company is working to
develop closer collaboration with them. An important element in their interest is the assessment capability that has been built into the e-module software. This allows both formative assessment – where students can repeat a task until they get it right – and summative assessment, where the performance of a task contributes to a student’s final mark.
There are obviously ‘handson’ elements that the elearning modules cannot cover – but here MedaPhor is again working on a contribution, using state-ofthe-art simulation. Taking the interactive process a step further, their simulation tool is now at the patenting stage. While the e-modules enable students to
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recognise and interpret visual information, the simulator will develop their manual dexterity, coordination and orientation – and these can also be assessed. There is an increasing move towards centres for simulation in many aspects of medical training, and MedaPhor envisages the simulator as being well within the budgets of academic, training and health institutions. Cardiff University and the Cardiff Partnership Fund, along with Biofusion plc, have invested in MedaPhor to develop this work, while Smart Cymru has grant-aided the project to prototype stage. MedaPhor ‘s particular educational philosophy, combining the physical and virtual learning environments, has been consolidated in their ‘Blended Ultrasound Training Environment’ (MedaPhorBUTE©). This model is implemented in the company’s 3-day hands-on workshops, which are run several times a year. They incorporate the Medaphor technology into a mix of lectures, small-group practicals and scanning of patients, to develop both the technique and the interpretative skills of the delegates. Meanwhile MedaPhor is working on its expanding portfolio of emodules. Together with the simulator and the MedaPhorBUTE model, these offer a toolkit with a worldwide market. ‘Anatomy is the same the world over,’ Dr Amso pointed out. ‘and this is a visual solution to an international medical training need’.
MedaPhor Ltd 2 Radnor Court 256 Cowbridge Road East Cardiff CF5 1GZ Tel: 029 2978 5253 Email: sales@medaphor.com Web: www.medaphor.com
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The Next Big Thing Nanomedicine is where nanotechnology meets human health care. This new, evolving discipline cuts across the borders of many different sciences, and Welsh institutions are proving particularly adept at the ambitious collaborative work it demands. The prefix ‘nano’ is now popularly used (and misused) to describe anything very small, but is actually a precise term of scale: a nanometre is one billionth of a metre. The double helix of the DNA molecule, for example, is about two nanometres in diameter. Nanomedicine addresses disease by working at the same molecular scale as the biochemical functions of the human body, using components that range in size from one nanometre to several hundred. Professor Ruth Duncan has played a leading part in clarifying the implications of nanomedicine at an international level. From her base at Cardiff University’s Welsh School of Pharmacy she heads the Centre for Polymer Therapeutics, which has long been at the forefront of molecular assembly techniques used to improve drug delivery: the Centre put the world’s first polymerbased anti-cancer nanopharmaceutical into clinical trial in 1994. Professor Duncan led an expert group in mapping out the future of nanomedicine for the European Science Foundation’s 2005 Forward Look report. The following year the
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European Commission published its nanomedicine strategy agenda, looking at research priorities. Together these documents outline a European perspective on nanomedicine, and on the part it can play in tackling our most significant health care problems. While the term ‘nanomedicine’ itself is comparatively new, there is already an extraordinary range of technologies and processes at work under its umbrella. There are patterns in the way these are evolving that are characteristic of nano-related activities. As Prof Duncan explained, work at the nanoscale essentially travels in two directions, and both routes demand novel connections between hitherto distinct specialist knowledge areas. From one direction there’s ‘topdown’ miniaturisation, where lithography or etching techniques ‘carve down’ materials to make nanoscale structures – a now familiar feature of semiconductor manufacture. ‘You’ll see this used in a diagnostic chip for example, with nanoscale components on its surface,’ said the Professor. ‘This work is developing out of areas such as biology, material science and engineering.’ From the other direction, ‘bottomup’ techniques assemble atoms or molecules to make larger structures. In the Professor’s own work at the Centre, polymers are incorporated into pharmaceuticals at the molecular level, enabling more precise targeting of a drug or its sustained release. ‘As we build more complex, multicomponent structures,’ Prof Duncan explained, ‘we’re also calling on the fields of information technology and mathematical modelling, as well as molecular engineering and supramolecular chemistry.’
The crossings between disciplinary boundaries are therefore multiple and complex, so effective collaboration is at a premium. Cardiff University has already established a Nanoscience Network (CuNN) comprising more than 120 senior academics from 15 Schools. This has enabled connection of research interests ranging from basic sciences to regulation and ethics, and the ability to conduct clinical trials locally will link laboratory advances with patient needs.
From an international perspective, the Professor sees in Wales both the expertise and the collaborative bias to support a leading role in nanomedicine development in Europe. At Cardiff she is already working closely with colleagues from the Schools of Dentistry, Bioscience, Optometry and Chemistry, to develop new nanopharmaceuticals for treating arthritis and diseases of the eye, and to promote wound healing.
At Swansea, the University’s NanoHealth partnership is building new connections between the already highly collaborative activities of the Multidisciplinary Nanotechnology Centre (MNC), and the recentlyestablished Institute of Life Science (ILS). The MNC is a hub for the most advanced nanotechnology research throughout Wales, and is the site for cutting-edge facilities needed by its partners from Cardiff, Aberystwyth and Bangor universities. The ILS was designed to be a focus for world-class research, and is assembling a team of internationally acclaimed scientists across a range of related disciplines. The NanoHealth partnership coordinates research between ILS and MNC involving engineers, physicists, biomedical scientists and clinicians from Swansea NHS Trust hospitals.
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Well before the partnership was established, Dr Steve Conlan, Senior Lecturer in Molecular and Cell Biology at Swansea’s School of Medicine, and his colleague Prof Steven Wilks, head of the MNC, were developing the collaborative groundwork. ‘It’s a real advantage that medicine and engineering are physically located very close to each other on this campus,’ said Dr Conlan. ‘It’s made it very easy for engineers and biomedical scientists to talk to each other, and this evolved naturally from people’s individual interests and the demands of the research itself. So we’ve really been able to develop this interface.’ Dr Conlan and Prof Wilks are both members of the partnership’s Working Group, overseeing its four major areas of activity in imaging, modelling, tissue repair and medical devices. All of these areas are however closely interwoven: here again the role of semiconductors is a classic example of the collaboration demanded of work at the nanoscale, and of the fruits of this ‘cross-pollination’. The demand has been for eversmaller semiconductors capable of processing ever-larger amounts of information – as in Swansea’s own supercomputer, ‘Blue C’, which is one of the largest in Europe. There is however a limit to the amount you can shrink a device in this way for it to still be functional. That limit is now on the horizon, so MNC researchers are investigating the use of biomaterials such as DNA and proteins for nanoscale wiring in devices.
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When an engineering colleague approached Dr Conlan wanting to source DNA for this work, not until they spoke did the engineer realise that Swansea’s bioscientists could synthesise as much DNA as he wanted. He had been using the Atomic Force Microscope (AFM) to study this material, and only during that same discussion did Dr Conlan realise the full potential the AFM could offer in imaging single molecules – such as DNA. ‘Generally,’ said Dr Conlan, ‘you’ll need a mass of DNA to be able to visualise it, and what you’ll see is its presence or
absence – by staining for example. But the AFM image maps the surface of one piece of DNA in three dimensions.’ An AFM uses nanoscale probes to scan an entity, with a feedback mechanism that adjusts the tip-to-sample distance to maintain a constant force between them. This means it can not only image the sample, but deploy and measure forces on it – and therefore manipulate it.
This ability made the AFM an early tool in nanotechnology research and manufacture, and now an important one in
MNC’s exploration of DNA as a wire in medical devices. ‘There’s a class of proteins that bind to a certain sequence of DNA,’ Dr Conlan explained. ‘So if you can use DNA as a wire and attach a protein, have you got a resistor? Because then you’ve got a conductor – and then you’ve got a device.’ An important focus in the area of devices is the development of biomarkers for detecting disease at the earliest possible stage, with the aim of developing tests that are both highly sensitive and low-cost. ‘We’re looking at the capacity to detect single molecules in the parts per billion range,’ said Steve, ‘and then to interface that biological recognition onto ultra-sensitive electronics’. WORD is funding two programmes at Swansea to apply this work to endometrial and cervical cancers. Part of Dr Conlan’s own research in the Reproductive Biology Group is looking at the role cell adhesion plays in the metastasis of cancer tumours, and here again the AFM probe tip can be used to measure the ‘stickiness’ of a cell. The development of devices is therefore closely linked to the analytical capacity served by imaging. This meshing of interests across the partnership’s research areas is typical. Its work on tissue repair is another example, bearing both on imaging and mathematical modelling. A classic application is the ‘smart scaffold’, a 3-d structure that can be populated with cells and then
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inserted into damaged tissue to repair it. Molecular assembly is one means of building such structures, while sourcing their cell populations links in with research into how stem cells are ‘instructed’ to become particular kinds of cell. Here mathematical modelling becomes important. At the nanoscale a material’s surface area is vastly increased in proportion to its bulk, and this can cause radical changes in its properties: gold becomes liquid at room temperature, for example. While there are models for cell growth at the microscale, at the nanoscale you have to re-investigate how the actual molecules behave. Modelling enables scientists to ‘plot’ molecular processes, and to use experimental parameters to look at the potential effect of modifying a process.
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A common – and highly significant – factor in all this interdisciplinary activity between experts is the challenge of linguistic translation. The more advanced the research, the more specialised its concepts and terminology, and this presents its own difficulties when scientists want to exchange information across disciplines. ‘We literally talk different languages,’ Dr Conlan pointed out, ‘so it’s been a real evolution in how to communicate. That’s been a huge learning process in itself.’ The onsite proximity of the different sciences on the campus has been a plus, but equally important has been the enthusiasm
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of the scientists themselves for crossing the disciplinary borders around them. This has created a climate at Swansea that favours the nuts-andbolts work of mutual understanding – or incomprehension. ‘I often go to conferences with my engineering colleague, Prof Wilks,’ Dr Conlan continued, ‘and there’ll be times when one of us simply has to ask the other, “What on earth does that mean?” And it’s really important to be able to do that.’ This climate has fostered the management of the NanoHealth partnership as a home-grown initiative, driven by the interests of a highly motivated, committed group of people. Its Working Group organises an open-invite monthly meeting which tends to be a focus
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1st ESF Summer School Nanomedicine. Dr M Gumbleton Cardiff Univ, front Dr C Moquin-Pattey Head ESF Medical Research Council Unit, behind Dr P Griffiths Cardiff Univ, Professor R Gaspar Univ Lisbon, Professor N P Weatherill ProVC Research Swansea, Professor R Duncan Cardiff Univ, Professor M Ferrari President NanoAlliance for Health Houston USA, Professor P Blood Pro-VC Research Cardiff Univ, Dr R Wallis BioScience Sector Manager Welsh Assembly Government, Dr D Grant VC Cardiff Univ, Dr O Crawley Chief Scientific Adviser Welsh Assembly Government
for new project ideas, and often works as a partnering event. The emerging projects then always involve people from both the engineering and the medical side, and are largely self-managed. The partnership’s momentum is driving its expansion, and it was recently awarded four prestigious research fellowships by Research Councils UK (RCUK). The Fellows have differing backgrounds covering cell biology, physics, engineering and toxicology. ‘They started arranging meetings right from the off,’ said Dr Conlan, ‘without any prompting from the Working Group. So we know they’ve got the collaborative drive we need.’ Swansea’s toxicology expertise reflects the fundamental importance of understanding the safety of novel nanomaterials - an issue that affects all nanoscience activities. At Cardiff, Professor Duncan is co-Chair of a group seeking funding for a Pan-European Centre for Nanomaterial Proactive Assessment of Risk (EuroNanoPar),
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to explore in depth the potential effects of nanomaterials on both humans and their environment. The aim is to pull together specialists from all related disciplines, looking not only at the scientific but the ethical and social implications of nanomedicine. Both Professor Duncan, who was Course Director, and Dr Conlan helped to organise the inaugural ESF Summer School in Nanomedicine at Cardiff in June, which was attended by all the Swansea Fellows. Sponsored by both Cardiff and Swansea Universities and the Welsh Assembly Government, the event attracted delegates and leading experts from 27 countries. The School will be held biannually at sites throughout Europe, and Cardiff University will continue its sponsorship for the 2009 event in Lisbon. Dr Conlan and the Professor both emphasise the importance of training specifically designed for nanomedicine, to develop the
interdisciplinary capabilities needed in the new generation of scientists. The highly active collaborations now maturing in Wales show these capabilities already at work, and suggest the potential for a leading role in nanomedicine’s future.
Prof Ruth Duncan Welsh School of Pharmacy Cardiff University Redwood Building King Edward VII Avenue Cardiff CX10 3XF Tel: 029 2087 4180 Email: duncanr@cf.ac.uk Web: www.cf.ac.uk/phrmy
Dr Steve Conlan Institute of Life Science School of Medicine Swansea University Singleton Park Swansea SA2 8PP Tel: 01792 295386 Email: r.s.conlan@swansea.ac.uk Web: www.medicine.swan.ac.uk
TECHNOLOGY ALERT
Healthcare Partnering Opportunities October 2007 The following are the latest technology transfer offers and requests in healthcare that are being promoted by the Wales Innovation Relay Centre (WIRC), part of a European network of 239 organisations with access to a large number of technology opportunities. If any of these opportunities are of interest, please contact the WIRC for further information. Welsh organisations are also welcome to register on the website www.walesrelay.co.uk which gives free access to all the opportunities that have been promoted throughout the network.
For more information contact Wales Innovation Relay Centre, Welsh Assembly Government,
depending on the novelty and maturity of the technology, how readily it can be deployed and how much value the new technology can add. Neutralisation of household pet allergens Reference No: 10858 A major global company, based in London, operating in consumer healthcare and household goods is looking to develop products for removing and neutralising household pet allergens. The company has offices all over the world and is interested in developing or acquiring product/products that can be used to eradicate pet allergens especially those from cats and dogs. The company would be happy to consider companies or academic institutions with possible technologies.
Plas Glyndwr, Kingsway, Cardiff CF10 3AH and speak to Sharon Thomas on +44 (0) 29 2082 8712, email: Sharon.thomas@wales.gsi.gov.uk or Julie Morgan on +44 (0) 29 2082 8759, email: Julie.morgan@wales.gsi.gov.uk
REQUESTS Non-contact pressure sensors to measure small pressure drop along the length of a hollow fibre Reference No: 10744 A company in Wales that develops respiratory aids must ensure that blood does not clot as it is oxygenated flowing through hollow fibres. As it clots, pressure drop increases, and this needs to be monitored. Conventional pressure sensors contact the fluid and act as clotting nuclei. To avoid this problem, they are seeking sensors that can be flush to the tube wall, or can avoid fluid contact altogether.
Technologies sought that enable the development of next generation breast prosthesis, pressure care and orthopaedic textiles products Reference No: 10838 An Irish company engaged in the creation, development, manufacture and marketing of branded niche healthcare products seeks next generation technologies that can be integrated and deployed in their existing and future product range. The company will consider technical cooperation and licence agreements,
Laparoscopic instrument for permanent ligation or welding of abdominal tissues Reference No: 10834 A large company based in Milan, active in the healthcare sector, is looking for manufacturers of specific instruments (single-use and/or reusable) to be used for ligating or welding permanently abdominal tissues without sutures or staples in laparoscopic procedures. This device, acting with radiofrequency-ultrasound output must be powered by a generator unit and activated by a footswitch pedal by the surgeon during the procedure. Partners are sought for a licence or joint venture agreement. Cholesterol Measuring and Tracking Device for Home Use Reference No: 10836 A UK company is seeking a small device for home use, which will allow the safe measurement and tracking of blood cholesterol levels. The device must be simple to use and should have sufficient memory capacity to track regular cholesterol level measurements over a period of months. A commercial agreement with technical assistance is sought and a joint venture is a possibility. Technologies, products, devices and materials relating to hair care Reference No: 10859 A UK company is searching for novel technologies and products in hair care. The solutions, leading to either novel formulas or packaging or dispensing innovation, are likely to come from sectors not connected to hair care.
Strong intellectual property is demanded. The type of collaboration may vary, including joint technical development and outright acquisition. eHealth Platform for the Management of Stress and Prevention of Life Threatening Diseases Reference No: 10860 A German SME has established a stress therapy method to observe harmful changes, to make data-based stress-diagnostics and to generate data-based stress-coping tools for patients. They are looking for companies active in the development/commercialisation of mentoring systems for high risk patients, of visualising software for risk taking behaviours of patients with life threatening diseases, and for partners developing software architecture to transfer analysed data into the health system. Drug screening technologies sought for identifying novel uses to drug candidates that have stalled in clinical development Reference No: 10835 A global pharmaceutical company with plants throughout Europe has identified new medical uses for compounds that have been in clinical development but were halted in their original indications for reasons other than serious toxicity. They are seeking to partner with SMEs that have capabilities of re-evaluating these compounds in various drug targets and disease models. The technology may vary from high throughput in vitro binding assays, human tissue screening to in vivo animal models of disease. OFFER Novel reagents for effortless Polymerase Chain Reaction (PCR) Reference No: 10634 A UK company has developed novel micro fluidics-based technology producing highly mono dispersed polymer beads with high accuracy and reproducibility. This technology allows the development of a range of enhanced formulation reagents for PCR applications. The formulations de-skill PCR reaction set-up whilst standardizing the reaction. This allows PCR to be used in field based applications e.g. bacterial detection and DNA based security tagging. Licensing and collaborative agreements are sought.
Make the most of Your Medical Technology Forum The Medi Wales Review Mailed to over 1500 contacts Distributed on line via the MediWales website visited over 5000 times per year Distributed at MediWales events and trade shows to over 500 leads The MediWales team would like to hear from members and colleagues who have news about new products, services or initiatives that would benefit from the publicity in the MediWales Review Press releases and to discuss inclusion in articles and features coralie.palmer@mediwales.com Advertising, reprints and special supplements debbie.laubach@mediwales.com
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MediWales Sector Survey It is generally recognised that the Welsh bioscience sector is a significant contributor both to the improvement of patient care and to the wider economy. There is however only limited hard data currently available on the sector’s profile: the size and number of its companies, the types of activity undertaken, its particular strengths and the barriers to its success. MediWales is therefore conducting a survey to assemble this data, which will help us to assess the needs of the sector as a whole and the companies within it, and how to improve the way these are being met. This material will be submitted to the Welsh Assembly Government and will guide and support MediWales activity for coming year. It will also ensure that government both in Wales and the UK is informed of the role and concerns of the Welsh sector. As we go to press our co-ordinator, Debbie Laubach, is conducting indepth company interviews. That activity will feed into a wider process of data collection through questionnaires that we are distributing to companies throughout the sector. It’s important that all companies contribute to this survey, so we would urge you to respond. Detailed findings will be distributed to all contributors, and summary findings will be published in the MediWales Review.
Events .... Review Over 40 delegates attended our most recent event, ‘Financing Research and Development’, which included speakers from DBERR (formerly the Dti) and EPSRC,
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Finance Wales and Wales Fund Managers as well as London venture capital company Longbow. The seminar took a strong UK-wide perspective on the issue in the light of the findings of the Ernst & Young Report five years ago, which suggested a gap in sources of finance for Welsh companies. How has the situation changed in the interim? There are clear indications that it has improved markedly. Those organisations providing funding at regional level such as Wales Fund Managers, Finance Wales and Smart Cymru have aligned their support to be more responsive to the needs of the bioscience sector. Equally, companies have become more proactive in seeking financial support from further afield (reflecting the Ernst & Young report recommendations). Welsh companies also now have a greater sophistication of awareness and approach, and funding organisations in the UK marketplace are treating them more seriously. Analyses at the event also made clear that finance is not all about funding. Cash flow, equity, and matching funding with private sector investment remain critically important. Meanwhile UK public funding for the sector has been strongly influenced by the HITF programme and other initiatives to improve innovation in health care, and this focus has become a significant force. It is still and always will be a challenge to finance projects that have long-term R&D phases and need to comply with high regulatory barriers, but there is now an environment in which the strong contenders will find the finance they require.
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Events .... Preview Our next event – the last one of this year – will be ‘The Lost Art of Selling’. A great deal of innovation and intellectual property is being developed in new Welsh companies. Nevertheless some of them are still not recognising the essential nature of sales in SMEs, which is about a good deal more than goods for money. The personal contact between salespeople and desired buyers constitutes vital intelligencegathering: identifying customers, meeting them, building good relationships and finding out what they need. This intelligence feeds directly into products, so it has a strong R&D component and is an important ingredient in successful innovation. This is particularly true at the more competitive end of the market, where constant customer contact is an essential ingredient in the successful business model. Our speakers will be drawn from highly experienced people who have long-term knowledge of this process in action, and whose companies demonstrate its importance and its benefits.
Awards This year’s MediWales Innovation Awards will again be held at the Cardiff Hilton, and we will be announcing the prizegiver shortly. It is already clear that this will be a bigger event than last year’s very popular inaugural ceremony, with an increased number of awards applications and significant opportunities offered by sponsorship and attendance.
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