Issue No. 256
The Leading Independent Journal For ALL Operating Theatre Staff
H a e m o d y n a m i c s
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s i g n N I C O M
Cheetah Medicalâ€™s totally Non-Invasive Cardiac Output Monitor uses BioreactanceÂŽ technology to offer the clinician real-time haemodynamic insight. The unit is compact and easy to use (with four sensors applied to the chest or back) and can be used on both conscious and unconscious patients to equal effect. Clinical parameters can be obtained within two minutes and fluid optimization begun quickly and in a safe and guided way. Continuation of haemodynamic monitoring during the crucial post-op surgical period can enable the Nursing Team to assist a swift recovery. The Cheetah NICOM has been validated with all major technologies both invasive and minimally invasive and is the only Non Invasive Cardiac Output Monitor whose FDA predicate is the Swan Ganz PAC.
Visit www.proactmedical.co.uk/nicom or call 01536 461981 for more infomation or to arrange a trial or demo.
NICE Guidance supports the case to adopt Inditherm patient warming systems in the NHS • Clinical evidence supports Inditherm’s effectiveness at preventing hypothermia • Annual cost savings of £9800 per Operating Theatre • Additional savings from reductions in post-operative infections, energy usage and clinical waste
Contact any of our Medical team today for further information or a free trial, on +44 (0) 1709 761000 or email: email@example.com, and quote Ref: MTG0811
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Full guidance can be found at www.nice.org.uk/guidance/MTG7
40 per cent of hospital medicines ‘involved an error’ A new study published on the 13th December in the Journal of Advanced Nursing has shown that nearly 40% of observed drug administrations involved errors . Patients with swallowing difficulties were at three times greater risk of medication errors being made . Earlier research has shown that patients with swallowing difficulties (dysphagia) spend 40% longer in hospital than those without dysphagia .
Our ‘Get it on time’ campaign aims to raise awareness of this issue amongst healthcare professionals and we welcome any initiative which will help people with Parkinson’s to get their medication on time.”
A total of 2129 medicine administrations were observed in a range of different hospitals and 817 involved an error. Medication administration errors for patients with swallowing difficulties involved patients chewing modified release tablets, nurses crushing tablets not authorized to be crushed, mixing medicines together to make them easier to swallow, not flushing tubes between drug administrations and using the wrong syringe to administer medicines down feeding tubes.
• 65 nurse-led medicine administration rounds were openly observed and recorded by the researchers on care-of-the-elderly and stroke wards.
Overall, the most common error involved medicines being given at the wrong time i.e. one hour earlier or later than had been prescribed. Whilst in many cases it is unlikely that this would cause any harm, it did include 18 of 49 doses of anti-Parkinson medication being given over an hour late, which could have led to patients with Parkinson’s not having their symptoms adequately controlled and being unable to move, get out of bed or walk down a corridor.
• 36 of the 50 patients with an enteral feeding tube experienced at least one error
Says Professor David Wright, University of East Anglia who supervised the research: “Whilst the level of errors in patients without swallowing difficulties was no different to that seen by other researchers, it is very apparent that patients with swallowing difficulties seem to be at greater risk of medication administration errors and therefore systems need to be reviewed to improve the quality of their care. Patients should be assessed on their ability to swallow their medication when first admitted to hospital. The results of this study have helped us to pilot new approaches in one of the trusts where observations took place to improve communication between nurses, pharmacists and doctors.” Daiga Heisters, Head of Professional Engagement and Education at Parkinson’s UK, commented: “It’s vitally important that people with Parkinson’s get their medication on time, every time and we know this can be a particular problem they are admitted to hospital. If people with Parkinson’s don’t get their medication on time, their symptoms become uncontrolled and their hospital stay is extended. In some cases, this can cause a lasting negative effect on their Parkinson’s symptoms.
THE OPERATING THEATRE JOURNAL
Summary of the Research Findings • 2129 drug administrations observed
• 34% of the 625 patients observed had swallowing difficulties • 817 drug administrations involved medication errors • 170 patients without swallowing difficulties and 133 patients with swallowing problems experienced at least one medication error
• 36.7% of anti-Parkinson medication was given over an hour late Summary of medication errors in patients with swallowing difficulties • 54.3% Medication given at the wrong time • 19.8% Wrong preparation • 9.6% Wrong form • 6.7% Drug not given • 2.2% Wrong dose • 0.7% Wrong drug • 0.3% Extra dose References: 1. Kelly J, Wright D, Wood J, 2011, Medicine administration errors in patients with dysphagia in secondary care: a multi-centre observational study. Journal of Advanced Nursing. 2. Altman K, Yu GP, Schaefer SD, 2010, Consequence of Dysphagia in the Hospitalized Patient Impact on Prognosis and Hospital Resources. Arch Otolaryngol Head Neck Surg, Vol 136 (8), 784-789 www.otjonline.com
MEDICS PETITION GOVERNMENT TO MAKE SEPSIS A CLINICAL PRIORITY The UK Sepsis Trust is petitioning the government to make sepsis a clinical priority by establishing it as a medical emergency. It believes this will save 10,000 of the 37,000 deaths caused each year by sepsis, and £170 million from the annual NHS budget.
My husband died from sepsis a few months ago aged just 38, leaving four young children aged from 6 to just 3 months old. There were no warning signs until a couple of days before when he said his eczema had got slightly infected, but he went to work as normal on the Thursday.
Sepsis, previously known as septicaemia, is blood poisoning which occurs following an infection. Well known sufferers treated successfully include the pop singer Lily Allen and Lily-Rose, the young daughter of Hollywood star Johnny Depp. Brazilian soccer legend Socrates died recently from sepsis.
Thursday night he put himself to bed early with sickness and diarrhoea as there had been a virus going round which me and a couple of the kids had had, so I thought no more about it.
Campaigners are urging healthcare professionals to screen for sepsis when examining patients with severe flu-like symptoms, most prevalent in winter months. When sepsis is suspected, it is recommend that their Sepsis Six treatment plan is carried out within one hour as a routine emergency process. Dr Ron Daniels, who works in the Intensive Therapy Unit at the Good Hope Hospital in Birmingham, and chairs UK Sepsis, urges vigilance among medics: Sepsis is a silent killer, and as an ITU doctor, I have seen the devastating impact it causes too frequently. Sepsis remains the primary cause of death from infection despite advances in modern medicine, including vaccines, antibiotics and acute care. This is why I am passionate about establishing it as a medical emergency involving all health workers from the community through to hospital working together to reliably deliver the necessary treatment including the Sepsis Six within one hour. Our e-petition has had tremendous support and been signed by more than 1,200 people, including medics, patients and their families. We strenuously plead with Health Secretary Andrew Lansley to make a commitment to ensure that all patients with sepsis get access to the rapid care they need in an emergency. This will require a co-ordinated national response, including strategies to heighten awareness and investment in the development of seamless care pathways from home to hospital. Sepsis claims 37,000 lives annually in the UK - more than breast, bowel and prostate cancers combined, with the majority of cases in the community. We know that simple, timely interventions, including antibiotics and intravenous fluids, can dramatically reduce the risk of dying by up to one half, yet these are delivered in fewer than 1 in 7 cases in the UK. Early sepsis treatment is cost effective, reducing hospital and critical care bed days for patients, as well as saving lives. The campaign is supported by Barbara Franks, a mother of four young children from Didsbury, Manchester whose husband Marc died from sepsis on 19 February. He was a director in his familys small property rental company where he had worked since leaving school at 18. This is their poignant story:
Friday came and he was still in bed. Then Friday night/early hours Saturday morning, he started having all the symptoms, light headedness, breathing problems and clamminess, so I called an ambulance, but unfortunately he went into cardiac arrest and after an hour was pronounced dead. It took a post mortem to tell us he had died from sepsis which I had never heard of until now. It would be great to make people more aware of the symptoms as my four children are now without a daddy. Dr Daniels said it is crucial that the public become familiar with the symptoms of sepsis so they can alert their doctor about it. He says: If a person has two or more of a very high (or very low) temperature, a racing heart beat, rapid shallow breathing, or confusion then they may have sepsis. They should seek medical advice if at all concerned. It is often difficult to distinguish sepsis from flu. However, if any of these features exist and the skin is cool, pale or mottled, the patient has lost consciousness or has not passed water for more than 18 hours then the patient needs to be taken to hospital as soon as possible. Tests should help to make the diagnosis. He added: Marcs death was a very tragic loss. Every fatality from sepsis is a tragic loss. We need to inform the general public, as well as medics, about the warning signs, and I believe that every emergency centre in the UK should follow our Sepsis Six plan so they can make that crucial early difference. The Sepsis Six treatment pathway is as follows: Give high flow oxygen Take blood cultures Give IV antibiotics Start IV fluid resuscitation Check lactate Monitor accurate hourly urine output Full details about the UK Sepsis Trust can be found at http://www.sepsistrust.org The petition can be found at http://epetitions. direct.gov.uk/petitions/19602
Optimize patients to effectively prevent periprosthetic joint infections Periprosthetic joint infections can be reduced by optimizing at-risk patients, screening for methicillin-resistant Staphylococcus aureus and properly preparing the skin perioperatively, according to a presentation at the Current Concepts in Joint Replacement 2011 Winter Meeting. “It is a known fact the incidence of periprosthetic joint infection is on the rise and, unfortunately, that rise is going to pose many challenges to us in … prevention, diagnosis and treatment,” Javad Parvizi, MD, FRCS, said. Optimizing patients for surgery to prevent perioperative joint infection (PJI) is essential, he said. This includes treating oral, gastrointestinal, genitourinary, skin and nail infections before performing surgery. Additionally, patients with uncontrolled diabetes or on anti-infl ammatory medications who are at “extreme risk of developing PJI” should not be operated on electively, according to Parvizi. Highlighting one take home message, he said, “Skin preparation is very important and, in my opinion, starts at home.” “Alcohol must be part of the skin preparation; otherwise, your agent will not work,” he said. Because surgical gloves are a source of contamination, “double gloving is a must during total joint arthroplasty,” Parvizi said. Currently there is no science suggesting that laminar airflow, protective “space suits” and the size and volume of the operating room affects PJI rates, according to Parvizi’s research. “But what is known is that wound contamination occurs during surgery and this is, the majority of the time, by direct fallout or contact with a contaminated glove or an instrument. So the primary source of bacteria in the operating room is the OR personnel,” he said. In discussing preventing PJI, Parvizi noted, “One of the most effective agents in prevention of periprosthetic joint infection and surgical site infection is administration of the appropriate and timely perioperative antibiotics. Currently, second-generation cephalosporins remain the most effective agents and they have excellent tissue activity against the majority of organisms, including gram-positive cocci. They have a long half-life and good tissue penetration.” Reference: • Parvizi J. Minimizing infection risk: Fortune favors the prepared mind. Paper #37. Presented at the Current Concepts in Joint Replacement 2011 Winter Meeting. Dec. 7-10. Orlando, Fla. • Disclosure: Parvizi has no relevant financial disclosures. OrthoSuperSite
The Next issue copy deadline, Friday 27th January 2012 All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY Tel: 02921 680068 Email: firstname.lastname@example.org Website: www.lawrand.com The Operating Theatre Journal is published twelve times per year. Available in electronic format from the pages of www.otjonline.com and 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. © 2012 Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD find out more 02921 680068 • e-mail email@example.com
BERCHTOLD at Arab Health 2012 in Dubai High-end products for the operating room BERCHTOLD will be presenting highlights from its innovative and flexible product portfolio at Arab Health, which will take place in Dubai from 23 to 26 January 2012. The new CHROMOPHARE F Generation surgical lights for example enable concentrated, safe surgeries thanks to the innovative LED Reflector Light Technology and individual colour temperature selection. With its 360 degree universal joint and full-circumference rail, the light head can be moved without restriction. The surgical lights are of the highest quality and are made of lightweight, robust materials. The wireless version of the ChromoVision Full HD camera system provides images in high-definition video technology and can be integrated in the surgical lights. With its efficient, high-performance LEDs, the new CHROMOPHARE F 300 treatment and examination light offers optimum lighting conditions for examinations.
Ready-to-use fibrin sealant for tissue adherence in plastic, reconstructive and burn surgery, aiding haemostasis on subcutaneous surfaces with potential to reduce in-patient stays in hospital Baxter UK recently announced the launch of Artiss, the only premixed, ready-to-use slow-setting fibrin sealant specifically designed to seal and adhere subcutaneous tissue in plastic, reconstructive and burn surgery as well as helping to improve haemostasis on subcutaneous tissue surfaces1. During plastic, reconstructive and burns procedures, the use of staples or sutures often leaves a dead space underneath tissue fl aps or skin grafts, which can lead to post-operative fluid accumulation such as haematoma or seroma as complications. 3,5
All light functions are clearly displayed and visually arranged on the CHROMOPHARE F Generation touch screen.
The new range of the TELETOM equipment management solution is modular in design and now even easier to configure. In addition, BERCHTOLD is introducing a new concept for its proven OPERON D 850, D 820, and D 760 surgical table models. Users are now able to configure the tables individually so that they meet the requirements of the intended surgical discipline and access to the surgical field. Every user gets exactly the table that is needed, which is also more cost efficient than many of the specialty tables, and it is suitable for all surgical methods. Arab Health is the largest medical technology congress in the Middle East and the second largest in the world. It brings together the important decision makers in the Arab world. The event, which was established more than three decades ago, receives an ever-increasing number of visitors from Turkey, India, Africa, and Southeast Europe. In 2011, 2800 exhibitors from 60 countries presented their products and services to some 72,000 attendees. BERCHTOLD is making its twelfth appearance at Arab Health.
BAXTER LAUNCHES ARTISS [Solutions for Sealant]
A spray application of Artiss over the wound bed gives surgeons 60 seconds in which to manipulate and accurately position the tissue2,4 to ensure a tight seal and achieve full surface adherence to the subcutaneous tissue. The elimination of dead space reduces drainage volumes, the occurrence of haematoma and seroma and thus reduces post-operative complications. 3,5,6, Clinical studies have shown that Artiss is well-tolerated and effective as a alternative to staples for attaching skin grafts in burn patients, with outcomes at least as good as staples, but with significantly less haematoma/seroma on Artiss-treated sites on day one. 5,6 Plastic Surgeon Professor Paul McArthur, from Whiston Hospital and Alder Hey Childrens Hospital, Merseyside said. This is great news. Eliminating the need to remove staples means that patients, particularly young children, will not undergo what is a painful procedure or require an additional anaesthetic event. If Artiss proves to be as effective for other plastic and reconstructive surgery procedures, minimising areas of dead space, and significantly reducing drainage volumes when compared to standard of care, then early drain removal or drain free surgery, could mean patients going home sooner, freeing up beds and similarly reducing NHS costs.
TELETOM creates an effi cient and effective working environment for giving the best care to patients in operating rooms and ICUs.
Baxter Hospital Products Business Unit Director Andy Goldney said, I am delighted that we have launched this innovative product for use within surgery. This further enhances the range of products that we offer to the NHS within our BioSurgery business to enhance and speed up recovery of patients who have undergone surgery. Artiss is also approved in the UK for use in plastic and reconstructive surgery for the adhesion of tissue flaps, for example in face-lift surgery (facial rhytidectomy).
Sales of several thousand OR-tables worldwide have made BERCHTOLD a specialist in mobile OR-tables.
BERCHTOLD Medical Technology: Arab Health Hall No. S2B10 Email: Nicole.Schaumburg@BERCHTOLD.biz Website: www.BERCHTOLD.biz When responding to articles please quote â€˜OTJâ€™
Royal Army Medical Corps
The phase 3 clinical study also reported that patients had less pain and anxiety related to their Artiss-treated sites, where the sealant replaced staples for skin graft fixation. Pain and anxiety are usually associated with staple removal. 6 References 1
ARTISS [Solutions for Sealant] Summary of Product Characteristics. Baxter AG, Vienna, Austria, 4/2011
ARTISS [Fibrin Sealant (Human)] full Prescribing Information, Baxter Healthcare Corp., Westlake Village, USA 12/2010
Rohrich RJ, et al. ARTISS Improves Flap Adherence Following Rhytidectomy Through Full Surface Adherence Between the Wound Bed and Applied Tissue which Eliminates Areas of Dead Space Often Associated with Hematoma and Seroma: Results of a Phase 3, Multicenter, Prospective, Randomized, Clinical Study, American Association of Plastic Surgeons (AAPS) 90th Annual Meeting, Boca Raton, FL, April 9-12, 2011.
Mittermayr R, Wasserman E, Thurnher M et al. Skin graft fixation by slow clotting fibrin sealant applied as a thin layer. Burns. 2006; 32: 305311.
Gibran N et al. Comparison of fibrin sealant and staples for attaching split thickness autologous sheet graphs in patients with deep partial or full thickness burn wounds: a phase 1/2 clinical study. Journal of Burn Care and Research 2007; 28(3): 401408.
Foster K et al. Efficacy and safety of a fibrin sealant for adherence of autologous skin grafts to burn wounds: results of a phase 3 clinical study. Journal of Burn Care and Research 2008; March/April 2008; 29(2). 293 303.
Operating Theatre Technicians (OTT) Operating Department Assistants (ODA) Operating Department Practitioners (ODP)
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THE OPERATING THEATRE JOURNAL
Essential checks’ not made in hospital operating theatre Aviation method linked Theatre staff at a Westcountry hospital have been criticised by health inspectors for not properly carrying out mandatory safety checks during operations. Inspectors from the Care Quality Commission (CQC) have told North Devon District Hospital (NDDH) to clean up its act after a three-day surprise inspection in November, which revealed staff had routinely not properly carried out essential checks – such as ascertaining whether patients had been screened for the MRSA bug. The CQC’s report of the inspection which was published on 14th December, has also highlighted a serious “never event” which took place in a hospital theatre in January. A never event, as defined by the National Patient Safety Agency (NPSA), is something which should never happen in a hospital if all the correct protocols have been followed. No one at the hospital would confirm on the record the exact nature of the mistake. The never event is now under investigation, but NDDH medical director Alison Diamond confirmed the person involved has made a full recovery. The inspectors were at the hospital initially to check whether the hospital was complying with CQC recommendations set out in July, which found major concerns with record-keeping at NDDH. The visit to the theatre was only part of a major look at the entire hospital, and the report shows all the areas which the CQC initially had issue with in July had now been dealt with at the hospital. The report said: “In theatres we observed to see if the surgical safety checks were carried out. These are mandatory formalised checks laid down by the world health organisation (WHO) to enhance patient safety. We watched at least three sign-in procedures. These are checks performed before the patient is put to sleep or given their anaesthetic. Of these checks we only saw one which was performed completely and formally. The rest were carried out informally without completing all the appropriate checks. “We saw examples where information about a patient’s blood pressure was not passed on from the anaesthetist to the surgeon and theatre staff.” A spokesperson for the hospital said: “The CQC found we are now compliant in all areas where they had previously felt improvements were necessary. However, during their November visit, the CQC also inspected theatres and reported major concerns relating to compliance with safety checklists. While the CQC found no evidence of adverse outcomes for patients, they found we were unable to demonstrate compliance with mandatory safety guidance and procedures. “The trust acted immediately to address the concerns in theatres; with the CQC noting steps had already been taken to address how surgical safety checklists were monitored during the third day of their inspection. The trust considers patient safety to be paramount and is determined and confident that as a result of the actions taken, there will be full and comprehensive compliance.” Source: This is North Devon find out more 02921 680068 • e-mail firstname.lastname@example.org
to safer surgeries
A nationwide program aimed at improving communication among physicians, nurses and other members of the operating room team helped lower surgical morbidity over three years, said a study in the December Archives of Surgery archsurg.ama-assn.org/cgi/ content/short/146/12/1368. Forty-two Veterans Health Administration hospitals implemented a program inspired by aviation practices to train OR teams on using checklistguided preoperative and postoperative debriefing to prevent mistakes and achieve safer surgical outcomes. Thirtytwo VHA hospitals did not implement the program. Surgical morbidity rates declined at both groups of hospitals during the three-year period. But the hospitals that underwent the team training program saw 20% lower rates of complications such as pulmonary embolisms, surgical infections and deep vein thromboses than those that did not get the training. The team-trained hospitals lowered their surgical morbidity rate from 90 per 1,000 operations before to 75 per 1,000 afterward. The OR team communication training, when combined with procedure-specific initiatives guided by evidence, can help improve surgical outcomes, said an invited critique that accompanied the study (archsurg.ama-assn.org/cgi/ content/extract/146/12/1374).
STERIS opens new European headquarters
STERIS Corporation, a leading provider of infection prevention and surgical products and services, is pleased to announce the opening of its new Centre of Excellence and European Headquarters in Bordeaux, France, running since July 4, 2011 and inaugurated recently. The state-of-the-art facility is designed to bring together Marketing, Research and Development, Manufacturing, and Sales and Customer Services under the same roof, ensuring closer ties between technical and application specialists and the R&D team, and allowing more rapid development of new products to meet the changing needs of the market. The choice of the city of Bordeaux has already proven to be a good one, particularly due to the quality of the local infrastructure and the European ethos of this city. The recently completed 8,000 m2 building currently houses
over 150 staff relocated from STERIS facilities in France, Switzerland and the UK, with over 100 additional posts expected to be created in the next few years. This expansion and centralization of resources will allow STERIS to serve customers even more rapidly and efficiently, and to offer new locally designed global solutions for infection prevention and contamination control, as well as surgical and critical care technologies. The new Centre of Excellence also incorporates technical training facilities and a large showroom allowing customers to see for themselves how STERIS solutions could fit into their workflows alongside the R&D, manufacturing and customer support functions. Together with a new Centre of Excellence for Sterility Assurance in Leicester, UK, the Bordeaux facility will provide comprehensive services to better serve medical professionals and improve patient outcomes across Europe, Middle East and Africa. When responding to articles please quote ‘OTJ’ www.steris.com
State-of-the-art theatres to open at Warwick Hospital
DOWNWARD TREND IN SHIFT DEMAND REVERSES SHARPLY IN ACUTE TRUSTS
WARWICK Hospital is to open a state-of-the-art operating theatre in the new year – the first of its kind in the West Midlands.
NHS Professionals National Trends report indicates a changing pattern in shift demand.
It will boast advanced equipment for keyhole surgery. The new suite is part of a pioneering £4million plan to refurbish and improve all the main theatres at Warwick Hospital in one go. Consultant surgeon Mike Stellakis said the new theatre meant the hospital could perform a greater number of advanced operations. “We will now have the ability to become a leading training institute to train other surgeons from around the country in these advanced keyhole techniques,” he said. All the equipment in the new laparoscopic theatre will be integrated, which means it will be suspended from the ceiling to improve patient safety and efficiency. Surgeons will also be able to control all the equipment with a single touchscreen monitor instead of using numerous control panels. The equipment can already be preset before the operation for the patient’s individual requirements. It means Warwick Hospital will be able to perform more advanced gynaecological and bowel keyhole surgery than ever before, as well as more of the complicated operations it already handled. Keyhole operations allow surgeons to operate with smaller incisions, meaning less blood loss, less pain for the patients and quicker recovery times.
Information from NHS Professionals quarterly report National Trends shows bank shift demand in England fell steadily from 2009 to June 2011, with requests down by 7.3% year on year in Acute Trusts and 13.9% in mental health trusts. However, against this trend, there has been a recent sharp increase in demand in Acute Trusts across the country, with the exception of London. According to the report, meeting rising demand for temporary workers in these NHS Trusts, without resorting to expensive agencies, requires an innovative approach to temporary workforce management. The number of short-notice shift requests in Non-Foundation, Non-Teaching Acute Trusts has also grown by 4.3% in the last 12 months, despite falling in all other Trust types, with a significant increase in demand observed from July onwards. Across the NHS there is a shortage of bank staff available to work shifts at the last minute. Expensive agencies continue to exploit opportunities to place workers in these shifts. An increase in agency use was observed in Acute Trusts, up 4.1% as a proportion of total fill over the whole year and rising sharply between June and September. Stephen Dangerfield, Chief Executive of NHS Professionals says: Until recently, we have observed a year on year downward trend in shift demand but data from the last quarter show a significant reversal, particularly in Acute Trusts. Its clear that with Trusts focusing on efficiency, short-notice shift demand is increasingly a fact of life. We are working with NHS Trusts to understand the impact of their recent changes in demand and be increasingly responsive to shifts released on the day. NHS Professionals is currently piloting two novel approaches to address increasing demand. These pilots are specifically designed to deal with both short-notice demand and for clinicians with specialist skills, who are always in demand. We expect these pilots to improve effectiveness and responsiveness of the managed services platform and offer an enhanced service for Trusts.
THE OPERATING THEATRE JOURNAL
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AfPP boosts training budget with £40,000 award The Association for Perioperative Practice (AfPP) has received a welcome boost to its training budget with an award of £40,000 from the Charles Wolfson Trust, which gives grants to registered charities in the fields of medicine, education and welfare. AfPP is also celebrating the appointment of Ian Proudler as Fundraising and Development Co-ordinator. The organisation receives no government funding and only 70% of its income is generated from its membership of around 6500 theatre practitioners. AfPP aims to improve patient care in the perioperative environment, promoting best practice through engagement with practitioners and other stakeholders. As well as extensive online and printed resources, the charity also runs free or low-cost study days for its members around the UK, provides advice to hundreds of practitioners every year via its professional advisory service, and visits universities and hospitals to deliver guidance on Continuing Professional Development (CPD) requirements. AfPP also awards bursaries, scholarships and prizes to support members learning needs. Chief Executive Dawn Stott explained: Training is essential for all practitioners throughout their career to ensure that they retain their capacity to practice safely, effectively and legally. Legislation is constantly being updated and safety guidelines enhanced and yet its an increasing struggle for our members to secure both funding and time off in order to attend study events and pursue other learning activities. As AfPP is a charity and receives no government funding, were very pleased with the award from the Charles Wolfson Trust which will help us to reach even more members with events and publications. Were also delighted to welcome on board Ian Proudler, who brings with him an enviable pedigree in fundraising and who were confident will help us to generate additional income to further improve our resources and services.
Lansley launches free whistleblowing helpline service NHS and social care staff who have concerns about patient care will be able to access a new, free whistleblowing helpline from the 1 January, Health Secretary Andrew said recently. The launch means that, for the first time, the helpline will be available to staff and employers in the social care sector, as well as the NHS, via a now-free phone service. The free whistleblowing helpline is funded by the Government and is part of the Governments drive to tackle poor practice. This is in addition to the introduction of a contractual duty to raise concerns, which will be enshrined in the new NHS Constitution. Andrew Lansley said: “Staff on the frontline know when patient services need to improve. That’s why staff who blow the whistle are crucial in helping to raise standards, and were determined to support them. Making it easier for staff to challenge the institutional power of organisations is a key factor in preventing, identifying and tackling pockets of culturally poor practice. Thats why weve created a helpline service for concerned staff, which, from 1 January, will be completely free and available to those in the NHS and social care sector. “This will play an important role in creating a culture where staff will be able to raise genuine concerns in good faith, without fear of reprisal. A similar web-based whistleblowing service is also being developed, with further details to be announced in due course.
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For more information about AfPPs extensive CPD resources and other benefits visit www.afpp.org.uk find out more 02921 680068 • e-mail firstname.lastname@example.org
The Operating Theatre Journal
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Ansell Healthcare Europe announces Europe-wide launch of surgical gloves that fight back against infection-causing viruses and bacteria Ansell Healthcare, a global leader in healthcare barrier protection, announces the European launch of GAMMEX® Powder-Free gloves with AMT Antimicrobial Technology. It is the first surgical glove to incorporate a proprietary antimicrobial coating that provides an additional level of protection to surgical staff against viruses and bacteria, in the event of a breach during surgery.
the risk of contamination in cases of glove perforation,” said Marcus Heimann, Marketing Director – Medical Solutions EMEA & India, Ansell Healthcare. “GAMMEX® Powder-Free with AMT acts like a second skin, with its own immune system to further protect surgical teams against harmful pathogens. Ansell is proud to present this new powerful protection to our customers.”
Healthcare systems around the world have been substantially improved by making healthcare workers aware that gloves provide effective protection against contamination from bacteria and viruses. “Despite rigorous infection control measures, surgical teams remain exposed to
Unlike gloves without AMT technology, GAMMEX® has the power to protect healthcare providers from contamination in two ways – the barrier and the active antimicrobial coating, which acts like an invisible backup system in case of breach.
A study1 revealed that 1 in 3 gloves were perforated during surgical procedures, potentially exposing healthcare providers to pathogens such as HIV or Hepatitis C and drug-resistant bacteria. By adding an additional safety mechanism to the gloves, in the form of an antimicrobial coating, the risks of contamination are significantly reduced, providing surgical teams with peace of mind and the sense of security that is needed to maintain their professional focus. Made of natural rubber latex, the gloves also provide enhanced sensitivity and low allergenicity, creating a new standard for the surgical glove industry.
Misteli et al., Arch Surg. 2009;144(6):553-8. When responding to articles please quote ‘OTJ’
Surgery to Snip Key Nerves May Help Life Threatening Heart Rhythms If you wonder what sweaty palms and abnormal heart rhythms have in common, the answer is both can be initiated by the nervous system during adrenaline-driven “flight or fight” stress reaction when the body senses danger. Governed by the sympathetic nervous system, an abnormal “flight or fight” stress response which causes excessive sweaty palms (called hyperhidrosis) may also contribute to problems like dangerous irregular heart rhythms from the lower chambers of the heart, called ventricular arrhythmias. UCLA cardiologists have found that surgery to snip nerves related to the sympathetic nervous system on both the left and right sides of the chest, may be helpful in stopping dangerous incessant ventricular arrhythmias -- called an electrical storm – treatment methods have failed. This same type of surgery has been used for years to alleviate hyperhidrosis. The UCLA team’’s findings are reported in the Dec. 27/Jan. 3 issue of the Journal of the American College of Cardiology. This is one of the first studies to assess the impact of performing the surgery on both sides of the heart to control arrhythmias, called a bilateral cardiac sympathetic denervation (BCSD). This builds on previous work at UCLA where this procedure was just done on the left side, but to obtain relief, some patients may need the procedure performed bilaterally. Many people suffer from ventricular arrhythmias, which is the leading cause of death in the U.S. (400,000 deaths/year). These arrhythmias can usually be controlled by medications, an implantable cardioverter defibrillator (ICD) that automatically shocks the heart to help bring it back into normal rhythm or a procedure called catheter ablation, which stops the arrhythmia by providing a targeted burn to the tiny area of the heart causing the irregular heart beat. “When these treatment options fail, especially for a patient experiencing a life-threatening electrical storm, the situation becomes critical. We are always seeking additional options to help patients,” said senior study author Dr. Kalyanam Shivkumar, director, UCLA Cardiac Arrhythmia Center and co-director of the Oppenheimer Family Center for Neurobiology of Stress at UCLA. The UCLA findings add to a growing field of research into the sympathetic nervous system’’s impact on stress and possible role in disease. Shivkumar notes that this may provide a unique opportunity. If snipping the cardiac sympathetic nerve proves to effectively alleviate irregular heart rhythms, perhaps this could be a treatment initiated early, before the disease manifests. “In the future, we may be able to correct what is wrong with the heart early, like fixing what’’s broken in an airplane engine before we need a parachute like an implantable defibrillator,” said Shivkumar, professor of medicine and radiological sciences at the David Geffen School of Medicine at UCLA. Specifically, surgeons cut the stellate ganglia, part of the sympathetic nervous system that delivers information to the body about stress and initiates the “flight or fight” response. These ganglia contain thousands of nerve cell bodies, and run on either side of the spinal cord in long chains. From these ganglia, nerves then travel to the heart.
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To help control arrhythmias, surgeons snip the stellate ganglion, as well as the following three ganglia below it to completely remove these nerves that are destined for the heart. The procedure can be done on the left, right, or both sides of the thorax, which is the area of the body located between the neck and the abdomen containing organs such as the heart and lungs For the study, researchers reviewed records from patients at UCLA and a collaborating center in France. The patients presented with electrical storm. The average age was 60 and all were poor candidates for a heart transplant. After other treatments had failed such as medications, catheter ablation and an implantable defibrillator, patients received surgeries to snip the cardiac sympathetic nerves destined for both sides of the heart. Researchers found that after the surgery, four out of the six study patients completely responded with no more arrhythmias. One patient had a partial response and one had no response at all. With their heart rhythms stabilized, three of the responding patients received no more shocks from their ICDs, which would previously occur when the devices tried to normalize irregular rhythms. One of these patients had been experiencing 11 shocks a day. The patient who partially responded to treatment had a shock reduction of more than 50 percent. All five responding patients survived until hospital discharge. Two of the responding patients passed away after discharge due to health issues not related to arrhythmias. No major operative complications occurred in the patients studied. Typical side effects related to this procedure such as alterations in sweating or temperature regulation were not significant. Researchers note that these side effects are usually acceptable to the seriously ill patients who are experiencing an electrical storm, considering that the alternative includes continued arrhythmias, ICD shocks or death. According to researchers, cutting the cardiac sympathetic nerve may interrupt pro-arrhythmic signaling within the heart tissue or stellate ganglion, thus stopping the irregular heart rhythms. “We are encouraged by this small study’’s results, and plan to further examine the role of this procedure in suppressing arrhythmias in a larger patient population,” said Dr. Olujimi Ajijola, a UCLA cardiology fellow and lead author of the study. “This type of innovative therapy is only possible because of close scientific and clinical collaborations between multiple teams of specialists caring for very sick patients” said co-author Dr. Aman Mahajan, chief of cardiac anesthesia and vice chairman of the Department of Anesthesia at UCLA. The research by this group in this area was supported by the National Heart, Lung and Blood Institute, part of the National Institutes of Health. Source-Newswise
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NHS will control Sussex orthopaedic centre
STARKSTROM – PLAYING ITS PART IN CREATING A ‘SUPER HOSPITAL’
A privately-run centre for patients needing hip and knee operations is to come under NHS control. The Sussex Orthopaedic Treatment Centre opened in the grounds of Princess Royal Hospital in Haywards Heath in 2007. The aim was to help cut back on waiting lists by carrying out routine operations on NHS patients from Brighton and Hove and Mid Sussex. The move was criticised by campaign groups, who said the services should not be given to private companies. The centre had been criticised in a review by the former government watchdog, the Healthcare Commission, in 2008. Inspectors raised concerns about some operating theatre procedures and decontamination methods. However, improvements have been made since then. Care UK, which runs the centre, comes to the end of its contract in March. Brighton and Sussex University Hospitals NHS Trust, which runs Royal Sussex County Hospital in Brighton and the Princess Royal, will take over from April. NHS Sussex chief executive Amanda Fadero said: “The orthopaedic treatment centre has successfully treated thousands of patients from across Sussex. “Feedback from patients about the quality of care has been very positive and I am confident it will continue to provide high quality, specialist care.” Source: The Argus
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Peterborough City Hospital, part of the Peterborough and Stamford Hospitals NHS Foundation Trust, was completed at the end of last year at a cost of £289million, and now dominates the skyline with its 13 wards, 612 beds and 18 operating theatres, spread over 4 storeys. The impressive ‘super hospital’ is designed to be modern and forward-thinking, and is equipped to provide the best possible service for patients. To this end, only the most technologically advanced equipment has been installed throughout the hospital, and nowhere is this more evident than in the operating theatres and critical care areas, many of which were fitted out by this country’s leading specialist medical manufacturer and supplier, Starkstrom, using products from its Integrated Solutions range. In its role as one of the new hospital’s key suppliers, Starkstrom worked on the Peterborough project for over two years, equipping 21 theatres with its clinical medical gas pendants, operating theatre lights, surgeons’ theatre control panels and examination lights. Six of the main theatres were fitted with ultra clean canopies. In addition, two critical care areas - the adult and paediatric ITUs, were also fitted with Starkstrom’s clinical pendants. A five year maintenance contract has further extended the hospital’s relationship with Starkstrom, giving access to a 24hr technical support line and ensuring that the complex equipment is maintained by the people who know it best. Crucially, Starkstrom is also able to maintain equipment from other suppliers, making its maintenance contracts an easy, cost-effective choice. Starkstrom is rare in the world of operating theatre and critical care area design in that it is able to put together an integrated package primarily featuring products which it builds in its own manufacturing
facilities, rather than having to source them from other companies. This ensures that hospitals and contractors only need to deal with one specialist supplier, with all the associated benefits such as having fewer sub-contractors on site and lower administrative and commissioning costs. It also means that there is faultless communication between products, whereas those provided by a variety of suppliers may not communicate so effectively. In this challenging financial climate, British-owned Starkstrom is proud to be involved with prestigious projects like Peterborough City Hospital, winning contracts which secure jobs, and supporting British industry by producing world class equipment, primarily manufactured in its British facilities. The operating theatre lights used at Peterborough have several features which set them above others on the market. Starkstrom’s latest MarLED lights have even more design features: lightweight, robust and easy to maintain, they have a unique design which allows the tessellation of the light heads to produce one very large, fully adjustable, light field. The lights also have an adjustable colour temperature, and an illumination depth superior to most others. The light heads are much lighter than usual, and have 3 non-sterile handles, so are easier for staff to position. In addition, they have no moving parts, so maintenance costs and power consumption are low. The Starkstrom medical gas pendants installed in Peterborough’s operating theatres and critical care areas are also full of design features which make them an efficient, cost effective choice. Highly flexible with a high pendant content capacity, the pendants also feature a unique integral cable management system, ensuring visible cabling is kept to
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a minimum for a clear, clutterfree environment. The pendants are easy to clean and ‘infection control-friendly’ due to elliptical arms, extruded aluminium fascia and electrical sockets with no visible fixings, thus eliminating dirt traps. Starkstrom is also able to supply specialist operating tables. Despite being very competitively priced, the table’s high quality and superior functionality make it the ideal choice for the operating theatre. Its maximum weight capacity of 350kg means it is suitable for bariatric surgery, and its six section modular top means it can be easily and precisely reconfigured to suit patients’ and users’ needs. Products from Starkstrom’s Integrated Solutions range can be purchased and installed separately, but it is the company’s ability to provide and install a complete package of integrated operating theatre and critical care equipment, as well as offering the most comprehensive post-installation service provision and warranty, which makes it stand out from the competition. Clients only need to deal with one specialist, experienced supplier, saving time and money and ensuring projects run smoothly and efficiently. The company also has strategic relationships with other key market leaders in the field, so when it is necessary to out-source elements of a project, it is always able to use established partners. Starkstrom prides itself on providing only the most advanced medical equipment and technology, and is proud of its position at the forefront of operating theatre and critical care area design. Starkstrom 0208 868 3732 www.starkstrom.com firstname.lastname@example.org When responding to articles please quote ‘OTJ’
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New processes use ozone and viruses to kill harmful bacteria According to Dr. Dick Zoutman of Queen’s University in Canada, over 100,000 people die every year in North America alone, due to hospitalacquired infections. It would only seem to follow that hospitals need to be kept cleaner, and Zoutman has developed something that he says can do the job - an ozone and hydrogen peroxide vapor gas. Some bacteria are particularly tenacious, however, and that’s where Dr. Udi Qimron of Tel Aviv University comes into the picture. He has developed a liquid solution in which viruses are used to make antibiotic-resistant bacteria once again vulnerable to traditional cleansers. Dr. Zoutman’s bacteria-killing gas incorporates a proprietary form of ozone, and is pumped into spaces such as operating rooms, where it sterilizes every surface within less than one hour. It is reportedly far more effective than wiping the room down with a disinfectant, by hand. The principle, in fact, is the same as that used by the human body - antibodies create ozone and hydrogen peroxide, in order to kill germs. The Queen’s treatment is said to leave the room with a pleasant smell, and doesn’t adversely affect medical equipment. The technology is currently being commercialized by Medizone International, with deliveries expected to begin in the first quarter of next year. Dr. Qimron’s liquid utilizes bacteriophages, which are viruses that infect bacteria. These particular bacteriophages have been genetically engineered, to alter the genetic make-up of antibiotic-resistant bacteria. More specifically, these alterations restore a gene within the super-bacteria’s ribosome, which the bacteria lose in the process of becoming antibiotic-resistant. Certain antibiotics target and bind to this gene, known as rpsL - when the bacteria adapt to the antibiotics and lose the rpsL, the antibiotics can’t bind to them, but when the bacteriophages restore it, the antibiotics are back in binding action. Once it has been further tested for safety at Tel Aviv University, the nontoxic solution could be used in conjunction with regular antibiotic cleansers, in a bucket or spray bottle. It is estimated that one liter (33.8 oz) of the liquid should cost only a few dollars. Source: Gizmag
SonoSites M-Turbo® ideally suited to vascular science Vascular scientists at Queen Elizabeth Hospital Birmingham (QEHB) are taking advantage of the flexibility of SonoSites M-Turbo ® hand-carried ultrasound system to provide a wide range of diagnostic and ultrasoundguided interventional services. Roger Chan, Vascular Scientist at the QEHB, explained: Advances in point-of-care ultrasound technology have significantly improved diagnostic confidence for vascular diseases, and hand-carried systems are now routinely used for a variety of vascular applications, including bedside assessments for inpatients on the ward, one stop outpatient clinics, critical care units and in ambulatory theatre. The multi-functional nature of the M-Turbo system is ideally suited to this varied role, offering rapid, good quality imaging for diagnosis and procedure guidance. The portability and robust nature of SonoSites systems and probes are also very important, as we need to be able to quickly and easily transport them between clinics, wards and theatres. Our MTurbo systems are increasingly being used to provide specialist services such as TIA clinics, DVT clinics and prescreening of cardiac cases to assess donor veins and have also allowed us to introduce ultrasound guided procedures such as endovenous laser treatment (EVLT) and foam sclerotherapy. The M-Turbos compact, ergonomic and user-friendly design also makes it easy to use for all levels of experience levels, from trainees to the most experienced practitioners, and we have been very impressed with both the performance of our instruments and the service we receive from SonoSite; it really does offer the whole package for our needs. For more information about SonoSite products, please contact: SonoSite UK, Alexander House, 40A Wilbury Way, Hitchin SG4 0AP T +44 (0)1462 444 800, F +44 (0)1462 444 801 Email: email@example.com Website: www.sonosite.com When responding to articles please quote ‘OTJ’
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The Year Ahead
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Introduction The surgical world is a fast-paced environment but the technologies that support it have until now been fairly traditional and slow to evolve in nature. This is particularly true if you compare it to other areas of healthcare where technology adoption is often much faster paced. Over the past year, however, the operating theatre has started to witness a revolution in terms of the introduction of new technologies to facilitate and improve surgery. From robotics to the use of multi-mode tomography, the surgical medtech world is truly entering an exciting new phase. Alistair Fleming, Surgical Specialist for product development consultants Sagentia, offers his perspective on trends that could make their mark in 2012: •
Surgery unplugged: Battery power technology has been steadily improving in recent years. Technology is finally reaching the point where the use of batteries in the Operating Room for high energy (and even single use device) applications is closer to reality. Added to that, the cost effectiveness of these new batteries makes single use applications a reality. Freeing the surgeon from the traditional tangle of cables has up till now resulted in bulky equipment with power density limiting the scope of application. New battery technology releases the potential for locally powered, more slimline surgical devices to make both commercial and practical sense. Looking further ahead, battery technology appears to be on the edge of its own revolution with energy storage predicted to be built into the structural fabric of products. This will allow for features to be introduced to a much wider range of devices.
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• Imaging: The use of imaging is expanding from the diagnosis phase toward the treatment phase. Imaging modalities such as X-ray, MRI, PET and CT are well established diagnostic tools, however there is a disconnect between pre-op and per-operative utility. Recent developments in multi-mode tomography have begun to provide deeper insight by combining scans of structure and process. Looking forward, the use of such data during surgery, potentially with overlays onto live endoscopic feeds, could allow more accurate and effective surgery. The Imperial NIHR Biomedical Research Centre has found that the use of augmented reality has risen in recent years, contributing to a range of new methods for training, education and diagnosis. The centre claims that in surgery, advances in medical imaging have permitted detailed pre-operative planning and intraoperative surgical guidance.
• Smaller but more intelligent: Allied to the developments in energy storage, the reduction in size and increasing processing power of electronics provides the opportunity to bring ‘intelligence’ to many traditionally passive devices. In the near future, we expect to see more and more devices conveying operative data and assisting with surgical procedures, be that in gathering target tissue properties, disease detection, usage statistics, integrated imaging or pressure feedback. Successful devices will combine embedded systems with detailed surgical know-how and breakthrough science and technology.
• Robotics: No review of technology in surgery would be complete without mention of robotics. Minimally invasive (or ‘keyhole’) surgery (MIS) was one of the great medical advances of the 20th century, allowing sophisticated surgical operations to be carried out with less trauma. The introduction and adoption of robotics over the recent years shows where MIS could head in the 21st century.
• Use, reuse and reprocessing: Over the past decade, medical product manufacturers have shifted focus from reusable devices to single use devices and now, in a twist driven by economics and the environment, towards the reprocessing of a single or limited use device. This can be seen particularly in the US surgical device markets where products from trocars to energy devices are routinely reprocessed and remarketed. With the large OEMs following this trend, product portfolios and business models may be scrutinised to respond to this shift.
Surgical Technologist states that the da Vinci Surgical System is a huge advancement that brings medicine closer to mistake-proof surgery. It is a robot-assisted laparoscopic surgery technique that is revolutionising the field of minimally invasive surgery. The da Vinci system allows the surgeon to work from a console instead of directly on the patient, while viewing the surgical field in full 3-D. The doctor then operates micro-instruments that perfectly mimic his or her every move, allowing the robotic “hands” to do the actual work on the patient.
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However, while the da Vinci system is now almost ubiquitous, the question on everyone’s mind is what shape will robotics take in the future? Research from both industry and academia demonstrates the huge potential within this field. These advances in technology to assist MIS will continue in 2012. Robotics in 2012 will illustrate the ideal blend of systems software, hardware and electronics to directly assist the surgeon to reduce fatigue, steady the hand and reach areas otherwise impossible to operate on directly. Not only will robotic surgery adoption expand into new indications, but we feel that the future may look very different from most people’s experience, with new products on very different scales, catering to specific needs.
Conclusion With great technology, offering advancements in procedure and efficacy comes great responsibility; the operating room is an environment requiring assured reliability. Newly introduced products and technology must undergo a rigid evaluation process, be deemed safe and effective and demonstrate cost effectiveness. By no means is this the place for gimmicks or fads. As a result, the surgeon’s toolkit has remained fairly traditional in contrast to the influx of new technology in other areas of the healthcare and consumer sectors. Surgeons will adopt new technology only if there is a clear, demonstrable advantage. As such, new products must be well researched and developed in sympathy with the voice of each stakeholder, be that the patient, surgeon, nurse or procurement office. However, with the right approach and implementation, the future holds some hugely exciting possibilities. Alistair Fleming, Surgical Specialist, Sagentia
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Thames Barrier: The decision to close the Barrier is based on a combination of factors, including the measurement of ﬂuvial river ﬂow entering the tidal Thames. Hydrological and meteorological data is fed into the control room at regular intervals and a mathematical matrix guides the closing regime. The end decision to close lies with the duty controller.
We provide the precision technology. You provide the expertise. The inﬁnite challenge of controlling ﬂuid is universally recognised. Engineers continue to devise ever more inventive and unique ﬂuid management solutions, designed to inform decision makers, minimise risk and protect against preventable damage. However, technology alone cannot negate the beneﬁts of insight and experience. During the intraoperative period, the effective management of intravascular ﬂuid is guided by the insight of the experienced anaesthetist, made easier by the availability of accurate and reliable patient data. Oesophageal Doppler monitoring using the CardioQ-ODM is the only therapy to directly measure blood ﬂow 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 ﬂow and measures them immediately. Placing a single-use probe in the oesophagus, the ODM technology precisely measures 10% changes in stroke volume, enabling clinicians to effectively intervene early during surgery, and control the management of ﬂuid. Randomised, controlled trials using Doppler have demonstrated that early ﬂuid management intervention will reduce post-operative complications, reduce intensive care admissions, and reduce the length of hospital stay. And whilst interventions requiring arterial access can only be applied to a limited number of surgical procedures, the ODM technology can beneﬁt the wider surgical population.
Tarilian Laser Technologies achieves greatest technological advance in blood pressure measurement for 130 years New optical sensor makes current blood pressure measurement devices obsolete Tarilian Laser Technologies (TLT) has invented a completely novel method of measuring blood pressure based on an optical sensor, reports Medical Technology Business Europe. The sensor outperforms the current “gold standard” for measuring blood pressure and effectively makes the older technology obsolete. The accuracy, breadth of data recorded, size and ease of use of the sensor are likely to have a profound effect on blood pressure measurement in the clinical setting, medical research and also home healthcare.
These abilities alone make it a world-beating technology, but what makes the sensor even more groundbreaking is its ability to measure blood pressure on virtually any part of the body without exerting pressure and with no energy entering the body. This creates additional unique applications: • blood pressure measurement of the eye without putting pressure on the eye; • foetal heart monitor; • health and blood pressure of the arteries in the leg; • health and blood pressure of the neck arteries (the carotid); and • highly accurate miniature sports biometric devices.
The TLT cuff-based blood pressure device incorporating the unique TLT sensor. TLT’s first product is a highly innovative consumer blood pressure device that is cuff-based and has unique features including superior accuracy and ease of use compared to current devices. Also, unlike other devices it does not need calibration to ensure accuracy of readings. The company is now completing the manufacturing scale-up and translation programme and expects to enter significant sales revenue by 2012. It has already secured advanced sales interest in this device, with first-year volumes expected to reach about 1 million units. TLT’s next-generation Sapphire sensor system allows direct measurement of blood pressure without a cuff within seconds. A further advantage is that the sensor doesn’t just measure blood pressure, it generates a continuous beat-tobeat blood pressure measurement and other ‘haemodynamic’ data, which in combination enable it to give a more complete vascular assessment than any other blood pressure device. This will give clinicians a much improved toolset for monitoring, diagnosing and treating patients suffering from a wide range of diseases.
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This miniature sensor will also make it possible to put blood pressure sensing technology into a completely new range of devices, such as a bracelet, plaster, pen, computer mice, mobile phones and clothing, so that the measurement of blood pressure could become completely innocuous and ubiquitous, while still achieving a high level of accuracy. With the growing use of healthcare in the home - as emphasised by David Cameron’s announcement of the 3 Million Lives Campaign to use telecare to monitor patients’ health in the home - the sensor provides a much simpler and accurate way to take the blood pressure of patients automatically and transmit the data to a telecare device. Dr Sandeep Shah, CEO of TLT, said, “This an exciting time for us. The TLT company was founded and developed in Hertfordshire, UK and within a short period of time, we have broken the barrier on sensor capabilities with our novel optical technology. The TLT sensor, because of its power, simply makes other technologies in medical biometrics obsolete, so we see the potential to have our sensor in every blood pressure device - which is a potential worldwide market expanding to a projected 100 million devices a year - projecting TLT into a billion plus dollar company within a short period of time.” “The technology is very scaleable and affordable; and indeed can compete extremely well with current costs within the BPM sector, and yet it offers unique and powerful advantages over all other technologies. These features simply do not exist with any other technology and this makes TLT a disruptive technology that has both redefined the state of the art of blood pressure monitoring and one that has created a paradigm shift in cardiovascular medicine. It has even been suggested that the ability of the TLT sensor to collect such a rich set of data on the cardiovascular system has opened up a whole new area of physiology. Furthermore we have created a unique proprietary production process of this optical sensor to manufacture large volumes, making us ready to capture this market with ease.” Dr Art Tucker, Principal Clinical Scientist and Vascular Researcher at St Bartholomew’s Hospital, V London, said, “The TLT sensor is a highly novel promising new technology that will have a large and a positive impact in this field. It is an exciting and a powerful new development in vascular science and a has created a new state of the art in blood pressure measurement. THE OPERATING THEATRE JOURNAL
It will no doubt be of great value both in hospitals and primary care as well as at home for the consumer, and offers a new paradigm in vascular biometrics.” Dr David Jefferys, ex Chief Executive and Director of the UK Medical Devices Agency, current President of The Organisation for Professionals in Regulatory Affairs (TOPRA), said, “Blood pressure is a critical biometric measurement in medicine and has ubiquitous utility in all areas of medicine and also in research, including pharmaceutical trials. There has been significant controversy and debate about the current BPM technologies - ausculatory, oscillometry and tonometry, especially. A lot of this debate has centred around the inaccuracies and the poor reliability of these systems, which has led to a series of regulatory concerns and investigations by the MHRA, US FDA and also AAMI.” “These concerns are of serious nature,” Dr Jefferys continued, “not just relating to causative morbidity but also mortality. Indeed, of particular note are the concerns of poor performance of these systems in sub-populations eg the elderly, children and also in pregnancy. A series of recent papers has highlighted technical performance issues with these older systems and also the limitations of their accuracy and reliability. Hence, there is a clear need for a better and more accurate, more robust, versatile technology to be made available within this critical field of medicine - not just from the view of experts but also from a general patient and consumer perspective.” “Simply put,” said Dr Jefferys, “the TLT Technology offers a significant competitive advantage to all others that are in the market. Furthermore, TLT’s Sapphire cuffless sensor promises to deliver a sophisticated and elegant solution to future demands within this sector. The TLT Sapphire sensor development has created a pioneering platform from which further technological advances in haemodynamic profiling may be realised and thus improve the management of an array of medical conditions.” Dr Shah concluded: “I often reflect on what I would like to achieve in my career in medicine and medical technology development, and to have created the world’s first unique optical sensor that accurately generates a carotid and eye BP makes me feel very satisfied and proud. The benefit to patients and also to the healthy to prevent disease is huge, and of course the associated commercial opportunity is also huge - into the billions of dollars! I believe that when we scale up our future developments at TLT, we will deliver an innovation explosion in further applications of our technology. And what’s more, it makes me proud that we intend to create up 19 new jobs in the first year of production and rising to over 60 in year three.” For further information contact Dr Sandeep Shah CEO, Tarilian Laser Technologies. Tel: +44 (0) 1707 356 112 Email: firstname.lastname@example.org Website: www.tarilian-lasertechnologies.com Source: Medical Technology Business Europe
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New discovery could lead to better artificial hips
Devon Positioning Products TM
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For many people who have suffered from an arthritic hip, the replacement of their natural hip bone with a prosthetic implant has meant an end to constant pain, and the restoration of a normal range of movement. Unfortunately, the ball-and-socket joints of the prostheses do wear down over time, so younger patients in need of the implants are typically told to either wait until they are older, or must face the prospect of someday requiring repeat surgery to service their device. A recent discovery, however, could lead to longer-lasting artificial hip joints - this could in turn allow patients to receive prosthetic hips at a younger age, without the need for additional surgery when they get older. Although a previous generation of artificial hips used a combination of metal and polyethylene surfaces for their ball-and-socket joints, these have since largely been replaced with longer-lasting metal-on-metal joints. It had previously been observed that over time, a lubricating layer formed between the two metal surfaces, once the implant had been in use in the body. Scientists generally assumed that this layer was made from some sort of protein from the body, as is the case with natural skeletal joints.
Designed to aid correct patient positioning and pressure distribution, the DevonTM positioner range protects against complications, pressure sores and nerve damage.
Recently, however, a team of physicians and engineers from the United States and Germany analyzed the lubricating layer on metal joint components that had been removed from patients in revision surgeries. To their surprise, they discovered that the layer was composed at least partly of graphite carbon. This is a solid lubricant, which is typically used in industrial applications.
Supplied vacuum-packed for easy storage, these lightweight disposable positioners offer an inexpensive alternative to gel positioners.
“Knowing that the structure is graphitic carbon really opens up the possibility that we may be able to manipulate the system in such a way as to produce graphitic surfaces,” said team member Dr. Alfons Fischer, of Germany’s University of Duisburg-Essen. “We now have a target for how we can improve the performance of these devices.” The researchers now plan on correlating the condition of layers on removed implants with those implants’ reasons for removal. They are also studying how neighboring cells could be affected by graphite particles that fl ake off of artificial hip joints. The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. A paper on the research was published on December 23rd in the journal Science.
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Welsh TA medics reveal what battlefield life is like as they prepare for Afghanistan tour of duty As if working in the NHS wasn’t hard enough, many employees are also in the Territorial Army. Health Editor Madeleine Brindley of the Western Mail spoke to members of 203 (Welsh) Field Hospital as it prepares to deploy to Afghanistan in 2013. COLONEL Tina Donnelly has just been appointed commander of 203 (Welsh) Field Hospital and will lead the unit’s deployment to Afghanistan in 2013. Her 20-year career in the Territorial Army has seen her serve in Bosnia, Kosovo, Iraq and Afghanistan in a series of senior roles, including the equivalent of matron. In civilian life, Col Donnelly is the director of the Royal College of Nursing in Wales. “I’m in civilian and military life because I want to make things better. Being part of a team and knowing that you can make a difference is a real driving force.” Speaking about her new command and the 2013 deployment, Col Donnelly said: “This is an exciting time to prepare a unit because of all the motivation and enthusiasm of the team we’ll be taking. “It’s about making sure we’re together and trained to the highest standard to deliver the highest standard of care when were on operations. “The fact we’re not going out for the first time is something of a relief – the last time out we had an excellent commanding officer who was a phenomenal leader. “Being in a war and under insurgency conditions doesn’t worry me because that’s what we train for – you have to have a level of efficiency and you have to prove your military skills. “It would be wrong to say, as the commanding officer, that you’re not concerned about making sure your team come back safely because it is an issue. “It is a brutal environment out there but you have to rise to the challenge. “I’ve spent four months in Afghanistan previously and a lot of the team going out have also served there – we are constantly going out. We will be taking some novices but we will look after them. “People join the TA to do something different and for a plethora of reasons, but ultimately it’s to work together as a team and deliver healthcare. “That’s the ethos of the unit and that’s been my experience of any members of the team who have gone out.” CAPTAIN Phil Thomas became the first operating department practitioner in Wales to win a commission earlier this year. The 45-year-old, who joined the Territorial Army in 1989, currently works at Prince Charles Hospital, in Merthyr Tydfil. Operating department practitioners work in operating theatres as anaesthetists’ right-hand men; care for patients in recovery and work on trauma and cardiac arrest teams.
Capt Thomas, who lives in Penderyn, near Aberdare, said: “When I joined the TA I was an infantry soldier for 10 years but when I went to do operating department technician training, I was advised to go to the medical corps, where I joined 203. “When they started calling people up for Iraq that changed everything – it was getting really exciting. “It was a bit of a shock because I only had 10 days’ notice and I didn’t have a clue what to expect. I went just before the war started and I don’t think anyone knew what to expect. “It was much harder than working in Afghanistan, where I was there for five-and-a-half months. In Iraq it was weeks before we could get to a telephone because the camps weren’t really established. “But in some ways it was better because we learned to live with what we had. “It was different when we deployed to Afghanistan – the training we went through was totally different. “At Camp Bastion you’re still in a tent, sleeping on camp beds but the food is good and there’s a gym. However, you can forget your normal NHS working hours – at one stage in Afghanistan I was working for 36 hours. “The 2008 tour was totally different to that in 2010 – the injuries were getting worse and although we were getting better at treating them, the Taliban were also getting better and making them. “It’s long hours and completely different to working in the NHS. You go back to your tent at night and you reflect on what’s happened; you think about the boys on the frontline – we’re there for them. “You do see some horrible things but you pull yourself together and get ready for the next shift.” Capt Thomas said his experiences in Afghanistan and Iraq benefit not just the NHS but Wales itself. “Doctors working here have probably never seen the kind of trauma I have. Last year, when we’d come back from Afghanistan, a soldier was injured in Sennybridge and I was asked to come in and advise. “I’ve been called to many trauma calls, I’ve given lectures to doctors and nurses and surgeons have consulted me. “But when you ask who benefits the most, I think it’s the patient at home who benefits from the little things I’ve picked up from being in Afghanistan.” LIEUTENANT Colonel William McFadzean is a consultant anaesthetist at Morriston Hospital, in Swansea. Formerly in the regular army – he joined as an anaesthetic registrar – he moved to Swansea in 2005 and joined 203 Field Hospital. The 56-year-old believes the main difference between the army and the NHS is simply that, in the army, you go to work in uniform before changing into scrubs.
“The techniques are the same as in normal day-today practice, although there is more formality in the military than in the NHS, which seems to have disappeared. “Working on operational tours is fantastic because you get to put all your skills to the test – it’s hard work, stressful but unbelievably rewarding. “I’ve done three tours of Afghanistan and I go back each time because I do thing out there that I don’t do here in the NHS. “Due to the complexity of the cases you’re tested to the limit but you’re part of a team where everyone knows what they’re supposed to do. It’s an unbelievable set up.” When Lieut-Col McFadzean first deployed to Afghanistan in 2007, the field hospital was under canvas, there were two operating tables and a fourbed intensive care unit. In 2010, his third tour, there were four operating tables, two CT scanners and eight ITU beds. “Even under canvas it was an unbelievably complex system – it really was an all-singing-all-dancing hospital with all the equipment you’d expect. “Everything in the hospital is so close to each other – from the emergency department its 10 seconds to the operating theatres and just seconds to the scanners, blood bank and intensive care unit. “Everything is in close proximity and you have all these experienced clinicians available 24-hours-a-day, seven-days-a-week. That just doesn’t happen in the NHS.” During his 2008 tour, Lieut-Col McFadzean was part of the helicopter retrieval team, which would take wounded soldiers from the frontline to the hospital at Camp Bastion. “As a doctor, this was the only time someone like me would be sat on a helicopter, unless you were on the frontline with the troops. The Chinooks make big targets for the Taliban and I found the whole experience incredibly exciting. It was as close as you get to the frontline. “The whole point is to bring expertise as far forward as possible to the injured soldier – as soon as he’s picked up and put on the back of the helicopter, resuscitation can begin. “It’s still sophisticated medicine – the people on the back of those Chinooks are extremely well trained and experienced.” He added: “I cam back from these three tours fizzing with expertise and experience in terms of dealing with major trauma, the things that you don’t see in the NHS unless you work in an exceptionally busy trauma centre. They say Bastion is the best trauma centre in Europe, if not the world.” SERGEANT Gary Wilkinson is a combat medical technician with 203 Field Hospital. By day, the 29-year-old from Cardiff works as a lab assistant. He joined the Territorial Army when
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he was 18 and about to study law at Aberystwyth University. Sgt Wilkinson said: “I wanted to experience a bit of military life – some of my family have worked in the military. “I really wanted the best of both worlds so I joined when I was 18 in the same week I went to university. “It worked out OK – I fitted my studies around the unit and vice versa and I was quite happy with the extra pay. I used a lot of my wages to pay my way through university. “I studied law at university but after doing four operational tours, I’d really enjoyed being involved in the clinical field and I didn’t feel like going in a legal direction. “I did a bit of work in offices in administrative posts but I wanted to pursue a civilian clinical career.” Sgt Wilkinson has completed two tours each of Iraq, in 2004 and 2005 and Afghanistan, in 2006 and 2008, with 203 Field Hospital. “At first I didn’t quite know what to expect. I flew out with another unit and arrived in the desert in Basra during the hottest three weeks of the year – it was about 62C. “I’d come straight from the UK and arrived at midday. I could only walk 100m and then I had to stop and have a break. It was very different from being back in the UK. “But while you’re there you get on with the job you’re doing; your training kicks in and you’re surrounded by like-minded individuals and you work as a team. “It’s possibly the best way of learning – you keep an eye out for each other. I don’t know where in civilian life that happens. “On the first tour I worked in hospital management, which was mainly paperwork and keeping track of casualties and informing their units where they were. Then I worked in A&E, which was a hands-on role. In Afghanistan I’ve also done a number of roles in forward posts and at Camp Bastion. “Sometimes, especially when you’re on the ground, you are aware you’re in an austere and inhospitable environment with the associated danger of having the enemy around you. “The risk is always in the back of your mind, but you focus on the team around you. My role in the forward operating base was as the only medic so everyone looks to you when there’s any incident but also for primary care. “You have to exert an air of calmness but, yes, it’s always in the back of your mind.” Speaking about how the NHS benefits from his work with 203 Field Hospital, Sgt Wilkinson said: “I think it has made me capable of deciding on the right course of action and being more decisive with it. And hopefullyI can bring a bit of team work from army life into civilian life.”
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Europe blocks export of execution drugs The European Commission on the 20 December announced that it is blocking the export of certain key lethal injection drugs which are widely used in US executions.
Mark van Rossum, General Manager of Fujifilm, presenting the donation of £1,000 to Jonathan Prince of the Pink Ribbon Foundation.
In 2010, Fujifilm donated £1,000 to the Pink Ribbon Foundation following their Symposium Mammographicum exhibition, and sought to extend their support throughout 2011. Mark van Rossum, General Manager at Fujifilm explained: “Fujifilm are dedicated to sponsoring worthwhile causes, and the Pink Ribbon Foundation is a perfect fit for us. We’ve used the Pink Ribbon logo on our recently refurbished Mammography Van, and made a further donation of £1,000 following UKRC.” The cheque from Fujifilm was presented to Jonathan Prince of the Pink Ribbon Foundation on 23rd November 2011. The Pink Ribbon Foundation has very little infrastructure and relies on volunteers in order to maximise the amount that goes to the charities which benefit from the funds raised. Operating in this way allows the Foundation to help charities both large and small – and many of the small organisations rely on donations such as these to keep them going. Fujifilm – pioneers in diagnostic imaging and information systems. Please quote ‘OTJ’
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A number of anaesthetics, including substances currently used as the first stage in a three-drug lethal injection ‘cocktail’ by US states, have been placed on a list of controlled substances which could be used in capital punishment. This is an important first step by the European Union in preventing the unethical use of medicines in executions, although it is still short of the catchall provisions necessary to ensure that no European drugs of any type are used to kill prisoners. It comes in response to a long-running investigation by the legal charity Reprieve into European complicity in executions by lethal injection. A draft of the amended regulation seen by Reprieve states: “It is […] necessary to supplement the list of goods subject to trade restrictions to prevent the use of certain medicinal products for capital punishment and to ensure that all Union exporters of medicinal products are subject to uniform conditions in this regard. The relevant medicinal products were developed for inter alia anaesthesia and sedation and their export should therefore not be made subject to a complete prohibition.” The regulations ban a number of short- and intermediate-acting barbiturates, including sodium thiopental and pentobarbital, which are currently used across executing states in the US as the first stage of a three-drug lethal cocktail – or in some cases, as a large, single, lethal dose. Reprieve’s Executive Director, Clare Algar said: “This is an important and positive first step in preventing the use of European drugs in executions. However, we need to see a broad, catch-all provision to prevent any drugs from being used in capital punishment in order to ensure Europe is never again complicit in the death penalty. “This should also make it clear to European firms, wherever they operate, that to continue supplying drugs for use in executions will be a clear breach of the spirit of the law. Any pharmaceutical company wishing to preserve an ethical reputation must take steps to ensure their drugs are not used to kill prisoners.” Source: Ekklesia
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Newspaper reports glamorise survival chances after cardiac arrest The public may have an over-optimistic impression of survival and neurological outcome after cardiac arrest because newspapers tend to report success stories. Good news might be unusual in newspapers but when it comes to cardiopulmonary resuscitation (CPR) the opposite applies, according to the results of new research published last month in the Journal of the Royal Society of Medicine (JRSM). The research team, led by Richard Field, Clinical Research Assistant, Heart of England NHS Foundation Trust, analysed all UK newspaper articles published between 1 January and 30 June 2010 containing the words ‘cardiac arrest’, ‘CPR’ or ‘resuscitation’. 203 articles were identified as referring to individual cardiac arrests. Of these, the researchers focused on the 181 cardiac arrests that occurred outside hospital. In this group newspapers reported that 17.7% survived to hospital discharge, almost all with good neurological outcome. This compares with an estimated survival rate of less than 10% for out-of-hospital cardiac arrests in Europe. It is important that public expectations of cardiac arrest survival and outcomes following CPR are realistic. However, perception of survival rates following CPR is much higher, with the public estimating survival rates of over 50% whereas survival to discharge is actually less than 10% for out-of-hospital arrests and 10-20% for in hospital arrests. It is likely that the majority of perceptions are formed through the portrayal of resuscitation in fictional medical dramas.
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UK medicines and medical devices regulator awards first elective prize for medical students A Kings College Medical School student with a special interest in hip replacement surgery is the recipient of the Medicine and Healthcare products Regulatory Agency’s (MHRA) first Trainee Doctors Advisory Board (TRAB) elective prize. The prize, worth £500, was introduced this year to encourage medical students to undertake electives in the area of safeguarding public health, encouraging the development of expertise and innovation in areas relevant to the MHRA’s business. The winning entry culminated in a presentation discussing metal-on-metal hip replacements and drew upon research conducted at the London Implant Retrieval Centre, as well as surgical experience undertaken by the applicant in his elective year at the Texas Medical Centre.
Mr Field said: “Public perception of outcome following a cardiac arrest is very important as it has the potential to influence the motivation for learning and performing CPR as well as making and/or supporting do not attempt cardiopulmonary resuscitation (DNACPR) decisions.” The Resuscitation Council (UK), which funded the study, advocates a joint approach to DNACPR decision-making. This can involve both the patient, or those close to the patient and the clinical team. It is therefore important that public perception is accurate of cardiac arrest survival to ensure correct decisions are made and expectations are realistic. The higher survival rate of newspaper reported resuscitation is likely to be associated with several factors. Resuscitations in a public place and involving heroic bystander CPR attempts are more likely to attract the media looking for high-impact news stories. Also, in reality around 70% of cardiac arrests occur at home and only 36% of these patients will receive bystander CPR, compared with bystander CPR performed in 75% of events occurring in a public place. These two factors alone are likely to be responsible for the over-optimistic survival rate portrayed by the newspapers. Epidemiology and outcome of cardiac arrests reported in the lay-press: an observational study by Richard A Field, Jasmeet Soar, Jerry P Nolan and Gavin D Perkins is published in the December issue of the Journal of the Royal Society of Medicine (JRSM).
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TRAB was first established in 2009 and is a voluntary advisory board made up of junior doctors recruited through the country’s medical deanery network as well as cross-Agency representatives from the MHRA. Board members, who are selected to represent a wide spectrum of medical interests, meet about twice a year to act as a sounding board and advise on diverse Agency matters.
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“To date TRAB members have provided valuable feedback on diverse Agency initiatives from medical device and medicines education modules” explains TRAB lead and Senior Medical Officer in the Medical Devices team, Dr Nicola Lennard.
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“In this first year of the elective prize we have restricted applications to medical device-orientated topics. For 2012 we will be opening up a further £500 prize for medicines-related projects which will significantly raise the profile of the competition.” she said. www.mhra.gov.uk
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“.....it is recommended that all hospita als s have able for bo oth routin ne second generation SADs availa ent” use and rescue airway manageme 1
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Reference (1): 14th National Audit Project of The Royal College of Anaesthetists and the Difﬁcult Airway Society. Major complications of airway management in the UK. Report and ﬁndings. March 2011. Chapter11. Page 95