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May 2014

Issue No. 284

ISSN 1747-728X

The Leading Independent Journal For ALL Operating Theatre Staff

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NHS Leadership Academy launches programme Surgeons Open New Birmingham Centre for next generation of systems leaders Britain’s oldest surgical Royal College opened their first-ever regional Applications are now open for Intersect, the ground-breaking new systems leadership programme from the NHS Leadership Academy, delivered in partnership with Leadership for Change. The year-long programme will provide the in-depth learning and transformational development that leaders working across the public and third sector need to deliver high-quality services with limited resources in a highly complex environment. Participants will develop the skills they need to work across sectors, returning to their workplace equipped with the understanding, self-awareness and confidence to work and deliver the whole systems co-operation and change that public sector demands.

centre in Birmingham’s Colmore Row with a series of innovative educational events aimed at the 80% of its UK membership based in England and Wales. The Royal College of Surgeons of Edinburgh dedicated to promoting the highest standards in surgical education, training and clinical practice; is running an exciting calendar of events, on the theme of patient safety, at its new Midlands base. From career development workshops, to presentations on operating theatre checklists, and discussions on the role trainees can play in advancing patient safety, Birmingham will play host to a unique week of events covering some of the most important issues facing the surgical profession.

Open to just forty people from across the public and third sectors in England, the programme is aimed at those in a position to lead systemwide change in the public sector. They are likely to be senior leaders, possibly on or reporting to the executive team, in positions that require people to work across and beyond organisational boundaries. Dr Nicholas Bradbury, Head of Systems Leadership at the NHS Leadership Academy, described the transformative learning that participants will undertake: Intersect will demand a significant commitment from participants and the organisations from which they come. Through the programme, participants will need to be willing to undertake a deep exploration of themselves, to ask and to answer some probing and difficult questions. Participants will base their learning in real projects in their places of work and demonstrate the impact those projects, and their learning, have had. On completion of the programme, they will make a significant impact to the local health, social care and public services economy when they return to their workplace and will be expected to share their learning and to develop an understanding and capability around systems leadership in their locality. Chris Lake, the NHS Leadership Academys Head of Professional Development, said: Taking a systemic approach to leadership across the public sector is really the only way to make genuine progress. Working across boundaries, being adaptable, looking for whole-system synergies, relying on trial and error over organisational charts and planning, and solving wicked problems with clumsy solutions. These are the skills and practices of the systemic leader and these are the skills and practices which participants on the Intersect programme will be focussing on. Jan Sobieraj, Managing Director of the NHS Leadership Academy said: The NHS can no longer expect to tackle the challenges it faces in isolation. To deliver the exceptional outcomes and outstanding care the population needs, the health service needs to work in close partnership with local government, social care, education and the third sector as well as with our communities themselves. With the Intersect programme, we are looking to provide the next generation of system leaders from across the public and third sector with the skills, understanding and self-awareness that they will need to succeed. Applications are open now, and can be made through the NHS Leadership Academys website: http://www.leadershipacademy.nhs.uk/grow/intersect/ For further information on the Intersect leadership programme, please email intersect@leadershipacademy.nhs.uk or call 0113 322 5663.

RCSEd President Ian Ritchie, Sir John Temple and Neil Rami chief executive Marketing Birmingham

Celebrating the College’s first-ever base outside Edinburgh at an evening reception on Thursday 3 April were prominent local figures such as Councillor Ian Ward, Chief Executive of Birmingham City Council Mark Rogers, alongside key representatives from the region’s health sector such as Chairman of Sandwell and West Birmingham Hospitals NHS Trust Richard Samuda; Drs. Russell Smith and Rob Cooper of Health Education West Midlands; Dean of Medicine for the University of Birmingham Professor David Adams; Warwick Medical School’s Dean of Medicine Professor Peter Winstanley and Elisabeth Buggins of the Birmingham Women’s NHS Foundation Trust. With 22,000 members around the world, the RCSEd’s presence means Birmingham is set to become a centre for innovation and development in surgery, as the College rolls out exciting courses on a range of topics; including core surgery skills for medical students (learning to handle instruments, manage wounds and suture), implant dentistry, anatomy sessions and a course designed by orthopaedic surgeons to train GPs in bone and joint health issues. Commenting on the Birmingham base, President of the Royal College of Surgeons of Edinburgh Mr. Ian Ritchie, a consultant trauma and orthopaedic surgeon, said; “Patient safety lies at the heart of everything we do as a College and is the principle which guides our membership. We therefore feel strongly that we need to provide the best services and facilities possible to everyone who has chosen to be part of our College, wherever they are based. Our new centre in Birmingham confirms this commitment by providing a focal point for our activity in England and Wales and cementing the College’s strength and relevance throughout the UK. I am thrilled to join our Fellows, Members and Affiliates, as well as our colleagues in all areas of healthcare, during this exciting opening week of events and hope they will feel at home in both our Birmingham base and Edinburgh headquarters for many years to come. “Source: Bdaily

The next issue copy deadline, Friday 23rd May 2014 All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY Tel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.com The Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, 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 above. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2014 Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks. All paper and ink waste is recycled.

Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD Find out more 02921 680068 • e-mail admin@lawrand.com

Issue 284

May 2014

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Explosion in NHS sell-off just one year on from governments changes Unite, the countrys biggest union, warns of an explosion in the selloff of NHS contracts to profit-first providers just one year on from the governments Health and Social Care Act. New findings from the NHS Support Federation show that in the year since the governments changes came into effect there has been a 30 per cent rise in the number of NHS contracts put out to competitive tender with their value increasing more three times to total £13.5 billion.

The invisible bugs that lurk on your hands Public Health England (PHE) supported the World Health Organizations Clean your Hands campaign on May 5 2014 by making that which is invisible, visible. Our hands touch hundreds, possibly thousands of surfaces each day and hands play a key role in spreading bacteria and viruses, some of which may be harmful to our health. They cause illness by what in scientific terms this is called the faecal-oral route of transmission. This is where we touch surfaces and then put our hands, and the bugs - including ones that are found in human faeces - into our mouths. Bacteria from faeces are spread around when people dont wash their hands after using the toilet, changing nappies, handling cat litter and similar activities. This striking selection of photos is from pressing real hands onto a growth medium that only allow germs of potential faecal origin to grow. This was done after touching everyday objects and contaminated foods or after using the toilet. The coloured areas show bacterial colonies grown from contamination on the hands.

With 70 per cent of NHS contracts being awarded to private companies over the last two years, serious questions need to be asked about the impact of the governments new contract culture on patient care and service quality. Unite is today backing the call for an inquiry into the impact of the governments changes, looking at the cost to the NHS of the new contract culture in terms of the bidding process and associated costs, as well as service and staff cuts as companies put profits before patient care. Responding to the new findings from the NHS Support Federation, Rachael Maskell, Unite head of health, said: The British public will not be deceived by Jeremy Hunt and David Camerons promises that the NHS is safe in their hands. Today we have proof that the government is flogging off great chunks of the NHS to profit hungry businesses. The findings are truly shocking; we are witnessing an explosion in the sell-off of the NHS in one short year with a massive 70 per cent of NHS contracts shifting to private hands and the number of contracts up for tender rising to 30 per cent.

Hands after handling raw chicken

Hands after handling old dishcloth

Hands after using the toilet

Hands after cleaning surface used for raw meat preparation

Peter Hoffman, an expert in infection control at PHE and the owner of the hands in the pictures, said: People may not be aware of how many germs they get on their hands after doing a range of general everyday tasks so this series of photos really helps to highlight this. Just as contamination was passed from my hands to the growth surfaces in the pictures, so it could be passed from your hands to your mouth, the food you handle or any other route of infection. Washing the hands using soap and water is integral to breaking the cycle of transmission of harmful bugs whether that is in a hospital or in our own homes and everyone needs to adopt this very good habit. Ingestion of these bacteria and viruses can cause a range of gastrointestinal and respiratory illnesses including E.coli O157, norovirus, colds and flu. It is also a way in which highly antibiotic-resistant bacteria can be spread around. These are increasingly being recognised as a major threat to public health. This next series of pictures show how the bacteria and viruses are removed with handwashing. It does not sterilise the hands but when done properly it greatly reduces contamination that is why there are still some bacteria on the hands as seen in the photos. The more germs there are, the greater the chance they will cause an infection so handwashing is a method of reducing potential harm.

At this rate, what will be left of the NHS by the next general election? That is why Unite is launching the community campaign to save it. David Cameron and Jeremy Hunt have to respond and explain to the public how he can justify diverting precious NHS resources away from patient care when the NHS is facing a £30 billion funding gap over the next four years. According to the NHS Support Federation findings 500 NHS contracts, worth £13.5 billion and covering 77 different types of care and treatment up from 44 a year before were advertised by NHS bodies in the last 12 months.

Hands after washing after handling raw chicken (thumb deliberately missed)

Hands washed after handling old dishcloth

Hands washed after using the toilet

Hands washed after raw meat preparation

Dr Paul Cosford, Director of Health Protection and Medical Director at PHE, said: It is quite shocking to see just how many bacteria we get onto our hands from doing everyday tasks. If we dont wash our hands properly then just one bacterium can grow into hundreds and thousands in a relatively short space of time. These are then spread around our environment and onto other people and so on. This is why it is so important that we wash our hands thoroughly particularly before preparing food, after handling raw meat and after going to the toilet.

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Pig hearts could be transplanted into humans after baboon success A genetically engineered pig heart which was transplanted into a baboon has survived more than a year without being rejected, leading scientists to hope that animal parts could one day provide a limitless sources of organs

Those on waiting lists have to use an artificial heart but these are not perfect and have issues with power supplies, infection, and both clotting and haemolysis, the break down of red blood cells.

The genetic modifications also mean that fewer immunosuppressive drugs are needed which are often responsible for complications. When Christiaan Barnard attempted the first heart transplant in 1967 it was the drugs which killed his patient as his immune system was so weak he died from pneumonia.

The hearts of genetically modified pigs could be transplanted into humans to solve the shortage of organ donors, scientists believe.

Transplantation using an animal organ, or xenotransplantation, has been proposed as an option to save human lives, but the challenge has been to stop hosts rejecting donor hearts.

Researchers successfully grafted a pig heart into a baboon more than a year ago and it is still functioning, they report today.

However researchers found that the pig hearts were alive and functioning well more than year after being grafted in place.

The experiments involved using these genetically engineered pig hearts, transplanted in the abdomen of baboons alongside their actual hearts.

Until now, organs transplanted into primates have only lasted for a maximum of six months before being rejected.

Pigs were chosen because their anatomy is compatible with humans and they have a rapid breeding cycle. Pig valves are already swapped for human heart valves.

The next step is to use hearts from the same pigs to test their ability to provide full life support by replacing the original baboon heart.

Critics claim that because the life cycle of pigs is shorter than humans they will need to be replaced. They could also pass on diseases.

Dr Mohiuddin said; “Based on the data from longterm surviving grafts, we are hopeful that we will be able to repeat our results in the life-supporting model.”

But scientists have tweaked the DNA of pigs so that their hearts are more compatible with primates and humans. “The developments may instil a new ray of hope for thousands of patients waiting for human donor organs,” said Muhammad Mohiuddin of the Cardiothoracic Surgery Research Programme at the National Heart, Lung, and Blood Institute in the US. “If successful, this method could change the current transplant paradigm, eliminating the shortage of donor organs including hearts, livers, kidneys, intestine, as well as insulin producing cells for treatment of diabetes.” At present people needing a heart transplant must wait until a suitable donor heart becomes available. Last year 145 operations were carried out at seven hospitals in Britain. However, only eight out of 10 people in the UK receive the transplant they needed because of a lack of suitable donors. Many adults and children are forced to wait more than a year for a new heart.

But through genetic changes, the scientists have added several human genes to the pig genome as well as removing genes which trigger a dangerous immune response in humans. Grafts from these genetically engineered pigs are less likely to be seen as foreign, thus reducing the immune reaction against them. Chris Mason, professor of regenerative medicine at University College London, said: “The fact is you have got lots of people waiting for heart transplants and if you could have a supply of hearts off the shelf then that is clearly beneficial.

Prof Peter Weissberg, the medical director of the British Heart Foundation said: “I think this stands a high chance of happening but it is still a very long way off. “There were similar projects happening in the 1990s but they ground to a halt because they struggled to deal with the problems of rejection. “There is a shortage of organs so this could be potentially promising and we already use pig valves in heart surgery.

“Heart failure is a really horrible condition so anything that could improve quality of life is of great value.

“But there is a long way to go. They still have to prove this would work in humans.”

“I think we are a long way off from being able to genetically engineer a whole heart though stem cells so this could provide a good stop-gap.”

The study was presented at the 94th American Association for Thoracic Surgery annual meeting in Toronto. Source: The Telegraph. 29.4.16

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Issue 284

May 2014

5


THE ROLE OF INDUSTRY IN ADVANCING SPINAL SURGICAL CARE: FINDING SOLUTIONS FOR UNMET NEEDS EXPLORED AT BRITSPINE Max Reinhardt, WW President DePuy Synthes Spine, Featured at 2014 Conference DePuy Synthes Spine* recently reinforced its commitment to addressing the challenge of increasing healthcare costs, while delivering enhanced clinical outcomes to advance the care of more patients around the world.

“Identifying and addressing these challenges has brought new stakeholders to the table where payers, providers and policy makers influence treatment decisions along with physicians and patients,” continued Mr. Reinhardt.

About DePuy Synthes Spine DePuy Synthes Spine has one of the largest and most diverse portfolios of products and services in spinal care and is a global leader in traditional and minimally invasive spine treatment.

Speaking at the biennial BritSpine 2014 conference; Max Reinhardt, Worldwide President, DePuy Synthes Spine, spoke about the past, present and future outlook for spinal implant companies and spinal surgeons.

“We must now operate in this new environment with new perspectives in mind and tailor solutions to bring the most value to our customers.”

The company offers procedural solutions for the full spectrum of spinal disorders including adult and adolescent deformity, spinal stenosis, trauma and degenerative disc disease.

“Spinal disorders impact patients of all ages as well as the families who care for them. The associated costs are considerable and have been estimated to exceed €12billion annually in the EU . Our primary aim at DePuy Synthes Spine is getting people back to doing the things they love, with the people they love, whilst reducing costs,” said Mr. Reinhardt. During the key note presentation, Mr. Reinhardt, who has worked in the Spinal industry for more than 12 years, recognized the significance of technological advancements from across the industry, yet highlighted the importance of adapting to current and future healthcare challenges.

Later in the conference agenda Mr. Reinhardt participated in an industry panel discussion. The Company showcased a selection of its solutions during the congress, and offered delegates the opportunity to learn more about how it’s minimally invasive spine (MIS), anterior cervical and adult deformity solutions can enhance patient outcomes whilst delivering value to health care professionals. Bevan, S [2012] The Impact of Back Pain on Sickness Absence in Europe [Internet] Lancaster, Lancaster University.

DePuy Synthes Spine is part of DePuy Synthes Companies of Johnson & Johnson, the largest provider of orthopaedic and neurological solutions in the world. For more information visit www.depuysynthes.com *DePuy Synthes Spine EMEA is a trading division of DePuy International Ltd. The third party trademarks used herein are the trademarks of their respective owners.

Available From: http://www.theworkfoundation.com When responding to articles please quote ‘OTJ’

[Accessed 24.03.14]

Pioneering ¿lm to help children face surgery at Royal Berkshire Hospital Magic Milk and Squidgy Masks was launched by the trust’s children’s and anaesthetics teams to explain to young patients and their parents the process of having an operation at the hospital A pioneering new fi lm will help put children at ease before surgery at Royal Berkshire Hospital. Magic Milk and Squidgy Masks was launched by the trust’s children’s and anaesthetics teams to explain to young patients and their parents the process of having an operation at the hospital. The teams decided to make the 10-minute fi lm after carrying out surveys in 2006 and 2012 which indicated only 50 per cent of parents felt their child was prepared for surgery. Consultant anaesthetist Sara McDouall said: “I felt as an anaesthetist that children who were prepared for the experience, having anaesthetic and the operation, the experience was smoother for them. They recovered quicker and were happier when they woke up. Anaesthetist Sarah Scott-Brown led the project and her 12-year-old son narrated the fi lm while her four-year-old daughter Daisy played the patient. Ms McDouall continued: “You see far more with video than you can with words. The children pick up a lot by seeing what happens.

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Ambulatory care sister Jessica Higson and consultant anaesthetist Sara McDouall “There is a lot of information embedded in the fi lm which parents will mostly pick up on while children will pick up on the visual.” The trust carries out between 600 and 800 operations on children every year. The idea is that the patient and their parents will watch the film before the surgery so they know what to expect. Sister for children services Jess Higson said: “The fi lm shows Daisy having a cannula put in and not worrying about it because she’s had the magic cream.

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“It is very visual – they can actually see what is going to happen.” As part of their children’s follow-up care, parents will be asked for feedback on the fi lm. Magic Milk and Squidgy Masks will be presented to the Association of Paediatric Anaesthetists of Great Britain and Ireland (APA).

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Ms Higson continued: “The fi lm is made by people from different specialities so every part of the surgical process is covered.” Source: getreading

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Fukuda Denshi provide an ideal opportunity to train and gain for Liam Fukuda Denshi is a leading supplier of advanced patient monitoring and user-configurable clinical information management systems, as well as cardiac monitoring and imaging technology. The company are pleased to announce they have taken on Liam Morgan as an apprentice, based at their Sheffield centre. Liam joined Fukuda Denshi in August 2013 and works with the company learning all aspects of the Fukuda Denshi business, including product support, installations, hardware and software support. He studies one day a week at a local Sheffield college, where he is working through his NVQ Level 2 and 3 in Engineering. Commenting on his role at the Company, Liam said: “I’m really enjoying my apprenticeship at Fukuda Denshi. I’ve been out on the road and had nights away when we’ve been working on large projects some distance from Sheffield.

The work here is varied and there is always something new for me to learn. I particularly enjoy interacting with our customers and suppliers, which gives me the opportunity to build on my communications skills as well as my engineering skills.” Terry Rickwood, Managing Director of Fukuda Denshi also commented: “This is the first apprenticeship scheme Fukuda Denshi has been able to be a part of, as our continued success throughout the UK has enabled us to provide this opportunity to train a young person in all aspects of our business. Liam has been a great addition to the team, and has proved to be a reliable and enthusiastic young man who has a bright future ahead with Fukuda Denshi.” Fukuda Denshi: Healthcare bound by technology. For more information visit www.fukuda.co.uk.

New EU Project Explores How to Remove Tumors with Ultrasound Ten institutes from seven countries will cooperate to develop a tumor-removal technique that uses concentrated ultrasound waves to destroy individual cancer cells. This kind of therapy is already being used to treat prostate and uterine cancer. But the procedure couldn’t previously be applied to other types of cancer because natural body movements have prevented physicians from accurately and precisely concentrating the ultrasound waves on the tumor. To overcome this challenge, the new project, dubbed Trans-Fusimo, aims to develop software that predicts the movement of organs—such as the liver under respiration—based on 3-D images obtained from magnetic resonance tomography. “In the future, such simulations can enable physicians to plan complex ultrasound interventions individual to the patient and in great detail,” explains Jan Strehlow, a researcher from Fraunhofer Mevis involved in the project. “This is especially important in moving organs and can be decisive for indication whether this method of therapy is a viable option for a patient.” The researchers hope to be able to treat the ¿rst patients without anaesthesia by 2018. The EU is supporting the project with approximately EUR 5.6 million in funding. Source: emdt Thomas Klein

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Issue 284

May 2014

7


Xograph Dental Systems Smiths Medical Promotes Normothermic Therapy On Its New Website included in Supply Fluid warming is a method of raising the temperature of fluids administered intravenously to a patient, Chain Framework Xograph Healthcare is pleased to announce that it has been selected as the sole supplier of Planmeca dental X-ray imaging systems for the NHS Supply Chain Dental Capital and Related Accessories Framework Agreement.

to maintain normal body temperature and prevent hypothermia. Keeping patients at a normal body temperature is crucial to prevent complications resulting from unintended perioperative hypothermia, which is a preventable complication of surgery. Healthcare professionals can now find out all they need to know about blood and fluid warmers in one place, thanks to the development of a new website by global medical device manufacturer, Smiths Medical.

Smiths Medical has launched a new website for its market leading Level 1® HOTLINE® Blood and Fluid Warmer. The site - www.level1warmth.com - has been developed to provide healthcare professionals with a central resource where they can obtain product information, marketing materials and device specifications, along with access to training. The easy to navigate website is split into clear sections, including background information on how Level 1® HOTLINE® Blood and Fluid Warmers work, features and benefits, products and accessories available in the range and a resource library containing brochures and manuals. The site includes a video, animation and illustrations so clinicians can see how the blood and fluid warmer works. It also details the causes of perioperative hypothermia and outlines its effects. For the past two decades, Smiths Medical Level 1® HOTLINE® Blood and Fluid Warmers have played an integral part in the prevention of perioperative hyperthermia in over 30 million surgeries worldwide. It offers safe, reliable and proven technology to warm and deliver fluid and blood products at gravity flow rates to improve patient outcomes and maintain normothermia. Only the HOTLINE® Blood and Fluid Warmer, with its unique triple lumen tubing, eliminates patient line cool-down and delivers consistently warmed fluids at the point of patient connection. Unlike the HOTLINE® Blood and Fluid Warmer; conventional fluid warming systems suffer from patient line cool down as the intravenous fluid travels from the warmer to the patient. The reason for patient line cool down is the infused blood or fluid is only warmed within the conventional warmer, allowing the warmed fluid to cool as it travels through the I.V. line before reaching the patient.

The Planmeca ProMax Dental System supplied by Xograph.

Planmeca is Europe’s premier manufacturer of dental imaging equipment with a full imaging range from intraoral dental phosphor plate scanners through to full head cone beam CT (CBCT) 3D imaging systems. The Planmeca range of intraoral and panoramic X-ray systems can meet almost any routine and specialist requirement. Most panoramic systems in the range are readily upgradeable to 3D (CBCT), allowing the versatility to produce routine panoramic and cephalostat imaging whilst, at the press of a button, having the capability to generate three-dimensional images at the same sitting. Fully integrated digital 3D facial photography can also be specified with the 3D X-ray and photography being captured in the same rotation cycle for improved workflow. The Planmeca Romexis software automatically superimposes both sets of images giving perfect image/volume alignment. New innovations also include fully integrated impression scanning allowing the system to send data to an online Computed Aided Milling (CAM) machine for rapid manufacture of, for example, dental crowns. 3D anatomical datasets can also be sent to an online model and prosthesis manufacturing service to aid surgical planning and treatment. Xograph Healthcare’s dental imaging product manager Simon Pike said: “We are looking forward to continuing our ongoing relationship with the NHS Supply Chain to bring the very best diagnostic imaging equipment, training and support to our customers in an efficient and costeffective way.” When responding please quote ‘OTJ’ www.xograph.com

8

The HOTLINE® Blood and Fluid Warmer can be used in a variety of surgical environments, including orthopaedic and cardiac wards, and has undergone extensive testing so clinicians can be confident their patients will be warm and protected. It provides the most consistent normothermic blood and fluid delivery performance across the range of fluid warmers on the market. Th is consistency is achieved through the unique design of the system, which comprises of a warmer with a pump to circulate warmth-transferring fluid and a disposable fluid warming set with triple lumen tubing construction. The triple lumen tubing allows blood and fluid to be warmed as it travels through the sterile centre lumen while heated circulating fluid flows through the outer lumens, enveloping the centre lumen in warmth. For more information on Level 1® HOTLINE® contact Glen Johnson, UK Marketing Manager at Smiths Medical, on 01303 260 551 or log on to www.level1warmth.com# When responding to articles please quote ‘OTJ’

Hartlepool patient almost had surgery on wrong body part A hospital patient was almost given surgery on the wrong part of their body, it has been revealed. The University Hospital of Hartlepool patient was not harmed and has been told about the error. North Tees and Hartlepool NHS Trust must now “restore public confidence”, Councillor Stephen Akers-Belcher has said. The trust, which refers to such cases as “never events”, said it “does all it can to avoid incidents occurring”. NHS England describes these as “serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented by healthcare providers”. A trust spokeswoman said the incident related to a “minor procedure” but declined to give further details or disclose when it happened, citing “patient confidentiality”. She added it was the only “never event” to occur within the trust’s hospitals in the past two years. ‘Lessons are shared’ Mr Akers-Belcher, vice-chairman of Hartlepool Council’s Audit and Governance Committee, said: “As soon as I was alerted I asked the trust to come forward to a formal meeting of the scrutiny function of the council so that we can question them about the incident and make sure safeguards are in place for the future. “It’s really scary that this nearly happened.” If the trust does not meet the council, the matter would be referred to Jeremy Hunt, the Secretary of State for Health, Mr Akers-Belcher said. David Emerton, medical director at the trust, said: “We have an open culture. “All incidents are reported, investigated and lessons are shared and learned irrespective of their seriousness.”

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STARKSTROM – MAKING INFECTION CONTROL A PRIORITY Infection Control is a key battleground and concern for every hospital. As a UK manufacturer, Starkstrom is committed to supporting the healthcare sector by focusing product design and development to reduce the potential for infections when using products from its S-equiP range. These products are packed full of infection-fighting innovations, and ensure the operating room or critical care area remain a “bacteria and virus-unfriendly” zone.

Clinical Lighting Starkstrom’s range of clinical lighting performs exceptionally well, even under UCV canopies, where clever design ensures there is minimal disruption to airflow and ultra clean conditions at the wound site are maintained. The lights can be controlled remotely via the wipe-clean eTCP, or directly by the surgeon using the Sensogrip controls, so fewer staff – and the bacteria that accompany them - need to enter the clean zone. Membrane-style control keypads and lenses made of strong glass rather than scratch-prone plastic make the lights easy to clean and less prone to bacteria.

Clinical Pendants Products in Starkstrom’s range of multi-movement pendants feature screwless sockets and fascias, easily removable end caps, integrated utility poles and oval structural arm design, ensuring they are easy to clean and have fewer ledges and screw heads to harbour dust and associated germs. Factory laser cutting of panel fascias enables third party products such as nurse call and emergency call systems to be seamlessly integrated.

Theatre Control Panels (eTCP) Starkstrom’s eTCPs feature a membrane-covered touchscreen, eliminating the need for protruding pushbuttons, controls and third party alarms that act as unnecessary dust ledges. A “cleaning button” means that screens are locked while the surface is cleaned, so no information is disturbed. The eTCPs are also Bluetooth-enabled, so the clinical team can connect smart media players in the operating room to play music if desired, rather than bringing in external bacteria-covered stereo equipment or docks.

Picture Archiving and Communications Systems (PACS) Starkstrom’s wallmounted PACS viewing station has been designed specifically for operating rooms. Fitted flush to the wall and off the floor, it is easy to clean as well as looking sleek and ergonomic. The recessed membrane keyboard, reminiscent of a cash machine, has fewer crevices where bacteria can settle and thrive, and is quick and easy to clean. Contact us now for quotations and site visits: t: +44 (0)20 8868 3732 e: info@starkstrom.com w: starkstrom.com


British Surgeons Design New Operating Lights Quasar® eLite is a new LED Operating Theatre Light that has been designed and built in Britain by a consortium of the UK’s finest Surgeons, Engineers and Infection Control Specialists. The outcome is a radical improvement in the performance of both surgical lighting and medical video systems. The results are enhanced light distribution, fully integrated HD-SDI video cameras and world-class hygienic design principles, improving performance of the operating theatre for surgeons, theatre staff and infection control. The project has been funded by the European Commission as part of their programme of developing high technology solutions in the EU. NHS Staff at Bradford Royal Infirmary have worked with Engineers from Brandon Medical and Scientists from TWI and Sagentia, in a 2 year collaborative research programme to develop improved surgical lighting and AV integration. With medial AV now at the heart of the modern digital operating room, Brandon Medical has paid particular attention to video integration in the design of the new light. Quasar® eLite is the first OR light which incorporates full SDI High Definition cameras and zoom controls, which are fully embedded within the slim lamp head. The new SDI system eliminates the expensive electronics and loss of signal quality normally associated with transmission through the rotating joints of an OR light to produce an outstanding picture quality on large monitors. Mounting the cameras inside the lamp head enclosure obviates the need for excessively large handles and restricted rotations whilst retaining the camera position directly above the subject. This also reduces costs as additional mounting systems are no longer required and the smooth facia of the lamp head is retained.

Wireless remote controls are also available enabling the lighting intensity, focus and camera zoom to be controlled outside of the sterile field. The HD-LED lighting technology of Quasar eLite, provides the surgeon with accurate full colour representation of anatomical structures during procedures. The colour temperature adjustable light (3,500 – 5,000°K) makes all colours vivid and vibrant making it easy to distinguish small differences in tissue. Such accurate colour rendition makes the light do the work rather than the human eye and ensures visual comfort for the duration of procedures. Prof Jonathan Sackier (FRCS, FACS) – comments: “Surgeon’s need “good lighting” but we are largely unaware what makes a surgical light “good”. Since working with Brandon Medical, I have learned that it’s about the colour of the light, the uniformity of the light field and the ability to adjust the colour balance, not just about how bright it is! It’s amazing how much research, knowledge and technology Brandon use in the design of their OR Lights”. Graeme Hall – Managing Director comments:

Quasar® eLite has been designed to minimise infections and adheres to world-class hygienic design principles. Andrew Kemp, Consultant Infection Control Nurse commented that “the surface of the lamp is easily the best design I have seen for cleaning.” The smooth continuous surfaces are easy to clean with minimal split lines, an anti-microbial agent is integrated into the lamp head surfaces and the lamp heads are sealed to IP54 guarding against the ingress of dirt and liquids. Embedding the camera inside the light head removes one of the hardest cleanliness problems and protects an expensive component from accidental damage.

“We’ve a long history of delivering innovation at Brandon Medical, but this project has been working to a whole new level. Quasar eLite is the result of working closely with Professors of Surgery, Consultants and infection control specialists to deliver a new product that addresses their everyday issues and delivers real life user benefits. On the industry side, our partners include two of the UK’s top technology research agencies in Sagentia and TWI. The result is a revolutionary change in the quality of surgical light and the creation of a stunningly uniform illuminated area for the surgeon. Th is project shows what we can do in Britain, when we work together to innovate and make better products” For further information please contact Brandon Medical: Tel: +44 (0)113 277 7393 visit www.brandon-medical.com follow @brandonmedical or When responding to articles please quote ‘OTJ’ email enquiries@brandon-medical.com

Review Off ers Insights on How to Manage Surgical Patients Who are Taking New Drugs that Prevent Blood Clots New oral anticoagulant drugs that treat and prevent clots offer a much-needed alternative to warfarin, which has been used for more than 6 decades and has serious shortcomings. A new article published in BJS (British Journal of Surgery) gives an overview of the major clinical trials and recommendations related to these new agents and will serve as a practical guide for their use in patients who require planned or emergency surgery. Warfarin has been the drug of choice to control blood clots in a variety of patients, including people with certain types of irregular heartbeats, people with prosthetic heart valves, and people who have suffered heart attacks. Unfortunately, warfarin has serious side-effects, requires frequent monitoring to reduce the risk of bleeding, and has interactions with multiple drugs and foods.

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New oral anticoagulant drugsApixaban, Dabigatran, and Rivaroxabanoffer safer alternatives to warfarin, but there are currently no markers for measuring activity levels of the drugs and there are no antidotes to reverse or neutralize their effects. Aida Lai, MBChB, of the North Bristol NHS Trust in the UK, and her colleagues searched the medical literature and analysed studies published between January 2000 and January 2014 that reported on the use of new oral anticoagulant drugs. As these drugs are still relatively new in the market, knowledge about how they work and their associated bleeding risks are still limited in the medical and surgical community, said Dr Lai. Our review covers recommendation for the discontinuation of new oral anticoagulant drugs before surgical procedures and resuming THE OPERATING THEATRE JOURNAL

of these drugs after procedures. The review also notes that because the drugs are eliminated by the kidneys, they require dose reductions dependent on a patients kidney function. Also, new oral anticoagulants are not recommended in patients with severe liver dysfunction. And because the three drugs have somewhat different properties, one of the drugs may be better suited to a particular patient than the others. It is anticipated that in the near future these drugs would replace warfarin to a large extent, said Dr Lai. Therefore our article is highly relevant to surgeons and any medical professional treating patients on these drugs. Full citation:Perioperative management of patients on new oral anticoagulants. A. Lai, N . Davidson, S. W. Galloway, and J. Th achil. BJS; Published Online: April 29th, 2014 (DOI: 10.1002/bjs.9485). http://doi.wiley.com/10.1002/bjs.9485

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Anetic Aid further expands tourniquet cuff range Following on from the launch of the AT4 tourniquet system, Anetic Aid has expanded its range of new, improved Six-use Day Tourniquet Cuffs. The first addition is a conical cuff – for use on legs in adult patients, particularly in knee replacement, where a larger leg is more conical in shape. Th is style of cuff contours more closely to the patient’s limb – aiding an effective tourniquet block. Other additions include three new sizes especially for use with infants: any aspect of neonate care always requires special attention and it is particularly important to have appropriate cuff sizes when dealing with their small, delicate limbs. These new items to the range follow recent enhancements to the Six-Use Day Tourniquet Cuff which were introduced following comprehensive customer feedback. Every cuff now features: • Compact design which is thinner yet more robust • Stiffer spine to spread pressure evenly over a greater surface area • Heavier duty material and a more convenient tie to prevent sideways roll and slippage • Superior inlet port which eliminates the need for metal hose retention clip • Individual batch numbering for full traceability Explained Sales Director Andrew Curtin: ‘Disposable tourniquet cuffs have a lot of advantages – their use reduces the risk of cross infection and it also cuts down the time staff have to spend cleaning and checking them for re-use. ‘We first introduced this range as an ideal alternative to re-usable cuffs: while they are guaranteed for six uses, they are cost-effective enough to be disposable. It’s the best of both worlds.’ ‘Our cuffs are latex free with a slim, low profi le design and the sizes are colour coded for ease of recognition.’

Anetic Aid is also continuing to offer a special deal to provide hospitals with its state-of-the-art, AT4 electronic or pneumatic tourniquet systems when they sign up to purchase a regular supply of the multi-use day tourniquet cuffs. The number of tourniquet systems included varies, depending on the quantity of cuffs to be purchased and the duration of the contract – one, two and three year options are available. The scheme was developed by Anetic Aid as a way of helping departments to gain access to the most modern and efficient tourniquet systems - without the capital outlay. For more information about Anetic Aid’s Six-use Day Tourniquet Cuffs – and the special deal – call 01943 878647, or see our website at, www.aneticaid.co.uk When responding to articles please quote ‘OTJ’

Find out more 02921 680068 • e-mail admin@lawrand.com

Issue 284

May 2014

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Xograph awarded Global Distributor of the Year for Mobile C-Arms The world’s leading premium mobile C-Arm provider Ziehm Imaging GmbH have awarded Gloucestershire-based independent medical equipment supplier, Xograph Healthcare, the award for ‘Global Distributor of the Year’ in 2013. Ziehm Imaging, both direct and through its distributors, have achieved major government contracts, significant sales and growth in the USA and America’s, expansion in every continent around the globe and coverage in almost every developed country on the planet during 2013. Ziehm presented the award for most outstanding performance by a distributor in 2013, to Xograph Healthcare, just as Xograph reported an impressive 68% growth in Ziehm C-Arm sales during 2013 following the introduction of Ziehm’s latest models: the Ziehm Solo, New Ziehm Vision and New Vision RFD Mobile C-Arm ranges which have been well received and appreciated by users in both the UK & Ireland.

Medical Aid International Providing healthcare Solutions to the Developing World Thousands of superb healthcare initiatives operate all over the developing world. Staffed by local and expatriate healthcare personnel these projects make a real difference to the local communities they serve. They may be run by vast Global Aid Agencies, Smaller Charities and groups or simply private individuals. The variety of these projects is enormous and ranges from holistic community medicine to complex in-patient hospital medical care. These projects exist because people and countries care - they want to make a difference. Using their abilities, talents and determination, combined with a tremendous sense of commitment these individuals, teams and projects give those in the developing world hope and a future. Medical Aid International (MAI) brings together all this enthusiasm to offer practical and on-going logistical support to such healthcare projects. With a track record of providing successful solutions to global and local charities, private individuals and philanthropists, we source the correct medical equipment and supplies from legitimate, high quality and verifiable suppliers and donors. Our aim is to make the money for these projects go as far as it can; this can mean utilising appropriate and fit for purpose donated goods sourced though our wide network, purchasing ex-lease equipment or ordering new equipment. Equally as important, we have proven experience in managing the logistical process to ensure that the correct equipment and supplies are delivered to the right people in the field at the right time. We are also involved in a diverse range of educational and research initiatives; a result of our wide array of projects.

Ziehm Imaging GmbH Global VP of Sales Martin Törnvik with Mike Biro, Nigel Darwell-Stone, Paul Andrews and Neil Staff of Xograph Healthcare together with Ziehm Region Sales Manager Timo Ihamäki, as Xograph receive the Ziehm Global Distributor Award 2013

The independent healthcare technology provider has equipped a number of major hospitals in the UK and Ireland with mobile C-Arms, including the biggest and busiest hospital in Merseyside: The Royal Liverpool University Hospital, part of the Royal Liverpool and Broadgreen University Hospitals NHS Trust. This particular hospital received a Ziehm Vision FD setting a trend for flat panel mobile C-Arm purchases, one that is really beginning to pick up pace according to Xograph Healthcare technical director Neil Staff. “I am very excited by the transition that we are now witnessing from conventional image intensifier-equipped mobile C-Arms to the new generation of flat panel-equipped units; a transition that for the most part has already taken place in fi xed fluoroscopy systems, particularly those intended for vascular and interventional procedures. I believe that image quality and accuracy should be the very highest priority during surgical procedures and today this is provided with flat panel imaging technology; I am glad that this view is now being reflected in so many of the new orders we are receiving, particularly those being targeted for trauma, spinal, vascular, cardiac and hybrid room applications.” The Ziehm Vision RFD range of mobile C-Arms has created quite a buzz in the mobile imaging arena. These powerful new intraoperative and interventional tools incorporate a choice of either a 20x20cm or 30x30cm dynamic flat panel detector for distortion-free imaging, and use a combination of Ziehm Advanced Active Cooling (‘AAC’) technology and Ziehm Adaptive Image Processing (‘ZAIP’) for the sharpest, contrast rich images acquired with unlimited fluoroscopy time even during the most complex and lengthy procedures. The ‘Hybrid Edition’ of the Ziehm RFD now uniquely offers fully motorised C-Arm positioning with motor drive in all 4 axes with 3 memorised positions for instant recall and an isocentric mode. Commenting on the award, Neil Staff, Technical Director at Xograph Healthcare said: “I am naturally delighted to have received this prestigious award from Ziehm Imaging. It reflects both the quality and clinical relevance of the mobile C-Arms being produced by Ziehm Imaging in Germany today and also the hard and effective work put in by our dedicated sales, marketing and technical support teams at Xograph. Together, by listening to users and clinicians needs, we remain very much at the forefront of mobile C-Arm technology supplying products which truly benefit our customers and their patients.” www.xograph.com

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When responding to articles please quote ‘OTJ’

Tim Beacon heads up the MAI team. He was formerly an Operating Department Practitioner and Assistant Training Co-ordinator for the NW Thames Health Authority. With a post graduate diploma in Travel Health Tim has received training in Anaesthesia for Developing Countries. He has been a part-time University lecturer and taught on remote medical courses within the armed forces as well as Directing Primary Trauma Foundation courses in Africa. Tim is also the author of “The Gap Year Handbook: An Essential Guide to Adventure Travel”. He enjoyed a successful career in the medical devices industry to Managing Director level; this included thirteen years in orthopaedic trauma. Each project is priced individually taking into account objectives, budget, local conditions and the logistics involved. From conception to completion, with our extensive experience and our network of contacts, we are able to offer specialist advice as required to ensure long-term successful outcomes to all our projects. If you are involved in a project, or a proposed project where you feel MAI can help, please do contact us. Equipment procurement is a vital aspect of our work. The organisations we work with have very diverse needs so if you are able to help us in this area, we would be delighted to hear from you. Medical Aid International Unit 3, Firs Farm Stagsden Bedfordshire MK43 8TB

Tel + 44 (0) 1234 930 394 Fax + 44 (0) 8000 151 906 tim@medaid.co.uk www.medaid.co.uk When responding to articles please quote ‘OTJ’

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SOMERSET

Mercian Surgical are recruiting a Sales Representative for the North West Territory

SCRUB PRACTITIONERS Experienced RGN or ODP’s are invited to apply. This departments work includes specialist orthopaedics, ophthalmology, ENT, general surgery and endoscopy. You will currently be working at Staff Nurse level in a UK theatre and it is essential that you have established scrub skills in a mixture of surgical specialities. You will be a good team player who can make a valued contribution to the continued delivery of ¿rst class patient care. A Àexible manner and exceptional communication skills are required for full time or part time positions. Drivers required.

Tel: 01303 840 882 Fax: 01303 840 969 enquiries@sophiebellandassociates.co.uk www.sophiebellandassociates.co.uk

We are a specialist Medical Device company established for over 45 years working in the fields of Spinal, Plastic Surgery and Orthopaedic Surgery. We are looking for candidate with experience of working in Operating Theatres, hardworking and self-motivated to join our sales team selling High Quality Surgical Instrumentation and Medical Devices. Duties to include servicing existing accounts, obtaining orders, and establishing new accounts by planning and organizing daily work schedule to call on existing or potential customers. Organisational skills are essential for this position.

LANCASHIRE THEATRE PRACTITIONERS - BAND 5 You will have current UK Theatre experience & RGN or ODPs are welcome to apply. Good communication skills (verbal & written) are essential. You will need to be an enthusiastic & Àexible team player who is most importantly patient focused. This is a busy & highly professional department which can enhance your career development with exposure to a mixture of surgical specialities.

Tel: 01303 840 882 Fax: 01303 840 969

Salary would be a combination of Basic and commission based. Reply to; John Duff y Managing Director Mercian Surgical Supply Co Limited Topaz Business Park Topaz Way Bromsgrove Worcestershire B60 1PZ

enquiries@sophiebellandassociates.co.uk www.sophiebellandassociates.co.uk

John.duff y@merciansurgical.com

Venepuncture and Cannulation: A Practical Guide ISBN: 9781905539444 May 2014 M&K Publishing 104pp illustrated £19.00 Nicola Brooks RN, PG dip, BSc Hons, NMC RTQ, Senior Lecturer, School of Nursing and Midwifery, Health and Life Sciences, De Montfort University, Leicester, UK Venepuncture and Cannulation: A Practical Guide offers an easy-to-read, comprehensive account of the practical procedures of venepuncture and intravenous cannulation. It provides the underlying theory and underpinning knowledge required, as well as a step-by-step approach that will enable healthcare practitioners to carry out these procedures safely, ef¿ciently and with con¿dence. This book is intended as a supplementary resource for those involved in practising or teaching these procedures, for healthcare practitioners wishing to update their knowledge, and for novice practitioners learning these skills for the ¿rst time. Each chapter contains intended learning outcomes and points for practice. Some chapters also include helpful illustrations and practical activities, and the book ends with two self-assessment checklists. Contents include: What are venepuncture and cannulation? An overview of the circulatory system and the related anatomy and physiology of the peripheral vascular system Vein selection Preparing yourself, your environment and your patient Venepuncture techniques Venepuncture when things go wrong Cannulation Cannulation techniques Cannulation when things go wrong Reducing risks when carrying out venepuncture and cannulation Appendix 1: Self-assessment checklist for venepuncture to ensure safe practice Appendix 2: Self-assessment checklist for cannulation to ensure safe practice Find out more 02921 680068 • e-mail admin@lawrand.com

Issue 284

May 2014

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EVERYTHING’S ROSIE – KARL STORZ SUPPORTS THE ROSIE HOSPITAL The Rosie Hospital, which with Addenbrooke’s Hospital forms the Cambridge University Hospitals NHS Foundation Trust, is Cambridge’s purpose-built hospital for women’s, neonatal, and maternity services. KARL STORZ has been a long-time supplier of advanced operating theatre equipment to the Trust, and when the Rosie announced its ambition to extend its ultrasound training programme, the company was delighted to help by gifting a state of the art KARL STORZ audio-visual link system, with the potential to benefit patients around the world, through Addenbrooke’s Charitable Trust’s Rosie Hospital Campaign.

The system also allows the team access to either real-time scans or stored still or video images for discussion and feedback during video conferences. These conferences are essential in communicating with partner hospitals across the region and thus facilitating better care for mothers where their baby has been recognised as having a problem. Over the next few years, the department plans to extend the range of options for ultrasound training regionally, nationally and potentially internationally, in particular with the introduction of foetal medicine ‘master classes’, where a renowned expert will demonstrate their skills to a group of foetal medicine trainees or consultants without the need for all the delegates to be present in the scan room. Th is reduces the stress and anxiety for the patients participating in such courses. The new resource was launched on 11th March at an event attended by the Chief Executive of the hospitals, Dr Keith McNeil, and former Chairman of the hospitals, Dame Mary Archer. At the event, the team at the Rosie was able to demonstrate the new equipment and showcase the impact that this will have on patients. KARL STORZ’s gift will also be acknowledged with a plaque on the donor wall in the main entrance of the hospital.

The team from the Rosie, representatives from KARL STORZ, and Dr Keith McNeil and Dame Mary Archer (centre). “Our involvement and input into Addenbrooke’s Charitable Trust’s Rosie Hospital Campaign is significant in many ways. It is now widely acknowledged that the NHS as a whole will not achieve its goals without some form of external help.

The hospital owes KARL STORZ and Mrs Storz herself absolutely nothing, other that is, than to carry on working closely together with the sole aim of bettering healthcare for patients.”

We embraced the idea several years ago that we, as a trusted and respected supplier to the NHS and as healthcare professionals ourselves, had the means (and indeed some responsibility) to do more to help sustain our primary customer. But, in order to do so, our relationship had to fundamentally change from one of customer and supplier to that of a partnership.

“The telemedicine facility in the Foetal Medicine Unit allows specialists to discuss difficult problems, exchange information, and support education and training. We are very grateful to have had the support and expertise of KARL STORZ behind this initiative, bringing the very latest technology to improve the outcomes for very many more mothers and their babies.”

Addenbrooke‘s is fortunate that Dame Mary truly understands the meaning of ‘partnership’ and moreover, strategic business relationships, and it was through her work in SDM (Shared Decision Making) and her support of our SMART (Saving Money and Resources in Theatres) symposia that our mutual understanding and special relationship was formed.

Gerry Hackett - Co-Divisional Director of Women’s and Children’s Services at Addenbrooke’s

I know that the Rosie is extremely appreciative of the work that KARL STORZ has carried out but its thanks is, in the true spirit of a partnership, unnecessary.

Mike Perks - Managing Director, KARL STORZ Endoscopy (UK) Ltd

The event was organized by Addenbrooke’s Charitable Trust, the only registered charity dedicated to supporting innovation in patient care across Cambridge University Hospitals NHS Foundation Trust, raising funds for cutting edge technology, additional specialist staff, environmental enhancements, extra comforts for patients, and research projects.

KARL STORZ Endoscopy (UK) Ltd. 415 Perth Avenue, Slough, Berkshire, SL1 4TQ Phone +44 (0)1753 503500, Fax +44 (0)1753 578124 e-mail: info-uk@karlstorz.com web: www.karlstorz.com

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The new audio-visual link opens up great opportunities for the team at the Rosie. It can deliver real-time ultrasound images from three scan rooms to two seminar rooms, with the sonologist undertaking the scan commenting directly to the seminar room or, via a more discrete link, speaking to a specific colleague there.


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