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May 2012

Issue No. 260

ISSN 1747-728X

The Leading Independent Journal For ALL Operating Theatre Staff

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Blood cell breakthrough could help treat heart disease Scientists at the University of Reading have made a groundbreaking discovery into the way blood clots are formed, potentially leading to the development of new drugs to treat one of the worlds biggest killer illnesses. Cardiovascular disease, which causes heart attacks and strokes, accounts for one in three of all deaths in the UK, often brought about by clots blocking major blood vessels, preventing critical blood Áow to the heart or brain. Now researchers at the Institute for Cardiovascular and Metabolic Research (ICMR) at the University of Reading have uncovered, for the Àrst time, the mechanism by which platelets, the blood cells that cause clots, communicate with each other and the inner walls of blood vessels when clotting. The clotting process helps the body to repair itself and stops wounds from bleeding. But inappropriate activation of platelets leads to the formation of clots in the bloodstream (thrombosis), which can lead to a potentially fatal heart attack or stroke. Currently, doctors treating heart disease can administer drugs which reduce the tendency of the blood to clot, and therefore decrease the risk of thrombosis.

Blood clot

However, such anti-thrombotic drugs are not effective for some patients, and can cause dangerous side-effects. Professor Jonathan Gibbins and Dr Sakthivel Vaiyapuri have headed up an international team of researchers that have discovered how platelets use specialised pore-like structures, called gap junctions, allowing direct communication between the cells. These structures have been studied previously in other cells that are in constant contact with each other, but the researchers said their role in platelets was a big surprise. The scientists, whose Àndings are published online in the journal Circulation*, conclude that the discovery could lead to the creation of innovative new drugs to prevent or treat thrombosis.

Jonathan-Gibbins

Professor Gibbins said: This appears to be a very important communication mechanism for blood clotting and thrombosis. Since we have found that molecules that block these channels reduce thrombosis this may pave the way for potential new avenues for the development of more effective antithrombotic therapies to prevent heart attacks and strokes. Dr Vaiyapuri said: Although this area of platelet research is still in its early stages, this is an exciting discovery. The pore proteins have important functions in a range of cell types in the body, and therefore in the future it will be important to consider how to modulate the opening and closing of the pores speciÀcally in platelets. The research was funded through a grant from the British Heart Foundation. *Gap Junctions and Connexin Hemichannels Underpin Haemostasis and Thrombosis is published online in Circulation. Link to abstract: http://circ.ahajournals.org/ content/early/2012/04/13/CIRCULATIONAHA.112.101246.abstract

Wound care device to be trialled in Birmingham Defence Medical Services trial next level of state-of-the art health technology An award-winning device that monitors how well wounds are healing, bringing faster relief to patients, is set to be used in a new research trial at a hospital in Birmingham. The WoundSense moisture sensor, which was developed by Ohmedics Ltd, a company set up by bioengineers at the University of Strathclyde, allows doctors and nurses to check the moisture conditions under a dressing without having to remove it.

The picture shows Professor Patricia Connolly using the technology.

WoundSense is a sterile,disposable sensor placed in the wound dressing that monitors whether the wound is moist the optimum environment for healing or too dry or wet to heal properly.

NPWT is an excellent technique but we believe that we can further optimise treatment protocols by understanding moisture levels at the wound and in the dressing during the application of NPWT. Any Àndings made in this programme will be shared with the wound management community and should be of beneÀt to many other patients as well as our own personnel. NPWT involves the application of suction, via a dressing, to the wound area using a pump. This draws out exudate wound Áuid and stimulates the healing process. However, before WoundSense came to the market, it was not possible to monitor moisture in a patients dressing in real time. Professor Connolly said: We have been aware from the early stages of this technology that it would impact widely on wound treatment. In ordinary use the measurement of moisture in a dressing with WoundSense allows a nurse or carer to make a decision about changing a dressing without disturbing it. This means less trauma for the patient and savings in time and costs for the clinical community. However, the new study is now moving to a new level to optimise advanced treatment regimes such as NPWT and the University and Ohmedics are delighted to be supporting this venture.

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Now the technology is to be used in a new trial in military personnel requiring wound treatment at the Queen Elizabeth Hospital in Birmingham. The WoundSense sensor will be used during Negative Pressure Wound Therapy to monitor moisture levels in healing wounds without disturbing the dressing. . Professor Patricia Connolly, CEO of Ohmedics and a bioengineer at the University of Strathclyde, is working with Lt Col Steven Jeffery, Consultant Plastic Surgeon for the Defence Medical Services, and Dr Erin Hankin, both based at the Burns Unit in the Queen Elizabeth Hospital. Lt Col Jeffery said: We want to provide state-of-the-art treatment for our military personnel and be at the forefront of advances in wound treatment.

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THE OPERATING THEATRE JOURNAL

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Synergy Health Becomes First Operational Partner at UK’s Newest Hospital Capital Hospitals selects hospital sterile services partner for Royal London Hospital

New Technique May Help Severely Damaged Nerves Regrow And Restore Function

The new Royal London Hospital (RLH), part of Barts and the London NHS Trust and the UK’s biggest hospital, has partnered with Synergy Health for its hospital sterile services.

Engineers at the University of ShefÀeld have developed a method of assisting nerves damaged by traumatic accidents to repair naturally, which could improve the chances of restoring sensation and movement in injured limbs.

The now operational Synergy Health facility, housed within the new Royal London site will serve the hospital’s 23 on-site theatres; decontaminating and sterilising approximately Àve million surgical instruments each year. The facility will also be linked to the London Chest Hospital by lifts enabling rapid access between the two different parts of the hospital and with plans to provide services both on and off-site.

In a collaborative study with Laser Zentrum Hannover (Germany) published recently (23 April 2012) in the journal Biofabrication, the team describes a new method for making medical devices called nerve guidance conduits or NGCs.

The company was selected by Capital Hospitals Limited as a key delivery partner alongside Skanska, Carilion, Siemens and Varian and is the continuation of a long relationship with the Trust where it has provided sterile services to St. Bartholomew and the London Chest hospital since May 2006. Synergy Health is one of the Àrst tenants in the new hospital after relocating its service from an interim facility at Wharf Road, Islington. The Islington site was built as a transitional, yet highly advanced and fully operational service that fulÀlled all sterilisation requirements while the new RLH facility was being built. This was vital to ensuring sustained and consistent quality and efÀciency and ensured the move posed no risk to patients. The Ànal transition to the new site took place following the full accreditation of the unit. The Trust will beneÀt from efÀciency and quality enhancements enabled by Synergy Health’s state-of-the-art technology, equipment and specialist staff - many of whom were employed by Barts and the London NHS Trust from before services transferred to the Islington site in 2006. Training of new staff has taken up to 18 months and all staff at RLH undertook training for Àre safety and the use of new equipment. NHS staff which transferred under TUPE included 33 technicians, Àve team leaders, six support staff and nine distribution staff who joined the Synergy team to bring the full unit complement to 60 The team operates a round-the-clock on-call service to support emergencies and major incidents. During the summer riots the team was able to scale up to ensure the Trust’s needs were met. The Trust’s Medical Director Dr. Steve Ryan said: “Like all of our key delivery partners Synergy Health will play a critical role in ensuring the timely, quality and consistent delivery of its expert service. Sterile services are critical to ensuring our surgeons and other healthcare professionals can rely on having the tools of their trade available through a safe, timely and traceable service and where patient safety features top of all agendas. By being located so close to our theatres we expect the sterile services unit to be able to provide an unrivalled service to our staff and - most importantly - our patients.” Synergy Health CEO UK and Ireland Adrian Coward adds: “We are delighted to have been chosen as a key delivery partner to provide sterile services through our best-in-class facility at this fantastic new hospital. We continually strive for mutual success based on trust, innovation and accountability and where we are focused on the needs of the hospital to deliver the utmost patient care at the best possible cost. I am gratiÀed to see the extreme efforts made by our staff to enable the transition to the new hospital with minimal disruption and which I know has involved many long hours! We look forward to working with the Trust to ensure that this Á agship hospital continues to enjoy the reputation for which it is renowned.” The new hospital plans to revolutionise the hospital experience for patients who will beneÀt from cutting edge facilities and standards of care to rival the best in Europe. The layout and facilities within the hospital have beneÀted from the input of clinicians to ensure they are able to provide safe and patient-focused clinical care. It will be completed by 2015. To learn more about Synergy Health’s services, please visit www. synergyhealthplc.com, contact decontamination@synergyhealthplc.com

The method is based on laser direct writing, which enables the fabrication of complex structures from computer Àles via the use of CAD/CAM (computer aided design/manufacturing), and has allowed the research team to manufacture NGCs with designs that are far more advanced than previously possible. Currently patients with severe traumatic nerve damage suffer a devastating loss of sensation and/or movement in the affected limb. The traditional course of action, where possible, is to surgically suture or graft the nerve endings together. However, reconstructive surgery often does not result in complete recovery. “When nerves in the arms or legs are injured they have the ability to re-grow, unlike in the spinal cord; however, they need assistance to do this,” says University of ShefÀeld Professor of Bioengineering, John Haycock. “We are designing scaffold implants that can bridge an injury site and provide a range of physical and chemical cues for stimulating this regrowth.” The new conduit is made from a biodegradable synthetic polymer material based on polylactic acid and has been designed to guide damaged nerves to re-grow through a number of small channels. “Nerves aren’t just like one long cable, they’re made up of lots of small cables, similar to how an electrical wire is constructed,” says lead author Dr Frederik Claeyssens, of the University’s Department of Materials Science and Engineering. “Using our new technique we can make a conduit with individual strands so the nerve Àbres can form a similar structure to an undamaged nerve.” Once the nerve is fully regrown, the conduit biodegrades naturally. The team hopes that this approach will signiÀcantly increase recovery for a wide range of peripheral nerve injuries. In laboratory experiments, nerve cells added to the polymer conduit grew naturally within its channelled structure and the research team is now working towards clinical trials. “If successful we anticipate these scaffolds will not just be applicable to peripheral nerve injury, but could also be developed for other types of nerve damage too. The technique of laser direct writing may ultimately allow production of scaffolds that could help in the treatment of spinal cord injury.” “What’s exciting about this work is that not only have we designed a new method for making nerve guide scaffolds which support nerve growth, we’ve also developed a method of easily reproducing them through micromolding,” says Dr Claeyssens. “This technology could make a huge difference to patients suffering severe nerve damage,” says Dr Claeyssens. This research was funded by the Engineering and Physical Sciences Research Council.

The Next issue copy deadline, Friday 25th May 2012 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 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 Ànd out more 02921 680068 • e-mail admin@lawrand.com

Issue 260

May 2012

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Endomagnetics Expands its Horizons Cambridge company Endomagnetics is receiving enquiries from across the world after it featured on the BBC World Horizons programme recently. The Horizons series features companies and technologies that have the potential to address some of the planets most pressing challenges. In Endomagnetics case, they have developed a medical device called SentiMag® based on principles of nano-magnetism, which gives clinicians a much simpler and cheaper method for tracking the spread of cancers, especially breast cancer. As CEO Dr Eric Mayes explained in the video clip, by avoiding the need for radioactive isotopes, the availability of a key technique - sentinel lymph node biopsy - is signiÀcantly extended. In some parts of the world, only 5% of the patients who could beneÀt have access to this technique. BBC reporter Adam Shaw visited the team in Cambridge as well as Àlming at Guys Hospital, London, where he saw a demonstration of how the SentiMag® instrument is used in an operating theatre. Shaw was enthusiastic about nanotechnology and commented: This could be one technology thats on the wave of what some experts have dubbed the next industrial revolution. You can see the video clip for yourself here: www.horizonsbusiness.com/episode/nanotechnology/

Intraoperative histological evaluation of tissue could prevent poor surgical outcome

QA3 for the QA Portsmouth’s Queen Alexandra Hospital has taken delivery of state-of-the-art patient trolleys - the latest model in Anetic Aid’s QA3 series which was Àrst developed with the hospital more than 30 years ago. The QA in QA3 stands for ‘Queen Alexandra’ in tribute to the contribution made by the hospital when Portsmouth Surgical Equipment Limited (PSEL), Anetic Aid’s manufacturing base, developed the original model. That was in the 1970s and the hospital was only at the planning stage too. The brief was to create a trolley that would be light weight and easy to manoeuvre with maximum comfort for the patient, whether they were on their journey from a ward to the operating theatre, or being treated in an Accident and Emergency Department.

Pediatric and Developmental Pathology Hirschsprung disease occurs when nerve cells in the colon do not develop normally before birth and the bowel is unable to move its contents along. Severe bowel obstruction and even perforation can then occur. The condition is usually diagnosed within the Àrst months of life, but can be found in older children as well.

The current issue of the journal Pediatric and Developmental Pathology reports on a study of 30 patients at the Colorectal Center for Children at the Cincinnati Childrens Hospital Medical Center. These patients underwent reoperation and removal of the bowel segment used unsuccessfully during the initial surgery. Researchers examined records and slides from the primary operations and fresh tissues from the secondary surgeries. To determine the suitability of bowel to be used, the authors of this study recommend histological conÀrmation of the presence of both ganglion cells and normal-caliber nerves circumferentially. This research found 16 cases in which abnormalities were found microscopically; in these cases, the patients improved following reoperations. The use of intraoperative consultation during the primary procedure should include frozen section evaluation of the entire circumference of the bowel at the point to be used to connect the pulled-through bowel down to the anus. Full text of the article, Reoperation for Hirschsprung Disease: Pathology of the Resected Problematic Distal Pull-Through, Pediatric and Developmental Pathology, Vol. 15, No. 1, 2012, is available at http://www.pedpath.org/toc/ pdpa/15/1.

Mark Archer of the Portsmouth’s Queen Alexandra Hospital’s Emergency Department and Deepa Carter from the Communications team demonstrate the QA3 vs 3.0

THE OPERATING THEATRE JOURNAL

Said Mark Archer, who looks after Logistics in the hospital’s Emergency Department: ‘The trolleys have always been good but there is a real difference in this new model. It looks 21st century and it’s a lovely bit of kit – it just does the job. ‘The customer service from Anetic Aid is excellent too, they are always happy to come and talk to us about any aspect of the equipment.’

PSEL founder, Havant-based Ivor SchoÀeld worked with clinical staff on the development - and the Àrst QA trolleys were hailed as considerably ahead of their time when they were delivered to the hospital as it opened its doors in 1979. The design was reÀned in the eighties with the QA2 – but more radical changes followed in the 1990s with the development of the QA3 vs 1.0 in 1998 – and more than 80 of these models were eventually in service at the Queen Alexandra.

And the company’s current CEO, Ivor’s son Guy SchoÀeld added: ’It is particularly pleasing for us to be delivering some of the very Àrst models of the QA3 Vs 3.0 trolley to the hospital it was named after. Ten models are now being used in main theatres and a further ten in the Emergency Department.

Website: http://www.aneticaid.com

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In 2009 there were changes for the hospital itself when it was rebuilt after ten years of planning, offering patient facilities that are amongst the best in Europe. But the story doesn’t end there: new materials and technologies are constantly being developed and the company has continued to listen closely to its customers and monitor changing healthcare needs for the next generation of this Á agship product. And the result is the QA3 Vs 3.0. Launched a few weeks ago, it takes ease of use, practicality and patient comfort to a new level - and one of the Àrst hospitals to take delivery is the Queen Alexandra in Portsmouth!

Hirschsprung disease affects most frequently the distal bowel propulsive function, and it occurs in about 1 in 5,000 live births. The condition is treated surgically, and poor outcomes can sometimes require further surgery. A new study recommends an intraoperative histological evaluation that could offer a better assessment of the bowel nervous system, leading to more successful procedures. Bowel function is restored by surgically removing the nonfunctioning segment of the bowel, then using a pull-through procedure that repairs the colon by telescoping functional bowel down into the anus. Normally innervated bowel tissue is needed for a successful outcome. A common reason for a poor postoperative outcome is the use of bowel for the pull-through that has abnormal innervation. A transition zone, consisting of a segment of bowel between the normal and abnormal sections of the bowel that can give the appearance of normal functioning, must also be removed.

Acting Head of Nursing for Emergency Department CSC Isabel Gaylard and CEO Guy SchoÀeld with the QA3 vs 3.0

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Find out more about CAVI at the 22nd European Meeting on Hypertension & Cardiovascular Prevention

Angioplasty Technology Developed at University of Limerick Licensed to Clada Medical

Fukuda Denshi is a leading supplier of advanced patient monitoring and userconÀgurable clinical information management systems, as well as cardiac monitoring and imaging technology. At the 22nd European Meeting on Hypertension & Cardiovascular Prevention, held at the ICC in London, the company hosted a Symposium on CAVI, the emerging arterial stiffness index that’s independent of blood pressure.

A technology developed at Ireland’s University of Limerick (UL) that allows for continuous blood Áow during angioplasty procedures has been licensed to Clada Medical. Based in Galway, Ireland’s medtech cluster, Clada Medical provides medical device design, research and development, testing and OEM manufacturing services.

The Symposium held in the Capital Suite from 11.30am to 12.30pm on Friday, April 27th included leading speakers from around the world. Prof Roland Asmar, Foundation-Medical Research Institutes Switzerland & Hôpital Hôtel Dieu, France, Chaired the Symposium, which was also co-chaired by Prof Kennedy Cruickshank of King’s College University of London & King’s Health Partners UK.

During angioplasty, particles of fatty deposits can become dislodged and enter the blood stream, blocking other arteries and triggering strokes or heart attacks, explains lead inventor Dr Michael Walsh in a press release issued by the university. While embolic protection devices are often used to capture and remove the dislodged deposits, the new device combines angioplasty balloon and embolic protection technologies, says Walsh, which enables continuous blood Áow.

Session speakers on the day were: • Prof Arno Schmidt-Trucksäss MD, MA from the University of Basel, Switzerland covering “Healthy vascular ageing in a Caucasian Cohort – CAVI as a biomarker”. • Dr Paul Leeson PhD, MRCP from the University of Oxford covering “CAVI and cardiovascular risk factors: the Oxford experience”. • Prof Shigeo Horinaka MD, PhD from Dokkyo Medical University in Japan, speaking about how “CAVI could reÁect arthrosclerosis”. The VaSera VS-1500N from Fukuda Denshi is a simple and effective product that can quickly calculate Cardio Ankle Vascular Index along with other measurements, and is ideal for measuring arterial stiffness that is independent of blood pressure. For more information on the 22nd European Meeting on Hypertension and Cardiovascular Protection and the CAVI Symposium held at the event, telephone Fukuda Denshi on 01483 728065. When responding to articles please quote ‘OTJ’

“In practice, this means the angioplasty balloon can be left in a full inÁ ated state in the artery for a longer period of time than is currently possible,” says Walsh. “This will increase the efÀciency of the angioplasty procedure and offers signiÀcant potential as a platform for drug-device combinations.” Clada Medical has particular expertise in balloon mould manufacturing and custom balloon/catheter design. Applying the UL invention to perfusion balloon technology will be very important for the future of the company, says CEO Ray Blowick. Enterprise Ireland funded the UL research. It was undertaken at the Centre for Applied Biomedical Engineering Research, which is based in the Materials and Surface Science Institute at UL. Source: medtechinsider Norbert Sparrow

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Issue 260

May 2012

5


New Ziehm Solo for Letterkenny General Hospital Eleanor Monaghan, Radiology Services Manager at Letterkenny General Hospital, commented: “The Ziehm Solo will be an invaluable addition to the Urology department. It will enable us to produce high quality images which can be sent effortlessly to PACS using wireless networking technology, not only this but the unit is also very user friendly and easy to understand.”

The Urology day care facility at Letterkenny General Hospital has just taken delivery of a new mobile Image IntensiÀer from leading independent diagnostic imaging supplier Xograph Healthcare. The new Ziehm C-Arm is aptly named ‘Solo’ as it is conÀgured as a single mobile unit, a separate conventional monitor cart not being an essential requirement, making it one of the most compact C-Arms available. This, together with excellent manoeuvrability, makes the Ziehm Solo the ideal mobile C-Arm to work in the limited space available in today’s operating and medical procedure rooms. The Solo will greatly beneÀt the Urology facility as it delivers excellent 1k2 image performance for imaging of the kidneys, ureters and bladder and has a dedicated anatomical imaging program for the urinary tract as well as programs for other anatomical regions and applications. Just one touch of the program key selects

Ann Mc Gowan, Deputy Radiology Services Manager and Eleanor Monaghan, Radiology Services Manager at Letterkenny General Hospital with Michael Leonard, Territory Manager at Xograph Healthcare Ltd.

all imaging parameters followed by a press of the Áuoroscopy hand or foot switch to produce optimum quality images. The Solo exhibits the same touch screen user interface as the Ziehm Vision series making it very familiar

Hospitals use new anti-bacterial spray and wipes to reduce infection Hospitals now have access to a range of disposable wipes and a spray which inhibits the growth of 99.9% of bacteria for a full four weeks after application. The products, which offer longer protection than any other product currently on the market, have been specially formulated and tested to decrease the spread of nosocomial viruses in the clinical environment.

About Xograph Healthcare www.xograph.com Please quote ‘OTJ’

Anaesthesia A Very Short Introduction By Aidan O’Donnell 978-0-19-958454-3 Paperback Press Date: 10th May, £7.99

A report by the National Audit OfÀce found that around 300,000 patients contract hospital acquired infections in the UK each year, and at least 5,000 patients are estimated to die as a result of complications. Whilst the rate of infection is reducing, the NHS still loses 3.6 million bed days each year because of these preventable infections. Known as Micro-Fresh, the spray and disposable surface wipes restrict the growth of life threatening bacteria such as, MRSA, Salmonella, Listeria, E-coli and Legionella. They can be used directly on surfaces in the clinical environment or during the manufacturing process of equipment. The active ingredient combats microbes in three ways: by disrupting cell metabolism, inhibiting respiration and cell division, making it effective against even the most resistant of bacterial strains. Whilst disinfectants currently on the market kill bacteria when applied, as soon as the product dries bacteria are able to start growing again. Independently tested by Bodycote Laboratories and IMSL who specialise in testing the microbiology of industrial processes and products, Micro-Fresh is the Àrst product of its kind to offer such long term protection and is effective after the Àrst application. “We believe that the Micro-Fresh spray and wipes will play an important part in the way that hospitals deal with infection control, which is a very serious issue for the NHS and private hospitals,” comments Glen Beavis, Operations Manager at Micro-Fresh. “Closing a single ward caused by a severe outbreak would typically cost over £20,000 in cleaning costs. It also delays operations – never mind the damage to the reputation to the hospital and the worry that it causes patients. Because Micro-Fresh continues to work on surfaces for weeks we believe it will have a serious impact on nosocomial infection rates.” The wipes and spray have been developed as the Àrst of a forthcoming range of products designed for reducing the spread of infections within hospitals which will be launched later in the year. Visit www.microfresh.co.uk for more information or contact: Glen Beavis on: 0116 270 1333 Please quote ‘OTJ’

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to existing users when customers standardise on the Ziehm platform. The Ziehm Solo is DICOM 3.0 conformant and the wireless networking option is extremely convenient to use for retrieving patient worklists and sending images to PACS.

Mike Biro, General Manager at Xograph Healthcare, said: “I am delighted that Letterkenny General Hospital have purchased a Ziehm Solo Mobile C-Arm. The unit is already conÀrming itself as the most popular newly purchased mobile C-Arm in Ireland. The Ziehm Solo’s superb image quality brings instant beneÀts by helping provide greater surgical conÀdence thereby reducing procedure times and most importantly resulting in improved patient outcomes.”

THE OPERATING THEATRE JOURNAL

What do anaesthetists do? How does anaesthesia work? What are the risks? And how does the anaesthetist know if you are really asleep? Anaesthesia is a mysterious and sometimes threatening process. In this Very Short Introduction, Aidan O’Donnell takes the reader on a tour through the whole of the modern anaesthetic practice. He begins by explaining general anaesthesia: what it is is, how it is produced produced, and how it differs from natural sleep and other forms of unconsciousness. He goes on to consider the main categories of anaesthetic drugs, including anaesthetic vapours, intravenous agents, muscle relaxants, and analgesics, together with explanations of how they work and what their purpose is. Set against the historical background of anaesthetic and surgical practice, O’Donnell examines the large role anaesthetists play in specialised areas such as intensive care medicine, pain medicine, and childbirth; and Ànally, he considers the risks of anaesthesia, putting in to context that anaesthesia is a very safe process. Aidan O’Donnell is a consultant anaesthetist and medical writer with a special interest in anaesthesia for childbirth. He was admitted as a Fellow of the Royal College of Anaesthetists in 2002 and a Fellow of the Australian and New Zealand College of Anaesthetists in 2011. This is his Àrst book. He is available for opinion pieces/articles and interview. Read Aidan’s blog piece on Propofol and the death of Michael Jackson http://blog.oup.com/2012/04/propofol-anaesthetic-michael-jackson/ There are more than 300 VSIs in the series, covering everything from Indian Philosophy to Global Warming, and Mathematics to Free Speech. Over 3.5 million copies have been sold since the series began in 1995. They have been translated into 25 different languages. Around the world there are 10,000 VSIs sold every week. When responding please quote ‘OTJ’

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THE HIDDEN THREAT OF DIRTY SURGICAL INSTRUMENTS

C F 3 F I N G E R TI P PU LS E OX I M ET E R

An independent report suggests that a welsh woman who died from hepatitis B may have been infected by a dirty surgical instrument. With similar cases seemingly on the rise, Single Use Surgical recommends replacing difÀcultto-clean devices with single-use to protect patients from hospital acquired infection Nancy Lane, a 68 year old woman from South Wales, underwent cardiac surgery at Morriston Hospital in March 2011. Although the mother-of-two made a good recovery from the procedure, she later became ill with hepatitis B and died in June from acute liver failure.

Now available on NHS Supply Chain Contract. (Ref: FAG531)

An investigation found that the virus was likely to have been transmitted from a previous patient via a probe - that is used to view the heart during surgery which had not been cleaned properly. Although a review by the Welsh Healthcare Associated Infection Programme Team found “signiÀcant improvements” have since been made in decontamination at the hospital, there is increased awareness of hospital acquired infection in the UK as a result of dirty instruments. Just over a year ago 38 patients in Wales were informed that they may have been put at risk of contracting Creutzfeld-Jakob Disease (CJD) through contaminated surgical instruments. Furthermore there are still instruments in use that cannot be guaranteed clean. For example suction tubes - an instrument that is used in most surgical procedures - often have long narrow channels that are difÀcult to reach during cleaning and impossible to inspect with the naked eye. Since inspection after cleaning is a critical step in ensuring a device is free from debris, if an instrument cannot be checked it cannot be declared clean. And there is evidence that more attention should be given to this issue. Researchers at the University of Michigan in the USA recently inspected 350 suctions using a small camera. Their results showed that all of the suction tubes contained blood, bone, tissue and even rust. It could be said that the instruments had not been cleaned properly, so the researchers tested this theory by cleaning all the devices following manufacturer’s instructions and inspecting them again. Re-examination showed only 7 of the 350 suctions were free from debris.

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Some argue that sterilisation eliminates any infection risk. However sterilisation only works when an instrument has been cleaned properly; there is no such thing as sterile dirt. There is also scientiÀc evidence that there are abnormal proteins associated with rare prion diseases, such as CJD, that form a resistance to conventional methods of decontamination. Experts at the University of Southampton found that “currently marketed cleaning chemistries and recent decontamination protocols do not completely suppress the threat from iatrogenic CJD” (Herve et al., 2010).

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However despite this knowledge, many hospitals still use these devices because the instruments look clean from the outside. Consequently patients are potentially being put at risk everyday across the UK.

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A UK company Single Use Surgical started manufacturing over 10 years ago with the aim of replacing difÀcult-to-clean instruments with single-use. Matthew Tulley, Single Use Surgical’s Director, commented on Nancy Lane’s case “it’s very sad that this has happened in today’s day and age. We hope that this has opened people’s eyes to the infection risks of dirty instruments and we are optimistic that this will encourage action so that cases like Nancy Lane’s can become a thing of the past”

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You may Ànd it interesting to watch an NBC investigation into the same problem in the USA which the OTJ team have added to their Facebook page.

www.timesco-primarycare.co.uk

www.susl.co.uk References Abertawe Bro Morgannwg University Health Board, 2012. Response to reports on Hepatitis B. [press release], 5 April 2012, Available at: < http://www.wales.nhs.uk/sitesplus/863/news/22465> [Accessed 17 April 2012]. BBC News, 2012. Morriston Hospital hepatitis B death: Lessons learned, says ABM health board. [online] Available at: <http://www.bbc.co.uk/news/uk-wales-south-west-wales-17624476> [Accessed 17 April 2012]. Eaton, J., 2012. Filthy surgical instruments: The hidden threat in America’s operating rooms. Washington DC: The Center for Public Integrity. Available at: http://www.iwatchnews.org/2012/02/22/8207/À lthy-surgicalinstruments-hidden-threat-americas-operating-rooms [Accessed 23 February 2012]. Herve, R., Secker, T.J. and Keevil, C.W., 2010. Current risk of iatrogenic Creutzfeld-Jakob disease in the UK: efÀcacy of available cleaning chemistries and reusability of neurosurgical instruments. Journal of Hospital Infection. Available at: <doi:10.1016/j.jhin.2010.01.024> [Accessed 23 February 2012]. ITV News, 2012. Reports published into heart patient’s hepatitis death. [online] Available at: < http://www. itv.com/news/wales/2012-04-05/reports-published-into-heart-patients-hepatitis-death-in-hospital/> [Accessed 17 April 2012]. The Telegraph, 2012. Grandmother poisoned by hepatitis B-infected equipment at NHS hospital. [online] Available at: <http://www.telegraph.co.uk/health/elderhealth/9197592/Grandmother-poisoned-by-hepatitis-Binfected-equipment-at-NHS-hospital.html> [Accessed 17 April 2012].

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Is Áexible working the way of the future? In a recent speech to the Demos Think-tank1, Deputy Prime Minister Nick Clegg said that the Government wanted to examine the option of extending Áexible working beyond mums and dads. He talked about extending Áexible leave to grandparents or close family friends in order to make it “much more common – a cultural norm”. The law currently restricts the right to request Áexible working to parents with children under 17 (or 18 if the child is disabled) or to carers. Sometimes such a request can stall or, at worst, end careers. It is often sensible for working parents to mention at interview stage that they want to work Áexibly, whether it is working four days a week, asking for a job share partner or leaving on a certain number of days to collect children from school. Refusing these requests can result in an unnecessary loss of talent. An employer is fully entitled to refuse such a request on the basis of a “genuine business ground” such as the negative effect on customer demand, quality or performance or due to the effect on existing staff. As we have read many times before, Áexible working can instil immense loyalty in workers and improve staff morale. This is often seen by management as a “nice” employee relations exercise and something that Àrmly falls within the remit of human resources. Yet, true change should come from management. There are many positive business advantages of Áexible/remote working and the real-life examples detailed below illustrate the beneÀts. Now is the time to consider extending the option of Áexible working beyond the current legal remit. Remote working does not mean working from a kitchen table surrounded by noisy children and builders. It means working anywhere that is not the Àrm’s physical ofÀce assisted by the use of skype, facetime and video conferencing to discuss matters with colleagues and clients. Employers often argue that they cannot be certain their employees are working hard. There is an element of trust in every employment relationship. Unproductive people will Ànd ways to procrastinate irrespective of whether they are remote working or gossiping with colleagues in the ofÀce. These issues should be managed through appropriate HR procedures. Remote working provides an employer with access to new markets. If your employee wants to spend a couple of hours after school with their child to assist them with their homework or coach a sports team every Wednesday afternoon or pursue a passion for music by giving regular piano recitals, then why not let them take the afternoon off work and reach your American client market for four hours that evening? This will invariably deliver a better and extended service for clients in our age of amazing technological advancement. Remote working can also have an enormous beneÀt in reducing sick days. According to a study of 24,000 IBM staff worldwide, employees who worked Áexibly were able to work an additional 19 hours a week before they experienced the same levels of stress as those who did not work Áexibly. 2 Reducing current levels of sickness is key for any employer and the positive effects of Áexible and remote working could therefore result in a win-win situation. 1 2 3 4 5

The upcoming Olympics will bring passion and excitement to London and the whole of the UK as well as its own set of employment challenges. Client demands will not cease whilst Bolt runs the 100 metre race. The sensible option is to ask your employees what they want from the Olympics. Treat them as grown ups and reach an understanding that they can, for example, watch certain races if they would want to do so as long as clients, suppliers and colleagues are unaffected. There are many positive side effects that can arise from the Olympics, such as client and supplier bonding events or a team building event with a communal screen at the ofÀce. Employers are being encouraged by the Department for Transport 3 to manage the impact of an extra 1 million passengers hitting our busy transport systems over the Olympics. Staggering hours and working from home are obvious solutions to enable your clients to be serviced when they need immediate assistance rather than making your clients wait for staff to travel an extra hour to reach a desk in an ofÀce. Why stop when Britain’s athletes parade (we hope!) their gold medals at the closing ceremony? Instead of returning to business as usual, why not embrace the Áexibility in the workplace that might have been inspired by the employment challenges brought about by the Olympics? Remote working can manage the increasing high percentage of ofÀce space that employers fail to utilise. Companies, like BT, allow its staff to vary their hours for a range of different reasons. This has resulted in the need for less ofÀce space and BT claims to have saved £500 million.4 Remote working frees up this space and reduces what is often considered to be “dead commuting time” especially when individuals need to change their mode of transportation a number of times in one journey in order to reach their ofÀce. How about the environmental impact? 22 per cent of UK domestic carbon emissions are from trafÀc. 5 The government is currently considering legislation to reduce parking spaces at work with Nottingham leading the way and imposing a “Workplace Parking Levy”. With the ongoing focus on reducing carbon emission, remote working is a pragmatic solution and is certain to impress employees and shareholders. The Government has re-commenced the Àght to prevent Europe from making our employees work less than 48 hours per week. Trade unions and employer organisations (collectively called “the social partners”) are trying to reach an agreement on ‘working time’ issues by September 2012. Currently, the UK’s Working Time Regulations 1998 which implement the European Working Time Directive (the “Regulations”) set out permitted exceptions to the prohibition on working more than 48 hours per week. Many employers rely on the commonly used exception that senior executives and senior employees work “autonomously” and as a result they can work as many hours as they want. This exception is used throughout the EU, especially in France and Italy.

It is likely that this exemption will be retained but many employment practitioners often query whether some of their clients’ senior employees really do work ‘autonomously’. The main debate in Europe relating to the Regulations is whether or not Europe will still allow the UK to ask its middle management and junior staff to sign a document, often attached to an employment contract, in which they agree to “opt out” of the 48 hour working week. Although it is often hard to exceed the 48 hour working week (as it applies over a rolling 17 week reference period but extended to 26 weeks for junior doctors), the fundamental aim of the restriction is to protect workers from the health and safety consequences of overworking. Even if a worker has agreed to “opt out”, he/ she cannot be required to work excessively long hours if this would create a risk to his/her own health and safety. Employers are under a duty to protect their workers’ health and safety and whilst many working time policies seek to place the onus on the employee stating that they should not put their own health and safety at risk, it is for the employer to monitor and manage this issue. Under the Regulations, if an employee agrees to “opt out” of the 48 hour working week then the law currently states that the employer need only retain updated records of the names of those employees. Rather than rely on this stringent 48 hour working week or lose sleep over the health and safety liabilities that might arise if these hours are exceeded, employers could start to focus less on potential loopholes and consider offering employees the right to work Áexibly and remotely. Meeting clients and colleagues face-to-face is hard to beat and should always be encouraged. However, all employers, whether large or small, should think imaginatively. A strategic business decision that is led by members of management who want to move out of the Victorian era and embrace the beneÀts of ever-changing technology could change the workforce of the future. Employees should be judged by the results they achieve and not by presenteeism. Emma Clark is a Senior Associate at Fox Solicitors She advises employers, employees, partners and Àrms on their full range of employment and partnership law concerns eclark@foxlawyers.com Fox Solicitors are a niche Àrm specialising in the law relating to employment, partnership and discrimination www.foxlawyers.com Tel: 020 7618 2400

http://www.demos.co.uk/; and http://www.bbc.co.uk/news/uk-politics-12204079 http://www.telegraph.co.uk/health/healthnews/7803246/Home-working-allows-employees-to-clock-up-an-extra-couple-of-days-of-work-a-week.html http://www.dft.gov.uk/news/press-releases/dft-press-20110803 http://www.btconferencing.co.uk/case-studies/the-conference-powered-agile-enterprise_en-gb.pdf http://www.greenpeace.org.uk/climate/solutions

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Issue 260

May 2012

9


TRUPORT WINS GOOD DESIGN AWARD

FujiÀlm unveils additional DR Mobile Imaging Options at ECR 2012 FujiÀlm is a pioneer in diagnostic imaging and information systems for healthcare, with a range of constantly evolving, clinically proven, products and technologies designed to assist medical professionals perform efÀciently and effectively. The company are pleased to have presented their enhanced mobile imaging range at ECR 2012, held from 1st to 5th March in Vienna, Austria. FujiÀlm’s FCR Go2, FDR Go and FDR Go Áex were among the range of FujiÀlm products on display at ECR, demonstrating the company’s ability to offer a variety of innovative mobile solutions that are both CR and DR based. These products are designed to bring digital X-ray exams to the patient and meet the varying needs of clinicians and facilities across Europe.

The long established Good Design Award is one of the world’s most prestigious and regularly attracts entries from around 50 countries across the globe. TRUMPF Medical Systems has been a winner in the ‘Medical’ category three times and is delighted to conÀrm that one of its products has again been singled out as best-in-category for 2011. The award recognises the considerable emphasis that TRUMPF places on aesthetics and ergonomics. The winning system is the TruPort ceiling mounted supply unit whose slim-line conÀguration and space saving design attracted the judging panel’s eye. Flush Àtted, sealed surfaces provide conformity with stringent hygiene standards and give the system a sleek and attractive Ànish. A key beneÀt of TruPort is that it provides a quick and easy way of conÀguring operating theatre or intensive care unit work stations, without tools in many cases. This makes it supremely versatile, enabling new services to be integrated in line with changing needs. TruPort has proved a highly successful addition to the company’s pendant range. In the UK its introduction has been met with considerable interest and newly conÀrmed orders are set to signiÀcantly boost worldwide installations of this product that currently number more than 850. The TRUMPF TruPort joins the company’s growing list of award winning products. They include the triple award winning AmbientLine therapeutic lighting system; the modular TruSystem 7500 operating table and the iLED and TruLight 5000 surgical lighting systems that have secured TRUMPF a further three design awards. http://www.uk.trumpf.com/products/medical-technology.html

The FDR Go is the company’s new DR portable digital X-ray system and the latest addition to its comprehensive and expanding FDR product line. This next generation portable system will offer the beneÀts of FujiÀlm’s FCR Go2 systems with the enhanced features of DR. New features of the FDR Go include: • A new, more compact, size capable of Àtting into even smaller areas. • The ability to employ any FDR D-EVO detector, including 35x43cm, 43x43cm and 24x30cm sizes. • Image preview in as little as 2 seconds. • Radiographers can send images wirelessly to the hospital network without leaving the patient’s bedside. • Several innovative features designed to simplify workÁow, including auto menu mapping, tube head inching and convenient spare battery charging. Rounding out the new mobile options at ECR is FujiÀlm’s most Áexible DR system to date, the lightweight, compact FDR Go Áex. The Flex consists of a wireless FDR D-EVO Á at panel detector, a full featured laptop workstation and supporting mini components box. This easily transportable, wireless system offers Radiographers the ability to turn virtually any analogue portable system, analogue X-ray room or remote location in to a DR imaging system instantly. Radiographers can simply drop the box into the cassette drawer and position the notebook on top to begin capturing DR images. In addition, the FDR Go Áex features FujiÀlm’s new X-ray detection feature, called “Smart Switch” that simpliÀes its use in any room by eliminating the need to connect the detector’s processing system to the generator equipment’s exposure circuit. The detector preps itself when the examination is started and automatically senses exposure to capture images. The new FDR portable system also includes Irradiation Side Sampling (ISS), FujiÀlm’s patented advanced detector technology. ISS technology improves DQE and MTF. This unique innovation aims to achieve signiÀcant dose efÀciency improvements compared to similar DR detectors. It also reduces scatter and blur from within the detector, resulting in sharper images with greater detail that enhances diagnostic conÀdence for the Radiologist.

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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

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The new standard in patient warming Full guidance can be found at www.nice.org.uk/guidance/MTG7

Hydroxyapatite-Based Coating Could Prevent Premature Implant Failure A new implant coating developed by MIT chemical engineers promotes bone growth and creates a stronger seal between the device and the patient’s bone than bone cement, thus preventing premature implant failure. Currently, about 17% of patients who receive a total joint replacement must go back into surgery because of premature failure. This new coating enlists the body’s cells to produce bone that securely Àxes the implant in place, according to a press release issued by the university’s news ofÀce. The research is described in greater detail in an article authored by Paula Hammond, the David H. Koch Professor in Engineering at MIT, and graduate student Nisarg Shah in the journal Advanced Materials. The thin-Àlm multilayer coating includes hydroxyapatite, a natural component of bone made of calcium and phosphate. The material attracts mesenchymal stem cells from the bone marrow and provides an interface for the formation of new bone. Another layer releases a growth factor that stimulates mesenchymal stem cells to transform into osteoblasts that produce new bone to Àll the spaces surrounding the implant and secure it to the existing bone. The process creates a strong bond and greatly reduces the risk of bacterial infection around the implant, as can happen with bone cement, add the authors. “When bone cement is used, dead space is created between the existing bone and implant stem, where there are no blood vessels,” says Shah, lead author of the article. “If bacteria colonise this space they would keep proliferating, as the immune system is unable to reach and destroy them. Such a coating would be helpful in preventing that from occurring.” Another beneÀt of the technology is the tunability of the Àlm’s thickness and the amount of growth factor that is released. Other systems do not allow scientists to Àne-tune the amount of growth factor that is embedded in the material, says Shah. “A lot of devices typically must use quantities that may be orders of magnitude more than [is needed], which can lead to unwanted side effects.” The researchers are now performing animal studies that have shown promising results.

www.inditherm.com/medical

The ECG ECGWorkbook Workbook 2/e 2/e Angela Rowlands, Lecturer, St Barts and the Royal London Medical School, Queen Mary University of London Andrew Sargent, Lecturer, Critical Care Nursing at the Florence Nightingale School of Nursing and Midwifery, King’s College London ISBN: 978-1-905539-77-2 • July 2011 • M&K Update A4 format • 108 pages • illustrated • £25.00

Many books on ECG interpretation use simulated ECG tracings. Most of the traces that you find in this book are from real people and of the quality that you will be expected to interpret from in practice. The second edition of worldwide popular ‘The ECG Workbook’ continues with a straightforward, systematic approach to ECG interpretation and includes:TWO NEW chapters pes of arrhythmia: Atrial Fibrillation Common Arrhythmias explains five of the most common types Fibrillation, Atrial Flutter, Ventricular Tachycardia, Supraventricular Tachycardia and Ventricular Fibrillation, and a whole chapter is devoted to Ectopics and Extrasystoles. Contents include: Recording a readable electrocardiogram (ECG) • The electrical conducting system of the heart • A systematic approach to rhythm strip analysis • Heart blocks • Common Arrhythmias • Ectopics and Extrasystoles • The 12 lead ECG • Axis deviation • Ischaemia, injury and necrosis • Sites of infarction • Bundle branch blocks • Chamber enlargement • A systematic approach to ECG interpretation Enhanced by real-life ECGs Many books on ECG interpretation use simulated ECG tracings. Most of the traces that you find in this book are from real people and of the quality that you will be expected to interpret from in practice. Books are available in eBook format from Apple iBookstore™ & Amazon Kindle™ Store ALSO AVAILABLE: Cardiac Arrhythmia Recognition an easy learning guide - ISBN: 978-1-905539-53-6 Ward Based Critical Care: a guide for practitioners - ISBN: 978-1-905539-03-1 Routine Blood Results Explained 2/e - ISBN: 978-1-905539-38-3 Arterial Blood Gases: an easy learning guide - ISBN: 978-1-905539-04-8 Deep Vein Thrombosis and Pulmonary Embolism - ISBN: 978-1-905539-51-2

In addition to joint replacements, the coating could also be used for bone Àxation plates and screws and dental implants.

M&K Update Ltd • Keswick • CA12 5AS

For additional information about developments in orthopaedic products, you may want to read New Frontiers in Orthopaedic Product Design authored by Xiang Zhang.

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Issue 260

May 2012

11


Nails, Teeth and Grandfather clocks (A brief history of the surgical blade)

I love thee, blood stained, faithful friend As warrior loves his sword or shield For how on thee I did depend When foes of life were in the Àeld Snodgrass Àeld surgeon 1841 Introduction The development and use of surgical blades has evolved from basic kitchen implements and military weaponry, although there is documented evidence that even more basic implements in surgery have been employed. In 1886 G.S. Englemann recorded that the human Àngernail was grown and sharpened by the Klatsoops tribe in North America to pinch through the umbilical cord of the new born infant, There are also incidents of certain Rabbi growing and sharpening their thumbnails to perform circumcision. Earlier in 1674 Scultetus exclaimed his alarm, and distaste, at reports that midwives purposely cultivated a long sharp Ànger nail to divide the fraenum of the new born infants tongue, as it was believed that the procedure prevented “tongue tie” in the infant. R. Pankhurst in 1964 reported that in Ethiopia an extraordinary long index nail was grown and sharpened to scarify tonsils or even dissect the tonsil completely. The use of the Àngernail as a surgical implement cannot be totally veriÀed, although in the late 19th century metallic Àngernails were designed and produced from nickel plated steel and ivory for scraping the post nasal space. Leaves and grasses The African Loanga tribe allegedly used certain palms, grasses and sharp bamboo leaves to separate the umbilical cord, and possibly may still be doing so. These organic materials are acutely sharp, consisting of a type of silica found in the composition of Áint, another common element we know has been used for spear and arrowheads, and would sufÀce for use as a surgical blade. Cockles and Mussels Later in 1925 B.G.Corney witnessed in Fiji an external urethrotomy with broken mussel or possibly, cockle shells. It is obvious from the last few paragraphs that anything with a sharp edge, either animal mineral, or vegetable can be used for basic surgical procedures. During the late 19th century in Europe thin ivory blades were produced and used for the administration of vaccinations, they were manufactured in packs of 100, at a price ranging from one shilling and sixpence, to three shillings and sixpence, in today’s decimalised market that’s seven and a half pence to seventeen and a half pence, depending on the size and shape of the blade, the blades were designed for single use and may be the Àrst massed produced disposable blade. You may be thinking where the Grandfather clock comes into the equation? The long case clock or what is more commonly known as the Grandfather clock works on a pendulous mechanism within the clock and is set with a toothed chain. In 1785 Aitken sharpened the mechanisms teeth and used it for Symphisiotomy during difÀcult childbirth. The sharpened teeth were employed to work from behind the bone in a reciprocal motion. Following this in 1830, Heine made a mechanical version of Aitken’s design, but unfortunately the mechanics were, to say the least, basic, and the contraption proved difÀcult to control in a surgical environment, and may have done more harm than good, it was also costly to produce and maintain. Aitkins Grandfather clock adaption was eventually replaced in 1894 by the barbed and twisted saw designed by Gigle still in use today. M.S. Jacobs in 1939 stated that he believed the oldest recorded operation was for male circumcision, this claim may be disputed by many historians with an interest in the development of surgery, he described how the Chippewa tribe of the Mississippi, along with ancient Aztecs and the Aborigines of Australia used stone knives for the ritual of circumcision it is also recorded in the old testament that the wife of the prophet Moses took a sharp stone and cut off the foreskin of their son Eliezer [Exodus 4:25] Jacobs claims and observations may be open to debate, as there is evidence to corroborate that in the Ayervedic writings of Susruta and Caraka in India, possibly prior to the old testament descriptions of circumcision, rhinoplasty, trephining of the skull and even excision and removal of bladder stones, and possibly kidney stones. Barbers or surgeons? In 1537 on a battleÀeld in Turin Italy a young surgeon, barber called Ambroise Pare wrote in his diary about the disgust and horror at the sights he had observed, and the bloody scenarios he was experiencing. Pare was only twenty seven years old and had been designated battleÀeld surgeon, although he possessed no formal medical qualiÀcations, the barber would obviously cut hair and trim beards, and perhaps remove the occasional mole with their cut throat razor, but when battle was Àerce and causalities high they were called to assist surgeons with operations, making their surgical expertise and experience a purely hands on experience. The cut throat razor Single edged blades evolved from kitchen knives, and hunting knives, history suggests that early surgeons were a natural progression from barbers both, professions were adapt in the use of the single blade cut throat razor, the cut throat would be kept sharp by the use of a long piece of leather known as a “strop” keeping it sharp for either hair cutting or performing surgery. The back of the blade was blunt to enable pressure to be placed for a controlled deep and clean incision, the cut throat razor is still in use by some surgeons today for the shaving of surgical areas, so back to the surgeon barber relationship, and the blades are today of course disposable. The next phase to facilitate surgical incisions With recent medical expertise, and the many scientiÀc breakthroughs that occur every day it is impossible to predict the “next best thing” with surgical blades, by the time this article goes to press more advances may be made, and the latest advances may be instant history. Can a scalpel smell? There is apparently a scalpel in production that can “smell” and detect cancerous tissue, this surgical blade is still in its infancy, it is being developed by doctors and scientists at the Justus –Lie berg university in Giessen Germany, the technique at the time of writing this article was still quite crude. They utilise an electro scalpel which detects fumes from the smoke that is produced from diathermy and other cautery devices, the fumes are collected by a device known as a mass spectrometer. The mass spectrometer is not a new devise to the scientiÀc world, it has been used within laboratories for analysing chemical compounds for some time, the devise can be used to identify thousands of different molecules by the density and electrical charge they produce. Professor Zoltan Takats who is leading the German research quotes “When a surgeon is performing cancer surgery he or she doesn’t have any direct information on where the tumour may be” Takats vision is to give surgeons an instrument that is within their hands at the point of surgery to detect cancerous tissue from normal tissue, so they can immediately identify what tissue requires excision and what healthy tissue can be left intact, providing the patient with the minimal amount of surgical excision possible. All views expressed within this article are the views of the author Trevor R Toman

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BRANDON MEDICALS INTEGRATED DIGITAL THEATRE

PENTAX Launches State-of-the-Art HD+ Endoscopy Video Processor

Brandon Medical’s fully integrated digital operating theatres have been installed at the Tunbridge Wells Hospital, Kent. Eight of the hospital’s theatres were equipped with the Àrst fully integrated digital operating theatres by UK manufacturer, Brandon Medical. Symposia® is a digital media package incorporating a complete range of Medical AV products servicing a number of users and applications. The system connects medical professionals to a range of AV resources which can be accessed immediately from any location.

New EPK-i5000 delivers high deÀnition endoscopic imaging using the latest technologies for routine applications to challenging examinations

The new EPK-i5000 video processor

Brandon Medical’s Symposia CoPAX® forms the central control in digital operating theatres. CoPAX is an integrated control and display system that combines the display and distribution of high deÀnition laparoscopic images, audio visual control and display functions. All of this is combined into a single, simple to use integrated wall unit. The 42” touch screen features unique applications such as automatic emailing and recording of documents such as operating information to basic administrative tasks. Bespoke functions that have been designed with the NHS client can also be integrated. These include swab and suture count, W.H.O safety checks, ancillary theatre equipment control and even the manoeuvring of the OT table. Brandon Medical’s Symposia® Digital Theatre allows medical professionals live interaction with surgeons in operating theatres. The technology provides a tool for knowledge sharing including surgical skills best practise, telemonitoring, medical lectures and communication between multi disciplinary teams. The integrated digital theatre technology builds on Brandon Medicals unique skills in developing surgical training centres. For further information, please contact Brandon Medical on Tel: 0113 277 7393 Email: enquries@brandon-mecial.com or visit www.brandon-medical.com When responding to articles please quote ‘OTJ’

PENTAX Life Care, experts in high deÀnition endoscopy, has introduced the EPK-i5000 video processor, the latest development in high deÀnition endoscopic imaging. Combining high illumination, HD+ resolution and PENTAXs advanced i-scan image processing technology, the EPK-i5000 ensures excellent endoscopic imaging and outstanding precision when assessing surface structures. This supports faster, more accurate diagnoses for routine applications through to challenging examinations. For those endoscopists using i-scan as part of their daily clinical routine, the EPK-i5000 features 3 pre-set buttons, assigned to the recommended proÀles of Surface Enhancement (SE) and Tone Enhancement (TE). Simply at the touch of a button, users beneÀt from clearly deÀned i-scan settings designed to support the endoscopic pathway of detection, demarcation and characterisation.

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Reference: 1. High-DeÀnition Colonoscopy Combined with i-scan Imaging Technology is Superior in the Detection of Adenomas and Advanced Lesions compare to High-DeÀnition Colonoscopy Alone. Gagovic V. et al, Abstract DDW, 2011.

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The PENTAX package brings together all essential elements required to make our endoscopy offering the best in the market; the introduction of the EPK-i5000 addresses our customers needs and makes operation of i-scan quick and comfortable, said David Moore, Managing Director, PENTAX UK Ltd. PENTAX has taken great strides in the Àeld of HD+ imaging in order to provide the highest deÀnition resolution available, and, with our built in i-scan technology clinicians have experienced an increase in overall polyp and adenoma detection rates1. For more information please visit www.pentax.co.uk or call PENTAX UK Ltd on + 44 (0)1753 792733.

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When the new video processor is used in combination with PENTAXs 90i series endoscopes, the HD+ images provide the highest endoscopic image resolution available. This delivers enhanced visibility of vessel architecture, miniscule structures, identiÀcation of margins or lesions and improved pit pattern classiÀcations.

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My Health, My Faith, My Culture: A guide for healthcare practitioners ISBN: 9781905539802 March 2012 M&K Publishing 80 pp £15.00 Sue Timmins, MSc, DMS, AssocCIPD, MIHM, GP Staff Training Manager, Kent and Medway, UK Every patient, whatever their cultural background and religious afÀliation, is entitled to receive healthcare that is sensitive, appropriate and personcentred. In the UK today, there are people from many different minority groups. There are also members of the host population who follow religions other than Christianity, either from birth or personal choice. The patients chosen or birth faith should always play an integral part in their care.

Surgical Catastrophes Haunt Anesthesiologists Results of a recent survey indicate that catastrophic medical errors can haunt practitioners for years, and in some cases, forever. The study, published in Anesthesia & Analgesia, looked at the results of surveys sent to 1,200 randomly selected members of the American Society of Anesthesiologists to determine how physicians handle the emotional impact of surgical catastrophes. A total of 659 physicians (56%) completed the survey. Results indicated that most respondents (84%) had been involved in at least one unanticipated death or serious injury of a patient during surgery. When asked about the emotional impact of the most memorable surgical catastrophe, more than 70% of physicians reported feeling guilt, anxiety, and reliving the event. Eighty-eight percent of physicians required time to recover from the incident and 19% reported never fully recovering from the event. Alarmingly, although 67% of physicians responding reported believing that their ability to provide patient care was impaired in the Àrst four hours following the event, only 7% were given time off. Results also showed that 12% of respondents considered a career change after a surgical catastrophe. The authors concluded that surgical catastrophes can have a profound and lasting emotional impact on anesthesiologists and may affect a physician’s ability to provide patient care following such an incident.

This helpful guide enables healthcare practitioners to rise to the challenge of providing culturally sensitive services by giving them an understanding of patients varying potential requirements and how to meet them.

Source: Renal & Urology news

About This Guide: Part 1 Culture, religion and health Chapter 1 Introduction: Healthcare: patients rights and expectations The ethnic composition of the population of the United Kingdom Culture and health Refugees and asylum seekers Intolerance and prejudice assimilation or integration Inequalities in health The research behind the production of this guide Chapter 2 - Equipping healthcare providers to deliver appropriately sensitive care: Education and training Local documentation Patient information documentation Consultations Interpretation facilities Summary Forms of address Religious beliefs Questions which you might like to ask yourself prior to a consultation Part 2 The faiths Chapter 3 Major world religions: Buddhism Christianity Hinduism Islam Judaism Paganism Rastafarianism Sikhism Chapter 4 Christian sects and faith groups: Jehovahs Witnesses Mormons Plymouth Brethren The Bruderhof Community Chapter 5 Other signiÀcant groups: The Chinese population, and Chinese medicine The Roma (Romany) people, travellers, gypsies

New C-Arm for Wexford General Cork University Hospital installed their Àrst Ziehm Solo mobile C-Arm image intensiÀer from Xograph Healthcare in January 2011, they have been so impressed with its performance and versatility that they had no problems in recommending their choice to Wexford General Hospital whom after evaluation have just acquired their own Ziehm Solo C-Arm for general Fluoroscopy work in the Operating Theatres, replacing their existing system of 20 years. The Ziehm Solo Mobile C-Arm is exclusively supplied in Ireland and the United Kingdom by the leading independent diagnostic imaging supplier Xograph Healthcare Ltd. The intuitive and user-friendly Ziehm Solo is available in three conÀgurations; the system of choice for Wexford General Hospital is the space-saving all-in-one compact version, with the monitors ergonomically mounted onto the C-Arm and an articulating support arm negating the need for a separate monitor cart. Other variants of the Solo can incorporate the monitors on a more conventional type monitor cart and/or remotely mounted, for example on the ceiling.

M&K Publishing (an imprint of M&K Update Ltd) Tel: 01768 773030 publishing@mkupdate.co.uk www.mkupdate.co.uk Please quote ‘OTJ’

Digital Reconstruction of Tissue Enables 3-D Virtual Microscopy Researchers at University of Leeds have created a digital scanning system of tissue samples that allows for 3-D reconstruction of tissue. Conventional microscopy does not allow for true 3-D analysis, as users examine ultrathin tissue samples one-by-one. The system developed at University of Leeds turns hundreds of slides into high-resolution digital images that are aligned using image registration software. The automated system turns slides into images with very little manual input required. It allows users to zoom into areas of interest to view the shape and structure of cells, blood vessels and tumours. The images can be rotated and examined from any angle. The technique could have applications both in research and clinical settings. The study was funded by the UK National Cancer Research Institute informatics initiative, the UK Department of Health, Leeds Teaching Hospital Trust Research and Development, UK National Institute for Health Research and West Yorkshire Comprehensive Local Research Network. It was published in the May issue of the American Journal of Pathology. Source: medtechinsider Camilla Andersson

The UK ODP Message Group Joining is easy, just send an e-mail,stating your name, e-mail address,position and Hospital to: theatrepractitioners-subscribe@yahoogroups.com

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Michael Leonard, Territory Business Manager at Xograph and Crona Carew, Radiology Services Manager at Wexford General Hospital

Crona Carew, Radiology Services Manager at Wexford General Hospital, commented: “We were impressed with the service received from Xograph at Cork so we decided to source a C-Arm from them for Wexford General Hospital and needless to say they did not let us down. Ziehm mobile image intensiÀers are very compact and easy to move; the touch screen is very intuitive and simple to use and the image quality is excellent, which is why we prefer to use them.” About Xograph Healthcare www.xograph.com

THE OPERATING THEATRE JOURNAL

When responding to articles please quote ‘OTJ’

www.otjonline.com


Infection Prevention Society Welsh Branch National Conference LONDON

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

SENIOR THEATRE PRACTITIONER & THEATRE PRACTITIONER

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

This is an exciting opportunity for two multi skilled practitioners to join this highly professional day case team. Dynamic and enthusiastic RGN or ODPs who have current and relevant experience are required. Comprehensive scrub skills as well as anaesthetic or recovery skills are ideal. It is essential that you are a good team player and have the commitment to the continued delivery of ¿rst class patient care. Further quali¿cations which support your development will be expected.

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

Scalpel A new ‘cutting edge’ discussion forum for all those involved with patient care and the operating theatre environment. Start a discussion, Join a discussion, Offer your opinion, Have your say. http://otjonline.com/scalpel/

Organiser: Infection Prevention Society Date and Time: Tuesday 10th July 2012, 8.45am 15.30pm Location: SWALEC Stadium, Cardiff Cost: FREE for all delegates Registration website: https://www.eventsforce.net/ipswnc2012 Programme: • Opening address including details on the IPS strategy: Tracey Cooper • Using Root Cause Analysis (RCA): Judy Potter • Results of the Point Prevalence Survey 2011 in Wales: Dr Eleri Davies • Acinetobacter at UHW: Speaker TBC • Pseudomonas in taps (the Gwent experience): Dr Neil Carbarns • Lessons from the vomit bowl - surviving and learning from a major outbreak of Norovirus: Tracey Cooper • E. coli O157 in a South Wales kebab house: Gemma Northey • Discovering NDM1 and implications for infection prevention and control: Professor Timothy Walsh • Antimicrobial Stewardship in ABMU Health Board: Siân Davies • Catheter association urinary tract infection (CAUTI): Julie Coslett Aims for the meeting The conference will have two themes. The Àrst will focus on signiÀcant incidents that have occurred across Wales and the lessons that can be learnt from them. The second is on emerging antimicrobial resistance and management. This one day conference represents an important educational activity for the Welsh Branch in an area of current strong clinical and commercial interest.

Course announcement AOTrauma – Hand & Wrist Fixation for ORP & Therapists 21-22 October 2012 Leeds, United Kingdom Course objectives At the conclusion of this course, the participant should be able to: - Explain the basic principles of internal fixation of hand and wrist fracture - Compare methods of fixation in different fracture situations - Apply learning to facilitate surgery for internal fixation - Apply learning to facilitate rehabilitation following internal fixation Features - Lectures and presentations by a national faculty of hand and wrist surgeons, ORP and therapists - Hands-on laboratory practicals on hand and wrist bone models - Discussion groups incorporating case studies including surgery and rehabilitation  Participant criteria The courses are aimed at: All levels of ORP and therapists with an interest in hand and wrist surgery. Participants will be encouraged to discuss and exchange ideas based on their own experiences to maximise personal learning.  For further information and to register online please go to: www.aotrauma.org/coursedirectory.aspx Ànd out more 02921 680068 • e-mail admin@lawrand.com

Issue 260

May 2012

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“.....it is recommended that all hospitals have second generation SADs available for both routine use and rescue airway management” 1

Reference (1): 4th 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. Section 3, Appendix, page 210.

www.i-gel.com

Quality, innovation and choice

The Operating Theatre Journal  

May 2012 Edition 260

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