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November/December 2009

Issue No. 230

ISSN 1747-728X

“Complete Airway Management”

The PRO-Breathe® range of Laryngeal Airways and Endotracheal Tubes offer unbeatable performance and value. Contact us to see how much you can save. PRO-Breathe® Laryngeal Airways are available in disposable pvc, disposable silicone or autoclavable silicone. All three options are transparent for clear observation of airway patency and come in either a standard rigid or an Armouflex® reinforced version. Their smooth integrated design gives a superb seal, optimum feel and less risk of patient trauma. PRO-Breathe® Laryngeal Airways are available in a full range of patient sizes, all clearly marked with inflation volumes and insertion guidelines, with colour coded pilot balloons. These are complimented by PRO-Breathe® single patient use ET tubes, recently rated joint top in a NHS Supply Chain evaluation and added to their catalogue. Armourflex® and pre-formed options are available, cuffed or un-cuffed. Large stocks of PRO-Breathe® products are held for next day delivery. We are so confident of the quality and value offered by the PRO-Breathe® range that, if you currently receive a lower price for a comparable product, we will beat it*. For free samples and full details of the PRO-Breathe® Airway Management range please contact us. *If commercially viable PROACT Medical Ltd - 9-13 Oakley Hay Lodge, Great Folds Road, Corby, Northants, NN18 9AS Tel: 0845 051 4244 Fax: 0845 051 4255 e-mail:

Non-steroidal anti-inflammatory drugs in peri-operative pain management

An interview with Dr Samuel Bass

FIRST HAND EXPERIENCE Non-steroidal anti-inflammatory drugs (NSAIDs) remain central to a best practice approach to peri-operative pain management. However, with so many NSAIDs available in multiple formulations, how does one choose which one to use? Here we talk to Dr Sam Bass, Consultant Anaesthetist and Lead Clinician for the In-patient Pain Service at Addenbrooke’s Hospital, Cambridge, about why he uses NSAIDs in the peri-operative period and his clinical rationale for selecting the most appropriate NSAID therapy. “NSAIDs are a very important part of postoperative and peri-operative analgesia. It has been shown that multimodal analgesia – that is, giving two or three drugs with different actions – is very good at reducing the side effects of any one of the drugs that you are giving,” explains Dr Bass. “The use of an NSAID, such as diclofenac or ibuprofen, in the peri-operative period reduces the amount of opioid required for effective analgesia, large doses of which can cause side effects such as nausea, vomiting, respiratory depression and sedation.”

diclofenac is that you can give it at any time during the surgical procedure.”

“NSAIDs have opioid-sparing abilities, which means that you are less likely to need to give large doses of opioids such as morphine.”

In recent years the need to be able to administer effective analgesia to the unconcious patient has become more important. Dr Bass explains, “With changes in nursing practice, difficulties in timing anaesthetic lists and anaesthetic starts, it has become more important to avoid using standard pre-medication. Therefore, we are limited to administering multimodal analgesia in theatre and this means using the intravenous or rectal route. It is obvious that I would prefer to give drugs intravenously if possible, as there can be problems with predicting absorption and ensuring patient consent for drugs given rectally. My choice has always been intravenous diclofenac.”

“There are good studies to show that the use of NSAIDs does actually reduce patients’ pain scores,” says Dr Bass. “I use diclofenac, partly because a large number of patients have already been on it, but also because it is a drug that has been around for a long time and so has a good safety profile. It is also available in different preparations, so if a patient has been on it orally pre-operatively, it is possible to administer it by other routes, such as intravenously or rectally intra- or post-operatively. Besides diclofenac there are very few intravenous NSAIDs and, while licensed for post-operative use, those such as ketorolac or the COX-2 inhibitors do not have a licence specifically for use in the peri-operative period. The advantage of

Recently, an innovative formulation of injectable diclofenac has been launched in the UK (Dyloject®), which has a number of advantages over standard formulations, the most evident of which is its ease of administration. This formulation contains a solubility enhancer (hydroxypropyl-ћcyclodextrin), which enables the drug to be given rapidly as a simple intravenous bolus injection. “Until recently I always used the standard intravenous diclofenac formulation, which required diluting, buffering and giving slowly over 1 to 2 hours. This meant that there was an inherent hassle in having to get the formulation ready and that the patient may have to spend longer in recovery”, explains Dr Bass. “Dyloject®, however, comes in a 2 ml solution, is easy to draw up and is

Dyloject® 75 mg/2 ml Solution for Injection – Abbreviated Prescribing Information (Please refer to full Summary of Product Characteristics when prescribing) Presentation: Each 2 ml vial contains 75 mg of diclofenac sodium as a ready to use solution. Uses: By intravenous injection: for the treatment or prevention of post-operative pain. By intramuscular injection: for post-operative pain and other types of acute pain, including renal colic, exacerbations of osteo- and rheumatoid arthritis, acute back pain, acute gout, acute trauma and fractures. Dosage and administration: Injection (intravenous or intramuscular). Adults: Dyloject® 75 mg/2 ml Solution for Injection should not be given for more than two days (dose not to exceed 150 mg within any period of 24 hours). Intravenous injection: Dyloject® 75 mg/2 ml Solution for Injection may be given as an intravenous bolus injection either inject 75 mg intravenously (e.g. for moderate to severe post operative pain) and repeat after 4 to 6 hours if necessary or a loading dose of 25 mg to 50 mg may be administered as a 5 to 60 second intravenous bolus after surgery for the prevention of post-operative pain, followed by additional injections up to a maximum daily dosage of 150 mg. Intramuscular injection: One vial once (or in severe cases twice) daily by deep intramuscular injection into the upper outer quadrant of the buttock. If two injections daily are required, it is advised that the alternative buttock be used for the second injection. Renal colic: One 75 mg dose intramuscularly. A further dose may be administered after 30 minutes if

necessary. The recommended maximum daily dose of Dyloject® is 150 mg. Elderly: The lowest effective dosage should be used in frail elderly patients or those with a low body weight. Children: Not intended for use in children. Hepatic impairment: No dose adjustment required. Renal impairment: Patients with severe renal impairment (creatinine clearance below 30 ml/min) should not be treated with Dyloject® by intravenous injection. Contraindications: General: History of, or active or suspected gastro-intestinal ulcers, bleeding or reactions. Severe heart failure, renal failure, hepatic failure. Last trimester of pregnancy. Hypersensitivity to NSAIDs, HPbCD or monothioglycerol. Specific to IV use: Concomitant NSAID or anticoagulant use (including low dose heparin), prior haemorrhagic diathesis, confirmed or suspected cerebrovascular bleeding, operations associated with a high risk of haemorrhage, history of asthma, hypovolaemia or dehydration from any cause. Precautions: Avoid concomitant NSAID or COX2 inhibitor use. Use with caution in patients with renal, cardiac or hepatic impairment, uncontrolled hypertension, symptomatic arteriosclerosis, and in the elderly, also in patients with a history of, or symptoms of GI ulceration, GI bleeding or inflammatory bowel disease or SLE. Caution advised in patients with bleeding diathesis or on drugs which increase the risk of GI bleeding (may reversibly inhibit platelet aggregation). Risk of oedema in patients with heart failure. May precipitate bronchospasm, renal failure and impaired female fertility. Interactions: The following drugs may interact with Dyloject® (consult SPC for details): analgesics,

Call us at +44 (0) 1223 257759 Fax + 44 (0) 1223 257800 or visit DYLUK1109AD - Date of preparation: Nov 2009

very easy to administer. Also, from a patient safety perspective, there have been recommendations from the NPSA which advocate the use of pre-mixed or pre-diluted injectable medicines. Dyloject® actually fits the bill in that it is available in a ready-to-administer ampoule.”

“The advantages of Dyloject® are that it is easy to give, it doesn’t require any dilution, and you can give it at any time during the procedure.” Dyloject® has been available on the hospital formulary at Addenbrooke’s for about a year, but Dr Bass has not been surprised by its acceptance within operating theatres. “Dyloject® is now available in all the operating theatres including gynaecology, neurosurgery, obstetrics, plastics and orthopaedics, and has been widely used without any problems. We are very happy with the safety profile and there have been no complications to date,” explains Dr Bass. “Dyloject® is an advance over the standard formulation of intravenous diclofenac since it is quick and easy to administer and does not need to be diluted or buffered before use.” NSAIDs continue to be an essential component of multimodal peri-operative analgesia. Dyloject® offers the efficacy, safety and convenience that is expected of perioperative analgesia, and offers significant advantages over the standard intravenous formulations of diclofenac. anticoagulants, antidiabetic agents, antiplatelet agents, corticosteroids, cyclosporin, digoxin, diuretics, lithium, methotrexate, mifepristone, other NSAIDs, quinolone antimicrobials, SSRIs, tacrolimus, zidovudine. Use in pregnancy and lactation: Diclofenac should not be prescribed during pregnancy unless there are compelling reasons for doing so. Use in late pregnancy should be avoided. Not contraindicated during lactation. Side effects: Occasional adverse effects may occur including epigastric pain, nausea, vomiting, diarrhoea, dyspepsia, flatulence, anorexia, headache, dizziness, vertigo, rashes, skin eruptions, elevation of serum ALT or AST, haemorrhage, IM injection site reactions such as local pain and induration, IV injection site reactions such as thrombophlebitis. Rare, but serious adverse effects include: anaphylaxis, hepatitis, GI bleeding, acute renal failure, cerebrovascular haemorrhage, myocardial infarction, bronchospasm, severe skin reactions, aseptic meningitis. Basic NHS price: £48.00 (10 x 75 mg/2 ml vials). Legal category: POM. Product Licence number: PL 25053/0001. Product Licence holder: Therabel Pharma UK Limited, Compass House, Vision Park, Chivers Way, Histon, Cambridge, CB24 9AD, UK. Date of revision: September 2009.

Adverse events should be reported. Reporting forms and information about adverse event reporting can be found at Adverse events should also be reported to Therabel Pharma UK Ltd on: 0800 066 5446


A rapid solution to post-operative pain

Patients are being harmed by working time limits, finds new study Surgeons across the country say patients are much less safe in the NHS since the August introduction of European Working Time Regulation (EWTR) 48 hour working limits as continuity of care for patient collapses, this is the damning assessment of a survey of NHS surgeons. Services are only being held together by a ‘grey market’ of doctors willing to covertly breaking the legislation to maintain care for patients. At the same time the College learns more than 100 further hospital rotas have applied to break the legislation (so-called derogation) because they cannot meet the legislation. This comes despite an original deadline of 28 May and further hospitals are expected to report failure.

PATIENT SAFETY IN THEATRE TEAMS A PRACTICAL APPROACH TO HUMAN FACTORS Course dates: 11-12 January & 25-26 March Royal College of Surgeons of England

The College surveyed 900 surgeons - almost an eighth of the UK surgical workforce – with responses from more than 360 consultants and more than 500 trainees to see how surgical services were faring under the new working time restrictions. It found some alarming results: * 64 per cent of all respondents thought quality of care had worsened due to the EWTR. * More than half of consultants believe compliance with EWTR has been achieved at the expense of patient safety (overall 44 per cent of respondents agreed). * A third say handover arrangements are inadequate in their hospital and 23 per cent say they cannot stay involved in all stages of individual patients clinical care that require their expertise. * 62 per cent of surgeons said they were not working a truly compliant 48 hour week with 70 per cent estimating they worked more than 48 hours – with these surgeons estimating they averaged between 55-60 hours a week. * A quarter of respondents say other professionals in the healthcare team are acting up to cover tasks previously done by surgeons and 43 per cent say they are covering rota gaps in other areas of their own hospital to keep services running. Patients are being lost and at increased risk of dying as a direct result of so many shift changeovers and rotas which leave no time available to handover. Trainee surgeons across the country are staying on unpaid after the hours limit because they want to see through care for patients. They are also taking on additional paid locum work in the hope of gaining the training opportunities they cannot get in their formal working week. Meanwhile hospitals are relying on this goodwill because they know they couldn’t stay open without them. As a result there is an emerging grey market in hospital cover with doctors true working hours being kept off the books.

This new multi – professional 2 day course has been specifically designed for the theatre team and would ideally comprise a surgeon, an anaesthetist, scrub nurse and ODP. Utilising a state of the art simulation facility, the course focuses on the non – technical skills, or human factors, of the team in order to maximise the safety of patients and the clinical success of operations. By using simulated mannequins and multimedia facilities, the course will be largely practical with each team being involved in a number of theatre – based scenarios with the feedback designed to help each individual team member work more effectively with their colleagues and as a team. For further information call 020 7869 6300 or email

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John Black, President of the Royal College of Surgeons said: “Throughout this affair the call from the Department of health has been that this legislation is about making patients safer. We now have a clear message from the frontline that patient care is being made significantly less safe through systems that lead to poor continuity of care, the loss of teams and ‘wildcat’ closure of services.

Next Issue Copy Deadline Friday 26th November 2009 All enquiries: Mr. L.A.Evans Editor/Advertising Manager Mr. A. Fletcher Graphics Editor The OTJ Lawrand Ltd PO Box 51 Pontyclun CF72 9YY

“We now have the ridiculous situation where the Department of Health in public moralises over fears that trainees are being coerced into working over 48 hours while privately relying on these doctors to stay longer or cover additional dead-end shifts as locums because there is no way the service could keep running otherwise.” Service failures are already beginning to show in Northern Ireland and Wales*, areas that have always struggle with recruiting doctors, and this is a pattern likely to be repeated across the country as winter bites and burnt-out clinicians drop out of unworkable rotas. The Department of Health no longer have a clear idea of the effect EWTR is having. Those hospitals which had a plan on paper to deal with EWTR were allowed to stop sending in performance data. Department of Health is now only tracking those who admitted they have problems. In July around 240 Trusts submitted a return, this has fallen to 122 Trusts in August. Earlier this year, surgical trainee organisations worked out an ideal working system that would offer safe and high quality patient care, ample training time and retain a good work/life balance for surgeons in training. They established that a core working week with flexibility to be on-call up to a combined total of 65 hours a week would be best and the Royal College of Surgeons calls for a sectoral opt-out of the European legislation to achieve this.

Tel: 020 7100 2867 Email: Website: The Operating Theatre Journal is published twelve times per year. Available in electronic format from the pages of and in hard copy to hospitals throughout the UK. 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. © 2009

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Pressure Area Care - e-Auction delivers huge savings e-Auction cuts Barnet & Chase Farm Hospitals NHS Trust’s mattress rental costs by more than half A mini-competition, which utilised the e-Auction tool for Pressure Area Care at Barnet & Chase Farm Hospitals NHS Trust, has resulted in savings of 66.7%. Managed and executed by NHS Supply Chain under the national framework agreement for Pressure Area Care, the mini-competition addressed the hire and management of pressure area care mattresses, based on approximately 140 alternating pressure replacement mattresses on site at any one time. As part of the mini competition process, five suppliers, including the incumbent, were invited to take part in a bespoke e-Auction which was managed by the NHS Supply Chain procurement team in Normanton, the NHS Supply Chain finance team in Alfreton and viewed by Barnet & Chase Farm Hospitals NHS Trust. Commenting on the e-Auction, Marie Streak, Procurement Project Buyer for Pressure Area Care at NHS Supply Chain, said: “The e-Auction generated a highly competitive situation and produced a superb end result for the trust. “Lasting over two hours, the e-Auction resulted in a change of supplier to Talley Medical Ltd. and a much improved daily rate which will deliver significant savings against current prices. This is an excellent result for our customer and significantly cuts their rental costs for alternating pressure replacement mattresses.” Concludes Marie: “This a very important result for NHS Supply Chain in the development of our mini-competition and e-Auction capabilities, which will deliver important learning, not just in terms of our existing Pressure Area Care contract, but across our general national portfolio.” The trust’s Head of Procurement, Caroline Simpkin, said “Marie and her team supported us throughout the whole process, from putting together the specification, supplier demonstrations and the mini-competition, as well as running the e-Auction. This is the first e-Auction that has been run specifically for the trust and we were extremely pleased with the way the tender was handled and with the outcome. It is certainly something that we would consider doing again.” About NHS Supply Chain NHS Supply Chain is operated by DHL on behalf of the NHS Business Services Authority (NHSBSA). Its aim is to provide over £1 billion of savings to the NHS so that resources are released for customers to focus on quality frontline patient care, manage costs and achieve sustainable value. NHS Supply Chain provides its services to over 600 NHS trusts and private healthcare providers and offers over 620,000 products.

BD launches BD OcuSeal™ liquid ocular bandage Innovative new protective barrier for ophthalmic surgery BD Medical – Ophthalmic Systems, a unit of BD (Becton, Dickinson and Company), recently announced the European launch of BD OcuSeal Liquid Ocular Bandage, a fully synthetic protective barrier designed to provide comfort for post-surgical, post-traumatic, and non-traumatic ocular conditions. This product has European CE Mark approval, and BD intends to initiate registration in other countries including the United States. BD OcuSeal Liquid Ocular Bandage is designed to help reduce the need for sutures and reduce complications typically associated with surgical incisions, including infection and patient discomfort. It is intended for direct application on corneal, conjunctival, and scleral surfaces. BD OcuSeal Liquid Ocular Bandage consists of a synthetic hydrogel that is applied directly to the ocular surface as a liquid, using a special brush applicator. The hydrogel is activated by mixing two separate components. This product is engineered to form a low-profile, smooth, soft and transparent protective barrier film on the ocular surface. An early user of BD Ocuseal is Sid Goel, Consultant Ophthalmic surgeon with a specialist interest in Corneo-plastics, Northern Lincolnshire Hospitals NHS Trust, UK. Mr Goel remarks, “Ocuseal has proved an extremely useful tool in various aspects of my surgical practice serving as a bandage: in promoting corneal epithelisation, in corneal protection during prolonged oculoplastic surgery, and stabilising leaky wounds at the end of cataract surgery. It is a cost effective and very successful alternative to use of standard bandage contact lenses, thick viscoelastics, and sutures in these situations.” Phillip Donoghue, Business Leader, UK and Ireland, BD Medical – Ophthalmic Systems, adds “With the addition of BD OcuSeal Liquid Ocular Bandage to the BD family of single-use ophthalmic products, BD continues to demonstrate its commitment to improving patient safety during ophthalmic surgery.” BD has an exclusive license from Hyperbranch Medical Technology to market BD OcuSeal Liquid Ocular Bandage for use in ophthalmology. When responding please quote ‘OTJ’

Fukuda Denshi UK to host major European Distributor Training Programme Fukuda Denshi is a leading supplier of advanced patient monitoring and user-configurable clinical information management systems.

It manages the entire supply chain process for medical consumables - from the sourcing of products, right through to their delivery and supply.

The company are using their recently expanded technical service centre in Sheffield to host a major European Distributor training programme, in November 2009.

Key services include: Procurement By ordering through NHS Supply Chain, trusts negate the need to tender themselves through EU processes (OJEU). This saves trusts time and money on the lengthy tendering process.

Commenting on activities, UK Managing Director Terry Rickwood said “Our Fukuda Denshi UK technicians are at the forefront of technical training knowledge and in conjunction with representatives from our Head Office in Japan, have structured a comprehensive 3 day programme for our expanding European Distributor network.”

Logistics NHS Supply Chain arranges the delivery of products at the required location.

The format for the 3 day programme will be ‘train the trainer’ and cover:

E-commerce NHS Supply Chain offers an electronic system to manage all transactions, including an online catalogue, online ordering and an e-billing system.

• Advanced fault finding and repair techniques.

The range of over 620,000 products includes:

For further information, please telephone Fukuda Denshi on 01483 728065.

· theatres · nursing · food and facilities · clinical markets · capital equipment.

Fukuda Denshi: Healthcare bound by technology.

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• Comprehensive installations including sophisticated telemetry.

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Theatre staff needed urgently throughout the country Due to our continued growth and increased demand, we need more staff


Our rates of pay are excellent and we have Clients nationwide. We offer free training and CRB’s.

Call to register today and work tomorrow! tel:

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Brain surgery done through nose

New Capnomask® Ophthalmic

British surgeons are carrying out cutting edge brain surgery - by operating through the nose.

Mediplus, specialising in products for urology, urodynamics, GI and anaesthetics, is launching a new ophthalmic medium concentration mask for oxygen delivery and side-stream CO2 monitoring. The “cut down” shape of the ophthalmic Capnomask® allows better access to the eyes, making it ideal for eye surgery, and also fits better smaller faces.

The procedure, being used at Southampton General Hospital, is used to remove skull base tumours and is performed entirely by entering the skull through the nose, known as endonasal endoscopic skull base surgery. Indian consultant skull base neurosurgeon Nijaguna Mathad and ENT surgeon Salil Nair have pioneered the procedure at the hospital’s Wessex Neurological Centre. Using the surgery has enabled them to reach tumours at the base of the skull and at the top of the spine using an endoscope that transmits images onto a high definition TV screen in the operating theatre. Previously, neurosurgeons would have had to split the facial skeleton or peel back the scalp and remove the skull on the forehead to complete the same operation. “This minimal access and maximal invasive procedure is at the cutting edge of neurosurgery,” Mr Mathad said.

The Capnomask® Ophthalmic, a single use device, is supplied with an oxygen line and a monitoring line, as well as a 0.22μ filter. The front dual connector on the Capnomask® facilitates connection of oxygen and monitoring lines at the optimal location. The end tidal CO2 measured is therefore much more accurate and the capnogram, easier to read. The 0.22μ filter, connected to the capnograph, offers good protection against bacterial contamination. For more information on the Capnomask® and other products, please contact Mediplus on 01494 551200, or visit

“One of the first patients we used this technique on was suffering from a tumour with an erosion of the skull base. “Conventionally, he would have undergone a bifrontal craniotomy with its associated risks of epilepsy and stroke. It would also have required the patient to remain in hospital for a number of days and restricted them from driving afterwards. “By using the endonasal endoscopic procedure, we were able to reach the tumour with minor disturbance to the surrounding parts of the brain and did not need to make incisions on the head, which would have resulted in a longer hospital stay.” Mr Mathad added: “The patient made an uneventful recovery and was discharged from hospital within 48 hours, which was a truly short stay for such a major procedure.” Source: The Press Association.

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Unique lighting system from TRUMPF AmbientLine is a lighting system from the medical technology company TRUMPF and has already won three prestigious design awards. An impressive achievement as this innovative product is only a matter of months old. It has clearly captured early attention and understandably so. Not only does it look good but it also has the ability to enhance the wellbeing of patients and the working environment of hospital staff.

For the new lighting concept, TRUMPF has expanded its ceiling pendants to include LED lighting elements.

AmbientLine is a modular, energy efficient lighting system that uses the latest LED technology, ensuring low power consumption and long life, and provides the perfect way to recover. Ambientline was developed by TRUMPF following research into the biological and psychological influences of light on the recuperation process, the system works with the natural cycle of day and night. It uses different brightness and colour phases to simulate the light-dark cycles that patients miss under conventional room lighting. In ICU especially, patients are exposed to unnatural lighting. Integrated into ceiling pendants, AmbientLine can provide direct and indirect lighting. It is simply and flexibly activated at the patient’s bedside or even from the door, using an intuitively controlled touch screen, making it easier to reach the patient without having to light up the entire room and disturb other patients.

A special LED light designed for platforms and drawers allows easy and secure access to instruments at the bedside and additional lighting units are available for patient examination and treatment. These are directed towards different areas on the bed and can be operated independently. In the event of an emergency, full lighting can be activated at the push of a single button.

A special semi-transparent screen suspended over the bed provides the personal touch. Its colour is easily adjusted to suit patient preference. Additionally this serves as a projection screen when teamed with a beamer connecting the patient with information, entertainment and communication systems. A glarefree reading light is integrated into the design, adjusted and controlled by the patient. More ambient light is introduced into the room by coloured wall lighting also serving as a night light. Indirect floor and ceiling lighting is available for use in the operating theatre and is ideal for endoscopic and minimally invasive procedures. Soft, coloured and individually adjustable ambient light improves monitor screen contrast.

The patient can relax in a pleasant, coloured light from indirect wall and sail lights.

Further information: Telephone - 0844 482 0188 or email:

AmbientLine brings important benefits to the welfare of the patients, clinicians and visitors and gives the hospital competitive advantage. When responding to articles please quote ‘OTJ’


Amnis and Terema achieve a full house

Despite its comparative youth, TRUMPF Medical Systems is a fast growing company in the UK and indeed wider Europe. Its award-winning medical technology products are being ordered by many of the UK’s leading hospitals and clinics that are investing to improve patient outcome. And with the introduction of the highly innovative AmbientLine LED lighting system, interest in its products has never been greater.

The collaboration between Amnis, the specialist healthcare quality, innovation and productivity improvement enabler, and Terema, the human factors organisation, was a resounding success at the Association for Perioperative Practice (AfPP) congress, in Harrogate, in October. Indeed, Diane Gilmour, President of the AfPP, commented: “The Amnis and Terema stand has been a highlight of the event for many participants.” Amnis and Terema brought together expertise designed to ensure a smooth and effective flow of patients into theatre and effective behaviours from the theatre teams themselves. To emphasise this, they arranged to bring a flight simulator - staffed by serving airline pilots - to the AfPP Congress and allow delegates to try their skills at flying and landing a modern passenger jet. According to Amnis’ managing director, Mark Eaton: “The focus at the Amnis and Terema stand was on both having fun as well as demonstrating the importance of improving the flow of patients and the way that teams work in high pressure environments. “Success in aviation is achieved by maintaining safety and quality while providing efficient and effective use of resources in a complex and dynamic environment,” he continued. “In healthcare, even more than aviation, staff are central to success. Optimisation of systems and processes – provided by Amnis – must be undertaken in co-ordination with the development of people and culture, which is provided by Terema.” Eaton added: “Over the three days of the congress, there were 86 ‘official’ slots available on the flight simulator. We managed to squeeze 88 people through and we had a waiting list that ran into dozens, so that we could have filled each slot three times.” Libby Campbell OBE, Director of Nursing at NHS Lothian said: “The simulator was excellent. I can see the link between it and the need for human factors and Lean methodology training in healthcare.” Terema’s Phil Higton commented: “It was great to be able to see the enthusiasm of the theatre staff in the simulator as they got the chance to fly and land a Boeing 737 - with many of them achieving impressive scores.” An article, by Mark Eaton and Phil Higton, on developing effective operating theatres can be downloaded from: For further details about developing effective operating theatres, visit:

To drive this growth TRUMPF Medical Systems in the UK has appointed a new and highly enthusiastic Managing Director. He is Oliver Law, an honours graduate in business management with seven years’ experience in medical device sales. Most recently he was the National Sales Manager with the Endoscopy Division of Stryker UK and previous to that, Head of Orthopaedics UK for Karl Storz Endoscopy. Oliver’s first tasks with TRUMPF Medical were to move the business to new premises at the Luton Airport Business Park and to initiate a major recruitment programme. “We have appointed new people across the board in sales, customer service and in our projects management team,” he explained. “We are now very well positioned to build our profile in the UK and meet the expectations of our five year growth plan.” With his new team in place Oliver focussed his attention on the opening of a purpose-built showroom at Luton in September. He concluded, “This is undoubtedly the best showroom in Europe. We are not just displaying our products here, we are actually creating a series of clinical environments to show our customers the full integration potential of our systems.” When responding to articles please quote ‘OTJ’



LESS Surgery – new equipment for truly minimally invasive surgery Olympus is one of the first suppliers to offer a complete set for the innovative minimally invasive operating technique LESS Surgery Laparo-Endoscopic Single-Site Surgery (LESS Surgery) is one of the most significant innovations in medical technology. Olympus is now one of the first providers in the world to offer a complete surgical instrument set specially tailored to LESS Surgery.

Since LESS Surgery was first introduced in May 2007, it has led to a surgical revolution. The advantages are evident: singlesite access, such as through the navel, means that LESS Surgery is practically scar-free and can result in a decrease in discomfort caused by wound healing. Together with experts from the field, Olympus is now one of the first providers in the world to have developed a set that supplies the entire range of necessary equipment. All instruments are specially tailored for operations using single-site access and significantly simplify adaptation of the new method.

Access through the navel is made using a TriPort or QuadPort, through which up to three hand instruments can be simultaneously guided. The single-access tailored HiQ LS hand instruments have a double angulation and their curved shaft design not only makes optimum use of the limited space, but also means that they are used in a similar way to standard laparoscopies: the right hand remains on the right side during operation and vice versa. With the instruments previously used for LESS Surgery, doctors sometimes had to work mirror-inverted. “Using the new instruments, operations are truly minimally invasive,” says Professor Jens-Uwe Stolzenburg from the University of Leipzig. “LESS Surgery is suitable for practically all laparoscopic procedures and already shows great potential for the future.” The new videolaparoscopes EndoEYE LS and LTF-VP transfer the advantages of the successful Olympus laparoscopes to the new operating method. The EndoEYE LS handle can be turned by up to 70° and therefore does not interfere with use of the hand instruments.

“As a world market leader in the area of high-quality endoscopic systems, we offer the ports, hand instruments and the optics needed for the essential minimally invasive surgery sector all from one source,” explains Heinz Jacqui, Executive Managing Director at Olympus Winter & Ibe.

“Olympus can capitalise on this to strengthen and build up its position as technology leader in the minimally invasive surgery sector.” For clinics, this process also offers advantages: with similar operating costs to comparable surgical methods, we expect that hospitals will be able to cut costs due to the decrease in the risk of post-operative wound infections. With its products and system solutions, Olympus is positioning itself as a strong partner for the world of medicine. Flexible and rigid endoscopes play a significant role in minimally invasive diagnosis and therapy.

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The range includes endoscopes and system solutions for a comprehensive series of applications in internal medicine and surgery, endoscopic video systems and systems for reprocessing, as well as a broad range of endotherapy accessories. You can find out more at: If you have any questions or would like additional information, please contact: Silvia Schanze Corporate Marketing Olympus Winter & Ibe GmbH Kuehnstraße 61, 22045 Hamburg Tel.: +49 40 669 66 2370 E-mail: When responding please quote ‘OTJ’



Making operations smoother and safer At first sight an airline pilot, a car plant worker and a hospital surgeon would appear to have little in common. But the NHS is learning from the aviation and automotive industries as it introduces new safety protocols to reduce the risk of accidents in the operating theatre. Whether it is hitting a tropical storm at 36,000 feet or negotiating an expected emergency in the middle of open-heart surgery, advance planning and a calm and ordered environment can make all the difference. It is a message NHS chiefs are keen to disseminate across the health service, and they have made a start with a new scheme called ‘Productive Theatre’. Good results The early results from the six trial hospitals have been positive. Trevor Dale, a retired airline pilot, who helped advise the test sites, said even little changes could make a big difference. “If we knew we would be flying through turbulence we could plan for that in advance,” he said. “We could then brief the cabin crew in advance, rather than waiting until they had the trolleys ready to serve the drinks and meals.” He said that operating staff could ensure they were similarly prepared. “Things such as getting equipment ready and making sure that if a procedure means there is likely to be significant blood loss that there are cross-matched supplies ready in advance.” These simple things seem obvious to outsiders, but health workers admit that without an overview little things such as extra blood, ensuring patients are given antiblood clot stockings and blood thinning drugs can slip through the net. Professor Lord Darzi, the former health minister, said Productive Theatre, launched across the NHS in England in September, offered much. “As a surgeon I know how vital a role a well organised operating theatre plays in ensuring a calm setting in a high pressurised working environment,” he said. “The operating theatre is a place where lives are transformed and saved and by taking simple steps to optimise the working environment, and where staff can continuously improve the quality of patient care.” Learning from industry Health workers found simple things like holding a briefing meeting each day before operations start - and a de-brief at their end - can make a real difference. Some have also implemented a check list system for each individual patient.


And in some hospitals the time taken to get patients to and from theatre has been sharpened up. Janet Henry, theatre manger/ matron at the West Middlesex University Hospital Trust, said her hospital had noticed considerable time savings. “One 5-6 minute briefing could save us up to an hour a day,” she said. She said staff focused on making little changes, such as juggling lists to ensure the right equipment was ready for each operation. “We had equipment for keyhole surgery, but because of the increase in this type of surgery there was increase in pressure on it. “So we discussed who had priority over the equipment and changed the list, rather than waiting until the patient was on the operating theatre and then realising there were going to be delays.” Hugh Rogers, a consultant urologist at West Middlesex, said he too had noticed great improvements.

He said the fact that the health professionals involved in a patient’s care came together to talk things through was a real step forward. “We did not really do that before, but now everyone knows what is going on,” he said. “Everyone is on the same page. As a result everything runs really smoothly and there are no surprises.” For instance, a group meeting previewing one morning’s schedule for surgery revealed that a particularly complicated procedure was due up first. By juggling the list around the team was able to slot in another case while the anaesthesia was prepared for the longer procedure. Production line Mr Rogers said his team had been particularly inspired by the concept key to any good motor industry - the smooth production line.

But instead of putting car components together, his team was focused on getting patients to and from theatre in the most effective fashion. “We try to avoid the risk of cancelling the operations because of overruns,” he said. “For instance, in orthopaedics we have found that the best time to send for the patient is the minute they start to close the wound.” Claire Bradford is theatre matron at the Royal Devon & Exeter NHS Foundation Trust, another of the pilot sites. She said the introduction of individual patient checks had had a transformative effect on the working day. “Everybody now expects it to happen and we are prepared for every eventuality,” she said. “It does make the day go better and we have avoided error.” Source: BBC Jane Elliott

Sunderland chooses SonoSite for emergency medicine Sunderland Royal Hospital has chosen an M-Turbo® hand-carried ultrasound system from SonoSite for a wide range of imaging applications in its busy Accident and Emergency Department. Mr Malcolm Jones, a consultant in emergency medicine, explained the departments ultrasound strategy: Several members of the department have undertaken year long postgraduate courses in FAST and echocardiography scanning at Teeside University. This, together with a shorter course in FAST scanning, has provided us with a good grounding in emergency room ultrasound. With the support of the radiology department, we have developed structured clinical guidelines for the scanning of patients in the department, and chose an M-Turbo system to meet our ultrasound needs.

Mr Malcolm Jones with the SonoSite M-Turbo

The M-Turbo is a very versatile system, allowing us to use a single instrument for various applications. Features such as the user-friendly controls and the ability to rapidly switch between probes are very well suited to emergency medicine, and we use the image capture option every time we scan, storing images on the system for use in case-based discussions with trainees. The colour Doppler mode is also very useful, particularly for difficult-to-image patients, and helps trainees to achieve a better understanding of the principles of ultrasound. For more information about SonoSite products, please contact them at: Alexander House, 40A Wilbury Way, Hitchin SG4 0AP T +44 (0)1462 444 800, F +44 (0)1462 444 801 Email: Website: When responding to articles please quote ‘OTJ’


About SonoSite SonoSite, Inc. ( is the innovator and world leader in handcarried ultrasound. Headquartered near Seattle, Washington, USA, the company is represented by ten subsidiaries and a global distribution network in over 100 countries. SonoSite’s small, lightweight systems are expanding the use of ultrasound across the clinical spectrum by costeffectively bringing high performance ultrasound to the point of patient care. The company employs over 700 people worldwide. SonoSite, Ltd., a wholly owned subsidiary of SonoSite, Inc. based in Hitchin, Hertfordshire, has a direct sales distribution network in the UK.

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Antibody ‘fixes internal bleeds’ Scientists say they have discovered an antibody that could minimise the major internal bleeding seen in traumas like bullet wounds and car crashes. The team at Oklahoma Medical Research Foundation (OMRF) has discovered that a protein called histone is responsible for much of the damage. They say they have found a specific type of antibody that can block the ability of histone to cause damage. They say it could lead to new ways to treat diseases and serious injuries. ‘Life threatening’ Writing in the journal, Nature Medicine, the OMRF researchers found that when mice had a bad blood stream infection (sepsis), their blood contained high levels of histones. They checked this in primates and humans and found the same result. The histone protein normally sits in the nucleus of a cell, packed around the strands of DNA. It regulates the DNA, causing it to fold and form the characteristic double helix. When the cell is damaged by injury or disease, the histone is released into the blood system

where it begins to kill the lining of blood vessels, causing damage, the OMRF researchers said. This, they believe, results in uncontrolled internal bleeding and fluid build-up in the tissues, which are life threatening. Dr Charles Esmon, of OMRF who led the research, said: “When we realised that histones were so toxic, we immediately went to work looking for a way to stop their destructive tendencies.” Mouse antibody Marc Monestier, a colleague at Temple University in Philadelphia, had already discovered a specific type of antibody known as a monoclonal antibody that could block the histones. It had been observed that patients with auto-immune diseases make antibodies to the proteins in their cell nuclei but it was not known why. This antibody came from a mouse with an auto-immune disease. The OMRF team have tested the antibody in mice with sepsis and it does stop the toxic effects of the histones and they recover, the researchers say.

They now want to test it in primates and eventually humans. Dr Esmon said histones were similar in all mammals because they were such basic building blocks. So a mouse antibody should work equally well in a human. He said: “We think it was an adaptation during evolution. “Millions of years ago, when people and animals got ill, they did not die of heart attacks or car accidents they died of infectious diseases. “Their immune systems went into overdrive throwing everything at it and we believe the histones in the cell nucleus, part of the basic building blocks of life, were the last resort.” Dr Stephen Prescott, president of OMRF, said: “These findings offer some clues as to why people suffering from one traumatic injury often experience a catastrophic ‘cascade’ of secondary traumatic events. “If we can figure out how to control the initial injury, perhaps that will stop the domino effect that so often follows.”

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Source: BBC

Nurse in the running for prestigious award A LOCAL operating theatre nurse’s hard work has led to her becoming a finalist for a prestigious nursing award. Sharon Richer, an agency nurse for Hays Healthcare who is currently working at Salisbury District Hospital, is in the running for The Nursing Times’ Bank or Agency Nurse of the Year Award. The awards are the most prestigious in the sector and the winner will be announced at an awards ceremony in London on November 18. The bank or agency nurse award recognises the valuable support bank and agency nurses provide to both NHS and non-NHS organisations and the winner will be the nurse who best embodies the essential qualities of flexibility, self-motivation, reliability and assertiveness. Anne Wilkinson, team manager at Hays Healthcare, said: “We were delighted to find out that Sharon has been confirmed as a finalist for this award; it is a fantastic result for both her and Hays Healthcare. We believe she should be rewarded and recognised as an outstanding and hard working agency nurse. We wish her the best of luck.” Source: Salisbury Journal



The body mass index (BMI) has long been the yardstick in deciding who is at risk because of their weight. BMI is essentially a measure of density, identifying under- and over-weight risk groups. Recent studies however point towards a more sophisticated approach to the issue. In a recent article for F1000 Biology Reports, Manfred J Müller and colleagues at the University of Kiel in Germany explain how functional body composition analysis (BCA) measures more of the variables that determine whether or not obesity is benign. Recent studies using similar analysis suggest that up to 30% of obese people do not in fact require medical treatment. Widespread adoption of BCA could significantly improve the targeting of limited healthcare resources in the context of one of modern societies global killers. Thanks to advances in imaging technology, variables - such as the bodies fat proportion, location and distribution and the size of fat cells and fat droplets within these cells can now be factored into the health risk assessment. Coupled with a better understanding of the interrelation between genes, environment, hormone levels and metabolism, BCA gives clinicians a clearer picture of the specific health risks to an individual. In light of the growing evidence in favour of functional BCA, the authors conclude that the definitions of both overweight and malnutrition should be reconsidered by clinicians and researchers. Evidently, size does still matter but its what you do with it that really counts. Faculty of 1000 is a unique online service that helps you stay informed of high impact articles and access the opinions of global leaders in biology and medicine. Our distinguished international faculty select and evaluate key articles across biomedical science, providing a rapidly updated, authoritative guide to the life science literature that matters.


S 10

One in 50 hospital episodes commissioned by the NHS result from a complication, provisional figures show One in 50 episodes of care commissioned by the NHS, in NHS hospitals or the independent sector, in England resulted from a complication between July 2008 and June 2009, provisional figures released on the 9th of October by The NHS Information Centre show. This equates to 326,000 (two percent) of the 16.3 million episodes during this period, a slight rise compared to the previous 12 month period when 295,000 (1.9 percent; or one in 53) of the 15.6 million episodes resulted from a complication. A hospital episode relates to a patient’s period of care under one consultant during their hospital stay. Complications relate to four areas of medical and surgical care in hospital. Between July 2008 and June 2009: * 95,930 complications (29 per cent of all complications) involved an adverse affect on a patient from drugs used in their treatment. * 5,050 complications (two per cent of all complications) involved misadventures to the patient during surgical and medical care * 3,690 complications (one per cent of all complications) involved an adverse incident relating to medical devices used for diagnosis or therapy * 221,150 complications (68 per cent of all complications) involved an abnormal reaction by a patient some time after a surgical or medical procedure, where misadventure was not mentioned at the time of the procedure. The figures are part of a new special topic from Provisional Monthly HES for Admitted Patient Care, which is now published monthly to provide up-to-date information and demonstrate approximate trends. Information must be seen as provisional, as it has not been subject to final checks and revisions ahead of annual publication and can be subject to change. This is particularly true of June 2009. Previous provisional data has been slightly lower than the final data published in annual publications. The publication also includes two other special topics relating to hospital care; Bariatric surgery; and also the Tackling Knives Action Programme (TKAP), relating to a cross-government programme to reduce incidents of death and serious violence among 13 to 24-year-olds in target areas in England and Wales. The NHS Information Centre has previously published special topics on both subjects. The TKAP special topic, which previously looked at admissions due to assault by sharp object to reflect the first phase of the programme, now includes for the first time provisional admissions information for all assaults, reflecting the expansion of TKAP in April 2009. Provisionally, between July 2008 and June 2009, for this particular measure of impact of the programme, there were: * 43,440 admissions across all age groups in all areas for assault, a 2.2 per cent increase on the previous 12 month period, when there were 42,490 admissions. 62.4 per cent of admissions were in TKAP local authorities, compared to 62.7 per cent in the previous 12 month period. * 27,100 admissions across all age groups for assault in TKAP local authorities, a 1.7 per cent increase on the previous 12 month period, when there were 26,650 admissions. * 16,340 admissions across all age groups for assault in non-TKAP areas, a 3.2 per cent increase on the previous 12 month period, when there were 15840 admissions. * 10,860 admissions for 13 to 24-year-olds within TKAP areas, a decrease of 120 (1.1%) from the previous 12 month period. NHS Information Centre chief executive Tim Straughan said: “This is the first time The NHS Information Centre has published a special topic about complications during a patient’s hospital stay. Provisionally it appears one in 50 hospital episodes involve a complication and two thirds of those arise at some point following a surgical or medical procedure. “It is important to note that complications can occur as a result of patient’s physical reaction to treatment that was not able to be predicted, rather than arising due to any fault of the medical professionals involved. Trends may also include effects of any changes in data recording and clinical coding practices. This information will be useful however to help the NHS examine possible reasons for complications and improve the quality of patient care.” Regional information is available from this publication. To access the special topics visit

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Redefining Obesitys Health Risks

Hospital Innovations Limited was founded in January 2008 as a result of key individuals coming together to pool their collective experiences to create what we believe is and will continue to be a truly outstanding company. HI Ltd is a medical company dedicated to providing medical products to the UK community at primary, secondary NHS levels and the private sector. HI offer world class products with a first class support package and service. HI offer quick, effective solutions to clinicians, with its broad distribution and client network, to ensure a service which will enhance clinician and patient choice. Our contact base both at regulatory and hospital level is unrivalled and allow us to prepare patient pathways for acceptance of our innovative and clinically effective products. All our products will have clinical appeal and are and will be state of the art products. We aim to make HI a significant company in the medical market whilst maintaining our customer commitment to quality, service and flexibility. Managing Director, Phil Davies, has been directly involved within orthopaedics since 1983 and in that time has worked for some of the Worlds leading companies. Our intention is to deliver products and services to the orthopaedic community in a way that is both innovative and sustainable. Sales and Marketing Director, Kevin Edwards, has over 20 years experience and has an extremely in-depth knowledge of the area of tissue and cell regeneration. Kevin will be responsible for delivering our wide range of products through a highly skilled network of specialists. Our product range is well established yet incorporates leading edge technology, design and implementation. Our approach to service, support and training is the cornerstone of our company’s philosophy. We hope you will be part of our success and we give you our assurances that Hospital Innovations Limited will truly be one of the most innovative companies. We are dedicated to delivering new concepts in patient care and we will do this with total dedication, drive, and a lot of enthusiasm! By making Hospital Innovations customer centric, we are able, through our proactive customer services department, to meet the customers needs consistently at all levels. Hospital Innovations purpose is to be the best in the industry for superior customer service, innovation, quality and commitment

Association of British Healthcare Industries launch their Industry Recommendations The ABHI recently officially launched their industry recommendations entitled Enhancing Patient Care In The NHS: The Role of Medical Devices, the document outlines the measures which the UK Government must take to support the medical devices sector. The recommendations cover topics such as ensuring the current regulatory regime is preserved; including clinicians in procurement processes; the importance of the NHS planning ahead for new technologies; more flexible payment systems; including the sector in official economic strategies and encouraging healthcare professionals to work with industry to ensure full understanding of the ABHI Code of Business Practice. Chairman of the ABHIs Public Affairs Policy Group, Richard Phillips said that- This document is an important step in helping policy makers to understand the needs of our industry. It comes at a crucial time with the NHS budget set to drop in coming years. Our Industry Recommendations document not only demonstrates the benefits of medical technology but also points out the measures necessary in order to help the British medical technology sector continue to thrive. Now is the time for industry to seize the initiative and work with the NHS to show that early and broad uptake of medical technologies can reduce patient pathway costs and improve patient care, whereas making short term spending cuts on medical technology will lead to long term costs and poorer patient outcomes The Association of British Healthcare Industries (ABHI) is the industry association for the UK medical devices sector. Our membership is made up of companies that innovate, develop and manufacture the medical technology and devices essential for the NHS. For further details contact 020 7960 4360 or visit

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RECORD REQUESTS FOR JOINT REPLACEMENT DATA More health professionals than ever before are turning to the National Joint Registry (NJR)1 for data that will help them to improve patient care, as well as inform their studies and research. This is because not only is the NJR the largest such registry in the world, but it is now an effective clinical audit of the quality of joint replacement treatment. According to the NJR’s 6th Annual Report2, a record amount of data on hip and knee joint replacement procedures has been requested by orthopaedic surgeons, suppliers and manufacturers of joint replacement implants and patients. This dramatic rise in data requests clearly demonstrates the importance to health professionals and patients of the information held on the Register for the purpose of quality monitoring and improvement. Further improving the accessibility and value of the data has been a priority for NJR this year with the launch in November 2008 of NJR Clinician Feedback. A secure online service, it enables surgeons to assess their clinical practice and compare it to that of their colleagues at hospital, regional (strategic health authority), sector (NHS or independent) and national levels; and through this, to identify practice that could be improved. A total of 160,0273 hip and knee joint replacement operations were reported to the NJR during the year under review, which represents 92.5% of all such operations carried out in England and Wales in the NHS and independent healthcare sectors. This success is underpinned by rising rates of patient consent4 and linkability5. During 2008/09, 87.5% of records submitted included consent from patients for their personal information to be held on the Register, the highest annual rate to date. This means that of all records held by the NJR, 78% now have patient consent. The NJR also saw record numbers of submissions with an NHS number5. Among other trends identified in the Report is the reduction in the average age of patients undergoing primary hip replacement surgery from 68.1 years in 2004 to 66.7 years. During the same period, the average body mass index (BMI) of patients having hip replacement surgery rose from 27.8 to 28.3. The average BMI of knee replacement patients has also risen in the last five years from 29.7 to 30.3. This is equivalent to a weight gain of 1.85kg (four pounds) for a person of average height and means that the average knee replacement patient, by BMI measurement, is now clinically obese. Bill Darling, Chair of the NJR Steering Committee6, said he was in no doubt that the NJR, the largest Register of its kind in the world, was a tool of excellence that was supporting improvements in practice and patient care.

He commented: “The quality of the data held on the Register is such that we can now quickly inform hospitals of potential problems with implants and so greatly reduce the time between identification of an issue and a patient review. “For the first time this year, an implant was withdrawn from sale by its supplier using information provided by the Register’s outlier analysis following a device alert issued by the Medicines and Healthcare products Regulatory Agency (MHRA). “The NJR was able quickly to identify patients who had received the implant and inform the relevant hospitals. Our ability to track patients is greatly enhanced by staff in hospitals and units obtaining patient consent, which, I am pleased to report, is happening on an increasingly frequent basis”, he added. Mr Darling went on to say that the overall rate of compliance of hospitals and treatment centres submitting data to the NJR had shown a steady upward trend since 2004, although a slight drop was reported in 2008/097. Looking ahead, Mr Darling said that a significant development for NJR would be its participation in the national Patient Reported Outcome Measures (PROMs) study, commissioned by the Department of Health (DH). “Agreement has been reached with the DH for PROMs data to be linked with the NJR data, enabling the Registry to provide outcomes information for the first time from the perspective of patients rather than clinicians,” he explained. Robin Burgess, the Chief Executive of the Healthcare Quality Improvement Partnership (HQIP), which manages the Registry, said: “This new report highlights that the Registry provides a significant measure of effective practice in joint replacement. Since HQIP took over the oversight of the Registry in April 2008 we have been examining how the Registry can develop further to offer a higher level of audit functions. A new strategic plan for the development of the Registry will carry through the work reported here in subsequent years.” Professor Alex MacGregor, a member of the NJR Steering Committee, added: “This study demonstrates the power of the NJR. It will be the first time that technical data on surgery is linked to directly to the patient’s experience of surgery on a national scale. The information will be invaluable to both surgeons and their prospective patients.” Plans for further developments to the NJR include extending it to data relating to ankle, shoulder, elbow and wrist joint replacement surgery.

NJR’s 6th Annual Report is available in full from the NJR website at

Nurses’ mission for quake victims TWO staff members have returned to Hinchingbrooke Hospital after a mercy mission to help people who suffered appalling injuries in the Indonesian earthquake. Operating theatre specialists Flora Henderson, 50, and Victoria Jeal, 27, helped save the lives of victims who had been crushed in the falling wreckage and treated people who would otherwise have had limbs amputated. It was the first time the duo, who went to Indonesia with the medical disasters charity Merlin, had taken part in a relief mission. They found themselves working in Padang where the local medical facilities had either been flattened or left badly damaged by the earthquake.

Victoria, an operating department practitioner, said: “We were working on a night shift with a consultant who said specialist theatre nurses were needed urgently in Indonesia and did we want to go, so we both said yes.” The members of staff took unpaid leave to take part in the trip. Flora, a staff nurse, said: “The facilities were pretty basic and they didn’t have much equipment, but they did very well with what they did have.” The two worked with a plastic surgeon dealing with complex injuries, which would have led to amputations or death. The earthquake is believed to have killed more than 665 people and left more than 1,000 others severely injured. Source: Cambridge Evening News

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NEW NHS CORD BLOOD COLLECTION CENTRE OPENED AT ST GEORGE’S HOSPITAL A new centre for the collection of vital cord blood donations was opened on Monday by Public Health Minister, Gillian Merron. NHS Blood and Transplant and St George’s Healthcare NHS Trust have established the fifth site at which mothers can donate cord blood. Cord blood is the blood that remains in the placenta and umbilical cord after a baby is born. It is rich in stem cells and can be provided to help patients whose bone marrow is not working properly due to disease or medical treatments such as chemotherapy and radiotherapy. Donations to the NHS Cord Blood Bank are given on a voluntary basis and can potentially help any patient in need of a cord blood transplant. The NHS Cord Blood Bank, which is part of NHS Blood and Transplant, (NHSBT) has four other sites across London and the south-east, chosen for the broad ethnic mix of the community they serve. This increases the chances of finding a suitable tissue type match for those seriously ill patients requiring a cord blood transplant. The Minister opened the new facility and met trained NHSBT cord blood collection staff, clinicians, mothers-to-be and donors in the maternity unit.

Rebecca Khan, is a cord blood donor and mother of two from Borehamwood, Hertfordshire. Donor ethnicity is an important consideration, when matching cord blood donations to a potential recipient, as it increases the chance of a possible match. Rebecca and husband Kyle’s diverse ethnic heritage of Greek and English; and Trinidadian and Scottish parents means her cord blood donation is unique. Public Health Minister Gillian Merron said: “Cord blood offers enormous potential to treat and cure.”

Public Health Minister Gillian Merron with Luam Kidane, Team Manager for cord blood collections

“The NHS bank offers cancer patients greater access to potential life-saving stem cell matches. Opening this new centre in an ethnically diverse area will help ensure we have enough cells of the right matches.”

“The location of St George’s allows collection from a large multi-ethnic community which is of great benefit as patients have a much better chance of finding a good match from donors of the same ethnic background.

be working in partnership with NHSBT to provide this hugely important facility. Based in the heart of Tooting, St George’s serves a very diverse population and is well placed to host the new unit.”

“Harnessing scientific advances offered by stem cells through this new NHS centre means that mums can save lives as they bring one into the world.”

“The stem cells that come from cord blood are similar to those found in bone marrow and are used in many different ways including treatment for illnesses such as leukaemia but are also used in research to help develop new treatments.”

There are currently more than 13,973 units of cord blood stored in the NHS Cord Blood Bank, making it the fourth largest single blood bank in the world. At present 40% of the cord blood units stored are from ethnic minority donors, which makes it the second highest percentage worldwide of rare tissue types in a cord blood bank and increasing the chances of people from a BME (Black and Minority Ethnic) background finding a match.

Lynda Hamlyn, Chief Executive of NHS Blood and Transplant, said: “The opening of this fifth cord blood collection site will give more mothers the opportunity to donate and provide hope for those patients where no bone marrow match can be found.

David Astley, Chief Executive of St George’s Healthcare NHS Trust, said: “The donations made here really will save lives and St George’s is very proud to

Clinicians and industry work together to develop tomorrow’s innovations Surgical Innovations - the designer and manufacturer of innovative surgical devices – is working with Medipex – the NHS Innovation hub for the Yorkshire and Humber region – in a unique forum that allows clinicians and industry to work together more closely to share ideas and develop new products. Engaging with the NHS can often be a long and difficult task, which is why Leeds-based Surgical Innovations have enlisted the help of NHS intellectual property experts Medipex to help them engage with leading clinicians and key figures from across the sector. The forum will allow the company to meet face-to-face with surgeons and gain a valuable insight into their needs; as well as seek feedback on their range of leading laparoscopic instruments. With the focus firmly on enhancing patient care, the meetings will also help identity evaluation opportunities and explore possible R&D collaborations that could take place between Surgical Innovations and the NHS. Interaction at this level means the company can react promptly to current market trends and their highly skilled team of designers can liaise with surgeons to develop products that exceed their needs at every level.

Through their state-of-the-art ‘in house’ manufacturing site, Surgical Innovations also have the capability to quickly transform ideas and visions into new pioneering products ready for market. Speaking about the partnership Managing Director of Surgical Innovations, Graham Bowland, said: “Working with surgeons to develop pioneering products is a key priority for Surgical Innovations and we are delighted to be able to have such direct engagement with clinicians. “Without specialist support, engaging with the NHS can be a long and difficult process, so to work alongside Medipex and tap into their indepth knowledge base is a fantastic opportunity for us. This insight, combined with our world class design and manufacturing expertise, means we have the ability to produce the innovations of tomorrow and improve patient care around the world.” Chris Herbert, Business Development Manager of Medipex Ltd, welcomes the partnership. “Accessing the right people in the NHS who can help companies to develop the next generation of products to improve patient care and save lives can be very difficult, especially for relatively small medical technology companies. Our unique links into the NHS mean that we can help innovative, forward-thinking companies like Surgical Innovations to meet the right people and also to provide assistance right through the product development and trials process.”

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New One-Stop-Shop for Healthcare Facilities A new single technical guidance website for providers of healthcare facilities was announced today by the Department of Health and the three UK health organisations Department of Health, Social Services and Public Safety for Northern Ireland, Health Facilities Scotland, and Welsh Health Estates. The new website Space for Health, linked to the Department of Healths website, will bring together a whole suite of guidance (including Health Technical Memoranda, Health Building Notes and other information) into one online resource for all those involved in the procurement, management, design and planning of healthcare facilities, including NHS and non NHS providers. Users will be able to seamlessly shift between different pieces of guidance, and will be able to access nation-specific information, depending on whether their project is in England, Scotland, Wales or Northern Ireland. It has been developed following an extensive three-year consultation period, including stakeholder events and evaluation of a pilot website. The healthcare community were able to take a first look at the system at the IHEEM Healthcare Estates Conference, 27-28 October 2009. The UK health organisations were encouraging people to come and try out the website on their stand . Health Minister, Mike OBrien said: This brings together all the guidance in one easy to access website. Space for Health goes one step further in providing region-specific information on procurement, management, design and planning of healthcare facilities. I am pleased to launch this website on behalf of all the UK health organisations. The website became available after the conference at: http://www. Space for Health will replace the current system, the Knowledge and Information Portal.

HPC launch new student resources The Health Professions Council (HPC) have today launched a variety of new resources for students and those working on approved programmes via a newly dedicated area of the HPC website.

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The new area of the website aimed at students, trainees and approved programme lecturers provides information for students, which includes information on applying for registration, application forms and guidance notes. The web page can be found under the Apply and Education section of the website and is titled Student Information. An Audio-visual presentation is now available to view with information on: · · · ·

the role of the Health Professions Council; information on regulation; how to apply for registration; and how to stay registered.

The presentation also includes subtitles and a transcript. It is suitable for use as part of a lecture on professional regulation and the HPC hope that students and lecturers will be encouraged to watch this. PowerPoint slides and handouts have been produced to complement the audio-visual presentation. They aim to allow lecturers to deliver the above information in their own style. The transcript for the presentation could also serve as a tool for delivering the slides. The HPCs new voluntary guidance on conduct and ethics for students based on the standards of conduct, performance and ethics is due to be published in late autumn and will be located in the student information section of the website. This guidance offers principles which the HPC would encourage students to use during their training. Information about the HPCs new student pages can be found on the HPC website here: and

OPPORTUNITY FOR PAEDIATRIC ORTHOPAEDIC SURGEONS In 2010, Mercy Ships is still looking for 1 or 2 paediatric orthopaedic surgeons to serve from March 6th - April 3rd. Criteria for the applicant: Current license: Paediatric Orthopaedic specialist. Cases to expect: Club Feet, and Angular deformities of the lower extremities (tibial and femoral varus and valgus). For an application or more information see or Please contact Dawn Crowther at for any specific questions Those interested will need to complete an application. All volunteers pay for their own way to/from the ship and pay a crew fee to cover housing, meals and evacuation & repatriation insurance. Crew fee is $650 per month. This enables all services to be delivered to the extreme poor free of charge. The ship will be docked in Lomé, Togo for the 2010 field service.

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Made to measure surgical solutions

SonoSite supports transplant charity

A British based surgical manufacturer, whose hand crafted instruments offer surgeons a ‘made to measure’ service, is looking to roll out their high quality products in hospitals around the world.

SonoSite is supporting the charity Transplant Links Community (TLC), loaning point-of-care ultrasound systems to medical teams visiting developing countries to establish sustainable kidney transplant programmes.

Sheffield-based Platts & Nisbett have already established a reputation across the UK for the high quality design, craftsmanship and performance of their surgical range and are now looking to expand their bespoke service to surgeons globally. All their products are manufactured in-house, which means they are able to accommodate unusual requests and produce bespoke instruments if clinicians prefer something different - a flexibility which allows the company to meet the increasing demands of the modern theatre environment. Founded in 1977, Platts & Nisbett is an independent family company owned by the Nisbett family, who only use the finest materials to make their surgical instruments. This ethos has ensured their reputation for manufacturing high quality surgical instruments and has also gained them the prestigious ‘Made In Sheffield’ credentials. Their team of over 20 highly skilled engineers are all apprentice trained and the company has just taken on new two more apprentices within the last year to ensure they are developing the next generation of surgical instrument makers.

Taking these cutting edge solutions to a worldwide audience, Platts & Nisbett will be showcasing their instrument range, which includes clamps, retractors and orthopaedic ranges, at MEDICA – the largest medical exhibition in the world. They will also use the event to source new international partners and speak to clinicians about developing new and innovative products for the future.


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Alyson Nisbett, Director of Platts & Nisbett, said: “We believe the quality of our instruments speaks for itself, which is why we are investing heavily to raise our profile around the world.” “When surgeons prefer something unique, we can help and regularly produce innovative cutting edge solutions from ideas that have been scribbled on a piece of paper by a consultant. This is our area of expertise and we are looking forward to working with hospitals around the world.” MEDICA will be taking place between 18-21 November at the Messe Düsseldorf. Throughout the show Platts & Nisbett will be located on the UK Pavilion, hall 16 stand G10. For more information or to view Platts & Nisbett newly launched printed and online catalogue visit When responding to articles please quote ‘OTJ’


Dr Mullhi with the SonoSite ultrasound system in Ghana

Surgical teams from the UK have already travelled to both Trinidad and Ghana, teaching local surgeons, doctors and nurses to perform live kidney transplants on both adults and children. Point-of-care ultrasound devices from SonoSite have helped to improve safety and aid training for these procedures, as Dr Dwomoa Adu, a trustee and overseas adviser of TLC, explained: Our first mission was to Trinidad, with the aim of developing the skills of local surgical teams to perform transplants in children. This was a huge success, with three successful transplants in two weeks, and the point-of-care ultrasound was particularly helpful in improving the safety of these procedures. SonoSites point-of-care instruments are absolutely fantastic; they are very easy to use. We have also used SonoSite equipment in Ghana, where we are working with local doctors to establish an adult transplant programme. The ultrasound system was used for both kidney scanning and line placement. Having ultrasound available makes a real difference, allowing us to rapidly scan patients to look for any potential complications. For more information about Transplant Links Community, visit When responding to articles please quote ‘OTJ’

NHS Blood and Transplant rated ‘excellent’ NHS Blood and Transplant (NHSBT) has received an “excellent” rating in the annual health check results announced recently by the Care Quality Commission. This is the highest standard achievable. The special health authority has stepped up from a “good” rating in its first health check during 2007-08, demonstrating improvements in infection control and medicines management to become compliant in 38 out of a possible 40 categories. Lynda Hamlyn, Chief Executive of NHS Blood and Transplant, said: “I am absolutely delighted with this ‘excellent’ rating of our performance over the past year. It is testimony to the considerable effort we have made to build and improve on performance across the board. “This reflects the hard work of all our staff and recognises our continued commitment to saving and improving lives through the service we provide to our donors of blood, organs, tissue and bone marrow, who in turn, make it possible for thousands of life-saving treatments for patients every year.” This is the second time NHSBT has been given a rating by the Care Quality Commission (previously the Healthcare Commission), the independent inspection body for NHS, social care and independent healthcare providers. NHSBT was judged on “quality of services” which is an overall score of performance against national standards and national priorities.


New steriliser to save lives Australian researchers have created a solution to deactivate prions, which are rogue, infectious proteins that cause Creutzfeldt-Jacob disease (CJD) and can be transmitted via surgical instruments. Novapharm Research (Australia) Pty Ltd, in collaboration with the University of Melbourne, has developed solutions which break up and deactivate the rogue protein molecules of CJD.

MJ Medical is a progressive, fast paced company offering Health and Equipment consultancy services in the UK and internationally. We are recruiting for the following full time position at our head office in Cornwall:

The outcome is cost effective, will enable all medical instruments to be treated against prions, will not disrupt current surgical procedures and is easily incorporated into current cleaning protocols.

Equipment Consultant £40 – 60k dependent on experience REF: EC1/2009

The importance of this is that CJD and other prion diseases have no known cure and can have a lengthy symptom-free incubation period of decades.

In summary the role will encompass the provision of technical equipment consultancy to clients, stakeholders and colleagues for UK and International Healthcare Projects. The role will include the delivery of effective equipment planning and research, equipment design data, quality control and support for specific healthcare projects. The applicant would benefit from: • Having an in-depth knowledge of medical, clinical & laboratory equipment solutions for a wide range of Primary, Secondary & Tertiary healthcare projects/facilities • Having a clinical background with an understanding of and insight into the dynamics of hospital activities, equipment, clinical design, departmental planning and work flows. • Demonstrable experience of providing clinical equipment specialist advice.

The human prion is resistant to both heat and chemicals and is reported to be up to a hundred thousand times more difficult to deactivate than the animal form of infective agent which causes well known diseases in cattle, such as mad cow disease, and scrapie in sheep. Any error in identifying a CJD-carrier can be fatal and costly - many hospitals around the world have been forced to destroy millions of dollars worth of instruments when patients were diagnosed with CJD some time after undergoing routine eye and neurosurgical procedures. A further factor limiting decontamination from prions is that existing cleaning protocols are damaging to medical instruments such as flexible endoscopes and some instruments used in neurosurgical, dental and opthalmological procedures. It is estimated that currently less than one per cent of medical instruments are treated against prions, with hospital procedures relying on staff to identify potential carriers.

You will be self motivated, flexible in your approach to your work and exude a professional and confident manner. You will enjoy the satisfaction of keeping abreast of changing technology and methods of healthcare delivery.

The treatment process was optimised and performed by a research team in the Department of Pathology at the University of Melbourne led by Dr Victoria Lawson. The University of Melbourne is Australia’s leading prion disease research centre.

For an application pack or to arrange an informal discussion please contact Karen Williams on 01872 226770 or email: Or visit our website:

Novapharm’s prion deactivating solutions have been approved by the Australian Therapeutic Goods Administration and have full CE certification for distribution in the European Union.

Closing date for position is 30th November 2009.

Use the Power of:

According to Mr Steve Kritzler, a director of Novapharm, there should be widespread interest from hospitals around the world in a solution that can deactivate prions on all medical instruments, including flexible endoscopes. “This solution fills a gaping hole in current infection control practices which basically rely on hospital staff identifying ‘high risk patients’ of these diseases which don’t have obvious symptoms,� Mr Kritzler said. “The new instrument reprocessing solutions developed by Novapharm can also be cost effective for hospitals, GPs, dentists, and vets since they will work with existing cleaning equipment and are highly effective as a general pre-cleaner compatible with any surgical or medical instruments. “We expect hospitals in the UK to be particularly interested in our solution since it has been the location for a number of CJD incidents in the past,� Mr Kritzler added. The commercial formulations will be sold in Australia under trade names Asepti RAPIDZYME Pr and Asepti AUTOZYME Pr. The solutions are derived from naturally occurring enzymes which have been specifically formulated to attack the structure of prions while maintaining characteristics which allow use as a general pre-cleaner of surgical and medical instruments. Source: Science Alert

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Surgical Scrub, Anaesthetic & Recovery Posts Full/part-time Permanent or Fixed term contracts St George’s Healthcare Trust is a busy teaching hospital, where we provide care for a variety of patient groups over a large modern campus. Our Trust is a designated major trauma centre with 26 operating theatres offering a wide range of specialty experiences. We are expanding our services with another two new theatres opening shortly. We have a team of Practice Educators and we maintain close links with local universities, which means we use new and innovative techniques. We can offer you support for further study via in-house courses, skills training in the Simulation Lab and in the clinical area and Critical Care courses in the University of Kingston faculty.

Wishgranting charity calling for medical professionals to refer more children Make-A-Wish Foundation® UK is looking to increase the number of wishes it grants each year. Throughout 2008, Make-A-Wish granted a record 961 magical wishes to children and young people fighting lifethreatening illnesses and is aiming to grant 1,000 a year by 2010. According to figures commissioned by Make-A-Wish, there are some 20,000 children in the UK at any one time with a life-threatening illness, so there are many more out there who could benefit from a Make-AWish wish.

Anaesthetic Nurses/ODPs Band 5: £24,852 - £32,207 p.a. inc. Ref: 200-SBNT-431-LK With an adaptable approach to work patterns, which will include weekend working, you will use your excellent interpersonal skills and evidence of personal and professional development to give direct patient care. There is an on-call commitment for these posts. These posts are suitable for newly qualified practitioners, as well as those with experience. To succeed, you will have a recognised Anaesthetic qualification. For further information or to arrange an informal visit, please contact, Alberto Castrillon, Clinical Theatre Manager on 020 8725 2921.

Recovery Nurses Band 5: £24,852 - £32,207 p.a. inc. Ref: 200-SJJD-301-LK Joining our friendly, post-anaesthetic team, you will have post anaesthetic or HDU experience, although we will consider applicants from a surgical ward background. Our main theatre recovery areas have a 24/7 provision for trauma and emergency work and this may be extended to other areas. For further information or to arrange an informal visit, please contact Nicky Fernandes, Clinical Theatre Manager on 020 8725 1942.

Scrub Practitioners Band 5: £24,852 - £32,207 p.a. inc. Ref: 200-SJKD-428-LK Working within one of our wide range of surgical specialities, you will have experience in Trauma and Orthopaedics, ENT and General/Vascular surgery. We will also consider those who do not have experience in theatres, but are keen to learn. You will have good interpersonal skills and evidence of personal and professional development. To succeed, you will have an accommodating approach to work patterns and work a range of shifts which include some weekends. Internal rotation to night duty is part of the role for those who work in our 24/7 Emergency & Trauma, and Obstetrics Theatres. For further information or to arrange an informal visit, please contact Maggie Savage, Clinical Theatre Manager on 020 8725 1958. Please apply online at

Anyone can refer a child - a health professional or social worker, the childs parents or their teacher. A child can even put themselves forward for a wish. Make-A-Wish asks medical and health professionals working with children to encourage referrals by suggesting they may enjoy a special treat. Make-A-Wish knows from its many years of experience that children and families benefit enormously from having their wishes granted. It provides them with hope and optimism, and a memorable experience. It lifts the spirit and brings joy and happiness to the child and the family, many of whom have to go through numerous medical visits and painful treatments. Since its inception in 1986, the charity has gone from strength to strength and is currently granting up to 11 wishes a week. The charity looks forward to receiving the imaginative requests of the children and young people who are referred for a wish, and enjoys rising to the challenge of granting them all. Referral forms are available through the website, , by calling 01276 40 50 60 or by emailing When responding to articles please quote ‘OTJ’

Royal Army Medical Corps Operating Theatre Technicians (OTT) Operating Department Assistants (ODA) Operating Department Practitioners (ODP)

Closing date: 2 December 2009.

Retired - Regular - Reserve Join OTT Reunited

Please note this vacancy will close before the advertised closing date if sufficient suitable applications are received.

Make contact with old friends and colleagues over 200 members worldwide The UK ODP Message Group Joining is easy, just send an e-mail, stating your name, e-mail address, position and Hospital to:

For more details go to our website:



More time

to care

Competitive salaries + benefits Mid Kent NHS Treatment Centre • Maidstone, Kent Will Adams NHS Treatment Centre • Gillingham, Kent You became a nurse because you want to give every patient exceptional care – and we’ll make sure that you have the time to deliver exactly that. A genuinely supportive team, elective surgery cases, state-of-the-art resources…it all adds up to a great opportunity to join an organisation that really will value your contribution. At both of these Centres, our aim is to reduce NHS patients’ waiting times while ensuring that their journey is as smooth and efficient as possible. If you can help us achieve that, you can look forward to ongoing training and professional development – plus the chance to build your future with one of the UK’s leading independent healthcare providers.

Operating Department Practitioners/Anaesthetic Nurses

Theatre and Endoscopy Nurses Part-time • Gillingham Experience in theatre or endoscopy would definitely be useful, but there’s full training available if you’re an ambitious nurse and keen to join our team.

Ward Manager Full-time • Gillingham Managing the team within this busy ward, you will ensure that each patient enjoys an outstanding experience. You’ll need solid leadership and coaching experience. Formal teaching and assessment qualifications are also important.

Full-time • Maidstone and Gillingham A qualified anaesthetic nurse/theatre nurse with ODP registration and relevant experience, you should bring strong leadership skills and a patient-focused approach.

Endoscopy Nurse

To apply, please send your CV and covering letter, including the role you wish to apply for, current salary and notice period, to Please note that offers of employment are subject to receipt of satisfactory references and a CRB check.

Full-time • Maidstone Endoscopy experience would be ideal, though if you’ve a theatre or ward background and you’re keen to specialise in this area, we’ll give you full training.

These positions are within the Mid Kent NHS Treatment Centre and Will Adams NHS Treatment Centre, run by Care UK on behalf of the NHS. At Care UK, we actively promote diversity and equal opportunities for all.

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The Operating Theatre Journal  

November 2009 Edition 230

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