The Operating Theatre Journal

Introducing the Allen Patient Transfer Board

For more information call: 01244 660 954www.melydmedical.comD-770546-A1 April 23, 2010

Roller-Free Roller Board: Better For Patients, Easier On Nurses, and Inexpensive

• Comfortable - Soft, sturdy board is easy on patients

• Lightweight - No lifting required, even with your heaviest patients

• Simple - Uses same or similar transfer technique as those used with metal roller boards

• Foldable - Long board folds for easy storage and set-up

• Resilient and Sturdy - More durable than existing boards on the market*

Low Friction Surfacesfor Easy Patient Transfer

Transfer Board Transfer Cover (rotates around transfer board)

No Lifting Required! Makes Fowler-PositionTransfer a Snap!

No Rollers - Less Traumatic Transfer for Patients

* Based on comparison to Samarit Rollbord™© 2010 Allen Medical Systems, Inc. All Rights Reserved

NEW!

Buy 3, Get 1 FREE! (offer valid until June 14th)

May 2010 Issue No. 236 ISSN 1747-728X

3MTM Custom Procedure Trays

Whatever your requirements, 3M Health Care can design a procedure tray that meets

your needs. We can access over 20,000 components from other manufacturers, and

you have our assurance that every pack will conform to our high standards of quality,

reliability and performance.

To request more information on 3M Custom Procedure Trays please call

01509 613151 or email [email protected]

3

3M Health Care is a leading provider of operating theatre packs and custom

procedure trays. The provision of packs and trays is a central element of 3M's

platform of infection prevention products.

Choosing 3M as your Custom Procedure Trays partner ensures:

• Quality components

• Reliable and flexible service

• Cost-effective solutions tailor made to your specification

• Support from a team committed to you

3M is a trademark of the 3M Company. © 3M Health Care 2009.

ReliableFlexible

Cost effectiveand

,

nd out more 020 7100 2867 • e-mail [email protected] Issue 236 MAY 2010 3

The Operating Theatre Journal is published twelve times per year. Available in electronic format from the pages of www.otjonline.comand in hard copy to hospitals throughout the UK. Personal copies are available by nominal subscription.

Looking to advertise within

‘The OTJ’?Next Issue Copy Deadline

Friday 24th May 2010All enquiries:Mr. L.A.Evans

Editor/Advertising ManagerMr. A. FletcherGraphics Editor

The OTJ Lawrand Ltd PO Box 51 Pontyclun CF72 9YYTel: 020 7100 2867

Email: [email protected] Website: www.lawrand.com

Neither the Editor or Directors of Lawrand Ltd are in any way respon-sible 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 repro-duced without prior permission from Lawrand Ltd.

© 2010

Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD

2010 AOCMF Courses for Operating Room Personnel

We would like to invite ORP’s with an interest in CMF surgery to join us on the following courses:

• AO Cranio-Maxillofacial Course for ORP: - 9th & 10th September 2010

Course Venue: Brandon Hall, Nr CoventryCourse Fees: £355 for 2 days, including course dinner

- COURSE NOW OPEN!

• AO Advanced Cranio-Maxillofacial Course for ORP: - 22nd November 2010

Course Venue: Nottingham Belfry, NottinghamCourse Fees: £100 for 1 day

- COURSE NOW OPEN!

Our courses are well established and internationally recognised as a key educational event for operating room personnel. The interactive programmes are designed to meet the needs of ORP facing the ever improving techniques in the operative management of the CMF patient.

Delegates wishing to attend the Advances course must have completed a Basic or Principles course.

Please contact the AOUK Education of ce for further details or alternatively visit our website.

Tel: 01707 823 345 Email: [email protected]: www.aouk.org

150,000 A Year Could Be Dying From A Lack Of First Aid

Up to 150,000 people a year could be given a chance to live if more people knew rst aid, says charity St John Ambulance, as it launches a hard-hitting campaign to encourage more people to learn this vital skill.

Thousands of people are dying each year in situations where rst aid could have made the difference. This includes nearly 900 people who choke to death, 2,500 who asphyxiate from a blocked airway and 29,000 who die from heart attacks*.

First aid could make a dramatic difference in these situations, either through direct intervention, in the case of choking, or by recognising life-threatening signs, such as a heart attack, and caring for someone until medical help arrives.

The startling gure is more than four times the number who die of lung cancer each year, the most common cause of death from cancer.

Startling lack of rst aid knowledge Research** commissioned by the charity has also revealed that: Nearly two-thirds of people (59%) wouldnt feel con dent enough to try to save a life. A quarter (24%) would do nothing and wait for an ambulance to arrive or hope that a passer-by knows rst aid.

The charity is urging everyone to get a free pocket-sized guide featuring rst aid skills that can help in ve common life-threatening situations*** by texting LIFE to 85010. The message is supported by a dramatic new advertising campaign depicting these ve situations in which rst aid could have been the difference between a life lost and a life saved. The public are also encouraged to donate to the charity to help others become the difference.

Be the difference Sue Killen, CEO, St John Ambulance comments: We believe that anyone who needs rst aid should receive it. Our latest research shows thats just not happening. We cant rely on other people to have the skills - everyone should take the responsibility to learn rst aid themselves. Armed with this knowledge we can all be the difference between a life lost and a life saved.

Sue continues: Around 2,500 people die each year from a blocked airway, but if someone had known the recovery position, lives could have been saved. Were urging everyone to text to claim a free rst aid guide today.

A life lost Guy Evans The campaign is backed by Beth Chesney-Evans, who believes her son might be alive today if he had been given basic rst aid. Guy Evans died in August 2008, when he was 17, after his motorcycle crashed near his home in Didcot, Oxfordshire.

Beth Chesney-Evans comments: Guy didnt die because of a terrible head injury or massive internal bleeding. He had no injuries at all but died because his heart apparently stopped and he couldnt breathe and those are conditions that rst aid is designed to deal with until the ambulance arrives. Ill never know whether Guy could have survived; but because he didn’t get any rst aid, he didnt have a chance.

Beth continues: Im supporting St John Ambulances campaign because I want to give others the chance Guy didn’t have. I dont want him to have died in vain.

Take action St John Ambulance is committed to ensuring everyone has the basic rst aid knowledge that could save someone’s life. To get your free pocket-sized guide, just text LIFE**** to 85010 or visit the St John Ambulance website for more information on the campaign www.sja.org.uk. You can also get advice on your iPhone with the St John Ambulance rst aid app, available through iTunes.

* Using death registration data from the Of ce of National Statistics, 2008

** Research conducted by ICM, February 2010, using a weighted sample of 2045 adults aged 18+. ICM is a member of the British Polling Council and abides by its rules. Further information at www.icmresearch.co.uk

*** The ve common scenarios tackled in the adverts and in the free rst aid guide are: Choking, heart attack, severe bleeding, an unconscious person who is breathing and one who is not breathing

**** Texts to this number are charged at standard network rate.

4 THE OPERATING THEATRE JOURNAL www.otjonline.com

Loyal staff at Southampton hospital take centre stage at £2.5 million theatre opening

Two members of staff at a Southampton hospital enjoyed the limelight when they took centre stage to of cially open a new £2.5 million operating theatre.

John Price and Debbie Hutchison have both been working at the 78-bed Spire Southampton Hospital for 21 years, where they started as a porter and part time housekeeper. The duo were invited to open the hospital’s fourth theatre in recognition of their commitment, dedication and hard work. Since joining the hospital they have progressed to become fully quali ed scrub assistants, supporting some of the country’s leading surgeons.

John rst saw the hospital in the late 1980s when he was working for a local garage and went there to deliver a car. He was really impressed, so when he saw a recruitment advertisement for a porter he applied and got the job. At around the same time Debbie started at the hospital doing the ‘twilight shifts’ as a part-time housekeeper. With two young babies to look after, the hours tted in well with her family life.

Over the years John and Debbie progressed their careers learning the necessary skills that are required in a busy theatre environment, and moved through the operating department ranks. Both went on to take NVQs level 2 and 3 in operating department and scrub skills, which the hospital funded as part of its staff development scheme.

John says: “I can’t quite believe that I have gone from being a porter to playing such a crucial role in an operating theatre. We are fortunate to work alongside leading surgeons which gives us the chance to be involved in a huge range of procedures including brain surgery.”

Debbie adds: “I’m sure John will agree, it’s thanks to the enormous support from the team at the hospital that we’ve been able to learn so much and been given the chance to gain the necessary practical skills. We’re honored to be of cially opening the new fourth theatre.”

The state-of the-art theatre is part of a £10 million development programme at Spire Southampton Hospital, which carries out complex surgery and pioneering techniques including stem cell transplantation and ‘awake’ brain surgery, as well as heart bypasses and innovative spinal procedures. As such, and as part of a dedicated theatre team, John and Debbie play crucial roles in some of the most highly complex and innovative surgical procedures in the UK.

David Doling, Spire Southampton Hospital’s theatre manager says: “Our staff work in a highly challenging environment and are involved in a wide range of procedures. Debbie and John’s enthusiasm and hard work has meant that they have become skilled and respected members of the hospital’s busy and experienced operating team. We were delighted to celebrate Debbie and John’s 21 years with them opening our fourth theatre.”

Also present at the of cial opening was eminent neurosurgeon, Mr Paul Grundy, who runs a dedicated neuro-oncology practice at Southampton University Hospital’s Wessex Neurological Centre, and introduced day case neurosurgery for brain tumours to the UK.

Speaking about the new facility, Mr Grundy says: “Modern surgery is intricate and complex and it is important to have up-to-date technology and equipment. It also helps improve the patient experience, as they can bene t from the best quality of care. The patients at Spire Southampton also bene t from a level three critical care unit which is unusual outside of the NHS and provides for greater care and reassurance.”

Mr Grundy, who is thought to perform the largest number of ‘awake’ brain operations in the UK, added: “The nursing teams at Spire Southampton are enthusiastic and have invested a great deal of time in learning their skills – it is great that the hospital has asked loyal members of the team to open the new theatre.”

Please quote ‘OTJ’

Jangro ‘NHS Approved’ rangeJangro the UK’s leading group of independent distributors of hygiene, cleaning, janitorial and catering supplies throughout the UK healthcare sector; is now offering an even larger range of specialist products including many carrying the ‘NHS Approved’ symbol.

In its latest 160-page catalogue Jangro offers a selection of ‘NHS Approved’ Clinell products that kill Swine Flu and includes Universal Sanitising Wipes, Hand and Surface Sanitiser/Disinfectant Spray, Antibacterial Hand Wipes and Sporadic Wipes.

This year, Jangro’s ‘Infection Control’ range has doubled to meet market requirements. It includes the popular Jangro Medical Sanitiser for terminal disinfection for use across the healthcare profession.

Jangro bactericidal, virucidal and sporicidal products effectively deal with MRSA, HIV and C Dif cile.

The Jangro range also includes Disposable Latex Gloves, Sovereign Examination Gloves and glove box holders, Alcohol Hand Gel and Rubs.

New to the 2010 range are Jangro’s handy sized disinfectant surface wipes, Biohazard and Sharps Disposal Kits, shoe covers, torches and rechargeable batteries.

The range includes many standard products including aprons, apron dispensers, dry patient wipes and a selection of paper disposables.

For both the healthcare and commercial markets Jangro has a large selection of First Aid products and kits including NHS approved bandages, adhesive dressings and eyewash stations.

Through its UK network of 37 privately owned, regional branches it offers the advantage of national product sourcing with local delivery and personal service.

Promoting ‘correct procedure’ is the Jangro exclusive Infection Control wallchart that provides guidance on the safe removal of body uids, spills and sharps. Test data is available on request for Jangro branded microbiological products.

For information on any of these products please call Jangro on Tel: 0845 458 5223, email: centralof [email protected] or visit our website at: www.jangro.net

Jangro’s Medical Sanitiser for hard surfaces in medical areas provides effective protection against a wide range of bacteria including e-coli and MRSA and the virus that causes Hepatitis B and HIV.



tel: 0870 833 9777email: [email protected]

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Fukuda Denshi to exhibit a wide range of monitors at the ICS Meeting in LeedsFukuda Denshi is a leading supplier of advanced patient monitoring and user-con gurable clinical information management systems. The company is exhibiting at the Intensive Care Society (ICS) Meeting, being held at the Royal Armouries Museum in Leeds, from 18th-19th May 2010, where they will be displaying an extensive range of patient bedside monitors.

Among the range on display will be the DS 7200 monitors, incorporating all of the major vital parameters, including 3, 5 or 12 lead ECG options, IBP, NIBP and SpO2, together with both hardwire and telemetry connectivity. These attractive, ergonomic monitors are future-proofed and feature a large 12” touch screen, together with an integrated 3-channel recorder. With a 10 waveform display capability, the DS 7200 bedside monitors are highly suitable for the HDU and A&E.

Also featured will be the very latest upgrades on the high performance DS 7300 system, the DS 7100 multi-parameter con gured bedside monitor, and the DS 7600 monitor, displaying waveforms for 16 patients on its wide 19” colour liquid crystal multi-functional touch screen.

Visitors can also see the Metavision Suite MVICU state-of-the-art clinical management system, which can be installed via PC access at the patients’ bedside for the convenient assessment of the patients’ progress and outcome.

For more information on the range of Fukuda Denshi monitoring systems please telephone the company on 01483 728 065, or visit their stand at ICS.

Fukuda Denshi: Healthcare bound by technology. Please quote ‘OTJ’

EXTENSION AT SPIRE BRISTOL HOSPITAL ENHANCES BRISTOLS REPUTATION AS

FOREMOST CITY FOR COMPLEX SURGERY

Bristol will become one of the countrys leading cities for the provision of vital health services including complex life-saving cardiac and brain surgery as well as orthopaedics and other specialties when Spire Bristol Hospitals new multi-million pound extension opens soon. The hospital, based at The Glen, is already a national centre of excellence for cardiac, brain and spinal surgery and the new extension will provide many new services, including the reconstruction of its intensive care unit and a redevelopment and expansion of its theatres and recovery area. Speaking ahead of the grand opening, where BBC TV presenter Monty Halls will be guest of honour, Spire Bristol Hospital Director Rob Anderson said: These are exciting times in the development of healthcare across the board in Bristol and the South West, and this development is key to securing the citys place as one of the countrys foremost locations for the provision of high-quality complex surgery. It is also extremely positive for Bristol that, despite the UK still being deep in the mire of the worst economic downturn for a generation, here we are talking about a major investment in the city which will create a nationally-recognised agship hospital with all the associated bene ts and kudos that brings. The new extension will also provide:

• major investment in new surgical and diagnostic equipment

• a total re- t and expansion of the outpatients department, increasing the number of consulting rooms to 26

• an internal refurbishment, including new patient bedrooms. As well as cementing our reputation as a national centre of excellence this development will also allow us simply to make more ef cient use of our space, improving the general environment for both patients and staff, added Rob Anderson.


NEW 3-WAY MRI TIVA SETMediplus, specialising in products for Anaesthetics, Urology, Urodynamics, GI and Gynaecology, has been supplying dedicated infusion sets for TIVA for more than eight years.

The standard Mediplus 3-way TIVA set was recently used by anaesthetists (as an example of the optimum confi guration) to issue recommendations on “Guaranteeing drug delivery in Total Intravenous Anaesthesia”.

Following increasing demand from customers for a dedicated TIVA set for MRI settings, Mediplus is launching a 6m version of its popular 3-way TIVA set. This new product eliminates the need for further extension lines – the main benefi ts being:

- Minimal risk of disconnection (and therefore drugs not reaching the patient)

- Less risk of boluses (as no disconnections)

For more information on the 3-way MRI-TIVA set (product code 6607) and other products, please contact Mediplus on 01494 551200, [email protected] or visit ww.mediplus.co.uk

Mediplus LtdUnit 7 The Gateway CentreCoronation Road, High WycombeBuckinghamshire HP12 3SUTel: +44 (0)1494 551200 Email: [email protected]: +44 (0)1494 536333 www.mediplus.co.uk

Wall and Ceiling Mounted LED Examination Lights Revolutionise

Lighting in Surgeries and Hospitals

Welch Allyn recently launched (16th April 2010) a new range of LED examination lights that can be wall and ceiling mounted. The LED lights have a 50,000 hour life span, allowing them to be fi tted in

surgeries and hospitals, without the long term concern for bulb replacement.

The Green Series medical examination lights offer a lighting solution for all healthcare environments. They have a low energy requirement, making them a greener alternative to conventional bulbs and contribute to the carbon emission targets surgeries and hospitals are under pressure to meet.

Each LED has an expected life span of 50,000 hours compared to the lifespan of 3,000 hours for a halogen bulb, offering cost savings up to £990 per light1.

The Green Series medical examination lights offers a lighting solution for all healthcare environments; the GS Exam Light IV, GS 300 General Exam Light and GS 600 Minor Procedure Light can all be wall mounted whereas the GS 900 Procedure light has the fl exibility to be both wall and ceiling mounted.

The GS 600 Minor Procedure Light has three LEDs, giving a larger head for enhanced accuracy to meet the demands of examination in any healthcare environment. The larger GS 900 Procedure Light features six LEDs and combines durability with manoeuvrability, this light can also be ceiling mounted to free up fl oor space during a procedure. The GS 900 is low maintenance and perfect for almost all healthcare settings including hospitals, surgeries or GP practices.

Jan McMeekin, UK Marketing Manager comments: The LED technology of the Green Series medical examination lights eliminates the need for bulb replacement. The new range offers lights that are not only energy and cost effi cient but the fl exibility in how the lights can be mounted enables building contractors to integrate them into the design of a surgery or hospital environment.

The lights all feature touchless on / off controls, reducing contact with the lights; the ergonomic design also makes the lights simple to clean. Green Series Exam Light IV is compatible with Welch Allyn disposable sheaths to further reduce the risk of cross contamination.

For further information about the Green Series or any products within the Welch Allyn range please contact 0207 365 6780 or visit www.welchallyn.com.

References1. Based on bulb replacement estimates of once a year for a halogen bulb and 10 years for an LED bulb. GS 300 £130 over 10 years, GS 600 £200 over 10 years, GS Light IV £330 over 10 years, GS 900 £990 over 10 years

The HPC launch online renewal service

The HPC has launched a new online service which will enable registrants to renew their registration and pay their registration fee securely using their online account.

In addition registrants will now be able to change their address and contact details as well as download direct debit instructions for further payment options.

The new system will enable faster renewal confi rmation for registrants and will allow the HPC to offer an improved service to all registrants. The new system will also enable the HPC to continue to develop the online service in the future.

We are delighted to be able to provide this opportunity to our registrants and look forward to receiving feedback on the system. We have launched this as part of our ongoing commitment to providing a high quality service to our registrants, said Richard Houghton, Head of Registration.

Further information can be found on the HPC website at:www.hpc-uk.org/registrants/renew

First Degree Teaching Disaster Management

Launched In ManchesterThe Masters in Health Incident Command, validated by Manchester Metropolitan University (MMU), is the fi rst degree of its kind in the UK.

It recognises there is no education or training for health commanders and is informed by serious incidents such as Hillsborough, the Clapham train crash and the 7/7 London bombings.

The course has been launched by South Manchester NHS Foundation Trust and is designed with experts from MMU’s Faculty of Health, Psychology and Social Care.

Paramedic Dave Whitmore, a tutor on the course, has worked on over 20 such incidents, starting with the IRA bombing of Chelsea Barracks in 1981.

Professor Janet Marsden, of MMU’s Centre for Effective Emergency Care and link tutor for the Masters degree, says the fi rst intake of students includes doctors, paramedics and ambulance service managers.

The online course is hosted within a new virtual learning environment developed by Gödel Technologies, which enable simulations of ‘real-life scenarios’ alongside online lectures, discussion forums and residential weekends.

The programme is supported by the Department of Health’s Emergency Preparedness Division and will eventually recruit internationally.

For further information please contact: Owen Morris [email protected] Tel: +44 1727 733887

When responding please quote ‘OTJ’


A message to healthcare professionals

Science, Guidelines and Users Agree: Forced Air Warming is Technology You Can Trust

Forced air warming is a clinically proven and trusted patient warming technology with 125 million patients warmed worldwide, a wealth of clinical research (including more than 170 published papers) and multiple international recommendations supporting its use. The evidence behind forced air warming’s safety and efficacy is overwhelming.1-6

Despite this, some manufacturers of electric blankets, pads and other conductive warming modalities are attempting to plant fears about the safety of forced air warming. One has even claimed that the country’s most prominent method of surgical warming may be contributing to surgical site infections (SSIs) by “blowing air” around the operating theatre, or disrupting laminar air flow.

It is time to put an end to these baseless claims about forced air warming and set the record straight.

These allegations contradict the extensive research reviewed by the National Institute for Health and Clinical Excellence (NICE) during the development of its Clinical Guideline 65: Management of inadvertent perioperative hypothermia in adults. This guideline states that forced air warming does not present an infection risk7, and specifically cited forced air warming as a proven tool for the reduction of SSIs.

Published research papers show that the use of forced air warming does not increase either the risk of wound

contamination in the operating theatre or bacterial contamination of operating theatres.8-12 Research published in the September 2009 issue of the Journal of Hospital Infection found that warming with the Bair Hugger® forced air warming system during orthopaedic surgery does not present an infection risk.11 In fact, when tested during actual surgical conditions, data show a decrease in the bacterial counts around the patient and in the operating theatre when forced air warming was used.10,11

Competitors offering conductive warming products have also recently made statements regarding forced air warming’s performance in laminar flow conditions. While simple logic makes it clear that forced air warming has no impact on laminar conditions, science also supports this. A forced air warming blanket delivers less than one percent of the airflow of a laminar flow system and therefore is unable to affect laminar flow ventilation systems.13

Rely on Evidence and Experience Maintaining normothermia with forced air warming has been demonstrated to reduce costly and serious complications associated with inadvertent hypothermia, including SSIs. The evidence is solid.

For more information on the evidence of forced air warming please visit www.arizant.co.uk or contact us directly at +44 (0) 1924 200550.

1. Sessler, D.I., Moayeri, A. Skin-surface warming: heat flux and central temperature. Anesthesiology 1990; 73: 218–24.2. Giesbrecht, G.G., Ducharme, M.B., McGuire, J.P. Comparison of forced-air patient warming systems for perioperative use. Anesthesiology 1994; 80: 671–9.3. Hynson, J.M., Sessler, D.I. Intraoperative warming therapies: a comparison of three devices. J Clin Anesth 1992; 4: 194–9.4. Kurz, A., Kurz, M., Poeschl, G., Faryniak, B., Redl, G., Hackl, W. Forced-air warming maintains intraoperative normothermia better than circulating-water mattresses. Anesthesia & Analgesia 1993; 77: 89–95.5. Borms, S.F., Englelen, S.L., Himpe, D.G., Suy, M.R., Theunissen, W.J. Bair Hugger forced-air warming maintains normothermia more effectively than thermo-lite insulation. J Clin Anesth 1994; 6: 303–7.6. Brauer, A., Pacholik, L., Perl, T., English, M.J., Weyland, W., Braun, U. Conductive heat exchange with a gel-coated circulating water mattress. Anesthesia & Analgesia 2004; 99: 1742–6.7. National Institute for Health and Clinical Excellence clinical guideline 65, The management of inadvertent perioperative hypothermia in adults – April 2008.

8. Sharp, R.J., Chesworth, T., Fern, E.D. Do warming blankets increase bacterial counts in the operating field in a laminar-flow theatre? J Bone Joint Surg Br 2002; 84: 486–8.9. Tumia, N., Ashcroft, G.P. Convection warmers--a possible source of contamination in laminar airflow operating theatres? J Hosp Infect 2002; 52: 171–4.10. Huang, J.K., Shah, E.F., Vinodkumar, N., Hegarty, M.A., Greatorex, R.A. The Bair Hugger patient warming system in prolonged vascular surgery: an infection risk? Crit Care 2003; 7: R13–6.11. Moretti, B., Larocca, A.M., Napoli, C., et al. Active warming systems to maintain perioperative normothermia in hip replacement surgery: a therapeutic aid or a vector of infection? J Hospital Infect 2009; 73: 58–63.12. Zink, R.S., Iaizzo, P.A. Convective warming therapy does not increase the risk of wound contamination in the operating room. Anesth Analg 1993; 76: 50–3.13. Arizant test data on file; Laminar Flow Filter Catalog. 2010. (Accessed February 20, 2010, at http://www.camfilfarr.com/cou_sve/catalog/upload/health_swe.pdf).


Penlon receives recognition for improving

healthcare around the worldCritical, life supporting medical equipment such as the anaesthesia systems and medical gas pipelines designed and manufactured by Penlon Limited, play a vital role in the care of hospital patients. The nature of their application means rigorous attention must be paid to ensuring design appropriately meets the needs of users and patients, together with high standards of safety and quality.

Penlon Limited, a small Oxfordshire based company and the only, independent UK based manufacturer of anaesthesia systems, has built a reputation for such excellence in its eld which goes back to 1943, when it was rst established by personnel from the Department of Anaesthetics at Oxford University. The business continues to go from strength to strength, exporting over 60% of its production to more than 90 countries worldwide, helping to improve standards of healthcare in many of the developing countries around the world.

In recognition of this success, Penlon has been bestowed a Queen’s Award for Enterprise in international trade for its continued record growth and commercial success in overseas markets, where revenues have more than doubled over six years.

During this period, the Company received its largest single order for 250 anaesthesia machines from the Iraqi Ministry of Health. Following a visit by Iraqi representatives to view our manufacturing capability, Penlon was selected as the winning bidder out of a total sixteen.

A large number of anesthesia machines were also placed into Mexico, where both the Mexico Ministry of Health and Social Security continue to choose Penlon as one of their preferred suppliers, based on our ability to supply affordable, t for purpose equipment, backed up by rst class customer care.

Ian Gil-Rodriguez, Business Director, Medical Gas Solutions says ‘The Penlon brand is very much an emblem of quality and we have worked closely with many Health Ministries to help them adopt this technology, to ensure the safe delivery of gases throughout hospitals. Our geographical reach continues to grow and we have been regularly supported by UK Embassies, as part of their trade and investment responsibilities’. Some of the projects Penlon has been involved with include supplying the rst liquid oxygen contract to Sri Lanka for ve regional hospitals following the tsunami of 2006 and the installation of medical pipeline into twelve new hospitals in Iraq.

This is Penlon’s fourth Queen’s Award and truly distinguishes Penlon, which competes against a number of multi-national players in this sector. Previous awards were in 1968 and 1976 for Export Achievement, followed in 2002 with a Queen’s Award for Innovation for the highly acclaimed Sigma Delta Vaporizer.

Peter Leyland, CEO commented, ‘Penlon is immensely proud to receive this accolade and re ects the combined expertise and effort of everyone who has contributed to the sustained success of the business and their genuine passion in helping to raise standards of healthcare’. Peter Worrallo, Group Sales Director, who has been with the Company almost twenty years adds, ‘This is another important milestone for the Company which has worked hard to establish its position internationally. It is particularly gratifying in what has been a tough economic climate and is a testament to the dedication of the team and strength of partnerships with our excellent distributors’.

For further information please visit www.penlon.com

The UK ODP Message GroupJoining is easy, just send an e-mail,stating your name, e-mail address, position and Hospital to:

[email protected]


First full face transplant welcomedBritish experts have welcomed the news that a team in Spain has performed the world’s rst full face transplant.More than 30 medics carried out the operation at Barcelona’s Vall d’Hebron University Hospital on a young man who was injured in an accident ve years ago.The patient was unable to breathe, swallow or speak properly before the transplant and was dependent on arti cial equipment to breathe and eat.He received new facial muscles, skin, nose, lips, jaw, teeth, palate and cheekbones in the 24-hour operation, which was performed on March 20.In a statement, the hospital said: “He had been operated on nine times without satisfactory success, therefore he was considered for full face transplant.“The operation was carried out by a multidisciplinary team led by Dr Joan Pere Barret, performing the transplant of the entire facial skin and muscles, nose, lips, maxilla, palate, all teeth, cheekbones, and the mandible by means of plastic surgery and micro-neurovascular reconstructive surgery techniques.“This is the rst full face transplant performed worldwide, as the 10 operations performed previously had been only partial.”Professor Peter Butler, head of the UK’s Facial Transplantation Research Team, has been ready to perform a full face transplant for several months.His team is understood to still be looking for donors that provide an exact match for several British patients.Prof Butler said: “We congratulate Dr Barret and his transplantation team in Spain on what may well be the most complex facial transplantation operation carried out so far worldwide.” Source:pa.press.net

Eudamed - Europes long-awaited Medical Devices database is a reality• First conceived in 1998, Eudamed is a secure web-based portal acting

as a central repository for information exchange between national competent authorities and the European Commission;

• Authorities enter the information needed into the database based on the information received from manufacturers and noti ed bodies;

• To ensure consistency of data, Eucomed recommends using the GMDN nomenclature as the internationally recognised nomenclature called out in the new EU legislative text.

Brussels, 20 April 2010 Eucomed, the European Medical Technology Industry association, welcomes the decision adopted by the European Commission to make the use of the Eudamed database obligatory by EU Member States from 1 May 2011.

This is a signi cant rst step in the right direction to make the EU medical devices system less fragmented and more ef cient. The next challenge is the multiplicity of different national registration systems. Together with the Member States and the European Commission we must develop a single European registration system for medical devices, says John Wilkinson, Eucomeds Chief Executive.

Eucomed sees the use of Information and Communication Technologies (ICT) as key to effective, ef cient and sustainable EU healthcare systems. Eudamed is already used on a voluntary basis by a number of EU countries. With this database, authorities will have fast access to information on manufacturers and authorised representatives, on devices and certi cates, and on vigilance and clinical investigation data. However, certain areas that could bene t from being within a centralised database, such as authority access to noti ed body reports and assessments, are currently not covered.

Until now, the ICT card has been underplayed in the regulations. Eucomed hopes that when the European Commission revises the Medical Devices Directives (MDD) we in Europe make full use of ICT to manage the regulatory system more effectively and ultimately improve patient safety in Europe. This may mean an expanded Eudamed or a new system, or even a network of interconnected EU databases. ended John Wilkinson.

Eucomed will be working with DG SANCO and Member States to better understand the challenges in managing the EU legal framework and to identify the best ICT solutions to increase its ef ciency, effectiveness and sustainability.

This EU decision will be published in the Of cial Journal of the European Union in the coming days.

Further reading: http://ec.europa.eu/enterprise/newsroom/cf/itemshortdetail.cfm?&item_id=4214


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Braun launches gold standard

haemostatA new haemostat launched by B.Braun Medical is proving to be the fastest on the market at stopping severe bleeding during major surgery.

Surgeons, scientists and production experts at B.Braun Medical have worked together to develop Sangustop to keep surgical sites free from blood.

The groundbreaking, high density pads are seen as a real advance in surgical care during major operations especially liver, neurological and gynaecological surgery.

They are much easier to use – surgical teams can use both sides with no need to moisten before applying or to maintain pressure for several minutes to stop the bleeding.

Sangustop does not contain any component of human origin, so reducing the likelihood of certain infections, and does not crumble.

The new product is particularly suitable for severe haemorrhages. Tests have shown the water uptake capacity of Sangustop is more than four times higher, and the wetting speed more than two times faster, than collagen containing human additives.

Mark Culf, National Sales Manager at B.Braun Medical, said: “This really is the gold standard product for quickly stopping severe arterial bleeding during surgery.

“We see Sangustop having a vital role in major liver centres across the country but it will also present a major advance in care during any surgical procedure where there is severe bleeding.

“It is so easy, fast and effective to use that we see Sangustop having an important role in reducing the chance of infection and complications during major surgery and so improving patient outcomes.”

www.bbraun.co.uk When responding please quote ‘OTJ’

New a skin friendly, low pro le neria™ Infusion Sets from ConvaTecConvaTec is a global company committed to serving healthcare professionals, hospitals and patients worldwide. In the ConvaTec Continence and Critical Care Division they specialise in the development, manufacturing and distribution of single-use devices to hospitals and healthcare sectors around the world.

New neria™ Infusion Sets from ConvaTec make Desferal® therapy more convenient and comfortable for the patients. Made from skin friendly Polyethylene and Polyurethane tubing to minimise the risk of contact allergies, neria™ is low pro le and at during use.

neria™ is indicated for Parkinson’s disease, primary immunode ciency and thalassaemia. It has been stability tested with APO-go®, Desferal® and subcutaneous immunoglobulin.

Other features of neria™ Infusion Sets include:• Siliconised 3-facet needle point for virtually painless injections, even

in children.• Flexible nger grips for exceptional ease of use.• Vertical 8mm needle to provide correct subcutaneous insertion for

optimal Desferal infusion.• Translucent window in the cotton backing for injection site

monitoring.• Kink-free tubing for uninterrupted ows of medication.• 8 or 10mm, G27 and G29 needles.• 60cm and 110cm tube lengths.

For more information on the new neria™ Infusion set, or for more information on the ConvaTec Continence and Critical Care range, please telephone 01527-583600 or visit www.convatec.com.ConvaTec: Realise the possibilities™™/® Indicates a trademark of ConvaTec Inc. ConvaTec Ltd is an authorised user. © ConvaTec Inc 2009



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Keeping up with technology: e-learning in the clinical environmentE-learning is an increasingly popular way of teaching new clinical techniques, but how can you be certain that the resources you use are as effective as they should be? Dr Nicholas Blackwell of the University of Leicester Medical School explains how to ensure that your e-learning project is an effective teaching tool.

Technology moves so fast in the 21st century that text books and printed matter can sometimes be out of date by the time they are published. Given the ever increasing speed of advances in clinical technology, it is hardly surprising that medical educators are increasingly looking towards e-learning as the way forward. However, it is important not to get carried away by the exciting opportunities that online learning brings without bearing in mind the challenges and pitfalls. In fact, done badly, e-learning may do more harm than good.

Set your goalsAs a clinical educator developing an e-learning resource, the rst things to determine are the key learning objectives and measureable outcomes of success which should drive the whole project. The next stage typically is to look to other online resources for inspiration and whilst this can be useful, I would urge a note of caution. For example, how do you know that these resources have met their objectives, that they been properly evaluated or that they are cost effective? If you lack experience in developing e-learning resources, the variation in quality, technologies and delivery styles can be bewildering – and you may simply end up repeating other people’s mistakes.

Play to your strengthsClinical educators are unlikely to be experts in online learning - and this is not something that can be achieved overnight. One solution is to use the services of an experienced medical e-learning developer who can help you understand its potential and give you useful examples of good practice and appropriate uses of technology. They will also do much of the technical and production work, allowing the educator to play to their strengths - preparing the educational content.

Being a subject matter expert with a talent for engaging learners does not necessarily qualify you to produce high quality e-learning content and simply placing pages of text or presentations online will do little to engage users. In fact, learners have increasingly high expectations of e-learning, ranging from interactive assessments through to simulated collaborative environments. Neither can clinical educators expect to be in experts in graphical design, animation, programming, multimedia and the host of other components necessary to produce an effective e-learning resource. In short, high quality e-learning development is a team effort, not a solo role.

Developing the contentThe development of content is best carried out in collaboration with an experienced instructional designer whose primary role is to work with and support an educator in establishing how best to deliver the resource and achieve the clinical learning outcomes. This relationship is central to the success of an e-learning project, ensuring that a high quality and effective resource can be produced making optimum use of an educator’s time and skills. The instructional designer creates the e-learning project model and content storyboards, based upon subject material provided by the educator, who then acts largely in an editorial capacity.

Marrying technology with educationAnother collaborator then enters the process in the form of the IT department which is usually responsible for implementing the necessary technology for delivering the learning. Unfortunately, the end result of this process is often the deployment or inheritance of expensive learning management systems (LMS) which either do not meet the needs of educators and learners, or have functionality far in excess of what is actually required.

This means that educators may nd themselves limited by operational parameters or LMS templates to such an extent that the nal outcome bears little relation to their initial vision or the learning objectives - which does little to inspire the development of further resources.As experts in their particular eld, technologists also have a tendency to promote the latest advances in technology, which aren’t always educationally relevant: for example, investment in synchronous video tools which can’t be used as it is impossible to get learners online at the same time due to work obligations and rotas, or an LMS used as a glori ed clinical discussion forums without the inclusion of any e-learning content.

So, whilst the deployment of appropriate technology is fundamental to the success of any e-learning project, it is essential to maintain the primary focus of meeting the learners’ needs and learning objectives. This means that the deployment of appropriate, cost effective technology is best agreed through the process of educator led discussion with technologists, ideally overseen by e-learning specialists.

Evaluating for improvementThe most effective educators are also aware of the importance of improving the resources that they use through ongoing assessment and evaluation to identify what worked well and what could be improved for the future. This can be a time consuming process and unfortunately, at present, few educational e-learning resources are formally evaluated against the original learning goals, with success frequently measured in terms of timescale and budget. However, this is a vital part of the process if e-learning is to be used to its optimum effect as a teaching tool.

Without proper analysis measured against learning objectives, not only can a resource be detrimental to the learning experience, but it may be used to develop future e-learning resources, resulting in bad practice being carried forward into the next cycle of development. Despite the capacity for getting it wrong, online learning is undoubtedly an exciting development in the eld of clinical education which offers rich potential for innovative interactive teaching and learning for many years to come. The key message to understand is that getting the process right does require a diverse set of skills and knowledge: subject expertise or technological knowhow in isolation simply isn’t enough to create a comprehensive clinical resource that makes the maximum impact on learners. The good news is, if you get it right, e-learning could revolutionise clinical teaching and become the most powerful educative tool that you possess.

Author backgroundNicholas Blackwell PhD, MIITT is Director of the Health Education Research and Development Unit at the University of Leicester Medical School. He is also the Managing Director of OCB Media (www.ocbmedia.co.uk) which specialises in the provision of e-learning facilities to the medical industry.



Part two, Meanwhile back in Europe

The European medical community were not deterred or downhearted by the judgement in the U.S.A. and their conclusions [42% for conventional treatment V 33% for the E.CM.O. treatment] The general feeling was that E.C.M.O. had the potential to signi cantly increase the mortality rates in patients suffering from severe A.R.D.S. and their impaired gaseous exchange during the acute phase of illness. Their belief was held in the previous, albeit uncontrolled studies where patients presented with up to 50% mortality rates.Many theories and explanation were presented. N.M.Habashi indicated that the ventilatory management of patients had not been uniform, and because of this, the patient outcome may have been compromised. The rst group of patients in one study had peak airway pressures controlled, the second group in the research were Vts controlled.F Brunel concluded, that as with the American studies the E.C.M.O. patients had no appreciable prognosis over the more conventional treated patients.Most independent reviewers who commentated on the research agreed that the method and the procedure did not achieve the necessary standards required in modern practice.Complications associated with blood loss during the E.C.M.O. procedure were attributed to the use of non heparin coated equipment, it was suggested this form of treatment may be an antiquated force, as the levels of anticoagulation employed proved to be a major drawback during E.C.M.O. treatment.In 1983 Larm further developed earlier research, and devised a system where the heparin molecule could be adhered to a synthetic surface. This development allowed every appropriate part of the of the E.C.M.O. machine that came in contact with the patient’s blood to be coated with heparin. In1987 a report was published concerning a 44 year old woman had been treated long term with E.C.M.O. Following her survival most European centres converted to the surface coated heparin technique, negating the use or drastically reducing the need for systemic anticoagulation.For patients suffering from A.R.D.S. the current treatment is by a low ow veno- venous bypass, when the patient requires some cardiac support, the new technique allows for the intensivist to have a more practical and exible approach to the patients care, whereby they can swiftly change to a high ow system if the clinical signs are appropriate.The E.C.M.O. Technique TodayAs with all medical techniques, and E.C.M.O. is no exception, developments are progressing, so fast that this part of the article may be outdated by the time it reaches the printers, so please bear with this article if techniques and research have changed overnight.In low ow E.C.M.O. venous blood is drained through two heparin coated 28g wire reinforced cannulae. These are inserted percutaneusly into both groins, allowing access into the inferior vena- cava, they are connected to a Y piece connector. Once oxygenated, the blood is returned via the superior vena-cava, into the right internal jugular vein.A femoral-jugular veno-venous bypass completes the circuit, a near occlusive roller pump drives the blood through two hollow bre oxygenators, all of the internal mechanical systems are coated as previously described with a lm of covalently coated bound heparin. The operating system is primed with packed red blood cells and fresh frozen plasma, using a ratio of 2:1. The oxygenator has a gas phase and that ushes the system with pure dry oxygen. The gas ow rate is adjusted to the appropriate carbon dioxide tension levels, once primed and ready for use, oxygenation is effected via the mechanically ventilated lung and by arterializing the circulating blood via the membrane oxygenator.The above description is by no means carved in stone, as discussed before it is a exible procedure, and variations of technique, may, and will, vary from centre to centre, and from clinician to clinician.Complications of E.C.M.O.So far the results of E.C.M.O. have proven to be acceptably positive, but as with any procedure there is the potentiality for complications. The complications fall mainly into two categories.Although the machinery is highly evolved and complex there is always the possibility of mechanical breakdown, the other is of course medico patient related.Mechanical complications may include oxygenator failure, circuit or tubing problems, kinks blockages, rupture malfunction of the pump or heat exchanger, down to the very basics of incorrect cannulae placement, or removal.

E.C.M.O [Extracorporeal Membrane Oxygenation]

Patient complications are as with any invasive procedures, the risk of haemorrhage, neurological problems, and even failure of other bodily organs, renal cardio-vascular, and of course the invasive techniques nemesis, infection.The extracorporeal life support registry store data recording the frequency of complications. During E.C.M.O. in 95 patients, it was found that 68 mechanical and 302 patient related complications were recorded, that clearly shows that complications are a still high, even with the highest quality of medical and nursing care. Patient Selection To reduce the risks of complications a strict and rigorous patient selection is employed.The criteria may vary from centre to centre, and the criteria may uctuate during chronic and acute phases, lung compliance, extra-vascular pulmonary oedema may be factors, and each patient will be marked on a pulmonary scoring system.The patients that may not be suitable would be those suffering from reduced clotting times, severe chronic pulmonary disease, a prognosis of terminal cancer, or patients experiencing multiple organ failure, and those with left ventricular failure.Mechanical failure is harder to foresee I’m sure everyone has had the occasion where an anaesthetic machine or ventilator has malfunctioned, even after being serviced by the most experienced bio medical engineer. Fig 1 A Simpli ed version of the E.C.M.O. System

What does the future hold?

We have discussed the many peaks and troughs with E.C.M.O. during its long history, it’s incredible to think when Frey and Gruber were practicing when the new settlers in the U.S.A were trailblazing across the prairies in canvass covered wagons.

At the moment there are only a handful of centres in the U.K. using E.C.M.O. but technology will keep progressing and while patient prognosis remain on an upward trend E.C.M.O. will continue. It has not been too long since a kidney transplant was a major event, it is of course still a major major event particularly to the recipient and donor, but with new techniques and anti rejection pharmacology, the procedure is now a fairly common place within most operating theatres, hopefully E.C.M.O. will follow suit.

All views expressed within this article are the views of the author

Trevor.R.Toman

patient

blood fromgroin

roller pump

hollow fibreoxygenator

corporealmembraneoxygenatorto internaljugular

gaseous e c a ge du g t e acute p ase o ll ess.Their belief was held in the previous, albeit uncontrolled studies wherepatients presented with up to 50% mortality rates.Many theories and explanation were presented. N.M.Habashi indicatedthat the ventilatory management of patients had not been uniform,and because of this, the patient outcome may have been compromised.The rst group of patients in one study had peak airway pressurescontrolled, the second group in the research were Vts controlled.F Brunel concluded, that as with the American studies the E.C.M.O.patients had no appreciable prognosis over the more conventionaltreated patients.Most independent reviewers who commentated on the research agreedthat the method and the procedure did not achieve the necessarystandards required in modern practice.Complications associated with blood loss during the E.C.M.O. procedurewere attributed to the use of non heparin coated equipment, it wassuggested this form of treatment may be an antiquated force, as thelevels of anticoagulation employed proved to be a major drawback during E.C.M.O. treatment.In 1983 Larm further developed earlier research, and devised a systemwhere the heparin molecule could be adhered to a synthetic surface.This development allowed every appropriate part of the of the E.C.M.O.machine that came in contact with the patient’s blood to be coatedwith heparin.In1987 a report was published concerning a 44 year old woman hadbeen treated long term with E.C.M.O. Following her survival most European centres converted to the surfacecoated heparin technique, negating the use or drastically reducing theneed for systemic anticoagulation.For patients suffering from A.R.D.S. the current treatment is by a low ow veno- venous bypass, when the patient requires somecardiac support, the new technique allows for the intensivist to havea more practical and exible approach to the patients care, wherebythey can swiftly change to a high ow system if the clinical signs areappropriate.The E.C.M.O. Technique TodayAs with all medical techniques, and E.C.M.O. is no exception,developments are progressing, so fast that this part of the article maybe outdated by the time it reaches the printers, so please bear with thisarticle if techniques and research have changed overnight.In low ow E.C.M.O. venous blood is drained through two heparincoated 28g wire reinforced cannulae. These are inserted percutaneuslyinto both groins, allowing access into the inferior vena- cava, they areconnected to a Y piece connector. Once oxygenated, the blood is returned via the superior vena-cava, intothe right internal jugular vein.A femoral-jugular veno-venous bypass completes the circuit, a nearocclusive roller pump drives the blood through two hollow breoxygenators, all of the internal mechanical systems are coated aspreviously described with a lm of covalently coated bound heparin.The operating system is primed with packed red blood cells and freshfrozen plasma, using a ratio of 2:1. The oxygenator has a gas phase andthat ushes the system with pure dry oxygen.The gas ow rate is adjusted to the appropriate carbon dioxide tensionlevels, once primed and ready for use, oxygenation is effected via themechanically ventilated lung and by arterializing the circulating bloodvia the membrane oxygenator.The above description is by no means carved in stone, as discussedbefore it is a exible procedure, and variations of technique, may, andwill, vary from centre to centre, and from clinician to clinician.Complications of E.C.M.O.So far the results of E.C.M.O. have proven to be acceptably positive, butas with any procedure there is the potentiality for complications. The complications fall mainly into two categories.

frequency of complications. During E.C.M.O. in 95 patients, it was found that 68 mechanical and 302 patient related complications were recorded, that clearly shows that complications are a still high, even with the highest quality of medical and nursing care. Patient Selection To reduce the risks of complications a strict and rigorous patient selection is employed.The criteria may vary from centre to centre, and the criteria may uctuate during chronic and acute phases, lung compliance, extra-vascular pulmonary oedema may be factors, and each patient will be marked on a pulmonary scoring system.The patients that may not be suitable would be those suffering from reduced clotting times, severe chronic pulmonary disease, a prognosis of terminal cancer, or patients experiencing multiple organ failure, and those with left ventricular failure.Mechanical failure is harder to foresee I’m sure everyone has had the occasion where an anaesthetic machine or ventilator has malfunctioned, even after being serviced by the most experienced bio medical engineer.

Fig 1 A Simpli ed version of the E.C.M.O. System



At the moment there are only a handful of centres in the U.K. using E.C.M.O. but technology will keep progressing and while patient prognosis remain on an upward trend E.C.M.O. will continue. It has not been too long since a kidney transplant was a major event, it is of course still a major major event particularly to the recipient and donor but

patient

blood fromgroin

roller pump



R10-230-F R10-387-UK-H*

R10-457

Enjoy Complete Confidence

*

The specially designed clamps, simply hook over the sidebar1, and with the switch of a lever, the clamp and any attached accessory is quickly secured2 in place ready for use.


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Subscribing to the OTJ costs £14.00 per year for delivery in the UK or £21.00 overseas.Alternatively just ll in your address details below and return with a cheque.

are published. Given the ever increasing speed of advances inclinical technology, it is hardlysurprising that medical educatorsare increasingly looking towardse-learning as the way forward.However, it is important not toget carried away by the excitingopportunities that online learningbrings without bearing in mindthe challenges and pitfalls. Infact, done badly, e-learning may do more harm than good.

Set your goalsAs a clinical educator developingan e-learning resource, the rst things to determine arethe key learning objectives andmeasureable outcomes of successwhich should drive the wholeproject. The next stage typicallyis to look to other online resourcesfor inspiration and whilst this canbe useful, I would urge a note of caution. For example, how do youknow that these resources havemet their objectives, that theybeen properly evaluated or thatthey are cost effective? If youlack experience in developinge-learning resources, thevariation in quality, technologiesand delivery styles can bebewildering – and you may simplyend up repeating other people’smistakes.

Play to your strengthsClinical educators are unlikely tobe experts in online learning - andthis is not something that can beachieved overnight. One solutionis to use the services of anexperienced medical e-learningdeveloper who can help youunderstand its potential andgive you useful examples of goodpractice and appropriate uses of technology. They will also do muchof the technical and productionwork, allowing the educator toplay to their strengths - preparingthe educational content.

p g q y gcontent and simply placing pagesof text or presentations onlinewill do little to engage users. Infact, learners have increasinglyhigh expectations of e-learning,ranging from interactiveassessments through to simulatedcollaborative environments.Neither can clinical educators expect to be in experts in graphicaldesign, animation, programming,multimedia and the host of othercomponents necessary to producean effective e-learning resource.In short, high quality e-learningdevelopment is a team effort, nota solo role.

Developing the contentThe development of content isbest carried out in collaborationwith an experienced instructionaldesigner whose primary role is towork with and support an educatorin establishing how best to deliverthe resource and achieve theclinical learning outcomes. Thisrelationship is central to thesuccess of an e-learning project,ensuring that a high qualityand effective resource can beproduced making optimum useof an educator’s time and skills.The instructional designer createsthe e-learning project model andcontent storyboards, based uponsubject material provided by theeducator, who then acts largely inan editorial capacity.

Marrying technology with educationAnother collaborator then entersthe process in the form of theIT department which is usuallyresponsible for implementing thenecessary technology for deliveringthe learning. Unfortunately, theend result of this process is oftenthe deployment or inheritance of expensive learning managementsystems (LMS) which either do notmeet the needs of educators andlearners, or have functionalityfar in excess of what is actuallyrequired.

outcome bears little relation to their initial vision or the learning objectives - which does little to inspire the development of further resources.As experts in their particular eld, technologists also have a tendency to promote the latest advances in technology, which aren’t always educationally relevant: for example, investment in synchronous video tools which can’t be used as it is impossible to get learners online at the same time due to work obligations androtas, or an LMS used as a glori ed clinical discussion forums without the inclusion of any e-learning content.


Evaluating for improvementThe most effective educators are also aware of the importance of improving the resources that they use through ongoing assessment and evaluation to identify what worked well and what could be improved for the future. This can be a time consuming process andunfortunately, at present, few educational e-learning resources are formally evaluated against the original learning goals, with success frequently measured in terms of timescale and budget. However, this is a vital part of the process if e-learning is to be used to its optimum effect as ateaching tool.

may be used to develop future e-learning resources, resulting in bad practice being carried forward into the next cycle of development. Despite the capacity for getting it wrong, online learning is undoubtedly an exciting development in the eld of clinical education which offers rich potential for innovative interactive teaching and learning for many years to come. The key message to understand is that getting the process right does require a diverse set of skills and knowledge: subject expertise or technological knowhow in isolation simply isn’t enough to create a comprehensive clinical resource that makes the maximum impact on learners. The good news is, if you get it right, e-learning could revolutionise clinical teaching and become the most powerful educative tool that you possess.



Eschmannoperatingtable accessories

Carbon fi bre hand and arm surgery table

complete with mattress integral UK

clamps and supporting leg

R10-396-UK

As above with integral Euro clamp R10-396

Adjustable/rotatable lateral support - narrow

(200mm x 80mm) c/w straight and contoured pads

Requires clamp R10-301/-UK

R10-560Adjustable lateral support - wide

(200mm x 200mm) Requires clamp R10-301/-UK

R10-565

Anaesthesia carbon fi bre screen with

extensions and integral UK clamp

R10-313-UK

Anaesthesia carbon fi bre screen with

extensions and integral Euro clamp

R10-313










Trevor.R.Toman

patient

blood fromgroin

roller pump



gaseous e c a ge du g t e acute p ase o ll ess.Their belief was held in the previous, albeit uncontrolled studies wherepatients presented with up to 50% mortality rates.Many theories and explanation were presented. N.M.Habashi indicatedthat the ventilatory management of patients had not been uniform,and because of this, the patient outcome may have been compromised.The rst group of patients in one study had peak airway pressurescontrolled, the second group in the research were Vts controlled.F Brunel concluded, that as with the American studies the E.C.M.O.patients had no appreciable prognosis over the more conventionaltreated patients.Most independent reviewers who commentated on the research agreedthat the method and the procedure did not achieve the necessarystandards required in modern practice.Complications associated with blood loss during the E.C.M.O. procedurewere attributed to the use of non heparin coated equipment, it wassuggested this form of treatment may be an antiquated force, as thelevels of anticoagulation employed proved to be a major drawback during E.C.M.O. treatment.In 1983 Larm further developed earlier research, and devised a systemwhere the heparin molecule could be adhered to a synthetic surface.This development allowed every appropriate part of the of the E.C.M.O.machine that came in contact with the patient’s blood to be coatedwith heparin.In1987 a report was published concerning a 44 year old woman hadbeen treated long term with E.C.M.O. Following her survival most European centres converted to the surfacecoated heparin technique, negating the use or drastically reducing theneed for systemic anticoagulation.For patients suffering from A.R.D.S. the current treatment is by a low ow veno- venous bypass, when the patient requires somecardiac support, the new technique allows for the intensivist to havea more practical and exible approach to the patients care, wherebythey can swiftly change to a high ow system if the clinical signs areappropriate.The E.C.M.O. Technique TodayAs with all medical techniques, and E.C.M.O. is no exception,developments are progressing, so fast that this part of the article maybe outdated by the time it reaches the printers, so please bear with thisarticle if techniques and research have changed overnight.In low ow E.C.M.O. venous blood is drained through two heparincoated 28g wire reinforced cannulae. These are inserted percutaneuslyinto both groins, allowing access into the inferior vena- cava, they areconnected to a Y piece connector. Once oxygenated, the blood is returned via the superior vena-cava, intothe right internal jugular vein.A femoral-jugular veno-venous bypass completes the circuit, a nearocclusive roller pump drives the blood through two hollow breoxygenators, all of the internal mechanical systems are coated aspreviously described with a lm of covalently coated bound heparin.The operating system is primed with packed red blood cells and freshfrozen plasma, using a ratio of 2:1. The oxygenator has a gas phase andthat ushes the system with pure dry oxygen.The gas ow rate is adjusted to the appropriate carbon dioxide tensionlevels, once primed and ready for use, oxygenation is effected via themechanically ventilated lung and by arterializing the circulating bloodvia the membrane oxygenator.The above description is by no means carved in stone, as discussedbefore it is a exible procedure, and variations of technique, may, andwill, vary from centre to centre, and from clinician to clinician.Complications of E.C.M.O.So far the results of E.C.M.O. have proven to be acceptably positive, butas with any procedure there is the potentiality for complications. The complications fall mainly into two categories.

frequency of complications. During E.C.M.O. in 95 patients, it was found that 68 mechanical and 302 patient related complications were recorded, that clearly shows that complications are a still high, even with the highest quality of medical and nursing care. Patient Selection To reduce the risks of complications a strict and rigorous patient selection is employed.The criteria may vary from centre to centre, and the criteria may uctuate during chronic and acute phases, lung compliance, extra-vascular pulmonary oedema may be factors, and each patient will be marked on a pulmonary scoring system.The patients that may not be suitable would be those suffering from reduced clotting times, severe chronic pulmonary disease, a prognosis of terminal cancer, or patients experiencing multiple organ failure, and those with left ventricular failure.Mechanical failure is harder to foresee I’m sure everyone has had the occasion where an anaesthetic machine or ventilator has malfunctioned, even after being serviced by the most experienced bio medical engineer.

Fig 1 A Simpli ed version of the E.C.M.O. System



At the moment there are only a handful of centres in the U.K. using E.C.M.O. but technology will keep progressing and while patient prognosis remain on an upward trend E.C.M.O. will continue. It has not been too long since a kidney transplant was a major event, it is of course still a major major event particularly to the recipient and donor but

patient

blood fromgroin

roller pump



Infusion stand with integral rotatable

UK clamp

R10-400-UK

Infusion stand with integral rotatable

Euro clamp

R10-400

Angular UK accessory rail with integral clamp R10-359-UK

Angular Euro accessory rail with integral

clamp

R10-359

UK extension rail with integral clamp R10-491-UK

Euro extension rail with integral clamp R10-491

Pair of safety rails with integral UK clamp R10-531-UK

Pair of safety rails with integral Euro clamp R10-531

Cover for safety rails (pair) R10-531H


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10

Subscribeto the OTJ



----

---

----

----

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----

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----

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-- --Delivered to your door every month

It’s easy to subscribe, just visit our website at www.otjonline.com and pay via Card or Paypal.

Name ___________________________________________

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are published. Given the ever increasing speed of advances inclinical technology, it is hardlysurprising that medical educatorsare increasingly looking towardse-learning as the way forward.However, it is important not toget carried away by the excitingopportunities that online learningbrings without bearing in mindthe challenges and pitfalls. Infact, done badly, e-learning may do more harm than good.

Set your goalsAs a clinical educator developingan e-learning resource, the rst things to determine arethe key learning objectives andmeasureable outcomes of successwhich should drive the wholeproject. The next stage typicallyis to look to other online resourcesfor inspiration and whilst this canbe useful, I would urge a note of caution. For example, how do youknow that these resources havemet their objectives, that theybeen properly evaluated or thatthey are cost effective? If youlack experience in developinge-learning resources, thevariation in quality, technologiesand delivery styles can bebewildering – and you may simplyend up repeating other people’smistakes.

Play to your strengthsClinical educators are unlikely tobe experts in online learning - andthis is not something that can beachieved overnight. One solutionis to use the services of anexperienced medical e-learningdeveloper who can help youunderstand its potential andgive you useful examples of goodpractice and appropriate uses of technology. They will also do muchof the technical and productionwork, allowing the educator toplay to their strengths - preparingthe educational content.

p g q y gcontent and simply placing pagesof text or presentations onlinewill do little to engage users. Infact, learners have increasinglyhigh expectations of e-learning,ranging from interactiveassessments through to simulatedcollaborative environments.Neither can clinical educators expect to be in experts in graphicaldesign, animation, programming,multimedia and the host of othercomponents necessary to producean effective e-learning resource.In short, high quality e-learningdevelopment is a team effort, nota solo role.

Developing the contentThe development of content isbest carried out in collaborationwith an experienced instructionaldesigner whose primary role is towork with and support an educatorin establishing how best to deliverthe resource and achieve theclinical learning outcomes. Thisrelationship is central to thesuccess of an e-learning project,ensuring that a high qualityand effective resource can beproduced making optimum useof an educator’s time and skills.The instructional designer createsthe e-learning project model andcontent storyboards, based uponsubject material provided by theeducator, who then acts largely inan editorial capacity.

Marrying technology with educationAnother collaborator then entersthe process in the form of theIT department which is usuallyresponsible for implementing thenecessary technology for deliveringthe learning. Unfortunately, theend result of this process is oftenthe deployment or inheritance of expensive learning managementsystems (LMS) which either do notmeet the needs of educators andlearners, or have functionalityfar in excess of what is actuallyrequired.

outcome bears little relation to their initial vision or the learning objectives - which does little to inspire the development of further resources.As experts in their particular eld, technologists also have a tendency to promote the latest advances in technology, which aren’t always educationally relevant: for example, investment in synchronous video tools which can’t be used as it is impossible to get learners online at the same time due to work obligations androtas, or an LMS used as a glori ed clinical discussion forums without the inclusion of any e-learning content.


Evaluating for improvementThe most effective educators are also aware of the importance of improving the resources that they use through ongoing assessment and evaluation to identify what worked well and what could be improved for the future. This can be a time consuming process andunfortunately, at present, few educational e-learning resources are formally evaluated against the original learning goals, with success frequently measured in terms of timescale and budget. However, this is a vital part of the process if e-learning is to be used to its optimum effect as ateaching tool.

may be used to develop future e-learning resources, resulting in bad practice being carried forward into the next cycle of development. Despite the capacity for getting it wrong, online learning is undoubtedly an exciting development in the eld of clinical education which offers rich potential for innovative interactive teaching and learning for many years to come. The key message to understand is that getting the process right does require a diverse set of skills and knowledge: subject expertise or technological knowhow in isolation simply isn’t enough to create a comprehensive clinical resource that makes the maximum impact on learners. The good news is, if you get it right, e-learning could revolutionise clinical teaching and become the most powerful educative tool that you possess.



OPERATINGTABLES










Trevor.R.Toman

patient

blood fromgroin

roller pump




SonoSite point-of-care ultrasound systems hit the spot in NottinghamA eet of SonoSite point-of-care ultrasound systems, including an M-Turbo® and three S-Nerve® instruments, is signi cantly changing the approach of anaesthetists in regional anaesthesia at the Nottingham University Hospitals NHS Trust. Dr Nigel Bedforth, consultant anaesthetist at the QMC campus of the hospital, explained: Both the M-Turbo and S-Nerve systems have great image resolution, offering excellent visibility of nerve structures. As a result, anaesthetists who are using point-of-care ultrasound are developing better awareness of internal anatomy; were realising that a more thorough understanding of muscles, tendons, vessels, bones and other structures is really important for being skilful at nding nerves, rather than relying solely on landmarks. Our SonoSite systems allow us to place nerve blocks more safely and accurately, even, for example, for the more dif cult blocks like supraclavicular, which were often previously avoided due to the risk of pneumothorax.

Dr Bedforth added: I personally use the M-Turbo for virtually everything I do, while the S-Nerve systems suit less frequent users because they are even easier to use, with a minimum of buttons and controls. We are keen to pass on our techniques to other anaesthetists and, as part of our established relationship with SonoSite, we have jointly run ultrasound-guided anaesthesia courses for a number of years.

For more information about SonoSite products, please contact: Sonosite at Alexander House, 40A Wilbury Way, Hitchin SG4 0APTel +44 (0)1462 444 800, Fax +44 (0)1462 444 [email protected] www.sonosite.comFor information and to register on SonoSite structured training courses, log on to www.sonositeeducation.co.uk

Dr Nigel Bedforth with the SonoSite S-Nerve

CHILDRENS EMERGENCY On the road with the UKs top childrens mobile intensive care team

IV drip rate AppIntravenous products: Designers in Wales have come up with a novel idea to help staff calculate and set gravity (drip) infusions for uid replacement and intravenous therapies. The Application, developed for the Apple iTouch and iPhone was designed in Swansea by Paul Lee (Medical Devices Training Manager: Singleton Hospital) and Mark Davies (MSc student, formally of Swansea University).

The application helps to calculate infusion drip-rates, indicates the correct drip-rate with audio and visual animation and includes a counter to verify that the drip rate is as expected. The application was launched recently on the apple iStore and is already receiving interest from across Europe and the USA. Source: IV Team

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BBC One 8 x 30minutes character led observational series - Started Tuesday 4th May 2010 at 10.35pm

For the rst time, a television series follows the remarkable work of the mobile intensive care teams dedicated to taking critically ill children to the UKs specialist hospitals.

Every year thousands of children fall seriously ill. But there is only a limited number of hospitals with paediatric intensive care units across the UK. What if your child is many miles away from one of these centres?

Childrens Emergency takes us on an exceptional journey with CATS (Childrens Acute Transport Service), a unique service designed to take the skills and high-tech equipment of a paediatric intensive care unit on the road. This highly specialised team operates around the clock to make sure that the sickest children in Britain get the life-saving treatment they need, wherever they are.

We follow the CATS elite as they travel by road, plane or helicopter to stabilise and safely transfer young patients to specialist hospitals including the world-renowned Great Ormond Street Hospital for Children, St Marys Hospital and Royal Brompton Hospital in London.

The series reveals the extraordinary skills of some of the countrys top paediatric consultants and nurses: Dr. Mary Montgomery, Dr. Daniel Lutman and Dr. Ram Ramnarayan, the full-time CATS Consultants; Dr. Andy Petros, Clinical Director of CATS and one of the UKs leading children medicine gures; and Lynn Shields and Mark Clement, two of the most highly quali ed CATS nurses who are authorised to take the lead on retrieval missions - a rare quali cation held by less than 10 nurses in Europe.

With a close focus on the key characters from the retrieval team we witness each story from their perspective: from the emergency call to the CATS HQ in London, the retrieval mission against the clock, the critical issues faced by the medical staff, the attention at the specialist hospital, to the rehabilitation; and nally the resolution of the story as the family return home.

Whether its a child with suspected meningitis, a cardiac problem, a mystery t, a newborn with respiratory illnesses, or even a transplant patient there is no mission impossible for CATS.

Moving a seriously ill child is high risk but is sometimes the only option. Our people must combine top medical expertise with the ability to provide emotional support to the parents involved in the emergency operation said CATS Clinical Director Dr Andy Petros.

Each episode intercuts several poignant cases with key elements common to all: the outstanding skills and care of the CATS teams; the often astonishing bravery of the children; and the families reaction to the unfolding events.

Childrens Emergency is a tribute to a very special team of men and women the public knows little about but who make a crucial difference in the lives of many families every day in the UK.


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Hospital checklists ‘cut deaths’Checklists that spell out exactly how to care for patients with common conditions have dramatically reduced hospital deaths, say doctors.The British Medical Journal reported a 15% fall in the number of people who had died at one north London hospital trust using so-called care bundles.These are checklists covering dozens of conditions including strokes, heart failure and MRSA infections.The researchers said death rates could be “halved” using the system.The lists were introduced at North West London Hospitals NHS Trust by its former director of nursing, Liz Robb, who travelled to the US to learn the methods.She focused on approximately 56 conditions which accounted for about four in ve of all deaths at the trust’s three hospitals.

Under the system, when a patient is rst diagnosed with one of these conditions, a coloured checklist is placed into their medical notes and a sticker on the front tells doctors and nurses to follow it.

Recommended treatments and care are based on the best available medical evidence and even include simple but vital elements such as hand-washing.

For example, any patient with diarrhoea and vomiting would be put in a side room with a closed door and have their antibiotic or laxative prescription reviewed.

Staff would also have to con rm with a signature that they had worn gloves and aprons, used soap and water to clean their hands before and after contact and notify the Infection Control Team.

‘Cheap and easy’

At the London trust, which already had better-than-average death rates, there were 174 fewer deaths from the 56 conditions in 2007/08 compared with the previous year - the sharp drop in the overall death rate made it the best-performing trust in the country for that year.

The fact that the sharpest improvement centred on those conditions, and the hospital with the highest use of the checklists, suggested that they played a signi cant role, said the researchers.

Dr Clare Higgens, the trust’s director of medical education, said: “It’s so simple to use for doctors, nurses and other clinicians.

“In short, it has worked, and it continues to work.”

Professor Brian Jarman, from Imperial College London, one of those involved in the scheme, said the impact could be massive if the system was adopted across the NHS, saving many thousands of lives each year.

Earlier this month he called for 25 trusts to be investigated over apparently high death rates.

He said: “It costs a few hundreds pounds per trust, but we believe it could make a substantial difference - any hospital could take this and say, ‘Let’s give it a go.’

“We think an average hospital could halve their death rate.”

Inquiries are already coming in from other trusts and the Care Quality Commission, which monitors healthcare standards in England, is also impressed by the idea.

Its national clinical adviser, Professor David Haslam, said: “There is increasing evidence that checklists can make a real difference.

“There is good evidence that they ensure that clinicians don’t miss the fundamental elements of delivering patient care and also that teams communicate better with each other.” Source: BBC


1. 75 Bair Hugger blowers were sampled in their operating room environments (6 hospitals).2

Micro-organisms were cultured from the internal air-flow paths of 95% of the blowers.

71% of the blowers were found to be internally generating and emitting significant levels of germ-size contaminates. Some were emitting up to 300 million germ-size particles per hour, which was 40 times greater than the intake particle counts.

The blowers with the highest level of particle emis-sions had the new Bair Hugger low efficiency (63.8%) intake filters.2. A recent study co-authored by Prof. David Leaper, Chair of NICE’s Surgical Site Infection Guideline Devel-opment Group, was published in Orthopedic Reviews. Prof. Leaper’s team sampled 25 blowers from the lead-ing manufacturer in operating theatres. The findings:

Pathogenic bacteria were cultured from theinternal air-flow paths of 94% of the blowers.

32% of the blowers tested were emitting internally generated airborne contamination.

The NICE Guideline also cites studies stating asfollows:

One study concluded that FAW is a “potential source of nosocomial infection that may be due to colonisa-tion in the machines distal to the filters.”

Although filters should protect against entrained bacteria, “microbial pathogens were detected in about 50% of the FAW devices when the air was sampled directly “ from the blower. Even a small number of organisms from contaminat-

ed air “may come into contact with the surgical area and cause serious complications.”

“Growth of bacteria was found in swab samples..., suggesting that risk assessment should be under-taken before using FAW.”

Is Forced-Air Warming safe?Here are the facts...

A message to health care professionals

4

FAW manufacturer claims: FAW can’t disrupt laminar flow because a blower “delivers less than one percent of the airflow of laminar flow system.”

THE FACTS:

The issue isn’t air. It’s heat. The physics are simple:

For more information about what happens when heat rises in your ultra-clean orthopedic theatre, please contact Nordic Surgical at 0844 811 2640 or visit www.nordicsurgical.com

3

IN RECENT ADVERTISEMENTS, the leading manufacturer of forced-air warming (FAW) hasoffered assurances about the safety of its hot-air blowers, attempting to “set the record straight” about whether their blowers spread bacteria in operating theatres and disrupt the protection of laminar flow ventilation systems.

FAW manufacturer claims: The NICE patient warming Guideline “states that forced air warming does not present an infection risk.”

FAW manufacturer claims: FAW does not increase the risk of bacterial contamination of operating theatres. THE FACTS:

THE FACTS:

It is well known that skin and bacteria shed from operating theatre personnel settle toward the floor. Waste heat from FAW can mobilize these contaminants and convey them to the operative site.5

1. Bair Hugger is a registered trademark of Arizant Inc.2. Forced-Air Warming Blowers - an Evaluation of Filtration Adequacy and Airborne Contamination Emissions in the Oper-ating Room. Pending publication.3. Albrecht M, Leaper D, Gauthier R, et al. Forced-air warming: a source of airborne contamination in the operating room? Orthopedic Reviews 2009; volume 1:e28.4. National Institute for Health and Clinical Excellence. The Management of inadvertent perioperative hypothermia in adults. PP 372-374 (April 2008)5. “Forced-Air warming Disrupts Laminar Air Flow” Video. Available at http://www.hotdogwarming.com

®

HEAT RISES!

The following compares these assertions with the facts.

®1


Surgery DivisionTheatres We are a busy teaching hospital providing care for a variety of patient groups over a large modern campus. We have 29 theatres and can offer a variety of experience in a range of specialties including cardiac, neuro and trauma.

We have a team of practice educators and maintain close links with local universities, which means we use new and innovative techniques. We can offer training opportunities to further your clinical skills and support you in other training opportunities via our Training and Development Department, Post Grad Centre and University of Kingston Faculty.

Anaesthetic ODP/NursesBand 5: £25,411 - £33,041 p.a. inc.Ref: 200-SJOS-996-LK As a qualified ODP/anaesthetic nurse, you’ll give direct patient care and have a flexible approach to work patterns, which will include weekend working. A recognised Anaesthetic qualification is essential, as well as having the relevant critical care course in anaesthetics or ENB 182 .

Some posts are suitable for newly qualified ODP or anaes nurses; we also welcome those with experience who would like to gain anaesthetic experience in our cardiac theatres.

Scrub PractitionersBand 5: £25,411 - £33,041 p.a. inc.Ref: 200-SJOS-996-LKWorking within a wide range of surgical specialties, you’ll ideally have experience in cardiac, ENT/Maxfax, trauma and orthopaedics, obstetrics & gynae or general surgery.

You’ll need a flexible approach to work patterns, as you’ll be required to work a range of shifts, which include some weekends. Internal rotation to night duty or on-calls are part of the role for those who work in our cardiac, neuro, 24/7 trauma, Cepod and obstetrics theatres.

For both posts, you’ll need excellent interpersonal skills and be able to provide evidence of personal and professional development.

For further information or to arrange an informal visit, please contact Joanna Turner, Recruitment Co-ordinator, Division of Surgery on 020 8725 0223 or email: [email protected]

Please apply online at www.stgeorges.nhs.uk

Closing date: 31 May 2010.

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

Senior management decontamination training – unique to Eastwood Park

Effectively managing medical instrument reprocessing whether in a sterile services department, a doctor’s surgery or dentist’s practice carries signi cant responsibilities. Eastwood Park Training runs three courses to assist senior staff improve their skills in successfully overseeing vital medical instrument decontamination processes.

This training is only available at Eastwood Park and will signi cantly improve understanding in order that managers become even more effective in their role:

The Decontamination Lead Courses in both acute and non-acute sectors, are for those heading a strategic operational team, placing emphasis on the importance of performing the decontamination lead role to the standards set out in relevant Health Technical Memorandum (HTM).

The Sterile Services department supervisors/manager’s course is for effective management and production of all sterile services and goods as set out in HTM 2010/2030, and HTM 01-01 Part A.

The Decontamination of exible endoscopes (HTM 01-06) will help improve the management skills of endoscope washer-disinfector users, decontamination leads and estate managers.

Sue Peckham, Eastwood Park’s Training Manager (Decontamination) commented: “It is vital that those in charge of signi cant medical instrument decontamination operations have a broad and sound understanding of the practical decontamination processes. Our courses include microbiological testing as well as audit and quality control measures right through to strategic planning and reporting.”

All the above courses are City & Guilds accredited. For more information visit eastwoodpark.co.uk or 01454 262777.

The Productive Operating Theatre – Process modules now available

The Process modules focus on Session Start-up, Patient Preparation, Patient Turnaround, Handover, Consumables and Equipment and Recovery.

The modules can help theatre teams achieve signi cant improvements in a number of key areas:

* start time and turnaround

* lists running more smoothly with fewer glitches

* reduction in costs associated with stock and equipment management

* improved patient experience and staff wellbeing.

Five Process modules box sets are available free to every NHS acute trust and PCT in England and can be ordered by visiting:

http://www.institute.nhs.uk/quality_and_value/productivity_series/the_productive_operating_theatre.html

Please quote: ‘Operating Theatre Journal’ when responding.

Jobs Jobs Jobs Jobs Jobs

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Advertise here& on our website!

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Market leaders in recruitment of permanent, temporary & locum Theatre staff

Operating Department Practitioners

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Excellent rates of pay Paid weekly

We are an approved supplier to the NHS and the first choice for many clients

Free Induction, excellent service and pay rates Experience the difference with PHC!

Contact Us Today!We look forward to welcoming you to the PHC team

Please Call 01869 321584www. paterson-healthcare.co.uk

Not all the best theatres are in the West End.Operating Theatre Practitioner – ODP or NursingFull Time and Part Time hours availableBand 5

We are seeking enthusiastic and motivated Operating Department Practitioners or Registered Nurses (with an appropriately recognised anaesthetic course). If you are passionate about orthopaedics, dedicated to the pursuit of excellence, always placing patients fi rst and can deliver high quality patient care, we would love to hear from you. You will possess the ability to work well within a challenging environment, be a team player and willing to learn.

If you are looking for a new challenge then please apply!

In return, we can offer a structured preceptorship and induction programme for all new members of staff. We also offer access to ongoing continuing professional education and development, appraisal and clinical supervision.

The Robert Jones and Agnes Hunt Orthopaedic and District NHS Trust is one of best known specialist hospitals in the country. The Trust serves a population across the immediate geographical areas of Shropshire and North Wales but also as a specialist orthopaedic hospital, to patients from across the United Kingdom. The Trust also has links with Keele University.

The Directorate comprises of 10 active theatres divided between Day Case and our Main Theatre complex which includes a unique “barn” style theatre design, which provide a service to a range of orthopaedic sub specialties including arthroplasty, spinal, foot and ankle, shoulder and hand surgery with a trauma provision. You will gain a wide range of experience and can expand your skills and knowledge in this challenging environment.

Internal rotation between the theatre areas, from day to evening duty and on-calls along with fl exible shifts patterns will be expected as part of the role. Previous theatre experience is preferable but not an essential aspect of this role.

For any further information, please contact Mrs Mandy Owen, Theatre Manager or Sue Sayer, Principal ODP on 01691 404211.

We will be holding a Recruitment Open Day for qualifi ed Operating Department Practitioners & Nurses on Sunday 6th June when

there will be an opportunity to tour all our theatres and meet our team. Further details are included within the application pack.

Application packs are available from the Human Resources Department on 01691 404575 or please apply on-line at

www.jobs.nhs.uk

Closing date: 28 May 2010.

“To be the leading provider of high quality and sustainable orthopaedic services, building on our reputation for excellence.”

Oswestry, Shropshire SY10 7AG.

A pill for every ill?Research by Professor Joan Bus eld from the Department of Sociology at the University of Essex shows a marked rise in expenditure on prescription drugs and in the number of prescribed medicines being dispensed in recent years.

The research published in Social Science and Medicine showed an increase in expenditure on drugs by the NHS in England of 60% over a ten year period, while the number of prescribed medicines dispensed increased from an average of 8 per person in 1989 to 16.4 in 2008 a doubling over twenty years, with annual increases now running at around 45 percent.

The article, A Pill for Every Ill, calls into question the standard progressive view of this growth in terms of the development of new, improved medicines, and provides an alternative framework for understanding the expansion.

Commenting on her ndings, Professor Bus eld said the pharmaceutical industry played a signi cant role in driving the increases, but other groups were also important: Whilst the pharmaceutical industrys intensive marketing to medical professionals, its control over the science underpinning drug development and testing and its disease mongering are key aspects, doctors have not generally

constrained the industrys commercial power but, for a variety of reasons, have largely played the role of handmaiden to the expansion.

Joan Bus eld also said the general public, policy makers and insurance companies had done little to stem the tide: People seem to have increased expectations of health and the evolution of a consumerist ethos have encouraged medicine use. Nor have governments or insurance companies done much to constrain growth. I think drugs, though frequently bene cial, are being overused. The population is getting healthier and healthier, and longevity is increasing because of improved standards of living, but we are using more and more drugs, too often unnecessarily.


DEPUTY TO THEATRE MANAGER OPERATING DEPARTMENT PRACTITIONERS SCRUB/RECOVERY NURSES Salary: Negotiable depending on experience Full Time: 37.5 hrs per week Shifts: To include evenings and weekends

We are looking to appoint staff to join our multi speciality department. We require experienced, flexible and highly motivated qualified theatre practitioners in anaesthetics, scrub and recovery.

In addition to your strong clinical skills, you will possess:

The personality to work as part of a small dedicated team The capacity to plan equipment and consumable requirements Team leadership skills Ability to participate in on-call duties The ability to work to tight deadlines

Necessary qualifications

Registered Nurse level 1 or ODP Teaching and assessing qualification is desirable but not essential

In return for your expertise we offer:

Competitive Salary Package 25 days annual leave (pro rata) Contributory Pension Scheme Private Healthcare Life Assurance Ongoing Training Subsidised staff restaurant

For further information or to arrange an informal visit please contact: Nina Jackson, Theatre Manager on 01883 337419 or email [email protected] A full job description and application pack can be obtained via Lynn Coote, HR Administrator on 01883 337407 or by email [email protected] All offers of employment in respect of these appointments will be subject to receipt of a satisfactory Enhanced Disclosure Certificate from the Criminal Records Bureau. North Downs Hospital, 46 Tupwood Lane, Caterham, Surrey CR3 6DP Committed to quality, equality and opportunity for all. www.ramsayhealth.co.uk

NORTH DOWNSHOSPITAL

Second Annual Conference and Annual General Meeting 28th May 2010. To be held at:

The Royal College of AnaesthetistsFor further information contact: Conference cost (lunch included)PA (A) Swift House Association of PA (A) members £80-006 Cumberland Way Non members £90-00Darwen BB3 2TRTelephone 07952 873378E-mail [email protected] Website: http://www.anaesthesiateam.com/news.php

HOYA CORPORATION APPOINTS CHRIS JAPP GLOBAL PRESIDENT

OF PENTAX LIFECARE DIVISION

Hoya Corporation selects industry veteran to head Global PENTAX Lifecare Business Unit TOKYO, JAPAN, March 26, 2010 - Hoya Corporation announced the appointment of Chris N. Japp, to the position of Global President, Pentax Lifecare Division.“Hoya Corporation is extremely pleased to have Chris Japp lead the global division for Lifecare,” said Hiroshi Hamada, COO of Hoya Corporation. “Chris brings a wealth of knowledge, insight and experience from the medical devices and imaging industry. We expect Chris’ leadership to have a major impact in growing Lifecare and Pentax Medical in the years to come.”

With more than 25 years experience as a senior executive in the medical imaging technology industry, Mr. Japp brings a proven track record in global healthcare rms. He has held executive positions at General Electric Medical, St. Jude Medical, and most recently was Vice President & General Manager of Boston Scienti c’s Imaging Business based in Fremont, California. Mr. Japp has a degree in Electrical Engineering from Queen’s University in Canada, has taken Executive MBA coursework at Temple University in Tokyo, and is Six Sigma certi ed.

“I am honored and excited to be leading the talented global team at PENTAX Lifecare,” Mr. Japp says. “Pentax’s expertise and knowledge in medical endoscopy technology combined with the additional strength and focus as a result of the recent merger with Hoya Corporation will position us as the global leader in this eld. Most importantly, our ongoing commitment and #1 objective will be to provide our physician customers and their patients with the highest quality products and services, as well as new innovations that improve the detection and treatment of cancer and other serious diseases”

For more information about PENTAX Lifecare, visit http://www.hoya.co.jp/english/index.html

Hoya PENTAX Life care equipment is marketed in the UK by PENTAX UK Limited, Pentax House, Heron drive, Langley, SL3 8PN. Telephone 01753 792792, Fax 01753 792791, e-mail [email protected], web www.pentax.co.uk


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