Europe - GIT Verlag

76961
4/2008
Dedicated Drug-Device Combination
In Gram-negative pneumonia, efforts to establish
inhaled therapy have failed. A project now suggests
that co-operation between pharma and device manufacturers
may bring significant benefits.
Page 3
The drive against diabetes
mellitus and cardiovascular
disease brings the United Arab
Emirates (UAE) and North
Rhine Westphalia (NRW),
Germany, close together. Besides
the medical treatment
of patients, this cooperation
includes the transfer of
knowledge by the exchange
of medical personnel and
experts. Common research
projects and the support of
public health by developing
programs for prevention are
first in line to set up a close
collaboration between the
partners.
India: Complex and Incredibly Dynamic
Symbol of the complexity of the healthcare system in
India: the Banyan tree sprouts roots from its stems
which end up covering the main structure of the tree
with its trunk. – Feature:
Pages 5–7
Advances in Diagnostics and Therapeutics
Dementia Panel at the European Research & Innovation Exhibition
The “major challenges facing
the world” were at the centre
of attention at the European
Research & Innovation Fair
and Exhibition (abbreviated
SERI in French) early June. At
the Porte de Versailles Expo in
Paris, more than 100 conference
sessions aimed at providing
answers regarding key
research topics of our times –
including issue in healthcare.
In our sector, early diagnosis
and optimized treatment of
cancer was a pivotal theme,
and so was dementia. A panel
presented the views of two
well-known experts.
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Within four years, The European Research
& Innovation Fair has become a unique European
meeting place gathering key R&D
actors, allowing them to network and develop
public/private projects, organizers
explained. The representation of 15 countries
– including Germany, Belgium, Egypt,
Finland, Greece, Hungary, Israel, Italy,
Luxemburg, Malta, Romania, Switzerland,
Great Britain, Russia, and the United States
– made the event truly international. During
three days, more than 25,000 visitors
came to the Porte de Versailles to check out
market trends and innovations showcased
by 360 exhibitors – public organizations,
industrial companies, regions and country
pavilions, higher education, consulting
services, etc., and the conference series.
Innovations and Visions for Leaders in Healthcare
Dr. Nori Graham, Vice President,
Alzheimer’s Disease International:
dementia is a “global
problem present in every
country of the world”.
Improving Workflow Efficiency in Labs
Turn-around-times in laboratories must be as short
as possible. However, clinical lab workflows will not
compare to production lines – automation solutions
need to account for individuality.
Page 24
Key innovative vendors of medical technology
at SERI included GE Healthcare
whose EMEA headquarters are located
in France. Dominique Blanc, GE Healthcare
Country Manager, France, outlined
the company’s research and development
strategy – “From late disease to early
health”. The approach, the manager explained,
is designed to help predict, diagnose,
treat, and monitor disease earlier, increasing
quality of life – and in turn reduce
the cost burden of acute inpatient care.
Dementia was the example used at
SERI to illustrate GE Healthcare’s strategy
in this area. As many as 5.5 mn people in
Europe currently suffer from dementia,
To be continued on page 23
Cooperation Across Continents
Exchange of Experiences between UAE and NRW
His Excellency Ali Ahmed Bin Shakar, Undersecretary of
the UAE Minister of Health recently visited the Heart and Diabetes
Centre NRW.
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The exhibition “Arab Health” earlier this
year gave rise to the envisaged project,
initiated by the Vice minister of NRW Ministry
for Labour, Health and Social Affairs
Professor Stefan F. Winter, MD. As a most
“dynamic location in world business” the
UAE are a potent partner and offer a “future
market with enormous prospects” in
which NRW could play a considerable role.
Based on a rough estimate the volume of
business resulting from the care of patients
from UAE would comprise around € 400
mn. Currently, the healthcare management
industry of NRW engages more than 1 mn
employees and is among the biggest economical
branches in Germany. “Services
and products ‘made in Germany’ enjoy an
To be continued on page 3

2 Intro • EvEnts
Hospital Post Europe 04/08
Healthcare
Facts and Visions
from all over Europe
Hospital Post Europe –
independent, pan-European,
and up-to-date – addresses
bimonthly decision makers in
hospitals all over the continent,
including CEOs, leading
physicians, IT and technical
managers, heads of lab and
pharmacy.
:
5/2007
Innovations and Visions for Leaders in Healthcare
Nosocomial Infections Managing Stored Information Effectively Public Private Partnerships
Despite New, Stricter Model of Prediction
A year ago, a pioneering South
London hospital became the
fi rst in Europe to publish its
death rates by individual
clinical specialty. Following
the example of St. George’s
Healthcare Trust, many heart
units and surgeons throughout
the UK have co-operated
with a government watchdog,
the Healthcare Commission,
to publish online
death rates after surgery
(cf. www.heartsurgery.healthcarecommission.org.uk).
Mednet Congress
on E-Health
Successful Survival Rates After UK Heart Operations
The Next Generation
Europe
A European Standards-Based Electronic Healthcare Record
Many politicians, healthcare
providers (including hospitals),
and patients expect a lot
of positive outcomes from the
use of the Electronic Health
Record (EHR). We all expect
such EHRs to be able to document
the care process, allow for
exchange with others in joint
work processes, and re-use the
documented data for public
health and clinical research …
and at the same time protect
the privacy of the patient. Of
course we expect that the EHR
should accommodate the variety
and responsive adaptation – Expectations and demands
to changes in work processes. are very high.
The “Medtech
Cornucopia”
Yes, please rush a free sample
copy of Hospital Post Europe
Fax, or e-mail
Fax +49 6151 8090179 · christina.keil@wiley.com
First name / Last name
Company / Institution
Department Function
Street / PO Box
Postal Code / City / Country
Tel. Fax
E-mail
Understanding Alzheimer’s Disease
Brain Tissue Bank Created in France
A bank of human brain tissues
has just been created in Paris
on the premises of the Hôpital
de la Pitié-Salpêtrière, in
order to improve the understanding
of lesions that lead
to degenerative diseases such
as Alzheimer’s. This tissue resource
centre will enable scientists
to study cell tissues
from neurologically impaired
individuals, and to compare
them to unaffected persons’
brain samples.
In France, an estimated 850,000 persons
suffer from Alzheimer disease, and their
number should increase dramatically in
view of an ageing population and could
reach 1.3 million persons in 2020.
The new tissue bank will gather samples
from different diseases such as Parkinson’s
disease and, for the first time in this country,
Alzheimer’s disease (AD). The tissue
samples are to be stored in freezers set
at a temperature of –80 C°. Currently, this
bank holds 127 samples coming from persons
suffering from neurological disorders,
and only three from people not affected.
A number of 500 persons, with no sign of
any neurological disease, have given their
agreement for a donation of their brain – a
deeply symbolic organ – after death.
Tissues from people with a condition
are classified according to the disease. For
ethical reasons, the use of them by scien-
tists will each time be submitted to a scientific
council – a specific panel for each disease
– and will require the approval from
the highest health authority, the Direction
Générale de la Santé.
In the case of AD, the brain tissues “will
allow scientists to better understand the
process of emergence of neurofibrillary
tangles and of amyloid plaques, characteristic
of this type of dementia, and invisible
with the scanner”, according to the France
Alzheimer Association (FA), which gathers
150,000 members and sponsors. FA pushed
the creation of this first tissue bank partly
dedicated to Alzheimer research, and financed
it up to € 100,000. The Association
France-Parkinson and the Association for
Research on Sclerosis in Plaques (ARSEP)
are also involved in the project. They expect
the French Federation for Research
on Epilepsy (FFRE) to join the structure.
The new tissue bank is managed by
a “Groupement d’Intérêt Economique”
called Neuro-CEB, and is in operation
since May. “For research to make progress,
it is indispensable to be able to work on
human material; animal models cannot
be sufficient to study the human brain,”
says Marie-Claire Artaud, the scientist in
charge of Neuro-CEB. Under the supervision
of Prof. Charles Duyckaerts, she is in
charge of the entire “chain”: obtaining the
patient’s consent for donation (or his family’s),
the brain collection itself, and getting
in touch with scientists in need of tissues
samples for their experiments.
Read more about perspectives on dementia on pp. 1 and 23
C o n t E n t s
Intro • Events • Index 2
Politics • Management 3 – 4
Focus on India 5 – 7
Medical Technology 8 – 17
Masthead 16
ESC – European Society of Cardiology
30 August – 3 September
Germany: Munich
www.escardio.org
ESMO – 33 rd Congress of the European Society for
Medical Oncology
12 – 16 September
sweden: stockholm
www.esmo.org
ESICM – 21 st European Society for Intensive Care
Medicine
21 – 24 September
Portugal: Lisbon
www.esicm.org
IT & Communications 18 – 22
Laboratory & Diagnostics 23 – 25
Pharma 26
Facility Management 27
Selected Major Events
eHealthCare.ch – 8 th Conference
24 – 25 September
switzerland: nottwil
www.ehealthcare.ch
6 th World STROKE Congress
24 – 27 September
Austria: vienna
www.kenes.com/stroke2008/
Baltic Conference on E-Health
26 September
Germany: Hamburg
www.baltic-conference-on-ehealth.com
21CHMS 5
3mensio Medical Imaging 8
ABB 23
Abbott Vascular 8
Academic Medical Center Amsterdam
8
Aerotel Medical Systems 16
Agfa Gevaert 21
Agfa Healthcare 5, 8, 16, 21
Aipermon 16
Alcatel-Lucent 16
Alicia Foundation 8
Alzheimer‘s Disease International 23
American College of Pathologists 5
American Society of Clinical
Oncology (ASCO) 26
American Telemedicine Association 21
American Thoracic Society 3
Amgen 4
Amrita 5
Apollo 5
Association for Research on
Sclerosis in Plaques 2
Association France-Parkinson 2
AstraZeneca UK 26
B-K Medical 5
Bajaj Allianz 5
Baltic Sea Forum 19
Barco 5
Bayer HealthCare 26
Biomarkers Consortium 4
Blancomed 5
BMC Software 20
Cantonal Hospital of St. Gallen 21
Cardiff University 11
Cardiovascular Research Foundation 8
Carestream Health 12, 15
Center for Connected Health 16
Charité Berlin 13, 14
Cisco Collaboration 20
Columbia University Medical Center 8
Continua Health Alliance 16
Datamonitor Europe 20
Dornier MedTech 5
Dr. Hiranandani Hospital 5
Dr. Mach 5
Drägerwerk 9
DSM 12
eHIT 16
Eizo 15
EMS 5
Erbe Elektromedizin 10
ESICM 13
Europa Organisation 8
European Association of
Percutaneous Cardiovascular 8
European Association of
Cardio-Thoracic Surgeons 8
European Commission 4, 16
European Society of Cardiology
(ESC) 8, 10
Fabiani & Budhrani Heart
Institute 5
Fontana Women‘s Hospital 12
Foundation for NIH 4
France Alzheimer Association 2
Fred Hutchinson Cancer
Research Centre 7
Fuji 5
Fujifilm Europe 17
French Federation for Research
on Epilepsy (FFRE) 2
GE Healthcare 5, 23
I N D E x
GE Healthcare Technologies 23
GE Transportation 23
GeoCom Software 1
German Association of Biomedical
Engineering (DGBMT) 12
German Electrical and Electronics
Industry (ZVEI) 10
German Ministry for Education
and Research 12
German Society of Genetics 4
GoodIT 16
Grundig GBS 20
GSD Ges. f. Systemforschung u.
Dienstleistungen 18
Gyrus-ACMI 5
Hamburg Chamber of
Commerce 19
Harvard Medical School 16
HealthwareIndia 5
Hitachi Medical Systems Europe
Holding 14, 15
Hohenstein Institute 27
Hospital Services/Teramed 15
Hôpital de la Pitié-Salpêtrière 2
IBM 19
Image Systems 15
imtmedical 10, 10
Inst. f. d. Entgeltysytem im
Krankenhaus (InEK) 27
Institute of Clinical Research (India) 5
IntelliDOT 20
International Soc. for Telemedicine &
E-Health 16
Inverness Medical 23, 24, 25
iTeleHealth 16
Jehandir Hosiptal 5
Karishma 5
Klinikum Chemnitz 22
Koch-Mechnikov-Forum 19
Kyritz Medical Laboratory (MLK) 24
Lab Diagnostics Consortium for
Diagnostics + Rationalisation 24
Landesmesse Stuttgart 10
Lisa Laser 5
Maan Hospital 27
Maquet 5
Maquet Cardiopulmonary 11
Matrox Graphics 15
Medical Fair India 5
MeDiSol 15
Medivance 1, 13
Messe Stuttgart 10
Microsoft 16, 21
Mount Sinai Hospital 3
Mölnlycke Health Care 11
Multigon Industries 14
National Cancer Institute 4
National Institute for Health +
Clinical Excellence 4, 26
National Institutes of Mental Health 4
NCR Corporation 22
NEC 15
Nektar Therapeutics 3
Neuro-CEB 2
NHS 4, 5
Novarad 5
Nuance 20
Olympus Life Science Europa 24, 25
OrbusNeich 8
Ostprignitz-Ruppin Association
of Laboratories 24
“Our aim is to obtain the patient’s agreement
before he/she dies. That consent for
a post-mortem brain donation makes it
possible for the procedure to be prepared
before death. Together with the certificate
of death, the doctor writes a document
authorizing the collecting of the brain tissue,
exclusively for research purposes,” explains
Artaud. All research projects are to
be submitted to one of the 13 centres for
the protection of the individuals.
Before the enacting of the law on bioethics,
scientists collected brain tissue during
autopsies, without any prior former agreement.
“People who call me are usually well
informed, often through the associations,
who are in charge of the general public’s
information on diseases and research. We
are mostly contacted by the families of
former patients, who are sensitive to the
problem of AD or those who read about
us in the press,” says Artaud. “Basically, all I
have to do is to provide answers to precise
questions about technical procedures and
emphasize the benefits of tissues donations
for the progress in research. In other words
it’s a rather positive approach even though
we are dealing with death,” she stresses.
Actually, at the moment of death, “we deal
mostly with the medical staff rather than
the family of the patient. We take everything
in charge, from the sampling itself to
the return of the body to the family within
24 hours, for funeral arrangements.”
Annick Chapoy, Paris
Parity Medical 15
Partners Health Care 16
Perfint 5
Philips Healthcare 5, 10, 12, 20
Philips Speech Processing 20
Pierre Fabre Laboratories 5
Piramal Diagnostics 5
Planar 15
Profactor Research and Solutions 17
Pronostics 25
Reed Exhibitions India 5
Rein EDV 15
Richard Wolf 10
Richardson Electronics 15
RS TechMedic 16
Rudolf Medical 10
Sabic Innovative Plastics 14
Sadhu Vaswani Mission 5
SonoSite 14
Sectra 15, 22
Sergas 22
Siemens 5, 18, 21, 24, 28
Skytron 12
Society for Medical Innovation
and Technology 17
Softlink 5
SonoSite 14
Spectaris Industry Association 10
SRIT 5
Storz 10
T-Systems 3
Telekom 3
Thieme 10
Tier-3 18
TietoEnator 5
Totoku Europe 1, 15, 19
Trevira 27
Trumpf Medical Systems 5, 10
Ulster Hospital 14
United States Agency for Int.
Development 27
University College of Medicine 26
University Hospital Maastricht 12
University Hospital Utrecht 8
University of Birmingham
Medical School (UBMS) 25
University of California 4
University of Karlsruhe 27
University of Newcastle upon Tyne 23
University of Vienna 17
VDE 12
Vepro 5
Visus Technology Transfer 3
Vitaphone 16
Wellspring 5
WHO World Health Organizat. 7
Winthrop University Hospital 3
Wockhardt 5
Wolfson Institute of Preventive
Medicine 26
World Academy for Biomedical
Technologies 16
World Health Organization 16
World Marrow Donor
Association 7
World Union of Wound Healing
Societies (WUWHS) 11
yanistra 18
Ziehm Imaging 16
ZKRD Deutschland 7

Hospital Post Europe 04/08
For diseases of the respiratory
tract, inhaled delivery of drugs
carries major advantages over
other methods of administration.
For asthma and COPD,
e.g., a faster onset of action,
lower doses, and an improved
efficacy-to-safety ration have
been demonstrated. Until today,
in certain diseases available
inhalers have not been
found to be efficient. In Gramnegative
pneumonia, e.g., all
efforts to establish inhaled
therapy have failed.
However, a ground-breaking development
project of Bayer HealthCare und Nektar
Therapeutics in Gram-negative pneumonia
now suggests that co-operation between
pharmaceutical and device manufacturers
may lead to solutions which carry significant
benefits to patients as well as caregivers.
For this drug-device combination
– dedicated to antibiosis of pneumonia in
intubated and mechanically-ventilated patients
– preliminary Phase II results were
presented mid-May at the recent Congress
of the American Thoracic Society in Toronto.
They may well stimulate the market.
Nosocomial infections of the lung are
a major cause for disease and fatalities in
hospitals around the globe. Gram-negative
bacteria account for a substantial proportion,
if not the majority of pneumonias in
intensive care units, with a mortality risk as
high as 50 % in mechanically-ventilated patients,
underlined Prof. Donald Low, Head
of the Department of Microbiology at the
University Health Network and Mount Sinai
Hospital, Toronto. “[Mechanically-ventilated]
patients in critical care units are at
particularly high risk of developing pneumonia.
Most of them are already seriously
ill because of severe underlying diseases,”
added Prof. Michael Niederman, Chairman,
Department of Medicine, Winthrop
University Hospital, New York, and one of
the lead investigators of the Phase II study.
“Fast, Efficient, Avoiding
Resistance”
Fast and efficient treatment is considered
essential by experts – a challenge not adequately
met by intravenous therapies
which cannot always reach effective concentrations
in infected lungs at tolerable
doses. The new study data, according to
Prof. Niederman, “shows that the [new]
device successfully delivers the antibiotic
amikacin directly to the site of infection,
without reaching high systemic concentra-
PoLItIcs • MAnAGEMEnt 3
Dedicated Drug-Device Combinations: Huge Potential
Antibiosis of Gram-Negative Pneumonia in Intubated and Mechanically-Ventilated Patients
“Pharmaceuticals and technology
companies are invited to
co-operate” – editor-in-chief of
Hospital Post Europe
Continued from page 1
excellent reputation in the Arabian countries
– a fact we should profit from,” Winter
emphasizes. Besides medical and pharmaceutical
companies and research and technology
centres, well known university and
clinical departments contribute to the famous
reputation and worldwide-accepted
standing of Germany’s healthcare section.
His Excellency Ali Ahmed Bin Shakar,
Undersecretary of the UAE Minister of
Health, was convinced by the innovative
expertise and the quality of healthcare in
NRW as he recently accepted the invitation
of the federal state government to visit the
Heart and Diabetes Centre NRW in Bad
Oeynhausen, Germany. His main concern
was with the treatment of diabetes mellitus
and cardiovascular diseases – namely
cardiac surgery. As a university hospital of
the Ruhr-University of Bochum, the Heart
and Diabetes Centre NRW enjoys reputa-
Panel of presenters in Toronto: this dedicated drug-device combination
enables better outcomes and reduced cost of the therapy as a
whole. Foto: M. Reiter
tion as a national and international reference
centre for the consolidated treatment
of metabolic and cardiovascular diseases.
Known from the first implantation of the
LionHeart as an artificial heart, and the first
transplantation of a beating heart without
use of a heart and lung machine, the Clinic
for Thoracic and Cardiovascular surgery
is amongst the world leading institutions
in this field. The use of ventricular assist
devices (VAD) as a bridge to transplant is
not only clinical routine but also focus of
cardiovascular research. The development
of a fully implantable miniaturized artificial
heart which is supported by a grant of
“Med in NRW” is the actual indicative of a
highly innovative clinical research program
to overcome the lack of donor organs.
Recently, the diabetes centre initiated a
clinical study using stem cells in the treatment
of critical limb ischemia induced ul-
tions”. – In addition, exhaled air is filtered,
inhibiting distribution of the antibiotic into
the environment. Together with reduced
concomitant intravenous antibiotic therapy,
this may well help to reduce the risk
of resistance – which threatens to become
paramount, in particular regarding Pseudomonas
aeruginosa.
Innovative Drug-Device
Combination
Amikacin Inhale is a unique drug-device
combination, under development by antibiotics
specialist Bayer HealthCare in cooperation
with medical technology company
Nektar Therapeutics. It brings together a
special liquid formulation of the aminoglycoside
antibiotic amikacin – which binds
to bacterial ribosomal subunits to inhibit
cell replication – with Nektar Therapeutics’
Liquid Pulmonary Technology (LPT),
designed to deliver amikacin deep into
the infected lungs. The device consists of
a reservoir for the liquid antibiotic, a specially
designed and optimized electronic
mesh nebulizer, a control unit, and a set
of attachments that enable two modes of
use. It can be integrated into mechanical
ventilation systems and can also be used
as a handheld ‘off-vent’ device for patients
no longer requiring breathing assistance.
This allows for a unique full course of drug
Cooperation Across Continents
cers in patients with diabetes mellitus. The
very promising results led to the establishment
of this treatment for patients with no
option of clinical or surgical intervention.
This program is added to the highly innovative
treatment regiments of patients with
diabetic foot syndrome.
Not only as a healthcare unit is the Heart
and Diabetes Centre NRW known worldwide.
Current research projects from the
diabetes centre as well as from the cardiac
research laboratories focus on cardiovascular
diseases. The metabolic circumstances
leading to cardiac failure are of major
concern. The impact of diabetes mellitus
to the development of cardiomyopathy
(“diabetic cardiomyopathy”) is not fully
understood. Multidisciplinary research
efforts are undertaken to enlighten the
interrelation of Diabetes mellitus and cardiac
disease. The role of advanced glyca-
therapy in critically ill patients with Gramnegative
pneumonia. In order to ensure
that the delivery of amikacin occurs at the
most appropriate time, which is during inhalation,
the nebulization is triggered by
the patient’s individual breathing rhythm.
Preliminary Phase II Results
In the current study for the adjunctive treatment
of Gram-negative pneumonia in intubated
and mechanically-ventilated patients,
the combination achieved over 1,000 times
greater lung exposure to the antibiotic amikacin
as compared to intravenous route of
administration. Both the once- and twicedaily
regimens were associated with reductions
in overall antibiotic use compared to
placebo. ”This shows,” said Philip Blake,
President and CEO, Bayer Inc. Canada,
“that targeting antibiotic therapy to the site
of infection might offer superior bacterial
eradication and increased efficacy, which
in turn may result in a higher likelihood of
the patient’s survival.” Greater efficacy also
suggests positive effects on the cost of the
therapy – conventional injection therapies
Amikacin Inhale
Amikacin Inhale is a developmental name for a drug-device combination
product currently under development as an adjunctive treatment of Gramnegative
pneumonia in intubated and mechanically-ventilated patients. It
is being developed by Bayer Healthcare in cooperation with nektar therapeutics
and combines nektar therapeutics’ LPt (Liquid Pulmonary technology)
pulmonary drug delivery system with the antibiotic amikacin that has
been formulated for highly efficient aerosolised delivery to the lungs.
tion end products and protein glycation in
the progression of arteriosclerosis as well
as structural impacts on heart function are
evaluated both in clinical studies and the
research laboratory of the diabetes centre.
In an interdisciplinary approach scientists
and medicines are working together to understand
basic mechanisms and to develop
new therapeutic options.
H.E. Bin Shakar was impressed by the
interaction of the clinics for cardiology,
cardiovascular surgery and the diabetes
centre. In the UAE every fifth inhabitant is
affected by diabetes mellitus, which brings
about a strong need for a concerted treatment
of patients, both from the metabolic
as well as from the cardiac point of care.
Therefore, H.E. Dr. Ali Ahmed Bin Shakar
proposed the establishment of a similar
configured centre in the UAE. Both parties
agreed to implement a close collaboration
of ventilated patients currently cost up to
CAN-$150.000, said Prof. Low.
Phase III studies will follow. They aim is
to assess whether the addition of Amikacin
Inhale to the current standard of care recommended
by the American Thoracic Society
is more effective than aerosolized placebo
for the treatment of Gram-negative
pneumonia in intubated and mechanicallyventilated
patients.
“We Need more Collaboration
of the Kind”
Better outcome, and reduced cost – these
highly promising expected benefits were addressed
by the experts at the media round
table. “The design and development of such
dedicated drug-device combinations carries
an enormous potential for many areas,” underlined
Prof. Niederman at the ATS congress.
“Only few companies have endeavoured such
a collaboration. Amikacin Inhale is a pioneer
project; we physicians see a huge demand for
more of such collaborative solutions.”
Michael Reiter
very soon. The contractual documents
are currently prepared and H.E. Shakar is
awaited for Medica in November for the final
signature. Arab Health in January 2009
in Dubai will be an optimum time point to
advance the collaboration by evaluating
further steps.
Contact:
Bernd Stratmann, PhD
Research Director
Heart and Diabetes Centre North
Rhine Westphalia
Bad Oeynhausen, Germany
Tel.: + 49 5731/973768
bstratmann@hdz-nrw.de
www.hdz-nrw.de

4 PoLItIcs • MAnAGEMEnt
Hospital Post Europe 04/08
Most diseases are associated
with genetic issues, explained
Dr. Alfred Nordheim mid-July,
on the occasion of the International
Congress of Genetics in
Berlin. According to the President
of the German Society of
Genetics, GfG, it is not only a
matter of passing on genetic
dispositions from one generation
to the next which plays
an important role: What is of
utmost importance is, too,
that cells are deregulated
due to stress which comes
from outside factors. Those
acquired genetic errors will
not be passed on.
New Technologies
Regarding new technologies – e.g., the sequencing
of the genome –, Prof. Nordheim
pointed out that few diseases are monogenetic.
Instead, a number of genes interacting
with the consequence of deregulation
can act as the cause for diseases. It is not
sufficient to look just at individual gene
loci.
Update On Genetics
Stem Cell Therapy, Gene Therapy – New Approaches and Technologies
Eva-Maria Koch
The genome sequence may have been
read; however, with 3 bn “letters” in one
human cell, that “book” is still far from
being understood. Work in sequencing is
greatly helped today by a new generation
of equipment which allows for reading an
entire genome within a few weeks. Large
machine parks working in parallel may
reduce this time to a few days.
In order to understand this avalanche
of information, biomedical exams and IT
are required. Computers interpret the
sequence of the genome, they help classify
it, or divide it into pieces. New soft-
ware enables precise interpretations of
the genome sequences. With hapMap for
instance (www.hapmap.org), SNP’s (single
nucleotide peptides) can be analyzed,
permitting the comparison of individual
ge nomes. The variability of individuals
compared to the variabilities or identical
elements in biopsates with or without
pathological findings, allows to identify the
cause for a disease.
Pharmacogenomics – New
Therapy Options
When asked about the most recent therapy
options – pharmacogenomics –, Prof.
Nord heim explained that it is now possible,
in combination with the ability to read
the genome sequence – to deduce the
primary sequence of proteins and analyze
them more precisely. Proteomics, the new
technology for proteom analysis, present a
powerful means in this respect.
Large databases serve to store the potential
materials and volumes derived from
proteins. Precise analyses of materials are
enabled by mass spectrometers of the
new generation. This may help detect new
markers potentially relevant for diagnostic
purposes.
Stronger Voice and Better Care for Patients
New Local Involvement Networks in UK
Now, British Citizens have
greater individual influence
over a larger number of local
health and care services than
ever before, as the Local Government
and Public Involvement
in Health Bill comes into
force, enabling the establishment
of Local Involvement
Networks (LINks).
LINks will replace Patients’ Forums as the
representatives of patient voices in the
NHS. New LINks will be set-up in 150 Local
Authority areas across the country, supported
by £84 mn of central Government
funding over the next three years. Health
Minister Ann Keen said: “The reasons behind
LINks are many but the main two
are simple – citizens have said they want
more influence, and services find it easier
to provide better care if they know what
the community wants. LINks will be run
by local people and local groups to give
communities a stronger voice and bring
real accountability to the whole system.
When people tell care professionals what
they think about local services, it is easier
for them to offer better care. If LINks are
going to work, they need local people and
groups to get involved and to use its powers
to hold services to account.”
The role of each network is to find out
what citizens want from local services to
monitor and review the care they provide
and to tell care management what the community
thinks. To ensure that LINks can
hold services to account, the Local Government
and Public Involvement in Health Act
2007 gives LINks certain powers – such as
being able to enter and view services. The
same legislation will also abolish Patients’
Forums, which could not scrutinise care
services funded by Local Authorities.
Each LINk will be independent of any
Government organization with its own
decision making process. It is unlikely
that any single network will be exactly the
same. Each community will determine
how they want their LINk to operate and
what local priorities will be. Each authority
is required to contract a ‘host’ organization
to establish and support a LINk in the Local
Authority area. Local Authorities have until
September to ensure that an organization
is in place to set-up and run the LINk for
their area.
Funding For LINks
The Government has made £ 84 mn available
to fund LINks between 2008/9 – 2010/11.
The vast majority of this money (£ 27 mn
per year) will go directly to local authorities.
The amount allocated to each area has
been calculated using a formula that takes
into account population size and factors
such as levels of deprivation. Under the
Local Government and Public Involvement
in Health Act Patients’ Forums will legally
cease to exist on the 31 st March. Many Patients’
Forum members were involved in
planning for the new system in addition to
many additional individuals and community
groups. The same legislation enables
LINks to be established. The introduction
of LINks is one of a number of initiatives
being introduced to strengthen the voice
of people who use services. The complaints
process is being reformed to make it easier
for people to complain when things go
wrong. A strengthened duty on the NHS to
involve patients in decisions about service
changes will also soon come into force.
What Services
Do They Cover?
A LINks’ remit covers all the state funded
health and care services in an area, except
children’s social services, which are covered
by separate arrangements.
What powers do LINks have?
The Local Government and Public Involvement
in Health Act provides LINks
with powers (similar to Patients’ Forums)
to help carry out their role. Under the legislation,
certain duties are placed on commissioners
and providers of services.
A LINks representative can enter specific
services and view the care provided
LINks can ask commissioners for information
about services and expect a response
LINks can make recommendations and
expect a response from commissioners
LINks can refer matters to the local
‘Overview and Scrutiny Committee’ for
action
Who Can Get Involved?
Anyone: carers, service users, community
leaders, patient representatives, ... everyone’s
views matter. Groups can also join:
charities, faith groups, tenant organizations,
youth councils, BME organizations,
and business federations ... anyone who
wants to make sure the needs of their community
are listened to.
www.dh.gov.uk/links
As for future developments, Prof. Nordheim’s
vision is of small arrays for home
use. This array could include a variety
of analytic tools, e.g. antibodies against
diverse proteins. A little drop of blood
would be sufficient to signalize to the user
at home that he/she needs to change his/
her lifestyle in order to avoid developing
certain diseases.
Regarding the cost aspect in the health
system, according to Prof. Nordheim diagnostics
will become the more expensive
the more parameters and diagnostic
markers are identified and used. This necessitates
significant investments which,
however, would pay off: Earlier diagnostics
lead to more targeted therapies. At the early
stage of a disease, therapies would turn
out be more effective. Understanding why
two individuals with the same disease react
differently to the same drug would help
develop more efficient drugs – leading to
economies at the therapeutic level.
Regarding trends in diagnosis and therapy
of the global “big diseases” – such as,
e.g., diabetes and cancer –, the expert emphasized
major recent discoveries in Japan
and USA (Prof. Rudolf Jänisch, Boston).
Reprogramming a cell, e.g. a skin cell, into
an embryonic stage is a key development
– induced pluripotent stem cells. This may
allow for correction of a gene error to be
proceeded in vitro. The cell with the –
now corrected – genetic default could be
returned to the patient’s organ (e.g. beta
cells of the pancreas, responsible for insulin
production).
Prof. Jänisch has already successfully
carried out experiments, in mouse models,
for sickle cell anaemia and Parkinson’s
disease. The condition of the animals
improved during a few weeks. Prof. Nordheim
estimates this to be a promising new
type of therapy.
The Future Role of Genetics
Genetics are the cause for many diseases;
improved genetic diagnostics will hep
identify predispositions of an individual
much easier, Prof. Nordheim summarized;
and targeted therapies based on pharmacogenomics
are in store for us. Genetics,
the basis of life and the functioning of cells,
are all around us – knowing, and working
with, them is an important factor of a
healthy life.
Eva-Maria Koch, Berlin
Focus On Biomarker Research
The Biomarkers Consortium,
a ground-breaking publicprivate
biomedical research
partnership focused on identifying
new biological markers,
announced a line-up of distinguished
biomedical luminaries
who were participating in
its two-part supersession during
the 2008 BIO International
Convention in San Diego last
June.
Geared towards industry leaders, this supersession
explored the role and importance
of new collaborative research models
and progress made towards transforming
the biomarker research paradigm, and
accelerating discovery of solutions to many
of the critical health challenges in the 22 nd
Century.
Supersession panelists included:
Anna Barker, Deputy Director for Advanced
Technologies and Strategic Partnerships,
National Cancer Institute, National
Institutes of Health.
ShaAvhre Buckman, Acting Director,
Office of Translational Sciences, Centre
Patients’ Rights – Cross-Border Healthcare
This draft EU Directive clarifies the rights
of patients to seek healthcare in another
Member State as recognized by the European
Court of Justice, and simplifies their
application in practice. Any (hospital) care
citizens are entitled to in their own Member
State they may also seek in any other
Member State, and be reimbursed up to
for Drug Evaluation and Research, Food
and Drug Administration.
Jeff Evelhoch, Executive Director, Medical
Sciences, Imaging Sciences, Amgen.
Joe Gray, Professor of Laboratory Medicine
and Radiation Oncology, University
of California San Francisco and Director,
Division of Life Sciences, Lawrence
Berkeley National Laboratory.
Thomas Insel, Director, National Institute
of Mental Health, National Institutes
of Health.
Gary Kelloff, Special Advisor, Cancer
Imaging Program, National Cancer Institute,
National Institutes of Health.
Garry Neil, Corporate Vice President,
Corporate Office of Science and Technology,
Johnson & Johnson.
Irene Norstedt, Head of Sector Innovative
Medicines, European Commission,
Directorate General for Research.
David Wholley, Director, The Biomarkers
Consortium.
www.biomarkersconsortium.org
www.fnih.org
the level of reimbursement provided by
their own system. Member States can put
in place a system of prior authorization for
hospital care, to safeguard their overall system
if necessary.
MR

Hospital Post Europe 04/08
What a challenge for public
health – this country sports,
on 3.2 mn km 2 , 28 states and 7
union territories. The number
of official languages total 16;
tax structures and regulatory
frameworks are diverse. Out
of the 1.1 bn population, 600
mn are considered poor; and
the democracy with its difficult
past still struggles with
the traditional caste system.
The economy shows growth
rates of 9 % – rather impressive
to Europeans – accompanied,
however, by an inflation
of 8.1 %.
The spectrum of caregiving ranges from
impressive high-quality, non-profit activities
in, e.g., CVD and oncology, to medical
tourism for elective therapy – e.g. hip replacement,
for patients not only from the
UK and the US. The major push for this
sector comes from a growing middle class
on the subcontinent – a quality and priceconscious
target group of roughly 250 mn.
– Your Hospital Post Europe editor brings
to you this feature based on interviews
with hospital and vendor representatives.
After the independence of India, the
healthcare infrastructure including district
hospitals, community, and primary health
centres was designed in line with WHO
norms; however, availability of staff and
medication was grossly inadequate. The
situation improved when the corporate
sector realized its social responsibilities,
with corporate hospitals mushrooming.
These state-of-the-art facilities, however
– explains Dr. Saurabh Bhatia, a physician
who today provides medical competence
to TietoEnator’s software development
work for the healthcare sector – “were
beyond the reach of the average Indian,”
at an annual per-capita income level of
around US-$ 2,700 (China – 5,300, Germany
– 34,400, US – 46,000; 2007 figures).
The Situation Today
“Traditional India came to rescue,” the expert
continues: Spiritual gurus and trusts
run by them started running charitable
hospitals. The majority of them engaged
in modern medicine, making it available
to the needy. By 2005, the infant mortality
rate, an indicator of the overall health status,
was down to 56 (1960: 146; compare to
China – 23, US – 6, Germany – 4 in 2005),
with average lifetime up significantly.
What is the current situation regarding
healthcare in India – who has access to
care and which groups do not, what are
the differences between urban and rural
areas, who is paying for care?
HealthwareIndia is a major distributor
that started out in 1989 for Dr. Mach (OR
lights) and Blancomed (now Trumpf OR
tables) and gradually specialized first in
Urology (Dornier MedTech, Lisa Laser, B-K
Medical, EMS and Gyrus-ACMI from UK/
US) before adding Surgical (Gyrus-ACMI
and B-K Medical). CEO Konakanchi Ram
Narayan summarizes the present situation:
“Despite the improving health status of the
Indian population, healthcare infrastructure
in the country has a long way to go to-
wards achieving 100 % quality, technology,
and superior healthcare delivery systems.”
While the central government is limited
to family welfare and disease control programs,
the manager goes on to explain,
the state governments are responsible for
primary and secondary medical care, with
a limited role in specialty care.
Governmental share in the healthcare
delivery market is roughly 20 %, while 80 %
is provided through the private sector. The
private healthcare providers consist of private
practitioners, for-profit hospitals and
nursing homes, and charitable hospitals;
this market is now open for foreign investments.
There is a huge difference in the quality
of medical care available to the urban
and rural population. Except for basic
healthcare through the governmental primary
health centres, the rural population
have to go to the nearest city for advanced
care. All governmental hospitals provide
free care to poor patients. Government
employees are covered by insurance (like
CGHS, ESI, etc.) and have access to care either
through governmental or private hospitals.
All other salaried (= urban) patients
either buy private insurance or pay out of
their pockets. Healthcare spending currently
amounts to over 6 % of the GDP, of
which three quarters are “out-of-pocket”:
Health Insurance
Insurance is still in its infancy – in India,
people are not used yet to paying without
receiving, instantly, anything concrete
in return, outlines Dr. Bhatia. Even after
economic liberalization in the 1980’s, multinationals
had to wait for the Indian government
to open up this sector, which
happened after 2000. Now, the market is attracting
significant attention also from international
actors who set up ventures such as
Bajaj Allianz and Apollo DKV Insurance. The
latter, a joint venture of a German payor and
a privately held Indian hospital group, plans
to invest up to 5 bn rupees in the next five
years to increase its market share, according
to Apollo Vice Chairperson Shobana
Kamineni. The health insurer, according to
Kamineni, aims at controlling at least 15 % of
the total health insurance business in India
which she estimates at currently US-$1 bn.
The addressable market is middle class.
Demand for medical and nursing colleges
is also up.
Who Takes Buying Decisions?
Physicians are the decision makers regarding
investment in medical technology – in
particular regarding procurement for the
attractive private caregiving segment which
is not required to issue tenders. There are
roughly 175 associations, and about 250
medical congresses – a difficult environment
for manufacturers and vendors who
wish to present their products, as well as
for organizers of general events for the
hospital sector – as explains Mahesh Gidwani
of Reed Exhibitions India. Only few
multinationals have as yet gone into manufacturing
activities in the country – this is
a new trend in India, presumably sparked
by the 15 – 16 % annual growth in medtech
sales, Gidwani assumes.
Focus on IndIA 5
“Complex Situation, Incredibly Dynamic Outlook”
Caregiving and Technology Penetration in India
Dr. Girish Mehta, Manager,
Wellspring Diagnostic Centre,
Mumbai
(Photos by Michael Waldbrenner
and MR unless noted otherwise)
Services and Technology
in Diagnostics
Piramal Diagnostics, part of a group of
companies, operates about 85 diagnostic
centres across the country. Services for
caregivers include general pathology and
basic blood-based diagnostics; some centres
also carry out sonography, CT, etc.
Asia’s first high-resolution PET-CT is also
operated by Piramal, outlined Dr. Girish
Mehta, who manages the highly reputed
Wellspring Diagnostic Centre in Mumbai’s
Lower Parel district. Wellspring’s many
hospital contracts include, e.g., radiology
outsourcing for the NABA-accredited
Dr. Hiranandani Hospital.
Whereas some centres sport full-time
radiologists, others acquire reports from
such centres in a private broadband teleradiology
network. Difficult cases, too, are
transmitted to specialists, e.g. in Mumbai.
Reports are sent in pdf format; the PACS
used is a proprietary solution, “developed
at a fraction of the cost of a commercial
system”. In total, roughly 4 mn patients
are handled by the diagnostics division
each year, with 150 highly qualified physicians
on staff, summarized Dr. Mehta, with
most devices, and reagents, imported from
Europe – Siemens is the main supplier.
While teleradiology services performed
in the country for, e.g., caregivers in the
US are still not an option due to physician
approval issues, lab tests offer a promising
business case: For European caregivers,
having lab tests carried out in India
Vishal Bali, CEO, Wockhardt
Group (Photo courtesy Wockhardt)
is a huge opportunity for cost savings and
higher throughput, underlined Dr. Mehta
– “we already have, as an example, a US
customer who sends us about 6,000 highend
samples per year. We are accredited by
the American College of Pathologists – the
top-level international accreditation. Quality,
therefore, is sound, and logistics from
and to the UK, France, and Germany – to
name examples – is fast and reliable.”
“In general, the service level in India is
a lot higher compared to Europe (and the
US) – at a fraction of the cost,” is the physician’s
conclusion – “my message to Europeans
and Americans is – we’ve got the best
machines, best people, and best prices.”
Research
This, too, is an area where Indians collaborate
with Europeans, explains Dr. Mehta:
earlier this year, Nicholas Piramal Life Sciences
and Pierre Fabre Laboratories, in
the presence of the French President, had
signed an agreement on research in oncology.
– And clinical studies can be done
in this enormous patient market at a cost
50 – 75 % below European and US levels –
adds Dr. S. K. Gupta, Dean of the Institute
of Clinical Research (India).
High-Level Therapy and
Medical Tourism
To Dr. Mehta, medical tourism is not a topic
– as patients, Westerners come for therapy.
Wockhardt’s CEO Vishal Bali benefits from
this trend: In 2007, more than 3,000 international
patients came for treatment to two
Wockhardt sites, Mumbai and Bangalore.
Around 7 – 10 % of Wockhardt’s revenue
comes from medical tourism, a volume
growing at 35 % annually; for the Apollo
group, corresponding estimates are 12,000
patients p.a., equalling 20 %. The Ministry
of Tourism promotes such activities aggressively
in its “Incredible India” campaign.
Medical tourists largely come from the
US, Canada, and Europe. Why is the US
prevalent? “Healthcare is more privately
driven there,” says Bali. “Those patients
ask for choice, compared to social-driven
caregiving in much of Europe.” JCAHO
accreditation for the two Wockhardt sites
is a key ingredient in this activity, according
to Bali: US patients, or large corporations
handling employee healthcare, take a close
look at quality standards. “US insurers”,
Vishal predicts, will soon offer low-premium
products to their customers which include
care in India; “here, care costs a third
at the most, and can go down to as low as
1/10th in comparison, for ophthalmology
– plus the plane ride”. Out of Europe,
patients from the UK are prevalent; they
have a long tradition of being treated by
Indian physicians, and long wait times are
placing increasing stress on the NHS, with
demographics giving an extra shove.
To Wockhardt, medical tourism focuses
mostly on elective surgery – much in
orthopaedics, such as knee/hip/joint interventions,
as well as spine surgery and cardiac
procedures. The hospital group was
recently awarded a prize for its website
which largely facilitates the gathering of information
to potential patients abroad.
With no international airport until
recently, Pune is no location for medical
tourism. The Jehangir Hospital here was
established in 1946. Today, the general
hospital with 325 beds and a luxury suite
is associated with the private Apollo group,
and handles close to the entire medical
spectrum. The caregiver sports, besides
medical staff with top qualifications, a
64-slice CT and more very modern technology.
The primary reason why many
Indian hospitals would not meet JCAHO
criteria, according to a leading physician, is
restricted space. Increasing awareness of,
and pressure from, patients paying from
their own pockets has led to significant improvements,
the physician continued; e.g.,
“No compromises on quality, and world class equipment” are key at Pune’s Fabiani & Budhrani Heart
Institute (from left): cardiologist Dr. Ritu Dhawan-Bhatia, the reporter, and healthcare expert Dr. Saurabh
Bhatia (TietoEnator)

6 Focus on IndIA
Hospital Post Europe 04/08
avoiding hospital-acquired infections is at
the top of the agenda. Jehangir has a guest
relations team dedicated to scrutinizing patient
opinion and improving processes. –
Regarding staff matters, the physician continued,
finding qualified nurses is difficult;
many of them leave the country for better
pay after finishing their 2-year course. In
general, demand is leading to a growing
number in educational institutions.
Charitable Care
“Man does not live by the beats of his
heart; he lives by the Grace of God” – this
teaching comes from Guru Dada J. P. Vaswani.
Healing those hearts is, indeed, the
aim of the Fabiani & Budhrani Heart Institute,
part of the Sadhu Vaswani Mission’s
364-bed Medical Complex in Pune. Inaugurated
recently, operations of the Heart Institute
are financed by a fund; and 90 % of
surgical interventions are concessional or
free. No patient is sent away – and “every
patient is a picture of God; to serve him is
to worship God,” summarizes admin manager
Lachmi Sadhwani.
“It is hard for lower-class people in India
to access healthcare – this trust helps each
and every needy patient,” identified by his
ration card. “There are no compromises
on quality, world class devices and materials
are used, and physicians had excellent
training in India, Europe, Australia, and/or
the US”, underlines consulting interventional
cardiologist Dr. Ritu Dhawan-Bhatia.
Besides the full spectrum of interventions
practiced elsewhere, too, valve repair or
replacement happens rather frequently in
India, describes the cardiologist – a result
of streptococcus-induced rheumatic heart
disease. Economies also known in other
places are applied at the Institute: e.g.,
catheters marked for single use are never
thrown away before having been used at
least five times. – Post-OP physiotherapy is
provided as a standard here, a service not
really common in India.
Other outstanding activities of the Complex
include ophthalmology as a mobile
service to surrounding villages, with 25
interventions preventing blindness daily;
and another charity scheme focuses on
artificial limbs which, for Indians, need
Healthcare in India is passing through an interesting phase. With a rapidly
growing economy – and an increasing focus on infrastructure development
– the healthcare sector presents great opportunities for able companies and
people.
this sector is witnessing unprecedented development, as is evident from the
following activities:
Large-scale private participation in healthcare.
Many regional players expanding into newer geographies.
Existing hospital groups extending their reach through franchises and
tie-ups.
Many hospitals undertaking up-gradation of existing facilities.
Increasing quality consciousness among healthcare providers.
Increase in healthcare insurance base.
Growing interest in Medical tourism among hospitals.
Growing number of Medical colleges.
Government subsidies in the form of a five-year “tax holiday” for hospitals
in rural areas.
Ashim Purohit, CEO, Maquet India
All this translates into business opportunities for companies with a locally
focused approach. However, the tendency to treat the local market structure
homogenously needs to be questioned. this is in light of the fact that there are different business subcultures
which affect the successful trans action of business. this requires a regional focus as well.
For a country with more than a billion people – as much as there is a need to address mass healthcare needs, there
is also a good opportunity for top technology providers. With a rapidly growing and prospering middle class, the
quality of the healthcare delivery system is definitely in focus. Add to that the prospects of medical tourism and
increasing trends of lifestyle diseases – and you have an interesting market for top technology providers.
our emphasis on setting up a strong service and sales network over the last four years has won us good customer
confidence. today we have a very strong regional presence with more than 20 out-locations spread across the
country, and a growing interest in our product range.
www.maquet.com
Comments on Healthcare in India: Ashim Purohit, CEO Maquet India
to support use without shoes (cf. also the
“Jaipur foot”).
Healthcare IT
Narayan sees market forces as a major
factor: The increasing demand for quality
care, with rising competition, “has made
hospitals maximize utilization of technology
in driving processes and streamlining
operations,” he describes; “not only corporate,
but also stand-alone small and midsize
hospitals are waking up to the adoption
of Hospital Information Systems (HIS)
making them an integral part of hospital
management. Similarly, electronic medical
records (EMRs) are making their way into
the hospitals – but at a slow pace.” Only
large corporate hospitals are implementing
EMR applications today, whereas most
of the other hospitals still maintain the old
format of paper-based records, Narayan
goes on to explain. The two major forces
driving EMRs – a key factor in healthcare
IT – and thus automation have been stringent
documentation requirements in the
emerging insurance sector and government
policy for medical standards; while
those are in place, conformance to imple-
mentation is somewhat limited in this complex
country. And any caregivers engaging
in medical tourism will need to use IT to
meet standards and “customer” expectations.
– One area where IT is ubiquitous in
hospitals in the country is billing.
The IT health market in India is estimated
to be “around US-$3 bn, and expected to
grow in the next 3 – 5 years,” is Rahul Sethi’s
baseline, who works for medical display solutions
vendor Barco. “IT investments are
currently about 1 % for large, 500 – 1,000
bed hospitals, expected to increase to
3 – 4 %,” Sethi goes on to say. Adoption, e.g.
of PACS, is still comparatively low. Factors
such as spiralling staff cost, shortage of
trained skilled staff, high attrition rate, and
the urge to benefit from clinical processes
will push stakeholders to use IT progressively
more than at current levels.
The image archiving and processing
market still remains the stronghold of modality
manufacturers, underlines Sethi; and
like elsewhere, every investment is compared
against cost returned. Major PACS
players in India are, at “Level 1”: GE, Siemens,
Agfa, Fuji, SRIT, and Amrita; at “Level
2”: 21CHMS, Karishma, Novarad, Softlink,
Perfint, and Vepro.
„Giving birth in this country? never!“ this was the statement the Waldbrenners
met with frequently when they confronted family and friends
with their decision. Many of those who – like the couple – live and work in
India, will instead fly home for this project.
the German expats, however, ventured to take a close look at a hospital
which had been suggested to them. the meeting with the customer liaison
turned out to be a very positive experience; she gave a tour of the obstetrics
department as well as patient/guest rooms of various categories.
they liked a suite which included a bed which was electrically adjustable,
two rooms and a kitchen, two bathrooms one of which had a massage
shower; all of this came with a nurse and a maushi. Extensive meetings
with the gynaecologist, anaesthetist, and paediatrician made clear that we
would be looked after much better than anywhere in Germany.
there are some differences in preparation, procedure, and peripherals
compared to Germany: staff will pause during the intervention to take a
call on a mobile phone; no vitamin-d prophylactics are carried out because
this is not considered necessary for Indian newborns. – All preparatory
exams are carried out on an outpatient basis.
For medical reasons, the decision had been taken in favour of a caesarian
section, and Michael was told by the management that he would be
allowed in the or. so, on the eve of that day in May, the couple moved in
to the suite and was impressed by the à la carte catering and 80 channels
of cable tv. there was another blood check, and a meeting wit the
anaesthetist.
on the following morning at 6:30 in the or, things were very relaxed,
with two anaesthetists, two paediatricians, and two gynaecologists
present – midwives are not part of that hospital’s concept.
For the PdA, German and British products were used, with well-known
brand names on the packaging. All use-by dates were o.k., and the sterility
and general procedures were as professional as in Germany. the optics of
the or suggested it was somewhat older, but all devices worked properly.
After the accouchement, Michael stayed with their newborn. After routine
tests, the two were escorted to their suite, where the mother also arrived
two hours later. the family spent four more days in the aesthetic environs,
and received many guests who also felt very comfortable.
Giving birth in India? Yes! Given the opportunity, the Waldbrenners will
gladly take that decision again.
The market for medical displays is still
very small, lack of information and no strict
medical norms or legal norms make it irrelevant.
The market is expected to grow at
20 % every year, so is the competition from
local players.
Offering a broad spectrum of medical services … including elective procedures for expats: Physicians and guest
relations staff at the Jehangir Hospital.
Lani Is Born in India – An Expat Reports
“Lani Waldbrenner – a look from the outside”: This young lady may not
be a typical example of medical tourism – her German expat parents,
however, are highly satisfied with the standards they’ve experienced in
Indian healthcare (Michael Waldbrenner, TietoEnator, at Jehangir)
A Different Angle –
IT out of Pune
It is called the “Oxford of the East” for its
many institutions of higher education, it
sports a huge military cantonment, and it
used to provide an amenable setting for
the rulers of the state of Maharashtra during
the monsoon season; Pune, in modern
times, has become the home to many wellknown
IT vendors. Highly skilled, affordable
manpower has attracted multinationals
to the city of 5.5 mn.
Among them is TietoEnator (www.
tietoenator.com/healthcare). For the global
IT vendor based in Finland, digital healthcare
is one of the core markets. The company
took over ITB’s activities in Pune as
part of the acquisition of the German HIS
manufacturer a few years ago (the companies
Waldbrenner and Cymed were also
aquired). Today, around 1,300 dedicated
healthcare and welfare software specialists
work for the vendor, 200 of them in Pune.
Tasks there include graphic design, usability,
UI programming, documentation, testing,
and sales support.
Michael Waldbrenner, former CEO of
the German HIS vendor by the same name,
is now Head of TietoEnator’s Healthcare &

Hospital Post Europe 04/08
Welfare part of the Indian Software Centre.
He quotes an example to explain how the
newly formed “Horizontal Competencies
Centre” in Pune works: Gynhälsan, a solution
for sending invitations to women for
doing cervical screening at Swedish health
centres, last year had serious problems
due to staff fluctuations, with the required
know-how lost. “The Pune lab unit took
the strategic decision to reengineer the
software,” explained Waldbrenner, “involving
the customer, and to do it bringing
together Swedish domain expertise and
Indian development expertise.” This collaboration
proved to be the right decision.
So, even if some areas of healthcare IT
still lack significant penetration in the Indian
market, work done in the country helps
develop solutions which cater for demand
in health sectors worldwide. And in Pune,
Ministers of health from the
53 countries of the WHO European
Region signed a new
charter on health systems,
committing themselves to
concrete and measurable action
on strengthening health
systems that will allow both
their own people and the
international community to
hold them to account.
All countries have pockets of people who
miss out on quality health care. The charter
stresses that strong health systems
must be put in place to remove barriers –
such as insufficient access, costs, and lack
of information – to ensure coverage across
the board. The charter declares: “Today, it
is unacceptable that people become poor
as a result of ill-health. … We the Member
States, commit ourselves to: promote
shared values of solidarity, equity and participation
through health policies, resource
allocation, and other actions, ensuring due
Focus on IndIA • nEWs 7
Philips has announced a series of new portable, compact patient monitors
providing a reliable, yet affordable means to observe and care for
patients. now available to healthcare providers in India, the new Philips
suresigns vM3 is the vendor’s first patient monitor designed for emerging
markets.
With a growing per capita income and adoption of new lifestyles, healthcare
services in India are rapidly changing, explains Moushumi dutt, director,
corporate communications, Philips Electronics India. In order to meet
the increasing demand for quality care, people in urban areas have seen
the construction of new, state-of-the-art hospitals and associated satellite
facilities, while others are increasingly seeking care at smaller nursing
homes and clinics. this has fuelled the demand for healthcare equipment
across segments; “combining advanced software and technology in a
compact economical package, the vM3 is the perfect solution for caregivers
across the wide variety of clinical environments we see here in India,”
said Anjan Bose, senior director and Business Head, India, Bangladesh,
sri Lanka and nepal, Philips Healthcare India. – the growth of the Indian
patient monitoring equipment market is estimated to reach us-$42 mn in
2010. By that year, Philips plans to garner a market share of 40 % through
its diverse range of patient monitoring equipment.
www.philips.com
“Designed for Emerging Markets”
attention is paid to the needs of the poor
and other vulnerable groups.”
WHO estimates that, each year, health
expenses cause 150 million people to suffer
financial catastrophe and push 100 million
below the poverty line. “Health is the right
of everyone and it has value in itself. It is in
the interest of all governments to invest in
the health of their populations, as improving
the health of the population makes a
material contribution to the wealth of the
nation,” said Dr. Marc Danzon, WHO Regional
Director for Europe, at the charter
signing ceremony.
“I am personally thrilled by the value
system so clearly evident in the Tallinn
charter,” said WHO Director-General, Dr.
Margaret Chan, addressing the Conference.
“As we now know, cash, commitment,
and commodities cannot boost adequate
progress in the absence of delivery
systems that reach those in great need, on
an adequate scale, in time,” she said.
The charter details the key actions needed
to make health systems stronger, such
as improving transparency and accountability
for health spending and ensuring that
spending is aligned to policy objectives.
“Increasing investment in health will pay
dividends only if it’s well spent,” said Dr.
Nata Menabde, Deputy Regional Director,
WHO Regional Office for Europe. “There
is no ‘right’ or ‘optimal’ size of budget that
should be devoted to health. We do not
“the wheel turns full circle”: the Identity
Foundation – a charitable trust supported
by TietoEnator and its employees – works
with an increasing number out of more
than 150,000 deprived children in the city,
providing learning opportunities and helping
them cope with a difficult life – including
healthcare matters.
Healthcare in India “in 2015”
For Narayan, these are the drivers which
will shape the future: “Doubling of health
spend (as a percentage of the GDP) by the
government, Public-Private Partnerships
(due to the huge increase in value of real
estate), growth in insurance, investments
by private/corporate hospital chains
spurred by the IT waiver for hospitals
established in smaller cities/towns, and
want to give the impression that simply
increasing the level of budget allocations
to the health sector will solve all problems.
The health system needs to increase and
demonstrate its capacity to use the money
in a prudent and transparent manner.”
As part of the preparations for the charter,
WHO conducted studies that have
produced evidence of the link between
consolidation in the private sector – large
hospital chains, in a drive to establish a
pan-Indian presence, are taking the acquisition/franchise
route.” According to Suraj
Ullal of Medical Fair India, a Messe Düsseldorf
activity, the country will sport the
highest IT growth rate in Asian healthcare
sectors: 22 %.
Just in the upcoming five years, India
will invest more than US-$45 bn in caregiving.
What a market for actors in European
academia, for payors, and for medtech
vendors who look for collaboration or
business. Why not come to a tradeshow
like Medical Fair India – New Delhi, 27 – 29
March 2009 – or Interphex, and go scouting
for your opportunities!
Michael Reiter
“Health Is the Right of Everyone”
European Ministers Sign Groundbreaking Charter on Health Systems
Signing the Tallinn charter, on behalf of all European ministers:
Maret Maripuu, Minister of Social Affairs of Estonia and President
of the Conference, and Dr. Marc Danzon, WHO Regional Director for
Europe
the health and wealth of the population,
making the case for giving serious political
attention to the performance of health
systems. WHO’s research shows that in the
past the importance of the health system
to the general health of the population has
been underestimated, as has the impact of
better health on economic growth. Rather
than being seen as a ‘necessary burden’,
investment in effective health systems
should be considered as an investment in
the future well-being of the population.
Speakers at the Conference stressed
that good health systems should not be
a luxury that only rich countries can afford,
but a fundamental part of the social
and physical infrastructure that supports a
country’s prosperity, cohesion, and social
well-being, underlining that the charter
places particular emphasis on ensuring
people are treated with dignity and respect
when they come into contact with their
health system.
www.euro.who.int
Anniversary Conference with International Flair
Top International Speakers at Annual ZKRD Conference
More than 160 specialists from
all over Germany met in June in
Ulm/Germany for the 10 th annual
conference of the ZKRD, the
German bone marrow donor
registry. For the representatives
of donor centres, transplant
centres, and search units this is
always not only a major educational
event but, at the same
time, an interesting forum to
discuss new developments in
the field. As the national registry,
ZKRD plays a central role
coordinating the cooperation
of all players in the field on
the way to a blood stem cell
transplantation. With over 3.3
million donors, ZKRD facilitated
over 3,500 transplants in Germany
and worldwide and is
the second largest but most efficient
institution of this kind.
(From left): ZKRDS’s CEO Dr. Dr. Carlheinz Müller, Dr. Effie Petersdorf
(Fred Hutchinson Cancer Research Center, Seattle), Dr. Machteld
Oudshoorn (Leiden), and Dr. Irina Ionescu
The opening session of this year’s ZKRD
meeting brought together three top ranking
international speakers in the field of
blood and marrow transplantation. Dr. Effie
Petersdorf from the Fred Hutchinson
Cancer Research Center in Seattle (USA)
presented the state of the art in selecting
optimal adult donors for a bone marrow
or blood stem cell transplantation. This in-
stitution in the extreme northwest of the
United States is the home of three Nobel
laureates and with its high reputation is regarded
as the Mekka of the field. The second
presentation was by Dr. Irina Ionescu
from the Eurocord centre in Paris collecting
and evaluating the clinical outcome data
of all cord blood transplants performed
in Europe. Her presentation focused on
the efficient use of cord blood as a stem
cell source for transplantation not only for
children but also for adult patients. The
third speaker, Dr. Machteld Oudshoorn,
came from the Dutch bone marrow donor
registry hosting also two of the world umbrella
organizations, Bone Marrow Donors
Worldwide and the World Marrow Donor
Association. Dr. Oudshoorn discussed the
obstacles and dilemmas in the process of
identification of a suitable donor. Subsequent
sessions covered current issues in
the diagnostics and therapy of leukaemia
and related diseases as well as new developments
in ZKRD’s infrastructure supporting
the donor search process. For several
years now, Ulm’s conference centre in the
“Maritim” is an attractive venue combining
efficient meeting facilities with a beautiful
surrounding on the river in a short distance
to the old town.
An average of about 8,000 people is diagnosed
with leukaemia or similar blood
diseases in Germany every year. According
to today’s science, a blood stem cell
transplantation is often the last chance for
these patients. That is why 29 donor centres
from all over Germany try to win and
register potential donors by organizing
“typing campaigns”: The volunteer donors
are drawn a little blood sample in order to
type the HLA which is important for the
search. All typing results from German
donors are collected at the ZKRD in Ulm,
which coordinates national and, if necessary,
international donor searches. The
ZKRD alone comprises the complete data
of all potential German donors typed. The
ZKRD currently has 3.2 million donors and
is, by far, the largest registry in Europe. It is
also the most efficient registry worldwide
with regard to the donors actually recruited
for transplantation every year.
www.zkrd.de

8 MEdIcAL tEcHnoLoGY
Hospital Post Europe 04/08
Marked by change and bathed
in tradition, the distinct and
rich cultural heritage of Barcelona
once again set the stage
for EuroPCR 2008. The 18 th
edition of the internationally
renowned cardiology course
took place in the middle of
May. EuroPCR is the official
congress of the European
Association of Percutaneous
Cardiovascular Interventions
(EAPCI) … with the collaboration
of the European Society
of Cardiology (ESC), the European
Association of Cardio-
Thoracic Surgeons (ARCTS),
the Transcatheter Valve Symposium
(TVS) as well as the
endorsement of numerous
interventional cardiology
worldwide. Over 10,000 participants
attended this year’s
meeting, representing over 80
countries – an extremely satisfactory
figure according to the
organizers, the French company
Europa Organisation.
Abbott Vascular
“Express the Truth to Gain the Trust”
Successful 18 th Edition of EuroPCR in Barcelona
These Are Some of the Vendors Who Showcased Their Recent Highlights at EuroPCR:
this exhibitor presented long-term data from the sPIrIt III trial, a pivotal trial studying the
XIEncE v Everolimus Eluting coronary stent system. the results demonstrated that this stent
continues to deliver clinically superior benefits for patients compared to the tAXus paclitaxeleluting
system. In the trial of more than 1,000 patients, XIEncE v demonstrated a 45 % reduction
in the risk of major adverse cardiac events (MAcE) and a 32 % reduction in the risk of target
vessel failure (cardiac events related to the treated vessel) at two years as compared to tAXus.
“not only did XIEncE v clearly differentiate itself from the tAXus stent in the first year after
treatment, it has now demonstrated even more positive effects at two years in the sPIrIt III
trial,” said dr. stone, columbia university Medical center and chairman, cardiovascular research
Foundation, new York. “As measured by clinically significant reductions in target vessel
failure and MAcE, XIEncE v demonstrated an even greater improvement in patient outcomes
compared to tAXus at two years than at one year, driven by numerically lower rates of heart
attacks and lower observed rates of re-intervention of the target lesion. We also saw encouraging
trends for lower observed rates of late and very late stent thrombosis in XIEncE v-treated
patients, especially in those who discontinued dual antiplatelet therapy.”
www.abbottvascular.com
www.abbott.com
Agfa HealthCare
For the first time, this company displayed its solution for convergence of images and clinical data
through integrated lesion follow-up. the solution will be part of IMPAX cardiovascular for integrated
data and image management in cardiology. the software, which will be available later
this year, allows the clinician to focus on the monitoring of the stenosis in a time-longitudinal
view, with all relevant data and images in one view, rather than being required to upload the
separate studies, as is currently the standard. “the solution is an integral part of the company‘s
drive towards the convergence of images and clinical data,” says dr. ciprian Albu, Medical director
of Agfa Healthcare for cardiology. “[We are] the first to achieve a full integration of the
image follow-up as part of the overall clinical follow-up of any procedures. this turns the post
procedure monitoring of coronary lesions into a more time efficient process, reducing the need
to sift through unrelated data.”
the new feature will be incorporated into Agfa Healthcare‘s IMPAX cardiovascular, a solution
with integrated multi-modality and multi-lingual cardiovascular information management
providing a consolidated view of all cardiology and radiology images within a single review station.
IMPAX cardiovascular is vendor-neutral and delivers innovative features, including tightly
integrated structured reporting, legacy equipment image management, and secure global access
to diagnostic data.
www.agfa.com
Edwards Lifesciences
Key figures from EuroPCR included: 617 faculty speakers, 34 Scientific societies, 14,000 m² of exhibition space, and 145 collaborating companies.
this vendor announced the launch of a next-generation transfemoral delivery system for the
sapien transcatheter heart valve. the retroFlex II delivery system retains many of the features of
the retroFlex delivery system, and adds a tapered nose cone that facilitates the passage of the
valve delivery catheter over the curve of the aortic arch and through the patient‘s native, diseased
aortic heart valve. the new system is designed to enhance ease-of-use and improve access
during the transcatheter aortic valve replacement procedure. the first procedures with the new
transfemoral delivery system were performed by John Webb, director of the cath lab and cardiac
intervention at st. Paul‘s Hospital in vancouver, British columbia. His multidisciplinary team has
performed more than 150 transcatheter aortic valve replacement procedures, including more
than 25 utilizing the retroFlex II delivery system.
“the retroFlex II delivery system is a big step forward. It is designed to give the physician maximum
control when delivering and implanting the transcatheter aortic valve, making it easier to
get to and then cross the patient‘s native valve“, said Webb.
www.edwards.com
OrbusNeich
orbusneich announced that multiple clinical data presentations in a symposium at EuroPcr 2008
support the use of the company’s Genous Bio-engineered r stent, the world’s first pro-healing
stent, as a safe alternative to drug-eluting stents.
Presented by robbert de Winter, M.d., of the Academic Medical center in Amsterdam, data from
the trIAs Hr (high risk) pilot study show similar target vessel failure (tvF) rates at 12-month
follow-up for orbusneich’s Genous Bio-engineered r stent and Boston scientific’s taxus stent in
high risk of restenosis patients. In the patients treated with taxus, there were four out-of-hospital
thrombotic events, while there were no reported events in the Genous group.
“Interventional cardiologists need better stent technologies,” said de Winter, principal investigator
of the trIAs Hr Pilot study. “A pro-healing approach with the Genous stent is a viable one.
We look forward to obtaining further data on the stent’s performance in our large, multi-center
trIAs trials that compare Genous to both drug-eluting and bare metal stents.”
In addition, de Winter presented interim follow-up data from patient subsets of e-healing, a
monitored, multi-center, worldwide (outside the united states) prospective registry with 5,000
enrolled patients. the data based on the real-world use of the Genous Bio-engineered r stent
show: good clinical outcomes at six and 12 months, a low target lesion revascularization (tLr)
rate of 4.7 % at 12 months in patients with diabetes and a low incidence of stent thrombosis.
the protocol for orbusneich’s e-healing registry recommends that patients receive one month of
clopidogrel treatment after the procedure. clinical follow-up takes place at 30 days, six months
and 12 months. the primary outcome of the registry is tvF at 12 months.
www.orbusneich.com
3mensio Medical Imaging
the dutch software development company receives cE Mark class IIa for 3surgery vascular Imaging
workstation.
university Hospital utrecht’s department of vascular surgery in the netherlands has been working
with the “3surgery” workstation within the “the next dimension“ project since 2006. the
project was initiated by Prof. dr. Frans Moll to validate measurements on length, diameter, as
well as volumetric data generated by this workstation. dr. Joost van Herwaarden, co worker of
Prof. dr. Moll who performed this extensive clinical validation, says: “We have used our extensive
patient database in utrecht to validate both volumetric and linear measurements performed
with the 3surgery system and we conclude that the tools are accurate and above all easy to use
in our busy daily practice.“
Imaging has become crucial in the process of diagnosis and pre operative procedures. new promising
techniques like Endo vascular Aneurysm repair (EvAr) rely completely on an accurate diagnosis
and measurements using solely 2d and 3d images from the radiology department. 3surgery
vascular imaging software provides these accurate tools for the pre and post operative planning
of your procedures on any Pc. Prof. dr. Frans Moll adds: “After the validation we will use the
3surgery imaging workstation to address our clinical needs to measure volumetric parameters.
this will have an effect on both pre-operative decisions as well as treatment of patients already
having an endovascular prosthesis.”
www.3surgery.com

Hospital Post Europe 04/08
The 18 th edition of the internationally
renowned cardiology course – EuroPCR 2008
– took place mid May.
Under construction since 1882:
the Temple Expiatori de la
Sagrada Família, often simply
called the Sagrada Família, is
one of the most popular attractions
in Spain.
EuroPCR is a unique course aiming to contribute
to the advancement of education
and information on existing and new technologies
in percutaneous interventions
in the fields of coronary, peripheral, valve
and non-coronary cardiac disease, cardiothoracic
and vascular surgery and imaging.
During the four day course, the programme
focused on two key messages: “what is best
for my patient” and “together we achieve
more”. This patient-centred approach consolidated
innovative technology and established
learning pro cesses. Participants had
the chance to learn and share experiences
with some of the world’s leading cardiology
experts during more than 100 hours
of live transmission from 17 international
centres.
This year’s event – in addition to allowing
professionals to share experiences – included
the launch of an important initiative
to provide training and aid in the field
of cardiovascular disease in sub-Saharan Africa
– a joint collaboration of EuroPCR, the
Government of Monaco and EAPCI. This
important initiative was announced during
the opening ceremony of the Course and
is endorsed by H.S.H. the Prince Albert II
of Monaco. According to Marc Doncieux,
President of Europa Organisation, “we are
extremely proud to have been able to welcome
His Serene Highness to our annual
course and believe that his support of the
cardiovascular training initiative will be vital
in ensuring the success of the project”.
Other highlights of this year’s event included
the EuroPCR awards ceremony and
the presentation of the Alicia Foundation,
created by the Generalitat de Catalunya
and Caixa Manresa dedicated to food and
science that was presented by the highly
acclaimed chef Ferran Adriá and leading
cardiologists Valentin Fuster and Carlos
Ruiz.
Regarding the future, Marc Doncieux
confirmed “the 19 th edition of EuroPCR
will return to the Barcelona International
Convention Centre in 2009 and, following
a very productive meeting held with the
key city hoteliers this week, and with the
continued support of the local authorities
we are hopeful that we will be able to host
this important event in this beautiful city”.
Christina Keil
MEdIcAL tEcHnoLoGY 9
What’s one way to dramatically
impact Critical Care ?
Euroanaesthesia 2008
May 31 - June 3
Copenhagen, Denmark
Bella Center
Hall C2, booth 038
Reduce
length of
stay by up to
3 days
EuroPCR 2009
takes place from
19 to 22 May – again
at the International
Convention Centre
(CCIB-Forum) in Barcelona
www.europcronline.com
Dräger’s non-invasive ventilation (NIV) technology holds the key.
By offering NIV across our complete line of ventilators and integrating
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Yet this is just one aspect of our integrated CareArea Solutions, to
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visit www.draeger.com
*Ram FSF et al, The Cochrane Library 2005, Issue 4
Dräger Medical: Emergency Care > Perioperative Care > Critical Care > Perinatal Care > Home Care
*

© www.pixelio.de
10 MEdIcAL tEcHnoLoGY
Hospital Post Europe 04/08
ESC – Cardiovascular Imaging at Top of Agenda
TopClinica: Strong Start for New Industry Meeting Point
Successful Premiere at the Stuttgart Trade Fair Centre
At the first TopClinica trade
fair to take place in Stuttgart
(Germany), 3,185 decisionmakers
from the European
clinics and hospitals met in
mid-July to gather information
about new products and
innovations. Despite not fulfilling
the ambitious aim with
regard to visitor numbers at
the premiere, the 175 exhibitors
from the areas of medical
technology, medical products,
and services were highly content
because they were able
to meet with “clinic principle”
decision-makers in an interesting
environment.
The accompanying congress at TopClinica
had the same target group. “We are very
satisfied with the start of TopClinica, in particular
with the visitor quality and the international
character”, says Ulrich Kromer,
Managing Director of Messe Stuttgart. “Together
with our partners, we plan to further
refine the concept in order to attract
even more decision-makers to the trade
fair next year.” A speaker for the congress
said: “The decision for the TopClinica trade
fair came at the right time because the information
required for the decision-makers
in hospitals will continue to increase. The
accompanying congress with its presentations
and discussions provides the trade
visitors with an ideal opportunity to gather
information about current themes regarding
hospitals.”
At the TopClinica premiere in Stuttgart it
was clear that the claim of establishing an
international trade fair for the “clinic principle”
was fulfilled from the word go. As
the percentage of exhibitors from outside
of Germany reached 10 %, the expectations
with regard to the internationality of the
visitors were realized: In addition to the
many market leaders from Germany who
presented at the new compulsory event for
clinic decision-makers, 10 % of the trade
visitors came from outside of Germany.
The visitors were primarily interested in
the areas of medical technology/electromedical
equipment (70 %), requisites and
consumables (30 %), equipment and fixtures
(24 %) and information/communica-
The ESC (European Society of
Cardiology) Congress, Europe’s
“largest medical meeting”,
will take place 30 August –
3 September in Munich, Germany.
It will offer 300 hours
of scientific lectures over five
days of science featuring 360
official ESC scientific sessions
and nearly 3,000 poster presentations.
The main theme of this year’s congress is
cardiovascular imaging, recognizing the
advances in echocardiography, nuclear imaging,
cardiovascular magnetic resonance
and cardiac computed tomography, which
can provide comprehensive information
tion/documentation technology (13 %).
There were a lot of happy faces among
the exhibitors due to the high percentage
of decision makers among the trade visitors.
According to surveys carried out at
the trade fair, visitors were often (jointly)
responsible for investments: 93 % of visitors
are involved crucially, jointly or on an
advisory basis in purchasing and sourcing
decisions and 71 % of those asked also
have concrete purchase intentions. The
high amount of investments is also impressive,
which was also referred to here. 45 %
of the trade visitors asked wanted to invest
more than €50,000 and 17 % decided on an
investment volume of over €500,000.
The visitors rated TopClinica as very
positive, for 59 % the new trade fair will be
firmly established among medical events.
For 76 % of trade fair visitors, the visit to
the trade fair was worth it and 78 % would
recommend the event to others. There
were also happy faces among the partners
and exhibitors; they were impressed with
about the heart and the coronary arteries
from anatomy to function and perfusion. A
number of specific sessions will dedicated
to this theme. Subjects discussed and presented
at the congress will cover the whole
spectrum of cardiovascular disease and research.
Also during the event, ESC President
Prof. Kim Fox will hand over his current title
to Prof. Roberto Ferrari; the new Board will
be elected at the General Assembly.
This unique forum welcomes medical
professionals from all around the world to
meet in beautiful Bavaria, and to exchange
ideas and information in the field of cardiovascular
medicine: www.escardio.org/
congresses/esc2008/Pages/welcome.aspx.
MR
Europe’s most modern trade fair centre,
as well as the atmosphere in the trade fair
hall. Dr. Tobias Weiler, Head of the Medical
Technology Specialist Association with
Spectaris Industry Association, says: “For
our members it is important to enter into
dialogue with medical and commercial
clinic managers. TopClinica provides them
with the space for interesting and effective
discussions.” Hans-Peter Bursig, Managing
Director of the German Electrical and
Electronics Industry (ZVEI), confirms this:
“TopClinica will be watched very closely
by many companies who have not yet attended
the premiere, because the concept
is convincing. Each person who decided
to attend the event is aware that it needs
some time in order to establish itself.”
Many market leaders were also very positive
about the premiere at the new trade
fair grounds. Thomas Frauendiene, with
Erbe Elektromedizin, had the following to
say: “This event is suited to the industry
and has a good concept. An event of this
Make ‘Timely Triage’ a Reality
At this year’s ESC (European Society of
Cardiology) Congress – from 30 August to
3 September in Munich/Germany – Philips
will be demonstrating how it focuses on
the totality of cardiac treatment, and by
removing obstacles that hinder the best
of care, delivers innovations that help improve
patient outcomes. By combining
unique human insights with solid clinical
understanding Philips creates integrated
solutions throughout the entire cycle of
cardiac care.
One specific area of focus for Philips at
ESC 2008 is ‘timely triage’ – identifying new
symptoms in chronic patients before they
present. By diagnosing the more advanced
stages of disease in a timely manner, physicians
are able to begin treatment earlier,
Successful Premiere in Stuttgart: TopClinica 2008. Photo: MR
kind cannot be perfect straight off, yet, despite
this, the start was very good.” Kamran
Tahbazian, Marketing Director with Trumpf
Medical Systems, supports this statement
too: “Many customers who we had invited
to this trade fair came to Stuttgart. We car-
potentially improving the quality of patient
care. A wide range of Philips solutions –
from cardiograph and ECG management
systems to CT scanning with the Philips
Brilliance iCT scanner and cardiac MR,
combine to make ‘timely triage’ a reality.
At ESC 2008, Philips will also be unveiling
several innovative solutions to the
European market for the first time as well
as demonstrating how the company is delivering
on its promise to cut ‘door-to-balloon’
time for heart attack victims with the
HeartStart MRx Monitor/Defibrillator.
www.philips.com
ried out a lot of good and high-quality discussions.”
“The infrastructure of the new
Stuttgart Trade Fair Centre is perfect and
many important market participants were
here. The attendance at the stand, however,
was slightly lower,” added Michael Martin,
Managing Director of Gebrüder Martin.
The verdict from Claus Wiest, representative
for Rudolf Medical, was also a positive
one: “The organization here in Stuttgart is
great. The quality too is just right – with the
decision-makers that we had at our stand,
we were able to take part in intensive discussions.”
“At this new trade fair we had a
lot of space to make interesting contacts,
many visitors were impressed and will certainly
return,” stated Helmut Werner, Head
of Key Account Management with Storz.
Jörg Mans, Head of Product Management
with Richard Wolf, sums up what is surely
the opinion of many exhibitors: “The discussions
at our stand were good and we
had a wide range of decision-makers visit
us. We stand behind the concept, support
TopClinica, and will certainly be returning
again next year.”
www.topclinica.de
TopClinica 2009
trade Fair and congress for
Medical technology, Medical
Products and services, will take
place from 24 to 26 June at the
new stuttgart trade Fair centre.
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The test combines high-quality, replaceable
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www.imtmedical.com

Hospital Post Europe 04/08
Mölnlycke Health Care announced
the release of a second
best practice guideline
during the World Union of
Wound Healing Societies (WU-
WHS) Congress. The document,
“Minimising Pain at Dressing
Related Procedures”, is an educational
initiative from WU-
WHS supported by Mölnlycke
Health Care.
It is building on the first document released
by WUWHS in 2004 and contains
expert knowledge from world renowned
wound care specialists. The guideline is
for anyone involved in wound care and
provides an update of the latest scientific
findings as well as easy to overview pain
relieving strategies.
For patients suffering from chronic
wounds, pain has a major impact on their
quality of life. Pain is often perceived as
most intense during dressing changes. In
fact, 40 % of patients living with an ulcer
experience pain at dressing removal as the
worst side effect. “There is a clear need for
this best practice document. It can provide
answers to common questions within
wound care regarding how to measure and
alleviate wound-related pain during dressing
changes,” emphasized Keith Harding,
professor and Head of the University Department
of Wound Healing at Cardiff University.
Over the course of developing the
document, ten easy-to-overview consensus
statements emerged. All are based on
the opinion of a renowned international
The Ten Pillars
of Wound Care
1. Identify and treat the cause
of the chronic wound and
address concerns expressed by
the patient, including a pain
assessment at each visit
2. Evaluate and document pain
intensity and characteristics
on a regular basis
3. cleanse wound gently, avoid
the use of abrasive wipes and
cold solutions
4. select an appropriate method
of wound debridement and
include the potential for causing
wound-related pain
5. choose dressings that
minimize trauma/pain with
application and removal
6a. treat infections that may
cause wound-related pain and
inhibit healing
6b. treat local factors that may
induce wound-related pain
(e.g. inflammation, trauma,
pressure, maceration)
7. select an appropriate dressing
to minimize wound-related
pain based on wear time,
moisture, balance, healing
potential, and peri-wound
maceration
8. Evaluate each patient’s need
for pharmacological (topical/
systemic agents) and nonpharmacological
strategies to
minimize wound-related pain
9. Involve and empower patients
to optimize pain management
10. Healthcare providers should
ensure wound-related pain
control for every patient
MEdIcAL tEcHnoLoGY 11
Minimizing Pain at Dressing Changes
Best Practice Document on Pain
expert working group from several clinical
disciplines. In order to alleviate pain at
dressing change, two of the ten statements
focus on appropriate choice of dressings.
This involves not using dressings with aggressive
adhesives that can cause pain to
the patient and trauma to the wound or
peri-wound skin.
According to the document, dressings
with soft silicone adhesive technology,
such as Safetac technology, have proven in
several studies to be less painful, before,
during, and after dressing changes compared
to other advanced dressings with
traditional adhesives. “Mölnlycke is always
striving to advance knowledge within the
field of wound care. The best practice document
is an important tool to raise awareness
of pain at dressing changes. We felt
that there was an urgent need for a new set
of guidelines surrounding dressing changes
and are happy to support the initiative,”
PORTABLE EXTENDED CIRCULATORY SUPPORT
THE ELS SYSTEM FROM MAQUET
A lifesaver also in the event of cardiogenic
shock: The Emergency Life Support (ELS) System
from MAQUET Cardiovascular is able to offer
more than sufficient support in case of cardiac
failure, but thanks to its oxygenator, it can also
ensure an adequate oxygen supply even in the
case of distinct right ventricular infarction. The
new ELS System from MAQUET Cardiovascular,
with the 14 day CE certification, is designed to
said Katriina Öberg, International Product
Director, Mölnlycke Health Care.
Each of the ten consensus statements
are followed by an overview of scientific
evidence supporting them. In addition,
readers will find practical tools and tips
that can be used to measure pain. These
include pain assessment scales and pain
monitoring tools. Since pain can vary over
time, it is important to measure it continuously.
“Since the WUWHS congress gathers
treat and transport patients needing longer term
respiratory and/or circulatory support. With the
ELS System, MAQUET is providing an effective,
reliable and safe solution for stationary and
transport applications. Products from MAQUET
Cardiovascular are the result of innovative engineering
and extensive clinical experience.
MAQUET – The Gold Standard.
leading experts from all over the world,
this is an optimum time for the release of
the best practice document. Hopefully it
will be shared and read among healthcare
practitioners as well as other caregivers
and patients,” outlined Harding.
www.molnlycke.com
MAQUET Cardiopulmonary AG
Hechinger Straße 38
D-72145 Hirrlingen, Germany
Phone: +49 (0) 7478 921-0
Fax: +49 (0) 7478 921-100
info@maquet-cp.com
www.maquet.com
MEMBER OF THE GETINGE GROUP

12 MEdIcAL tEcHnoLoGY
Hospital Post Europe 04/08
Therapeutic decisions are
based on a widely generalized
patient model that rests on
broad, physiological, pathophysiological
knowledge derived
from studies. This model
forms the basis for therapeutic
guidelines. However, the individual
status parameters of a
patient – such as anomalies in
anatomy, physiology, metabolism,
or genetics – can rarely
be taken into account with
such a generalized therapy
model. Examples from operating
practice indicates, however,
that a stronger consideration
of individual patient
factors leads to significantly
higher success rates and lower
costs for post-surgery treatment.
Prominent authors and
members of the German Association
of Biomedical Engineering
(DGBMT) in the VDE
have published a book on
Every Patient Is Different
Individualized Medicine Improves Quality and Reduces Costs
“model-facilitated therapy”.
The book’s German title is
“Modellgestützte Therapie”
and it is now available from
the DGBMT.
In diagnostics, all quantitative and qualitative
information of a patient is compiled
in order to generate the most realistic, yet
abstract, patient model possible. For therapeutic
planning, this model is currently
interpreted according to evidence-based
medicine, and operative therapies are derived
with the help of the prescribed guidelines.
Consideration of patient-specific and
individual characteristics is only possible
to a limited extent with such a procedure,
and is heavily dependent on the surgeon’s
expertise and experience.
Model-Facilitated Therapy
In contrast, the concept of model-facilitated
therapy (MFT) is based on a highly
individualized, patient-specific model that
takes into account, a priori, all of a pa-
tient’s individual factors during surgery.
All patient data – derived from data bases,
evidence-based medicine, epigenetic information
and electronic patient files – is
networked and made available to the surgeon
in real time and fitting the specific
phase of the surgery. By implementing
and networking technologies and ensuring
their embedding in an IT environment
within the operating room, it is possible
to provide a maximum of patient-specific
data during an operation, and to select and
interpret this data for the surgeon so the
procedure can be individually adapted to
the situation.
Improved Quality and Lower
Costs
With the interoperative use of digital reconstruction
technologies and concepts
of “enhanced reality” – that is, the virtual
visualization and interpretation of anatomic
and functional structures – the DGBMT
believes the quality of results in many interventions,
such as in endoprothetics or in
Hybrid OR’s for Minimally Invasive Procedures
At the SVS Vascular Annual
Meeting Royal Philips
Electronics and Skytron announced
a partnership to deliver
hybrid operating rooms
for minimally invasive cardiovascular
surgical procedures.
The solution combines Philips’
cardiovascular X-ray systems
with Skytron’s surgery room
equipment to enable clinicians
treat cardiovascular patients
in the same room.
Increasingly, clinicians require more versatile
environments that enable them to
carry out complex minimally invasive interventions.
By working together to tailor
solutions to meet each customer’s needs,
Philips and Skytron will deliver operating
rooms that optimize workflow whilst reducing
the length of the planning and installation
process. As a result, clinical staff
will benefit from a more tailored and intuitive
environment that has the potential
to reduce costs for the care provider and
decrease the amount of time the patient
spends in the hospital.
“By working together with Skytron we’re
able to provide hybrid operating rooms
that offer flexibility along with easy to operate
equipment in a room with optimal
layout,” said Bert van Meurs, senior vice
president of cardiovascular X-ray, Philips
Healthcare. “As a result, the amount of
time clinicians spend worrying about technology
is reduced, enabling them to spend
more time focusing on the patient.”
“The hybrid room solution from Skytron
and Philips combines excellent medical
equipment and information solutions,
together with our experience in delivering
turn-key hybrid operating rooms,” commented
David M. Mehney, President & CEO
of Skytron. “By delivering a well-planned
and coordinated design that puts flexible
solutions at the fingertips of healthcare
providers we’re able to improve workflow
and ultimately increase the utilization of
the operating room.”
Philips will provide interventional X-ray
equipment and specialized imaging tables,
whilst Skytron will deliver advanced operating
room communications control integration,
and surgical lighting and boom
technologies specifically designed to support
hybrid surgical suites. As a result, care
providers will be able to carry out a wide
range of image-guided interventional radiology
procedures including cardiovascular,
vascular & cardiac surgery, neurosurgery,
and orthopedics.
Skytron and Philips will work together
across North and South America, including
Latin America and Canada.
www.medical.philips.com
cardiac surgery, can be further improved.
The service life of various hip prostheses,
for example, depends on how precisely
anatomic or individual muscular influences
are considered when positioning the implant.
Today, around 10% of all implants are
corrective surgery due to material wear. By
linking digital, patient-specific models with
navigation systems, one can optimize the
adjustment and positioning of prostheses,
extend their service life, and reduce the
number and costs of corrective surgery.
In cardiac surgery, 3-D models can be prepared
prior to surgery with telemanipulators
in endoscopic procedures, and the patient’s
individual anatomic structures can
be made visible to the surgeon. With this
method, target structures such as stenoses
or risk areas can be better identified.
The Future Of MFT
In the framework of projects supported
by the German Ministry for Education and
Research – such as the Preventative Micromedicine
Project (PMM) and the othoMIT
Project (www.orthomit.de) – and in the
Telemedicine Committee, the DGBMT is
working to further develop model-facilitated
therapy as a method for improving
the quality of medical results. Since the
networking of individual technological solutions
is a prerequisite for developing an
overall diagnostic and therapeutic concept,
the interoperability of various technologies
is a focus of the work. The DGBMT brings
together national and international experts
from medicine, the sciences, and industry
for this purpose.
www.vde.com
Correcting Spinal Deformities
DSM Dyneema and University Hospital
Maastricht collaborate.
Combining the materials technology
of DSM Dyneema with the clinical expertise
of the university, this project aims to
develop new solutions that support the
trend toward minimally invasive procedures
as well as the need for preservation
of mobility. The project team will focus on
leveraging Dyneema Purity, an Ultra High
Molecular Weight Polyethylene fiber offering
maximum strength and minimum
weight, to enhance post-operative mobility
and quality of life for surgery patients as a
result. Furthermore, the high strength-toweight
ratio of Dyneema Purity enables device
miniaturization to support minimally
invasive surgical techniques that promote
faster recuperation and reduced scarring.
Dr. Lodewijk W. van Rhijn, orthopedic
surgeon at the University Hospital Maastricht,
explains, “The dynamic nature of
cable constructions made with Dyneema
Purity enable preservation of mobility as
well as fixation. This combination of properties
opens-up numerous possibilities
for improvements of surgical techniques
and devices. The results of the project are
expected to allow me to improve the patient’s
quality of life.”
The research agreement has initially
been set for one year. Both organizations
have expressed willingness to continue the
project over a longer term once the results
in the first year support such continuation.
Development of an actual prototype device
will take several years.
Dyneema Purity fiber is 15 times stronger
than steel on a weight-for-weight basis.
It provides a high level of stiffness and resistance
to fatigue and abrasion. This material
has successfully been independently
tested for cytotoxicity, sensitization, irritation,
and mutagenicity.
www.dsm.com
New CAD System in Fontana Women’s Hospital, Chur, Switzerland
The Fontana Women’s Hospital
in the Swiss town of
Chur installed a Digital Mammography
CAD System from
Carestream Health in June
2007, since when it has successfully
been in full clinical
operation.
“My experience up until now shows that
the Carestream CAD System is a significant
step forward in the diagnosis of breast cancer,”
said Dr. Gerold Reutter, leading physician
in Radiology, Fontana. “The digital
mammograms clearly outclass traditional
images in terms of detail resolution, making
our findings more reliable. Furthermore,
it is a well developed system and
through regular updates it keeps pace with
changes and remains state of the art technology
in computer based diagnostics.”
Images are captured using a Kodak Directview
CR 975 System and displayed on
a high-resolution mammography workstation.
The CAD System highlights suspicious
areas on the monitors with triangular
and star shaped markers. “With these tags,
the CAD system shows me points of potential
interest,” comments Dr. Reutter. “The
triangles clearly indicate the micro calcifications;
the star shaped marks indicate
denser soft tissue relative to the surrounding
tissue structure. We know that there is
a high correlation between the preliminary
stages of carcinoma and the formation of
a micro calcium group of 5 calcifications/
cm 2 . The CAD System from Carestream
Health highlights such a group and this
helps us in our diagnosis. The accuracy of
findings is very high.”
Dr. Reutter also finds image quality to
be better when compared to conventional
mammography with improved contrast,
Carestream’s CAD
System highlights
suspicious areas
on the monitors
with triangular
and star shaped
markers.
detail and resolution and that by comparison,
conventional images have a blurred
and dull effect. The once indispensable
magnifying lens is also now no longer
needed at the workstation with the ability
to enlarge part of the image marked by the
CAD system.
Digital mammography not only enhances
the reliability of diagnosis, it also provides
workflow benefits. For example, the
highly developed, integrated speech recognition
system enables the direct recording
of findings and automatic conversion
into written text files. All the image data is
downloaded and stored for instant recall
and can also be printed or sent via e-mail.
www.carestreamhealth.com

Hospital Post Europe 04/08
MEdIcAL tEcHnoLoGY 13
Mild Therapeutic Hypothermia in Post Resuscitation Care
Investment into New Treatment Options Saving Money?
Persistent coma is a common finding
after cardiac arrest and has profound
ethical and economic implications. Recent
randomized controlled trials demonstrate
that therapeutic hypothermia
is highly effective in improving the
neurological outcome in patients after
cardiac arrest.
In 2003 the International Liaison Committee on Resuscitation
(ILCOR) recommended this treatment for
all comatose survivors of out-of-hospital cardiac arrest
due to ventricular fibrillation. Unfortunately, current
surveys have confirmed that only a minority of hospitals,
to date approximately 40%, have implemented
mild therapeutic hypothermia as a routine procedure
after cardiac arrest - although the ILCOR recommendations
had already been presented in the year 2003. The
reasons are manifold, and vary from the low number of
patients after cardiac arrest per year in small hospitals,
fear of side effects, as well as the concern of additional
costs.
The 21 st Annual Congress of the European
Society of Intensive Care Medicine
(ESICM) will be held in Lisbon, Portugal
on 21 to 24 September. This congress
is likely to be the biggest critical
care meeting taking place in the world
this year, according to organizers. Over
three days, it will feature ten parallel
sessions with over 800 lectures, presentations,
debates, round table discussions,
tutorials and interactive educational
sessions. Invited speakers are
all well-known international experts
in their field, and organizers anticipate
having a faculty of over 220 speakers.
Presentation of original research is
one of the priorities of this series of
congresses, and over 1,200 abstracts
have been submitted to the meeting.
Many of these will be presented in
either oral or poster format to congress
registrants. This combination
of thematic presentations, education,
discussion and debate of new data is
an intoxicating mixture that will make
the congress an event that should not
be missed.
Lisbon lies lazily on the Tejo river, very close to the
Atlantic coast, near the history and the beauties of
Estoril, the fish restaurants of the little fisherman’s village
of Cascais or the green and wild landscapes that
inspired Byron in Sintra. Historically, Lisbon was the
European hub of commerce with Africa, the Far East
and Brazil. The city today remains stunning, a prior
“Cultural Capital of Europe”. Add to that its multicultural
diversity, where Africa, South America and Europe
mix in complex sounds and tastes, the laid-back feel and
architectural time warp, and you have one of the most
enjoyable cities in Europe. To recognize Lisbon’s tradition
of discovery and integration of diverse cultures
as well as the joys of learning from different points of
view, this meeting has been designed around a number
of key controversies pertinent to Critical Care. These
will be presented in a series of debates that will run
through the meeting.
The objectives of this meeting are to update clinicians,
nursing staff, allied health professional and in-
However, one of the major problems is obviously the
reimbursement for hospitals applying mild therapeutic
hypothermia therapy in patients after cardiac arrest. In
many countries a diagnosis related group (DRG) classification
system was introduced for funding of treatment
costs. A case-based lump sum has to cover the
main therapy costs and all additional treatment costs
with only little possibilities for expansion. In Germany,
for example, the application for an auxiliary income for
hypothermia treatment after cardiac arrest was rejected
by the regulatory authority in 2007.
A key factor in reimbursement in ICU patients is the
duration of mechanical ventilation; however, increased
profits due to long-time respirator therapy are often
associated with further complications and higher total
costs. Furthermore length of ICU stay (ICU-LOS) has
been identified as a major determinant of total treatment
costs after survived cardiac arrest. Therefore
the correlation between the use of mild therapeutic
hypothermia and respirator treatment as well as ICU-
LOS has now been investigated by the hypothermia
research group of the Charité hospital in Berlin. With
regard to the current ILCOR recommendations, a pro-
spective observational hypothermia treatment group
(n=52) was compared to historical controls (n=74)
after out-of-hospital cardiac arrest. Therapeutic hypothermia
was identified in univariate testing as the main
variable for significantly reducing respirator time and
ICU-LOS in survivors after cardiac arrest. A multivariate
regression model for the subgroup of survivors identified
hypothermia treatment as an independent predictor
of shorter ICU-LOS.
In contrast to these findings there was no statistically
significant difference regarding ICU-LOS in patients
who died during ICU stay. However, hypothermia
treatment was associated with significantly improved
neurological outcome assessed by CPC and a significantly
higher probability for 365-day survival in Kaplan-
Meier analysis.
From a medical viewpoint, the positive effect on
neurological outcome caused by hypothermia treatment
has been confirmed by this study and is a great
benefit for the patients. Regarding the economic aspect,
the reduction of costly ICU-LOS when using hypothermia
treatment in patients after cardiac arrest
seems to be a possible tool and motivation to broaden
Controversies In Intensive Care
ESICM Congress in Lisbon
dustry partners on all the relevant and recent data and
changes that pertain to critically ill patients and emer-
gency medicine. The focus is
not only on patient management
decisions but also on
organizational and management
topics that are important
in this area. Prior to the
congress beginning, there
will be a number of postgraduate
courses. These will
include a refresher course
designed to update on all relevant
subjects. This course
will be best suited to anyone
thinking of taking the European
Diploma in Intensive
Care or other ‘more senior’ parties wanting to refresh
themselves on a broad number of topics. Postgradu-
the implementation of mild therapeutic hypothermia.
Although the actual costs and cost reduction have not
been calculated in this study, a reduction of ICULOS
followed by a faster discharge from ICU to intermediate
care or other levels of lower care is obviously a
financial benefit for the hospital. Therefore financial
investment into a cooling device may result not only in
the improved patient outcome but also in reduction of
costly ICU-LOS. An encouraging parallel between patient
improvement on a high level of health care and
cost effectiveness for the hospital seems to be found in
the field of post resuscitation care and now only has to
be implemented.
References are available upon request.
Contact:
Dr. Christian Storm, MD
Charité-Universitätsmedizin
Berlin, Germany
Campus Virchow-Klinikum
Department of Nephrology and Intensive Care
Medicine
christian.storm@charite.de
ate courses on trauma, sub-arachnoid haemorrhage,
patient safety, chronic obstructive pulmonary disease
and asthma, echocardiography and the microcirculation
will also be hosted.
Lisbon is the city for fado, funiculars, feasting and
frolicking and remains one of the cheapest cities in
Europe. Good fish and fresh seafood can be found
just steps away from the traditional fisherman, cooked
in thousands of small familiar restaurants. Organizers
invite readers to attend the 21 st annual congress in
Lisbon which will offer both an enjoyable and exciting
scientific program, together with an entertaining social
and cultural spectacle.
Andrew Rhodes, London
Rui P Moreno, Lisbon

14 MEdIcAL tEcHnoLoGY
Hospital Post Europe 04/08
Tumours and certain inflammatory
conditions can lead to tissue hardening
and loss of elasticity. Assessment
and visualization of elasticity can provide
potentially vital information for
disease diagnosis. Hitachi’s Real-Time
Tissue Elastography (HI-RTE) module
uses an extended combined autocorrelation
methodology to produce an
elasticity image in real time.
Clinical evaluation of the modality has shown that lesions
can be characterized more rapidly and with a
higher degree of accuracy when elastography is built
into the conventional examination. In breast applications,
HI-RTE has been shown to improve both the
accuracy in differentiating between benign and malignant
tumours (especially if smaller than 1 cm), and
specificity compared with US BIRADS classification, for
benign lesions. As a result, elastography can reduce the
biopsy rate in atypical cysts, and may suggest appropriate
workup for cancers with atypical presentation.
Hospital Post Europe spoke with Dr. Anke Thomas,
Head of the Gynaecological Ultrasound Research
Labor atory, Charité Berlin/Germany, about her experiences
in this field.
Hospital Post Europe: Please describe the technical
and methodological approach of elastography.
What are the advantages of this technique?
A. Thomas: Aside from B-image diagnostics and
Doppler sonography, sonography includes the option
of elastography. It can be carried out with the same
Relying On Ultrasound
Russell McLaughlin, Consultant in Emergency Medicine
at Ulster Hospital in Belfast, Northern Ireland, is relying
on ultrasound for a wide variety of applications in
the emergency department. “We have become quite
dependent on ultrasound imaging in emergency medicine,”
the consultant explained. “I use it daily, mainly
for assessing trauma patients or looking for abdominal
aortic aneurysms. I also use ultrasound to identify soft
tissue abscesses, hip effusions, pulmonary oedema, and
deep vein thrombosis, for placing lines, and for performing
bedside echocardiography. In fact, I’d rather
go to work without my shoes on than without the ultrasound
machine!”
McLaughlin also teaches on a number of emergency
ultrasound courses throughout Europe that frequently
depend on the SonoSite MicroMaxx hand-carried ultrasound
systems to give the attendees good hands-on experience.
“The SonoSite systems are very portable, robust,
and user-friendly, with good image quality, which
are particularly important features in emergency medicine.
I know straightaway where to find critical controls
such as gain and depth. The uses of these systems are
endless – the more I use ultrasound the more applications
I seem to find for it!”
www.sonosite.com
Supporting More Precise Diagnosis
HI-RTE Delivers Results in Elastography On-line
Dr. Anke Thomas, Head of the Gynaecological
Ultrasound Research Laboratory,
Charité Berlin
transducer and requires no extra effort. Elastography
means that elasticity of tissue can be measured. This is
done by relating pressure to the resulting elongation
of the tissue. In other terms – how much pressure is
required to deform a specific tissue. Tissue is subject
to changes – for reasons such as age, inflammation, or
tumours; these modifications are made apparent by
elastography, supporting the diagnostic process.
Due to the fact that this approach is rather new regarding
convenient use in practice, elastography still
needs to be evaluated scientifically. Studies correlating
the method with histology are available. The question
is, will the application of elastography in acquiring a
diagnosis add certainty in decision making.
Transcranial Doppler Device to Detect Brain Injuries
A new portable Transcranial Doppler
(TCD) device from Multigon Industries,
featuring Sabic Innovative
Plastics’ LNP Faradex compound, provides
a new way to detect unseen, yet
traumatic, brain injuries in the field
– whether a football field or a battlefield.
The Neurovision 500P pocket
TCD, with electromagnetic/radio frequency
interference (EMI/RFI) shielding
provided by LNP Faradex compound,
makes it easier for doctors and
other medical personnel to evaluate
a potential brain injury on site, possibly
improving outcomes from head
injuries through early diagnosis and
intervention.
Before the use of TCD technology, assessing a possible
brain injury in the field was an inexact process:
ask questions; check speech patterns; look for dilated
pupils. However, lacking these clues and access to a CT
scan, an injured athlete or soldier might be sent back
into action instead of receiving treatment. To meet the
need for a highly precise yet highly portable diagnostic
tool, Multigon developed the handheld Neurovision
500P device. The company sought a solution for the
housing that would offer shielding yet help keep costs
down to spur wide adoption and minimize weight for
maximum portability.
The Neurovision TCD requires EMI/RFI shielding
to prevent interference that could impair its performance.
Multigon turned to Sabic Innovative Plastics to
find a cost-effective and lightweight shielding solution
for the housing. Traditional plastic using a copper overspray
is expensive, labor-intensive, and may result in
uneven application that can affect performance. The
company supplied LNP Faradex DS 1003 FR HI com-
What is special about Hitachi’s Real-Time Tissue
Elastography?
A. Thomas: There are various approaches to elastography
differentiated, e.g., by off-line or real-time analysis
of data. Off-line analysis required more time, and
can only be evaluated after the patient exam, making
it harder to integrate the method into clinical routine.
The method of real-time elastography, developed by
Hitachi, allows to assess elasticity, in unclear findings
in focuses or tissue types, just by adding this option
at the ultrasound device. The usual B image is dyed,
as with colour dopplers, and the various defined colours
relate to a certain density of the tissue. Soft, easily
compressed tissue is coloured red, tissue which is hard
to compress is dyed blue. This image, acquired in real
time, instantly provides additional information.
For which symptoms can the technique be
used?
A. Thomas: Until now, it has been applied in various
studies to the mamma, cervic, liver, thyroid, and prostate.
What is of particular interest is the breast exam:
When a woman with an unclear finding from palpation
sees a physician, he/she will first palpate, and then
offer an ultrasound of the breast. Elastography can be
provided instantly, by way of the colour codes in the B
image. This way, to the diagnostic process to ascertain
focus findings – benign, suspicious, highly suggestive
of malignancy (BI-RADS) – in the B image, elastography
can be added as an additional criteria. Studies have
demonstrated that elastography lends itself, in particular,
to increase certainty in unclear focus findings, for a
posite, a polycarbonate-based material infused with
stainless steel fibers. By avoiding the secondary metalspraying
operation, LNP Faradex compound reduced
manufacturing costs while delivering equivalent or better
shielding performance.
Improved Performance
“We initially used a copper overspray to provide shielding
for the Neurovision housing,” said William Stern,
vice president, Multigon Industries. “However, the
time and labor associated with spraying added a significant
amount to the cost of producing the housing. We
also were concerned about inconsistencies in the application
that could impact performance. By working
with Sabic Innovative Plastics, we found a much better
solution that not only cut our costs by 60 percent,
but also provides uniform shielding performance. LNP
Faradex compound helps us keep costs down to drive
adoption of the Neurovision 500P.”
benign/malign diagnosis. If, e.g., a focus in the mamma
is presented as green, or medium hard, this correlates
with a benign diagnosis (e.g. a fibroadenome). If the
focus finding shows significant blue colour – meaning
the focus cannot be compressed – this supports
a malignity diagnosis (mamma carcinoma), requiring
validation by punch biopsy.
What are the future perspectives for the application
of this approach?
A. Thomas: One of the benefits we expect is a
more precise diagnostic distinction between benign
and malign tumours – e.g., an exam being sufficient
in benign cases, requiring no further histological
validation. This would save cost and provide instant
reassurance of patients. In order for this diagnostic
method to be considered safe, additional evaluation
is needed.
A kind of CAD (Computer Aided Diagnosis) system
may also be an option – in diagnosing a focus, elastography
is applied, with automated indication of the category
which determines whether the tumour is benign
or malign. This means that a large number of studies
needs to be carried out, with the aim of standardizing
focus findings in elastography, and integration into
existing diagnostics.
Contact:
Priv.-Doz. Dr. Anke Thomas
Head of the Gynaecological
Ultrasound Research Laboratory
Charité Berlin, Germany
Tel.: +49 30 450564172
www.uslab-charite.de
The Neurovision 500P TCD Device’s Housing is Shielded with LNP Faradex Composite
from SABIC Innovative Plastics.
The new system opens up new possibilities for TCD
exams and patient care. Its small size, portability, and
full feature set, as well as low cost, make it a perfect diagnostic
tool for any setting. Intuitive and convenient
one-handed operation helps clinicians conduct exams
accurately and efficiently. Completed studies are stored
on removable flash cards and transferred to a personal
computer for post-processing and patient report generation.
By using a complete range of Doppler probes,
the Neurovision 500P can be used for transcranial, carotid,
and peripheral Doppler analysis.
LNP Faradex DS 1003 FR HI compound leverages
stainless steel fibers to provide enhanced shielding
performance without the need for secondary metalcoating
operations. It also provides flame retardance
that supports requirements for elimination of halogenated
additives, as well as high impact resistance performance
and low shrinkage.
www.sabic-ip.com

Hospital Post Europe 04/08
“Control
Inside”
Aimed at all those involved
in the field of radiological
science and attracting around
3,000 delegates annually, the
2008 UK Radiological Congress
(UKRC) brought together professional
medical and industry
delegates at the NIA, ICC, and
Austin Court in Birmingham at
the beginning of June.
Matrox display controller boards were demonstrated
by partners at UKRC’s technical
exhibition, close to 100 companies in total.
Well-represented within PACS solutions
throughout the show floor, the vendor’s
products were found inside numerous
workstations including those from Carestream
Health and Sectra. Carestream
Health chose the company’s AuroraVX
Series to drive the triple-display RIS/PACS
workstation in their booth, while Sectra
chose the MED Series to drive their 5-megapixel
mammography workstation.
Display partners and integrators of
Matrox were also present at UKRC 2008,
including Eizo, NEC, Richardson Electronics,
Hospital Services/Taramed, and Parity
Medical. Eizo bundles MED, RAD, and
AuroraVX Series with RadiForce panels
and featured MED5mp driving the Eizo
RadiForce GS520. This 5-megapixel display
was designed for displaying mammography
images and features the smallest pixel
size (0.165 mm) amongst current medical
monitors of the company, providing highdefinition
and high-density display without
shadings appearing granular.
NEC showed Matrox TheatreVUE in their
booth, which is designed to clone the entire
main display or any portion of it onto a second
display or projector. The company’s
demonstration convinced UKRC visitors
that radiology images displayed on a NEC
grayscale display running at 2560 x 2048
may be viewed at a distance in an educational
theatre or meeting room environment,
using the NEC LCD6520 DICOM preset
65” display running at 1920 x 1080 resolution
(2.1 MP). Products of Parity Medical
include mobile carts which can be configured
to carry multiple monitors as well
as fixed and variable height wall-mounts.
Their solutions are designed to allow clinicians
in all areas of the hospital (including
Radiology, Clinics, Recovery, and Theatres)
to access including PACS.
A unique combination of displays from
top manufacturers including Image Systems,
NEC, and Planar, plus mounting
solutions, specialized imaging hardware,
and peripherals is offered by Richardson
Electronics. A variety of Matrox solutions
are offered within their integrated systems
and the company’s boards were driving
the majority of their displays at UKRC.
Taramed Distribution carries medical
display from a variety of manufacturers
including Totoku and MeDiSol (a division
of Rein EDV), available bundled with
Matrox display controller boards including
MED3mp and MED5mp. Monitors on
display at UKRC included the new MS51i2
5-megapixel display equipped with ISV (Independent
Sub-pixels Drive) technology.
www.matrox.com
MEdIcAL tEcHnoLoGY 15
Science – “A Diplomacy of Trust“ – Symposium Heidelberg-Israel, Science and Culture
The German Cancer Research Centre
(DKFZ), the city of Heidelberg, and the
University, as well as the Higher Education
Institution for Jewish Studies located in the
city organized, mid-July, a symposium as
part of the German-Israeli Year of Science
and Technology 2008. Insights in cancer research
were at the top of the agenda.
“Contacts in Academia had paved the
way, fifty years ago, for diplomatic relations
between Israel and West Germany;
they form a cornerstone of these relations
until today,” organizers explained: the city
of Heidelberg and research institutions
.artundwork designbüro
located there made significant contributions.
The event served to commemorate
the 25-year anniversary of the jumelage
with Rehovot, which is home to the wellreputed
Weizmann Institute of Science.
Since 1983, the University of Heidelberg
entertains a partnership with the Hebrew
University in Jerusalem, and there has
been scientific co-operation in the field of
cancer research for more than 30 years.
The symposium, opened with an address
by Germany’s Federal Research
Minister Dr. Annette Schavan, presented
– besides topics from, e.g., Hebrew lit-
Hitachi Real-time Tissue Elastography:
Discovering
with all senses.
Hitachi Real-time Tissue Elastography (HI-RTE)
HI-RTE is an emerging ultrasound modality for the
assessment and real-time colour display of tissue
elasticity. The value of this 2nd generation ultrasound
modality has been proven in a variety of different
clinical areas, including breast, urology, endoscopy
and many more.
Hitachi Medical Systems Europe Holding AG · Sumpfstrasse 13 · CH-6300 Zug
www.hitachi-medical-systems.com
Hitachi Medical Systems Europe Holding AG · Sumpfstrasse 13 · CH-6300 Zug
www.hitachi-medical-systems.com
erature, archaeology and environmental
physics – current knowledge in oncology
research. Prof. Dr. Dr. Wolfhard Semmler,
DKFZ, gave an overview of the German-
Israeli scientific co-operation in oncology;
a keynote lecture on “Adhesion, migration,
and cancer metastasis” was held by Prof.
Dr. Benny Geiger, Weizmann Institute, and
Prof. Dr. Varda Rotter of the same Institute
spoke on “Tumour suppressor gene p53 –
our cell guardian”.
MR
This unique HI-RTE modality...
· Extracts strain data ensuring that quantitative measurements are
available from the Strain Ratio tool
· Is easy to perform, fast, accurate and reproducible
· Incorporates an adjustable colour transparency feature, enabling
instant correlation between the native B-mode and elasto image
· Is available for the new range of HI Vision platforms
Germany’s Federal Research
Minister Dr. Annette Schavan
speaking with Ilan Mor, Deputy
Ambassador of the State of
Israel, as well as keynote
speaker and literature expert
Prof. Dr. Anat Feinberg, College
of Jewish Studies
Photo: courtesy DKFZ

16 MEdIcAL tEcHnoLoGY
Hospital Post Europe 04/08
In April, the Luxexpo Exhibition
and Congress Centre in
Luxembourg was host again
to the international Med-e-
Tel meeting. In its sixth edition,
and with a proven track
record of highly efficient and
effective networking, Med-e-
Tel attracted a qualified audience
of 500 telemedicine and
e-Health industry representatives,
association executives,
government officials, healthcare
providers, payors, insurers,
and researchers from 54
countries around the globe.
Telemedicine and e-Health are all about
making healthcare delivery more efficient
and effective and to cope with some of the
challenges laying ahead, such as the ageing
of the population, the rise in chronic conditions,
the shortage of healthcare professionals,
and the healthcare budgets. The
development and implementation of telemedicine
and e-Health tools – because that
is what they ultimately are – requires good
coordination and mutual understanding
between all parties involved (patients, citizens,
care providers, government, health
insurers, industry, research), so that the
tools can be implemented and used in the
most optimal way. Med-e-Tel ’08 attendees
agreed almost unanimously that this is
indeed where the meeting serves a great
networking purpose and acts as a catalyst
Flat-panel technology takes
the centre stage of several
medical exhibitions this year.
Being a technological pioneer
within the mobile imaging
business, Ziehm Imaging
presents the mobile C-arm
Ziehm Vision RFD, which offers
significantly more benefits
compared to a common
C-arm.
On top of the generously proportioned
flat-panel detector, the system also offers
a powerful generator with intelligent pulse
technology and continuous pulsing – even
for real-time imaging. From this technology,
as well as from dose savings resulting
from it, not only patients will benefit but
also the OR personnel.
With its impressive C-arm opening of
nearly 90 cm, the Ziehm Vision RFD offers
easy handling in the OR. Numerous exhibition
attendees have already been convinced
the uncomplicated way of handling during
hands-on testing. The market launch of this
highlight product is expected at the end of
the year. This C-arm has deliberately been
formed “the mobile intervention suite” as
it opens up new application fields within
interventional radiology, vascular surgery,
and general radiology.
Besides the technologically outstanding
flat-panel detector, other topics such
as workflow optimization and user-friendly
handling play a big role, too – especially
Catalyst Between Various Stakeholders
Med-e-Tel 2008
between the different stakeholders, providing
opportunities to share experiences,
demonstrate technologies, and convey
user needs among people with many different
backgrounds and from many different
places.
Participants were welcomed in an official
opening ceremony by Mars Di Bartolomeo
(Luxembourg Minister of Health), Prof. Dr.
Michael Nerlich (President of the International
Society for Telemedicine & eHealth),
Pierre Gramegna (Director General of the
Luxembourg Chamber of Commerce),
Nick Fahy (Head of Unit, Health Information
Unit, DG Health and Consumer Protection,
European Commission) and Prof.
Giuseppe Tritto (President of the World
Academy for Biomedical Technologies).
Following the opening ceremony and a
tour of the exhibition, a keynote session,
chaired by Frank Lievens, Secretary of the
International Society for Telemedicine &
E-Health, featured eight opinion leaders
who shared their views and experiences on
Mobile Imaging
Current Situation And Trends
when it comes to technologically comparable
systems. Martin Herzmann (Director
Global Marketing at Ziehm Imaging): “In
our opinion, intuitive touchscreens and
workflow-oriented programs which adapt
to the requirements of the surgeon and the
OR team have achieved acceptance in the
market. The OR staff should not be forced
to adapt their workflow to a machine but
the machine should be flexible and intuitive
so that it suits the daily routine in individual
OR set-ups.”
The company aims to render usability
as easy as possible in order to allow for
maximum patient orientation. The fewer
buttons the user sees and has to learn, the
easier the handling of the systems will be.
This means in no case that functionality
will be limited.
Ziehm Imaging strives persistently to
integrate the continuously increasing demands
in X-ray-based imaging into one
simple user interface, e.g. with 3-D imaging:
This technology is applied in specific
indications which are not necessarily daily
routine. 2-D imaging still is the standard
application in X-ray-based surgery. This is
the reason why the user interface for 2-D
will show only those buttons that are relevant
and of use during the application. As
soon as 3-D imaging is activated (a function
which can be upgraded optionally with the
standard C-arms of Ziehm Imaging), the
user interface will change accordingly and
the workflow-oriented software will guide
the user through the 3-D image data ac-
a number of current issues and initiatives,
several of which were discussed further in
more detail throughout various sessions of
the three-day conference programme.
Med-e-Tel offered an extensive conference
program which featured an additional
150 presentations and workshops on a
wide variety of Telemedicine and e-Health
topics. Some of the program highlights
were:
A session on product interoperability
architecture.
Extensive focus on personal telehealth
applications, experiences and research
in various sessions dealing with telehealth
for chronic disease management,
telehealth, telecare and services for the
ageing, and telehealth in support of self
care.
An overview of international telemedicine
and e-Health initiatives and developments
by members of the International
Society for Telemedicine &
eHealth (ISfTeH), focusing on the current
state of telemedicine and e-Health
in, e.g., Austria, Brazil, Finland, France,
Georgia, Hungary, Poland, Russia, South
Africa, Switzerland, and Ukraine.
A mini symposium on telenursing.
Also a session on nursing informatics.
A session on e-Health for developing
countries and low-resource settings.
On a related subject, there was also a
special training session on “how to develop
and implement e-Health and telemedicine
solutions”.
quisition process. This combination of 2-D
and 3-D imaging with intelligent workflow
orientation is very much respected and
appreciated by customers and users of
products from the well-renowned German
manufacturer, and much positive feedback
is received.
Last but by no means least comes the
“dose” topic. This is a radiological issue
that Ziehm Imaging deals with actively:
The ODDC technology, which has been
developed by the company, enables dose
savings up to 60 % (“Influence of Grid
Control and Object Detection on Radiation
Exposure and Image Quality using
C-Arms.“ D. Gosch et al., RöFo 2007), and
it can be applied with a common image intensifier
as well as with flat-panels.
Besides automatic motion and object
detection as well as metal artefact correction
in the visible area, ODDC controls the
complete monoblock generator in order to
regulate the pulse rate to the lowest possible
level. In this way, moving objects will be
detected and displayed with optimal image
quality. With static objects, however, ODDC
reduces the pulse frequency automatically
and, as a beneficial result, the dose. Martin
Herzmann: “Ziehm Imaging, the technological
leader within the area of mobile
flat-panel imaging, feels a strong sense of
responsibility for both patients and medical
staff who are in contact with radiation
during work on a daily base.”
www.ziehm.com
A workshop on facilitating collaboration
to facilitate “tele-success”.
Various sessions on telecardiology,
health informatics, e-Learning, e-Health
in support of routine medical practice,
efficiency in e-Health, telepsychiatry,
teledermatology and image transfer,
mobile health, new trends in e-Health
showed what works and what doesn’t,
as well as what exists or what is under
development in Telemedicine, e-Health
and health ICT systems and solutions.
A regional (BeLux) seminar about clinical
strategy and the use of balanced
scorecards.
Through these conference sessions, the
exhibition and an extensive media corner
(featuring some 35 journals, books, and
magazines), participants were provided
with hands-on experience and an opportunity
to discover and evaluate new
systems and technologies and to hear
Publisher
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HOSPITAL POST EUROPE
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and many others.
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www.medetel.lu

Hospital Post Europe 04/08
250 participants are expected for the 20 th
International Conference of the Society for
Medical Innovation and Technology (SMIT)
in Vienna, Austria. From 28 to 30 August,
more than 115 presentations are scheduled
either as oral or poster presentations.
Among others, topics for this year’s
event include: Tumor Ablation and Interventional
Oncology, Endoluminal Surgery
NOTES and NOSCAR, Surgical Manipulators
and Image-guided Robotics, Hybrid
OR, Work Flow and Systems Integration,
Cooperation – Image Data Archiving
Hospitals have to keep digital medical
documents audit-proof, investing a lot of
material and staff capacity. German Telekom
subsidiary T-Systems – together with
PACS vendor Visus – now offers a solution
relieving hospitals of installation, maintenance
and services for the necessary systems
– in line with the principle of „Software
as a Service“. Customers are able to
rent services on a flexible basis. They will
pay per examination or per data unit (e.g.
Gigabyte) or they simply pay a fixed price
for each year of archiving. So they do not
have to invest in their own hardware and
software. This solution is already successful
in the market.
www.visus-tt.com
www.t-systems.de
Setting ICT Trends for Europe
Top Modern Technology für Norwegian
Hospitals: Hewlett Packard inaugurated,
last June, a Centre of Excellence for
Health Technology. At this Centre, as well
as at the university hospitals of Oslo and
Trondheim, care providers from all over
Europe will be able to scrutinize the potentials
of fully digitized hospital. Future,
broader perspectives include the virtual
hospital aimed at connecting with patients
outside the hospital, through telemedicine
and monitoring.
The Centre of Excellence is laid out
like a small hospital – with a patient
room as well as a ward and exam room.
These premises serve to present a multitude
of ICT solutions, e.g. integrated
PACS and RIS, locating and identification
services, alarm and access systems,
patient telephony and TV. At the same
time, the Centre is to help foster the research
into, and development as well as
trialling of ICT in healthcare. HP has collaborated,
in setting up the Centre, with
renowned companies such as Microsoft,
Cardiac, Cisco, and Telenor – the leading
Norwegian telco.
Many of the solutions demonstrated
are already in use in the university hospitals
of Trondheim (St. Olav’s) and Oslo.
There, the relocation into the fully digitized
Nye Ahus (New Akershus University
Hospital) in Oslo will be finished by October.
All 970 beds will be equipped with
patient terminals; there will be 3,200
phones in a wireless network as well as a
very modern alarm system.
Dr. Jörg Raach
Nanotechnology and Microsystems in
Medicine, New Instruments and New Materials,
Rapid Prototyping in Medicine,
MEdIcAL tEcHnoLoGY 17
SMIT 2008 In Vienna
FUJIFILM
MEDICAL
IMAGING
e-Health, MRI Safety, Navigation and Augmented
Reality, Molecular Imaging and
Targeted Drug Delivery, and Model based
A D V E R T O R I A L
Therapy. These topics will be presented by
an international forum of outstanding endoscopic
surgeons, interventional radiologists,
biomedical engineers, and industrial
instrument manufacturers. Furthermore,
conference-goers are invited to join workshops
on Radiofrequency Ablation (handson),
Embolic Particles, and Robot-Assisted
Interventions (hands-on).
SMIT 2008 “offers an outstanding platform
to stimulate discussions, and sharing
ideas with other attendees”.
www.smit2008.com
Enhancing the Quality of Life of People world-wide
Innovative Medical Systems:
Fujifilm is a market leader in developing
innovative, technically advanced medical
imaging systems including its highly successful
computed radiography (CR) and digital
radiography (DR) products.
In addition the company is at the forefront
of harnessing the growth of IT in medical
facilities with SYNAPSE®, its picture archiving
and communication systems (PACS),
leading the way.
Similarly, Fujifilm is proud to announce it is
advancing with moves to create comprehensive
healthcare by directly aligning the field of
diagnosis with preventative and pharmaceutical
treatments.
Finally, a major breakthrough in DR is Fujifilm’s
revolutionary MAMMO System
AMULET, a completely new and innovative
x-ray detector for mammography.
The new mammo DR system
Fujifilm has developed a completely new
kind of x-ray detector that represents a
breakthrough for upcoming applications in
digital mammography.
World’s best resolution for detectors of
its kind
The detector uses two layers of amorphous
selenium and, at 50 µm pixels,
offers the world’s best resolution in
detectors of its kind. A sharper picture
and improved signal/noise ratio result,
making for significantly enhanced imaging
quality in breast cancer diagnostics.
President Dr. Joachim
Kettenbach (far left,
Medical University
of Vienna, Austria)
and Co-President
Dr. Gernot Kronreif
(Profactor Research
and Solutions) are
looking forward to
SMIT 2008.
High pixel density and improved
signal/noise ratio
The x-rays are converted into electric signals
in the first layer, and are then
detected in the second layer with the
help of an optical switch and presented
as an image. The procedure reduces the
amount of time needed for erasing and
re-exposing the detector, accelerating the
overall exam workflow.
Conference Venue
university vienna · universitätscampus
“Altes AKH“
Hof 2, Hörsaalzentrum · spitalgasse
2 · 1090 vienna
Austria
Optical Switch – as new development
New procedure for selenium vacuum
deposition technology generates extremely
pure selenium layers with an even
thickness across each layer. Light is used
as a switch for detecting electric signals.
The data is thus read out from the detector
directly, without first being converted.
It enables the operator to lower the radiation
dose while improving diagnostics
and the efficiency of the examination.
Specifications
– High DQE, high MTF
– Optimised compression feature
– More convenience and safety for
the patient
– Detector method:
a-Se with optical switch
– Exposure interval: approx. 20 s
– Pixel size: 50 µm
– Bit depth: 14 bit
– Image display after: approx. 10 s
FUJIFILM Europe GmbH, Heesenstrasse 31
D-40549 Düsseldorf, Germany
Tel: +49 211 5089 100
www.fujifilm.eu

18 It & coMMunIcAtIons
Hospital Post Europe 04/08
“Science – as opposed to technology
– does violence to common
sense!” This provocative
remark was casually slipped
into the conversation by one
of the participants at the networking
dinner in Stuttgart
mid-May. The direct implication
was of course that modern
theoretical physics has
become practically nonsense
and that we can only really
understand the practical application
of existing technologies.
But the speaker also
had a subtext, and he continued
by asking: “Does any of
the science and technology
discussed on this conference
make sense?”
This question is actually an interesting and
relevant filter through which to view the
conference in Southern Germany. The first
European matchmaking summit on mobile
and e-technologies was a unique two-day
event focusing on the collaboration between
the public sector and private enter-
Mobile And E-Technologies
Living Labs Europe – First European Matchmaking Summit
prises. Participants came from one hundred
of the most innovative firms in the
mobile and wireless sector, and together
they represented over twenty European
countries. Another important group was
comprised by various public decision
makers, from healthcare specialists to city
administrators. The third and all-important
ingredient in this melting pot of the new
mobile market was the very active participation
of the most advanced science clusters
in Europe today.
On the first morning of the conference
which took place within appropriately
high-tech convenience of the Fraunhofer
Institute in Stuttgart, many people showed
up early, and the place was already buzzing
with anticipation and conversation when
the first speakers got ready to launch the
event. Prof. Jan Annerstedt from Living
Key organizers of the Summit: Dr. Jakob Rasmussen and
Liza Wohlfart Photo: MR
Labs Europe welcomed everyone to the
conference and proceeded to sketch out
the new challenges: In opening the European
markets for digital solutions, a crucial
key to success lies in the ability of the private
and the public sector to communicate
and to work together. He underlined that
we can find better ways to make small and
medium-sized enterprises smarter in the
way they approach users. Finding the best
business models and opening up for new
instruments such as venture capital is a
step in the right direction – but to overcome
the weaknesses, we must be able to
create larger partnerships. Prof. Annerstedt
presented the Living Lab concept as an
ideal network of clusters that enable faster
cooperation between users and providers,
and most importantly as a network that
uses the city as an innovative space where
the involvement of the users is always the
centre of attention.
The audience was attentive, but there
was a clear and positive shift in the energy
in the auditory as Prof. Annerstedt gave his
final statements. He made clear that the
whole project is only a stepping stone, and
that Living Labs as a self-funded organisation
will make a platform where we will
see a real model emerging. The audience
knew that the European market has 70
million potential end users, and everyone
were thrilled to be part of an active network
where this is the main focus. These
thoughts were also taken up by the next
speaker, Dr Reinhart Büscher, Head of
Unit, Innova programme, who was happy
to continue on the subject of innovation
and markets. He explained that Europe
has too many standards today and that Innova
is not going to be standard setting.
But that programme is going to find which
good standards are and which are bad.
This will be of the greatest help to enterprises.
Innovation management as a craft
will have to be developed further, and the
art of converting ideas into money is still
very much on the agenda. There will be a
strong research and science perspective,
and Dr. Büscher stipulated that the public
funds, time, and energy that go into these
projects must be converted into value added.
Therefore, cluster networking alone is
no longer enough, it will have to be taken
to the next level – where real collaboration,
professional partnerships and world class
excellence are achieved. This was all well
received, as the new cross-network collaboration
between clusters in Europe, public
sector agencies, business firms, venture
capitalists and research institutions has already
begun to flourish.
All of these points were summed up
by Dr. Jakob Rasmussen, who stated that
Europe has a leading global competence in
mobile communication services – and he
continued by asking the question: “What
can we do in the future?” Dr. Rasmussen
mapped out the huge potential in the
European market, and explained how the
public sector and private enterprises working
together in unison can create initial
demand for new services and drive the
demand by functioning as advance buyers.
This dynamics is being strengthened
by the mClusters project, and people were
happy to learn that Living Labs Europe
will continue to map out competences in
Europe, will continue to establish partnerships
of trailblazers, and will continue to
make innovative showcase projects that
can be exported.
But most important of all – and the
point that everyone nodded their heads
at – Living Labs Europe will continue to
hold matchmaking sessions of supply and
demand in the future.
At no point during the two days was
it forgotten that this was a matchmaking
summit, and Dr. Rasmussen’s speech
served as the perfect link to the lunch and
to the following matchmaking sessions
that continued for the duration of the afternoon.
The participants were divided
into three groups and they spent four and
a half hours discussing mCities, mLearning
and mHealth. In the first part of the sessions
an expert panel comprised by exponents
from the public sector, private enterprises,
and from universities told about
their own projects, and they showcased
interesting examples for the whole group
to dissect. The second half of the sessions
saw the further splitting up of the groups,
as people were put together in small teams
of four or five members. These small teams
now had to make an assessment of the
killer applications that already exist – then
they had to brainstorm about the coming
trends, and finally they had to “dream up”
their ideal applications of the future. These
interactive workshops really livened things
up, and it was clear for all to see that the
participants began to enjoy themselves
while learning interesting and important
things from their colleagues and potential
partners.
It proved quite a task for the group moderators
to stop the eager participants, who
were now deep into heated discussion and
complicated explanations, but all good
things come to an end, and Fraunhofer
laboratories had generously arranged for
everyone at the conference to visit their research
facilities before the grand networking
dinner started. When people began to
arrive at the dinner there seemed to be
widespread jealousy towards those who
had gone to the interactive driving simulator,
and there was much joking about the
fairground experience provided by Fraunhofer.
All social ice was now broken, and
as it’s so often the case in situations like
these, everyone was beginning to communicate
actively – the real matchmaking had
begun. Evening turned into night to the
tones of a small jazz ensemble, and no one
can deny that this was the most valuable
hours seen from a networking perspective.
On Friday, the last day, there was a short
introduction and an interesting speech by
Ulrike Daniels on the European Satellite
Navigation Competition 2008. Then three
new groups were established and three
new subjects were introduced: mLogistics,
mTourism and mPayment. The same procedure
as on Thursday was followed, but
this time there was a lot of participation
and discussion from the beginning. When
Jan Annerstedt held the closing note just
before lunch, it was only natural that he
should be positive and happy in his evaluation
of the event; all participants were
enthusiastic about the time that they had
invested in coming to Stuttgart, and there
was a genuine spirit of expectation, when
Prof. Annerstedt made a promise: “This is
only the beginning.”
The speaker who made the cheeky
question about science and technology at
the networking dinner, was referring to
the speculative discussions about future
trends at the interactive workshops. But
he continued and gave an answer himself.
He was impressed with what was being
achieved and created on the conference,
and for him too, this was only a beginning.
Anders Biel, Copenhagen
Enhanced Archiving and Documentation Management
Siemens Healthcare announced
that Soarian Health
Archive, its digital archive
and document management
solution, provides enhanced
archiving and document management
functionality for various
kinds of documents and
data that occur in a hospital.
The Soarian Health Archive
platform is based on the archiving
solution from yanistra
GmbH, a subsidiary of the
Gesellschaft für Systemforschung
und Dienstleistungen
im Gesundheitswesen mbH
(GSD). Since March 2007, the
GSD operates under the name
of Siemens Medical Solutions
GSD; yanistra was integrated
in October 2007.
The functionality of Soarian Health Archive
fulfills many of the demands for a digital
archive and documentation management
system, particularly for the German and
European markets. “One of the particular
strengths of Soarian Health Archive is
its seamless interoperability with Siemens
hospital information systems such as
medico//s, Clinicom, and i.s.h.med; and it
is planned for future development of Soarian,”
explains Karin-Marie Tretter, head of
the Medicine and Care business area of Sie-
mens Medical Solutions GSD. “We have set
the course for the future with this strategic
solution,” she emphasizes. HIS solutions
from other manufacturers, as well as subsystems
and special systems, digital cameras,
and imaging systems, can also connect
with the solution.
The archive goes beyond the patient file
to seamlessly combine multiple archiving
scenarios into a single, centralized storage
solution. The archiving functions are
not limited to the traditional contents of
a patient record in that the solution offers
a full and comprehensive document
management and archiving solution for
the enterprise. Non-clinical documents –
such as financial, personnel, and contrac-
tual documents – can easily be archived.
Additionally, many formats are recognized
by and can be archived in Soarian Health
Archive, including e-mails, e-mail attachments,
and Microsoft Office files.
Soarian Health Archive also offers a freetext
search function which enables users to
retrieve any and all relevant archived information
from the HIS without changing programs.
With this, it is possible to integrate
OCR systems for character recognition, allowing
scanned documents to be included
in full-text searches. The solution can also
be used for research in patient records and
documents independently of the HIS.
In addition to providing users a quick
and easy way to search for patient data and
archived documents, the solution helps to
create greater efficiency and potential costsavings
across the enterprise. By offering a
way for care givers to search for electronically
archived patient information, Soarian
Health Archive is helping to reduce the
amount of time these care givers might
spend in trying to locate and access hardcopy
information from their archives departments.
Also, by offering a way to archive
critical patient information and administrative
documents electronically, the solution
can potentially help hospitals to reduce the
space necessary and costs associated with
storing large amounts of paperwork.
www.siemens.com/healthcare

Hospital Post Europe 04/08
The second Baltic Conference
on e-Health – under the
Patronage of Ulla Schmidt,
Federal Minister of Health,
Germany – takes place on
September 26 in Hamburg.
The primary aim of the conference
organized by the Baltic
Sea Forum, the Hamburg
Chamber of Commerce, and
IBM, in cooperation with the
U.S. Commercial Service, is to
provide a cross sector forum
for healthcare providers from
Germany, Poland, Lithuania,
Estonia, Latvia, Russia, Finland,
Norway, Sweden, and
Denmark.
The European healthcare sectors are faced
with many common challenges associated
with delivering affordable, quality care. In
view of rising costs, the healthcare industry
needs to make the transformation to an
interconnected, cost-efficient and, above
all, patient-centric system. Representatives
from hospitals, governments, health insur-
ance organizations, service providers, and
media will have the opportunity to discuss
potential solutions in patient-centric health
management during the Baltic Conference
on e-Health.
The conference presents a well-balanced
mix of best practices and strategyoriented
presentations. Keynote speakers
from Poland, Denmark, Lithuania, Estonia,
Russia, and Germany, workshops and
a panel discussion are the basic features
of the meeting. Moreover, international
solution and service providers will display
and present their product and service
achievements to policymakers, users,
suppliers, and implementation managers.
The conference program will focus on
the following topics:
Best Practices and Case Studies from the
Baltic Sea region countries.
Disease Management as concept of
reducing healthcare costs and improving
quality of life for individuals with
chronic disease conditions by preventing
or minimizing the effects of a disease
through integrative care.
It & coMMunIcAtIons 19
Baltic Sea Region Countries Discuss Innovations for Health Management
Second Baltic Conference on e-Health in Hamburg
Identity management systems
(IDM) control user access to
specific information in an
organization, based on user
identity, duties, and responsibilities.
Increasingly today’s
enterprises are turning also
to the next level of security
with the use of network access
control systems (NAC) to
verify the integrity of devices
as they access healthcare networks.
There is little doubt that IDM and NAC
security systems are necessary for sound
access control but they fail to address a potentially
more dangerous threat. One that
in recent months has loomed ever larger
in the concerns of CIOs: the risk of data
breach through inappropriate behaviour
by someone who is authorized to access
the network and its information.
Unauthorized Access and
Improper Use
Let’s consider a situation where a user
has been granted access to the network,
applications, and databases in order to
undertake their normal business activity;
but whose behaviour becomes mischievous
after authorization. Perhaps they are
downloading entire patient or customer
databases to their laptop or seeking to
email sensitive data to an address outside
the company, or copy it to a removable medium
such as a USB stick. Either way they
are abusing the access rights they have
been granted and will need to be stopped
urgently to protect against the loss of valuable
company information assets.
Lars Davies, a lawyer and provider of
compliance consultancy services in the
Optimization of clinical and business
processes as well as of hospital information
and communication systems in
order to increase the quality and economics
of patient care.
Latest developments in the EU regarding
standardization, interoperability, and
patient safety.
The international conference – which
is, among others, supported by the Koch-
Mechnikov-Forum – features presentations
e.g. on disease management in Russia and
the future of health management in Poland.
Main objectives of the conference organizers
are to exchange views and experiences
among all those involved in health
management, to learn from each other,
and to work with one another.
Another very important topic is the
crucial financial situation of hospitals and
clinics: Due to rising costs (personnel,
energy, food, etc.) and increasing regulatory
constraints, many hospitals are underfunded.
How the deployment of highquality
e-Health solutions will contribute
to solve these problems, is presented by
several speakers. Their presentations deal
with process optimization and change
management in hospitals, improvement of
continuity and quality of care by e-Health
solutions as well as increasing efficiency by
technological partnerships.
However, a win-win strategy for all e-
Health stakeholders is only possible if solutions
respond to patients’ needs and have
direct impact on access, quality, cost, and
safety of healthcare. The acceptance of e-
Health among patients and consumers is
essential. A panel discussion on “Patient-
The Threat Within
Patient Privacy Issues from Unauthorized Access and Improper Use
U.S. notes: “If an authorized individual,
for example, has inappropriately accessed
or copied information then potentially an
unauthorized access under the Computer
Misuse Act has occurred; it could also be a
breach of copyright law. If any personal data
is involved, it could also constitute a breach
of the Data Protection Act (DPA), The
Health Insurance Portability and Accountability
Act (HIPAA) or similar privacy legislation.
This type of act by a senior employee
could also result in a breach of their duty of
confidence and a breach of their terms of
employment.” The issue for the organization
however is more immediate; it needs
to be able to identify the inappropriate use
of the organisations information and protect
against its loss. The main legal issue is
again the DPA. The organization can be accused
of having failed to put in sufficient
safeguards in place to prevent a breach and
the directors and managers could be implicated
for failure in their fiduciary duties to
protect stakeholders from loss.
Data Leak Prevention
In response to this type of threat the information
security industry has, in recent
years, developed a flurry of so-called data
leakage prevention (DLP) systems which
seek to address this emerging exposure for
companies. While the goal of DLP systems
is undoubtedly well intended, the effectiveness
of these technologies relies upon
the satisfactory matching of user access authorisation
levels with the classification of
all corporate information assets according
to their sensitivity and “value”. The logic of
such systems is clear but inflexibility and
the administrative overheads of such systems
are prohibitively high.
The bottom line is that the thief may be
a disgruntled employee, a doctor, an ex-
Geoff Sweeney, Co-founder &
Chief Technology Officer, Tier-3
ternal contractor or even a trusted senior
executive; there are no rules to predicting
human behaviour. Inappropriate action of
this type by anyone who has the authority
to access sensitive information can and still
does occur. What is required is the means
by which suspicious or unusual movement
of sensitive data, irrespective of the initiator
can be detected and assessed for legitimacy.
Beyond IDM and NAC systems
– Behavioural Anomaly
Detection
Behavioural Anomaly Detection uses intelligent
analysis technology to inspect and
immediately alert on inappropriate user
or system behaviour as soon as it deviate
from the norm. Without the need for complex
access and asset prioritisation rules
and the resulting configuration and management
overheads the technology simply
blocks and flags unusual system or user
activity to security administrators and risk
managers.
A lot of companies with inspection
technology claim behavioural analysis ca-
pabilities yet limit themselves to looking
at the data, network and transport layers
(i.e. Layers 2–4 of the OSI stack). This unfortunately
is insufficient for effective data
protection capabilities, which requires the
monitoring of multiple layers. The fact is
that few vendors provide sufficient visibility
of anomalous events to enable meaningful
risk alerting and protection against
data loss.
Data breaches from unauthorized access
and improper use are a growing
problem, but they can be detected and
prevented with appropriate security strategy
and technology. Behavioural Anomaly
Detection technology identifies when a legitimate
user’s behaviour begins to deviate
from the norm, blocks it and systematically
stores a copy of all access logs in foren-
Innovation For Modality Imaging
The installed base of modality devices inside
the hospitals is constantly growing.
Nearly all of them require a display device.
A lot of those are already installed for a
long time. Quite often here are CRT monitors
connected which are almost at the end
of their lifetime. Those units need to be replaced
quickly and easily.
“Exactly for those purposes Totoku offers
now the new 19 inch, 1,3 Megapixel
grayscale display ME191L. It is able to support
all modality devices of the most common
manufacturers but fits also perfect for
special applications like cardiology,” explains
Dirk Cordt, General Manager Sales
and Marketing department Totoku Europe.
Thanks to the various gamma presets the
display can be adapted easily to the connected
modality device.
Centric Healthcare Systems” will bring together
the different stakeholders in order
to review the necessary transformation
processes and to develop visions for the
future of healthcare.
All conference presentations are held in
English (no simultaneous interpretation).
For further information and registration,
please cf. the website.
www.baltic-conference-on-ehealth.
com
sic repository which can have evidential
weight in any resulting action against an
individual. Using smart technology Behavioural
Anomaly Detection can automatically
detect and prevent a potential data theft
as it occurs rather than respond “after the
horse (and its valuable information) has
bolted”.
Contact:
Geoff Sweeney
Co-founder & Chief Technology
Officer
Tier-3
Sydney, Australia
Tel.: +61 2 9419 3200
www.tier-3.com
The display fulfills all requirements of a
high quality medical imaging device. With
a maximum brightness of 1000 cd/m² and
a contrast ratio of 900:1 even under bad
circumstances a very high image quality is
secured. With the integrated lambda sentinel
the calibrated brightness is kept permanently
on the right level.
The display offers a flexible input concept;
thanks to this also non standard timings
are displayed. “In addition to this the
supported frequency range is wider than
usual. That’s the reason why signals can be
displayed where other displays fail,” Cordt
explains further. A wide viewing angle of
178° in vertical and horizontal axis ensures
always an accurate view at the X-ray images.
www.totoku.com

20 It & coMMunIcAtIons
Hospital Post Europe 04/08
Innovation in healthcare
doesn’t always come in the
form of a powerful new drug
or even through improvements
in the way physicians
provide care. New developments
in information technology
can drive innovative
projects that can help physicians
save lives.
IT and business management have become
tightly intertwined in hospitals, as in other
industries. Because of this important relationship,
IT executives in the medical industry
can make significant contributions
by helping hospital managers implement
automated systems to monitor patient
care. But first, IT executives and their
teams need a vision of how medical information
is communicated, controlled, and
integrated. Their IT infrastructure must
support that vision. Failure to share critical
information with the systems and people
who need access to it may result in unnecessary
deaths. The clock is ticking.
Here is an example to illustrate this
point: a patient underwent a medical test
about 14 months before he was diagnosed
with terminal cancer. The initial report
gave him a relatively clean bill of health.
Yet there was also a second report, which
indicated a spot on his liver, and recommended
an ultrasound for further evaluation.
The patient was discharged from the
hospital based on information from his
first report, which did not highlight the
problem or the recommended test. Unfortunately,
the second report was filed away
without ever reaching the patient or his
healthcare providers.
The patient didn’t have the information
he needed, and went about the remainder
of his life wondering why he continued to
have medical problems when there was
“nothing seriously wrong” with him. He
was unaware of the existence of the second
report until after he was diagnosed
with cancer over a year later, and asked to
see his file to compare it against his latest
CT scan. By then, the cancer had already
spread, and it was too late to save his life.
This case illustrates the need for automation
in reporting medical test results.
Apparently, this patient’s healthcare facility
did not have automated workflow notifications
or automated escalation processes in
place. There were no automatic alerts to
the patient’s physicians, or the patient himself,
advising them of the need for further
screening. Failure to have these processes
in place – and enforced – prevented the patient
and his physicians from acting upon
critical information in a timely manner.
“Do You Understand Me?!”
The new translation technique
facilitates daily work in hospitals.
(Photo courtesy of Cristina Torres)
Translating 42 official languages, 24 hours
of the day: hospitals in the province of
Albacete – part of the autonomous community
Castilla de la Mancha in Spain – use
a new simultaneous translation technique.
A lot of the patients who visit hospitals
in Spain do not speak Spanish. Therefore,
a lot of communication difficulties between
doctors and patients occur. For four hospitals
in the province of Albacete, this problem
is now a matter of the past: six months
ago, a new translation technique was introduced
there. Via a mobile and headsets,
doctors and patients have the possibility
Austrian-based Philips Speech
Recognition Systems announced
the launch of its services
portfolio which enables
its global network of Speech-
Magic partners to access the
company’s know-how and expertise
in the field of healthcare
documentation.
The aim is to facilitate the integration,
deployment, and support of the Speech-
Can Software Save Lives?
Automation in Reporting Medical Test Results
to get in touch with a professional translator.
This person immediately translates
the conversation of the interlocutors. The
new service is used to make communication
easier – and it works: The users are
very satisfied.
Arabic, Chinese,
And Romanian
During the six-month test period, it
became clear that Arabic and Chinese are
the languages that are mostly requested
(60 % of demands) – Romanian ranks third.
Therefore, the translation for these three
languages is immediate – without the need
to feed a code in the mobile. The rest of
the languages supplied, up to a total of
42, is translated with a delay of 10 to 30
minutes.
The new translation technique is introduced
to reduce social difficulties in the
medical sector.
CK
IT organizations, especially those in the
healthcare industry, cannot afford to underestimate
the vital, strategic role integrated
systems and communications play in their
success. With the strategic use of technology,
it’s possible to improve and transform
business processes and react quickly to
real-time data changes. Failure to take this
approach can cause IT organizations to
operate in a vacuum – disconnected from
their businesses’ primary objectives and
processes, and lacking consistent goals,
procedures, controls, and best-practice
guidelines.
The Need For Automation
Emergency rooms are very busy places. It
is increasingly difficult for ER personnel to
rely on manual data-sharing processes in
this environment, especially as the number
of patients continues to increase and more
demands are put on the hospital staff.
The example cited earlier might have
ended differently had an integrated and
automated process been in place. With
integrated workflows, notifications, and
escalations, a fully enabled service automation
process could have engaged the appropriate
people (doctors, administrators,
etc.) with the data contained in the second
report. The policy-driven attention and ac-
tions could have alerted the patient and his
healthcare team of the recommendations
for further testing. The physicians might
have been able to diagnose the patient’s
illness in the earliest stages. The patient
could have had the information available
to take a more active role in seeking the
best treatment for his medical condition as
soon as possible. At the very least, he could
have had a fighting chance.
This patient’s example is indicative
of the types of problems that can plague
hospitals and other medical facilities that
do not have the processes, systems, and
infrastructure in place to prevent a similar
gap in critical communications. This example
demonstrates an important lesson:
by leveraging IT and business automation,
medical teams can have real-time visibility
into any critical information and changes
related to a patient’s health.
Hospitals and their staffs are in the
business of saving lives, and their systems
should enable that effort. Staff members,
departmental teams, and the third parties
that work with them (i.e., the outside radiology
labs, pharmacies, doctors, and others)
need to collaborate and communicate.
And although each of these groups may
provide specialty functions, they need to
share patient data with each other within
the HIPAA guidelines.
Without alignment, healthcare specialists
do their jobs in a vacuum and may
unknowingly risk their patients’ lives; lifesaving
information can fall through the
cracks. With the right management vision,
processes, and technologies in place, additional
deaths may be prevented. This vision
is based on an approach for managing IT
based on business priorities, an approach
known as Business Service Management.
Ideally, hospitals and doctors should
have fully implemented systems and processes
in place to share critical data using
this holistic approach. Unfortunately, this is
not always the case. It’s also important for
patients to be actively involved in securing
their own data. They should ask whether
the systems their healthcare providers use
are working together effectively. Patients
should also follow up with their doctors
and hospitals after a critical medical test
has been taken, and ask if any additional
information or reports might be available.
They should secure copies of their reports
to discuss and review with their healthcare
providers. These actions are vital and
could make the difference between life …
and death.
Linda Donovan
BMC Software
www.bmc.com
Speech Recognition “in the Fast Lane”
A new report by market analyst
Datamonitor discusses
speech recognition and its
use in the medical industry
for transcription and dictation.
It reveals that healthcare
automation is driving growth
in speech technology and the
leading vendors, Nuance and
Philips, are providing specialized
solutions.
The report, “Automating and Enhancing
Processes through Voice in Desktop and
Back Office Environments”, explains that
although adoption of PC-based speech recognition
is not widespread, the technology
has found its niche in the healthcare market,
where automation and cost savings are
key drivers.
Changes are taking place in the healthcare
industry as issues over budgets and
the accuracy of patient information arise.
In order to reduce the error rate in diagnosis
and ensure information is recorded efficiently,
healthcare providers are adopting
electronic health records (EHRs). Using
speech recognition with digital dictation
systems, to dictate notes directly into
EHRs, means that doctors can update information
faster and with lower error rates.
“Patient information is gradually becoming
digitized in order to address issues with
delivering records and test results faster,”
said Aphrodite Brinsmead, analyst at Datamonitor
and author of the report. “By reducing
the number of illegible handwritten
documents and simplifying processes, providers
can eradicate errors in diagnosis.”
Speech recognition is also being used
for medical transcription, easing pressure
Speech Recognition to Capture Healthcare Information
Magic platform as well as provide expert
consultancy on productive medical reporting.
The launch of its service portfolio is
part of the companys’ strategy to grow
from a technology provider into a team of
globally recognized experts on information
capturing in healthcare. “Philips has
acquired a unique wealth of knowledge and
proficiency while working with the world’s
largest healthcare speech recognition sites
which stretch across city-, region-, and even
country-wide health systems,” commented
Marcel Wassink, CEO of Philips Speech
Recognition Systems. “The service offering
now enables our SpeechMagic partners
to apply this knowledge and experience
directly to their IT applications. Our technicians,
developers and consultants will
help them design optimal solutions that
boost productivity in hospitals and provide
physicians with better information.”
The company offers four key services:
First, Philips helps define and integrate
the optimal set of SpeechMagic features;
Dictation Management
the new Premium Kits from
Grundig Business systems provide
packaged solutions for use in the
office, for mobile dictation, and
for external transcription services
and are suited for both professional
users and secretaries.
www.grundig-gbs.com
this includes input channels and the ability
to deploy in Citrix Access infrastructures
or on Windows Terminal Servers. Next,
deployment services prepare for fast system
roll-out with the aim of facilitating user
acceptance and minimizing downtime during
implementation and set-up.
Support services also provide the knowledge
and tools for optimal system maintenance
and fast resolution of technical
issues, including training and workshops
as well as standby and third-line support.
on transcriptionists and allowing healthcare
providers to save on staffing costs.
Medical transcription is estimated to be a
multi-billion dollar market and speech recognition
vendors are taking advantage of
this. Healthcare currently represents 85 %
of the PC- and server-based speech recognition
market. Datamonitor estimates
that the market for speech recognition in
healthcare globally is worth an estimated
US-$170 million in 2008. Between 2008 and
2013, the market will more than double in
size.
One area where speech recognition has
seen a significant uptake is for imaging
where a number of radiologists are using
the technology to dictate reports. Radiologists
work in controlled environments
using specialized vocabularies to dictate
reports that often use repeated language
and are therefore an ideal target for speech
recognition vendors.
Healthcare will remain the largest market
for speech recognition through 2013.
www.datamonitor.com
Finally, the productivity services round up
the service package, as Philips experts analyze
end users’ working methods, evaluate
results and user satisfaction, and provide
recommendations to optimize workflows
and processes.
www.philips.com/speechrecognition

Hospital Post Europe 04/08
Kantonsspital St. Gallen (Cantonal
Hospital of St. Gallen),
Switzerland, encompasses the
hospitals of St. Gallen, Ror-
schach, and Flawil, and provides
essential medical care
for eastern Switzerland. For
seven years, the hospital’s
computer workstation infrastructure
was based on the
Windows 2000 operating system
and Microsoft Office 2000
desktop applications. The client
software was increasingly
reaching the limits of its performance,
however, and becoming
unstable in some areas.
In order to retain high service
levels at a reasonable cost,
Kantonsspital St. Gallen chose
to deploy the Windows Vista
Enterprise operating system
and the 2007 Microsoft Office
system on 2,000 computers
across the organization. This
powerful new IT infrastructure
will also support the hospital
in introducing further valueadded
services such as a clinical
workstation portal for its
employees that will be built
using Microsoft Office Share-
Point Server 2007.
Situation
“One company, three hospitals”: Under
this motto, Kantonsspital St. Gallen – with
approximately 3,000 employees – provides
basic and specialist medical care for the
population of east Switzerland, making it
the sixth largest hospital in the country. In
addition, Kantonsspital St. Gallen conducts
research, performs educational activities,
and offers accredited university-level training
in its specialist disciplines.
Until recently, the hospital’s 2,000 computer
workstations ran desktop software
based on the Windows 2000 operating system
and Microsoft Office 2000 programs.
These programs had been in use for seven
years, and were repeatedly reaching the
limits of their performance in day-to-day
business.
“The platform was beginning to become
unstable. When we purchased new
computers, we didn’t have the necessary
drivers, and not all applications were
supported,” explains Stephan Schläpfer,
Project Manager at Kantonsspital St. Gallen.
For example, employees had problems
synchronizing their notebook computers
via Microsoft ActiveSync technology, and
mobile access to specialist applications
using Windows 2000 was problematic. On
top of this, Microsoft had ceased to provide
mainstream support for the outdated
operating system. “We urgently needed a
powerful new basic IT infrastructure,” says
Schläpfer.
Kantonsspital St. Gallen also needed
software that could support a new clinical
workstation portal for its employees. The
organization wanted to set up a dashboard
page from which employees could access
all required information and programs
from their notebook computers. The portal
would enable employees to locate information
more quickly and improve their
communication with one another. “Our
aim is to turn IT into an easy-to-use everyday
tool for users,” says Schläpfer. “At the
same time, new tools would reduce administrative
work for IT employees, increasing
their productivity.”
Solution
The hospital chose to continue using Microsoft
solutions to fulfill its software requirements.
Employees work around the
clock, using approximately 400 different
specialist medical applications, and many
of these already have interfaces to Microsoft
Office applications. To support the
software upgrade, Kantonsspital St. Gallen
also upgraded its hardware, purchasing
2,000 new computers: 1,750 desktop PCs
and 250 notebooks.
With Microsoft Office SharePoint Server
2007 collaboration software, Microsoft was
able to offer a solution for the planned portal
that fully met the expectations of the IT
managers. “The focus here is on employees
and their needs. The company’s ‘people-ready’
philosophy corresponds exactly
to our planned clinical workstation portal,”
explains Jürg Lindenmann, Head of IT at
Kantonsspital St. Gallen.
Project planning for the implementation
of the Windows Vista operating system and
2007 Microsoft Office was undertaken by
department and external service providers.
By participating in the Microsoft Technology
Adoption Program (TAP), the project
team was able to extensively test Windows
Vista long before its market launch and
ensure compatibility with special medical
applications.
In line with the people-ready philosophy,
users were involved in the project
right from the start. The project team
mapped various user scenarios using the
pre-release versions of Windows Vista and
2007 Microsoft Office programs. In this
way, users learned, for example, how meet-
It & coMMunIcAtIons 21
Upgraded Desktop Infrastructure
New Operating System for Swiss Hospitals
Essential medical care providers for east Switzerland: Kantonsspital St. Gallen (Cantonal Hospital of St.
Gallen), Switzerland, combines the hospitals of St. Gallen, Rorschach, and Flawil.
ings could be managed using the Microsoft
Office Outlook 2007 messaging and collaboration
client. “This approach went down
very well, and we received a great deal of
positive feedback from employees,” says
Schläpfer.
The project team also built a prototype
of the clinical workstation portal using Office
SharePoint Server 2007. “In rolling out
Windows Vista, Microsoft Office 2007, and
Microsoft Office SharePoint Server 2007,
we are taking the first big step towards
establishing a clinical workstation portal,
which is to be implemented in phase
three, by the end of 2009,” states Schläpfer.
Thanks to the smooth interaction between
Microsoft products, employees will have
central access to office applications, specialist
functions, appointments, and meeting
management. Forms, archives, and
the Intranet are also incorporated. All this
will make it easier for employees to locate
cross-clinical information.
Preparations for the broad deployment
continued up to March 2007. In September,
the pilot rollout took place in the IT
department and in three clinics: Cardiology,
Infectious Diseases, and Ear, Nose
and, Throat. Those involved in the project
had one month to make any necessary
modifications. The full rollout then began,
building by building, in mid-November.
“We were not able to carry out the rollout
clinic by clinic, as many departments are
spread across several locations,” Schläpfer
explains. “During the rollout, we took
measures to ensure that employees could
access their data as usual, both on the old
platform and on the new platform.” As
planned, the team was able to conclude
the rollout on all 2,000 computers by the
end of February.
In order to prepare employees for the
new system, Kantonsspital St. Gallen began
providing appropriate training seminars
months before the actual rollout using
a learning approach that combines face-toface
instruction with flexible online training.
“We provide one-and-a-half-hour seminars
to teach employees the basics. They
can then familiarize themselves with the
new software at home and learn on their
own,” Schläpfer continues.
The Home Use Program included in the
Microsoft Enterprise license agreement
supports this option. The Home Use Program
allows the hospital to issue Office
2007 licenses for home use.
Benefits – Modern and Stable
Working Environment
Various users, from doctors and physiotherapists
to nursing staff, use the new system
and can access their specialist applications
just as before. Plus, users are finding that
the system starts up quicker and it’s easier
for them to find documents and files.
“Windows Vista and the 2007 Microsoft
Office system are being very well received
by employees, both experienced and occasional
PC users,” maintains Schläpfer.
“They are all particularly impressed by the
efficient Instant Search function in Windows
Vista. Thanks to the online learning
program, they can independently expand
their knowledge and thus complete their
work on the PC more efficiently. As for IT
employees, the analysis tools in Windows
Vista make their jobs easier.”
Equipped For Future Projects
The Microsoft solutions lay the foundation
for future projects. “Windows Vista
and the 2007 Microsoft Office system are
not just new products for us, but also core
elements of our long-term IT strategy,” emphasizes
Lindenmann.
www.microsoft.com
www.kssg.ch
New Head of Healthcare IT
Agfa HealthCare, provider of IT-enabled
clinical workflow and diagnostic imaging
solutions, announces today that it has
hired Dr. Volker Wetekam as its new Executive
Vice President for its global HealthCare
IT division. Dr. Wetekam will head up an
operation of around 3,000 staff members
and report directly to Christian Reinaudo,
President of Agfa HealthCare. He will take
up his new position mid-September.
In his new role, company speakers
explained, Dr. Wetekam – who comes from
a top position with Siemens Healthcare
– will define and implement the overall
strategic positioning and roadmap for Agfa
US: Huge Step Forward for
Telemedicine
At the end of June, the U.S. House of Representatives
passed the bill H.R. 6331 by a
landslide vote of 355-59. It contains provisions
adding skilled nursing facilities, hospital-bases
dialysis centres, and community
mental health centres as originating sites
for Medicare telehealth reimbursement.
Shortly afterwards, Sens. Max Baucus
and Charles Grassley, the Chairman and
Ranking Republican on the Senate Finance
Committee, announced that they had
reached a compromise in their negotiations
on the Medicare legislation. While a
written copy of this compromise has not
been released, American Telemedicine Association
(ATA) has learned from sources
HealthCare’s IT division, which manages
both the company’s Imaging Informatics
and its Enterprise IT business, covering
solutions from Picture Archiving and Communications
Systems (PACS) over Cardiovascular
Information Systems (CVIS) to
Hospital and Clinical Information Systems
(HIS/CIS). He will be responsible for driving
the division’s overall profitable growth.
Dr. Wetekam will also become a permanent
member of the HealthCare organization’s
Executive Committee.
www.agfa.com/healthcare
on Capitol Hill that at least the skilled nursing
facility provision and the hospital-based
dialysis provision are in the compromise
bill. ATA has indications that the community
mental health centers provision is also
in the compromise bill, but we have yet to
confirm this.
Inclusion of the telemedicine language
in both the House and Senate versions of
the Medicare bill makes its inclusion in the
final legislation likely. “Passage of this legislation
represents a huge step forward for
telemedicine and a major victory for ATA,”
the organization underlined.
www.americantelemed.org

22 It & coMMunIcAtIons
Hospital Post Europe 04/08
Klinikum Chemnitz has become
one of the first hospitals
in Germany to link its teleradiology
service with the
electronic health record (EHR).
This means that, effective immediately,
data obtained from
a remote diagnosis, e.g. computed
tomography images
and the corresponding findings,
can be stored in a shared
health record and then used
for information exchange
between different facilities
participating in the patient’s
treatment.
Siemens supplied and implemented the
overall technical solution: This included
the software for the radiological image
communication as well as the Soarian Inte-
Teleradiology plus Electronic Health Record
Integrated Healthcare in the Chemnitz Region
grated Care (Soarian IC) ehealth solution
for the electronic health record. In cooperation
with the regional county hospitals
as well as numerous practicing physicians
and medical centers in its service area,
Klinikum Chemnitz has thus assumed a
leading role in integrated healthcare in
Germany.
In teleradiology, a hospital electronically
transmits X-ray exposures from imaging
techniques to a specialist who is not located
at the site of the examination. The specialist
then transmits his findings, again by
means of data communication. Klinikum
Chemnitz utilizes this radiological image
communication to provide, among other
things, diagnostic resources and medical
expertise to county hospitals, medical
centres, and practicing physicians. Close
cooperation has already been practiced
for some time in this region, especially in
the fields of neurosurgery, traumatology,
angiology, and radiology. If, for example,
a patient is delivered to a county hospital
following an emergency, a diagnosis can
Joint Solution to Increase Patient Safety
In the future, IntelliDOT, a
leading provider of wireless
handheld, barcode point-ofcare
(BPOC) solutions to hospitals,
is going to collaborate
with Cisco, the market leader
of enterprise WLAN infrastructure,
to develop a new mobile
solution for clinical asset location
in hospitals.
The initiative is based on an enhancement
of the wireless, handheld IntelliDOT CAR-
Et System barcode point-of-care (BPOC)
solution and integration with the Cisco
Context Aware Mobility solution, via an
open API that runs on the new Cisco 3300
Series Mobility Services Engine. “With the
rising cost of healthcare, hospitals need to
maximize efficiency and equipment utilization
without compromising patient safety,”
explained Thomas G. Klopack, President
and CEO of IntelliDOT. “With the Cisco
Context-Aware Software providing contextual
information to our medical appli-
Breakthrough in the Spanish Public Market
The Swedish IT and medical-technology
company Sectra has signed an agreement
with SERGAS (Servizo Galego de Saúde) –
the healthcare service provider of the Galicia
region in the northwest of Spain – to
install PACS at five of the region’s public
hospitals. The order comprises PACS products
and services and the company’s productivity
suit for radiology departments.
Sectra’s PACS will serve in a totally integrated
radiology solution incorporated into
the hospitals’ existing IT infrastructure.
Digitizing imaging operations will increase
workflow efficiencies and provide radiologists
with instant access to images and
information regardless of location. The
hospitals will be able to exchange data and
share workload in a completely secure way
without compromising patient integrity.
“We were looking for a solution to view
images and information across hospital
cations on a wireless handheld unit, staff
have the real-time information they need
to locate and utilize their handheld BPOC
devices and other medical equipment in
the most safe and efficient way.”
The co-developed wireless BPOC solution
will help hospitals overcome the
challenge of quickly locating critical equipment
and resources, including IV infusion
pumps, portable vital signs monitoring
equipment, handheld electronic thermometers,
wheelchairs, and even patient
medical charts and medical personnel.
Nurses will eventually be able to click on
an icon within the Cisco wireless application
to locate needed supplies and equipment
using the handheld device instead of
logging onto a network station, thus saving
precious caregiver time. The solution will
use the vendor’s patented DOT technology
that nurses can simply scan with the
handheld device to display the locations of
the specified equipment or resources.
The module will operate over a hospital’s
existing 802.11 WLAN, and will com-
boundaries which enables us to utilize our
resources in the most efficient manner,”
explains Benigno Rosón Calvo, IT Manager
at SERGAS. “Sectra has proven very flexible
and attentive to our needs and the effectiveness
of radiological performance will
increase significantly since all relevant imaging
and findings data is available whenever
and wherever they are needed.”
“The agreement with SERGAS is a strategic
step into the public healthcare market
in Spain. It confirms our ability to provide
first-class products and service and support,”
emphasizes Carlos Cardoso, President
of Sectra Iberia.
www.sectra.com
municate with the Cisco Mobility Services
Engine, which will gather resource
position data from access points on the
WLAN and make it available for display on
the vendor’s handheld unit via the Cisco
API. “Cisco and IntelliDOT will break new
ground in leveraging contextual information
via our open API for clinical asset location
in the hospital, bringing together
both technical and healthcare expertise to
deliver greater patient care,” emphasized
Ben Gibson, Cisco’s senior director of mobility
solutions. “We are excited about the
potential caregiver workflow efficiency and
patient care benefits that the integration of
networking technologies and healthcare
information systems such as IntelliDOT
BPOC solutions will be able to provide.
Hospitals will be able to take advantage of
advanced wireless services with the added
benefit of improved caregiver responsiveness.”
www.intellidotcorp.com
www.cisco.com
be performed via computed tomography
without always having to have a specialized
expert on site. The expert responsible for
Klinikum Chemnitz receives the image dataset
electronically and returns his findings
to the requesting unit. Over 1,600 datasets
were thus transmitted during 2007 alone.
With the help of Soarian IC, this data can
now also be stored in a long-term health
record. The advantages: A high quality of
healthcare and treatment can be offered
even outside of major centers, the cost
effectiveness of clinics will be increased
due to common utilization of the available
resources, and patient satisfaction will be
enhanced, since waiting periods will decrease
and unnecessary patient transports
can thus be avoided.
“As one of the largest hospitals in Germany
and due to its wide performance
spectrum and staff of medical specialists,
Klinikum Chemnitz is an important partner
for the hospitals in the region. Via telemedicine,
we can also make this knowledge accessible
outside of the clinic, i.e. across institutional
borders. This offers cost-cutting
potentials to the entire network and provides
the patient with healthcare close to
home with fewer relocations,” emphasized
Prof. Olaf Schlimpert, head of the Medical
Information Technology Deptartment
at Klinikum Chemnitz. “In the future, not
only institutional borders, but also the interfaces
between outpatient, inpatient, and
rehab treatment will disappear altogether.
Siemens is also the partner that can support
these new trends over the long term
with ehealth solutions.”
“Optimal communication between
all participants is a basic requirement
for smooth workflows in cooperations
between service providers,” explained
a speaker of Siemens Healthcare. “With
Soarian Integrated Care, we were able to
offer Klinikum Chemnitz a solution for a
single communications and IT platform for
transsectoral cooperation.”
The demographic and administrative
data of a patient receiving treatment at
various medical facilities can be managed
in the electronic health record (EHR). The
patient’s medical data are saved either with
or without case management. Whereas images
and results from remote diagnosis
previously had to be printed out and filed
in paper records, all data now automatically
flows from telediagnostics into an EHR,
provided that the patient consents to this
process. A special security concept ensures
that the data is accessible only to authorized
persons.
www.klinikumchemnitz.de
www.siemens.com/healthcare
Deploying Self-Service Solutions in US
Siemens and NCR Corporation
are collaborating to offer
“MediKiosk” solutions to
the Siemens customer base
in North America. NCR manufactures
self-service solutions
across multiple industries, including
healthcare, where its
products and services help enhance
the patient experience
(cf. also issue 3).
As an authorized reseller, Siemens will
now offer MediKiosk, a self-service checkin
solution that allows patients to identify
themselves upon arrival at the facility, view,
and confirm demographic and insurance
information, electronically sign consent
documents, and make co-payments. “Today’s
consumers are extremely tech-savvy
and are already using self-service tech-
nologies in their daily lives, such as the
self-checkout lines at the grocery store
and automated check-in kiosks in airports
and hotels,” said Marilyn Marchant, vice
president, Foundation Enterprise Systems,
Health Services, Siemens Healthcare.
“This technology also makes sense for the
healthcare industry and we are pleased to
now be able to offer self-service solutions
to our customers through our agreement
with NCR. We anticipate that many benefits
will be realized by our customers and their
patients.”
Employing self-service technology helps
healthcare organizations streamline the
patient registration process, shorten wait
times, and reduce administrative costs by
eliminating redundant and manual steps
such as signature capture and forms scanning,
as well as minimizing paper use. Hospitals,
clinics, and physician practices that
deploy self-service can also improve revenue
cycle management by reducing the
number of denied claims and increasing
collection of co-payments and account balances.
All information entered by patients
at check-in flows seamlessly to healthcare
organizations’ health information systems
or physician practice management systems,
helping minimize the risk of error.
“The use of self-service kiosks in healthcare
has been shown to reduce wait times
up to 75 %, while significantly improving
patient care,” said NCR Vice President
of Industry Marketing Bob Tramontano.
“Working with Siemens extends NCR’s ability
to improve the patient experience at
every step of the healthcare process.”
www.usa.siemens.com/healthcareit
www.ncr.com

Hospital Post Europe 04/08 LABorAtorY 23
Continued from page 1
Dementia – Advances in Diagnostics
and Therapeutics
“Molecular imaging paves the way for better outcomes and lower treatment cost” –
recent panel in Paris (from left): Dominique Blanc and Dr. Jean-Luc Vanderheyden, GE
Healthcare; Dr. Nori Graham, Vice President, Alzheimer’s Disease International (ADI),
and Prof. John O’Brien, Psychiatric Services, University of Newcastle upon Tyne, UK
(Photo courtesy GE)
of which Alzheimer’s is the most common cause. Neurodegenerative
conditions such as Alzheimer’s are
very much on the rise due to demographics, imposing
a significant burden on the public. The development
of molecular imaging techniques, driven by this
vendor and a network of academic actors, “is the preferred
route towards optimized diagnosis and targeted
therapy adjusted through monitoring,” said Dr. Jean-
Luc Vanderheyden, a specialist in in vivo imaging and
Global Molecular Imaging Leader with GE Healthcare.
“Turning Into An Epidemic”
Effective approaches are urgently required for this disease
which is developing into an epidemic, according
to Dr. Nori Graham. This expert in Psychiatric Services
for the elderly, former President of Alzheimer’s Disease
International (ADI), and current Vice President
of this global umbrella organization of Alzheimer’s associations,
laid out a profile and roadmap for dementia
– with 9.9 mn people affected in Europe by 2040.
Dr. Graham’s call for action on “this global problem
present in every country of the world” includes, besides
timely recognition of symptoms, accurate diagnosis,
and monitored treatment, a focus on the carer. She
sees positive effects from the 77 national Alzheimer’s
organizations around the globe which act as catalysts
for support groups and individual carers.
“Proper Diagnosis Is Essential”
John O’Brien, Professor of Psychiatric Services at the
University of Newcastle upon Tyne, UK, described the
various conditions which make up the spectrum of
dementia: approx. 65 % of cases are Alzheimer’s and
others, vascular dementia accounts for 15 – 20 %, and
another 15 % is characterized by dementia with Lewy
bodies (DLB). Diagnostics for vascular and Lewy body
dementia show low sensitivity today, with overlapping
symptoms – “which provides significant room for improvement,
if one takes into account that the medical
management for each of these three types is very specific”.
– Until recently DLB has been difficult to diagnose,
and is often misdiagnosed as Alzheimer’s disease
as many symptoms overlap. Datscan (ioflupane) is a
molecular imaging diagnostic agent from GE Healthcare
that may assist in distinguishing probable DLB
from Alzheimer’s disease.
For Prof. O’Brien, too, molecular imaging is the
path of choice for improved diagnostics: biomarkers
are very useful, e.g. markers of the hippocampal atrophy,
FDG PET trace, and CSF. Potential treatments
include anti-inflammatory action, cholinesterase and
GICS inhibitors; and eliminating the amyloid neuritic
plaques from the system. “Combining clinical information
with biomarkers is the most promising way
to go.”
“Fundamental Change Called For”
Out of five adults aged 75, one will develop dementia,
and public health cost is becoming tremendous – “we
need a fundamental change, moving from late disease
to early health” with prevention and prediction as key
elements. New molecular approaches are to have a key
role in this, summarized Vanderheyden.
Michael Reiter
PET Diagnostics of the Brain
Identifying cases of Alzheimer’s (AD) among patients with Mild Cognitive Impairment
(MCI) – molecular imaging turns out to deliver valuable results, enabling early diagnosis
New President And CEO
John Dineen is the new president and CEO of GE
Healthcare. Dineen, 45, is a 22-year GE veteran, and
since 2005 has been president and chief executive officer
of GE Transportation. In his new position, he will
be located in London, where GE Healthcare is headquartered.
“John Dineen is a talented global leader
who has consistently delivered double-digit growth by
globalizing our Transportation business and diversifying
its high-tech portfolio,” said GE Chairman and CEO
Jeff Immelt. “John has developed broad operations
expertise across a range of industries for two decades.
His sharp customer focus combined with the talented
team at Healthcare will help the business continue to
grow around the world.” – Dineen succeeds Joseph
Hogan, who has taken a position as CEO of ABB.
www.gehealthcare.com
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turn up today?
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©2008 Inverness Medical. All rights reserved. SureStep is a registered trademark of the Inverness Medical group of companies.

24 LABorAtorY
Hospital Post Europe 04/08
The intelligent human being is
rather lazy and tends to leave
more monotonous tasks to
others, machines preferably.
This is why there’s not only
a dishwasher and a washing
machine in every household,
an ATM at the bank and a
welding robot in the car factory,
but also a system for
laboratory automation, which
now has thousands of fans
through the 100 systems that
have been installed throughout
Germany. We talked to its
creator, Dr. Robert Hecht of
Olympus Life Science Research
Europa in Munich.
Hospital Post Europe: Being a veterinary
doctor, how did you come across
the idea to automate laboratory workflows?
R. Hecht: After studying mechanical engineering
for two years and completing my
studies of veterinary medicine, I started
to work in a development laboratory for
transplantation sciences at the University
A Bavarian in Automation Heaven
„The Art of Constructing a Complicated System in a Simple Way“
Dr. Robert Hecht of Olympus
Life Science Research Europa,
Munich
of Munich in the Großhadern hospital.
While conducting fluorescence measurement,
one single test was connected with
three to four thousand samples. I did not
like us to have to process them manually,
so I insisted on buying a robot. We improved
its interface for starting the procedures
and then automated the measurements.
Motivated by the positive feedback
from the industry I founded an engineering
company.
And the connection to Olympus? How
did it start?
R. Hecht: After several contacts to lab specialists,
we decided to develop customerspecific
projects in laboratory automation
together. There were enough large and
non-flexible systems on the market, so we
decided to construct small ones that are especially
adjustable to the individual needs
of laboratories. This brought us in contact
with renowned customers. Soon we realized
that we could not expand on our own,
because development and distribution are
two separate things. So we searched for
a big and reliable partner who believes in
our system. And that’s Olympus.
Besides the improved distribution,
were there also improvements in the
construction?
R. Hecht: Indeed, at first we adapted
the design of OLA to the Olympus style.
Then several mechanical and electronic
improvements followed. Since the beginning,
we have relied on state-of-the-art
components, so quality and long life cycles
are always guaranteed. The biggest challenge
with Olympus was to develop an
industry standard out of this small series.
At first every machine was unique. Now
it was documentation of assembly, securing
of quality and the extreme growth of
our number of employees from 30 to 120.
Lab Automation Grows from Strength to Strength
Just four years after being
launched, Olympus has installed
its 100 th OLA2500 system
for the automation of pre
and post analytical processes
at the Kyritz Medical Laboratory
(MLK) in Brandenburg,
Germany.
Installed in January, the 100th system has
already been responsible for improving
workflow efficiency and demonstrates the
breakthrough the company has made in
the German lab automation market.
As is the case throughout the healthcare
community, laboratories today require in-
telligent solutions to successfully combat
rising costs. With its diverse automation
capabilities, the OLA2500 boasts just such
savings potential. One example is in the
system’s ability to manage standard processes
such as the decapping, aliquoting,
barcoding, sorting and sealing of test tubes,
saving valuable time, money, and energy.
One of the companies taking advantage
of the benefits offered by the OLA2500 is
the MLK in the northeast German state of
Brandenburg, where since the end of January,
numerous tasks have been handed
over and entrusted to automated lab management.
For Olympus, this implementation
is an important milestone: “With the
The Kyritz Medical Laboratory (MLK)
MLK is a partner of the ostprignitz-ruppin Association of Laboratories, a
member of the Lab diagnostics consortium for diagnostics and rationalisation
(LAdr) and has been certified since 1997 – currently in accordance
with dIn En Iso 15189. A total of 65 employees support about 250 privately
practising doctors, four emergency hospitals, and four rehabilitation clinics
throughout greater Brandenburg, Mecklenburg-Western Pomerania and
saxony-Anhalt, providing external medical laboratory diagnostics services.
www.labor-dr-hassfeld.de/mlk/mlkindex.htm
Besides the launch of its latest
fourth-generation rapid
HIV diagnostic test, Inverness
Medical introduced its new
Clearview TB ELISA at the
International AIDS Conference
(AIDS 2008). Tuberculosis (TB)
is a leading cause of death in
HIV infected patients, and the
unique urine based Clearview
TB ELISA LAM antigen test
can provide a much needed
aid in the diagnosis of TB
100th installation of an OLA2500 in Germany,
we’ve crossed a magic threshold.
Just four years after the system’s introduction,
we’re able to declare successful penetration
in the lab automation market in
Germany,” said Thorsten Laubert, Product
Manager, Lab Automation.
One Million Test Tubes a Year
Around 2,500 test tubes are analysed at
MLK every day. That amounts to roughly
one million test tubes a year which previously
required labour-intensive management
prior to and following analysis. “Since
the end of January, the OLA2500 has completed
these tasks automatically. The time
we’ve saved as a result can now be used
much more effectively,” adds Dr. Manfred
Haßfeld, founder and head of MLK. “What’s
more, samples can now be localized much
more quickly, while automatic barcoding
rules out any chance of a mix up. The system
even helps with archiving. In short, the
OLA2500 has been a fantastic investment.”
www.olympus-europa.com
Fighting Back Against TB and HIV
in TB/HIV co-infected patients.
HIV is driving the TB epidemic in many
countries such as sub-Saharan Africa, Asia,
and South America where HIV infection
amongst the population is high. Inverness
Medical is now able to offer a rapid diagnostic
kit using ELISA (Enzyme Linked Immunosorbent
Assay) technology capable
of aiding the diagnosis of TB in these vulnerable
patients where previously existing
tests have failed.
Traditional sputum smear tests for TB
incur considerable limitations when used
as a primary diagnostic test in co-infected
HIV-TB patients, with a sensitivity falling to
as low as 20 % in patients who are also HIV
infected. Clearview TB ELISA uses antibodies
specific to the antigen lipoarabinomannan
(LAM) which forms part of the TB cell
wall. The elevated levels of the LAM antigen
within the urine of TB/HIV co-infected patients
provides a specific diagnostic target.
When targeting this specific antigen, clinical
data shows that in TB-HIV co-infected
We had to organize everything properly to
start with. Our drawers and sensors, for example,
were already working and made our
concept superior to others. But to transfer
this to serial production with standards
that remained identical whilst constructing
a complicated system in a simple way,
that’s an art.
Does that mean that every OLA is the
same now?
R. Hecht: No, absolutely not. The quality
standard of every OLA is identical, yes. But
every square millimetre of it is freely configurable.
The customer or user does not
have to adjust to the machine, because it
is extremely flexible in its parameters and
able to adapt to its surroundings. Every
OLA2500 can be freely defined because
every laboratory, every task is different.
One user wants to aliquot, but works only
with a small throughput, the other user
needs to be extremely fast. The hospitals
wants to analyse STAT samples first, the
large laboratories want to concentrate on
routine samples. The very special thing
with OLA is its easy handling, so everyone
can easily work with it.
Hepatitis Tests for all Sizes of Laboratories
Siemens Healthcare Diagnostics
received CE marking approval
to sell the hepatitis B
virus e-antigen (HBeAg) and
antibody to the hepatitis B
virus (anti-HBe) tests in the
European marketplace.
The two new tests may be used as an aid in
the diagnosis of hepatitis B infections and
to monitor the effectiveness of hepatitis B
virus treatment. With these additions, the
company now offers complete hepatitis
A, B, and C test panels that can be run on
the high-throughput ADVIA Centaur and
ADVIA Centaur XP immunoassay systems.
Consolidating all A, B, and C hepatitis tests
onto one instrument creates cost efficiencies
by reducing the time needed for laboratory
personnel to produce test results.
In addition, Siemens Healthcare received
CE marking approval to sell multiple
hepatitis B tests for use on the ADVIA
Centaur CP immunoassay system in the European
marketplace. This allows mid-sized
patients detection rates increase to 80.3 %.
The use of urine also offers the clinician
the advantage of a sample material which
is safer and far less invasive than conventional
sputum sample collection.
The new, user-friendly, Clearview test
screens for the LAM antigen in urine samples
in less than three hours, significantly
faster than bacterial cultures that can take
up to six weeks to develop. By using the
LAM ELISA technology, Inverness Medical
is leading the way in reducing the prevalence
of this preventable and curable dis-
What do you think is the current trend
in development?
R. Hecht: The overall trend is obvious:
Since 2006 the big track systems have
made a comeback. But they are very complex,
and in my opinion in laboratories it’s
not about cycle times as it is in industry.
laboratory workflows can not be compared
to production lines, as they are predefined.
We regard every lab as an individual, so to
speak. The turn-around-time (TAT) must
be as short as possible; the system must
be able to cope with chaos. That’s why we
believe that the true trend is connected to
the software. The mechanical part can be
handled relatively easily seen from the construction
perspective. But one should not
let the separate software packages get too
big. We focus on modularity, and we know
that implementation time has to be short.
Who wants to unnecessarily delay his lab
workflows?
www.olympus-europa.com
clinical laboratories to consolidate hepatitis
B tests with other immunoassay tests
onto one compact, bench top, fully automated
immunoassay system. This, again,
creates cost efficiencies by reducing the
time needed for laboratory personnel to
produce test results. The hepatitis B tests
approved for use on the ADVIA Centaur CP
system are hepatitis B surface antigen (HBsAg),
HBsAg confirmation, total antibody
to the core antigen of the hepatitis B virus
(HBcTotal) and IgM to the core antigen of
the hepatitis B virus (HBcIgM). All of these
tests are routinely requested by physicians
to screen and diagnose hepatitis B infections
in patients.
“These introductions demonstrate Siemens’
commitment to making quality hepatitis
tests available to all sizes of laboratories,”
said Jay Snyder, vice president, global
clinical chemistry, immunoassay and automation,
Siemens Healthcare Diagnostics.
www.siemens.com/healthcare
ease in areas with a large HIV population
through effective early diagnosis.
www.invernessmedical.com

Hospital Post Europe 04/08
Pronostics, developer and
manufacturer of next generation
multiplexed diagnostics
for healthcare providers and
the pharmaceutical industry,
has signed a deal with University
of Birmingham Medical
School (UBMS) to provide
next-generation autoimmune
testing services for its clinical
immunology service.
As part of the deal, Pronostics will provide
UBMS clinical immunology service with its
New Rapid HIV Test Detects Acute
HIV Infection
Inverness Medical announced
the launch of its new 4 th generation
rapid HIV diagnostic
test – Determine HIV-1/2 Ag/
Ab Combo – at the International
AIDS Conference (AIDS
2008 – 3 – 8 August) in Mexico
City. Capable of detecting HIV
infection several days earlier
than HIV antibody only tests,
Determine HIV-1/2 Ag/Ab
Combo enables simultaneous
separate detection of HIV p24
antigen (Ag) and antibodies
(Ab) for HIV-1 and HIV-2 in human
serum, plasma, or whole
blood.
The p24 antigen is produced during the
first few weeks of HIV infection and is
detectable before HIV antibodies are produced,
making it an ideal marker in aiding
early HIV diagnosis. By simultaneously detecting
for p24 antigen and HIV antibodies,
Determine HIV 1/2 Ag/Ab Combo increases
the ability to detect and diagnose primary
HIV infection.
The lateral flow test from Inverness
Medical provides clear visual results during
the patient visit. The easy to use, robust
format of Determine does not require
electricity, water, or the use of bulky laboratory
equipment and can be performed in
point-of-care settings and remote locations
where laboratory facilities are limited. This
gives significant advantages over lab-based
EIA and ELISA 4 th generation HIV testing.
The Determine HIV-1/2 Ag/Ab Combo
test is ideal to help diagnose and screen
for early HIV infection. The ability of this
test to enhance diagnosis of those with
acute HIV infection will provide additional
benefits in HIV prevention programs and
ultimately contribute to a reduction in the
spread of HIV.
www.invernessmedical.com
LABorAtorY 25
Providing Next-Generation Multiplexed Diagnostics
fully automated UltraPlex system and ANA
Assay for the diagnosis of autoimmune disease.
This follows an independent trial at
UBMS in 2007 which compared Pronostics’
UltraPlex ANA assay with existing testing
methods employed. The UltraPlex solution
eliminates the possibility of subjective errors,
removes non-specific positive results
and focuses on clinically significant results,
with known disease association. Its introduction
will also significantly reduce test
turn-a-round times.
The UltraPlex ANA assay consists of 11
tests in one, providing valuable time and
cost savings compared to serial testing
approaches or current multiplexing methods.
It allows hospitals and laboratories to
perform fully automated tests on patient
samples and gives both quantitative and
qualitative results for antibodies in autoimmune
diseases.
UltraPlex is an exceptionally accurate,
digital multiplexing solution which enables
tens to hundreds of tests to be performed
simultaneously in a single assay using a
microscopic bar coding system. Over the
coming year, Pronostics will be launching
assays in the cardiovascular and cancer dis-
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ease areas to supplement its autoimmune
range which currently includes ANA, Coeliac,
and Thyroid assays.
Timothy Plant, Laboratory Manager for
UBMS clinical immunology services said:
“We are very pleased to have signed this
deal with Pronostics and look forward to
enjoying the benefits the UltraPlex platform
has to offer”. Rob Booth, CEO of
Pronostics added: “This deal highlights the
benefits of the UltraPlex ANA solution and
we look forward to providing additional assays
to UBMS as our relationship progresses.
The great thing about UltraPlex is that
it provides significant time and cost savings
which benefit hospitals and patients
alike. Hospitals save money, waiting times
are reduced and patients are diagnosed
sooner.”
www.pro-nostics.com

26 PHArMA
Hospital Post Europe 04/08
Arid deserts and icy peaks –
Geri Winkler loves extremes.
The Vienna resident is the third
Austrian and the first person
with diabetes to conquer the
Seven Summits – a group of
mountains comprising the
highest peaks on each of the
seven continents. By successfully
scaling Mount McKinley
(Denali) in Alaska, which is
nearly 6,200 meters high, the
type 1 diabetic – whose pancreas
can no longer produce
the vital metabolic hormone
insulin – has conquered the final
mountain missing from his
collection. “I’ve fulfilled a lifelong
dream with this climb,”
says the adventurer after his
Overcoming Boundaries
Geri Winkler becomes the first Diabetic to Conquer the Seven Summits
return to Vienna. “The tour
was physically demanding,
but at the same time an unbelievable
experience mentally.”
Winkler made the decision to take up the
Seven Summits challenge in the autumn of
2003. “What made the project so appealing
was climbing the highest peaks in regions
and climate zones that are completely different
in terms of landscape,” explains the
globetrotter. On the agenda were expeditions
to Mount Elbrus in the Russian Caucasus,
Aconcagua in South America, Mount
Vinson in Antarctica, Kilimanjaro in Africa,
and Carstensz Pyramid in Oceania. The biggest
athletic and mental challenge of the
project, however, was the ascent to the
roof of the world – Mount Everest. In May
2006, Winkler became the first diabetic to
reach the 8,848 meter-high summit of the
world’s highest mountain.
The success of his Seven Summits project
was dependent not just on endurance and
physical fitness, but also particularly on a
functioning insulin therapy. This gives the
diabetic athlete a high level of flexibility, as
he can administer the hormone according
to his body’s demand for it. To regularly
monitor his glucose level, Winkler always
has a blood glucose monitoring system
from Bayer HealthCare with him on his
journeys around the world. The system
provides the avid outdoorsman with reliable
and precise measurements and therefore
gives him security. “I prefer a system
that is easy to use and good for ten tests
after I insert the sensor disc,” says Winkler.
Of particular advantage is the fact that the
system doesn’t need to be manually coded
when a new test strip pack is opened – a
frequent source of errors. After all, reliable
test results are vital for the athlete.
Whether it’s wild glacier ridges in the
Andes or rocky deserts in Africa – despite
breathtaking landscapes, Winkler has never
underestimated the risks of his tours.
The beauty of mountainous terrain is often
deceptive, as the adventurer must expect
avalanches at any time. Winkler knows that
he has to carefully prepare himself for each
mountain. He never gave up and lost sight
of his main objective. Thanks to his strong
willpower, the passionate mountaineer
successfully completed his Seven Summits
project. “You have to believe in yourself
and keep setting new goals for yourself,”
emphasizes Winkler, describing his phi-
losophy of life. www.bayer.com
About Geri Winkler
Geri Winkler was born in vienna
in 1956 and has suffered from
type 1 diabetes for 24 years. His
passion is the discovery of foreign
countries, cultures, and communities.
He prefers to explore these
worlds on foot or by bicycle. on
May 20, 2006, he reached the
8,850-meter summit of Mount
Everest. It was the longest ascent
of all time, as Geri Winkler began
the climb at the lowest point in
the world – on the banks of the
dead sea in Jordan, 411 meters
below sea level. traveling alone
by bicycle and ultimately on
foot, he reached the base of the
world’s highest mountain in five
months before ascending to the
peak together with an American
colleague.
New Treatment Strategies for Women with Early-Stage Breast Cancer
Until recently, a five-year period
of endocrine treatment
with tamoxifen was widely acknowledged
as being the gold
standard, adjuvant therapy
for postmenopausal women
with early breast cancer (EBC).
Recent clinical data suggest
that the new generation of
endocrine agents – aromatase
inhibitors (AIs) – provide more
effective protection against
breast cancer recurring than
tamoxifen – while at the same
time reducing the risk of complications
such asthromboembolic/cerebrovascular
events
and endometrial cancer.
A group of 15 internationally-renowned
breast cancer specialists (oncologists, surgeons,
and gynaecologists) is so concerned
that some women with EBC are continuing
to receive sub-optimal endocrine treatment
that they have met to discuss the
prevailing evidence on the use of AIs as
adjuvant treatment.
Meeting in the UK last spring, members
of this forum first considered why postmenopausal
hormone receptor-positive
women with EBC should be treated with
endocrine therapy in the first place:
to prevent recurrence;
to prolong survival;
to minimize life-threatening side-effects;
to maintain quality of life.
The American Society of Clinical Oncology
(ASCO) and the National Institute for
Health and Clinical Excellence (NICE) in
the UK both signal that AIs should be playing
an essential part in treatment strategies
in this vulnerable cohort of women. However,
clear guidance as to the timing of AI
initiation remains somewhat vague. While
there is a steady take-up of AIs as the endocrine
treatment of preference, there are
some who are still reluctant to commit to
AIs up-front.
Data From Clinical Trials?
100-month data from the ATAC (Arimidex,
Tamoxifen, Alone or in Combination) trial
have revealed that the “carry over” benefits
of managing hormone-sensitive EBC
with an up-front AI (anastrozole) are maintained
well beyond the conventional fiveyear
course of treatment.
Those taking part in the discussions at
Crewe Hall acknowledge that the absolute
benefit of an AI seen in ATAC might seem
small. They also concede that the “carryover”
effect may be a difficult concept to
understand. The term “carry over” may
even be confusing clinicians, and might be
better described as a “cure” effect. Thus, if
malignant cells are killed during endocrine
therapy, future recurrences are prevented.
Dr. Jack Cuzick (Wolfson Institute of Preventive
Medicine, London, UK) says that
the carry-over effect should not be so mystical.
“If you eradicate micro-metastases in
just a small proportion of patients, it’s an
effect that lasts forever. In those patients,
this is a cure – and it establishes the case
for treating with an AI in the first few years
to create a carry-over benefit later on.”
Data from the Early Breast Cancer Trialists’
Collaborative Group show that while
the carry-over benefit with tamoxifen only
extends to ten years of follow-up, there is
every expectation that the additional benefit
of AI therapy will continue for 20 years
and possibly longer.
To date the, upfront trials ATAC (Arimidex,
Tamoxifen, Alone or in Combination)
and BIG1-98 have not demonstrated an
overall survival (OS) benefit for the AI, and
clinicians continue to be cautious about
up-front AI therapy. However, the specialists
who took part in the forum recognized
that believe there are competing causes of
mortality that increase with age which decrease
the likelihood of being able to easily
demonstrate a better survival outcome
with AIs. “In a sense,” said Dr. Cuzick, “it
means that these women are not dying
from breast cancer, but from other causes.
We must make sure that oncologists appreciate
the significance of the difference in
recurrence with an AI. It is totally unrealistic
to expect a decrease in OS.”
However, in the ATAC trial, fewer deaths
after recurrence were seen on anastrozole
compared to tamoxifen. Based on the outcome
of studies comparing tamoxifen to
placebo, Dr. Chlebowski suggested “Follow-up
exceeding ten years may be needed
before an OS benefit could be anticipated
to emerge.”
Even if clinicians accept the evidence for
giving up-front AIs, cost may be an issue.
Members of the forum argue, however,
that the impact of recurrence is too great a
price to pay for not choosing a therapy that
has been shown to reduce that risk. They
emphasize that the psychological impact
of recurrence cannot be overestimated in
terms of anxiety, stress, and a negative impact
on overall quality of life.
Impact of Non-Breast
Cancer Deaths etc.?
In the management of women with EBC,
clinicians do not always think about the
impact that their prescribed therapies are
having on other aspects of their patients’
health and well-being, or on other potential
causes of mortality. In terms of therapeutic
intervention, their decisions tend
to focus largely upon what can be done to
minimize the risk of recurrence.
Members of the forum are anxious; however,
to stress that as adjuvant endocrine
therapy does not offer most women a cure
for breast cancer, it is vital that those women
experience an optimal quality of life
during the course of their remaining years.
With this in mind, the risk-benefit profile
of AIs is an important issue. Are clinicians
being deterred from prescribing AIs because
they perceive that the side-effects of
therapy outweigh the proven advantages
in extending time to recurrence?
Prof. Rowan Chlebowski (University College
of Medicine, Los Angeles, US) commented
that the side-effects of endocrine
treatment must be put into perspective.
“The scarcity of adverse events is more
striking than any potential safety differences
between tamoxifen and AIs,” he said.
“We can be too negative about side-effects.
We must convince patients of the benefits
of persisting with therapy through years 3,
4 and 5 – not just year 1.”
It was pointed out that much has been
made of the link between AIs and an increased
risk of musculo-skeletal problems
– but that while these may be troublesome,
they are not life-threatening, and can be
treated. Indeed, when the risks associated
with AIs (e.g. bone fractures and arthralgias)
are compared with that of tamoxifen
(e.g. life-threatening endometrial cancer,
strokes, pulmonary embolism, urinary sarcomas)
few oncologists would think twice
about prescribing an AI.
Meanwhile, the ATAC 100-month data
also indicate that the excess fracture risk
associated with active anastrozole therapy
– a continuing concern for physicians
considering AI therapy in this setting –
completely disappears within a matter of
months of stopping treatment (i).
Promoting Adherence to
Endocrine Treatment in EBC
Even if clinicians are persuaded by the
powerful arguments in favour of up-front
AIs, there may be a problem of convincing
women with EBC that they need to persist
with these new agents Prof. Peyman
Hadji (University of Marburg, Germany)
highlighted the importance of adhering to
endocrine therapy – at least for the 5-year
period currently recommended.
There is no question, he said, that AIs
offer greater benefit than tamoxifen in
terms of risk of recurrence – but how to
keep patients on AIs when they perceive
that the side-effects of therapy outweigh
those benefits?
Professor Hadji says that a significant
proportion of patients do not perceive
an improvement in their symptoms or
the likelihood of a cure. Patients will not
experience an immediate benefit since
there are no acute symptoms from which
AIs give relief – but AIs do reduce the
risk of recurrence and distant metastases.
Furthermore, a significant percentage of
patients who say they are compliant, are
not. As with clinicians, they may have difficulties
in accepting that the side-effects
associated with AIs pale into insignificance
when compared to the potential benefits.
“We must strike a balance,” he says, “between
telling patients about the potential
for side-effects from AI therapy – none
of which are life-threatening and most of
which can be treated successfully – and
the need to warn women that recurrence
and its consequences are a constant risk of
non-adherence.”
“It underlines,” says Prof. Hadji, “the importance
of communicating with patients
from the outset – involving women with
EBC in the choice of endocrine therapy,
and increasing the intensity of consultations
in the first three to six months following
diagnosis to ensure patients understand
the importance and value of their
treatment and the potential side effects.”
Proceedings To Be Published
The members of this international forum
of breast cancer specialists are planning to
publish a proceedings from their discussion
later in 2008. Prof. Chlebowski concluded:
“We have to convince clinicians that an upfront
strategy with AIs will pay dividends
– and we have to convince patients that
they have to take their treatment for the
duration of prescribed therapy. If cost were
not an issue, there would be no argument
against giving an AI up-front.”
The UK forum was chaired by Professor
Rowan Chlebowski (USA). The other participants
were: Jack Cuzick (UK), Peyman
Hadji (Germany), Shinzaburo Noguchi (Japan),
Sunil Verma (Canada), Stephen Chia
(Canada), Andre Robidoux (Canada), Nicholai
Maass (Germany), Ingo Bauerfeind
(Germany), Bruno Cutuli (France), Aman
Buzdar (USA), Rick Linforth (UK.)
This article has been supported by funding
from AstraZeneca UK Ltd.
Stephen Pinn

Hospital Post Europe 04/08
Through the implementation
of the German Diagnosis Related
Grouping (DRG) system
and the resulting cost pressure,
the need for optimized
use and operation of the
premises in hospitals is growing.
The link between primary
processes and facility management
(FM) services, however,
is missing. Therefore the
Chair for Facility Management
at the University of Karlsruhe
(Germany) analyzed the interdependencies
between facility
management performance,
costs, and primary processes
in hospitals. This project is abbreviated,
in German, OPIK –
optimization and analysis of
hospital processes.
Process-Oriented Cost Model
The treatment of patients in hospitals can
be described by a clinical path that is interpreted
in terms of space. Figure 1 illustrates
this – the patient’s way through the
hospital follows a certain path, symbolized
by the black line. Along this, the patient
requires specific functions from various
entities. Depending on each function, differing
infrastructure services are necessary
– symbolized by the grey circles. At the
level of space, primary and infrastructure
processes are linked through the functional
units. The focus is set on the patient
and his/her presence in the functional unit.
Any performance is related to this case.
Fig. 1: Patient’s path through the hospital
This relation between FM services and the
primary processes has been described in a
mathematic process modelled by the University
of Karlsruhe.
The model’s quintessence is the
description of the relation of all core infrastructure
processes to a primary process
profile. Thus, a value from the primary
process has been assigned to each relevant
main FM process. For the operation room
(OR) – of key importance –, the cost dominant
process “sterile goods supply” is discussed
in the following as an example. The
results are based on the analysis of empirical
data of four German hospitals.
Sterile Goods Supply
in the OR
Figure 2 shows the average cost shares of
the FM processes for the OR: 39 % of the
costs are related to the process “sterile
goods supply”. Therefore, this process is
paramount for the OR.
Fig. 2: Average FM cost share for the functional unit operation of
four hospitals
FAcILItY MAnAGEMEnt 27
FM Cost in the OR
Cost Driver
The relation between primary and FM
processes can be separated into fixed and
variable costs. “Sterile goods supply” is
part of the variable costs. When changing
intervention activities in the OR from one
shift to two shifts per day and assuming
similar workload, it may be assumed that
these costs will double in a linear manner.
According to the standard of the German
“Institut für das Entgeltsystem im Krankenhaus”
(InEK), the basis of the allocation,
and therefore abstract cost driver for the
costs of the medical and non-medical infrastructure
in the OR, is the time between
first incision of the skin and last suture plus
the setup time for each intervention. This
approach is simplistic in assuming that all
infrastructure costs are linear dependent
on the length of the intervention. Time is
the only cost driver. For a transparent analysis
of costs and for the purpose of benchmarking
and optimization of FM products,
the relation between cost and cost driver
has to be examined in detail.
Does an intervention of double length
really mean a doubled effort for sterilization
and packing of the surgical kits? The
cost driver for sterile goods supply is, rather,
the number, and content of surgical kits
– i.e. the type of intervention rather than
the procedure time. A problem occurs
when large surgical kits are opened just for
the use of one or two elements: the unused
content has to be sterilized and repacked.
To avoid this needless effort, there has
to be good communication between surgeons,
medical staff, and the sterilization
Texcare International – New Technologies
Early in June, the international
tradeshow for textile handling
took place in Frankfurt/
Germany. Around 15,500 trade
visitors from 80 countries
came to discuss solutions and
products from 258 exhibitors
who included “big names”
such as Kannegiesser, Jensen-
Group, Lavatec, Pellerin Milnor,
Alliance, Renzacci, Girbau,
Multimatic ilsa, Miele, and
Ecolab. More than half of the
attendees travelled to Frankfurt
from outside Germany.
The portfolio of the show included laundry
and dry-cleaning machines, logistics
and transport, finishing and ironing equip-
ment, as well as linen hire and research.
“The Texcare Forum was also given a good
reception by all visitors and well attended,”
said Friedrich Eberhard, Vice President
of the German Dry Cleaning Association.
“The most important topics at this year’s
Texcare were: energy efficiency, environmental
conservation, and the linkage of
mechanical units for greater efficiency and
economy.”
New technologies supporting logistics
were also at the top of the agenda – in particular
at the booths of Tagsys, Sokymat –
where the Miniature Laundry Tag S-Tag10
was presented – and Datamars.
The Swiss RFID specialist Datamars announced,
in Frankfurt, a partnership with
the Dutch logistics vendor ABS Laundry
Business Solutions. A modular approach
is the partners’ reply to increasing demand
in handling industrial and rental textiles,
speakers said at the press conference.
“Our objective is to ensure that [RFID]
technology is accessible to businesses of all
sizes, by bundling hardware and software
components to deliver total customized
ID solutions that are affordable and truly
meet the individual needs and budgets of
our customers. Our alliance with the leading
automation and logistics solutions provider
for the textile rental business worldwide,
ABS, reflects this objective,” underlined
Ken Boyle, Chief Marketing Officer at
Datamars.
The next Texcare is to take place four
years from now.
Michael Reiter
department. Standardized surgical kits
should be used for routine interventions
and the documentation should be made
available for FM purposes.
The average costs for sterile goods
supply for the operation of a hip joint in
2005 – based on the information from four
hospitals – is about € 190 with an average
number of sterile goods entities of 5.5. The
average cost for sterile goods supply for any
intervention is only € 58. This difference
can be related to the average intervention
time, including setup, for a hip joint: the
reference time is about 190 minutes. The
average time for the different intervention
portfolios in the hospitals of the research
sample varies between 72 and 165 minutes.
Considering the possible time span of
interventions and the cost differences for
sterile goods supply for a relatively short
but complex kind of intervention – as in
the case of a hip joint surgery –, the need
for transparent, realistic cost allocation be-
comes clear. For sure, the cost for sterile
goods supply can not properly be set in
relation with intervention time.
The University of Karlsruhe is developing
a model that allows a realistic cost
allocation for FM processes. Thus, the
researchers are linking FM processes and
the primary process for the function areas
in the hospital. This is an important step
towards cost transparency, and gives a very
important basis for strategic planning of
resources in the hospital.
Contact:
Dipl.-Ing. Karin Diez
Prof. Kunibert Lennerts
University of Karlsruhe (TH)
Facility Management
D-Karlsruhe
Tel.: +49 721/608 8225
Fax: +49 721/608 4351
karin.diez@uni-karlsruhe.de
www.facility-management.
uni-karlsruhe.de
Significant Effect on Skin Flora
Trevira Bioactive is kind to
the skin – as confirmed by a
study of the Hohenstein Institute,
which specializes in the
physiology of clothing.
Can wearing antimicrobial clothing in Trevira
Bioactive exercise a negative effect
on the skin flora? Does Trevira Bioactive
influence other parameters of a skin-physiological
nature? Evaluation of a four-week
wearer trial should supply answers to these
questions. The testers came to the conclusion
that the antimicrobial activity of the
fibres had no harmful effect on the skin flora,
even after being worn for some considerable
time. They were unable to establish
any negative impact by the textile fibres on
the flora, either in the case of individual
trial participants or taking the whole participant
group into consideration. In the
wearer trials where Trevira Bioactive was
compared with conventional textiles, it was
not possible to establish any noticeable dif-
Renovation Work in Jordania
Thanks to the funding of the
United States Agency for International
Development (US-
AID), renovation and expansion
work in the Maan hospital
in Jordan is now complete.
The upgraded facilities were inaugurated
in the middle of May by the Minister of
Health Salah Mawajdeh and USAID Mission
Director Jay Knott. The new facilities include
a renovated delivery ward, obstetrics
and paediatric departments, and operating
theatre. After the renovation, the hospital
is equipped with state-of-the-art medical
equipment and furniture which are crucial
to the safety and quality of the services
provided to the women and newborns in
Maan, according to a statement released
by USAID.
The renovation work was designed to
meet the functional, infrastructure, and
infection control requirements in accordance
with international standards (AIA-
ference in the total number of germs on
the skin. In addition, the most important
indicator of the protective function of the
skin, “transepidermal water loss” (TEWL),
stays unchanged when wearing Trevira Bioactive.
There is also no alteration in the pH
value and surface temperature of the skin.
In comparison: in contrast to wearing
clothing made from permanently antimicrobial
polyester fibres, alcoholic skin
disinfection has a significant effect on skin
flora. By virtue of a silver additive that is
firmly anchored in the raw material, Trevira
Bioactive fibres prevent the growth
of bacteria on the fibre surface. The effect
is permanent and is not affected by either
washing or usage. Furthermore it prevents
odours forming and textiles stay fresh for
longer. The vital factor is that in all this the
effect is limited to the textile.
www.trevira.com
American). Furthermore, the staff of the
Maan Hospital was also provided with clinical
guidelines and trained how to use and
maintain the new equipment in the obstetrics
and neonatal departments.
The Maan hospital – built in 1950 –
serves about 100,000 people. Before the
renovation work, a lot of Maan residents
had to travel to Aqaba because of the limited
services provided by the hospital. Now,
medical treatment improved considerably
and the people no longer need to take a
trip.
After renovating Maan hospital, renewals
and expansion work of other hospitals
will follow. The primary objective of the
USAID’s Health Systems Strengthening
project is to improve the health status of all
Jordanians. Coverage and access to needed
services for all citizens should be improved
to provide high-quality and client-oriented
care.
CK

GSD-Z1077-1-7600
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