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Company Profile: Shimadzu Europa GmbH family, combines high patient throughput with optimal convenience for users as well as patients and, at the same time, delivers brilliant image quality. RADspeed safire acquires clear images of difficult-to-diagnose findings such as round lesions that are often obscured by ribs. Award-winning mobile X-ray technology In 2009, Shimadzu introduced the MobileArt Evolution series, the next generation mobile X-ray systems of the award-winning MobileArt series. This family of systems offers efficiency as well as user and patient friendliness together with high-quality images. The premium version can be extended to a fully digital unit applying FPD. The new mobile fully digital MobileDaRt Evolution system covers the entire radiological spectrum. Based on its high-performance flat-panel detector of 35 x 43 cm, an optimal image quality can be guaranteed under the most difficult conditions, for example in trauma and intensive care medicine or on patient wards. With the integrated touch-screen monitor an image can already be processed within 3 seconds after exposure. In this way, the MobileDaRt Evolution closes the “work-flow gap” in fully digitally equipped clinics, as the critical intensive care or trauma images are already available within a few seconds after creation on the PACS diagnostic workstations. Patented technology for angiographic applications Using novel technologies and equipment, the company paved the way for new applications and diagnostic tools, for example Realtime Smooth Mask DSA. The patented RSM-DSA technology enables subtraction angiography, where the mask and filler images are acquired almost simultaneously and subtracted in real-time. Finding the right diagnosis becomes much easier and more precise while reducing the enormous technical effort, time and cost required for modern angiography applications. Figure 2: The MobileDaRt Evolution stands for mobile state-ofthe-art technology. Each customer benefits from each customer Shimadzu’s research and development is led by a simple yet central mission: to offer the best possible diagnostics with the highest patient- and user friendliness. Shimadzu’s medical technology is applied on all continents. The feedback from Shimadzu’s customers is integrated directly in the development of new systems. In this way, each of Shimadzu’s customers benefits from globally acquired knowledge. Shimadzu’s technology is further complemented by proximity to its customers: Shimadzu has an extensive sales and service network all over Europe. Shimadzu Europa GmbH Albert-Hahn-Str. 6-10 47269 Duisburg, Germany Phone: +49 (0) 203-76 87-0 Fax: +49 (0) 203-76 87 680 E-mail: medical@shimadzu.eu www.shimadzu.eu Hospital and Healthcare Innovation Book 2009/2010 89
Innovation and clinical specialities: oncology Breast Cancer – a review for African surgeons ARTICLE BY ADISA ADEYINKA CHARLES MD, FWACS, FICS Director, Residency Training Program, Abia State University Teaching Hospital, Aba, Nigeria ALEXANDRA M EASSON MSC, MD, FRCSC, FACS Assistant Professor, Department of Surgery, General Surgery and Surgical Oncology, Mount Sinai Hospital and Princess Margaret Hospital, 610 University Avenue Toronto, Ontario, Canada Breast Cancer constitutes a major public health issue globally. In Africa, it is the commonest malignancy affecting women and the incidence rates appear to be rising. While mortality rates are declining in the developed world as a result of early diagnosis, screening, and improved cancer treatment programmes, the converse is true in the developing world. Breast cancer and its treatment constitute a great physical, psychosocial and economic challenge in resource limited societies as found in Africa. The hallmarks of the disease in Africa are clinically advanced disease, lack of adequate infrastructure for diagnosis, screening and treatment, preponderance of younger pre-menopausal patients. This Review is meant to provide practical guidance for the surgeon working in the developing world. There is an international/geographical variation in the incidence of Breast Cancer. Incidence rates are higher in the developed countries than in the developing countries and Japan. Incidence rates are also higher in urban areas than in the rural areas. In Africa, Breast Cancer has overtaken cervical cancer as the commonest malignancy affecting women and the incidence rates appear to be rising. 3,4 In Nigeria for example, incidence rate has increased from 13.8–15.3 per 100,000 in the 1980s, to 33.6 per 100,000 in 1992 and 116 per 100,000 in 2001. 5 These increases in incidence are due to changes in the demography, socioeconomic parameters, epidemiologic risk factors, better reporting and awareness of the disease. While mortality rates are declining in the developed world (Americas, Australia and Western Europe) as a result of early diagnosis, screening, and improved cancer treatment programmes, the converse is true in the developing world as well as in eastern and central Europe. 6-8 Breast cancer and its treatment constitute a great physical, psychosocial and economic challenge in resource limited societies as found in Africa. The hallmarks of the disease in Africa are patients presenting at advanced stage, lack of adequate mammography screening programmes, preponderance of younger pre-menopausal patients, and a high morbidity and mortality. 3,6 This Review is meant to provide practical guidance for the surgeon working in the developing world. We have relied on the Chapter on Breast Cancer by Bland et al in Schwartz’s Principles of Surgery, 8th Edition. 9 Material which is of interest but not immediately applicable has been placed in smaller print. In the Recommendations we have followed the principles developed in the Breast Health Global Initiative. 10-12 History Breast cancer is one of the oldest known forms of malignancies. The earliest known documentation on breast cancer was the Smith Surgical Papyrus (3000-2500 B.C.) written in Africa (Egypt). It described 8 cases of tumors or ulcers of the breast that were treated by cauterization, with a tool called “the fire drill.” The writing says about the disease, “There is no treatment.” At least one of the described cases is male. There were few other historical references to breast cancer until the first century when Celsus recognized the relevance of operations for early breast cancer. In the second century, Galen inscribed his classical clinical observation: “We have often seen in the breast a tumor exactly resembling the animal the crab. Just as the crab has legs on both sides of his body, so in this disease the veins extending out from the unnatural growth take the shape of a crab's legs. We have often cured this disease in its early stages, but after it has reached a large size, no one has cured it. In all operations we attempt to excise the tumor in a circle where it borders on the healthy tissue.” 13 Halsted and Meyer reported their operations for the local treatment of breast cancer in 1894. Both Halsted and Meyer advocated complete dissection of axillary lymph node levels I to III and removal of pectoral muscle along with the breast. By demonstrating locoregional control rates after radical resection and providing the first opportunity for cure, these surgeons established radical mastectomy as state-of-the-art treatment in the early part of the 20th century. Later in the century, there was a transition from the Halsted radical mastectomy to the modified radical mastectomy (MRM) as the surgical procedure most frequently used for breast cancer. This procedure maintained the en bloc dissection of the breast and lymph nodes, but left the pectoralis major muscle intact. The recognition in the 1950s that breast cancer was often a systemic disease at presentation shifted the management of primary breast cancer away from a purely surgical approach to a multidisciplinary one that uses systemic therapy, surgery and radiation. As a result surgery for breast cancer may now be 90 Hospital and Healthcare Innovation Book 2009/2010
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International Hospital Federation I
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Introduction Sterile Barrier System
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Contents Healthcare transformation
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International Hospital Federation H
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Introduction Introduction ERIC DE R
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Innovation and strategy 14 Creativi
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Innovation and strategy: creativity
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Innovation and stategy: Acceleratin
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Innovation and stategy: Acceleratin
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Innovation and clinical specialitie
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Innovation and clinical specialitie
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IHF reference JAPAN JAPAN HOSPITAL
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IHF reference KENYA THE NAIROBI HOS
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IHF Corporate Member Profiles GE He
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How Can Health Organizations Get th
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