The Operating Theatre Journal Digital Edition July 2018

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July 2018 Issue No. 334 ISSN 1747-728X
The Leading Independent Journal For ALL Operating Theatre Staff
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July 2018 Issue No. 334 ISSN 1747-728X
The Leading Independent Journal For ALL Operating Theatre Staff
Patient safety
compromised by NHS
understaffing
Royal Colleges join together to reveal results
of annual physician’s survey
Senior doctors have raised new concerns for
patient safety in the NHS across the UK in a new
report released on Tuesday 26 June.
The fears are highlighted in “Focus on Physicians
2017 - 18”, the annual census of consultant
physicians and higher speciality trainees (HST)
workforce across the UK. The report has
been jointly published by the Royal College of
Physicians and Surgeons of Glasgow, the Royal
College of Physicians of Edinburgh, and the Royal
College of Physicians of London.
The survey reveals that more than half of all
consultants and two thirds of trainees reported
frequent gaps in trainees’ rotas, with one in five
respondents saying these are causing significant
problems for patient safety in hospitals , while
three quarters of respondents have highlighted
the workaround solutions they are regularly
having to find.
Other high-level findings include:
• Almost half of advertised consultant posts
remain unfilled because of a lack of suitable
applicants
• Consultants and trainees are working around
10 per cent more than their contracted hours.
This equates to trainees working an extra six
weeks and consultants an extra month unpaid
a year
• Thirty-three per cent of the current consultant
workforce are predicted to reach their
intended retirement age in the next decade.
Medical student places need doubling now to
fill this and the gap left generally by doctors
leaving the profession
• Satisfaction among consultants and trainees
with working in general internal medicine
remains significantly lower than with specialtyworking
Commenting on the findings of the census
Professor David Galloway, President of the Royal
College of Physicians and Surgeons of Glasgow
said: “I’m glad that the three Royal Colleges
have once again joined together to produce this
important piece of work. It’s vital that everyone
involved in the NHS now reflects on these findings
and takes all the action necessary to replicate
best practice and address the challenges that
this document has highlighted.
“What’s of particular concern is the finding
that almost one in five consultants across the
UK reported that rota gaps cause significant
problems for patient safety in their hospital.
This is an unsustainable situation which must be
addressed as a matter of urgency.
“While we welcome short term actions being taken by
governments across the UK to tackle workforce issues,
such as the lifting of the cap on tier 2 visas for NHS staff,
we need consistent and sustained action if we’re to
address this situation in the longer term.
“Government, patients and the medical profession must
work hand in hand if we’re to deliver the best possible
NHS for all.”
Professor Derek Bell OBE, President of the Royal College
of Physicians of Edinburgh, said: “As one of the three
Royal Colleges that commissioned this report, we believe
that Focus on Physicians provides an important snapshot
of the state of play within the medical profession. We
welcome, in particular, that 88% of consultants enjoy
working in their chosen speciality. This indicates a high
level of job satisfaction for consultant specialists.
“Our report also highlights some challenges which must
be tackled head on, and we support any actions which
allow doctors time to care, time to train and time to
research. We believe that these conditions are essential
for job satisfaction, and ultimately for enhancing the
care that our patients receive.”
The full census findings can be found at:
https://www.rcpsg.ac.uk/
http://www.rcpe.ac.uk/
https://www.rcplondon.ac.uk/
RCSEd President welcomes
announcement of proposed £20bn
for the NHS but fears it is only the
bare maintenance minimum
Following the Government’s announcement of a
proposed £20bn annual real term increase in NHS
funding in England by 2023-24, Professor Michael
Lavelle Jones, President of the Royal College of
Surgeons of Edinburgh said: “The announcement that
the NHS will receive an average 3.4% yearly increase
in NHS funding over the next five years is a significant
step forward and a welcome response to the huge
pressures the service continues to work under.
“However, we do share the concerns expressed
by a range of independent commentators, such as
the Institute of Fiscal Studies, Kings Fund, Health
Foundation and Nuffield Trust, that this represents
the bare minimum that the NHS needs to stabilise
its performance and maintain the current level of
services.
“As the announcement does not appear to cover
important areas such as funding for training, capital
improvements, public health and social care, we are
unsure whether it will be enough to allow the NHS to
expand its workforce and tackle some of the causes of
poor staff morale to make much needed changes such
as integrated care and preventative health.
“That’s why The Royal College of Surgeons of Edinburgh,
along with the Federation of Surgical Speciality
Associations and the other surgical Royal Colleges,
are calling for an open and honest debate on the NHS
as it approaches its 70th year. Only through this can
we ensure that the NHS can continue to provide high
quality care and meet the many challenges it faces.”
Inside this issue
State-of-the-art eye
centre opens
Never event at Shropshire
health trust
Patient stayed awake
through 90 minutes
of CPR
RCSEd Faculty of
Pre-Hospital Care
launches new
Diploma
Up to 1,000 patients
suffered harm from
cyber attack
Employers witness
the reserve forces
in action
First UK womb transplant
‘by end of 2018’
How aspirin may block
bowel tumour
formation
Find out more 02921 680068 • e-mail admin@lawrand.com Issue 334 July 2018 3
P4
P4
P8
P9
P10
P12
P12
P13
Hololens augmented reality
enters the operating
theatre
P14
BRITS ARE PULLING
SICKIES BECAUSE THEY
ARE TOO TIRED
£900 million Future
Leaders investment
Clydebank hospital first to
offer dedicated robotic
surgery
P16
P16
P17
Gene therapy restores paw
function in rats with
spinal cord injury
P17
Pelvic floor problems and
incontinence:
autoprosthesis
Nightingale Health and UK
Biobank announce
major initiative
New Kurt, New Power
UK’s NICE publishes a
Medtech innovation
briefing on PICO
P18
P18
P20
P21
INNOVATION AND REDUCED
COMPLICATIONS IN
THORACIC SURGERY P22
Digital system to monitor
recovery room
patients
P22

State-of-the-art eye centre set to transform care for
thousands of patients needing cataract surgery
A brand new state-of-the art £6.7m eye centre
has opened its doors to patients.
The new purpose-built centre, which is located
at the Northern General Hospital and follows a
multi-million pound investment from Sheffield
Teaching Hospitals NHS Foundation Trust, is
set to transform care for thousands of patients
needing surgery to treat cataracts, which
commonly affect older people and are the
leading cause of impaired vision throughout
the world.
It is estimated that over half of all people aged
65 and over have some cataract development
in one or both eyes.
Offering some of the best ophthalmic
assessment and surgical facilities in the UK,
the new Northern General Eye Centre is the
first of its kind cataract treatment centre,
providing care for over 5,000 patients across
the Sheffield and South Yorkshire region in
spacious and accessible surroundings.
The light, airy facility – which has been
designed with the needs of people with
limited vision in mind – boasts ten consulting
rooms, world-class diagnostic equipment, two
hi-tech operating rooms, a large, welcoming
reception area, dedicated drop off and pick
up points outside the centre, and handy self
check-ins enabling patients to notify staff of
their arrival in a matter of seconds.
As a dedicated centre for cataract surgery,
patients visiting for assessment and treatment
of cataracts will benefit from a unique ‘onestop
approach’. This will mean that they
will now be able to have their outpatient
consultation, all diagnostic tests, preoperative
assessments and consent for surgery
process completed in just one visit, saving
unnecessary repeat trips prior to surgery.
If patients are fit for local anaesthetic
cataract surgery they will be given a date
for their operation before they leave. On the
day of surgery, patients will be seen by the
same consultant they saw at their outpatient
appointment and a named nurse will stay with
them to ‘hold their hand’ during surgery.
Patients often feel nervous prior to having
eye surgery, and research shows that having
a named nurse to accompany them through
the operation decreases anxiety and offers
comfort during the procedure. Refreshments
will also be provided to patients after surgery.
All patients returning for post-operative
check-ups will be able to see their consultant
if necessary and agree a date for surgery in
their other eye if this is needed.
Dalip Malkani, 78, of Bradway, is one of the
first patients in the region to benefit from lifechanging
cataract surgery at the brand new
eye centre. “My vision is much improved in
that eye and the overall quality of my vision
is much better than before,” said the IT
consultant who first started to get a cloudiness
in his vision a year ago and was diagnosed with
a cataract in his right eye.
“The staff have been marvellous, they’ve
taken really good care of me and kept me
informed throughout, and I can see things
much more clearly now. My TV looks like it
has much higher resolution than it did before.
I am very fortunate to be in Sheffield and have
world renowned eye specialists.”
Carolyn Wilkie, Operations Director for Head
and Neck services at Sheffield Teaching
Hospital NHS Foundation Trust, said: “We are
delighted to be opening this state-of-the-art
£6.7m facility which will benefit thousands
of patients in the region both now and in
the future. Having cataract surgery can be
a daunting experience, so a huge amount of
planning has gone into the design and set-up of
this building to ensure that every detail, from
patients being able to have a named nurse to
hold their hand throughout surgery to patients
being collected from reception and taken
to the consulting rooms rather than being
called in by the doctor or nurse, improves and
enhances the patients’ experience.
“The £6.7m building is a fantastic investment
by Sheffield Teaching Hospitals NHS Foundation
Trust, and not only will patients experience an
extremely high standard of care and have as
much done in one appointment as possible to
avoid unnecessary trips, but by opening up this
facility we will be able to build our services
in the future and ensure that we meet the
increasing demand for cataract eye surgery.”
Cataract surgery is the most commonly
performed operation in the UK, with around
330,000 operations performed each year on
the NHS.
During surgery the lens inside the eye that
has become cloudy is removed and replaced
with an artificial lens to restore clear vision.
If untreated, the clouding can worsen, making
driving and working difficult, and in some
cases, causing complete blindness.
Adult emergency eye care services will
continue to be available from the Royal
Hallamshire Hospital (Monday to Friday,
8.15am to 4.30pm).
For further information about the centre visit
www.sheffieldeyecentre-nhs.uk.
Never event at Shropshire
health trust involved
‘wrong site’ surgery
A serious medical ‘never event’ involving
‘wrong site’ surgery has happened at the
trust running Shropshire’s two main hospitals
The never event, named so because they are
incidents that guidelines say should never
happen, was recorded by Shrewsbury and
Telford Hospital NHS Trust (SaTH), which
runs Royal Shrewsbury Hospital and Telford’s
Princess Royal Hospital.
Dr David Lee, chairman of SaTH’s quality
and safety assurance committee, told a
meeting of the trust board yesterday that
an investigation is under way following the
recent incident.
Board members were told it involved ‘wrong
site’ surgery, but the exact details have not
been disclosed.
Dr Lee said the affected patient is currently
recovering.
A report to the board said clinicians have
explained the circumstances to the patient
and family members.
Wrong-site surgery can involve surgery being
performed on the wrong side or site of
the body, the wrong surgical procedure or
surgery on the wrong patient.
In response, the trust’s chief executive
Simon Wright said: “It’s entirely right we
should be taking this extremely seriously.”
The trust has recorded two other never
events in the past eight months.
Source: Shropshire Star
The next issue copy deadline, Friday 27th July 2018
All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY
Tel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.com
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and in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription.
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Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD
4 THE OPERATING THEATRE JOURNAL www.otjonline.com

MAT PARTNERS WITH TOLENT CONSTRUCTION FOR RAMSAY
HEALTH CARE’S NEW TEES VALLEY HOSPITAL
Medical Air Technology (MAT) recently completed work at Tees Valley
Hospital, a brand new £23m hospital provided by WW Medical Facilities
and operated by Ramsay Health Care UK, designed to be a bespoke,
patient-centred environment for care and treatment.
The hospital is in the grounds of the beautiful 17th century Acklam Hall
and replaces the Tees Valley Treatment Centre. It has 19 beds, consulting
rooms, minor procedure rooms, a diagnostic imaging department, a
physiotherapy department and rehabilitation gym, an inpatient ward
and a day case unit with 12 recovery pods. It also has three ultraclean
operating theatres and an endoscopy suite with recovery room, all
fitted out to the highest standards by MAT, so is able to offer patients
a wide range of surgeries, including orthopaedic procedures. MAT has
a long history of working successfully with Ramsay Health Care and, in
accordance with the client’s wishes, was brought into the Tees Valley
project by the main contractor, Tolent Construction.
MAT provided a turnkey ventilation and equipment package, which
included three ECO-flow ultraclean ventilation (UCV) canopies,
mechanical ventilation systems for the theatres and endoscopy suite
and recovery room, medical gas pendants, surgeons’ panels, operating
lights, pressure stabilisers and firefighter control panels. The hospital’s
location close to Acklam Hall, which has a Grade I listing, meant
that the plant room size was restricted to ensure the new building
complemented its historical surroundings. To accommodate this, the
engineers at MAT had to develop a design and ductwork route, unique
to the hospital, that ensured the air handling units fitted into the space
allowed. Dr Andy Jones, Chief Executive of Ramsay Health Care UK,
wanted Tees Valley Hospital to offer “a broader range of services in a
clean, crisp, modern, welcoming environment”, and MAT has helped this
to be realised, providing the hospital with world-class, user-friendly,
energy-efficient operating theatres that will enable and support the
outstanding work of the hospital’s clinical teams.
MAT has worked with Ramsay Health Care UK for many years, installing
operating theatre equipment packages across its hospitals. This year
alone, in addition to Tees Valley Hospital, MAT has installed energyefficient
ECO-flow canopies and other equipment at Rivers Hospital in
Hertfordshire, and Woodland Hospital in Northamptonshire.
MAT FM also holds the service contract for all the hospitals in the group,
ensuring that the critical air system in each facility is compliant and
working correctly, providing a safe environment for patient care and
reducing operating costs.
MAT offers a wide breadth of services so is able to respond flexibly
and quickly to the specific needs of each client. With an in-house
manufacturing facility and dedicated team of highly skilled engineers,
the company makes and supplies bespoke equipment for demanding
clinical arenas. There are several options available, from “equipment
only” packages right up to total turnkey installations, all delivered with
the same commitment to outstanding quality and customer service.
MAT FM can provide a range of competitively priced and highly effective
service and maintenance packages for all core products and turnkey
solutions offered by MAT or other suppliers, ensuring that equipment is
maintained, serviced and validated correctly for optimum performance.
Take a video tour of the new Tees Valley Hospital at:
https://www.gazettelive.co.uk/news/teesside-news/inside-teessidesnew-23m-hospital-14469351
Further information from:
Stephen Taylor, Tel: 0844 871 2100
Email: stephen.taylor@medicalairtechnology.com
www.medicalairtechnology.com
When responding to articles please quote ‘OTJ’
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Find out more 02921 680068 • e-mail admin@lawrand.com Issue 334 July 2018 5

An exclusive resource for Practitioners, Nurses, Managers, Clinical Specialists, Anaesthetics, Scrub, PACU, Training & Procurement
ISSN 1747-728X
The Leading Independent Journal For ALL Operating Theatre Staff
Discover more online!
Join our FREE mailing list at www.otjonline.com and stay in touch with News and Reviews
Queen’s Hospital to help boost health coffers - and here’s how
It comes as Prime Minister Theresa May has called for action on waste in the NHS
Plastic used in Burton’s Queen’s Hospital’s
operating theatres is now being recycled and
can be sold on to boost health coffers.
The Belvedere Road hospital has installed a
recycling machine called a Sterimelt which
turns clinical blue waste, used in operating
theatres, into a product that can make money
for the NHS.
This technology is leading the way as Prime
Minister Theresa May sent out a call to action
on waste reduction within the NHS.
The Prime Minister said that a £20 billion
spending boost to the National Health Service
in the UK would be conditional on them
cutting bureaucracy and waste.
Mrs May, in a speech at the Royal Free Hospital
in London, said: “This must be a plan that
ensures every penny is well spent.
“It must be a plan that tackles waste, reduces
bureaucracy and eliminates unacceptable
variation, with all these efficiency savings
reinvested back into patient care.
“It must be a plan that makes better use of
capital investment to modernise its buildings
and invest in technology to drive productivity
improvements.”
Burton Hospitals NHS Foundation Trust,
which runs Queen’s, started this process with
the installation of a revolutionary recycling
machine called a Sterimelt from multi-awardwinning
Welsh company Thermal Compaction
Group.
The cutting-edge sustainable recycling
technology has had interest from around
the world and Burton is the first health
service trust in England to have installed this
technology.
Clinical Sterilisation Wrap, the single use
disposable plastic material which is used
in operating theatre’s and for encasing
sterile instruments, is normally mingled with
hazardous material, then incinerated or sent
to special landfill when finished with. This
costs the NHS trust money to dispose of.
However, the Sterimelt machine takes the
blue Sterilisation Wrap and thermally densifies
it into polypropylene blocks that the trust
can then sell on to third party manufacturers
which, in turn, can be made into anything
from a tool box to a plastic hazard warning
sign for water spillages.
Recently, other single use disposable
items have been identified for recycling in
Sterimelt, such as blue polypropylene patient
bed transfer sheets, adding more value to NHS
sustainable recycling.
Other than Burton, Thermal Compaction
Group has received interest around England,
particularly in the North East and South West,
for the Sterimelt to be installed in other
trusts, said a spokesman.
Natalie Roddis, the waste and sustainability
officer for Burton Hospitals NHS Foundation
Trust, said: “My colleague James Chadwick
went to a convention where he saw it and
spoke us about it.
“We got in touch with Thermal Compaction
Group and they were fantastic and very
responsive. We all jumped into a car and
drove to Wales to see it. We spoke to them
[Thermal Compaction Group] and the current
Welsh NHS user about it and it was just as
good as we thought.
“It came at the right time when Blue Planet
was on the TV highlighting plastics (pollution)
in the sea.
“We had it installed in March and we have
not had any problems at all. To get our
uncontaminated clinical waste recycled, it is
fantastic.”
The machine has already created interest
from other trusts who have been to Queen’s
Hospital to see it in action.
And Natalie said it is “exciting” to be the
first trust in England to install one of the
revolutionary Sterimelt machines.
She said: “Because it is only the second
commercial Sterimelt to be built by Thermal
Compaction Group, there are a couple of
tweaks but the contact we have with the
Thermal Compaction Group team means we
just tell them about anything and within a day
or two, they are here from Wales to help us.
“We have had a lot of interest already from
other trusts to come and look at it.”
Thermal Compaction Group has won the
Cardiff Business Awards Innovation award
for the Sterimelt, beating three other major
companies to the prestigious trophy.
It also won the Welsh Business Awards
‘Success Thorough Innovation’ category just
three months after final trials on the Sterimelt
and full implementation of the product were
completed at the Aneurin Bevan University
Health Board in South East Wales.
Thermal Compaction Group’s sales and
marketing director Thomas Davison-Sebry
said: “It is fantastic to be working with a great
team of people like those at Burton Hospital
NHS Foundation Trust.
“As a private company, at first, we were
unsure how it was going to go with working
with public bodies because this was new to us
but it is incredible.
“We have come up against small issues but we
have worked together as a team, accomplished
and addressed all these and come up with a
fully commercialised machine.
“We have been speaking to people across Asia,
Australia, North America and just recently
signed a distributor in South Africa who are
also enthusiastic about the Sterimelt machine
and can see the potential this possesses
to deliver revenue from waste that would
otherwise be incinerated.”
Source: Derbyshire Live (Jenny Moody)
6 THE OPERATING THEATRE JOURNAL www.otjonline.com

BOA CONGRESS 2018
25th - 28th September, ICC Birmingham
REGISTRATION IS NOW OPEN!
The theme for the Congress is
‘Taking stock: Planning the future’
Join us in Birmingham to celebrate our 100th Anniversary!
Register online at:
congress.boa.ac.uk
@BritOrthopaedic #BOAAC British Orthopaedic Association BritOrthopaedic
BOA Congress 2018 (A5) - BESS.indd 1 16/05/2018 14:48:09
Doctor: Patient stayed awake through 90 minutes of CPR
A case report said that a man was showing unusual signs of conscious awareness while a medical team performed CPR on
him after he suffered cardiac arrest
COPENHAGEN, Denmark — A new case report said a man who underwent cardiac arrest showed unusual signs of conscious awareness while a
medical crew performed CPR on him.
CNN reported that the medical team performed CPR on the 69-year-old man for 90 minutes when he suffered cardiac arrest shortly after being
admitted to a hospital for indigestion and nausea.
“At this time, paramedics were still in the room, and CPR was initiated immediately,” Dr. Rune Sarauw Lundsgaard said. “Due to a recent event
with another patient, the cardiac arrest team was in the next room, and advanced CPR was initiated shortly after. This means that two paramedics
and four hospital porters were shifting in pairs of two at performing the CPR. The patient had no electrical activity in the heart at any time. The
heart only functioned because of the manual compressions.”
Lundsgaard said the patient occasionally showed signs of conscious awareness while CPR was performed on him.
“As soon as CPR was initiated, the patient opened his eyes,” he said. “When CPR was performed, the patient was able to respond to verbal
communication by moving eyes, lifting hands and legs and nodding his head. The patient’s wife was present and able to hold his hand.”
Dr. Sam Parnia, who led a study on the topic in 2014, said it is extremely unusual for patients to show such a level of consciousness during CPR.
“It is exceedingly rare for people to have actual awareness with external signs of being conscious as is being discussed in this case report,” Parnia
said. “All the studies of CPR have demonstrated that there is insufficient blood flow to the brain (approximately 15 percent of baseline blood flow)
to allow for the return of brain stem reflexes and consciousness with external signs of being awake.”
Parnia added that “it is much more likely to have people waking up during compressions when the additive effect on an already beating heart
raises the blood pressure to a sufficient level to provide enough blood flow to the brain.”
Lundsgaard said CPR is usually stopped when a patient begins to appear conscious.
“Normally, chest compressions are stopped once the patient shows signs of life or spontaneous breathing,” he said. [When] the patient moved, we
stopped CPR, and immediately the patient went unconscious due to his nonfunctioning heart. This was done several times with the same result.”
Dr. Parnia said the team performed CPR for much longer than is customary.
“Most hospitals will stop at around 20 minutes. However, based on results of studies, it is recommended to continue for at least 45 minutes. This
is unusual,” he said.
Despite the lifesaving efforts, the team was unable to save the patient.
“The cardiac arrest team in our case was very affected by the situation,” Lundsgaard said. “For me, having to tell the patient that we were unable
to save his life ... and that in a minute we will stop chest compressions and you will not survive was a challenging situation.”
Lundsgaard said the incident brought up the issue of sedating patients during CPR.
“The question of sedation during CPR is not new, but sedation is not routinely performed during CPR,” he said. “We know from anesthesia that
accidental awareness during operations often leads to post-traumatic distress and decreased quality of life. One might suspect that awareness
during CPR may be just as stressful.”
Source www.ems1.com
8 THE OPERATING THEATRE JOURNAL www.otjonline.com

JRI Orthopaedics celebrates gold standard ratings
for hip replacement systems
“The 13A* rating demonstrates
the abundance of evidence about
the Furlong as one of the best
performing stems on the market –
cemented or uncemented.”
JRI Orthopaedics’s, state-of-the-art manufacturing facility in Sheffield
JRI Orthopaedics’ pioneering
uncemented hip implant system
has been awarded the highest
rating by ODEP – the Orthopaedic
Data Evaluation Panel - in
recognition of its clinical
performance.
The multi-award-winning company
has received a 13A* rating – the
highest possible award – from
ODEP for both its long-established
Furlong® Uncemented H.A-C
coated hip stem and CSF® cup.
JRI Orthopaedics was the first
company in the world to produce a
hip implant with a Hydroxyapatite
(HAC) coating enabling a biological
bond with the patient’s bone and
so the prospect of a hip for life.
The Furlong HAC stem was
launched in 1985 and is now one
of the leading uncemented hips
on the UK market. It is one of only
six such products to be given the
gold standard 13A* rating by ODEP.
ODEP independently assess
whether orthopaedic products
have reached quality performance
benchmarks in accordance with
the National Institute for Health
and Care Excellence (NICE)
guidelines for survivorship of total
hip replacements.
John Suggitt, Senior Product
Manager at Sheffield-based JRI
Orthopaedics, said: “ODEP ratings
provide a simple, independently
verified assessment of the
strength of evidence of an
implant, assessed against national
clinical best practice guidelines by
an independent panel of experts.
“We are absolutely delighted to
have received the highest 13A*
rating for the Furlong® HAC hip
stem and CSF® Acetabular Cup.
“Only six uncemented stems and
cups have 13 A* ratings and so we
feel very proud to be part of such
an exclusive club of excellence.
ODEP award ratings for clinical
evidence at three, five, ten
and now 13 years of total hip,
knee and shoulder replacement
products.
JRI Orthopaedics’s next
generation uncemented hip
replacement system, the Furlong
Evolution®, was launched in 2012
and has just received an ODEP 5A*
rating – the highest award after
five years of impressive clinical
evidence.
John added: “We manufacture
and supply products that
provide the best solutions for
joint replacement, repair and
reconstruction allowing patients
to have a better quality of life for
longer.
“The 5A* ODEP rating for the
Evolution® shows just how
good this technology is and that
the next generation is just as
good which is why these hip
replacements come with our 20-
year warranty.”
JRI Orthopaedics has worldclass
expertise in the design,
development and manufacture
of a portfolio of orthopaedic
implants and systems which
deliver the best solutions in
joint reconstruction, repair and
regeneration.
JRI Orthopaedics’s
Furlong® Uncemented
H.A-C coated hip stem
which is made at the
company’s state-ofthe-art
manufacturing
facility in Sheffield.
The company, which
employs over 100 people at
its showcase manufacturing
facility in Chapeltown, has
internationally recognized
research and development
capabilities.
Earlier this year JRI
Orthopaedics was acquired
by China’s leading
orthopaedic implant
company AK Medical in a
£16.7M deal. The company,
which was wholly owned
by the charity Orthopaedic
Research UK (ORUK), is now part
of one of the world’s largest
3D-printed orthopaedic implant
manufacturers.
The synergy created by combining
the two businesses will create a
larger and stronger group within
the international orthopaedic
sector.
Latest ODEP ratings can be found
at www.odep.org.uk
When responding to articles please quote ‘OTJ’
RCSEd Faculty of Pre-Hospital Care launches new Diploma in Urgent Medical Care
The Royal College of Surgeons of Edinburgh (RCSEd), Faculty of Pre-Hospital
Care, is the first medical Royal College to develop a Diploma in Urgent
Medical Care (DipUMC RCSEd), targeted at the many thousands of nurses,
doctors and paramedics that provide essential healthcare across the UK
when GP surgeries are closed.
Colville Laird, Convener for Examinations in Urgent Medical Care RCSEd,
explained: “The diploma is to start the thinking about professional
development in this important area of healthcare. For example, the
Government has said it wants 15,000 more paramedics. Career progression
and professional development in this vital area of healthcare needs support
because much of the healthcare patients experience will be delivered by this
group of multi-professional practitioners, which includes nurses, paramedics
and doctors providing out-of-hours (OOH)/Urgent Care services.”
Pre-hospital Emergency Medicine is an established sub-speciality of medicine
provided by a broad range of practitioners: first aiders; paramedics; doctors;
nurses; first responders; and emergency service professionals that include
the police, fire and armed forces. The role of the RCSEd’s Faculty is to set
and maintain clinical standards for practitioners in this evolving specialty.
The new Diploma in Urgent Medical Care exam will focus on the timely
recognition, diagnosis and management of conditions and situations in urgent
care settings, which can present a variety of challenges to practitioners.
Practitioners will already have skills equivalent to level 7 of the
Skills for Health Career Framework for Health, and be able to
demonstrate knowledge and skills to manage complex and atypical
cases. The syllabus includes the care of patients from all age
groups from neonates to the very elderly.
Students will self-study for the two-day exam supported by an
extensive syllabus and study guidance available on the RCSEd
website. Day one of the exam is a written paper, and day two oral
is a structured oral exam. Applications for the diploma close on 2
November 2018, and the two-day exam takes place at the RCSEd
in Edinburgh on 12 and 13 March 2019.
Colville Laird concludes: “We hope that by setting up a postgraduate
diploma open to a multi-professional group of healthcare
practitioners we will raise the awareness of continuing professional
development (CDP) in an essential area of healthcare provision.”
For more information about the work of the Faculty go to
https://fphc.rcsed.ac.uk/my-fphc/about-us
For more information about the Diploma in Urgent Medical Care go
to https://www.rcsed.ac.uk/exams/exam-entry?calId=5a512efa-
1345-44e8-a209-ef6d47d0b12d&locName=Edinburgh
Find out more 02921 680068 • e-mail admin@lawrand.com Issue 334 July 2018 9

Up to 1,000 patients suffered
harm from medical devices
hit by a cyber attack
As many as 1,000 patients suffered harm from medical devices hit by a
cyber attack, according to a new survey conducted by researchers at
the University of California San Diego. The results were announced at
the HIMSS Healthcare Security Forum recently.
Commenting on this, Garrett Sipple, managing consultant at Synopsys’
Software Integrity Group, said “This is another example of recognising
the importance of security as it plays a role in maintaining the safety
and effectiveness of medical devices. Medical devices often move
through long product development cycles that can make them slow to
react to new cybersecurity threats, especially if cybersecurity wasn’t
even a key consideration in the development process.
Cyber-attacks aren’t the only side effect to consider when it comes to
medical device security. In a survey Synopsys ran with Ponemon last
spring, it was found that in 38% of cases where a medical device had
been breached, inappropriate health care had been delivered to the
patient – and that could be lethal.
One of the prevalent themes in this document is the critical role that
systems must play in the healthcare sector, because there is shared
responsibility among regulators, manufacturers, healthcare providers,
and patients. While software security has been discussed for many
years, fewer people are talking about systems security and integrating
security into systems engineering. The healthcare industry must solve
this problem at the system-of-systems level, as well as for individual
products like MRI machines and patient monitors.
Well known technical activities such as static code analysis are
important, but so are non-technical elements like risk management
processes and program-level prioritisation of resources based on
identified risk.
Many of the recommendations are already understood and documented.
One specific example is the recommendation that stronger mechanisms
are
“The
needed,
measures
but there
Sir Bruce
is no
Keogh
silver bullet.
outlined
That
during
concept
his speech
is fully embodied
last night
in
will
the
be
BSIMM
instrumental
framework.
in supporting
BSIMM identifies
healthcare
a superset
professionals
of 113
to
security
identify
the early signs and enable them to act, Health Education England’s new
activities that have been used to build security into systems. Leveraging
education and training materials will be particularly relevant as will a
this superset to identify new activities is one step organisations can
clinical network approach to care where professionals and organisations
take. The key message from this is that evaluating security at every
work together across a dened geographical area – this helps to bring
layer in a product or system lifecycle – systems, software, firmware,
a safe, standardised and equitable approach to care.
hardware – is the only way to fundamentally build security into a
product.”
Further “As a college, reading: we https://www.fiercehealthcare.com/tech/ucsdmedical-device-cybersecurity-patient-harm-advamed-legacy-devices
Child Health Record to include information for parents on how to tell
have updated the national template for the Personal
if your child is ill, and for health professionals, have recently launched
Paediatric Care Online (PCO-UK) – an online decision support tool,
providing specialist diagnostic advice to help ensure children get the
right treatment at the earliest opportunity.
“To support this, I now urge paediatricians and all healthcare
professionals to utilise the resources Sir Bruce has outlined. Collectively
we www.facebook.com/TheOTJ
can slow down the grip of this deadly disease and reduce the number
of children who come face to face with it.”
Louise Silverton, Director for Midwifery at the Royal College of
Midwives, said: “Severe sepsis can and does kill. Though it is rare, it
can be catastrophic for pregnant and postnatal women.
Nurse Led Clinics - Preoperative assessment
(2-Day Programme)
“Sepsis remains a leading cause of maternal death. That is why it is so
important that we do all we can to identify it as soon as possible so that
it can be treated. It is also important not to forget newborn babies who
can succumb to infection very quickly.
Thursday 5th and Friday 6th July 2018
“Midwives The Royal Marsden should certainly Education “think and sepsis” Conference where Centre there is deterioration
in Stewart’s the health Grove, of either Chelsea, mother SW3 or 6JJbaby. This means we need the right
number of midwives so that they can deliver the best possible care,
The study days are aimed at nurses and other health care professionals
including in the postnatal period.
with an interest in preoperative assessment; they will cover a wide
range of clinical and organisational topics facilitated by specialist
“Having nurses and the consultant right numbers anaesthetists. of staff will also help to ensure continuity
of care and carer for women. Midwives who know the woman will be
better For further equipped information to spot and changes to book in the your woman’s place please condition visitand identify
problems www.royalmarsden.nhs.uk/studydays
such as sepsis developing.”
TCI & BIS Practicum
Friday 21st September 2018
The Royal Marsden Education and Conference Centre
Stewart’s Grove, London, SW3 6JJ
A highly practical one day course delivering:
- Consultant led teaching and advice, by clinicians using TCI and BIS
everyday
- Small group ‘hands on’ clinical workshops, using simulation with
BIS
- Problem solving and trouble shooting
- TCI in a wide range of settings
For further information and to book your place please visit
www.royalmarsden.nhs.uk/studydays
Exenterative Surgery for Pelvic Cancers:
Current Practices and Future Directions
Thursday 27th - Friday 28th September 2018
The Royal Marsden Education and Conference Centre
Stewart’s Grove, London, SW3 6JJ
Professor This conference Helen Stokes-Lampard, presents new Chair information of the Royal concerning College GPs, opioids said:
“Sepsis examining is a scientific huge worry and for clinical GPs as subjects initial germane symptoms to can patients be similar and
to practitioners.
other common illnesses, and the College is putting a lot of effort
into Novel helping opioid-related family doctors topics recognise and updates potential on existing sepsis issues and ensure will seek that
patients to educate rapidly those receive who appropriate deal with opioids assessment in whatever and treatment. professional
“We capacity. have produced a toolkit, in partnership with NHS England, which
brings For further together information existing and guidance, to book your training place materials please visit and patient
information www.royalmarsden.nhs.uk/studydays
to encourage us all to ‘think sepsis, talk sepsis and treat
sepsis’.
“We are pleased to be working with NHS England to raise awareness
and improve outcomes for patients. It really could save lives.”
Anna Crossley, Professional Lead for Acute, Emergency & Critical
Care at the RCN, said: “Sepsis is a life-threatening condition and early
identication is the key to survival, but it can be difcult to diagnose
and often symptoms can be mistaken for a u-like illness. This is why
raising
The
awareness
11th Royal
among carers,
Marsden
health
Pain
care professionals
and Opioid
and the
public is so vital. Even though Conference
there has been good progress to improve
diagnosis, a cohesive national plan is needed to ensure that healthcare
professionals Thursday are 16th supported – Friday and equipped 17th to November identify and treat 2018 sepsis
early.
The Royal Marsden Education and Conference Centre
“If Stewart’s sepsis is Grove, not recognised London, SW3 quickly, 6JJ it can lead to shock, multiple organ
failure and death, which is why early detection is critical to start
treatment This conference within the presents hour. Nurses new and information health care concerning support workers, opioids
who examining see their scientific patients and on clinical a regular subjects basis, germane and are to often patients the and rst
healthcare practitioners. worker to see them, are well placed to recognise the signs
of sepsis early and raise the alarm. If a person has signs or symptoms
Novel opioid-related topics and updates on existing issues will seek
that indicate possible infection, think ‘could this be sepsis?’ and act
to educate those who deal with opioids in whatever professional
fast to raise the alarm, wherever you are.
capacity.
https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-
For further information and to book your place please visit
Action-Plan-23.12.15-v1.pdf
www.royalmarsden.nhs.uk/conferences
twitter.com/OTJOnline
10 Find out more 02921 680068 • e-mail admin@lawrand.com THE OPERATING THEATRE JOURNAL Issue 316 January www.otjonline.com
2017 7

Theatres and Anaesthesia
Conference 2018
“Patient Centred Care”
n
The Leeds
Teaching Hospitals
NHS Trust
Saturday 13th October 2018, 09:00 - 16:00
Bridge Community Church, Rider Street, Leeds, LS9 7BQ
Think
Drink
Patient
Engagement
Leeds
Improvement
Method
Day case
Challenge
Tickets
£40
To book a place please visit:
https://theatres-and-anaesthesia.eventbrite.co.uk/
As all Getinge Flow models, the Flow-c hav
For more information please contact Vicky Tye via:
Email: v.tye@nhs.net Tel: 0113 206 5580
feature.This safety mechanism overrules th
and oxygen if the O2 level should drop belo
Getinge to launch the Flow-c Anesthesia Machine at the
Euroanaesthesia Congress
Getinge, a leading global provider of innovative medical technology, announced its
attendance at The Euroanaesthesia Congress (ESA) in Copenhagen which ran from June
2 – 4, 2018 and the official launch of the Flow-c Anesthesia Machine. Euroanaesthesia
is Europe’s largest annual event showcasing the latest developments in the field of
anesthesia, perioperative medicine, intensive care, emergency medicine and pain
treatment and this event was expected to attract over 5000 participants.
‘We are excited to announce that Getinge will launch the Flow-c Anesthesia Machine
at this major international event. Flow-c is a compact anesthesia machine where
every detail has been designed to ease the daily work, enabling cost-efficient and
safe treatment for patients, says Markus Stirner-Schilling, Senior Director, Acute Care
Therapies, Global Commercial Operations.
sia Machine
About Flow-c:
Based on the world-class Servo ventilator platform and with the same innovative
technology as Flow-i, the Flow-c ensures superior ventilation performance with the
power and precision needed to ventilate all patient categories.
“The Flow-c is designed to simplify everyday anesthesia workflow in the fast-paced
gy, announces OR.The today intuitive its attendance and easy to use touch screen gives one point of control for all
functions, and the system’s operational simplicity saves time and contributes to
June 2 – improved 4, 2018 mobility and the official in the ORs,” says Lena Evander, Director Product Management
is Europe’s Anesthesia largest at annual Getinge. event
, perioperative
Despite
medicine,
its compact
intensive
design, Flow-c packs in a great rail length using every millimeter
t is expected of space. to attract The stepless over 5000 rails allow monitors, tables and other accessories to be added
where it best suits the user. And with the neatly routed back, covered by specially
designed panels, Flow-c minimizes the clutter of hoses and cables, and contributes to
an improved hygiene and safety in the OR.
c Anesthesia Machine at this major
As all Getinge Flow models, the Flow-c have the unique O2Guard to prevent hypoxia
ere every as detail a standard has been feature.This designed safety mechanism overrules the clinician´s settings and
nt for patients, increases says Markus the flow Stirner-
of fresh gas and oxygen if the O2 level should drop below 21%.
rcial Operations. Read more and watch the film about the new Getinge Flow-c:
https://www.getinge.com/int/product-catalog/flow-c-anesthesia-machine
When responding to articles please quote ‘OTJ’
Please visit the booth to ‘experience the flo
Find out more 02921 680068 • e-mail admin@lawrand.com Issue 334 July 2018 11
ame innovative technology as Flow-

Employers witness the
reserve forces in action
Employers within the NHS were recently invited to observe reservist
training taking place at the North Atlantic Treaty Organisation (NATO)
Saber Strike exercise in Poland.
During the visit, employers were able to witness first-hand how
beneficial the training exercises were for the reservists and how these
skills can be transferred into the NHS workforce.
Clinicians from the UK worked side by side with medics from the
US army’s 212 combat support hospital during the exercise, which
consisted of two weeks training, involving 19 countries and 18,000
troops. Throughout the exercise, NHS reservists tackled complex
training scenarios including major incidents and chemical, biological,
radiological and nuclear attacks.
David Cox, senior operating department practitioner at University
Hospitals Coventry & Warwickshire NHS Trust said:
“Prior to the visit to Poland, I was not fully aware of the range of
medical specialities supplied by reservists. I now have much more
awareness and a fuller understanding of what reservists can do.
“They have a broader range of experience in challenging situations,
where team work and flexibility are essential. By being a reservist, it
demonstrates the motivation and commitment of the individual.
“I would say to any employer with reservists as part of their workforce:
your staff will be committed, motivated and have a broader range of
clinical experiences in emergency care. This ultimately enables better
standards of patient care within the NHS.”
Heena Asher, general manager of Stroke and Neurosciences at Imperial
College healthcare NHS Trust added:
“I was overwhelmed at the size of the training exercise and the
partnership with the US Army. I was amazed by the levels of respect,
focus and coordination between the reservists to deliver clinical care.
“The exercise made it very clear that reservists shine as leaders, inspire
their colleagues and are focused on getting things right the first time.
“As a trust, we need to ensure that we’re doing everything we can to
support reservists so that we attract these people with such expert
qualities to work in our organisation.”
To find out more about recruiting and supporting reservists in your NHS
workforce, visit our dedicated web pages - http://www.nhsemployers.
org/your-workforce/retain-and-improve/managing-your-workforce/
supporting-the-armed-forces-in-the-nhs.
Are You Linkedin ?
Join our Group
The Operating Theatre Journal
When responding to articles please quote ‘OTJ’
in TM
First UK womb transplant ‘by end of 2018’
The surgeon planning to do the first womb transplant in the UK says
he hopes to carry out the first operations “before the end of 2018”.
Mr Richard Smith, clinical lead at the charity Womb Transplant UK, also
said that they plan to use living donors.
In 2015, approval was given for 10 womb transplants in the UK, but
these were from deceased donors, whose hearts are still beating.
Now the team plans to use both live and cadaveric donors.
Mr Smith, a consultant gynaecologist at Queen Charlotte’s and Chelsea
Hospital in London, said this was because the procedure to retrieve a
womb from a living donor was now simpler and safer, with the surgery
time cut from 12 to four hours.
Around 750 women in the UK have approached the team to enquire
about transplantation.
Womb Transplant UK says it has enough funds to pay for three transplants
but will need hundreds of thousands of pounds more to complete a
total of 15 transplants - five of these with living, related donors.
Around 6,000 women in the UK were born without a womb, while others
lose their uterus to cancer.
At present, their only chance of having a genetically-related child is
through surrogacy.
A global review of womb transplants has found that the procedure is a
“major advance” but requires strictly controlled clinical trials.
Writing in BJOG: An International Journal of Obstetrics and
Gynaecology, a team of doctors in Japan said while womb transplants
offer “great hope” for women born without a uterus, the practice is
still experimental.
Womb transplants to date:
Womb transplants have been carried out in 10 countries: Saudi Arabia,
Turkey, Sweden, US, China, Czech Republic, Brazil, Germany, Serbia
and India.
• 2014 - woman in Gothenburg, Sweden gives birth to a baby boy using
a transplanted womb in world first. The 36-year-old mother received
the donated womb from a friend in her 60s
• 2017 - woman in Dallas, Texas gives birth to a baby, in the first
successful procedure in the US
• 42 women worldwide have received transplanted wombs
• 11 babies have been born, eight of them in Sweden
Surgical risk
The paper is the first global review of womb transplantation.
It says surgical risk is the major concern due to the difficulty of obtaining
the uterine veins which run along the pelvic floor.
In a trial in Sweden involving nine patients, the average time to remove
the uterus from a living donor was 11.5 hours, with 4.5 hours for the
recipient surgery.
A team in China reduced the time of living donor organ retrieval to
six hours using robot-assisted surgery, and the ovarian vein as an
alternative to the uterine veins.
How would the procedure work in the UK?
• Women being considered for a womb transplant will undergo clinical
and psychological investigations as would any potential living donors
• Living donors are likely to be the mother or sister of the recipient
• The recipient will need to take immunosuppressant drugs following
the transplant and throughout pregnancy to prevent their body
rejecting the donor organ
• After six months, if there are no complications, the woman will have
frozen embryos implanted, created from her eggs and her partner’s
sperm
• If all goes well, the baby will be delivered by caesarean section
between 35-37 weeks gestation
• Couples will be given the option of trying for two pregnancies
• Once it is no longer needed, the womb will be removed to allow the
recipient to stop taking immunosuppressant drugs
Mr Smith told the BBC that after a preliminary selection process,
the team was in contact with around 50 women who were potential
recipients.
Some of these women had close relatives who were willing to donate
their wombs.
He said: “The new method of live donor retrieval changes the equation
to make it much safer.
“It is still major surgery but the risk of clot formation, DVT and damage
to pelvic organs is greatly reduced, making it an acceptable approach.”
The surgery will take place in NHS transplant centres, but the costs will
be paid for by the charity, and team members will give their services
free.
Source: BBC News Fergus Walsh
12 THE OPERATING THEATRE JOURNAL www.otjonline.com

Registered Anaesthetic Technician
North Shore & Waitakere Hospital & Elective Surgical Centre
Waitemata District Health Board
New Zealand
• Diverse
• Team Culture
• Variation of specialties
If you are an Anaesthetic Technician who is interested in joining our
dynamic, proactive hardworking team on a permanent basis, long with
extending your practice; then we want to hear from you
You will be joining a team of 40 Registered Anaesthetic Technicians who
collectively cover three sites working 24/7. You will need to have a broad
range of experience in many surgical and anaesthetic specialities including:
ENT, Obstetrics, Gynaecology, and Emergency Department, Intensive care,
also being part of the Cardiac Arrest team and out of hospital transfer.
You will need to have the following:
• Excellent communication skills and will fit seamlessly into our multidisciplinary
team.
• Registered Anaesthetic Technician or eligible to be registered with the
Medical Sciences Council of New Zealand.
To be considered for this position or to view the position description,
please apply online at: www.wdhbcareers.com
For further information please email Julie Bromley
julie.bromley@waitematadhb.govt.nz
View the Benefits for working for Waitemata District Health Board
www.wdhbcareers.com/Benefits
Job code: NOR03459
Closing date: 31st July 2018
www.wdhbcareers.com
www.operatingtheatrejobs.com
Wish You Were Here
Operating Department Practitioners/RGNs:
We are currently recruiting Theatre Practitioners
with either Scrub and First Assistant or Recovery
and Advanced Life Support qualifications, to work
in Torquay.
This is a great opportunity to join a dedicated
theatre team and receive a variety of benefits, in
addition to a competitive salary.
So if you are keen to flourish and grow beside the
sea, we would love to hear from you. Interested?
Then please visit our website to apply or telephone:
01803 321640 for further information
https://www.atscloud.co.uk/ramsayhealthcare/
vacancies.aspx?lstLocation=15
How aspirin may block bowel
tumour formation
Researchers have shed light on how taking aspirin can help to prevent
bowel cancer. They found that the painkiller blocks a key process linked
to tumour formation.
Regular use of aspirin is known to reduce a person’s risk of developing
colon cancer but the drug’s tumour-fighting properties have not been
well understood.
Researchers at the University of Edinburgh, funded by the MRC and
BBSRC, focused on a structure found inside cells called the nucleolus.
Activation of the nucleolus is known to drive tumour formation and its
dysfunction has also been linked to Alzheimer’s and Parkinson’s.
The team tested the effects of aspirin on cells grown in the lab and on
tumour biopsies from colon cancer patients.
They found that aspirin blocks a key molecule called TIF-IA, which is
essential for the nucleolus to function.
Not all colon cancer patients respond to aspirin but the researchers say
their findings could help pinpoint those most likely to benefit.
Aspirin has side effects that include internal bleeding and it can cause
certain types of stroke. Long term use is not recommended. The
researchers say the study paves the way for the development of new,
safer therapies that mimic aspirin’s effects.
Dr Lesley Stark of the Cancer Research UK Edinburgh Centre, MRC
Institute of Genetics & Molecular Medicine at the University of
Edinburgh, said: “We are really excited by these findings as they suggest
a mechanism by which aspirin may act to prevent multiple diseases. A
better understanding of how aspirin blocks TIF-IA and nucleolar activity
provides great promise for the development of new treatments and
targeted therapy.”
The research, published in Nucleic Acid Research, was also supported
by Worldwide Cancer Research, Bowel and Cancer Research and The
Rosetrees Trust.
This article is adapted from materials supplied by the University of
Edinburgh.
Find out more 02921 680068 • e-mail admin@lawrand.com Issue 334 July 2018 13

Hololens augmented reality enters the operating
theatre at Imperial College
Hololens augmented reality technology is being used during surgery at
Imperial College. We spoke to Dr Philip Pratt about introducing the AR
headsets into the operating theatre.
Imperial College London is trialling Microsoft’s mixed reality Hololens
headsets for skin graft surgeons at St Mary’s Hospital, London.
While at first glance, the Microsoft Hololens headset appears identical
to a VR headset, this technology in fact creates a ‘mixed’, rather than
virtual, reality.
This is where a layer of augmented reality is overlayed on top of the
physical world, and can be used to enhance our perception of physical
objects. The tech has currently found applications in manufacturing and
construction, but is now being used, perhaps to most groundbreaking
effect, in medicine.
“We have these incredible machines in the basement of the hospital
- the CT and MRI scanners - that can essentially give us pictures of
what’s inside the patient...We can see all of that on the screen, but the
way that information is currently used in the operating theatre is so
antiquated,” says Dr Philip Pratt, research fellow at the Department of
Surgery and Cancer at Imperial College London.
Now, using the Hololens headsets, Pratt wants to give surgeons access
to these images while they are actually performing surgery, starting
with skin grafts at St Mary’s Hospital, London.
Skin grafts are suitable for the types of injury which result in trauma
to the flesh - for example, those resulting from car accidents or severe
burns.
To heal the area, a piece of healthy skin is taken from a different part of
the body and attached to the damaged area. However, importantly, it
must be attached in a location where it can be connected with a blood
supply, to ensure the skin does not die.
Therefore, locating the position of major blood vessels under the skin
surface is of the utmost importance in this type of surgery. In most
hospitals around the world, this form of surgery involves a painstaking
process where a sterile ruler is used to map out measurements taken
from a scan, making multiple, small incisions on the skin’s surface.
Another option is to use an instrument which amplifies blood flow,
the Doppler Ultrasound Probe, to try to detect the location of blood
vessels.
“That’s a very approximate method and there’s no guarantee that
where x marks the spot, you’ve actually got the right place. It’s very
important that when you make your incisions, you’re exactly on top
of the vessels of interest - it can take a long time to locate,” says Dr
Pratt. “Time in operating theatres is very precious, you’ve got a lot of
surgeons in the room and time is money,” he says, pointing out that it’s
also preferable to reduce the amount of time patients need to be kept
under general anaesthetic.
----S ubscribe
to the OTJ
Information on the location of blood vessels is available from a CT
scan - something that has been around since the ‘70s. However, it has
been hard to mirror this two dimensional information onto the patient’s
body. Until Hololens, that is.
“Hololens came along and I immediately thought, yes, this is a classic
clinical problem that we can use the technology to help solve,” says Dr
Pratt. “Because what surgeons want to do is visualise the interior of the
patient and overlay that information intraoperatively.”
The technology is currently being used in the hospital for any cases that
require lower limb reconstructive surgeries.
The Hololens ability to tether the overlayed images onto physical
landmarks means that the accuracy of the image mapping is crucially
preserved even when the body part moves. However, as this is the
first time the technology has been used in this setting, lower limb
surgeries were selected because the large, rigid bone structures in the
legs means that there is less movement of the blood vessels when the
patient changes position.
With a background in robotic surgery, Dr Pratt himself wrote the code
for the software used in the hospital. He points out that to work, he had
to make the technology as simple to use as possible.
“[The surgeons] did adapt to it very quickly. It has to be very intuitive
in terms of how you manipulate the images, how you align images to
the patient. If it takes someone more than you know 30 seconds or a
minute to get the hang of it, then you’ve not done the job properly.”
So far, the feedback from surgeons has been overwhelmingly positive.
“They’re delighted with it,” he says.
So, what could be next for the tech? Some of the immediate future
applications also involve surgery where locating particular blood
vessels is imperative.
An obvious area where this is true is breast reconstructive surgery,
following breast cancer for example. Another potential area is colon
or rectum cancers, where an MRI scan identifying the tumour could
be projected onto the area during surgery to ensure that all of the
malignant tissue is excised. However, as this involves more fluid,
flexible structures, it will be more challenging to map imagery onto this
area of the body.
However - despite being a pioneer of innovation in the medical sphere
- Dr Pratt cautions against over-zealous attitudes towards technology.
“We have to go first to the problem and not the solution,” he says. “It’s
not about taking a piece of technology and finding something to use it
for. Instead, we have to start with a problem and then find the most
appropriate technology to help it.”
Right now, the technology can only be used by hospitals associated with
Imperial College, including St Mary’s, Charing Cross and Hammersmith
Hospitals. However, Dr Pratt is focused on increasing the number of case
studies conducted using the technology, with the goal of eventually
having the technology rolled out to every hospital in the UK.
This will involve a laborious, regulatory process before it can become
a standardised tool across the NHS. But this aim remains firmly within
the sights of the tech.
“My driving motivation behind this is to see it used as often and as
geographically widespread as possible,” says Dr Pratt. “I want it to be
not just in one hospital or 10 hospitals, but 100 or 1,000 hospitals.
That’s definitely part of the grand scheme.”
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14 THE OPERATING THEATRE JOURNAL www.otjonline.com
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ISSN 1747-728X
The Leading Independent Journal For ALL Operating Theatre Staff
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BRITS ARE PULLING SICKIES
BECAUSE THEY ARE TOO
TIRED TO WORK
A staggering quarter of Brits are routinely “too tired” to go to work and
one in twenty workers have called in sick up to four times in the last
year due to feeling sleep deprived after either a poor quality or not
enough sleep the night before according to new research from Bensons
for Beds.
Bensons for Beds has conducted a sleep wellness survey which looked
into the nation’s sleep patterns and found that the average adult gets
just six hours of sleep per night, despite claiming they need at least
eight hours in order to feel rested!
Of those that do drag themselves into the office, one fifth have nodded
off on public transport commuting to work, and people admitted to also
falling asleep in meetings and at their desks.
70 percent say a poor night’s sleep and tiredness affects their ability to
do their job effectively, with 60 percent of the 2,500 full-time workers
surveyed claiming that work and family stresses were the biggest
causes of anxiety. However, almost a quarter of Brits blame their sleep
problems on their partner’s snoring!
Harveys Chief Customer Officer, Henry Swift said: “At Bensons for Beds,
we take sleep and wellness seriously which is why our in-store experts
are on hand every day to help you get the best night’s sleep you can.
We have everything you need to get the most out of your bedroom
environment, which is crucial to set you on your way to a good night’s
sleep. Our Comfort Station Adaptive, for example, uses our unique
body-track technology to help you find the perfect mattress firmness
and our exclusive iGel range with temperature regulating technology,
warms you up when you get too cold, and cools you down when you
get too hot.”
Stephanie Romiszweski, Sleep Physiologist at the Sleepy Head Clinic
added: “Making sure your bedroom environment is suitable for you
is the first step to achieving the most out of sleep. Once you have
done this, if you are still struggling to sleep it’s time to look at your
behaviour. Try and keep a regular wake time, and whilst having the
same sleep ‘opportunity’ is important, it doesn’t mean going to bed
when you are anxious or not sleepy just because the clock on the wall
says so.
“Only go to bed once you are really sleepy and spend the rest of your
sleep opportunity enjoying yourself and finding things that make you
feel good. That way work and the days events are less likely to impact
on the quality of your sleep. Remember it’s all about quality and not
quantity
£900 million Future Leaders
investment will sustain the UK as
global home of research talent
Business Secretary Greg Clark recentl unveiled a major new £900
million investment in the UK Research and Innovation Future Leaders
Fellowship Scheme.
The inaugural UKRI Future Leaders Fellowship Scheme will receive £900
million over the next 11 years, with six funding competitions and at
least 550 fellows awarded over the next three years.
The investment will provide up to seven years of funding for earlycareer
researchers and innovators, including support for part-time
awards and career-breaks, providing flexibility to researchers to tackle
ambitious and challenging research questions.
Business Secretary Greg Clark said: “We are a nation of innovators, with
some of the world’s greatest inventions created on British soil – from
penicillin to the first computer program. We want to retain our global
reputation as a destination for world-class scientists and researchers,
by providing opportunities to find and nurture the next Ada Lovelace
and Isaac Newtons.
“I want the UK to remain the go-to destination for the best researchers
and innovators and that is why we are investing in the rising stars of
research and innovation to develop the new products and technologies
of tomorrow.”
Previous investment in new talent has funded research into new cancer
drugs and developed critical technology which will bring us driverless
cars. Today’s announcement will build on this success and boost the
pipeline of talent needed to build a Britain fit for the future. The
money, which is part of the single biggest investment in science in 40
years, will help ensure the UK invests 2.4% of GDP in R&D by 2027 and
becomes the most innovative economy by 2030.
Chief Executive of UK Research and Innovation, Professor Sir Mark
Walport said: “Talented people are the energy and engine of new
knowledge, new ideas and new opportunities. The long-term investment
announced today means the UK will continue to attract and grow
the very best, supporting those who want to solve the most difficult
questions whether they are in frontier science, our evolving society or
our changing economy.”
www.ukri.org
www.OperatingTheatreJobs.com
A one-stop resource for ALL your theatre related Career opportunities
View the latest vacancies online !
16 THE OPERATING THEATRE JOURNAL www.otjonline.com

Clydebank hospital first to
offer dedicated robotic surgery
system to chest patients
A Scottish hospital has become the first in the UK to dedicate a stateof-the-art
robotic surgery system for the use of lung patients, a move
which could have a transformational impact on recovery times. The
£1.3million Da Vinci system enables surgeons to perform operations
through a few small incisions, instead of more invasive procedures
which take longer to heal.
While the machine has been installed at several NHS facilities across
the country, the one installed at the Golden Jubilee National Hospital
in Clydebank is the first to be used solely by a thoracic services unit.
Clinicians believe the system will pay for itself in the long term by
allowing patients to return home quicker and require less care as their
outcomes are improved.
Cardiothoracic consultant Alan Kirk, who has used the Da Vinci on
lung patients, said: “It is probably standard of care for most urology
or prostate cancer work and recently over the past five years in the
UK people have diversified and started using it for chest surgery. “We
are the first unit in the whole of the UK to buy one specifically for lung
surgery. “Although it looks very complicated, it’s really an extension of
what we already do on a keyhole and minimally invasive platform, but
this takes things one stage further forward. “Over the past five years,
we’ve gone from big open operations for lung cancer to 80 per cent of
our lung cancer procedures now being done by conventional keyhole
surgery and now there is a natural extension of that, which we hope
and anticipate will result in improved patient outcomes.”
Mr Kirk added his colleagues at other hospitals had to compete with
various departments for access to their respective Da Vinci system. He
continued: “Our plan over the next 18 months is to develop this to the
stage that those who need or want robotics will be able to get it. One of
the reasons we are at this stage is that we are one of the biggest units
in the UK. “But we now have the ability to operate on more people
with lung cancer – of which there are 4,600 cases in Scotland each year.
Twenty years ago, only 10 per cent got an operation. Now it’s in excess
of 25 per cent.” The robotics system also benefits the surgeons who use
it as well as the patients.
“The vision you get is high-definition and in 3D and is fantastic,”
added Mr Kirk. “You’re looking at 360 articulation, which you cannot
have working under your own hand. The precision of the surgery, the
dexterity, and the vision makes it better for all.” There are currently
38 units delivering lung cancer and chest surgery across the UK, eight
of which have access to robotics. Case study: Climbing the stairs a
week after surgery is no problem for one patient Living on the top floor
of a tenement block with no lift could seem a daunting prospect for
many patients recovering at home from major surgery. But Geraldine
MacAulay, 55, is already able to routinely scale the more than 80
steps to her flat in Glasgow’s leafy west end district, despite having
undergone treatment in April at the Golden Jubilee National Hospital
in Clydebank.
The optometrist was diagnosed that same month with adenocarcinoma,
a malignant tumour formed from glandular structures in epithelial tissue.
This meant she had to undergo a lower left lobectomy, which entailed
the removal of part of the lower left lobe of her lung due to cancer.
Such surgery would previously have entailed a long and often painful
period of convalescence due to its invasive nature. Instead, Geraldine is
managing her recovery by simply taking four paracetamol tablets each
day. It follows surgery using a state-of-the-art Da Vinci system, which
is controlled by a surgeon from a console in the operating theatre. The
hospital is the first unit in the UK to dedicate such a robotics system to
lung patients within its thoracic services team. “The diagnosis was a
bolt out of the blue,” she told The Scotsman. “It was mooted around two
weeks before that my operation would be something more unusual. “I
was quite happy. I was of course pleased with anything that would give
me a better outcome, and to support something progressive. Geraldine
was in hospital for five nights, and was back “out and about” just a
week later. “It’s a daunting prospect having any kind of surgery as well
as being diagnosed with cancer,” she continued. “But my situation was
definitely helped, despite the traumatic experience of being diagnosed,
by having an easier experience (post-surgery)
Gene therapy restores paw function
in rats with spinal cord injury
Medical Research Council (MRC)-funded researchers at King’s College
London have shown that rats with spinal cord injuries can re-learn
skilled hand movements after being treated with a gene therapy.
People with spinal cord injury often lose the ability to perform
everyday actions that require coordinated hand movements, such as
writing, holding a toothbrush or picking up a drink. Regaining hand
function is the top priority for patients and would dramatically improve
independence and quality of life. No regenerative treatments are
currently available.
The researchers, whose work is published in the journal Brain, tested
a new gene therapy for regenerating damaged tissue in the spinal cord
that could be switched on and off using a common antibiotic.
Professor Elizabeth Bradbury from the Institute of Psychiatry,
Psychology & Neuroscience (IoPPN) said: “What is exciting about our
approach is that we can precisely control how long the therapy is
delivered by using a gene switch. This means we can hone in on the
optimal amount of time needed for recovery. Gene therapy provides a
way of treating large areas of the spinal cord with only one injection,
and with the switch we can now turn the gene off when it is no longer
needed.”
After a traumatic spinal injury, dense scar tissue forms which prevents
new connections being made between nerve cells. The gene therapy
causes cells to produce an enzyme called chondroitinase which can
break down the scar tissue and allow networks of nerve cells to
regenerate.
Most human spinal cord injuries occur at the neck level and affect all
four limbs. The researchers gave the gene therapy to rats with spinal
injuries that closely mimicked the kind of human spinal injuries that
occur after traumatic impacts such as car crashes or falls.
Dr Emily Burnside from the IoPPN explains: “Rats and humans use a
similar sequence of coordinated movements when reaching and grasping
for objects. We found that when the gene therapy was switched on for
two months the rats were able to accurately reach and grasp sugar
pellets. We also found a dramatic increase in the spinal cord of the
rats, suggesting that new connections had been made in the networks
of nerve cells.”
The researchers had to overcome a problem with the immune system
recognising and removing the gene switch mechanism. To get around
this, the researchers worked with colleagues in the Netherlands to add
a ‘stealth gene’ which hides the gene switch from the immune system.
Professor Joost Verhaagen at the Netherlands Institute for Neuroscience
says: “The use of a stealth gene switch provides an important safeguard
and is an encouraging step toward an effective gene therapy for spinal
cord injury. This is the first time a gene therapy with a stealth on/off
switch has been shown to work in animals.”
The gene therapy is not yet ready for human trials. While the ability
to switch a therapeutic gene off provides a safeguard, the researchers
found a small amount of the gene remained active even when switched
off. They are now working on shutting the gene down completely and
moving towards trials in larger species.
The research is funded by the International Spinal Research Trust and
Wings for Life, as well as the MRC.
We are pleased to accept
clinical articles for publication
within the pages of
The Operating Theatre Journal
Please send for the attention of the
Editor at:
admin@lawrand.com
Source: The Scotsman Chris McCall
Find out more 02921 680068 • e-mail admin@lawrand.com Issue 334 July 2018 17

Pelvic floor problems and incontinence:
autoprosthesis significantly improves
quality-of-life
Meeting of the International Urogynecological Association in Vienna under the leadership of MedUni Vienna/Vienna General Hospital
Due to their anatomical difference and also the particular stresses
associated with pregnancy and childbirth, incontinence and pelvic
floor problems are particularly prevalent in women. Apart from
incontinence, women can also develop pelvic floor muscle weakness,
overstretching of the pelvic connective tissue and displacement of
the pelvic organs. Their quality-of-life can be significantly improved
by surgical transplantation of endogenous tissue to strengthen the
affected area of the pelvic floor.
“This is therefore a form of autoprosthesis,” summarises Heinz Kölbl,
Head of the Division of General Gynecology and Gynecologic Oncology at
the Department of Obstetrics and Gynecology, MedUni Vienna/Vienna
General Hospital. Kölbl is also head of the local organising committee
for the 43rd Annual Meeting of IUGA (International Urogynecological
Association), the largest conference in the world in this field, which will
took place in the Austria Center Vienna on 27 – 30 June 2018.
In this surgical procedure – which is performed when conservative
techniques or medications have failed to achieve the desired result
– endogenous tissue is taken from an area adjacent to the affected
area, tautened and allowed to scar over, thereby producing the desired
strength. Says Kölbl: “On average that improves quality-of-life for
affected patients by at least 30%.” Research is also being conducted
into the use of external stem cell tissue. Says Kölbl: “It is our vision
that, in future, we will be able to insert external tissue that is even
stronger and more functional, using minimally invasive techniques.”
Currently many patients still suffer a relapse, requiring a second or
even third operation to strengthen their pelvic floor.
Viennese pelvic floor unit is a world leader
The pelvic floor unit within MedUni Vienna/Vienna General Hospital’s
Department of Obstetrics and Gynecology is a world leader – a fact that
is underscored by the large number of urogynecological conferences
held in Vienna. The ESGE 27th International Congress of the European
Society of Gastrointestinal Endoscopy will also be held in Vienna in
October – with the focus on women’s health. Researchers in Vienna are
currently conducting studies using GenePatterns to develop risk profiles
for subsequent major pelvic floor damage. “So that we can potentially
establish in advance that women from the high-risk group should not
be allowed to give birth naturally, for example, in order to prevent
subsequent incontinence or other pelvic floor damage,” explains Kölbl,
who is also a member of MedUni Vienna/Vienna General Hospital’s
Comprehensive Cancer Center. A similar risk profile already exists for
women who are less than 160 cm tall: they should no longer be allowed
to give birth naturally, if the embryo weighs more than 4,000 g. Says
Kölbl: “That would give them a 100% risk of developing pelvic floor
problems.”
One in three women has bladder problems over the course of her life
and one in 25 women experiences pelvic floor problems after childbirth.
And around 3% of all women are affected by symptomatic forms of
pelvic floor prolapse.
For more information: www.iugameeting.org
Nightingale Health and UK Biobank announce major initiative to analyse
half a million blood samples to facilitate global medical research
Comprehensive metabolic biomarker profiles of the world’s largest health database to be analysed in 30 months.
Nightingale Health, the Finnish innovator of an internationally
recognized blood biomarker technology for studying chronic diseases,
will analyse the biomarker profiles of 500,000 blood samples from UK
Biobank. The ground-breaking research initiative was announced today
at the UK Biobank Scientific Conference 2018 in London.
Nightingale’s biomarker profiling technology will be used to analyse UK
Biobank blood samples by measuring metabolic biomarkers that recent
studies have found are predictive of future risk for heart disease, type
2 diabetes and many other common chronic diseases. Until recently,
technological constraints and prohibitive costs have prevented the
analysis of comprehensive metabolic data from large-scale biobank
collections, but this process has been made viable by Nightingale’s
technology, which measures over 200 metabolic biomarkers in a single
blood test.
This initiative will further enrich the world’s most detailed public
health database provided by the UK Biobank.
Professor Sir Rory Collins, UK Biobank’s Principal Investigator, said
the commitment by Nightingale to perform these assays would allow
researchers around the world to advance health research more quickly.
He expects the combination of these biomarker data with the detailed
health information that participants have already provided to generate
many new insights. “We are delighted to see these novel blood sample
analyses being done in UK Biobank,” said Professor Collins. “We already
have an enormous amount of information about the lifestyles and
genetic make-up of the participants in UK Biobank, as well as about
their health, and are currently conducting imaging studies of their
brains, hearts and bodies. Providing the medical research community
with these additional high quality metabolic biomarker data on such
a large scale will enhance discovery science and population science,
providing opportunities to benefit patient care and public health.”
“Analysing 500,000 blood samples from a single study with Nightingale’s
comprehensive biomarker profiling technology allows us to uncover
metabolic signatures that reflect a risk for future disease onset, as
well as their underlying risk factors. We anticipate this detailed
molecular readout of the health state, combining both lifestyle and
genetic makeup, will result in a wealth of scientific applications from
the research community. This will be relevant not only to the British
population but also yield ground-breaking science and enhanced drug
development opportunities with a global public health impact,” said
Dr. Peter Würtz, Scientific Director and Founder, Nightingale Health.
Nightingale Health’s technology has been previously used to analyse
more than 500,000 blood samples from over 200 cohort studies and
clinical trials around the globe, with more than 150 peer-reviewed
publications showcasing how the detailed metabolic biomarker data
provide novel insights into health and disease.
“Nightingale’s mission is strongly linked to scientific evidence
generation. This means working with world-leading institutions and
biosample collections to continuously improve the understanding of
health and disease. Our aim is to translate this understanding into
improved early prediction of diabetes and cardiovascular diseases,
achieving better healthcare for everyone. Our initiative with the UK
Biobank demonstrates Nightingale’s unwavering commitment towards
supporting innovative medical science carried out by researchers from
across the world,” said Teemu Suna, CEO and Founder, Nightingale
Health.
The initiative corresponds to over 10 million EUR investment in UK
Biobank and will be funded by Nightingale Health, with analyses of
UK Biobank samples being performed at Nightingale’s laboratory in
Finland. In line with the founding principles of the UK Biobank, this
metabolomic data will be incorporated back into the UK Biobank’s
resource following a 9 months exclusivity period for Nightingale Health
and made openly available to the scientific community.
For more information, please visit https://www.nightingalehealth.com
18 THE OPERATING THEATRE JOURNAL www.otjonline.com

NNATIONAL CONFERENCE *
INNOVATION AND EFFICIENCY IN THE
Operating Theatre
Department
6 th
ATIONAL CONFERENCE *
Tuesday, 13th November 2018 Crowne Plaza, City Centre, LIVERPOOL £279pp
The 6th national Operating Theatre Department conference
focus is on efficiency, innovation and effectiveness which is
reflected prominently in the programme.
There is an excellent mix of evidence and cases from clinical practice from all over the UK and
Ireland. The event is an opportune resource to network with nationwide colleagues providing
evidence, anecdote and information to take back to your own operating theatres.
Attended by Theatre Managers, Senior Operating Department and Perioperative Practitioners,
Educationalists, Nurses, ODPs, Clinical Managers and Government leads.
INCLUDES:
• Re-defining metrics for change and improvement
in theatres
• Efficiency under pressure - A Quality Champion Project
• Financial effectiveness in the Operating Theatres
• The Empty Recovery Room
• ISO 9001:2015 industrial standard for a clinical area?
• Debriefing as an education tool in the Operating Theatre
• How Intra Operative Cell Salvage transformed our
department and Trust
• Development of an innovative collaborative approach
to Peri-operative training programmes
HOW TO
BOOK
Online: www.mkupdate.co.uk E: bookings@mkupdate.co.uk
T: 01768 773030 and SMS: 07375 032963 (Mon - Fri)
CONFERENCES
professionals
training professionals
since 1992
M&K Update Ltd, Keswick, Cumbria CA12 5AS
Tel: 01768 773030
www.mkupdate.co.uk

New Kurt, New Power | PatientSafe Network
New Kurt, New Power
There would always be the laggards who would do everything they
could to maintain the status quo.
The closer the messengers got to delivering the change the greater the
bullying and intimidation would become. All the messengers had to do
was put up with all the shit that was flung their way.
Please note – the Please Kurts note – the depicted Kurts depicted in these in images and this and story this are not story real are not real
Someone told Old Kurt that clearly displaying his name and role was
Someone told Old Kurt that clearly displaying his name and role was better for communication, team
better for communication, team work and ultimately patient safety and
work and ultimately patient safety and care.
care.
Old Kurt was offended having never done this before. He felt he was being told he hadn’t been doing his
Old Kurt was offended having never done this before. He felt he was
job to the best of his ability. He was understandably a bit annoyed.
being told he hadn’t been doing his job to the best of his ability. He was
understandably a bit annoyed.
New Kurt, New Power | PatientSafe Network
And so he looked for ways to rebuff what had been said:
They knew they’d be able to, having been exposed to far worse and
realising what was at stake.
Eventually Old Kurt relented (in this story he does anyway).
It took Old Kurt a while and required a lot of searching within himself
and yes, courage.
He had to accept that displaying his name and role, for others to clearly
see, was better. He was actually a better doctor providing better care
than he had before just because he took this simple step – after all
caring for patients was his job.
And so he looked for ways to rebuff what had been said:
world ‘Show – connected me the evidence’ as they – was were an old favourite. through It wouldn’t social work media here platforms though. It was and obvious the that internet. There was no denying it any more – it was obvious – and his head hurt
‘Show displaying me ones name the and evidence’ role made it – easier was for an people old to favourite. remember (Old It Kurt, wouldn’t like most of work his here less from thinking about it.
though. colleagues, had It kept was it to obvious himself that that he’d struggled displaying to remember ones others name names). and role made it
‘Cost’ – he could try this angle, yet he’d seen some staff using a pen to write And their names so another and roles step onin the right
easier for people to remember (Old Kurt, like most of his colleagues,
Further, collaborative teams were now openly gathering supportive data on the initiative from all over the
direction was taken – towards a
their had heads kept – pretty it to himself much for that free. he’d struggled to remember others names). culture which welcomes change and
https://www.psnetwork.org/new-kurt-new-power/[02/07/2018, 12:37:23]
Further, collaborative teams were now openly gathering supportive improvement.
‘Infection data on control’ the initiative – Old Kurt from loved all over his cotton the world hats – so connected couldn’t as use they infection were control as an angle to
Something else amazing happened
maintain through the status social quo. media He platforms considered and going the internet. back to using disposable hats but – his New College Kurt had found just putthat through
out a ‘Cost’ statement – he supporting could try this reusable angle, hats yet over he’d disposable seen some ones staff (no using evidence a pen of differences
wearing his
in
name
infection
& role hat meant
to write their names and roles on their heads – pretty much for free. others felt more confident in doing
rates and reusable hats being better for the environment).
so. They were less likely to feel
‘Infection control’ – Old Kurt loved his cotton hats so couldn’t use threatened by the intimidation.
infection control as an angle to maintain the status quo. He considered
The only remaining line of attack was the most primitive of all – bullying, threats and Staff intimidation. within theatre He
going back to using disposable hats but his College had just put out a
now communicated more easily on numerous
could statement attack the supporting way the message reusable was hats being over delivered. disposable He ones asked (no for evidence it to be softened different and things. presented Resultantly as the camaraderie in his theatre complex
was much greater than it had ever been.
a nice of way differences to support in infection team introductions. rates and reusable But it was hats more being than better that, wasn’t for the it – he knew that – it had
environment).
clinical outcome implications.
The only remaining line of attack was the most primitive of all – bullying,
threats and intimidation. He could attack the way the message was
So then
being
he
delivered.
chose to attack
He asked
the messengers
for it to be softened
and galvanised
and presented
others to
as
do
a
the
nice
same.
way to support team introductions. But it was more than that, wasn’t
Yet despite – he knew this the that messengers – it had clinical persisted outcome because implications. they knew the message was right.
So then he chose to attack the messengers and galvanised others to do
The messengers, the same. being human themselves, appreciated what humans were like – perhaps one of the
reasons Yet the despite message this was the conceived messengers in the persisted first place because – it’s visual they nature knew the would display to everyone how
much
message
we resist
was
change.
right.
The messengers, being human themselves, appreciated what humans
There were would like always – perhaps be the one laggards of the who reasons would the do message everything was they conceived could to in maintain
Staff
the
also
status
started
quo.
to think – ‘if there’d been so much resistance to adopt
the first place – it’s visual nature would display to everyone how much this simple change what else had been resisted‘.
we resist change.
Staff also felt more empowered to change their work environments in
the interest of patient welfare. Further because of the internet and
social networks they were able to collaborate rapidly and effectively
on thousands of other projects seeing them to fruition. They delivered
brilliant solutions to problems they’d been blinded to in the past.
New Kurt was much happier in the New Power workplace which he’d
helped create.
So we’re his colleagues.
And everyone lived happily ever after.
(Well almost. At least things started heading in the right direction.
There is still a tonne of work to do).
New Power by Jeremy Heimans & Henry Timms.
20 THE OPERATING THEATRE JOURNAL www.otjonline.com
The closer the messengers got to delivering the change the greater the bullying and intimidation would

UK’s NICE publishes a Medtech innovation briefing on PICO
for the prophylactic use in surgically closed incisions to
reduce surgical site complications
Smith & Nephew, the global medical technology business, announces that the UK’s National Institute for Health and Care Excellence (NICE) has
issued a Medtech innovation briefing (MIB) on the use of PICO Single Use Negative Pressure Wound Therapy (sNPWT).
The MIB reports the prophylactic use of PICO as a potentially more effective alternative to standard surgical dressings in the prevention of surgical
site complications (SSCs). This is the first and only MIB published by NICE on an NPWT device for preventing SSCs.
Complications from surgical incisions are a significant economic and human burden, costing an approximate £1 billion 1 to the NHS each year and
contributing to significant morbidity and mortality in the UK and globally. A recent World Union of Wound Healing Societies consensus guidelines
reports that up to 60% of surgical site infections (SSIs) are preventable 2 .
The prophylactic use of the PICO system is proven to be effective in reducing SSCs, including SSIs and dehiscence (wound rupturing) of the surgical
incision, in patients at elevated risk of SSCs 7 .
The PICO dressing has a proprietary AIRLOCK Technology that uniformly and consistently delivers NPWT across a surgical incision and the
surrounding zone of injury generated naturally by the incision itself 3,4 . This proprietary feature is designed to help reduce the risk of wound
complications by reducing post-operative fluid, swelling and associated tension around a closed surgical incision compared with standard
dressings 5,6 . The combination of these actions helps reduce the risk of surgical wound dehiscence 7 and SSIs 7 , the 2 most common SSCs.
Evidence shows how the prophylactic use of PICO resulted in fewer complications, and in earlier discharge from hospitals, reducing length of stay,
on average by more than 8 days, in closed laparotomy wounds after abdominal surgery 8 *, which has the potential to release bed days for the NHS.
In patients undergoing primary hip and knee arthroplasties, it was estimated that care with PICO enabled cost savings of more than £7,000 per
high-risk patient (BMI ≥35 or ASA ≥3) compared with care with standard dressings 9 **.
Read more about NICE’s finding here: http://www.smith-nephew.com/PICOMIB
Ms Pauline Whitehouse, Consultant General and Colorectal Surgeon, Worthing Hospital, said, “Following the introduction of PICO into our Trust
for moderate- to high-risk incisions, we quickly noticed a significant reduction in superficial surgical site infections. We have now introduced PICO
across the Trust and are seeing similar reductions in infective complications for other specialities”.
MIBs are objective information on device and diagnostic technologies to aid local decision-making by clinicians, managers and procurement
professionals. They are NICE advice, designed to support NHS and social care commissioners and staff who are considering using new medical
devices, and other medical or diagnostic technologies. The briefing will help avoid the need for organisations to produce similar information
locally, saving staff time and resources. MIBs are commissioned by NHS England and produced in support of the NHS 5-Year Forward View,
specifically as one of a number of steps that will accelerate innovation in new treatments and diagnostics.
As part of the MIB, NICE conducted a thorough review of the published and peer-reviewed data from a variety of meta-analyses and randomised
controlled trials (RCTs). The effectiveness of PICO in reducing SSCs has been examined in 10 RCTs and multiple observational studies. A recently
published 1,839 patient meta-analysis demonstrated the efficacy of PICO, used prophylactically, significantly reducing SSIs by 58% in closed surgical
incisions compared with standard care 5 ***.
PICO is suitable for use in both hospital and community settings, and is approved for a number of indications, including surgically closed incision
sites.
“NICE MIBs are a great resource for NHS organisations, and are often a reference used by healthcare systems beyond the UK. Today we are
delighted to see the NICE MIB support for the prophylactic use of PICO as an effective alternative for clinicians who look to reduce their rates of
surgical site complications. This will provide them with the confidence to use PICO for their at-risk patients and procedures, in support of their
efforts to achieve better economic and clinical outcomes,” said Paolo Di Vincenzo, Smith & Nephew’s SVP of Advanced Wound Management. “With
PICO, we are keeping Smith & Nephew at the forefront of delivering pioneering solutions that continue to improve current standards of care, by
reducing the burden and delivering better clinical and economic outcomes. PICO has shown significant clinical results in reducing life-threatening
infections on closed surgical incisions, which has contributed significantly to improved patient outcomes, in a cost-effective portable solution”.
For more information about Smith & Nephew, please visit our website www.smith-nephew.com,
follow @SmithNephewplc on Twitter or
visit SmithNephewplc on Facebook.com.
References:
1. Guest J et al, Health economic burden that different wound types impose on the UK’s National Health Service. Int Wound J 2016; doi: 10.1111/
iwj.12603
2. World Union of Wound Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: understanding the role of NPWT.
Wounds International, 2016
3. Data on File. DS/17/253/R. Project Opal PICO 7 System Stability Testing - Initial Time Point. October 2017
4. Malmsjö M et al. Biological effects of a disposable, canisterless Negative Pressure Wound Therapy system (in-vitro). Eplasty 2014; 14:e15
5. Selvaggi F et al., New Advances in Negative Pressure Wound Therapy (NPWT) for Surgical Wounds of Patients Affected with Crohn’s Disease.
Surgical Technology International XXIV; 83- 89
6. Loveluck et al (2016) Biomechanical modeling of forces applied to closed incision during NPWT eplasty16e20
7. Strugala, V. and Martin, R. Meta-analysis of comparative trials evaluating a prophylactic single-use negative pressure wound therapy system
for the prevention of surgical site complications. Surgical Infections (2017). DOI 10.1089/sur.2017.156
8. O’Leary, Donal Peter et al. 2017. “Prophylactic Negative Pressure Dressing Use in Closed Laparotomy Wounds Following Abdominal Operations.”
Annals of Surgery. Jun 265(6): 1082-1086
9. Nherera LM, Trueman P, Karlakki SL. Cost-effectiveness analysis of single-use negative pressure wound therapy dressings (sNPWT) to reduce
surgical site complications (SSC) in routine primary hip and knee replacements. Wound Repair Regen. April 2017. doi:10.1111/wrr.12530
Find out more 02921 680068 • e-mail admin@lawrand.com Issue 334 July 2018 21

NEW EVIDENCE SHOWS ASSOCIATION BETWEEN INNOVATION
AND REDUCED COMPLICATIONS IN THORACIC SURGERY
Studies presented at the European Society of Thoracic Surgeons meeting examine the impact of innovation on
both patient outcomes and hospital costs
Exciting data from the 26th European Society of Thoracic Surgeons meeting shows an association between innovation, and improved patient
outcomes and lowered hospital costs. Two studies presented at an Ethicon* sponsored symposium show that significantly lower rates of bleeding
complications occurred when ECHELON FLEX Powered Staplers where used, [1] and how a first of its kind lung model can identify the cause of
air leaks post-surgery. [2] With such complications proving costly and dangerous for patients, finding ways to minimize risk is vitally important. 1,2
Findings from the first real-world study exploring the impact of powered staplers compared to manual devices in video-assisted thoracoscopic
surgery (VATS) for lung cancer, found that bleeding complications dropped by nearly half when surgeons used a powered stapler. The study which
has been published in Advances in Therapy, also found a nearly 10% reduction in total hospital costs, and one day sooner discharge from the
hospital associated with the powered-stapling procedures.1
“This real-world study shows stapler choice really does matter in significantly reducing bleeding complications and lowering overall costs in VATS
lobectomy procedures. The results in favor of powered stapling devices in thoracic surgery are compelling,” said lead study author Daniel L. Miller,
MD, Chief, General Thoracic Surgery at WellStar Health System, Mayo Clinic Care Network in Marietta, GA.
A lobectomy is a surgical procedure where an entire lobe of the lung is removed due to lung cancer, infection, chronic obstructive pulmonary
disease (COPD) or benign tumors. [3] Between 2-10% of lobectomies result in bleeding complications. [4],[5]
Findings from a lung model study, published in IEEE Transactions on Biomedical Engineering, found that unlike any system before, the novel ex-vivo
model was able to successfully replicate a person’s breathing both under ventilated and natural conditions. Developed by Ethicon, in partnership
with leading experts in thoracic surgery, the new model simulates the various physiologic environments experienced by an isolated lung during
the perioperative period, allowing researchers to monitor how and why air leaks happen. 2 Researchers will now be able to explore under clinically
relevant conditions, the possible ways to reduce the risk of air leaks, 2 a post-operative complication that occurs in 24% of lobectomies and
associated with an almost doubled increase in hospital mortality. [6]
“We continue to take aim at critical clinical issues such as hemostasis complications through the development of innovative devices like ECHELON
FLEX Powered Staplers and the generation of meaningful clinical and real-world evidence that fills knowledge gaps, validates outcomes and
better informs everyday decision making,” said Edmund Kassis, MD, Ethicon Sr. Medical Director for Thoracic Surgery.
This year, more than 310,000 adults all over Europe will be diagnosed with lung cancer, and it is approximated that only 18% will survive for longer
than five years. Lung cancer is the biggest cancer killer worldwide, causing more deaths than breast and prostate cancer combined. [7]
*Ethicon represents the products and services of Ethicon, Inc., Ethicon Endo-Surgery, LLC and certain of their affiliates. Ethicon Endo-Surgery, Inc.
is the legal manufacturer of ECHELON FLEX Powered Staplers. All other trademarks are the property of their respective owners.
References
[1] Miller DL, Roy S, Kassis ES. et al. Impact of powered and tissuespecific
endoscopic stapling technology on clinical and economic
outcomes of video-assisted thoracic surgery lobectomy procedures:
a retrospective, observational study. Advances in Therapy (2018).
https://doi.org/10.1007/s12325-018-0679-z.
[2] Klassen C, Eckert CE, Wong J. et al. Ex Vivo Modeling of
Perioperative Air Leaks in Porcine Lungs. IEEE Transactions on
Biomedical Engineering (2018). https://ieeexplore.ieee.org/
document/8325303/
[3] American Lung Association. Lobectomy. Available at: www.
lung.org/lung-health-and-diseases/lung-procedures-and-tests/
lobectomy.html. Accessed May 2018.
[4] Kent M, et al. Open, video-assisted thoracic surgery, and robotic
lobectomy: review of a national database. Ann Thorac Surg.
2014;97:236-444.
[5] Based on Ethicon (2016) internal analysis of data from 26,955
lobectomy procedures captured in Premier Perspective database
for the period of 2008- 2014.
[6] Yoo A, Ghosh SK, Danker W. et al. Burden of air leak complications
in thoracic surgery estimated using a national hospital billing
database. ClinicoEconomics and Outcomes Research. 2017;9:378-
383.
[7] Lung Cancer Europe. Our Diagnosis. Available at:
www.lungcancereurope.eu/lung-cancer/. Accessed May 2018.
www.facebook.com/TheOTJ
Digital system to monitor
recovery room patients
Adelaide - SA Health is to implement a digital health solution in the
form of a post-surgery cloud-based patient monitoring system. The
system will be fitted into the Royal Adelaide Hospital.
The new platform has been developed by Allscripts, working
in collaboration with iProcedures. The platform is called the
iPro Post-Anaesthesia Care Unit module (PACU), and it enables
recovery room nurses to record patients’ post-operative data, with
metrics collected in real time. For nurses this requires the use of
resuscitation skills, knowledge and application of new techniques
and the application of pain management.
iProcedures delivers software solutions to streamline the
perioperative workflow in hospitals; this includes technologies
like iPro Anesthesia, which is a mobile application that aims to
improve documentation and patient safety. Allscripts is a Health IT
technology solutions company.
The platform was developed by anaesthesiologists with a focus on
improving patient safety, documentation, hospital efficiency and
medication management, according to the Healthcare Information
and Management Systems Society. The comprehensive end-to-end
solution is used to generate a complete, compliant and legible
anaesthesia record.
To date over one thousand patients have been administered in
the system across 33 operating theaters, where all; vital signs are
automatically tracked. Discussing this, Royal Adelaide Hospital’s
AIMS project manager Paul Dawkins stated: “When you get
anaesthetists going out of their way to visit you to thank you for
AIMS, you know it is doing a good job.”
Source: Digital Journal TIM SANDLE
22 THE OPERATING THEATRE JOURNAL www.otjonline.com

Advanced Surgical Practice (MSc)
Part-time distance learning programme
Postgraduate Certificate and Postgraduate Diploma exit points available
For those who wish to increase their knowledge of surgical practice in order to help improve patient
care. Graduates have reported that this programme has led directly to promotion, and many were
stimulated to pursue academic careers.
The modular approach allows you to evaluate care from an evidence-based perspective, starting
with admission and preoperative preparation through to postoperative care and discharge.
A range of other programmes are also available including Pain Management, Critical Care, and
standalone CPD modules.
Contact us to find out more
pgtmedadmissions@cardiff.ac.uk
+44 (0)29 20687214
www.cardiff.ac.uk/medicine

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