The Operating Theatre Journal February 2019

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February 2019 Issue No. 341 ISSN 1747-728X 

The Leading Independent Journal For ALL Operating Theatre Staff 

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2 THE OPERATING THEATRE JOURNAL www.otjonline.com

February 2019 Issue No. 341 ISSN 1747-728X 

The Leading Independent Journal For ALL Operating Theatre Staff 

Powerful new models of the Anetic Aid QA3 Patient Trolley 

Compact and highly manoeuvrable, latest models of Anetic Aid’s QA3 

Patient and Emergency Trolley now offer special features to aid moving 

and handling - benefiting medical practitioners and patients alike. 

The new DRIVE option means there is no need to physically push the 

trolley - touch-sensitive handles activate an inbuilt motor, giving 

controlled, effortless travel up to gradients of 10° 

Meanwhile, the powered option offers electronic positioning - raising 

and lowering the backrest, or the whole trolley platform. This model 

also has a CPR feature, which returns the trolley swiftly to a horizontal, 

optimal height position for CPR treatment at the touch of a button. 

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and our K8 Pressure care mattress. 

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with any of our trolleys. Call us on 01943 878647 to find out more.’ 

Inside this issue 

Surgical Safety Checklist 

still faces implementation 

challenges 10 years 

later 

P4 

Trusts urged to review spinal 

surgery practice to reduce 

cases of paralysis and save 

NHS £27m 

P5 

Mortality review to be held 

into 250 deaths at crisis-hit 

London heart surgery 

The growing burden of 

Atrial Fibrillation in 

the UK 

Oh my god it’s a patient 

on ECMO! 

P5 

P8 

P9 

More die after surgery than from HIV, TB, and malaria combined - study 

A new role for the brain’s 

support cells 

P10 

Around the world 4.2 million people die every year within 30 days after surgery – with half of these deaths 

occurring in low- and middle-income countries (LMICs), a new study reveals. 

There is also a significant unmet need for surgery in LMICs and researchers believe that if operations were 

provided for all patients who need them the number of global post-operative deaths would increase to 6.1 

million. 

Researchers at the University of Birmingham published their analysis on the numbers of people dying within 

30 days of surgery in a research letter to The Lancet. They estimate that more people die each year within 30 

days after surgery than from HIV, tuberculosis, and malaria combined (2.97 million). 

The Lancet Commission on Global Surgery identified that 313 million surgical procedures are performed 

each year, but little is known about the quality of surgery globally, as robust postoperative death rates are 

available for only 29 countries. 

Researchers at the University’s NIHR Global Health Research Unit on Global Surgery analysed available 

information to estimate how many people around the world die after operations - based on surgical volume, 

case-mix and post-operative death rates adjusted for country income. 

Dr Dmitri Nepogodiev, Research Fellow at the University of Birmingham, commented: “Surgery has been 

the ‘neglected stepchild’ of global health and has received a fraction of the investment put in to treating 

infectious diseases such as malaria. 

“Although not all postoperative deaths are avoidable, many can be prevented by increasing investment in 

research, staff training, equipment, and better hospital facilities. To avoid millions more people dying after 

surgery, planned expansion of access to surgery must be complemented by investment in to improving the 

quality of surgery around the world.” 

Professor Dion Morton, Barling Chair of Surgery at the University of Birmingham and Director of Clinical 

Research at the Royal College of Surgeons of England, commented: “Surgery saves lives and can transform 

patients’ quality of life, but this study shows that a large number of patients die in the immediate 

postoperative period. As efforts continue to increase access to surgery around the world, there is also an 

urgent need for research to improve the quality and safety of surgery.” 

The researchers project that expanding surgical services to address unmet need would add another 1.9 

million post-operative deaths in LMICs each year. Based on 4.2 million deaths, 7.7% of all deaths globally occur 

within 30 days of surgery. This figure is greater than that attributed to any other cause of death globally 

except ischaemic heart disease and stroke. 

At present, around 4.8 billion people worldwide lack timely access to safe and affordable surgery and it is 

estimated that there is an annual unmet need for 143 million procedures in LMICs. 

Surgery remains the most 

effective weight loss 

treatment for severely 

obese adults 

P10 

Enhanced research reporting 

method to improve 

patient care 

P11 

RCS comment on NHS 

Improvement Theatre 

Efficiency report 

Health service staffing is 

compromising patient 

health, says UNISON 

P11 

P12 

Southampton NHS Treatment 

Centre makes CQC 

‘Outstanding’ hat trick 

for Care UK 

P13 

FibriCheck” wins the MEDICA 

App competition 

P16 

Pherecydes Pharma reports 

successful patient treatment 

with bacteriophages 

P17 

£1m of research grants 

set to save lives 

P18 

Socioeconomic disadvantage 

may trigger chronic 

inflammation 

P18 

MediSieve receive two 

grants, totalling £1.56M 

Surgeons left medical 

instruments in 23 hospital 

patients (Australia) 

P19 

P20 

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 341 February 2019 3

Vanguard provides mobile theatre 

unit to UHMBT 

A UK medical technology company is helping a hospital trust continue to 

deliver orthopaedic procedures during a planned refurbishment of one 

of its operating theatres, as well as reduce waiting times for patients. 

Gloucester-based Vanguard Healthcare Solutions is working alongside 

University Hospitals of Morecombe Bay NHS Foundation Trust (UHMBT) 

to provide a mobile laminar flow operating theatre at Westmorland 

General Hospital in Kendal. 

Designed and built by Vanguard, the mobile theatre provides an 

anaesthetic room, operating theatre, two bed first-stage recovery area, 

staff changing room and utility areas. Vanguard are also constructing a 

corridor and ramps to ensure a seamless journey for the patient from 

the main body of the hospital to the unit. 

The unit is expected to be on site for 24 weeks while refurbishment is 

carried out from December. 

The theatre has been commissioned before the refurbishment work 

started to help the hospital improve patient waiting times for elective 

orthopaedic procedures. 

Simon Squirrell, Vanguard Senior Account Manager for the region, 

explained: “We are delighted to be working alongside University 

Hospitals of Morecombe Bay NHS Foundation Trust in this important 

project. 

“Working alongside Deepak Herlekar, clinical lead of trauma and 

orthopaedics at UHMBT, we have made sure the theatre meets all 

clinical needs.” 

Kate Maynard, Director of Operations (Hospitals) at UHMBT said; 

“During the 2018/19 financial year UHMBT will invest £19million capital 

funding into improving patient areas. As part of this £1.9 million will 

be spent upgrading a theatre at Westmorland General Hospital (WGH). 

“There are four theatres at WGH and the team care for around 400 

patients each month, covering a range of specialities including 

orthopaedics, ophthalmology, general surgery, and urology. 

“On 3 December 2018, a major refurbishment started in theatre two 

which will see it equipped with a state-of-the-art air handling and 

filtration system and become a modern environment for patients. 

“During the refurbishment theatre capacity will be maintained with 

the use of a temporary vanguard theatre located at the back of 

Westmorland General Hospital. This temporary unit will be in place 

until April 2019 while theatre two is upgraded.” 

www.vanguardhealthcare.co.uk 

When responding to articles please quote ‘OTJ’ 

Surgical Safety Checklist still faces 

implementation challenges 10 years later 

A decade after the development of the Surgical Safety Checklist 

(SSC), data and anecdotal evidence reveals that mortality rates have 

been reduced at sites that successfully adopt it, but implementation 

challenges remain a barrier to more widespread use of the checklist. 

Atul A. Gawande, MD, MPH, FACS, who founded Ariadne Labs at 

Brigham and Women’s Hospital and Harvard, helped develop the 

checklist, which was adopted in 2008 by the World Health Organization 

in a global effort to standardize safety measures in operating rooms. 

In agreeing to create the checklist, Dr. Gawande not only wanted to 

develop standards of care, he also wanted to focus on implementation. 

“Our usual way of dealing with delivery of better ideas in health care 

has been first to say, ‘Let’s teach people the right thing to do,’” said Dr. 

Gawande, a general and endocrine surgeon at Brigham and Women’s 

Hospital, Boston, MA. “Then when we’re frustrated that we’re not 

getting the results we need, we start saying, ‘Well, let’s mandate that 

people do the right thing.’ That’s where you get stacks of guidelines, 

but you don’t get tremendous amounts of change.” 

Data from sites that have adopted the 19-step checklist reflect this. 

In a pilot study of preselected sites that were “enthusiastic” about 

implementing the checklist and received weekly support from the 

Ariadne team, 47 percent of the sites had a decrease in mortality 

after implementation. At surgical sites in Scotland and France where 

the checklist was mandated and team members received regular 

feedback, mortality declined 26 percent and 35 percent, respectively. 

At other sites where the checklist was simply mandated with no regular 

feedback, there was no reduction in mortality. 

The SSC, which identifies three critical pause points in surgery (before 

the induction of anesthesia, before the incision in the skin, and before 

the patient leaves the operating room), encourages communication and 

teamwork to help reduce surgical errors. However, it can take time 

to create a team-oriented culture among surgeons who have different 

values, Dr. Gawande said. 

“It’s an approach that requires you to work with different values, 

humility, discipline, and teamwork,” he said. 

Adriana M. Serna Lozano, MD, general and thoracic surgeon, Clínica El 

Country, Colsanitas, Bogotá, Colombia, reviewed challenges associated 

with implementing the checklist in Colombia. Those challenges 

included major trauma, busy days, frequent staff changes, and getting 

people to speak up. 

“The challenge here is to avoid emergencies,” Dr. Serna Lozano said. 

“Everybody has to be ready for the emergencies, especially in trauma, 

and we have to be prepared for busy days.” 

King-David Terna Yawe, MD, FWACS, FICS, FISS, FIICA, MNIM, 

University of Abuja and University of Abuja Teaching Hospital, Nigeria, 

discussed the overall status of SSC implementation and offered 

future recommendations. Knowledge and awareness of the checklist 

is generally high, he said, but implementation has been slow and 

inadequate in many settings. Implementation has been better in highincome 

countries, he noted. In low-income countries, implementation 

challenges include lack of cooperation from team members, workforce 

shortages, equipment and infrastructure limitations, and lack of 

patient care protocols. 

Dr. Yawe said strong local leadership, training workshops, and monthly 

feedback meetings would foster better implementation. “Also, tailoring 

the checklist specifically to accommodate cultural differences and local 

practices,” he said. 

For more information about the Surgical Safety Checklist, 

visit www.who.int/patientsafety/topics/safe-surgery/checklist 

The next issue copy deadline, Monday 25th February 2019 

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 

The Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, www.otjonline.com 

and in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription. 

Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors. 

All communications in respect of advertising quotations, obtaining a rate card and supplying all editorial communications and pictures to the Editor 

at the PO Box address above. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2019 

Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks. All paper and ink waste is recycled. 

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


Trusts urged to review spinal surgery practice to 

reduce cases of paralysis and save NHS £27m 

Up to £27m could be saved by the NHS improving its spinal surgery 

services as the health service spends millions on compensation for 

patients given delayed treatment, a government report has found. 

Getting It Right First Time’s (GIRFT) report revealed that £27m could 

be saved in efficiencies by improving “unacceptable” standards and 

inefficiencies, particularly cancelled operations and delayed discharges 

from hospitals. 

The report published on 30.1.19 said professional standards “were 

not currently being met, with potentially life-changing impacts on 

patients,” which, it noted, was concerning – considering that £100m is 

roughly spent each year by the NHS on clinical negligence payments for 

spinal injuries. 

The spinal surgery national report warned that delays to MRI scanning 

for patients with a suspected spinal emergency known as cauda equina 

syndrome can lead to limb paralysis, bowel and bladder paralysis, and 

incontinence. 

With lower back or radicular pain being the primary cause of disability 

in the UK, GIRFT also strongly recommended investing in longer-term 

physical and psychological rehabilitation programmes over short-term 

pain relief injections. 

It found that, despite NICE guidance, a significant number of NHS 

patients are still receiving injections of anaesthetic or steroids to 

block pain, costing the NHS £10.5m for procedures “which have limited 

clinical value.” 

The report’s author, Mike Hutton of Royal Devon and Exeter Hospital, 

said: “During my visits, I have been repeatedly struck by the passionate 

commitment of the clinical staff towards the NHS as a force for good 

in society. 

“They do so, however, under significant increasing demand on their 

services and financial constraints.” 

GIRFT’s report makes 22 recommendations to improve the quality of 

spinal surgery services, improve outcomes and save the NHS £27m. 

This includes implementing a system of referring patients without delay 

to 24-hour MRI scanning in all hospitals and ensuring all major trauma 

centres have a round-the-clock ability to stabilise and decompress the 

spine for patients with fractured and dislocated spines. 

Health minister Stephen Hammond commented: “This is a significant 

step forward in the way the NHS cares for people living with spinal 

conditions, focusing on rehabilitation rather than just relief to improve 

patient experience and lead to better treatment outcomes. 

“These clinically-endorsed recommendations could have a major 

beneficial impact on the quality of life for tens of thousands of patients 

a year.” 

Kathy McLean of NHS Improvement said the recommendations in the 

report will benefit patients and free up funds and encourage trusts to 

review their own practice without delay. 

Source: Nationalhealthexecutive.com 

UK 

Mortality review to be held into 250 

deaths at crisis-hit London heart surgery 

Experts are investigating the deaths of up to 250 patients who underwent 

heart surgery at St George’s University Hospitals NHS Foundation Trust 

after inspectors found “feuding surgeons” and a culture of hostility at 

the cardiac unit. 

The mortality review into St George’s has been commissioned by NHS 

Improvement (NHSI), with a panel of independent cardiac surgery, 

cardiology, and anaesthetic consultants into the death of patients who 

died following cardiac surgery between April 2013 and September 2018. 

The panel is reviewing the deaths of all patients in this timeframe 

after the trust was found to have a statistically higher mortality rate 

compared to the 31 other cardiac surgery centres in the UK, nearly 

double the average of 2%. 

In December, the CQC delivered a devastating report on the London 

trust’s cardiac unit after finding weak leadership, a culture of bullying, 

and tribalism following a leaked document revealing that a “toxic” row 

between surgeons had contributed to a higher-than-average death rate. 

The CQC were told by staff that the cardiac surgical team “had not 

healthcare worked effectively for several years” solutions 

and described a “culture of 

bullying and harassment,” with the reviewing finding that the unit had 

split into two camps displaying “tribal-like activity.” 

NHSI has ordered the probe in order to ensure St George’s is offering 

heart patients safe care, and the panel will examine the safety and 

quality of care provided by the trust during the review period. 

It will review the medical records of deceased cardiac surgery patients 

and is likely to review 200 to 250 deaths during a six to 12-month 

project. 

The trust has insisted the cardiac surgery practice is safe at St George’s 

despite 100s of the more complex cases being moved to other London 

hospitals, stating that it has been introducing improvements to its 

cardiac surgery practice since April 2017 and is overseen by a separate, 

external oversight panel convened by NHSI last year. 

Jacqueline Totterdell, chief executive at St George’s, said: “It is 

absolutely essential that patients and their families have full confidence 

in the care our cardiac surgery team provide – and this review of past 

deaths will be a key part of that process.” 

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Source: Nationalhealthexecutive.com 



MAT CARRIES OUT EXTENSIVE THEATRE 

REFURBISHMENT AT BEDFORD HOSPITAL 

Disposable Bronchoscope Now 

Available From CMS 

Central Medical Supplies (CMS) has been chosen by medical device 

company Axess Vision Technology as the sole UK distributor for its 

single use endoscope range. 

One of the products in the range is Broncoflex®, a single use bronchoscope 

that’s available in two sizes. Broncoflex® S has an insertion tube with an 

external diameter of 3.7mm and an operator channel of 1.4mm. It has a 

distal end diameter of 3.9mm. The insertion tube of Broncoflex® M has 

an external diameter of 5.5mm and an operator channel of 2.1mm. It 

comes with a distal end diameter of 5.5mm. 

Medical Air Technology (MAT) recently completed the refurbishment of 

a pre-existing operating theatre complex at Bedford Hospital, upgrading 

both theatres 3 and 4 with the addition of ECO-flow Dynamic ultraclean 

ventilation (UCV) systems. The new ultraclean theatres will allow the 

hospital to increase its orthopaedic output and expand the range of 

surgeries it is able to offer its patients. MAT was appointed directly 

by the hospital, winning the contract in a competitive tender with a 

submission that showed it offered not only the best equipment package 

and shortest delivery period, but also the best overall understanding 

of the project. 

The work carried out by MAT was a total design-and-build turnkey 

refurbishment, necessitating a complete reconfiguration of the layout in 

both theatres and new HVAC systems. The extensive refit included ECOflow 

2800 UCV canopies, operating lights, pendants, theatre control 

panels, furniture, floors, lighting, sanitaryware, IPS and UPS, chillers, 

air handling units (AHUs), ductwork, pipework and HVAC controls within 

each theatre. MAT designed, manufactured and installed major roofmounted 

steelwork and maintenance access walkways for the two new 

AHUs and a new chiller to support the existing chiller, which supplies 

cooling to the whole building. 

Nearly 11,000 operations were carried out at Bedford Hospital in 

2017, and to sustain this level it was important that essential theatre 

capacity was not affected while the refurbishment of the complex 

was underway. To achieve this, before work began on theatres 3 and 

4 the hospital commissioned a new modular theatre, replicating the 

equipment within the main complex to ensure continuity and familiarity 

for staff and clinical team members. While it was being built, MAT 

undertook the roof plant installation. This necessitated close liaison 

between MAT, the hospital estates department and the supplier of the 

modular theatre. When the modular theatre came online, theatre 3 was 

closed to allow the refurbishment to begin. The seamless and efficient 

programme ensured any disruption was kept to an absolute minimum 

and theatre lists were unaffected. 

“Finding a solution to improving our theatres has posed a significant 

challenge and a lot of thought, planning and hard work has gone into 

finding a solution so that we can better meet the 18-week referral to 

treatment (RTT) pathway, providing quick and effective care to our 

patients. “Refurbishing our current theatre complex will allow us to 

make sure our current operating rooms are fit for the future, ensuring 

we can provide a safer, more efficient service for our patients, and a 

better environment for our staff to work in.” 

Stephen Conroy: Chief Executive, Bedford Hospital NHS Trust 

MAT offers a wide range of services so is able to respond flexibly and 

quickly to the specific needs of each client, providing all the benefits 

that come from working with a specialist contractor. With its own inhouse 

UK manufacturing facility and dedicated team of highly skilled 

engineers, MAT manufactures and supplies bespoke equipment for 

demanding clinical arenas. Clients can choose from several options, 

ranging from UCV canopy only right through to a total turnkey package, 

ensuring they get exactly the solution they need. In addition, 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. 

Further information from: Stephen Taylor 

Email: stephen.taylor@medicalairtechnology.com 

Telephone: 0844 871 2100 


Broncoflex® S is clinically indicated for the positioning of double 

lumen probes and bronchial blockers, broncho-alveolar lavage and 

endoscopic assisted tracheotomy. It’s also suitable for explorations of 

the pulmonary passages, difficult intubation and sampling. The clinical 

indications for Broncoflex® M include broncho-alveolar lavage, foreign 

body removal and the management of excess secretions. It too can 

be used for endoscopic assisted tracheotomy, explorations of the 

pulmonary passages, difficult intubation and sampling. 

As Broncoflex® is designed for single use there’s no risk of cross 

contamination. Unlike traditional bronchoscopes, which are unavailable 

for use during their cleaning cycle, Broncoflex® is always ready, as 

after each use the bronchoscope is discarded and a new sterile one 

opened. Normal wear and tear, caused by cleaning, can also impact 

the quality of the exams carried out with a traditional bronchoscope. 

Unlike reusable bronchoscopes, Broncoflex® doesn’t require a repair or 

disinfection budget. 

Broncoflex® produces high quality images, with good colour 

reproduction, along with a large depth of field and viewing angle. 

Broncoflex® has an innovative visualisation system, via a touch screen. 

SCREENi®, the viewing solution for Broncoflex® is also available from 

CMS. SCREENi® is a high resolution screen with a bright touch panel, 

which gives optimal colour reproduction and contrast. A compact and 

mobile system, it’s easily transportable to different examination sites. 

The display can also be exported to an existing medical monitor. 

For more information contact Tracey Pavier-Grant, 

Sales Director at Central Medical Supplies, 

Telephone: 01538 392 596 

email: tracey@centralmedical.co.uk 

or visit: www.centralmedical.co.uk 

Nurse Led Clinics - Preoperative Assessment 

(2 Day Programme) 

Thursday 20th – Friday 21st May 2019 

These study days are aimed at nurses and other health care professionals 

with an interest in preoperative assessment. 

They will allow participants to update and enhance their knowledge 

within the speciality of preoperative assessment, covering a wide range 

of clinical and organisational topics facilitated by specialist nurses and 

consultant anaesthetists. 

The Royal Marsden Education and Conference Centre 

Stewart’s Grove, London, SW3 6JJ 


For further information and to book your place please visit 

www.royalmarsden.nhs.uk/studydays 


The Axis Operating table is the most reliable table on the market. 

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Congratulations, your reading the extended OTJ 

The Growing Burden of Atrial Fibrillation in the UK 

By: Alison James, Biosense Webster Inc UK Business Leader 

Heart disease kills 152,000 people each year 

in the UK and is one of the country’s leading 

cause of death. But did you know that Atrial 

fibrillation (AF), a common heart rhythm 

problem, is fast becoming one of the UK’s most 

significant health issues, affecting 1.2million 

people, as well as placing a critical financial 

burden on healthcare, accounting for 0.9% - 

2.4% of total annual healthcare expenditures 

in the UK. 

AF is characterized by an irregular and often 

fast heartbeat that results in uncoordinated 

contraction of the top 2 chambers of the 

heart 1 and can be a debilitating disease 

with life-threatening complications. Patients 

have a 5-fold increase in heart failure, 2.4- 

fold increase in stroke and 2-fold increase in 

cardiovascular mortality risk 2 . It nearly affects 

as many people as stroke and cancer does in 

the UK. Unfortunately, it is known to be a 

progressive disease, which worsens over time, 

but early detection and diagnosis may help 

improve patient outcomes 3-6 . 

Through our report: The Burden of Atrial 

Fibrillation: Understanding the Impact of the 

New Millennium Epidemic Across Europe, we 

aim to shed light on the growing scale and 

impact of this disease in the UK and to renew 

focus on this health topic to protect more 

people from its life-threatening complications 

and to reduce its economic burden. 

Projected estimates suggest that by 2030 the 

number of people with AF will increase by up 

to 70% 7 , and that by 2050 Europe will have 

the greatest increase in AF compared to other 

regions globally. 8 Furthermore, the number of 

stroke events and medical visits is expected 

to increase, with 280k – 340k new ischemic 

strokes, 3.5-4 million hospitalizations for AF 

and 100-120 million outpatient visits expected 

across Europe. 

However, a key conclusion of the report 

published today is that data on AF is not upto-date. 

There is a significant lack of recent 

and robust studies into epidemiologic and cost 

of burden data and up-to-date research on the 

risks, causes and treatment outcomes relating 

to AF. For example, most of the evidence on 

the national or regional burden of AF is based 

on data collected over 10 years ago, and is 

therefore outdated. The lack of recent, robust 

data suggests that despite AF becoming a 

growing burden, it is considered a low priority 

on the health agenda. 

Other findings in the report highlight the 

high costs of AF management - direct costs 

such as hospitalization, outpatient visits and 

prescriptions and indirect costs such as loss 

of work productivity and caregiver support. 

Direct costs are highest and are similar across 

France, Germany, Italy and the UK. 

Aside from the burden on healthcare systems, 

the report draws attention to the impact of 

AF on patients and caregivers. Caring for 

family members with AF can be extremely 

burdensome with caregivers experiencing 

considerable changes to their daily lives and 

high risk of burnout when caring for patients 

who are frail, sick and debilitated. 9-10 

We hope that this report will serve to raise 

awareness of the growing burden of AF. For 

over 20 years, Biosense Webster has led the 

science of diagnosing and treating heart 

rhythm disorders. We have partnered with 

clinicians to develop innovative technologies 

that improve the quality of care for arrhythmia 

patients worldwide and we remain committed 

to this cause as we call for urgent focus on this 

disease so we can all work together to tackle 

it head on and heal more hearts. 

A full copy of the report is available at: 

https://www.jnjmedicaldevices.com/en-EMEA 

References 

1. Iaizzo PA (2015). Handbook of Cardiac Anatomy, 

Physiology, and DeviceS. Springer Science+Business 

Media, LLC: Switzerland. 

2. Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman 

DG et al. (2016) Atrial fibrillation and risks of 

cardiovascular disease, renal disease, and death: 

systematic review and meta‐analysis. Bmj. 354 i4482. 

3. Scherr D, Khairy P, Miyazaki S, Aurillac‐Lavignolle V, 

Pascale P et al. (2015) Five‐Year Outcome of Catheter 

Ablation of Persistent Atrial Fibrillation Using 

Termination of Atrial Fibrillation as a Procedural 

Endpoint. 

4. Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan 

R et al. (2014) Aggressive risk factor reduction study 

for atrial fibrillation and implications for the outcome 

of ablation: the ARRESTAF cohort study. J Am Coll 

Cardiol 64 (21): 2222‐2231. 

5. Matsuo S, Lellouche N, Wright M, Bevilacqua M, Knecht 

S et al. (2009) Clinical predictors of termination and 

clinical outcome of catheter ablation for persistent 

atrial fibrillation. J Am Coll Cardiol 54 (9): 788‐795. 

6. Takigawa M, Takahashi A, Kuwahara T, Okubo K, 

Takahashi Y et al. (2014) Long‐term follow‐up after 

catheter ablation of paroxysmal atrial fibrillation: the 

incidence of recurrence and 

progression of atrial fibrillation. Circ Arrhythm 

Electrophysiol 7 (2): 267‐273. 

7. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S 

(2014) Epidemiology of atrial fibrillation: European 

perspective. Clin Epidemiol 6 213-221 

8. Rahman F, Kwan GF, Benjamin EJ (2014) Global 

epidemiology of atrial fibrillation. Nat Rev Cardiol 11 

(11): 639-654 

9. Coleman CI, Coleman SM, Vanderpoel J, Nelson 

W, Colby JA et al. (2012) Factors associated with 

‘caregiver burden’ for atrial fibrillation patients. Int J 

Clin Pract 66 (10): 984-990. 

10. Oliva-Moreno J, Pena-Longobardo LM, Mar J, Masjuan 

J, Soulard S et al. (2018) Determinants of Informal 

Care, Burden, and Risk of Burnout in Caregivers of 

Stroke Survivors: The CONOCES Study. Stroke 49 (1): 

140-146. 


R, Purchon. N, O’Ciardha. & C, Bishop. Royal Brompton Hospital Cardiothotacic Theatres 

“Oh my god it’s a patient on ECMO!” 

But what’s it all about? 

Target Audience for this article will be newly qualified nurses and ODPs with an interest in cardiothoracic surgery. 

Extracorporeal: 

The term extracorporeal refers to the application of a procedure 

outside of the body. In ECMO the patients’ blood is pumped through an 

artificial lung to oxygenate and decarboxylate the blood (the addition 

of oxygen and removal of carbon dioxide, respectively) 

Membrane oxygenation: 

Membrane oxygenators utilise the continuous flow of gases (An 

oxygen and air mixture) across a semi-permeable membrane, similar 

in principle to the human alveoli. Oxygenators comprise a case or 

housing, which contains multiple hollow fibres through which the gas 

mixture flows. Blood is brought into very close contact with the fibres 

and gas exchange occurs across the membrane of the fibres. Gaseous 

transfer is dependent upon the surface area of the membrane, the 

diffusion distance across the membrane, the time blood is in contact 

with the membrane, and the concentration gradient of gases across the 

membrane. The oxygenator housing also contains heat exchange fibres. 

An external heater cooler device may be connected to the oxygenator 

to regulate the patient’s blood temperature. 

Basic principles: 

The basic principle of ECMO (a form of extracorporeal life support), 

is extracorporeal gas exchange and/or augmented cardiac output and 

improved haemodynamics for patients with acute severe respiratory 

and/or cardiac failure. It should be noted that ECMO itself is a means of 

organ support and is not a cure for the underlying pathology. It provides 

support until the underlying condition can be effectively treated. The 

two main modes of ECMO are veno-venous (VV-ECMO) and veno-arterial 

ECMO (VA-ECMO). 

oxygenator efficiency, haemoglobin (Hb) concentration, FiO2 of the gas 

mixture and contribution of the native lung to gas exchange. In severe 

ARDS, the majority of gas exchange occurs within the ECMO circuit 

itself, with little contribution of the native lung. Veno-venous ECMO 

does not provide any support for the failing heart as the oxygenated 

blood is returned to the right heart. 

Veno-arterial ECMO is indicated in patients with acute cardiac failure 

that is potentially recoverable. Indications for VA-ECMO include acute 

myocarditis, cardiogenic shock, poisoning with cardiotoxic drugs 

(e.g. calcium channel blockers), massive pulmonary embolism, and 

refractory cardiac arrest. It is also used for haemodynamic support 

when patients fail to wean from cardiopulmonary bypass following 

cardiac surgery, primary graft failure following a heart transplant or 

as a bridge to cardiac transplantation in patients with decompensated 

acute-on-chronic heart failure, or longer-term support such as a 

ventricular assist device (VAD). In VA-ECMO, gas exchange and cardiac 

output of the failing heart can be augmented. The retrograde arterial 

blood flow provided by the ECMO circuit will ‘compete’ with the native 

cardiac function. The final cardiac output will therefore be a function 

of the VA-ECMO flow and that provided by the patient’s intrinsic cardiac 

activity. 

In the UK, VV-ECMO is commissioned to be provided by five severe acute 

respiratory failure (SARF) centres across the critical care network, 

which facilitates equity of access and timely referral. In contrast, VA- 

ECMO is non-commissioned, and hospitals providing VA-ECMO do so at 

their own cost, without the financial support of NHS England. 

Data from an international registry (Extracorporeal Life Support 

organisation) demonstrate survival to discharge or transfer for 

respiratory ECMO (VV-ECMO) in 59% of cases (9649 ECMO runs); for 

cardiac ECMO (VA-ECMO) the survival to discharge or transfer is 42% 

(6747 ECMO runs). 

The Authors of this article all work at the Royal Brompton Hospital, 

Richard Purchon is a Senior Operating Department Practitioner, both 

Naoise O’Ciardha and Chris Bishop are both Senior Clinical Perfusion 

Scientists. 

In VV-ECMO, blood is taken from a vein and returned via a vein. It 

is used predominately for supporting patients with acute respiratory 

failure. 

In VA-ECMO, blood is taken from a vein and returned via an artery. It is 

used to support patients with acute cardiac failure. 

Indications and contraindications: 

VV-ECMO is indicated in patients with acute severe hypoxaemic 

respiratory failure due to moderate/severe acute respiratory distress 

syndrome (ARDS) that may be the result of pneumonia or influenza; 

or secondary to an extrapulmonary insult that leads to lung injury 

(for example sepsis, severe burns or trauma). These patients are 

usually ventilated and are often unable to achieve adequate gas 

exchange despite increasing concentrations of oxygen and ventilator 

driving pressures – settings which can lead to further lung injury. In 

these patients ECMO can be used as rescue therapy for refractory 

hypoxaemia, and/or to permit lung protective ventilation until the 

underlying lung disease resolves. Currently, patient selection criteria 

for VV-ECMO include : age

A new role for the brain’s support cells in controlling circadian rhythms of animal behaviour 

Astrocytes, ‘caretaker’ cells that surround and support neurons in the brain, play a much more important role in circadian rhythms, the 

body’s 24-hour internal clock, than previously understood. 

The MRC-funded study published recently in the journal Science, found 

that these star-shaped cells, previously thought of as just supporting 

neurons in regulating circadian rhythms, can actually lead the tempo of 

the body’s internal clock and have been shown for the first time to be 

able to control patterns of daily behaviour in mammals. 

The findings of the new study could pave the way for new treatments 

to be exploited when circadian rhythms are disrupted, which can 

cause jet lag and sleep disorders, as well as contribute to a range of 

health conditions, from psychiatric disorders to dementia, diabetes and 

cancer. 

Circadian rhythms are well known for their role in maintaining human 

health and although many different types of cells across the body have 

been found to have their own internal clock, the timing of these clocks 

is chiefly controlled by the suprachiasmatic nucleus (SCN), a small brain 

region in the hypothalamus which acts as the master clock responsible 

for regulating daily behaviour. 

This new study, led by the MRC’s Laboratory of Molecular Biology 

(LMB) in Cambridge, used microscopic imaging to observe the detailed 

internal molecular clock timing of the astrocytes and neurons of the 

SCN. Surprisingly, this showed that although both types of cell have 

their own circadian clocks, they are differently regulated and were 

seen to be active at different times of the day. This delicate interplay 

was found to be critical in keeping the entire SCN clockwork ticking. 

Following this initial discovery, the scientists found mice genetically 

altered to silence their internal body clock showed disruption to 

their SCN function and behaviour but, unexpectedly, found that the 

restoration of a genetically functional clock in astrocytes alone enabled 

the mice to regulate their daily activity. This meant that even when 

astrocytes were the only cell in an animal with a working internal clock, 

there were still observed patterns of daily behaviour of mice. When 

the researchers compared this pattern of behaviour to mice whose 

neuronal clocks were working, they found that the period of regulated 

activity in the SCN was approximately one hour shorter, which was 

also reflected by the mouse behaviour, showing that astrocytes were 

capable of controlling animal behaviour to their own cell-specific tune. 

The study also revealed that glutamate, a neurotransmitter in the 

brain and central nervous system, acted as the chemical signal used 

to convey time cues from the working astrocytes of the SCN to their 

clockless neuronal partners. 

“The discovery that astrocytes can be as effective as neurons in 

generating and transmitting a circadian timing signal across an animal 

really surprised us,” said Dr Marco Brancaccio, a Dementia Lecturer 

and UK Dementia Research Institute Fellow at Imperial College London 

and lead author of the paper, previously at the MRC’s LMB when this 

research was undertaken. “We knew from previous research that these 

cells played a role in circadian clocks, but we had no idea they could 

restart the circadian function of neurons. This adds a totally new 

and unanticipated dimension to the neurobiology of circadian body 

clocks and suggests some exciting avenues for future research and the 

potential to develop treatments.” 

“This is the first time that it has been demonstrated that astrocytes, 

cells we’d previously overlooked as mere support cells, can actually 

control animal behaviour. This is a significant advance in the field of 

neuroscience.” added Dr Michael Hastings, Head of the Neurobiology 

Division at the MRC’s LMB and senior author of the paper. 

Dr Joanna Latimer, Head of Neurosciences and Mental Health at the 

MRC, said: “In recent years it has become increasingly clear that 

disruption of the body’s internal clock through shift-work, dementia 

and other neurological diseases can have a dangerous impact on our 

health and wellbeing. This research is an important step towards a 

better understanding of how the brain controls these circadian rhythms 

at a molecular and cellular level, an essential advance if we are to 

manage the impact of these conditions more effectively.” 

The image shows a micrograph of suprachiasmatic nucleus tissue 

(SCN) showing a subset of astrocytes within the nucleus, as revealed 

by staining by the GFAP-GFP marker. The inset is a magnification of 

the astrocyte highlighted in the low resolution figure, showing the 

distinctive shape of these cells. 

Surgery remains the most effective weight loss treatment for severely obese adults 

Surgery remains the most 

effective and cost-effective longterm 

approach to reducing weight 

for adults who are severely obese, 

according to new research funded 

by the NIHR. 

However, the study also found that 

high quality weight management 

programmes (WMPs) are effective 

tools in reducing weight for up to 

10 years in some cases. 

The REBALANCE study was led by 

the University Of Aberdeen and 

also included researchers from 

the University of Oxford and the 

UK Health Forum. It reviewed 236 

studies looking at evidence for 

acceptability, effectiveness and 

value for money of surgery, diet 

and exercise weight management 

programmes, and the drug 

orlistat. 

The review, funded by the NIHR’s 

Health Technology Assessment 

Programme (HTA) found that 

surgery for obesity had the best 

long-term weight-loss results 

and could be a good use of NHS 

resources, compared with no 

surgery or weight management 

programmes on their own. 

Of non-surgical approaches, 

very low-calorie diets produced 

the best weight-loss result at 

12 months, but it was unclear if 

weight-loss was any greater than 

standard WMPs for longer than 

this. 

Adding a very low calorie diet to 

an existing weight management 

programme was shown to 

not be a good use of NHS 

resources. However, most weight 

management programmes, 

including those with very low 

calorie diets, appeared to be 

a good use of NHS resources 

compared with doing nothing at 

all. 

Low-carbohydrate Atkins-type 

diets, higher protein intakes or 

the use of meal replacements had 

small added effects on improving 

weight loss compared to other 

WMPs at 12 months We found no 

evidence that they were better 

than other diets after 12 months. 

The best result for long-term nonsurgical 

weight loss (over nearly 

10 years) came from an intensive 

WMP with all of the following - a 

low-fat reducing diet, a calorie 

goal of 1200–1800 kcal/day, initial 

meal replacements or meal plans, 

a tailored exercise programme, 

cognitive behavioural therapy, 

intensive group and individual 

support, and follow-up by 

telephone or e-mail. However, 

this type of WMP would be more 

costly for the NHS than simpler 

WMPs. 

Other components of effective 

interventions included increasing 

physical activity to help prevent 

long-term weight regain and 

receiving longer-term help with 

diets or using the drug orlistat. 

Adding telephone or internet 

support, and group support, also 

helped to keep weight off. 

Participants in weight 

management programmes valued 

novelty, weight management 

programmes endorsed by healthcare 

providers and belonging to 

a group of people who shared 

similar issues. 

Lead author Professor Alison 

Avenell from the University of 

Aberdeen said: “The purpose 

of this study was to examine 

the available evidence looking 

at the effectiveness and costeffectiveness 

of different weight 

management procedures from the 

perspective of the NHS. 

“Whilst the study shows that 

surgical interventions remain 

much more effective, provision of 

surgery for obesity management 

by the NHS is presently very 

low. Other weight management 

programmes can be effective in 

terms of helping people who are 

severely obese lose weight and 

are cost-effective for the NHS.” 

More information on this study 

can be found on the NIHR Journals 

Library website at: https:// 

www.journalslibrary.nihr.ac.uk/ 

programmes/hta/150904/#/ 


Enhanced research reporting 

method to improve patient care 

Patients could benefit from improved care and 

outcomes thanks to new research guidance 

developed as part of a University of Stirlingled 

study. 

Experts have advanced an approach that 

enables the effective collation and analysis 

of qualitative studies – such as information 

garnered from patient interviews and focus 

groups. 

The study has led to the creation of the 

first-ever tailored reporting guidance for the 

methodology, known as meta-ethnography. It 

will give researchers and healthcare bosses 

greater confidence in the findings of qualitative 

studies and, ultimately, aid the improvement 

of patient care and services. 

Dr Emma France (pictured), of the Faculty of 

Health Sciences and Sport and the Nursing, 

Midwifery and Allied Health Professions 

Research Unit, led the study, published in four 

journals. 

“To create high-quality, patient-focused health services, we need to consider why and how they 

work – and people’s experiences of using them,” Dr France said. 

“Information about people’s experiences of health services and care should play a major role in 

improving NHS services, but individual studies of this kind are often seen as anecdotal, so rarely 

influence decision making. 

“Pulling together evidence from many existing qualitative studies, including those using patient 

interviews or focus groups, can shed light on important factors, such as why patients or health 

professionals behave in a certain way, or what it’s like to experience an illness.” 

The study is funded by the National Institute for Health Research (NIHR) and involves a number 

of partners, including the Universities of Bangor, Cardiff, Edinburgh and Napier. 

Meta-ethnography – developed by sociologists George W Noblit and R Dwight Hare in 1988 – 

involves systematically comparing conceptual data from primary qualitative studies to identify 

and develop new overarching concepts, theories and models. It enables researchers to combine 

the findings of qualitative studies, rather than concentrating on the individual cases. 

The quality of the reporting of meta-ethnographies is often poor – meaning patient groups and 

NHS managers often lack trust in the findings and, ultimately, do not use them to improve their 

decisions, services and patient care. However, Dr France’s team – working closely with Professor 

Noblit, of the University of North Carolina – have, for the first time, provided bespoke guidance 

on this approach to improve reporting of data collection and analysis. 

Before putting together the guidance, the team reviewed existing literature, consulted academic 

experts, carried out consensus studies within the research community and with members of the 

public, and interviewed professionals working in non-academic settings. 

The new guidance has 19 specific reporting criteria, supported by detailed explanatory notes. 

It includes recommendations on all aspects of meta-ethnography conduct and reporting, from 

selecting studies to analysing data. 

The guidance will be free to use and is aimed predominantly at researchers, journal editors, and 

academics who review research articles to guide how meta-ethnographies should be reported. 

It will also be used by researchers and students looking to understand how to conduct a metaethnography. 

“We have developed guidance to assist researchers in carrying out quality meta-ethnographies 

and reporting them to a high standard, meaning this rich information can be used to create 

better decision-making and improve outcomes for patients,” Dr France explained. 

“The guidance will help to provide new insights and conclusions regarding specific health topics, 

for example, people’s experiences of being treated for a certain type of illness. 

“Ultimately, improving the way researchers report meta-ethnographies, will help to ensure that 

the best use is made of research evidence for the benefit of people who use health and social 

care services.” 

The study, Improving reporting of Meta-Ethnography: The eMERGe Reporting Guidance, is 

published in the Journal of Advanced Nursing; BMC Medical Research Methodology; Review of 

Education; and Psycho-oncology. 

Find out more about the eMERGe project at: http://emergeproject.org/ 

Comment on NHS Improvement 

Theatre Efficiency report 

Comment on NHS Improvement Theatr 

NHS Improvement have found up to an extra 

300,000 Efficiency operations report could be carried out 

each year through the improved scheduling 

of NHS operating Improvement lists. have The found RCS up had to an extra early 300,000 sight operations co 

carried out each year through the improved scheduling of operating list 

of RCS NHS had early Improvement’s sight of NHS Improvement’s findings findings and is and is supportiv 

supportive, there are wider but challenges there facing are wider surgeons challenges 

which prohibit an increase 

facing number surgeons of operations which able to prohibit be performed. an increase 

in the number of operations able to be 

performed. 

Ian Eardley, council member of the Royal College of Surgeons’ said: 

Ian Eardley, council member of the Royal 

College of Surgeons’ said: 

“The NHS is already one of the most efficient health services in the wo 

“The academic NHS experts is already have repeatedly one made of clear. the However, most every mem 

staff and patient can recite examples of waste, and increased efficien 

efficient health services in the world, as 

never-ending battle for any large organisation. 

academic experts have repeatedly made 

clear. However, every member of staff and 

patient “The Royal can College recite of examples Surgeons is supportive of waste, of the and findings of this 

increased which highlight efficiency the opportunity is a never-ending to improve the battle scheduling of operatin 

for The any reasons large for organisation. 

this will differ by hospital but need to be fully invest 

by local staff. 

“The Royal College of Surgeons is supportive 

of the findings of this report which highlight 

the opportunity to improve the scheduling 

of operating lists. The reasons for this 

will differ by hospital but need to be fully 

investigated by local staff. 

“However, we must not underestimate the 

wider challenges hospitals face to increase 

the number of operations they perform. Bed 

capacity is severely constrained across the 

NHS with recent OECD statistics showing 

that the UK has the second lowest number 

of hospital beds for each 1,000 people in the 

whole of the EU. Such shortages mean time 

is wasted by NHS staff in freeing up beds 

instead of treating patients. This problem is 

compounded by workforce shortages. 

“We look forward to working with NHS 

Improvement and the Government to address 

these wider issues, alongside supporting 

improvements to the management of 

operating lists.” 

Further notes on bed capacity: 

Today’s NHS Improvement report admits 

‘clinicians and hospital administrators are 

under ever-increasing pressure from rising 

demand for elective surgery, the availability 

of beds and workforce challenges’ and ‘There 

is a widening mismatch between demands 

on the NHS and its available resources, 

including bed capacity, as demonstrated by 

the national deterioration in waiting lists.’ 

The NHS long-term plan warned that 

increased investment in community and 

primary care will not ‘necessarily reduce the 

need for hospital beds.’ (page 9) 

The most recent data shows overnight 

hospital (general and acute) bed occupancy 

averaged 89.1% for July-September 2018. 

The Royal College of Surgeons of England is 

a professional membership organisation and 

registered charity, which exists to advance 

surgical standards and improve patient care. 


Health service staffing is compromising patient health, says UNISON 

Crisis level staffing has become normal across the NHS 

Almost half of NHS workers on the front line of patient care say there 

are not enough staff on their shift to ensure patients are treated safely 

and with compassion, a new survey published recently by UNISON 

reveals. 

The study illustrates the effect of chronic understaffing in the health 

service, with unfilled posts and uncertainty about the future status of 

many workers having an impact on patients, says UNISON. 

The snapshot survey Just Another Day examined attitudes and 

experiences for staff across the UK during one working day – the 24 

hours of Tuesday 18 September 2018. The aim is to paint a picture of 

how staff felt about the pressures they were under. 

The public service union, which represents hundreds of thousands of 

people in a range of health professions, is warning the government it 

must pump significant funds into the NHS to fix the problems caused 

by years of austerity. In addition, ministers must put a greater focus 

on apprenticeships to usher more people into healthcare professions. 

Almost half (45%) of the respondents who were directly involved with 

patient care (6,778 out of 15,134 respondents) said there were not 

enough staff on their shift to deliver a safe, dignified and compassionate 

service. 

Some departments were more severely affected than others. Hardest 

hit were those in acute inpatients where almost three in five (59%; 

1,381 out of 2,345) said staffing was insufficient. It was also a serious 

issue for those in mental health (45%; 996 of 2,203), primary care (41%; 

777 of 1,893) and community health (36%; 642 of 1,794). 

Concerns about staffing levels come despite the number of bank or 

agency staff being used on the day. Nearly half of respondents (47%) 

said their service relied on bank staff on the day of the survey, mainly 

to fill nursing roles but also healthcare assistant posts, administration 

and a variety of other positions. 

UNISON’s survey also raises other serious concerns. One in seven (14%) 

of respondents rated the quality of care as “compromised” and one in 

six (15%) said patient safety was compromised on the day of the survey. 

The findings are based on responses from more than 18,000 healthcare 

staff from across the UK including nurses, healthcare assistants and 

support workers, students, ambulance service staff, cleaners and 

porters. The vast majority (90%) worked in the NHS, the remainder 

from the private and voluntary sector. 

Other findings of the report include: 

* Almost two fifths of respondents (38%) worked longer than their 

scheduled hours, in many cases unpaid 

* Nearly one in six (16%) were subjected to violence, aggression and/or 

verbal abuse during their shift 

* More than a quarter (26%) reported extremely high stress levels. 

The desperate state of staffing is illustrated by the most recent figures 

for the NHS in England, issued in November 2018. These indicated 

the service was short of almost 41,000 nurses (nearly 12% of the 

entire nursing workforce), with the total number of vacancies for all 

occupations close to 103,000. 

UNISON outlines a number of specific recommendations to the 

government in its report. These include: 

* The NHS must be given a significant increase in funding to tackle the 

serious cuts to the service brought about by the squeeze on funding. 

Current resource pledges are not enough to meet patients’ needs 

* Legislation must be introduced for mandatory safe-staffing levels 

in England and Northern Ireland, building on the lead of Wales and 

Scotland 

A renewed focus is needed on apprenticeship schemes as a way 

to improve access routes into healthcare professions. Changes to 

healthcare student finances are also essential to encourage training and 

recruitment to the service 

* The investment in improving pay and rewards must be continued in 

order to attract and retain health service staff. Stress and violence 

must be tackled to improve the working environment. 

UNISON head of health Sara Gorton said: “This survey shows the extent 

to which crisis level staffing has become normal across the whole NHS. 

“These are long-term, systemic factors not being properly addressed. 

The government must give the system the funding needed to tackle 

these issues. But hearteningly it also shows the dedication and 

compassion these hard-working committed staff continue to show at 

the most trying times.” 

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Southampton NHS Treatment Centre makes CQC ‘Outstanding’ hat trick for Care UK 

The team at Southampton NHS Treatment Centre celebrates its ‘Outstanding’ rating from the CQC. This is the third Care UK-run Treatment Centre 

to achieve this rating – the others are Peninsula NHS Treatment Centre in Plymouth and Shepton Mallet NHS Treatment Centre in Somerset 

Southampton NHS Treatment Centre is the only hospital in Hampshire to 

be rated ‘Outstanding’ overall by the Care Quality Commission (CQC), 

according to its latest CQC report. 

It joins two other Care UK treatment centres with ‘Outstanding’ ratings 

– Peninsula NHS Treatment Centre in Plymouth and Shepton Mallet NHS 

Treatment Centre – to form an outstanding hat trick for the independent 

care provider. 

The rating puts the centre at the very top of the regulator’s quality 

ratings across England - only the top three per cent of hospitals in the 

country have been awarded the exceptional ‘Outstanding’ rating by the 

quality watchdog. 

Southampton NHS Treatment Centre achieved an overall rating of 

‘Outstanding’, which incorporated a ‘Good’ rating for criteria which 

cover the safety, effectiveness and responsiveness of services, and 

‘Outstanding’ for criteria which cover caring and well-led services. Its 

overall rating is an improvement on its previous rating of ‘Good’. 

CQC inspectors visited the hospital in September 2018 and inspected 

and reported on its two core services – surgery and outpatient. 

In their summary of findings, the CQC inspectors said of surgery: “We 

rated this service as outstanding because feedback from people was 

continually positive about the way staff treated people. People told 

us that staff went the extra mile and their care and support exceeded 

their expectations. They told us that staff had been kind and had 

treated them with compassion and care.” 

With regard to outpatient services, the CQC inspectors said: “We 

rated this service as outstanding because the staff without exception 

demonstrated respect, kindness and care to patients and relatives, and 

also towards colleagues. The service had exceptional leaders at every 

level, who cared for their staff and did not expect them to do anything 

they themselves were not prepared to do. There was a learning culture 

where staff were encouraged to be honest, open and transparent.” 

Peter Harris, Hospital Director at Southampton NHS Treatment Centre, 

commented: “Everyone here is thrilled that the care we provide to 

patients has been rated ‘Outstanding’. To be the only ‘Outstanding’ 

hospital in Hampshire is a reflection of the consistently high standards 

of care and professionalism displayed by my colleagues every day.” 

He added: “The CQC’s rating demonstrates that NHS patients in our 

region are able to choose one of the very best hospitals in the country 

when they need elective surgery. We’re proud that we continue to 

develop and expand as a key centre of excellence for local communities 

and for NHS commissioners.” 

Southampton NHS Treatment Centre, which celebrated its 10th 

anniversary last year, is an independent sector treatment centre which 

provides NHS and self-pay treatment across a range of areas, including 

major and minor orthopaedics, ear nose and throat, eye surgery, dental 

surgery, gynaecology, urology and general surgery, supported by inhouse 

diagnostic imaging, physiotherapy and pharmacy. The hospital 

is part of local patients’ choice for NHS care. Provided their referring 

clinical practitioner (GP, dentist, optician) agrees they need the 

treatment and it is for a procedure carried out at the hospital, patients 

can ask to be referred to Southampton NHS Treatment Centre for their 

care – it is their right under the NHS Constitution. 

Independent sector treatment centres were introduced in 2005, to 

provide NHS patients with a wider choice of where they receive their 

treatment and to help alleviate waiting list pressures on the NHS. 

Southampton NHS Treatment Centre is run by Care UK which also runs 

Peninsula NHS Treatment Centre in Plymouth and Shepton Mallet NHS 

Treatment Centre. Peninsula was the first hospital of its kind in the 

country to achieve an overall ‘Outstanding’ rating, and Shepton Mallet 

was the first in the country to achieve ‘Outstanding’ across all criteria. 

Jim Easton, Chief Executive Health Care, Care UK, commented: “My 

congratulations go to colleagues at Southampton NHS Treatment Centre 

for this superb achievement, which give us a ‘hat trick’ of ‘Outstanding’ 

ratings in our treatment centre portfolio. This latest rating emphasises 

our ongoing commitment to providing sector-beating, high quality 

treatment to our patients. Both they, and those who refer them to us 

for treatment, can be confident in the safety and excellence of the care 

they will receive from a Care UK treatment centre.” 

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 



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New research finds that artificial 

intelligence can dramatically cut time 

needed to process abnormal chest x-rays 

New research has found that a novel Artificial Intelligence (AI) system 

can dramatically reduce the time needed to ensure that abnormal chest 

X-rays with critical findings will receive an expert radiologist opinion 

sooner, cutting the average delay from 11 days to less than 3 days. 

Chest X-rays are routinely performed to diagnose and monitor a wide 

range of conditions affecting the lungs, heart, bones, and soft tissues. 

Researchers from WMG at the University of Warwick, working with 

Guy’s and St Thomas’ NHS Hospitals, extracted a dataset of half million 

anonymised adult chest radiographs (X-rays) and developed an AI system 

for computer vision that can recognise radiological abnormalities in 

the X-rays in real-time and suggest how quickly these exams should 

be reported by a radiologist. In the process of building the AI system, 

the team developed and validated a Natural Language Processing (NLP) 

algorithm that can read a radiological report, understand the findings 

mentioned by the reporting radiologist, and automatically infer the 

priority level of the exam. By applying this algorithm to the historical 

exams, the team generated a large volume of training exams that 

allowed the AI system to understand which visual patterns in X-rays 

were predictive of their urgency level. 

The research team, led by Professor Giovanni Montana, Chair in Data 

Science in WMG at the University of Warwick, found that normal 

chest radiographs were detected with a positive predicted value of 

73% and a negative predicted value of 99%, and at a speed that meant 

that abnormal radiographs with critical findings could be prioritised 

to receive an expert radiologist opinion much sooner than the usual 

practice. 

The results of the research are published today, 22nd January 2019 in 

the leading journal Radiology in a paper entitled “Automated triaging 

and prioritization of adult chest radiographs using deep artificial neural 

networks.” 

WMG’s Professor Professor Helen Stokes-Lampard, Giovanni Montana Chair said: of the “Artificial Royal College intelligence GPs, said: led 

reporting “Sepsis is of a imaging huge worry could for be GPs a valuable as initial tool symptoms improve can department be similar 

workflow to other common and workforce illnesses, efficiency. and the The College increasing is putting clinical a lot of effort 

demands into helping on family radiology doctors departments recognise worldwide potential has sepsis challenged and ensure current that 

service patients delivery rapidly receive models, appropriate particularly assessment in publicly-funded and treatment. healthcare 

systems. “We have It produced is no longer a toolkit, feasible in for partnership many Radiology with NHS departments England, which with 

their brings current together staffing existing level guidance, to report all training acquired materials plain radiographs and patient in 

a information timely manner, to encourage leading to us all large to backlogs ‘think sepsis, of unreported talk sepsis studies. and treat In 

the sepsis’. United Kingdom, it is estimated that at any time there are over 

300,000 radiographs waiting over 30 days for reporting. The results of 

this “We research are pleased shows to that be working alternative with models NHS England of care, to such raise as awareness computer 

vision and improve algorithms, outcomes could for be patients. used to greatly It really reduce could delays save lives.” in the process 

of identifying and acting on abnormal X-rays - particularly for chest 

Anna Crossley, Professional Lead for Acute, Emergency & Critical 

radiographs which account for 40% of all diagnostic imaging performed 

Care at the RCN, said: “Sepsis is a life-threatening condition and early 

worldwide. The application of these technologies also extends to many 

identication is the key to survival, but it can be difcult to diagnose 

other imaging modalities including MRI and CT.” 

and often symptoms can be mistaken for a u-like illness. This is why 

raising awareness among carers, health care professionals and the 

public is so vital. Even though there has been good progress to improve 

In case you missed it……….. 

diagnosis, a cohesive national plan is needed to ensure that healthcare 

professionals NHS Wales Agency are supported Staff Costs and Spiral equipped to Cover to identify Vacancies and treat sepsis 

early. 

https://otjonline.com/news2019/01/news23a.php 

“If sepsis is not recognised quickly, it can lead to shock, multiple organ 

failure and death, which is why early detection is critical to start 

treatment In case you within missed the it……….. hour. Nurses and health care support workers, 

who see their patients on a regular basis, and are often the rst 

healthcare GMB Consultative worker to Ballot see Results them, are in Rejection well placed of Proposed to recognise Changes the signs to 

of On-call sepsis Payment early and Calculations raise the alarm. at Royal If a Alexandra person has Children’s signs or symptoms Hospital 

that in Brighton indicate possible infection, think ‘could this be sepsis?’ and act 

fast to raise the alarm, wherever you are. 

https://otjonline.com/news2019/01/news30a.php 

https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis- 

Action-Plan-23.12.15-v1.pdf 

Royal College’s Hope Foundation 

Announces Grants Awards 

The Royal College of Physicians and Surgeons of Glasgow’s HOPE 

Foundation has announced its first round of funding, awarding seven 

grants to a variety of organisations. The projects supported by these 

grants range from work in Glasgow to support homeless people to 

funding a doctor to provide healthcare in Amazonian Peru. 

The seven successful organisations that have been granted funding are: 

• Glasgow City Mission for the Winter Night Shelter 

• Medics Against Violence for a violence reduction Mindfulness project 

• Glasgow based Eiger Music for the Fit-as-a Fiddle project 

• ReSurge Africa for Noma Flap and Microsurgery Training in Accra, 

Ghana 

• Diabetic Foot Management Training in Malawi 

• Vine Trust for a volunteer physician to support outreach healthcare 

in Amazonian Peru 

• King’s Kongo Central Partnership Safer Surgery Training 

The HOPE Foundation is a philanthropic fund of the Royal College of 

Physicians and Surgeons of Glasgow, a charity registered in Scotland. Its 

purpose is to make a positive difference to the health of people living 

in challenging circumstances where access to quality healthcare is, for 

whatever reason, limited. 

The fund receives donations from the Fellows, Members and friends 

of the College to support projects that overcome barriers to quality 

healthcare locally, nationally and internationally. 

Mike McKirdy, Chair of the Hope Foundation said: “I am delighted 

to announce these very important grants that have the capacity to 

transform lives in our own area and through global citizenship. The 

HOPE Foundation can make these grants thanks to Fellows, Members 

and friends of the College who have donated to the fund. I thank them 

and wish our grantees every success in their activities over the coming 

year.” 

Lorna McIntosh, Winter Night Shelter Manager at the Glasgow City 

Mission said: “Glasgow City Mission is very grateful for the generous 

donation of £10,000 for the Glasgow Winter Night Shelter from the Royal 

College of Physicians and Surgeons of Glasgow’s HOPE Foundation. 

“The Glasgow Winter Night Shelter provides a safe and warm place 

to sleep for those who would otherwise be sleeping rough during the 

coldest winter months. The donation from the HOPE Foundation will 

help improve the health and wellbeing of some of the most vulnerable 

men and women in Glasgow who stay at the night shelter. 

“Those who use the night shelter often lead chaotic lifestyles which can 

be characterised by poor mental and physical health, however, looking 

after their health can be low down their priority list. The night shelter 

enables guests at the shelter to receive the healthcare they require. 

“For example, NHS Hunter Street, which includes a GP service for 

people who are homeless, is just around the corner from the night 

shelter. Staff at the night shelter make guests aware of the services on 

offer at Hunter Street and encourage them to go. Having a member of 

the night shelter team explain to a guest what happens at Hunter Street 

and encouraging them to go works well. 

“Nurses from NHS Hunter Street attend the night shelter each morning 

which ensures the guests receive vital medical attention they would 

otherwise miss out on. Thank you once again to the HOPE Foundation.” 

Emily Adams, the Vine Trust said: “Vine Trust is an international 

development charity which is involved in long-term health partnerships 

with local organisations to strengthen health systems, increasing access 

to primary healthcare to remote and vulnerable communities. As part 

of its activities, Vine Trust offers health professionals the opportunity 

to participate in short-term volunteering opportunities on-board 

our medical ships in the Peruvian Amazon. Working alongside our 

national team in 2018, volunteers helped Vine Trust to deliver 248,000 

consultations across our 3 vessels. The grant awarded from the Royal 

College of Physicians and Surgeons of Glasgow’s HOPE Foundation 

will be allocated directly to aiding the Amazon Hope programme in 

delivering more consultations to those in remote Amazonia with little 

or no access to healthcare in 2019.” 

‘‘Learning to play a musical instrument has many benefits - from 

twitter.com/OTJOnline 

increasing your confidence, learning new skills, meeting new people, 

improving health and wellbeing for isolated people and above all it’s 

FUN!” 

wrand.com Issue 316 January 2017 7 


www.OperatingTheatreJobs.com 

A one-stop resource for ALL your theatre related Career opportunities 

View the latest vacancies online ! 

Theatre Practitioners Recovery Nurses Anaesthetic Nurses ODPs 

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and Clinical Advisers 


“FibriCheck” wins the MEDICA App 

COMPETITION 2018: Heart check via 

smartphone and finger scan 

Is it possible to discover cardiac arrhythmias via a smartphone’s camera? It is! Using the “FibriCheck” app. 

This innovation by the start-up of 

the same name jumped into first 

place at this year’s MEDICA App 

COMPETITION, the competition 

that honours the best health app 

solutions as part of the world’s 

largest medical trade fair MEDICA 

in Düsseldorf. Embedded in a 

session at the MEDICA CONNECTED 

HEALTHCARE FORUM, the 

presentation by “FibriCheck’s” 

Belgian development team was 

voted the best among the 10 

finalists at the thrilling live pitch 

on the stage in Hall 15. The 

10-person international jury also 

elected the “Tonic App” (from 

Portugal) in second place and the 

“Veta Health App” (from the USA) 

in third place. Impressively, this 

showed: Digital health is not a 

man’s business. All three winning 

apps were presented by women. 

They had already won through 

against eighty submissions from 

around the world, as had the 

other finalists. Applications came 

from Europe and North America as 

well as from Australia, Barbados, 

Ghana, India, Singapore and 

Thailand. Among the final top 10, 

who were given the opportunity 

to present their innovations to 

the international professional 

audience at MEDICA 2018, there 

were even applications from 

Taiwan and the United Arab 

Emirates. 

In fact, the Belgian winning 

app “FibriCheck” has already 

been recognised by the FDA, 

the regulatory authority in the 

USA. The app recognises various 

cardiac arrhythmias with a 

smartphone camera and creates 

a report for both doctor and 

patient. The app is based on 

photoplethysmograhpy. This is an 

optical measuring method that 

utilizes the fact that scattered 

light changes in accordance with 

the amount of blood contained 

in the skin’s blood vessels. In 

this procedure, the smartphone’s 

LED flash is used to sufficiently 

illuminate the user’s finger. 

The skin scatters the light. The 

intensity of the scattered light 

vibrates with the amount of blood 

that the heart pumps into the 

illuminated fingers. 

As a result, the camera passes 

information on the oscillations of 

the scattered light to the app. With 

the aid of artificial intelligence, 

the app then recognises whether 

there are cardiac arrhythmias. 

Prescriptions for matters of the 

heart 

In Belgium, “FibriCheck” is 

already available on prescription. 

The app is available as a free 

download. Doctors simply hand 

their patients a piece of paper 

with a QR code. Patients then 

use this code to activate the app 

on their smartphone. During her 

live pitch presentation, Stephanie 

Vinckenbosch, who is with 

“FibriCheck” drily commented 

on the app’s function and hit the 

nail on the head: “Users put their 

finger on the camera with the 

LED lamp and we take care of the 

rest.” Meanwhile, doctor’s orders 

are just one way to make good use 

of the app. “FibriCheck” plans to 

raise awareness for this innovative 

version of digital screening with 

previously symptomless users and 

offer them the chance to use it. 

A rather uncomplicated method 

to do this has also already been 

tested: A QR code was printed 

in a newspaper and readers 

were invited to download and 

activate the app and to contact 

their doctor if any abnormalities 

should be diagnosed. As a result, 

over 12,000 users created 120,000 

reports within 48 hours, says 

Vinckenbosch. The app diagnosed 

atrial fibrillation in 136 users (1.1 

percent). 2,111 users (17 percent) 

showed other arrhythmias. 

Measurements taken by 191 users 

(2 percent) had insufficient quality 

for an analysis. “FibriCheck” has 

already received the CE symbol as 

a Class IIa medical screening and 

monitoring device for identifying 

irregular cardiac rhythms. 

And what is the competition 

up to? Apple Watch may have a 

similar feature, however, using 

it requires owning a smartwatch. 

All “FibriCheck” needs is a 

smartphone. 

www.facebook.com/TheOTJ 

Medical “ecosystem” for optimal 

support 

The Portuguese makers of the 

“Tonic App”, on the other hand, 

address doctors directly and 

exclusively. “Our app offers 

everything doctors need,” 

explains Daniela Seixas, CEO of 

Tonic App, in her presentation. 

She emphasises the challenge: 

“Doctors are burned out.” Cost 

and time pressure are responsible 

for this. “They have to handle a 

knowledge base that is steadily 

growing as well as a variety 

of interest groups.” This has 

created demand for a mobile 

all-in-one solution that enables 

doctors to find everything and 

everyone they need, and vice 

versa, allowing relevant interest 

groups to also find the right 

doctor. The app is therefore 

a platform for doctors that is 

similar to LinkedIn and gives them 

access to recommendations, case 

discussions, guidelines, coding 

recommendations, news, jobs 

and networks. “We are building a 

medical ecosystem using mobile 

phones, the internet and our 

partners,” as Seixas explained 

their intention at the MEDICA 

App COMPETITION. In short: The 

app aims to help patients with 

their diagnoses and treatment 

by more intelligently providing 

doctors with the often scattered 

resources they need for their 

daily work. This has proved a big 

hit in the app’s country of origin, 

Portugal, says Seixas. “Within 

only 17 months, we have achieved 

a market share of 17 percent.” 

The app’s market share is even 

estimated to lie at 58 percent 

for general practitioners under 

41. These numbers are begging 

for expansion. And in fact, 

“TonicApp” is already available in 

Great Britain, France and Spain. 

On the other hand, the “Veta 

Health App”, which took third 

place and originates from the 

USA, explicitly addresses and 

accompanies patients: “Veta 

Health offers a front end platform 

that supports patients on their 

journey through treatment,” says 

co-founder Dr. Nora Zetsche. 

The app enables over 400 

wearables to be integrated and 

offers information in real-time 

on the patient’s level of health. 

Adaptable supply paths enable 

patients to manage their level of 

health and to easily understand 

care protocols, says Zetsche. “We 

give patients all the information 

they need during treatment.” This 

aims to optimise therapy loyalty 

when taking medication and to 

better observe undesired effects 

of the medication, for example. 

The app complies with the US 

Health Insurance Portability and 

Accountability Act (HIPAA), which 

provides strict rules in order 

to protect the confidentiality 

and integrity of patients’ data. 

Now, the makers of the “Veta 

Health App” have their eye on 

Europe. Speaking of which: The 

internationality of the MEDICA App 

COMPETITION participants as well 

as the alignment of the apps across 

countries once more emphasised 

how strongly Germany is called 

upon to remain competitive 

when it comes to digital health 

offers for health systems. The 

creators of the digital translation 

aid “Medicospeaker” faced this 

challenge, at least, and were the 

only German health app among 

the finalists at MEDICA 2018. 

For more information about all 

finalists, please visit: http://www. 

medica-tradefair.com/mac2. 

Date of the next MEDICA in 

Düsseldorf: 18 – 21/11/2019 


Pherecydes Pharma reports successful patient treatment with bacteriophages 

Phage therapy could offer an alternative treatment method in the fight against antimicrobial resistance 

Pherecydes Pharma, a biotechnology company specialized in the 

research and development of anti-infective therapies based on the use 

of bacteriophages, announces that its bacteriophage therapies have 

been successfully used to treat a patient with relapsing Staphylococcus 

aureus prosthetic-joint infection (PJI). The results of the treatment 

were published in Open Forum Infectious Diseases at the end of last 

year and can be found here: 

https://academic.oup.com/ofid/article/5/11/ofy269/5144083 

The patient had relapsing severe prosthetic joint infection of the 

hip. As a salvage treatment, in combination with antibiotics, phages 

selected by Pherecydes from its library and manufactured in an R&D 

laboratory according to a strict quality control process were applied 

onto the infection site during surgery. Phages were well tolerated and 

the treatment led to a favorable outcome. 

Phage therapy is an innovative therapeutic approach against bacterial 

infections, particularly those acquired in hospitals (HAI) - and/or 

resistant to antibiotics. According to the O’Neill report, if antibiotic 

resistance continues to increase it will result in the deaths of 10 million 

people each year and a 2 to 3.5% reduction in global GDP from 2050 

onwards. The WHO estimates that the annual costs generated represent 

€7bn ($8.3bn) in Europe and $6.5bn (€5.5bn) in the United States. The 

rapid development of antibiotic resistance has become a major public 

health issue. In 2017, the WHO published a list of priority targets, which 

includes those pathogens selected by Pherecydes. 

“We are delighted to report the successful use of our bacteriophages 

for the treatment of a patient,” said Jérôme Gabard, COO of Pherecydes 

Pharma. “We will continue with our work on phage therapy to provide a 

new option to address the antibiotic resistance issue.” 

“As of now, nine patients have been treated with our phages,” said Guy- 

Charles Fanneau de La Horie, CEO of the company. 

“Twenty-one months without relapse show that this successful 

outcome makes phage therapy a promising method to treat bone and 

joint infections. It could contribute significantly to the fight against 

antimicrobial resistance,” said Tristan Ferry, professor at the reference 

center of bone and joint infections of the Hospital de la Croix-Rousse- 

HCL (Lyon – France). 

About phage therapy 

Phage therapy involves using lytic bacteriophage viruses (more 

commonly known as phages) to treat bacterial infections. Such a 

treatment was widely used on an informal basis throughout the world 

before the discovery of antibiotics. Today, both Georgia and Russia 

include phages in their pharmacopeias. Phages are also used in Poland 

in compassionate practice. 

Since the early 2000’s, the emergence of HAIs involving multi-resistant 

bacteria and the lack of new and effective antibiotics has led to a 

modern form of phage therapy emerging in numerous countries. 

In Europe, this revival can be traced back to 1994 when, during skin 

grafts, the use of phages to treat an infection caused by Pseudomonas 

aeruginosa proved effective. Since 2017, France and the US have agreed 

to reintroduce this modernized therapeutic approach for last resort 

treatments. 

www.pherecydes-pharma.com 

Aquilant Launches Eleview a Major Advance for 

Gastrointestinal Endoscopic Procedures from Fujifilm 

New injection agent designed to enable simpler and safer endoscopic resection procedures 

Aquilant, a leading provider of endoscopy equipment has launched 

the Fujifilm Eleview product, a ready-to-use submucosal injection 

composition that can dramatically improve the lift of polyps, adenomas, 

early stage cancers or other gastrointestinal mucosal lesions, prior 

to resection with a snare or endoscopic device. The move further 

strengthens Fujifilm’s extensive portfolio of cutting-edge endoscopy 

products and is also a positive development for the UK healthcare 

market, giving them a solution that can significantly enhance the 

performance and efficiency of gastrointestinal endoscopic procedures. 

Eleview is a premixed blue, sterile, clear emulsion designed to enable 

simpler endoscopic resections through assisting in visualising the 

margins of the target lesion and elevating the mucosal layer and tissue 

to be excised. By reducing the risk of damage to the external muscular 

layer, which can lead to gastrointestinal perforation, Eleview also 

helps improve the safety of gastrointestinal endoscopic procedures. 

It is particularly effective for challenging polyps, regardless of size, 

location, or type providing a long-lasting lift cushion that can hold 

for up to 45 minutes. In addition, Eleview is efficient, requiring less 

injected volume to create cushions and fewer reinjections compared 

to saline alternatives, which can reduce the time needed to resect a 

lesion. 

Given the growing demand for gastrointestinal endoscopy procedures in 

the UK, which is expected to increase further over the coming decade, 

developments such as Eleview are crucial. Mathew Tallis, Business 

Unit Manager at Aquilant explains: 

“Clinicians face many challenges when performing endoscopic mucosal 

resection (EMR) procedures, from being able to accurately define 

the margins of a lesion to effectively isolating the target tissue and 

reducing the risk of any complications. With Eleview we finally have 

a solution that can effectively assist them during this process. This is 

paramount, as the safety, efficiency and performance of EMR becomes 

even more crucial moving forward to meet the growing demand for 

gastrointestinal endoscopy procedures and the need to improve 

diagnosis and the treatment of diseases.” 

For further information about the new Eleview range, 

visit the website, http://www.aquilant.net 

or email contactus@aquilantendoscopy.com 



£1m of research grants 

set to save lives 

A NEW report reveals that £1m of 

research grants have been awarded 

by the Royal College of Surgeons of 

Edinburgh. 

The grants will play a key role 

in saving lives and improving 

treatments for patients. 

The College’s Research Report 2016- 

2018 revealed that grants to the 

sum of £996,164 had been awarded 

by the Research and Grants 

Committee. 

It details a range of grants into 

research areas such as cancer, 

orthopaedic surgery and urology. 

The RCSEd is one of the oldest 

surgical corporations in the world 

and can trace it’s roots back to 

1505. 

The college embeds research as a 

key part of surgical training and has 

research partnerships and links with 

some of the UK’s leading medical 

research charities. 

Past-President Michael Lavelle- 

Jones, whose period of office 

covered the report, said: “The 

future of our research programme 

is exciting. 

“We are looking forward to working 

with major medical research 

charities to grow surgical research 

from the periphery and place it 

at the heart of medical research 

agendas nationwide. 

“This innovative approach to 

working together is in all our 

interests and will leave a lasting 

legacy of treatments that will 

transform lives.” 

Professor Stephen Wigmore, Chair 

of the RCSEd Research Committee 

added: “Supporting high quality 

surgical research is essential if we 

are to make progress in our quest 

to provide better treatment for our 

patients. 

“We are committed to delivering 

results that will ultimately improve 

and save lives. 

RCSEd recently launched a website 

featuring true accounts of Burke 

and Hare, and other gruesome 

medical history tales which had 

never before been released online. 

The site includes historic notebooks 

available in full, including the 

memoirs of Thomas Hume, which 

offer an account of an Edinburgh 

student who was close friends with 

the assistants of the notorious 

anatomist Dr Robert Knox. 

The Burke and Hare murders were 

a series of 16 killings committed 

over a period of about ten months 

in Edinburgh in 1828. They were 

undertaken by William Burke and 

William Hare, who sold the corpses 

to Robert Knox for dissection at his 

anatomy lectures. 

https://archiveandlibrary.rcsed. 

ac.uk/ 

Source: Deadlinenews 

Lucy Samson 

Socioeconomic disadvantage may trigger chronic 

inflammation, thus leading to health inequalities 

• A study on 18,349 individuals from Britain, Ireland, Portugal and Switzerland has shown that socioeconomic 

position could affect biological health by acting on the inflammation pathway 

• The size of within country socioeconomic inequalities in health reflects differences in income inequality 

between countries. 

• Between-country differences in overall health and mortality may be better explained by variation in 

income inequality than by national income and wealth 

• Mean inflammation levels are highest in Portugal, the country with the highest income inequality and 

lowest in Switzerland, the lower income inequality country 

• The absolute and relative differentials between socioeconomic groups in mean concentration of 

C-reactive protein, measured as a marker for chronic inflammation, are higher in countries with higher 

income inequality 

Populations from countries with higher income inequality have higher average levels of inflammation and 

display greater differentials in inflammation based on individuals’ socioeconomic position. These are the 

striking findings of a study published on Scientific Reports by researchers of the Lifepath project, an EUfunded 

consortium that investigates the biological pathways underlying social differences in healthy ageing. 

It is now a well-established fact across all societies where evidence has been collected that socioeconomic 

position (SEP) has important effects on health and life expectancy. Irrespective of the measure of SEP used 

(e.g. income, education, social class or status), one thing is clear: socially and economically disadvantaged 

individuals have a shorter life expectancy and worse health during life. Moreover, these external influences 

on health start to emerge early in childhood and gets steeper with age. 

SEP can impact on our life by influencing biological function via the material environment – the location and 

quality of housing, exposure to pollutants, damp and pathogens as well as health behaviours. But there is a 

growing body of evidence suggesting that SEP may also directly shape biological health via neurological and 

hormonal pathways. 

Economic strain, uncertainty and lack of control or threats to social status may provoke chronic psycho-social 

stress, which in turns can result in a chronic inflammatory response. This emerging link between psychosocial 

stress and disease could provide an explanation of cross-national variation in health and well-being 

that is not based on national wealth. Several scientists have developed the ‘status anxiety hypothesis’, 

which argues that absolute variation in morbidity – the rate of illness in a population – and mortality across 

developed societies is more strongly correlated with level of income inequality than to gross domestic 

product per capita. 

To test this hypothesis, Lifepath researchers analysed data from 18,349 individuals aged 50 to 75 from Britain, 

Ireland, Portugal and Switzerland, using the individuals’ employment position as a marker of socioeconomic 

position, the concentration of the C-reactive protein (CRP) as an indicator of chronic inflammation and a 

series of parameters like smoking, body-mass index, diabetes and hypertension to adjust for variation in 

lifestyle factors. 

What they found is that, holding the distribution of age, sex and SEP constant, the mean concentration of 

CRP is highest in Portugal, the country with the highest income inequality and lowest in Switzerland, the 

lower income inequality country. It is possible that this pattern actually reflects the per capita income of 

these countries, but the research also shows that the absolute and relative differentials between SEP groups 

also varies across countries in a way that would be expected if level of income inequality contributes to 

inflammatory processes. Age seems to act as a leveller, since differentials between low SEP and high SEP 

in inflammation are highest at the age of fifty and fall thereafter. Lifepath results also suggest that health 

behaviours play a relevant role in the development of inflammation. 

“Across countries socio-economic mortality differentials have been rising since the 1980s and in some countries 

such as the US, overall life expectancy is now falling compared to previous generations”, commented Richard 

Layte from Trinity College Dublin, the leading author of the study. “Is this trend related to the economic 

changes that have occurred since the 1980s, one dimension of which is increasing income inequality? Some 

have labelled this excess mortality as “deaths of despair”, driven in large part by decreasing psychological 

well-being. Our paper provides the first evidence of the physiological process that may account for this trend 

and the important role of inflammatory processes for the risk of diabetes, heart disease and cancer”. 

“This study constitutes an important step in our understanding of the origins of social inequalities in health 

and also in the understanding of cross-country variations in population health. Further studies using markers 

of stress at the individual level will help in validating our results”, added Silvia Stringhini from the Lausanne 

University Hospital, another author of the study. 


MediSieve receive two grants, totalling £1.56M 

from Innovate UK 

MediSieve is delighted to announce that it is receiving two grants from Innovate UK, worth a total of around 

£1.56m. One large biomedical catalyst grant will progress development of a severe sepsis product, developing 

five magnetic particles to remove different sepsis targets. Another SRBI grant enables further focus on one 

of those particles and how it can be used to remove anti-microbial resistant (AMR) bacteria from a patient’s 

bloodstream. Both are 2-year projects starting in 2019. 

Sepsis is a life-threatening infection that causes the body to attack its own organs and tissues. It kills 

44,000 individuals in the UK and affects 20 million people globally each year. Six million of these are babies 

and children. Sepsis research is of high priority because, with mortality over 30% and antibiotic therapies 

increasingly at risk from antimicrobial resistance, its human and economic impact have never been more 

concerning. 

The Biomedical Catalyst (BMC) project aims to develop a multi-target magnetic blood 

filtration treatment that is complimentary to antibiotics, working to address the LPS 

and cytokines that antibiotics release and which exacerbate the immune response and 

elevate cytokine levels. 

The SBRI project explores an alternative to antibiotics to reduce the level of bacteria 

in the bloodstream of AMR sepsis patients, with the added benefit of LPS removal as a 

secondary effect. 

Both projects involve distinct experimental pathways which can be delivered 

simultaneously with the added benefit that areas of synergy and overlap reduce 

workload. Whilst the SBRI project focuses exclusively on targeting and removing E. coli, 

the BMC project does not include any E. coli or other bacterial testing. The SBRI project 

includes a clinical trial, whereas the BMC does not. 

Speaking about the biomedical catalyst grant Dr George Frodsham, CEO and founder of 

MediSieve, says, “Our technology is like dialysis, circulating a patient’s blood through 

an external loop to remove disease-causing targets. While dialysis relies on non-specific 

size-based filtration, MediSieve uses magnetic particles coated with antibodies (Ab-MP) 

to target specific components, and a magnetic filter to extract them. 

“The patented MediSieve Filter (MF) can safely remove magnetic components from the bloodstream. It is already developed as a treatment for 

severe malaria (Ab-MPs are not required for malaria, since malaria infected cells exhibit naturally occurring magnetic properties). The MF has 

completed pre-clinical testing and will enter first-in-man clinical trials in 2019. 

“This project concerns the development of the Ab-MP to apply our technology to Sepsis. Sepsis is caused by an infection that creates a dysregulated 

immune response which can escalate to septic shock. The destruction of bacteria by the immune system or antibiotics creates large quantities of 

endotoxins, which aggravate the immune response, causing the over-production of inflammatory cytokines and a cascade towards septic shock. 

Antibiotics kill pathogens, but do not remove them from the bloodstream, so the immune system’s overreaction continues. 

“Our Ab-MPs target LPS, gram-negative bacteria, specific cytokines and 

damage associated molecular patterns (DAMP), rapidly reducing the 

levels in a patient’s bloodstream. Used in combination with antibiotics, 

it could help eliminate the infection, and reverse the escalation to 

septic shock. Treatment of sepsis with antibiotics increases the LPS 

load in the bloodstream, since LPS persist after the pathogens have 

been killed. LPS, inflammatory cytokine and DAMP levels correlate with 

clinical outcomes, and their removal would be beneficial in helping to 

treat the disease. 

“This project will focus on the development of the Ab-MP to target 

LPS, cytokines and DAMP, proving their safety and efficacy in both 

laboratory and pre-clinical safety and efficacy trials, and performing 

the biocompatibility testing required in order to progress the treatment 

to first-in-man clinical trials.” 

Being awarded both grants is especially motivating because it enables 

areas of overlap and synergy across the research in: 

• regulatory work 

• expertise and know-how 

• the opportunity to include some or all of the Ab-MPs from the BMC 

project in the clinical trial of the SBRI project. 

This improves the chances of rapid and successful outcomes of both 

projects. 

MediSieve is a medical device organisation developing “magnetic blood 

filtration”: a ground-breaking treatment for blood-borne diseases which 

filters pathogens directly from the bloodstream. 

For more information, visit www.medisieve.com 


RCSEd Trainees’ Committee Chair says HSJ report 

into junior doctor hours extremely worrying 

Responding to recent news that junior doctors have worked beyond 

their contracted terms and conditions more than 63,000 times since 

2015, David Riding, Chair of the Trainees’ Committee at the Royal 

College of Surgeons of Edinburgh (RCSEd) said: 

“Today’s (15.1.19) HSJ report finds that 36,000 trainee doctors have 

filed exception reports since August 2016, meaning a substantial 

part of the medical workforce are working beyond their contracted 

hours and /or without breaks. 

“This is extremely worrying as it not only shows the extent to 

which the health service is fundamentally dependent on trainees 

to provide vital services, but also the extent to which training is 

increasingly seen as disposable. 

“Moreover, the report again highlights the disregard in which many 

trainees are held. We already know that trainees are encouraged 

not to report additional working hours, but this also shows how 

a substantial number are being leant on not to exception report 

contract breaches, with others told to log overtime as bank shifts. 

“RCSEd takes these issues seriously. Our #letsremoveit campaign 

has highlighted the direct impact that poor working cultures have on 

patient care and the extent to which individuals can feel victimised 

and intimidated by colleagues. Further we are working with NHS 

bodies to persuade them to implement the recommendations of our 

plan for a safer working environment. 

“However, as we want to learn more of your experiences, we 

encourage UK trainees to contact me via birmingham@rcsed.ac.uk 

should they wish to confidentially raise their experiences of this 

issue.” 


InHealth strengthens long-term imaging 

partnership with Canon Medical Systems 

Four Aquilion Prime SP CT systems selected to deliver improved 

outcomes to patients 

InHealth, the UK’s largest specialist provider of diagnostic and 

healthcare solutions to the NHS and independent sector, has selected 

Canon Medical Systems UK to replace and expand its range of CT 

scanners. Four Aquilion Prime SP CT Systems have been ordered to 

support InHealth’s high-quality service provision to over 2 million 

patients per year, and underpin the clinical and operational needs of 

its radiographers and reporting radiologists. 

Surgeons 

left medical 

instruments in 23 

hospital patients 

More than 20 people were forced to have unnecessary hospital 

procedures after medical instruments were left inside their bodies, a 

damning report into Australian hospitals has revealed. 

A Productivity Commission report on government-funded health 

services found 23 patients required re-operation or a further medical 

procedure in a single year after “instruments or other material” were 

left during surgery. 

Of the 23 patients, eight were from NSW hospitals, seven were from 

Victorian hospitals and two were from Queensland hospitals. Another 

two were from Western Australian hospitals, while four were from 

South Australian hospitals. 

The report, which was released today, also detailed more than 430,000 

patients were either poisoned, injured or suffered an infection while in 

hospital care in the 12 months to 2016-17. 

Of this figure, more than 167,000 patients suffered injury and poisoning 

from, among things, the adverse effects of drugs, while more than 

215,000 patients underwent procedures “causing abnormal reactions 

or complications”. 

The four new Canon Medical Systems Aquilion Prime SP CT Systems will 

operate within InHealth’s mobile fleet to meet the growing needs of general 

and specialist CT imaging. 

The new orders are the latest in a decade long CT partnership between 

the two companies. The four new CT scanners will all operate within 

InHealth’s mobile fleet as part of its aim to meet the growing needs of 

general and specialist CT imaging as a frontline healthcare treatment 

planning and review tool. 

“This deal represents a significant investment in renewing and 

increasing our portfolio of scanners to allow us to continue to meet the 

growing demand from the healthcare sector, and help deliver better 

outcomes for our patients. We are excited to be working with Canon 

Medical Systems and continue to strengthen and expand our presence 

in the field of diagnostics,” states Geoff Searle, Managing Director – 

Integrated Services at InHealth. 

Alistair Howseman, Sales Director at Canon Medical Systems UK states, 

“Our strong and long partnership with InHealth is testimony to Canon 

Medical Systems’ record of providing imaging equipment that is not 

only best in class for clinical and operational needs, but also to it giving 

a sound financial return on investment. We are delighted to receive 

the new order and look forward to providing a smooth installation of 

the equipment as well as training and meeting ongoing service needs.” 

The Aquilion Prime SP CT powers productivity within imaging 

departments by speeding up and simplifying complex or routine 

procedures and automating patient positioning. It has been designed 

to help save time and increase patient throughput, as well as deliver 

exceptionally low radiation doses and assure clinical confidence in the 

resulting scans. 


More than 23,000 suffered “misadventures” while in hospital, with more 

than 24,000 patients contracting an infection following a procedure. 

The report also found 20 patients took their own life while in an 

inpatient unit – a figure down on the previous corresponding year. In 

the past five years, hospital suicides have dropped from 35 deaths in 

2012-13 to 30 deaths in 2014-15. 

Meanwhile, ambulances reached the most urgent of patients fastest in 

Perth last year, with Sydney trailing all other Australian capital cities. 

In the Western Australia capital, ambulances reached urgent patients 

within 14.1 minutes in 90 per cent of cases in 2017-18. 

That compared to a 20.8-minute wait for an ambulance to arrive in 

Sydney, the capital with the slowest response time. 

The slowest statewide response was in Tasmania, where 90 per cent of 

the most urgent call-outs were attended within 29.4 minutes. 

Once people arrived at a public hospital emergency room, the report 

shows they were a little less likely to leave within four hours last year 

than they were several years ago. 

According to the report, Australia had 695 public hospitals as of 2016-17, 

with more than 61,000 beds for admitted patients. 

In the past 12 months, there were around 6.6 million patients discharged 

from these hospitals, with just over half of this number same day 

patients. 

Public hospitals across Australia shared a budget of $63.8 billion for 

the past 12 months. This was 91.6 percent funded by federal, state and 

territory governments while 8.4 percent are funded by non-government 

sources. 

Source: 9news Kate Kachor 


Looking after ourselves at work: The importance of being hydrated 

and fed 


Guidelines for the safe provision of anaesthesia in magnetic 

resonance units 2019 

https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14578 


Patient Safety Movement Announces 273,077 Lives Saved 


Clinical leadership — a framework for action 

https://blogs.bmj.com/bmj/2019/01/31/looking-after-ourselves-workimportance-hydrated-fed/ 

https://patientsafetymovement.org/news/patient-safety-movementannounces-273077-lives-saved/ 

https://improvement.nhs.uk/resources/clinical-leadership-frameworkaction/ 


SPECIALIST HEALTHCARE EVENT TO EXPLORE WAITING TIMES IN SCOTLAND 

Healthcare professionals from across Scotland are being invited to 

a specialist event which will explore the Scottish Waiting Times 

Improvement Plan next month. 

The event, being hosted by medical technology organisation Vanguard 

Healthcare Solutions, will explore flexible infrastructure strategies to 

help NHS Boards across the country meet requirements to reduce the 

length of time people are waiting for diagnostic and surgical procedures. 

Lindsay Dransfield, Commercial Director at Vanguard, said: “The 

Scottish Government recognises the increasing demand on the whole 

system of health and care and has issued an improvement plan which 

focuses on the length of time people are waiting for these procedures. 

“The Waiting Times Improvement Plan outlines the steps and 

timescales alongside significant and focused additional investment. 

The use of temporary infrastructure, such as mobile wards, endoscopy 

and theatres, has been endorsed as a viable and cost-effective way 

to support additional capacity in both theatre and in-patient services. 

“Our event will look at how these temporary solutions can help NHS 

Boards in Scotland meet their capacity needs in the future.” 

Individuals working within hospitals across the UK in clinical, 

management or estates roles are invited to join Vanguard at the Golden 

Jubilee Conference Hotel in Glasgow on Friday February 22nd 2019 from 

10.30am to 2pm. 

Speakers at the free-to-attend event will introduce flexible 

infrastructure strategies which can be deployed across Scotland and 

give delegates the chance to hear about a proven solution already 

working in Scotland, from the professionals using it every day. 

There is also an opportunity to tour an existing, fully-equipped and 

operational mobile solution at Golden Jubilee and meet specific 

professionals in clinical, management and estates roles who can answer 

questions on those areas of expertise. The unit is an example of how 

a mobile solution is being utilised in a real situation by clinical staff on 

a daily basis. 

Senior estates, management and clinical professionals from across 

Scotland can book a place by emailing marketing@vanguardhealthcare. 

co.uk or calling 01452 651850. Places are limited and will be allocated 

on a first-come, first-served basis. Lunch and refreshments will be 

included. 

Vanguard mobile clinical units can increase clinical capacity in 

both planned and emergency situations and can help with reducing 

procedure waiting times. 

Alongside its temporary mobile clinical environments such as operating 

theatres, endoscopy suites, day surgery, clinics and ward space which 

help healthcare providers, including the NHS, increase patient capacity 

and clinical space, Vanguard also provide highly trained support staff. 



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The Operating Theatre Journal February 2019

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