The Operating Theatre Journal July 2021

THE THE

THE

SEPTEMBER JULY 2020 2021 2020 ISSUE NO. 360 370 360 ISSN 0000-000X

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SEPTEMBER 2020 ISSUE NO. 360 ISSN 0000-000X

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THE THE

THE

SEPTEMBER JULY 2020 2021 2020 ISSUE NO. 360 370 360 ISSN 0000-000X

1747-728X

SEPTEMBER 2020 ISSUE NO. 360 ISSN 0000-000X

The The Operating Theatre Theatre Journal

Journal

OTJONLINE.COM £2.00

OTJONLINE.COM

£2.00

The The Leading Leading Independent Print Print & Digital & Digital Journal Journal For For ALL ALL Operating Theatre Theatre Staff

Staff

The Leading Independent Print & Digital Journal For ALL Operating Theatre Staff

Good standard of care despite the

unprecedented challenges of COVID-19

Healthcare Inspectorate Wales (HIW) on the 30th June published the findings from its’ COVID-19 themed

national review.

This review draws together the findings from all assurance activity undertaken since March 2020. More than

110 checks were conducted across Wales over the period, focusing on the extent to which healthcare services

provided safe and effective care to patients during this time, as well as how the health and wellbeing of staff

was supported.

Throughout the pandemic, HIW has continued to check that people in Wales are receiving safe, effective,

good quality care.

To support healthcare providers to focus their resources on keeping people safe, we adapted our approach to

assurance and inspection work by revising the focus of when and how we conducted our work. This included

developing a new approach to gaining assurance remotely and using more traditional onsite inspection

activity where the risk to patient safety was very high or where new models of care had been introduced

at pace, for example field hospitals and mass vaccination centres. Throughout the pandemic, this work was

supported by our ongoing review of intelligence, including information and concerns received via our first

point of contact and notifications from healthcare organisations about incidents. We also worked closely with

partner organisations.

Overall, we found that the quality of care provided across Wales during the pandemic was of a good standard.

We found that good arrangements had been introduced throughout healthcare services to adapt both the

environment of care and the way in which care was accessed, enabling services to continue operating during

the pandemic. These changes were often made within extremely short timescales and included changes

to the environment to support social distancing requirements, and the provision of remote appointments

to maintain healthcare services as safely as possible. Services have implemented innovative approaches to

support patients’ physical and mental well-being during the pandemic.

The pandemic has, at times, rapidly evolved, and whilst on the whole we believe that infection control

has been managed appropriately, the number of hospital outbreaks that we saw during the second wave

illustrates the need to ensure arrangements are effective, reducing the risk of transmission as much as

possible.

We noted the outstanding efforts made by staff working in healthcare services, who continued to demonstrate

tireless commitment and flexibility during a time of such unprecedented challenge. However, the impact

on the wellbeing of these staff was clear. As Wales begins its journey to recovery, the challenge faced by

healthcare services to address treatment backlogs will undoubtedly bring with it a different type of pressure.

Services will need to ensure there are robust arrangements in place to support their staff to deliver safe and

effective care.

Alun Jones, Interim Chief Executive of Healthcare Inspectorate Wales said:

“I want to commend the commitment, resilience and flexibility of staff across NHS Wales and independent

healthcare services who have worked tirelessly to provide care to patients and to each other during the

extraordinary challenges presented by COVID-19. Despite the unprecedented complexities of providing care

during the pandemic, our overall finding, that good quality care was being provided, is testament to the

dedication and resourcefulness of healthcare teams across Wales.”

BAOMS President comments on crisis in H&NC surgery

Commenting on a recent letter published in the British Dental Journal (BDJ) about the crisis in head and neck

cancer surgery and the impact on patient care, British Association of Oral and Maxillofacial Surgeons (BAOMS)

President Austen Smith says it is an astute summary of the challenges facing maxillofacial units, adding:

“BAOMS Council member Bhavin Visavadia and colleague Hussein Mohamedbhai raise a very important point

that is critical to the immediate future of head and neck cancer surgery provision - based on data from the

recent UK CoVidSurg project.

“The CoVidSurg project findings are an example of short-term, rapidly organised and efficiently processed

research that offers a timely appreciation of the real-life events affecting acute hospital units across the UK.

This sort of fast response research will become even more important in the future - and should serve as a

template for similar, rapid extractions of valuable information on trends affecting surgery in the UK.”

P2 Surgery: Crisis….what crisis? Letter from Hussein Mohamedbhai and Bhavin Visavadia published in BDJ May 14 2021

Read here go.nature.com/3vHDjUM

Inside this issue

University wins multi-million

pound funding

P4

Surgical care can be made

more environmentally

sustainable.

P6

Where did you get those

scrubs?

P8

Better treatment

for miscarriage

patients

P9

Day One Trauma Support,

Set for National Expansion

P10

Laughter is the

Best Medicine

P12

Hinchingbrooke

redevelopment plans

P12

Field Hospital

Tested

P13

Nisha recognised

at prestigious healthcare

awards

P14

HCPC approves increase

to SET 1 to degree level

for Operating Department

Practitioners

Laughing gas has shown

potential as a treatment

for depression

Specialist responds to

Africa’s Oxygen

Shortage

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 370 July 2021 3

P17

P18

P18

Queen Alexandra Hospital’s

lengthy surgery waiting

lists could be cut with new

anaesthesia roles

P21

Cell-type-specific insight into

the function of risk factors

in coronary artery disease

P22

Researchers reduce severity

of sleep apnoea by at

least 30 per cent

P24

Blood flows are more turbulent

than previously suspected

P26

University wins multi-million pound funding to

run new health courses in first for North Wales

Wrexham Glyndwr University is celebrating the prospective contract win of multi-million pound funding to launch an exciting

raft of new Nursing and Allied Health Professions courses.

The successful tender for funding from Health

Education and Improvement Wales (HEIW) will

lead to a new tripartite working arrangement

with HEIW and Betsi Cadwaladr University

Health Board (BCUHB), that will be based on

pre-existing partnership working.

This commissioning contract enables the

university to substantially increase its portfolio

of Nursing and Allied Health Professional

programmes offer, with new courses ranging

from Mental Health Nursing to Speech and

Language Therapy.

As well as a significant increase in student

numbers, a host of new jobs are being created

at the university as a result of the successful

bid, with new roles ranging from lecturers to

administrative staff, with a recruitment drive

imminent.

It is another first for Wrexham, as some

of these Allied Health Practitioner Degree

courses have never been delivered in North

Wales before.

The portfolio area also includes the university’s

British Association of Sport Rehabilitators and

Trainers (BASRaT) accredited Sports Injury

Rehabilitation programme.

The successful funding bid means Glyndwr

University will now be in a position to offer

courses in;

- Adult Nursing

- Mental Health Nursing

- Children’s Nursing

- Paramedic Science

- Operating Department Practice

- Dietetics

- Speech and Language Therapy (English)

- Speech and Language Therapy (Welsh)

The University will also be able to continue with

its Occupational Therapy and Physiotherapy

courses.

The funding has been made available by HEIW

to change the ‘shape’ of education provision in

Wales to closely meet the needs of all Health

Boards and Trusts, and develop a cutting

edge innovative contract to put Wales at the

forefront of Health Professional education.

This huge boost for the university will enable

Wrexham Glyndwr to work closely with HEIW,

Betsi Cadwaladr University Health Board

(BCUHB), Powys Teaching Health Board, the

Welsh Ambulance Service Trust (WAST) and

other stakeholders, building on already strong

partnerships to ensure the curriculum closely

matches service needs.

Welcoming the announcement, Wrexham

Glyndwr University Vice-Chancellor Maria

Hinfelaar said: “This announcement is a huge

boost to the University and the region.

“I want to say thank you to our team and

everyone who was involved in making the bid

a successful one.”

Dr Simon Stewart, Faculty Dean of Social

and Life Sciences at Glyndwr said: “This is

a landmark day for the university and the

faculty.

“This is a huge boost, not only for everyone at

Wrexham Glyndwr, but North Wales as a whole

– as we are now able to offer a wider range

of Allied Health practitioner courses than has

ever been available in the region before.

“Potential students from the North Wales area

who would have previously had to relocate to

take these courses will now be able to stay to

learn and study here.

“I would like to express my thanks to HEIW for

the funding, and everyone who worked hard

throughout the bid process.”

Madi Ruby, Associate Dean responsible for

Nursing and Allied Health Professions added:

“We are absolutely delighted to learn that our

bid has been successful and that we can now

substantially broaden our Nursing and Allied

Health Professions offering as a result.

“In the short-term it is fantastic for us that

the faculty is expanding, and in the long-term

it is incredible to know we’ll be providing

opportunities for people to become Nursing

and Allied Health professionals of the future

– that we will be developing the practitioners

of tomorrow.

“I want to say a huge thank you to everyone

who has been instrumental in making this

ambition a reality.”

Jo Whitehead, Chief Executive of Betsi

Cadwaladr University Health Board, said:

“We’re delighted to be working in partnership

with Wrexham Glyndwr University and other

health boards and trusts to help provide

high-quality health education and training

opportunities in Wales.“The courses will help

us recruit in the future within these areas

of healthcare and meet the needs of our

patients.”

A spokesman for HEIW said: “We are very

pleased to announce the successful conclusion

of the all Wales pre-registration healthcare

professions education tender. This is the

largest commissioning process we undertake

and is worth over £1bn in the next 10 years.

“We are looking forward to working with

partners over the next 12 months on the

implementation phase of the contracts and

thereafter on the delivery of high-quality preregistration

healthcare professional education

in Wales.”

The first intake of students for these courses

will be welcomed next year, with space

available on Foundation Nursing programmes

from September 2021 and their delivery is a

future step in the university’s Campus 2025

strategy, with designs being drawn up for a

new Health and Innovation Quarter.

The next issue copy deadline, Wednesday 28th July 2021

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

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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

4 THE OPERATING THEATRE JOURNAL www.otjonline.com

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Healthcare staff at Wythenshawe Hospital – part of Manchester University

NHS Foundation Trust (MFT) – have launched a collaborative research project

into how surgical care can be made more environmentally sustainable.

Dr Cliff Shelton

Supported by the Manchester University NHS Foundation Trust (MFT)

Charity and run in collaboration with The James Lind Alliance (JLA), the

Greener Operations Priority Setting Partnership (PSP) aims to gather

views from patients, carers, healthcare professionals and the public to

guide future research areas to make peri-operative practice ’greener’.

Peri-operative practice refers to healthcare before, during and after

an operation – including the procedure itself – as well as consultations

before an operation, and hospital care afterwards.

The project is jointly led by Wythenshawe Hospital’s Dr Cliff Shelton,

Consultant Anaesthetist, and Mr David Jones, Medical Examiner and

retired Consultant Surgeon.

“Healthcare itself makes a significant contribution to global warming

and pollution, with the NHS alone responsible for almost four per cent

of the UK’s carbon footprint. It’s estimated that each operating theatre

creates around two tonnes of waste each year, and a single operation

can generate greenhouse gas emissions equivalent to driving an average

car for 2,000 miles.”

Mr Jones added: “Last year NHS England and NHS Improvement set

out a vision for the NHS to become the first national health system in

the world to reach ‘carbon net zero’, where emissions are reduced as

more sustainable patterns of care are developed and implemented. We

hope this project will make a significant contribution to understanding

how we can achieve this during and around the time of surgery, while

maintaining excellent standards of care.”

Environmental sustainability is a key priority for MFT, with a strategy in

place to embed sustainability across the Trust’s 10 hospital sites.

In 2020, MFT was also named Investors in the Environment ‘Natural

Environment Champion’ for its work in promoting biodiversity through

its green spaces and rooftop beehives.

“We’ve led a number of green projects over the past few years. Some,

such as our current £7 million energy upgrades funded via the Public

Sector Decarbonisation Scheme (PSDS) are focussing on energy and

efficiency improvements, while others are supporting staff learning

and engagement – such as our staff Green Impact scheme, or our latest

travel campaign ‘MFT Cycling Club’, which rewards staff for active

travel.

“Historically, there has been a lot of focus on the estate, however the

challenge ahead for sustainability is how we green the way we deliver

care, and we hope this project will help us to understand this further.”

The JLA is a non-profit organisation which brings together Priority

Setting Partnerships (PSPs) – made up of patients, carers, and healthcare

professionals – on a range of areas within health and care. PSPs

collectively identify unanswered questions or evidence uncertainties,

to help guide future research priorities.

The Greener Operations project steering group is made up of people

who represent all areas affected by peri-operative practice – including

both patients and healthcare staff. It is also supported by a range

of professional and charitable partners interested in sustainable

healthcare, including patient groups, UK Royal Colleges, and

professional associations.

Jonathan Gower, James Lind Alliance Advisor and chair of the PSP

steering group, said: “Priority Setting Partnerships aim to gather a

wide range of views and experiences from across different groups of

people, to help decide the most pressing issues for research to look at.

“With the Greener Operations PSP we’re looking to gather as many

ideas as possible from people who have undergone surgery or are

involved in surgical care, or even those interested in making healthcare

greener, to help researchers focus their efforts into making surgical

care more environmentally sustainable.”

The team has launched an online survey for people to share their

views, with responses forming an initial ‘long list’ of ideas. These will

be prioritised in subsequent surveys, before going to a collaborative

workshop to decide a final ‘Top 10’ research priorities.

Bob Evans, a public representative on the steering group, added: “In

all walks of life, we are urged to have less impact on the environment.

In the same way, we want your help to identify the priority issues for

making operations more environmentally friendly. Taking a few minutes

to respond to our survey could really help make an impact.”

Another member of the steering group, Becky Knagg, is chairperson of

the Bay-Wide Maternity Voices Partnership. She added: “As an advocate

for women who use maternity services and their families, I am really

pleased to be involved in this priority setting partnership. I look

forward to seeing the impact this project will have on the sustainability

of surgery in the future.”

John Hitchman, a public representative member, added: “I commend

the team for their ground-breaking work in sustainable healthcare.

There are so many pressing environmental issues to pursue, but by

making ‘greener operations‘ a priority, they fulfil both patient and

public aspirations. I am proud to play a small part in this valuable

research.”

Jennifer Strong, Senior Sustainability Officer at MFT

Jennifer Strong, Senior Sustainability Officer at MFT and a member

of the PSP steering group, said: “The scale and pace of the changes

required to drive out carbon emissions are significant.

The survey will remain open until August 2021, with the team looking

to finish the project by the beginning of 2022.

For more information on the project, visit the Greener Operations

webpage, or follow latest updates on Twitter at @SusPeriopPSP.


A simple solution for improving

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Miele offers savings across washer-disinfector

for hospital and medical environments

Miele has launched a new campaign offering £250.00 off its PG8582 Washer Disinfector model.

The Clean Start campaign – a first from the manufacturer – is designed

to help hospitals and medical environments make the switch from

handwashing to automated reprocessing, to replace an old machine or

upgrade to a larger and newer model.

Customers can save £250.00 on their purchases until the end of August

2021.

Miele’s national account manager for medical and decontamination,

Nadine Bellamy-Thomas, said that this offer couldn’t have come at a

better time.

“Our Clean Start campaign means there has never been a better

opportunity for hospitals and medical environments to invest in, or

upgrade, professional reprocessing equipment. Over the last year,

existing machines have been working tirelessly to maintain hygiene

standards in line with stringent legislation due to the current pandemic

and it’s now time for an upgrade,” she said.

“Hospitals and medical

environments with older

washer-disinfectors may

find them unreliable and

older models will have

longer cycles and will use

more water, power and

cleaning agent than new

products, that also have

the benefit of modern

accessories designed to

protect items and provide

the best possible clean.

Miele offers savings across washer-disinfector for hospital and medical environments

Miele has launched a new campaign offering £250.00 off its PG8582 Washer Disinfector model.

The Clean Start campaign – a first from the manufacturer – is designed to help hospitals and medical

environments make the switch from handwashing to automated reprocessing, to replace an old

machine or upgrade to a larger and newer model.

“Miele manufactures

several accessories which

are compatible with this

model; our theatre shoe

inserts for example allow

for theatre shoes to be

disinfected in the same

way as medical equipment,

reducing the spread of

harmful bacteria.”

Customers can save £250.00 on their purchases until the end of August 2021.

Miele’s national account manager for medical and decontamination, Nadine Bellamy-Thomas, said

that this offer couldn’t have come at a better time.

All Miele products are guaranteed to have spare parts produced for

15 years after they are discontinued, for ultimate peace of mind in

a long-term investment. Miele washer-disinfectors come with a range

of accessories to hold smaller and more delicate instruments as well

as hospital theatre shoes making them extremely versatile and always

reliable.

“Our Clean Start campaign means there has never been a better opportunity for hospitals and

medical environments to invest in, or upgrade, professional reprocessing equipment. Over the last

The Clean Start offer applies to the Miele PG8582 and PG5852 CD

models. The promotion applies to new customers or those replacing an

older model from any manufacturer.

year, existing machines have been working tirelessly to maintain hygiene standards in line with

stringent legislation due to the current pandemic and it’s now time for an upgrade,” she said.

For more information or to order email lab@miele.co.uk or visit the

Miele GB website. www.miele.co.uk/professional/clean-start-2241.htm

“Hospitals and medical environments with older washer-disinfectors may find them unreliable and


Where did you get those scrubs?

Have you ever wondered where your colleagues have been getting those funky scrubs? Chances are, they

will have been sewn by one of the army of volunteers who joined forces to support frontline workers...

Throughout 2020 the Health

Services in the UK had to adjust to

a new “normal”, with the arrival

of Covid 19.

Health care practitioners in the

NHS were deluged with patients

in severe respiratory distress,

highly contagious and requiring

24-hour management.

A critical weapon in this battle to

save lives and contain the spread

of the virus was the use of PPE

- and scrubs. It became clear

very quickly that NHS stores and

commercial suppliers were unable

to cope with the massive increase

in need, and the supply chain

was compromised by worldwide

demand and factory closures.

By January 2020, nurses and

healthcare workers were

reporting shortages, and it

affected hospitals, care homes

and surgeries across the country.

Following an early appeal by

Nurse Ashleigh Linsdell - who

has been awarded an OBE for

her contribution - “For the Love

of Scrubs” (or FtLOS) grew to a

social media Facebook group of

close on 70,000 - with groups

of active seamstresses covering

every area of the UK from the

north of Scotland to the south

coast of England. Other groups

also formed, based on criteria

such as occupational groups –

tailors and fashion designers – and

location – local colleges.

There was no shortage of willing

volunteers but it was a different

story when it came to fabric.

Hospitals (mostly) suspended

colour rules for scrubs, as fabric

in “approved” colours ran out.

Inventive methods of recycling

fabric were utilised. Whole

communities supported us,

collecting and donating fabric to

their local hub. Washing machines

went on high temperature

overtime, and washing lines

across the country were on

constant alert for sun!

Fundraising became a necessity

for FtLOS - with many thousands

of yards of fabric being sent

across the country.

The volunteer motorbike riders

(VRUK) allowed for a quick and

efficient collection and delivery

service, and the involvement

of Noah Evans and family in

fundraising gave a vital fillip to

fabric supplies.

Many major and minor companies

gave their support- from the John

Lewis Partnership to Painswick

textiles - a tiny haberdashers in

the Cotswolds.

Online companies gave generous

discounts, print shops downloaded

patterns for us and sewing machines

became a rare commodity!

Our communities rallied round us,

and our families became adept at

picking up the domestic slack - we

were too busy sewing! Our homes

became haberdasheries and the

elastic was kept in the safe...

Some groups adopted a re-use/

recycle ethos, and homes across

the country were stripped of spare

bedding.

Children’s duvets in particular

provided some light relief in

paediatric wards.

In the first year of the pandemic

FtLOS members sewed over 1

million sets of scrubs and well

over one million ancillary items -

laundry bags, caps, ear protectors,

gowns and headbands.

We sewed for junior healthcare

assistants and senior consultants

- and everyone in between. We

sewed for all shapes and sizes,

from extra petite to 6XL.

What became quickly apparent was

the profile of our membership, and

the potential lack of resilience in

future crises. The majority of our

seamstresses are aged between 40

-65 and had the benefit of formal

sewing lessons at school.

Now, sewing as a life skill has

largely disappeared from the

national curriculum and several

generations have no experience

of sewing - possibly a contributing

factor in the rise of “fast fashion”?

Our volunteers are rightly

concerned about this: our country

needs to foster and value sewing

skills.

With the growing awareness of

the need to protect the whole

population, FtLOS began a

second phase in partnership with

HelpMyStreet - a charity designed

to match supply and demand in

voluntary social services. We made

face coverings by the million.

We posted them to individuals,

donated them to food banks, gave

them away in markets, handed

them out from our doorsteps and

delivered them to care homes,

colleges, and commuters. In

addition, some of our members

developed the first “lip reading

friendly” face covering, and this

essential aid to communication

for the deaf has spread across

the country and is still in great

demand.

Our members value our NHS – and

this, our linked community. They

value the sense of being part of

the group, of sewing for the public

good. Many have found solace in

FtLOS work during this difficult

time. Many feel that their mental

health has benefited as a result of

their efforts. And many members

sewed to support family members

working in the NHS - sewing

love and support in every seam.

Sometimes, this took physical

form, in little messages stitched

into labels.

Our move from a wholly social

media group to a web based

organisation is being assisted by

donations from Whiteley & Sons,

the last scissor maker in Sheffield,

who could not have been more

supportive. Like many British

craft associated companies, they

share our concerns about a lack of

life skills. As our focus diversifies

into education, “slow” fashion,

community projects and recycling,

being online offers great flexibility

in addressing these areas.

FtLOS is strictly non - political.

That does not mean that we are

prepared to ignore the lack of a

robust supply chain.

We strongly support the growing

home market in scrubs and PPE

manufacture.

We continue to support NHS staff

- and all frontline workers - in the

fight against Covid 19. As has been

oft-quoted “we are not all in the

same boat - but we are all in the

same storm”.

Now we are seeing our scrubs

taking on a further life - being

donated to countries who do not

have the resources to protect

themselves in this most basic form.

Our scrubs have gone to Uganda

and St Vincent, amongst others,

where they continue to assist their

frontline workers in the battle

against Covid.

FtLOS is proud to be standing

behind frontline workers. It has

been an honour and a privilege to

support you.

We hope that FtLOS, the first,

biggest and most productive

national scrubs sewing group,

will play an effective role in any

discussion about life skills for

future generations

There may come a time when they

too may need to sew for their

lives...

Collette Glynn,

For the Love of Scrubs

Management Team.

(Copyright FtLOS)

To our frontline friends:

Introducing the Whiteley and Sons range of premium grade medics scissors,

manufactured from 420 stainless steel with riveted pocket clip for the

upmost in durability. Available in sets of two with 5” and 6” options as well as

straight and curved options - and the choice of blunt and sharp tips ensuring

you get the set that’s just right for you.

Finished with the ‘For the Love of Scrubs’ branding as a memento of your

time working for Britain and achieving something wonderful.

In purchasing these scissors you are supporting the For The Love of Scrubs

community with 5% of all proceeds going back to support their initiatives.

Set of any FtLOS two, a discounted price of £20, and personalise both for

one additional £5.

See the full range of options here: www.whiteley.co.uk/ftlos


Better treatment for miscarriage

patients is more cost effective

than current standard NHS

treatment, study finds

A new drug combination that is better at treating miscarriage is also

more cost-effective than current standard NHS treatment, finds a

National Institute for Health Research-funded study.

A previous paper by the same team that published in The Lancet in

August last year, found that a combined drug treatment is more effective

than the standard medication for women having miscarriages without

symptoms - also known as missed, delayed or silent miscarriage.

Missed miscarriage occurs when a baby has died in the womb but the

mother hasn’t had symptoms, such as bleeding or pain. Current hospital

restrictions on surgery mean that many women face waiting for the

miscarriage to happen by itself, which can take weeks and still might

not happen, or being offered medication to speed the process along.

National guidelines recommend a treatment called misoprostol, which

is successful in most cases – but some women wait anxiously for weeks,

repeating the medication and eventually needing surgery.

The research published in The Lancet in August 2020 showed that

misoprostol is more effective when combined with mifepristone, an

anti-progesterone drug used to induce labour. The trial found that the

combined drug treatment worked in 83% of cases, compared to 76% in

the misoprostol and placebo group – and crucially, it reduced the need

for surgery. One in four women (25%) given the placebo later needed

an operation to complete the miscarriage, compared with less than one

in five (18%) of those who had the new medication.

Now the team has carried out a further study to assess the costeffectiveness

of mifepristone and misoprostol combined compared with

misoprostol alone for the medical management of a missed miscarriage.

The study, led by the University of Birmingham and Tommy’s National

Centre for Miscarriage Research, involved 711 women across 28 UK

hospitals with a diagnosis of missed miscarriage in the first 14 weeks of

pregnancy, who were randomly assigned to receive either mifepristone

or a placebo drug followed by misoprostol two days later.

Published in the British Journal of Obstetrics and Gynaecology, the

study found the new combined drug treatment was on average £182

cheaper for each successfully managed miscarriage than the current

standard NHS medication.

As this is the largest ever study into the most effective medical

treatment for missed miscarriage, and the results are so clear,

researchers and campaigners are calling for guidance from the National

Institute for Health and Care Excellence (NICE) to be updated in light

of the newly published findings. In the meantime, Tommy’s experts

encourage anyone diagnosed with missed miscarriage to ask their

doctor about the combined drug treatment.

Senior author Tracy Roberts, Professor of Health Economics at the

University of Birmingham, said: “Pregnancy loss causes heartbreak

for millions of families, and it is crucial that we find better ways to

care for everyone going through miscarriage. Our findings could have

huge benefits if they’re translated into clinical practice, with better

outcomes for patients and lower costs for care services.”

Tommy’s CEO Jane Brewin commented: “Besides the physical harm,

miscarriage can have serious psychological consequences, which can

be made worse by the trauma of a failed treatment forcing mothers to

endure weeks of carrying a baby they know has died.

“One in four pregnancies ends in loss, and while our researchers work

to understand how we can prevent this, it’s vital their latest findings

are put into practice so that everyone going through miscarriage has

the best possible care. Particularly given Covid-19 pressures on the

NHS, our new study could be applied to make better use of precious

resources, as well as reducing the toll miscarriage can take on parents.”

An estimated 23 million miscarriages occur every year worldwide –

equating to 44 pregnancy losses each minute. Miscarriage (defined as

the loss of a pregnancy before 24 weeks) costs the UK at least £471

million a year, through direct impact on health services and lost

productivity, but scientists expect the costs surpass £1 billion a year

when factoring in longer-term physical and mental health impacts.

The project has been funded by the NIHR Health Technology Assessment

(HTA) Programme. See the project page for more details.

Source: NIHR

Innovating through backlogs:

The NHS Future of Surgery

Conference

Go to webinar 19th October 2021

To Register for the conference

please email

josh.barrow@convenzis.co.uk

IV Summit 2021

Tuesday 5th October 2021

Mercure Sheffield St Paul’s Hotel

Free registration: https://fitwise.eventsair.com/iv-summit-2021/

IV Summit 2021 from IVTEAM… How people, policy, product and

process are integrated into practice.

Join us at the Mercure Sheffield St Paul’s Hotel on Tuesday 5th

October 2021. Registration is free.

The IV Summit 2021 from IVTEAM will deliver a modernised conference

agenda. With our extensive online presence (which includes thousands

of weekly visitors to the IVTEAM website), we have developed a

programme based on the most read topics on IVTEAM. Our conference

agenda has been influenced by delegates for delegates.

This unique approach has resulted in content that has a direct

relationship to clinical practice. Each speaker will demonstrate how

people, policy, product and process are integrated into practice.

Programme highlights include:

• IV Training: International development and online learning: Sarah

Phillips

• Clinical review of ECG PCC tip location innovation: Dave Wynne

• How to set up a nurse led implantable port insertion service:

Andrew Barton

• Interesting cases and innovative solutions for implantable port

placement: Sviatlana Vasileuskaya

• How to manage common implantable port complications: Dr Ram

Kasthuri

• Unravelling the complexities behind IV flushing: Paul Lee

• Evaluation of sutureless securement device for children with PICCs

• Long peripheral IV catheters in clinical practice: Dave Wynne

• …Plus more

View the full programme and register for free at https://fitwise.

eventsair.com/iv-summit-2021/

Get involved on social media! Use the hashtag #IVSummit21

Facebook: @ivteampage

Twitter: @ivteam

LinkedIn: in/ivteam


Leeds Based Charity, Day One Trauma Support, Set for National

Expansion after Life-Changing Local Impact

Day One Trauma Support, a service pioneered by Leeds Teaching

Hospitals NHS Trust in 2014, has recently announced its official launch

as the first national independent charity supporting survivors of major

traumatic injuries on UK-wide scale.

Day One, which was founded by leading orthopedic surgeon, Professor

Peter Giannoudis, has until now been operating in solely in West

Yorkshire, under the umbrella of the Trust. Now its unique model of

care will be the blueprint for major trauma support nationwide.

Day One was created to offer financial, legal, practical and emotional

support to help people cope with the wider implications of life-changing

injuries, such as those resulting from car accidents, sporting accidents,

physical attacks or falls from height.

The charity, which has supported more than 1,000 patients locally since

its inception, now looks to extend its reach to the 27 major trauma

centres across the country to ensure that no one is left to cope with the

impact of traumatic injuries alone. While some rehabilitation support

already exists for neurological injuries, Day One will serve a wider

tranche of patients, including those with muscular-skeletal conditions,

for whom no existing support exists.

Day One offers a range of support, including emergency funding for

accommodation for families needing to be close to their loved on in

the aftermath of an incident, as well as longer-term funding to help

survivors adapt their housing or purchase equipment. Legal expertise

is offered via Day One’s pro bono partners, as well as access to

counselling, advice with welfare benefits, and befriending from its

dedicated team of volunteer Peer Supporters. Patients are matched

in person or by telephone with peer supporters who have had similar

accidents or injuries and can listen to their anxieties, empathise, and

share their own experience of recovery.

Day One’s fresh ambitions are already coming to fruition with the

creation of a new Day One Case Worker post confirmed to work with

patients admitted to the Aintree Major Trauma Centre, at Liverpool

University Hospitals NHS Foundation Trust.

As the charity expands, it aspires to have presence across all 27 Major

Trauma Centres across the country. In future, Day One will look to

provide wraparound support for patients, via a mixture of Day One

Case Workers, Peer Support Volunteers, and help from their legal panel

and other associated partners.

Lucy Nickson, CEO of Day One Trauma Support, said:

“We are extremely proud to be launching Day One as the first national

charity for survivors of major traumatic injuries. Patients who have

multiple serious injuries receive exceptional clinical care from the

NHS, but we know that patients often face many years adjusting to

the often devastating effect of their injuries or disabilities and indeed,

rehabilitation and processing their traumatic event can be a life-long

process.

“Having evolved Day One’s services in Leeds since 2014, we know that

many people need support above and beyond the NHS to make the

best possible recovery. For some people, support from Day One has

meant the difference between keeping or losing their home, accessing

financial support and feeling positive that they can rebuild their life

after major trauma.

“There isn’t any other charity in the country that works specifically to

meet the needs of this group of patients, and we are delighted that

Liverpool University Hospitals NHS Foundation Trust, through their

Aintree Major Trauma Centre recognise how our support can reduce

the worry of patients and improve their outcomes. The LUH Foundation

Trust is the first to embrace our vision to have a presence in every

Major Trauma Centre in the country and we are absolutely delighted to

be able to work with them on the next step on the Day One journey.”

Professor Peter Giannoudis, Day One Founder and President explains:

“The launch of Day One Trauma Support as a national charity is a

huge milestone, enabling us to work towards realising our ambition to

provide equitable support to trauma patients, wherever they are being

treated across the country.

“NHS staff who treat and rehabilitate major trauma patients in

emergency care, orthopaedic surgery, plastic surgery, physiotherapy

and clinical psychology do a great job delivering excellent clinical

outcomes, but by bringing Day One to their Trust they can be more

confident that their patients’ wider needs are met helping to facilitate

their recovery and preventing issues such as depression taking hold

once people are discharged from hospital.”

Julian Hartley, CEO of Leeds Teaching Hospitals NHS Trust said: “I am

delighted that Day One is now able to share more widely the expertise

it has developed alongside our clinicians not just in the Leeds Major

Trauma Centre, but also in allied services and throughout the wider

Major Trauma Network across West Yorkshire. It means our patients

and their families are fully supported during their hospital stay and

beyond, as they transition back home and continue along their recovery

journey.”

Simon Scott, Clinical Director for Major Trauma at Liverpool University

Hospitals NHS Foundation Trust, said: “The Major Trauma Centre at

Aintree University Hospital prides itself on the exceptional care it

provides to patients with major traumatic injury, pioneering new

surgeries and pathways of care to ensure the very best outcomes. Now,

through Day One, we can offer our patients another layer of care which

will help support and improve their long-term recovery and quality of

life once they leave hospital.”

Around 1000 individuals and their families have been supported by Day

One’s work in Leeds since 2014, amongst these are Nick Godbehere,

whose son, Charlie, was seriously injured in a car accident in 2019.

Charlie suffered severe abdominal injuries and his bowel was ruptured

in two places. His sister Emma, who was also in the car suffered minor

injuries but was traumatised by the accident. Nick’s father, the driver,

sadly passed away as a result of his injuries.

The family were put in touch with one of Day One’s legal partners who

were able to provide advice on their insurance claim and they also

received immediate financial assistance from the Emergency Fund to

pay for the cost of new clothing for the children whilst they were being

treated in the hospital. Nick said of the support:

“Emma’s shoes had come off in the crash and because of his injuries

Charlie needed large baggy clothes. Everyone at Day One is kind and

compassionate, but they also have lots of knowledge about where to go

for extra support. It meant so much to just have that help in our hour

of need.”

Jacqui Moorhead, Lead Major Trauma Specialist Nurse at Leeds Hospitals

Trust, said: “When working with people coping with traumatic injuries

I get asked a lot of questions such as, ‘how am I going to support my

family if I can’t return to work immediately?’, “who do I get advice

from?”, and “is there anyone I can talk to who has gone through the

same thing?”.

“Day One’s support during hospital stays, and helping with aspects

like providing equipment at home, means there are fewer barriers to

discharge, so we can get people home from hospital safer and sooner.

“I am so excited for Day One to become the first national charity

supporting survivors of trauma. It will be a light in the dark for so many

people and I hope it continues to go from strength to strength.”

Day One is celebrating its launch by encouraging people to take part in

its fundraising challenge, to cover 75 Miles in July – by foot, bicycle or

any other means. To learn more or sign up to participate, visit www.

dayonetrauma.org

Are You Linkedin ?

Join our Group

The Operating Theatre Journal

in TM


Topics for 2021 include

Realising Your Potential

Designing the Risk Out

of Operating Theatres

Join over 500 perioperative practitioners

at AfPP’s Virtual Annual Conference

Featuring inspirational speakers, educational

sessions and virtual networking opportunities

to support your personal and professional

development. There are two educational

streams that you can switch between and

watch later on catch up.

Sustainability

Human Factors

Keynote Speakers

Dr Phil Hammond

Corinne Hutton

Prof Jean White

Ticket prices start from £25 for Student Members & £60 for Non-members.

Book now at www.afpp.org.uk/events/Annual-Conference

#AfPPConf2021

UP TO

*

18.5

CPD HOURS

AVAILABLE

*Two-day ticket includes 12.5 hours live

plus six additional hours on catch up tv.

@SaferSurgeryUK

The Association for Perioperative Practice is a registered charity number 1118444 and a company limited by guarantee,

registered in England number 6035633. AfPP Ltd is a wholly owned subsidiary company, registered in England number

3102102. AfPP, Daisy Ayris House, 42 Freemans Way, Harrogate HG3 1DH T: 01423 881300 F: 01423 880997 W: afpp.org.uk

disc

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discs

also

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become

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s been

Con_2021_half_page v2.indd 1 22/06/2021 12:56:40

biolitec®: Microsurgical laser treatment for disc herniation

reduces successfully intra-discal pressure and pain

Minimally invasive PLDD laser interventions

for biolitec herniated AG discs new standard - PLDD

biolitec® laser system now also international

Untere Viaduktgasse 6/9

in the South Americas and Asia - With PLDD

of A-1030 biolitec® Vienna precise microsurgical access to

sensitive areas - Significant pain reduction

proven - Intradiscal applications and other

complicated interventions can be performed

on an outpatient basis - No soft tissue injury

or scarring - Rapid recovery time and cost

reduction

Minimally invasive laser interventions

have become the new standard of care for

herniated discs when conservative treatment

approaches fail to produce improvement.

Since Percutaneous Laser Disc Decompression

(PLDD) was licensed by the FDA as a minimally

invasive method for the treatment of disc

herniations, this method has been successfully

established. All over the world, today many

orthopedics are using the minimally invasive

PLDD laser method by biolitec®, among others

in Austria, Prim. Mag. Dr. Gregor Kienbacher,

MSc, performs the interventions in the Private

Clinic Kreuzschwestern in Graz. In Croatia,

Ass. Prof. Ivan Radoš operates with PLDD laser

procedures in the University Hospital Osijek.

Even in Brazil, Dr. Paulo de Carvalho at the

Neurocor Center in Rio de Janeiro applies the

PLDD biolitec® laser system and, in Indonesia,

Dr. Muki Partono at Puri Indha Hospital

Jakarta.

A lot of clinical studies have shown with PLDD

laser procedures a significant pain reduction

with low incidence of complications. At the

end of 2020 a recent study from Iran was

published. The clinical study* was conducted

on 43 patients who were treated with the

PLDD biolitec® laser. Results showed as well

a significant reduction in the mean value

of back and radicular pain in both patient

groups (discogenic disorder as well as

complex degenerative disorder) at one year

after surgery (P smaller than 0.05). None of

the patients have shown new neurological

symptoms.

With the PLDD of the laser developer and

manufacturer biolitec® intervertebral disc

tissue is shrinked specifically with laser energy

while maintaining full function. The intradiscal

pressure is significantly reduced and thus the

pain subsides.

The moderate penetration depth of the

flexible, tactile laser fibers with a core

diameter of only 360 micrometers together

with the excellent absorption characteristics

in water of the 1470 nm wavelength of the

biolitec® LEONARDO® laser allow extremely

precise treatment in very sensitive areas

under high surgical safety. Intradiscal

applications on the cervical, thoracic and

lumbar spine as well as neurotomy of the

facet and sacroiliac joints can thus even be

performed on an outpatient basis under MRI/

CT control. Further indications are: discogenic

spinal stenosis, contained disc herniation with

consecutive foraminal stenosis, discogenic

pain syndromes, chronic facet and sacroiliac

joint syndrome as well as other applications

such as tennis elbow and heel spurs.

With the minimally invasive PLDD laser

procedure, no soft tissues are injured and

there is no risk of epidural fibrosis or scarring.

Patients usually recover quickly, and a long

hospital stay and thus high costs are avoided.

In addition, the unique safety concept of

biolitec® ensures easy set-up, operability and

maintenance and increased safety.

For more information, visit our website at:

www.biolitec.com/Orthopedics.

* Shekarchizadeh, A. et al: Outcome of

patients with lumbar spinal canal stenosis

due to discogenic under percutaneous laser

disc decompression, in: Am J Neurodegener

Dis 2020;9(1):1-7. https://pubmed.ncbi.nlm.

nih.gov/33489482/

When responding to articles please quote ‘OTJ’


‘Laughter is the Best Medicine by

Peter Sykes ISBN 978-1-80031-285-2

Confessions of a Young Surgeon A collection of 30 short medical stories

A graduate of Manchester

University Medical School in

1966, I worked as a Consultant

Surgeon in Trafford until I laid

aside my surgical scalpel in 2005.

Now aged 78, I have put down

my pen having published my

final novel. It is a ‘coffee table’

collection of patient based short

stories - many humorous, some

sad, all very human.

All proceeds are going to our

two local hospices (St Ann’s and

the East Cheshire Hospice). You

might say it is a ‘novel’ way to

raise money for very worthwhile

charities!

Further details are available at www.medicaltales.org and details of

all my books can be found by searching for Peter Sykes on Amazon

Books.

The Novel

It is said that a surgeon must have ‘the eyes of a hawk, the heart of

a lion, and the hands of a lady,’ but have you ever wondered how a

surgeon learns to operate, how he ‘cuts his teeth’ progressing from

naive newly-qualified doctor to competent surgeon?

In this novel, the training of one slightly naive young trainee is viewed

through the experiences of the patients he treats as he embarks of

this most challenging of careers. We share his joy when things go well,

his anguish when they don’t and learn that, at the end of the day,

compassion and a sense of humour make wonderful medicine.

The main characters are distinctive and attractive, the patients’

stories varied and interesting and situations are descried with the

realism and detail that one would expect from an author of wide

medical experience.

Triumphs, failures and embarrassing incidents are all told with equal

candour. There is humour throughout.

The Author

Peter Sykes served the NHS as a consultant surgeon for 25 years, later

becoming the medical director of an NHS Trust, winning a ‘UK Medical

Management Team of the Year’ award. During the final three years of

his career, he was involved at a national level in the control of quality

of surgical services.

Peter then swopped his scalpel for a pen and recorded some of his

life’s experience in a series of light-hearted novels. Search for ‘Peter

Sykes’ on Amazon Books for full details.


www.facebook.com/TheOTJ

Hinchingbrooke redevelopment

gains support from planners

Theatre block preferred exterior design

Plans for a new, purpose-built operating theatres block at Hinchingbrooke

Hospital have been approved by Huntingdonshire District Council.

The approval marks the latest milestone on the hospital’s journey to

provide new facilities to enhance the experience of patients requiring

surgery at Hinchingbrooke Hospital.

Caroline Walker, Chief Executive Officer at North West Anglia NHS

Foundation Trust, which runs Hinchingbrooke, said: “We are delighted

that Huntingdonshire District Council has backed our plans to transform

the operating theatre facilities at Hinchingbrooke Hospital. This is

another important milestone for our Trust as we seek to invest in

modern healthcare facilities across the site.

“It is an exciting time for our patients and staff, particularly those

working in our existing theatres, as they have been closely involved in

planning the new operating environment they will be working in. We

are looking forward to involving all our stakeholders in every stages of

the process.”

The theatre block development at Hinchingbrooke is the second part

of a three-phase redevelopment scheme to replace the old hospital

building and modernise Hinchingbrooke Hospital which opened in 1984.

Background:

• The theatre block development will be located between the

main hospital building and the Treatment Centre. It will provide 7

operating theatres, recovery and admission facilities and a separate

area for children to be cared for during their surgical procedure. The

new facility will incorporate the latest thinking on operating theatre

design and technology. It will replace the theatres in the main

hospital building, which are coming to the end of their operational

life.

• This substantial investment demonstrates the important long term

role Hinchingbrooke Hospital will play in the provision of acute

hospital care within the Cambridgeshire and Peterborough health

system.

• The Outline Business Case to build the theatre block was awarded

national approval in April, enabling the Trust to proceed to the final

stage of the business case process.

• This redevelopment project will be one of the first driven forward by

the new Cambridgeshire and Peterborough Integrated Care System, a

partnership organisation bringing together the local health and care

organisations.

Source: North West Anglia NHS Foundation Trust

Call for abstracts open:

submission deadline Friday 27 August

Programme, abstract submission and registration available:

https://fitwise.eventsair.com/fis-2021/


Army Field Hospital Tested To Ensure

Five-Day Global Deployment Time

Head Medical’s Theatre Division was launched in February 2019.

We specialise in the recruitment of Theatre RNs and ODPs for

the NHS and private hospitals, covering scrub, anaesthetics and

recovery shifts.

Our Recruitment Consultants have over twenty years of combined

experience looking after theatres. Our two Nurse Managers have

worked in operating theatres themselves and are here to support

you with free training, appraisals and guidance through your NMC

revalidation.

We started with one ODP working in a hospital in the West of

Scotland, and now have over 120 candidates working across the

country. We can offer full time block bookings and ad hoc shifts at

competitive pay rates. Our friendly team will help you through the

registration process and then match you to your ideal assignment.

We need more people to join our team and become part of our

community. If you are an ODP or RN who is registered with either

the NMC or HCPC and eligible to work in the UK, we would love to

hear from you. We have a referral scheme in place too. For every

successful RN or ODP you send to us, you will receive £250.

T&Cs apply.

Please get in touch to find out more! Quote: otjjobs

Tel: 0131 240 5254 www.headmedical.com

“The measures Sir Bruce Keogh outlined during his speech last night

will be instrumental in supporting healthcare professionals to identify

the early signs and enable them to act, Health Education England’s new

education and training materials will be particularly relevant as will a

clinical network approach to care where professionals and organisations

work together across a dened geographical area – this helps to bring

a safe, standardised and equitable approach to care.

“As a college, we have updated the national template for the Personal

Child Health Record to include information for parents on how to tell

if your child is ill, and for health professionals, have recently launched

Paediatric Care Online (PCO-UK) – an online decision support tool,

providing specialist diagnostic advice to help ensure children get the

right treatment at the earliest opportunity.

“To support this, I now urge paediatricians and all healthcare

professionals to utilise the resources Sir Bruce has outlined. Collectively

we can slow down the grip of this deadly disease and reduce the number

of children who come face to face with it.”

Louise Silverton, Director for Midwifery at the Royal College of

Midwives, said: “Severe sepsis can and does kill. Though it is rare, it

can be catastrophic for pregnant and postnatal women.

“Sepsis remains a leading cause of maternal death. That is why it is so

important that we do all we can to identify it as soon as possible so that

it can be treated. It is also important not to forget newborn babies who

can succumb to infection very quickly.

“Midwives should certainly “think sepsis” where there is deterioration

in the health of either mother or baby. This means we need the right

number of midwives so that they can deliver the best possible care,

including in the postnatal period.

Exercise Chiron Certify in Hampshire has been putting

22 Field Hospital to the test.

The British Army has been putting one of its mobile field hospitals

through its paces to ensure it is capable of deploying anywhere in the

world within five days.

This year’s exercise has also seen the trialling of a smaller medical facility

capable of receiving its first patient within 60 minutes.

During Exercise Chiron Certify, 22 Field Hospital have had to prove it is

capable of taking on the mantle of the Army’s High Readiness Hospital.

This means being able to set up a hospital within 24 hours and be fully

operational within two to four days.

Once the structure is up it’s then about the provision of care.

Sergeant Suzzi Bipond, Field Surgical Team, told Forces News the

exercise, which takes place every two years, lasting four weeks and

involving 300 personnel, is “very realistic”.

“We have... casualty simulation and we have these ‘real-life’ dummies

Professor that we take Helen through Stokes-Lampard, as well that Chair can of be the operated Royal College on and GPs, they said: can

“Sepsis simulate is breathing a huge worry and they for can GPs talk as as initial well,” symptoms she said. can be similar

to other common illnesses, and the College is putting a lot of effort

Inside the hospital, there are two emergency bays, one operating

into helping family doctors recognise potential sepsis and ensure that

theatre, two intensive care units and a 12-bed ward – meaning military

patients rapidly receive appropriate assessment and treatment.

personnel patients are provided with an NHS standard of care anywhere

“We in the have world. produced a toolkit, in partnership with NHS England, which

brings together existing guidance, training materials and patient

Anaesthetist Lieutenant Colonel Paul Davies told Forces News the

information to encourage us all to ‘think sepsis, talk sepsis and treat

training is “extremely important”.

sepsis’.

“We all work in NHS practices for the most part so any opportunity we

“We are pleased to be working with NHS England to raise awareness

can to do military-specific training is very important to our ability to

and improve outcomes for patients. It really could save lives.”

effectively deliver on operations,” he said.

Anna Crossley, Professional Lead for Acute, Emergency & Critical

This year’s exercise has also seen the trialling of a veterinary hospital

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

attached to the field hospital, as well as a smaller medical facility being

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

certified.

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

raising The smaller awareness facility among can be carers, set up quickly, health care capable professionals receiving and its first the

public patient is within so vital. 60 Even minutes though and there being has fully been operational good progress within to two improve hours.

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

professionals This means it are is perfect supported for supporting and equipped peace to operations, identify and or treat as an sepsis earlyentry

capability, and is an essential facility with teams currently on

early.

operations in the Middle East and Africa.

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

failure Captain and Rupert death, Milward-Wiffen, which is why early Commander detection Ground is critical Manoeuvre to start

treatment Surgical Group, within said the the hour. facility Nurses has a and smaller health team, care with support each individual workers,

who expected see their to take patients on up to on “five a regular different basis, roles”. and are often the rst

healthcare “Compared worker to the to bigger see them, field are hospital, well placed which to has recognise got a couple the signs of

of hundred sepsis people early and in it, raise we’re the a alarm. team anywhere If a person between has signs about or symptoms 13 and 17

that people,” indicate he said. possible infection, think ‘could this be sepsis?’ and act

fast to raise the alarm, wherever you are.

“So the dynamic changes a lot more and generally the smaller the team,

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

the more roles you’re expected to take on.

Action-Plan-23.12.15-v1.pdf

Source: Forces net

“Having the right numbers of staff will also help to ensure continuity

of care and carer for women. Midwives who know the woman will be

better equipped to spot changes in the woman’s condition and identify

problems such as sepsis developing.”

twitter.com/OTJOnline

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Find out more 02921 680068 e-mail admin@lawrand.com Issue 370 July 2021 13

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ss release

10, 2021

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clinical articles for publication

within the pages of

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Getinge’s New Torin Artificial Intelligence

Solution Improves Hospital Efficiency

The introduction of the Torin Artificial Intelligence (AI) functionality

is designed to improve efficiency in managing schedules for surgical

procedures and comes in the wake of a new Getinge survey. Among

the participating hospitals 41% report significant backlogs and only 44%

have implemented new digital tools that can improve proficiency in OR

scheduling and patient management.

Getinge, a leading global provider of products and solutions that

contribute to quality enhancement and cost efficiency within healthcare

and life sciences, now introduces Torin with AI in the United States. The

company also announced results from a landmark survey of hospital

executives and surgeons in the U.S. showing hospitals are taking steps

to speed up OR turnover times, hire new staff and require staff to work

longer hours to address backlogs.

“For almost 18 months during the COVID-19 pandemic, both surgeons

and patients made decisions to defer many forms of surgery if possible.

As more patients feel confident about considering surgery, demand

to schedule procedures at all types of hospitals and surgery centers

inge’s New Torin Artificial Intelligence Solution

has exploded in recent months,” says Eric Honroth, President, North

roves Hospital Efficiency

America at Getinge. “While hospitals can take steps to hire more people

and have staff work longer hours to address this backlog, they must

also look at the most effective technology options to improve scheduling

ntroduction Theatre of the Torin Practitioner, Artificial Intelligence Nisha recognised

(AI) functionality is efficiency designed and utilization to improve of resources.”

ency in managing

at prestigious

schedules for

healthcare

surgical procedures

awards

and comes Getinge’s the wake Torin software a new uses artificial intelligence technology that

ge survey. Among the participating hospitals 41% report significant quickly backlogs and seamlessly and only improve the speed and efficiency of

A Theatre Practitioner from George

scheduling surgical procedures. The Torin solution was launched in

ave implemented Eliot Hospital new NHS Trust digital has tools been that can improve proficiency 2020 in OR as a scheduling new resource and to help with the planning, management and

nt management.

named as a ‘rising star’ at a

optimization of surgical procedures. Today’s introduction of a new suite

prestigious national award ceremony.

of advanced functions for Torin, significantly expands capabilities in

ge, a leading Theatre global Operating provider Department of products and solutions that contribute key to areas quality including enhancement predicting surgery times, managing wait lists and

Practitioner (ODP) Harinder Grewal,

data security. The system can produce highly accurate assessments

ost efficiency within healthcare and life sciences, now introduces Torin

known as Nisha to her colleagues,

of surgical with AI procedure in the United timing based on a range of variables including

s. The company was given the also accolade announced of Rising results Star from a landmark survey of hospital surgery type, executives patient data, and relevant devices and staffing. To address

at the Advancing Healthcare Awards

scheduling backlogs, the software ranks pending procedures based on

ons in the U.S. showing hospitals are taking steps to speed up OR turnover times, hire new

at the virtual ceremony in London

clinical and resource parameters, proposes optimized pre-schedules

nd require recently. staff to work longer hours to address backlogs.

and integrates the process with existing scheduling functionalities.

Nisha was nominated by Theatre Manager, Paula Quinn for her excellent “The new capabilities now available with Torin are specifically designed

lmost 18 months during the COVID-19 pandemic, both surgeons and

leadership during the COVID crisis, by her overseeing the purchase of to patients help hospitals made and surgery centers address many areas that are

ions to defer equipment many which forms allows of surgery safer laparoscopic if possible. work As within more the patients colorectal feel major confident challenges, about including accurate assessments of surgery times,

cancer patients. Nisha has also undertaken shifts in the ITU department scheduling and wait list management, applications of mobile devices

dering surgery, demand to schedule procedures at all types of hospitals and surgery centers

to support the team there.

and data security requirements based on their specific pre-requisites,“

xploded in recent months,” says Eric Honroth, President, North America says at Charlotte Getinge. Enlund, “While Vice President Integrated Workflow Solutions

Paula said: “Nisha qualified as an ODP in 2016 and works within the

tals can at Getinge. She adds, “For long term acute care facilities, which our

Colerectal take steps Team. to hire She is more forward people thinking and have leads by staff example work to longer others. hours to address this

study found to be extraordinarily challenged by surgical backlog, we

og, they She must is well also respected look at the by most her peers effective and the technology wider multidisciplinary options to improve are happy scheduling

to offer support with Torin OptimalQ, our stand-alone tool, for

team.”

ncy and utilization of resources.”

quick relief in planning and optimizing the waiting list.”

ODPs provide high standards of skilled care and support during

Getinge Post-Pandemic Surgical Backlog Study

each phase of a patient’s care when they are having an operation –

ge’s Torin software uses artificial intelligence technology that can quickly

anaesthetic, surgical and recovery.

In May and 2021, seamlessly

Getinge conducted a survey of 60 senior executives and

ve the speed and efficiency of scheduling surgical procedures. The Torin surgeons solution from U.S. was hospitals to assess the extent and impact of surgical

This is the fourth year in a row that a member of George Eliot Hospital’s

backlogs that are developing as a result of the increase in patient

hed in 2020 ODP team as a has new scooped resource the award. to help with the planning, management and optimization of

demand as the U.S. emerges from the COVID-19 pandemic. Among

al procedures. The UK-wide Today’s Advancing introduction Healthcare of Awards, a new organised suite of by advanced Chamberlain functions the findings: for Torin,

icantly expands Dunn, now capabilities in their fifteenth in key year, areas recognise including and reward predicting projects surgery and

• times, 41% of managing hospitals report wait that they are experiencing a surgical backlog,

professionals that lead innovative healthcare practice and make a real

nd data with higher levels of delays reported in long-term acute care (60%)

difference security. to The patients’ system lives can in the produce healthcare highly science accurate and allied assessments health of surgical procedure

and outpatient surgery (53%) settings.

based professions. on a range of variables including surgery type, patient data, relevant devices and

• While 56% of hospitals report that they plan to hire more staff and

g. To address scheduling backlogs, the software ranks pending procedures 52% say based they plan on to clinical require staff to work more hours to address the

source parameters, proposes optimized pre-schedules and integrates backlog, the process fewer than with half (44%) report that they are using advanced

digital tools that have been widely shown to improve operating

g scheduling functionalities.

efficiencies and scheduling challenges in surgical settings, with the

lowest rate found in acute care settings (27%).

new capabilities now available with Torin are specifically designed to help hospitals and

• Hospitals with the longest scheduling delays were also the least

ry centers address many areas that are major challenges, including accurate likely to assessments use advanced digital of technologies to improve operational


efficiencies.

AB (publ)

1

othenburg

Email: media@getinge.com

www.getinge.com

“With thousands of patients facing delays in surgeries because of

the COVID-19 pandemic, the need to improve scheduling efficiencies

has never been more essential,” says Eric Honroth. “Advances in AI

technology can play a central Page 1 role in a comprehensive plan to address

these backlogs and can help to improve efficiency and lower costs for

hospitals and surgery centers.”

Watch a short film about the consequences for patients and medical

staff here - https://bit.ly/OTJGET


www.OperatinggTheatreJobs.com

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

View the latest vacancies online !

Theatre Practitioners Recovery Nurses Anaesthetic Nurses ODPs

Scrub Practitioners Nurse Practitioners Medical Representatives

and Clinical Advisers

83 AUDIT REPORT Waitematā District Health Board Annual Report 2018/19


Congratulations, you are now reading, the extended OTJ


Discovering the many more pages available online @ www.otjonline.com

Cherwell reaches custom cleanroom product development

milestone in its 50th year

Company establishes new role of Director of Quality and Technology to oversee development of custom products for specific

customer and market needs

Cherwell’s new Director of Quality and

Technology, Steven Brimble, will oversee

cleanroom microbiology product development

and continual improvement.

Cherwell Laboratories, specialists in

cleanroom microbiology solutions, announces

in its 50th anniversary year that it has

successfully developed in excess of 400

custom products.

These many new product developments are

in addition to Cherwell’s extensive portfolio

for environmental monitoring and sterilisation

process validation. In recognition of the

importance of bespoke product development

to Cherwell’s offering, the Company has

promoted Steven Brimble to the newly

created role of Director of Quality and

Technology, with a core focus on product

innovation and continual improvement.

Cherwell’s ability to respond to customer

needs and to successfully develop so many

new products, stems from its agile approach,

enabled by its in-depth industry knowledge,

flexibility, and long-standing expertise.

Due to his extensive experience and

understanding of quality in microbiology,

Steven is ideally placed to oversee Cherwell’s

continued development and production of

custom products.

He has worked for the past five years as

Cherwell’s Quality Manager, is a Practitioner

with the Chartered Quality Institute, and was

also formerly the National Quality Manager

for Public Health England (PHE) Food, Water

& Environmental Microbiology.

Cherwell’s broad product range enables its

customers to reduce risk during the aseptic

production of pharmaceuticals and other

related healthcare products. Examples of its

product innovations include: many different

culture media formulations and formats,

including broth in bags; bespoke packaging

solutions, such as gamma-irradiated media

with triple wrap barrier packaging; and the

Multi-SAS fixed microbial air sampling and SAS

isolator monitoring systems.

Cherwell has also created some media

products in kit formats, such as its operator

validation process kit; as well as cleanroom

accessories, including settle plate stands,

contact plate carriers and air sampler

tripods.

“Over the years we have intentionally focused

on our agile-manufacturing approach, so

that we continue to develop the necessary

solutions to ensure our customers meet and

surpass the requirements of increasingly

stringent GMP regulations,” said Andy

Whittard, MD, Cherwell Laboratories.

“We are delighted to announce Steven’s new

role as Director of Quality & Technology

which will enhance our ability to quickly

develop new products as required,

strengthening our position as the goto

supplier of cleanroom microbiology

solutions.”

Cherwell’s expert team is always available to

offer practical advice and solutions tailored

to meet individual customers’ specific

microbiological monitoring and validation

needs.

In addition to bespoke product solutions,

the Company also offers many standard

quality tools for the effective management

of controlled environments and processes.

These include the Redipor® prepared culture

media range, which includes agar plates,

bottled media, broth bags and ampoules,

vials and DIN bottles; plus, SAS microbial

air samplers, ImpactAir and ISO90 microbial

air monitors, and a variety of cleanroom

accessories.

For more information about Cherwell

Laboratories, please visit:

www.cherwell-labs.co.uk, follow @

CherwellLabs on Twitter or follow us on

LinkedIn



HCPC approves increase to SET 1 to degree level for

Operating Department Practitioners

On 1 July 2021 HCPC took a decision to increase the threshold level

of qualification to the Register (SET 1) for Operating Department

Practitioners (ODP) to degree level following our public consultation.

Our public consultation earlier this year showed support for the

increase and aligned with HCPC’s own goals of service user safety and

the advancement of the ODP profession.

What does this mean?

The first of the standards of education and training (‘SET 1’) sets out

the Hlevel of qualification required for entry to the Register for each of

the professions we regulate.

Our standards of education and training ensure that applicants to the

register can meet their standards of proficiency and practise safely and

effectively as soon as they are registered.

HCPC has taken the decision to increase this threshold. This means

that, from 2024, we will only approve ODP education programmes at

degree level. This decision will not affect currently registered ODPs, or

any ODP who completes a diploma level programme before 2024.

In England, Wales and Northern Ireland the level has increased

from Level 5 to Level 6 (using the Framework for Higher Education

Qualifications) while in Scotland the change will be from Level 8 to

Level 9/10 (using the Scottish Credit and Qualifications Framework).

Why did the HCPC make the change?

This change is not a new issue and was raised in a 2014 paper presented

to HCPC’s Education and Training Committee. The paper quoted the

Council of Deans of Health which argued that “the changes to ODP

practice, changes to the clinical environment and new expectations for

future roles suggest that there is a strong case to move the educational

threshold from DipHE to BSc (Hons) on the grounds of patient benefit.”

We had been monitoring the issue closely since then and a number of

stakeholders approached HCPC to highlight the increasing complexity

of ODP roles across the country – a trend which was accelerated by

COVID-19.

ealthcare Safety Investigations

The increase to SET 1 ensures that the education of ODPs is keeping

pace with the increasingly complex roles ODPs play in our health and

care system. This is a positive development for the profession and for

the

Conference

safe and effective treatment for service users.

• By: Communications team

• Posted on: 17 Jun 2021

Healthcare Safety Investigations

H

Conference

Date: 16 September 2021

Time: 10:00 – 15:30

REGISTER NOW

How does this impact existing registrants?

This a change which will affect future applicants and does not impact

existing registrants.

Regardless of the qualification you had when you entered the register,

you will be able to continue to practise and HCPC will not require you

to undertake additional training.

How does this impact existing students?

There will be no impact on existing students, even if you are on a

diploma programme. The vast majority of ODP programmes in the

UK are offered at degree level and therefore already meet the new

threshold. Diploma level programmes that are currently approved will

also still grant students eligibility to join the Register.

Changes to SET 1 will only affect to those who begin to study after 1

September 2024 – by this date we will only be approving degree level

programmes.

What happens next?

The process will be taken forward by HCPC’s Education Department.

We have developed an implementation plan which aims to make sure

that there is as little disruption as possible to the ODP workforce.

Key dates

• 2 July 2021: No new programmes below degree level can register

with the HCPC (this does not affect existing programmes).

• 2 July 2021 – 31 August 2024: HCPC assists education providers who

want to provide ODP programmes at degree level.

• 1 September 2024: Diploma level programmes are no longer approved.

• 1 September 2024: Students beginning an ODP course after this date

will have to complete a degree level course to enter the register

when they graduate. This does not affect ODPs who have already

completed their education before 2024 – who can still apply as

before.

What about Scotland?

Scottish students and employers have raised concerns because there is

only one ODP programme in the country and this is delivered at diploma

level.

HCPC has been working with colleagues from Scottish education

providers, NHS Education for Scotland (NES) and the Scottish

government since 2020 to ensure a smooth transition for Scotland. Our

timetable was designed with this goal in mind.

Matthew Clayton

Senior Policy Officer, Policy and Standards 02 Jul 2021

We would like you to join us for our second Conference Healthcare Safety

• By: Communications team

Investigations Conference this September.

• Posted on: 17 Jun 2021

We have an exciting programme lined Conference up. This year we will:

• share the learning from our investigations, and the positive

Time: 10:00 – 15:30

impact that recommendations have REGISTER been NOW having on healthcare

and patient safety across the country

• find out more about how we are teaching investigation science

• guide you through the principles which sit behind modern

healthcare safety investigations

• take a close look at safety management systems. How they’re

used in other organisations, and could they work in the NHS?

• focus on how together we can make maternity care safer

• share case studies and patient stories from across our

investigations.

Register now- https://bit.ly/OTJHSIB921

ealthcare Safety Investigations

Healthcare Safety Investigations

Date: 16 September 2021

By signing up you will receive occasional updates about the

conference in the run up to the event.

College of Operating Department Practitioners

join the CPOC Board

We are pleased to warmly welcome the CODP and Hannah Abbott to the CPOC Board.


Laughing gas has shown potential

as a treatment for depression

Nitrous oxide, also known as laughing gas, has shown promise as

a treatment for depression. When people inhaled a low dose as

part of a small study, their depression improved over the next

two weeks.

It has long been known that nitrous oxide can give a short boost

to mood as well as relieving pain – hence its original name of

laughing gas – but the effect is thought to wear off quickly.

Nitrous oxide is one of the most common anaesthetics, used

by hospitals, dental surgeries and paramedics, as well as being

available illegally in small capsules for recreational use.

The gas seems to chiefly affect the brain by blocking molecules

on nerve cells called N-methyl-D-aspartate (NMDA) receptors.

This is the same thing targeted by the stronger anaesthetic

ketamine, which also relieves depression; a similar chemical to

ketamine has recently been approved as a new intranasal spray

treatment.

It isn’t known how NMDA receptors change mood. But as the

antidepressant effects of ketamine started to emerge, Peter

Nagele, then an anaesthetist at Washington University School

of Medicine in St Louis, Missouri, wondered if nitrous oxide had

similar potential.

In 2014, he and his colleagues found that one hour’s inhalation

of nitrous oxide reduced symptoms for up to a day in people

with depression who hadn’t improved after trying standard

antidepressant medicines, but the study didn’t record whether

the effect lasted any longer.

Prolonged nitrous oxide use can can lead to nausea and

headaches. So, in the latest study, Nagele’s team looked at

24 people with treatment-resistant depression and gave them

half-dose nitrous oxide, a full dose or a placebo mixture of air

and oxygen. They were given one treatment a month for three

months.

After two weeks, depression symptoms for those with the halfdose

treatment had reduced by an average of five points on a

commonly used depression rating scale, compared with those

who had the placebo, which is a significant benefit. After the

full-dose treatment, depression symptoms reduced a little more,

although the difference was so small that it could have arisen by

chance. The half-dose group also had a much lower incidence of

side effects, such as nausea, headaches and light-headedness.

As with ketamine, nitrous oxide has the benefit of improving

mood quickly, says Nagele, who is now at the University of

Chicago in Illinois. “Something happens in the brain – it’s like

flipping a switch. But how this works, no one knows.”

Journal reference: Science Translational Medicine, DOI: 10.1126/

scitranslmed.abe1376

Source: New Scientist

GAS SYSTEMS SPECIALIST RESPONDS TO AFRICA’S

OXYGEN SHORTAGE WITH LIFE-SAVING SOLUTION

Many African countries are facing a growing crisis of severe oxygen shortages

which is leading to preventable deaths, according to a recent report from the

BBC. Whilst there are no official figures available, international health agencies

have sounded a warning. But global gas process systems specialist Oxair has

developed a simple solution to prevent hundreds of lives being lost in Africa – and

it has already been deployed and proven.

Oxair engineer David Cheeseman explains: “A number of African hospitals,

including the likes of Heal Africa in Goma, The Democratic Republic of the

Congo (DRC), are already saving lives with an off-the-shelf Oxygen Pressure

Swing Adsorption (PSA) system. These are high quality, robust medical devices

designed to last and deliver consistent, high purity oxygen on tap to hospitals and

healthcare facilities even in the remotest locations around the world.”

Medical facilities are often forced to rely on outsourcing this life-giving gas, with

failing supplies a potential catastrophe for hospitals, not to mention the problems

associated with storing, handling and removing traditional oxygen cylinders. The

situation is being exacerbated by the Covid-19 pandemic, with multiple remote

hospitals and care facilities in low-income countries struggling to source the

oxygen supplies they need.

PSA Oxygen offers better patient care with a permanent flow of high-quality

oxygen. In this case a plug and play system with output pressure of five bar and a

flow rate to suit the needs of the hospital, and capable of piping oxygen around

the hospital to every department as needed. Or, in cases where the hospital

does not have a central piping system, Oxair will supply an on-site cylinder filling

system. It’s a highly cost-effective and hygienic alternative to the inconvenience

and uncertainty of cylinder delivery.

David adds: “Oxair’s system delivers constant oxygen of 94-95 per cent purity

through PSA filtration, a unique process that separates oxygen from compressed

air. The gas is then conditioned and filtered before being stored in a buffer tank

to be used directly by the end user on demand. We can turn around orders for

ready-to-use, standalone Oxygen PSA units in just a few weeks, and we’ll happily

provide a charitable rate for organisations with a bona fide charitable status, to

supplement funding available from international finance sources.

“We are ready to step up supplies and prepared to do whatever is necessary to

help healthcare services during the current coronavirus crisis - and beyond -

by providing this life-saving oxygen equipment in Africa and wherever else it is

needed. The design of these PSA systems as ‘plug-and-play’ means that they are

literally ready to start working as soon as they are delivered and plugged in, with

voltage adapted to the country of delivery. So, hospitals can rely on technology

that is tried and tested over many years, coupled with almost instant access to

vital oxygen supplies.”

For further information on Oxair’s products and services visit: www.oxair.com.au

Sources: The BBC Report is at https://www.bbc.co.uk/news/world-africa-57501127

The Royal Marsden Adult

Palliative Care Virtual

Update

Explore new trends and ideas

surrounding palliative care issues

Wednesday 3 and Thursday 4 November 2021

Register: www.royalmarsden.nhs.uk/studydays



New Study Evaluates the Ability of Masimo SedLine® Brain Function Monitoring to

Predict Neurological Outcomes and Long-term Survival in Post-Cardiac Arrest ICU Patients

Researchers Found That the Combination of Two SedLine Parameters,

Patient State Index (PSi) and Suppression Ratio (SR), Had High

Predictability for Mortality 180 Days After Cardiac Arrest

Masimo announced recentty the findings of a study published in the

Journal of Critical Care in which Dr. Tae Youn Kim and colleagues at

the Dongguk University College of Medicine and Yonsei University

College of Medicine in Korea evaluated the ability of two parameters

provided by Masimo SedLine® brain function monitoring to predict

neurological outcomes and long-term survival in post-cardiac arrest

ICU patients. 1 The researchers found that the combination of the two

parameters, Patient State Index (PSi) and Suppression Ratio (SR), had

“high predictability” for mortality 180 days after cardiac arrest.

Noting that “accurate prognostication” in post-cardiac arrest patients

is important to determine treatment plans and “whether to continue

or withdraw intensive care,” and that a “multi-modal” approach is

recommended because “no single prognostic factor has been shown

to have higher prognostic accuracy than those of other factors,” the

researchers sought to evaluate the prognostic accuracy of the two

Masimo SedLine parameters as predictors of neurological outcomes,

both alone and in combination. The researchers chose PSi because,

as they note, raw EEG data can be “difficult to use” and PSi, which is

derived from EEG, is widely used in anesthesiology for determining the

degree of procedural sedation, “significantly co-varies with changes in

the state” under general anesthesia, and “can significantly predict”

the level of arousal in varying stages of anesthetic delivery. The

researchers chose SR because it helps to estimate the percentage of

EEG suppression and is therefore considered a good predictor of poor

neurologic outcomes. 2

They enrolled 103 adult patients between January 2017 and August

2020 who experienced a non-traumatic out-of-hospital cardiac arrest,

had been successfully resuscitated after CPR, and received targeted

temperature management during their ICU stay. PSi and SR were

continuously monitored using Masimo SedLine from immediately after

ICU admission until 24 hours after return of spontaneous circulation

(ROSC), recorded at one hour intervals. Neurological outcomes were

categorized using the Pittsburgh Brain Stem Score (PBSS) and Cerebral

Performance Category (CPC). Data on survival at 180 days was obtained

via telephonic interviews.

The researchers found that using either PSi or SR alone had “good

predictability” for poor neurological outcome, and that the combination

of low PSi and SR had “high predictability” for mortality 180 days after

cardiac arrest. They used receiver operating characteristic (ROC) curves

to determine that “a mean PSI ≤ 14.53 and mean SR > 36.6 showed high

diagnostic accuracy” as single prognostic factors for patients in their

study. Furthermore, “Multimodal prediction using the mean PSi and

mean SR showed the highest area-under-the-curve value of 0.965 (95%

confidence interval 0.909 – 0.991).” In the study cohort, patients with

mean PSi ≤ 14.53 and mean SR > 36.6 had “relatively higher long-term

mortality rates” (69% died in the group) than those of patients with

values > 14.53 and ≤ 36.6 (11% died in the group).

The researchers concluded that “PSi and SR are good predictors for

early neuro-prognostication in post-cardiac arrest patients.” They also

noted, “The combination of PSI and SR showed better predictability of

poor neurologic outcome than did each individual parameter.”

Masimo SedLine® Brain Function Monitoring

References

1. Kim TY, Hwang SO, Jung WJ, et al. Early neuroprognostication with the Patient State

Index and suppression ratio in post-cardiac arrest patients. J Crit Care. 2018. https://doi.

org/10.1016/j.jcrc.2020.06.003.

2. 2. Seder DB, Fraser GL, Robbins T, Libby L, Riker RR. The bispectral index and suppression

ratio are very early predictors of neurological outcome during therapeutic hypothermia

after cardiac arrest. Intensive Care Med 2010;36(2):281-8.

3. Published clinical studies on pulse oximetry and the benefits of Masimo SET® can be found

on our website at https://www.masimo.com. Comparative studies include independent

and objective studies which are comprised of abstracts presented at scientific meetings

and peer-reviewed journal articles.

4. Castillo A et al. Prevention of Retinopathy of Prematurity in Preterm Infants through

Changes in Clinical Practice and SpO2 Technology. Acta Paediatr. 2011 Feb;100(2):188-92.

5. de-Wahl Granelli A et al. Impact of pulse oximetry screening on the detection of duct

dependent congenital heart disease: a Swedish prospective screening study in 39,821

newborns. BMJ. 2009;Jan 8;338.

6. Taenzer A et al. Impact of pulse oximetry surveillance on rescue events and intensive care

unit transfers: a before-and-after concurrence study. Anesthesiology. 2010:112(2):282-287.

7. Taenzer A et al. Postoperative Monitoring – The Dartmouth Experience. Anesthesia Patient

Safety Foundation Newsletter. Spring-Summer 2012.

8. McGrath S et al. Surveillance Monitoring Management for General Care Units: Strategy,

Design, and Implementation. The Joint Commission Journal on Quality and Patient Safety.

2016 Jul;42(7):293-302.

9. McGrath S et al. Inpatient Respiratory Arrest Associated With Sedative and Analgesic

Medications: Impact of Continuous Monitoring on Patient Mortality and Severe Morbidity. J

Patient Saf. 2020 14 Mar. DOI: 10.1097/PTS.0000000000000696.

10. Estimate: Masimo data on file.

11. http://health.usnews.com/health-care/best-hospitals/articles/best-hospitals-honor-rolland-overview

The 14 th Royal Marsden

Opioid, Cannabinoid &

Gabapentinoids Conference

What’s new in the science of opioids?

Wednesday 25 and Thursday 26 November 2021




Discovering the many more pages available online @ www.otjonline.com

Queen Alexandra Hospital’s lengthy surgery waiting

lists could be cut with new anaesthesia roles

FOUR new anaesthesia specialists are set to help improve lengthy surgery waiting lists

at Queen Alexandra Hospital.

Anaesthesia associates are starting at the Cosham hospital in autumn, in a bid to boost

capacity on operating lists.

It comes as the waiting lists at Portsmouth Hospitals University NHS Trust had reached

their highest numbers since records began

NHS statistics show 36,653 patients were listed as waiting for elective operations or

treatment at PHU at the end of March this year - up from 35,948 at the end of February

and up from 33,802 in March 2020.

It was also the highest figure for the month of March since comparable records began

in 2012.

Anaesthesia associates were first introduced in the UK in 2005 and provide services

to patients requiring anaesthesia, respiratory care, cardiopulmonary resuscitation and

other life sustaining services – as well as deputising for anaesthetists where needed.

Lead anaesthesia associate Lisa Churchill was one of the practitioners who originally

came over from Switzerland in 2005 and has been seconded from Hywel Dda University

Health Board to help set up the programme at PHU.

She said: ‘It was really exciting to be a part of a two-year pilot with the aim of introducing

this unique role to the UK, which I have continued to do since. I have seen this role

expand since 2005, with over 200 anaesthesia associates up and down the country.

‘I am really passionate about this, so I am delighted to be here.’

The new associates at Queen Alexandra Hospital in Cosham will undertake a 27-month

distance learning course with Birmingham University.

Vaughan Lewis, medical director at NHS England and NHS Improvement South East,

added: ‘Hospitals across the South East have responded rapidly to Covid-19 and are

now increasing the number of operations performed to accelerate the restoration of

services.

‘The introduction of anaesthesia associates is one way to reduce operating theatre

downtime, leading to increased capacity on operating lists and improved theatre

utilisation – which means more patients’ can be seen, faster.’

QA Hospital is the first in the south east to use the associates.

Across England, the number of people waiting to start hospital treatment rose to 4.95

million in March this year – the highest total since records began in August 2007.

Source: The news Portsmouth Fiona Callingham

NewPace Selects Wireless

Power Market Leader Powermat

Technologies to Develop Advanced

Wireless Charging Technology for Innovative

Life-Saving Devices

Next-Generation Medical Device Designer, NewPace

Ltd., to Embed and Commercialize Powermat’s Wireless

Charging Solution for Advanced Healthcare Devices

Powermat Technologies, a leading global provider

of wireless power solutions for medical devices &

IoT (IoMT), today announced that NewPace Ltd., the

developer of advanced cardiac rhythm management

technology, will leverage the company’s patented

wireless charging technology which will be embedded

in their newest devices.

NewPace will license Powermat’s technology platform

for medical devices to wirelessly power the company’s

life-saving cardiac rhythm product, providing seamless,

sterile, and safe access to power.

Powermat’s wireless chargers for medical devices are

now available to support a wide variety of devices,

including neurostimulators, insulin pumps, sensors,

and remote healthcare monitoring devices, providing

safe, efficient, and easy-to-use power solutions. The

company’s sophisticated yet straightforward approach

to providing wireless power for patients’ healthcare

devices was designed to simplify patient care and

reduce the need for hospital and clinic visits. By

integrating wireless charging technology, battery size

in existing devices may be reduced, decreasing weight

and offering a more comfortable charging experience

for patients.

“Medical devices and IoMT are a great fit for Powermat’s

technology. Patients need a non-invasive charging

solution for their critical care medical devices and

emergency equipment that keeps their good health

at bay,” said Elad Dubzinski, CEO of Powermat.

“Powermat’s technology will now enable the users of

NewPace’s medical devices a safe, fast, and convenient

wireless charging solution. We can’t wait to continue

working with our partners to make wireless power a

standard feature for medical devices and implantables.”

SOURCE Powermat.com


Cell-type-specific insight into the function

of risk factors in coronary artery disease

Using single cell technology, a new study sheds light on the significance of genetic risk factors for, and the diversity of cells involved in, the

development of coronary artery disease. The researchers analysed human atherosclerotic lesions to map the chromatin accessibility of more

than 7,000 cells. The chromatin accessibility is known to reflect active regions and genes in the genome. The findings were published in

Circulation Research.

Genome-wide association studies of the human genome have identified over 200 loci associated with coronary artery disease. More than 90% of

them are located outside protein-coding genes, in so called cis-regulatory elements, whose significance in the pathogenesis of coronary artery

disease remains unclear.

Previous research has demonstrated that the development of coronary artery disease involves a variety of different cells and their subtypes.

The now-published study is the first to use single cell technology to map epigenetic changes in these cells. The researchers used the ATACseq

sequencing method to discover the nuclear chromatin structure of endothelial cells and smooth muscle cells, as well as immune system

monocytes, macrophages, NK/T and B cells, providing a unique resource to study the cell-type specific activity of the cis-regulatory elements in

the disease affected vessel wall.

The study demonstrated that genetic risk variants associated with coronary artery disease are particularly enriched in cis-regulatory

elements specific to endothelial and smooth muscle cells, indicating that these cells play a significant role in transmitting susceptibility to the

disease. Based on chromatin accessibility mapping and gene expression data, the researchers were able to identify putative target genes for

approximately 30% of all known loci associated with coronary artery disease. In addition, the researchers performed genome-wide experimental

fine-mapping of the variants, allowing them to identify potential causal single-nucleotide polymorphisms and the associated target gene for over

30 loci that have been linked to coronary artery disease.

The study also presented a number of examples of how the chromatin accessibility and gene expression data can be used to predict target

cells via which the function of the genetic changes associated with the disease is transmitted in the tissue. This is a significant step forward

that helps to understand the real functional significance of risk variants in the pathophysiology of coronary artery disease. In the future, this

information can be used to develop more effective, safer and more individualised treatments for coronary artery disease.

The study was conducted in the Cardiovascular Genomics laboratory led by Associate Professor Minna Kaikkonen-Määttä at the University of

Eastern Finland, in close collaboration with the research groups of Tapio Lönnberg (University of Turku), Seppo Ylä-Herttuala (University of

Eastern Finland), Mete Civelek (University of Virginia), and Casey Romanoski (University of Arizona).The study was funded by the European

Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Grant No. 802825), the Academy of

Finland, the Sigrid Jusélius Foundation, the American Heart Association, and the US National Institutes of Health.

https://uefconnect.uef.fi/en/group/cardiovascular-genomics-kaikkonen-lab/

https://sites.uef.fi/cardiovasculargenomics/

Research article:

Örd T, Õunap K, Stolze L, Aherrahrou R, Nurminen V, Selvarajan I, Toropainen A, Lönnberg T, Aavik E, Yla-Herttuala S, Civelek M, Romanoski

CE, Kaikkonen MU. Single-Cell Epigenomics and Functional Fine-Mapping of Atherosclerosis GWAS Loci. Circ Res. 2021 May 24. doi: 10.1161/

CIRCRESAHA.121.318971. Epub ahead of print. PMID: 34024118.

https://pubmed.ncbi.nlm.nih.gov/34024118/

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Anniversary celebration of

Ultimax-i digital C-arm system

The Royal Oldham Hospital praises image quality & equipment service

support

The Royal Oldham Hospital, Greater Manchester, is celebrating the first

anniversary of its Ultimax-i ‘three-in-one’ angiography, fluoroscopy and

radiology system from Canon Medical Systems UK.

Reflecting on its first year of service, Helena Hill, Interventional

Radiology and Fluoroscopy Manager at The Pennine Acute Hospitals

NHS Trust states, “The Ultimax-i has given us a flexible resource to

manage Musculoskeletal (MSK) and upper gastrointestinal (GI) work.

Our endoscopy staff and speech therapists feel it has changed the way

they work with brilliant image quality and the multi-directional digital

C-arm.”

“The quality of service and applications support we receive from Canon

Medical is amazingly reliable – everyone is so friendly and helpful. If

we need an engineer to support, one comes out straight away which

gives total peace of mind that they were the right choice of provider

and remain committed to our equipment long after the procurement

process has ended. We look forward to many more years of working in

imaging partnership,” she continues.

The Ultimax-i is a multi-directional, interactive digital C-arm requiring

minimal space requirements. It is also a multi-purpose system designed

for ultimate clinical flexibility to meet the needs of DR, angiography

and fluoroscopy.

Daniel Parr, Interventional X-ray & HIT Modality Manager at Canon

Medical states, “The Ultimax-i answers the need for improving

efficiency in healthcare imaging by providing a single, multi-purpose

system that can provide simple radiography procedures, full head-totoe

coverage and angio-lab capabilities at low dose. We’re delighted to

hear from The Royal Oldham Hospital that our product innovation and

NHS imaging service support still meets the grade, a year on.”

“Ultimax” and “Made for Life” are trademarks of Canon Medical

Systems Corporation.

Helena Hill, Interventional Radiology and Fluoroscopy Manager at The

Pennine Acute Hospitals NHS Trust reflects on the first year of service of the

Ultimax-i at The Royal Oldham Hospital.

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Researchers reduce severity of sleep

apnoea by at least 30 per cent

New research published in The Journal of Physiology shows that

researchers have successfully repurposed two existing medications to

reduce the severity of sleep apnoea in people by at least 30 per cent.

Affecting around 1.5 million adults in the UK, sleep apnoea is a condition

where the upper airway from the back of the nose to the throat closes

repetitively during sleep, restricting oxygen intake and causing people

to wake as often as 100 times or more per hour (1).

Those with untreated sleep apnoea are more likely to develop

cardiovascular disease, dementia and depression, and are two to four

times more likely to crash a car than the general population (2).

Despite almost thirty years of research, there are no approved drug

therapies to treat the condition.

Professor Danny Eckert, Principal Research Scientist at NeuRA and

Professor and Director of Adelaide Institute for Sleep Health at Flinders

University, has brought scientists one step closer by repurposing two

existing medications to test their efficacy in people in sleep apnoea.

Previous research showed two classes of medication, reboxetine and

butylbromide, were able to keep muscles active during sleep in people

without sleep apnoea, and assist their ability to breathe.

By repurposing the medications, researchers used a multitude of

recording instruments to measure whether reboxetine and butylbromide

could successfully target the main causes of sleep apnoea.

This included balancing the electrical activity of muscles around

the airway, preventing the throat from collapsing while people were

sleeping, and improving the regulation of carbon dioxide and breathing

during sleep.

Results from the study showed these medications did in fact increase

the muscle activity around participants’ airways, with the drugs

reducing the severity of participants’ sleep apnoea by up to one third.

Almost everyone we studied had some improvement in sleep apnoea.

People’s oxygen intake improved, their number of breathing stoppages

was a third or more less.

These new findings allow researchers to further refine these types

of medications so that they have even greater benefit than what has

currently been found.

Commenting on the study, Professor Eckert said: “We were thrilled

because the current treatment options for people with sleep apnoea

are limited and can be a painful journey for many,” he said. Next, we

will look at the effects of these and similar medications over the longer

term. We will assess whether we can harness the benefits of one drug

without needing to use them both.”

“Equally, we will test whether these treatments can be combined with

other existing medications to see if we can improve their efficacy even

more,” he continued.

Until now, the main therapy for sleep apnoea involves wearing a mask

to bed, or Continuous Positive Airway Pressure Therapy (CPAP), which

benefits millions. However, many people find it uncomfortable and half

the people that try it find it hard to tolerate.

Plus, the efficacy of second line therapies, such as mouthguards fitted

by dentists, can be unpredictable and expensive.

This study was funded by the National Health and Medical Research

Council of Australia

1. https://www.blf.org.uk/support-for-you/obstructive-sleep-apnoeaosa/health-care-professionals/health-economics-report

2. Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The

association between sleep apnea and the risk of traffic accidents.

Cooperative Group Burgos-Santander. N Engl J Med. 1999; 340 (11):

847-851

3. Full paper title: Link to paper https://physoc.onlinelibrary.wiley.

com/doi/abs/10.1113/JP281912

4. The Journal of Physiology publishes advances in physiology which

increase our understanding of how our bodies function in health and

disease. http://jp.physoc.org

5. The Physiological Society brings together over 4,000 scientists from

over 60 countries. The Society promotes physiology with the public

and parliament alike. It supports physiologists by organising worldclass

conferences and offering grants for research and also publishes

the latest developments in the field in its three leading scientific

journals, The Journal of Physiology, Experimental Physiology and

Physiological Reports. www.physoc.org


The London Clinic chooses Hyland Healthcare

to manage unstructured clinical content and to

deliver a complete image-enabled patient record

One of UK’s largest independent hospitals selects OnBase Medical Records

to manage content and meet clinical and operational needs

The London Clinic, the UK’s largest independent charitable hospital, has

selected OnBase, Hyland’s enterprise information platform, to digitise and

manage clinical and back office documents, complementing its existing

Acuo Vendor Neutral Archive. The platform will optimise workflows and

performance across the organisation, delivering content to clinicians and

staff by integrating with its existing Meditech electronic patient record

(EPR) and other core clinical software applications to improve medical data

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With over 1,000 staff, 600 consultants and 234 beds, The London Clinic

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London.

Already an existing customer benefiting from Hyland’s enterprise imaging

solutions, The London Clinic will work with leading IT services and

solutions partner Arkphire to leverage OnBase across the organisation. The

enterprise-wide strategy will allow the health system to realise the full

benefits of Hyland’s content services and enterprise imaging solutions to

better connect and improve business processes across all departments and

specialties.

Since 1932, The London Clinic has been providing patients with the highest

standards of treatment. The guiding principle of The London Clinic has

always been to deliver exceptional patient care. This was the focus in 1932

when The London Clinic first opened, and it has remained the ethos it has

followed for nearly 90 years.

James Maunder, chief information officer at The London Clinic, said:

“We have a long-standing relationship with Hyland and value the team’s

commitment to delivering cost-effective solutions that add real value to

our hospital. OnBase is at the very heart of our journey to a paper-free

and digitally-transformed organisation and we welcome the opportunity to

develop this partnership further.”

‘’We are excited to be a part of this transformational project at The London

Clinic. Patients will see a significant difference in the quality of interaction

and information available to them,’’ added Haroon Iqbal, Hyland’s

EMEA healthcare account manager. ‘’By connecting all departments

and specialties, healthcare staff and patients will have secure access to

information, such as medical records and consent forms, from anywhere –

including mobile devices. There aren’t many private health care facilities

in the UK where such depth of patient insight is available, and we know

from other markets that these are aspects valued by patients and clinicians

alike.’’

For more information about the benefits of implementing content services

and enterprise imaging solutions to improve clinical information access and

management, visit Hyland.com/Healthcare.

PANASONIC 4K-4MOS CAMERA

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The much higher sensor performance of the 4K-4MOS camera delivers 4K

resolution that is four times greater than Full HD for more detailed images

during medical procedures and surgery. OEM manufacturers can integrate

the camera into their solutions to provide medical professionals with

microscopy or endoscopy devices with a whole new level of visual quality.

The 4K-4MOS camera solution can be used for surgical procedures in various

medical areas such as the lymphatic system, monitoring blood circulation

and for cancer cell detection. By utilising ICG/fluorescence fluid in the

patient’s body, the camera can be used in surgical procedures to visualise

images on a 4K monitor, such as areas affected by a tumor. The 4K 4MOS

camera supports the physician with superimposed RGB and IR real-time

images (60fps) in ultra-high resolution 4K quality and without any frame

rate loss. Picture-in-picture (PiP) display is also an option.

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delicate procedures, where the visualisation of details sometimes invisible

to the naked eye can be crucial. As a result of these early project-based

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For more information about the 4K-4MOS camera visit: https://business.

panasonic.co.uk/professional-camera/panasonic-4k-4mos-technology

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Blood flows are more turbulent than

previously suspected

The physicist Björn Hof and his research group are investigating how

turbulence forms in pulsating blood flows. In the process, they came

across a previously overlooked type of turbulence that could also be

present in veins in the human body.

In large human blood vessels, such as the aorta, turbulence may occur

as is known from the aerodynamics of aeroplanes and cars. While this

is a well-known phenomenon in medicine, the exact processes are still

poorly understood, although they have a bearing on various aspects of

health. In a project funded by the Austrian Science Fund FWF, a team

led by principal investigator Björn Hof is now exploring in greater detail

what type of turbulence can occur in pulsating flows such as blood flow.

In the process, they discovered a new type of turbulent flow that can

also occur in smaller blood vessels.

The fact that turbulence in blood has been little studied so far can

be explained by the fact that this chaotic form of flow is one of the

most complex phenomena in physics. Because turbulence has a great

influence on the flow resistance of gases and liquids, understanding it

is important for many technical applications, for example in aviation or

the construction of pipelines. Chaotic flows also occur in simple pipes

or hoses, but whether this actually happens depends on a number of

factors, such as the diameter of the pipe and the viscosity of the fluid.

“In the aorta, the largest blood vessel in the human body, the velocities

are high enough for turbulence to develop, just as it would in a garden

hose or a water pipe,” Hof explains, and he also notes that this is a fact

known in medicine. Blood does not move around steadily in the human

body, however, but flows in spurts induced by the pumping motion of

the heart. There are more exotic types of instability and turbulence

specifically associated with pulsating flows, which could also form in

smaller blood vessels. Hof has now succeeded in demonstrating such a

phenomenon in the context of an FWF-funded project at the Institute

of Science and Technology Austria which will run until 2022.

Unstable during braking

In order to demonstrate this phenomenon, Hof’s team conducted flow

experiments with water in pipes. Tiny reflective particles were added

to the water to make the currents visible and to be able to analyse

them with cameras. The research team did not pump the water evenly

through the pipe, but in a pulsating rhythm. It turned out that at small

points of disturbance such as bends or branches rotating, helical flows

occur which were previously unknown in blood vessels. “The particular

feature of the instability we found is that it occurs during deceleration

and disappears again during acceleration,” Hof explains.

Flow experiments with blood

The proof of the new effect was achieved with water, but Hof’s research

group was not content with that. “Blood is much more complex. It

consists of 40 percent red blood cells, which have a great influence

on the properties of the liquid,” Hof explains. The experiments

were therefore repeated with pig’s blood. In this case, detecting the

turbulence was more difficult because blood is not transparent. But

by measuring pressure distributions at the edge of the liquid, the

researchers were able to detect the new form of flow also in blood.

“This result convinced us that the new instability can actually occur in

human blood vessels. It differs significantly from well-known turbulence

as found in garden hoses or pipelines,” Hof notes.

The team’s result is of medical interest because turbulence leads to

shear stress on the vessel walls, where it can cause inflammation and

subsequently thrombosis. In addition, perturbations in blood vessels

trigger turbulence in the first place, which makes this a chicken-andegg

problem, as Hof explains. In further studies, Hof and his team

now want to look at how turbulent flows affect the epithelium, the

innermost cell layer of blood vessels.

Difficult experiments

In his work, Hof relies mainly on experiments. While pipes in particular

can be simulated very efficiently on the computer, simulating realistic

situations is more complex and thus significantly more expensive.

Pulsating flows as they are found in blood vessels can create turbulence and

damage vessels. A team of researchers has now succeeded in the extremely

difficult undertaking of furnishing evidence of such a phenomenon.

“In real blood vessels there are complex fluid properties, elastic walls

that expand and contract,” Hof notes, listing the challenges. And the

trials with real blood also revealed the limits of the experiment, he

says: “You can’t simulate the entire complexity of the flow in such

cases, and the experiments also become much more difficult.” With

the measuring methods available, it is not possible to look inside the

blood, but only to observe individual blood cells at the edges. While it

has proved possible to indirectly detect the turbulence seen in water

also in blood, Hof has to concede: “There are many things that we

unfortunately don’t yet know, and we hope to draw the right conclusions

from the combination of model calculations and experiments.” The

project has been running since 2019 and is designed to last three years.

It is being conducted in collaboration with partners from Germany and

Switzerland. Hof, who initiated the project with the German partners,

is the principal investigator of the Austrian team.

Why there isn’t more turbulence

After the discovery of the new helical turbulence, there is still one

puzzling aspect that keeps Hof’s team busy: vessels like the aorta are

actually large enough also to allow the conventional kind of turbulence

that occurs not only in pulsating flows. Why this does not seem to

happen to the extent one would expect at the prevailing velocities

is still unclear. “We want to investigate whether the waveform

of pulsatile velocity makes it more likely or less likely for normal

turbulence to occur in large blood vessels,” Hof announces. The team

already has new results on this issue, which Hof is currently preparing

for publication. He hopes that these findings could prove useful for

technical applications, for example to reduce turbulence, and thus

friction, in pipes.

Personal details

Björn Hof is professor and head of the Nonlinear Dynamics and

Turbulence Group at the Institute for Science and Technology Austria

(IST Austria) in Klosterneuburg near Vienna. The physicist is interested

in the emergence of turbulent flows and in self-organisation. The

international research project “Instabilities in pulsating pipe flow in

complex fluids” is co-funded by the Austrian Science Fund FWF to the

amount of EUR 356,000 and runs until the end of 2022.

Publication

Credit: Wikimedia

Duo Xu, Atul Varshney, Xingyu Ma, Baofang Song, Michael Riedl, Marc

Avila, Björn Hof: Nonlinear hydrodynamic instability and turbulence in

pulsatile flow, in: PNAS, May 2020

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The Operating Theatre Journal July 2021

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