The impact ofpurchasing

co-operativesThe proportion of hospital turnoverlinked to purchasing co-operatives willrise from the present 45% to 90% in2010, according to the study FutureRelevance and Consequences ofHospital Purchasing Cooperatives forMedical Technology Suppliers inGermany, commissioned by the Germanmedical technology association BVMedfrom the consultancy firm SimonKucher & Partners.

‘The bundling together of hospitals’purchasing power is resulting in contin-uous pressure on prices, which presentsnew challenges for the sales and mar-keting activities of medical devicesmanufacturers,’ BVMed reports.‘Between 2002 and 2005 the net pricesof medical devices in hospitals fell by anaverage 10%.’

Drawing attention to the ‘responsi-bility for prices’ of the entire medicaltechnology sector, the consultants saidcompetition should concentrate on theproduct and service elements and noton prices. Companies, they predicted,would be influenced in the future by‘large, commercially experienced andauthoritative purchasing co-operativesand competition-oriented individualhouses’. www.bvmed.de/publikationen/Studien/?language=2

7Management

Experts discussaccreditation,

certification,quality andperformance

measures

EUROPEAN HOSPITAL

News . . . . . . . . . . . . . . . . 1-3Management . . . . . . . . .4-7Radiology . . . . . . . . . . . . . .8Surgery, Cardiology Intensive Care . . . . . . . .9-13IT & telemedicine . . . . . .14Hygiene . . . . . . . . . . . . . . .15Lab & Pharma . . . . . . . . . .16Publications . . . . . . . . . . . .17Innovations . . . . . . . . . . . .18Awards . . . . . . . . . . . . . . .19

contents

18Innovations

Therevolutionarydelivery bed,

automateddelivery vehicle

& space research

9-13Surgery

Shockwaves,super patient

transport, plusanaesthesiology,

cardiology,transplants

At the Vascular andEndovascular Issues,Techniques and Horizons(VEITH) Symposium) in

November, attended by key opin-ion leaders in the field of vascularsurgery, physicians remained divid-ed on the issue of stroke preven-tion with carotid stent placementin patients with carotid artery dis-ease. Most experts agree that moreinformation is needed regardingstents, particularly for those withasymptomatic disease.

Kenneth Ouriel MD, of theCleveland Clinic, Ohio, an avidproponent of stenting who wasinvolved in the pivotal SAPPHIREtrial, sees a ‘big future’ for carotidstenting. ‘All the trends look infavour of stenting,’ he said in aninterview.

The SAPPHIRE trial, a ran-

domised study comparing stentingto surgery in symptomatic patientswith over 70% occlusion of thecarotid artery, paved the way forFDA-approval and reimbursementthis year. However, it has been thesubject of much debate, and thevalue of the study has come underheavy scrutiny by many opponentsin the field of vascular surgery,who have performed the surgicalprocedure to remove plaque formany years with a very low risk ofcomplications.

Carotid stenting is rapidlybecoming a high-volume operationin the United States, hastened onby device-manufacturers promul-gating it as a minimally invasiveprocedure. Frank J Veith MD, hostof the symposium and ViceChairman at the department ofcontinued on page 2

Cervicalcancer vaccine -

soon?USA - Cervical cancer, caused byHuman Papilloma Viruses (HPV), mightbecome the first cancer type to be pre-vented by a vaccine.

The results of a clinical study of avaccine named Gardasil, involving12,000 women from 13 countries,were presented at the Annual Meetingof The Infectious Diseases Society ofAmerica, held in San Francisco thisOctober.

Gardasil is still under development,but was said to work against the mostwidespread kinds of the viruses HPV16and HPV 18 - responsible for about70% of all cervical carcinomas - byinhibiting the preliminary stages andearly forms of this disease.

After breast cancer, the cervical car-cinoma comes second as the cause ofdeath from cancer in women inEurope. 33,000 new illnesses andaround 15,000 deaths are registeredannually. Report: Holger Zorn

Dental treatment has decreased inmany areas where dental serviceshave suffered health service cut-backs, but this, in turn, this coulddent healthcare budgets in a biggerway.

In the December issue of theJournal of Lipid Research,researchers at the VirginiaCommonwealth University (VCU)reported finding that patients withgeneralised aggressive periodonti-tis generally had elevated plasmalevels of a particularly bad subclassof the low density lipoprotein(LDL) called small-dense LDL.Severe periodontitis is charac-terised by chronic infection andinflammation of the gums - andthis may contribute to thesepatients’ elevated risk for heart dis-ease and stroke. The researcherssuggest that it may be beneficial totest periodontitis patients forchanges in their plasma lipoproteinprofiles, so that available medica-tion can be taken if necessary.

15Wounds & Hygiene

New hygienicwound

trackingdevice, plus

nanotech paintcombats MRSA

V O L 1 4 I S S U E 6 / 0 5 D E C E M B E R 2 0 0 5

New link between gumand cardiovascular diseases

‘Previous research has shownthat people who have predominant-ly small-dense LDL in their bloodare at a three- to six-fold increasedrisk of heart disease and stroke,’said lead author Rik vanAntwerpen PhD, an assistant pro-fessor of biochemistry at VCU. ‘Aperson may have predominantlysmall-dense LDL without havingalarmingly high blood levels of cho-lesterol. Therefore, unhealthy levelsof small-dense LDL are not alwaysdetected in regular cholesteroltests.’

According to the study, a secondfactor influencing the cardiovascu-lar risk of patients with severe peri-odontitis may be platelet activatingfactor acetylhydrolase (PAF-AH),an enzyme that is associated withsmall-dense LDL. PAF-AH is ableto break down some of the inflam-matory, atherogenic components ofLDL. Dr Van Antwerpen said thatthe enzyme may lower the athero-continued on page 2

CAROTID STENTING:‘A FEEDING FRENZY’

Dr Frank J Veith

Vascular expertsurge cautionover stentplacement toprevent strokeKaren Dente reportsfrom New York

T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K

ECR2006E U R O P E A N C O N G R E S S O F R A D I O L O G Y

March 3-7

Vienna, Austria

Registration online until February 10, 2006 at www.ecr.org

the art of scienceT H E S U P R E M E M E E T I N G I N E U R O P E

:: 15,000 participants from 91countries :: CME accreditation ::270 scientific and educationalsessions :: 1,500 oral scientificpresentations :: 1,000 electronicposter presentations in EPOS™ ::More than 200 companies on 25,000 m² ::

2 EUROPEAN HOSPITAL Vol 14 Issue 6/05

N E W S

surgery at the Albert EinsteinCollege of Medicine, describes itas ‘...a feeding frenzy’.

The fact that carotid stenting isgenerally perceived to be a lesserprocedure than surgery raises thefear of implementation of wide-spread stenting - even in asympto-matic patients who may not be athigh enough risk to justify treat-ment. Dr Veith shares the belief,along with other surgeons, thatsymptomatic patients should betreated, but that caution is war-ranted in implementing a stentdevice in asymptomatic patients. ‘I don’t know if I would go againstlevel 1 evidence. Level 1 evidenceis pretty strong,’ he stated in aninterview.

‘If you leave patients with a lowrisk for stroke alone, then the riskof getting a stroke per year isabout 1.5%, which is low,’ saidPeter R F Bell MD, a vascular sur-geon at the Leicester RoyalInfirmary in the United Kingdom,and leading opponent to the SAP-PHIRE trial. In Europe there is thetendency not to operate on lowrisk patients, while in the US, his-torically, such patients have beenoperated on, he explained. ‘A 3%risk for stroke and death has beenestablished as the acceptable rateof complications associated withsurgical treatment,’ he pointed out,referring to results from the recentEuropean ACST trial. ‘There hasnever been a good study showingthat carotid stenting reduces strokerate to that level,’ Dr Veith added.

The industry’s apparent push toreplace it by a procedure thatremains yet to be proven inprospective, randomised trials, hasmany stroke experts alarmed, par-ticularly since the procedure is notwithout inherent risks, such asembolisation to the brain, a com-plication affecting up to 80% ofpatients.

In a scathing rebuttal to DrOuriel’s defence of SAPPHIRE at

the symposium, Dr Bell contendedthat SAPPHIRE was industry-funded and its investigators lack-ing in equipoise-’It is just not thetrial on which you should base awhole trend of treatment, which iswhat they are suggesting.’

A recent Cochrane systematicreview found insufficient evidenceto support widespread change inclinical practice away from recom-mending carotid endarterectomyas the treatment of choice for suit-able carotid artery stenosis. ‘It isethical and necessary that ran-domised trials comparing endovas-cular treatment with surgery con-tinue to recruit patients,’ authorsconcluded.

Well, what about the patient?The patient foremost needs tounderstand and become knowl-edgeable about the risks and bene-fits related to both stenting andsurgery, which will hopefullyemerge with greater clarity asmore data is revealed from ongo-ing trials.

ACST and ACAS trials cut the5-year stroke risk in half with verylow peri-operative morbidity.These trials showed that you cantreat asymptomatic disease with astroke and death rate of around 2-3%. ‘That’s the ball park,’ saidPeter A Schneider, ManagingDirector of the Hawaii PermanenteMedical Group, speaking at thesymposium. ‘You’ve got to be inthe ball park to have somethingthat I think will be of value to thepatient.’

In the end, it all depends onhow the risks and benefits arephrased by the doctor to thepatient. ‘If you tell them, look, I have something that is going towork 95 percent of the time,they’ll say they want it. And thatcan be a stent at this point. It hasthat kind of success rate,’ PeterSchneider explained. ‘But if, onthe other hand, you say you canhave a stent, but the risk of strokeor death is going to be twice ashigh, they’ll say ‘I’d rather havethe surgery’. So it all depends onhow you present the data to them.’

Stenting proponent Dr Ourielacknowledges that SAPPHIRE didnot show superiority of stentingover surgery, but ‘did show non-inferiority.’ He stated in an inter-view, ‘...it doesn’t show we should-n’t be choosing endarterectomy inthese [high risk] patients, but itdoes say we should consider stent-ing and we certainly should beoffering that to the patients as aviable option. I personally try togive my patients that data andmost of them will pick stenting -almost all - will pick stenting overendarterectomy.’

continued from page 1

22nd Annual KoreaInternationalMedical & HospitalEquipment Show -16-19 March 2006 - will draw 1,000 medical equipmentcompanies and over 65,000 visitors from 35 nations to theCOEX exhibition Centre in Seoul

This annual event, first held 26 years ago, has contributed to the expansionof medical-equipment exports and imports. Concurrent with the show,medical conferences and seminars will be held at the COEX conferencecentre to promote the exchange of new medical-related information andtechnologies.

In addition, the organizer Korea E & EX, Inc. received the officialmembership status from UFI - The Global Association of the ExhibitionIndustry, in the category of trade fair/exhibition organizers and KIMES wasgiven the status of ‘UFI approved events’. The organiser was also selected bythe Ministry of Commerce, Industry and Energy to develop this exhibition toan international competitive brand exhibition. Only nine exhibitions werechosen from all industries and KIMES is the only one of its kind for themedical related industry.

This year, the show will occupyaround 28,746m2 of exhibition space,in three exhibition halls, where over25,000 products will be on show in1,500 medical categories, includingdiagnostic and treatment equipment(including those for Oriental medicine)

as well as IT solutions for healthcare. Show and education details:

www.kimes.info

KIMES 2006genic effects of LDL, and that theobserved decrease of LDL-associatedPAF-AH activity in patients withsevere periodontitis may increase thecardiovascular risk of these patients.

The study involved only 12patients with generalised aggressiveperiodontitis and 12 control subjectswithout periodontal disease.Currently, Dr van Antwerpen and hiscolleagues are evaluating a greaternumber of patients with varyingdegrees of periodontal infection andinflammation, as they work towardsestablishing testing guidelines forperiodontitis patients.

In the research, supported bygrants from the National Institutes ofHealth, Dr Van Antwerpen collabo-rated with Harvey A Schenkein PhD,Director of the Clinical ResearchCentre for Periodontal Diseases, andchair of the Department ofPeriodontics, VCU School ofDentistry. And, at the VCU School ofMedicine: Suzanne E Barbour PhD,associate professor in theDepartment of Biochemistry, andJohn G Tew PhD, professor in theDepartment of Microbiology andImmunology. Experiments were con-ducted by Miguel Rufail, a graduatestudent in the VCU Department ofBiochemistry.Source: Virginia CommonwealthUniversity

NEW LINK BETWEEN GUM ANDCARDIOVASCULAR DISEASEScontinued from page 1

Most experts at the symposiumagreed that patient selection forintervention remains crucial, sinceinappropriate selection of patientsor poor surgery could obviate anybenefits.

The potential problem of over-treatment looms large. ‘Invasivetreatment should not be givenwhere it causes more trouble thanit’s worth,’ Dr Bell said.

Invoking the conscience of physi-cians and their professional ethos,and in a critique of the SAPPHIREtrial, Dr Bell declared at the sympo-sium, ‘It is our duty as physicians toprotect our patients from these risksand do a proper trial that actuallytells us what’s the right thing to do.The only person who actually isresponsible for what happens to thepatient is you, the doctor. Theindustry doesn’t care, the govern-ment doesn’t care - nobody caresapart from the doctor.’

Dr Peter Bell

EH-ECR 1/05

ENTRY COUPONFAX TO: EUROPEAN HOSPITAL, +49-211-7357-530DO YOU WISH TO RECEIVE OR CONTINUE TO RECEIVE EUROPEAN HOSPITAL � YES � NO

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Job title

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Address

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Phone number Fax

Now, tell us more about your work, so that we can plan future publications with your needs in mind.Please put a cross ✘ in the relevant boxes.

1. SPECIFY THE TYPE OF INSTITUTION IN WHICH YOU WORK

� General hospital � Outpatient clinic � University hospital

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2.YOUR JOB

� Director of administration � Chief medical director � Technical director

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� Up to 150 � 151-500 � 501-1000 � more than 1000 � None, (not a hospital/clinic)

4 . WHAT SUBJECTS INTEREST YOU IN YOUR WORK?� Surgical innovations/surgical equipment � Radiology, imaging/high tech advances� Clinical research/treatments/equipment � Intensive Care Units/

management/equipment� Ambulance and rescue equipment � Pharmaceutical news � Physiotherapy updates/equipment � Speech therapy/aids� Nursing: new aids/techniques � Laboratory equipment, refrigeration, etc.� Hospital furnishings: beds, lights, etc. � Hospital clothing and protective wear� Hygiene & sterilisation � Nutrition and kitchen supplies� Linens & laundry � Waste management� Information technology & digital communications � Hospital planning/logistics� Personnel/hospital administration/management � Hospital Purchasing� Material Management � Medical conferences/seminars� EU political updatesOther information requirements - please list

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Do you consider that your equipment isout-dated � Yes � Norelatively modern � Yes � Nostate-of-the-art � Yes � No

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Is your department linked to an internal computer network? � Yes � NoIs your department linked to an external computer network? � Yes � NoIs your department involved with telemedicine in the community? � Yes � NoDo you consider your department is under-staffed? � Yes � NoAre you given ample opportunities to up-date knowledge? � Yes � NoDo you attend congresses or similar meetings for your speciality? � Yes � No

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and fax to: +49 211 73 57 530No fax? No problem. Please post your coupon to: European

Hospital Verlags GmbH, Höherweg 287, D-40231 Düsseldorf

The impact of

purchasing

co-operatives

The proportion of hospital turnover

linked to purchasing co-operatives will

rise from the present 45% to 90% in

2010, according to the study Future

Relevance and Consequences of

Hospital Purchasing Cooperatives for

Medical Technology Suppliers in

Germany, commissioned by the German

medical technology association BVMed

from the consultancy firm Simon

Kucher & Partners.

‘The bundling together of hospitals’

purchasing power is resulting in contin-

uous pressure on prices, which presents

new challenges for the sales and mar-

keting activities of medical devices

manufacturers,’ BVMed reports.

‘Between 2002 and 2005 the net prices

of medical devices in hospitals fell by an

average 10%.’

Drawing attention to the ‘responsi-

bility for prices’ of the entire medical

technology sector, the consultants said

competition should concentrate on the

product and service elements and not

on prices. Companies, they predicted,

would be influenced in the future by

‘large, commercially experienced and

authoritative purchasing co-operatives

and competition-oriented individual

houses’.

www.bvmed.de/publikationen/Studien

/?language=2

7

Management

Experts discuss

accreditation,

certification,

quality and

performance

measures

EUROPEAN HOSPITAL

News . . . . . . . . . . . .

. . . . 1-3

Management . . . . . . . . .4-7

Radiology . . . . . . . . . . . .

. .8

Surgery, Cardiology

Intensive Care . . . . . . . .9-13

IT & telemedicine . . . . . .14

Hygiene . . . . . . . . . . . .

. . .15

Lab & Pharma . . . . . . . . . .16

Publications . . . . . . . . . . . .

17

Innovations . . . . . . . . . . . .

18

Awards . . . . . . . . . . . .

. . .19

contents

18

InnovationsThe

revolutionary

delivery bed,

automated

delivery vehicle

& space research9-13Surgery

Shockwaves,

super patient

transport, plus

anaesthesiology,

cardiology,

transplants

At the Vascular and

Endovascular Issues,

Techniques and Horizons

(VEITH) Symposium) in

November, attended by key opin-

ion leaders in the field of vascular

surgery, physicians remained divid-

ed on the issue of stroke preven-

tion with carotid stent placement

in patients with carotid artery dis-

ease. Most experts agree that more

information is needed regarding

stents, particularly for those with

asymptomatic disease.

Kenneth Ouriel MD, of the

Cleveland Clinic, Ohio, an avid

proponent of stenting who was

involved in the pivotal SAPPHIRE

trial, sees a ‘big future’ for carotid

stenting. ‘All the trends look in

favour of stenting,’ he said in an

interview.

The SAPPHIRE trial, a ran-

domised study comparing stenting

to surgery in symptomatic patients

with over 70% occlusion of the

carotid artery, paved the way for

FDA-approval and reimbursement

this year. However, it has been the

subject of much debate, and the

value of the study has come under

heavy scrutiny by many opponents

in the field of vascular surgery,

who have performed the surgical

procedure to remove plaque for

many years with a very low risk of

complications.

Carotid stenting is rapidly

becoming a high-volume operation

in the United States, hastened on

by device-manufacturers promul-

gating it as a minimally invasive

procedure. Frank J Veith MD, host

of the symposium and Vice

Chairman at the department of

continued on page 2

Cervical

cancer vaccine -soon?

USA - Cervical cancer, caused by

Human Papilloma Viruses (HPV), might

become the first cancer type to be pre-

vented by a vaccine.

The results of a clinical study of a

vaccine named Gardasil, involving

12,000 women from 13 countries,

were presented at the Annual Meeting

of The Infectious Diseases Society of

America, held in San Francisco this

October.

Gardasil is still under development,

but was said to work against the most

widespread kinds of the viruses HPV16

and HPV 18 - responsible for about

70% of all cervical carcinomas - by

inhibiting the preliminary stages and

early forms of this disease.

After breast cancer, the cervical car-

cinoma comes second as the cause of

death from cancer in women in

Europe. 33,000 new illnesses and

around 15,000 deaths are registered

annually.

Report: Holger Zorn

Dental treatment has decreased in

many areas where dental services

have suffered health service cut-

backs, but this, in turn, this could

dent healthcare budgets in a bigger

way. In the December issue of the

Journal of Lipid Research,

researchers at the Virginia

Commonwealth University (VCU)

reported finding that patients with

generalised aggressive periodonti-

tis generally had elevated plasma

levels of a particularly bad subclass

of the low density lipoprotein

(LDL) called small-dense LDL.

Severe periodontitis is charac-

terised by chronic infection and

inflammation of the gums - and

this may contribute to these

patients’ elevated risk for heart dis-

ease and stroke. The researchers

suggest that it may be beneficial to

test periodontitis patients for

changes in their plasma lipoprotein

profiles, so that available medica-

tion can be taken if necessary.

15

Wounds & Hygiene

New hygienic

wound

tracking

device, plus

nanotech paint

combats MRSA

V O L 1 4 I S S U E 6 / 0 5

D E C E M B E R 2 0 0 5

New link between gum

and cardiovascular diseases‘Previous research has shown

that people who have predominant-

ly small-dense LDL in their blood

are at a three- to six-fold increased

risk of heart disease and stroke,’

said lead author Rik van

Antwerpen PhD, an assistant pro-

fessor of biochemistry at VCU. ‘A

person may have predominantly

small-dense LDL without having

alarmingly high blood levels of cho-

lesterol. Therefore, unhealthy levels

of small-dense LDL are not always

detected in regular cholesterol

tests.’According to the study, a second

factor influencing the cardiovascu-

lar risk of patients with severe peri-

odontitis may be platelet activating

factor acetylhydrolase (PAF-AH),

an enzyme that is associated with

small-dense LDL. PAF-AH is able

to break down some of the inflam-

matory, atherogenic components of

LDL. Dr Van Antwerpen said that

the enzyme may lower the athero-

continued on page 2

CAROTID STENTING:

‘A FEEDING FRENZY’

Dr Frank J Veith

Vascular experts

urge caution

over stent

placement to

prevent stroke

Karen Dente reports

from New York

T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K

ECR2006

E U R O P E A N C O N G R E S S O F R A D I O L O G Y

March 3-7

Vienna, Austria

Registration online until February 10, 2006 at www.ecr.org

the art of science

T H E S U P R E M E M E E T I N G I N E U R O P E

:: 15,000 participants from 91

countries :: CME accreditation ::

270 scientific and educational

sessions :: 1,500 oral scientific

presentations :: 1,000 electronic

poster presentations in EPOS™ ::

More than 200 companies on

25,000 m² ::

Please inform me about the Hospital AdministratorForum at the ECR 2006.

Signature Date

EUROPEAN HOSPITAL Vol 14 Issue 6/05 3

N E W S

Germany - After the new UNICEFcampaign You and me against AIDS (Duund ich gegen Aids) was launched, atBiotechnica and Medica Eppendorfdonated €1 for each campaign braceletworn by their customers, which raised€10.000,– for UNICEF.

You still have time to donate. If you‘Add your personal Christmas candle’ - to help light up theDräger Medical virtual Christmas tree, each candle will makethat tree grow 0.6 metres. Based on the height of the tree byChristmas, Dräger Medical will donate a gift to that level toUNICEF. Websites to visit: www.unicef.de/aids www.draeger-medical.comwww.eppendorf.com

Germany - The organisers ofMedica, the world’s largest medicaltrade fair, and ComPaMED, theinternational trade fair for compo-nents, parts and raw materials formedical manufacturing, havereported that 137,000 visitors fromaround 100 countries attendedthese events in November. Almost40% of the visitors were fromcountries other than Germany, andthese included a particularly highnumber from overseas markets suchas the USA, India, China orTaiwan, and Arab countries.

Future?’ and over 1,500 participantsgained perspectives on DRGs, increas-ing competition and demands for thequality care. ComPaMED had 302 exhibitors thisyear, visited by around 9,000 people.

The trend towards miniaturisationand ever more compact, yet increas-ingly complex systems was the centraltheme of the joint stand and Forum ofIVAM - Germany’s ProfessionalAssociation for Microtechnology. Details for 2006:http://www.medica.de.http://www.compamed.de

Medica and ComPaMED Sent your donation to UNICEF?137,000visitors

swarm in

‘The industry, with its innovativepower, has sent out exactly the rightsignals countering the discussionsabout healthcare costs, saidWilhelm Niedergöker, ManagingDirector of Messe Dusseldorf, whosaid he had conducted numeroustalks with exhibitors during theevent. ‘The interest taken by visitorsin more efficient and higher qualitydiagnosis and therapy procedureswas enormous and therefore spiritsamong exhibiting firms were corre-spondingly high.’

The Medica Media section virtu-ally served as a point of departurefor an electronic health card route,the organisers noted. ‘Visitors alongthis route were able to networkwith various exhibits covering thecard theme.’ Companies explainedthe functions and procedures associ-ated with the card explained,including, for example, cardprocesses, electronic prescription,data-protection, physicians’ digitalsignatures etc.

Other new innovations viewed byvisitors was a heart implant withbuilt-in transmitter that automati-cally sends cardiac data to a med-ical care centre; ultrasound deviceswith optimised sound heads forimproved 3-D imaging, and morecompact laboratory equipment forlow-cost rapid tests at doctors’practices. The Congress There were over 500speakers and 170 workshops, andmuch else, and discussions rangedover cancer types; worldwide infec-tious diseases; pain therapy and dis-ease in old age. ‘The presentation ofthe latest state-of-the-art research instem cell therapy by experts fromthe Dusseldorf Heinrich-HeineUniversity was very well received,’said Gerd Fischer, Secretary Generalof the German Society for MedicalDiagnostics. ‘The pros and conshad already been exhaustivelydebated in the run-up and now atthe event itself the focus was on anexchange of ideas about currentoptions.’The 28th DeutscheKrankenhaustag (German HospitalCongress) followed the theme‘Hospital 2006 - Closure or

4 EUROPEAN HOSPITAL Vol 14 Issue 6/05

M A N A G E M E N T

Simon Leary Jim Henry

Global healthcarereport identifies

BEST PRACTICESHealth organisations

and governmentsshould seek

solutions beyondtheir own borders

Faced with rising costs, dimin-ished resources and growingdemands, health systemsaround the world are under

siege and many will be unsustain-able within 15 years unless funda-mental change occurs. The crisis,according toPricewaterhouseCoopers HealthResearch Institute, is promptinghealthcare organisations and poli-cymakers to seek urgent solutionsin unlikely places — outside theirown borders. In the Institute’srecent report ‘HealthCast 2020:Creating a Sustainable Future’, theresearchers have identified bestpractices and unveiled the result ofsurveys and interviews with 700health leaders in 27 countries.

‘Everyone we spoke with, inevery country, told us they areafraid their current health systemwas not built to last,’ said JimHenry, global leader forHealthcare,PricewaterhouseCoopers. ‘Mostcountries have some aspects oftheir health system that are work-ing, but no one country has themagic bullet. We need to riseabove nationalism and turf protec-tionism, learn the lessons of othercountries and sectors, and build on

Innovative, flexible care models areemerging. Many countries areexploring more innovative, adapt-able care models to increase accessand productivity and to circumvent

HealthCast 2020 identifies sevencommon features for sustainabilitythat include: the need for commonground among stakeholders; a dig-ital backbone; incentive realign-ment; quality and safety standardi-sation; strategic resource deploy-ment; innovation and processchange; and adaptable models ofcare delivery centred on the needsof patients.

Along with the survey responsesfrom 578 healthcare executives,policymakers and employers from27 countries to assess their opin-ions about health systems sustain-ability, PricewaterhouseCoopersalso conducted in-depth interviewswith over 120 healthcare thoughtleaders in 16 countries, includingAustralia, Canada, Europe, India,Japan, Singapore, South Africa,the United Kingdom, the UnitedStates, as well as in the MiddleEast.

researchers also found that con-sumerism, the use of informationtechnology, incentive realignment andnew reimbursement models such aspay-for-performance are soaring glob-ally as nations seek to reduce health-care costs and improve access, safetyand quality for their citizens.

More than half of those surveyedby PricewaterhouseCoopers expecthealth spending to accelerate at agreater rate in the future than in thepast. Health spending patterns alsoare becoming more similar amongcountries in the Organisation forEconomic Cooperation andDevelopment (OECD), although USspending remains the highest in theworld. Americans spend 53 percentmore per capita on healthcare thanthe next highest country, Switzerlandand 140 percent above the medianfor OECD countries.PricewaterhouseCoopers projects thatglobal healthcare spending will tripleover the next 15 years to $10 trillion,consuming 21 percent of grossdomestic product (GDP) in the U.S.and 16 percent of GDP in otherOECD countries. The report highlights best practicesand common trends in health systemsaround the world - highlighted herein colour.

the best ideas. What’s clear is thatno one government can solve thehealthcare problem. It will be upto governments, working togetherwith private industry and con-sumers who not only have a biggerfinancial stake but also a greaterresponsibility in their healthcare.’

The report finds a convergence

of trends and solutions in the glob-al healthcare market, including theway healthcare is funded.Countries are moving towardgreater shared financial responsi-bility among the government, theprivate industry and consumers,even in historically taxpayer- andemployer-funded systems. The

workforce shortages. This includeshospital redesign, use of technology,outsourcing of elective proceduresand importing of nurses and otherclinical staff.

* PricewaterhouseCoopers Health Research Institute(www.pwcglobal.com) provides new intelligence, perspective andanalysis on trends affecting all health-related industries,including healthcare providers, pharmaceuticals, health and lifesciences and payers. The Institute is part ofPricewaterhouseCoopers’ larger initiative for health-relatedindustries that brings together expertise and allows collaborationacross all sectors in the health continuum

There is wide support for sharedfinancial responsibility among pri-vate and public payers. More than75 percent of health leaders andpolicy makers believe that finan-cial responsibility for healthcareshould be shared. Only a minorityof industry leaders in the US,Canada and Europe think that amostly tax-funded system is sus-tainable. Even in systems wherehealthcare is primarily tax-funded,such as in Europe and Canada,only 20 percent of respondentsfavour that approach. Despite callsfor universal healthcare in the US,only 6 percent of US respondentsfavour a mostly tax-funded sys-tem.

Examples in Practice: US healthspending already is 46 percent tax-funded and growing asMedicare/Medicaid programsexpand. Market reforms in gov-ernment-run systems such asEngland, the Netherlands andGermany are increasing use of co-pays or providing compulsoryinsurance coverage with theoption to add services throughsupplemental private insurance.

Consumerism is changing theway healthcare will be delivered.As patients pay more for their ownhealthcare, they are demandingaccountability and informationabout pricing, safety and quality tomake better decisions about whatthey are ‘buying.’ Healthcareorganisations will have to publishor perish and, like the automobileand airline industries, are begin-ning to report their prices, errorrates and safety standards. Eight in10 executives surveyed said thattransparency will be one of themost important features of a sus-tainable health system. Two-thirdsbelieve hospitals are currentlyunprepared to meet the challengesof empowered consumers.

Examples in Practice: To promiseworld-class care to its citizens,Hamad Medical Corp. in Qatar isworking to be a Joint CommissionInternational-accredited hospital.As part of a safety assurance initia-tive, the United Kingdom hasadopted a non-punitive medicalerror-reporting system based on amodel used by the US FederalAviation Administration.

Pay-for-Performance is soaring.Misaligned incentives are identi-fied as a root cause of gaps in thequality in healthcare andinequitable sharing of risk andrewards. Eighty-five percent oforganisations surveyed say theyhave begun moving toward pay-for-performance initiatives, a sig-nificant increase in the past twoyears.

Examples in Practice: Physiciansin California receive bonuses forscreening patients for conditionsthat are expensive to treat, suchas cervical cancer and coronaryheart problems. The Dutch willintroduce a new health insurancesystem in 2006 that realigns theirincentive structure. Spain is usingpatient choice as a lever forchanging physician behaviour.

Examples in Practice: Norway isusing telemedicine to provide health-care in remote areas. A German com-pany is buying smaller hospitals andconnecting them to specialised, cen-tralised high-tech medical units.More than 100 smaller, specialty hos-pitals have been built in the US in thepast five years. In Australia, 45 hospi-tals now offer ‘Hospital in the Home’.

‘Innovative solutions to commonhealthcare problems are emerging inthe global healthcare market,’ saidSimon Leary, the firm’s UK partner,who is also part of the research team.‘Governments and healthcare organi-sations across industries and sectorsmust find a way to share ideas andwork together in ways that they havenot in the past.’ Healthcare is goingglobal, just as other industries such asmanufacturing and technology didbefore it, he pointed out. ‘The UK is

importing resources from SouthAfrica and across the EU to reducewaiting lists and bolster access forNHS patients. We are also increas-ingly exporting expertise to theMiddle East and elsewhere to sup-port their emerging healtheconomies.’

In terms of quality and perfor-mance, he added: ‘Getting incen-tives right is proving a key themeacross the world. The increasinginterest in pay-for-performancemodels in driving up quality anddelivering cost effective care hasreally taken off in the last few years.Globally, our survey suggests a dou-bling of the effort in this area since2002 and in the UK the roll out ofPayment by Results and the Qualityand Outcomes framework in prima-ry care suggest we are catching upfast.’

Information technology is thebackbone of care. Lack of careintegration was cited as thebiggest problem facing healthdelivery systems, according tomore than 80 percent of respon-dents. Three-quarters of respon-dents viewed information technol-ogy as most important to integrat-ing care (74 percent) and informa-tion sharing (78 percent).

Examples in Practice: TheNational Health Service (NHS) inthe United Kingdom is committing$12 billion over 10 years to build anational healthcare informationnetwork and requires some physi-cians to use computers to get paid.The Canadian government is build-ing the Canadian Health Infoway.The US has a goal to build anational medical record system.Australia is considering makingelectronic reimbursement manda-tory.

Focus is shifting to wellness andprevention. Preventive care anddisease management were citedby two-thirds of respondents asthe most important ways toreduce healthcare costs and man-age demand on health systems.Health promotion and wellnessinitiatives are being sought volun-tarily by employers and mandatedby governments.

Examples in Practice: Ireland wasfirst to place a countrywide banon smoking indoors, and this hassince spread to other countries.The Swiss are considering a tax onfood with high glycaemic content.The UK is considering a ‘trafficlight’ nutritional labelling systemon foods to make it easier for con-sumers to make healthy choices.

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EUROPEAN HOSPITAL Vol 14 Issue 6/05 5

P A T I E N T S I N F O C U S

In December, An Tánaiste, andthe Minister for Health andChildren, Mary Harney, willlaunch The Irish Society forQuality and Safety inHealthcare’s national report,

‘The Patient’s View’, in which4,820 patients’ tell of the qualityof care and service they receivedduring hospital stays in 26 Irishhospitals during 2004.

Founded in 1994, the IrishSociety for Quality and Safety inHealthcare, is a not for profit,members-based charitable organ-isation that promotes quality andsafety improvement throughoutthe Irish health service. It cur-rently has in excess of six hun-dred members nationwide, andincludes public, voluntary andprivate sector representation, allof whom believe in the benefits ofnetworking and sharing informa-tion and best practice in health-care. The Society also serves asan umbrella organisation formany other organisationsinvolved in the quality in health-care field and has strong affiliatelinks with both the International(ISQua) and European Societiesfor Quality in Healthcare(ESQH).

Its new report identifies certainareas of care and service that areperceived by the patient to befunctioning well and others thatneed improvement. The findingsillustrate the challenges that facehealthcare service providers inbuilding a culture that putspatients first and values theirinput, feedback and participa-tion.Key areas for improvementinclude:● Communication issues, includ-

ing adequacy and clarity ofinformation

● Levels of cleanliness, privacyand general services in hospi-tals e.g. car parking, food etc.

● Patients’ safety and patients’rights

AUTOMATICITY PUTS PATIENTS AT RISK United Kingdom - A new study hasraised serious questions about howclinicians understand failures in safe-ty checking tasks in the healthcaresystem.

One way to manage patient safetyinvolves challenge-response proto-cols. This is a process of verbal chal-lenge, made by one colleague toanother, as and when a course ofaction is proposed. This technique ofdouble-checking is also called ‘wit-nessing’. Errors that occur in thisprocess are typically attributed to

negligence on the part of the checker.Automaticity is a term given to

skilled action that people developthrough repeatedly practising thesame activity - such as driving a car.

Writing in Health ServicesManagement Research, ProfessorsBrian Toft and Hugo Mascie-Taylorargue that individuals who fail in thissystem are the victims of a socio-psy-chological mechanism. Theresearchers labelled this ‘involuntaryautomaticity’. When it occurs, onlysuperficial attention is given and

errors happen without the checkerrealising it.

Given that this situation is inducedby the repetition of a job itself, thestudy suggests that some of the seri-ous adverse incidents in healthcareoccur because the verbal double-checking protocols do not providethe level of safety envisaged.

The study also argues that thehealthcare system, and those whomanage it, is responsible rather thanthe individual clinician. This phenom-enon poses a major challenge to the

National Health Service and theauthors have urged the introductionof measures to reduce involuntaryautomaticity, thereby reducing therisk to patient safety.

‘Involuntary automaticity: a work-system induced risk to safe health-care’, by Brian Toft and Hugo Mascie-Taylor, was published in theNovember edition (vol. 18) of HealthServices Management Research(HSMR), a quarterly publication pro-duced by Britain’s Royal Society ofMedicine.

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6 EUROPEAN HOSPITAL Vol 14 Issue 6/05

There is much talk about thequality of healthcareservices. Organisations needto respond pro-actively and

rapidly to constantly changingdemands and environments, whilstcontinually improving their levelsof service.

But what to we really mean byquality, and how should you goabout it? And if, as must surely bethe case, quality is about theservices you provide for patients,how does this balance with othertargets and performance measuresthat healthcare organisations mustmeet - not to mention financialconstraints? Some managers seemso focused on meeting targets andmeasuring performance that theyforget there is a customer whomakes use of your service. Thepatient is the final arbiter ofproduct and service quality. Soquality is best optimised through aclear focus on the needs of currentand potential customers.

It’s probably easier to start byidentifying the pitfalls. There are aplethora of quality systems,standards and awards ‘on themarket’; some are healthcare-specific, others (such as ISO9000)generic to organisations of allkinds. However, many of thesetake a limited view of theorganisation, for exampleconcentrating on clinicalprocesses, research andinnovation, staff training,leadership standards and so forth.The truth is that really excellentorganisations need to have all ofthese things working together.

The danger of this approach isthat of the ‘silo effect’ - peoplefocusing their efforts on particularaspects of quality, possiblydisconnected from otherorganisational priorities, andpotentially seen just as a ‘flavourof the month’.To achieve a more holisticapproach to quality improvement,ask yourself:● ‘What key things should we do,

and do well, in order tosucceed?’

● ‘How well do we do these, andhow can we improve?’

The answers to these questions

Healthcare accreditationThe JCI External Quality Evaluation ModelBy Paul R vanOstenberg

Paul R vanOstenberg DDS MS,Managing Director of theInternational Office of JointCommission International (JCI). InSeptember 2004, he was the firstto take up this post, after hisappointment in Ferney-Voltaire,France. In his role, he isresponsible for the co-ordinationof European projects and thefurthering of JCI recognition as apartner in healthcare quality andpatient safety issues.

The topic of healthcare accreditationappears on the agenda of healthcareconferences around Europe. Why?The principle reason is that theWorld Health Organisation, WorldBank and many other internationalorganisations view accreditationmethodology as the most powerfultool available to bring about sus-tained change for quality improve-ment in healthcare organisations.Accreditation and its standards arederived from the health professionsfor healthcare organisations and isequally applicable in developed anddeveloping countries.

What are the unique characteris-tics of the accreditation model ofJoint Commission International(JCI)? The model reflects, first andforemost, the clear mission of JCI: Toimprove the safety and quality ofcare in the international communitythrough the provision of education,publications, consultation, evalua-tion, and accreditation services. Thephilosophy underpinning this mis-sion includes; a focus on the patientin the context of their family, usingstandards that focus on functionsand systems rather than people andthe risk points of healthcare process-es, setting expectations that pushorganisations toward excellencehowever are achievable with effort,and an evaluation process thatstresses measurement — what is notmeasured cannot be improved —and finally, standards that embed inorganisations a sustainable qualityframework.

Accreditation is, by definition, avoluntary process granting recogni-tion for meeting standards thatrequire continuous improvement instructures, processes and outcomes.The accreditation methodology isbased on consensus standards and,in the case of JCI, the standards aredeveloped and maintained by aninternational task force with repre-sentatives from around the world toensure that those standards can beinterpreted and applied in differentcultures, under diverse laws and reg-ulations. The standards address hos-pitals, emergency transport, clinicallaboratories, ambulatory care, thecare continuum, and disease or con-dition-specific programmes, andhave been applied in over 18 coun-tries (including seven in Europe).

The tools of JCI accreditation arethe standards, indicator measures,patient safety goals and educationfor leadership. The JCI standards aredivided into two sections, those thatfocus on the patient and their careprocess and a second section thatfocuses on the management of theorganisation. The on-site evaluationof the standards is a convergentvalidity model with a physician,nurse and administrator evaluatingall the standards, from their ownunique perspective, through observ-

ing care, talking to leaders andstaff, talking to patients, and con-ducting group interviews on priori-ty topics.

The JCI indicator measures wereintroduced in 2005 on a voluntarybasis. The first sets include acutemyocardial infarction and heart fail-ure and community acquired pneu-monia. Measures for pregnancy andrelated conditions, paediatric asth-ma, and in-patient psychiatric carewill follow. An international data-base will be available for compari-son. The JCI patient safety goalswere also introduced in 2005 andinclude: the correct identification ofpatients prior to obtaining lab sam-ple and prior to administering med-ications or starting surgical proce-dures; improvement in communica-tion between health workersthrough the use of ‘read back’ ofcritical information, and the avoid-ance of look and sound-alike sym-bols and abbreviations; the removalof high-alert medications frompatient care units; the use of check-list prior to surgery to ensure theright patient, right procedure andright surgical site; the reduction ofhospital acquired infectionsthrough hand hygiene, and thereduction of patient falls throughbetter fall risk assessment.

Finally, the education for leader-ship builds on the accountabilityand authority of leaders describedin the standards and assists them tocreate a more safety-oriented cul-ture in their organisation; engage inproactive system analysis and riskreduction; standardise processesand equipment; promote communi-cation; ensure effective staffing andencourage and support patientinvolvement in quality and safetyinitiatives.

In summary, the JCI methodologysupports organisations in their qual-ity and safety efforts through theuse of standards and related toolsthat bring about practical solutionsto the quality and safety issues atall levels of the organisation. P.v.O

ACHIEVINGEXCELLENCE

Eirian Lewis is a director of TealConsulting Ltd, which works withhealth organisations, localauthorities, central governmentdepartments and in the privatesector, and lists its services as:Performance Management,Transforming Service Delivery,Adaptive Change, EFQMExcellence Model and BalancedScorecard, and Leadership strategyand development. Here, hedescribes the firm’s conceptsregarding the internal ethosneeded to upgrade anorganisation towards excellence

could be wide-ranging, but shouldenable you to consider whatmodels or frameworks will workbest for you. Will your chosenapproach help people establishimplementation strategies, set upthe necessary linkages betweenindividuals and groups,understand the enablers, developco-ordination and buildcommitment to the successfuldelivery of outcomes?

Some fundamental thoughts:There needs to be on-goingcommitment from the top and,once started, there is no room forcomplacency. The behaviour of anorganisation’s leaders creates aclarity and unity of purpose withinthe organisation and anenvironment in which theorganisation and its people canexcel. This requires personalcommitment from theorganisation’s most senior leaders -it is not something that can bedelegated to a Quality Manager.

The whole concept needs thebuy-in of all and leaving it to theQuality Manager is not thesolution (although if you have one,they have a role). Leaders have tolive and breathe it and be a rolemodel for what you intend to

achieve.Also, beware of silos of another

kind. It is far too easy to think ofquality only in the context of yourparticular function within theorganisation. There is a whole valuestream which contributes todelivering successful outcomes. Youneed to think about how to movefrom a set of separate functions, toa more integrated system that workstogether:

The message is ‘Make it work foryou’. Think about what yourorganisation needs to achieve, andhow it needs to operate. Thereneeds to be a clear focus - quality isnot about collecting ‘badges’, butabout integrating it into the cultureof the organisation. Never becaught, as we once heard someonesay, by the idea: ‘We’re not doingquality today - we’re too busy!’

Every organisation is special -different because of its objectives,its environment, and its culture.Really understanding theimplications of these differences isthe key to effective change andimprovement.

You cannot buy it off the shelf.The most effective system is not onethat does things straight from thetextbook or by copying others. It isone that really allows anorganisation to achieve itsobjectives, and is adapted andapplied to deliver on-goingimprovement. E.L

M A N A G E M E N T

If you ever thought that quality topics and certificationissues might be boring, stressful or even harmful for anyorganisation, being in Frankfurt for this meeting (29October) would have taught you otherwise.

First, you learn that one ‘certification expert’ cannothandle certification and accreditation: It involves theentire company or hospital, beginning with the CEO.Second, once you start thinking about getting yourorganisation certified, you are already half way towardscreating a better organization. One way or another,these points were emphasised by all the speakers,including Paul van Ostenberg and Eirian Lewis, whosearticles are printed on this page.

Professor Sibbel, Fresenius Chair for InternationalHealth Management at HfB, underlined the struggles ofGerman hospitals as they move towards becomingservice and market-oriented institutions, whichdemands legally-driven quality management.

THE NATIONS HEALTHCAREER ALUMNI MEETING‘ International Management Approaches toHealth Services: Accreditation, Certification,Quality and Performance Management’

Cheong Choy Fong, Director of Human ResourceDevelopment, Alexandra Hospital, Singapore, whopresented an integrated approach to theimplementation of quality management from Asia,summarised the level of effort needed to get a service-oriented and patient-friendly institution thus: ‘Imageyou will have to bring your mother to the hospital!’The Alexandra hospital has been so ambitious in itsoutcome improvements, that besides its ISO 9001and 14000, EQM, JCI, Six Sigma certification, it haseven participated in Toyota’s production system.

Hospital managers from Germany, Austria andDubai also presented experiences on the long route tofull accreditation. Finally, theoretical aspects of datacollection and the diversity of European Healthcaresystems were presented by Dr Nikolas Matthes (seepage 7) and Dr Ann-Lise Guisset, of the Ministry ofHealth, Brussels.

For further details on this lively, in-depth seminar, go to: www.nations-healthcareer.com.Or contact: Dagmar Möller at HfB. Phone: +49-(0)6171-9704217

EUROPEAN HOSPITAL Vol 14 Issue 6/05 7

M A N A G E M E N T

In many countries, performancemeasurement for hospitals is nowhigh on the agenda of policy mak-ers, regulators, payers, patients,and other stakeholders. Externaldrivers include demand for valuefrom payers and the public,increased competition betweenproviders, patient safety concerns,increasing evidence of variation inmedical practice, questions aboutappropriateness and effectivenessof care, and methodologicaladvances in the science of mea-surement that make assessmentand comparison on the basis ofindicators more feasible.

In the USA, performance mea-surement for hospitals has been onthe agenda since at least the1980s, when States started to pub-lish hospitals mortality data forcoronary artery bypass grafts, andthe federal government releasedhospital-wide mortality rates. Inthe private sector the QualityIndicator Project, a co-operativeprogramme, began in 1985 to helphospitals understand their perfor-mance. Its emphasis on standard-ised performance measures thatreflected important aspects of careand its comparative databaseproved popular; by the mid-90s,over 1,000 hospitals in the USAwere using its performance mea-sures for acute in-patient, psychi-atric, and long term care. TheProject has shifted its approach inthe USA, providing patient-leveland disease-specific indicators toits US participants and, since1992, also serves several hundredhospitals in Europe, using aggre-gate clinical performance indica-tors like nosocomial infections inintensive care, or unexpectedreturns to the operating theatre,for benchmarking purposes.

Accreditation and performancemeasurement are often consideredmutually exclusive when, in reali-ty, they are complementary con-cepts approaching performancefrom different perspectives.Accreditation tends to focus onstructure and process based onintermittent assessment.Accreditation occurs at certainintervals with no, or little, assess-ment or monitoring of howprocesses are maintained. On theother hand, performance measure-ment seeks to measure processesand outcomes on a continuousbasis, thus building momentum forongoing assessment of processesand outcomes of care. Hospitalsare to use data, evidence, to driveimprovement and, ultimately, cul-tural change within their organisa-tion.

Over the past five years the USAhas moved to a strictly regulatedframework of standardised perfor-mance measurement for hospitals.National Hospital QualityMeasures were developed andimplemented.

These clinical, patient-level, per-formance measures focus on cer-tain services or diseases. Currentlymeasures for pneumonia, heartfailure, acute myocardial infarc-tion, pregnancy, and surgery areavailable, with measures for theICU, childhood asthma, and psy-chiatric in-patient care to followsoon. These uniform measuresserve multiple purposes: TheFederal Government requires par-ticipation for reimbursement, theJoint Commission made it a

MEASURING HOSPITAL PERFORMANCEBy Dr Nikolas MatthesNikolas Matthes MD PhD MSc is an Associate of the JohnsHopkins Bloomberg School of Public Health, where he isaffiliated with the Department of Health Policy andManagement. His professional experience andresearch cover clinical performancemeasurement, disease-specific and patient-level clinical performance indicators,performance improvement, statistical processcontrol, international health systems.

requirement for accreditation, andmany other stakeholders such asStates use the data for publicreporting and regulatory purposes.

Two trends are of particularimportance. First, data from theseNational Hospital QualityMeasures is being publicly reported- by States, by the FederalGovernment, and the JointCommission - and are available forany patient to see. Patients are sup-posed to compare hospitals’ perfor-mance for the areas mentioned, to

support decisions as to which hospi-tal to select. However, the jury isstill out on whether patients reallyunderstand or use this informationfor decision-making. Second, data isincreasingly used for pay-for-perfor-mance. Reimbursement levels for adisease are tied to performance lev-els. Pilot projects are in progress.Challenges include low volume,random variation of performance,and to disincentivise poor perfor-mance but offer the opportunity toimprove performance.

Hospital and Radiology Management - Future challenges for innovation, transparency,

personnel management, training and finance

Austria Center Vienna, AustriaMarch 3 - 7, 2006

Presented and organised by:

Preliminary programme

Welcome and introduction by Prof. Andy Adam,President of the ECR 2006

Session 1March 4, 12:15 - 13:45 Management

This session is dedicated to the ”hottest”controversies in hospital management.Can public hospitals learn from private ones? Is the focus onprofitability the panacea for hospitals and radiologists? Doprivate hospital groups invest sufficient resources in trainingand education? Do alliances, cooperations, mergers and out-sourcing help to tackle spiralling costs?

Session 2March 4, 14:00 - 15:30 IT-Solutions

Session 2 will show that in the end integrated IT,workflows and so-called Enterprise Solutions willdetermine the future of the hospital.PACS sharing - the integration of all imaging modalities in asystem and its impact on interdisciplinary work in thehospital. How far along are we on the road towards theelectronic patient record? IT follows the hospital structures;departmental and enterprise solutions will bring togetherimage- and patient-related data.

Session 3March 5, 14:00 - 15:30 Finance

Session 3 will focus on the question whether privatefunding of healthcare and medical technology can complement/replace public funding.Innovative financing, procurement and maintenance ofmedical facilities. What are the pros and cons of leasing,private investments, private equity, PPP, fund raising etc.?

Preliminary list of sponsors:

8 EUROPEAN HOSPITAL Vol 14 Issue 6/05

In his opening speech Dr David H Hussey,president of the RSNA, indicated that hehopes for closer co-operation between the

doctors involved in diagnosis and therapy. ‘Ifdiagnostic radiology and radio-oncology co-operated more, this could only be for thebenefit of cancer patients,’ he emphasised.This is why, he said, he would be pleased ifmore radio-oncologists played an active rolein the RSNA. Over 700 companies presentedtheir latest products at this year’s event inChicago.

The co-operation between Agfa andSiemens is already successful. The Agfa exhi-bition stand - still adorned with the Siemenslogo – displayed Mammomat Novation. Theco-operation between the two companiesenvisages that Agfa will offer their customersthe digital mammography system manufac-tured by Siemens and that in return, Siemenswill include Agfa’s range of digital storagesystems in their portfolio. However, empha-sis at Agfa was on its Impax Enterprise,which includes Impax RIS (radiology infor-mation system) and the new release 6.0 ofImpax PACS as important parts of the elec-tronic patient file.

Aycan, well known in Germany as a pio-neer of the DICOM concept, introduced theXerox Dokucolor 240 - the new flagshipproduct for the printing of X-ray images onpaper. The DC 240 prints bones and soft tis-sue in colour or black and white on DIN A3or DIN A4 paper.

Barco, manufacturer of display solutions,presented colour monitors with three millionpixels. These new, high-resolution colour dis-plays are calibrated with the DICOM-

THERSNA2005

Not revolution, butsuperb evolution

Grayscale.The radiologist can use the same monitor

to make a diagnosis viewing images of thelungs, or to view 3-D reconstructions of theheart in colour. Barco’s 3-D image displayand analysis software, Voxar, impresses withits sheer range of functions - leading to itsdemonstration at numerous other exhibitionstands as well.

Eizo was another manufacturer presenting3 Megapixel displays. All display manufac-turers have one thing in common - they donot simply offer the hardware (the panels)but also useful software features. Eizo’s LEA(Lifetime Expectancy Analyzer), for instance,can predict the lifetime of the screen’s sensi-tive backlighting.

Fujifilm was the first company to introducedigital storage systems in radiography. The

Japanese company intro-

duced two new readers in Chicago, theCapsula and Clearview systems. The innova-

tive company, with its Europeanheadquarters in Dusseldorf, hasalso had a lot of success with itsSynapse PACS system over the lastfew months.

It would be almost impossibleto name all the highlights pro-duced by General Electric. Theirdominance in the American mar-ket was obvious from their hugeexhibition stand. GE’s newrange of products for digitalradiography is called Definium -which ranges from mobile sys-tems to fully-fitted X-rayrooms. The LightSpeed series isnow complemented by aBrightSpeed range with a 4-, 8-and 16-slicer. GE is now offer-ing its flagship product - the

volume scanner VCT - in combination with aPET (positron emission tomography).

The three large manufacturers, Philips,Siemens and General Electric, see molecularimaging combined with personalised medi-cine as one of the most important growthsegments. In the future, molecular imagingwill enable all oncology patients to receivefully personalised therapy. In their technolo-gy pavilion, GE demonstrated to RSNA visi-tors how they envisage the care cycle willlook in 10-15 years.

The German-Pavilion: For the last fiveyears the RSNA has been part of the interna-tional trade fair programme run by theGerman Federal Government. This meansthat the Federal Ministry of Economics andTechnology (BMWi) as well as the FederalMinistry of Food, Agriculture and ConsumerProtection (BMVEL) make quite substantialsubsidies available to smaller companies that

hope to exhibit abroad.Among the firmsexhibiting in theGerman Pavilion wereIT specialists Medavis,Medos and Visus, as wellas the contrast mediamanufacturers Medtronand Ulrich.

Whilst Medavis as aradiology information sys-tems (RIS) manufacturer,and Visus, as a PACS man-ufacturer, co-operate inGermany, Medos can sup-ply department manage-ment systems as well as dig-ital imaging archives. In

Late in November and into earlyDecember, as icy air streamed over theshores of Lake Michigan - affirming thenickname ‘windy city’ for Chicago -radiologists continued to immigrate hereen masse for their biggest annualgathering. This year the RadiologicalSociety of North America (RSNA) held its91st annual meeting, parallel with thescientific congress and trade fair. Theexhibition alone involved 28,700 staff -almost as many people as the 32,800visitors to the event.Manufacturers regularly launch newproducts at this international radiologyfair, before introducing them to Europe.On behalf of European Hospital, GuidoGebhardt* toured this important event toreport on developments and innovations.

R A D I O L O G Y

May 2005, Medos was taken over by theSwedish Ortivius group, a company thatoffers, amongst other products, completesolutions for primary control units, ambu-lances and telematic systems for the trans-mission of patient and vital data from anambulance directly to electronic patient filesused by the hospital information system(HIS).

Visus entered into a large contract with theDiagnostic-Network AG, a teleradiology ser-vice provider from Dillingen/Saar, whichalready provides CT and MRI image analysisto 50 German clinics, day and night.

Medtron and Ulrich manufacture innova-tive contrast media injection concepts formedical imaging.

Hitachi used to attract a lotof attention (in the early1990s) as the supplier of basictechnology for PhilipsTomoscan computed tomo-graphs (CT), but then theyapparently retreated from theEuropean market. However,the firm has returned toGermany with a new prod-uct range of computer andmagnetic resonance tomo-graphs.

Although Kodak offers acomplete product range fordigital radiography, thecompany is a long wayfrom the days where thename Kodak stood forinnovation in radiologicalimaging. Holding a KodakX-ray, mammography ordry laser film used to be

like looking at holiday snaps. However, thenew digital, complete product range DR3000, DR 7500, CR 850 and CR 950 seemsto lack that certain something which wouldmake it stand out from the competition. Thesame fate befell Konica-Minolta. Theirstrategists reacted too late to new trends.Admittedly, digital radiography has onlyreally achieved a notable turnover in the lastthree or four years, but the trust that a cus-tomer requires in a company would havebeen built up long before that. However,Konica-Minolta is now also back, with twodigital storage systems and a digital mam-mography scanner.

Compared withBarco, Eizo, Planarand Totoku, NECDisplaysolutions isone of the newerplayers in the medicalimaging manufactur-ers market. Theirrange of grayscaleand colour monitorsis adequate, by allmeans, but there areno particular high-lights. However,Planar can offerjust that. Their 30-inch display withfour Megapixels,framed by high

sheen, black casing,clearly stands out. The landscape format islarge enough to display two mages side byside. With this product, the unsightly divid-ing line that occurs when images are dis-played across two monitors has become his-tory. A dream to look at, but at around€10,000.– not cheap!

Philips hit the headlines last year whenthey acquired the American companies Epicand Stentor. Epic produces hospital informa-tion systems. Stentor (digital imagingarchive, PACS) is a long-standing winner ofthe KLAS report, an American classificationsystem for PACS systems. The integration ofall imaging systems into the IT infrastructureis part of the vision of this Dutch company.The test-runs of the German versions ofXtenity (Epic-KIS) and iSite (Stentor-PACS)

are due to start in 2007/2008. Despite

EUROPEAN HOSPITAL Vol 14 Issue 6/05 9

R A D I O L O G >

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rather than revolution. All manu-facturers have developed theirmodalities, as well as their IT sys-tems, to an extremely high, techni-cal level over the last few years.The keyword DICOM (DigitalImaging and Communication inMedicine), up until recently a syn-onym for data connectivity, ishardly mentioned these days.Exchange of data within radiologyand interdisciplinary across differ-ent areas of medicine is now thereality. So, we can get on with thebusiness of making diagnoses inpeace.*Editor: www.radiologieforum.de

the fact that it has been marketedfor about a year, the magnetic res-onance tomograph Panorama 1.0Tesla manufactured by Philips isstill a particular magnet for visi-tors at the RSNA.

Sectra has released its PACSRelease 10.2, which has beenadapted to the new requirementsof multislice CTs. Computer tomo-grams with a full resolution of 64slices produce several thousandcross-sectional images duringexamination. The ‘Smart Caching’function of Version 10.2 is aimedin particular at working with largesets of data. Moreover, as of now,Sectra offers a new 3-D applica-tion as well as an integrated cardi-ology solution. The Swedish com-pany’s ‘Microdose Mammography’system is a digital mammographymachine of the highest quality.

The only real surprise for mostvisitors at the exhibition camefrom Siemens. For the first time,the Dual Source CT, a computedtomograph with two tubes anddetector systems was introduced tothe international public. TheGerman premiere happened justprior to this, at Medica 2005. Thesystem is likely to significantlyimprove quality in coronary imag-ing. In the field of magnetic reso-nance imaging, the Erlangen-basedcompany is banking on their twoworkhorses Magnetom Espree, a1.5 Tesla System with a gantryopening of 70cm and a gantrylength of only 125cm and theMagnetom Trio. The 3 Teslamachine is now also equippedwith TIM (Total Imaging Matrix)technology for whole body exami-nations. Siemens’ combination ofthe PET scanner and the computedtomograph Sensation 64 is of par-ticular interest, as it facilitatesnon-invasive imaging of coronaryvessels and perfusion studies all inone examination.

Swissray is a Swiss X-ray systemmanufacturer with considerablesuccess in the US and EasternEurope. It now offers flat detectorsbased on silicon technology for itsradiography systems. The compa-ny uses the tried and tested detec-tors produced by Trixell, whichSiemens and Philips are also usingin their systems. The new technol-ogy, along with innovative productdesign, should enable the Swisscompany to penetrate theGermany market as well.

Last but not least, Toshiba. TheJapanese have a complete range ofX-ray systems, modalities andultrasound scanners. A regularcycle of innovation ensures up-to-date technology. Be it digital X-raysystems, 64-slice CT or open MR,Toshiba has it all.

All in all, visitors at RSNA 2005had the impression that the mottoof the congress was evolution

10 EUROPEAN HOSPITAL Vol 14 Issue 6/05

S U R G E R Y

Diabetes mellitus is strongly asso-ciated with the development ofcoronary artery disease (CAD) -up to one third of patients attend-ing cardiac catheterization labora-tories have diabetes. In addition,treatment outcomes are signifi-cantly poorer in this group ofpatients compared with the gener-al population (restenosis rates[RR] are higher and clinical out-comes are worse). Thus patientswith CAD and diabetes present aparticular therapeutic challenge.Recent advances in percutaneouscoronary intervention (PCI) mayoffer a new approach to treatingthis complex group of patients.

PCI started with balloon angio-plasty, but this was associatedwith high RR. The introduction of‘bare metal stents’ (BMS)improved clinical outcomes andlowered RR, but the treatmentsuccess of this procedure is stilllimited in high-risk populations.Drug-eluting stents (DES), whichrelease antiproliferative agents,offer lower RR, and a reducedneed for re-intervention. The mostwidely used DES to date are‘Taxus’ (eluting paclitaxel) and‘Cypher’ (eluting sirolimus).

The TAXUS V study - DES incomplex casesTAXUS V compared Taxus with aBMS specifically in higher riskgroups, including patients withdiabetes, small vessel disease, andwhere overlapping stents wererequired. The study included 356diabetic patients. Over a 9-monthfollow up period, Taxus wasfound to have significantly lowerRR (53% lower than BMS, P <0.0001) and target lesion revascu-larisation (TLR) rates (46% lowerthan BMS, P < 0.09). In the sub-population of 102 insulin-depen-dent patients, RR was reduced by55% and the need for TLR wasreduced by 52%. This reductionwas similar to that seen in theorally treated and non-diabeticpopulation suggesting that Taxushas a similar significant benefit inorally-treated diabetic, insulin-

Coronary artery diseasein diabetes mellitus -The emerging role ofdrug-eluting stents

By Dr Akhil Kapur of the London Chest Hospital, United Kingdom

dependent diabetic and non-diabet-ic populations.

Pooled analysesA recent meta-analysis of fourTAXUS clinical trials (TAXUS II,IV, V, and VI), involving 3,545patients, including 814 diabeticpatients, demonstrated clear superi-ority of Taxus over BMS for theoverall population during 9-monthfollow up (in terms of TLR andRR). When diabetic and non-dia-betic sub-populations were exam-ined, TLR was similarly reduced innon-diabetic (61% reduction) anddiabetic patients (59% and 66% fororally-treated and insulin-depen-dent patients).

Pooled data are also available forCypher. This analysis included dia-betic patients from the RAVEL,DIRECT, SIRIUS, E SIRIUS, andSVELTE studies. The TLR rate inall diabetic patients treated withCypher was 5.8%, and the TLRrate for the insulin-dependent pop-ulation was 10.1%.

While both DES offer significantbenefits for diabetic patients, com-parison of the Cypher and Taxuspooled analyses suggest that theTaxus stent may offer a small effi-cacy advantage in insulin-depen-dent diabetes.

Independent studies of DES indiabetesA number of independent studieshave also examined the use of DES

in diabetic populations. Theseinclude ISAR-DIABETES, DIA-BETES, SIRTAX and PORTO.While these independent studiesoften provide valuable supportingdata for the use of DES in patientswith diabetes, their conclusions aresometimes limited by issues such aslack of statistical power, clinicalprimary endpoints, blinding, orrandomization. Given the largeamount of data in this fast movingfield, recent guidelines for PCI fromthe European Society of Cardiology(ESC) recommend the use of DESbased upon the level of availableevidence from clinical trials. BothCypher and Taxus are recommend-ed for de-novo lesions in nativecoronary arteries. In addition,Taxus is recommended for longlesions. The ESC guidelines providea useful tool for assessing theweight of evidence suggested byclinical trials in this field whenselecting a DES.

RegistriesCardiology registries provide valu-able insights into the meaning ofclinical practices in the ‘real world’.ARRIVE, an FDA-mandated USregistry of patients using Taxus,found that Taxus was associatedwith a 6-month re-intervention rateof 3.1% for diabetic patients, com-pared with 3.0% for non-diabeticpatients. Similarly only small differ-ences were found in the EuropeanMILESTONE II

registry, where Taxus was associatedwith a re-intervention rate of 6.2%in diabetic patients compared with5.5% for all patients at 12-monthfollow up. The E-Cypher registrydemonstrated similar results in dia-betic patients. Taxus and Cypher arethe only two DES to have provenbenefit in this high-risk group ofpatients in both randomized andlarge registry studies. These findingsfurther support the application ofDES in diabetic patients with CAD.

What next?DES with improved deliverabilityare now being developed. Theseinclude Taxus LibertÈ, which isavailable in a range of diameters aslow as 2.25 mm, launched in Europein September 2005. These stents aredesigned to treat small, tortuous ves-sels that are otherwise very difficultto reach. This should further

Economics of using DESWhen considering the financial casefor PCI, it is vital to consider the fol-low up costs as well as the initialexpense. Repeat interventions arevery expensive to perform - inEurope CABG costs an average€13,000 and PCI costs approximate-ly €3-5,000. High-risk patients arealso at greater risk of needing re-intervention, increasing this cost stillfurther.

Compared with BMS, the lowerrate of re-intervention with DESmeans that costs are vastly reduced -in high-risk patients, the average 24-month follow up cost with Taxuswas calculated as €625, comparedwith €1,960 for BMS. These costsavings associated with DES out-weigh the higher initial proceduralcosts, with overall costs at 24months for high-risk Taxus recipi-

ents calculated as€6,490, compared with€6,600 for BMS.

The financial case forusing DES, rather thanCABG, has recentlybeen explored in twostudies from Italy andGermany. In the Italianmodel, total health sys-tem costs were project-ed to decrease by 2.1%if 60% of PCI proce-dures were converted

to DES, and 15% of CABG to DES.Studies such as SYNTAX will pro-vide a stronger basis for economicanalyses of DES vs CABG.

ConclusionsDES offer a major advance in thetreatment of CAD in patients withdiabetes and further improvementshave already been made in DES withimproved deliverability such asTaxus LibertÈ. Higher initial proce-dural costs for DES are expected tobe compensated for by lower costsduring follow-up, especially inpatients at highest risk such as thosewith diabetes.

TAXUS meta-analysis - effect of diabetic status on 9-month TLR

improve the treatment of CAD indiabetic patients who are knownfor their complex coronary anato-my. A paradigm shift away fromcoronary artery bypass grafts(CABG) to PCI as the first lineapproach for CAD in more com-plex patients will require convinc-ing data from large, multicentrerandomized controlled trialsincluding SYNTAX, CARDia andFREEDOM. SYNTAX, which isongoing and recruiting well, com-pares DES with CABG in approxi-mately 4,200 patients with surgi-cal-type disease in up to 90 centresworldwide. This study is expectedto report its first data at theAmerican Heart Association annu-al meeting in 2007.

Patient transportation to the operatingtheatre often involves up to three people,not necessarily for nursing care en route, butfrequently because a ward bed is used, and/or ahospital is old and presents many obstacles on thejourney.

Maquet - which began making transportation systems in 1880, and up to1950 produced a ‘patient transport chair’ with an operating table surface thatserved as a sitting or lying area during patient transportation - decided to res-urrect that long-proven concept, but to fit the new model with state-of-the-art technology to match today’s hospital demands. The company launchedthis new operating theatre table system at Medica 2005 in November.

Named Magnus, the table surface can be used for sitting or lying on, anddespite tight spaces, elevators and obstacles, just one person can manoeuvreit; even when surfaces are uneven, the large wheels keep the journeysmooth. Once in the operating theatre, the table’s surface can be shifted safe-ly and comfortably from the transporter to the operating table column, andpreparation for surgery can begin immediately.

‘Magnus is defining a new independent class for operating theatre tablesystems,’ Maquet pointed out. ‘Ease of handling and a wide range of settingsfor optimum patient positioning make it the most modern and powerfuloperating theatre table and transport system on the market.’

(In addition to marketing Magnus, the company confirmed that, due to theinternational success of its Alphamaquet models, it would also continue tosell its Alphamaquet 1150 models).

757 PT (with Pulse Timechestpiece)www.mdfinstruments.com –contact: teigelkamp@unit-medienhaus.deJust one person

makes the move

Mitral valvediseaseAustria - The firstCardiac Surgery Updateand Progress (CSUP)Meeting, which will takeplace in Lech-Zürs, from25 February to 4 March2006, will focus on mitralvalve disease. Congressdetails and theregistration form areavailable on www.csup-lech-zuers.org

Representing the CSUPteam, Guenther Lauferand MartinGrabenwoeger reportthat they areencouraging online-submission of abstractsassociated with eithermitral valve disease orcardiac surgery.Deadline: 31 January.The best eight abstractswill be presented orally,all other abstracts are tobe displayed as postersthroughout theconference.

Do you hear what I hear ?Medical instructors don´thave to describe the faintsounds to students anylonger. With the newbowles-type teaching/train-ing stethoscope, instructorand up to 3 students can

listen to the same source ofsound. The MDF 757 offersmulti-functional teachingapplications and the neces-sary flexibility in all clinicaland educational settings. Chestpiece: The multiple out-put acoustic stems,available in 2, 3 or4 outlets, is com-bined with ananodized alu-minum bowles(4.cm) chestpiecefitted with ultra-thin fiberdiaphragm (4.3cm). Designed toincrease acousticamplification and detecthigh-pitched sound, thisinstrument is well suited forgeneral examination andblood pressure measurementin an academic setting.Also available in in MDF

Hi-tech patienttransport

EUROPEAN HOSPITAL Vol 14 Issue 6/05 11

S U R G E R Y

A new, minimally invasive devicecalled the Glider Articular CartilageProbe, designed to treat articularcartilage disease, has beenlaunched by Smith & Nephew.

To devise this new probe thedesigners had to find a way toeffectively smooth diseased tissuewhilst preserving surroundinghealthy tissue. The firm’sendoscopy team, working with DrJames H Lubowitz, founder anddirector of the Taos OrthopaedicInstitute in Taos, New Mexico, firstconducted a study of how factorssuch as probe design and generatorpower settings, as well as speedand force of application affect theprocedure. Their study indicatedthat those design features could beoptimised to ensure retention ofthe maximum amount of healthycartilage.

Their research earned theRichard C O’Connor Award, thehighest award bestowed by AANAat the group’s 2005 spring meetingin Vancouver, British Columbia.

The Glider features a pivotinghead that emits radiofrequency(RF) energy as it follows the con-toured surfaces of the joint. Then,through controlled application ofenergy, it restores smoothness to adamaged cartilage surface whilepreserving the maximum amountof healthy tissue, the firm reports.A flexible wire frame, supportingthe pivoting head, operates as akind of shock absorber, whichallows the electrode in the pivotinghead to maintain consistent con-tact along the cartilage surface. Theframe also enables the probe toreach parts of the joint surface thatrigid probes cannot access.

With a history of 25 yearsof treatment-resistantdepression Charles EDonovan, 47, received theimplant during the clinicaltrial. ‘It changed my life,’ hesaid. ‘We couldn’t care lessabout any side effects relat-ed to continual vagal nervestimulation.’ His book, Outof the Black Hole, recountshis experiences withdepression

By Karen DenteUSA - According to the WorldHealth Organisation, depression isthe leading cause of disability inthe US, with direct and indirectcosts relating to medical expensesand lost productivity due to daysmissed from work reaching $80billion per annum. The figures arenot surprising, since around19 mil-lion of the country’s adults suffer adepressive disorder - which affectsnearly twice as many women thanmen.

Many patients, particularlythose with mild-to-moderatedepressive disorders respond topsychotherapy and antidepressantmedications. However, some withsevere depression do not. 20% ofAmericans with depression - aboutfour million people - experiencetreatment-resistant depression(TRD), defined as a major depres-sive episode that has not had ade-quate response to at least two dif-ferent classes of antidepressants.

The new, recently FDA-approved VNS (vagus nerve stimu-lation) Therapy is being used forthe long-term treatment of treat-ment-resistant depression. Theindication is specifically for theadjunctive (add-on) long-termtreatment of chronic or recurrentdepression, for patients 18 years ofage or older, who are experiencinga major depressive episode andhave not had an adequate responseto four or more antidepressanttreatments.

This pacemaker-like device issurgically implanted into the chest.A thin wire is connected to thevagus nerve in the left neck areaand guided under the skin to con-nect with the device, which sendsout gentle pulses back to the vagusnerve, modulating activity in brainzones such as the hypothalamusand hippocampus, thought to beresponsible for regulating mood.

Several studies haveshown that VNS Therapymay modulate neurotrans-mitters such as serotoninand norepinephrine in thebrain.

So far it has been usedto treat over 32,000patients worldwide. Whileit does not claim to curedepression, some patientshave shown ‘tremendousimprovement’ of theirdepressive symptoms.

Articularcartilage

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one of its subsidiary companies. ©2005 Smiths Medical. All rights reserved.

Portex•MedexDeltec•PneupacGraseby•BivonaWallace•BCILevel1•DHD

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12 EUROPEAN HOSPITAL Vol 14 Issue 6/05

C R I T I C A L C A R E

Infinity PiCCOSmartPodDräger Medical and Pulsion MedicalSystems, which specialises in intelligentmedical diagnosis and therapy manage-ment systems, launched the InfinityPiCCO SmartPod at Medica 2005. Thisdevice integrates Pulsion’s PiCCO-Technology with Dräger’s Infinity patientmonitoring.

PiCCO-Technology provides continu-ous monitoring of cardiac output (C.O.),cardiac filling status, and water contentin the lungs. ‘PiCCO can replace the rightheart catheter, which is currently usedfor advanced haemodynamic monitoring,by providing a lower risk but more com-prehensive approach for guiding therapyin critical care patients,’ Pulsionexplained.

When the PiCCO Pod (which supportsadults and paediatric patients) is pluggedin to the Infinity patient monitor, clini-cians can immediately access the rangeof PiCCO-Technology parameters.

Before a patientsession beginsthe clinicianenters a menuto tailor the‘Zone ofRespiratoryComfort’, whichis defined by thepatient’sbreathingfrequency, tidalvolume andend-tidal CO

Intensive care specialist DrPhilippe Jolliet (right), a seniormember of the medical staff of theMedical Intensive Care Unit (MICU) atGeneva’s University Hospitals, recent-ly participated - along with a dozenother physicians in European hospi-tals - in the multicentre, randomised,controlled study ‘Computer-drivenventilation reduces duration ofweaning’. This involved the use ofthe software SmartCare, introducedat Medica 2004 by Dräger Medical.

Dr Jolliet has reported that he wasnot surprised when the results of the12-month study into the benefits ofusing SmartCare software on the hos-pital’s EvitaXL critical care ventilatorsindicated a reduction in weaningtime. However, he said: ‘Even I wasshocked by the results. On average,we had cut the time between start-ing and completing the weaningprocess by around 50%. If we achievethis while maintaining patients in apathophysiological comfort zone,and reduce the period when they aremost at risk of contracting a nosoco-mial infection, this has to be a majorbenefit. Furthermore, if we can con-stantly tailor the exact level of pres-sure support to their exact needs, itwill reduce the discomfort associatedwith intubation and assisted ventila-tion.’

Dr Jolliet also observed that cut-ting time spent on the ventilator usu-ally reduces the total length of stay in

an ICU. The software could also ‘...help with planning elective proce-dures if we can be more confidentwhen beds will become free for post-operative recovery’, he added.

However, Dr Jolliet said that not allcases need weaning via software use.‘Some only need to be intubated andventilated for a very short periodprior to a natural and speedy recov-

ery and transfer out of theICU. Others, because of

the severity of theirdisease, associatedconditions, andadditional compli-cations, such as

the nurses - so it was not unusual forcertain checks to be missed. This couldlead to a missed opportunity to alterthe settings and potentially shortenthe weaning time.’ SmartCare, heobserved, represents a ‘real world’approach to protocol-driven weaning.‘It is, after all, based on the pooled clin-ical experience of some of the world’sleading intensivists and pathophysiolo-gists!’ he exclaimed. Using the soft-ware means the EvitaXL ventilators canbe left to control the process, provid-ing medical teams with more time topatient care and other tasks, he point-ed out, adding that some of the nurseshad joked that the system would leave

GE Healthcare recently launched Aisys - a new peri-operative system, integrates electronic gas and agentcontrol and delivery with advanced ventilation, vitalsigns monitoring and breathing system. Electronic

delivery measures and checks the gas andagent at five different stages in the deliverysystem before it reaches a patient. The systemalso identifies the agents and gases based onmolecular weight, a very accurate way of

determining the gas and agent selected for deliv-ery to the patient, GE points out. Omar Ishrak,president and CEO, GE Healthcare ClinicalSystems, explained: ‘Using input from hundreds of

clinicians, we designed Aisys as a completepatient care solution, integrating all elementsof anaesthesia, monitoring and electronicpatient records (EPRs) into one collective unit.’

GE’s platforms enable software and technology sharing across itsanaesthesia products including, the 7900 SmartVent Ventilator and AdvancedBreathing System (ABS). The former, says GE, is flexible enough to accom-modate a broad range of patients. The latter provides a low circuit volumethat delivers fast-response, ideal low-flow anaesthesia. ‘The design of theAisys system also provides a clear visual of the rising bellows, controlled bymicroprocessors, for immediate feedback about the patient’s status,’ GE adds.

Aisys integrates with hospital information systems (HIS) and Centricityanaesthesia systems, to automatically collect and document anaesthesiadelivery and physiological data.

The equipment was designed for maximum mobility and economy of size.CableCare holds the cables, and INview Patient Displays are mounted on amoveable arm with 360 degrees of rotation.

FASTERWEANINGENHANCES

PATIENTCARE

ANAESTHESIOLOGYMERGING MULTIPLE FUNCTIONS AND EPRS

infection, may need to spend threeweeks or more on a ventilator, andthereafter be very difficult to wean. Ifeel SmartCare would be inappropri-ate for both patient categories.However, there is a large ICU patientpopulation that falls between thesetwo ends of the spectrum, who Iwould describe as being either aver-age of moderately difficult to wean. Ibelieve these patients would benefitconsiderably from the use ofSmartCare.’

Asked whether equivalent resultscould have been achieved using hisprevious weaning methods, Dr Jollietreplied: ‘We employed a protocol-dri-ven system, and posted the details allaround the ICU. It worked well, butrelied on nurses following it to theletter. Unfortunately, as patients’ con-ditions improve, they tend to drawless attention to themselves - thereare always plenty of others to distract

NEW

Neonatal ventilation The SERVO-i ventilator has been continuouslyupgraded since its launch by Maquet Critical Care,over four years ago. The latest version, for neonatalICU patients, includes nasal continuous positive air-way pressure (Nasal CPAP), an option that can beused with various patient interfaces.

New hardware has also been introduced. A new Y-piece measurement sensor for all SERVO-i modelsallows near-patient measurements of pressure andflow with minimal dead space.Additional new features to improve clinical efficiencyand safety in ICUs include:● Fi02 trend values can be stored and viewed● Reference loops can be presented on screen

together with the current loop ● The patient circuit can be tested independently

of the pre-use check● Alarms for airway pressure upper limit can be muted● Apnoea alarm limit has been extended from 15 to 45 seconds

them with nothing left to do.Significantly, the nurses had reportedfinding the software easy to follow,despite early on blaming any compli-cations they experienced on that samesoftware.

In addition to weaning, Dr Jollietsaid he saw a potential for elements ofthe software to be used within non-invasive ventilation, where its abilityto titrate the exact level of pressuresupport required might lead to farmore patient comfort.

In summary he compared the soft-ware with an autopilot on an aircraft.95% of the time, he said, it could do agood job, but it could not quitereplace the hands-on approach need-ed when landing in lashing rain with astrong side wind. So, he quipped, heand his colleagues would not start tolook for careers beyond the ICU: ‘Manyaspects of patient care will alwaysneed the human touch.’

Info

/ Se

rvic

e-N

r. 04

3.03

RICHARD WOLF GmbH · D-75434 Knittlingen · PF 1164 · Tel.: +49 70 43 35-0 · Fax: +49 70 43 35-300 · Subsidiaries in Austria · Belgium · France · Germany · Great Britain · USA

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EUROPEAN HOSPITAL Vol 14 Issue 6/05 13

N E W SM I N I M A L L Y I N V A S I V E S U R G E R Y

The PiezoLith 3000, launchedby Richard Wolf GmbH, has a new high-performancepiezo power source that

enables fast, accurate and effectivehigh-energy therapy, with mini-mum tissue damage. The firmreports the following benefits: ● Multifunctional diagnosis and

therapy centre for urology andESWT

● Unmistakable diagnosis andtherapy in ESWL and ESWT

● Best possible patient positioning ● Short treatment times● Continuous location during

treatment● No anaesthesia● Simultaneous ultrasound and X-

ray location with real-time dis-play

● Radio translucent● Optimum working height● When necessary, auxiliary proce-

dures can be carried out imme-diately with the X-ray unit

Richard Wolf also adds that it is‘Right on target even with smallurinary stones.’

New features include the X-rayunit with LithoArm, for precise,stable attachment of the therapysource. This enables the C-arm tobe used as stand-alone unit, byswinging out the therapy sourcefrom the X-ray path.

The new shockwave source hasa multiple focal area and selectablefocal zone, which allows focaladjustment to the stone size, forbetter stone disintegration, as wellas treatment without anaesthesia.

The therapy head is easy toremove and features two layers ofpiezo elements and an integratedultrasound transducer for real-timemonitoring.

The Comfort Stretcher has a lowtable height that allows even low-mobility patients to get on easily.It is also multi functional, allowingauxiliary procedures combinedwith the X-ray unit.

The integrated operating theatreRichard Wolf is an early innovatorin minimally invasive surgery(MIS), well-known for its develop-ment of core - a complete operat-ing theatre concept that centralisescontrol via a modular, integrativestructure. This networks individualtheatre devices and provides inter-active monitoring. The widelyadopted communications standardCAN Open BUS protocol is used -an excellent platform for continu-ous integration of further compo-nents, the firm points out.

‘The networking of the devicesand the unique visualisation andoperating concept allow the cen-tralised control of the entire sys-tem from one central operatorpanel. core brings with it a furthersignificant increase in efficiency inthe form of voice control that isnot dependent on the speaker. Thisallows the direct operation of

Piezoelectric shockwave systemNEW

devices such as cameras, light andoperating theatre (OT) table fromwithin the sterile field of the operatingtheatre and provides the basis forimmediate intra-operative preparationof the OT report. The consistent useof this module ensures the immediatepostoperative availability of the elec-tronic operating report, includingimages of findings, and allowsincreased efficiency in the documenta-tion from a forensic perspective.’Medimage (PACS) - ‘With Medimage,complete, digital patient picture and

document management is possible.Starting from workstations for pictureacquisition, processing and archivingand progressing to server, network andtelecommunications solutions, it pro-vides every form of image data man-agement, as well as tailored, cus-tomised solutions. Medimage unites alltypes of pictures, films and reportsfrom radiology, cardiology and surgery.The possible intra-operative visualisa-tion of pre-operative image data (X-ray, CT) on suitable monitors in theoperating field of the physician plays

just as great a role in cost reduction asin increased operating safety.’

The system can be variably installedin ceiling supply units, distributednurse stations and mobile system trol-leys, and theatre tables and otherperipheral devices can be integrated.

The core team provides specialistconsultation and planning services,and additional services include theorganisation of installation ‘... andcommissioning of the customer’s sys-tem solution and formulation of tai-lored service concepts’.

14 EUROPEAN HOSPITAL Vol 14 Issue 6/05

I T & T E L E M E D I C I N E

Siemens Communications (Com) and DrägerMedical have extended their partnership. Thefirms intend to use the latest Wi-Fi WLANtechnology to create a wireless hospital infra-structure through which medical teams canaccess clinical applications and real timepatient monitoring data throughout the hos-pital.

Siemens Com is a certified solutions partnerfor Infinity OneNet, providing expertise inwireless network planning and customer ser-vice to the hospitals that implement this new

The importance ofadministrative modulesAs the global healthcare industryincreasingly moves towards inte-grated care, there is a growing trendamong hospitals to replace outdatedsystems with modern and compre-hensive hospital information sys-tems (HIS), writes research analystKonstantinos Nikolopoulos, researchanalyst at the global growth consul-tancy Frost & Sullivan. The goal is tohave sophisticated solutions in placethat include both clinical and busi-ness modules and support clinical aswell as business functions. ‘Hospitalsand vendors alike are beginning torecognise the actual business bene-fits that the sum of the functions ofmodern administrative and clinicalsystems can bring to healthcareorganisations,’ he adds. ‘Withadministrative systems increasinglyincorporating advanced capabilitiesand offering greater functionality,administrative software vendors canlook forward to a whole new rangeof opportunities.’

As implementation of HIS proac-tively continues in major Europeanmarkets such as the UnitedKingdom, Germany and France, F&Sbelieves that the hospital adminis-trative systems market will seesteady growth, increasing from$1338.9 million in 2004 to $2069.0million by 2010, at a compoundannual growth rate (CAGR) of 7.5per cent from 2004-2008.

‘Investing in back-office adminis-trative applications makes eminentbusiness sense as it can give hospi-tals a strong competitive advantage.These modules more or less form thefoundation for electronic medicalrecords (EMR), picture archiving andcommunications systems (PACS) and

other clinical modules. In fact, hos-pitals cannot really move to fullEMR, PACS and other clinical sys-tems implementation without firsthaving a modern administrative sys-tem in place,’ the report points out,adding: ‘Therefore, doctors and hos-pitals would do well to ensure thatthey first implement these buildingblocks, even though the appeal ofclinical modules, which are directlylinked to enhanced quality of care,might be greater. Hospitals that fol-low this approach will be able totake advantage of the full benefitsof modern software.’

The report discusses many inter-esting aspects of IT upgrading,(including progressively complexbilling processes due to DRGs, point-ing out that HIS developments inEurope tend to be ‘patient- ratherthan billing-centric, which can cre-ate difficulties for international ven-dors in terms of adapting US prod-ucts for use in Europe and viceversa’).

A virtual brochure, which pro-vides manufacturers, end-users, andother industry participants with anoverview of the latest analysis ofthe European Hospital Admin-istrative Systems Market (B662-48),is available. Simply send an e-mailto Radhika Menon Theodore,Corporate Communications, atrmtheodore@frost.com, which mustinclude your name, company name,title, telephone number, fax numberand e-mail address.

F&S Report: The European HospitalAdministrative Systems MarketB662-48.http://healthcare.frost.com.

Luxembourg - Next year’s Med-e-Tel - the International Exhibitionand Conference for eHealth,Telemedicine and Health ICT - willpresent a multitude of ICThealthcare applications for debate.

eHealth standardization andinteroperability issues will betackled by the IHE initiative(Integrating the HealthcareEnterprise) whose experts willexplain the IHE process and theindustry’s role in this, and whatIHE has to offer for RegionalHealth Information Networks.

The European Commission willuse Med-e-Tel as a forum topresent results of recent health ICTresearch, and this, together withEuropean ehealth projects (e.g.standard and interoperable satellitesolutions to deploy healthcareservices over wide areas),knowledge sharing and decisionsupport for healthcareprofessionals (Doc@Hand), andnew generation telemedicineservices for homecare (Interlife).

The role of advanced technologyin global healthcare challenges andopportunities will be addressed bythe Telemedicine and AdvancedTechnology Research Centre(TATRC), an element of the USArmy.

A returning topic at Med-e-Tel is‘eHealth for DevelopingCountries’. eHealth is animportant tool to cope with thespecific healthcare problems thatexist in the developing world(shortage of qualified doctors andspecialists, AIDS/HIV pandemic,etc.). Previous Med-e-Tel editionsalready saw participants from El

A co-operation agreement between T-Systems SFH GmbH and the HealthGroup of Kodak GmbH will combine the companies’ complementaryhospital information systems (HIS) and PACS/RIS Solutions, (KodakGmbH) resources, so that hospitals can opt for an integrated solution forKIS/RIS and PACS. The firm’s reported: ‘The certified interfaces willbenefit customers by avoiding nuisance, loss of time and, not least, loss ofmoney.’ Announcing the agreement at Medica, in November, they also saidthis is a first step towards a countrywide common archiving solution forGermany, which healthcare institutions may either manage themselves, orhandle according to an outsourcing business model. T-Systems - The information and communication technology (ICT) firmhas taken care of the corporate customer segment of the Deutsche TelekomGroup since January 2005. Employing 51,000 co-workers in over 20countries, the company reported 13 billion euros sales in the fiscal year2004. Kodak Health Group - IT products include PACS, RIS, company-wide anddivision-wide medical information systems, computed radiography systems(CR), digital radiography systems (DR), laser imagers, mammographysystems, and X-ray film systems for general X-ray diagnostics.

Med-e-TelAPRIL 5-7, 2006

Professor Michael Nerlich, PresidentInternational Society for Telemedicine &eHealth (IsfTeH) and Dean of the MedicalFaculty at Regensburg University

Dr Jean-Claude Healy, Director, Office ofthe Assistant Director-General ExternalRelations and Governing Bodies of theWorld Health Organization, at the openingof Med-e-Tel 2005

Salvador to Tanzania and fromZambia to Indonesia gaining awealth of information at the event.The 2006 session will again drawlarge numbers from developingcountries. This session is co-organized by the World HealthOrganization (WHO),International TelecommunicationUnion (ITU), International Societyfor Telemedicine & eHealth(ISfTeH) which are at the forefrontof telemedicine and ehealthimplementation in the developingworld.

In addition, the role of satellitecommunication and space-basedtechnology applications, especiallyfor developing countries, will beexplored by the United NationsOffice for Outer Space Affairs(UNOOSA).

The information,communications and technologysectors, are an integral andimportant part of he telemedicineand ehealth landscape. “What arethe implications of ehealth for theICT industry?” and “What will (orshould) be the impact of ehealthon ICT regulation and policy?”are questions that form the basisof a session that the InternationalTelecommunications Society (ITS)is presenting in the frame of Med-e-Tel 2006. ITS regroupsprofessionals and researchers fromthe concerned ICT industries.

The Luxembourg Institution forHealthcare Research (CRP-Santé)will conduct a regional seminaraimed at hospitals, health insurers,industry, and policy makers. Theseminar will look at how health ITleads to new solutions, patient

empowerment, and new marketingstrategies for hospitals, mutualitiesand insurance providers and theindustry. Business cases willillustrate successful applications inautomated appointment bookings,online consultation of patientrecords, CRM in the hospital, e-learning, telemonitoring, imagetransfer, mobile applications, e-prescribing and health portals.

The above conference sessionswill be complemented with variousadditional sessions on the topics ofhome telehealth, disease/healthmanagement, legal and ethicalaspects of ehealth, and practicaltelemedicine and ehealthapplications in various medicaldisciplines.

The Med-e-Tel exhibition floorwill showcase medicationcompliance products,imaging/PACS systems, hometelehealth and remote monitoringsystems and services, clinicalsoftware packages, electronicmedical records, results oftelemedicine and ehealth projects,and much more.Details: info@medetel.lu orwww.medetel.lu

Partnership toprogress mobility

Volker Geyer,ManagingDirector of T-Systems SFH(right) withAndreas Dahm,Sales Director ofKodak GmbH’sHealth Group

Speeding medical communicationstechnology. Dräger Medical will provide its in-depth clinical experience in patient monitoringand clinical applications for the acute point ofcare.

As an example of potential integrated solu-tions, the firms said that, using InfinityGateway technology, alarms triggered by apatient monitor could be automatically routedthrough the hospital network using the intelli-gence built into the nurse call system - thusdirectly alerting the most appropriate caregiverin an emergency.

EUROPEAN HOSPITAL Vol 14 Issue 6/05 15

H Y G I E N E & W O U N D M A N A G E M E N T

Although physically very small bacteria, such as Staphylococcus aureus,often wreak havoc in hospitals an can cost around €37,000 per case totreat. However, nanoparticles are a thousand times smaller and these arenow being used in paints and coatings to wipe out bacteria. ‘The effectis mainly based on the well-known antibacterial properties of metallicsilver, combined with the characteristics of nanoparticles,’ explainedHelmut Schmid, chemist and head of the energy systems department atthe Fraunhofer Institute for Chemical Technology (Germany), whichdeveloped the new technology with paints/coatings manufacturer BioniCS GmbH. This September, the first commercial product using thistechnology - named Bioni Hygienic - was launched at a nanotechnologymeeting in Dubai. ‘Over a hundred manufacturers are interested infitting their products - catheters and heart valves, bone and dentimplants - with our technology,’ Helmut Schmid reported.

wound, is then peeledaway and disposed of

as clinical waste. Thetracing grid is placed on

the Visitrak Digital and thetraced lines of the wound are

followed with the supplied stylus.When the outline is completed, thedevice beeps and displays the areameasurement in cm2 in its digitaldisplay. Functions are alsoprovided to allow calculation ofpercentage wound area that is

The endoscope cleanerThe UK firm Labcaire Systems Ltd has launched a newAutomated Endoscope Reprocessor (AER), which ‘... radical-ly redraws the performance and usability limits for this typeof instrument,’ the firm reports. ‘Developed as Project Isis,the new unit will still be the only AER to offer users achoice of detergent and disinfectant type and be construct-ed throughout from anti-microbial coated materials.’

The unit’s BioCote anti-microbial coating inhibits bacterialgrowth, and the machine meets the HTM 2030 & prEN ISO15883 washing and validation requirements.

‘A kinetic cleaning process ensures thorough cleaningthat does not depend on the presence of detergent,’ thefirm adds. ‘An elevated temperature capability ensures thatoptimum operating conditions can be achieved for every detergent and dis-infectant type. Process efficiency is also guaranteed by automatic leak testing of every endoscope,individual monitoring of each channel throughout the cycle, thorough rinsing after the disinfectioncycle to ensure that chemicals are not carried across to the next patient and an automatic channeldrying cycle.’

Although with a footprint of under a square metre, the Isis can take one or two endoscopes onindividual load carriers. Washes can be either at room or elevated temperatures.

As a dual-sided unit the Isis can be installed as a pass-through type design between a pre-process-ing area and clean storage facility - particularly useful in new-build projects in which the pass-through design is being increasingly adopted.

THE PAINT THAT KILLSNanotechnology combats MRSA

A synthetic surface coated with biocide. Colonies of Staphylococcus aureus are colouredred. The untreated control sample (left) shows uninhibited cell growth. The coatedsample (right) shows a 100 times reduction in the number of germs. The test was carriedout according to guidelines for spray tests.

necrotic, and width and lengthmeasurements.Visitrak Depth - This disposable,foam-tipped, sterile depthindicator is placed into the deepestpart of the wound and depth ismeasured according to the scale.

PROJECT ISIS

The more accurately the rateof wound healing isdocumented, the faster non-responsive wounds can be

identified. A percentage woundarea reduction of less than 20-40% over the first two to fourweeks is a reasonable indicatorthat the wound is showing a lowresponse to treatment.

Methods of tracking woundprogress include length and widthmeasurements and counting gridsquares. However, the mostaccurate method is to measurechanges in precise wound area.

Visitrak, a new digital systemlaunched by Smith Nephew, islikely to simplify the task ofwound measuring considerably.The company reports that itprovides accurate, reproducibledata for tracking wound progress.Components: Visitrak Digital - a neat, battery-operated portable digital tablet tohelp measure the area, length,width and depth of wounds. Thisproduces a visible record ofwound dimensions by convertingtraced lines into a true areameasurement, which is then usedto calculate the percentage areachange since the last measurement.Percentage non-viable tissue, orother wound regions can also bemeasured. Visitrak Grid - This transparent,three-layer sheet is placed over awound, and the edge of the woundis traced, using a permanentmarker pen. The white sterilebacking of the grid, which createsa barrier between the grid and

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16 EUROPEAN HOSPITAL Vol 14 Issue 6/05

20th TRADE FAIR FOR ANALYSIS,LABORATORY

TECHNOLOGY &BIOTECHNOLOGY

Balkan Clinical Laboratory Federation(BCLF) 2005 held in September, attract-ed over 250 clinical laboratory profes-sionals from 14 countries to the venuein Tirana, Albania. ‘The opening ceremony, and speechesby Professor Anyla Bulo, president ofthe meeting, Prof. T Gruev, the BCLFpresident, and Prof. V. Blaton, theFESCC president, were followed bytwo excellent plenary lectures, fromV Blaton (Belgium), speaking on thecardio protective effect of HDL’s, andS Danev (Bulgaria) giving insightsinto atherosclerosis research, diagno-sis, prevention and treatment in theproteomic era,’ Dr Cojocaru report-ed, adding that the research studiesthat followed had contributed to theadvance by numerous new and inter-esting observations, studies, and dis-coveries in all laboratory medicinebranches.

Dr Cojocaru himself presented‘Asymptomatic chronic hepatitis withC virus associated with anticardi-olipin antibodies and ischaemicstroke’. We do not have the space tohighlight all those he mentioned inhis report. However he did point out:‘For the further advancement andcollaboration in Balkan region, anactive inclusion of many Europeanscientists was of great significance.

During the BCLF Executive BoardMeeting Professor Nada Majkic-Singh (Serbia & Montenegro) waselected President of the BCLF (forthree years).

The 14th BCLF meeting will beheld in Sofia in September 2006.

In October, Dr Cojocaru openedthe 2nd Danubian Symposium of theRomanian Society of LaboratoryMedicine, held jointly with the 4thNational Congress of LaboratoryMedicine and 3rd Symposium onQuality Assurance in Laboratory

At Medica in November,Greiner Bio-Onelaunched the world’sfirst patented SalivaCollection andQuantification Systemto be based on a liquidcollection medium, which,the firm explained, enablesstandardisation of saliva pre-analytics for the firsttime: ‘This applies to standardised collection, preparation aswell as storage of saliva samples. It is the prerequisite for development ofnew and innovative saliva diagnostics.’

The easy method of collection, together with permanent availability, makessaliva an interesting alternative to other specimen materials, such as blood orurine, Greiner Bio-One explains. ‘The areas of application are varied, rangingfrom therapeutic drug monitoring to drug tests in traffic controls or at work.Furthermore, many clinical chemical parameters, e.g. electrolytes or hormonesin saliva can be detected in addition to bacteria and viruses. Previously, theproblem with saliva was that the collected sample quantity was subject tovariations. Due to this, it was difficult to determine the quantity of saliva forthe analysis. Our pre-analytics product experts have found the solution: Theworld’s first collection system based on a saliva extraction solution as well asa method for quantitative determination of the saliva quantity allow thestandardisation of saliva pre-analytics.’

Collection is non-invasive, so is totally painless. In addition, HIV infectionvia saliva is virtually impossible, the firm points out, adding that, unlike urinecollection, the presence of a supervisor during saliva collection does not posean invasion of privacy. ‘Corruption of the sample, either intended or unaware,is prevented. In contrast to other saliva collection systems, a dry mouth,which can occur, for example if a person is under the influence of drugs, isgenerally not a problem with the Greiner Bio-One system.’

The, based in Kremsmünster, Austria), Greiner Bio-One International AG, isan independent concern owned by the Greiner family, which was formed in2001 when the Labortechnik branch left the Greiner Holding AG. Details: www.gbo.com/preanalytics

The European trade fair andconference Analytica focuseson analysis, laboratory tech-nology, biotechnology and the

life sciences, high-tech laboratoryautomation and data and processmanagement. In 2006, this event,which includes the AnalyticaConference, will celebrate its 20thanniversary. The 20th Trade Fair forAnalysis, Laboratory Technology andBiotechnology intends to continue toplay an important role internationallyas a basis for investment decisions inindustrial and commercial laborato-ries. ‘Dealing with a growing numberof tasks more quickly - and if possibleat increasingly affordable prices - isespecially important in the analysissector,’ the organisers point out. ‘Forthis reason, Analytica 2006 will focuson economical solutions, which willapply to the sectors for classic instru-mental analysis as well as microscopyand special applications in processcontrol and quality assurance.Analytica 2006 will present the latesttrends including new techniques, newintegration potential and a newunderstanding of the term service.’

Klaus Dittrich, Managing Directorof the event’s organising groupMunich International Trade Fairs,said: ‘We are looking forward to pre-senting the industry and all of itsfacets to decision-makers from theanalysis, laboratory-technology andbiotechnology sectors. And instead ofgigantomania, we are focusing oncontent depth and positioningAnalytica as a force that promotestransfer between research and appli-cations.’ Subjects to be coveredinclude: Analysis using standard browsersResearchers can now control high-performance analysis equipment

from their desks and retrievedata using the mouse.Additional steps or modulesare no longer necessary to net-work the electronics used totake measurements and analyseresults. In the latest generation ofequipment for high-performanceliquid chromatography (HPLC), allequipment can be controlled using astandard browser, and without hav-ing to install additional software. Acommunications module that servesas a central control unit for the sys-tem provides the necessary intelli-gence in the form of a web server.Entering the systems’ IP address theresearcher can call up the start pageover an intranet. Once logged on,s/he has access to all HPLC functions.Methods and sample tables can becompiled and read out as XML files. Online analysis - in real timeMolecules that must be analysedvery quickly and, if possible, online,are becoming increasingly complex.While conventional offline analysisprovides information about a singlestate, online analysis makes it possi-ble to follow an entire process andcall up data in real time. Besides pro-cessing and cost advantages, in somecases by-products can be discoveredthat would have gone undetected ina routine analysis of products. Notall processes are suitable for onlineanalysis because it generally has todo without any form sample prepa-ration. Furthermore, having to dealwith media that might be aggressivecalls for sturdy equipment with along service life. These requirementsare best met using optical tech-niques, such as infrared, UV-Vis andRaman spectroscopy. Specially cus-tomised software can analyse rawdata automatically - even as part of

a multi-component analysis thatuses multiple measuring parametersto find the desired data in real time. High-speed gas chromatographyusing short columnsEven ‘very advanced’ classic tech-niques like gas chromatography arebeing developed further. Due tocapillary columns and efficientdetection systems this is now one ofthe most efficient separation andanalysis techniques. Short analysistimes combined with unreached pre-cision, play an important role, partic-ularly in food and environmentalsamples. Combined with mass spec-trometry (GC-MS), this technique isunrivaled when it comes toanalysing volatile mixtures, theAnalytica report points out, adding:During the past few years, shorter

range. And coupling them with sys-tems such as a nuclear magnetic res-onance spectroscope (LC-NMR)improves detection sensitivity. Newonline coupling techniques for sepa-rating and analysing the structuresof complex compounds can be usedto identify even the smallest quanti-ties of biologically active substancesgently and without destroying thesample. Service providers and full-linesuppliersModern analysis equipment isincreasingly functional, providingeasy operation, high throughputrates and improved performance. Ina growing number of devices thetechnology itself remains concealedfrom the user. Analysis is now a ser-vice that many companies takeadvantage of, instead of viewing itas a core competency, ‘...althoughanalysis information provided bylaboratories is the basis for decisionsof considerable economic and eco-logical significance,’ Klaus-PeterJäckel, Head of the BASF Group’sworldwide competence centre foranalysis, explained. Analytica 2006will showcase the latest analysistechniques and solutions, as well asserve as a venue for industry repre-sentatives to discuss the latest appli-cations with companies that needspecific services and identify futurerequirements. That includes distrib-uting tasks and redefining the rolesto be played by university researchand industrial operations as well asthe new market orientation in thechemical industry. Klaus-PeterJäckel, for example, is working withthe German Chemical Society(GDCh) to strengthen the role thatanalysis plays at German universities. Further details: www.analytica.de

During the General Assembly ofRomanian Society of Laboratory

Medicine, last September, Professor MCucuianu, of Cluj-Napoca, was electedan honorary President, Prof. GheorgheBenga became President, and Manole

Cojocaru MD PHD was elected vice-president of the Society and

IFCC/FESCC National Representative.Dr Cojocaru subsequently reported on

several Balkan events

Medicine, held under the auspices ofIFCC, FESCC, Romanian Academyof Medical Sciences and VasileGoldis West University, Arad, whichwas attended by around 200 scien-tists.

The Annual Meeting OrganisingCommittee, said Dr Cojocaru, haddeveloped an exceptional education-al programme. ‘Everything you needto stay ahead of changes in clinicallaboratory science, medicine andmanagement.’ The main topics, hesaid, encompassed laboratory medi-cine, integrative discipline for diseasediagnosis, and trace-ability and stan-dardisation in the European conceptof laboratory medicine. Among themany outstanding plenary lectures(too many to report on this page), DrManole remarked that Professor MCucuianu, from Cluj-Napoca, pre-sented an ‘excellent’ address on themetabolic risk factors and thrombo-atherosclerosis - a mini review.

5th FESCC Continuous PostgraduateCourse in Clinical Chemistry.Evidence-based medicine has resultedin a huge body of knowledge, sodiagnostics are expanding, includingthose for auto-immune diseases, DrCojocaru pointed out. ‘I think the labis becoming a centre for technical andclinical advice to clinicians.Diagnostic tests are fast becomingmore important and more appropri-ate. How can they be used to reducetreatment costs? In Romania, auto-immune diseases represent an excel-lent model for postgraduate educa-tion.’

This was the focus of postgraduateweekend courses, held in Dubrovnikin October, and organised by theCroatian Society of MedicalBiochemists and SlovenianAssociation for Clinical Chemistry,with the FESCC (IFCC in Europe).Programme: 1. Basic concepts - New aspects of the

immunopathogenesis of auto-immune disease; genetics; auto-immune aspects of pregnancy andinfertility; apoptosis and autoim-munity, etc.

2.New approach to diagnosis con-tents; laboratory standards in thediagnosis and therapy monitoringof auto-immune diseases, e.g. celi-ac, rheumatoid arthritis, vasculitis,multiple sclerosis and systemiclupus erythematosus.

3. Evidence-based diagnosis, qualityassurance and organisation of theauto-antibody laboratory; statisti-cal management of auto-immunediseases data; guidelines for ANAtesting; therapeutic potential inauto-immune disease.

The FESCC and Dubrovnik’s Inter-university Centre presented partici-pants with Handbooks andCertificates.

columns have made it possible tospeed up separation considerably.Two-dimensional GC using twocolumns with different retentioncapacities increases separation per-formance for complex compoundsenormously: At the same time, bothphysical and physicochemical ana-lyte properties such as boiling point,structure and polarity can be usedduring separation.

Capillary columns with increasing-ly smaller dimensions are also usedfor high-performance liquid chro-matography (HPLC). They make itpossible to reduce solvent consump-tion on the one hand, and in mostcases, only extremely small samplequantities are available on the other.Capillary columns make it possible toperform analyses in the pictogram

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EUROPEAN HOSPITAL Vol 14 Issue 6/05 17

P U B L I C A T I O N S

Those who care for relatives with Alzheimer’s disease often pay a high pricein terms of increased demand, stress and personal distress. This book is a trea-sury of powerful ideas, information, and techniques designed to emotionallystrengthen the person who cares for someone with Alzheimer’s disease.‘Strength in Caring’, a new 244-page book, has been written to help them.The author, Mark Matloff PhD, is a psychologist in private practice, who hasover 28 years of experience. Since his graduate studies in gerontol-ogy, he has worked with adults, elderly clients, nursing home resi-dents, Alzheimer’s caregivers,and a large number of sup-port agencies. ‘People whocare for a person withAlzheimer’s disease have todeal with two challenges: thepractical demands of care-giv-ing, and the emotional andpsychological toll of extendednurturing,’ Dr Matloff pointsout. The chapters cover areas

such as: medical and legal aspects of the disease; where to go for morehelp; psychological approaches to gain more personal power and controlof their stress; dealing with grief; combating the negative feelings ofdepression, self-blame, self-pity, hopelessness, anxiety, anger, and guilt;turning perfectionism into acceptance; going from procrastination intoaction; stress-busting; building happiness; and constructing a working plan

for empowerment. Each chapter contains an overview of a particularproblem, followed by ideas, techniques, and/or powerful questionsthat caregivers can use to cope and help themselves.

In addition to his psychology practice, US-based Dr Matloff is aconsultant, coach, and adjunct psychology professor. He has con-ducted public workshops, written a weekly newspaper column, and

been featured on Syracuse TV and radio. In November, he was thekeynote speaker at the ‘Power Caregiving: Rising to the Challenge’

workshop put on by the Central New York Alzheimer’sAssociation and Onondaga County Department of Agingand Youth.

ISBN 1-59800-162-0. Price: $18.95 Ebook website: www.StrengthinCaring.com

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Help forAlzheimer’scarers

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Zellamed, of Zella-Mehlis, Germany,which has produced medical instrumentssince 1884, specialises in stethoscopes andreflex hammer for the newborn, children andadults. All of this firm’s high-tech instrumentspresent a face.

The ‘Trabant’ child stethoscope is a very small, double ring stethoscopewith a soft, warm, silicon 35-mm external ring, and an internal ring thatmeasures only 15 mm diameter - which is covered with an antibacterialcoating. The firm reports that this stethoscope readily adapts to thedermal anatomy of infants - from premature babies to seven year-olds.The firm’s ‘Satellite’ - a 45:25mm double silicon bell - has been developedfor older children and adults patients. The universal ‘Kosmolit’ has a newdouble bell and intercostal membrane.

The firm’s hammers have a flexible handle, so that very soft areas canbe tapped, and they have red/green eye-check and Babinski-reflex. Eightdifferent weights are also available for each user, from 50-125 grams. Thefirm also reports that it produces very soft bumpers, with its original childfriendly look.

18 EUROPEAN HOSPITAL Vol 14 Issue 6/05

The innovative TransCar LTC 2Automated Guided Vehicle (AGV)has an on-board IPC that storesnavigation/destinations informa-tion. The system also includesradio communication, and the newnetwork-compatible TCMS con-trol (TransCar ManagementSystem) with visualisation.

After the daily workflow - plusany ad hoc itineraries - are down-loaded from a central system con-troller, supplies such as medicines,meals, linen, bulk supplies andtrash are loaded into containersand placed into sending stations.Jobs are automatically generatedby reading the specific targetsfrom RFID-tags and are automati-cally assigned to vehicles. The

The European Space Agency (ESA)was at Medica 2005 (Dusseldorf) topresent the European Commissionfunded SURE project (TheInternational Space Station (ISS): aUnique Research Infrastructure). Thisprovides the opportunity for newresearch in space, primarily for EastEuropean countries, researchers andindustry.

The group reported that, far abovethe constraints of the atmosphere,and free from the effects of gravity,the Space Station provides a uniqueinfrastructure for performingresearch in weightless conditions -unachievable on the ground - anddeveloping and testing new productsand innovative technologies. ‘Fromlife and physical sciences to healthand nutrition, the facilities andresources available onboard theStation not only allow scientists tocarry out groundbreaking research,but also offer companies the oppor-

Natural Rubber Latex (NRL) is stillthe recommended choice for barrierprotection. However, at the Medicatrade fair this year, AnsellHealthcare, which specialises inhand barrier protection, pointedout: ‘Scrubbing with soaps and anti-septics combined with continuedglove use (which can result in soggy,easily eroded skin) contributes toattacking healthy skin’s protectivebarrier. The resulting dry, crackedskin opens a migration path for irri-tants, allergens and micro-organ-

isms.’ At the fair, Ansell present-ed three new approaches tosuch glove-related allergies,

which include information, pre-vention, and alternative materials.(To provide information, the compa-ny has also launched a multi-lan-guage international online educa-tional programme: www.anselleu-rope.com).

Improving on prevention, Ansellhas produced NRL gloves with anintegrated hydrating solution -HydraSoft. This helps to protect the

Advertisers IndexCompany Page ProductAgfa 3 IT solutions - imagingBoston Scientific 10 Drug eluting stents ECR Congress 1 Radiology meetingE & Ex Korea 19 Medical trade fairEH & ECR 7 3rd Administrator

SymposiumISICM 13 International congress:

Intensive care &emergency medicine

Meiko 15 Hygiene equipmentMEDICA 4 International trade fair

& congressNations HealthCareer 17 HealthcareSchool of management Management courses

Philips Medical Systems 5 Diagnostic imagingsolutions

Richard Wolf 12 Integrated operatingtheatre solutions

Smiths Medical 11 Critical care/International patient monitoring

Siemens 9 Diagnostic imagingequipment

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Take your research

Patient-friendlydiagnostic tools

Latex allergyprevention

skin’s natural barrier. The firm alsopointed out that Hydrasoftimproves the comfort and flexibili-ty of the neoprene, accelerator-free product DermaPrene Ultra,also used in the glove, and explainsthat this is a unique formula ofneoprene that is free of vulcanisa-tion accelerators - a source of TypeIV allergies.

Laboratory tests of the AnsellHigh-Temperature Post WashingProcess indicated that this develop-ment has reduced the NRL allergencontent of NRL gloves in somecases by over 20 times more thanDPNR (Deproteinised and purifiednatural rubber latex).

Automated deliveriesIntelligentvehicledistributessuppliesaided by lasertechnology

vehicles pick-up the load fullyautomated. Then, using its on-board electronic map and laserguidance technology this intelli-gent vehicle travels, at a walkingpace, to its pre-programmed desti-nations. Althoughthese may be ondifferent floors ofa hospital, or inother buildingswithin the com-plex, TransCarnavigates its way,through narrowaisles, aroundpassers-by, and,adds its manufac-turer Swisslog, itwill safely inter-

face with elevators, doors, washdevices and other automated facili-ty equipment. The system alsodoes not interfere with medicaldevices.

An additional benefit in thisnovel vehicle is that no tracks needbe laid in floors or any otherequipment installed on walls etc.

The Healthcare SolutionsDivision of Swisslog, which spe-cialises in the production of auto-mated in-house transport, invento-ry and distribution systems,demonstrated the TransCar atMEDICA (Dusseldorf) this year,along with its Pneumatic TubeSystems (with differentreceiving/sending stations), anElectric Track Vehicle System, andthe company’s PillPick AutomatedDrug Management System - previ-ously featured in EuropeanHospital.

The aesthetic, functional Ave Delivery Bedprovides patient comfort as well asmeeting the professional needs ofa delivery team. New technicaldevelopments include the asymmetric positioning of thelifting post, very low minimumheight and an entirely newconcept of foot adjustment,which makes patient handlingeasier during delivery. Thedesign, plus materials used,speed up adjustments, cleaning,and ultimately servicing.

The many Ave delivery bed accessories allowfor conventional or alternative positions:recumbent on back; half-seated; on all fourlimbs-back; lying on the side; suspended bent-knee, and bent-knee with partner’s support.Details: www.borcad.cz

Easier births for all

Designed by JiríSpanihel, the bed has received an‘excellence’ awardfrom the CzechDesign Centre

I N N O V A T I O N SEUROPEAN HOSPITAL

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A W A R D S

EUROPEAN HOSPITAL Vol 14 Issue 6/05 19

Professor Harald zur Hausen, 69, former Chairmanand Scientific Member of the Management Boardof the German Cancer Research Centre (DeutschesKrebsforschungszentrum, DKFZ) has won this year’sHis Royal Highness Prince Mahidol of SongklaAward (worth US$ 50,000) for his contributions topublic health. In January 2006, King BhumibolAdulyadej of Thailand will present the prize, onbehalf of the Prince Mahidol Award Foundation.

Prof. Zur Hausen’s cancer research is focused onpapilloma viruses, considered the cause of cervicalcancer.

The Deutsches Krebsforschungszentrum has fos-tered scientific relationships with Thailand forsome years. In 1995 the Centre concluded a cooper-ation agreement with the Chulabhorn ResearchInstitute covering a joint project to study the chem-ical constituents of Thailand’s flora. The Thai

Chronic obstructive pulmonary disease (COPD) is thefastest growing cause of death in the world’sadvanced economies and projected to bethe world’s third leading cause of deathby 2020. Early diagnosis and treatmentcan greatly improve the quality of lifefor COPD patients, yet many are unawarethey have the disease - up to 50% ofAmericans and 75% of Europeans with COPDare estimated to be undiagnosed. Indeed, thenumber of people who know about this disease islow ‘...which is why the media play a crucial role inraising awareness and educating the public aboutCOPD,’ said Leonardo Fabbri, Professor ofRespiratory Medicine, University of Modena & ReggioEmilia, Italy, and Chair of the Judging Panel for theannual Eloquium awards for communication, presentedby the pharmaceutical firm Boehringer Ingelheim.

This year, a panel comprised of international COPDexperts and healthcare media specialists judged 69 sub-missions from 17 countries.

The winners1st: Rosalina Grilo, for ‘Over 600,000 Portuguese people suffer from COPD’ pub-lished in Saúde Pública, Portugal. 2nd: Michael Baggeler, for ‘When air is in shortsupply, give the lungs a chance to breathe deeply again’, published in Neue Welt,Germany, and 3rd, Riwa Al-Atrash, for overviews on COPD, for Future TV, Alam Al-Sabah, Sohtak, in the Lebanon.

HEART CAMPAIGN WINS AWARD

Left to right: Lauren O’Brien, Cohn & Wolfe PR; Liz Hazell,Director, Charities Group, PWC; Victoria Dix, Cohn & WolfePR; Helen Alderson, World Heart Federation, and journalistKate Silverton

The Geneva-based NGO, The World HeartFederation, and Cohn & Wolfe, an internationalpublic relations consultancy, have received aThird Sector Excellence Award for the interna-tional campaign, ‘A Heart for Life’, focusedaround their World Heart Day campaign.

In 2004, over 350 articles and broadcast fea-tures were generated, reaching over 395 millionparents, children and adolescents with education-al messages about the risks of unhealthy lifestylesand the link to heart disease and stroke.

During World Heart Day (involving over 100countries) in Brazil, for example, participants in

a walk carried red heart-shaped balloons to a citypark where they were given fruit, tips on living ahealthy lifestyle and a free yoga and dance class;in Egypt, text messages (SMS) containing healthtips were sent to cell phone users by a mobilenetwork company, and in Cameroon over 800people received free screenings for obesity, dia-betes and hypertension.

Princess, Professor Chulabhorn Mahidol, visitedthe DKFZ in October 2000 to learn about researchinto natural substances that can prevent or slowdown the development of tumours. She alsogained an overview of the diagnosis and therapyof lung cancer, and of cancers that affect women.With this transfer of knowledge, the DKFZ is sup-porting the development of a cancer centre inBangkok.

Prince Mahidol of Songkla, father of the pre-sent King of Thailand, was responsible for mod-ernizing Thailand’s healthcare and health educa-tion systems. In his honour the Prince MahidolAward Foundation was founded in 1992 and theprize bearing his name was introduced.

The Deutsches Krebsforschungszentrum inHeidelberg (German Cancer Research Centre,DKFZ) systematically investigates the mecha-nisms of cancer development and works to iden-tify cancer risk factors. 90% of the centre’sfinance comes from the Federal Ministry ofEducation and Research and 10% from the Stateof Baden-Wuerttemberg. It is a member of theHelmholtz Association of National ResearchCentres (Helmholtz-Gemeinschaft DeutscherForschungszentren e.V., HGF).

Journalists raiseCOPD awareness

Thai award forcancer researcher

Professor Haraldzur Hausen

into space

tunity to increase their competitiveadvantage by using the space envi-ronment as a platform for appliedR&D and technology demonstrations,’ESA pointed out.

With the co-operation of theEuropean Commission, the four-yearSURE project will enable ESA tobroaden access to the ISS to a widerinternational community. Priority willbe scientists, small & medium enter-prises (SMEs) in the new EuropeanMember States (EU10), and Romaniaand Bulgaria.

ESA Astronaut Frank de Winnedescribed his life and work in spaceand spoke of research activities cur-rently performed onboard the ISS.Speakers from ESA and the EuropeanCommission also introduced the SUREproject. Future projects will be select-ed on the basis either of scientificexcellence or of their potential forindustrial applications.Details: www.spaceflight.esa.int/sure.

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