EUROPEAN HOSPITAL - Semantic Scholar · 2017-10-18 · PARKER LABORATORIES, INC.286 Eldridge Road, Fairfield, NJ 07004 Tel. 973-276-9500 Fax 973-276-9510 E-mail: [email protected]

EUROPEAN HOSPITAL

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News . . . . . . . . . . . . . . . . 1-3Management . . . . . . . . . . .4Pharmaceuticals . . . . . . . .5Cardiology . . . . . . . . . . .6-9Radiology -Mammography . . . . . . . .10-15

Respiratory care . . . . . .16-17

Nutrition . . . . . . . . . . . . . .18IT & Telemedicine . . . . . .19

contents

V O L 1 3 I S S U E 4 / 0 4 A U G U S T / S E P T E M B E R 2 0 0 4

10-15Mammography

Why screen? EUvariations, scanners,

projects andbreast therapies

www.medica.de

Your No.1 medical

information portal:

24/7 all year round

First implantsof absorbablemetal stents

Germany - Following positiveresults in numerous animalstudies and the first humanimplantations of the BiontronikAbsorbable Metal Stent (AMS) inbelow-the-knee arteries thatconfirmed device safety, at theend of July the first patients(worldwide) received AMSimplants. Professor RaimundErbel, Director of the CardiologyClinic, Essen University, andProfessor Michael Haude, carriedout the procedures as part of a‘Progress-AMS’ study.

‘This technology combines -for the first time - the short termvessel support of a metal stentwith the advantage of removingthe long term presence of animplant,’ explained Dr ClausMartini, Vascular InterventionCEO at Biotronik GmbH & CoKG, Essen.

The four-month follow up willdetermine the great potential ofthis technology, the firm added.‘We also believe that AMS hasthe potential to overcome thefuture hurdle of non-invasiveimaging, because it doesn’t createartifacts under X-ray and allowssuccessful utilisation of non-invasive vessel imaging withcomputed tomography CT ormulti-slice CT (MSCT). Inaddition AMS stents aremagnetic resonance compatible,because no artifacts areproduced.’

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

Adverse drug reactionsCases cost thousands and take up 4% of beds

6-9Cardiology

ESC Congress plusreports on CVD,

CHD, CHF andVADs research

An ISO Certified Company

ECLIPSE® PROBE COVERLATEX-FREEPre-gelled inside with Aquasonic® 100Ultrasound Transmission Gel

PARKER LABORATORIES, INC. 286 Eldridge Road, Fairfield, NJ 07004 Tel. 973-276-9500 Fax 973-276-9510 E-mail: [email protected] www.parkerlabs.com

U.S.A. and International patents granted

PARKERWorld leader in ultrasoundsupplies Please see page 15

Equipment salesFrom 2000-2003, the UK alonepurchased 204 CT Scanners, 88 MRIscanners and 91 linear accelerators, aswell as 44 computers for radiotherapyplanning, 23 simulators and over 600devices for breast screening.

However, whilst some EU countriesplough ahead with their cancerdetection programmes, others appearto drag their feet about adoptingimportant new technologies, or evensetting up national breast screeningprogrammes.

On pages 10-15 European Hospitalasks why, and feature the political,economic and technical influences onapproaches to cancer care today -particularly focusing onmammography. In this special newsection, we also highlight currentresearch and technological advances.

Sleep apnoea study mayalter stroke managementSpain - New research suggests thatsleep apnoea is a new risk factorfor death from stroke.

Sleep apnoea describes repeated-ly interrupted breathing whenasleep. Sufferers may stop breath-ing for 10 secondsand, in some, thismay occur over300 times a night.The syndromeaffects some 20% of people.

During their 30-months study(pub: European RespiratoryJournal) Dr Olga Parra, andresearchers at Barcelona UniversityHospital, began monitoring thebreathing of 161 stroke patientssoon after their hospital admit-tance due to strokes. An apnoeaindex was used for each patient.The team found that the higher thepatient scored on the apnoea scale,the greater the risk of dying fromstroke. In that period, about 50%suffered a second stroke, and 22patients died.

The team also pointed out thatthe risk of a stroke and death was

more obvious in those with obstruc-tive sleep apnoea, in which theupper airways collapse.

The team do not explain whysleep apnoea raises the risk ofstroke death, but they do indicate

that the syndromecan be treated byusing a nasal maskto give continuouslysupply pressurised

air, which reduces breathing inter-ruptions. A study in several Spanishcentres is now underway to find outwhether treating sleep apnoea couldindeed cut the death rate fromstroke. Although results from thiswill not be published for about fiveyears, Ludger Grote, at theSahlgrenska Hospital, Sweden,commenting in the same journal,said that the Spanish study repre-sents ‘... a milestone in our under-standing of the potential role ofsleep apnoea in stroke patients’andthat the initial Spanish results couldhave considerable implications forfuture stroke management.Respiratory reports: pages 16-17

About 5.5 million peopleworldwide died from strokes

in 2002 (Source: WHO)

Although most patients do notreact badly to prescriptions, anew study has found that one in16 hospital admissions (in twohospitals) were caused by adversedrug reactions, and these resultedin an average of 8-day inpatientstays, using 4% of the hospitals’bed capacity. Therefore, in all,adverse drug reactions alonecould cost the UK’s healthcareservice about £466m per annum.

Gastrointestinal bleeding wasfound to be the most commonreaction seen, and among themost commonly implicated drugswere low dose aspirin, diuretics,warfarin, and non-steroidal anti-inflammatory drugs, in a newstudy by researchers at LiverpoolUniversity (pub: British MedicalJournal).

For their survey, the drughistory and symptoms of 18,820patients aged over 16 years, wereassessed after they had beenadmitted to two Merseysidehospitals over a six-month period.1,225 admissions (a prevalence of6.5%) were due to adverse drug

reactions. Most of the patientsrecovered, but 28 (2.3%) died as adirect result of the reaction, yet theresearchers pointed out that about70% of their reactions could havebeen definitely - or possibly -

avoidable during prescribing:‘Simple measures, such as a regularreview of prescriptions,computerised prescribing and theinvolvement of pharmacists inassessing prescribing behaviour,may all reduce the burden causedby adverse drug reactions.’

The study also implied that,nationally, 5,700 patients may bedying due to adverse drugreactions, but the number might beeven higher, because the researchdid not include numbers who diedfrom adverse reactions to drugsreceived during hospital stays. Theteam concluded that measures areurgently needed to reduce thishealthcare burden.

In the UK, the safety of drugs iscontinuously monitored by theMedicines and HealthcareProducts Regulatory Agency(MHRA), which investigates alland any emerging safety issues.The country’s Department ofHealth is now considering theintroduction of an ‘online yellowcard’ and modernising the wayreactions to drugs are reported.

Oncology

Childhoodleukaemia Internationalscientific conference UK - A large number internationaland renowned experts are set toconverge on London’s WestminsterHall to examine environmental andother factors affecting the inci-dence of leukaemia and other child-hood cancers, as well as their mech-anisms of action and interactionacross a range of scientific disci-plines.

Topics, in this September confer-ence, will include the effects of ion-ising and non-ionising radiation, airand foodborne pollutants, infec-tions and modern lifestyles. Theconference will also compare howthe precautionary principle isapplied to different hazards.

Future research priorities will beidentified. Along with this, toencourage new research, ‘Childrenwith Leukaemia Paul O’Gorman’research grants, from a £1 millionbudget, will be awarded. Leadauthors of the best conferenceposters will be invited to submitresearch proposals for funding.

Sir William Stewart FRS, Chairmanof the UK Health Protection Agency,formerly UK Chief Scientist thenChair of the UK Independent ExpertGroup on Mobile Phones andHealth will open the event.

www.leukaemiaconference.org

N E W S

2 EUROPEAN HOSPITAL Vol 13 Issue 4/04

EH 4/04

Challenges for thenew EU member states

7th European Health Forum Gastein

Austria. 6-9 October - Challenges ofthe new EU Member States will behigh on the agenda of this year’sEHFG. The forum, timed to coin-cide with the constituent meetingsof the European Parliament commit-tees, expects 600 participants fromover 45 countries, and reports that56 government members have beeninvited, with acceptances confirmedby EU Commissioner David Byrneand WHO Regional Director MarcDanzon confirmed, as well as RoelBekker (General Secretary of theHealth Ministry, Netherlands),Chien-Jen Chen (Taiwan, R.O.C),Julio Frenk (Mexico), deputy statesecretary Mojca Gruntar Cinc

background of the Lisbon Strategy. ‘Certainly, our commitment to

health cannot stop at the Schengenborders,’ Dr Leiner said,‘Infectious diseases don’t respectborders either. We cannot ignorethe fact that HIV rates in theUkraine are twelve times as highas in the bordering countries ofPoland or Hungary, or that TBcases are five times as high as inneighbouring Hungary. The EUmust in its own interest undertakeall efforts to help the states at theouter borders of a larger EU tocope with their health problems.’

Dr Leiner said the Europeanhealthcare debate must turn glob-

EHFG pointed out. ‘Currently there isa huge gap between the demand fortreatment and the services actuallyavailable. Even in economicallyadvanced states with well-developedhealth systems, 44-70 % of patientswith mental disorders receive notreatment, this figure being as muchas 90% in developing countries. As itis often the case in the health sector,however, it would be economicallysound to invest more into mentalhealth, and in particular in preventivemeasures. The cost of mental diseasesin EU Member States is estimated at3-% of the GDP. In many developedcountries, 35-45% of work absen-teeism is attributable to mental prob-lems.

In a parallel forum the OECD willpresent its latest study ‘Towards high-performing health systems’ (based onexperiences in different countries) andin another parallel forum the focuswill be on pharmaceutical policy inthe enlarged Europe, as well as ontechnology assessment. Indeed,October’s EHFG meeting will exam-ine almost all frontline issues inhealthcare today - delivery, finance,politics - even the effects of ourchanging weather will have on health-care in our united Europe. Full details: www.ehfg.org

Asylum seekers and healthcareUK - Over 100,000 asylum seekers have been relocated throughout Londonand England’s southeast, to spread the cost of their medical care. However,because many of these people are from countries where HIV and AIDS arerife, many doctors have pointed out that their dispersal may lead toincreased HIV transmission in the UK. Additionally, the relocations mightnot only harm those who might contract the disease, but the asylum seek-ers themselves, i.e. those already undergoing medical investigations, orbeginning antiretroviral therapy, or alternative therapy after drug regimeshad failed, or whose care involves multiple medical specialities. Dispersalshould also not be considered for those with full-blown AIDS.

A survey of 56 employees in sexual health clinics in London revealed con-cern that dispersal of asylum seekers was often done within just 48 hours oftheir arrival, and often without the transfer of their medical details. Onlythree centres reported appropriate transfer of care.

The doctors argued that before the decision to disperse, the NationalAsylum Support Service (NASS) should consider expert medical advice, aswell as consider the impact on the infrastructure and staffing of sexualhealth clinics taking over these cases.

However, the Home Office said that the NASS did consider medical con-ditions and dispersed asylum seekers with hi considerations into there wasno evidence that dispersal increased the likelihood of onward transmissionof HIV to others, and it was working with HIV or AIDS to areas with suitablemedical services.

Nurse receives£354,000compensation Wales - Forced to stop nursingseven years ago, due to asthma andanaphylactic attacks and skin prob-lems that were blamed on her sen-sitivity to dust from latex gloves,nurse Alison Dugmore received£240,000 in compensation for per-sonal injury, loss of future earningsand loss of pension.

(Slovenia), and Maria Rauch-Kallat (Austria), Mihály Kökény(Hungary), Mitalip Mamytov(Kirghizia), Michéal Martin(Ireland).

Borders disappear, yet healthgaps remain - The EHFG organis-ers point out that not all EU citi-zens have equal access to optimalmedical care. Many must live andwork under conditions likely tocause physical and mental disease.Many suffer from health disordersthat could have been avoidedthrough sufficient information andprevention. Despite the economicand political integration of the oldand new EU Member States, thedifferences in life expectancy andhealth of the citizens within theEuropean Union remain blatant:Swedish men live an average of 77years, but the average Latvian manwill die when aged 64. InHungary, lung cancer numbers arefive times higher than in Sweden.In Lithuania, TB cases are 17times higher than in Sweden. ‘Canwe accept such discrepancies in aunited Europe?’ the EHFG asks.

EHFG President Dr GüntherLeiner said: ‘It is not primarily aquestion of fate whether peoplestay healthy or become ill. It isnecessary to examine the reasonsbehind such health inequalities anddevelop strategies to counteractany undesirable developments.’The EHFG said it could make asubstantial contribution toimprove health in Europe as acompetitive factor against the

al, and that, in this context, theforum had convinced the OECDto become a partner of the 7thEuropean Health Forum Gastein.‘After the World Bank and theWHO, the OECD is now the thirdglobally operating organisationthat actively contributes to theEuropean health debate at theEHFG. From the European side,the EHFG receives support fromthe EU Committee of the Regions(CoR), from the EuropeanCommission, General Directoratefor Health and ConsumerProtection, and from the EuropeanObservatory on Health Systemsand Policies.’ Mental health - The 7th EHFGwill also examine the current situ-ation of people with mental dis-eases, define targets, discuss solu-tion approaches, and work on thedevelopment of networks to bettersupport sufferers and families.

According to a report by theEuropean Commission, the EHFGpointed out, mortality due to sui-cide and self-inflicted injuriesreached a rate of 42 for every100,000 inhabitants (76.5% men,12.6% women) in Lithuania in1999, the highest rate in the entireEuropean region and four timeshigher than the EU average. Thisfigure is just as alarming as it isinconclusive in understanding theunderlying problems and ade-quately counteracting these. All inall, there are too little resourcesfor the research, prevention, andtreatment of mental diseases, the

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EUROPEAN HOSPITAL

www.esaote.de . [email protected] . phone: +49-(0)180-5 37 26 83

Ultrasound

wherever

you are

whenever

you need it.

High

Performan

ce

without

Compromis

e

MyLab30 CV

new

new

new

new

new

new

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

. . . . 1-3

Management . . . . . . . . . . .4

Pharmaceuticals . . . . . . . .5

Cardiology . . . . . . . . . . .6

-9

Radiology -

Mammography . . . . . . . .10-15

Respiratory care . . . . . .16-17

Nutrition . . . . . . . . . . . .

. .18

IT & Telemedicine . . . . . .19

contents

V O L 1 3 I S S U E 4 / 0 4

A U G U S T / S E P T E M B E R 2 0 0 4

10-15

Mammography

Why screen? EU

variations, scanners,

projects and

breast therapies

www.medica.de

Your No.1 medical

information portal:

24/7 all year round

First implants

of absorbable

metal stentsGermany - Following positive

results in numerous animal

studies and the first human

implantations of the Biontronik

Absorbable Metal Stent (AMS) in

below-the-knee arteries that

confirmed device safety, at the

end of July the first patients

(worldwide) received AMS

implants. Professor Raimund

Erbel, Director of the Cardiology

Clinic, Essen University, and

Professor Michael Haude, carried

out the procedures as part of a

‘Progress-AMS’ study.

‘This technology combines -

for the first time - the short term

vessel support of a metal stent

with the advantage of removing

the long term presence of an

implant,’ explained Dr Claus

Martini, Vascular Intervention

CEO at Biotronik GmbH & Co

KG, Essen.

The four-month follow up will

determine the great potential of

this technology, the firm added.

‘We also believe that AMS has

the potential to overcome the

future hurdle of non-invasive

imaging, because it doesn’t create

artifacts under X-ray and allows

successful utilisation of non-

invasive vessel imaging with

computed tomography CT or

multi-slice CT (MSCT). In

addition AMS stents are

magnetic resonance compatible,

because no artifacts are

produced.’

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

Adverse drug reactions

Cases cost thousands and take up 4% of beds

6-9Cardiology

ESC Congress plus

reports on CVD,

CHD, CHF and

VADs research

An ISO Certified Company

ECLIPSE® PROBE COVER

LATEX-FREE

Pre-gelled inside with Aquasonic® 100

Ultrasound Transmission Gel

PARKER LABORATORIES, INC. 286 Eldridge Road, Fairfield, NJ 07004

Tel. 973-276-9500 Fax 973-276-9510 E-mail: [email protected] www.parkerlabs.com

U.S.A. and International patents granted

PARKERWorld leader

in ultrasound

supplies

Please

see page

15

Equipment sales

From 2000-2003, the UK alone

purchased 204 CT Scanners, 88 MRI

scanners and 91 linear accelerators, as

well as 44 computers for radiotherapy

planning, 23 simulators and over 600

devices for breast screening.

However, whilst some EU countries

plough ahead with their cancer

detection programmes, others appear

to drag their feet about adopting

important new technologies, or even

setting up national breast screening

programmes.

On pages 10-15 European Hospital

asks why, and feature the political,

economic and technical influences on

approaches to cancer care today -

particularly focusing on

mammography. In this special new

section, we also highlight current

research and technological advances.Sleep apnoea study may

alter stroke management

Spain - New research suggests that

sleep apnoea is a new risk factor

for death from stroke.

Sleep apnoea describes repeated-

ly interrupted breathing when

asleep. Sufferers may stop breath-

ing for 10 seconds

and, in some, this

may occur over

300 times a night.

The syndrome

affects some 20% of people.

During their 30-months study

(pub: European Respiratory

Journal) Dr Olga Parra, and

researchers at Barcelona University

Hospital, began monitoring the

breathing of 161 stroke patients

soon after their hospital admit-

tance due to strokes. An apnoea

index was used for each patient.

The team found that the higher the

patient scored on the apnoea scale,

the greater the risk of dying from

stroke. In that period, about 50%

suffered a second stroke, and 22

patients died.

The team also pointed out that

the risk of a stroke and death was

more obvious in those with obstruc-

tive sleep apnoea, in which the

upper airways collapse.

The team do not explain why

sleep apnoea raises the risk of

stroke death, but they do indicate

that the syndrome

can be treated by

using a nasal mask

to give continuously

supply pressurised

air, which reduces breathing inter-

ruptions. A study in several Spanish

centres is now underway to find out

whether treating sleep apnoea could

indeed cut the death rate from

stroke. Although results from this

will not be published for about five

years, Ludger Grote, at the

Sahlgrenska Hospital, Sweden,

commenting in the same journal,

said that the Spanish study repre-

sents ‘... a milestone in our under-

standing of the potential role of

sleep apnoea in stroke patients’and

that the initial Spanish results could

have considerable implications for

future stroke management.

Respiratory reports: pages 16-17

About 5.5 million people

worldwide died from strokes

in 2002 (Source: WHO)

Although most patients do not

react badly to prescriptions, a

new study has found that one in

16 hospital admissions (in two

hospitals) were caused by adverse

drug reactions, and these resulted

in an average of 8-day inpatient

stays, using 4% of the hospitals’

bed capacity. Therefore, in all,

adverse drug reactions alone

could cost the UK’s healthcare

service about £466m per annum.

Gastrointestinal bleeding was

found to be the most common

reaction seen, and among the

most commonly implicated drugs

were low dose aspirin, diuretics,

warfarin, and non-steroidal anti-

inflammatory drugs, in a new

study by researchers at Liverpool

University (pub: British Medical

Journal).

For their survey, the drug

history and symptoms of 18,820

patients aged over 16 years, were

assessed after they had been

admitted to two Merseyside

hospitals over a six-month period.

1,225 admissions (a prevalence of

6.5%) were due to adverse drug

reactions. Most of the patients

recovered, but 28 (2.3%) died as a

direct result of the reaction, yet the

researchers pointed out that about

70% of their reactions could have

been definitely - or possibly -

avoidable during prescribing:

‘Simple measures, such as a regular

review of prescriptions,

computerised prescribing and the

involvement of pharmacists in

assessing prescribing behaviour,

may all reduce the burden caused

by adverse drug reactions.’

The study also implied that,

nationally, 5,700 patients may be

dying due to adverse drug

reactions, but the number might be

even higher, because the research

did not include numbers who died

from adverse reactions to drugs

received during hospital stays. The

team concluded that measures are

urgently needed to reduce this

healthcare burden.

In the UK, the safety of drugs is

continuously monitored by the

Medicines and Healthcare

Products Regulatory Agency

(MHRA), which investigates all

and any emerging safety issues.

The country’s Department of

Health is now considering the

introduction of an ‘online yellow

card’ and modernising the way

reactions to drugs are reported.

Oncology

Signature Date

EUROPEAN HOSPITAL Vol 13 Issue 4/04 3

N E W S

The Point of Knowledge

ShareShare the right information, the right way,At the right time, with the right people.

Share the advantages of a digitally connected world:From Home to Hospital;From Clinic to Multi-site Network.

Share beyond Radiology and PACS.Share end-to-end.

Our IMPAX and RIS/PACS solutions pave the wayfrom web-distribution of radiology and cardiology results to a comprehensive Electronic Patient Record:In an integrated & open environment, yet fully secure.

Use our experience of more than 10 years and over 850 PACS projects.

Grow into the future.Share, with Agfa.

www.agfa.com/healthcare

H E A L T H C A R EFraud andcorruptionconference

18-19 October 2004 -The firstconference to focus on tacklingfraud and corruption in EU health-care is being organised by the NHSCounter Fraud and SecurityManagement Service (CFSMS), andpartner organisations from fiveother EU countries, havingsecured funding from AGIS, an EUCommission programme to helpEU member states co-operate incriminal matters.

Over £600 billion is spent on theprovision of healthcare across theEU. The conference will aim atensuring the best possible protec-tion of those funds.

CFSMS is organising the confer-ence to examine problems andsolutions in healthcare fraud andcorruption within the 25 EU mem-ber states, with a view to encour-aging joint working, developingcommon standards and sharingbest practice.

Although the CFSMS is the leadorganisation for this initiative, theapplication to the EuropeanCommission’ AGIS programme forfunding was a result of a jointworking group with counter fraudand corruption representativesfrom five other European Unioncountries, such as the PolishMinistry of Health; Official Collegeof Pharmacists of Madrid; DutchAssociation of Health Insurers(ZN); The Bureau of Fight againstCorruption (Ministry of Interior -Slovakia).

Actual savings on fraud£478million (enough to pay for60,000 kidney transplant opera-tions or 100,000 hip replacements)has been saved by the CFSMSwhile investigating fraud in theUK’s National Health Service(NHS). The CFSMS, which employsmore than 400 fraud specialists,reported that the savings weremade in their first five years ofwork, in its ten-year plan. Everysingle NHS trust, primary caretrust and other health bodies areto be investigated during thatdecade.

A special ‘Fraud and CorruptionReporting Line’ (08702 400 100)was set up for those who suspect-ed fraud in their workplace.(However, the NHS emphasisedthat the majority of employeesare honest).

By making claim forms ‘fraudproof’, the reduction in fraud bypatients was 49% (false free med-icine claims, etc), and by NHS staff(lies about hours worked) was46%.

Globally, about two million people die each year after consuming spoilt food, according to theWorld Health Organisation (WHO). In Germany alone, about 200,000 cases of illnesses resultingfrom food are reported annually - over 60,000 caused by salmonellae - and experts believe casesmight be 10-20 times higher. The EU estimated that salmonellae infections cost the healthcaresystem about three billion euros annually.

Professor Andreas Hensel, President of the BfR, speaking at the 5th World CongressFoodborne Infections and Intoxications, said: ‘Food infections are a global problem. Only if weimpose uniformly high hygiene requirements around the world, will we be able, in the longterm, to prevent new pathogens from gaining ground and diseases that had been eradicatedin some regions, from flaring up once again.’

400 people from over 50 countries attended the congress, staged every six years. Organisedby the Federal Institute for Risk Assessment in its capacity as a Collaborating Centre for Researchand Training in Food Hygiene and Zoonoses of the World Health Organisation and the Foodand Agriculture Organisation, it serves as a forum for the exchange of scientific findings on thecauses and spread of foodborne infections and intoxications as well as for the sharing of prac-tical experience in their prevention and control. Details : www.bfr.bund.de

Czech Republic - Health leaders from 20 countries will gath-er in Prague for three days (5-8 September) to explore trendsand innovations effecting the development of new cross-border health services and insurance. James A Rice PhD,President of the International Health Summit, said this wouldbe a good opportunity ‘... for good networking and discus-sions about challenges and solutions for cost-effectivehealthcare and health gain’.

The faculty in the Prague symposium includes: Sir AlanLanglands, former CEO of the UK’s NHS; David Fine,University of Alabama Medical Centre, USA; Andy Black, UK,and several other insurance, disease management, hospitaland medical technology leaders from Germany, Spain, Czechand Slovak Republics and Poland.

Programme details: www.ihsummit.com/article.cfm?id=80.Email contact: [email protected].

CleanMed EuropeAustria - 6-8 October

CleanMed Europe, the firstinternational healthcare con-gress on ecologically sustain-able healthcare in Europe willtake place in Vienna. Withhealthcare experts from Europeand the US, the congress aimsto highlight the significance ofenvironmental protection in allareas of the healthcare indus-try. Environmentally sound hos-pital products and services willalso be exhibited.

Details: www.cleanmed.org

NEW

Cross-border health summit Food threat to health congress


M A N A G E M E N T

O P E N M I N D S

Austria - A new hospital is rarely agroundbreaking enterprise forurban planners and engineers.Recently, however, a whole riverhad to be re-routed to make wayfor a new medical centre atKlagenfurt, capital of BundeslandCarinthia. Indeed, in late July, theriver Glan was diverted along astretch of about 850 metres and106 000 m3 of ground was shifted,creating a six-hectares site wherethe new hospital will be built, andall this without interruptingoperation of the existing hospital,without costly temporary quartersand without having to settle forarchitectural compromises.

Designed by Austrian architectDietmar Feichtinger, the €316million project promises not onlyto be progressive in terms ofearthworks, but also for hospitaltechnology, quality and service.Feichtinger has a proven trackrecord of tailor-made structuralsolutions: the new access to theMont Saint Michel, France, and anew bridge over the Seine in front

closer together and working moreclosely with each other, moreefficient use of expensiveequipment - these are just someof the ideas that, in total, offerenormous savings potential.

Copenhagen’s Rijk Hospital isa role model for the newapproach to hospital buildingand management, and itsconsultants were involved in thedevelopment of the Klagenfurtproject.

In 2010, after all departmentsand wards have moved in to theirnew quarters, the vacated sitewill be returned to the city ofKlagenfurt, which has plans forits future use.

River shifts for a streamlined hospitalBy Christian PruszinskyEH Austrian Correspondent

Above: 2003 Red Cross parkingFeschnigstrasse BridgeBelow: 2004 Parking, Western bridgeIsland, Northern bridge

of the National Library, Paris,were conceived on his drawing-board.

For the Klagenfurt hospital,Feichtinger has designed a flatensemble that will not dwarfsurrounding buildings. Glass will

make this, Austria’s second-largesthospital, open, airy andtransparent, and more like a hotelthan the traditional medicalinstitution. Lots of green, smallunits and easy orientation also willhelp make patients more at home.

Improved logistics reduce costs -Shorter lengths of stay mean fewerbeds; indeed, the new hospital willhave 200 beds less than thecurrent one. However, this requiressophisticated logistics. Shorterroutes, less staff, departments

Virtual visitswith neonatesAlthough parents are allowed inneonate ICU units, family mem-bers and friends are barred. Tomeet this need, InnsbruckMedical University recentlylaunched the project ‘Babywatch’in its neonatology ICU. Installedin an incubator, a webcam relaysimages to the website www.baby-watch.at. Parents can then supplytheir user names and passwordsto log on, via the internet, for avirtual visit with their infants, atany time, as well as show themoff to friends and family.

Doctors also can use Babywatchto make unscheduled virtualward rounds and monitor theirtiny patients. ‘The off-limits rulein ICUs is something that is oftenhard to understand or accept forrelatives and friends. It’s greatthat for everyone with internetaccess this is now a thing of thepast,’ said Professor GeorgSimbruner, Head of clinicalneonatology at InnsbruckUniversity, who developed theproject in co-operation withChello broadband nv, a Europe-wide broadband provider, andTelesystem Tirol.Christian Pruszinsky


N E W SP H A R M A C E U T I C A L S

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The Pillpick system packs tablets,suppositories, phials, syringes, etc.into small plastic bags

New hospital automates drugs distribution

Forli, Italy - With constructionalmost completed, the 550-bedOspedale Nuovo G B Morgagnican now provide state of the artservices for the community itserves.

Among advances at the new hos-pital are an automated storage anddistribution system for pharmaceu-ticals and a pneumatic tube systemto deliver laboratory samples.

Dr Patrizia Grementieri, ProjectManager at the new hospital, said:‘One of our top priorities is to sup-ply patients with appropriate drugs,safely and efficiently. The Pillpicksystem lets us reduce errors remark-ably when issuing drugs. The newdrug management solution alsosaves costs and time compared withmanual medication selection anddistribution.’

As well as the Swisslog Pillpicksystem - used for patient/individualmedication selection, supportingpharmacy staff in their dispensingand care personnel in administeringthe correct doses to each patient -the hospital has installed two

Boxpicker units in its pharmacy,and a medicine cabinet with pass-word-protected access in the emer-gency ward.

A pneumatic tube system (com-pressed air), also being installed bySwisslog, based in Buchs/Aarau,Switzerland, will transport test tubesamples from the emergency depart-ment to the lab, alleviating the needfor manual transportation.

The Pillpick system packs individ-ual tablets, suppositories, phials,disposable syringes and other med-

ications into small plastic bags.Depending on the chosen methodof drug therapy, the system picksall medications to be administeredto the individual patient on agiven day. Tied on plastic ringsthese drugs are then delivered tothe right wards in transport carts.About 70% of all the drugs sup-plied by the pharmacy to in-patients can be handled in unitdoses by Pillpick, which marks thebags with barcodes and assignsthem to each patient. The system

also manages the return of drugsnot administered by the hospitalpharmacy.

Boxpickers - With these space-saving, automated cabinets, drugsthat cannot be packaged in unitdose, e.g. multi-dose and largevolumes can be handled and dis-pensed easier and better, Swisslogpointed out. ‘For secure storage ofdrugs that must be available atshort notice in the emergencyward, the hospital management inForlÏ decided to use Medihive, our

medicine cabinet that can only beopened by doctors and care per-sonnel subject to prior identifica-tion. Access is granted only forone specific drawer. The metal slotis unlocked automatically, so thatthe operator can take out the med-ication requested. Through cen-tralised storage and standardisedprocesses Medihive helps to pre-vent dispensing expired drugs.’

In the next few months thiswholly automated drugs systemwill be fully operational.

Prion filterfor red cellsScientists at biopharm firm PathogenRemoval and Diagnostic Tech-nologies Inc* (PRDT) recently con-firmed their identification of leadligands capable of specifically target-ing certain ‘challenging’ viruses.PRDT has also reported that its prionremoval ligands - successful in recentpreliminary studies - are the onlyproducts that specifically address theselective adsorption of infectiousprion proteins.

Now, with the American Red Cross,PRDT has announced a strategicalliance with MacoPharma, whichdistributes blood collection bag sets,to market and further develop prod-ucts for the selective adsorption ofprions and viruses from blood andblood-derived products. PRDT saidthis product line extension mightultimately target viruses by on-sitefiltration of donor blood supplies inblood transfusion centres, to reducepotential transmission risk of variousviruses, e.g. West Nile virus andHepatitis C (flavivirus and parvovirusfamilies).

Over 40 million blood units arecollected annually, so such filterswould find a significant market. TheAmerican Red Cross alone collectsover six million units a year, to supplyaround 3,000 hospitals across theStates, via its 36 Blood Servicesregions.

The European launch of first com-mercially available prion filter forred blood cells is expected next year.* PRDT is a joint venture of Canada-based ProMetic Life Sciences Inc.

involvement in these, including‘Promoting Heart Health - A EuropeanConsensus’ (Feb 2004) and the meetingon Cardiology Audit and RegistrationData Standards (CARDS) this May.

Professor Martin said therelationship between the ESC and theIrish Department of Health andChildren during the Irish Presidency ofthe EU ‘... may act as a model for othermedical societies in Europe to identifysimilar problems and advisegovernments accordingly’.

Professor John Martin


C A R D I O L O G Y

Cardiovascular diseaseEurope - Every year, 4 millionpeople die from cardiovasculardisease (CVD) in Europe as awhole (as many as 800,000 ofthem under 65 years old) and, inthe EU Member States, over 1.5million people die annually fromCVD. Many of those deaths werecaused by unhealthy lifestyles socould have been avoided, says TheEuropean Heart Network, based inBrussels. EHN also points out: ● CVD is the main cause of death

in women in all countries ofEurope and is the main cause ofdeath in men in all countriesexcept France.

● CVD is the main cause of yearsof life lost in early death inEurope and the EU.

● Nearly 30% of years of life lostin Europe are due to CVD (over30% in the EU).

● CVD mortality, incidence andcase fatality are falling in mostNorthern, Southern and WesternEuropean countries but rising inCentral and Eastern Europeancountries.

● Each year smoking kills about1.2 million people in Europe(430,000 from CVD) and about500,000 people in the EU(130,000 from CVD).

● Smoking has declined in manyEuropean countries but that rateis now slowing. Women nowsmoke almost as much as men inmany European countries andgirls often smoke more thanboys.

● Diets are generally improving inNorthern and Western Europeancountries but deteriorating inSouthern, Central and EasternEuropean countries.

● Dietary patterns across Europe -once very different - are nowconverging.

● Levels of obesity are increasingacross Europe.

● The prevalence of diabetes isincreasing across Europe.

Economic Costs - Coronary heartdisease is not only the single mostcommon cause of death in the UK,for example, but it also imposes ahuge annual burden on itseconomy. The costs of healthcarealone are over £1.7 billion a year.However, the majority of the costsof CVD fall outside the healthcaresystem and are due to illness anddeath in those of working age andthe economic effects of theirfamilies and friends who care forthem.

Prioritising EU heart health The Council of Ministers of theEuropean Union (EU) recentlyacknowledged not only thatcardiovascular disease in Europe is‘the largest cause of death of menand women in the EuropeanUnion’ - and is too frequentlycaused by unhealthy lifestyles - butthat these risk factors must beaddressed in the development ofnational and European policy.Professor John Martin,Chairperson of the EuropeanSociety of Cardiology (ESC)Committee for EU Relations,pointed out that nationalgovernments and the medicalprofession have been workingtogether to bring about anadvance, and that the EU move is a‘great step forward for Europeanhealthcare’

The EU declaration is a directconsequence of the recentinitiatives on cardiovascular healthstaged by the Irish Department ofHealth and Children and the ESC

The developing world: SoaringCVD hits the youngIn developing countries, heartdisease and stroke are causinghundreds of thousands of deaths inyoung people of productive age,according to a report entitled ARace Against Time, released inApril by Columbia University’sEarth Institute. The research,supported by the Initiative forCardiovascular Health Research inDeveloping Countries and theAustralian Health Policy Institute,University of Sydney, focused onBrazil, South Africa, Tatarstan,India and China.

Sorry statistics fromEurope and developingworld. EU heart healthpolicy is now a priority

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Population estimates for the fivecountries were combined withcurrent death rates and workforcedata to calculate the future effectsof CVD both on society and on theworkforce.

In India, South Africa andBrazil, the researchers found thatamong working age peoplemortality rates for cardiovasculardisease (CVD) are almost twicethose in the more affluent USA. InIndia, for example, five millionpeople die of CVD each year, and28% of those people were under65 years old. In the RussianRepublic of Tatarstan, CVD death

rates for young men have increasedin just 20 years by 70% - increasedrisk factors there include poor diet,smoking, high blood pressure andmore sedentary lifestyles.

CVD, the report also points out, isoften unrecognised as a cause ofimpaired health among women, yet,in South Africa, despite HIV/AIDStopping mortality figures, CVDranks sixth in men’s diseases, but athird in women’s diseases, and mostheavily affects poor women, causingthe highest portion of life years lostdue to non-communicable diseases(46%). The proportion of deathsoccurring among 35 to 44-year-olds

due to chronic disease (mainlyCVD) is 12% for men and 17.2%for women.

Australian epidemiologist andEarth Institute Visiting ProfessorStephen Leeder, a former dean ofthe University of Sydney MedicalSchool who led the research team,pointed out that treatment is oftenunavailable in these countries andlifestyle programmes such asdiet/exercise awareness and anti-smoking campaigns, as well astobacco taxes that have impactedin the US over the past 40 years,have not yet occurred in thecountries surveyed.

PURCHASINGGermany, Austria, Switzerland GEHealthcare’s Prucka CardioLabIT will now be exclusively dis-tributed by Biotronik VertriebsGmbH & Co KG in these coun-tries. The firms report thattheir agreement will benefitcustomers because they canorder a comprehensive rangeof catheters and GE’s electro-physiological measuring sys-tem from a single source.

Processing cardiac sounds

A processing system said to pick upcardiac sounds and correlate thesewith any related abnormalities, e.g.valve defects, stenosis, fibrillation,septal defect, etc, has been developedby the US firm BiosigneticsCorporation. This patent-pendinginvention, named Heart EnergySignature, is aimed at helping physi-cians and medical students to identi-fy cardiac problems during routinemedical checkups. If defects are pre-sent, the cardiac sounds processedthrough the system prompt on-screen images that indicate what theproblem may be.

Reported preliminary results alsoimply promising possibilities for usein neurology.

‘Our research direction is focusedon early detection of silent heart dis-eases, so that they can be treatedusing less invasive methods,’ said DrVladimir Polyshchuk, President andTechnical Director of Biosignetics,which is registered with the USA’sFederal Drug Administration (FDA)as an equipment supplier, and is cur-rently seeking clinical research part-ners.

The Biosignetics Corporation,founded in January 2004, is a smallbusiness start-up located in Exeter,New Hampshire. It was founded todevelop an inexpensive and widelyavailable early detection heart diag-nosis system. ‘We are focused on thecardiovascular market, specialisingin cardiac rhythm management,monitoring, and diagnostics. Ourshort-term product strategy is tofocus solely on the developing soft-ware applications that will utilise theelectronic stethoscope for sounddata collection.

Biosignetics Corporation hasdeveloped patent-pending heartenergy signature phonocardiograph(PCG) software.’

Currently the firm sells two soft-ware products for educational andnon-clinical research, and is workingon heart sound databases, as well ason the regulatory approvals with theUS Food and Drug Administration. Details: www.bsignetics.com

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Germany - 0.7% of newbornbabies need surgery for congen-ital heart defects (CHD) - i.e.around 5,000-6,000 children inevery 700,000 born. In theentire CHD spectrum, somedefects are ideally treated inthe first month of life (newbornperiod), first year of life (infan-cy) or in childhood before enter-ing school. Indication forsurgery depends on symptoms -either cyanosis, congestiveheart failure, failure to thrive orhaemodynamic reasons. After the introduction of minprostin andthe Rushkind procedure almost the only real surgical emergencyis for obstructed total anomalous venous return, because oxy-genated blood from the lungs does not reach the systemic circu-lation. The following heart defects are recommended for correc-tion in the first month of life: transposition of the great arteries,critical aortic stenosis and critical coarctation of aorta, interrupt-ed aortic arch, truncus arteriosus, hypoplastic left heart syn-drome, anomalous origin of the left coronary artery etc. In thefirst year of life, the following heart defects should be treatedsurgically, before irreversible damages to lung and heart occur:persistent ductus arteriosus, ventricular septal defect, atrioven-tricular septal defect (AVSD), and Tetralogy of Fallot. Beforeschool age, all CHD with no irreversible damage to heart andlung should be corrected e.g. atrial septal defects.

For all CHD one may argue that the earlier the defect is cor-rected the shorter the heart has to suffer from dysfunction.Furthermore, correction of CHD indicates an anatomical correc-tion and not palliation, such as banding the pulmonary artery forAVSD in order to limit pulmonary blood flow, or placement of anaorto-pulmonary shunt in Tetralogy of Fallot because of cyanosis.

After about two years of age, complex CHDs in functionallyuni-ventricular hearts are treated by aiming at a perfect Fontancirculation, by early banding of pulmonary arteries in the case ofpulmonary hypertension, and implantation of a limited-sizedshunt in the case of cyanosis. The ideal Fontan circulation thenallows maximal passive blood flow from the superior and inferi-or vena cava to the pulmonary arteries.

Increasing knowledge in science and physiology and advancedsurgical techniques, have led to low mortality even for correctionof complex heart defects in infancy, especially in specialised highvolume heart centres where over 250 procedures are performedannually. Very few centres in Germany can offer this level of highexpertise, thus centralisation of heart centres for congenital dis-ease should be promoted.


C A R D I O L O G Y

The ESC Congress28/8 - 1/9 Munich Germany

25,000 visitors and medical professionals from 47 National Cardiac Societies acrosscentral and greater Europe, will attend the 2004 ESC Congress, where ‘Diabetes and

heart disease’ will be the main theme. Lars Ryden, ESC Past-President, team member forthe Euro-Heart Survey on Diabetes, and Chairman of the ‘Guidelines for Diabetes & the

Heart’, and William Wijns, co-chair and Chairman of the Congress ProgrammeCommittee, explain why this has become such a central focus for cardiologists

Accumulating evidence indicatesthat the burden of cardiovasculardisease in patients with diabetes isgrowing to such an extent thatacknowledging the ‘epidemic’growth of the problem representsby no means an exaggeration. Thisincreased cardiovascular riskextends to the many patients withobesity, metabolic syndrome andother conditions that are associat-ed with all too often unrecognisedinsulin resistance.

For instance, abnormal glucoseregulation (defined as previouslyunknown diabetes and impairedglucose tolerance) is present in67% of patients admitted foracute myocardial infarction to theCoronary Care Unit. Thesepatients are at increased risk ofdeath, re-infarction and progres-sion to heart failure.

In order to respond to the grow-ing burden of cardiovascular dis-ease in patients with diabetes, theemphasis of the 2004 ESCCongress will be placed on thegeneral theme of ‘Diabetes andthe Heart’.

Both education and science willbe covered. This means that signif-icant parts of the pre-arranged andabstract-based programme willpresent the latest information onmolecular mechanisms, pathophys-iology, epidemiology, preventionand treatment of cardiac disordersthat are associated with diabetes.

As to the pre-arranged pro-gramme, we are introducing the‘Diabetes Track’, a series of 12didactic symposia, or clinical semi-nars, that will take place continu-ously during the congress.

In addition, for each major sub-specialty topic, issues specificallyrelated to diabetes will beaddressed by dedicated lectures in

several sessions.The final results of the Euro

Heart Survey on ‘The diabeticstate of patients with coronaryartery disease’ will be presented on29 August. The overall results aswell as a preliminary report of theone-year follow up, conductedduring spring and summer 2004,are available.

Practical approaches to the man-agement of the diabetic patientwill be illustrated during one ofthe popular FOCUS CardiologyPractice sessions (on (August 30).The topics and patients to be dis-cussed are chosen so that availableand upcoming ‘Guidelines forDiabetes and the Heart’ may beused for commentary.

Even the satellite programme,organised by our industrial part-ners, will cover many importantaspects of this new epidemic, witha special emphasis on the value ofprescribing drugs such as ACEinhibitors, angiotensin II receptorblockers, beta-blockers, met-formin, moxonidine and others.

Because the EuropeanAssociation for the Study ofDiabetes (EASD) will hold itsannual meeting in Munich imme-diately after the ESC Congress, wewill take advantage of this oppor-tunity to share a number of initia-tives.

We will have a joint main ses-sion entitled: ‘Caring for patientswith type 2 diabetes - a responsi-bility to be shared between cardi-ologists and diabetologists’. Besure to attend this session onAugust 30.

As for the abstract-based pro-gramme, we will hold a prestigiousjoint session called the EASD-ESCscholarship session. Six abstractsof outstanding quality (half select-

ed by each organisation) will bepresented at both meetings.Sincere congratulations to theAwardees: N Kraenkel (Leipzig,DE), T Mazurek (Warsaw, PL)and F Cipollone (Chieti, IT) onbehalf of the ESC; and W Otter(Munich, DE), C B Kragelund(Frederiksberg, DK), and GDoronzo (Orbassano, IT) onbehalf of the EASD.

The regular programme willdiscuss over 60 abstracts on top-ics related to Diabetes & theHeart, either during oral orposter presentations.

Last but not the least, some ofthe trials presented during theHot Line sessions will releaseimportant data for the manage-ment of patients with diabetes,for example INTER-HEART (aworld-wide study of the impactof risk factors), RIO-EUROPE (arandomised trial on weightreduction with Rimonabant inobese patients) and DETAIL (atrial on the value of Telmisartan& Enalapril in diabetics).Exciting results of Clinical TrialUpdates are expected as well,including follow-up data ofGAMI and the subgroup analysisof TAXUS VI in patients withdiabetes.

Lars Ryden

CHF: A major healthcare burdenBy Professor H P Brunner-La Rocca MD, Cardiology Department, Basel University Hospital

Congestive heart failure (CHF) isa major healthcare problem with1-2% of the population affectedin Western countries. Because itincreases with age, the prevalenceof CHF is escalating with ouraged populations. Despiteimprovement in CHF therapy,prognosis is still poor. After hospi-tal discharge, about 50% ofpatients are readmitted within ayear, due to decompensated CHF.Accordingly, healthcare costs areenormous and estimated at about€10,000 / year / patient, of whichhospitalisations account for 2/3.Therefore, apart from reducingmortality, a major target of CHFtherapy is to reduce the hospitali-sation rate.

Dyspnoea is the leading symp-tom of CHF. However, diagnosismay be difficult. Blood measure-ment of B-type natriuretic peptide(BNP), which is released by the

Successfully treatingCHD in infancy

By Professor Boulus Asfour MDAssistant Medical Director at the German Children’s

Heart Centre, Asklepios Klinik Sankt Augustin GmbH

heart in parallel to the severity ofCHF, significantly increases theaccuracy of diagnosing CHF.

The most important underlyingcauses of CHF are coronary arterydisease and arterial hypertension.Other causes such as valvularheart disease, dilated cardiomy-opathy, and other diseases aremore seldom. The risk of CHFmay be reduced by treating and/orpreventing these disorders. Also,even when CHF is established,treatment of the underlying diseasemay improve outcome.

Therefore, diagnostics shouldnot only define the severity andpossible complications, but also

Other drugs (e.g. diuretics,digoxin, nitrates) are additional-ly used for symptomatic reasons.Importantly, therapy must beinitiated and up-titrated careful-ly to increase tolerability. Also,regular controls, particularly ofserum creatinine and potassium,are crucial. Since medical thera-py of CHF is complex and thesepatients often have diseasesother than CHF, drug interac-tions must be considered care-fully.

Therapy of diastolic CHF (i.e.CHF with preserved EF) is lesswell defined and mainly aims atreduced symptoms (primarilydiuretics). Since arterial hyper-tension is the most commoncause of diastolic CHF, bloodpressure control is important. Ifthere is an additional prognosticbenefit of medical therapyremains to be investigated.

the underlying cause of CHF.If left ventricular ejection fraction

(EF) is reduced (i.e. �45%) medicaltherapy is well studied and established.Thus, all these patients should receivean ACE-inhibitor, even if they are notsymptomatic. If not tolerated, theyshould receive an angiotensin-II antag-onist (candesartan, losartan, valsar-tan). Patients should also receive �-blockade (bisoprolol, carvedilol,metoprolol) and, if still sympto-matic during daily life activi-ties, spironolactone. Recently,the CHARM study showedthat angiotensin-II antagonism(candesartan), added to othertherapy, might be beneficial.

H P Brunner-La Rocca


C A R D I O L O G Y

Small silent VADsPowerful tools to beat end-stage HF

By Roland Hetzer MD PhD, of theGerman Heart Centre, Berlin

Ventricular assist devices (VAD) havebeen used since the 1980s, primarily toprovide support after cardiac surgeryfor several days during recovery, ormore often to keep patients alive untillater heart transplantation (HTx). Thislatter concept, named ‘bridge-to-trans-plantation’ (BTT), has saved manypatients who otherwise would havedied before a donor heart became avail-able.

Organ failure from cardiogenic shock- brain, lungs, kidney, and liver - wasreversed by VAD support, which onlythen made heart transplantation suc-cessful. Thus, in experienced teams, theresults of HTx after BTT are the same

BP: A poor indicator for cardiac diseaseBlood pressure (BP) screening, either alone or in combination withother cardiovascular risk factors such as cholesterol levels, doesnot determine a person’s chance of having a heart attack orstroke, reports Professor Malcolm Law and colleagues at theWolfson Institute of Preventive Medicine in the Journal of MedicalScreening. Although high BP is a proven cause of heart diseaseand stroke, the authors claim that most heart attacks and strokesoccur in people who do not have high levels of blood pressure.Pre-treatment blood pressure measurements identify people whowill not suffer from heart disease in addition to those who will.History of heart disease is best indicator - ‘Identifying patientsat the time of hospital discharge following a heart attack or strokeis the most effective screening test to distinguish those who willdie of cardiovascular disease,’ the authors report. This is support-ed by the fact that about 50% of deaths caused by heart disease

occur in people who have already had a heart attack.All people over 55 are at higher risk - We know that lowering BPdecreases the risk of heart attack and stroke, regardless of thepatient’s existing level of BP. The authors conclude that preventivetreatment might as well be offered to everyone above a specifiedage of 55 ‘...rather than attempting to discriminate between peo-ple using measurements of blood pressure or cholesterol’.Lower dosage reduces incidents - Professor Law and colleaguesalso discuss recent work that has ‘...shown that blood pressure low-ering drugs are in general best used at half the present standarddoses, because the resulting reduction in adverse effects outweighsthe relatively small loss of efficacy.’ Using BP lowering drugs at lowdose in persons over 55 would reduce the number of heart attacksby 46% and stroke by 63%.Details: www.rsm.ac.uk/new/prbody.htm

attractive as a treatment concept; how-ever, so far, recovery in the individualpatient has remained unpredictable.

Second, long BTT waiting periods,improved VADs, high patient mobilityand quality of life on VADs and thedischarge of patients to home, then areturn to work with a VAD haveopened the view to permanent VADsupport, and now an increasing num-ber of patients receive VADs as ‘desti-nation therapy’, either because of con-traindications to HTx or due to apatients’ own wishes.

Some VADs have now been designedfor permanent use and experience withthis latter concept shows well-func-tioning devices in patients up to oversix years.

Newly developed devices are smaller,need less energy, are silent and mostlyfollow the continuous flow principle.Expectations are justified that suchVADs will become a powerful routinetool to battle end stage heart failure.

as after primary HTx. However, withBTT the number of possible HTx is notincreased.

The waiting time for HTx has nowbecome as long as many months. Thishas allowed the observation of extend-ed periods on VADs, which has led totwo important concepts. First, somepatients with acute myocarditis anddilated cardiomyopathy have displayedcomplete cardiac recovery after weeksand months of unloading of the heartwith a VAD, which could then beremoved, followed by stable heart func-tion, up to now for over nine years.Such ‘bridge-to-recovery’ is excitingly

the Institute of DiagnosticRadiology, University of Erlangen-Nuremberg, Germany, conducted anexperimental investigation - a so-called phantom study using waxblocks - to compare image quality inX-ray mammography. They com-pared results using conventionalscreen systems (SFS) with those

using this new full-field digitalmammography unit (DR) with anamorphous Se-detector, determin-ing the differences in imagequality delivered by both sys-tems.

In their investigation, radi-ograms were acquired by boththe conventional film screen

system as well as the digital sys-tem. A phantom was construct-ed of wax blocks that could bevariably arranged into columnsand rows. The thickness was 45mm in agreement with the stan-dard phantom in the EuropeanProtocol on Dosimetry inMammography. Some blockscontained nylon strings, some


O N C O L O G Y - B R E A S T S C R E E N I N G

Why screen?Mammography as a diagnosticprocedure to evaluate detectedtumours is not an issue. Butbecause the technique is per-formed, in screening pro-grammes, on apparently healthypeople, for ethical reasons itbecomes an issue. Screeningshould be based on a sound sci-entific foundation, so resultsfrom several studies of mammo-graphic screening need critical re-evaluation of this procedure,according to Professor IMühlhauser, specialist in internalmedicine, diabetology andendocrinology at HamburgUniversity, Germany.

Using an evidence-basedapproach, Danish researchersPeter Goetzsche and Ole Olsenevaluated all available data onmammographic mass screening.They concluded that there is noreliable evidence that regularmammograms reduce breast can-cer mortality and argue that six ineight studies showed flawedmethodology, questioning thereliability of their results. Twostudies that were reliable, i.e.meeting the strict criteria of theNordic Cochrane Centre,Copenhagen, indicated thatmammographic screening doesnot yield any benefits (The Lancet2001; 358, 1340-1342).

In Sweden, mammographicscreening began in the late 80s.The study included 600,000women aged 50-69. A recentlypublished analysis of the dataraised doubts on the usefulnessof these expensive screeningprogrammes, because, from1986-96 breast caancer mortality hadnot significantly decreased in theregion. The number of deathsfrom breast cancer in the groupof women who had undergonemammographic screening wasonly 0.8 % below the expectedvalue (British Medical Journal1999; 318: 621).

Both findings, published inrenowned medical journals, aredisquieting in themselves, butworse, Professor Mühlhauserpoints out, is that screening mayhave negative effects: wrongresults, be they positive or nega-tive. Incorrect positive findingslead to unnecessary interventionsand create fear in the womenconcerned; incorrect negativefindings create a false sense ofsecurity. In the Swedish study,

T H E O N - G O I N G D E B AT E Mammography plays a criti-cal part in diagnosing breastcancer. Although this doesnot prevent the disease, diag-nosing breast cancer as earlyas possible can save lives. Inthe past, women who came inwith a lump were found tohave breast cancer. Nowadays,radiologists find cancer via

mammography early in the diseasedevelopment, and often before apatient can feel it. Usually, theseearlier stages also have far lowerlymph node involvement.

While mammograms do not pre-vent breast cancer, they have beenshown to reduce mortality by 35%in women over 50 years old; inwomen between 40 and 50, studieshave shown that mammogramsmay lower the chance of dyingfrom breast cancer by 25-35%. Byusing mammography to detectlocalised breast cancers at an earlystage there is less need for surgicalbreast removal.

Mammograms are far from per-fect: breast tissue can conceal agrowing cancer and prevent it fromshowing up on the mammogram(women with breast implants areadditionally prone to this). Manyhealth experts agree that thebiggest misconception about mam-mography is that is picks up everybreast cancer. However, this is notthe case - mammography actuallymisses at least 10% of all breastcancers. Women should alwayspractice self-examination and bringany lump they feel to their doctor’sattention to have it evaluated.

However, mammograms remainone of the most important tools tohelp doctors to diagnose and evalu-ate women who have had breastcaner, and leading experts, theNational Cancer Institute, theAmerican Cancer Society, and theAmerican College of Radiology

now recommend annual mammo-grams for women over 40 yearsold.

The technique of X-ray imaginghas been used for roughly thirtyyears, with digital technology nowbeing utilised increasingly toimprove image quality andincrease patient comfort.

A novel digital mammographysystem manufactured by Siemens,which optimises clinical workflow,has been tested in clinical trialsand appears to have all the quali-ties for becoming the new bench-mark in X-ray technology in digi-tal imaging of the breast. Besidesoffering the latest in digital tech-nology, it provides advantages inpatient comfort as well excellentimage quality based on amorphousselenium (a-Se). It also offers anoptimised solution from screeningand diagnosis through biopsy, toevaluation, follow-up and archiv-ing in a single system.

The large format size of the digi-tal plate allows imaging even oflarge breasts in a single image,permitting the entire breast as wellas a larger area of the pectoralmuscle to be included. Through aspecial function, examination isless painful - compression ofbreast tissues is controlled andoptimised to exert only minimalpressure while ensuring optimaldigital quality of the entire breast.

A group of clinical researchersled by Schulz-Wendland, Professorof Gynaecological Radiology at

contained aluminium oxide grains,and others were empty, whilst stillothers contained round lesions withblurred margins to simulate the con-tours and textures of breast tissue.

When primary dosimetry wascompleted, the results were com-pared, using both imaging modalitiesand X-rays. The five investigatorsnoted their observations for everyfinding of the 16 wax blocks: ‘g’ forgrains, ‘l’ for round lesions, ‘s’ forstrings and ‘e’ for empty. Resultswere then compared with the truearrangements, whereby the test forrecognition was planned only fortrue positive results. In other wordsthe sensitivity of the two systemswas proved. For each modality amaximum of 45 true positive resultswere possible (18 strings, 15 grains,12 round lesions).

The results showed that using con-ventional film screen system mam-mography, a total summary of 191(average 38.2) of 225 possible detailswere detected by the five investiga-tors, compared with a summary of219 (average of 43.8) using digitalmammography. Based on theseexperimental findings, theresearchers conclude that, from thetwo modalities, full-field digitalmammography shows better resultsin the capacity for detection ofdetails, despite lower resolution (7lp/mm vs. 14 lp/mm). The limit dueto lower resolution is compensatedin this system by higher DQE (detec-tive quantum efficiency) and signal-to-noise ratio.

The researchers conclude that theirphantom study shows the possibilityfor replacing conventional filmscreening systems with digital mam-mography (DR) that includes anewly developed a-Se-detector.

With X-ray technology mod-ernising, as in this new Siemensdevice, screening women with breastcancer enters a new era. The goal isto have mammography as a highlyreliable diagnostic tool for breastcancer, with the potential to becomea widespread screening deviceemployed routinely, so that themajority of breast cancers can bedetected in their incipient stage.

Worldwide about 600,000 new casesof breast cancer are diagnosedannually

By Karen Denteour USA correspondent

100,000 women received an incor-rect positive diagnosis and conse-quently biopsies for further clarifi-cation were performed on 16,000women. 4,000 women underwentunnecessary surgery, in manycases even a mastectomy.

These findings should influencethe design of future screeningprogrammes. Comprehensibleand objective information for thepublic must include the possiblebenefits as well as possible harm.Only then can all findings can beevaluated and analysed. One fea-ture of mammographic screeningis that many women participate;some benefit and many sufferserious harm. Women can onlymake an informed decision if theycan assess personal benefits inrelation to effort and effect.

The primary goal of screening isto achieve a decrease in mortality- while maintaining an acceptablelevel of quality of life, effort andcost. Data presentation influencesthe decisions of women and doc-tors. What does it mean, whenmammography allegedly reducesbreast cancer mortality by 30%?Most people would assume that,out of 100 women, 30 fewer diefrom breast cancer. But that is notthe case. Absolute figures are farmore transparent.

There are different ways to pre-sent data in favour of early detec-tion screenings. Often, results arebeing shown in percentages.Using Swedish data Mühlhauserillustrates the danger inherent indifferent presentations: Withoutmammography four out of 1,000women die of breast cancer with-in a 10-year period. With mam-mography, the number is reducedto three. In absolute figures:Without mammography 996women don’t die from breast can-cer over a period of ten years.With mammography the figure is997. Or: Out of 1,000 women withmammography one woman bene-fits by not dying of breast cancer,999 women have no benefit asthey would not have died frombreast cancer anyway (996women) or because they diedfrom breast cancer despite mam-mography (three women). Further details: www.mammographie-screening-online.de www.gmc-uk.org/standards/CON-SENT.htmReport: Christian Pruszinsky

Screening update

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The UK - In the 1990s, the nationallyco-ordinated NHS Breast ScreeningProgramme was already saving lives -a 21% fall in breast cancer mortalityover the last decade and, with the cer-vical screening programme, this wasviewed as among the best cancerscreening programmes in the world.However, in that period, the country’scancer services, as a whole did notmatch up to those of other Europeancountries.

In September 2000, the governmentpublished its NHS Cancer Plan, pro-viding a long-term national strategythat heralded radical reform of cancerservices, aimed at reducing mortalityfrom cancers by at least 20% in peo-ple under 75 by 2010 (using 1995-97figures as a baseline).

Between then and 2002 the coun-try’s cancer death rate fell by 10.3%,which, by comparison of categorieswith results from other countries,indicated that Britain had achievedthe world’s sharpest decrease in pre-mature deaths from breast cancer andhad made a substantial decrease inlung cancer deaths. In that period, 1.3million women had been screened and8,545 breast cancer cases were diag-nosed. Now, new figures published inFebruary 2004 have revealed thatbreast screening detected 9,848 can-cers in 2002/03, over 13% morebreast cancers detected by screeningthan in the previous year.

Because research has shown thattwo-view mammography could leadto a 42% increase in the detection ofsmall cancers, this was also intro-duced to the programme, and itt isbelieved this produced the new rise inbreast cancer detection. It involvestaking two x-ray views of each breastduring screening. By December 2003,86% of local screening services car-ried out two-view mammographies.(England now has about 80 breastscreening units at 87 sites - with somelocal breast screening programmescreating additional space by under-taking new building projects).

Breast cancer screening pro-grammes were also extended and newprogrammes and technologies intro-duced - if proven lifesavers.Additionally, the NHS BreastScreening Programme was extendedto include women aged 65-70 years,so that women aged 50-64, formerlyinvited for five screens, now receivetwo additional invitations for screen-ing. An additional 400,000 womenwill be invited for screening annuallyby the end of 2004.Screening staff - To remedy a dearthin radiographers, training places weredoubled. Additionally, theDepartment of Health (DoH), part-nered by the Society and College ofRadiographers and the Royal Collegeof Radiologists, developed a pro-gramme in which four new roles werecreated: assistant practitioner, stateregistered practitioner, advanced prac-titioner and consultant. Advancedpractitioners are radiographerstrained to take on some of the tasks ofradiologists, i.e. interpreting X-raysand inserting marker wires to identifybreast tumour locations. Trainedassistant practitioners produce basicbreast screening X-rays and can deliv-er basic radiotherapy to cancerpatients.

The NHS reported that this roleenhancement attracted more person-nel to work for the NHS. By springlast year, 53 assistant practitionersand 158 advanced practitioners wereemployed and 28% of breast screen-ing units were using assistant practi-tioners to help deliver the service.


O N C O L O G Y - M A M M O G R A P H Y

Ploughing vigorously forward Equipment - The DoH allocated£12 million to buy new breastscreening equipment, whichincludes mobile screening units.Purchasing from 2000-2003 includ-ed 204 CT Scanners (164 replace-ments; 40 additional), 88 MRI scan-ners (51 replacements; 37 addition-al) and 91 linear accelerators (66replacements; 25 additional), as wellas 44 computers for radiotherapyplanning, 23 simulators and over600 devices for breast screening. Patients - Under the NHS CancerPlan, new information leaflets about

screening were introduced toexplain to patients the potentialbenefits and harm of screening pro-grammes to help them base theirdecisions on evidence-based data(information overseen by theAdvisory Committees on Breast andCervical Screening and NationalCancer Director). Since 2001, thesehave been included with the invita-tions women receive for breast (andcervical) screening.

Following publication of the gov-ernment’s White Paper, ‘The newNHS - Modern, Dependable’, which

guaranteed anyone with suspectedcancer would see a specialist withintwo weeks of their general practi-tioner (GP) requesting urgent con-sultation, from April 1999 thisapplied to anyone with suspectedbreast cancer. It was reported that96.9% of women with breast cancernow receive first treatments within amonth of diagnosis. Ways of seeingnon-urgent referrals within twoweeks have also being investigatedby the Cancer ServicesCollaborative ‘ImprovementPartnership’ (CSC ‘IP’) breastgroup.

Rapid access (‘one stop’) clinicswere also established for patientspresenting common problems

(including breast cancer symptoms)that might point to an underlyingcancer. In addition, in some areasGPs can refer patients directly fordiagnostic tests, bypassing the waitfor a consultation.

To further streamline diagnoses,significant streamlining of diagnos-tic tests has also been a focus. Peer reviews - To improve qualityof care, assessments of cancer teamshave been rigorous, and the value ofpeer reviews is generally acknowl-edged. A peer review steering groupwas established, closely linked to theshadow Commission for HealthcareAudit and Inspection (CHAI), andthis summer a three-year peerreview programme commenced.

T h e U K



Austria is the only ‘old’ EU Member State that has not implemented a nationalbreast cancer screening programme. That, plus an increasing public debate sur-rounding hormone replacement therapy (HRT), prompted the country’s HealthMinister to commission a study, from the Federal Institute of Health (ÖBIG), toexamine parameters for such a programme. This set in motion a pilot project, basedin Vienna and Vorarlberg, that offered mammographic screening to 70,000 womenaged 50-69. A second research programme targets women with genetic breast can-cer risk, and a third examines women on HRT over a long period of time.

4,500 Austrian women are diagnosed with breast cancer annually, and about1,600 women die of it. A systematic screening programme is expected to reduce themortality rate by a third. By comparison, in the EU-15: 220,000 breast cancer diag-noses and 75,000 deaths from breast cancer, means 25,000 women could be savedthrough screening. Both the EU Commission and the WHO expect, based onresearch findings in Sweden and Finland, a reduction of the mortality rate by 30%,if all member States implement a high-performance screening system that includessecond diagnosis and follow-up examinations when necessary.

The authors of the ÖBIG report, Mammographic Screening Austria, conclude thata widespread national early detection programme could save the lives of 500women annually, but they also point out that the Austrian health system currentlylacks basic preconditions for a quality-based screening programme that complies toEU guidelines such as training, technical and equipment-related quality assurance ora breast cancer register. The maximum costs of such a programme, not taking intoaccount synergy effects on space, equipment and personnel resources, are estimat-ed at about 22 million euros per annum. Details: www.oebig.at Report: Christian Pruszinsky

Quality assurance firstG E R M A N Y

By Antonia Hanne, of themammographic screening

unit, Bremen Clinic, describesthe lead-up to the

adoptionof a national

breast screeningprogramme

Germany’s Federal Committee ofPhysicians and Statutory HealthInsurance Funds set up threemodel projects, based in Bremen,Wiesbaden and Weser-Ems, totrial the third edition of theEuropean guidelines on healthcarewithin the German system and todevelop the necessary organisa-tional structures to make thesework.

Following negotiations over the‘Model Project MammographicScreening in Bremen’, between theAssociation of Statutory HealthInsurance Physicians of theHanseatic City of Bremen and thenational associations of the statuto-ry health insurance funds of theCity of Bremen, Dr HansJunkermann MD, of Heidelberg,was appointed project leader asthere was no role model or similarproject in any other German citymammographic screening inBremen oriented itself on examplesfrom the Netherlands, Sweden andEngland.

The objective was to create con-ditions to provide quality assuredmammography and sufficient infor-mation for all women in Bremenaged 50-69 years. The objective ofmammographic screening, accord-ing to the European guidelines, isto lower the mortality rate frombreast cancer by about 30%.According to those guidelines, themain features of mammographicscreening should be:● Organised screening followingwritten invitation to all womenaged 50-69, based in the region● Mammography to be carried outby a qualified radiography assistantwho has undergone further training● Second assessment of each mam-mographic examination, with bothassessments being carried out bypracticing radiologists, with furthertraining, who evaluate at least5,000 images annually● Assessment based on EU guide-lines● Second diagnosis of all pathologyresults● Complete, gapless documentationand publication of results● Pre-and postoperative, interdisci-plinary conferences with compulso-ry attendance● Work flow and results based onEU standards● Internal and external qualityassuranceEvery step in mammographicscreening, from initial invitation todiagnosis, the documentation andpossible further assessments rightup to surgery (if necessary) must becarried out with quality assurance.Mammographic screening is a

chain of events where each step,plus the whole procedure, must betotally quality assured.

Individual steps● All women aged 50-69 shouldreceive a written invitation to vol-untarily participate in the pro-gramme. They can change appoint-ments by phone, fax or email.● Examinations are carried out inspecial facilities where speciallytrained radiography assistantswork autonomously and self-dependently

Agency for Research on Cancer)statement and clarified: Qualityassured mammographic screeningreduces mortality rates from breastcancer by up to 35%. On onehand, this ended the emotionallyheated discussion on disadvantagesor benefits of mammographicscreening. However, it also made itclear that only quality assured,organised mammographic screeninglowers mortality, as opposed to theopportune (grey) type of screening,then widespread in Germany.

In October 2002, Germany’sNational Cancer Institute publishedthe ‘Shanghai-Study’, whichdeclared that manual examination

● Each mammogram is assessed bytwo practicing radiographers, inde-pendently● Any suspicious images are dis-cussed and assessed with the doctorresponsible for the project andpatients are then recalled for fur-ther assessments● Final diagnosis is carried out inthe screening centre through clini-cal examination, ultrasound scan,additional mammography and, ifindicated, biopsies● All clinical, pathological andradiological results of patientsexamined are introduced to, anddiscussed by surgeons, radiologistsand pathologists during multidisci-plinary, pre-operative conferences.Results of surgery and courses oftreatments are discussed duringpost-surgical meetings.The model project in Bremen, thefirst to be set up, began in July2001, followed soon afterwards byWiesbaden, then by Weser-Ems justover a year later.

Up to 31/12/2001, a small num-ber of women due for examinationwere invited on a daily basis, whilethe facilities for the clinical aspectsof the mammographic screening(assessment, first and secondpathology examination, stereotacticbiopsy) were being set up.Simultaneously, further trainingwas carried out for staff; guidelinesfor regular, ongoing training weredeveloped, and external qualityassurance was finalised with thereference centre in Nijmegen,Netherlands. Medical documenta-tion programmes were selected andtested and the final data protectionconcept completed. Around thistime, the Goetsche and Olsen’sMeta study was published by theCochrane Institute, which took aclear stance against mammographicscreening, causing confusion inBremen as much as elsewhere.

Since 1/1/2002 Bremen’s mam-mographic screening unit hasworked to full capacity. In May ofthat year, the WHO contradictedGoetsche and Olsen’s interpretationwith the Lyon IARC (International

of the breast was not a suitablemethod for early detection of breastcancer. So, from a scientific point ofview, only organised mammographicscreening can be considered as asuitable tool of early detection thatcan lower mortality significantly.

In the first two years, 83,102women across the three model pro-ject regions were invited for screen-ing. 44,934 women from the targetgroups participated in mammo-graphic screening. 6% of partici-pants were recalled for furtherassessments. 2% of participants hadtissue removed through needle biop-sies. Breast cancer was discovered inmore than 9 (9.6) in a 1,000women, and in 17% of cases thecancer was still at the in situ stage.The proportion of invasive carcino-mas of less than 10mm in diameterwas 36%. There were no significantdifferences between the three modelprojects. With the exception of theparticipation rate, all EU guidelines

Weighing up the way to go

Mobile mammography goes digital

AU ST R I A

T H E N E T H E R L A N D S

Financed by the Ministry of Health, nine regional screening organisationsarrange and implement the Dutch national breast cancer screening programme,in which, every two years, all women from 50-75 years of age are invited for afree mammogram at one of the 62 screening points, of which 56 are mobilevans.

With nine vans, including a new digitally equipped van, BBNN is responsiblefor the country’s northern area. About 80% (84 % in the BBNN region) of allwomen have registered at one of the screening points in their neighbourhood.

The Dutch BBNN (Breast Cancer Screening Organization) added the newmobile mammography van to its fleet of eight mobile breast cancer screeningvans that visit 229 screening points in the country’s northern region. This van isequipped with Agfa’s Embrace DR system, which sends mammograms inDICOM format to a central PACS database for diagnosis in one of threeregional reporting units.

Detection) technology, willbe integrated in future releases.Using the Agfa Embrace DR systemwill result in a more consistent image quality, a more reli-able workflow and noticeable labour cost savings, Agfapoints out. Results from this pilot project, which com-menced in June, will be assessed at the end of the year.

Aiming to assess the clinical valueand cost-effectiveness of routinebreast screening for under 50-year-olds, the UK’s ‘age’ study, begun in1991, recruited some 160,000women aged between 40-50 years.Results from this £1 million perannum trial are expected in 2005.

UK age andmortality research

were achieved or exceeded. Threetimes as many cases of breast cancerwere detected in Bremen andWiesbaden, with intensive medicalcare, compared with the periodbefore the screening programmebegan.

Dealing with external qualityassurance is a new and unusual con-cept in the German healthcare sys-tem and was initially considered tobe limiting, strange and controllingby staff involved in the mammo-graphic screening programme.However, today external qualityassurance is regarded as a naturalsafeguard and a check on one’s ownwork to ensure efficiency, benefitsand evidence.

Experiences gathered from themodel projects provide the founda-tions for the national programme forquality assured mammographicscreening, based on EU guidelines,which was recently adopted inGermany.

Herman H Meerholz, General Manager of BBNN saidthat Agfa’s Embrace DR system, which combines seleniumdetector technology with Agfa’s MUSICA2 image process-ing software, covers the complete workflow of the organ-isation’s mobile screening programme. ‘Using GPRS(General Packet Radio Service, the latest mobile telepho-ny generation) technology, the radiology technician inthe van will retrieve a customer list from a central data-base for each screening point. During an examination thetechnician can annotate and prepare images on the AgfaEmbrace viewing station and store the images in DICOMformat on a removable hard disk, storing 80 examina-tions. Each day, this is transported to a nearby reportingunit for integration on the central PACS server. The examscan then be accessed for diagnosis from one of the threereporting units in our region.’

Further enhancements, such as CAD (Computer Assisted

Interviewed by Daniela Zimmermann, Executive Director of EH,Jean Hooks, General Manager, Global Mammography at GE

Healthcare, examined reasons behind the slow uptake of digitaltechnology in some European countries, comparing this

with its early adoption in the USA

No reimbursement for digital screening



Jean Hooks: Let me begin by say-ing that digital mammographyoffers proven benefits to cliniciansand patients including reducedpatient examination time andreduced waiting time; lower call-back rates; simplified managementof past mammograms; and oppor-tunities for advanced applicationsincluding computer-aided detection(CAD) and better access to abroader range of populations withgreater use of tele-mammographyand tele-radiology.

France was one of the earliestadopters of mammo-technology,and particularly digital technology.But there is still no established dig-ital screening and quality controlprogramme. We see some hesita-tion about moving to a digitalenvironment. DZ: Is this because digital imagesare not yet as good as film images? JH: I’m not sure how you formedthat opinion. Hopefully I can shareinformation from clinical partnerswho have shown the benefits ofdigital mammography.

About 300 hundred studies havebeen published - not by GE, but byclinicians around the world usingGE systems, who describe whatthey’ve learned from using digitalmammography - recall rates, can-cer detection, improved lesion andcalcification detection.

Regretfully today, there is someconfusion about performance relat-ed to digital mammography, forexample with CR, which is one ofthe hot topics in France. In manyEuropean countries, the hardestaspect is scepticism and the rela-tively low level of digital mammog-raphy education. Yet France wasthe place where clinicians took up

digital mammography very quickly.They believed that, by carrying outstudies, they could show the clinicalbenefits and outcomes in this tech-nology. A lot of our French cus-tomers know that it gives them farmore information about the breastthan can be obtained from film.With image processing you canwork through the image in muchmore detail, and algorithms allowcertain features to be highlighted,such as micro-calcifications orinstant contrast, from skin-line tothe chest wall, without window lev-elling.

A great deal of French cliniciansknow that digital mammographygives them far more informationabout the breast than can beobtained from film. With imageprocessing you can work throughthe image in much more detail, andalgorithms allow certain features tobe highlighted, such as micro-calci-fications or instant contrast, fromskin-line to the chest wall, withoutwindow levelling. DZ: Do the French have a screeningprogramme? JH: Screening, reimbursement andquality control are three armamentsthat go hand in hand in any mar-ket. France has screening pro-grammes but no reimbursement fordigital screening. One key reason

F R A N C E

for this is that, as yet, there is noestablished quality control pro-gramme for digital mammography.We are supporting regulatory bod-ies efforts towards that objective. DZ: You have to convince politi-cians? JH: With the French Minister ofHealth and the former Minister ofHealth, we have discussed thistechnology’s capabilities and howto introduce it. There is also quitean open and positive dialoguebetween our safety regulatorygroup and the French regulatorybody. It is critical to ensure thatthey have the information theyneed to make very good decisionsfor putting programmes in place.Technology without screening andregulatory quality control pro-grammes can’t benefit anyone.DZ: In France, as in Germany, digi-tal mammography is for womenwho can afford it. JH: Right now that’s the challengeand that’s why we are working oneducation in three areas: first ongovernment and regulatory bodies,then on the physicians, radiologistsand technologists - the people whouse the technology.

These specialists have a learningcurve going fully digital, as is illus-trated by the confusion regardingperformance of some CR systemscompared to other digital mam-mography devices. If people don’tunderstand the difference, at theend of the day they think it’s alldigital, all soft copy. But this is notabout soft copy; it’s about gettingvery good images through digitalmammography.

The third area covers educatingpatients, for which GE has done alot of work in various Europeancountries - where we have pub-lished around 1.5 millionbrochures dealing with patient edu-cation. If women do not under-stand breast cancer, how can theydetect it earlier? They need to learnthe procedures for self-examina-tion, not just mammography, to

gain knowledge about their ownbodies. They also need to understandsome of the benefits they gain byhaving mammograms on a regularbasis - digital or film - it doesn’t mat-ter. We’re trying to educate womenso that they can get on a screeningprogramme and detect cancer earlyon. 95% of stage one and stage twocancers are curable. Patient educa-tion is as important as that of a radi-ologist, doctor, technologist and gov-ernment regulatory body.

At GE Healthcare, we’re commit-

ted to better breast cancer care forwomen. Among the many reasonswe’ve led the industry is because ofinnovation — we listen to cliniciansworldwide and have incorporatedtheir needs and the needs of theirpatients in advanced breast imagingtechnologies.

We will continue to work withclinicians and government organi-sations in the effort to bring bettermammography and overall breastcare to patients in Europe andworldwide.

Automated screening & reduced biopsies

PET and recurrent cancer

Although X-ray mammography can detect small cancersbefore they have spread. However, because abnormali-ties can only be identified non-specifically, percutaneousor surgical breast biopsy must follow - but less than20% of women recalled for biopsies have cancer.

Now, research on the use of scattered X-rays hashighlighted the potential for creating an automatedprocess for breast cancer screening and reducing theneed for biopsies. This work is among the many pro-jects undertaken by the Synchrotron RadiationDepartment at the CLRC Daresbury Laboratory, UK,which span physics, chemistry, materials science, struc-tural biology, engineering, environmental science, andnovel applications to medicine and archaeology.

‘Invasive tumour expansion in breast carcinomasaffects the collagen scaffold structure, a major compo-nent of breast tissue. Using small-angle X-ray scattering(SAXS), such changes in collagen structure are nowdetectable, and may lead to the characterisation of fea-

tures in X-ray scatter distributions that show potentialas disease markers,’ Daresbury Synchrotron explains.‘If the molecular structure of the collagen is intact, thefraction of X-rays that pass through it appear in theform of peaks or rings, representing the effects ofcoherent interference caused by the diffracted rays.Peaks that are strong demonstrate healthy normal tis-sue, whereas peaks that are weak or diffuse indicatedegraded tissue. The peak intensities have been shownto indicate conclusively which of the collagen speci-mens were cancerous and which were healthy.’

Preliminary results suggest that this technique canbe used to make accurate assessments of cancerousversus normal breast tissue, and also for the detectionof benign tumours,’ the lab points out. ‘There is alsoscope for in vivo application, which would both elimi-nate the need for breast tissue removal and greatlyreduce the analysis time compared to that of currentmethods.’ Details: www.srs.dl.ac.uk

More sensitive dissemination tests are needed forpatients with locoregionally recurrent (LRR) breastcancer, according to a paper by Dutch researchers pub-lished online by the European Journal of Cancer(Volume 40, Issue 10 , 7/2004).

The study aimed to describe the extent and yield ofdaily clinical practice when staging LRR breast cancerpatients and to explore prospects for positron emissiontomography (PET). Using the population-basedEindhoven Cancer Registry to select all breast cancerpatients in the country’s southeast, with a first episodeof LRR between 1/1/1994 and 30/6/2000, it was foundthat, on LRR presentation, 16% of the 175 patients

had distant metastases and a further 24% were diag-nosed with distant metastases within 18 months.

Additional data concerning staging proceduresand follow-up were collected from medical records,and 77 physicians were also approached with aquestionnaire seeking their opinions on staging pro-cedures and actual treatment policy. Of the 75% ofphysicians who responded to the questionnaire,33% thought the sensitivity of conventional imagingtechniques was too low. The study team said it tend-ed to conclude that ‘...in daily clinical practice thereis a need for more sensitive dissemination tests forpatients with a LRR of breast cancer.’

Jean Hooks BA hasworked for GE for 16

years. Entering thefirm’s Healthcare

division in 2001, shebecame General

Manager of the GlobalMammography

business in 2003, andis based in Paris

N E W S

The Swedish firm Sectra reports that its digital MicroDoseMammography system reduces radiation by 80%, comparedwith traditional film-based systems, and that its completely newdetection technology allows this without compromising imagequality. The MicroDose, developed in co-operation with mam-mography specialists to optimise ergonomic features and work-flow, has been used to examine over 7,000 women since instal-lation at Helsinborg Hospital in autumn 2003. Since April, thesystem also has been fully operational at Klinikum Krefeld, themunicipal hospital of Krefeld and academic teaching hospitalfor the University of Düsseldorf. This hospital is now one of thefirst fully digitised mammography departments in Germany,producing breast images at the diagnostic workstation secondsafter they are taken. The Sectra PACS for Breast Imaging is usedfor image review, communication and storage. ‘This combina-tion facilitates efficient review and thus faster diagnosis,’ saysSectra. ‘The direct digital system makes the cumbersome han-dling of cassettes and chemicals a thing of the past.’

Klinikum Krefeld has 19 clinics, 29 departments and over1,100 beds, and provides all medical specialties for some

500,000 inhabitants of the Linker Niederrhein region, where the hospital has currently been commis-sioned to conduct a disease management programme against breast cancer.

With its roots in Linköping Institute of Technology, Sectra (which recently received the 2004 Frost &Sullivan Medical Imaging Company of the Year Award) is one of Sweden’s fastest growing high-tech com-panies in IT and has over 500 installations worldwide. Recently the company also became 100% ownerof Mamea Imaging AB.


N E W SN E W SN E W SN E W SN E W SN E W SO N C O L O G Y - M A M M O G R A P H Y

World’s lowest radiation doses

Siemens Medical Solutions reports that the first installations havebeen completed in France, Germany, Italy and Sweden of its newall-in-one system for digital full-field mammography, namedMammomat Novation. This new system provides screening, diag-nosis, digital biopsy in a single unit, enabled by the ‘Flying Wing’,used in Mammomat Novation’s forerunner, the analogue modelMammomat 3000.

The unit includes the most up-to-date full-field detector tech-nology based on amorphous selenium (a-Se). A photoconductorthat directly converts X-rays to electric signals without any inter-mediate steps prevents scattered light effects that might occurwith other technologies and impair the resulting image quality.Siemens Med points out that, in combination with the provenmolybdenum/tungsten anode, this direct detector technologyyields maximum image quality whilst minimising dose exposure.

A large detector of 24x29cm allows imaging of almost allbreast sizes, including the pectoral muscle. A new compressionplate enables central positioning of the breast for all projectionswithout readjustment of the X-ray arm. The Opcomp functionensures that the breast is only compressed as long as it is soft and

3D images with 10x higher resKarlsruhe, Germany - A new type of ultrasound computedtomography (CT) system promising to improve diagnosis sig-nificantly is currently being developed at the Research CentreKarlsruhe. The procedure delivers three-dimensional (3D),reproducible images with a resolution ten times higher thanconventional ultrasound images. The centre, part of theHelmholtz Community (www.fzk.de) reports that the first 3D-

demonstrator will shortly be available to carry out first examinations on live tissue.The new system makes it possible to capture even capillary structures with good

contrast. In trials, objects such as straws and nylon threads were embedded in gela-tine and measured with the tomograph. ‘Even structures of 0.1mm in size with gapsof 0.5mm between them could clearly be recognised,’ said Rainer Stotzka, head ofthe project. Experts agree that ultrasound CT could soon become the preferredmethod for early diagnosis, particularly for younger women, because this new sys-tem does not share the harmful side effects of X-ray mammography.

Describing the interdisciplinary project, Hartmut Gemmeke, head of the Institutefor Data Processing and Electronics (IPE) at the research centre, said: ‘In the devel-opment of the ultrasound CT system we have combined innovative concepts fromthe worlds of sensor technology, microelectronics, high-performance computing andalgorithm development.’ The Institute developed a method for the inexpensive pro-duction of thousands of miniaturised ultrasound converters required for the pro-duction of 3D tissue images. The control logic for the tomograph was also developedand manufactured at the IPE, along with high-performance computers with severalgigabytes per second for the processing of large volumes of data.

All-in-one digital mammography pliable and automatically stops at the point of maximum imagequality.

The system has a MammoReportPlus reporting station anddedicated AWS Acquisition Workstation, which is operated viaSiemens’ standard syngo user interface, an intuitive softwareplatform suitable for all imaging modalities and systems.MammoReportPlus enables adaptable reporting to meet indi-vidual needs, and features ultra-short image loading time: onecase with 8 images in under a second. Findings or evaluationspreviously obtained with other modalities can also be displayedin the shortest possible time.

The firm also points out that it can provide a wide spectrumof individual archiving solutions for its mammography systems.

‘Thanks to a combination of a-Se detector technology andour X-ray tube with a molybdenum/tungsten anode, both imagequality and dose exposure reduction achieve an optimum level.The acquisition and reporting stations have been optimised fora smooth and trouble-free workflow.’ said Holger Schmidt,Head of Special Systems at Siemens Medical Solutions inErlangen, Germany.

Ultrasound CT for early diagnosis

Modern methods and technology make it pos-sible to combine out- and inpatient treatmentthrough comprehensive, overlapping systemsand to standardise and optimise early diagno-sis, therapy and aftercare for malignant dis-eases of the female breast regionally.

The introduction of standardised documen-tation and the opportunity to implement qual-ity assurance programmes require the set up ofsuitable networks to complement the develop-ment of digital networks. They are of particu-lar importance in mammography screeningwhere multiple diagnoses are required andwhere a network significantly eases the work-flow. The harmonisation and acceleration ofprocesses, avoidance of information loss andthe resulting effects, as well as the stimulationof a close co-operation between everyoneinvolved, open up the opportunity to imple-ment patient-oriented and, in the mediumtern, cost-effective medicine.

A workflow scenario with different rules

Rule Result of Result of Final diagnosisfirst diagnosis second diagnosis made by

1 + - Third specialist

2 - + Third specialist

3 + + Third specialist

4 - - Second specialist

When carrying out a diagnosis, if the first andsecond person differ, or if both diagnose a positiveresult, a third person has to compile a diagnosisand summarising report. If the third specialist thenmakes a negative diagnosis, no further measuresare required. However, if the third assessment alsoresults in a positive diagnosis, the patient isdefinitely referred to an assessment centre, wherefurther investigations are carried out. If the firstand second diagnosis are both negative, thespecialist carrying out the second diagnosis isresponsible for concluding the case.

Efficient screening programmesEngineer Dr W Schneider, of

image diagnost GmbH discussesdigital screening networks and

multi-centre co-operation,based on automated DICOM

communication. Along with itsmammography solutions, image

diagnost also specialises indeveloping concepts for

regional and national digitalscreening networks

Mammography screening networks can onlybe successful if suitable measures for qualityassurance are introduced. The enormous vol-ume of data generated through a qualityassured diagnosis process can only be support-ed effectively through integrated technical con-cepts. Solutions based on the sending of imagesand results by post are no longer acceptable formammography screening programmes; in factthey are counterproductive from an economicand quality assurance point of view.

Organisational structures, and networkingconcepts matched to them, should take intoconsideration geographical factors as wellavailable expertise and technical equipment.Image diagnost GmbH of Munich thereforedeveloped a concept for multiple diagnosis thatis adaptable to these different concepts and issuitable for a central facility, as well as thedevelopment of networks linking outpatientand inpatient units.

Graphically, a digital network with completeand standardised data recognition, which con-sists of a digital screening centre with severalparticipating diagnosis groups, is sketched in anexemplary manner. The system can facilitatefirst, second and third diagnoses, assessmentand central screening data collation and archiv-ing, using the Worklist - and CollaborationServer developed by image diagnost. All digitaldiagnosis consoles, used instead of alternators,are equipped with a user-interface that can beused to monitor all data input and automatedprocesses.

The Worklist- and Collaboration Server hasbeen especially developed for screening net-works. It generates different types of work listsbased on adaptable rules and makes theseaccessible to all partner groups and partnerswithin the network. This makes it possible to setup multi-locational workflow scenarios thatallow for a patient and the person carrying outthe diagnosis to remain anonymous.

Image- and diagnosis data are centrallystored for a screening network and are addi-tionally backed up in a superordinate centre.Access permissions are monitored by theCollaboration Server and also can be manually

manipulated via the diagnosis workstation. Thismakes it possible to make images and resultstemporarily accessible to other colleagues. TheCollaboration Server guarantees consistentaccess to all data. A particular advantage forscreening scenarios is that copies of data sets donot need to be stored in an archive file whenmammography images are made accessible toother locations, thus saving on storageresources and avoiding unnecessary conflict sit-uations.

The Dutch Breast Cancer ScreeningProgramme BBNN is already using a version ofthe Collaboration Server developed by imagediagnost in its mobile screening units (Mammo-Buses).

Other products from Image Diagnost includethe MammoWorkstation, with possibilities forintegration into existing infrastructures sup-plied by various manufacturers; the CAD-Server(Computer Aided Detection) for automatedmarking of potential malignant structures in amammography image, and the DigitisingWorkstation for the secondary digitisation offilm mammographies, based on EUREF guide-lines.

The system is an inexpensive first step into theworld of digital mammography and the DICOM-shuttle as the key element for automated imageand results transmission with high quality imagecompression.


R A D I O L O G Y

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B R E A S T T H E R A P I E S

Balloon BrachytherapyBalloon brachytherapy is an acceptable alternative to external beamradiation for selected operable breast cancers, and this one-week treat-ment time allows working women and those living some distance fromradiation centres to choose breast conservation rather than mastectomy,according to a paper published in Arch Surgery in June*.

‘Partial-breast irradiation for carcinoma by a single source of radiationplaced in the centre of a balloon inserted in the lumpectomy cavity is aneffective method of treating breast cancer. Previous interstitial radiationtherapy using iridium seeds placed within multiple catheters has beenshown to be effective but impractical and cosmetically unacceptable towomen,’ said the research team, who work at the Departments ofGeneral Surgery and Radiation Oncology, Rush University MedicalCentre, Chicago; the Alabama Breast Centre and Department ofRadiation Oncology, Montgomery Cancer Centre, Alabama, and theLanshe Breast Centre and Centre for Cancer Care, Sacred Heart Hospital,Allentown, PA.

Women aged 40 years plus, who had been diagnosed with in situ andinvasive T1 through T2 and N0 or N1 breast cancer and treated withlumpectomy and axillary node sampling, took part in the study to evalu-ate immediate and short-term complications, their acceptance of thetreatment, and cosmetic outcome.

‘Of the 129 patients taking part, 112 completed the treatment. 28experienced transient skin erythema; three had localized oedema andnine showed skin blisters adjacent to the balloon. Seven developed infec-tion, which needed drainage and antibiotic treatment. In ten, ultrasoundindicated seromas had developed after removal of the device, whichwere aspirated percutaneously. In four patients, punctured or rupturedballoons had to be replaced before treatment could be completed. Theteam reported that patients quickly adjusted to breast distension causedby the balloon, and their acceptance of the procedure was good. Thecosmetic outcome was rated high. There were no recurrences during thisvery short follow-up.’ * Arch Surgery Vol. 139, June 2004. 603-608. Authors: Kambiz Dowlatshahi MD;Howard C Snider MD; Mark A Gittleman MD; Cam Nguyen MD; Phillip M VigneriDO; Robert Lee Franklin MD.

Effective drug combinationCombining the molecularly targeted therapy Herceptin with a specificchemotherapy combination has resulted in significant tumour responserates and longer relapse-free periods in women suffering an aggressiveform of advanced breast cancer, according to two studies carried out atthe Jonsson Cancer Centre, University of California Los Angeles, whichwere published recently in the Journal of the National Cancer Institute.The first study was carried out on cell lines in the laboratory and the sec-ond focused on over 120 patients in two Phase II clinical trials.

Left: Original uncorrected image of thehuman head with corresponding CDOF.

Right: An on-line, real-time correctedimage of the head movement shows onlysmall artifacts depending on the latencytime of the current implementation tomeasure the 6DOF and update the MRIgradients. Soon, in the newimplementation, this latency time will besignificantly reduced

Despite advances in magneticresonance imaging (MRI) thathave revolutionised diagnosticpossibilities, e.g. for functionalimaging (fMRI), motion artifactsare still extremely detrimental inmulti-slice 3D sequences, oftenused in fMRI or withuncooperative patients (children,elderly, accidents, stroke...).

However, Philips has succeededin compensating breathingartifacts by using data from ‘pencilnavigators’, which can measurediaphragm movement in just10ms. This technique went intoclinical use this year.

In brain imaging, however,

although some procedures havebeen developed to removeartifacts caused by patients’ headmovements, their disadvantagesinclude increased imageacquisition time and a negativeinfluence on scanner performance.

The EU project MRI-MARCB isaiming to produce an integratedsolution to reduce motion effectsin brain and cardiac imaging.Working within this projectChristian Dold, research engineerat the Fraunhofer Institute ofComputer Graphics in Darmstadt,Germany, explained: ‘Theproblem of motion compensationin MRI technology deals with

capturing the source and patternof motion; obtaining amathematical model of motion,using this to identify andcompensate for the motion effects,further for optimising the imageacquisition sequence so as tominimise, or even eliminate, theeffect of motion.’

In its research the FraunhoferIGD is using an infrared opticaltracking system with highprecision (RMS about 0.1mm,FOV = 50x50x50cm) to trackpatients’ movements. By capturingca. 20 movements per second inreal-time - with parameters of sixdegrees of freedom (6DOF)- avolume-to-volume or a slice-to-

slice prospective correction is madein the MR-tomograph during thescan and just before the next sliceis captured to translate thesemovements into new gradients, sothat the acquisition of each newvolume/image corresponds to thenew direction of the head. AsChristian Dold explained: ‘At theend of each volume/sliceacquisition the MR scanner readsthe co-ordinates from the trackingsystem and changes prospective the3 MR field gradients andfrequencies in the sequence priorof acquiring the next volume/slice.The result is a real-timeprospective compensation for thecomplete head movement. This is

based on the fact that the timeneeded to acquire a single k-spaceline is very much shorter than thetime needed between acquiringsubsequent k-lines. Hence, motionsof the head during acquisition of a

single k-line are negligible andeffects of motion are visiblebetween subsequent lines.’

The technique promises asignificant reduction in imagingtime by lowering the need for

repeat scanning and will, he said,‘... improve the quality and speedby imaging uncooperative patientsand increase the efficiency offunctional MRI, which isbeneficial for surgical planningand neuroscience research.’ Bycompensating for patients’restlessness during imaging (e.g.children, Parkinson’s patients, etc)this technique should also increasepatient throughput and ‘reducemeasurement redundancy’.Details: www.mri-marcb.org

The MRI-MARCB project Adjusting for motion artifacts

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R E S P I R A T O R Y C A R E

Céad Mile Fáilte!‘Céad Mile Fáilte!’ said ERS President WalterMcNicholas (right), to greet those about toattend this the 14th Annual Congress of theERS, (Glasgow, Scotland, 4-8 September 2004).English translation from the Gaelic greeting:‘A hundred thousand welcomes!’

Each successive year of the ERS sets newrecords in terms of attendance and scientificpresentations, he pointed out. Last year 15,000people from over a hundred countries attendedthe congress in Vienna - an over two-third risein numbers compared with 5 years ago.’

Whilst the congress is the highlight of the year for the Society, theERS is increasingly active in many other areas, ranging from educationto advocacy, he pointed out. ‘The ERS School has become a vital andvibrant part of the Society, particularly in terms of external educationalcourses, and this year alone eight such courses are planned for variousvenues around Europe, on topics ranging from cystic fibrosis to non-invasive ventilation.’

Political advocacy, a particular focus of activity this year, is nowsupported, particularly at the EU, due to a new office being establishedin Brussels. Active efforts are also underway to increase interaction andcooperation with National Respiratory Societies, he added.

Among new offerings from ERS is clinically oriented journal, aimedprimarily at practitioners, and revised membership options that offerreduced membership fees to those in poorer regions of Europe andbeyond.

Camena, an innovative ventilator thatprovides clinical-quality ventilationfor patients at home, will be launched,at the European Respiratory Society(ERS) annual meeting (4-8 September2004, Glasgow, UK), by DrägerMedical AG & Co KGaA, of Lübeck,Germany.

With the support of patients and asix-member scientific team of interna-tional experts, Dräger Medical’s teambased in the Netherlands created thenew device in just one-and-a-halfyears. The result is an advancedmechanical ventilator designed partic-ularly for long-term ventilation in adomestic environment. Patient-oriented system technology- Camena provides both invasive andnon-invasive ventilation. A new fea-ture, Volume Guarantee, safeguardsgas exchange by assuring the targettidal volume range. The device offerspressure-supported and pressure-con-trolled ventilation. Modes such asCPAP, Bi-Level and PCV further pro-vide versatile ventilation performance.The AutoSlope software feature auto-matically adjusts the respective inspi-ration curve to provide comfortable,

Clinical quality ventilatorfor home use

supports patient mobility. For exam-ple, the system could be used in acar, boat or ambulance, due to the12 V - 24 V power connection.Camena is also ideal for use withwheelchairs. A built-in batteryserves as a power backup supply forup to two hours of ventilation, andan optional external battery can addanother 20 hours of backup power.

To ensure that the delivered gas isclean, the system includes a highlyeffective particle absorption (HEPA)filter that removes dust particles andbacteria. Service and maintenance iscovered by remote service and diag-nosis and backed by DrägerService.This saves time and money, andmakes patient location no problem.

‘Fifty years ago, Dräger’s

Viagra tested on EverestAgent may treat PHTSildenafil, an active agent used inthe impotence drug Viagra, hasbeen administered to seven youngmountaineers on an Everest expe-dition, to test its effect on thelungs. Seven other men on theexpedition are receiving a placebo.

Leading the research, FriedrichGrimminger, from the Centre forInternal Medicine, University ofGiessen, Germany, was at the basecamp to carry out heart, lung andblood tests on the volunteers. Heexplained that sildenafil mightimprove the quality of life of pul-monary hypertension (PHT)patients significantly.

In PHT patients blood vessels inthe lung constrict, and they sufferbreathlessness and cardiac strainduring strenuous activities. If thecondition is not diagnosed, heartfailure (HF) can result. Currenttherapies are said to be risky,because they reduce general bloodpressure and this can lead to circu-latory collapse. Dr ArdeschirGhofrani, another Geissen studyteam member, reported that thedrug reduced PHT without causinga dangerous reduction in bloodpressure elsewhere. Because a bio-chemical similarity exists betweenthe penis and lungs - both containlarge amounts of the enzyme phos-phodiesterase - it limits penis erec-tion and has been found to con-strict blood vessels around lungs.Sildenafil blocks that enzyme,which then allows sustained erec-tion. Similarly, in the lung walls, itappears to improve blood circula-tion.

In 2003, the healthy youngmountaineers were chosen for thistest because their lungs undergorapid change in a matter of weekswhen staying at high altitudes.Professor Grimminger explainedthat they suffer pulmonary hyper-

NEW

Breathlessness, the most commonsymptom in patients with chronicobstructive pulmonary disease(COPD), greatly reduces their abil-ity to participate in day-to-dayactivities. Inhaled bronchodilatortherapy is the first step in themanagement of the breathlessCOPD patient. By achieving sus-tained improvements in airwayfunction, long-acting bronchodila-tors, e.g. salmeterol, can achievesuperior symp-tom relief com-pared with tra-ditional short-acting bron-chodilator ther-apy.

The evalua-tion of bron-chodilator effi-cacy has evolved considerably inrecent years. New informationsuggests that improved breath-lessness after bronchodilator ther-apy is principally related toreduced air trapping.

In COPD, the inability to expelair from the lungs during expira-tion through abnormally nar-rowed and collapsible airwaysresults in air trapping and lungover-inflation. This, in turn, putsthe muscles of breathing under amajor mechanical disadvantage.Breathing, therefore, requiresmuch greater effort and thepatient senses this as breathless-ness.

By improving airway functionand lung emptying, bronchodila-tors reduce lung over-inflation,thereby relieving breathlessness.

A current study*, undertaken byDenis O’Donnell and colleagues atthe Dept of Medicine, Queen’sUniversity, Kingston, Ontario,Canada, examined the impact ofsalmeterol, a long acting bron-

patient-specific ventilation.Ideally sized for the home, Camena

weighs just 4.8 kg and measures 385mm x 175 mm x 275 mm (L x W xH). It is also extremely quiet andoperates at 10 mbar with <29 dB(A)and at 18 mbar with <32 dB(A). Thedisplay provides additional conve-nience - automatically going blankafter two minutes.The user interface - This has two lev-els: a professional user interface dis-plays pressure and flow curves, andthe patient interface displays settingsand alarm information in case of anevent. The number of alarm occur-rences, their causes, as well as trends,can be stored internally for up to ayear.

Set values can only be set andchanged by physicians. In addition,specific parameters can be ‘tagged’ sothat, if necessary, patients can adjustsettings themselves - also via theoptional remote control. The inte-grated Rescue Mode ensures thatventilation continues even in theunlikely case of a pressure sensor fail-ure.Mobility and service - Camena also

Ardeschir Ghofrani & Friedrich Grimminger

Changes caused by lack of oxygencan serve as a model for numerousheart and pulmonary diseases.While the process in the moun-taineers’ systems is reversible this isnot the case for the disease processin patients,’ he added.

Although the study results, pub-lished in the Annals of InternalMedicine, concluded that sildenafilreduced arterial pressure andimproved oxygen transport,Professor Grimminger has stressedthat the drug would not receiveregulatory approval as a treatmentfor PHT until worldwide tests arecompleted.

Viagra was invented to treat arange cardiovascular problems butis only licensed to treat impotence.This possible new use is early stageresearch, said a spokesman forPfizer, the manufacturer of Viagra,adding, by the by, that this yearmarks the 50th anniversary of theconquest of Everest, and it is fiveyears since Viagra was launched.

tension due to a lack of oxygen,which is only partly resolved byacclimatisation. ‘A stay at heightsabove 5,500 metres cannot be sur-vived in the long run. In the deathzone, at levels of above 7,000metres, survival without an addi-tional oxygen supply is only possi-ble for a few hours to a few days.

chodilator, onb r e a t h l e s s n e s smeasured duringa standardisedtask (cycle exer-cise) and toexplore possiblemechanisms ofbenefit.

Twenty-three symptomaticpatients with advanced COPD partic-ipated in this placebo controlled,

crossover study.Breathlessness,exercise perfor-mance, and vari-ous physiologi-cal measureswere comparedduring salme-terol and place-bo.

The authors found that during sal-meterol therapy the intensity ofbreathlessness (measured by a vali-dated scale), during a standardisedphysical task, fell significantly com-pared with placebo, and that symp-tom-limited exercise endurance timesignificantly improved by 58%.

These improvements in breath-lessness and in exercise performancecorrelated strongly with the extentof salmeterol-induced lung defla-tion (i.e. inspiratory capacityincreased by 18% on average).Salmeterol, by reducing lung over-inflation, also improved thepatient’s ability to increase theirbreathing capacity to higher levelsduring exercise than was previouslypossible and to do so with substan-tially less breathing discomfort.

The researchers concluded thatsalmeterol therapy provides effec-tive symptom relief for sufferers ofCOPD and enhances their ability toundertake physical activity.Pub: European Respiratory Journal.7/04. Vol. 24, No. 1)

THE EUROPEANRESPIRATORY SOCIETY (ERS)14TH ANNUAL CONGRESS

Poliomat revolutionised the marketfor home mechanical ventilation,’said Bas Dirkson, General Managerat Dräger Medical BV, in Best, theNetherlands, and Head of theBusiness Unit Pre & Post HospitalCare. ‘Based on this technology,which was first developed by Drägerin 1906, we have combined today’sscientific knowledge with patientrequirements, to find a solution thatnot only meets our standards forinnovation but also elevates the qual-ity of care.’

Relievingbreathlessness

in COPD

Tuberculosis bloodtest gains EU approval


R E S P I R A T O R Y C A R E

SenTec Digital Monitor System:The new age of non-invasivepatient ventilation monitoring

SenTec Inc.SwitzerlandPhone +41 61-726 97 60E-Mail: [email protected]: www.sentec.ch

ERS European Respiratory Society 14th Annual Congress in Glasgow (UK)4 – 8 September 2004Booth D56

MEET US:

SenTec Digital Monitor System in combination with one unique single and digital V-SignTM Sensor for a continuous, real-time and non-invasive monitoring of● Carbon Dioxide Tension (PCO2)● Oxygen Saturation (SpO2)● Pulse Rate (PR)Complete and easy monitoring of patient’s respiration and ventilationSuitable for almost all clinical applications or careunitsCost-effectiveSignificantly reduce the number of blood samplesrequired to assess the ventilation and oxygenation of the patientEasy-to-use digital sensor designed for patient’s comfort and safetySingle sensor monitoringLight weighted sensor (< 3 g)Highly flexible, digital cableEasy positioning at the ear lobe with an ear-clip

With increasing numbers of nurses specialising the care of lung cancerpatients, The National Lung Cancer Forum for Nurses (NLCFN) wasestablished in 1997 to offer them a network for information exchangeand to support nurses working in ‘isolation’ due to their changing anddifferent roles. Membership is open to specialist nurses whose work, orclinical activities, focused on lung cancer patients amounts to over 50%of their employment. Seven years ago the NLCFN had about 40 mem-bers. By last year the number had increased to over 200 specialist nurs-es.

In 2002 a new website, developed by Sequence in conjunction withAstra Zeneca, was set up to offer an updateable online resource for pro-fessionals and patients. Along with member contributions to the web-site, including their experiences in the field, nurses can also access newresearch studies, news and events, resources and education.

As part of on-going activities, for example, the London and SouthEast Lung Cancer Forum for Nurses (c/o the NHS Trust, Palliative CareDepartment, Guy’s Hospital, London, UK, has drawn up guidelines onthe role of the specialist nurse in supporting patients with lung cancer.(Pub: Blackwell Publishing Ltd: European Journal of Cancer Care 13,344-348). The recommendations made in these guidelines are based onGovernment guidelines, in which the NHS Executive reminds health pro-fessionals that, despite the very high mortality figure for lung cancer,‘improved quality of life represents an important therapeutic gain thatshould not be subsumed by a sense of nihilism or clinical failure’.

On 25-26 November there will be a members-only meeting of theNLCFN, in Chester, UK. However, for our specialist nurse readers in theEU, this information on the forum’s activities may offer inspiration forthe setting up such help groups elsewhere, and perhaps a greater inter-national sharing of experiences in this difficult nursing field. NLCFN details: www.nlcfn.co.uk

NEW

TB causes three million deathsannually, ranking it higher thanany other infectious disease. AndTB has resurged in Europe. InAugust, the British ThoracicSociety, British Lung Foundationand TB Alert highlighted itsincrease in over the last 15 yearsin the UK alone. During thisperiod, the number of TB cases inLondon doubled and it has beensuggested that the capital is onthe brink of an epidemic. PaulSommerfeld, Chairperson of TBAlert said: ‘The importance ofhaving access to accurate andreliable diagnosis cannot beoverstated. Accurate testing isvital for effective disease control,especially with the threat ofmulti-drug resistant TB and therecent increase in incidence of thedisease hanging over us.’

Up to now, a century-old skintest (the oldest diagnostic test stillin use today) has been used, butthis can produce both false-positive and false-negative resultsand previous BCG vaccinationmakes it inconsistent, accordingto a report from the firm Oxford

Immunotec, the internationalclinical diagnostics companyheadquartered near Oxford, UK.‘It is also inconvenient, taking 3-7days before it can be read, and itcan cause painful blistering andscarring of the skin,’ the firmadded.

Now a new blood test has beenapproved for use in Europe.Named T SPOT-TB, and madeOxford Immunotec, this promisesto replace the old TB skin test. DrAjit Lalvani of Oxford University,who led the development of thistest over the past decade, said:‘The tools we use to diagnose TBare 50-100 years old; this diseasehas been neglected for decades. Iam pleased that we have finallybrought the benefits of modernscientific research to the front-lineto fight this age-old disease. Incontrast to the crude andinaccurate skin test, the new bloodtest is fast, accurate andconvenient. It is a 100-yearupgrade for diagnosing TB and Ibelieve it will significantlyimprove the way we managetuberculosis.’

The SPOT test works in aunique way, the firm pointed out.‘Whereas conventional diagnostictests rely on detecting antibodiesinduced by an infection, suchantibodies are not generated by TBinfection. However, TB infectioninduces a strong response byimmune cells in the blood called T-cells. It is these T-cells, in a smallblood sample, that are detected byT SPOT-TB, which literally countsthem as spots on a test plate.

The T SPOT-TB test has beentested in 16 clinical studies,involving over 4,000 patients in 11different countries, in both thedeveloped and developing world.99.9% specificity was shown inhealthy unexposed controls, in fiveseparate studies of low-risksubjects. Sensitivity of the test hasbeen shown to be over 96%.

SPOT will be used to screenpeople who have been in contactwith a TB sufferer, so that, if

TB charityTB Alert, registered in 1998 and launchedin London’s Houses of Parliament onWorld TB Day in 1999, was set up by peo-ple who believe there should be agreater response to the resurgent threatof TB - already declared a global emer-gency by the World Health Organisation(WHO) in 1993. TB Alert is the first TB-specific charity in Britain since the 1960s,when earlier organisations, assuming toosoon that the disease had been van-quished, faded away or shifted to otherinterests. TB Alert aims to:● Raise awareness of TB as a global

threat and as a disease resurgent inBritain

● Advocate for greater global spendingon TB

● Support TB control programmes over-seas, focusing on increasing access totreatment especially for poor and mar-ginalised groups

● Complement the work of the NHS inthe UK, supporting public and patienteducation and information

TB - the disease and its treatmentThe TB bacteria may infect most a third of the world’s population, and an estimated eightmillion people develop the active disease annually.

TB is passed from person to person through the air, but a person exposed to TB does notnecessarily develop the disease. Some people are able to clear it from the system throughtheir natural immune response, but most only control it and do not clear it completely, soit remains dormant in their systems. This latent infection can reactivate at any time, tocause the active disease.

TB is usually curable with effective antibiotic treatment. Typically a long course of a com-bination of four antibiotics is recommended for initial treatment of the active disease. Ifcaught in its latent state, only one drug is usually needed to manage the disease.

Due to poor compliance to therapy over the long period required to completely cure TBand because there have been few new drugs to treat TB over the last 30 years, there hasbeen a substantial increase in the number of strains of TB resistant to current treatments. The rise and spread of multi-drug resistant (MDR) TB is a cause of great concern.

infected, they could be identifiedand treated long before theyactually develop the disease andinfect others. ‘Crucially, it is thefirst test that reliably detectsinfection in people with weakimmune systems, including new-born babies, people with HIV andtransplant patients - precisely thepeople who are most vulnerable todeveloping full-blown TB,’ thefirm added.

T SPOT-TB is OxfordImmunotec’s first product, whichis based on its patented T SPOTtechnology, a novel platform thatopens up new ways of diagnosingand monitoring infections byproviding a simple and extremelyaccurate method of studying aperson’s cellular immune responseto an infection. T-SPOTtechnology can be applied todiagnose and monitor any majordisease driven by a T-cell response,the firm pointed out.

Magnetic resonance imaging (MRI)as a non-invasive diagnosticmethod has been evolving into anattractive alternative to methodsassociated with radiation exposure.In a recent issue of the journalRadiology*, Dr Christian Fink andcolleagues at the RadiologyDepartment of the German CancerResearch Centre also pointed outthat this development is beginningto manifest itself in lung perfusionimaging.

Diagnosis of numerous lung dis-eases requires precise perfusionimaging. The standard method,perfusion scintigraphy, involvesinjecting a radioactive substanceinto the bloodstream to scan its dis-tribution in the lungs. Now theequally precise and completelyradiation-free method for evaluat-ing lung perfusion turns out to be aMRI scan.

In a comparative study of sevenhealthy pro-bands and 20 patientswith suspected lung cancer, theresearchers compared MRI withperfusion scintigraphy. MRIshowed a higher temporal and spa-tial resolution in lung perfusionimaging and provides the addition-al advantage of 3D image data,

which makes it easier to recogniseblood circulation changes.Perfusion defects caused bytumours were recognised with highaccuracy. In direct comparison withthe standard method, MRI wasfound to be at least equally good.

It is too early yet for MRI tobecome a routine clinical method oflung perfusion imaging. The valueof the new method first needs to beassessed in larger studies. But theinvestigators are optimistic that theradiation-free option may turn intothe method of choice: ‘Image reso-lution in MRI is about twice as highas in perfusion scintigraphy so thatwe expect a higher detail precisioncompared to the standard method,’Dr Fink said. Along with evaluationof perfusion, MRI also providesadditional information, e.g. aboutthe anatomy of blood vessels in thelungs and the temporal process oflung perfusion. Thus it providesinsight about both vessel organisa-tion and function of blood circula-tion down to the tiniest branches ofthe lungs.

The method can be used not onlyin diagnostics and surgery planningfor lung tumour patients. It may, inthe future, also be beneficial in non-

The UK’s National LungCancer Forum for Nursesinvasive diagnoses of other lung

diseases, such as pulmonaryembolism, emphysema, and chronicbronchitis. For now, however, MRIis substantially more expensivethan the standard method (approx.300 euros v. 75 euros per examina-tion), since the remuneration sys-tem does not yet take adequateaccount of innovative methods ofthis kind.

* Christian Fink et al.: RegionalLung Perfusion: Assessment withPartially Parallel Three-dimension-al MR Imaging; Radiology 2004;231: 175-184.Source: DeutschesKrebsforschungszentrum,Heidelberg. www.dkfz.de

Non-invasive lung diagnosis

Dr Christian Fink


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An extensive international study,presented at the American Societyfor Microbiology meeting in NewOrleans, concludes that baby foodscontain worrying levels of disease-causing microbes, includingEnterobacter sakazakii (linked tosome fatal outbreaks of meningitisat children’s hospitals in Europe andthe USA*). Although the E. sakazakiihas been found in powdered infantformula before, findings from thestudy, which focused on powderedinfant formula, dried infant foodand milk powder from sevenEuropean countries, the US, SouthKorea and South Africa, have provedthat it can be present in those foods.

The team analysed over 200samples from 110 different products.Stomach bacteria were found ineight out of 82 of the powderedinfant formula samples, and in 12out of 49 of the dried infant foodsamples. Thirteen of bacteriaidentified, including E. sakazakii, aremembers of the Enterobacteriaceae,which is associated with hospital-acquired infections.

Although manufacturers do notclaim the absence of bacterium intheir products, Carol Iversen saidthere is a misconception amongparents and nurses that infantformula powder is a sterile product.

In a separate study, also presentedduring the New Orleans meeting,

ObesityStudy shows

increased chronicillness in children and

adolescents

President of the congress. Onecause is early and uncontrolledconsumption of psycho-activesubstances such as cigarettes,alcohol and illegal drugs. Twofurther factors are poor eatinghabits and lack of physical activity -both the underlying cause obesity.In Germany alone, depending onthe definition used, 10-20% ofchildren and adolescents areconsidered obese.

In view of these developments itis important that children becomehealth conscious from very early onand learn permanent selfmanagement because such chronic -an non-chronic - illnesses oftenmean a substantial decrease in thequality of life. But these childrenare not the only ones who suffer, for

Baby food & meningitisthe team examined the best waysto prepare and store infantformula made from powder tominimise infection risks. Theyreported that, when kept in afridge the number of bacteria inthe preparation doubled every 10hours, but at room temperaturethis occurred in just 30 minutes. So,any formula left ready for nightuse could go from containing veryfew bacteria to harbouringdangerous levels, said StephenForsythe, who urges parents toresist the temptation to prepareinfant feeds in advance.

Few meningitis cases ariseannually, but the death rate can beas high as a third of those affected- particularly putting prematurebabies and those with weakenedimmune systems at risk. Survival ofthe infection can still leave patientsbrain damaged. ‘Very few recoverfully,’ said Carol Iversen, atNottingham Trent University.

In 2001, an outbreak ofmeningitis at a Tennessee neonatalintensive care unit infected ninebabies. One died. The infection wastraced to a batch of powderedinfant formula, and prompted theCentres for Disease Control inAtlanta, Georgia, to warn doctorsabout potential dangers inpowdered formula. The productwas recalled by the manufacturer.

The disturbing internationalcomparative study on healthbehaviour in school children(HBSC), conducted by the WorldHealth Organization (WHO),European regional offices, havebeen presented by the researchdirector for Germany, ProfessorHurrelmann, Dean of the School of

Public Health at the University ofBielefeld, at the 3rd GermanCongress for Health ServicesResearch. ‘Although children andadolescents consider themselvesquite healthy, chronic illnesses havecontinuously increased in that agebracket over the last three decades,’said Professor Klaus Hurrelmann,

their families have to adapt andadjust to unexpected pressure andoften a change in lifestyle.

At the congress patienteducation programmes werepresented that were developedwith children and adolescents.Such strategies take into accountthe special needs of youngpatients, because difficulties inhandling chronic illnesses seem toincrease after puberty. Source: Young people’s health incontext. Health Behaviour inSchool-aged Children (HBSC)study: international report fromthe 2001/2002 survey.Copenhagen, WHO RegionalOffice for Europe, 2004 (HealthPolicy for Children andAdolescents, No. 4).

Italy - The WardInHand project, which set out to provide atool for medical teams to access a hospital information sys-tem (HIS) from wards, does not replace or compete withexisting hospital systems but adds mobility and ‘ubiquitouscomputing’ to the HIS, by exchanging information withexisting tools and updating clinical data in real time. Thedevice also allows data exchange between medical person-nel, the co-ordination and synchronisation of activities, andhelps to ensure drugs and/or consumables availability.

The project co-ordinator - Salvatore Virtuoso, of TXT e-Solutions, Milan, Italy - said that, when prototypes wereused in trials at three European hospitals, a significant

increase in the quality of the healthcare services was recorded -due to reduced errors in data transcription; enforcement of quality and safety standardsand the provision of better, more timely information to healthcare professionals.

The WardInHand project sprung from an initiative of an international consortium, ITcompanies and hospitals, and has received European Commission financial support.

USA - As part of a pilot project headed by Dr OlafKaestner at the Jacobi Medical Centre, New York, SiemensBusiness Services has provided over 200 patients withradio wristbands. These contain a radio frequency identi-fication (RFID) chip (already marketed), on whichpatients’ details and medical record numbers had beenentered on admission. Hospital staff have beenequipped with extra-light notebook PCs, PDAs, or tabletPCs that are WLAN-enabled and fitted with a small RFIDreader, which, via a WLAN, allows them to gain autho-rised access to the central database from which they candownload patients’ data, whilst standing at patients’bedsides. There they also can update the electronic patient record (EPR), eliminated theneed to do this later, or to print them. So far time saving is reported as ‘substantial’.

RFID functions were integrated into existing character-oriented hospital backendapplication through a direct link to the Windows-based front-end that runs on themobile PC. The new RFID components in the wristbands and data transmission RFID chipwere developed on the basis of Microsoft. NET, using a toolbox created by SiemensBusiness Services. Details: [email protected]


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

StreamliningrehabilitationBy Wilhelm Brokfeld, Administrative Director at Münsterland Clinic

Germany - Rehabilitation clinicsare taking on an increasinglyimportant role, because the coun-try’s Social Security Code indicatesthat, where possible, rehabilitationis preferable to providing pensionsand long-term care. This is the log-ical consequence of a changingdemographic structure and work-ing conditions, as well as increas-ing numbers of elderly patientswith therapeutically challengingconditions and increasing multi-morbidity. With their specific struc-ture and focus on therapeutic mea-sures, which include psychosocialaspects and a ‘holistic’ approach,the work of rehabilitation clinicscan result in the reintegration of

rheumatology and provides in- andout-patient therapies for those whohave left hospital following treat-ment. The clinic also works closelywith hospitals and medical facultiesin a number of universities.

The objective was to create a cen-tral electronic data pool, to containindividual patients’ files, and toenable doctors to add notes, and toprovide an order/entry procedurefor the laboratory and appointmentplanning, facilitating optimum timeand resource management for allphases in the rehabilitation process.The order/entry procedure trans-mits all orders to the subsystemsand retrieves relevant data from theappointments, laboratory and care-management system, visualisingthese in the electronic patient file.Planning is done almost in real-time, errors or misunderstandingscaused by insufficient information

ous advantages. The level of accep-tance among clinic staff was veryhigh shortly after the introduction ofthe new system. Central data storage,which means all patient data isentered in the system only once, alsosaves a lot of time.

Status tracking is possible, whichincludes electronic data transmission,the automated creation of a dischargereport, and the fast and targeted datarecall facilities. Paper and transportcosts have also been reduced signifi-cantly.

The access authorisation conceptensures high security. A standardiseddesktop eases workflow and facili-tates fast familiarisation, with littleneed for training. Independence ofsoftware suppliers is achieved byusing standardised interfaces, there-fore reducing expenditure on cus-tomisation. The once-only develop-ment of this solution and co-opera-tion with other funding institutionsand clinics has created a synergy.

Due to the modular structure, allsoftware solutions can be integratedinto the overall concept via the com-munication server - and costs for itsintroduction may be staggered.

The considerable changes to med-ical work due to, among other sys-tems, the introduction of voice recog-nition, as well as changes to adminis-trative procedures require more train-ing for hospital staff. A timely, sensi-tive information policy in co-opera-tion with the staff council is essential.

Participating organisations:health.united, in close co-operationwith the LVA Westphalia.health.united is a joint venture byseven companies: Optimal SystemsGesellschaft für innovativeComputertechnologien mbH(electronic patient file OS:EPA),SeeBeyond Germany GmbH(communication server e*Gate),Magrathea Informatik GmbH(appointment administration systemTimeBase, HINZ Fabrik GmbH (caremanagement system Nancy), ComedGmbH (laboratory system Lab-Com) aswell as ID GmbH (coding software ID-Diascos) and Philips Speech Processing(voice recognition SpeechMagic).Details: www.klinik-muensterland.de

Gothenburg, Sweden - Ascom Wireless Solutions reports on a new Internet Protocol-basedmessaging platform that can integrate traditional hospital paging with DECT systems andpublic communications technologies such as GSM, Email and the Internet. Using Linux asits operating system, Unite provides a standard communications protocol to connect dif-ferent types of applications and hardware modules.

Called Unite, the system automatically converts messages from any source, for examplean equipment alarm or email, in to the format needed by the communications device thatthe intended recipient uses. Referring to an address database the system finds all contactdetails associated with a specific user, including email addresses, mobile and office phonenumbers and pager IDs. If there is no response to a pager message within a given time-frame, Unite then tries another address until contact is made. However, if a message can-not be delivered to the intended recipient, it can be automatically re-routed to anotheraddressee, based on predefined rules.

Hospitals can create automated responses reflecting their standard procedures so thatstaff can react quicker to time-sensitive messages, for example, a nurse receiving an alarmfrom a heart monitor on a pager or cordless phone has options such as alerting the resus-citation team, ordering emergency drugs or obtaining help from other nurses, to ensure notreatment time is lost.

Unite can also interface with clinical systems such as HIS, LIS, PACS and RIS as well asbusiness, accounting, building management and security systems. All applications linkingto the Unite platform are managed centrally by the Enhanced System Services (ESS) plat-form. ESS enables Unite systems to be configured remotely via the Internet using a stan-dard web-browser.

Unite will be available from September 2004. Unite modules currently available includethe MailGate email server, NetPage for web-to-pager messaging, Alarm ManagementServer, and Open Access Toolkit for creating customised applications. The manufacturerreports that Unite integrates seamlessly with existing Ascom messaging solutions such asteleCOURIER on-site paging, teleCARE nurse call and the Ascom 9d cordless telephony solu-tion.

Ascom Wireless Solutions, which specialises in customised on-site wireless communica-tions for healthcare, manufacturing and process industries, has installed over 30,000 sys-tems for healthcare institutions across Western Europe.

Intelligent messaging

Wireless at the bedside

Wristbands tell all

tion clinics funded by public insur-ance organisations are piloting thedevelopment of rehabilitation con-cepts. For example, at the 190-bedMünsterland Clinic, in BadRothenfelde, various organisations(see box) participated in setting up anew electronic system, into whichthe clinic’s existing patient adminis-tration and book-keeping system(supplied by NovaCom) was inte-grated. The social data areexchanged externally with the fund-ing institutions in line with legalguidelines.

Münsterland Clinic, founded in1995 and funded by the PublicInsurance Organisation Westphalia,specialises in orthopaedics and

or lost paperwork are unlikely.Along with the existing patient

administration system, the appoint-ments planner, laboratory system,electronic diagnosis and services log-ging, electronic care documentationand planning, plus digital voicerecognition, are all connected by adefined interface via the communi-cation server.

Diagnoses are coded according tothe rehabilitation-specific ICD 10code, set by the funding organisa-tion via coding software, and thera-pies are also coded according to acatalogue of therapeutic services.The subsystems retain data authori-ty over their specific areas.

The patient administration systemtransmits the required master datafor electronic data transfer to thefunding organisation.

All processes in the electronicpatient file originate from a stan-dardised desktop, structured in rela-tion to individual patients, and eachis given a lifetime ID number forquick identification on readmission.Administration and archiving of allpatient-related data within the elec-tronic patient file means that allpatient data is accessible at any clin-ic workstation, with defined andauthorised access for all users. Allpatient/treatment data are securelyarchived to comply with legalrequirements. On re-admission, allthe patient’s data from the previousattendance are immediately at hand.

Business processes are optimisedvia workflow. Additionally, qualityassurance is supported by the intro-duction of comprehensive qualitymanagement (all processes can beretraced). A medical dischargereport is the last document for in-patient treatment, and all necessarydata, e.g. from the admission reportto examinations and laboratoryresults, are automatically fed fromthe electronic patient file into theappropriate spaces in the form onscreen. The final discharge reportcan be compiled more quickly andeasily and reaches its destinationmuch faster, Advantages and disadvantages -Overall, this is a trend-setting solu-tion convinces because of its numer-

patients into their homes, societyand occupations.

The cost-effectiveness of rehabili-tation is also a key issue. However,many have no transparent systemfor data exchange and archiving,which can lead to duplicated andinconsistent data administration.Orders for laboratories, appoint-ment planning and diagnosis areoften written manually, and thendelivered to departments by messen-gers, where the details are againlogged manually. This results in asignificant time delay between anorder being placed and a resultachieved. Investing in a modernelectronic data processing systembased on new technological devel-opments has become essential. Atthe same time, such a system mustreflect existing clinic structures andintegrate heterogeneous concepts.

To meet these needs, rehabilita-

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