The Operating Theatre Journal

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July 2010 Issue No. 238 ISSN 1747-728X

nd out more 020 7100 2867 • e-mail [email protected] Issue 238 JULY 2010 3

The Operating Theatre Journal is published twelve times per year. Available in electronic format from the pages of www.otjonline.comand in hard copy to hospitals throughout the UK. Personal copies are available by nominal subscription.

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Health Secretary sets new challenges for the NHS

- NHS must accelerate cuts in management costs -- Targets removed as focus shifts to outcomes -

The NHS will begin to make immediate ef ciency savings by tackling escalating management costs in order to meet the increasing demands on NHS services, Health Secretary Andrew Lansley said on the 2ist of June.

A revision to the 2010/11 NHS Operating Framework, published today, sets out changes to key priorities for the NHS including plans to reverse the rise in management costs seen in the last year.

Health Secretary Andrew Lansley said:NHS spending will increase, but so too will the demand on NHS services. In order to meet this demand, the NHS needs to make substantial savings and that is why I want to see immediate action this year to reduce management costs so that the savings made can be reinvested in NHS care for patients.

Management costs in Primary Care Trusts and Strategic Health Authorities have increased by over £1bn since 2002/03, with over £220m of the increase taking place during 2009/10.

Management costs now stand at £1.85bn and its our intention that during 2010/11 we will remove all the management costs that have been additionally incurred during 2009/10, to get back to the level of 2008/09. Then in subsequent years, we will go beyond that, with a further £350m reduction in 2011/12.

The overall reduction in management costs by 2013/14 will be £850m, which is a 46 per cent reduction on the 2009/10 management costs.

The revised Operating Framework also sets out for the rst time changes to the use of targets in the NHS. These include:

• removal of targets around access to primary care;

• removal of top-down performance management of the 18 weeks referral to treatment target; and

• reduction of the 4 hour A&E target threshold from 98 per cent to 95 per cent.

Andrew Lansley added: I want to free the NHS from bureaucracy and targets that have no clinical justi cation and move to an NHS which measures its performance on patient outcomes. Doctors will be free to focus on the outcomes that matter providing quality patient care.

But I want to be clear while the NHS will no longer be accountable to ministers or the Department for its performance in these areas, it will be very much accountable to the patients and public it serves. Patients will still be entitled to rights under the NHS Constitution and the quality of their experiences and outcomes are what will drive improvements in the future.

We expect providers to continue to make improvements, for example on referral to treatment times, and to provide this information to patients themselves, driving choice and competition in the NHS.

Today’s revisions also ask the NHS to give greater priority to two important areas, military veterans health and dementia. The NHS must ensure that injured military personnel experience a smooth transition from military to NHS care as well as receiving priority treatment for conditions related to their service.

On dementia, the NHS must work closely with partners to implement the National Demential Strategy and publish information on how they are doing this so that people with dementia and their families have access to clear information to help them understand local services.

The changes set out today also reinforce recently announced plans to publish more transparent hospital infection data; new rules on recon gurations that must have the support of local doctors and patients; and plans to withhold payment from hospitals where patients are readmitted within 30 days of discharge.

The Revision to the Operating Framework for the NHS in England for 2010/11 was published on Monday 21 June 2010 and can be found at:http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_110107

On 21 May 2010, the Health Secretary announced new rules for service recon gurations in the NHS. Further information can be found at: http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_116290

On 2 June 2010 the Health Secretary announced plans to publish more detailed and frequent information on Healthcare Associated Infections. From 5 July the HPA will publish data every week to increase transparency and drive improvement through patient choice. Further information can be found at: http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_116533

RCS response to revised operating framework for the NHS

The President of the Royal College of Surgeons John Black, said:

The Royal College of Surgeons welcomes the change in emphasis from targets to measurement of outcomes in the revised operating framework for the NHS published today (June 21st), especially the commitment to remove altogether those targets that have no clinical relevance. The relaxation of the 18 week deadline should allow surgeons to treat patients depending on clinical need and not on whether they are about to breach a target. The acknowledgement that the four hour A&E target has severely distorted care for many patients and is under review will also be viewed as a positive step by hospital doctors.

We hope that the removal of the target culture will signal the end of the pooled waiting list and the inability in some areas of GPs to refer patients to an individual consultant. Patients and doctors value continuity of care highly.

The decision to proceed with specialist centres for trauma care and paediatric cardiac surgery are positive steps that will improve standards of care. We hope that the inclusion in the four tests for recon guration of clarity on the clinical evidence will ensure con dence of both patients, and clinicians involved in redesigning their service. Continued involvement of the medical royal colleges will be essential.

iPad in the OTApple’s tablet computer, the iPad®, has made its way into the operating theatre in Japan.According to MedGadget, the iPad® was released in Japan on May 28, 2010, and Japanese doctors and surgeons have been eager to see how this new technology may enhance their workstations.Six days after the computer’s release, it was reported that the iPad® was already used in a Japanese operating theatre. A Japanese surgeon at Kobe University in Nada-ku, Kobe, used the device to review abdominal computerized axial tomography (CAT) scans during a procedure. The doctor stated that he wrapped his iPad®carefully in plastic, but the touch screen still responded well to his gloved hands.

4 THE OPERATING THEATRE JOURNAL www.otjonline.com

‘It Takes All Kinds’ - an Innovative MRI System Which is Open for all Patients - OASIS(TM) Hitachi Medical Systems UK Sells its First 1.2 Tesla Open Architecture Vertical High-Field MRI System to Mayday Hospital, Croydon Mayday Hospital - Hitachi Medical Systems UK has been awarded the contract for OASIS(TM) 1.2 Tesla high- eld open MRI by InHealth MRI Centre at Mayday Hospital, Croydon - the high performance system with a truly open architecture available in the UK. This unique product combines unrivalled patient comfort together with rst class imaging comparable to that of a closed bore system. CT and MRI have become indispensible in radiological diagnostics. However, conventional MRI systems with a narrow, restricted scanning tunnel can cause great anxiety to the patient and with almost one in every four patients suffering from claustrophobia the examination either does not take place or can only go ahead if sedation is used. The OASIS(TM) combines a truly open design together with high eld strength providing optimal image quality comparable to that of a closed bore system. The 270degrees angle of vision allows the patient an unobstructed view during the scan for a far more comfortable experience whilst simultaneously giving the clinician a clear view of the examination in progress.

The bariatric issue is a burgeoning problem in Europe demanding a radical rethink in MRI design whilst maintaining the necessary image quality. The OASIS(TM) provides the widest patient table, largest ex body coil and speci c bariatric scanning protocols within an open MR environment meeting the bariatric imaging challenge and reducing rejection rate.

Mayday Hospital has of cially reopened its fully renovated state-of-the-art MRI unit marking the occasion with a visit from three nationally renowned Harlequin rugby players who demonstrated the true openness of the system! The design is unique and can accommodate patients who cannot t into a conventional closed bore type magnet. Anxious or nervous patients are easily reassured and those suffering from claustrophobia don’t always have to be sedated. Referrals for patients suffering from claustrophobia to Mayday MRI from London and the South East has risen signi cantly since installation in April 2010 proving that there is an essential requirement for this technology. Powerful, high performance MR electronics with fast gradients and multi-channel RF technology provide diagnostic performance comparable to that of a 1.5T MR but with the advantage of the open architecture design.

About Hitachi Medical Systems Europe

Hitachi Medical Corporation, a globally active company owned by the Japanese Hitachi Ltd. Group (NYSE: HIT / TSE: 6501), is a leading international electronics company with approximately 400,000 employees worldwide.

The Hitachi Medical Corporation is represented in Europe by Hitachi Medical Systems Europe Holding AG, with headquarters in Zug, Switzerland and its subsidiaries. The company is a rst choice supplier of powerful open high- eld MRI systems and multi-slice CT systems, as well as medical ultrasound and optical topography devices.

Ultrasound expertise encompasses clinical applications including general radiology, internal medicine, gynaecology, cardiology, gastroenterology, urology and surgery. Hitachi Medical Systems offers a complete range of solutions to address a wide range of medical challenges.

For more information: http://www.hitachi-medical-systems.com

Contact: Barbara DowellHitachi Medical Systems UK LtdPhone +44-844-800-4294E-mail [email protected]

3 of the Harlequin Rugby team demonstrating true openness of OASIS(TM). (PRNewsFoto/Hitachi Medical Systems (Holding) AG) LONDON ENGLAND

When responding to articles please quote ‘OTJ’

Operating theatres benchmarking paves the way for ef ciency savingsUsing operating theatres more ef ciently could save hospitals millions of pounds a year. This was one of the ndings from a benchmarking exercise conducted by the Foundation Trust Network (FTN) for member trusts.

One trust that took part in a FTN benchmarking project used its operating theatres for twice as many hours a week as the least ef cient. The benchmarking programme helps NHS trusts take a detailed look at a particular clinical service and compare their costs and outcomes with each other with a view to adopting the most outstanding practices.

The 12 authorised and aspirant foundation trusts that took part in benchmarking their operating theatres had between 10 and 36 theatres each. The FTN benchmarking team collected theatre logs showing detailed information including timings and clinical procedures over two weeks in November 2009. This showed that across the total of 290 theatres, there were over 15,000 procedures; nearly a quarter of them were day case units.

According to McKinsey & Company, which worked with the FTN on the benchmarking project, for most trusts, a productivity increase of around 25 to 35 per cent in a single theatre would result in one extra procedure per day, and an additional pro t of £1,000 per day or at least £250,000 per year or £2.5 million a year for a trust with 10 theatres.

One of the participating trusts had already demonstrated that it could increase the number of procedures undertaken in its theatres by 24 per cent with increases across elective and non-elective surgery, and private patient work.

This was achieved by making theatre sessions ve hours long rather than three and a half or four hours; reviewing job plans; and setting up a multidisciplinary project group.

The most ef cient trust was using its operating theatres for twice as many hours a week as the trust with the least intensive use of its theatres. The benchmarking work showed that on average only 34 hours a week were scheduled for each theatre. But one trust averaged 52 hours a week, while the least productive trust averaged 26 hours a week for its theatres.

Just under half the time (47%) theatres were in use was procedure time; 19 per cent for pre- and post-operative activities such as positioning the patient and applying dressings; and 16 per cent of the time was accounted for by turn-around time between patients, including anaesthesia. Late starts (7%) and early nishes (11%) accounted for 18 per cent of scheduled theatre time.

On average patients spent 145 minutes in theatre. Recovery time accounted for an average of 60 minutes and showed the greatest variation across the 12 trusts in the project.

Staff costs make up the largest share of theatre costs at over 60 per cent of total costs.

The mix of grades of nurses and operating department practitioners varied widely with some trusts relying more heavily on bank and agency nurses.

As a result of taking part in the benchmarking, the trusts are planning to review operating theatre schedules, including late starts and turnaround times; examine ways to reduced cancellations and reallocate unused theatre slots; and nd ways to reward staff for their contribution to improvements.

Sue Slipman, director of the Foundation Trust Network said:

Staff recognise the importance of quality in their work, but are not always aware of how their trust is performing against quality targets.

Benchmarking makes everyone involved more aware of how they are performing and points the way to ways in which they can deliver a more ef cient service at the same time as improving clinical outcomes for patients.

www.foundationtrustnetwork.org


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KIMBERLY-CLARK HEALTH CARE CREATES NEW SURGICAL GOWN FABRIC FOR HIGH LEVEL PERFORMANCE, PROTECTION AND COMFORTKimberly-Clark Health Care has created a new, innovative fabric for its best-in-class MicroCool* surgical gown that combines high performance with high level protection and superior comfort.

Using its own patented SFS technology, Kimberly-Clarks KC400 MicroCool* offers all over impervious protection for complex, high risk specialized surgery as well as long-lasting high uid procedures.

In a survey amongst 1400 clinicians, two out of three OR clinicians said they found the new KC400 MicroCool* surgical gown was more comfortable than ever and 97% of those surveyed found the fabric softer.1

The unique SFS technology of the MicroCool* gown achieves the combination of performance, protection and comfort through a thin, strong layer of breathable lm enclosed in two layers of soft, nonwoven fabric. The lm lets moisture vapour pass easily through the gown whilst preventing penetration of blood and bodily uids.

The KC 400 MicroCool* exceeds the European Norm EN 13795 High Performance Standard in preventing liquid and microbial penetration and ISO 11810-1 for ame resistance which is vital in the operating room that frequently makes use of oxygen, lasers and cautery devices.

We are constantly looking at how we can provide the best protection, performance and comfort in single-use surgical gowns in the high-pressure operating room environment, explains Jonathan Price, General Manager of Europe, Middle East and Africa for Kimberly Clark Healthcare.

The innovation of KC400 MicroCool* fabric and the new SFS technology is testament to our long standing commitment and success in, yet again, raising the standard for the bene t of clinicians.

The new KC400 MicroCool* is part of the Kimberly-Clark four-tier range of surgical gowns, drapes and packs that provide the operating room (OR) team with a wider choice to select the appropriate level of protection to meet the demands of the speci c surgical procedures as well as the exibility to meet their nancial requirements.

The approach focuses on distinguishing between four performance classes and provides a cost effective surgical gown, drape and pack solution by combining the right protection for the right procedure at the right price. The comprehensive range combines Kimberly-Clarks focus on product quality with the companys expertise in in-service training, clinical education and nancial guidance in helping the OR team select the correct product for the appropriate procedure.

The range is supported by the Kimberly-Clark Advantage* in-service and support which covers OR utilization reviews, in-service training on the companys products, nancial guidance with Kimberly-Clarks COMPASS tool, Custom Procedure Tray options, clinical education and technical support. In addition on-line clinical information is provided at www.HAIWatch.com.This website focuses on the latest news, best practice, training and educational tools to further help hospitals deliver the best patient care and help reduce the levels of hospital-associated infection (HAI). http://www.kchealthcare.com

References:1. Based on 1400 product evaluations.

Kimberly-Clark Healthcares KC400

MicroCool* surgical gown



HPC launches new resources

for registrants to promote their HPC

registrationThe Health Professions Council is pleased to announce the introduction of a new resource for individuals on the HPC Register.

The resource includes a new HPC registration logo as well as a dedicated webpage and a lea et which contain information for registrants on how to promote their HPC registration.

The new HPC registration logo is designed to be simple, bold and recognisable, providing reassurance to the public and differentiating HPC-registered professionals from non-regulated health professionals.

Marc Seale, Chief Executive of the HPC said: Registrants can display the new registration logo as a clear sign that they meet the HPC standards. It is de nitely a positive new direction and a change that is supported by the public.

These changes have resulted from consultation and development with both professionals and the public. Results from research carried out by GFK Healthcare said 90 per cent of the public were positive or neutral in their reaction to the logo and three quarters of the public thought it would be a good idea for healthcare professionals to display the HPC registration logo.

The newly dedicated webpage and supporting lea et for registrants titled Promoting your HPC registration provide registrants with information on how to describe registration, how to access up-to-date registration details through www.hpcheck.org and explains how to use the registration logo.

Within the new webpage registrants can place orders online to request free public information materials for them to display in their place of work e.g. waiting room area. These recently refreshed promotional materials provide information speci cally for the public about the HPC and the bene ts of using a registered professional.

If you are using the HPCheck logo, please replace it with the new HPC registration logo when you next update your printed materials, and amend any online information as soon as possible.

For more information, and to download the new HPC registration logo or order free public information materials, see:

www.hpc-uk.org/registrants/promoting

Liverpool Womens Hospital chooses SonoSite for anaesthesia guidance

Dr Philip Barclay with the SonoSite M-Turbo

The Liverpool Womens Hospital, the largest maternity unit of its kind in the UK, relies on the SonoSite M-Turbo® point-of-care ultrasound system for guiding anaesthesia for a range of procedures in obstetrics and gynaecology. Dr Philip Barclay, consultant obstetric anaesthetist at the hospital, explained: In obstetrics we principally use the M-Turbo to guide spinal epidural blocks for caesarean sections. It reduces the number of attempts required to site the blocks, and the increased accuracy helps us to choose the right needle at the beginning of the procedure. Previously, I was unable to visualise the actual epidural space when administering epidural anaesthesia to morbidly obese patients, but the M-Turbo produces superb quality images which allow us to determine this with a high degree of accuracy.

In gynaecology, the big development with regard to ultrasound has been the transversus abdominis pain (TAP) block, which provides patients with long lasting analgesia after major abdominal surgery. The M-Turbo allows us to directly visualise the needle rather than performing blind TAP blocks. This is particularly useful, again with obese patients, and people with dif cult anatomy.

Dr Barclay added: The simplicity of the SonoSite machine means that it is very user-friendly for anaesthetists, and the quality of images has been extremely helpful for teaching and presentations.

For information and to register on SonoSite structured training courses, log on to www.sonositeeducation.co.uk

For more information about SonoSite products, please contact: Alexander House, 40A Wilbury Way, Hitchin SG4 0APT +44 (0)1462 444 800, F +44 (0)1462 444 [email protected] www.sonosite.com

Please quote ‘OTJ’

Ansell Healthcare supporting the Royal College of Surgeons of England

Ansell Healthcare (www.ansell.eu), global leader in healthcare barrier protective solutions, recently announced a three-year partnership with the Royal College of Surgeons of England (www.rcseng.ac.uk). The partnership is part of Ansells policy to support education initiatives and collaborating with the healthcare community to increase the health and safety of professionals and patients alike. By supporting the initiatives of the Department of Education of the Royal College of Surgeons of England, Ansell reaf rms its long-term commitment to the healthcare community in general and the surgeons in particular.

Committed to continued educationAfter having developed a close and successful educational partnership with the UK Association of Surgeons in Training (www.asit.org), focusing on infection control, allergy prevention and barrier protection, Ansell considers its partnership with Royal College of Surgeons of England as the next important milestone in its ongoing commitment to provide support for continued education of healthcare professionals.

The RCS is delighted to be working with Ansell Healthcare. The College bene ts greatly from unrestricted partnerships of this kind. It helps us to keep our courses, delivery methods and teaching materials up to date, and so enables us to offer the highest quality training said Mike Larvin, Director of Education at the Royal College of Surgeons of England. Therefore we consider the partnership between Ansell and the College as a very important support to achieve our goals to provide quality educational programmes for surgeons at all stages of their careers.

“We are proud to be able to contribute offering surgeons the opportunity to access and follow educational courses”, says Werner Heintz, Sr Vice President & Regional Director of Ansell EMEA. “By teaming up with the Royal College of Surgeons of England, Ansell con rms its commitment for educational support to the healthcare community with the aim of maintaining the highest possible standards of clinical care for patients.

Training surgeons in the interests of patients Ansell and the College share the same objectives of promoting and protecting the interests of patients by maintaining professional standards in surgery and advancing the frontiers of surgical care. An adaptable, well-trained surgical workforce is a necessity in providing high quality, safe patient care.

Ansell will support several educational programmes including the funding of the development by surgical tutors of an orthopaedic and vascular specialty courses portfolio and the organisation of a ve day modular course for surgical trainees Furthermore, Ansell will offer bursaries to specialty surgical trainees at all levels to attend a College skills course.

About Ansell:Ansell is a world leader in providing superior health and safety protection solutions that enhance human well being. With operations in the Americas, Europe and Asia Paci c, Ansell employs more than 10,000 people worldwide and holds leading market positions in industrial and medical gloves. Ansell is also a leading player in the household gloves and condom market segment globally. Information on Ansell and its products can be found at http://www.ansell.eu.


The patented tray has been designed and tested by Vernacare with detailed input from front-line clinicians. Theatre staff from four NHS Trusts and delegates to the AFPP Exhibition helped to evaluate an initial prototype. The design was then modi ed to re ect their views, and a second prototype tray created in single-use pulp.

Evaluation of the Vernatray has been carried out at three Trusts and one independent hospital, with 99% of clinicians reporting that they found it easier to correctly identify labels on syringes and 100% of respondents stating that the syringes were stable in the tray.

Added Paula Cockcroft: “We have listened carefully to the feedback from Operating and Theatre Department Practitioners, Anaesthetic Consultants and Assistants, Theatre Team Leaders and Practice Educators, together with Infection Prevention specialists, and re ected their suggestions in the nal design.”

To register for free samples of the Vernatray or set up a trial, please email [email protected] or contact Vernacare on 01204 555999, www.vernacare.co.uk

For more information call: 01244 660 954

www.melydmedical.com www.allenmedical.com

© 2010 Allen Medical Systems, Inc. All Rights Reserved

Introducing the Allen® Paediatric Stirrups!

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Theatre practitioners help develop new anaesthetic medication safety trayVernacare’s new single-use anaesthetic safety tray will help reduce operating theatre error and advance standards of infection prevention.

The Vernatray has individual channels to ensure the correct alignment of syringes and has a separate storage area for ampoules and sharps. It is intended to replace plastic and stainless steel trays where the medication is stored in one single compartment - making it dif cult to locate the relevant syringe.

The Vernatray has been created by medical products manufacturer Vernacare In partnership with NHS Innovations South West, who devised the concept with theatre and engineering staff at Poole Hospital and worked with other South West Trusts to produce early prototypes.

Chris Sawyer, Business Development Manager, NHS Innovations South West, said: “The Vernatray has been designed by theatre staff for theatre staff. The original idea and thinking came from anaesthetists who identi ed the need to increase safety by organising medication better. Vernacare has taken their concepts to a new level and created a single-use tray that meets the safety needs of modern healthcare practice.”

Said Paula Cockcroft, Senior Product Manager for Vernacare: “The Vernatray contains six individual syringe channels, including two large channels for 30ml+ syringes together with a storage area for ampoules and some sharps bins. It makes it easier for theatre staff to locate the relevant equipment and reduces the risk of incorrect medication being administered. Staff nd the Surgical Safety Checklist easier to perform, which includes con rmation of the formal inspection of the anaesthetic equipment, medications and patient’s anaesthetic risk.

“In addition, the single-use pulp avoids infection risks associated with re-using plastic and stainless steel receptacles and saves cleaning time as the biodegradable pulp can be simply disposed of in clinical waste or via maceration.”

According to the The Association for Perioperative Practice (AFPP), the majority of critical incidents in anaesthesia arise from human error and it reported 128,000 patient safety incidents from surgical specialities from October 2006 to September 2007. When responding to articles please quote ‘OTJ’


Controlling hemorrhage during surgical procedures.Hemorrhage is perhaps the most dif cult aspect of surgical procedures.Proper hemostasis is an important prerequisite for a successful outcome in all operative elds, and post-operative oozing is a precursor to the added complication of adhesions.Surgeons employ several standard techniques and devices to gain control of unrelenting bleeding.

When these conventional means fail or are impractical, there are adjunctive hemostasis devices available.

The market for such hemostats is varied and growing. According to MedMarket Diligence LLC, worldwide sales in topical absorbable hemostats are expected to rise from $595mil in 2006 to about $842mil in 20111.

Choice of hemostat depends on ef cacy of action, risk to patient and cost value to the Trusto Ef cacy: Mode of action and time to stop hemorrhage. o Risk to patient: Source of hemostat re transmission of disease eg human to human transmission, vCJD,

bovine allergies, cultural sensitivities. Whether a biodegradable/absorbable hemostat actually does biodegrade and in the stipulated time.

o Cost value to Trust: Saving life, reducing complications, reducing theatre time and hospital care.

Topical absorbable hemostats fall into the following categories1. Oxidised regenerated cellulose (OCR)2. Gelatin-based sponges3. Thrombin-based4. Chemical hemostats 5. Collagen

Table exploring differences between topical absorbable hemostats

Evidence of exogenous collagen’s role in hemostasis is well understood. Market trends indicate the eld of biomaterials will show a 34% growth to 2012 (Frost & Sullivan Global Wound Care Market Report 2009).

The recent UK introduction of a Type I sh collagen powder hemostat (Helisorb Powder, Medira Ltd) thus may provide an interesting and cost effective alternative to current bovine, equine or human thrombin hemostats7. Not only providing bleeding control, this product is proving to play an important role in lymphorrea management post block dissection of lymph nodes.

References1 Berg J, Biomedical Business & Technology, 01 April 2009, vol./is. 32/4(20-23),

193026142 Julina Ongkasuwan, M.D. Hemostat Agents, Baylor College of medicine, October

20, 2005 3 E. N. Papacharalabous; T. Giannopoulos ; A. Tailor; S. A. Butler-Manuel.

Intraoperative haemostasis with new brin surgical sealant (Quixil®) in gynaecological oncology Journal of Obstetrics and Gynaecology, Volume #29, Issue 3 April 2009 , pages 233 – 236

4 Busuttil RW. A comparison of anti brinolytic agents used in hemaostatic brin sealants. J Am Coll Surg 2003; 197: 1021-8.

5 The Eu J Hosp Pharma Sci Vol 12 2006 Issue 1 P. 3 – 9. Evaluating the differences between brin sealants

6 Celox Medical7 V. Karayiannis et al. The use of absorbable collagen type I powder in the

treatment of bleeding, Hellen Obstet Gynecol 17(3):304-308, 2005

Further information: [email protected] www.medira.co.ukTel +44 (0) 8445 617622 Fax +44 (0) 1767 699063Medira Ltd, 1 Monoux Place, Sandy, Bedfordshire, SG19 1JN

Type of hemostat Material Mode of Action

1 OCR Cellulose When saturated with blood, oxidized cellulose sheets rapidly swell into a gelatinous mass, aiding hemostasis. Works proximally in the intrinsic coagulation pathway via contact activation2

2 Gelatin Porcine gelatin origin Not fully understood, may be more physical than the result of altering blood clotting mechanism5

3 Thrombin based collagen sponge, manufactured from horse tendons, coated with human fibrinogen and human thrombin

Contact with a bleeding surface, or triggered by the presence of physiological saline, the coating of the collagen sponge dissolves and the subsequent thrombin-fibrinogen reaction initiates the last step of the coagulation cascade3

Fibrin derived from human blood plasma

mimics the final stages of the clotting cascade4, but works independently of the body’s clotting mechanism5

CaCl2, human thrombin, gelatine matrix

Requires mixing components and preparation time

4 Chemical Chitosan purified from shrimp shells, a granular powder

Works independently of the bodies normal clotting process, forms a sticky pseudo clot. Does not set off normal clotting cascade6

Volcanic rock powder Side effect of exothermic reaction

5 Type I Collagen Fish collagen In heavy powder form. Works with the body’s natural coagulation cascade. Primary hemostasis occurs, blood platelets aggregate on the collagen, releasing coagulation factors. A fibrin clot is formed creating a physiological plug. Allergen free.

Helisorb® Powder is used as an adjunctive haemostat in surgical procedures when control of bleeding by conventional methods is ineffective or impractical

HeliSorb® Powder

1

2

Helisorb

Helisorb® Powder is biocompatible and activates healing factors. Haemostasis should be achieved in a few seconds to a minute depending on the volume of bleeding. Depending on the amount of Powder used, Helisorb® Powder is completely biodegraded in 3 to 21 days

Indications:

HeliSorb® Powder is derived from Piscean sources

References1 Krieg T. Collagen in the Healing Wound. WOUNDS. 1995;7(Suppl A):5A–12A. 2 Hampton S, Understanding the pH balance in wound healing, JCN 2008,22:05

An intact Type I

collagen powder

of fish origin

0434

Helisorb®

POWDER


GW Announces UK Launch of World’s First Prescription Cannabis

MedicineSativex(R) Marketed to Treat Spasticity Associated with Multiple Sclerosis

GW Pharmaceuticals plc on the 21st of June announced the UK launch of Sativex(R), its Oromucosal Spray for the treatment of spasticity due to Multiple Sclerosis (MS). Sativex(R) is the world’s rst prescription cannabis medicine and the UK is the rst country in the world to grant a full regulatory authorization for the product.

Sativex(R) contains two cannabinoids or active ingredients - THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). It is the rst cannabinoid medicine derived from whole plant extracts from the cannabis sativa plant.

Sativex(R), available as a prescription only medicine, was developed by GW in speci c response to calls from people with MS for a prescription cannabis-based medicine. Today’s launch means that MS patients suffering the spasms and cramping associated with spasticity have access to a new treatment option which has been shown to improve their symptoms where current treatments have failed.

Sativex(R) is manufactured by GW under Home Of ce licence at an undisclosed location in the UK. The medicine is being marketed in the UK by GW’s UK licensee, Bayer Schering Pharma.

Dr Geoffrey Guy, GW’s Chairman, said: “The approval and launch of Sativex(R) in the UK is the world’s rst full approval of a cannabis-derived prescription medicine and the product of eleven year’s research by GW into the cannabinoid system. GW was founded with the primary goal of developing a medicine to address the unmet needs of people with MS and today’s launch of Sativex(R) represents a welcome advance in MS symptom treatment. This is also an historic moment for GW and marks the beginning of the company’s transition from late stage development company to a commercial pharmaceutical business. Today’s news validates our cannabinoid technology platform and enables us to progress the development of our pipeline across a range of therapeutic areas with increased con dence.”

Under the terms of the agreement with Bayer, GW will receive a GBP10m milestone payment in respect of the UK approval of Sativex(R).

Outside the UK, Sativex is expected to be approved in Spain shortly. Further submissions will be made in additional European countries during the second half of 2010 under the mutual recognition procedure. Almirall S.A. will market Sativex in Europe (ex-UK). http://www.gwpharm.com

Source: GW Pharmaceuticals plc PR Newswire


New surgical sealant lm provides usable, effective and economic solution for reducing air leaks during lung operation

Leeds based Tissuemed has announced a new iteration to their surgical cling lm range, which has been speci cally dedicated to address the speci c challenges of lung surgery.

The worlds rst surgical cling lm designed for minimising leaks encountered during surgical procedures was launched by the company in 2007. Now the company have launched TissuePatchThoracic - a usable, effective and economic solution for reducing air leaks during lung operations which uses keyhole surgery techniques.

TissuePatchThoracic is an ultra thin adhesive lm, which is more resilient and more conformable to the tissues, possesses improved handling characteristics compared with its predecessor.

In addition the range now incorporates sizes and accompanying instruments which enable surgeons to use the product in keyhole procedures, known as Video Assisted Thoracic Surgery (VATS).

TissuePatchThoracic has been speci cally designed to enable thoracic surgeons to seal internal air leaks during complicated lung

surgery cases in which part of the lung is resected, most commonly for tumour removal. Surgical resection lines are usually closed with staples, and the addition of TissuePatchThoracic adhesive lm over these staple lines provides the surgeon with reassurance that air will not leak through the tissue and between the staples.

Published data suggests that 70% of lung surgeries result in air leaks and 15% of these can be prolonged and problematic. If the surgeon can reduce the number and duration of air leaks,

patients can have surgical drains removed more quickly, suffer fewer complications and be discharged from hospital more quickly.

The new patch is also able to be inserted into surgical sites using a bespoke VATS Delivery System, which uses a cleverly

designed loading device to take the patch directly from the packaging into a delivery tube in one easy, direct movement, ready to be dispensed directly onto the target area.

TissuePatchThoracic works by bonding to proteins on the

surface of internal organs and tissues, enhancing traditional suture or staple line closure and supporting healing tissues. The product requires no advance preparation and is easy to apply to often complex tissue surfaces.

Mr Kostas Papagiannopoulos, Consultant Thoracic Surgeon from St Jamess Hospital in Leeds, UK states Ive used the new product and it represents an improvement over the original. Its stronger, softer and ultimately conforms to lung tissues better.

For more information visit www.tissuemed.com

New improved 3D endoscope camera

system should reduce surgical error and the

risk of litigationA Dorset research and development company says it has produced a 3D camera system that improves picture quality and adds a depth dimension to images produced by endoscopes with a unique twin lens arrangement potentially reducing patient risk and intervention error.

And the company behind it Stereoscopic Optical Systems says that should lead to a signi cant reduction in litigation threat.

Surgeons who have seen and used the system in early trials say it is much lighter and easier to manipulate than the conventional approach to 3D endoscopes and laparoscopes and initial reports say it is far less tiring.

During surgical training or post-operative analysis a video recording will give freeze-frame images and a 3D view without ickering, unlike current 3D systems which show a single left or right eye image only, with potential shudder, but not in 3D.

Hospital surgical trials are to resume shortly.

Instead of using two electronically- or mechanically-linked cameras and ickering two sets of images, the company says its new JC3D system shows images to both eyes at the same time by incorporating two views from adjacent lenses that are manipulated into a single camera by passive optics.

Conventional 3D imaging often involves co-ordinated twin camera arrangements, twin projectors, or very complex methods of displaying stereoscopic images to each eye in turn, or showing left and right eye images alternately to the same camera.

Russell Wilson, managing director of Stereoscopic Optical Systems Ltd, says Our passive optical arrangement produces continuous images in a simpler way which improves image quality and brings costs down for equipment manufacturers.

Other applications for the system include inspection in the aviation, nuclear, industrial, undersea exploration and oil and gas sectors.

The system is the result of 15 years of research and development by a team led by inventor John Christian, and Stereoscopic Optical Systems now hopes to stimulate collaborative or joint-venture interest.www.stereoscopic3dimages.com

Medtronic Launches New Midas Rex(R) High-Speed Electric Drill for SurgeonsNew Surgical Drill Offers Power and Maneuverability with Easy Fingertip Control

Medtronic, Inc. recently announced availability of the company’s new Midas Rex(R) Legend(R) EHS Stylus Touch(TM) high-speed electric drill for spinal, cranial and orthopaedic surgical procedures. This is the rst electric drill from Medtronic with integrated nger control and is based on the well-established Legend EHS Stylus(R) motor. With high torque and a compact size, the Legend EHS Stylus Touch drill offers excellent balance and maneuverability for procedures in tight anatomic spaces. Surgeons can operate the drill using nger control only, footpedal control or both.

“With almost 50 years of leadership and innovation in high-speed surgical drills, we’re excited to offer our newest Midas Rex drill for surgeons who prefer the convenience and familiarity of nger control,” said Darren Woodruff, product manager for Spinal Power with the Neurologic Technologies division at Medtronic. “The Legend EHS Stylus Touch doesn’t require a footpedal at all, which can be advantageous during multi-surgeon procedures and at busy trauma centers.”

Additional features of the Legend EHS Stylus Touch drill include:

-- Ergonomic positioning and true variable speed adjustment

-- Easy-to-use design and quick set-up-- Adjustable speeds from 200 to 75,000 RPM

The Legend EHS Stylus Touch drill is powered by Medtronic’s Integrated Power Console (IPC(R)) system, a multispecialty surgical power console that offers improved intraoperative functionality. With the IPC system’s intuitive touchscreen interface,

surgeons can use saved custom settings, quickly adjust irrigation via simple remote control, and run multiple Medtronic handpieces.

As part of the standardized Legend platform, the Legend EHS Stylus Touch drill works with Medtronic’s interchangeable Legend tools and attachments for a broad range of surgical procedures.

“The Legend EHS Stylus Touch drill continues our tradition of innovative, powerful high-speed surgical drills, and is a direct result of listening to our customers’ needs,” said Bob Blankemeyer, president of the Surgical Technologies business and senior vice president at Medtronic.

About the Surgical Technologies Business at Medtronic The Surgical Technologies business develops products for the diagnosis and treatment of chronic diseases and disorders of the ear, nose and throat; surgical devices and implantable products for the treatment of cranial, spinal and specialty small-bone conditions; and state-of-the-art navigation equipment used in operating rooms to assist physicians in neuro and spinal surgery procedures.

About Medtronic Medtronic, Inc. (www.medtronic.com), headquartered in Minneapolis, is the global leader in medical technology -- alleviating pain, restoring health, and extending life for millions of people around the world.

Any forward-looking statements are subject to risks and uncertainties such as those described in Medtronic’s periodic reports on le with the Securities and Exchange Commission. Actual results may differ materially from anticipated results.

SOURCE: Medtronic, Inc.

produced a 3D camera system that improves picture quality and adds a depth dimension to images produced by endoscopes with a unique twin lens arrangement potentially reducing patient risk and intervention error.





Instead of using two electronically- or mechanically-linked cameras and ickering two sets of images, the company says its new JC3D system shows images to both eyes at the same time by incorporating two views from adjacent lenses

The worlds rst surgical cling lm designed for minimising leaksencountered during surgicalprocedures was launched by the company in 2007. Nowthe company have launched TissuePatchThoracic - ausable, effective andeconomic solution for reducing air leaks during lung operations which uses keyhole surgery techniques.

TissuePatchThoracic is an ultra thin adhesive lm, which is moreresilient and more conformableto the tissues, possesses improved handling characteristicscompared with its predecessor.

In addition the range nowincorporates sizes andaccompanying instruments which enable surgeons to use the product in keyhole procedures, known as Video Assisted Thoracic Surgery (VATS).

TissuePatchThoracic has been speci cally designed to enablethoracic surgeons to seal internal air leaks during complicated lung

surgery cases in which part of the lung is resected, most commonly for tumour removal. Surgical resection lines are usually closed with staples, and the addition of TissuePatchThoracicadhesive lm over these staple lines provides the surgeon with reassurance that air will not leak through the tissue and between the staples.

Published data suggests that70% of lung surgeries result inair leaks and 15% of these can be prolonged and problematic. If the surgeon can reduce the number and duration of air leaks,

be inserted into surgical sites using a bespoke VATS DeliverySystem, which uses a cleverly

designed loading device to take the patch directly fromthe packaging into a delivery tube in one easy, directmovement, ready to be dispensed directly onto the target area.


surface of internal organs and tissues, enhancing traditional suture or staple line closure andsupporting healing tissues. The product requires no advancepreparation and is easy to applyto often complex tissue surfaces.

Mr Kostas Papagiannopoulos, Consultant Thoracic Surgeon from St Jamess Hospital in Leeds,UK states Ive used the new product and it represents an improvement over the original. Its stronger, softer and ultimatelyconforms to lung tissues better.


that are manipulated into a single camera by passive optics.




The system is the result of 15 years


Medtronic, Inc. recently announced availability of the company’s new Midas Rex(R) Legend(R) EHSStylus Touch(TM) high-speed electric drill for spinal,cranial and orthopaedic surgical procedures. This isthe rst electric drill from Medtronic with integrated nger control and is based on the well-establishedLegend EHS Stylus(R) motor. With high torque anda compact size, the Legend EHS Stylus Touch drilloffers excellent balance and maneuverability forprocedures in tight anatomic spaces. Surgeons canoperate the drill using nger control only, footpedalcontrol or both.

“With almost 50 years of leadership and innovationin high-speed surgical drills, we’re excited to offerour newest Midas Rex drill for surgeons who preferthe convenience and familiarity of nger control,”said Darren Woodruff, product manager for SpinalPower with the Neurologic Technologies division atMedtronic. “The Legend EHS Stylus Touch doesn’trequire a footpedal at all, which can be advantageousduring multi-surgeon procedures and at busy traumacenters.”

Additional features of the Legend EHS Stylus Touchdrill include:

-- Ergonomic positioning and true variable speed adjustmentEasy to use design and quick set up





About Medtronic Medtronic, Inc. (www.medtronic.com), headquartered in Minneapolis, is the global leader in medical technology -- alleviating pain, restoring health, and extending life for millions of



































HeliSorb® Powder

1

2

Helisorb


Indications:



An intact Type I

collagen powder

of fish origin

0434

Helisorb®

POWDER












According to MedMarket Diligence LLC, worldwide sales in topical absorbable hemostats are expected to rise from $595mil in 2006 to about $842mil in 20111.




Topical absorbable hemostats fall into the following categories1. Oxidised regenerated cellulose (OCR)2. Gelatin-based sponges3. Thrombin-based4. Chemical hemostats5. Collagen









5 The Eu J Hosp Pharma Sci Vol 12 2006 Issue 1 P. 3 – 9. Evaluating the differences


1 OCR Cellulose When saturated with blood, oxidized cellulose sheets rapidly swell into a gelatinous mass, aiding hemostasis. Works proximally in theintrinsic coagulation pathway via contactactivation2


3 Thrombin based collagen sponge,manufactured fromhorse tendons, coated with humanfibrinogen and human thrombin

Contact with a bleeding surface, or triggered by the presence of physiological saline, the coating of the collagen sponge dissolves and the subsequent thrombin-fibrinogen reactioninitiates the last step of the coagulationcascade3


mimics the final stages of the clotting cascade4,but works independently of the body’s clottingmechanism5


Requires mixing components and preparationtime

4 Chemical Chitosan purified from shrimp shells, agranular powder

Works independently of the bodies normalclotting process, forms a sticky pseudo clot.Does not set off normal clotting cascade6


5 Type I Collagen Fish collagen In heavy powder form. Works with the body’snatural coagulation cascade. Primary hemostasis occurs, blood platelets aggregate on the collagen, releasingcoagulation factors. A fibrin clot is formedcreating a physiological plug. Allergen free.

Helisorb® Powder is used as an adjunctive haemostat in surgicalprocedures when control of bleeding by conventional methods is ineffective or impractical

HeliSorb® Powder

1

2

Helisorb

An intact Type I

collagen powder

of fish origin

Helisorb®

POWDER

of June announced the UK launch of Sativex(R), its Oromucosal Sprayfor the treatment of spasticity dueto Multiple Sclerosis (MS). Sativex(R)is the world’s rst prescription cannabis medicine and the UK is the rst country in the world to grant afull regulatory authorization for theproduct.

Sativex(R) contains two cannabinoids or active ingredients - THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). It is the rstcannabinoid medicine derivedfrom whole plant extracts from thecannabis sativa plant.

Sativex(R), available as a prescription only medicine, was developed by GWin speci c response to calls frompeople with MS for a prescription cannabis-based medicine. Today’slaunch means that MS patients suffering the spasms and cramping associated with spasticity haveaccess to a new treatment optionwhich has been shown to improvetheir symptoms where currenttreatments have failed.

Sativex(R) is manufactured by GWunder Home Of ce licence at an undisclosed location in the UK. Themedicine is being marketed in the UK by GW’s UK licensee, Bayer ScheringPharma.

Dr Geoffrey Guy, GW’s Chairman, said: “The approval and launch of Sativex(R) in the UK is the world’s rst full approval of a cannabis-derived prescription medicine and the product of eleven year’s research by GW into the cannabinoid system. GW was founded with the primary goal of developing a medicine toaddress the unmet needs of people with MS and today’s launch of Sativex(R) represents a welcomeadvance in MS symptom treatment.This is also an historic momentfor GW and marks the beginning of the company’s transition from late stage development company to a commercial pharmaceutical business. Today’s news validates our cannabinoid technology platformand enables us to progress the development of our pipeline across a range of therapeutic areas with increased con dence.”

Under the terms of the agreementwith Bayer, GW will receive a GBP10m milestone payment in respect of theUK approval of Sativex(R).

Outside the UK, Sativex is expectedto be approved in Spain shortly.Further submissions will be madein additional European countries











































produced a 3D camera system that improves picture quality and adds a depth dimension to images produced by endoscopes with a unique twin lens arrangement potentially reducing patient risk and intervention error.





Instead of using two electronically- or mechanically-linked cameras and ickering two sets of images, the company says its new JC3D system shows images to both eyes at the same time by incorporating two views from adjacent lenses

The worlds rst surgical cling lm designed for minimising leaksencountered during surgicalprocedures was launched by the company in 2007. Nowthe company have launched TissuePatchThoracic - ausable, effective andeconomic solution for reducing air leaks during lung operations which uses keyhole surgery techniques.

TissuePatchThoracic is an ultra thin adhesive lm, which is moreresilient and more conformableto the tissues, possesses improved handling characteristicscompared with its predecessor.

In addition the range nowincorporates sizes andaccompanying instruments which enable surgeons to use the product in keyhole procedures, known as Video Assisted Thoracic Surgery (VATS).

TissuePatchThoracic has been speci cally designed to enablethoracic surgeons to seal internal air leaks during complicated lung

surgery cases in which part of the lung is resected, most commonly for tumour removal. Surgical resection lines are usually closed with staples, and the addition of TissuePatchThoracicadhesive lm over these staple lines provides the surgeon with reassurance that air will not leak through the tissue and between the staples.

Published data suggests that70% of lung surgeries result inair leaks and 15% of these can be prolonged and problematic. If the surgeon can reduce the number and duration of air leaks,

be inserted into surgical sites using a bespoke VATS DeliverySystem, which uses a cleverly

designed loading device to take the patch directly fromthe packaging into a delivery tube in one easy, directmovement, ready to be dispensed directly onto the target area.


surface of internal organs and tissues, enhancing traditional suture or staple line closure andsupporting healing tissues. The product requires no advancepreparation and is easy to applyto often complex tissue surfaces.

Mr Kostas Papagiannopoulos, Consultant Thoracic Surgeon from St Jamess Hospital in Leeds,UK states Ive used the new product and it represents an improvement over the original. Its stronger, softer and ultimatelyconforms to lung tissues better.


that are manipulated into a single camera by passive optics.




The system is the result of 15 years


Medtronic, Inc. recently announced availability of the company’s new Midas Rex(R) Legend(R) EHSStylus Touch(TM) high-speed electric drill for spinal,cranial and orthopaedic surgical procedures. This isthe rst electric drill from Medtronic with integrated nger control and is based on the well-establishedLegend EHS Stylus(R) motor. With high torque anda compact size, the Legend EHS Stylus Touch drilloffers excellent balance and maneuverability forprocedures in tight anatomic spaces. Surgeons canoperate the drill using nger control only, footpedalcontrol or both.

“With almost 50 years of leadership and innovationin high-speed surgical drills, we’re excited to offerour newest Midas Rex drill for surgeons who preferthe convenience and familiarity of nger control,”said Darren Woodruff, product manager for SpinalPower with the Neurologic Technologies division atMedtronic. “The Legend EHS Stylus Touch doesn’trequire a footpedal at all, which can be advantageousduring multi-surgeon procedures and at busy traumacenters.”

Additional features of the Legend EHS Stylus Touchdrill include:

-- Ergonomic positioning and true variable speed adjustmentEasy to use design and quick set up





About Medtronic Medtronic, Inc. (www.medtronic.com), headquartered in Minneapolis, is the global leader in medical technology -- alleviating pain, restoring health, and extending life for millions of



































HeliSorb® Powder

1

2

Helisorb


Indications:



An intact Type I

collagen powder

of fish origin

0434

Helisorb®

POWDER












According to MedMarket Diligence LLC, worldwide sales in topical absorbable hemostats are expected to rise from $595mil in 2006 to about $842mil in 20111.




Topical absorbable hemostats fall into the following categories1. Oxidised regenerated cellulose (OCR)2. Gelatin-based sponges3. Thrombin-based4. Chemical hemostats5. Collagen









5 The Eu J Hosp Pharma Sci Vol 12 2006 Issue 1 P. 3 – 9. Evaluating the differences


1 OCR Cellulose When saturated with blood, oxidized cellulose sheets rapidly swell into a gelatinous mass, aiding hemostasis. Works proximally in theintrinsic coagulation pathway via contactactivation2


3 Thrombin based collagen sponge,manufactured fromhorse tendons, coated with humanfibrinogen and human thrombin

Contact with a bleeding surface, or triggered by the presence of physiological saline, the coating of the collagen sponge dissolves and the subsequent thrombin-fibrinogen reactioninitiates the last step of the coagulationcascade3


mimics the final stages of the clotting cascade4,but works independently of the body’s clottingmechanism5


Requires mixing components and preparationtime

4 Chemical Chitosan purified from shrimp shells, agranular powder

Works independently of the bodies normalclotting process, forms a sticky pseudo clot.Does not set off normal clotting cascade6


5 Type I Collagen Fish collagen In heavy powder form. Works with the body’snatural coagulation cascade. Primary hemostasis occurs, blood platelets aggregate on the collagen, releasingcoagulation factors. A fibrin clot is formedcreating a physiological plug. Allergen free.

Helisorb® Powder is used as an adjunctive haemostat in surgicalprocedures when control of bleeding by conventional methods is ineffective or impractical

HeliSorb® Powder

1

2

Helisorb

An intact Type I

collagen powder

of fish origin

Helisorb®

POWDER

of June announced the UK launch of Sativex(R), its Oromucosal Sprayfor the treatment of spasticity dueto Multiple Sclerosis (MS). Sativex(R)is the world’s rst prescription cannabis medicine and the UK is the rst country in the world to grant afull regulatory authorization for theproduct.

Sativex(R) contains two cannabinoids or active ingredients - THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). It is the rstcannabinoid medicine derivedfrom whole plant extracts from thecannabis sativa plant.

Sativex(R), available as a prescription only medicine, was developed by GWin speci c response to calls frompeople with MS for a prescription cannabis-based medicine. Today’slaunch means that MS patients suffering the spasms and cramping associated with spasticity haveaccess to a new treatment optionwhich has been shown to improvetheir symptoms where currenttreatments have failed.

Sativex(R) is manufactured by GWunder Home Of ce licence at an undisclosed location in the UK. Themedicine is being marketed in the UK by GW’s UK licensee, Bayer ScheringPharma.

Dr Geoffrey Guy, GW’s Chairman, said: “The approval and launch of Sativex(R) in the UK is the world’s rst full approval of a cannabis-derived prescription medicine and the product of eleven year’s research by GW into the cannabinoid system. GW was founded with the primary goal of developing a medicine toaddress the unmet needs of people with MS and today’s launch of Sativex(R) represents a welcomeadvance in MS symptom treatment.This is also an historic momentfor GW and marks the beginning of the company’s transition from late stage development company to a commercial pharmaceutical business. Today’s news validates our cannabinoid technology platformand enables us to progress the development of our pipeline across a range of therapeutic areas with increased con dence.”

Under the terms of the agreementwith Bayer, GW will receive a GBP10m milestone payment in respect of theUK approval of Sativex(R).

Outside the UK, Sativex is expectedto be approved in Spain shortly.Further submissions will be madein additional European countries

Enjoy Complete Confidence












































Complete range of Careline® continence solutions from ConvaTec

ConvaTec is a global company committed to serving healthcare professionals, hospitals and patients worldwide. In the ConvaTec Continence and Critical Care division they specialise in the development, manufacturing and distribution of single-use devices to hospitals and healthcare sectors around the world.The company has a complete range of products under the Careline® banner, speci cally designed to address incontinence. These products are latex-free and carefully crafted solutions for incontinence.The Careline® brand of urine drainage leg bags and collection systems are designed to provide comfort and assurance. The leg bag is of contoured design, with a non-woven fabric backing to absorb perspiration and reduce skin irritation. Leg straps helps prevent slippage and low memory silicone tubing prevents kinking and blockages.The Careline® sterile drainable E4 2-litre night bags have non-return valves and an Easi MT™ outlet to reduce the hazards of splashes, spillage and cross contamination. There are also non-drainable, non-sterile options.In a comprehensive brochure on the entire Careline® range, are listed details of sizes and NHS codes on the following:

• Careline® Leg Bags and 2-litre night bags• Aqualine foley catheters with pre lled syringe• Nelation catheters for intermittent catheterisation • Careline® catheters Valves• Careline® hanger and stand, leg straps and spigots.

All Careline® products help achieve optimal continence management. For a copy of the brochure on the Careline® range, or for more information, please telephone ConvaTec on 01527-583600 or visit www.convatec.com ConvaTec: Realise the possibilities™

™/® Indicates a trademark of ConvaTec Inc. ConvaTec Ltd is an authorised user. © ConvaTec Inc 2010.

mfort and assurance The leg bag

NHS asked to work together to protect quality and unlock savings

BMI Healthcare continues to set the standard through continuing relationship with mobile

surgery specialistState-of-the-art unit allows BMI Saxon Clinic to boost capacity and treat extra 114 patients during refurbishment project

BMI Healthcare, the largest independent provider of private healthcare in the UK, has set the standard for the provision of exible healthcare services in a rewarding partnership with mobile surgical services provider Vanguard Healthcare to boost capacity during a refurbishment project.

The partnership saw Vanguard deploy a state-of-the-art mobile operating theatre at BMI Saxon Clinic in Milton Keynes, which allowed the hospital to treat 114 extra patients in just one month.

The unit which was used to carry out an array of additional procedures from ophthalmology and gynaecology through to general surgery ensured that the Saxon Clinics project to upgrade permanent facilities did not impact upon waiting lists or the hospitals high standard of patient care.

Rod Morphew, Executive Director of BMI Saxon Clinic said: Deploying this highly sophisticated mobile facility at the Saxon Clinic has allowed us to maintain the high standard of care that we strive to deliver and has come to be expected of us, providing us with the resources to treat patients on site by our own staff..

The mobile theatre, during its deployment at the Saxon Clinic, was connected to the hospital by a purpose-built walkway the logistics for which were advised by Vanguards project management team. From an internal perspective, the mobile units are connected seamlessly to the main hospital building.

Ian Gillespie, CEO of Vanguard Healthcare Solutions, said: For the patient, the experience is no different to that of a permanent operating theatre. The patients were treated by the Saxon Clinics surgeons, who had the same state-of-the-art equipment to hand.

For the hospital itself, this meant that capacity and standards have been maintained while the permanent facility was being refurbished, concluded Ian, without the need to stretch the Saxon Clinics resources or resort to more expensive temporary solutions.For more information, visit www.vanguardhealthcare.co.uk When responding please quote ‘OTJ’

The NHS Institute is encouraging all NHS organisations to submit examples including effective ways of measuring patient and staff experience and satisfaction, safety, clinical outcomes, prevention, population health and staff productivity.

The call to arms follows a recent web seminar involving 100 people and subsequent report: Measurement for Quality and Cost: Challenges, examples of success and working collectively which showed that the main barrier to effective measurement was perceived as a lack of clari cation about the de nition of what is meant by measurement as well as a lack of practical skills, time and understanding of the value and bene ts. The group also cited many examples of excellent practice where measurement systems had an impact on improving care such as:

• A reduction in referrals of false positives for glaucoma patients to secondary care leading to subsequent savings at NHS Nottingham City

• A signi cant reduction in absconsions at a mental health service for older people at Leicestershire Partnership NHS Trust leading to better care.*

NHS staff can log onto http://www.institute.nhs.uk/MfQ to submit their measurement examples and to review and comment on other peoples submissions. The website will be live for four weeks until 8 July 2010 after which a panel of specialists from the NHS will help determine which examples have the biggest potential to make a difference across the whole of the service. These will be published on the Ideas Channel website. For more information about how and where to submit ideas, email [email protected].

Jim Easton, NHS national director of ef ciency and improvement, is calling on the NHS to work together to nd solutions to local healthcare challenges by sharing examples of good practice in effective measurement. He explained that learning from local successes not looking to central Government for answers will be the only effective way to learn how to track quality improvements and cost savings.

Examples of good practice can be submitted to a new web-based Measurement for Quality and Cost Ideas Channel, launched recently. The channel, hosted by the NHS Institute for Innovation and Improvement, will capture all the submissions of evidence-based good practice and insight in one place so that they can be shared and adopted across the NHS.

Jim Easton said: Delivering improved quality care against a dif cult cost backdrop is not going to be easy so it is vital that we know whether we are being successful or not. To do this we need to be able to measure our work at every level to show that we are making quality improvements and cost savings at every step of the way.

Effective measurement will be crucial in providing us with the benchmarks we need to help us understand where we need to start from, where we are now and where we need to be so that we start moving away from a top-down approach to one where what is happening at a local level will increasingly help inform and shape the provision of quality care.

Mike Davidge, head of measurement at the NHS Institute for Innovation and Improvement, agreed: Measurement at local level is the key. We need to be able to determine early on whether something is working or not and change tack if need be rather than nd out afterwards that a service is not delivering quality care or is not viable cost wise.

However, many people are unsure about what to measure, how to measure it and whether they are going about it in the right way. The Ideas Channel will be a resource that they can draw from its not just about learning from local successes as to what works and what doesnt, its also about identifying the best metrics and the type of data we want to capture.


Full Anaesthetic Gas Measuring Capability for Fukuda Denshi DS-7000 Patient MonitorsFukuda Denshi is a leading supplier of advanced patient monitoring and user-con gurable clinical information management systems. Now the company is announcing the availability of a new anaesthetic gas measuring capability on its range of compact, lightweight, integrated DS-7000 monitors.

The Fukuda Denshi DS-7000 series of patient monitors now have an inbuilt software capability, allowing them to accept IRMA™ plug-in multigas probes as an optional extra for customers. This is a convenient and practical anaesthesia support option, enabling full system integration without any host device hardware modi cations.

IRMA mainstream probes, each weighing only 30 grams, can measure C02/02/N20 anaesthetic gases (HAL, ENF, ISO, SEV, DES), provide agent identi cation and are available in customised con gurations. All probes are universally calibrated and deliver processed data for display on the DS-7000 LCD screen. They are extremely cost effective, while adding to the system’s mobility. IRMA mainstream probes are designed to overcome the shortfalls of sidestream technologies.

With the new DS-7000 patient monitor and the IRMA anaesthetic gas probes, further opportunities in gas monitoring have arrived! Simply connect the IRMA probe into the digital port of the DS-7000 and start measuring.

For more information on the Fukuda Denshi DS-7000 series of patient monitors and the IMRA gas probes, please telephone the company on:Tel 01438 728065.

Fukuda Denshi and IRMA: Just Plug in and Measure.

When responding please quote ‘OTJ’

Surgery targets endanger patient safety, poll suggestsPressures over hospital budgets and targets may be damaging safety in operating theatres, a survey suggests.

About one in ve of the nearly 600 surgeons questioned by Bournemouth University reported being involved in incidents, during a two-week period, where patients were harmed.

Many complained of having to operate on patients they had not seen before, or a lack of time for complex operations.

The government says “a culture of micromanagement” has endangered safety. For many years the NHS has been told to make patient safety a top priority. But this survey suggests many surgeons are unhappy with the overall approach to safety.

Near missesA total of 549 general surgeons responded to the online questionnaire - about one in four members of the Association of Surgeons of Great Britain and Ireland.

Of these 40% said they had been involved in an untoward event where a patient was nearly harmed, and a further 19% where there was actual harm, during the two-week period covered by the survey.

The authors of the paper, published in the Bulletin of the Royal College of Surgeons, estimate that the problems arose in about 3% of operations.

This is signi cantly higher than the gure cited by the National Patient Safety Agency, but lower than those from other studies in North America.

When asked about what gets in the way of patient safety, many said they did not feel in full clinical control, because of pressure from managers to get through operating lists.

One surgeon quoted in the paper warns against bowing to these pressures: “Don’t be seduced by management into making do, thinking you are being heroic; you’re not, you are being dangerous.”

The lead author, Professor Colin Pritchard from the School of Health and Social Care at Bournemouth University, says surgeons often come under pressure to “slip in” extra patients on their lists.

“If anything goes wrong they’re responsible but not in charge. The key is the in uence - and often the malign in uence - of managers who are concerned with meeting targets.”

However, he says, the surgeons are “very understanding” of the pressures faced by managers, who he says are forced to look at patients as “numbers or nuts and bolts”.

‘Struck off’Other concerns raised by the surgeons included poor staf ng, the breaking up of clinical teams, and lack of equipment.

A spokesman for the Patients Association said the paper once again raised the spectre of a “production line” approach to NHS care.

“This study gives yet more weight to the idea that whilst the NHS may have been meeting its targets over the past few years, that doesn’t mean those targets are always a bene t for patients,” he said. He also called for better regulation of health service managers, so they could be struck off in the same way as doctors if their decisions harmed patients unnecessarily.

In a statement the health secretary for England, Andrew Lansley, said the report highlighted a point he had made repeatedly.

“Patient safety must come rst, that means allowing clinicians to focus on the outcome of a patient’s treatment, rather than the diktats of managers. That’s why we will abolish Labour’s top-down process targets and replace them with outcome measures, which drive improvements in the quality of patient care.”

A spokesman for the NHS Confederation, which represents health service managers in England, said the methodology used in the study was “unusual”, but he added that patient safety was “of paramount importance to all NHS staff”.

He cautioned against “a potentially fruitless debate” about who was in control. “Ensuring patients are treated right rst time, every time, is not only bene cial to the patient but is also the most ef cient way of running any health service,” he said.

Source: BBC NEWS Adam Brimelow Health Correspondent


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TRUMPF INTRODUCES DEDICATED UK SERVICE AND SUPPORT

Minimising operating theatre downtime is crucial as hospital and clinics strive to keep on top of waiting list targets. So now more than ever, post-sales service is an important part of any package provided by healthcare suppliers. Medical technology company TRUMPF is no exception in this regard but during the last year it has been developing a dedicated service programme that meets the speci c needs of its British customers.

“We started with a blank sheet of paper and have created a multi-faceted programme that will allow us to provide rst class local service in the UK,” explained the company’s Technical Services Manager, Alasdair Owen. He joined Luton-based TRUMPF Medical Systems from Stryker in 2009 and is about to see the fruits of his labour become reality.

The aim of the new programme is naturally to correct any equipment malfunction in the shortest possible time. And for this purpose the company has invested in a service eet. The rst two of the fully custom- tted vehicles are now operational.

“We have also appointed our rst service engineers,” Alasdair Owen con rmed. “They have just completed in-depth training at our headquarters in Saalfeld and it is our intention to recruit additional engineers throughout this year.” A comprehensive stock of spares is now held at Luton in readiness for their needs.

The infrastructure is also in place for UK-based service engineers to interrogate any problem with TRUMPF operating tables via remote diagnosis. This service also allows the UK team to share problem-solving with specialists based at the manufacturing plant in Germany.

To ensure maximum availability of its operating tables, pendant and lighting systems TRUMPF in the UK has also introduced a choice of service contracts. The three-tier programme extends from a Classic level Planned Preventative Maintenance (PPM) to an Elite level encompassing breakdown cover, scheduled PPM’s, free equipment loan and staff product training. These contracts make sound nancial sense as they all provide highly competitive discount on call outs and parts.

“Introducing dedicated UK service for our customers is a very important step for us,” Alasdair Owen concluded. “But this is just the start. In common with all our products our service provision will be subject to continuous development to ensure our customers get the best possible return on their investment in TRUMPF.”


Health Secretary speech to NHS Confederation

In a speech at the NHS Confederation annual conference on the 24th of June, the Health Secretary set out how a vision for patient-centred care will propel the NHS, the professionals and the front-line through the unique and challenging times ahead.

The coalition government has agreed to increase health spending in each year of this parliament. The commitment re ects the increasing demand on services. It does not negate the necessity to make the tough choices that are required in order to meet the scale of the demand and to drive up quality improvements.

The Health Secretary showed how the NHS can build on work done, remove obstacles, focus on outcomes and quality, and align the incentives and standards to support quality. He described a coherent, sustainable framework for the next ve years and beyond, centred on the following ve priorities:1. Making patients the starting point of everything we do, not just as

bene ciaries of care but as participants in its design.2. Focussing on outcomes. Not process targets, not measuring inputs,

but a consistent, rigorous focus on results for patients and health outcomes of the highest standards.

3. Empowering professionals by setting them free to use their skills, judgement and creativity to drive up quality care.

4. Improving the health and well-being of our families and communities by prioritising public health and preventing ill-health more effectively.

5. Reforming social care by empowering care users and delivering further integration in how services are commissioned and provided.

Health Secretary Andrew Lansley said: I know the changes I propose are far reaching. And as decision-making shifts and as we work together to deliver change, I know there will be some uncertainty. But I can and will create a bridge between the past and the future and help map out the journey we need to take: I will be clear what the strategy is and the shape of new priorities and systems; I will build on the good work already being done; I will devolve real freedom and responsibility to competent managers, and I will engage all NHS staff doctors, nurses, and managers in working out how to implement a strategy with one shared vision in mind to improve NHS care for patients and the public it serves.

High NHS hospital bed occupancy remains a big infection risk, says RCS

Hospital patients remain at signi cant risk of picking up dangerous infections because more information is required about bed occupancy rates on a ward-by-ward basis says the RCS. The annual publication of the Department of Health’s bed occupancy statistics this week shows that bed occupancy rates remain high with general and acute beds occupied almost 87 per cent of the time. Such high occupancy rates do not allow thorough cleaning and changing between patients. This results in a greater risk of infection. The RCS agrees with the National Audit Of ce report on hospital acquired infections that maximum bed occupancy should not exceed 82 per cent.John Black, President of the Royal College of Surgeons, said: “The government has made a great start by publishing weekly infection rates for individual wards. The public can now get a clear idea of which wards are overcrowded. Bed occupancy rates above 82% are a clear predictor of an increased risk of infection after an operation and patients should be given this information. The RCS remains committed to seeing bed occupancy rates fall, as this will signi cantly improve patient safety.”


Now there’s more time to do what you do best: deliver outstanding nursing care.That’s because you’ll be working with elective cases only. So forget the constantdistractions of on-call demands. Instead, be part of a forward-thinking team atone of our state-of-the-art Independent Treatment Centres.

It’s an exciting opportunity to join a business that’s transforming healthcare,reducing waiting times and creating an exceptional experience for every patient.It’s also a chance to take your career forward with one of the UK’s leadingindependent providers.

To find out more, visit: www.careuk.com/theatrenursesThese positions are within NHS Treatment Centres, run by Care UK on behalf of the NHS.

Full and part-time opportunities

Attractive benefits + sign on incentives available

Anaesthetic Nurses/Operating Department Practitioners£26k - £30kMaidstone, Southampton, Ilford, Portsmouth,Haywards Heath and Gillingham

Scrub Nurses£26k - £30kIlford, Southampton, Haywards Heath

Recovery Nurses£26k - £30kMaidstone, Ilford

At Care UK, we actively promote diversity and equal opportunities for all.

Time to do whatyou do best

Since its foundation in January 2008, Hospital Innovations Limited has grown rapidly despite the current dif culties surrounding the UK market. As the name might suggest, much of this growth has come about because of the inherent desire to provide high quality products with a creative business approach.

Working closely with customers to provide solutions rather than merely products has been the cornerstone of this success. The formation of an experienced sales team with the ability to implement this exibility is another important factor. The team was recently augmented with the arrival of Simon Bone as Corporate Sales Development Director from Smith and Nephew Orthopaedics in January 2010. Simon has been in the business for 20 years working with J & J / De Puy and Plus Orthopedics in addition to his role as Commercial Director at Smith and Nephew.

“Having worked for both large and small companies in the past,

It seems clear to me that there is a de nite place in the market for a responsive, fast-moving company that is able to quickly and easily adjust its tactics to suit the requirements. Working purely as a Distributor, I believe Hospital Innovations is in a strong position to add to its core ranges of Orthobiological and Spinal products and to take advantage of this situation.”

The current product range is now well established with exciting, new developments in the pipeline. In the area of orthobiologics, Hospital Innovations already has one of the most complete offerings in the UK, with more additions imminent. Many of these are class leading products with signi cant clinical advantages for the customer. Allied to novel ways of taking costs out of the system for the hospital, this provides a powerful package for the customer that typi es the approach of the company.

Hospital Innovations Limited is committed to delivering new concepts in business practices and patient care with dedication, drive and enthusiasm. The aim is to provide truly world class products with a service and support to match. More information on Hospital Innovations can be found by visiting

www.hospitalinnovations.comTel: 0845 8803 545 Please quote ‘OTJ’

Assistant Practitioners supported with further education

Canterbury Christ Church University, together with East Kent Hospitals NHS Trust and the South East Coast Strategic Health Authority, have showcased how Foundation Degrees can help support the new role of Assistant Practitioners (AP) working in Kent.

The AP role is currently an unregulated position in the health and social care workforce, with APs working in operating theatres, outpatients, audiology and other key areas. The role is designed to support registered nurses and other health and medical colleagues to improve ef ciency and effectiveness of services.

Executive leaders in health and social care from across Kent, Surrey and Sussex attended the conference, held at the University on Friday, 21 May 2010, where the role of the AP was discussed.

Carrie Jackson, Head of Department for Nursing and Applied Clinical Studies, and Claire Thurgate, Director for the Foundation Degree Framework explained how the Foundation Degree Framework can support APs in their jobs and have a positive impact on the quality of services provided.

Carrie said: “Currently there is a wide variation in the pay and conditions of APs, the type of work and roles that they undertake, and importantly, their educational preparation for such roles.

“Therefore, it is important to create a national benchmark for standards and de ne the role of the AP. As well as ensuring adequate educational preparation through a Foundation Degree as a baseline quali cation.”

As a result of the conference a Regional Task Group has been organised to work with the Strategic Health Authority to develop general standards and a role description for APs. The group will also have links to the national working party set up by the Department of Health to develop the role.

Reports and presentations from the workshop are available on the Nursing and Applied Clinical Studies Department’s webpages. For more information view the link below: http://www.canterbury.ac.uk/health/nursing-applied-clinical-studies/department-events/Assistant-Practitioner-Workshop.aspx


AOSPINE Course for Operating Room Personnel

11 & 12 November, 2010, The Holiday Inn, Taunton

We would like to invite ORP’s with an interest in Spine surgery to join us on the AOSpine Injured and Degenerative course for Operating Room Personnel.

The objectives of this course are to discuss the AOSpine principles and techniques around the management of spinal degenerative disease and trauma patients, Identify anatomical landmarks of the spine, Understand instrumentation through workshop exercises, planning appropriately and anticipating pitfalls, Build a network of colleagues to share ideas, challenge practices and offer support to colleagues involved in spinal surgery.

The interactive programme is designed to meet the needs of ORP facing ever improving techniques in the operative management of the injured and painful spine.

The course fee is £395.00, which includes your lunches and a course dinner on the 11 November. Members of AOSpine receive a 10% discount.

If you wish to register for this course, please either apply online at www.aospine.org

If you require any additional information, please contact the AOUK Education of ce:

Tel: 01707 823345 Email: [email protected]

News, RSS Feed, Blogg, Twitter, Study Days, Links and more at:

Infection Prevention 2010

Bournemouth International Centre

20-22 September 2010

Infection Prevention 2010 Conference and Exhibition is being held at the Bournemouth International Centre from 20th-22nd September 2010.

Organised by the Infection Prevention Society this event is the major infection prevention conference and exhibition of the year.

The conference has been awarded 16 CPD points and it attracts over 700 delegates and almost 150 exhibitors and will have a glittering array of speakers covering all your infection prevention needs.

For further information contact 01506 811077 ips@ twise.co.uk

Website: http://www.ips.uk.net

To Book: http://www.infectionpreventionconference.org.uk/booking.php

Please quote: ‘OTJ’ when responding

Beating DiabetesGroundbreaking research may lead to treatments that encourage diabetics to produce their own life-saving insulin.

A study team including scientists in Brighton believe the breakthrough could have a major impact on a disease which affects 285 million people worldwide and costs Britains NHS alone over £9 billion.

It was discovered in samples taken from people who died from the disease and the researchers believe it could lead to treatments aimed at preventing the development or progression of diabetes in newly-diagnosed patients.

Professor Adrian Bone, from the University of Brighton, said the samples showed that, contrary to popular belief, the body ghts back when diabetes strikes by replicating insulin-making islet cells in the patients own pancreas.

The Professor of Cell and Molecular Biology said this potentially could lead to a therapy that would allow sufferers to produce their own insulin to treat Type 1 diabetes, the most severe and potentially fatal variety of the disease.

Professor Bone and colleagues, Professor Noel Morganat the Peninsula Medical School (Universities of Plymouth and Exeter) and Dr Alan Foulis at Glasgow Royal In rmary, said the breakthrough challenged the belief that the islets simply lose their functions and die.

INNOVATION IN HEALTH AND SOCIAL CAREThe Royal Society for Public Health (http://www.rsph.org.uk), with support from the Centre for Public Innovation, has launched a new range of one day courses on Innovation in Health and Social Care.

As the UK faces shrinking budgets, public sector innovation is now more than ever essential to securing the best possible results from investment. Innovation and a focus on client outcomes are at the heart of recent agendas, including High Quality Care for All, World Class Commissioning and Every Child Matters. Public sector commissioners and service providers have been increasingly aware of the need to innovate, to deliver new services in creative and dynamic ways, to look at old problems from a different perspective, but must now acquire the skills to innovate.

In response to this rapidly changing environment, this series of new innovation courses has been developed to equip public sector practitioners and managers with the tools to deal with the rapidly changing economic environment.

Professor Richard Parish, Chief Executive of RSPH comments Whether you would like to gain an understanding of the key concepts of innovation, to develop the skills and techniques to make innovation a reality in your organisation, or you are working to get your community involved in innovative projects, you will nd these courses invaluable.

Bernadette Bruton, Business Manager at CPI, says The economic landscape that public sector commissioners and providers face can seem daunting. However, it is not all doom and gloom. Times like this can bring out the best in people. With the right tools and approaches, commissioners and providers can take the opportunity to be much more creative and collaborative.

A series of six courses, focusing on different aspects of innovation and outcomes, are scheduled for 14th- 30th July 2010.

To nd out more about this new range of courses, and other programmes offered by RSPH, visit: www.rsph.org.uk or speak to Nicolette Smith on 020 3177 1625.

Professor Bone said: Our observations suggest the cells dont just passively succumb but rather try to mount a defence in order to delay the onset of the symptoms of diabetes. This response takes the form of a marked increase in the rate of islet cell replication following the attack on the pancreas by Type 1 diabetes patients own immune system.

The samples from patients who died, retrieved with patients and their families consents, were collected by Dr Alan Foulis in Glasgow.

Professor Bone said the teams work on the specimens was continuing. He said: We are now trying to understand what signals trigger the Type 1 diabetes patients pancreas to try and regenerate as the disease develops.

This increased understanding could lead to the exciting possibility of helping newly-diagnosed patients to replace their own islet cells and delay the need for insulin treatment.

Professor Bone said: In the UK alone there are almost three million people whose lives are affected by diabetes, costing 10 per cent of the entire NHS budget.

The development of a therapy is still some way in the future but we do believe that we have opened up an exciting new avenue for research into the possible prevention and treatment of diabetes.

The research is funded by the Juvenile Diabetes Research Foundation.

Quality, innovation and choice

Less means more to the power of four

Introducing QuadraLite. Anatomically-shaped with a flexible seal in four sizes to fit all patients.

You can find out more atwww.intersurgical.com/quadralite

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