Member of the Audit Bureau of Circulations www.practical-patient-care.com Media Information

In association with:

WUWHS Logo Why is Practical Patient Care essential reading?

Today’s healthcare providers are faced with the hugely challenging task of optimising medical treatment for patients, while minimising operational costs. The level of care provided plays a crucial role in health outcomes, from initial diagnosis to discharge.

Technology, as in other industries, is rapidly evolving and is improving the quality of healthcare. It is not only making processes more effi cient and effective for professionals and patients, but also reducing costs.

Practical Patient Care is published with medical practitioners and senior managers in mind. It provides the news and information that they need to enhance healthcare delivery, improve patient outcomes, while adhering to a strict budget.

Expert Opinion from Industry Partners Practical Patient Care is proud to be affi liated with a number of industry leading bodies and associations. With the shared objective of educating the healthcare market we have featured key opinion pieces from the following associations:  European Wound Management Association  British In Vitro Diagnostics Association  World Union of Wound Healing Societies  European Society of Clinical Microbiology and Infectious Diseases  Association of Molecular Pathology  National Institute for Health and Care Excellence  World Health Organisation www.practical-patient-care.com Editorial Contributors Past and present contributors include... Practical Patient Care offers some of the most comprehensive editorial coverage for the healthcare sector:’  Diagnostics: Professor Clare Turnbull, Royal Marsden Hospital  Whole exome sequencing for heart disease  Spider inspired sticky tape to heal wounds Nassos Typas, European Molecular Biology Laboratory  New candidate cancer genes identified  Sparing painting fibre bandages Bekim Sadikovic, London Health Sciences Centre using mathematical models onto wounds Doris-Ann Williams, BIVDA  Blood test for melanoma  Healing gloves for wound care  Infection Control:  Skin test for neurological decisions  New defensive mechanism against Lona Mody, University of Michigan bacterial wound infections  Optimising infection prevention Martine Caris, OLVG Hospital Amsterdam  Non-invasive ventilation Nancy Chobin, Sterile Processing University  Tailored ‘cell sheets’ to improve post- Keith Kaye, Society for Healthcare Epidemiology operative wound closing and healing  Simulations before surgery of America  Better hand hygiene to prevent infections  Non-invasive imaging for thyroid disorders  Wound Care: Sue Bale, European Wound Management

Operating room technology Operating room technology Wound care Wound care Association

Researchers from Charité – Universitätsmedizin Comic-style presentation is able to recognise common wound types a well as of information could Berlin, one of the largest university hospitals in help patients to atypical characteristics in order to identify the best Nutritionist Europe, were inspired by the idea that a picture better understand course of treatment. Problems with the assessment is worth a thousand words and wanted to test the procedures they can result in failing to recognise the early signs of are undergoing. Physical Podiatry Dr Xudong Wang, University of Wisconsin-Madison whether comic-style information might be more infection or wound deterioration, which can result Therapy easily digested by patients. The team focused in more expensive treatment, the use of antibiotics on cardiac catheterisation, the most common or hospital readmissions. procedure in the field of cardiology. A systematic approach needs to be taken Comic The provision of medical information within to determine wound aetiology and underlying Vascular Endocrinology a comic format is seemingly an unusual choice causes, and thus obtain an accurate diagnosis. but was a carefully considered decision by This often entails multiple steps, including a researchers. A key factor was the realisation biopsy, which provides a histopathologic diagnosis Professor Adrian Gombart, Oregon State of the ineffectiveness of the current method of and identifies a skin disorder that is not responding informing patients about cardiac catheterisation. to current treatment. “We realised that patients were not as well Research published in Wounds recommends PMR Dermatology relief prepared as we would wish them to be, even a biopsy for diagnosing inflammatory, though the physician was communicating all microthrombotic and bullous disorders such as University’s College of Science aspects of the investigation and they were non-atherosclerotic ischemic ulcers, inflammatory receiving a standard written consent form,” anxiety as well as informing them about conditions, malignancies, infections, autoimmune Wound Nurse Psychiatry says Anna Brand, lead investigator and cardiologist the treatment. bullous disorders, venous ulcers, neuropathic at Charité – Universitätsmedizin Berlin. “They In order to put the comic-style booklet to the ulcers, medication-induced wounds, pressure Ortho/Plastic still had several questions at the beginning of test, the team recruited 121 individuals scheduled ulcers and traumatic wounds. Surgery the procedure.” to undergo cardiac catheterisation. Patients A challenging If a punch biopsy performed in an outpatient received either the standard informed consent setting cannot confirm a suspected diagnosis Professor Sean Murphy, Wake Forest Baptist Better by design procedure or the standard informed consent with in a wound that has failed other treatment an unknown cause. It causes large painful ulcers Atypical wounds, as with Researchers looked for alternative approaches additional comic-style information. Using a range measures, a surgical biopsy that can sample a to form, mainly on the legs, but they can also other types of wounds, also require treatment to presenting the information. They stumbled of questionnaires administered before and after the larger area of tissue may be needed. In cases occur anywhere on the body as a secondary by clinicians from a upon graphic medicine – a growing field in the provision of the information, researchers assessed where the biopsy does not help diagnose the complication of any skin cut or trauma. An range of disciplines. US and France, in particular – which uses comics levels of comprehension and anxiety in addition to landscape wound aetiology, the clinician should review example is Bullous pemphigoid, a rare autoimmune the satisfaction with the consent process. the patient’s medical history again. Medical Centre to communicate information to patients and their inflammatory condition of unknown cause. This Before undergoing surgery, families, as well as educating students. The comic-style booklet was found to be Atypical wounds include a broad spectrum of conditions of these wounds are underdiagnosed. Typical Some newer oncology drugs can also trigger is where the immune system creates antibodies patients must be fully “We thought that comics might help in the significantly superior to the standard information. challenges include considerable diagnostic skin reactions. Tracking the timing of chemotherapy against its own tissue. caused by inflammation, infection, malignancy, chronic informed about what the informed-consent procedure because text is too delays and prolonged healing times – for example, is therefore essential, as it can be the cycle of illnesses or genetic disorders. An atypical wound may be procedure entails, yet the complex for patients who lack knowledge of their inflammatory and vasculopathy wounds (such the medication, not just the medication itself, disease and its treatment,” says Brand. “Patients who read the comic before the suspected if the wound has an abnormal presentation or as pyoderma gangrenosum, an inflammatory causing the wound. “Many atypical wounds have an enormous complex nature of the content Together with Alexandra Hamann, a science procedure could answer 12 of 13 questions location and does not heal following a good treatment plan. neutrophilic disorder, and cutaneous vasculitis). impact on the quality of life in the affected provided means they often feel communication specialist, Brand and Professor correctly on the multiple-choice test that was The European Wound Management Association (EWMA) In addition, many atypical wounds have an Atypical wound treatment individuals, and a multidisciplinary team overwhelmed. New research Verena Stangl from the medical department, enormous impact on the quality of life in the Normal wound care therapies tend not to be assessing comprehension.” discusses its work to increase awareness about the clinical approach is necessary to ensure patients receive shows that comic-style division of cardiology and angiology on Campus affected individuals, and a multidisciplinary team effective and when treating atypical wounds it picture, diagnosis and treatment of these wounds. high-quality treatment in a timely fashion.” information can be helpful. Charité Mitte, developed a storyboard based on the approach is necessary to ensure patients receive is also essential to control the underlying disease standard consent form for cardiac catheterisation. “Patients who read the comic before the high-quality treatment in a timely fashion. process. This includes evaluating and managing  Operating Room Technology: Emma Green speaks to The team went to great lengths to optimise the procedure could answer 12 of 13 questions n author group, chaired by document wound tunnels. During treatment, it is important These are formed against the junction between Anna Brand, lead investigator likelihood of it being effective for patients. correctly on the multiple-choice test that was editor Dr Kirsi Isoherranen, is currently Risk factors and diagnosis to understand proteases and inflammatory the upper and lower skin layers, leading to large and cardiologist at Charité – “We didn’t only want to have the comic but assessing comprehension,” explains Brand. “We A working on a new EWMA document that The risk for atypical wounds is usually higher in processes. Proteases are enzymes that break clear fluid-filled blisters formation that are difficult Universitätsmedizin Berlin, about we really wanted to test its effects,” says Brand. were even more surprised by the limited value of will be published and launched at the EWMA 2019 elderly people with weaker immune systems and is down proteins into peptides and amino acids. to rupture. If this does occur, the blisters can become Wound care “Is it useful? Do patients understand more? Does the standard information because patients who read Wound careconference in Gothenburg, Sweden. The document associated with Diagnosticspre-existing chronic medical illness, In wound healing, the major proteases are painful and sensitive. These are most frequent on the Diagnostics the implications of these findings. the comic help them to feel less anxious?” a text which contained all the information for the focuses on atypical wounds – those wounds that infections, inflammations or tumours. Taking a the matrix metalloproteinases (MMPs) and abdomen, groin, inner thighs and arms. Anna Brand, Charite-Universistatsmedizin Berlin As cardiac catheterisation is so routine within test only answered 9 of those 13 questions.” create the most challenging situations for clinicians number of prescribed medications and leading an the serine proteases, such as elastase. The two key vasculopathy wounds are he aim of an informed consent procedure is to cardiology, Brand was acutely aware of how There were also positive emotional effectsby ofresearchers the from the Wake Forest Institute for and/or patients from prevention, treatment and unhealthy lifestyle can also increase the risk for cryoglobulinemia and vasculitis. Cryoglobulinemia the key advantages of NGS is that researchers do not ensure that patients can make an autonomous patients felt about it. comic-style information for participants. Regenerative Medicine, the bioprinting system is organisational perspectives. The author group developing these wounds. Types of atypical wounds is a systemic inflammation primarily affecting the % have to know the question they are asking before decision. This involves the provision of details “A lot of patients are very worried about “Patients in the comic-style information group includes prominent and well-respected clinicians Managing any type of wound successfully There are six main types of atypical wounds – kidneys, joints and skin and is caused by deposits 10 T unique, offering onsite management of extensive carrying out the sequencing. “Until next-generation about the procedure, including the associated risks the procedure and they expect a larger operation also reported feeling less anxious after theirwounds by scanning and measuring a wound to who have all volunteered to use their expertise demands an accurate patient assessment using inflammatory, vasculopathy, infection, malignancy, of immune complexes containing cryoglobulin. The amount of all sequencing, if we wanted to look at a gene, we could and benefits. Due to the complex nature of certain than just an invasive coronary angiography,” informed consent procedure,” says Brand. deposit cells exactly where they are needed to create to describe the aetiologies and treatment strategies a multidisciplinary approach that moves beyond hereditary and genetic, and wounds of external The condition leads to itchy, small red skin lesions wounds that can only look at one chunk at a time,” says Turnbull. “This treatments, as well as the anxiety associated with she explains. “Patients even expressed more anxiety followingnew skin. of different types of atypical wounds. standard care. Comorbidities, medical history cause. In terms of inflammatory wounds, pyoderma and ulcers, particularly on the legs, and causes be classified as meant you had to know which gene or part of the Rolando Del Maestro, McGill University them, patients often struggle to fully understand Researchers hoped that the comic-style the standard informed consent, which was Skin has an important role in immunity; it protects The prevalence of atypical wounds can be as high and social support networks should all be evaluated gangernosum is a condition characterised by joint pain in fingers, hands, knees and ankles, atypical wounds. genome you were interested in before being able to European Wound studiostoks/Shutterstock.com; rogistok/Shutterstock.com Charité – Universitätsmedizin Berlin the steps involved. Charité – Universitätsmedizin Berlin information might be a useful way of reducing something that was really surprising to us.”the body against pathogens and excessive water loss, as 10% of all wounds, and it is probable that many during this process. It is essential that the clinician skin cell death and destruction resulting from bloody urine, general weakness, and decreased Management Association amplify and sequence it.” in addition to insulating and regulating temperature. The capabilities of NGS not only allow the use of

84 Practical Patient Care / www.practical-patient-care.com Practical Patient Care / www.practical-patient-care.com Early treatment and rapid closure of acute85 and 80 Practical Patient Care / www.practical-patient-care.com Practical Patient Care / www.practical-patient-care.com 81 different sequencing techniques but also to carry these chronic wounds is essential for normal healing and out at a much larger scale than was previously possible. the prevention of hypertrophic scarring – scars that “The technology shift completely changed what we have deposits of excessive amounts of collagen, and were able to do,” explains Turnbull. “It allows you Dr Philip Chen, University of Texas Health so appear raised. to sequence an entire genome in one experiment. If there are a few genes you are interested in, you could Skin on skin sequence them all in a way that wasn’t possible before.” The skin is made up of several layers and shields the Within genomics, the speed of technological underlying muscles, bones, ligaments and internal wounds and burns,” says Murphy. “Currently, skin Above: Using a advancement and reduction in costs has massively patient’s own skin to Science Centre organs. The major skin cells are dermal fibroblasts, grafts are used and there is sometimes a limited repair injuries and burns outpaced predictions. “Before the human genome which synthesise the extracellular matrix and availability of healthy skin to harvest, while skin could be a game changer project, it was shotgun sequencing, so they were in wound care. collagen, and have a vital role in wound healing; and grafts from donors risks immune rejection. having to sequence each chunk separately. Each Opposite page: A mobile epidermal keratinocytes, which are the predominant “Our system uses a patient’s own cells, taken skin bioprinter in action. would be sent to a different lab for sequencing, and cells in the outer layer of the skin, the epidermis. from a small biopsy the size of a postage stamp, it took 10 years to get the first draft assembly and Dermal fibroblasts and epidermal keratinocytes and expands those cells that actively contribute cost $2.7 billion dollars,” explains Turnbull. “Now, can easily be isolated from a small biopsy of uninjured to the wound healing and formation of new skin.” in a very high-throughput laboratory, they can do tissue and expanded. The cells are then mixed into a test for a tiny fraction of the price.” hydrogel and placed in a bioprinter. “The mobile bioprinter has the potential “We take a handheld device used to scan the to eliminate painful skin grafts and the Up the ante wound, which feeds data into the software,” says NGS, although well established as a technology, has  Sean Murphy, assistant professor of regenerative disfi gurement from scarring that patients only recently been implemented into the NHS due Patient Care: medicine, Wake Forest Institute for Regenerative currently endure.” to a lack of infrastructure, tools, skills and funding. Medicine. “We are using this data to tell the print In late 2012, then UK Prime Minister David Cameron heads which cells to deliver exactly where in the “What is unique about the technology is the announced the provision of financial support for wound layer by layer. This process replicates and mobility of the system,” explains Murphy, who is also several important projects, as part of the Olympic accelerates the formation of normal skin structure assistant professor of biomedical engineering. It is Legacy Funding. Dr Neelkanth Bardan, Massachusetts and function.” designed to be wheeled right up to the bedside, which One of these was the 100,000 Genomes Project. Integrated imaging technology determines the allows on-site management of wounds. The mobile Map the future Following consultation, it was decided that rare disease Skin in the game topography of the wound and aids the precise in aspect allows for delivery of cells directly into and cancer research would stand to gain the most from situ delivery of dermal fibroblasts and epidermal wounds, with an organisation that replicates healthy Hot on the heels of the success of the NHS’s 100,000 Genomes Project, which fi nished at the end the technology and thus became the focus. In order to Affecting millions in the US, chronic, large or non-healing wounds, such as diabetic pressure keratinocytes directly to the injured area, skin. This significantly accelerates wound healing of 2018, the NHS Genomic Medicine Service is due to be launched later this year. It aims to bring deliver the project, a new sequencing site, the Genome replicating the layered skin structure and function. and formation of new skin, compared with printing Campus in Hinxton, near Cambridge, was built and Institute of Technology ulcers, are especially costly as they often require multiple treatments. Scientists have created The bioprinter is an inkjet printer that delivers externally and manually placing printed tissue onto equitable access to genetic and genomic testing to patients in the UK to improve the diagnosis and funded by the Wellcome Trust. a new mobile skin-bioprinting system, which allows bilayered skin to be printed directly onto a controlled volumes of cells to predefined locations the patient. treatment of cancer and rare diseases. Professor Clare Turnbull, researcher and consultant at the Royal An upgrade of software was also needed to deal wound. Sean Murphy, assistant professor at Wake Forest Baptist Medical Centre, speaks to using thermal or acoustic forces to eject matter “The mobile bioprinter has the potential to eliminate Marsden Hospital, speaks to Emma Green about how this technology can enhance diagnostic strategies. with the huge amount of information generated by the Kerry Taylor-Smith about the implications for wound care. from the cartridge to the skin. painful skin grafts and the disfigurement from scarring research. A major element was building the informatics The technology is tailored to the individual patient’s that patients currently endure,” he says. “Patients ver the past decade, we have witnessed structure, function, evolution, and mapping of infrastructure to process, analyse and interpret the bioprinter that uses a patient’s own skin to Another option is to use donor skin, but this runs needs, with their own cells dynamically contributing who received delayed treatments or under-performing dramatic technological evolution, transforming a genomes. Professor Clare Turnbull, a senior researcher sequencing data and to distribute the results out to repair injuries and burns could be a game the risk of scar formation and the patient rejecting to wound healing by organising up front to start treatments often experience extensive scarring that O number of industries. In October 2018, the UK at The Institute of Cancer Research, fuses genetic NHS centres. This also enabled UK researchers and Kristina Sheridan, MITRE Corporation A changer in wound care, accelerating the the donation. Cellular and non-cellular biological the healing process much faster. Using this method can result in long-term physiological defects, such as health and social care secretary released a policy paper sequencing technologies to identify and characterise partners from the industry to access the genome data delivery of treatment, and reducing costs for the skin equivalents are commonly used as alternatives, of wound repair could eradicate the need for disfigurements and loss of range of motion.” 7million outlining his tech-vision for the UK NHS to modernise genetic predispositions to a number of different in a secure research environment, where it was held There are numerous potential applications of this patient and healthcare providers. The gold standard but these usually involve multiple surgical uncomfortable skin grafts, which can also cause Patients affected by both its practices and services delivered. As part of this cancers. Her team investigate ways to optimise next- in a de-identified format. of wound repair is currently the skin graft, but procedures at a high cost. defects, especially for those suffering from burns or technology. Chronic wounds, such as diabetic and chronic wounds, strategy, there has been pressure for the NHS workforce generation sequencing (NGS) and analyse the resulting Clinical staff received special training to ensure that the treatment is not without problems; it can be A mobile skin-printing system that allows bilayered large wounds caused by diabetic or pressure ulcers, pressure ulcers, and burn wounds affect more than such as diabetic and to expand their skills and knowledge to be able to take data to identify novel cancer predisposition genes. this data could be accurately and ethically interpreted. difficult to achieve adequate coverage of the wound, skin to be printed directly onto a wound has the for example. seven million patients in the US alone with an annual pressure ulcers, or burn advantage of these advances. Turnbull has been heavily involved in the NHS’s “There was a lot of work to create a knowledge base to particularly if damage is extensive and there is potential to revolutionise how chronic, large or non- “Our skin-printing system has the potential to expenditure of $25 billion. Full-thickness skin injuries wounds in the US. One of the areas most affected is genomics, the 100,000 Genomes Project, which aimed to capitalise ensure that we could make the best clinical inferences Ajay Kohli, Drexel College of Medicine Philadelphia

a limited availability of healthy skin to harvest. healing wounds are treated and managed. Developed Baptist Medical Centre Forest Wake Baptist Medical Centre Forest Wake alleviate a lot of problems related to the treatment of are a major source of mortality and morbidity with an Journal of Functional Biomaterials branch of molecular biology concerned with the on these recent improvements in technology. One of from the genomic data,” explains Turnbull.

60 Practical Patient Care / www.practical-patient-care.com Practical Patient Care / www.practical-patient-care.com 61 26 Practical Patient Care / www.practical-patient-care.com Practical Patient Care / www.practical-patient-care.com 27 Dr Dominic King, DeepMind www.practical-patient-care.com Geographical breakdown

Rest of World 14% North America 37% Circulation & Distribution Eastern Europe 13%

We continue to make a massive investment into the ABC-accredited Nordics and circulation of Practical Patient Care and have created the most Scandinavia 14% exciting and engaged database available. Western Europe 22% Copies will be sent by name to key decision-makers in the healthcare Job function industry, which will generate a projected readership of approximately 65,000 Clinical Executives Hospital Managers (publisher’s survey), accounting for the majority of purchasing activity in the and Heads of and Directors 26% healthcare industry. The journal is audited by the ABC yearly. Department 74%

PPC is read across every department within the patient care sector’’ Type of organisation  Hospital Managers  Primary Care Physicians Regional Purchasing Organisations 5%

 Hospital Directors  Wound Care specialists Private Clinics 10%

 Procurement Managers  Tissue Viability Nurses Long Term Care Facilities 10%  Microbiologists  Heads of OR

 Lab Managers  Chief Surgeons Hospitals 75%  Lab Technicians  Diabetologists  Heads of Nursing  Heads of Infection Control Level of purchasing involvement  Heads of ICU/CC  Clean room managers Low 14% Extremely High 19%  Ward Doctors  Heads of CSSD

Moderate 19%

High 50% www.practical-patient-care.com Digital Edition Online advertising digital edition 20,000 copies of Practical Patient Care will be sent by email to the Advert sizes senior decision makers within the healthcare industry globally that  Banner (468×60 pixels) our circulation team have confirmed have responsibility for buying,  Mini Tower (120×300 pixels) specifying and recommending new products and technologies.  Spotlight (120×60 pixels) High Impact Production details The fact your ad will be placed in front of a specialist audience with  All ads must be supplied in either JPG, GIF, a confirmed interest in using products and services such as yours animated GIF, HTML or SWF file formats will stimulate an even higher level of response. However, the value of your insertion is increased further when you consider the viral marketing opportunities attached to the new digital edition. We estimate the digital circulation will treble to 60,000 as a result of the original recipient forwarding Practical Patient Care to their peers and teams.

The digital edition also provides live hyper-links to a chosen landing- page or email address to encourage instant access or ordering. In addition, your advertisement or editorial can be enhanced with sound, animation or video to create a greater impact and response.

Search-engine friendly Our proven SEO techniques ensure each digital edition of Practical Patient Care is indexed by all of the leading search engines, providing yet another way to draw readers to your ad. Readers looking for specific information will be able to arrive at your page within the digital magazine as easily as they would arrive at your website. www.practical-patient-care.com E-BLASTS: Created by Online you and distributed by us, e-blasts are www.practical-patient-care.com, in conjunction with its partner publication, targeted emails sent enables easy and thorough communication between buyers and sellers to our readers on your through multiple, fully optimised channels. behalf – a great way to reach our Our online service brings together a global community of industry professionals audience. The emails are perfect and a wealth of market knowledge based around extensive experience. for exhibition marketing, product launches, new website designs and tactical offers or sales promotions. Content WHITE PAPERS: The stimulating content and focused services for your business includes: Host your white paper on the PPC website with  Industry projects  Key websites data capture options to Details of past, present and A repository of knowledge deliver a successful lead future projects, including an containing major resources generation programme. indispensable source of direct on the web. links to tier suppliers.  Events VIDEO: Promote your  Products and services The latest conference and company via video. Categorisation of leading meetings of particular relevance Created by you, it can suppliers, providing buyers with to the market. be uploaded to our crucial information for critical dedicated Video page,  White papers purchasing decisions. the digital publication and your A repository containing the latest own dedicated profile on  Feature articles analysis, insights and technology the PPC website. Strategic articles and compelling solutions updates. comment written by leading industry figures and covering the cutting edge of technological and strategic development. www.practical-patient-care.com Web A prime location to get your message to the right people… And most importantly for our key clients:  Measurable results from qualified sources. Our expertise, contacts and community ensure that your message reaches the right people in the diagnostics Our key clients promote their targeted message community, and with maximum impact. through specifically designed profiles.

Each profile consists of: www.practical-patient-care.com delivers:  600 words of optimised, product or service-specific content  Great brand awareness in line with your  Five expandable images with captions corporate strategy  Contact information  Potential customers to your corporate homepage  Corporate URL  Qualified business enquiries from your target markets  Increased visibility for your latest products or services Optional profile additions include:  The opportunity for you  Up to 12 press releases linked to your profile and included to increase your market in the hmi-online.com monthly newsletter share and penetration.  Downloadable white papers linked to your profile and housed in the white paper archive  Exclusive lead banners, strategically positioned, at the head of an appropriate page within hmi-online.com to divert traffic back to clients’ corporate homepage  Advanced, industry-leading marketing statistics by WebTrends, providing exhaustive, real-time data on user sessions to confirm our clients’ return on marketing spend.

For further information on joining the Practical Patient Care community, please contact your Publication Manager, Shamraiz Ayub on +44 (0)115 704 3715 or email [email protected] www.practical-patient-care.comHuntingdon House, 290 Huntingdon Street, Nottingham, NG1 3LY, UK