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EUROPEAN HOSPITAL THEEUROPEAN FORUM FOR THOSE IN THE BUSINESS OF MAKING HEALTHCARE WORK 13-15 6-7 Cardiology Radiology Matrix-array CENTRA 18 transducer checks enhances Orthopaedics valves. Plus: stents, CE-MRA. strokes, surgery Patients use EU law Plus:1,000-fold for cross-border help. magnification Plus:implants, treatments

VOL 12 ISSUE 5/03 OCTOBER/NOVEMBER 2003 Polymer-based Homicidal nurses pulsed drug Costly hospital delivery Prescription drugs dominate many injuries people’s lives, but the advent of controlled-release delivery systems is set USA - Analysis of over seven share common traits he first systematic analysis of identified only up to five years early warning signs, which to change all that. Examples already million recent discharge a taboo topic in medical and after the homicides had taken include: in the marketplace include time- records from hospitals in 28 Thealthcare circles - the place. ● crude language release pills that reduce the number states has revealed that a murder of patients - could provide Professor Beine also found that ● isolation within the team of doses required for pain relievers group of 18 medical injuries early warning signs to prevent their crimes were not committed ● a ‘cynical paralysis’ towards and antidepressants, and contracep- occurring during hospitalisa- future patient homicides. due to poor working conditions. the nursing profession tive patches and implants. tion may account for 2.4 mil- Karl H Beine, Professor of Nor was sympathy for the patients ● Additonally, the offenders A new drug delivery system, based lion extra hospital days, $9.3 Psychiatry at the University a trigger for the carer to murder often even predicted the exact on a microchip formed from poly(L- billion in excess charges, and Witten/Herdecke, Germany, time of death of the patients. lactic acid) - a slowly degrading poly- almost 32,600 attributable conducted a study (published: Observation and These factors, he suggests, ester - has been reported in the publi- deaths in the US annually. International Journal of Law and may help to indicate something cation Nature Materials, by Robert Psychiatry 26/2003) based on 16 is going terribly wrong, and he Langer and colleagues at Reporting in the Journal of homicides, which occurred in discussion may recommends increasing Massachusetts Institute of the American Medical recent decades, and has developed prevent patient sensitivity to such signs. Add- Technology, Cambridge, MA, USA. Association (8/10/03), the a detailed psychological offender itionally, he urges the promotion Drug solutions are injected into researchers from the Johns profile. murders of a working environment where reservoirs on the chip surface, and Hopkins Children’s Centre and Contrary to popular belief, Prof open and frank discussions are sealed by biodegradable polymer the Agency for Healthcare Beine found that most offenders possible. ‘Nursing staff in membranes with different degrada- Research and Quality (AHRQ) are male not female nurses, and Karl H Beine hospitals and nursing homes tion rates. By varying the composi- found that among the 18 that they - should be able to speak openly,’ tion and molecular weight of each patient safety events, severe ● tended to be insecure and them. ‘The patients who were he stresses, ‘... even about polymer membrane, Langer et al say infection or sepsis, developing administer non-prescribed killed were not in their terminal aggressive fantasies.’ they are able to tightly control the after elective surgery was the medication. phase,’ the professor pointed out. (Ref: Beine, Karl-H, ‘Homicides of degradation rate (and thus drug ● In their work environment they The act was more to do with their patients in hospitals and nursing release time) over a broad range. most common treatment- had to deal with long, unsolved inability to endure suffering. homes: a comparative analysis of The new polymer-based system is related injury. conflicts. Concerned about prevention, the case series’, International Journal capable of releasing a variety of dif- Frequently, these offenders were professor has identified typical of Law and Psychiatry 26/2003) ferent drugs at well-controlled times. So far, the team has shown that heparin - a common anticoagulant - remains bioactive after incorporation and release from the system over Fighting for EU rights periods up to 140 days. They MPX Technos UK - Over a quarter of a million judge rejected the British govern- researchers add that, given the high people are on waiting lists for ment’s claim that only patients who biocompatibility and superb perfor- orthopaedic surgery in England wait over twelve months are eligi- mance of the polymer-based system, alone, and some are actively seek- ble for reimbursement for surgery clinical demonstration should not be ing surgery overseas, and pressing overseas, and the NHS has been too far off. for the country’s health service to forced to reconsider the situation. Details: http://dx.doi.org/ The Department of Health fig- 10.1038/nmat999 ures reveal that some 1,120 NHS VISIT US AT OUR BOOTH Patients seek patients were treated elsewhere in 9A22 ON MEDICA 2003 overseas hip and Europe in 2002. However, many FROM 19TH UNTIL 22ND who have been unable to gain con- OF NOVEMBER IN DÜSSELDORF knee surgery sent to become cross-border

Contrast processing under license of SCHERING Patent N. EP 0357164 N. Contrast processing under license of SCHERING Patent pay for those operations - notably a patients have funded themselves to Comfort is getting smarter pensioner who has challenged her seek surgery overseas. For example, z rights, under European law, to have this October, a 68-year-old patient reference class in contrast £3,800 reimbursed after receiving needing a double knee replacement, ultrasound surgery in another country. The travelled to the Krishna Heart patient had been told by the Institute, Ahmedabad, India, where Also see our report on the z crystal clear images thanks National Health Service (NHS) that he will receive the surgery and stay NANOTECHNOLOGY Pure Brilliance Imaging she must wait up to a year for a hip for seven weeks. His action, he controversy, in Laboratory and operation. continued on ORTHOPAEDICS Pharmaceuticals news: page 16 European law states that any EU page 18 z extremely simple and citizen facing ‘undue delays’ in intuitive user interface treatment in their own country can News ...... 1-5 Laboratory & apply to have an operation in another member state. However, in Radiology & Oncology . . . .6-7 Pharmaceuticals ...... 16-17 the UK, do do so they must have Orthopaedics ...... 18 the support of their general practi- IT & Telemedicine ...... 8-10 tioners and consultants under the tents Surgery ...... 11-12 Company News ...... 19-22 NHS’s E112 certificate scheme.

www.esaote.de . phone: 0180/5 37 26 83 Recently, in the High Court, the con Cardiology ...... 13-15 Politics/EU Update ...... 23 NEWS

EUROPEAN HOSPITAL Berlin, Germany - Primary immun- incurable, biological products ● Antibiotic therapy for two HOSPITAL odeficiency (PI) arises from an obtained from human blood plas- months or longer without effect 18 ● 6-7 003 R 2 immune system defect and results ma can be used to replace missing Complications following injec- aw E OrthopaedicsU l M B Reader Survey se E V E RadiologyA s u p. /NO NTR r hel BER CE Patient T O UROPEAN ts O C OPEAN FORUM FOR THOSE IN THE BUSINESS OF MAKINGs-borde HEALTHCARE WORK R hances os en 0 3 13-15 en . for cr eatm E 5/ E RA nts, tr ISSU -M 2 THE EU CE :impla 1 rdiologyy 0-fold Plus V OL olymer-based Ca s:1,00 n P Matrix-arra s Plu io eck magnificat nsducer ch pulsed drug any tra s:stents, inate m . Plu s dom in an increased susceptibility to components of the body’s immune tion of live vaccines, particularly lves surgery n drug advent of iscon- set va kes, delivery ems stro Prescriptio es, but the lready people’s liv ase delivery syst hat. Examples a trolled-rele all t nge ce includehe time- number to cha rketpla e t vers in the ma pills that reduc hich release and contracep- ns, w . arning sig of doses required for pain relie sed rly w nd implants - ea : and antidepressants, uage ivery system, ba includee lang e team tive patches drug a del infections of, for example, the system and thus prevent lasting BCG (Bacille Calmette-Guérin) years ud wards ormed fromding poly(L poly-- ● cr n within this’ to A new degra Homicidal nurses to five taken ralys ly low only up had ● isolatio pa ssion on a microchip - a sf ed in the publi ‘cynical profe ers by Robert identified homicides that ● a rsing end act lactic acid) ls, of r the u e off ateria afte found d the n lly, th d the ex ure M nalysis ine also itte icte ester - has been reportes at atic a place. t comm ● Additona pred e patients. olleagu of YOU may qualify for a FREE subscription to sor Be ven cation Nat stem dical and fes e no ditions. s ften e sts, itute A, USA. ostly hospital st sy Pro s wer g con tient o ath of th ugge ger and c s Inst , M C sharehe fir opic in me commonrime in pa traitse of de he s ething Lan chusett ridge o t ircles - the their c or work for the r tim factors, som e Massa amb injected intoand injuries a tabo e c thy rde ese dicate gy, C ace, - could provide due to po ympa to mu Th to in ong, and h hnolo healthcarients event was s e carer Tec solutions arechip surf er s of over seven pat Nor th may help g Drug polym T of signs to pr er for erribly wr dd- able rada- - Analysi urder ng s. going t s. A grad USA m arni icide a trigg is nds increasin sign reservoirs onbiode the erent deg lungs, airways, ears or paranasal damage, Bayer HealthCare points vaccine against TB and Sabin nd me motion y omposi- illion recent discharge early w tient hom recom to such ere m rom hospitals in 28es pa , Professor of es the pro sealed b ing the c each future ine niversity sensitivity urg ent wh vary ght of y records f - the U , bservation a ally, he vironm are membranes with diff et al sa Karl H Beat ermany O ition ussions anger states has 18revealed medical spitalisathatinjuri a cke, G king en tion rates.molecular By wei ol the of l- Psychiatry rde ublished: and of a wor frank disc f in nd contr group .4 mi (p Law and staf es tion a membrane,ght Lly ing during ho Witten/He a study f 16 discussion may rsing i EUROPEAN HOSPITAL, the bi-monthly journal ,’ ccurr $9.3 ted rnal o d on open ing hom nly polymer able to t thus drug o account forl days, 2 onduc ase ssible. ‘Nu nurs re e (and may pita c ) b po speak ope they a broad range.m is tion s ternational 6/2003Jou prevent patient le to charges, andble In 2 occurred ineloped hospitals eand ab bout degradation rat sed syste on extra ho ta chiatry dev rs ven a mer-ba of dif- li excess Psy which has der rde should b s, ‘... e s of poly iety es. 00 attribuy. s, and mu sse de release time) over a billion in homicides, ade ical offen stre fantasies.’ Homici The new log H Beine he H, ‘ ng S annuall cent dec ycho Karl ressive rl- n that almost n32,6 the U Journal of re f, Prof agg of capable of releasing a varw sinuses. ‘Without treatment, per- out Presently this is achieved with polio vaccine the ere : Beine, Ka ls and nursilysis deaths i a detailed ps ders (Ref n hospita al ent drugsteam at well-controlled has sho timation orting in he le. nts who wrminal ts i rative ana Journ fer on anticoagulant - Rep profi to popularost belieoffen patie eir te patien ompa nal ar, the omm ntrary s, and in th d out. : a c So f /10/03), t Co nurse em. ‘The not pointe mes ternatio 26/2003) rin - a c ctive after incorporstem over the Americann (8 Medical found that male th re their ho es’, In iatry hepa sy ine t fem we ith se seri sych Associatio Be d killed to do w ca d P remains bioase from the s. They e male no se,’ the professorore Law an - serving hospitals throughout the EU. en’s Centrelthcare and ar - ecure an pha as m suffering. of and relea or researchers from the Johns at they be ins ribed ct w ention, the opkins Childr AHRQ) th esc The a o endure t prev al periods up to dd140 that, day given the high H y ( ● tended to non-pr y bility t abou typic and superb perf Agency for Hea ina researchers iability be ● nt the ntified er-based system,not the administern. Concerned n- t among the 18 edicatio environme solved ssor has ide gover biocompat he polym Researchtha and Qualit m r work profe ho onstration should thei ith long, un e British nts w mance of dem t found ● In eal w ere ed th ligi- / manent damage is inevitable as a highly effective biological medi- Failure to thrive in infancy, with is, developing eject clinical ff. patient safetyseps events, severe had to d nders w e r that only patie ry ar o /dx.doi.org nt- flicts. judg ths are erge too f p:/ con t’s claim for su infectione ctorive surgerytreatme was the ntly, these offe million men ent Details: htt at999 er el over twelve mon

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9 9TH SS C nsioner who has cha 1 DÜ pe Institute, Ahmive the surgeryis action and stayS EUROPEAN HOSPITAL every three months ROM R IN ece F MBE rights, under Euro country. The weeks. H OVE he will r HOPAEDIC OF N ,800 reimbursed aftertold receiving by the ratory & . . . . 16-17 worst-case scenario: it can even of immunoglobulins to replace Repeated occurrence of deep £3 for seven Labo als . . . smarter surgery in another e (NHS) that ed on ORT aceutic .18 g continu18 ttin patient had been a year for a hip page Pharm is ge to ...... 1-5 National Health Servic y EU s .. . rthopaedics ...... 19-22 she must wait. up New cology . . . .6-7 O s . . ation gy & On ss in contrast oper pean law ‘unduestates that delays’ an in diolo ...... 8-10 pany New Comforte cla Euro country can Ra Com date ...... 23 renc en facing edicine . . 11-12 U Up refe citiz eration in Telem z d ment in their own ever, in IT & ...... Politics/E un treat . AND you will have a chance to win our so ges thanks ber state. Howust have ultra ar ima g apply to have an theyop m Surgery . . . . cle gin ther mem prove fatal,’ said Professor Volker immune cells (antibodies) that are skin or organ abscesses e.g. in a ano eneral practi- logy ...... 13-15 z crystal nce Im their g io

rillia d the UK, dot doof so contents Card Pure B ple an the suppor and consultants underurt ,the the ly sim tioners me S’s E112 certificate scheme. z extre interface NH Recently, in the High Co intuitive user splendid prize (see below) because your 83 7 26 Wahn, Director of a new Immune missing from the blood, which lymph nodes or 3 180/5 ne: 0 . pho e.de .esaot www name will be entered for the draw. Deficiency Centre, during its open- liver To participate, simply fill in this coupon and fax to: ing this September at the CharitÈ Professor Volker ● Two or more University Hospital, Berlin. Wahn, Director of purulent internal +49 211 73 57 530 the new Immune Prompt diagnosis and early, suit- infections, e.g. No fax? No problem. Please post your coupon to: European Deficiency Centre able treatment is therefore vital in at Charité meningitis, severe Hospital Verlags GmbH, Höherweg 287, D-40231 Düsseldorf NEW preventing secondary damage, but University Hospital soft tissue infec- as there are no clear symptoms tions, inflammation ENTRY COUPON this is not easy. ‘About 50 percent of bone marrow, of all cases are diagnosed inade- arthritis, accumula- FAX TO: EUROPEAN HOSPITAL, +49-211-7357-530 quately, if diagnosed at all,’ said tion of pus in body PLEASE ACCEPT MY REQUEST FOR A FREE SUBSCRIPTION TO EUROPEAN HOSPITAL the professor. Thus the centre will cavities, blood poi- provide lectures and information soning Name to increase awareness of PI among ● Persistent fungal

Job title Hospital/Clinic The Immune Deficiency Centre Address doctors in out-of-hospital practices reduces infections by about 90%, infections of skin or mucous Town/City Country - and particularly pediatricians. allowing PI patients to live an membranes after aged one year. ● Phone number Fax ‘The disease is caused by a genetic active, normal life. Rejection reactions caused by defect in the immune system, so There are eight of these special- maternal T cells in a child’s Now, tell us more about your work, so that we can plan future publications with your needs in mind. mostly infants and young children ist centres in the USA and Europe blood (chronic graft-versus-host Please put a cross ✘ in the relevant boxes. are affected and they are usually (where an estimated 1.5 million disease) manifested, for exam- 1. SPECIFY THE TYPE OF INSTITUTION IN WHICH YOU WORK first seen by a pediatrician,’ people suffer PI. Worldwide, the ple, as inflammatory reddening General hospital Outpatient clinic University hospital explained Professor Ulrich Wahn, figure is about ten million). Bayer of skin of unclear origin in Specialised hospital/type the Paediatric Unit’s director and a says it has carried out R&D of infants. chest and immunology specialist. biological drugs to treat congenital ● Normally harmless, ‘atypical’ Other institution (eg medical school) ‘Our aim is to increase aware- immunodeficiency for over 60 mycobacteria cause life-threat- 2.YOUR JOB ness of this disease and provide years and supports patient organi- ening and sometimes even fatal Director of administration Chief medical director Technical director patients and their families with sations and self-help groups in infections. In healthy people extensive assistance with diagnosis haemophilia, alpha-1 antitrypsin atypical mycobacteria infect Chief of medical department/type and treatment so they can live as deficiency and immunodeficiency only the lymph nodes and are Medical practitioner/type normal a life as possible,’ said Dr disorders. successfully controlled by a Gunnar Riemann, President of the PI warning signs functional immune system. Other/department Biological Products Division of ● Family history of congenital If any of these warning signs 3. HOW MANY BEDS DOES YOUR HOSPITAL PROVIDE Bayer HealthCare, which is fund- immunodeficiencies apply, a doctor should investigate Up to 150 151-500 501-1000 more than 1000 ing the centre (US $150,000 over a ● Eight or more purulent ear whether the patient might have a None, (not a hospital/clinic) three-year period) in association infections per year congenital immune deficiency (PI) with the American Jeffrey Modell ● Two or more severe sinus infec- - congenital immunodeficiency 4 . WHAT SUBJECTS INTEREST YOU IN YOUR WORK? Foundation, founded by Vicki and tions per year diseases are also known as Surgical innovations/surgical equipment Radiology, imaging/high tech advances ● Fred Modell. Two or more episodes of pneu- primary immunodeficiency, PI, Clinical research/treatments/equipment Intensive Care Units/ Although the disease is mostly monia during one year PIDD and PID. management/equipment Ambulance and rescue equipment Pharmaceutical news Physiotherapy updates/equipment Speech therapy/aids Nursing: new aids/techniques Laboratory equipment, refrigeration, etc. Hospital furnishings: beds, lights, etc. Hospital clothing and protective wear Hygiene & sterilisation Nutrition and kitchen supplies When LESS Is MORE... Linens & laundry Waste management Information technology & digital communications Hospital planning/logistics Personnel/hospital administration/management Hospital Purchasing Material Management Medical conferences/seminars EU political updates Other information requirements - please list QUALITY and VALUE ESPECIALLY FOR DOCTORS: Please complete the above questions and we would like you to answer the following additional questions by ticking yes or no or filling in the lines as appropriate. It’s a fact: A single ® What is your speciality? application of Aquasonic 100 Ultrasound Transmission In which department do you work? Gel is more cost effective Are you head of the department? Yes No Are you in charge of your department’s budget? Yes No than repeated applications of a "cheap gel" that quickly How much influence do you have on purchasing decisions? I can only present an opinion Yes No dries out. I tell the purchasing department what we need Yes No I can purchase from manufacturers directly Yes No It’s also the reason why Do you consider that your equipment is more professionals rely on out-dated Yes No the consistent quality of relatively modern Yes No Aquasonic® 100 Ultrasound state-of-the-art Yes No Transmission Gel, the Do you use/buy second-hand equipment? Yes No World Standard for Medical If so, what do you use of this kind? Ultrasound. Is your department linked to an internal computer network? Yes No Is your department linked to an external computer network? Yes No Is your department involved with telemedicine in the community? Yes No Why compromise Do you consider your department is under-staffed? Yes No quality when quality Are you given ample opportunities to up-date knowledge? Yes No is more cost effective PARKER LABORATORIES, INC. Do you attend congresses or similar meetings for your speciality? Yes No 286 Eldridge Road Fairfield, New Jersey 07004 ✂ This information will be used only in an analysis for European Hospital, Höherweg 287, 40231 Düsseldorf, Germany, and An ISO Certified Company 973-276-9500 • Fax: 973-276-9510 for the mailing out of future issues of the Beta publication European Hospital. Candidates will also be automatically www.parkerlabs.com entered for a draw to win the prize featured on this page. E-mail: [email protected]

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2 EUROPEAN HOSPITAL Vol 12 Issue 5/03 NEWS 13th EUROPEAN RESPIRATORY SOCIETY ANNUAL CONGRESS At the 0pening ceremony awards clinical diagnoses and treatments, pharmaceutical industry leaders, In terms of trade shows, and were presented to Neil B. Pride and included 20 assembly and 20 major symposia covering developments in respiratory (Presidential Award), Severin Daum symposia, 12 hot topics symposia, the most recent topics on research treatments, Boehringer-Ingelheim’s (Congress Chair Award), and Gro free communication sessions and clinical practice. presentation of its Respimat Soft Harlem Brundtland (3rd European In general, the focus was on Mist Inhaler attracted constant Lung Foundation Award). Born in Rostislav Kuklik chronic obstructive pulmonary crowds to the stand - although it’s 1923, Professor Daum, escaped disease (COPD), asthma, broncho- difficult to assess whether that was from the Czech Republic in 1968 reports from Austria alveolar lavage (BAL) procedures, due to the device itself, or the give- and was supported in Basel, and lung cancer issues. away items available. Switzerland, by Professor Heinrich including 80 oral presentation Immunotherapy and The European Respiratory Herzog. His background was just sessions, 35 informal discussions of immunomodulation modalities Society Annual Congress 2003 one point of interest among many posters during thematic poster were also widely addressed in the was truly outstanding, providing in the 14,000 people who flocked sessions, 22 postgraduate courses, speakers’ programme - particularly all the pre-requisites to attract at to Vienna for an event which 20 ‘Meet the Professor’ seminars, with regard to smoking and smoke- least the same number of visitors addressed the latest advances in evening symposia organised by the induced pathology. next year. Dräger Medical AG & Co.KGaA ©

The compact, mobile Permox SC oxygen concentrator was presented at ERS 2003 by We see a way to get reports to physicians 12 hours faster the Dräger/Siemens division Dräger Medical

If you were in Vienna, “ between 27 September and 1 October, you may have witnessed an extraordinary event - the ERS Annual We see a way to virtually eliminate Congress 2003 telephone and verbal orders he gathering was first” held in 1991 in Brussels, Belgium, when Tthe ERS President was S W Clarke (UK), and J C Yenault (Belgium) was Congress Chair and Scientific Committee Chair. This year John G Gibson (UK) was elected President, Friedrich Kummer (Austria) Congress Chair, William MacNee (UK) Scientific Committee Chair, and Maximilian Zach Congress Vice-Chair. Under their auspices the whole congress presents a must to scientists and physicians What do involved in research or treatment of respiratory tract disorders. you see? CANCER We see a way to get meds to patients 33% faster Patients’ network goes global

Each year lymphoma kills www.siemens.com/medical Results may vary. Data on file. 186,000 people and presents 350,000 new cases. The new Lymphoma Coalition, set up to raise awareness of the disease and treatment, is a Proven Outcomes. It’s what we’re delivering medical technology, IT, management consulting networking organisation of right now. Across the entire healthcare and services. In a way that only Siemens can. lymphoma patient groups

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EUROPEAN HOSPITAL Vol 12 Issue 5/03 3 NEWS

he Netherlands - Demand for much of the discrepancy points to costs or lowering business risk. and Emery, who, after point out premium medical services by culture leading to earlier diagnosis Allan Fine, Principal of Navigant that compassion is not the exclu- Tpatients who are underserved in the USA. Consulting, reinforced this, show- sive domain of non-profit groups, Physicians in their own countries is increasing. International European health- ing that half of a hospital’s cost presented the pros and cons of pri- By Karen Dente Focusing on this market and on care costs, as well as those of the increases relate to new and emerg- vatisation, with various options streamlining those services while US, were compared by John ing technologies - but which and forms. reducing costs, Dr Joseph F Straus Hutton, Vice President European increase long-term viability. He Julie McCashin, Vice President (founder/principal of Raphael Operations and Head of Global advocated strategic planning by for Medical Services, SOS, Medical, LLC), convened the sec- Health Economics, MedTap hospitals, such as structured tech- entranced the audience with expe- ond annual meeting of Healthcare International, Inc, who demon- nology assessment and evidence- riences in delivering healthcare to Across Borders - organised by the strated that clinical culture, social, based medicine. When in place, he remote international locations. The Strategic Research Institute of New personal economic and political said, both administrative and clini- biggest challenges lie in selecting York. factors resulted in variability in the cal departments must be involved the right local partner, she said, Comparing the development and and the next is licensing and reten- use of electronic data in healthcare tion of expatriate staff while locals with the Industrial Revolution over train to international standards. the past 150 years, Dr Ajit Singh, Also focusing on the developing President of the Oncology Care world, Paul Eckbo, CEO of Systems Group of Siemens Medical Preferred Global Health said the Solution Data, said space and time Healthcare application of global best practice need to be perceived in a new way could decrease cost by 25% and in order to create a formula to increase outcome by 25%. This improve healthcare delivery and ambitious plan is based on best best outcomes for patients. across borders patient outcome, by acquiring a Other speakers examined cost second opinion and using a treat- containment, comparative survival ment plan that requires patient statistics, forms of healthcare deliv- involvement. This further implies ery, hospital know-how and inter- quality control and use of the best national collaboration and solu- hospitals. Report by SA - A decade ago Clinton’s tions for improved outcomes. His theme was echoed by initiative to extend health Kristine Hoover, Director of Hanna Politis Chimon Schurr, President and Ucare to more Americans UnitedHealth Access, CEO of Collaborative Medical failed. A radical new proposal has UnitedHealthcare International, European Hospital Technology Corporation, whose been endorsed by thousands of showed how the right alignment of solution for improved outcomes in US physicians that would abolish healthcare benefits with a health- developing regions is to intercon- for-profit hospitals and insurers care delivery system improves out- nect major hospitals to form a net- and provide universal health comes for quality treatments and work, then to connect this, via a coverage to some 41 million US costs. Patient information, interna- primary hospital centre, to US citizens who are uninsured - tional administrative efficiency, medical experts. including those who are employed including increased transparency Dr Szabolcs Dorotovics, MD but without health coverage. and accountability, need work, she Europe of Johns Hopkins The proposal, recently stressed: ‘The right relationships, International, projected new published in the Journal of the marketing alliances and public-pri- approaches to hospital manage- American Medical Association vate collaboration contribute sig- ment, innovations in quality (JAMA), was authored by four nificantly’. patient care and cost-efficient man- physicians (three affiliated with Undertaking the formidable task Dr Joseph Straus agement applications shared with Harvard Medical School). A large of comparing Healthcare Services Chairman of other hospitals through interna- number of doctors endorsed the in the US and Europe, Dr Michel P Healthcare Across Borders tional collaboration. Coleman, Professor of Finally, discussion centred on Epidemiology and Vital Statistics, quantity of services offered. Costs in implementation and results health insurance challenges faced Head of Cancer and Public Health rose, he said, due to changing should be tracked and return on by multinational employers, which Unit of London School of Hygiene demographics, increased consumer investment documented. pinpointed not only the need for US citizens and Tropical Medicine, pointed out demand and demand for technolo- Healthcare privatisation was individual planning, but also more that US cancer survival figures are gy. Cost containment, he added, defended by Monte Dube, standardised and efficient adminis- almost 50% higher than in Europe. could be achieved by benefit reduc- Chairman, Health Law tration. healthcare Although partly due to statistics, tion, decrease in administrative Department of McDermott, Will Details:www.raphaelmedical.com

Dissatisfaction with US healthcare delivery has risen 10% since 2000, according to a recent poll of 1,000+ people carried out by the ABC News- Washington Post. The study revealed that 54% of respondents were dis- satisfied with the overall quality of US healthcare, whilst 44% were satisfied. 65% of insured respondents said they are satisfied with its cost, but this represents a drop of 9% since 1997. However, 62% said they would .EWå%XAMINATIONå,AMP prefer a government programme to provide healthcare, instead of the !SKåFORåMORE present employment-based system, even if it meant higher taxation. 4(%å7/2,$å/&å$%25.'3å (32% did not agree). 53% percent of -%$)#!,å,)'(4).' the insured respondents said they are worried about losing their insurance in the event of job loss. /URå MODULARå ANDå FORWARD LOOKINGå IDEASå In 2002, 43.6 million people were FORå LIGHT å ENERGYå ANDå COMMUNICATIONå uninsured in the USA - about 15.2 SYSTEMSåEXTENDåFROMåAåCOMPLETEåLIGHTINGå percent of citizens. Over one in six respondents said they have no insur- SYSTEMå FORå Aå CONSULTINGå ROOM å RIGHTå UPå ance. Up to a third of those earning TOå INDIVIDUALå DESIGNå ANDå MANUFACTUREå under $20,000 a year were uninsured, compared with 8% of those INå ACCORDANCEå WITHå YOURå REQUIREMENTS earning over $50,000 annually. Six in 10 of the respondents said they are worried about affordability $ERUNGSå,ICHTå!' of health insurance in the future. VISIT US AT OUR BOOTH 70% said buying prescription drugs (OFMATTSTRASSEå å#( å'OSSAU 1B26 ON MEDICA 2003 1 outside the United States should not 0HONEå åååå å&AXå åååå FROM 19TH UNTIL 22 ND OF be illegal, and one in eight reporting WWWDERUNGSLICHTCOM åMAILBOX DERUNGSLICHTCOM NOVEMBER IN DÜSSELDORF doing this or having a family member who did. $ERUNGSå,ICHTå!'åISTåEINå-ITGLIEDåDERå7ALDMANNå,ICHTTECHNIKå5NTERNEHMENSGRUPPE

4 EUROPEAN HOSPITAL Vol 12 Issue 5/03 NEWSNEWS

York Metro Chapter of Physicians for a National Health Programme said, ‘Proposals that call for tax call for national health insurance credits, or that push seniors into plan, for-profit insurance companies Rashi Fein said that is was a moral private HMOs, all retain the role would not have been abolished, but issue for society and that the of private insurers. They are all companies would have been interest of conservatives had to be doomed to failure because they required to offer health insurance sought for the proposal to go perpetuate administrative waste with subsidies helping smaller anywhere. and make universal coverage employers. Dr Gerald Thompson, Professor unaffordable.’ Sceptics of the health plan think of Medicine at Columbia University Dr Victor Seidel of Albert that America is not ready for such a said, at a NY press conference: ‘The Einstein College of Medicine, NY, drastic proposal. Rashi Fein of privatisation of healthcare hasn’t agrees with the waste of costs for Harvard Medical School said in an worked. We could take care of administration in the current health editorial accompanying the proposal everyone if we didn’t have this insurance system. Twenty percent published in JAMA that the plan devotion to the private sector.’ Lack of current costs are administrative, might be too radical to find of insurance was equivalent to which, he added, ‘...could be acceptance in the US political having a disease with higher extended for universal coverage for Dr Oliver Fein, Chair of the New York system, but that the physician mortality, he added. everyone in the US and for Metro Chapter of ‘Physicians for a proposal should rekindle the debate. Dr Oliver Fein, Chair of the New preventive medicine.’ National Health Programme

plan (7,782) and two include former surgeon generals. The physicians’ plan was developed by the Physicians for a National Health Programme and would transfer all US citizens into an embellished Medicare programme (the federal health I need to have faster access insurance programme for the to patient images and data. elderly) for all age groups. It would control costs by having the government pay for healthcare Q: Who can I trust to deliver an integrated through a fixed national budget. Private insurance companies radiology management system? would be eliminated, while most hospitals would remain privately owned, with the government providing them with fixed amounts for operating costs on a monthly basis. Under Clinton’s Kodak DirectView PACS System 5 want A: for all

Almost two-thirds believe the country will ration healthcare - whereby some medical procedures will not be covered by insurance. But - UK/USA study shows US surgical cases fare better Patients undergoing surgery under the UK’s National Health Service are seven times more likely to die than equivalent cases in the USA, according to results from a small study of 1,100 patients carried out by University College, London and Columbia University, New York. Cases from only two hospitals were studied: the Queen Alexandra Hospital in Portsmouth, UK, and Mount Sinai Hospital, USA. However, the study showed that, after major surgery, Introducing the new KODAK D IRECTV IEW PACS System 5. Built to connect and patients in the US are transferred to communicate across platforms to accommodate multiple modalities and preferences. With a comprehensive critical care, where high-level monitoring takes place and where they also tool set that lets you display, manipulate, and store images. For increased flexibility, improved work flow, continue to be cared for by their con- and efficiency. sultant and anaesthetist. By contrast, in the parallel cases studied in the UK over a third of the patients who died after major surgery had not received similar attendance. A shortage of specialists plus inten- FOR MORE INFO, CONTACT YOUR KODAK REPRESENTATIVE sive care beds, and the longer UK wait- HEALTH IMAGING ing lists were considered major influ- or visit www.kodak.com/go/pacs ABETTER V IEW OF L IFE. ences on the case outcomes. In the last six years, the National Health Service has recruited 55,000 more nurses, 6,500 additional consultants, 1,600 extra GPs.

EUROPEAN HOSPITAL Vol 12 Issue 5/03 5 RADIOLOGY & ONCOLOCY

atients at risk of suffering an ischaemic stroke may be iden- 48-year-old male 68-year-old male. presenting Right ICA tified with greater precision as P amaurosis fugax: occlusion was a result of advances in imaging Coronal, contrast- suspected by techniques being pioneered by doc- enhanced 3D MR duplex tors at the University of Bonn. angiography using ultrasound. CENTRA covers Dr Winfried Willinek and col- However, high- brain-supplying grade right ICA leagues in the department of radiol- arteries from aortic stenosis with ogy have worked with Philips arch to the circle of secondary Medical Systems to develop con- Willis, without hypoplasia CENTRA venous overlay (arrows) was trast-enhanced timing-robust depicted on the angiography (CENTRA), which enlarged sagittal enhances contrast material- view of the MR enhanced magnetic resonance angiogram (left angiography (CE-MRA). This tech- image) nology offers clinical and practical 65-year-old male advantages over conventional imag- enhances An incidental, with suspected left 5mm left MCA ing modalities in diagnosing carotid subclavian steal aneurysm artery stenosis, a major risk factor syndrome. Due to visualised in a for ischaemic stroke. extensive anatomic 67-year-old CENTRA is currently used for coverage provided male patient by high spatial screening patients having surgery resolution MRA that could put them at risk from using CENTRA, ischaemia, e.g. a liver transplant, severe stenosis of and those who may be asympto- obese patients, or those with high the technology in 2000. The first the left proximal CE-MRA subclavian artery matic, but considered at risk of blood pressure or high cholesterol, year was spent conducting valida- (arrow), detection of stroke due to the presence of gener- who can be asymptomatic. tion studies but for the past two an asymptomatic alized atherosclerotic disease, for CENTRA not only produces years it has been an established part stenosis of the right example. CENTRA also used for images with superb resolution, it of the protocol for investigating ICA (arrowhead) and screening patients who present clin- can also be applied across large patients showing clinical symptoms visualisation of the circle of Willis could ical indications such as dizziness or anatomic regions of interest within of cerebrovascular disease. The be diagnosed in just disturbed vision, or have had previ- a single scan. The scan gives high team has now carried out over one examination ous minor strokes or transient quality views of the carotid and 1000 investigations and is currently ischaemic attacks. vertebral arteries from the aortic seeing 30-40 patients monthly. Identifying patients with athero- arch above the heart to the circle The basis of the new technology Enlarged sagittal views of the right ICA. sclerotic plaques, which can be of Willis, the loop of arterial ves- is improved capture and analysis of High-grade stenosis and ulceration of removed surgically by carotid sels at the base of the brain. So the data obtained from an MR scan. atheromatous carotid plaque is displayed. In endarterectomy, will be the most technique has potential to be used Conventional CE-MRA has prob- this patient, DSA was available for comparison and confirmed the MRA important clinical application - but in the diagnosis of a wide range of lems with artefacts caused by inter- diagnosis (right). certainly not the only one. As MR abnormalities of various parts of ference from contrast medium in imaging using CENTRA is a far the supra-aortic arterial system adjacent vessels. To minimise these less invasive technique, than con- such as subclavian steal syndrome effects the start of image acquisition ventional x-ray, it is safe enough to - a defect that impairs blood circu- must be carefully timed to coincide have the potential to be used for lation to the arms, Dr Willinek with the arrival of contrast medium mass screening of at risk groups says. in the artery. This restricts the Winfried A Willinek, MD such as diabetics, cigarette smokers, Dr Willinek’s team began using acquisition times available, ONCOLOCY Thousand-fold magnification NM camera and agent oyal Philips Electronics Molybdinum generator, or by is collaborating with ordering a unit dose from radio- Rbio-tech firm CellPoint pharmaceutical firms. However, to LLC, of Englewood, date, promising molecular imaging Colorado, to combine the agents have not been labelled with firm’s diagnostic imaging Tc-99m due to its chemical com- agent with Philips’ plexity and lack of a chemically sta- SKYLight gantry-free gamma cam- ble coupler capable of linking it to era and share clinical trial costs in developing cost-effective imaging techniques for cancer diagnosis and Cost effective pre-screening for therapy. ‘There is an interdependence between com- molecular imaging panies developing molecular imag- onventional endoscopes often do not allow diagnosis of ing technologies and those develop- diagnostic compounds. EC Clesions at an early stage - which could lead to tumours or car- Above left: OCT ing the agents. Close collaboration Technology’s chemical stability and cinomas. Along with digital endoscopy systems, new technolo- System: Image of a among these groups is essential for versatility will enable the wide- gies offer the possibility of early cancer detection. For example, stenotic biliary duct applied molecular imaging to spread use and availability of Tc- Pentax, in co-operation with LightLab Imaging Inc, Boston, is due to scarring become a reality,’ explained Peter 99m labelled agents. working on optical coherence tomography (OCT) in endoscopy, Luyten, Philips Medical Systems’ In the trials, Tc-99m-EC- a system that will enable identification of microstructures in director of molecular imaging. deoxyglucose will target tumours gastroenterological and pulmonological applications. CellPoint’s ethylenedicysteine and SPECT cameras, including OCT combines ultrasound (US) with microscopic image quali- The confocal system drug conjugate technology (EC Philips’ nuclear medicine cameras ty. However, images are not generated by using sound waves, Technology) is a unique delivery will image them. Tumours absorb but through light waves, transmitted from a light source via a system that functions as a chemical more glucose than surrounding tis- probe inserted into the body through an endoscope channel. As In 2002, Pentax also joined bridge to link tissue-specific ligands sue, so when a patient is injected a result of high frequencies and bandwidths of infrared light, a OptiScan Imaging Ltd, Melbourne, to pursue a (e.g. hormones, proteins, peptides, with this chemically linked agent resolution of 10-20 µm can be obtained, providing images 8-25 second research emphasis: confocal endoscopy - glucose analogues) or pharmaceuti- (via EC Technology), active times better than in which laser light is introduced directly, via an cal compounds (investigational or tumours absorb both the glucose those generated by endoscope, to produce microscopically accurate FDA-approved drugs) to radio-iso- and radioisotope. In several med- US, Pentax reports. real-time images of living cells can be generated topes for cancer diagnosis and ical institutions where further clini- Extremely high reso- in thousand-fold magnification. treatment. cal trials take place, SKYLight cam- lution allows even The bundled laser light beam is reflected by For diagnostics, the firms will eras and associated analytical soft- the smallest tissue the outer intestinal tissue surface, and transmit- collaborate on CellPoint’s first mol- ware will produce images of changes within the ted through confocal fibre optics, which only ecular imaging agent, Tc-99m-EC- tumours and their rate of radioiso- mucosa to be seen, conduct light from a specified focal plane to the deoxyglucose. EC Technology tope uptake, and data from SPECT as well as precise processor, which transforms the signals into allows deoxyglucose to be labelled imaging will be used to determine differentiation of images. Due to thousand-fold magnification of (i.e., linked) with the radioisotope the tumour’s location and size, and individual layers. tissue structures, the microscopic images enable Technetium-99m (Tc-99m) - excel- predict therapeutic doses of agents. recognition of structures to the size of cell lent for NM imaging due to its high ‘Since SPECT cameras are nuclei. To better differentiate and identify tissue imaging energy, long half-life, wide already installed in thousands of Left: Distal end of structures, the surface of the mucous membrane availability and ease of use. clinical departments nationwide, confocal endoscope is first stained with a fluorescent contrast agent. Radiologists can access Tc-99m the adoption curve for this technol- with confocal image either from an in-house ogy should be reasonably quick,’

6 EUROPEAN HOSPITAL Vol 12 Issue 5/03 RADIOLOGY & ONCOLOGY

which in turn limits the spatial reso- Radiology Nov. 2002,Vol. 225, No. lution that can be achieved. 2, p583-588technology), the Virtual ultra-low-dose CT-Colonography CENTRA employs a novel tech- University of Bonn team is keen to Virtual CT-Colonography, a new, non-invasive diag- stages of intestinal cancer as reliably as a conven- nique for sampling the image - ran- develop the technique to full poten- dom segmentation of the central k- tial. Dr Willinek is carrying out a nostic procedure for early detection of intestinal tional colonoscopy,’ Dr Vogt explained. ‘For that space - which minimises the effects comparison of the results of the tech- polyps and colonic cancer, is in an early stage devel- reason patients are examined with the virtual CT- of the interference from overlying nique with DSA (digital subtraction opment. At Dusseldorf’s University Hospital, Dr Colonography as well as (and on the same day) angiography), the method currently Christoph Vogt and colleagues are performing a with conventional high-resolution colonoscopy. viewed as the gold standard in coro- large prospective study for direct comparison of the This research will be presented at MEDICA 2003 Images over nary artery stenosis diagnosis. computer-tomographic virtual colonography in an (November, Dusseldorf) at the North-Rhine The latter, a much more invasive ultra-low-dose technique and conventional Westphalia stand. 350 mm FOV technique, involves exposure of colonoscopy (high-resolution video-colonoscopy). Contact: Dr Christoph Vogt, Dept. of patients to radiation, so is unlikely to ‘Quite often there is additional information from Gastroenterology, Hepatology and Infectiology, venous vessels. This allows a much be used except in patients who are these investigations performed at the same time. Institute of Informatics and Institute for longer data acquisition time and showing symptoms. In contrast The comparative study aims at determining Diagnostic Radiology. greatly improves the spatial resolu- because MR with CENTRA is a far tion achieved. safer technique it could allow for whether virtual colonography detects preliminary Email: [email protected] For radiological technicians carry- mass screening for those at risk. ing out the scans the main advantage of the new technique is ease of use. A scan of the whole head and neck can be done without reposi- tioning a patient. ‘We also used to H EALTHC ARE have to take two measurements with different coils - now it is a one stop shop,’ Dr Willinek explains. Although it is too early to assess the financial impact of the technique, he believes these are likely to be positive. ‘The single measurement obviously has an effect on patient throughput and we can increase the number of patients receiving the stroke protocol. So, yes, I would say there is definitely an economic benefit for the university hospital,’ adds Dr Willinek. Having carried out the first published study on the CENTRA technology (W.A.Willinek et. al. Randomly Segmented Central k- space Ordering in High-Spatial- Resolution Contrast-enhanced MR Angiography of the Supra-aortic Arteries:Initial Experience. combine The Point of Knowledge Greg Colip, CellPoint’s CEO, point- Share ed out. The Phase I clinical trial began Share the right information, the right way, this April at The University of Texas At the right time, with the right people. M D Anderson Cancer Centre, Share the advantages of a digitally connected world: ranked the nation’s best cancer hos- From Home to Hospital; pital (2002 and 2003. US News & From Clinic to Multi-site Network. World Report). Trial data will be reviewed by Philips to determine if Share beyond Radiology and PACS. adjustments are needed to improve Share end-to-end. the clinical/diagnostic image quality. If necessary, Philips will reprocess Our IMPAX™ and Quadrat solutions pave the way the data by optimizing the recon- from entry level digitization to a comprehensive Electronic Patient Record: struction filtering parameters and In an integrated & open environment, yet fully secure. acquisition protocols for molecular imaging in oncology. Use our experience of more than 10 years in over 700 PACS projects. The firms’ agreement could Grow into the future. expand into treatments using the Share, with Agfa. same EC Technology to couple a therapeutic radionuclide to a tissue- www.agfa.com/healthcare specific ligand or targeting cancer drug to deliver therapy directly to a tumour. The SKYLight gantry-free nuclear camera allows gamma detectors to be mounted directly onto a room’s structure/ceiling, and enables opera- tors to image almost any size patient, in almost any condition and almost any position, without leav- ing a patient’s side. The SKYLight 2.0 version offers concurrent imaging that allows clin- icians to acquire images for molecular agents and drugs/radiopharma- Visit us at RSNA Hall A ceuticals simultaneously, providing South Building - Booth #1129 better quality images significantly faster. Concurrent imaging uses a single acquisition data stream to generate up to 16 image sets simultaneously, each with a different energy window setting. The sets can then be processed and converted into clinically useful information.

EUROPEAN HOSPITAL Vol 12 Issue 5/03 7 ITNEWS & TELEMEDICINE

In the special section MEDICAMEDIA, during a day-long programme consisting of 17 The Webby awards workshops and forums, over 120 experts from research, hospitals, associations and industry, will discuss trends and problem solving in healthcare telematics. Over 30 research institutes USA - Planned Parenthood Golden and institutions will also present the latest e-health developments Gate (www.ppgg.org) has won the 2003 Webby Award, and HIV Stops ‘The gap between vision and continues. The infrastructure for Knowledge-based systems and With Me (www.hivstopswithme.org) application results partly from this is provided by information the clinical workplace has won the People’s Choice Award, research and development offering and communication technology The increasing distribution of both in the healthcare category of good products without first looking and telemedicine. Differences in healthcare telematics offers new the Webby Awards. at a realistic implementation,’ said quality, waiting periods and perspectives on the application of Dr Volker Hempel, organiser of costs of national healthcare knowledge-based or expert Other nominees in this category MEDICAMEDIA. ‘We are markets are prompting regional, systems and their integration into were: presenting a programme in which European and international medical decision-making. Medical www.cancer.gov visions are considered, but one that boundary crossing of patients, expert systems as a rule require www.lifeclinic.com and also offers practical and specific which in turn can prompt clinics an experienced doctor whom they www.teenwire.com solutions to healthcare practice. to ask whether they can benefit are supposed to support in patient Participants from the associations from this demand by expansion care and the associated and public institutions in and performance improvements. administration of data. The healthcare and science will be able What has the experience been dialogue between the doctor and to inform themselves about the with foreign patients to date? knowledge-based computer current state and perspectives.’ What problems arise? Can systems can raise the clinical telemedicine contribute to quality standard while making Health card and electronic optimisation? more time available for To enter patient file The SARS outbreak doctor/patient dialogues. your site The German health card is emphasised the necessity to Knowledge-based systems do not go to scheduled to arrive in 2006. A network disaster and emergency replace but support the doctor workshop will introduce and medicine data with public during diagnosis and possibly also www.webbyawards.com

Webby Awards are presented annually by The International Academy of Digital Arts and Sciences (www.iadas.net), linked with publisher and computer exhibitions organiser IDG (www.IDG.net). Awards judges have MEDICA MEDIA included David Bowie, Francis Ford Coppola and other specialists among 19-22 NOVEMBER • DUSSELDORF the Academy’s membership list, who hail from diverse fields such as arts, science and business. Sponsors have included Intel, Hewlett-Packard, PricewaterhouseCoopers, Visa, Pacific Bell, United Airlines and many more national and international organisations. If you’d like to enter your site, or any other in healthcare, for the 8th Annual Webby Awards, or you would like more details, go to Expert presentations www.webbyawards.com of new concepts prompt discourse and potential solutions Data errors and responsibility

UK - A National Health Service (NHS) electronic medical records contract, worth 3.7 million dollars and up for tender at the time of going to press, stipulates that the supplier(s) will be responsible for identifying and solving the problem of inconsistent data entered in the system by medical staff. IBM Global Services and the BT Group PLC top the bidders, Lockheed Martin Corporation having now withdrawn. E-Health 2003 The healthcare net Congress

Dresden, Germany - A pro- departments. gramme for the digitisation of From various German regions, fif- imaging and image communication teen experts in medicine, econom- in Saxony’s hospitals was presented ics, and informatics, appointed to a at E-Health 2003 by SaxTeleMed. board for the project, set standards Saxony has 90 state hospitals and and structural guidelines for the two university clinics. The seven main SaxTeleMed hospitals. discuss the framework and primary decision makers and research therapy. A workshop will SadTeleMed project, focusing on One notable development in this applications of the card, plus legal facilities and decision makers, attempt to dispel many radiology, was initiated by the free project has been a quality function and economic factors. not just at regional and national prejudices against expert state’s Ministry of Social Welfare, deployment (QFD) method for PACS ‘Individual’ and ‘virtual levels but also internationally. In systems. Health, Youth and Family, and specification and selection. Another electronic’ patient files will also be a user forum, these structures New media in medical training involves 39 hospitals and medical is the introduction of a health pro- discussed, using examples of will be outlined and centres in seven regional projects. fessional card (HPC). communication platforms for demonstrated through examples, This year, with participation by electronic communication among and their successes and weak almost all medical projects that Lead hospitals in the seven regions Other key issues at the E-Health doctors (D2D). points will be discussed. were sponsored in the Federal are: Chemnitz General Hospital, 2003 congress included cross border Solid experience has grown in Ministry for Education, Science, Erlabrunn Hospital, Dresden- and international trends in health network-based healthcare research Telecare and telemonitoring Research and Technology Neustadt City Hospital, Zittau telematics as well as strategies for and care, for example in the human Telecare is multimedia-based (BMBF) programmes ‘New District Hospital, Dresden- progress. Participants included stan- genome network, the transregio remote treatment or remote care Media in Education’ (2000- Friedrichstadt General Hospital, dardisation and data protection project of special research fields and of regular and care patients in 2004) and ‘Notebook Riesa District Hospital and Zwickau groups, managers of healthcare a multitude of networked care their private setting. The focus Universities’ (2002) - the Heinrich Braun Hospital. telematics firms, ministry represen- initiatives. Network-based co- of telemedical pilot projects lies question of a permanent and Organisational, technical, legal, tatives and international represen- operation requires rethinking by all in complex telematic monitoring nation-wide use of new media in and economic problems in digitisa- tatives from science and industry. participants. Its status will be tasks and rehabilitation medical faculties will be pursued tion and networking, are being The congress was organised joint- evaluated in the context of the EU measures that could otherwise in a high and other nations. only be performed in the level tested in the programme. In these ly by the Action Forum for hospital, without the use of discussion lead hospitals, a restructuring into Telematics in Healthcare (ATG), Global networking of national telematics, e.g., after a stroke. forum. an almost film-less hospital is meant Federal Ministry of Health and healthcare systems Can clinics benefit from to take place by means of digitisa- Social Security, and the Saxony The internationalisation and telematics developments already tion and image communication that State Ministries for Social Affairs, Europeanisation of healthcare in use? spreads out from radiology to other and Economics and Labour. Complete programme: www.teleforum-medizin.de or www.medica.de (special presentations)

8 EUROPEAN HOSPITAL Vol 12 Issue 5/03 IT & TELEMEDICINENEWS

evelopments in IT are prov- expanded from $68 million in 1997 future. This will present the compa- ing as critical as medical to $500 million in 2000, projecting ny supplying the software with the Dadvances in spurring the $10 billion in revenues by 2010. opportunity to supply and/or control growth of evidence-based medicine DISEASE ‘In Europe, the multiplicity of the supply of all the essential com- and significant opportunities are health systems and languages has patible hardware and other prod- emerging for healthcare IT compa- underlined a fragmented IT sector. ucts.’ nies within general healthcare pro- In this scenario, medical product ‘This will require organisations vision and particularly in disease companies active in IT are likely to with very considerable resources, management, according to a new management have the best prospects for ascen- and the need for corporate mass will report from consultants Frost and deliver a coordinated campaign agement appears to have proven dancy. Most healthcare specialist mean that the end-point of the devel- Sullivan (F&S). against multiple and overlapping cost effective in the US, there is lit- companies in the IT sector are opment is likely to be a small num- Healthcare IT companies mainly chronic conditions thereby cutting tle proof of the cost effectiveness or small. They will therefore have to ber (perhaps five or six) global giants focus on clinical information sys- the administrative costs associated even potential long-term cost achieve rapid growth or enter into in the area that will dominate the tems (CIS) and hospital informa- with managing a medley of pro- reduction accrued from the use of acquisition programmes, to be able healthcare marketplace,’ Gordon tion systems (HIS), but there are grammes,’ Gordon Blackwell the Internet in disease management, to compete effectively. Blackwell concluded. several niche areas, in which the pointed out. ‘They provide the ben- the report indicates. ‘Despite this, ‘Clinical information systems, ‘disease management service sector’ efits of one-stop shopping with leading healthcare consultancies with the ability to provide comput- * Pub: August 2003. Report code: is the most prominent, the report only one contact point.’ estimate the U.S. market for IT- er-assisted diagnosis, are expected B251. Price: US$ 9,950. Details: points out. While traditional disease man- based disease management services to anchor healthcare systems of the http://healthcare.frost.com). Small, flexible and innovative organisations are expected to be the early beneficiaries of emerging Gastroscopes opportunities in the disease management service sector, the report continues: ‘In the USA, the IT route

is being adopted by many pioneer- Duodenoscopes buerofuergestaltung.de ing companies that are offering the information provision, patient monitoring, communication facilities and data collection essential for are Colonoscopes disease management.’ ddetailsetails are ‘By transforming themselves from occupying a sub-contractor role to being perceived as disease Enteroscopes management enablers, these companies appear to have gained the lions’ share of opportunities in raising care quality. They are the only everythingeverything Sigmoidoscopes company type currently able to provide the right input,’ said Gordon Blackwell, Research Zoom Colono- and Gastroscopes Analyst at F&S.

A niche for Ultrasound-Endoscopes small IT firms

The congruence between IT and Intubations-Endoscopes disease management techniques is well established. Successful disease management depends on a disease- specific information system that Bronchoscopes manages care programmes across the healthcare continuum, enables home monitoring, monitors self- care procedures and, ensures effec- Naso-Pharyngo-Laryngoscopes tive communication/information exchanges among patients, care- givers, and health care providers, the report continues. Cystoscopes ‘The IT sector is now emphasis- ing that it is no longer sufficient to have clinical programmes producing health improvement and reducing costs. Rather it is essential to provide the necessary integration and connectivity to give real-time information and data to all the stakeholders in a programme,’ Gordon Blackwell added. The emphasis is therefore on achieving integration within hospitals and then community-wide systems. ‘While this is a positive development, the continued neglect of elderly and functionally limited home-based patients requiring dis- MEDICA Dusseldorf, ease management remains disqui- November 19 – 22, 2003 eting. The marginalisation of these booth-no. 10 F 13 potential user groups compels technology designers to address 11th UEGW Madrid, the constraints related to old age (November 01 – 05, 2003 and functional inexperience. booth-no. 33 ) ‘Today, both specialised, single- Ureteroscopes disease as well as multiple disease Whenever something truly new is to be created, you need vision. Taking several steps at a time, management service companies are the new Video System from Pentax sets new standards in digital video endoscopy. The EPK-1000 active on the market. Rare dis- video processor and video endoscopes of the 70K and 80K series feature innovative design and ex- eases, such as haemophilia, offer ceptional ergonomics, optimizing image quality and therapy capability. If you too want to ex- Choledocho-Nephroscopes prospects for specialisation. perience endoscopy digitally, contact us: Telephone +49-40-56192·0; Fax +49-40-5604213; E-mail: However, the trend favours multi- [email protected] or Internet: www.pentax-endoscopy.com ple disease management providers. Cholangio-Pancreaticoscopes This stems from the fact that chronic conditions often involve overlapping diseases,’ the F&S report adds. Autofluorescence-Bronchoscopy ‘Multiple disease companies can

EUROPEAN HOSPITAL Vol 12 Issue 5/03 9 NEWSIT & TELEMEDIDINE

the first hospitals in Europe to upgrade their digital dictation Sales of speech recognition system to speech recognition. Additionally, the Berlin-based IT firm Optimal Systems has secured a major order to integrate SpeechMagic in nine German systems accelerates convalescent clinics - initially Specialist terminology equipping over 170 workstations with SpeechMagic. Marcel from various medical Wassink, General Manager of Philips Speech Recognition fields can now be Systems pointed out: ‘These orders show that hospitals are recognised, recorded increasingly embracing modern technologies to help face the challenges of increased cost and transcribed in pressure and reduced public healthcare budgets.’ German, Austrian, Dr Marion Kalwa, responsible for the pilot project in the Dutch, French, Münsterland Clinic, Germany, said: ‘The service for patients has Swedish, Flemish and improved because waiting time between dictation and release of a UK English report has been almost eliminated. In addition, automatic filing has reduced the number of errors resulting from manual filing. The increased productivity n Europe, medical reports cost Mercer, using speech recognition Vienna, who has used a Philips all medical disciplines. of our transcription department an average of four euros to can increase efficiency in report SpeechMagic system for over five Now Philips and the medical IT has freed resources, which we Iproduce. In the USA total costs production and decrease costs by years. ‘95% of documents are company Kuhlmann Information now use for more important for information capture and report some 50%. available on the same day.’ Systems have announced that the tasks. All these improvements will generation in healthcare is Radiologists (among the first to The interest of specialists university hospital in the state of lead to a clear reduction in estimated at $50 billion annually use speech recognition) use a fairly working in other fields inevitably Saarland, Germany, and two administrative costs.’ (Healthcare Documentation: A standard vocabulary, so high increased. district hospitals in the north, will Philips now provides MultiMed Report on Information Capture recognition rates were achieved. Philips was the first to combine be the first in Germany to ConTexts for use in German, and Report Generation, 6/2002. ‘The turn-around time for various ConTexts (recognition introduce speech recognition on a Austrian, Dutch, French, Swedish, © C P Waegemann, C Tessier, et radiology reports improved by vocabularies) in one MultiMed hospital-wide scale. They follow Flemish and UK English. The al., Newton, MA). However, 35%,’ said Professor Kumpan, at ConText. MultiMed is used with the Vejle Hospital and Kolding company also plans to release according to market research firm the Kaiser Franz Josef Hospital, SpeechMagic and covers 80% of Hospital in Denmark, which were further language versions shortly.

T ELEMED Home monitoring success Telediagnosis E-health in practice Illinois, USA - The combination of tic outcome. Heart failure patients Files move, patients do not. remote monitoring, patient educa- have the highest rate of readmis- could cut flights tion and medical intervention virtu- sions to hospital or emergency care Australia - Currently the Royal Report by Dr Hans-Jürgen ally eliminated re-hospitalisation and while under home care supervision.’ Flying Doctor Service flies suspect- emergency room visits and signifi- Nationally, 25% return to hospital ed coronary heart disease patients Hühne of Deutsche Telekom cantly improved patients’ satisfac- within 30 days of treatment - and from distant hospitals to Perth for nformation and telecommunication tion with home care services and 45% return within 90 days. diagnosis - but for many the flights infrastructures, and the quality of life, according to a 120-day Traditionally, patients are moni- prove unnecessary. Now, due to a Iimplementation of tailor-made pilot study conducted by the Visiting tored from visit to visit rather than system developed and tested over solutions, are core competences of Nurse Association of Southeast daily, which leaves uncertainty an eight-year period, local scan- Deutsche Telekom. In healthcare, Michigan (VNA). about their condition between vis- ning may save patient transporta- eHealthConnect and eHealth Net, In the TeleHomecare programme, its. The VNA points out that tion costs and keep more hospital produced by the firm’s T-COM focusing on 32 heart failure patients, TeleHomecare is a far more proac- beds free. division, not only provide each received a special weighing tive approach, and is readily accept- Dr John Walker, a nuclear physi- necessary location-spanning for scale and blood pressure cuff, which ed by patients and family, encour- physicians, hospitals and other were connected to their home tele- ages education, prevention and cian, has been developing and testing a radiology service Imaging health sector teams, but also phone lines. Each day, when patients self-management and employs a secure communications. weighed and took their own blood team approach, the South (ITS), which uses myocardial perfusion scintigraphy Primarily, the aim is to implement suitable network- pressure (BP) their weight, heart rate Within the next year, the associa- information systems as the technical basis to meet two and BP readings were automatically tion plans to expand the (MPS) via a web-based system, to check out emergency patients who important requirements shared by hospitals and external sent to a secure internet site and TeleHomecare programme to cover general practitioners: ensuring patients receive the best evaluated by the VNA nurses. ‘Only asthma, chronic obstructive pul- present chest pains in their local hospitals. The system now covers treatment and achieving this at the optimum costs. one person during the study was re- monary disease (COPD), diabetes The Rotkreuz hospitals in Frankfurt have achieved hospitalised for heart failure,’ said and hypertension. about 470 cases daily, carrying out real-time transmissions between both aims. An electronic patient file is at the heart of Rosanne Brugnoni, VNA director of Email contact for details: the solution. Information is available not only to hospital clinical innovations. ‘That is a fantas- [email protected]. primary care physicians and consultants, and provides 24/7 service staff, but also to external physicians in their medical for A&E patients and multi-trauma practices. State-of-the-art secure technology protects cases seen by hospitals a distance sensitive data within the network and during International Society away. transmission. NEW A fast and secure network is also the basis for a co- for Telemedicine (ISfT) Dr Walker said internet-based operation, across several locations, used by an appliance- RIS and PACS help to streamline legal aspects, rules for good prac- sharing group of nuclear physicians in the Nuremberg- Tromsø, Norway - The new reporting, and enable second tice, and the bringing together of based Radiologische Nuklearmedizinische International Society for opinions, even from international scientists and researchers, sponsors Apparategemeinschaft. Their aim is for diagnostic and Telemedicine (ISfT) was inaugurated specialists if necessary, and the sys- and advisers, manufacturers and therapeutic patient data to be available to medical (as a Society under Swiss Civil Code) tem demonstrates high sensitivity distributors and their scientific per- teams involved. In other words, data moves, patients do at the 8th International Conference and specificity in diagnosing sonnel, and promote initial and sup- not. The result of using this system is that Deutsche on the Medical Aspects of myocardial ischaemia, thus plementary theoretical and practi- Telekom’s ‘all-in solution’ helps to attain efficient, full- Telemedicine in September. improving risk stratification and cal training in telemedicine. capacity use of expensive equipment, which also IsfT aims to promote international clinical management for emer- Details: www.isft.org Contacts: optimises the group’s economy. health telematics - particularly gency patients. He believes the Professor Michael Nerlich These modules of a comprehensive telematics solution telemedicine, telecare, telehealth, same results will be achieved when (President) or Frank Lievens represent a strategic contribution towards the evolution ehealth and associated fields. The using CT, MRI, and ultrasound. society will focus on, for example, (Treasurer) of a networked health sector.

10 EUROPEAN HOSPITAL Vol 12 Issue 5/03 SURGERYNEWS

MEMBER BANKS Disaster prompts critical care course Y. Beguin (Liège) UK - During a football game in Hillsborough, This September the college launched the sec- M. Boogaerts (Leuven) Sheffield, 14 years ago, 96 people were crushed ond edition of the course, aimed at ensuring M. Contreras (London) to death. Later, the Hillsborough Disaster Fund trainees are taught the systematic manage- Network was set up. From this funds, in 1989 funds were ment of the acutely ill patient, either in the W. Fibbe (Leiden) J. GarcÌa (Barcelona) given to the London-based Royal College of emergency room or on a surgical ward. E. Gluckman (Paris) Surgeons to develop facets of the hospital Manchester-based consultant surgeon Iain for stem cells phase of emergency care. The College chose to Anderson, who donates time to tutor on the P. Hervé (Besancon) Leiden, NL - Up to now, transplant develop a special course called ‘Care of the crit- CCrISP, said that the newly-devised course was NETCORD is a foundation R. Kekomäki (Helsinki) centres have had to check each cord ically ill surgical patient’ (CCrISP), which developed by a multidisciplinary team of sur- G. Koegler (Dusseldorf) blood stem cell (CBSC) bank subject to Dutch law. The became one of its most popular courses. geons, intensivists and anaesthetists, who J. Marolleau (Paris) individually. However, leading Thousands of surgical trainees and their revised it due to the experience as well as opin- registered office of the A. Nagler (Jerusalem) patients have benefited from this teaching and ions canvassed from all CCrISP instructors. public cord blood banks have been P. Rebulla (Milano) training, and the course is run in over 50 cen- ‘Piloting of the new course suggests it will joining the Netcord Foundation - foundation is situated in E. Shpall (Houston) tres nationally - as well as in Ireland, Hong achieve its aims - to make the dissemination of which aims to provide cord blood Kong, Australia and New Zealand. In Leiden (NL). The NETCORD C. Stevens (New York) this knowledge easier, more effective and more stem cell (CBSC) transplants Australasia it has in fact become a mandatory enjoyable for student and teacher alike.’ T. Takahashi (Tokyo) produced in accordance with foundation has branch part of surgical training, with 1,000 trainees http://www.rcseng.ac.uk/surgical/raven_ M. Vowels (Sydney) Netcord FAHCT standards. This offices in other countries last year alone. courses/bst/bsc_html?CourseID=11 centralised system will present the full inventory of CBSC held by the member banks, speed up selection and reservation of a cord blood unit, and help reduce the frequency of possible allocation conflicts for a cord blood transplant provided by a bank, Netcord points out. Registered in the Netherlands, MEDICAL TECHNOLOGY and subject to Dutch law, the Netcord Foundation also has offices in other countries. The European Community (EC) supported the banks involved during the development of a Netcord Virtual Office - which can be seen at MEDICA in November. [email protected] Stem cells under scrutiny Fusion or transformation? Transplanted bone-marrow-derived cells (BMDCs) can fuse with other mature cell types in live mice, according to a new study published online by the journal Nature (http://dx.doi.org/10.1038/nature0 2069), a finding could undermine the rationale that stem cell transplants can be a genuine replacement therapy. In culture, bone marrow cells can TRILUX medical technology stands for a wide product range of generate liver, heart and brain cells. medical supply units in care and intensive care areas as well as In vivo, the same also appears to be lighting systems destined for use in the health care sector. true. However, although some researchers believe the transition to TRILUX sets new standards in medical technology with creative be a genuine transformation of one solutions for basic, normal and intensive care at the international cell type to another, others think trade fair MEDICA 2003. that the transplanted cells fuse with host tissue, thereby taking on the characteristics of the host cell. Fusion had been shown to occur in vitro, and an earlier study published in Nature this year showed that bone marrow cells could fuse with cells of a damaged liver in vivo. Now Arturo Alvarez-Buylla and colleagues at the Univ. of California, San Francisco, have shown that transplanted mice BMDCs can fuse with liver, brain See for yourself! and heart cells, even in a healthy animal, but there was no evidence At MEDICA 2003 in Dusseldorf, of authentic transdifferentiation November 19-22 (the ability of one cell type to turn Hall 16, stand 16A59 into another). This result hints that cell fusion might occur naturally. Under normal conditions, many heart and liver cells have two or more nuclei - which may be due to fusion, the TRILUX LIGHTING LIMITED authors speculate, although Medical Technology whether this represents a repair SAXON HOUSE, Swallowdale Lane mechanism for damaged tissue is Hemel Hempstead 03

unknown. / The rationale for clinical proce- Herts HP2 7EA dures based on the idea of transdif- Tel. 0 14 42 214063 ferentiation may also need rethink- Fax 0 1442 266077

ing. The team conclude that further MED-GB-EH11 www.trilux.co.uk animal studies are needed to assess the value of BMDC transplants as a useful replacement therapy. Email: [email protected]

EUROPEAN HOSPITAL Vol 12 Issue 5/03 11 SURGERY ORGAN TRANSPLANTS TRANSPLANTS GRANT of organ donation is often closely Spain leads tied to the co-operation of hospitals, the forum adds. Procurement The Netherlands - Dr Harm Hoekstra, organisations are there to support of Groningen University Hospital, has in organ donations hospitals and transplant centres been awarded the Fujisawa 2002 Study round the clock, the declaration also EU - The striking taking steps towards improving emphasises. Procurement and Research Grant. differences between the organ donation. This goal is organisations ensure that Created in partnership with the number of organs reflected by the countries’ first joint information is found and provided European Society for Organ donated for transplants in six declaration, which forms the basis quickly and professionally, using Transplantation (ESOT), this annual European countries was highlighted for concrete future measures. These information technology that is vital grant recognises innovative excellence during September’s first European include sharing information, joint in the process of organ donation. by young researchers in clinical and Forum ‘Alliance for Organ study of best practice models, joint Organ transplantation is a proven Donation’, arranged by the German initiatives for standards in quality experimental transplantation and aims therapy and organ donations from Organ Transplantation Organisation assurance and recipient safety. cadavers have priority. There are to fund a new research project. (DSO). According to 2002 statistics, many situations where donation Spain - a best practice country - has Six countries from living donors is justified from a 33.7 organ donors per million medical, legal and ethical inhabitants, whilst France had 20; enter new alliance standpoint, but the health risks for Italy 18.1; Hungary 16.4; United the donor must always be taken into Kingdom 13 and Germany 12.2. This co-operation will also result consideration, the forum pointed ‘Even though the legal and in planning and implementation of out, adding that alternatives to organisational frameworks vary joint research projects to further organ donation (e.g. Future included greatly between the Member States develop transplants. xenotransplantation) will not be a of the European Union, transplant The organisers also want to pay a short or medium term option for candidates all over Europe suffer contribution to renewing public candidates on waiting lists. because waiting times are much too awareness of the issue of organ ‘We want to learn from the best long,’ said DSO president Professor donation. practices in our respective countries, Martin Molzahn. ‘In Germany, The declaration underlines that formulate joint objectives and find which has not yet achieved the same the partner organisations support solutions,’ the declaration concludes. rate of transplants as its European the ethical principles of solidarity ‘It is our objective to establish a rate neighbours, the death of patients and altruistic organ donation and of organ donation in all European awaiting heart or liver transplants is are clearly opposed to countries that is similar to the the sad reality.’ material incentives for current rate in Spain.’ At the forum, politicians and organ donation and to experts discussed options for the organ trade. improving European organ donation Hospitals - The State Secretary Dr Klaus by working together. Despite Theo Schroder (right) declaration adds welcomed by Dr Martin differences in healthcare policies and that they should Molzahn (left), Chairman legal and organisational always try to give of the German Organ frameworks, much common ground anyone wishing Transplantation exists. The initial goal of the forum to donate his or Foundation was to look more closely at the her organs after European situation, focusing on the death the six participant countries, and to find opportunity to do some preliminary approaches for so. The situation

Live kidney donors increase But many more are needed Venice, Italy - The Transplant Recipients and the Organ parents and children. This has number of live kidney Procurement and Transplantation been made possible due in part to donations in the USA Network. www.optn.org/data/annu- the recent advances in immunosup- now exceeds the number cadaver alreport.asp) pressive therapy, including kidneys donated, and they are It is now common for partners, Fujisawa’s Prograf(r) (tacrolimus), expected to increase, according to distant relatives and friends to the firm reports. data presented at the 11th donate a kidney, as well as siblings, Details: www.livekidney.com Congress of the European Society for Organ Transplantation. The finding was announced at a USA - Removing key muscles in the paralyse muscles in each of those areas major symposium entitled ‘Living forehead and neck of migraine individually - except the nose. In a fol- Donor Kidney Transplantation patients can reduce migraine low-up, these patients were asked 2003: Looking to the Future’, attacks, according to Dr Bahman whether they still had migraines. When the answer was affirmative, he sponsored by Fujisawa Guyuron, who presented his early findings, from a 5-year study, at the deduced the cause to be in the nose, Pharmaceutical Co Ltd, of Osaka, World Congress of Plastic Surgery in and those patients had surgery to Japan, which is conducting a Operating tables · Accessories Sydney, Australia. A year after 100 straighten bone separating nostrils, major global initiative to help the Surgical lights · TV systems · Ceiling pendants patients received whilst the others had transplant community educate and this type of surgical surgery to remove rel- Patient positioning and transfer raise awareness of the issues treatment at the evant branches of the involved, and to encourage debate Muscle Functional furniture · Services Zeeba Clinic, trigeminal nerve - into all aspects of living donation. Cleveland, Ohio, 90 known to trigger Greater focus has been placed had reported hav- surgery cuts migraines. MEDICA 2003 · Düsseldorf/Germany on live-donation of kidneys as the ing no migraine Now the biggest number of those needing a trans- attacks - or far majority of the volun- Hall15C 23 plant far exceeds the number of fewer than before migraines teers (each formerly donor organs available. Indeed, as the surgery. averaging 15 transplantation has become more Dr Guyuron, a plastic surgeon, migraines monthly) have reported TRUMPF KREUZER and more successful, the numbers said that about four years ago, improvements or no migraines. ‘They Medizin Systeme GmbH + Co. KG and types of people who are now when two patients reported having have seen at least a 50% reduction in Benzstrasse 26 · D-82178 Puchheim considered possible candidates to fewer attacks after ‘brow lift’ treat- the severity of migraines. Some have Telephone +49 (0) 89 / 8 09 07-0 benefit from a transplant has ment with Botox to paralyse muscle, no migraines at all now,’ said Dr Telefax +49 (0) 89 / 8 09 07-20 grown, and demand for donor he checked on 314 people who had Guyuron. ‘Botox effects are also received this treatment and only temporary. We hope e-mail [email protected] organs is expected to continue to exceed organ availability. found that 39 of the migraine suf- surgery will be more ferers said they still regularly suf- long-lasting and per- TRUMPF Medizin Systeme GmbH The latest data (end of 2001) fered migraines, but 31 said their haps even perma- show that 52% of donors were liv- Carl-Zeiss-Strasse 5 · D-07318 Saalfeld headaches had ceased after the nent. The worst ing donors and that the number Telephone +49 (0) 36 71 / 5 86-0 injection. He speculated that scenario is that increased by an average of 12% Telefax +49 (0) 36 71 / 5 86-1 65 migraines occur in many cases the patient will each year in the previous five e-mail [email protected] because of a trapped or pinched look better,’ he years, compared with 2% from nerve in any one of four areas - fore- added. deceased donors. By contrast, dur- head, temple, back of the neck ing the same period the number of or nose - or in more than one of www.trumpf-med.com patients on the cadaver organ those areas. waiting list increased by 11% per In a small trial, over a three- annum (2002 Annual Report of month period, he used Botox to the US Scientific Registry of

12 CARDIOLOGY

besity increases the risk adverse outcomes than normal researchers also found that Automatic valve of heart disease by weight patients’ - and, overweight patients were at checks via matrix- raising blood pressure interestingly, they were less likely particular risk. Oand levels of LDL than normal weight patients to The team examined the impact cholesterol and triglycerides, and require a transfusion. of the diluting process on kidney array transducer reducing HDL cholesterol. In Indeed, an unexpected finding efficiency. They examined over addition obesity can provoke left was that underweight CABG 1,400 bypass patients, comparing technology ventricular hypertrophy - an patients showed a higher risk of the percentage concentration of abnormal thickening and death or complications than red blood cells (haematocrit) after enlargement of the left ventricle - normal weight patients. dilution with levels of creatinine in which could lead to heart failure ‘It is as safe to operate on obese the blood. When functioning etc. And when obese patients need patients as normal patients,’ Dr normally, the kidneys remove this cardiac surgery, their condition has Angelini concludes. However, he chemical from blood, secreting it been considered a greater risk factor for complications and even death. However, according to a new study, obesity does not lower the patient’s chances of surgical A diagnostic tool, Flow Navigator, checks cardiac valve function using a success. search beam generated by an ultrasonic matrix-array probe to scan the Dr Barnaby Reeves, at the heart three-dimensionally and, via high-frequency Doppler signals, London School of Hygiene and analyse the power/velocity of blood flow through the valves Thus the Tropical Medicine and surgeon Dr Obesitypointed out that the study only navigator can automatically detect valve damage and help decide the Gianni D. Angelini at Bristol looked at surgical outcome - it did optimal time for surgery. University have evaluated the not address the overall negative No big deal in In addition to providing a simplified and more accurate method for effect of obesity - specifically body health effects of obesity itself. the assessment of heart valve disease in clinical practice, Thomas Buck mass index - on the outcome of However, in a different study, bypass surgery - PhD, at Essen University, reports that this approach provides a further coronary artery bypass graft carried out in the USA, obesity diagnostic application of the new matrix-array transducer technology. (CABG) surgery, and reported was a risk factor - in blood but blood thinning E-mail: [email protected] their findings in the Journal of the thinning during bypass surgery. American College of Cardiology is a threat (20/8/03). Blood-thinning risks The team looked at results from About one in 12 bypass patients in urine. The researchers found the Stopping the heart safely 4,372 cases of CABG from April suffer kidney damage as a result of lower the concentration of red 1996 - September 2001. Three blood thinning during major cells, the higher were the creatinine Substitutes for potassium ions percent were underweight (BMI cardiac procedures - when a heart- levels - which was particularly Australia - Although many cardiac surgical procedures are now carried less than 20); 26.7% were of lung machine is used. About 2% noticeable in overweight patients. out without stopping the heart, the use of alternative drugs to potassi- ‘normal’ weight (BMI 20-24); end up on dialysis. ‘This is the first report um ions would help during surgery on the inside of the organ. In experi- 49.7% were overweight (BMI 25- When heart function is stopped highlighting the association of ments, two drugs - adenosine and lignocaine - have now been used to 29); 17.1% obese (BMI 30-34); for surgery, the need for haemodilution during bypass stop the heart by a research team at James Cook University (due for pub- and 3.6% severely obese (BMI oxygenation is reduced, then surgery with acute injury to the lication in the Journal of Thoracic and Cardiovascular Surgery). 35+). The patients were monitored blood thinning, when the blood’s kidneys,’ Dr Stafford-Smith said. Potassium ions work by interfering with the movement of chemicals in for infection, respiratory and usual 36-40% of red cells is ‘Our findings question the wisdom tissues that generate electrical activity in the heart, and so beating stops. neurological effects, length of time diluted to 22-26%, is used to help of tolerating the lowest levels of However, potassium doses can cause permanent damage. In rat experi- in intensive care unit (ICU) and prime the heart-lung machine and haematocrit during bypass ments, when their hearts were flooded with potassium for two hours the hospitals - and early death. also reduce the risk of blood clots. surgery.’ only about 50% began to beat again. However, when perfused with The study pointed out that However, thinning, achieved with The use of donated blood adenosine and lignocaine for four hours, all the animal’s hearts began to obese patients were ‘less likely to a saline solution, could harm the instead of saline also could prove beat - although showing just 70% of earlier ability. Additionally, in an be selected for surgery than kidneys, according to a new study harmful. The researchers suggested experiment involving a dog, one five-minute infusion of adenosine and normal weight patients’. However, by Dr Mark Stafford-Smith and that redesign of heart-lung lignocaine stopped the heart for an hour and later it began to beat spon- they found that ‘overweight, colleagues at Duke University machines, so they would need less taneously, seeming to work as before. Another advantage was that, obese, and severely obese patients whereas the body is generally cooled for open-heart surgery, the dog’s Medical Centre, USA (pub: Annals fluid, could be one solution to were no more at higher risk of heart had been maintained at body temperature. of Thoracic Surgery). The reduce this risk. Open-heart surgery Patients prefer being awake he use of an epidural, instead of Ta general anaesthetic, in open- heart surgery has been practiced in Britain for the first time, although the technique, pioneered in Turkey three years ago, has been adopted in other EU countries and the USA. Consultant cardiac surgeon Mohamed Amrani and team at the UK’s renowned Harefield Hospital, have operated on several heart disease patients, administering an epidural at a level similar to that received by women undergoing cae- sarean sections, and patients remain wide awake during the procedures. Mr Amrani said the time in which these patients recovered is impres- sive and pointed out that discharge is earlier than after general anaesthetic - in days rather than a week. Although lack of training in epidural administration - and the need for larger randomised controlled trials for use in other cardiac surgery - will limit the use of this ‘wide awake’ option in most hospitals, Harefield Hospital will now offer suitable coronary artery bypass patients the choice of staying awake during their operations.

EUROPEAN HOSPITAL Vol 12 Issue 5/03 13 NEWSCARDIOLOGY

Drug eluting stents stabilise tudies have shown that the diseased coronary arteries and use of a drug eluting stent release an active substance to S(DES) - which releases active Drug eluting stents prevent unwanted cell growth agents prevent cell growth at the don’t want to use conventional Now Aktion Meditech, comprised site - to treat arterial stenosis, has stents any more. Can you imagine of physicians, patients, scientists and resulted in a significant reduction what it means to a patient if you companies, and ‘...working to create in restenosis cases. Underlining the spare him bypass-surgery?’ said more patient-oriented healthcare benefits of their use, Dr Fabian Professor Eberhard Grube, policies’, is asking for reimbursement cardiologist at KH Siegburg and a models to be reshaped so that as Time member of the German group many coronary heart disease (CHD) Aktion Meditech. patients as possible can be provided However, because a DES costs with this new technology. ‘Currently for policy more than non-drug eluting the TKK (one of the biggest German versions, arguments continue about sickness funds) is testing whether changes reimbursement for their use - and, using drug eluting stents can even Stahl, one of the first cardiologists in general, only risk groups, such as reduce costs in the long run, because to participate in a pilot project diabetics or patients with small follow ups are reduced,’ said Aktion

using DES, said: ‘Usually you see vessels, receive them. Meditech, Aktion Meditech DES from patients with coronary heart disease over and over. But those who receive a DES only come once to the catheter lab. More quality of life and less costs for follow ups - you couldn’t think of better arguments for a new technology.’ The use of non-drug-eluting stents has shown 25 % restenosis in patients, within six post- operative months. This means angioplasty must be repeated, and often bypass-surgery becomes necessary. ‘With data like that you Heart failure

The value of resynchronisation Vienna, Austria - Heart failure affects over 5 million Europeans and over 600.000 new cases are diagnosed annually in Europe alone. This is therefore one of the major causes of hospitalisation, yet, despite improvements in pharmacotherapy, the disease retains high rates of hospital admissions and mortality, as well as poor quality of life. At the European Society of Cardiology Congress (ESC) in September, a computerised health economics model, developed on behalf of the Eucomed Cardiac Resynchronisation Therapy (CRT) Uniting to Steering Committee and titled ‘Cardiac Resynchronisation Therapy in Heart Failure - A Model to Assess the Economic Value of this New Technology’ was presented. This demonstrated that in Germany, for example, average savings from using CRT amount to 3300 euros per patient in the first year of treatment and hospitalisation days could be reduced by 90%. The model Evolutionize explores the cost-effectiveness of CRT compared with traditional Experience pharmaceutical treatment for heart failure, and enables similar conclusions to be drawn for other European countries. Besides the favourable economic outcome, patients undergoing this treatment also benefit from improved quality of life, Eucomed added. Visit our booth ‘Innovation in medical technology November 19.–22., 2003 today brings considerable benefits to Düsseldorf, Germany the patient and contributes to better, Hall 11 / 11 J 39 faster, higher quality and cost-effective healthcare. The European Commission should encourage and actively promote equitable and time- ly patient and clinician access to life- saving and life-enhancing medical technology in the European Union,’ said Maurice Wagner, Director General of Eucomed, which has worked for a year and a half with . / . . . five major pacemaker manufacturers Emergency Care OR Anesthesia Critical Care Perinatal Care Home Care to elaborate the CRT model.

14 EUROPEAN HOSPITAL Vol 12 Issue 5/03 CARDIOLOGY

Sharps injuries examples). Highly effective Aktion Meditech is also warning of protection is given from MORE WOMEN DIE OF STROKE THAN MEN the dangers of using unsafe innovative medical products that Geneva, Switzerland - Stroke kills of Cardiology (ESC) Congress, in products that cause injury, such as aim exactly at these precarious 400,000 more women than men August. sharps and/or sharp instruments, situations, for example canulas annually - yet 6 out of 10 ‘While most people think of with the potential to cause hepatitis with a safety-shield that is easy to physicians said they believe men cardiovascular disease as a man’s B or C or HIV. activate and safety catheters that are more likely to die from a problem, the truth is that both sexes ‘New medical products with almost fully eliminate the contact stroke, according to findings in suffer just about equally, but for a integrated safety mechanisms with the patient’s blood the ‘Global Reality of Attitudes variety of reasons cardiovascular provide effective protection,’ the American studies show that on Stroke Prevention and conditions, such as stroke, are more group says, advising that those who using such safety products would Hypertension’ (GRASP) survey, often fatal in women than in men,’ are responsible in the healthcare avoid 84 % of all sharps injuries! compiled from 825 primary care said Janet Voûte, CEO of the World sector for protecting users and This is also economically physicians in eleven countries Heart Federation (WHF) which, with patients should use those products. important, because sharps injuries (France, Germany, Italy, Spain, Merck & Co Inc sponsored the survey ‘84 % of infections are avoidable - are causing consequential costs of United Kingdom, Canada, to ascertain physicians’ perceptions on using safety products. Sharps several 100 million Euros Mexico, Sweden, Turkey, South hypertension management. That injuries often happen after taking annually!’ Korea and South Africa) and general misconception among blood or giving infusions (concrete www.aktion-meditech.de presented at the European Society physicians, plus other findings from

the survey were highlighted during this year’s World Heart Day (also sponsored by WHF). According to the World Health Organisation (World Health Report 2002), 11% (2.9 million annually) of women’s deaths result from stroke, compared with 8% (2.5 million annually) of men’s deaths from stroke. Additionally, if women survive a stroke they are more likely to be severely disabled than men, according to Wolf-Maier K et al (JAMA 2003). ‘Cardiovascular disease is the largest single cause of death among women, accounting for a third of all deaths, Janet Voûte continued. ‘The understanding about cardiovascular disease in women needs to be raised to the same level it is for cardiovascular disease in men. We also want World Heart Day to serve as a catalyst to encourage women around the world to be proactive in preventing heart disease and stroke. Women must have discussions with their physicians about their risk factors - such as hypertension - and, if necessary, seek the best available treatments and/or make appropriate lifestyle changes.’ Hypertension and stroke - links are strong A common public perception is that the main risk associated with hypertension is heart attack, but hypertension is a major contributing factor in strokes. Additionally, a recent analysis published in the Journal of American Medical Association (JAMA) showed the prevalence of hypertension is much higher in a sample of six European countries (England, Finland, Germany, Italy, Spain and Sweden) than in Canada and the United States. This pattern strongly correlates with death rates from stroke in Europe (Roger J et al. Stroke 2003, 34: 1581-5.3). Physicians appreciate the fact that hypertension and stroke are strongly correlated. The GRASP survey indicates that 70% of physicians Together, we’ll transform knowledge into advanced solutions for you. believe all or most first strokes can be prevented by properly treating high In the complex world of medical technology, proven experience and expertise are critical assets. Now two leading players – blood pressure. The majority of Dräger and Siemens – are pooling their resources at the acute point of care to offer you exciting new breakthroughs in healthcare physicians, 87%, also said they believe performance. Dräger Medical, the new joint venture, is committed to sharing its combined competence to anticipate and meet there is a need for improvement your needs. You will profit from increased R&D efforts generating the advanced solutions more quickly. From the integration of regarding the treatment of hypertension and its consequences.’ processes and the seamless flow of information at the acute point of care. From dedicated sales and service teams worldwide. ‘It is encouraging that physicians are From education and training tools that help you get higher performance from your therapy devices. All these benefits are made concerned about preventing stroke in possible by the unique, new constellation that is Dräger Medical. Day after day, the experience of two leading innovators will be hypertensive patients,’ said Professor Massimo Volpe, hypertension expert at your fingertips, launching a new era in care. and professor of cardiology, Join the evolution at www.draeger-medical.com Department of Medicine and Pathology, University of Rome. ‘Now we need to ensure that they also appreciate that women are just as much at risk of having a stroke as A Dräger and Siemens Company men. Therefore, women as well as men need to be evaluated and treated appropriately, using evidence-based medicine, to reduce their risk of Because you care having a stroke.’ Details: www.worldheartday.com

EUROPEAN HOSPITAL Vol 12 Issue 5/03 15 LABORATORY & PHARMACEUTICALS

Micro-systems technology used for molecular detection has already resulted in DNA-arrays and biochips being used extensively in genetic, disease and drug research Particles used in nanotechnology are gy features as one of the thematic priori- the US of this work: ‘The US is way ahead and invisible to the human eye - one ties and has been allocated a budget of so won’t lose anything with a slow deceleration nanometre being one billionth of a metre. 1,300 million euros for the years 2003-6. and it could buy time for an international agree- A human hair is 80,000 nanometres wide. Within the Commission, the Head of Unit ment on limits [to such technology].’ for nanotechnology, Renzo Tomellini, Pat Mooney, Executive Director of the action Nanotechnology can therefore produce explained that the Commission’s aim in group on erosion, technology and concentration smaller, stronger products. But shouldn’t funding such research is to create new (etc) underlined the need for deceleration and economic opportunities and improve liv- investigation. ‘Do policy makers know this tech- we assess the dangers before racing ing conditions for Europe’s citizens. He nology is coming?’ he asked. ‘Most have no idea towards finding increasing uses recognised concerns about the implica- - and it’s here.’ Governments, he added, are run- for this in our everyday lives? tions of this technology, and stressed that ning around five years behind time in terms of if a danger is perceived, it should be inves- assessing the potential impacts. ‘As much as ‘Innovation is running ahead of regulation,’ tigated. health and environmental concerns must be a said Dr Caroline Lucas,UK MEP, during Groups of scientists are Jurgen Altmann, University of priority, there is a desperate need to look at the Dortmund, drew attention to the possible effects on and control of the economy,’ he the first international seminar on the working independently. impact that nanotechnology could have on pointed out. Nanotechnology will mean that the societal impacts of nanotechnology They must talk! military operations. Research is already raw materials that we currently consider essen- (European Parliament in June). being conducted by the military, and has tial will change, and this will have a dramatic

hilst those working in nanotechnology recognise future benefits, most others at the seminar Wexpressed various concerns about the impact of this new technology on human health and the environment, its effects on international trade and developing countries, Nanotechnology and the possible proliferation in armaments. In summary, the over-riding concern was: we do not know what the impact of nanotechnology will be, and therefore should have a Decelerate research! moratorium on aspects of its use as well as size. Pointing to concerns about particles been since as early as the 1980s. There has effect on developing countries, many of which research. between 65 and 200 nanometres in size he been a recent increase in such activity, partic- rely on the export of raw materials. ‘I am not against new technologies, but said toxicity increases as the size of the parti- ularly in the US, said Dr Altmann, pointing Vandana Shiva, from the Indian Research want to be sure about their impact,’ Dr Lucas cle decreases. ‘Another worry is where the out that US researchers are working on battle- Foundation on Science and Technology criti- pointed out. ‘The minimum we need now is a particles go within the body,’ he added. We dress that would protect soldiers from radia- cised the way in which some countries are moratorium on products applied to the skin.’ know from pharmaceutical companies that tion as well as become a compress when a sol- being told that they must become nano-adapt- Most people do not realise that products putting a drug on the back of a nanoparticle dier is injured. Other innovations could ed or remain underdeveloped. ‘The way in developed by using nanotechnology already can increase the delivery of the drug to the include the facilitation of surveillance, bombs which nanotechnologies are being presented is surround us - face creams and sun lotions, for brain. ‘If it [the nanoparticle] can get to the the size of a pen that could flatten a whole a betrayal of the science on which they are example, which can pass through the skin brain, I see no reason why it wouldn’t get to city and, most worryingly for Dr Altmann, based,’ she also added. ‘At a time when science and potentially be mutagenic and cancerous. the foetus.’ Dr Howard called for more the manipulation of the human body to make allows us to see the world in a deeper way, the Toxicologist Vyvyan Howard (University of research on such implications and for scien- soldiers more stress-tolerant, to repair injuries quantums are brushed aside.’ Liverpool, UK) reported that nanoparticles tists to work together: ‘Groups of scientists more effectively and to speed up reactions. Dr Pat Mooney was also concerned about the can pass into the body in three ways: inhala- are working independently. They don’t seem Altmann is also concerned that once such impact on intellectual property, because it is tion, ingestion, and transdermally. ‘Breathing to be talking, and I think they must.’ technology has been used by the military, conceivable that a single patent may have dom- in very small particles has toxic effects, and it One way of increasing such collaboration is transfer to civilians will be a natural step. He inance over many industrial sectors by covering doesn’t seem to matter what they’re made of,’ through the European Commission’s Sixth called for a moratorium on non medically-dri- the fundamentals of all matters. ‘This avoids he said, adding that the important thing is Framework Programme, where nanotechnolo- ven implants, as well as a slowing down by most of the debates which have taken place on patenting life because it goes below the level of life - which concerns the ownership of nature.’ DRUG SALES INCREASE 180 He also warned that, ‘the coalition between

Constant exchange % growth industry and government will get worse. It will 160 From June 2002 to May 2003 drug retail sales The top 5 corporations in the year to May 2003 Value US$ Bill protect the interests of what they say is society, 140 increased by 6% in 13 key countries, closing at in order continued to be: 1: Pfizer 2: % Growth but what they mean is industry.’ US$289.5 billion, according to IMS Health, the GlaxoSmithKline, 3: Merck 4: AstraZeneca 5: 120 `Pointing to different ways in which researchers are handling nanoparticles, he said, global healthcare information company. The Novartis. 100 IMS Retail Drug Monitor covers direct and these are justification for decelerating and tak- 80 indirect pharmacy channel purchases from European Pharmaceutical Pricing ing stock of nanotechnology. While scientists in

US$ Bill South Africa handle nanoparticles as if dealing wholesalers and manufacturers in 13 key Pricing for pharmaceuticals in Europe is becom- 60 with the AIDS virus, other researchers wear countries. Sales figures are at ex-manufacturer ing increasingly complex. Government-led cost 40 prices and include all prescription and certain and volume containment measures and increases only a ‘Japanese subway mask’ as protection. over-the-counter data. Figures include sales in the volume of parallel trade have all con- 20 ‘It’s like wearing a volleyball net to keep out from the hospital sector in Japan and mail tributed to European pharmaceutical growth lev- mosquitoes,’ he said. order in the USA. els at less than 8% in 2002 (versus world growth North Europe Japan Douglas Parr, chief scientist with Greenpeace America above 8% and US at double-digit levels). Is the in the UK, compared the nanotechnology con- In the 12 months covered, sales in the top five European pricing model outdated or can and try’s Department of Health appreciates both the troversy with the debate on genetically modi- European markets showed a 5% constant should the US continue to be the mainstay for value that genetics and personalised medicine fied organisms (GMOs). Policy makers’ consid- exchange growth - up on last month’s survey, with future growth? may add to the provision of healthcare in the eration of GMOs was originally very narrow, Spain again the best performer at 10% growth. An in-depth review by Janice Haigh, at IMS UK, and the importance of long-term planning in he said: The overall lesson should be that poli- Low growth rates for Europe compared to our sur- Consulting, looks at reasons why European phar- realising this value. cy must not be composed by small groups of veys in 2002 are attributed to French price cuts & maceuticals pricing strategies are failing. From The press focused on the social and ethical experts and bureaucrats, he added, calling on re-imbursement changes in France and Italy. corridor pricing (with its minimal impact on the implications of this - such as the impact on insur- the EU to act as a technology facilitator with a ● North America posted an 11% sales growth at growth of parallel trade and potentially revenue ers. However, a further and equally critical ques- user or civil society forum. $159.8 billion in sales in the 12 months to May, the limiting effects), to the effects of organisations tion is the impact on healthcare infrastructure in Last June, the UK government had already same as our last survey. The Key therapy growth such as NICE and the justification of price differ- adopting and applying that technology. Guy requested a study on the potential benefits and area for North America was the Central Nervous ences within the EU as differential in ability to Bate, of IMS Global Consulting, reviewed the problems. System group with a 14% growth in the same peri- pay (Ramsey pricing). IMS argues that Europe is White paper and its potential impact both on However, despite the many reservations od. USA growth remained at 11% for the year to becoming increasingly important - not only and for the pharmaceuticals industry. about nanotechnology (including the fear of May 2003. because an expanded EU represents 450 million, The UK’s Department of Trade and Industry is autonomous self-replicating nanorobots), a By therapeutic category the biggest increase but that, increasingly payers globally are looking exploring the impact of such issues on industry number of potential benefits were acknowl- worldwide continues to be in the Cytostatics to Europe for guidance on price and pricing pol- (report due shortly). Guy Bate said individual edged. Products such as self-cleaning trousers group all with a sales growth at constant icy. Janice Haigh concludes that the answer is to companies also need to consider the implications and crack-resistant paint are already marketed, exchange of 14%. radically alter the way prices are perceived and now, and he highlights the impact of person- and future applications could enable removal The single largest therapeutic sub category in set by moving to a value-based pricing approach, alised medicine on pharmaceutical commerciali- of miniscule contaminants - including green- dollar sales continues to be the C10, hypolipi- in which drug prices would be set and flexed sation strategies (including market fragmenta- house gases in the atmosphere. demia, class selling $20.5 billion with a growth of according to stakeholder perception of their tion and ‘niche-ing’), the hurdle or stimulus for In conclusion, Dr Lucas recommended that 13% in the 12 months to May value and that price. new therapy adoption represented by genetic policy makers ensure they are asking the right 2003. 66% of the sales of this class are in the US Details: [email protected] screening and the need for diagnostic processes, questions, and stressed that ‘the most immedi- and 20% in the leading five European countries. as well as challenges for clinical development for ate priority is to prevent those who have the ● The best selling drug for the 12 months ending Genetics - realising the future of the NHS new therapeutics for a genetically targeted most to gain - big business - from beating the May 2003 was still Lipitor, worth over $8 billion, June saw the publication of The UK government’s group. regulation race’. This, she said, is unlikely to which showed the highest growth at 16% in the White paper - ‘Our Inheritance, Our Future - Details: [email protected] happen in the EU without huge pressure, and called on the Commission to mainstream safety top five. The five top drugs are 1. Lipitor 2. Zocor Realising the potential of genetics in the NHS” Source: IMS Health, IMS Retail Drug Monitor. concerns. 3. Losec 4. Norvasc 5. Prevacid (Ogastro). (published last June) demonstrates that the coun- www.imshealth.com Links: www.cordis.lu/nanotechnology and www.etcgroup.org

16 EUROPEAN HOSPITAL Vol 12 Issue 5/03 LABORATORY & PHARMACEUTICALS

are being produced on a laboratory that matches it - and the Nanoparticles to deliver drugs scale. With these, simple proteins nanoparticle will bond to the (oligopeptides) are created to site,’ explained Professor project named TATLYS, thrombolytic drugs, but these can more cost-effective, and you get match specific sites on fibrin mole- Chiellini. ‘Choosing different led by the scientific co- cause serious side effects (e.g. fewer side effects.’ cules in a clot. Combinations of polymers to make the nanoparti- Aordinator Professor Emo haemorrhage) if given systemical- Supported by the EU, the nanoparticles, oligopeptides and cles allows us to release the drug Chiellini (University of Pisa) is ly. ‘Given orally they partly break TATLYS project is studying surface drugs will be tested to ascertain either in a short burst, or slowly developing a system in which down, so efficiency is reduced,’ chemistry and is using nanoparti- which produce the most effective over a period of time.’ biocompatible nanoparticles Prof Chiellini pointed out, adding: cles for drug delivery. Prepared fibrin targeting and drug release, as The EU has contributed 2.14 carry drugs and target them to ‘If you protect them with a from biocompatible polymers, well as their stability and possible million euros to the project, and break down blood clots - which nanoparticle, they can be delivered nanoparticles containing urokinase toxicity. research contributors are based are made up of the insoluble pro- directly to the specific site. We use ‘Knowing the structure of the site in academic centres in Italy, the tein fibrin. The usual treatment is less material; the treatment is on the fibrin, we design a peptide UK, Czechoslovakia and Israel.

Increased malignant Recent mergers of large laboratory With a research budget of Western Europe Sun creams warning diagnostics firms may be at a stand- should also melanoma still since the Bayer/Chiron and about 2-3 billion euros have a positive 13-year British study indicates that sun creams may not risk Roche/Boehringer mergers, but globally, the laboratory impact. protect against skin cancer - and worse - may actually increase risk of the disease. The study by Professor Roy large companies keep a keen eye on diagnostics industry is Further im- A smaller start-up companies that may provements can Sanders and colleagues, published in the October issue of the Journal of present new methods developed one of the most be expected from new Investigative Dermatology, was carried out by a medical research charity, the during university research pro- research-intensive sectors. diagnosis related groups (DRG) Restoration of Appearance and Function Trust (RAFT), based at Mount Vernon Hospital, London, UK. grammes. The resulting small firms Internationally, among some 800 accounting procedures, which will either find their niche in the labora- boost laboratory diagnostics because The researchers warn that using a sunscreen could increase the risk of tory diagnostics market or are taken companies the ten largest firms share improved diagnosis enables better developing malignant melanoma - the most aggressive and potentially fatal over - for example, Igen by Roche 85% of the market turnover - 23 billion treatment and ultimately saves costs. form of skin cancer. The team said British consumers were and Visible Genetics by Bayer. This euros. In this field, developments in This transforms the laboratory from trend is expected to continue. a mere cost factor into a means of staying out longer in the sun while using Examples of new technologies industrialised nations are much the production that can generate high-factor sun creams that protected entering laboratory diagnostics same, so Germany can be used as a income for hospitals. against UVB radiation and prevented burning. But the same creams offered include nanoscale sensors, genetic yardstick for expansion: Product registration and licens- chips and proteomic chips are exam- ing has also improved interna- almost no protection against the invisible ples of new tech- tionally. In the damage caused by the more penetrating UVA nologies entering past, every country rays, despite assurances on the bottle. laboratory diag- in Europe had its Claire Linge, head of cell biology at Raft, nostics. Genetic LABORATORY DIAGNOSTICS own licensing sys- said her team tested three high-protection chips are already in tem. However, from sunscreens on skin discarded from surgery. use in some areas, 7 December this Although the sunscreens claimed to offer and will become year, Europe will protection against UVA, tests showed UVA particularly impor- a growth market have a unified regis- radiation penetrated the skin even when tant in early diag- tration and licensing creams were applied in the recommended nosis of genetic illnesses and By Rolf Haker system, so export problems should amount. UVA, once believed to be less tumours. Proteomic chips and become history. Efforts to achieve harmful than UVB, is now thought to cause the release of free radicals, which nanoscale sensors are still in early * The German Association for the bilateral arrangements and mutual stages of development, but are also recognition of licensing systems with damage DNA and cause melanoma. expected to become an important. Laboratory Diagnostics Industry countries outside the EU are also Dr Linge said: ‘We found the protection The introduction of personalised was founded in 1975 with just 13 underway, already with encourag- against UVA was the equivalent of only sun medicine is another area of interest. members and a turnover of ing developments with protection factor 2. The non-education of Before licensing, all new drugs must around 150-200 million euros. some countries, although the public is worrying. You don’t have to be tested on patients, which Today this association has 75 an agreement with the go red to have UVA damage.’ includes continuous testing to USA’s FDA probably will RAFT is in discussions with members and represents 95% of manufacturers about funding research into a ensure effectiveness and safety. the country’s laboratory be difficult. (One example is the HER2 test, Freedom of movement new additive to protect against UVA, which which is required for the use of diagnostics turnover - which last between EU member states has not could be available within a year. Manufacturers claimed their Herceptin). year amounted to around 1.7 yet resulted in a unified reimburse- products were safe but agreed to conduct further research. There is also a trend towards non- billion euros. ment procedure for tests. The reim- No discussion was made of the beneficial effects of UVB in generating invasive examinations, which do not bursement structure is still controlled vitamin D, critical in the update of calcium in the body, nor of the effects of require blood sampling. This is par- patients’ demands for better, faster by national committees - in Germany diet on susceptibility to sunburn. Report: Simon Best MA ticularly important for the advance- health service and diagnosis mean by the German General Medical ment of ‘near patient testing’. At that laboratory testing in surgeries Council. Whereas generally we can present, only the determination of will become more important. In be optimistic about developments of blood glucose levels is of economic industrialised countries, the estab- new laboratory procedures and the Chemotherapy nausea importance. However, current lishment of large laboratory units has worldwide laboratory diagnostics research should lead to procedures led to a decrease in the cost of single market in general, in Germany hopes Aprepitant blocks NK1 receptors and prevents vomiting reflux to determine other parameters. tests, but unfortunately customer ser- for new products may be more pes- An international clinical trial involv- Paul Hesketh at the Caritas St. Recently a new cholesterol test that vice has deteriorated. simistic. Important tests such as ing 520 patients with respiratory Elizabeth’s Medical Centre, Boston, determines parameters directly from The reimbursement structure has Viruslast for HIV and Troponin took cancers and being treated with USA, who led the 520- patient the skin was been introduced. also had a negative impact on the four years and eight years respective- chemotherapy, has shown that only study, said that, in almost a decade Apart from near patient testing, laboratory diagnostics industry in ly to be included in the approved list 26% percent of those who received this is the first substantial advance direct testing on patients - point of many industrialised nations because of treatments. aprepitant - along with the standard in prevention of nausea and vomit- care testing (POCT) by doctors and the payment for tests has been antinausea/vomiting drugs dexam- ing related to chemotherapy. other medical staff - will increase decreased - leading to enormous Conclusion: We can state that in the ethasone and ondansetron - experi- Cisplatin - Of those patients given significantly. Although predicted competition in this area. The future the diagnostics industry is set enced the side effects. 48% of the aprepitant plus the usual suppres- growth rates of 20-30% per annum turnover for laboratory diagnostics to experience a healthy growth, patients who were given a placebo sor drugs (which work on another have not yet been achieved, the firms over the last few years has been based on: with the standard drugs did suffer family of receptors in the brain) 25 annual growth rate will definitely be weak, and in some countries is even ● New technologies leading to quick- nausea and vomiting. Additionally, a percent of those receiving the in two figures. turning downward. However, for the er/better testing, even for new dis- Small, handy equipment to carry next few years an upward trend is ease markers separate Dutch study of 164 patients common chemotherapy drug cis- out tests quickly and safely is being predicted, mostly attributed to meth- ● New therapies need intensive diag- - led by Dr Ronald de Wit, at the platin, complained of nausea and developed. These machines will ods such as POCT/OTC and the new, nostics Rotterdam Cancer Institute, the vomiting. Those on the placebo adhere to quality assurance require- predominantly molecular-biological ● A focus on keeping populations Netherlands - showed that 73% of reported those symptoms 44% of ments, store results and can be con- approach. These new procedures will healthy leads to a growth in pre- the Boston patients given aprepi- the time. After six courses of cis- nected to central processors as and also bring better pricing and so ventive diagnostics tant did not suffer vomiting on the platin, 59% did not experience the when required. improve the situation in that indus- ● Strong growth in POC and OTC day of chemotherapy. 52% of those symptoms if given aprepitant, but The problem with these methods, trial area. markets due to demands for on the current standard treatment 34% on the placebo with standard apart from the need for blood sam- The expansion of healthcare ser- instant results alone did not. Aprepitant was effec- therapy did. pling, is the unfavourable reim- vices in many fast-developing nations ● Development of healthcare mar- tive from day one, and proved effec- In March, following earlier data bursement structure in many coun- should also impact positively on lab kets in the fast-developing nations tive four days after treatment, when from these studies, plus a separate tries. In some, the tests are currently diagnostics turnover. The predicted ● Harmonising of licensing require- nausea and vomiting frequently one which took place in Latin either not reimbursed at all or only growth rate for some countries in ments leading to fewer export bar- occur in those receiving repeated America, the US Food and Drug by very little, so there is no incentive South America, as well as China and riers chemotherapy. Current treatments Administration’s (FDA) approved ● for doctors to use them. In others, India, approaches 20% per annum. Introduction of DRG (diagnosis to control these symptoms tend to the use of Emend - Merck’s version doctors are not even allowed to per- The alignment of central and east related groups) in industrialised become less effective during contin- of aprepitant. (Ref: Journal of form these tests at all. However, European countries with the level of nations uing chemotherapy. Clinical Oncology).

EUROPEAN HOSPITAL Vol 12 Issue 5/03 17 ORTHOPAEDICS 6-13 November erugia, Italy - An overview of of plating vs. external fixation Specialist course Elbow injuries and current treatment of pilon fractures. Paediatric Elbow Fractures Sanjeev Poptions for complex extremity ● Identify treatment options for Sabharwal MD: Fractures of the trauma will be presented in a course dealing with bone and soft tissue Complex extremity trauma Radial Head and Neck: Excision, organised by the Department of loss. ORIF, Prosthesis John Capo MD; Orthopaedics, New Jersey Medical The intensive, four-day course, Femur & Knee Shoulder & Humerus Distal Humeral Fractures Prof. School North Jersey, USA. given by US and Italian experts, Distal Femur: Physis Sanjeev Acute Management and Modern Francesco Maggi; Olecranon Fractures The course directors are Professor will cover: Sabharwal MD; Extensor Treatment of Shoulder Instability Dr Filippo Randelli; Elbow Fred Behrens, who is Chair of the Dislocations, Hinged Fixators John Foot & Ankle Mechanism Injuries Louis Rizio Louis Rizio MD; Proximal department, and Professor Giannia MD; Distal Femur: Plates Humerus Fractures: Plating John Capo, M.D. Randelli, of the Orthopaedics and Talus Fractures Prof. Roberto Michel Oransky, MD; Distal Capo MD; Humeral Nailing: Traumatology Department at the Buzzi; Calcaneus Fractures Femur and Retrograde Nailing Proximal and Shaft Prof. Michel Bone & Soft Tissue Defects Policlino di Sand Donato Hospital, Michael Sirkin MD; Malleolar Michael Sirkin MD; Fracture Oransky; Humerus Shaft Fractures: Diagnostic Dilemma: Don’t Get Perugia. Professor Fulvio Pecorelli, Fractures Prof. Antonio Pace; after TKA Joseph Benevenia Plating, MIPO Prof. Dario Fooled Joseph Benevenia MD; of Perugia University and the Understanding Paediatric Ankle MD. Acute Management of Capitani; Radial Nerve, What To Osteomyelitis Michael Sirkin MD; Policlinico hospital will be local host Fractures Sanjeev Sabharwa, MD. Knee Dislocations Louis Rizio Do Dr Ettore Sabetta; Bone Grafting Options Fred Behrens during the programme, which, say MD; Antegrade Femoral MD; Bone Transport Sanjeev the organisers, will aid orthopaedic Tibia Nailing Dr. Ettore Sabetta; Forearm & Wrist Sabharwal MD; Soft Tissue Coverage specialists to: Pilon Fractures: Temporising Unstable Peritrochanteric Forearm Shaft Fractures Dr Nicola in Trauma John Capo MD. ● Recognize and understand trauma Fixation & Staged Plating Michael Fractures Fred Behrens MD; Annichiarico; Paediatric Forearm *Unrestricted educational grants have of the extremities, with treatment Sirkin MD; Pilon Fractures: Femoral Neck Fractures Prof. Shaft Fractures Dr Maurizio De been made by Merck-Italy and the options. Definitive External Fixation Prof. Marco D’Imporzano; Pellegrin; Distal Radius Fractures, Krugman Group International Inc. ● Evaluate and manage paediatric Federico Santolini; Tibial Plateau Haemiarthroplasty Failures: External Fixation Prof. Federico Details: http://ccoe.umdnj.edu/ccoe/italy/. fractures. Fractures: Plating Prof. Max What To Do? Prof. Marco Santolini; Distal Radius Fractures, Registration: Course code: 04MN08. ● Effectively manage tibial plateau Morandi; Tibial Plateau- D’Imporzano; Fracture after Plating Prof. Pietro Regazzoni; Fee: $850 http://pluto.umdnj.edu/educa- fractures. Percutaneous Techniques Fred THA Joseph Benevenia MD. Galeazzi Fractures and DRUJ tion/coneducation.asp (Click on ● Compare and contrast techniques Behrens MD. Injuries Prof. Antonio Pace. Physician CME icon).

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Trade-Fair Knee and hip DGO/OC Berlin wo new innovative NEW therapy Booth 86/06 products - the AEQUOS PRODUCTS Pulsed magnetic fields knee endoprosthesis and T Dr Goettfert Systems, which holds the VarioFit hip prosthesis system - world patent for developments in have been launched by aap pulsed magnetic field therapies for www.kuenzli-schuhe.ch Implantate AG, which specialises in mobile use in surgeries, clinics and at biomedical implants for bone fractures home, reports increasing demand (osteosynthesis), joint replacement (endoprosthetics) from surgeries and clinics, which ‘... and biological bone substitute (orthobiology). reflects therapists’ and patients’ inter- ‘AEQUOS, the firm reports, is the newest generation of est and satisfaction, and also high- knee endoprosthesis. The patented design of the lights the limitations of equipment replacement almost perfectly replicates the physiological previously available in this market. rolling-sliding movement of the knee joint. The rolling Business people, freelance profession- movement in the high-burden phase of the movement als, managers, sales reps and sports minimises abrasion and consequently wear of the people have ever busier lifestyles or endoprosthesis,’ Thus, AEQUOS solves the problems caused by are always on the move,’ the firm wear not only by the materials mix but by replicating the actual adds, ‘and despite needing treatment movement,’ the firm points out. ‘In addition, the construction of it cannot be performed in a surgery or the AEQUOS prothesis prevents hyperextension and thus supports at home.’ Künzli AG Schuhfabrik · CH-5210 Windisch · [email protected] the patient’s ligaments. The AEQUOS knee system has two The firm points out that its mobile Telephone +41 56 450 26 21 · Telefax +41 56 441 19 18 · www.kuenzli-schuhe.ch outstanding features: almost entire restoration of the natural G-ogo sport device is ‘...the ideal solu- movement of the knee joint and long durability. tion for this patient group. It combines The stability shoe ‘The Variofit hip endoprosthesis, with its combination of all the advantages of a professional pulsed magnetic field device with the for achilles injuries patented innovations and well-tried elements of hip endoprosthetics, sets a new standard for the patient-centred benefits of its mobility. Comfortable to restoration of hip anatomy. The wear and without needing power, it offers a wide range of convenient prosthesis’ hip shaft and four applications for patients and thera- different cones can be pists. adapted to the individual ‘Within a very short time we have patient’s anatomical become a consultant for orthopaedic requirements. This surgical specialists and a market leader for flexibility allows an almost pulsed magnetic field therapy sys- exact restoration of any tems,’ the firm adds. ‘Our expert team given hip anatomy as well as realises the dynamic and efficient compensation of an existing implementation of new developments malposition. VarioFit not only such as the patented G-ogo systems or adjusts different leg lengths but our G-support CD-ROM with a mix of also provides optimal muscle- courage, an entrepreneurial spirit and ligament load which helps minimise without external investors.’ Explaining spine problems. Even under complicated why it does not use intermediaries or a anatomical conditions the VarioFit hip sales force, the firm point out that it endoprosthesis allows normal load and provides relies on good recommendations from longer durability of the implant. doctors, therapists and patients: ‘... the aim and result of our work’.

continued from page 1 In June this year the government quickly’, and that by 2005 no one estimated, would save about launched a £50 million drive ‘...to should have to wait longer than six £12,000 and a two-year NHS eliminate long waits for NHS months for an operation. delay. (The same treatment, carried orthopaedic patients and boost The fund is to be invested in out privately in the UK would have capacity in the NHS, so that an NHS orthopaedic services includ- been about £20,000). extra 41,000 patients per year can ing those in NHS Diagnosis and Around one in four patients on receive an operation’. The Treatment Centres (DTCs) and will the overall NHS waiting list need Department of Health also pointed be spent on modernising theatres orthopaedic surgery. Historically out that, at the end of this March, and buying new equipment or orthopaedics is the specialty that 254,496 orthopaedic patients were upgrading existing facilities. has the biggest proportion of waiting for inpatient treatment in In figures covering all surgery patients waiting over 6 month for England - ‘a substantial fall of procedures, the NHS has shown a surgery (35% of the total) and almost 10,000 since last December’. considerable drop in number of those waiting 9 months (38%). By the end of 2004 the NHS predicts waiting longer than 12 months for Many of these are elderly, with that none of its orthopaedic patients an operation (from almost 22,000 poor quality of life due to pain and will wait more than 9 months, ‘ with on 31 March 2002, to 134 at 30 immobility. urgent patients being seen more April 2003).

18 EUROPEAN HOSPITAL Vol 12 Issue 5/03 COMPANY NEWS - EDUCATION

ermany - The non-profit London, Phoenix, Singapore, Münster Guests of honour: the students, they are united by their desire to and Nicolette Reuther. Nations HealthCareer School of and Vienna. You have willingly who were joined at the celebration succeed, their willingness to prove The current course – In October, GManagement gGmbH, based in accepted that paying your university by the board of examiners, Professor themselves, their commitment, and students from Ethiopia, Cambodia, Hennigsdorf/Brandenburg, was fees involves some opportunity cost. Roman Brandtweiner, Head of the their initiative.’ Germany, Indonesia, Iran, Kuwait, founded in cooperation with the Your spouses, parents and families MBA Centre at Danube University Their MBAs will, she added, equip Malaysia, Nigeria, Oman, Austria, Fresenius University Foundation for have all given you their support and Krems; Professor Ray Robinson the medical professionals to tackle Sweden and the United Arab Emirates, Healthcare Management in Bad made sacrifices as well. We would also (London School of Economics) and Dr management shortcomings in the as well as other countries, commenced Homburg and the co:bios Foundation like to pay tribute to their Christian Rauscher (Faculty of hospital sector and the business and the Autumn 2003 MBA in International for Biosciences mbH in Hennigsdorf. commitment’. Economics at the University of financial professionals to further their Hospital Management programme, Their aim is to bridge the gaps ‘You are the pioneers of this Vienna) Thomas Bethke, Managing know-how to cope with rapidly jointly offered by the HfB-Business between science, teaching and practice postgraduate training programme, Director of Co:Bios Foundation. Also changing fields - particularly in School of Finance and Management, in the field of hospital management which is unique in the world,’ she present were Dr Christian Ehler, technology-based industries. Frankfurt and Nations HealthCareer and to offer international, talented continued. ‘It links theory and Member of the Land Brandenburg Among future challenges is the School of Management. The18-months Parliament, and Andreas Schulz, academics an excellent foundation for practice, in eight attendance modules, globalisation of healthcare as well as MBA course is being taught by an Mayor of Hennigsdorf City, where a career in the international healthcare and places great emphasis on an commercial considerations, Ms Nations HealthCareer School of equally international team of professors entrepreneurial and international Moeller pointed out. Given all the market. Management is based, and many and experts in healthcare management. This October, the first intake of approach. We are immensely proud of others who significantly supported changes in healthcare delivery, due to Sponsorship of particularly talented students (Spring 2002) graduated with you, and would like to take this this postgraduate programme deregulation worldwide, future health students - who this year hail from an MBA in International Hospital opportunity to thank you for your managers will need to demonstrate Africa, Asia and the Middle East– were Management, an event celebrated at a patience, inevitably called for in your strong entrepreneurial skills. ‘They granted by the Co:Bios Foundation for lunch held at German Parliamentary role as the programme’s pioneers. must be open to international Biosciences, the Fresenius University Association, Berlin. ‘The students who followed you developments and solutions, and most Foundation for Healthcare Management Congratulating the graduates on have greatly benefited from your ideas importantly, they should establish and and other foundations. The English- utilise their own personal networks.’ language degree course, accredited by Ms Moeller also referred to the the FIBAA, consists of eight attendance international friendships formed, and modules as well as two e-learning MANAGEMENT GRADUATES said the intercultural sharing that sessions. During the 9-day international occurred at the university would form modules, running every six to eight a common bond and ‘… undoubtedly weeks and held in Germany, Finland, influence the way in which you deal Austria, the United Arab Emirates, celebrate success with teamwork and cooperation in Great Britain, Phoenix (USA) and Japan, behalf of the Nations HealthCareer and experience. In April 2004, the academic and industrial partners, future’. participants will learn about a variety of School of Management and its partner next international group of students companies and foundations, we will In her address, Ms Moeller also healthcare systems worldwide. organisations, Dagmar Moeller, will conclude their studies. The MBA offer the alumni and subsequent thanked all those involved in Excutive Director, said that the first degree course in International groups of students the opportunity to educational roles and in sponsorship, The next MBA in International Healthcare course, run as a pilot programme by Hospital Management which since expand their contacts further. who had ‘ensured that many talented Management programme: 30 April 2004 Danube University Krems in autumn 2003 is being conducted in Ms Moeller went on to point out young managers from countries with a Deadline for applications: 28 February 2004 cooperation with Nations cooperation with HfB Business School that students registering for the MBA low per capita income have a chance Further advice and information: HealthCareer, had proved its success. for Finance and management, offers course already had an academic to participate in this postgraduate Nations HealthCareer School of Management The graduates, who hailed from the students from Asia, the Middle qualification and often years of programme’. gGmbH, Palisadenstrasse 48, 10243 Berlin, Vietnam, Pakistan, Croatia, the East and Europe an even more professional experience in healthcare Gifts, including the book Germany. Phone +49(0) 30-467936 93/94 United Arab Emirates, Italy, Romania international programme with new – whether medical, pharmaceutical, ‘Management Across Borders’, were Fax +49(0) 30-467936 95 and Germany, had been motivated by modules and practical insights in medical-technical or health insurance presented to graduates Zia Bokhari; Email [email protected] the principle of learning for leading, Dubai, Rotterdamand Tokyo.’ and other administrative fields. ‘They Aglaia Frommholz; Dragan Juric; HfB - Business School of Finance and and had taken on a tremendous The group, she pointed out, is have up to ten years’ professional Oussama Kayali; Stephan Meister; Management. Mr Felix Müller, Director of challenge, involving: ‘enormous already regarded as a significant experience -three to five years are the Gudrun Mekle; Dafin Muranescu; Postgraduate Studies, Sonnemannstrasse 9-11, professional stress and a great deal of network of competence. As part of the minimum required for matriculation. Dagmar Powitz; Alexandra Simböck; 60314 Frankfurt / Main, Germany personal sacrifice,’ she pointed out. alumni activities which will begin in They are true professionals. And, Jürgen Sprekelmeyer; Elena Vanni; Phone +49(69) 154008-712 ‘You have attended modules in Berlin, Spring 2004, and which will involve despite their different backgrounds, Anh Duong Vuong; Claudine Ahrens Fax +49(69) 154008-728. Email [email protected]

ANAESTHESIA AND VENTILATION WELCOME TO MAQUET

MAQUET is one of the world’s leading suppliers of products for operating theatres MAQUET offers practical solutions for three areas. and ICUs. MAQUET products and services contribute to the improvement of patient Surgical Workplaces: equipment of operating theatres with operating tables, lighting care and the optimisation of medical procedures in hospitals, clinics and doctor’s for operating theatres, ceiling pendants and modular construction systems for operating surgeries all over the world. theatres. Cardio-Pulmonary: heart-lung machines, oxygenators and disposable pro- MAQUET – THE GOLD STANDARD. ducts for open-heart surgery. Critical Care: anaesthetic and ventilation systems for operating theatres and intensive care. Visit us at MEDICA 2003 in Düsseldorf between 19 and 22 November, Booth 12, Stand D 51/D 52, and meet the new MAQUET family. MAQUET GmbH & Co. KG · Kehler Strasse 31 · D-76437 Rastatt · www.maquet.com

EUROPEAN HOSPITAL Vol 12 Issue 5/03 19 COMPANY NEWS • AWARDS • INNOVATIONS

AWARDS Entry to US neonatal care market solutions combined with patient monitoring Lung research rewarded for neonates. Clinical staff will benefit from these integrated solutions through increased Spain - Epidemiologist Judith GarcÌa-Aymerich has received quality of therapy and process cost the European Respiratory Society (ERS) Research Award 2003 Luebeck, Germany - Draeger Medical AG reductions,’ said Dr Wolfgang Reim, for her original research on the risk factors of Chronic & Co KGaA and the US firm Hillenbrand President & CEO of Draeger Medical. Obstructive Pulmonary Disease (COPD) exacerbation (EFRAM Industries Inc, of Batesville, Indiana, have Draeger Medical, the largest division of Study). Sponsored by Boehringer Ingelheim, 50,000 euros signed a contract for Draeger to acquire Draegerwerk AG and one of the world’s award recognises the work of young European ERS members the Air-Shields infant care business of Hill- leading manufacturers of medical active in pulmonary research, and is to be used to further Rom Company Inc, a subsidiary of equipment, is a Draeger and Siemens those studies. 12 national winners also received travel grants Hillenbrand Industries. With 200 company. The division employs about 5,700 for the ERS 13th Annual Congress in Vienna. employees, Air-Shields reported a people worldwide and R&D and production Dr Garcia-Aymerich, who works at the Respiratory and worldwide net revenue of c. US$ 40 are located in Luebeck, Germany; Best, The Environmental Health Research Unit, Municipal Institute of million (c. 36 million Euros) in 2002 - Netherlands; Shanghai, China, and in the Medical Research (IMIM), Barcelona, said cases of COPD are a over 50% gained in the US. US, Telford, PA and Danvers, MA. significant challenge to all involved. ‘We need to know more Air-Shields is a leading provider of Hill-Rom will continue to provide its about factors which trigger the development of the disease and Dr Judith Garcia-Aymerich, 31, customers with maternal care products that graduated in Medicine at the infant care warming therapy, incubators how it worsens over time.’ University of Barcelona in 1996, and other infant care products. Draeger cover labour, delivery and foetal monitoring. COPD exacerbations are associated with significant health and and joined the Respiratory and Medical plans to consolidate Air-Shields’ The firm specialises in sales and rentals, plus economic costs, primarily due to hospital admissions. The Study Environmental Health Research employees and assets into its Luebeck- healthcare products such as beds, therapy of the Risk Factors of COPD Exacerbation (EFRAM), involving a Unit of the Municipal Institute based company. The transaction should be surfaces, stretchers, infant warmers, of Medical Research (IMIM) of large cohort of these patients, and on which Dr Garcia-Aymerich Barcelona as an epidemiologist. completed early in 2004. ‘Through this incubators, furniture, communication worked, is considered to have increased still scarce knowledge The focus of her continuing acquisition, Draeger Medical gains access systems, surgical columns, medical gas regarding COPD exacerbations, and the results will help with work there (and PhD thesis; to the important US neonatal business and management systems and headwall systems. health planning and COPD guidelines. 2002) has been on Chronic extends its portfolio in neonatal care by In addition, two subsidiaries specialise in One important finding was the moderate to high prevalence Obstructive Pulmonary Disease burial and cremation products, as well as (COPD), specifically the Study adding products tailored to the needs of of potentially modifiable risk factors of COPD exacerbation. It of the Risk Factors of COPD our North American customers. We will insurance and trust-based financial products was found that the risk of COPD admission increased in patients Exacerbation (EFRAM Study). also be able to offer them comprehensive for pre-planning funeral services. with low levels of normal physical activity, under-prescription of long-term oxygen therapy, and more severe COPD (i.e. more previous admissions, lower FEV1 and lower PO2). Current research is focused on the heterogeneity of COPD phenotypes, which it is hoped will lead to a better understanding of the clinical course of COPD and therefore result in LSS takeover Swiss buy US firm better disease management. Sweden -The medical technology group Nidau, Switzerland - Under new ownership, The European Respiratory Society (est. 1990) has over 6,000 members, who are scientists, Getinge AG took over the Life Support the Ohio Medical Instrument Company, Inc. doctors and allied health professionals working in over 90 countries. Systems (LSS) Division of Siemens (OMI®) of Cincinnati, has been merged by the The German pharmaceutical company Boehringer Ingelheim, with 32,000 employees Medical Solutions for 200 million worldwide, produces inhaled anticholinergic bronchodilators, used in the management of holding company of Schaerer Mayfield Euros, on 1st October. The division’s Schweiz, AG under the joint name Schaerer COPD. Carrying out research on COPD, and working to raise awareness of the disease sales volume is over 200 million Euros. Mayfield. worldwide, the firm points out that it is under diagnosed and under treated. The 720 LSS employees will become part of Getinge AG and the firm will In recent years, these long-established com- integrate LSS into its Surgical Systems panies have operated as a business alliance, Pharmaceutical awards division. the former producing the Mayfield line of cra- The take-over was subject to agree- nial stabilisation products for use in neuro- Sydney, Australia - Professor Ernst analytical publications - particularly on centrally ment by the EU anti-trust authority. In surgery, and the latter specialising in Schaerer Mutschler received the Høst-Madsen Medal active and cardiovascular drugs. His textbooks March, Siemens announced that it was surgical tables and steriliser lines. Schaerer - the International Pharmaceutical are used worldwide. ready to divest itself of LSS to fully Mayfield Schweiz, AG, was founded in 1892. Federation’s (FIP) highest scientific honour - From 1991-’94 he was President of the comply with requirements of the EU Schaerer Mayfield, USA, Inc, formerly OMI, at the FIP World Congress in September. European Federation of Pharmaceutical Sciences. anti-trust authority for a joint venture in and based in Cincinnati, Ohio, was founded in Presented every two years by the Danish critical care with Draegerwerk AG, in Prof Ernst 1968 by neurosurgeon Frank Mayfield. Pharmaceutical Association, the medal hon- Muschler (right) Luebeck, Germany. ours the memory of former FIP President Dr with FIP Høst-Madsen. president Jean Currently professor emeritus of the Parrot INNOVATIONS Pharmacological Institute, Frankfurt/Main University, Dr Mutschler has received many international awards for his scien- Flexible synthetic layers of ‘skin’ tific research, which includes differenti- ating muscarinic receptor subtypes as Dresden, Germany - The Gottfried The upper layers of various materials are well as the discovery of new tri- Wilhelm Leibniz Research Society reports to be given functions that will make them amterene derivatives. that scientists at the Dresden Institute for particularly resistant against external He has also authored and co-authored Polymer Research (IPF) are studying influences. over 600 scientific papers, ranging from possibilities for the production of an In developing new, multifunctional pharmacodynamic, pharmacokinetic and artificial surface based on human skin. surfaces, researchers often look to nature.

he Neema Project, focusing on villages ran fundraising events internationally for this Customised for cardiology and angiology Tin Tanzania, has won the 2003 project. Since May 2001 over 47 international Pharmaceutical Practitioner Award, given and local students/graduates (pharmacy, Acuson CV70, a new digital ultrasound system from by the International Pharmaceutical agriculture, medicine and economics etc) have Federation (FIP) volunteered to work in the dispensary, and Siemens Medical Solutions (Med), was developed In 1993, an idea presented by two liase with village communities to increase specifically for hospitals providing adult and paediatric pharmacy students, from Tanzania and access to healthcare services through the cardiovascular services, and for trans-oesophageal and Spain, prompted the International building, equipping and staffing of a Kiromo- intra-operative applications. The system’s open Pharmaceutical Student’s Federation (IPSF) based dispensary and Mother-Child Healthcare architecture enables integration of future technologies, to initiate the Neema Project, which aims to Centre. They have also worked with the which makes the system a secure long-term improve the health of people living in Village Health Committee and local investment, the firm reports. Kiromo, Buma and Mataya. Run by the government officials to organise health A Dimaq ultrasound workstation, for digital Neema Coordinating Group, with campaigns and a local health insurance system. acquisition, storage, and display of full ultrasound representatives from students’ associations The Neema dispensary will be handed over studies, has been integrated into the system. ‘The in Tanzania, Canada, USA, UK, Portugal, to local government and included in the multihertz function ensures improved penetration Spain as well as past participants, students Tanzanian government’s network of dispensaries in 2004. depth, while Tissue Harmonic Imaging provides high * The International Pharmaceutical diagnostic certainty in patients that are difficult to Students’ Federation represents 300,000+ scan,’ the firm adds. pharmacy students in over 60 In terms of workflow, Siemens Med points out that countries. support for DICOM 3.0 formats enables fast digital Details: data transfer and easy integration into existing PACS www.ipsf.org/projects/Neema systems, a connectivity that means images are www.fip.org/foundation available throughout the hospital immediately Diane Gal, Neema Coordinator (left) after an examination. Additionally, images can be with Simon Bell, President: stored in a digital patient folder or on a CD-ROM in International Pharmaceutical Students Federation, and Dr Peter Kielgast of FIP DICOM standard.

20 EUROPEAN HOSPITAL Vol 12 Issue 5/03 COMPANY NEWS • AWARDS • INNOVATIONS Kodak buys CAD Technology Maquet expands

Image reveals The acquisition will expand areas, Kodak’s capabilities in ‘image OT and ICU presence pinpointed intelligence’, a key element in its presence in the operating the- ● Critical Care: Anaesthesia by CAD strategy for leading the digital atre and expanding in intensive and ventilation systems in technology, which should information transformation care. The firm reports that the the operating theatre and in be closely occurring in the medical imaging acquisition brings a leading intensive care. examined for field, the firm points out. market position in ventilation Dr Heribert Ballhaus, vice disease Kodak plans to offer CAD Dr Heribert Ballhaus, Vice President of GETINGE Medical Systems and CEO and makes it the global number president of GETINGE software as a stand-alone product of Maquet three in anaesthesia. In May Medical Systems and CEO of and as a component of its digital this year, Getinge AB also Maquet added, ‘In the world capture and image-and- Sweden - Following the acqui- acquired Jostra AG (Hirrlingen, of medicine, the Maquet information management systems. sition of Siemens Life Support near Tübingen), which ranks product range has tradition- Systems (LSS) by the medical among the four leading global ally been known for setting The Eastman Kodak Company has technology group Getinge AB, bought CAD Technology from GE set to acquire UK firm the firm has formed a new MiraMedica Inc of Los Gatos, business unit - Maquet Critical California. To accelerate and lead Purchase price: $9.5 Billion - 800 pence per share Care (MCC), based in Solna. other CAD development at Kodak, General Electric Company has agreed (subject to regula- Getinge is one of the world’s a number of MiraMedica tory approval etc in 2004) to buy all outstanding shares leading providers of technical employees will join Kodak’s Health in Amersham plc, which specialises in diagnostic imaging equipment and systems for Imaging Group, the firm reports: agents (Omnipaque, Myoview, Omniscan and Visipaque) medical surgery, intensive care, Wido Menhardt, MiraMedica’s and life sciences as well as healthcare information tech- extended care and the pharma- Chief Technology Officer, will nology (IT). ceutical industry. become General Manager of CAD GE’s Chairman of the Board and CEO, Jeffrey R Immelt, MCC will focus on anaes- operations, and Caren Mason, said the purchase would add new, high growth plat- thesia and ventilation technol- President & CEO of MiraMedica forms to GE Medical’s diagnostic imaging, services and ogy and market the firm’s Inc will serve as a business healthcare information technology businesses, enabling established product groups consultant during the transition. GE to accelerate the development of molecular imaging Servo (ventilation), Kion and Computer-aided detection (CAD) and personalised medicine - predicting disease and tai- Symeon (anaesthesia) under technology includes software that loring therapies to the individual. ‘We’re delighted to the corporate brand name automatically highlights suspicious bring Sir William Castell and his team to GE to help make Maquet - for 165 years a lead- areas on digitised images by this vision a reality,’ he added. ing name in operating theatre analysing the shape, groupings and It is planned that Sir William Castell will become a Vice and intensive care equipment. Maquet specialises in equipment for operating theatres, anaesthetics/artificial Chairman and member of GE’s Board of Directors and, as respiration, and cardiac surgery other characteristics of Sales of the firm’s anaesthesia CEO of GE Healthcare Technologies, will have financial abnormalities and determining their and ventilation systems manufacturers of heart-lung forward-thinking standards. and leadership responsibility for GE Healthcare correlation to previously analysed reached some 205 million machines and disposable open- The Maquet group of compa- Technologies, the combined Amersham and GE Medical euros (year ending 30/9/03). heart surgery products, the nies has a joint approach to disease characteristics, thus firms. The division will be based in the UK, where Sir Getinge AB now counts over signalling radiologists to examine William Castell will head the integration process. Joseph firm points out. strict customer orientation 720 employees from the for- those areas for possible disease. Hogan, Senior Vice President of General Electric, will In line with expansion three and the power of innovation, mer Siemens LSS business unit continue to lead the GE Medical business. clear sales and services divi- highest product safety and GE expects the firms’ combination to be non-dilutive among its workforce of some sions will be made: quality, the highest level of Press presence to 2004 earnings per share (before in-process research 6,860 staff, producing total ● Surgical Workplaces: reliability and the best service. sales of around 1.2 billion Courses to guide public relations and development charges) and $0.01 accretive in 2005. Operating theatres, surgical Maquet focuses on solutions euros. Of that, the firm’s med- personnel in promotion and the The firm also expects to generate revenue by the end of tables, surgical lights and for faster and safer patient ical systems division (head- development of individual the third full year of $350-400 million annually - expect- ceiling supply units, plus treatment, which also benefits quartered with Maquet in profiles for directors are ed to translate into operating profit benefits of $100- prefabricated operating hospitals worldwide from an Rastatt, Germany) accounts available at ‘Media Workshop’. 200 million per annum. suites economic point of view. for c. 590 million euros, and ● Details: In 2002, the Amersham Group, with 10,000 employees Cardio-Pulmonary: Heart- Maquet offers perfect prod- employs about 2,930 employ- [email protected] worldwide, had sales of £1.62 billion. The firm was lung machines, oxygenators ucts for the best possible sur- formed in 1997 following the mergers of Amersham ees internationally. (artificial lungs) and dispos- gical results and optimum International (UK), Pharmacia Biotech (Sweden) and With this development, able products for open-heart workflows: Maquet is the Nycomed (Norway). Getinge AB is strengthening its surgery gold standard.’

‘Everyone knows how resistant and sensitive, tough and rough, smooth or wrinkled, fatty or dry the human skin can be,’ said Sergej Minko of the IPF. It reacts with great The integrated OR. sensitivity to temperature, humidity and different pH-levels and can absorb fat and water in different First class Consulting, Design, ways. ‘The skin fulfils important functions - it protects the body Installation and Service for grea- against dehydration, overheating ter efficiency in your future OR. and penetration by germs,’ he added, so it is a big challenge to Consulting create a synthetic surface with those useful characteristics. So far, only certain skin functions have been copied - such as ‘switchable, Service mixed polymer brushes’. The objective was to make them with various layers of synthetic materials Installation attached to a surface, Manfred Design Stamm, who heads this project at IPF. The brushes react to certain solvents, such as water, different pH-levels or temperatures. The ‘switching’ of surface characteristics means the polymer brush layers adapt their structure and characteristics to different environments and react, in a hydrophobic or hydrophilic way, so the brushes can resist or attract water. The polymer brush layers may be used, for example, in textiles used in healthcare, such as those to cover wounds. Your partner in Endoscopy and ESWL [email protected] · www.richard-wolf.com Details: www.ipfdd.de RICHARD WOLF GmbH · D-75434 Knittlingen · PF 1164 · Tel.: +49 70 43 35-0 · Fax: +49 70 43 35-300 · Subsidiaries in Belgium · Germany · France · Great Britain · Austria · USA

EUROPEAN HOSPITAL Vol 12 Issue 5/03 21 EUROPEAN HOSPITAL E VENTS

Published by: EUROPEAN HOSPITAL Verlags GmbH, Höherweg 287, 40231 Düsseldorf Prim Dr Günther Leiner (left), President of being frightened!’ moted by all means, which would Phone: +49 (0)211 7357 532 the International Forum Gastein and David Dr Stein also emphasised that the pay off in the long run. ‘Nothing Fax: +49 (0)211 7357 530 Byrne (right), EU Commissioner for Health e-mail: [email protected] and Consumer Protection possibilities of cross-border co-oper- costs a health insurance company as ations in the health sector are little as a healthy person who can www.european-hospital.com and the number of working people exhausted: there are already pilot lead an independent life,’ she Editor-in-Chief Brenda Marsh will decrease. Additionally, the projects to create a balance between stressed. But, said Dr Stein: ‘There Art Director Mary Pargeter Executive Directors Daniela Zimmermann, number of people over 80 will the under and over supply existing would have to be massive changes Reiner Hoffmann increase from the 2000 figure of in certain regions. Underlining this, in the employment policy,’ if setting Editorial Assistant Denise Hennig some 14 million to about 38 million Dr Henk Nies, head of the Nether- retirement years at 67, 80 or 100, Founded by Heinz-Jürgen Witzke in 2050. As a result, expenditure on land’s Institute of Care and Welfare, because people already face the pos- Correspondents health services will surge, and the presented the Care and Manage- sibility of unemployment at 50. Austria: Christian Pruszinsky. Belgium: Hannes rise in the number of working ment of Services for Older People in Moreover, for many people sudden Frank. Czech Republic: Rostislav Kuklik. Finland: Marti Kekomaki. Germany: Anja Behringer, Heidi women will lead to an even greater Europe Network (CARMEN) pro- retirement is a shock: ‘From one Heinold, Max Heymann, Prof Tinneberg. Great Britain: need for institutional nursing. ject, in which 40 organisations from day to the next their usual life style Brenda Marsh. Italy: G. Sinaccio. Poland:Pjotr Szoblik. Spain: Eduardo de la Sota. Sweden: Ake Spross. Switzerland: Jaqueline Merlotti. USA: Karen M Dente, an the EU afford the life Ivan Oransky, Craig Webb. expectancy of its citizens? UK editorial address Pointing to the scandalous 55 Wey Meadows,Weybridge C Surrey KT13 8XY inhumane neglect of patients at a Subscriptions nursing home in Lainz (Austria), Denise Hennig, European Hospital, and to inadequate hospital services Höherweg 287, 40231 Düsseldorf, Germany in France during last summer’s heat Subscription rate 12 issues: 74 Euro, single copy: 6.16 Euro. Send order wave, resulting in thousands of EU hospital crisis and cheque to: European Hospital Subscription Dept deaths, Dr Hans Stein said, Finishing media technique jöhri, ’Nothing will happen until there are Weilerswist, Germany Printed by Frotscher Druck, dead bodies on the streets!’ Darmstadt, Germany Speaking at the 6th European Publication frequency bi-monthly Health only for the Rich? Health Forum Gastein (EHFG), in European Hospital ISSN 0942-9085 October, which focused on ‘Health Report by Christian Pruszinsky Advertising: Ted Asoshina, Japan, +81 3 3263 5065 & Wealth’, and for which Dr Stein Ben Chen, Taiwan, +886 2 8712 2385 had organised a parallel forum on Nonetheless, Dr Stein does not ten countries are establishing an and organisation status changes; Denise Hennig, Germany, +49 211 7357 532 ‘Healthy aging’, he pointed out that believe the welfare state will neces- international, low-cost and compre- social contacts with colleagues and Juri Laskin, Russia, +70 95 2711 006 Simon Kramer, BeNeLux, GB, Scandinavia, France events reported in Lainz are not a sarily collapse under the burden of hensive geriatric care system. the appreciation of job performance +31 180 6172 26 unique, not in Austria and not in the elderly. What is needed, he said, Dr Patricia Barry, expert in geri- disappears. Social isolation and C.K. Kwok, Hong Kong, +85 2 2890 5510 C.H. Park, South Korea, +82 2 3644 182 Europe. However, he added that is a change in our prevailing ‘disas- atrics and public health at the loneliness often lead to geriatric Hanna Politis, USA, Canada +1 301 8696 610 such scandals only bring the calami- trous attitude’. Eventually, increased Merck Institute for Ageing and depression, which is lethal or ties of nursing and geriatric care life expectancy could manifest eco- Health (MIAH), Washington, said decreases quality of life more often Germany Head Office Düsseldorf before the public for a short time. nomic and social achievements, but, that US surveys of Europe had than dementia. We should consider European Hospital, Höherweg 287, By 2050, he said, the number of at present, he added, ‘… we have a shown that higher life expectancy whether flexible retirements, for 40231 Düsseldorf, Federal Republic of Germany Tel: +49 211 7357 531, Fax: +49 221 7357 530 people over 65 will increase in the high life expectancy and instead of can result from the increase in a example a period of ten years, e-mail: [email protected] 15 EU states to about 103 million, being proud of this, citizens are life-span of good health, which would be useful. Pension funds GB, Scandinavia, BeNeLux, France meant that senior citizens would would be disburdened and health Simon Kramer, Willem Alexander Plantsoen 25, 2991 NA Barendrecht need less or later medical help. So, insurance companies could help Tel: +31 180 6172 26, Fax +31 180 6200 20 rather than being a burden, they active semi-seniors to remain more e-mail: [email protected] could increase state productivity by actively, socially integrated and Hong Kong, China working after retirement ages. healthier.’ ‘The EHFG is no chat Eastern Source Int. Media Centre, C K Kwok, 25/F Great Smart Tower, 230 Wanchai Road, ‘Labour is linked to health, not to hour!’ EHFG President Dr Günther Wanchai, Hong Kong life span,’ Dr Barry pointed out. Leiner emphasised, when addressing Tel: +85 2 2890 5510, Fax: + 85 2 2895 1443 ‘The role of healthcare in an ageing 550 leading decision makers from Japan Echo Japan Corporation, Tetsuzo Asoshina, society is not just to prolong the European Institutions, patients and Grande Maison Room 303 lives of the elderly but to keep them consumers representatives, politics, 2-2 Kudan Kita, 1 Chome Chiyoda-Ku Tokyo 102, Japan healthy and enable them to lead a economy, industry and science, from Tel: + 81 3 3263 5065, Fax: +81 3 3224 2064 beautiful life,’ she added. Healthier 43 nations, who had gathered at the e-mail: [email protected] nutrition or physical and mental EHFG to discuss health policies – South Korea Far East Marketing Inc, C H Park, activity of the elderly should be and issues that now face all Room 1806/7, Golden Tower Building, 191, 2-ka encouraged, and healthy ageing pro- Europeans. Choongjung-ro, Sedoaemun-ku, Seoul, Korea Tel: +82 2 3644 182/3, Fax: +82 2 3644 184 e-mail: [email protected] USA & Canada LINK UP Media International, Hanna Politis, 8508 Plum Creek Drive, Gaitherburg, MD 20882, USA Tel: +1 301 8696 610, Fax: +1 301 8696 611 email: [email protected] Taiwan Jurassic Communications Corp., Ben Chen, 2F-3, No. 147, Lung Chiang Rd., Taipei 104, Taiwan R.O.C. Tel: +886 2 8712 2385, Fax: +886 2 8712 2618 e-mail: [email protected]

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22 EUROPEAN HOSPITAL Vol 12 Issue 5/03 NEWS

EUROPEAN HEALTHCARE By Dr Martin Schoelkopf POLICY UPDATE

Restricting job emigration of healthcare selection process and on Cross-border healthcare professionals to the wealthier financing and regulating access access nations of the expanded EU - to the centres ilan, Italy - European ● Information for patients, now to be discussed in depth in ● Use of free medical services: On 9 September, the European Court health ministers healthcare professions and an additional working group. here, a European framework decided on the admissibility of restric- discussed the status of political decision makers. Final report due: 8 December must be introduced which will tions on access to the job of hospital M consultations in the High-Level The ministers differed on 2003. Source: gid. facilitate the conclusion of administrator in France (case C- Reflection Group on cross- cross-border agreements 285/01). In the case, a Portuguese citi- conclusions emerging from the A statement on the High-Level border healthcare at an between financial backers and zen qualified as a hospital administra- reflection process. France urged Reflection Process (23/9/03) tor in her own country, had applied to informal meeting in September, that the principle of health from the European Social service providers ● join the senior ranks of public hospital following the EU Health protection should be anchored Insurance Partners (ESIP) urged Within the framework of the administration in France. Her applica- Commissioner David Byrne’s more firmly than before in the the EU Commission to reflection process, further tion was refused on the grounds that report that the Group had Constitution Contract. The UK incorporate more concrete discussion is needed on the she would first need to have successful- resolved to tackle: and others argued in favour of legislation recommendations into consequences of competition ly participated in the selection proce- ● Optimisation of use of re-imposing restrictions on the the Reflection Group’s final law for health insurance dure for admission to the Ecole resources in the healthcare legal entitlement - subject to report. The need for a list of companies Nationale de la SantÈ Publique system, on a cross-border broad interpretation by the political priorities, including a ● The setting up of a ‘permanent (ENSP). The European Court decided basis where appropriate (e.g. European Court - to cross-border concrete timetable for mechanism on quality issues’ at that the requirement of participation in specialised technical healthcare and cost implementation, was also European level is advocated, a selection procedure for the ENSP cre- equipment, hospital reimbursement. On this issue, argued, which the ESIP said aimed at the reciprocal ates an impediment to the freedom of capacities); Germany tends to assume the should include: exchange of quality standards movement of workers, which is not ● Securing access to and quality role of mediator, but has stated ● European reference centres. in healthcare. compatible with the EC Treaty if the of healthcare; that it wishes to approve the Here, a proposal for Against this background, ESIP qualification in another Member State ● Harmonization of national draft Constitution in unchanged implementation is required advocates continuation of the has the same status as the French qual- healthcare policy with form. The acceding countries which will also comprise reflection process in 2004. ification. European law; and drew attention to the risk of statements on the facility Source: ESIP. Source: European Court of Justice. EU CALLS FOR TENDERS EU citizens’ freedom of movement 1 A study to analyse the impact of the enlargement n early September, the European benefits if relocating within the EU. the Regulation, since this leaves the Parliament welcomed the pro- The Commission proposal serves Regulation open to further develop- process on health and the health sector in the 10 new Iposal of the Commission regard- simplification on the one hand and, ments. However, the Council of Member States ing simplification and moderniza- on the other, proposes changes in Ministers would prefer a definitive Questions to be addressed: Did the implementation of Community tion of Regulation 1408/71 - content. Its proposal extends the list. Further significant changes pro- public health and other health-related legislation improve national which aims to guarantee freedom Regulation to all those covered by posed by the Commission, which the legislation or did it lead to countries having to change existing effective of movement for EU citizens; national social-insurance systems, MEPs accepted, relate to the incorpo- practices? Has the enlargement process in general enhanced health therefore it should co-ordinate an amendment welcomed by ration of pre-retirement provisions efforts in the countries - e.g. the resources and priority given to health cross-border aspects of the various Parliament. MEPs also supported into the Regulation’s area of applica- - or has it diverted efforts from national priority areas? Has fulfilling EU social-welfare benefit systems - the Commission’s proposal not to tion, as well as changes to the rules membership requirements led to more efficient management and use particularly in terms of retaining generate a definitive list of the relating to unemployment and cross- of resources, or have the budgetary rules led to restrictions on resources accrued claims to social-welfare types of social insurance covered by border employees. for health? However, the MEPs also urged that The contractor is also asked to develop recommendations for policies the Regulation be brought into line and action and the Commission expects the project outcome to provide with the latest judicial rulings of the valuable information to stakeholders and decision-makers at national An EU Centre for Disease European Court on cross-border and EU levels. take-up of medical services - particu- http://europa.eu.int/comm/health/ph_programme/howtoapply/call_151 Prevention and Control larly relating to patients on waiting 875_2003.htm At the informal meeting of the Council of European Health Ministers lists. In addition, they wish to (Milan, 9/03), the planned setting up of a European Centre for Disease improve the situation of the disabled 2 Health challenges in candidate countries Prevention and Control was discussed. There was broad unanimity who move to another Member State, that the actual authority for epidemic risk management should con- who, during a transitional period The study objective is to improve understanding of health challenges tinue to be held by Member States. Germany and other Member States often receive no benefits. An amend- facing 13 applicant countries and how to address them. This consists of referred to the very positive work of existing national organisations ment motion would help overcome surveying the existing data and gaps in relation to the strengths of and and rejected the idea of a new ‘higher authority’. However, the need to these financial difficulties. Via a num- challenges facing the applicant countries with regard to their health set up a co-ordinated structure at Community level was undisputed. In ber of amendment motions, the policies and measures, health capacity, health determinants and health addition, the future co-ordination centre would have to be networked MEPs are also aiming to improve the systems. The project encompasses an assessment of existing analytic with the European Food Authority. Against this background, one may situation of cross-border workers and capacity for each country and the identification/analysis of needs, anticipate that political agreement on the Commission’s proposal will their dependants. One very contro- priorities and challenges, both specific for individual applicant countries be reached at the Council of Health Ministers on 1/2 November. versial proposed amendment, aimed and shared by them. Further to approval by European Parliament and the Council, the at expanding the definition of family, Recommendations for policies and action aimed at addressing the Centre could commence work as an independent European institution to incorporate the cohabiting com- above issues are also requested. in 2005. munities recognized in several http://europa.eu.int/comm/health/ph_programme/howtoapply/call_151 Details: http://europa.eu.int/eur- Member States, failed to win a 874_2003.htm lex/en/com/pdf/2003/com2003_0441en01.pdf. majority in the Parliament. Source: European Parliament Publications, studies, reports Legal framework for EU-wide calls for hospital tenders The EC envisages that all public procurement be open for EU-wide Cross-border co-operation competition, for which a number of EU directives were amended or The EU Commission presented a ● Support of local and regional ● Promotion of cultural adopted. Contracting authorities are primarily local, regional or fed- programme to promote authorities in acquiring the communication in the border eral/national institutions or their assets, which include all public hos- collaboration in regions bordering knowledge to develop and regions by way of joint pitals (city, community, military, university - if it is public, etc). on the newly acceding EU Members. implement cross-border structures neighbourly activities. Therefore, contracting authorities that enter into a public procure- This programme aims, inter alia, at ● Institutionalisation of contacts Further information: ment procedure must comply with a number of rules and regula- the development of cross-border co- and promotion of future- (http://europa.eu.int/comm/ tions. Baumann-Fachverlag has published a current summary of the operation in healthcare. The oriented cross-border structures enlargement/borderregions/pdf/ legal framework for EU-wide calls for tenders for hospitals (in following will be promoted within jointly with district and regional 2003/calls3/call_for_proposal_ German): www.klinikmarkt.com/download/Europ.doc the programme’s framework: authorities notice_ADM_DE.pdf)

EUROPEAN HOSPITAL Vol 12 Issue 5/03 23 35TH WORLD FORUM FOR MEDICINE

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