Fewer than half of the people in the UK who are at high risk of having a stroke are benefiting from an operation that could improve blood flow in the neck, a report in the BMJ has noted.

UK vascular surgeons carry out 4,500 carotid endarterectomies a year but an estimated 10,000 patients could benefit from the operation, according to a recent audit. The number of carotid endarterectomies per head of population in the UK is the lowest in the developed world.

Surgeons have called for an urgent review to ensure that patients who are at high risk of a stroke are fast-tracked to hospital.

NICE guidelines say that patients with symptoms of stroke or transient ischaemic attack (TIA) should have surgery within two weeks, while the National Stroke Strategy recommends surgery within 48 hours. However, the audit shows that only 3% of these patients have surgery within 48 hours, and only a third within 14 days – the average wait being 28 days.

The audit found that 18% of delays were due to patients not presenting, 40% to lack of GP referral, 18% to lack of hospital staff or theatre time, and 9% to lack of imaging equipment.

Ross Naylor, consultant vascular surgeon at Leicester Royal Infirmary and a member of the audit steering group, said that achieving the goal of surgery within 48 hours of symptoms depended on “multidisciplinary team working”.

He added: “Healthcare purchasers and providers must stop tolerating delays in the system and address the problems. Strokes and TIAs are emergencies and must be treated as such.”

David Mitchell, chairman of the Vascular Society of Great Britain, called for the creation of “a comprehensive service fit for purpose for urgent carotid surgery” through centralisation of in-patient vascular services.

A new neurovascular stent system for treatment of brain aneurysms has been launched in Europe and the US.

The Neuroform EZ Stent System from Boston Scientific is a fourth-generation product intended for use with endovascular coiling to treat wide-necked aneurysms.

The new stent is designed to provide flexibility and conformability, especially in tortuous cranial blood vessels. It employs the Segmental Expansion technology, which is designed to improve stent anchoring.

The product features the hybrid cell design of prior-generation Neuroform stents, but incorporates a simplified, single-operator delivery system intended to facilitate the stent’s delivery and positioning.

The first implantation of the Neuroform EZ Stent was carried out by Demetrius Lopes of the Rush University Medical Center in Chicago, and the first European procedure was performed by Professor Laurent Spelle of Foundation Rothschild Hospital in Paris.

“The Neuroform EZ Stent System performed well in a very challenging first procedure,” said Dr. Lopes. “The smooth transfer of the stent into the catheter, combined with excellent support, stability and visibility, facilitated accurate stent placement.”

“The improved delivery system of the Neuroform EZ Stent helped me to place the stent exactly where I planned,” said Professor Spelle. “In my experience, Boston Scientific’s new system is easier to use compared to its previous microdelivery system and should offer benefits for both physicians and patients.”

“Boston Scientific is pleased to offer this new technology, which is designed to help physicians simplify these complex neurovascular procedures,” said Mark Paul, President of Boston Scientific’s Neurovascular Division.

Boston Scientific is a leading global supplier of interventional medical devices.

A dedicated online resource has been launched to help GPs get to grips with the new NHS commissioning process announced in the White Paper Equity and excellence: Liberating the NHS.

The new microsite, www.doctors.net.uk/commissioning, has been created by the medical professionals’ network Doctors.net.uk.

The resource was developed in response to opinion polls and comments on the network indicating that most GPs needed more information and support to make the required changes to the commissioning of health services.

The new microsite is designed as a central resource with information about the reforms, and a forum for doctors across general practice, public health and hospital-based services to share ideas and examples of best practice. It will act as an evolving resource, with the content being updated regularly.

A Doctors.net.uk poll revealed that 83% of GPs do not feel equipped to take over all commissioning of local healthcare services. The figure rises to 93% among those GPs who are expected to lead the reform.

Doctors.net.uk medical adviser Dr James Quekett said of the microsite: “Bringing all of the available information together and providing the opportunity to discuss and collaborate in one place, it not only equips doctors with the facts they need to make informed opinions on reform, but it also gives grass-roots doctors a voice on the issue.

“We can’t predict what the future outcome for GP commissioning will turn out to be, but we can at least ensure that doctors are informed and involved throughout this intense period of change to give it the best chance of success.”

Doctors.net.uk is the largest and most active network of medical professionals in the UK. Its membership comprises the vast majority of UK doctors, with over 50,000 using the service every week.

 
Dr James Quekett

Plans for the development of GP consortia to commission health services at a local level have been outlined by the Government.

The proposed structure for commissioning and local control of health services is described in two new consultation documents, Commissioning for patients and Local democratic legitimacy in health.

The documents expand on the White Paper Equity and excellence: Liberating the NHS and invite comment from patients and other stakeholders.

Commentators in the private sector and the NHS have pointed to the major opportunities in service management and provision that this new structure may open up for independent healthcare providers.

Andrew Lansley, Secretary of State for Health, said: “Power has to be devolved to local people so that decisions about their health are made by them, or by people that best understand their needs. Everyone should have their say in these consultations so we can get on with building strong local partnerships and improve people’s health.”

Local democratic legitimacy in health describes the Government’s plans to give new Local Directors of Public Health control over local health improvement funds, which they will use to improve public health, support patient choice and promote effective commissioning. This, it is hoped, will enable healthcare to be more effectively integrated with social care and other services.

The long-term aim is to build a national Public Health Service to support local decisions with evidence and evaluation. Patients will be represented by local ‘HealthWatch’ groups that will voice their health and social care needs and impact on local service planning.

Commissioning for Patients sets out detailed proposals to put GP consortia in charge of commissioning local health services, with the support of the NHS Commissioning Board. The document invites feedback on:

• How GP consortia and the NHS Commissioning Board can involve patients in improving health services.

• How GP consortia can work with secondary care, community partners and other health and social care professionals to design services.

• How the NHS Commissioning Board and GP consortia can work together to make effective and efficient commissioning decisions.

• How the NHS Commissioning Board can support GP consortia to ensure they improve health outcomes within the financial constraints set.

Dr Hamish Meldrum, Chairman of BMA Council, commented on the plans for GP commissioning: “There are still many questions that need answering. The proposals contain both opportunities and threats and we will be actively engaging with the consultation process to explore this in great detail and to ensure our members’ views are taken on board.”

Given the anticipated workload and financial pressures on GP consortia, it has been widely predicted that independent healthcare providers will soon play a large role in managing and providing NHS healthcare. According to Tribal Healthcare’s Business Development Director, Kingsley Manning, the new structure “could amount to the denationalisation of healthcare services in England”, with major opportunities arising for the private sector.

Health Minister Earl Howe stated: “We want consortia to have the freedom to arrange themselves how they wish and get support from whom they choose. All consortia will need to be well managed and we are not asking doctors to become managers.”

The consultations will run until 11 October. NHS Chief Executive Sir David Nicholson has sent a letter to NHS organisations requiring the transfer of commissioning powers to be carried out as soon as possible.

A cardiologist at Southampton University Hospitals NHS Trust has developed a revolutionary technique for ‘slicing’ 3D images of the heart into infinite sections using computer software.

Multiplane review (MPR) 3D echocardiography lets the user see movement in three dimensions of the heart at once, enabling them to identify heart defects more accurately than with traditional scans.

It is thought that MPR technology could replace the need for magnetic resonance imaging (MRI) in most areas of cardiac imaging.

Consultant cardiologist Dr Joseph Vettukattil developed the technique at Southampton General Hospital to identify congenital heart abnormalities.

“The most important aspect is the operator’s ability to slice the dynamic cardiac structures in infinite sections through all the three dimensions,” Dr Vettukattil said. “By using MPR, because you are slicing and seeing it in three different planes, you can get a clear understanding of a patient – especially in a child whose heart is congenitally malformed.”

MPR could replace the need for invasive cardiac catheterisation to complement 2D scans in the diagnosis of congenital heart defects. “We are able to visualise even more than a surgeon can during an operation, minimising the need for additional and invasive assessments,” Dr Vettukattil added.

The technique enables cardiologists and cardiac surgeons around the world to capture 3D data of patients and upload them to a dedicated website, or e-mail them for assessment.

Dr Vettukattil hopes to establish an MPR imaging and training centre in Southampton that will lead the world in advanced 3D echocardiography.

 
Dr Joseph Ventukattil

The first hospital orders of two high-productivity MRI scanners have followed their UK launch.

The new Magnetom Aera 1.5 Tesla and Magnetom Skyra 3 Tesla scanners from Siemens Healthcare offer features that improve ease of use as well as patient experience.

The first hospitals to order these scanners are Wythenshawe Hospital (Manchester), Guys Hospital (London), Kidderminster Hospital and Royal Brompton Hospital.

The Magnetom Aera and Skyra combine advanced features: Tim (total imaging matrix) improves image quality, and Dot (day optimising throughput) simplifies the process. The combination raises productivity levels by increasing efficiency.

Both MRI systems have a 70cm open bore that can accommodate a variety of patient sizes, shapes and conditions, reducing stress for claustrophobic patients. The visual front panel can be fitted with a coloured MoodLight to further calm the nervous patient.

“The Aera is a great example of where MR imaging should be heading. The wide, short bore will make MR more accessible to patients who find conventional MR scanners too claustrophobic,” said Nick Sanderson, Lead Radiographer for MR Imaging at Wythenshawe Hospital. “The integrated coil technology will also make a massive difference to our patient throughput, with an estimated 30 per cent increase in patient exams done.”

Jane Kilkenny, MR Product Manager at Siemens Healthcare, commented: “The Aera and Skyra systems fundamentally transform the way hospitals are able to work with MR. We look forward to seeing the clinical results, patient service enhancements and efficiency benefits once they are installed into these pioneering hospitals.”

 
Magnetom Aera 1.5 Tesla

Ealing Hospital NHS Trust in London is using SRC’s electronic Discharge Summary (eDS) Solution to deliver discharge summaries within 24 hours of patients leaving hospital.

The solution, which was rolled out across the Trust in under two months, has enabled it to improve patient safety and experience using built-in medicine management tools (such as the Multilex Drugs Dictionary).

Clinicians at the hospital complete discharge summaries electronically to be authorised by pharmacists. On patient discharge, the completed summary is sent automatically and securely to the patient’s GP practice. Patients leave the hospital with a printed copy that explains their medication regime.

SRC implemented the eDS Solution in partnership with clinical software specialists Bluewire Technologies, working with the hospital’s senior pharmacists and clinicians to ensure that it fitted hospital workflows and to tailor the medicines management software.

“The system has now been live for over a month and in that time we have not encountered any significant issues, nor complaints amongst clinical staff about the burdens introduced by a new computer system,” said Kevin Connolly, Director of ICT at Ealing Hospital.

This, he added, was “the pay-off for the very detailed initial process design work undertaken by our clinical and pharmacy leads, expertly guided by the SRC and Bluewire Technologies implementation lead.”

Chris Hart, CEO of SRC, commented: “Our eDS solution, part of the SRC Clinical Information Toolkit, is unique in its ability to reduce production and delivery timescales as well as significantly improving the quality and content of discharge summaries. We are delighted by the successful and rapid rollout which the joint project team has achieved at the Ealing Hospital NHS Trust.”

SRC, a leading UK provider of clinical information solutions, has partnered with global technology providers such as Olympus and Philips.

A new shock wave regenerative device intended for orthopaedic, trauma and sports injury therapy has been launched in Europe following CE Mark approval.

The orthoPACE from Sanuwave Health incorporates the company’s Pulsed Acoustic Cellular Expression (PACE) technology platform, which delivers shock wave technology to treat a range of conditions in hard and soft tissue.

The device’s high-energy electrohydraulic shock waves activate biological responses such as revascularisation, helping to restore the body’s normal healing processes and promote tissue regeneration.

The orthoPACE has a compact, portable design that allows treatments to be performed by a single operator in the hospital or office. The device’s unique applicator may reduce (or even remove) the need for anaesthesia.

Treatment of orthopaedic conditions such as tendinopathy with the orthoPACE device have a success rate equal to or greater than that of surgery – usually with a single 15-minute procedure. The treatment is non-invasive, so there is no risk of infection or scarring.

Christopher M. Cashman, President and CEO of Sanuwave, said: “The orthoPACE device offers significant enhancements to our past successful legacy orthopaedic products. [It] offers the best aspects and the same solid clinical efficacy, along with new features and expanded treatment potential. [It] has been well received by our European distributors and clinicians, and we expect the product to continue to gain visibility and momentum in 2010.”

The orthoPACE will initially be used to treat tendinopathy and acute and nonunion fractures. It can also be used as an adjunctive treatment to fixation, fusion and grafting.

Sanuwave Health is an emerging company that supplies biological response-activating devices for tissue repair and regeneration.

Proposals for replacing NHS process targets with health outcome targets that focus on patient benefit have been set out in a public consultation by the Department of Health.

Transparency in Outcomes – a framework for the NHS elicits the views of healthcare professionals and the public on the best means of setting targets for NHS organisations and measuring their success.

The consultation document follows the White Paper Equity and Excellence: Liberating the NHS, which proposes to make GP commissioning and patient choice the key drivers of improvement in the quality of care.

Transparency in Outcomes proposes a new framework for NHS targets, with the emphasis on outcomes achieved for patients rather than processes measured within the NHS. This, it is argued, will address the notorious issues of ‘ticking boxes’ being prioritised over treating patients.

Health Secretary Andrew Lansley said: “I want to free doctors and nurses to focus on what really matters – better results for their patients – instead of them being stifled by top-down targets. We will measure the outcomes that are most important to patients and that are relevant to healthcare professionals.”

The framework includes a set of proposed national outcome goals that can be used by Government, patients and the public to judge the overall performance of the NHS. The new NHS Commissioning Board will identify ‘improvement areas’ within each outcome goal where it will guide GP commissioning in order to raise standards of care.

Five outcome ‘domains’ are proposed: preventing people from dying prematurely; enhancing the quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring people have a positive experience of care; and treating and caring for people in a safe environment, protecting them from avoidable harm.

For example, within the domain of treating long-term conditions, the framework document proposes three key principles:

• Treating the individual rather than the specific condition, and thereby improving the treatment of patients with multiple conditions.

• Focusing on functional and episodic outcomes, which are more important to the patient than physiological measures.

• Meeting the needs of all age groups, as the appropriate functional outcomes for a patient change depending on age.

To support the framework, NICE will develop 150 new Quality Standards to cover “the majority of NHS activity”. The content of these standards will have a significant impact on procurement and commissioning.

Health organisations have responded positively to the aims of the new outcomes framework, while noting the difficulty of achieving these aims at a time of strict cost controls and cuts in staffing levels.

Dr Hamish Meldrum, chairman of the BMA, praised the Government’s intention to focus on “patient outcomes supported by clinical evidence”, but noted: “This is a highly complex undertaking, and many difficult issues need to be addressed, such as how success against these goals is measured, the robustness of any data used, and how we avoid creating unwelcome perverse incentives.”

Katherine Murphy, director of the Patients Association, said: “The Secretary of State’s vision for patients of ‘no decision about me without me’ is spot on.” However, she argued, for this vision to be realised “patient experiences, surveys and the like must be genuine and robust, not carried out in settings and at times which do not give the whole story, and patients’ views must be independently determined.”

Consultations on other aspects of the NHS, including regulation and commissioning, will follow. It is expected that the new NHS operating framework will be in place by April 2011.

 
Andrew Lansley

The first partial knee replacement system, designed to correct progressive osteoarthritis in active patients, is now available in Europe.

The Sigma High Performance Partial Knee from DePuy Orthopaedics EMEA is aimed at meeting the treatment needs of patients who are not ready for a total knee replacement.

The system enables surgeons to repair only the parts of the knee that are damaged. Further parts can be added if the disease progresses. Full function can thus be restored and pain relieved at all stages of osteoarthritis.

“Sigma High Performance Partial Knee is a major step forward for the growing number of active patients in their 40s and 50s requiring knee surgery,” said Professor David Barrett, Consultant Orthopaedic Surgeon, Southampton University Hospital. “The profile of knee replacement patients in Europe is changing, with patients getting younger and living more active lifestyles. It is important that we are now able to provide active patients with a surgical solution better suited to their lifestyle and expectations.”

The Partial Knee is the first modular system designed to allow partial or staged replacement of the knee joint, meaning that surgeons can match the implant specifically to a patient’s disease state and allow healthy bone, cartilage and ligaments to remain intact. The preservation of the natural tissues around the treated knee enables most patients to continue with active working and social lives following surgery.

Due to the ageing population, osteoarthritis is set to become the fourth highest cause of global disability by 2020. In the UK, approximately a fifth of people aged 45–64 suffer from osteoarthritic knee pain, and an estimated quarter of adults aged 50 or over report disability from it.

DePuy Orthopaedics, a Johnson & Johnson company, is a leading global provider of orthopaedic devices.