As in the United States, Europeanhospitals now face an inevitableresult from escalating compensationpayments made to medical injurypatients - in the near future,premiums are expected to rise 25-100% in some EU countries.

In France, Belgium and Irelandsome insurance companies will noteven insure hospitals for patientinjury claims. In other countries, suchas Denmark, the Netherlands,Luxembourg and Malta, insurancepremiums are increasing to such anextent that it is difficult for hospitalsto cover the costs. As a result, severalhave cancelled their insurance -opting to pay claims directly fromalready beleaguered budgets.

This disturbing situation became akey issue at the 9th Plenary Assemblyof HOPE, the European HospitalsOrganisation (May, Portugal).

Insurance companies cannot rely

EUROPEAN HOSPITAL

COMFORTABLE SERVICE

H+P Labortechnik AG

Bruckmannring 15-19

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Tel: +49 89 31 58 22-0Fax: +49 89 31 54 45 3E-Mail: hpinfo@hp-lab.deInternet: www.hp-lab.de

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News/management . . . . . . 1-5Radiology . . . . . . . . . . . . . .6-9Surgery . . . . . . . . . . . . . . . . . 10Urology . . . . . . . . . . . . . . . . . 11SPECIAL REPORT Education . . .12-13co

nten

tsNuclear medicineNew Orleans, USA - The Society ofNuclear Medicine celebrated half a

century of annual meetings thisyear - with over 1,480 scientificpapers, presentations and posters.

Cycle saddle unsafeBrussels - Following a study of1,000 bicyclists, gynaecologistDr L Baeyens reports they are twiceas likely to suffer erectile and otherproblems than non-cyclists (studysample: 1,000) and, he adds, afashionable saddle, with centralhole, is also harmful.

Asylum seekers and HIVLondon - People from HIV/Aids-ridden countries face screening onarrival, since some doctors’ reportedthat two thirds of new HIV patientsare foreign, many seeking asylum.Cost to the NHS: c. £15,000 a yeareach, cutting budgets to treatBritish citizens.

Cardiology . . . . . . . . . . . . 14-16

Company news,innovations . . . . . . . . . . . . . . 17

IT & telemedicine . . . . . . . . .18

Laboratory news . . . . . . . . . .19

14-16Cardiology

Paclitaxel-elutingstents ‘safe’ for

coronary artery;cardiac devices

and research

IN BRIEF

6-8Radiology

An interview withProfessor Helen Carty

President ECR 2004

on income from stock markets as inthe late 1990s, and they motivaterising premiums by invokingdifficulties to obtain accurate andreliable knowledge on the realnumber of injuries that occur and offuture claims they will have to pay,HOPE pointed out. Although somecountries have found temporarysolutions, the long-term positionremains unsatisfactory, theorganisation added.

In the UK and Ireland, ‘stateclaims agencies’ have been set up tomeet public liability claims of publichospitals. In France the governmenthas taken economic responsibility topay for ‘non-fault-injuries’ with over25% invalidity. The Netherlands,France, Finland and Sweden havemutual, non-profit, insurancecompanies owned by hospitalsthemselves.

Funds for compensation are being

discussed in Luxembourg, France,Belgium and Hungary.

No-fault compensation systemsalready exist in the Scandinaviancountries and are being studied inBelgium, the UK and Ireland (forchildren). In Austria this system wasintroduced on a small scale.

Insurance systems are also beingdiscussed in Hungary and Cyprus.

Risk prevention to reduce medicalinjuries is now a major topic in manycountries. The creation of high quality,patient centred care, based on safepractice and supported by safe systemsremains the goal for Europeanhospitals, HOPE pointed out. ‘It is ofutmost importance that patients acrossEurope can feel confident that there isa robust and reliable insurancecoverage for medical risks. Theorganisation plans to focus on: ● A study and comparison of differentsystems for medical risk insurance andevaluation of the scale of the crisisfacing many European hospitals. ● Encouragement for the developmentof risk prevention schemes to reducemedical injuries. ● Examination of how patients areinsured when using ‘free movement ofpatients’ entitlements. Details: www@hope.be.Or: Kaj Essinger, kaj.essinger@lf.se

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17-18IT/Telemed &

InnovationsIris recognition,

PACS, patientalarms etc

A newly invented ‘Polypill’,composed of currently availabledrugs, may act as a ‘vaccine’against heart disease, according tonew research published in theBritish Medical Journal (28 June.BMJ 2003;326:1419).

Professors Nick J Wald andMalcolm R Law, the Polypill’sinventors, maintain: ‘The Polypillstrategy could largely prevent heartattacks and stroke if taken byeveryone aged 55 and older andeveryone with existingcardiovascular disease. It wouldbe acceptably safe and withwidespread use would have agreater impact on the prevention ofdisease in the Western world thanany other single intervention.’

In his related editorial, RichardSmith, Editor of the BMJ, alsoexpressed excitement, stating that

The impact of this invention on disease prevention will beenormous - but, manufacturers may not rise to low profits

this issue may well become acollector’s item. ‘It’s perhaps morethan 50 years since we publishedsomething as important as thecluster of papers from Nick Wald,Malcolm Law, and others.’

At the Department ofEnvironmental and PreventiveMedicine, Wolfson Institute ofPreventive Medicine, Barts and theLondon, Queen Mary’s School ofMedicine and Dentistry, Universityof London, London EC1M 6BQ, theprofessors worked to determinedrug and vitamin combinations anddoses that could, in a single pill,achieve a large effect in preventingcardiovascular disease with minimaladverse effects. The strategy was tosimultaneously reduce fourcardiovascular risk factors (lowdensity lipoprotein cholesterol,blood pressure, serum homocysteine,

and plateletfunction) regardless of pre-treatment levels, they write.

Efficacy and adverse effects ofthe proposed combination wasqualified from published meta-analyses of randomised trials andcohort studies and meta-analysis of15 trials of low does aspiring (50-125 mg/day)

‘They synthesise an enormousamount of information (includingover 750 trials with 400,000participants) to estimate that thepill would reduce heart disease andrisk of stroke by over 80%, whilecausing symptoms warrantingwithdrawal of the pill in one totwo per 100 and fatal side effectsin less than one in 10 000 users. Ifthis were correct the benefits wouldsubstantially outweigh hazards incontinued on page 15

‘Polypill’ cuts cardiacattacks by 80%

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U.S.A. and International patents granted

2 EUROPEAN HOSPITAL Vol 12 Issue 3/03

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As in the

United State

s, Europea

n

hospitals n

ow face a

n inevitabl

e

result from

escalating

compensati

on

payments

made to m

edical inju

ry

patients -

in the ne

ar future,

premiums

are expecte

d to rise 2

5-

100% in so

me EU coun

tries.

In France,

Belgium an

d Ireland

some insura

nce compa

nies will no

t

even insure

hospitals

for patient

injury claim

s. In other c

ountries, su

ch

as Denma

rk, the

Netherland

s,

Luxembourg

and Malta

, insurance

premiums a

re increasin

g to such a

n

extent that

it is difficul

t for hospita

ls

to cover the

costs. As a

result, sever

al

have cance

lled their

insurance -

opting to p

ay claims d

irectly from

already bele

aguered bu

dgets.

This disturb

ing situatio

n became a

key issue at

the 9th Ple

nary Assemb

ly

of HOPE,

the Europe

an Hospita

ls

Organisation

(May, Port

ugal).

Insurance c

ompanies c

annot rely

EUROPEAN HOSPITAL

COMF

ORTA

BLE S

ERVIC

E

H+P Lab

ortechn

ik AG

Bruckma

nnring 1

5-19

85764 Ob

erschleiß

heim - Ge

rmany

Tel:

+49 89 3

1 58 22-0

Fax:

+49 89 3

1 54 45 3

E-Mail:

hpinfo

@hp-lab

.de

Internet

: www.hp

-lab.de

Finger-T

ip lock -

quick

opening

and clos

ure

Program

-selectio

n,

efficient

fraction

ated

pre-vacu

um and

drying

vacuum

by one t

ouch

VARIOK

LAV 25 T

C

FOR ME

DICAL US

E

Steam

Steri

lizers

News/managem

ent . . . . . . 1-5

Radiology . . .

. . . . . . . . . . .6

-9

Surgery . . . .

. . . . . . . . . . . .

. 10

Urology . . . .

. . . . . . . . . . . .

. 11

SPECIAL REPO

RT Education . .

.12-13

cont

ents

Nuclear medi

cine

New Orleans

, USA- The

Society of

Nuclear Me

dicine celeb

rated half a

century of a

nnual meeti

ngs this

year - with

over 1,480 s

cientific

papers, pres

entations an

d posters.

Cycle saddle u

nsafe

Brussels - Fo

llowing a stu

dy of

1,000 bicyc

lists, gynaec

ologist

Dr L Baeye

ns reports th

ey are twice

as likely to s

uffer erectile

and other

problems th

an non-cycl

ists (study

sample: 1,0

00) and, he

adds, a

fashionable

saddle, with

central

hole, is also

harmful.

Asylum seeker

s and HIV

London - Pe

ople from

HIV/Aids-

ridden coun

tries face sc

reening on

arrival, sinc

e some doct

ors’ reported

that two thir

ds of new H

IV patients

are foreign,

many seeki

ng asylum.

Cost to the

NHS: c. £1

5,000 a yea

r

each, cuttin

g budgets to

treat

British citize

ns.

Cardiology . .

. . . . . . . . . . 14

-16

Company new

s,

innovations .

. . . . . . . . . . . .

. 17

IT & telemedi

cine . . . . . . . .

.18

Laboratory ne

ws . . . . . . . . .

.19

14-16Cardiolo

gy

Paclitaxel-elu

ting

stents ‘safe’ fo

r

coronary arte

ry;

cardiac device

s

and research IN BRIEF

6-8Radiolo

gy

An interview w

ith

Professor Hele

n Carty

President ECR

2004

on income f

rom stock m

arkets as in

the late 19

90s, and th

ey motivate

rising pre

miums by

invoking

difficulties t

o obtain a

ccurate and

reliable kn

owledge o

n the real

number of i

njuries that

occur and o

f

future claim

s they will

have to pay

,

HOPE point

ed out. Alth

ough some

countries h

ave found

temporary

solutions,

the long-te

rm positio

n

remains

unsatisfact

ory, the

organisation

added.

In the UK

and Irela

nd, ‘state

claims agenc

ies’ have bee

n set up to

meet public

liability clai

ms of publi

c

hospitals. In

France the

governmen

t

has taken ec

onomic resp

onsibility to

pay for ‘non

-fault-injurie

s’ with over

25% invali

dity. The

Netherlands

,

France, Fin

land and S

weden have

mutual,

non-profit,

insurance

companies

owned by

hospitals

themselves.

Funds for co

mpensation

are being

discussed i

n Luxemb

ourg, Fran

ce,

Belgium and

Hungary.

No-fault c

ompensatio

n systems

already exi

st in the

Scandinavia

n

countries a

nd are bei

ng studied

in

Belgium, th

e UK and

Ireland (f

or

children). I

n Austria th

is system w

as

introduced o

n a small sca

le.

Insurance s

ystems are

also bein

g

discussed in

Hungary an

d Cyprus.

Risk preven

tion to red

uce medical

injuries is no

w a major t

opic in man

y

countries. T

he creation

of high qua

lity,

patient cen

tred care,

based on

safe

practice and

supported b

y safe system

s

remains t

he goal

for Europ

ean

hospitals, H

OPE pointed

out. ‘It is

of

utmost impo

rtance that p

atients acro

ss

Europe can

feel confiden

t that there

is

a robust

and reliab

le insuran

ce

coverage

for medical

risks. T

he

organisation

plans to fo

cus on:

● A study a

nd compari

son of diffe

rent

systems for m

edical risk i

nsurance an

d

evaluation o

f the scale

of the cris

is

facing many

European

hospitals.

● Encourag

ement for th

e developme

nt

of risk pre

vention sch

emes to red

uce

medical inju

ries.

● Examinat

ion of how

patients a

re

insured whe

n using ‘free

movement

of

patients’ ent

itlements.

Details: ww

w@hope.be.

Or: Kaj Ess

inger, kaj.es

singer@lf.se

10Surgery

Breastimplan

t

with titanium

,

plus virtual

patients for

MIS training

V O L 1 2

I S S UE 3 /

0 3

J U NE / J

U L Y 2 0 0

3

T H E EU R O P

E A N FO R U M

F O R TH O S E

I N T HE B U S

I N E S SO F M

A K I NG H E

A L T HC A R E

W O R K

INSURERS BALK

AT MEDICAL RIS

K COVER

17-18

IT/Telemed &

Innovations

Iris recognition

,

PACS, patient

alarms etc

A newly inv

ented ‘Poly

pill’,

composed o

f currently

available

drugs, may

act as a ‘va

ccine’

against hea

rt disease, a

ccording to

new researc

h published

in the

British Med

ical Journal

(28 June.

BMJ 2003;

326:1419).

Professors N

ick J Wald an

d

Malcolm R

Law, the Po

lypill’s

inventors, m

aintain: ‘Th

e Polypill

strategy co

uld largely

prevent hea

rt

attacks and

stroke if ta

ken by

everyone ag

ed 55 and o

lder and

everyone wi

th existing

cardiovascu

lar disease.

It would

be acceptab

ly safe and

with

widespread

use would h

ave a

greater imp

act on the p

revention o

f

disease in th

e Western w

orld than

any other s

ingle interv

ention.’

In his relate

d editorial,

Richard

Smith, Edit

or of the BM

J, also

expressed e

xcitement, s

tating that

The impact of

this invention

on disease pr

evention will b

e

enormous - b

ut, manufactur

ers may not r

ise to low pro

fits

this issue m

ay well bec

ome a

collector’s i

tem. ‘It’s pe

rhaps more

than 50 yea

rs since we

published

something a

s importan

t as the

cluster of p

apers from

Nick Wald,

Malcolm La

w, and oth

ers.’

At the Depa

rtment of

Environme

ntal and Pr

eventive

Medicine, W

olfson Instit

ute of

Preventive

Medicine, B

arts and th

e

London, Qu

een Mary’s S

chool of

Medicine an

d Dentistry,

University

of London,

London EC

1M 6BQ, t

he

professors w

orked to d

etermine

drug and v

itamin comb

inations an

d

doses that

could, in a

single pill,

achieve a la

rge effect in

preventing

cardiovascu

lar disease

with minima

l

adverse effe

cts. The str

ategy was t

o

simultaneo

usly reduce

four

cardiovascu

lar risk fact

ors (low

density lipo

protein cho

lesterol,

blood press

ure, serum

homocystei

ne,

and platelet

function) re

gardless of p

re-

treatment le

vels, they w

rite.

Efficacy an

d adverse e

ffects of

the propose

d combinati

on was

qualified fr

om publishe

d meta-

analyses of

randomise

d trials and

cohort stud

ies and met

a-analysis o

f

15 trials of

low does as

piring (50-

125 mg/day

)

‘They synth

esise an eno

rmous

amount of

information

(including

over 750 tri

als with 40

0,000

participants

) to estimate

that the

pill would r

educe heart

disease and

risk of stro

ke by over

80%, while

causing sym

ptoms warr

anting

withdrawal

of the pill

in one to

two per 100

and fatal s

ide effects

in less than

one in 10 00

0 users. If

this were co

rrect the be

nefits woul

d

substantially

outweigh h

azards in

continued o

n page 15

‘Polypill’cuts card

iac

attacks by 80%

21-24Parker –

World

leader in

ultrasound

supplies

please see pag

e 4

An ISO Cer

tified Compa

ny

ECLIPSE

® PROBE COV

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PARKER LAB

ORATORIES,

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9500 Fax 9

73-276-9510

E-mail: park

er@parkerlab

s.com www.p

arkerlabs.com

U.S.A. and In

ternational pa

tents granted

Signature Date

Disturbingly high rates of medicalerrors, lack of care co-ordination,poor communication between doc-tors/patients, and barriers whenaccessing care, are experienced bypatients in the United States (US),Australia, Canada, NZ (NZ) andthe United Kingdom (UK).

These findings - from a surveyconducted by the CommonwealthFund, a private foundation sup-porting independent research onhealth and social issues, and pub-lished recently in Health Affairs -point to widespread error, ineffi-ciency and missed opportunities inthe five countries’ healthcare sys-tems. The authors, health policyanalysts R J Blendon and CDesRoches of the Harvard Schoolof Public Health, C Schoen and ROsborn of The CommonwealthFund, and K Zapert of HarrisInteractive, suggest that reformstargeted at populations with healthproblems could reap system-wideimproved quality and potential costsavings.

‘Frequent error, miscommunica-tion, and wasted resources fromduplicate tests, delays, and conflict-ing information are common prob-lems in the health systems of all thecountries studied,’ said KarenDavis, President of The

Managed Care - Facts, Trends &Data - the 8th edition of apublication that annually updatesmarket and healthcare informationrelating to the US, is due out inAugust. Details: www.AISHealth.com/Products/mfbE199.html

The Yellow Book, published by theUSA’s Centres for Disease Control andPrevention, focuses on internationaltravel and covers everything from theuse of insect repellents, to scubadiving safety, high altitude travel,children and travellers with specialneeds, to health hints aboutinternational adoptions, plus, ofcourse, vaccination and medicationsrelating to disease risks according todestinations. Details: www.cdc.gov/travel/Or: http://bookstore.phf.org/prod159.htm

The high cost of bipolar disorderThe most expensive behavioural healthcare diagnosis, for sufferers and theirinsurers, is bipolar disorder, according to a study published in the AmericanJournal of Psychiatry (160:1286-1290, July 2003). For every behavioural health-care dollar spent on outpatient care for those with this disorder, $1.80 is spenton inpatient care, say the researchers, adding that this suggests that better pre-vention management could decrease the financial burden of bipolar disorder.

The researchers examined insurance claims from 1996 from about 1.66 mil-lion people. The average annual charges per person and payments for behav-ioural healthcare were calculated along with patient’s out-of-pocket expensesand in-patient hospital admission rates. Behavioural healthcare expendituresfor bipolar disorder were compared to expenditures for other behaviouralhealthcare diagnoses in the same insurance plans. The researchers found that7.5% of all covered individuals filed a behavioural healthcare claim. Of those,3.0% were identified as having bipolar disorder, but they accounted for 12.4%of total plan expenditures. Patients with bipolar disorder incurred annual out-of-pocket expenses of $568, over double the $232 incurred by all claimants. Thein-patient hospital admission rate for patients with bipolar disorder was alsohigher (39.1%) compared with 4.5% for all other behavioural healthcareclaimants. Additionally, annual insurance payments were higher for coveredmedical services for individuals with bipolar disorder than for patients withother behavioural healthcare diagnoses. Full details: http://ajp.psychiatryonline.org/cgi/content/abstract/160/7/1286

Britain earmarks £50 million for NHS geneticsA ‘Genetics Strategy for the NHS -‘Our Inheritance, Our Future -Realising the Potential of Genetics inthe NHS’, presented to Parliament inlate June by John Reid, Secretary ofState for Health, aims to set out avision of how patientscould benefit fromfuture advances ingenetics, and raiseawareness of thepotential of genetics inhealthcare. The ‘WhitePaper’ sets out a com-prehensive plan to pre-pare the NHS, andincludes an investment of £50 millionover the next three years towards thisinitiative, by ● Substantially upgrading geneticslaboratories, and boosting the genet-ics workforce: more genetics counsel-lors, consultants and laboratory scien-tists ● Spending over £7 million on newinitiatives to introduce genetics-based healthcare into the main-stream of the National Health Service

● Setting up a new GeneticsEducation and Development Centreto spearhead education and trainingin genetics for all healthcare staff ● Funding a new research pro-grammes in pharmacogenetics, gene

therapy and health ser-vices research to helpturn the science intoreal patient benefit.

Safeguards and con-trols against inappro-priate or unsafe use ofgenetics developmentsare also set out. Inaddition to existing

controls on gene therapy and use ofgenetic test results by insurers, newlegislation is planned, to ban DNAtheft: it will become an offence totest someone’s DNA without theirconsent except for medical or policepurposes.

The Government said it recognisesthe importance of openness andpublic debate, and will continue torespond to new developments andshifts in public attitudes

Patients in five countriesreveal healthcare deficiencies

Commonwealth Fund. ‘These find-ings highlight serious problemswith quality of care and wastedresources, and make a compellingcase for implementing interventionsthat we know will make a differ-ence, including electronic medicalrecords and computerised systemsfor physician ordering of prescrip-tion drugs.’

The survey of healthcare experi-ences involved patients aged from18 years, who reported fair or poorhealth, serious illness, injury, dis-ability, major surgery or hospitali-sation for something other than anormal delivery in the past twoyears. Medication and medical errors -One-fourth of adults with healthproblems in Australia, Canada,NZ, and the US and one-fifth in theUK, reported experiencing a med-ication error or medical error in thepast two years. Most of these, inevery country, said the error causedserious health consequences.Among all respondents, this repre-sented 13% in Australia, 15% inCanada, 14% in NZ, 9% in the UKand 18% in the US.Lack of care co-ordination - One infive of the more ill adults in Canada(20%) and the US (22%) reportedbeing sent for duplicate tests by dif-

ferent health professionals, as did onein six in NZ (17%), one in eight inAustralia (13%) and the UK (13%).In all five countries, about half of thepatients said they had to repeat theirhealth history to multiple health pro-fessionals

One-fourth of US (25%) and UK(23%) respondents, one-fifth (19%)of Canadian respondents, and one insix in Australia (14%) and NZ(16%) said their medical records didnot reach a doctor’s office in time foran appointment. About one-fourth ofrespondents in Australia, Canada,NZ, and the US, and one-fifth in theUK (19%), reported receiving con-flicting information from differenthealth professionals.Communication - US patients weremore likely than those in the othercountries to report communicationdifficulties with their physicians.Three in 10 in the U.S. (31%) saidthey did not have important ques-tions answered by their physicians,compared with one in five inAustralia (21%), NZ (20%), and theUK. (19%), and one in fourCanadians (25%). Access and Cost Problems - Not sur-prisingly, a higher proportion of USrespondents said they encounteredproblems accessing healthcare due tocost - although cost did affect accessto an extent in all the countries. Alsodue to cost, in the US 35% of respon-dents did not fill a prescription(35%), and 28% did not receivemedical care or a recommendedtest/treatment/follow-up (26%). 23%in Australia, 19% in Canada, and20% in NZ, said they did not fill aprescription due to cost, but only10% in the UK said the same.

26% of NZ respondents said theydid not have medical care due to cost,as did 16% in Australia. UK respon-dents were least likely to report this:4% cited cost as the reason they didnot have medical care and 5% saidcost influenced the lack of a recom-mended test/treatment.

About 16% of US respondents saidthey skipped doses to make theirmedication last longer, but less than10% did this in the other four coun-tries.Full details or to order publications:www.cmwf.org.

‘Genetics offers predictionof risk, more precise

diagnosis, more targetedand effective use of existing

drugs, new gene-baseddrugs and therapies, and

prevention and treatmentregimes tailored to an

individual’s genetic profile.’

PUBLICATIONS

Dr.GoettfertSystems

please see page 17

EUROPEAN HOSPITAL Vol 12 Issue 3/03 3

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UK - Launching the ‘world’s most advanced mobile operating theatre’,at the annual scientific meeting of the British Association of DaySurgery, Gary King, Managing Director of Vanguard Healthcarepredicted that, as from January 2004, over 40,000 NHS operations willbe carried out in mobile theatres. This, he said, would aid the NHSTrusts’ strategy in the face of tough Government day surgery targetsand: ‘Because the units can operate anywhere in the UK at short noticethey can also help to smooth out regional inequalities in healthcare.’

A fleet of 15 units are being developed by the firm, which includemobile eight-bed recovery wards that self-unload from low loaders onto hospital car parks. Arriving complete with nursing team, a unitcontains a high tech operating room, anaesthesia facilities and recoveryarea and can receive patients within two hours of arrival at a site.

Mobile surgical units made by the firm have just completed their10,500th surgical procedure. Details: phone +44 (0)1270 884067

40,000 mobile theatre operations

First EU Women’sHealthcare Centreopens

The Diagnostic Breast CentreGottingen has opened the firstEuropean Women’s Healthcare Centre(WHC). Professor Uwe Fischer, headof the new centre, said: ‘We have setourselves the objective, with the helpof ultra-modern systems and high-quality processes, to diagnose breastcancer in the very earliest stages. Ourmedical team has a combinedexperience of over 40 years inmammography, and the centre alsoconsults with senior physicians at theUniversity Hospital.’

Bernd von Polheim, Vice Presidentof GE Medical Systems CentralEurope added: ‘GE Medical Systemshas supported the opening of WHCsin the USA for many years... and thefirm is working in close co-operationwith doctors, universities and otherhealthcare representatives to initiatefurther women’s prophylaxis centres.’

Senographe 2000 D, a full fielddigital mammography system, plusultrasound and MR mammographyhave been installed at the centre,where comprehensive training coursesare being provided to keep abreast ofthe latest imaging technology.

Karin Samorra, Women’sHealthcare Manager at GE MedicalSystems, said the firm would like tosee further development of theWomen’s Healthcare Centres ‘...horizontally and vertically’ - meaningproliferation across Europe, with theGottingen centre used as a kind ofprototype. ‘Our aim is to offer womanin all phases of life everything that ismedically necessary under a singleroof,’ she explained, adding that thefocus would not only be on breastcancer prophylaxis, but also ongynaecology, cosmetic therapies andhealth through exercise/sports.

ConferenceHealthcare

across bordersAmsterdam • 22-23 Sept

The Netherlands - RaphaelMedical and the Strategic ResearchInstitute will hold a conference atthe Grand Sofitel Demeure,Amsterdam (22-23 September2003), following a successfulinaugural conference inWashington DC, last October.Under the banner Seeking,Providing and Funding Excellencein International Healthcare, theevent is anticipated to attractinternational healthcare managers,insurers, hospital medical directorsand business and political experts,investors, and healthcareequipment manufacturers coveringall healthcare fields. Within abroad range of topics, emergingstrategic and technological trendsand best practices will bepresented. Details:www.srinstitute.com/ci278

From left: Dr F Baum,Dr D von Heyden and

Professor Uwe Fischer,medical executives at

Europe’s first Women’sHealthcare Centre

NEW

4 EUROPEAN HOSPITAL Vol 12 Issue 3/03

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U.S.A. and International patents granted

SARS

HOTSPOTS COOL DOWN BUT STAY ALERT!The known global death toll due tothe new virus (as of 1 July) was 811.Total number of cases 8447. Casesreported in Europe were: one caseeach: United Kingdom, Switzerland,Spain, Finland and Romania; 3cases Sweden; 5 cases Italy; 7 casesFrance and 10 cases Germany.

China, Hong Kong, Macao andTaiwan had a combined total of7761 reported cases as of June.

Towards the end of May, theWorld Health Organisation lifted itswarning about travel to Guangdong,China. This month the organisationremoved the warning about fourmore Chinese areas - Hebei andShanxi provinces, Inner Mongoliaand Tianjin city.

However, the WHO has notraised the warning about non-essen-tial travel to Beijing, which hadreported about 2,500 cases and justunder 200 deaths, out of China’s5,300 cases 347 deaths. WHOExecutive Director forCommunicable Diseases, DavidHeymann, has travelled to China toassess the level of control of the Sarsepidemic, indicating doubt on thedecline in reported numbers of newinfections. His team are investigat-ing whether cases are being missed,or that patients with suspected Sarsare being turned away.

Both China and Taiwan are lob-bying the WHO to lift warningsagainst travel to their areas.

New infections and deaths causedby the respiratory disease have beenreported as lower in all affectedcountries except Canada over recentweeks, but China and Taiwanreported the highest success rate inreduction of cases, despite a largesurge of cases in Taiwan in April andMay. The figures logged in haddropped to such a level that theWHO pointed out that it is unlikelythat the SARS virus has suddenlybecome less virulent - or that

China’s isolation and quarantineprocedures are more successful thanthose of other nations. (The WHOhad already warned that facilitiesfor monitoring and treating thevirus are inadequate in China, and itwas concerned that the virus couldspread to rural areas from Beijing).

In Taipei, over 150 doctors andnurses quit their jobs in protest atthe lack of safeguards and two hos-pitals were fined for covering up thespread of the disease. Taipei’s tophealth official, Chiu Shu-ti, resignedin late May. Just prior to this, theisland’s record number of new infec-tions in one day reached 65, atwhich point the WHO extended its

travel warning about Taipei to coverthe whole of Taiwan.

That outbreak prompted an offerof help from Mainland China tocombat the disease. Taipei refusedthis and demanded that China stopblocking the island’s efforts to jointhe WHO.

Meanwhile, Singapore wasremoved from the list of SARS-affected countries at the end of May.There, 31 people had died due toSars out of 206 cases. Singaporetook stringent measures to preventthe spread of the disease, whichinclude isolating all Sars patientsand suspected cases in one hospital;the thermal-imaging of air passen-

gers to detect any with high tempera-tures; issuing digital thermometers tothousands of primary school childrenfor daily temperature checks; and thecity state has now announced that itwill fine and imprison patients wholie on new health forms distributed athealth clinics and Chinese medicinehalls. The country also recentlyimplemented mandatory temperaturechecks for workers at constructionsites, factories and shipyards.

Hong Kong was also taken off thenon-essential travel list in June,although this area had more Sarscases per capita than any other.

Meanwhile in Canada, which hadapparently eliminated Sars, doctors

SINGAPORE - The UK firm Bioquell haswon a Singapore contract, said to bework £250,000) with Asia’s largest pri-vate healthcare company to ‘bio-decon-taminate’ two hospitals.

The firm reports that three of itsemployees will be working in Sars-freehospitals but will wear protectiveclothing and take relevant precautionswhen they work with the company’scomputerised sterilisation system inthe Gleneagles and Mount Elizabethhospitals.

Weighing only 25kg, the system killsbacteria and viruses in hospital wardsby spraying hydrogen peroxide vapourthat then catalytically converts intooxygen and water.

Although the hospitals are Sars free,the contract was said to be part of a‘robust approach’ to infection control.

Existing drug may combat virusGERMANY - Tests have shown that theexisting anti-viral drug Glycyrrhizin maybe effective in reducing the ability of the‘Sars’ virus to reproduce itself, accordingto a report in The Lancet by scientists atthe Frankfurt Medical School. JindrickCinatl indicated in the journal that sincethe side effects of the compound areknown and can be controlled, ‘... propermonitoring could lead to effective use ofGlycyrrhizin as a treatment for Sars.’

Used to treat hepatitis C and HIV infec-tions, this compound is made fromliquorice roots.

The researchers also that, althoughRibavirin has been used in some cases totreat Sars patients, it shows no effect.

100 mobile X-ray systems and 200 respiratory systems wereoffered to the People’s Republic of China by Siemens MedicalSolutions (Med) and Lufthansa cargo offered to deliver themfree of charge, to help the country to combat the Sars outbreak.Both companies worked closely with the Ministry for EconomicCo-operation and Development, which is led by HeidemarieWieczorek-Zeul, who said: ‘The strong commitment shown to

Despite global unrest and the economic picture,the organisers of MEDICA 2003(www.medica.de) Messe Dusseldorf, reportcontinuing expansion. ‘Space bookings for the35th world forum for medicine (19 to 22November 2003) have already reached the finalfigure of the previous year (111.800 sq. net).About 3,600 exhibitors will participate, despitethe numerous company mergers in the medicalindustry.’

‘Over 43,000 trade visitors from more than132,000 will come to MEDICA 2002 from othercountries,’ said Horst Giesen, Project Managerof MEDICA.

International sales of German-made medicalproducts account for a good percentage of thereported sales growth of 8-10% in this industry,seen despite years of market stagnation in itsown country. The proposed healthcare reforms- depending on the extent to which they areimplemented - will contribute to clearing theaccumulation of investments and provide newfunds for various health service providers, said a

the people of Asia by Lufthansa Cargo and Siemens is com-mendable. They deserve a lot of credit.’

The delivery was accepted in Beijing by a delegation fromthe German embassy, which officially handed over the systemsto members of the Chinese Ministry of Finance for distributionto Beijing hospitals. The Schenker Logistics Company spon-sored and co-ordinated local deliveries in China.

More exhibits, morehotel rooms and a

bigger emphasis onservice

were recently investigating whether anew cluster of pneumonia cases at ahospital near Toronto is Sars-related.

Health authorities were criticisedfor easing up on precautions toosoon, when it was also reported thatsome quarantined people had ignoredisolation orders.

The authorities appealed to healthworkers in Toronto to go voluntarilyinto quarantine.

Meanwhile, health authorities inthe USA reinstated advice to those vis-iting Toronto to take precautionsagainst infection.

Many countries won praise fortheir approach to reporting and con-trolling the disease; these includeCanada, Singapore, Vietnam, and thePhilippines. Most have not only suf-fered the disease but economically dueto the drop in tourism.

The Sars epidemic is now possiblytailing off. Gro Brundtland, DirectorGeneral of the WHO, said the numberof new Sars cases logged in daily wasdeclining, but has advised that coun-tries remain on the alert. ‘We haveseveral examples where we have seenthe figures drop in one country beforeseeing a new wave,’ she said during apress conference in Oslo. She alsowarned of a possible surge when win-ter arrives in the NorthernHemisphere.

Why is there so much concernabout Sars? Because other contagiousdiseases, such as influenza (which kills1% or less of those with the illness)do not all show the very high mortal-ity rate that Sars has achieved.

‘We’re so used to there being ananswer to everything, that there iseither a medicine or a vaccine,’ saidGro Brundtland, but this time theworld had to rely on old-fashionedways of isolating cases to combat thisdisease.

MEDICA expands againMEDICA representative.

This year, an addition to the fair will be MED-ICA MEET-IT, a forum for trade visitors interestedin medical software products for in-patient andout-patient care.

The International Trade Fair for Components,Upstream Products and Raw Materials forMedical Production (ComPaMed) will again runparallel with MEDICA.

Messe Dusseldorf has started an extensivemodernisation and extension programme of theExhibition Centre, building a new exhibition hallon the Europaplatz, near a multi-purpose arenacurrently under construction. Completion isscheduled for late 2004. There will also be a newrailway bringing direct access to the centre.

Currently twelve new (*** to *****) hotels,which ill offer 3,100 rooms, are under construc-tion, increasing the city’s capacity by 20%.

Day trips - Fairs & Guests travel services isoffering various travel packages from differentairports in Germany as well as from Vienna andZurich. E-mail: info@fairs24.com.

TREATMENT

HYGIENE

SYSTEMS SOAR TO CHINA

UP-DATE

I N T E R V I E W

EUROPEANHEALTHCARE

policy updateBy Dr Martin Schoelkopf

EUROPEAN HOSPITAL Vol 12 Issue 3/03 5

E U P O L I T I C S & M A N A G E M E N T

Professor for International Health Management

Professor for International Health Management

The Chair for International HealthcareManagement will focus on new approachesin hospital management in a global entre-preneurial business environment.

The faculty member appointed to this posi-tion is expected to teach postgraduate level(MBA) courses in the fields specified belowand to conduct scholarly research in relatedareas.

Furthermore, he/she will be the head of anewly created institute in hospital manage-ment. Opportunities for collaboration withhealth organisations and providers are given.The position is in the first round limited to 5 years.

Candidates with postdoctoral lectureexperience in management and hol-ding the following qualifications areinvited to apply:

• High academic reputation in the field of anentrepreneurial approach to internationalhospital management

• Academic focus on patient-focused workflow, optimal clinical structures, effectiveuse of capital investments and staff, opti-mised teams, supply-chain management,eCommerce solutions

• International didactic experience with smallgroups and an intensive interactive focus

• High motivation to collaborate with otherprofessionals in research, business, financeand healthcare.

HfB - Business School of Finance & Manage-ment is an innovative, private University loca-ted in Frankfurt am Main, Germany, a regionrecently ranked no. 4 in the world for its qua-lity of life. Since its establishment in 1991, HfB has developed a strong track record inresearch and teaching in the areas of Finance and Management. In Fall 2003, HfB will expandits portfolio by launching an internationalpart-time MBA Programme in Hospital Management in co-operation with NationsHealthCareer School of Management, Berlin.

Nations HealthCareer is a non-profit BusinessSchool dedicated to providing high-qualityprofessional training for managers in hospi-tals and related entities worldwide.

If you are interested in this position please contact:

NationsHealthCareers c h o o l o f m a n a g e m e n t

www.Nations-HealthCareer.com www.hfb.de

Prof. Dr. Thomas Heimer, Dean,Hochschule für BankwirtschaftUniversity of Applied SciencesBusiness School of Finance & ManagementSonnenmannstraße 9-1160314 Frankfurt/MainPhone: +49 (0) 69 - 154008 -725Fax: +49 (0) 69 - 154008 -728heimer@hfb.de

Professor Matthias Schrappe, Chairman of the Gesellschaft für Qualitätsmanagement in der Gesundheitsversorgunge.V. GQMG - (Association for Quality Management in Healthcare) and Medical Director of the Philipps UniversityClinic, Marburg, Germany, discussed quality management issues during an interview with Denise Hennig, ofEuropean Hospital

EH: You believe thatquality managementshould be an integralpart of a hospital’sworkflow, not just anadditional service.Would you explainyour ideas? MS: Quality

management should always have ajoint ‘bottom up and top down’approach - that is, not simplyimposed from above but experiencedand managed on the frontline. It isnot viable to address qualitymanagement issues in wards ordepartments, with hospital orcompany managers showing littleinterest. They depend on each other.Therefore, training and resourcesshould be made available for thoseworking in the departments, so thatthey can establish qualitymanagement activities and find anddevelop solutions for qualityassurance. Individuals with the rightknow-how, who develop andimplement improvement processes,and who can solve problems, mustalso provide adequate support.EH: But departments and wards areusually under-staffed - does thismean more people should beemployed to improve quality of care? MS: Yes, that’s the big problem - notenough staff! Of course it would benice to have more. However, until wecan afford it we must make do with

the level we have. On the other hand,we have to develop self-criticism andadmit that certain issues can beimproved simply by better workorganisation. Hospitals are quitesluggish when it comes to makingchanges. Recently, we’ve made somequite surprising improvements simplyby changing certain workflowprocesses. Initially, both doctors andnurses expressed doubts about ourideas. However, by demonstratingissues with encouraging examples we

Hospital quality reports

In June the European Commissionreported (Employment, social policy,health and consumer affairs meeting)on the status of the European healthinsurance card scheduled for introduc-tion by summer 2004. Among subjectsdiscussed was the problem that someMember States don’t have the technicalinfrastructure necessary to introducethe health insurance card. For thesecountries, the Commission suggests atransition period until the end of 2005,to set up facilities for the card’s use.

Other open issues concern the type ofdata to be included on the card and theperiod of a card’s validity. http://regis-ter.consilium.eu.int/pdf/en/03/st09/st09910en03.pdf

In May, EU Ministers for healthand for telecommunications, at ameeting attended by ErkkiLiikanen, EU Commissioners forthe Information Society, and DavidByrne, EU Commissioner forHealth, confirmed their intentionto develop national and regionalplans to implement electronic

At the request of Belgium, in a June meet-ing the Council of EU Health Ministersfocused on medicines for children, look-ing at clinical research and developmentwork on paediatric medicines. Until now,the development of medicines was notgenerally tailored to the specific require-ments of children. For this reason, theCommission published a consultationpaper and requested views on the topic.(Summary of proposals: http://pharma-cos.eudra.org/F2/pharmacos/docs/Doc2002/june/overchild.pdf). At the Councilmeeting, the Commission agreed to pre-sent the proposal for a correspondingDirective beginning of 2004.

The first eHealth 2003 conference was initiated by the EuropeanCommission and carried out in close collaboration with the GreekPresidency. At the conference, the first eEurope awards in the fieldof electronic healthcare were presented.

High costs ofUS healthcare

The May/June edition of the spe-cialist journal ‘Health Affairs’ con-tains the results of a current com-parison of costs and capacities ofhealthcare systems of the OECDMember States. Referring to theOECD Health Care Data statistics,the authors particularly considerwhy the US healthcare system is themost expensive in an internationalcomparison (healthcare expendi-ture/GDP in 2000: 13%), althoughin terms of capacity indications andtake-up of medical services, the val-ues are below average.

The authors attribute this to sev-eral factors: The highly fragmentedUS fee-payment system for in-patients involves a high level ofadministrative expenditure, whichpartly explains the high costs of UShospitals. In addition, the UShealthcare system is exceptional interms of the significantly above-average availability and use ofhigh-quality and cost-intensivemedical technology (although it isalso worth noting that such tech-nology is more widespread inJapan, without this being reflectedin the level of Japanese healthcareexpenditure).

However, according to the study,the principal cause of the high costsof the American healthcare systemis the level of prices, fees and wagesfor medical services (‘It’s the prices,stupid’). All are significantly higherthan in other OECD countries.

Not only do the Americans paysignificantly more, they actuallyreceive fewer services than patientsin other countries.Free study: www.healthaffairs.org

Health insurancecard - update

E-health

Recipients of the 1st e-Europe Awards for electronic healthcare

Name Description Organisation & Place Country

EVISAND Virtual environment Consejeria de Salud, Spainfor healthcare Junta de Andalucia, Seville

SJUNET National IT infrastructure Carelink, Stockholm Swedenfor healthcare in Sweden

COHERENCE Information system for Georges Pompidou Francesuccessful hospital European Hospital (HEGP),

restructuring, Paris

NHS Direct NHS direct online website National Health Service, UKSouthampton

healthcare and to investigate thepossibility of co-ordinating EU-wide implementation.

The ministers have also wel-comed the Commission’s Comm-unication regarding quality criteriafor websites on healthcare andencouraged the Commission toexamine the possibility to introduceEU-wide quality seals.

In addition, they agreed on anumber of specific measures toimprove access to and exchange ofrelevant health information and tosupport the development of stan-dards which ensure the interoper-ability of the many different sys-tems and services. http://europa.eu.int/information_society/eeurope/ehealth/confer-ence/2003/doc/min_dec_22_may_03.pdf

could show how beneficial andtimesaving certain changes toindividual workflow can be. So nowour available resources are used farmore efficiently, which, in turn, givesmore satisfaction to employees.EH: Patients also profit from this, andwill talk about positive experiences.MS: That’s our intention. Modernhospitals are service-orientated.Patients have a right to expectprocesses to be centred on their needs. EH: As a patient, how do I find a

good hospital? Is there a hospital ‘sealof quality’?MS: There are various accreditationconcepts for hospitals. Audits arecarried out by licensed independentorganisations, which then issue one ofthe three types of certificate externally.Some are certified by the ISO. Also,there’s the European Foundation ForQuality Management (EFQM), and theCo-operation of Transparency andQuality (KTQ) - a self-evaluation toolwhich uses ‘visitors’ who are healthcare

experts trained to write reports onhospitals, on which the accreditation isthen based. Hospitals can add theaccreditation to letterheads so patientsknow they are taking the certificationissue seriously.

That’s one way. However, accordingto current Social Welfare Legislation Vguidelines, there is another way. For2004, all licensed hospitals will have towrite up quality reports. We have donethis since 1995 in Marburg. Thequality report contains information -accessible for patients - on how manyoperations of a certain kind werecarried out at the hospital, or howmany types of illness were treated atthe hospital. There will also be dataabout the degree of complicationsexperienced by patients in the hospital.We think this is a good thing - if thefigures are correct.EH: That can be the problem withstatistics.MS: Which brings us to the nextproblem. If quality and competition areso important politicians will argue thatthere must be spot checks. Manycountries have done this for a longtime and I think we in Germany willfollow soon. This will be a good thing,otherwise those who are honest andup-front with their facts and figures -for example about numbers ofcomplications - will lose out tohospitals that are vague about theirstatistics and do not admit toproblems.

Paediatric medicines

Awards

Involvement with the EuropeanCongress of Radiology (ECR) Professor Carty was invited lecturerat the ECR in 1991, a year in whichshe also became a member of theECR’s Scientific and Paediatric com-mittees. In 1999 she was electedmember of the Executive Committeeand became a member of the ECRCouncil in 2000. The following year,Professor Carty became PresidentElect 2004. She is now President ofthe European Congress ofRadiology.

Plans are well underway for thenext congress, she said, in a recentinterview with Brenda Marsh,Editor-in-chief of EuropeanHospital, in which she also describedher hopes for ECR 2004, andsome ideas about the future ofradiology.Helen Carty: I want to buildon the excellence that hasalready been established andto continue to develop its roleas the major multinationalEuropean meeting for scienceand education in radiology. TheECR has already attained a veryhigh reputation for the quality ofboth and, in particular, for its recog-nition of developments in radiology- and, indeed, for supportingthem. With this in mind, for ECR2004 we will hold separate sci-entific sessions on molecularimaging, followed by a sub-com-mittee for molecular imaging, andthere will be several special focusand new horizon sessions on thatsubject.

Hands-on workshops will covermusculoskeletal ultrasound, verte-broplasty and virtual reality angiog-raphy - sessions created with theenthusiasm and help of radiologistsfrom across Europe and supportedby companies. I’m very grateful toboth.

All these developments are at thecutting edge of radiology. Mindfulthat the spectrum of radiology ishuge, we are also developing a clini-cal radiology foundation course, tobe further developed in subsequentyears. This will lay down the stan-dards of knowledge required fortrainees across Europe and will bethe basis for the standard of theEuropean Diploma.Brenda Marsh: What other issueswill you highlight and why?

The range of her knowledge and experience is impressive(Her distinguished medical record even includes a goldmedal in midwifery). For example, as an adviser to theBritish Department of Health (DOH) the professor hasfocused on the administration of radioactive substances, andpatient dose reduction in paediatric radiology. She has previouslybeen personal advisor in radiology to the Breast Committee. Shehas served on many other DOH working parties. She has alsoserved the Royal College of Radiologists, in many guises, overmany years, and completed her four-year term as Warden inSeptember 2002. As a member of various RCR committees andworking parties her contributions are too numerous to mention.

In 2002 the professor was guest lecturer at the InternationalSymposium on Medico-Legal Exposure for the DOH, speakingon ‘Ethical and radiation issues in child abuse’. She is currentlythe Radiology Representative for the NHS InternationalFellowship Scheme, assisting the celebrated transplant surgeonSir Magdi Yacoub.

Numerous publishing involvements include the editing of ‘TheEncyclopaedia of Medical Imaging. 2001’ (Ref: PaediatricImaging Vol. VII. Volume Ed. Carty H. Nicer Institute, ElandersPublishing AS, Oslo), and Imaging Children - a 2 volumetextbook of paediatric radiology. Her editorial boardmemberships include Paediatric Radiology, European Journal ofRadiology (1990-2000), Radiology Now, and EuropeanRadiology. Professor Carty is also a regular reviewer for leadingspecialist medical journals and was section editor of two editionsof the European Journal of Radiology (Jan ‘98, Feb 2000).

As a lecturer, Irish-born Helen Carty is renownedinternationally - from Europe to the India sub-continent and theFar East, the USA and Africa and back, south and north. Lastyear, for example, the professor was Visiting Expert in PaediatricRadiology and Postgraduate Radiologic Education at Singapore’sMinistry of Health HMDP. This year she is Invited ExternalAssessor of the Department of Anaesthesia, Ophthalmology,Otorhinolaryngology, Surgery and Radiology, National Universityof Ireland.

Professor Carty is a renowned expert in non-accidental injury(NAI). Having seen some 1,000 of such cases she continues tobring valuable insights to the police, the law, specialist societiesand medical colleagues (e.g. pathologists), and to writeextensively on NAI and enigmas in the diagnosis of child abuse.

The professor’s interest and experience in paediatrics, alongwith her birthplace, have influenced the ECR choice of honouringIreland (along with England and Poland) next March, at ECR2004. On exhibit will be the painting ‘Bird Market’, by Irishartist John Butler Yeats. As a celebration of the innocence ofchildhood the picture has ‘... some of the magic and mystery ofour speciality,’ explained Professor Carty, who is married and hasthree children.

6 EUROPEAN HOSPITAL Vol 12 Issue 3/03

R A D I O L O G Y

“I N T E R V I E W

‘I am rather awed,’ says the new Presidentof the European Congress of Radiology

At this year’s ECR in Vienna, Helen Carty, the incoming ECR2004 president, said she felt both honoured - and rather awed- at being entrusted to lead a congress built on friendship, inwhich ‘disparate nations of many creeds and races, rich andpoor, come together to give and to share knowledge,

experience and science in this nonconfrontationalatmosphere’. Awe is something many radiologists might feel

about the new president, for Helen Carty, 59, is not only Professor ofPaediatric Radiology at the University of Liverpool, but an international lecturer,educator and important voice in both medical and political levels.

Advances in imaging: Aquilion 16 CT angiography of the abdomenusing volume-rendering technology. Courtesy of Toshiba

HELEN CARTY

Radiology’s leadinglady

HC: I specialise in paediatric radiol-ogy, and we will highlight particu-larly relevant aspects in this field forradiologists who are not specialistsin paediatrics. Not every child canhave radiographs reported by a spe-cialist paediatric radiologist - this isnot only impractical but impossible.However, it is important that con-tinuing support and refresher cours-es are available for those who mustdo a small amount of paediatrics, tokeep them up to date with develop-ments, and to ensure children arenot treated as ‘small adults’.BM: How have the lecturers beenselected? HC: For 2004 lecturers were chosen

following advice from theEuropean specialist societies, whowere asked to identify outstandingspeakers in their own fields and, inaddition to the tried and trusted, tointroduce new speakers - ensuringcontinuing refreshment in the meet-ings.

Most suggestions came from thesocieties, but the final balancing - toachieve a reasonable spread ofspeakers from across Europeannations - is undertaken by the ECRProgramme Planning Committee.However, I’d like to emphasise thatECR is constantly looking out fornew, good speakers, and welcomessuggestion and advice (including

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The term used in the UK is clinicalradiology, and without correlationand understanding of clinical issuesone cannot practise radiology -which is why I believe that one needsa basic medical degree for safe prac-tice across the board. This does notmean that I don’t respect the profes-sions supplementary to medicine or,indeed, technicians doing tasks thatwere previously radiological, but onestill has to have an overview of theclinical problems if safe practice is tobe maintained.

As I said during my talk onEvidence Based Medicine, in Vienna,(when I was billed as the Cynic):patients and disease do not totallyfollow scientific rules and it is vitally

important that radiologists retain abroad view of a subject so that theycan spot, almost instinctively, theuncommon presentation of an illnessor, indeed, the uncommon cause of agroup of symptoms. BM: You have seen many changes inyour career. Which are the most sig-nificant, and which, among R&Dprojects, do you foresee as affectingradiology most significantly? HC: Yes, as a UK consultant radiolo-gist spanning 28 years, and all of thatspent in paediatric practice, I’ve seenmany, many changes, the most obvi-ous being the explosion in the imag-ing fields available to us. Of course,cross sectional imaging, in the broad-est sense, is the most significant. I

think the advent of spiral CT is, infact, going to have a continuing hugeimpact on medical practice. So muchcan be done and diagnosed with a spi-ral CT, non-invasively and so quicklythat I think it will become almost theprimary tool of investigation of mostacute presentations in medicine.

I’m fully conscious of the signifi-cance of the radiation issue. I thinkthis is an area where there will have tobe increasing and continuing co-oper-ation between industry, radiationphysicists and clinicians, to ensure thatthe use of radiation in CT is kept aseconomical as possible, consistentwith diagnostic imaging. In this con-text it is important that the concept ofcontinued on page 8

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Axial image of bilateral condylar fracturesof a polytrauma patient, taken with aSiemens SOMATOM Emotion 6 at H.-HartZiekenhuis, Lier, Belgium

self-nominations, appropriately sup-ported). As before, all the talks willbe in English.BM: What other targets have youset? HC: We also want to encourage col-leagues from the Middle East, SouthAmerica, the Far East andAustralasia, to come to ECR anddevelop further links with the conti-nent of Europe. Many colleagues,particularly in Australasia and SouthAmerica, have their roots here, soECR provides a golden opportunityfor them to combine science andCME with a return to the back-ground of their ancestors. With thisin mind, ECR Meets - a great successin 2003 - will expand. An invitationhas been sent to Poland, as theEuropean nation for ECR Meets,and to Korea, the first overseasnation to attend.BM: Will there be a debate on -and what are your views on - EUharmonisation of qualifications?HC: No, a formal debate on this isnot envisaged. The subject is dis-cussed at EAR. The role of ECR isto provide the basis of science andeducation to support any decisionmade about the harmonisation ofqualifications.

My own personal view about theharmonisation of qualifications isthat one should make haste slowly.Training methods are variable and Iwould like to see co-ordination oftraining and standards of trainingestablished before one embarksupon examination structures.Personally, I find that the standardsof European radiologists are mainlyvery high, with core knowledge at arelatively uniform level. If thesestandards can be harmonised, thenany qualification that follows willfall into place. However, I believethere are considerable difficultiesabout translation of multiple choicequestions into different languages,because nuances, if not carefullytranslated, can vary significantly. BM: Do you have ideas to improvestaff shortages? HC: I am not Solomon! I’m in nobetter position to solve staff short-ages than our political masters. Thebasic problem is that doctors’ train-ing has been controlled for a verylong time, for various economic rea-sons. And when you run into staffshortages it takes about twelve years- for basic medical training pluspostgraduate training - before youcan redress any staff shortages, atwhich stage it is obviously too lateto catch up. The issue is basicallyone of economics and of failure toshift resources in the context ofalternative developments in differentfields. A good example might belargely the replacement of upper GIbarium studies with endoscopy. Thisresulted in a significant reduction inupper GI contrast studies, but theresources used by upper GI contraststudies have long since been

absorbed by an increase in ultra-sound and, of course, cross section-al imaging. As both these fields con-tinue to expand almost exponential-ly, with each taking a significantlength of time for any individualradiologist to interpret them, short-ages will inevitably continue.

The attraction of trying to trainnon-radiologically qualified staff or,indeed, even non-medically qualifiedstaff, to do single task jobs is great,but the difficulty with this is that,although at the individual level theyare extremely effective, it removesthe flexibility of someone who istrained across many fields. Weshould never forget that technologyis only one component of radiology.

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N E W SR A D I O L O G Y

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risk/benefit is discussed, not just risk.Because, if risk is what is emphasisedto a patient, then it may interfere withcase management in the long term, ifthe patient should then refuse to havethe appropriate investigation for theirproblems.

Though I grew up in the era of ahigh understanding of plain radi-ographs, I am increasingly consciousof the relative lack of understanding ofthese by trainees, beguiled as they areby the detailed anatomy presented incross sectional imaging. I fear thatplain radiographs will become increas-ingly relegated, which is sad, because aproperly interpreted, straight radi-ograph remains something that canguide patient management properly.However, I hope I am not obtuse and Iaccept that cross sectional imaging cansupplant quite a lot of them and givefar more information faster. This, initself, has a huge impact on health eco-nomics, as rapid diagnosis leads torapid treatment and probably savesmoney in the long term. More impor-tantly, it also has great benefits for thepatient, reducing anxiety and improv-ing quality of medical care. Thisinevitably begs the question that therewill have to be an increase in the avail-ability of that technology 24 hours a

a lot about a little, which is the waymedicine has gone. Each subspecialtyis now so confined to its own areathat the broad sweep of general med-icine is something that has virtuallydisappeared from clinical practice,and this can lead to delays in diagno-sis if the patient gets into the wrongfield. The same could arise in radiol-ogy, if the core knowledge does notremain fairly broad before embarka-tion on specialist training. Howeverit’s a little different, for example, forinterventional radiology, where tech-nical skills are so very important andunderstanding of various diseases isin more limited fields.

My personal view is that when anew technique is discovered it should

be developed so that there is a spe-cialist in that technique but, as infor-mation is acquired and disseminat-ed, radiologists should shift frombeing technique-based to system-based, because this is in the bestinterests of patients. Technology isbeguiling, and you can forget under-lying clinical issues. The bestadvances are achieved by a symbio-sis of those with deep knowledge ofa technique combined with an equalknowledge of the clinical issues.

I do not believe one can lay downa blueprint for the future that isunalterable. As situations change, Ithink the best way to ensure the con-tinuation of high standards is tohave enough wise and far-seeing

people in radiological developmentsin different countries, to be able toanticipate the need for change earlyenough and to ensure that it isachieved smoothly.BM: How do you view the arrivalof teleradiology and out-sourcing? HC: Teleradiology is happening andis here to stay and I believe it canwork to the benefit of patients.However, I am concerned about tel-eradiology being practised in differ-ent countries, when what is prof-fered is an opinion on a scan or X-ray based on very limited clinicalinformation, and without the avail-ability of dialogue with the clinicalconsultants in charge of the patient.It may be expedient for governments

to try and cover their shortages byusing such technology, but I do notbelieve it is in the interests of patients.

However, within one’s own country,in the context of seeking second opin-ions, this is an invaluable resource. Ibelieve that, for subjects like paediatricradiology, what will ultimately evolveis a core of fairly major paediatric hos-pitals, employing more radiologiststhan they need, but who would pro-vide, by teleradiology and videoconfer-encing, paediatric radiological opinionsto hospitals within a much wider sur-rounding area. These would work onthe basis of hub and spoke, with spe-cialist radiologists going out to themore peripheral units to do proceduralwork, as necessary.

continued from page 7

day and, because looking at a spiralCT takes longer than a plain radi-ograph the number of radiologistswill have to increase.

The second field I foresee having ahuge future impact will be molecularimaging, using the term in the broad-est sense. This will give increasedinsights into disease pathology and,once that understanding is achieved,we can begin to design more appro-priate therapies, in which I believeradiology will have a huge impact.BM: Due to advances - and thevolume of learning involved witheach - could radiology becomeincreasingly more sliced intospecialities, say, according toequipment skills? And in thiscontext, how do you perceive therole of the radiologist in futureyears? Is there, for example, thepossibility that, one day,intervention may be undertakensolely by a radiologist, supersedingthe work of the surgeon?HC: I think the role of interventionalradiology will increase in the future,not only in the way we understand ittoday but also as a consequence ofmolecular imaging advances, with thepossibility of delivering precise drugtreatments for certain types of cancer.This will have to be carried out in co-operation with our clinical colleagues.With a bit of sensible planning thiscould occur without turf battles -which bedevil medicine.

It is possible that radiological train-ing will alter to a core training, fol-lowed by training in interventionalradiology for perhaps three or fouryears, rather than the current four-year core training followed by inter-ventional radiology. This model maybe attained in several other subspe-cialties of radiology.

The days of someone being able todo everything are rapidly diminishing.However, this is one of the advantagesto date of radiology: most radiologistsknow a little about a lot, rather than

Professor Helen Carty President - ECR 2004

EUROPEAN HOSPITAL Vol 12 Issue 3/03 9

N E W SR A D I O L O G Y

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PUI saves costs 3-D simulationstreamlines radiotherapyExomio, a new simulation technique, improves the accuracy ofradiation therapy and reduces treatment planning time to amatter of minutes, according to scientists at the FraunhoferInstitute for Computer Graphics Research IGD, who developedthe system with industrial partners MedCom GmbH andMedintec GmbH. They also report that the product has obtainedworldwide clinical approval and that 60 clinics in 19 countriesare now using the system, including the radiation clinic inOffenbach, Germany, and the Tubingen’s University Hospital.

When radiotherapy is the choice oftreatment for a cancer patient,physicians use the medical casehistory and computer tomographydata to determine the number,position and intensity of theradiation beams to be applied.

A large amount of preparatorywork involves simulating theradiation therapy using low-powerx-ray beams, says ProfessorGeorgios Sakas of the IGD. ‘Duringthis, a patient must remaincompletely immobile on anexamination table for up to an hour.‘Even the slightest movement couldcompromise the accuracy of theensuing treatment - every millimetrecounts,’ he adds. Sites for treatmentare drawn on the patient’s skin withan indelible marker pen. Theseoutlines must not be changed orwashed off for the duration oftreatment, which may last manyweeks and cause considerableinconvenience for a patient andincur high personnel and othercosts.

Using the new technique aphysician simulates treatmentrealistically and accurately, based oncomputerised CT data, which doesnot tie up medical resources - and apatient need not be present. ‘Exomiohas a simple, intuitive user interfacethat enables a physician to evaluate3-D images as easily as conventionalX-ray images,’ says Professor Sakas.‘The greatest advantage is thatpreparatory simulation offers moreflexibility in the siting and numberof areas to be targeted by theradiation source.’ Without thepatient’s presence, a physician canstudy individual tumours andexperiment with various alternativetreatment plans before deciding thebest choice. ‘After simulation, theprepared therapy plan is passed tothe radiologist who calculates therequired doses.’

Modification of the beam anglecan improve the accuracy of theradiation treatment and the abilityto lower or raise the dose and limitdamage to healthy tissue benefits thepatient’s well-being and prospectsfor recovery. Professor NikosZamboglou of the Offenbachradiation clinic also adds: ‘Thissoftware allows us to show patientswhat the therapy involves, how itworks, and where the radiationtreatment will be applied, whichhelps them to better understand andthus place more trust in the therapy.’

In October, the Exomio, whichruns on a standard high-performance PC, gives superiorresults and improves treatment costswithout major investment, wasvoted a finalist out of 600 other ITprojects in the ‘Health’ category ofthe prestigious Stockholm ChallengeAward.Details: www.igd.fhg.de/igd-a7/index.html

RUSSIA & NETHERLANDS - Immediate echocardiograph-ic assessment during consultation rounds can lead tosignificant cost savings and can shorten the time todiagnosis, according to a new study carried out byteams at the Dept. of Cardiology, Thoraxcentre, ErasmusMedical Centre, Rotterdam and the Dept. of InternalDiseases, Medical Academy of Nizhny, Novgorod.

To assess the clinical utility and cost effectiveness of apersonal ultrasound imager (PUI) during consultationrounds to evaluate patients with suspected cardiac dis-ease, the teams enrolled 107 unselected patients fromnon-cardiac departments (55% men). After a physicalexamination, the consultant cardiologist used the PUI toobtain an echocardiograph of each patient, and the finalreport was passed on immediately to the referringphysician.

Subsequently, all patients were checked with a stan-dard echocardiographic device (SED), and in each casethe consultant noted whether the PUI findings hadbeen sufficient for a final diagnosis. The time fromrequest to diagnosis was also compared for eachmethod.

In 84 (78.5%) patients no further examination withan SED was considered necessary. 23 patients (21.5%)needed a further detailed SED examination to obtainhaemodynamic information.

Both devices produced excellent detection of abnor-malities (96%). Use of the SED per patient cost €132;PUI per patient cost €75 - showing a 33.4% reductionin total cost. Diagnosis times: SED = 4 days, PUI =immediate.Source: Heart 2003;89:727-730 Details: j.r.t.c.roelandt@erasmusmc.nl

Titanised siliconebreast implants

NEW

10 EUROPEAN HOSPITAL Vol 12 Issue 3/03

S U R G E R Y

By Professor VicenteHernandez andIgnacio Blanquer

Minimally invasive surgery (MIS),carried out through very smallincisions, minimises patient traumaand shortens rehabilitation time.However, there are drawbacks:direct contact is not possible, visi-bility is limited to a screen image,and special training in the use oftools is necessary.

Generally surgeons have trainedon cadavers, phantoms, live ani-mals or during actual surgicalinterventions under supervision of

ment of repeatability of actions -which obviously cannot occur ifusing animals or humans. Anotherobjective is to train specificpathologies.

The simulator consists on twomain modules: the image pre-pro-cessing module, which consists ofthe segmentation Model GeneratorTool and the Scenario Generator,and the Surgery Simulator module.One module presents surgical sce-narios, using real medical images,for example of an abnormal anato-my or an interesting pathology.Thus the teaching surgeon can pre-pare special cases to increase thetrainees’ abilities and skills beforedealing with the first real case.

The image pre-processing mod-ule presents surgical scenariosusing synthetic organs or real

Implants presently in use consist ofa smooth or textured silicone shellfilled with a silicone gel or salinesolution. The latter has onedecisive drawback - the breast maycool considerably in winter.Smooth silicone implants may alsoshift or turn.

Currently most surgeons opt fortextured plastic silicone shellsfilled with silicone gel. Plastics areused to great effect in manymedical fields without showingsuch dramatic side effects as incapsular fibrosis, so cosmeticsurgeons have hoped for a morebiocompatible coating for sometime. Finally, at last year’s GermanSurgeons’ Association Congress,surgeons were introduced to breastimplants made from a brand new

Injury to the brain and spinal cordcause permanent damage because,unlike bone and skin tissues, they losethe ability to repair themselves soonafter birth. Some experts suggest this isdue to an inability to form new con-nections, others think the adult ner-vous system produces molecules thatstop the growth of nerve fibres.

Both theories are disputed by DrGeoffrey Raisman, at the NationalInstitute of Medical Research, whopoints out that the brain constantlychanges as we learn throughout life,and that cut nerves ‘sprout vigorously’,albeit not in the right direction. He sug-gests that adult nerve fibres fail toregenerate because they have to con-tend with much greater distances andmuch more complex pathways thanthose in the embryo.

Scarring is another problem withhealing spinal cord injuries. Duringdevelopment, nerves grow along glialcells (types of supporting tissuearranged in regular networks andchannels). When glial cells are dam-aged each type behaves differently -some swell up, others die and somemove into the damaged area, which isswamped with blood cells. The result-ing scar blocks nerve fibres.

Dr Raisman has now developed anew and novel method for spinal cord

Blanqu - VincentHermandez

Ignacio Blanquer

organs obtained from real images(such as 3-D CT or MRI). Medicalimages are processed to obtainmodels of the organs, which arecompiled on the scenario generatorto present textures, dynamic prop-erties and to define the surgicalenvironment. Thus qualified sur-geons can prepare training in com-plex or rare cases using patients’real anatomic data.

Scenarios are loaded on the sur-gical simulator, which computesorgan deformity with respect tothe interaction of users. Surgery iscarried out on the virtual patientvia haptic devices, resembling realsurgical instruments, which allowusers to feel the feedback of theforce of organ reactions. The sim-ulation is computed in real-timeusing high-performance parallelcomputing, by simultaneous use ofseveral processors.

The system automatically gener-ates a report on the quality of theintervention, indicating parameterssuch as the number of incorrectcuts, poor placement of staples,procedural errors, organ damageand the intervention time.Currently, although the simulatoris generic and can be used formany different MIS interventions,the system has been validated forcholecystectomy interventions -usually one of the first learnt, butwhich requires most of the surgicalgestures used in conventionalinterventions. Currently the systemis being adapted for arthroscopy.

As in many engineering disci-plines, virtual training will becomethe most common method to beginsurgical practice in the future.Surgery simulation is more com-plex that flight or driving simula-tion, but advances in this technol-ogy, and physical models, can pro-vide enough sensitive feeling toachieve a useful training of motorskills and procedures. Patients willno