EUROPEAN HOSPITAL

News 1-7IT & Telemed 8-9Radiology 10-12Cardiology 12Surgery 13-14Lab & Pharma 15-17Patient care 18-20

contents

T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K8 IT & Telemed

● Enhancing therapists’ workflow ● Digital pens collect data● Connectathon

success foreFA project

V O L 1 7 I S S U E 6 / 0 8 D E C E M B E R 2 0 0 8

4 Events● Heartfelt economic

gloom?EH reports fromtop medical tradefairs: Chicago’sRSNA andGermany’s MEDICA

continued on page 2

10 Radiology● Multidetector

CT angiography● The dawn of

molecular CT ● Global aims

for Chineseultrasound

First introduced in the late ‘80s, bythe mid-90s pilot tele-oncologyprogrammes were implemented.However, when the funding ended,most were discontinued, either asnot cost-effective or inadequatelyutilised.

Today, the ubiquity of theInternet and the sophistication ofstreaming video and audiotechnology eliminate the highesthurdles of adding teleradiologyconsultations to the repertoire ofservices provided by cancertreatment centre. Other than cost,now the biggest hurdle is specialistacceptance.

A model tele-oncologyprogramme has flourished since2003 in the far north-easternCanadian provinces of Labradorand Newfoundland. This was thebrainchild of Dr Max House, an

emeritus professorat the MemorialUniversity ofNewfoundland. Dr

House is not a household name, yethis pioneering initiatives, started in1980, to put the earliest commercialtelemedicine equipment on offshoreNorth Atlantic drilling rigs to deliverremote triage to seriously injured rigworkers, was instrumental in thedevelopment of teleradiology andtelemedicine.

Since then, the clinical culture ofthe Memorial University ofNewfoundland has been keen onimplementing cost effective andbeneficial ways to use telemedicineand has been a global leader in thisfield. In 2003, the NewfoundlandCancer Treatment and ResearchFoundation and MemorialUniversity’s Telehealth and

Education Technology ResourceAgency began an 18-month pilotprogramme to demonstrate theeffective development, integrationand sustainability of deliveringoncology clinical services remotely.

The Newfoundland and LabradorTele-oncology Programme originatesfrom the Dr H Bliss Murphy CancerCentre in St. John’s, Newfoundland,and initially served 24 communities,some located a four-hour distanceaway. The video-conferencing systemis used by patients for pre- and post-surgical and radiation therapytreatment consultations with anoncologist. The patient visits aparticipating clinic or hospital, wherea clinician or nurse is in attendance.

Utilisation has increaseddramatically. In the second half of2005, Dr House, the principal

Tele-oncology provessuccessful in CanadaAn estimated 6.7 million people in developed countries were diagnosed with cancer in 2007.Delivering their care is no easy matter. Tele-oncology, the remote provision of oncology services, couldnot only reduce the costs of consultations for cancer departments, but also for patients. Kerry Heacox,of i.t. Communications, reports on the success of remote consultations in Labrador and Newfoundland

Don’t wait to watch them dieTake health services to men!Compared with women, the lowerlife expectancy of men is only to avery limited extent the result ofgenetic determination. The mainreasons are an unhealthy lifestyleand the fact that men use health-care services too little and too late.‘That’s the bad news. The goodnews is: We can change this,’ saidIan Banks, British MedicalAssociation (BMA) spokespersonfor men’s health issues and presi-dent of the European Men’s HealthForum at the 2008 EuropeanHealth Forum Gastein. Urging aradical change in the attitude ofhealth professionals and health-care systems towards men’s obvi-ous disregard of health issues, headded: ‘As long as we sit aroundand wait for them, it makes nosense to lament about men’sneglect of their health needs andinadequate use of our great healthsystem. If men do not come to us,we must go to them.’

Where? Men who are faced withhealth issues in the workplace,

• The lower life expectancy ofmen is mainly due to insufficientuptake of healthcare servicesand an unhealthy life style

• Low social status influencesmen’s health far more thanwomen’s health

• Medical care must address menat work, at sports centres, andother gatherings

where it is made obvious that betterhealth is linked with greater successand higher professional standing,are more open to advice andlifestyle changes. Information cam-paigns at football or rugby stadiumshave also proved quite successful,Ian Banks pointed out. ‘No matterwhat someone may think about it –it works.’ He also expressed regretthat too little political backing isplaced on men’s health issues:‘There were already two EU reportson women’s health but we are still

waiting for the first one on men’shealth.’

There is little doubt about theurgency. A striking fact is that lowsocial status affects men’s health farmore than for women. In sociallydeprived areas of Great Britain, forexample, men’s life expectancy is aslow as 54 years, whereas in other areastheir life expectancy is up to 80 years.There are no similar differencesbetween women with low or high socialstatus, he pointed out. ‘Furthermore,we know the health of women and menis often inextricably linked. Whoeverwants to seriously tackle the problem ofinequalities in health has to deal withmen’s health issues.’

May you know joy, peace and success

in all your fine endeavours in 2009

To medical and

healthcare workers worldwide

Season’s greetings

from the EH team

Admittedly not one of the easiestnames to pronounce but a name tonote: Luhacovice in the CzechRepublic. Nestled in the rollingWhite Carpathian hills of Moraviathis small spa is a renowned centrefor the treatment of a substantial

Luhacovice A tongue twister town(but easy on the eye,body and soul) is all setto welcome EU VIPs

beautifully restored period build-ings, is currently under review as aUNESCO World Heritage site.

The spa town boasts 16 sodiumhydrocarbonated acidulous springs,with water temperatures fluctuatingbetween 10 and 12°C. Due to theirhigh CO2 content, the springs aredeemed to be the most effective incentral Europe.

The spa reached a height of popularityfrom the beginning of the 20th century.Architecture, and particularly Moravianart deco, are significant attractions

For over 300 years, these springshave been used for their health-giv-ing properties. The current spaoperator, Bad Luhacovice AG,offers 1,300 beds, and 15% ofpatients/guests are foreigners, pri-marily from Germany, Austria andIsrael, but more recently also fromthe US, Asia and Russia. The ratioof private payers to insurancepatients is currently 50:50.

13 Surgery● LED lighting

units● Endoscopic

submucosaldissection

● Arthroscopicprocedures

number of disorders (respiratorytract, digestive and metabolic sys-tems, musculoskeletal, diabetes,certain vascular diseases and somecancers) with procedures includinginhalations, carbonated baths andother hydrotherapies.

During the EU Presidency of theCzech Republic in the first half of2009, Luhacovice will host a three-day meeting of the Council of theEuropean Union this January, whichprompted the organisers to proudlypoint out that their little town of just5,000 inhabitants triumphed overthe famous three Czech spasKarlovy Vary, Marianske Lazne andFrantiskovy Lazne. Perhaps thechoice was influenced by the factthat the entire Spa Square, with its

Spa medical director Jiri Hnátek (left)with European Hospital correspondentChristian Pruzsinsky

^

^

For games players, Nintendo's new homevideo game console, the Wii (pronouncedwe), is described as ‘the next level ofgaming’.

Along with their ever-increasing popularity,video games have also increased incomplexity. With Wii, Nintendo has focusedon minimising the fuss, whilst maximisingthe actual physical involvement during play.‘The Wii console returns gaming to simplertimes while innovating game developmentat the same time,’ the maker explains.

Wireless and motion-sensitive, the WiiRemote offers an intuitive, natural way ofplaying. The ergonomic controller reactswith the conventional motions we makeeveryday. When hitting a drum, swinging atennis racket, bat or golf club, the playerdoes not have to press a button toreplicate these movements. Nintendopoints out that its Wii Remote is themost multifaceted gaming device evercreated. ‘It can be a sword in onegame, or a steering wheel for racinggames. It's your paintbrush, your golfclub, your aeroplane, but most ofall, it's your key to unlocking aworld of fun you've never imagined.The Wii console makes you feel less like aplayer and more like you're in the game.’All these activities, without having to pusha button.

DO YOU WISH TO RECEIVE OR CONTINUE TO RECEIVE EUROPEAN HOSPITAL � Yes � NoAND THE EH ONLINE NEWSLETTER?

Reader Number

Name

Job title

Hospital/Clinic

Address

Town/City Country

Phone number Fax

E-mail address

Now, tell us more about your work, so that we can plan future publications with your needs in mind.Please put a cross ✘ in the relevant boxes.

1. SPECIFY THE TYPE OF INSTITUTION IN WHICH YOU WORK

� General hospital � Outpatient clinic � University hospital

Specialised hospital/type

Other institution (eg medical school)

2.YOUR JOB

� Director of administration � Chief medical director � Technical director

Chief of medical department/type

Medical practitioner/type

Other/department

3. HOW MANY BEDS DOES YOUR HOSPITAL PROVIDE

� Up to 150 � 151-500 � 501-1000 � more than 1000

� None, (not a hospital/clinic)

4 . WHAT SUBJECTS INTEREST YOU IN YOUR WORK?

� Surgical innovations/surgical equipment � Radiology, imaging/high tech advances

� Clinical research/treatments/equipment � Intensive Care Units/management/equipment

� Ambulance and rescue equipment � Pharmaceutical news

� Physiotherapy updates/equipment � Speech therapy/aids

� Nursing: new aids/techniques � Laboratory equipment, refrigeration, etc.

� Hospital furnishings: beds, lights, etc. � Hospital clothing and protective wear

� Hygiene & sterilisation � Nutrition and kitchen supplies

� Linens & laundry � Waste management

� Information technology & digital communications � Hospital planning/logistics

� Personnel/hospital administration/management � Hospital Purchasing

� Material Management � Medical conferences/seminars

� EU political updates

Other information requirements - please list

ESPECIALLY FOR DOCTORS:Please complete the above questions and we would like you to answer the following additionalquestions by ticking yes or no or filling in the lines as appropriate.

What is your speciality?

In which department do you work?Are you head of the department? � Yes � NoAre you in charge of your department’s budget? � Yes � No

How much influence do you have on purchasing decisions?I can only present an opinion � Yes � NoI tell the purchasing department what we need � Yes � NoI can purchase from manufacturers directly � Yes � No

Do you consider that your equipment isout-dated � Yes � Norelatively modern � Yes � Nostate-of-the-art � Yes � No

Do you use/buy second-hand equipment? � Yes � NoIf so, what do you use of this kind?

Is your department linked to an internal computer network? � Yes � NoIs your department linked to an external computer network? � Yes � NoIs your department involved with telemedicine in the community? � Yes � NoDo you consider your department is under-staffed? � Yes � NoAre you given ample opportunities to up-date knowledge? � Yes � NoDo you attend congresses or similar meetings for your speciality? � Yes � No

This information will be used only in an analysis for European Hospital,Theodor-Althoff-Str. 39, 45133Essen, Germany, and for the mailing out of future issues and the EH electronic newsletter.

2 EUROPEAN HOSPITAL Vol 17 Issue 6/08

DO YOU WISH TO RECEIVE OR CONTINUE TO RECEIVE EUROPEAN HOSPITAL � Yes � NoAND THE EH ONLINE NEWSLETTER?

Reader Number

Name

Job title

Hospital/Clinic

Address

Town/City Country

Phone number Fax

E-mail address

Now, tell us more about your work, so that we can plan future publications with your needs in mind.Please put a cross ✘ in the relevant boxes.

1. SPECIFY THE TYPE OF INSTITUTION IN WHICH YOU WORK

� General hospital � Outpatient clinic � University hospital

Specialised hospital/type

Other institution (eg medical school)

2.YOUR JOB

� Director of administration � Chief medical director � Technical director

Chief of medical department/type

Medical practitioner/type

Other/department

3. HOW MANY BEDS DOES YOUR HOSPITAL PROVIDE

� Up to 150 � 151-500 � 501-1000 � more than 1000

� None, (not a hospital/clinic)

4 . WHAT SUBJECTS INTEREST YOU IN YOUR WORK?

� Surgical innovations/surgical equipment � Radiology, imaging/high tech advances

� Clinical research/treatments/equipment � Intensive Care Units/management/equipment

� Ambulance and rescue equipment � Pharmaceutical news

� Physiotherapy updates/equipment � Speech therapy/aids

� Nursing: new aids/techniques � Laboratory equipment, refrigeration, etc.

� Hospital furnishings: beds, lights, etc. � Hospital clothing and protective wear

� Hygiene & sterilisation � Nutrition and kitchen supplies

� Linens & laundry � Waste management

� Information technology & digital communications � Hospital planning/logistics

� Personnel/hospital administration/management � Hospital Purchasing

� Material Management � Medical conferences/seminars

� EU political updates

Other information requirements – please list

ESPECIALLY FOR DOCTORS:Please complete the above questions and we would like you to answer the following additionalquestions by ticking yes or no or filling in the lines as appropriate.

What is your speciality?

In which department do you work?Are you head of the department? � Yes � NoAre you in charge of your department’s budget? � Yes � No

How much influence do you have on purchasing decisions?I can only present an opinion � Yes � NoI tell the purchasing department what we need � Yes � NoI can purchase from manufacturers directly � Yes � No

Do you consider that your equipment isout-dated � Yes � Norelatively modern � Yes � Nostate-of-the-art � Yes � No

Do you use/buy second-hand equipment? � Yes � NoIf so, what do you use of this kind?

Is your department linked to an internal computer network? � Yes � NoIs your department linked to an external computer network? � Yes � NoIs your department involved with telemedicine in the community? � Yes � NoDo you consider your department is under-staffed? � Yes � NoAre you given ample opportunities to up-date knowledge? � Yes � NoDo you attend congresses or similar meetings for your speciality? � Yes � No

This information will be used only in an analysis for European Hospital,Theodor-Althoff-Str. 39, 45133Essen, Germany, and for the mailing out of future issues and the EH electronic newsletter.

HOW TO ENTERSimply answer the questions in the Readers Survey (left), fill in yourdetails as appropriate, then send as directed at the top of the coupon.PLEASE NOTE:● The closing date for entries to the EH 6/08 competition:

30 January 2009.● Coupons received after that date cannot be entered in the draw.● The winning coupon will be drawn from the correct entries.● Only the winner will be contacted directly.● The winner’s name and location will be published in a future issue

of European Hospital.● NB: The prize is not exchangeable for cash.● The usual competition rules apply

R E A D E R S ’ C O M P E T I T I O N

EUROPEAN HOSPITALReader Survey

✂

YOU may qualify for a FREE subscription to EUROPEANHOSPITAL, the bi-monthly journal serving hospitals throughoutthe EU.

*If selected, you will be sent a copy of EUROPEAN HOSPITALevery two months, as well as the EH electronic newsletter

To participate, simply fill in this coupon and fax to:+49 201 87 126 864

No fax? No problem. Simply post your coupon to:European Hospital Publisher, Theodor-Althoff-Str. 39, 45133 Essen, Germany

Or, for even quicker entry, please visit our website: www.european-hospital.com

EUROPEAN HOSPITAL

News

1-7

IT & Telemed

8-9

Radiology

10-12

Cardiology

12

Surgery

13-14

Lab & Pharma15-17

Patient care18-20

contents

T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K

8 IT & Telemed

● Enhancing therapists’ workflow

● Digital pens collect data

● Connectathon

success for

eFA project

V O L 1 7 I S S U E 6 / 0 8

D E C E M B E R 2 0 0 8

4 Events

● Heartfelt economic

gloom?

EH reports from

top medical trade

fairs: Chicago’s

RSNA and

Germany’s MEDICA

continued on page 2

10 Radiology

● Multidetector

CT angiography

● The dawn of

molecular CT

● Global aims

for Chinese

ultrasound

First introduced in the late ‘80s, by

the mid-90s pilot tele-oncology

programmes were implemented.

However, when the funding ended,

most were discontinued, either as

not cost-effective or inadequately

utilised.

Today, the ubiquity of the

Internet and the sophistication of

streaming video and audio

technology eliminate the highest

hurdles of adding teleradiology

consultations to the repertoire of

services provided by cancer

treatment centre. Other than cost,

now the biggest hurdle is specialist

acceptance.

A model tele-oncology

programme has flourished since

2003 in the far north-eastern

Canadian provinces of Labrador

and Newfoundland. This was the

brainchild of Dr Max House, an

emeritus professor

at the Memorial

University of

Newfoundland. Dr

House is not a household name, yet

his pioneering initiatives, started in

1980, to put the earliest commercial

telemedicine equipment on offshore

North Atlantic drilling rigs to deliver

remote triage to seriously injured rig

workers, was instrumental in the

development of teleradiology and

telemedicine.

Since then, the clinical culture of

the Memorial University of

Newfoundland has been keen on

implementing cost effective and

beneficial ways to use telemedicine

and has been a global leader in this

field. In 2003, the Newfoundland

Cancer Treatment and Research

Foundation and Memorial

University’s Telehealth and

Education Technology Resource

Agency began an 18-month pilot

programme to demonstrate the

effective development, integration

and sustainability of delivering

oncology clinical services remotely.

The Newfoundland and Labrador

Tele-oncology Programme originates

from the Dr H Bliss Murphy Cancer

Centre in St. John’s, Newfoundland,

and initially served 24 communities,

some located a four-hour distance

away. The video-conferencing system

is used by patients for pre- and post-

surgical and radiation therapy

treatment consultations with an

oncologist. The patient visits a

participating clinic or hospital, where

a clinician or nurse is in attendance.

Utilisation has increased

dramatically. In the second half of

2005, Dr House, the principal

Tele-oncology proves

successful in Canada

An estimated 6.7 million people in developed countries were diagnosed with cancer in 2007.

Delivering their care is no easy matter. Tele-oncology, the remote provision of oncology services, could

not only reduce the costs of consultations for cancer departments, but also for patients. Kerry Heacox,

of i.t. Communications, reports on the success of remote consultations in Labrador and Newfoundland

Don’t wait to watch them die

Take health services to men!

Compared with women, the lower

life expectancy of men is only to a

very limited extent the result of

genetic determination. The main

reasons are an unhealthy lifestyle

and the fact that men use health-

care services too little and too late.

‘That’s the bad news. The good

news is: We can change this,’ said

Ian Banks, British Medical

Association (BMA) spokesperson

for men’s health issues and presi-

dent of the European Men’s Health

Forum at the 2008 European

Health Forum Gastein. Urging a

radical change in the attitude of

health professionals and health-

care systems towards men’s obvi-

ous disregard of health issues, he

added: ‘As long as we sit around

and wait for them, it makes no

sense to lament about men’s

neglect of their health needs and

inadequate use of our great health

system. If men do not come to us,

we must go to them.’

Where? Men who are faced with

health issues in the workplace,

• The lower life expectancy of

men is mainly due to insufficient

uptake of healthcare services

and an unhealthy life style

• Low social status influences

men’s health far more than

women’s health

• Medical care must address men

at work, at sports centres, and

other gatherings

where it is made obvious that better

health is linked with greater success

and higher professional standing,

are more open to advice and

lifestyle changes. Information cam-

paigns at football or rugby stadiums

have also proved quite successful,

Ian Banks pointed out. ‘No matter

what someone may think about it –

it works.’ He also expressed regret

that too little political backing is

placed on men’s health issues:

‘There were already two EU reports

on women’s health but we are still

waiting for the first one on men’s

health.’

There is little doubt about the

urgency. A striking fact is that low

social status affects men’s health far

more than for women. In socially

deprived areas of Great Britain, for

example, men’s life expectancy is as

low as 54 years, whereas in other areas

their life expectancy is up to 80 years.

There are no similar differences

between women with low or high social

status, he pointed out. ‘Furthermore,

we know the health of women and men

is often inextricably linked. Whoever

wants to seriously tackle the problem of

inequalities in health has to deal with

men’s health issues.’

May you know joy, peace and succes

s

in all your fine en

deavours in 2009

To medical and

healthcare workers

worldwide

Season’s greet

ings

from the EH team

Admittedly not one of the easiest

names to pronounce but a name to

note: Luhacovice in the Czech

Republic. Nestled in the rolling

White Carpathian hills of Moravia

this small spa is a renowned centre

for the treatment of a substantial

Luhacovice A tongue twister town

(but easy on the eye,

body and soul) is all set

to welcome EU VIPs

beautifully restored period build-

ings, is currently under review as a

UNESCO World Heritage site.

The spa town boasts 16 sodium

hydrocarbonated acidulous springs,

with water temperatures fluctuating

between 10 and 12°C. Due to their

high CO2 content, the springs are

deemed to be the most effective in

central Europe.

The spa reached a height of popularity

from the beginning of the 20th century.

Architecture, and particularly Moravian

art deco, are significant attractions

For over 300 years, these springs

have been used for their health-giv-

ing properties. The current spa

operator, Bad Luhacovice AG,

offers 1,300 beds, and 15% of

patients/guests are foreigners, pri-

marily from Germany, Austria and

Israel, but more recently also from

the US, Asia and Russia. The ratio

of private payers to insurance

patients is currently 50:50.

13 Surgery

● LED lighting

units

● Endoscopic

submucosal

dissection

● Arthroscopic

procedures

number of disorders (respiratory

tract, digestive and metabolic sys-

tems, musculoskeletal, diabetes,

certain vascular diseases and some

cancers) with procedures including

inhalations, carbonated baths and

other hydrotherapies.

During the EU Presidency of the

Czech Republic in the first half of

2009, Luhacovice will host a three-

day meeting of the Council of the

European Union this January, which

prompted the organisers to proudly

point out that their little town of just

5,000 inhabitants triumphed over

the famous three Czech spas

Karlovy Vary, Marianske Lazne and

Frantiskovy Lazne. Perhaps the

choice was influenced by the fact

that the entire Spa Square, with its

Spa medical director Jiri Hnátek (left)

with European Hospital correspondent

Christian Pruzsinsky

^

^

Signature Date

EH 6/08

ENTRY COUPONCOMPETITION QUESTIONThe iPod nano prize comes in several colours. How many?

Your answer

Enter today! Simplyfill in the ReaderSurvey (left) and send it in

No buttons topush: the motionsensitive remotereacts to your ownmovements,whether a golfswing, steeringwheel turn orother gamingactivity

Dr Maximilian Kellner, Head of thePaediatric Radiology Departmentat Kliniken der Stadt KölngGmbH, in Cologne, Germany,has won the iPod nano prizefeatured in issue 5/08

ENTRY COUPONCOMPETITION QUESTIONWhich part of Nintendo's new home video game console iswireless and motion sensitive?

Your answer

So, even if our competition winner is not aplayer, this is likely to make a reallystimulating gift for a member of his or herfamily or a friend or, another thought, whynot for your hospital’s rehabilitation unit?

To be in with a chance of winning thisdelightful prize, all you need do is enterthe EH competition – so, why not today?

investigator of the pilot programme,reported that 132 patients withprostate, breast, colorectal and lungcancer had remote consultations. In2006, the success of the programmeled to its transfer as a full-fledged,and fully funded TelehealthProgramme operated by theNewfoundland and Labrador Centrefor Health Information.

The Telehealth Programme nowencompasses treatment for kidneydisease, neurology, occupationaltherapy and in 2009, diabetes, as wellas oncology in 42 rural communities.The Centre for Health Informationreported that, between July 2006 andOctober 2008, more than 22,000patient visits and physician casereviews with specialists had beenconducted.

Tele-oncology has become one ofthe largest components in oncologistDr Jonathan Greenland’s practice.He attributes the tele-oncologyprogramme for being able to reduce

continued from page 1

Your chance to win aWii console

Tele-oncology proves asuccess in Canada

The winner of the EuropeanHospital issue 5/08 competition

Healthcare and the2009 EU Presidencies The next two countries to preside overthe EU Presidency – the CzechRepublic (first half year of 2009) andSweden (second half) recently pre-sented the priorities of their presiden-cies for healthcare at the EuropeanHealth Forum Gastein (EHFG).

In cooperation with France, holderof the previous six months EUPresidency, five common key themeswere defined:Promoting an EU for patients • Improving health security at

European level • Ensuring safe and efficient

pharmaceuticals • Addressing disease prevention and

health promotion • Promoting actions for healthy,

active and dignified ageingIn terms of healthy active and digni-fied ageing, the Czech Republic willfocus on financial sustainability, whileSweden will highlight the dignityaspects of elderly care, promoting

closer cooperation between healthand social policy areas.

Another focal point for both presi-dential periods will be the antimicro-bial resistance in and beyond hospi-tals. Sweden will focus on the poordevelopment of new antibiotics, andevaluating the possibilities of acceler-ating research for new antibiotics.

E-health implementation to improvepatient safety and quality of care isalso on the agenda during both presi-dencies.

The Swedish presidency will alsofollow up on the EU alcohol strategy. Aconference, which will examineprogress made in its implementationand to explore possible improvements,may include topics such as youngwomen and fatal alcohol syndrome,children in families with alcohol prob-lems and the identification of the ‘dri-vers’ that contribute to alcohol-relatedharm.Report: Christian Pruzsinski

EUROPEAN HOSPITAL Vol 17 Issue 6/08 3

M A N A G E M E N T : E N E R G Y E F F I C I E N C Y

his in-person travel to clinics inCentral Newfoundland from fivedays to two days per month.‘Elimination of two days of travelenables me to schedule moreconsultations with patients, whetherremote or at our centre. Overall, thepercentage of patients from ruralareas in my practice has increasedsignificantly. Patients are alwayswelcome to meet with me in person.But many can be examined by thelocal physician or nurse. I can fitmore patients into a video clinicthan a real one because it is moreefficient. Delays are eliminated ornewly diagnosed patients, because I can now see that patient almostimmediately after referral, optimisetheir symptom control, and arrangefor appropriate treatment beforethey travel to our hospital.’

A cost-evaluation of the Tele-oncology programme has not yetbeen issued by the Newfoundlandand Labrador Centre for HealthInformation. However, from theperspective of patients, havingaccess to oncology specialistsavailable rapidly and efficiently ispriceless.

Czech hospitals are seeking powerfulinspiration regarding antibiotics (ATB)consumption from France, where a recentpublic campaign helped to decrease ATBconsumption by 30%. It is generallyrecognised that Czech physicians over-prescribe antibiotics, leading to the gen-esis of new antibiotic-resistant bacterialstems. According to Dr Vlastimil Jindrak,who heads the antibiotic unit at PragueHomolka Hospital, it is more than likelythat antibiotics worth over CZK one bil-lion are prescribed and used improperlyeach year. Czech officials and healthcaresector leaders are preparing a publiccampaign similar to French one, expect-

Costs and job cuttingexpected at GE Healthcare

2009economiesAt the dawn of 2009, amid econom-ic gloom worldwide, GE Healthcarehas predicted that sales of its high-er-priced (imaging equipment willbe down in the USA in 2009, com-pared with 2008, and it is anticipat-ing cost-cutting, which wouldinclude a reduction of employeelevels. The price of MRI or CT scan-ners range from $500,000 to $2 mil-lion. Capital expenditure by US hos-pitals on tighter budgets has beencut back. A recent AmericanHospital Association (AHA) studyindicates that 45% of the hospitalssurveyed reported they were delay-ing purchases of clinical technologyand equipment; 39% were defer-ring investments in new IT systems.

The GE Healthcare GlobalDiagnostic Imaging business unit, inWaukesha, Wisconsin, has about7,000 employees working on CT,MR, and molecular imaging equip-ment as well as X-ray and digitalmammography machines.

However, speaking at the RSNAmeeting in Chicago, Mark Vachon,President and CEO of GE HealthcareGlobal Diagnostic Imaging, pointedout that the US sales losses in theUS are alleviated by better sales inother markets, and that the diag-nostics unit’s overseas salesamount to around 50% of output. InChina, for example, sales areexpected to rise by 5–10% nextyear, and in Russia and EasternEurope he expects double-digitsales growth rates. Sales in WesternEurope are expected to grow in thelower single digits next year, whilstJapan should remain stable in 2009.

Fortunately, revenues from GEHealthcare’s services division tooksome of the edge off its US saleslosses.

Predicting better economic con-ditions in 2010, he added that a‘pent up demand’ will again driveup purchasing, particularly due tothe healthcare needs of ageingpopulations.

Healthcare sector to fight ATB over-consumptionNEWS FROM THE CZECH REPUBLIC FROM OUR CORRESPONDENT ROSTISLAV KUKLIK

ing that both health professionals andthe public will gain better knowledge ofappropriate ATB usage.Another Nobel Prize winner? TheCzech Academy of Sciences hasannounced that its representatives willnominate Professor Antonin Holy forNobel Prize for Medicine in 2009.Interviewed by a newspaper, AcademyChairman Professor Vaclav Paces said:‘We will do our best to make the NobelPrize committee members change theirthinking in a way to recognise not onlyexceptional minds working in basicresearch but also those who developedinstruments directly saving patients’

lives. This is the case for Prof Holy’s dis-coveries.’

Prof Holy is certainly one of the bright-est brains Czech science has ever had.His numerous discoveries include antivi-rotics used for the treatment of herpeticeruptions (Duvira, 1980, or Vistide,1996), AIDS/HIV (Viread, 2001 orTruvada, 2004) or hepatitis B (Hepsera,2002). He invented the above mentioneddrug, Viread, in 2001; it is currently themost powerful treatment available forAIDS/HIV infection. Should the Academyof Sciences efforts be fruitful, Prof Holywould be just third Czech and NobelLaureate in this country’s history. So far,

the Nobel Prize for Chemistry (polarogra-phy) was awarded to Jaroslav Heyrovsky in1959, and to Jaroslav Seifert in 1984 forliterature.Air ambulances are ineffective –Several Czech hospitals have inappropri-ately situated helipads for air ambulanceslanding, according to recent reports.Helipads have been located too far fromthe hospitals, resulting in double-trans-portation for patients: first by helicopter tothe hospital, then by ambulance to theemergency room. Usually, helipads shouldbe located on hospital roofs or at nearestaccessible area. However, this is not thecase in some locations, and time neededfor patients’ transportation becomesunnecessarily long (in some cases byalmost 12 minutes) resulting in undue riskin emergencies.

Mark Vachon

Answers for life.

By integrating imaging, lab diagnostics and healthcare IT, we can advance the science of medicine and the economics of healthcare.

Imagine a healthcare system that keeps us healthier by detecting disease earlier. Quality of life increases and costs are better controlled. Genomics and the integration of molecular diagnostics, advanced imaging and healthcare IT open up new possibilities for a lifetime of care. Together, we can deliver on the promise of personalized medicine. www.siemens.com/healthcare +49 69 797 6420

CC-Z1091-1-7600

Can you afford to give us a lifetime of the very best care?

90259_Anz_MED_Z1091_A4_e.indd 1 09.12.2008 8:44:52 Uhr

4 EUROPEAN HOSPITAL Vol 17 Issue 6/08

I N T E R N A T I O N A L E V E N T S

Chicago, November – At first glance, the 94thScientific Assembly and Annual Meeting of theRadiological Society of North America appeared tobe bigger than ever and impervious to the massiveeconomic recession of its host country. RSNA 2008ate into every inch of Chicago’s McCormick Placetrade centre. To reduce crowd congestion, technicalexhibitions had been expanded to include a thirdmassive exhibit hall.

Despite the poor marketoutlook Medica 2008proved a superlative eventDusseldorf, November – Medica’sanniversary had many significantfacets: in its 40th year, and for the 40thtime, this spectacular internationalmedical trade fair broke its previousyear’s record in visitor numbers – but,only just. The event was not onlystruck by the snow and ice of a suddenwinter onset, but also by a storm thatbrought a level of chaos to MesseDusseldorf’s outdoor environs.

Meanwhile, the 17 exhibition halls,hosting 137,000 visitors, were somanic that even mobile phone net-works overloaded and transmissionintermittently ceased.

Nonetheless, MEDICA and COM-PAMED again offered a superlativestage on which to present the world’smost up-to-date medical technologiesmanufactured by over 4,300 exhibitors(50% of them from countries otherthan Germany). Along with the exhibi-tion the congress programme pro-voked stimulating discussionsbetween and with medical experts.

Apart from the customary highinterest in medical technology andelectronics, interest was high in phys-iotherapy procedures and medical IT.

Among the individual country’spavilions we visited, New Zealandshowed us innovations from Pulsecorand WinScribe.

Pulsecor was demonstrating itsmobile, non-invasive measuringdevice, which is already in use at uni-versity hospitals in Edinburgh andAarhus. This provides a simple, accu-rate and quick assessment of aorticstiffness and central blood pressure;measuring various echocardiographicvalues takes a minute.

With so many US companies filing bankruptcy orshutting down, some RSNA attendees also appearedvery cautious about ordering products from smallervendors. The topic of vendor survival and the robust-ness of the diagnostic imaging industry to withstand arecession successfully appeared to have been dis-cussed more than the RSNA 2008 scientific pro-gramme itself.

for his vision and work for the European Congress ofRadiology (ECR), the European Society ofMusculoskeletal Radiology, and the GermanRadiological Society. Another new Honorary Memberwas neuroradiologist Dr Jian-Ping, President ofBeijing Tiatan Hospital, who is also principal advisorfor radiology to the Chinese Ministry of Health.

More than 1,800 scientific papers, 1,606 educationexhibits and 729 scientific posters were accepted.

Ways to reduce the use of CT exams by replacingthem with procedures where patients would beexposed to less or no radiation dose was empha-sised, and an entire session was dedicated to paedi-atric CT dose reduction.

Virtual colonoscopy, cardiac CT angiography,breast imaging, and ways to use 3-D and CAD soft-ware also took up whole sessions. Breast imaging –mammography, ultrasound, MRI and positron emis-sion mammography – were also emphasised.

The relationship of radiologists with industry ven-dors, the rationing of scarce radiology services andbetter utilisation through the use of examinationresults software, minimising the retake of proceduresfor emergency patients via the better use of DICOMCDs, better workflow allocation and performanceusing PACS, speech recognition systems, and struc-tured reporting, and the acknowledgement of jobstress and methods to reduce it were also key topics.

For more detailed information European Hospitalreaders are encouraged to visit our online magazinewww.european-hospital.com or AuntMinnie.com,which provided daily on-line coverage of the most important and provocative sessions andposters.

The 2008 head-turners To present various mobile applicationsfor the world’s smallest heart-lungmachine (Cardiohelp), Maquet showedan original and completely equippedADAC rescue helicopter, causing a stirand much interest among visitors.

was pointed out that this improvedcommunication can result in up to50% savings in diagnosis manage-ment costs.

Draeger introduced Drug Test 5000,a saliva-based, quick drug test thatrecognises six different classes of sub-stances: cannabis, cocaine, opiates,amphetamines, metamphetamines(so-called designer drugs) and benzo-diazepines (tranquilisers). In up to 10minutes the system indicates a clearresult for each substance, firm report-ed. This not only leads to fast infor-mation about potential drug misusebut also helps to reduce the numberof more costly and time intensiveblood tests in a laboratory.

No less impressive were accessibleplastic models of the human anatomy,for use by doctors to explain their ill-nesses or surgical interventions moreclearly to patients who often cannotunderstand what is being said. Evenexperts in various medical fields weremarkedly impressed by the oversizeddimensions of the organs.

WinScribe focuses on equippingmobiles, e.g. blackberries and PDAs,with a dictating function, so thatphysicians can update medicalrecords wherever they are and trans-mit them to a typist automatically. It

Crowding and congestion in the aisles were indeedreduced. In fact, there were 24 fewer companiesexhibiting and 3,373 fewer vendor employees, a dropof 12% compared to the record vendor participantattendance of 2007. And even though more exhibithall space was now available, the total area rentedwas 47,759 square metres, a reduction of 4% in rent-ed space compared to the previous year.

Throughout the RSNA meeting, the visual effectwas that each exhibit hall was sparsely populated andprofessional attendance had plummeted. In fact, ithad not. The RSNA reported a decline in professionalattendance of only 1%, or 778 fewer medical profes-sionals and a total attendance of 58,795.

Judging by the size of the crowds in the hallwaysand sky bridge linking exhibition halls and seminarrooms, it appeared that a good number of profession-al attendees were not keen on physical expansion ofthe exhibits. At the RSNA, where a stroll around exhi-bition halls can lead to the discovery of new productsand services, the three-hall layout may have had atotally unexpected, very detrimental effect. With theexception of the smaller vendors lucky enough to findtheir booths strategically positioned near the hugedisplays of Agfa Healthcare, Fuji Medical Systems, GEHealthcare, Philips Healthcare and SiemensHealthcare, many vendors were publicly saying thatradiologists and their administrative staff were notvisiting the exhibit halls in the way they had doneduring the past decade.

This does not bode well for the economic well-being of diagnostic imaging vendors. Just prior to theRSNA meeting, Philips Healthcare had announcedthat 1,600 jobs would be cut in 2009.

Mark L Vachon, GE Healthcare’s president and CEOfor global diagnostic imaging, said in an interviewwith international news agency Reuters that GEHealthcare probably would also reduce jobs and cutcosts (see report on Page 3). Additionally, theAmerican Hospital Association (AHA) had recentlypublished a report stating that 45% of US hospitalssurveyed stated they were delaying purchases of clin-ical technology or equipment, and that 3% weredelaying IT investments.

Some programme highlightsDuring the opening session the focus was on theRSNA’s goal to work with other international radiolo-gy societies to establish a uniform global standard ofpractice. RSNA President Theresa C McLoud MD, saidthat universal availability of images electronically, andthe potential of universal access to global specialiststhrough Internet technology, has ‘flattened’ the world,and made the need for worldwide uniform standardsfor radiology professionals of critical importance. Sherecommended that ‘radiology training and residencycurricula should reflect international changes in ourspecialty and the need for subspecialisation’. In addi-tion to the implementation of a core curriculum forthree years of residency training, Dr McLoud recom-mended that all radiologists should have two years ofsubspecialty training. Global certification shouldinclude a national board to oversee standardised

exams, managed through the cooperative efforts ofthe world’s radiology societies.

Professor Maximillian F Reiser MD, Chair of theDepartment of Clinical Radiology, Munich University,was named Honorary Member, the highest tributethe RSNA bestows to radiologists who do not workin North America. Dr Reiser was recognised for hisleadership in European radiology, specifically cited

Recession fears penetrate RSNA 2008

DAILY:Latest research news fromvarious medical disciplines

and medical industry

WEEKLY:English and german

e-mail newsletter (free of charge)

MONTHLY:Editorial topics and specials

ww

w.m

ed

ica

.de

Your No.1medical

informationportal: 24/7 all

year round

Messe Düsseldorf GmbH

Postfach 1010 06

40001 Düsseldorf

Germany

Tel. +49(0)211/45 60-0 1

Fax +49(0)211/45 60-6 68

www.messe-duesseldorf.de

Sour

ce:M

EDIC

A

Sour

ce:M

EDIC

A

Sour

ce:M

EDIC

A

C O U N T R Y S P E C I A L

EUROPEAN HOSPITAL Vol 17 Issue 6/08 5

Product innovations inneurological rehabilitationand traumatologytyromotion GmbH presenteda truly sensational andinnovative neurologicalrehabilitation device, namedPABLO. Developed with thehelp of top physicians andtherapists, the devicemeasures hand and armfunctioning and has anadditional sensor system toprovide interactive trainingprogrammes. PABLO issimply plugged in to the USBinterface on a patient’s PC orlaptop and then the tailor-made software provides theappropriate therapy.

The core competence oftyromotion GmbH and itsextensive network is in itscombination of mechanics,electronics and software,which promises all-in-oneproduct development inmedical technology. www.tyromotion.com

A full service provider intraumatology, I.T.S. GmbH,specialises in medical implants andinstruments made of titanium. Thefirm’s research and developmentdepartment has worked withAustrian doctors to make existingplates even more advanced anduser-friendly, so that patients canparticularly benefit from thereduced intervention times.

A good example is the new,narrower I.T.S. plate for the headof the humerus, which ensures asurgeon’s intervention can beminimally invasive. Thisreduces operating times,which saves costs andbenefits patients,because they canreturn to their normalway of life morequickly. www.its-

implant.com

Life Science Austria (LISA) is afocal programme acting as a centre forpeople from all over the world who areinterested in the life sciences inAustria. With its associates in theAustrian regions, ecoplus/TechnopolsLower Austria, Human TechnologyStyria, the LISA Vienna Region, theTyrolean Future Foundation and theUpper Austrian Technology &Marketing Company TMG includingthe Health Cluster, LISA is the firstpoint of contact in Austria for anyonewith questions about scientificcollaboration, setting up an operation,or funding and sponsoring projectsand businesses in this country.

Austria Wirtschaftsservice GesmbH(aws) is responsible for running theprogramme for the Austrian FederalMinistry of Economics and Labour.LISA forms the gateway to theAustrian life sciences scene – livelyand creative, and with enormouspotential for innovation.

LISA – Life Science AustriaUngargasse 37, 1030 ViennaE-mail: lisa@awsg.atwww.lifescienceaustria.at

Since 1985, Ortner cleanrooms unlimited has spe-cialised in all areas of clean-room technology – fromclean-room planning and implementation to clean-roomfacility management.

The special requirements of customers and partnersrequire comprehensive, expert knowledge of each ofthe special aspects of clean-room technology, such asflow measurement technology, or ventilation and airconditioning. Providing solutions for customers’ prob-lems requires not only experts, with their sovereigncommand over their individual specialties, but also, andespecially, partners for whom the classic skills of accu-racy, reliability and discipline continue to be a guidingprinciple. Ortner cleanrooms unlimited stands for thisdual way of thinking.www.ortner-group.at

HÄMOSAN Life Science Services GmbH is a privateResearch and Service Company with core competenciesin bio-safety and total quality management systems.

Clean-room facilities are available for training andsmall scale production. The training programmes have aclear emphasis on hands-on experience. Correct behav-iour and procedures in clean-rooms are explained intheory in the morning classes. In the afternoon, theideas are put into practice. Thus, the goals of learning bycarryout out a method and creating awareness for con-tamination control are the basis of HÄMOSAN clean-room training.

Teams from hospitals will find a place where bothlearning and the training of the new contents can bedone in a top quality, appealing environment.www.haemosan.com

At MEDICA 2008 – the world’s biggest medical trade fair – Life Science Austria (LISA)placed 16 companies and institutions firmly under the international spotlight. At theAustrian stand visitors examined their impressive range of innovations, which includedmedical implants and instruments, neurological rehabilitation equipment, videocommunications systems for healthcare, such as e-health systems using NFC andother innovative IT solutions, bio-safety and clean-room technology, mechatronicsand precision engineering. Along with these were inspiring presentations ofresearch projects carried out at the Medical University Graz

IT-solutions and tele-monitoringOther Austrian companies focus onhospital equipment and IT-solutions. For example, the Graz-based e-nnovation team focuseson the development, introductionand integration of highlyinnovative, comprehensive ITsolutions for healthcare industryand its service providers, together

The clean-room specialists

Bringing innovative companiesand products under MEDICA’spowerful international spotlight

with complex e-governmentapplications and their integrationwith local authorities and existinghealthcare structures. At Medica2008, the company’s presentationfocused on the development ofmobile solutions based on theApple iPhone as an all-in-one enddevice for doctors and healthcarestaff, and on the introduction ofRFID components in thehealthcare industry. There was alive demonstration of a supportapplication for logistical andclinical processes in healthcarebased on intelligent RFID systems. www.e-nnovation.at

By using the Near FieldCommunication (NFC) standardeHealth systems provide an out-of-the-box solution for easy-to-useand wireless home-, health- andtele-monitoring applications. TheeHealth systems research unit ispart of the Biomedical Engineeringdivision of the Austrian ResearchCentres GmbH – ARC, developingand evaluating IT-solutions andservices, for example to facilitatepersonalised therapy managementof chronic diseases such asdiabetes mellitus, heart failure,hypertension, obesity and others.www.arcsmed.at

I.T.S. implants enable aquick return to normallife for patients

tyromotion’s innovative neurologicalrehabilitation device PABLO

From planning to training and facility management

HÄMOSAN provides cleanroom training facilities

MANAGEMENT

N E W S

6 EUROPEAN HOSPITAL Vol 17 Issue 6/08

M A N A G E M E N T

Stefan Furtmüller MA, Manager of Contrast Management-Consulting‘What makes a hospital successful?’The general conditions for hospital management are not easy (toomany stakeholders and interest groups, different finance systems, etc.)Nonetheless, the existing conditions and structures still offer numerousopportunities to increase efficiency with regards to customised andhigh-quality patient care. Business tools and methods can help here.Some hospital groups make good use of these approaches (at least insome areas) and for most organisations there is still quite a lot of roomfor improvement.

Leonardo La Pietra, CEO of the European Institute of Oncology‘Accreditation and standards of excellence in Europe’Leonardo La Pietra will describe the individual management of theEuropean Institute of Oncology and experience with Joint CommissionInternational Accreditation.

In perspective, the MCC should be part of a more integrated patientfile, aimed to accompany the patient in his or her journey through thehealthcare system. Information technology (IT), with the realisation ofan electronic patient’s record (EPR), accessible online from differentplaces, could provide a valuable aid in the management of medicationcontinuity.

Participation in the Hospital Manager Symposium, which isorganized by EUROPEAN HOSPITAL in cooperation with theEuropean Congress of Radiology and which is part of the con-gress, has increased continuously since its introduction six yearsago. Last year about 250 attendees listened to the lectures anddiscussions.What makes this event so successful is the combination of threecritical areas (apart from medical knowledge) that make for ahealthy radiology department: management, IT and finance.Once again, this event has invited leading experts in thesefields to give talks and lead discussions with participating hos-pital and department managers.

Dr Marco Marchetti, Medical Director of Unità di valutazione delle tec-nologie‘The impact of IT on the healthcare system and organisation’ Dr Marchetti will explore and provide an overview of the impact of ITradiology innovation processes on healthcare systems and healthcareorganisations, according to the principles of Health TechnologyAssessment (HTA). HTA is a multidisciplinary process that produces infor-mation on the impact of technology introduction to healthcare systems.This is a useful tool because the information produced aids policy-makingdecisions at macro-level (national, regional level) and meso-level (institu-tional level or healthcare organisational level). Information produced dur-ing the HTA process relates to different aspects: effectiveness, economic,organisational, social, ethical and legal impacts.

Dr Pierre Thepot, Director of the Arras Hospital‘Changing medical and organisational processesthrough IT’The new Arras Hospital has incorporated far-reaching choices in terms oftechnology. The first results of these selections are visible today. Theimplementation of new ‘admissions-pathway-billing’ circuits and newcooperation initiatives is having an impact on information productivity,particularly in relation to the ‘Programme for the Medicalisation ofInformation Systems’ and DRGs financing. The results are positive. SinceJuly 2007 we have been experimenting with ‘paperless’ consultations:the analysis and impact of this new way of working. At Arras, informa-tion moves – not nursing staff! Access to information in treatment organ-isation is facilitated by the use of tablet PCs and multimedia terminals.

Dr Hanna Pohjonen, Healthcare IT Consultant, RosaliecoOy‘Enablers for teleradiology’In her speech, Hanna Pohjonen will discuss the advantages of e-market-places that offer a secure platform for the provision and consumption ofimaging services by developing a new working environment for profes-sionals and teams, a shared workspace for cross-border consultations andaccess to individual images and patient records.

other European countries is that, in Germany,there is not normally a requirement to make adown-payment, something which is arequirement for a leasing contract in most othercountries. Additionally, the balance sheets in thevarious countries are very different. In EasternEuropean countries, for instance, hospitals drawup balance sheets in an analogue way, based onthe IFRS standard or the US-GAAP standard,that is, based on international balance sheetguidelines, which is actually quite rare inGermany.

In Eastern European countries we alsodistinguish between financial leasing andoperating leasing, which, again, is the exceptionin Germany.What is the difference between the twokinds of leasing and which is suitable forwhat?With financial leasing the acquisition is fullyamortised, that means there is no residualvalue. With operational leasing, the leasingcompany retains a residual value, theinvestment is not fully amortised and at the endof the lease term the leasing company has todispose of the medical equipment on the free

Make a note in your 2009 diary:The Hospital Manager Symposium

André Hoppen: When it comes to financingwe distinguish between manufacturer-ownedleasing, which means financing solutionsavailable directly from the manufacturers whoseproducts a hospital chooses; the independentleasing companies that mainly offer contractswith small business volumes, and bank-linkedleasing as offered by VR-Leasing.

The particular feature of the VR-Leasing groupis that, whilst it is a generalist company andoffers the complete leasing spectrum, it worksaround specific business divisions, which meansthere are specific solutions for IT companies, forthe automotive sector and the medical sector.VR Medico is a separate division within VR-Leasing. All our employees have many years ofexperience in areas such as medical technology,health economics, medicine andpharmaceuticals. With this staff structure we arewell positioned and talk the same language asthe customers. This is particularly important foradvising large and individual customers, helpingus to gain an understanding of their specificrequirements and enabling us to offercustomised financial solutions.

A further feature of VR-Medico is that ourcredit analysts are trained at the Academy of theGerman Hospital Association to ensure they canfully read and understand hospital balancesheets, because these differ significantly fromthose in private industry and they have verydifferent parameters. When a decision is madeon financing there has to be a clearunderstanding of how a hospital draws up thebalance sheets, as well as why and howbalances function, based on the DRGs. Or, let’stake the example of the gGmbH in Germany:this type of company is not aimed at achievingprofits – it has a social aspect – but it stillenters into leasing contracts.

We don’t only operate in Germany; VR-Leasing cooperates with a multitude ofsubsidiaries and partner companies and offersmedical technology leasing over almost all ofEurope. Each country has specific requirementsas to how a leasing contract should be set up.One basic difference between Germany and

Do you know the right financing strategy for your hospital?Since the beginning of the global economic crisis thequestion of whether and how much hospital managersshould invest in updating medical technology hasbecome more complicated. Fear of making the wrongdecisions and insecurity around future budgets make iteven more important to find trustworthy and competentfinancial solutions shaped to the specific needs ofindividual hospitals. VR Medico, the medical branch ofVR-Leasing AG, offers such solutions. At the HospitalManager Symposium (7 March 2009. 8:30 am – 1:30 pm),held during the European Congress of Radiology (ECR) inVienna, André Hoppen (AH), Sales Manager for VR Medico, will discuss ‘FinancingHospital Equipment’ with the symposium participants. European Hospital (EH)met up with him at RSNA 2008 to learn about the sustainable financing on offerand what criteria influence lenders’ decisions to hand out funds.

Vasco Luis Jose de Mello, CEO of Quiron Hospital ‘Investment strategies and financing solutions inhealthcare projects’Vasco Luis Jose de Mello will deal with the question: What newapproaches are available for hospital managers and hospital groupsto face general investment and it’s financing?

He will focus on two key issues – how to minimise investmentneeds and how to optimise financing solutions – with an actual per-spective from a company with the biggest infrastructure plan inSpain in the last 5 years.

The 6th Hospital Manager Symposium – 7 March 2009, Vienna, Austria

Preliminary Programme

Session 1 – ManagementStefan Furtmüller MA, Manager of Contrast Management-ConsultingDr Wilhelm Marhold, CEO of Wiener Krankenanstalten Verbund ‘Changes in Viennese hospital structure’Leonardo La Pietra, CEO of the European Institute of Oncology‘Accreditation and standards of excellence in Europe’

Session 2 – ManagementDr Marco Marchetti, Medical Director Unità di valutazione delletecnologie ‘The impact of IT on the healthcare system and organisa-tion’Dr Pierre Thepot, Director of Arras Hospital ‘Changing medical and organisational processes through IT’Dr Hanna Pohjonen, Consultant ‘Enablers for teleradiology’

Session 3 – FinancingVasco Luis Jose de Mello, CEO of Quiron Hospital‘Investment strategies and financing solutions in health-care projects’

market in a way that ensures they don’t sufferany losses.

Operational leasing means that the leasingcompany has to dispose of the equipment at theend of the lease term. Within the EU, medicaltechnology can only be sold (and sold on) viaso-called medical products advisors. This is whythe leasing company has to work with themanufacturers and brokers when it comes toselling on the equipment.

Operational leasing offers more flexibility butis more expensive. The lease duration is amaximum of four years, after that theequipment is returned or sold on. Operationalleasing is the right product for customers whowant to keep continuously abreast withtechnological progress and innovation, maybebecause they are market leaders for a certainmedical service in their area. These may be largeservice providers but also individual, smallersurgeries that cooperate with large serviceproviders and which bridge a medical gap forthe respective service provider, or which offerthe best possible service based on the latesttechnological developments. By comparison, thelease duration for financial leasing is eight years

and obviously works out cheaper.Our concept of responsibility towards the

customer not only includes advising them tochoose the right strategy but also to monitorwhether they actually generate enough moneyin working with the leased equipment to coverthe monthly outgoings of the lease. Thisinvolves assessing how many private payers,private patients, patients covered by medicalinsurers and referring doctors are passingthrough the hospital and what types of patientswith what GOA figure (physician fee schedulefigure) these are. A lease contract is not amatter of course but in each case is put to theacid test.

This can lead to surprising results. Oneexample: A hospital with 80 beds, located neara conurbation, was under economic pressureand the question is whether it should be closedor whether there may be a new, viable concept.If yes, what could this concept look like? Thehospital’s advantage is its regional aspect andlocation, which many patients appreciatebecause relatives and friends have easy accessand can visit more often. Through negotiationsinstigated by VR Medico the hospital madecontact with a large provider in the nearest bigtown, which was interested in attracting morepatients from further afield to certaindepartments. Both hospitals operate withdifferent billing structures. The small hospitalworks with DRG-based compensation structuresfor appendix operations, for instance, somethingwhich the large hospital cannot afford to dobecause it has a different structure. In the end,the model agreed on ensured a minimumprovision of basic services in the small hospital,whilst special interventions or intensive therapywere to be carried out by the large hospital.After such intensive therapy the patients weretransferred to the small, regional hospital.

The conclusion: The large hospital gets somerelief with the length of hospital stays, theregional hospital takes over aftercare and bringspatients closer to their families – and thecooperation has positive effects for bothhospitals in terms of DRG billing.

INFORMATION TECHNOLOGY FINANCING

EUROPEAN HOSPITAL Vol 17 Issue 6/08 7

C O M P A N Y N E W S

According to the American CancerSociety’s first Global Cancer Facts &

Figures report there will be 27 mil-lion new cancer cases and 17.5 mil-lion cancer deaths globally in 2050,‘due to the growth and aging of thepopulation’ as well as lifestyles.Sadly, the lack of access to medicalcare is one reason for the gap in can-cer survival between economicallydeveloped nations and developingcountries, the report adds.

New cancer centres to be set upinternationally by the University ofPittsburgh Medical Center (UPMC) ina partnership with GE Healthcarecould help to alleviate pressures fromhealthcare providers within suchareas. Their aim is to combineUPMC’s strength in developing andoperating oncology centres that offeradvanced diagnosis and radiotherapytreatments close to patients’ homes,and GE’s expertise in the provision ofthe necessary medical equipment.

UPMC already operates one of thelargest cancer programmes in theUSA, serving 30,000 newly diagnosedpatients annually in over 40 centres inwestern Pennsylvania, and also runstwo cancer centres in Ireland.

GE Healthcare will conduct assess-ments to determine which marketsare most appropriate for cancer cen-tres. Key factors will include theavailability of a suitable local partner,regulatory requirements and patientvolumes. Once a market is selected,UPMC will negotiate definitive agree-ments and take responsibility, withthe local partners, for the construc-tion, ownership and operation ofthose centres.

Meike Lerner of European Hos-

pital, asked Charles E Bogosta,Executive Vice President Universityof Pittsburgh Medical Centre(UPMC), President, International andCommercial Services Division, andJim Torres, General Manager, GlobalFunding Operations, GE Healthcare,about the background and aims of theproject.

‘About a year ago, GE and UPMCcame together to tackle a commonproblem: to improve the level of can-cer care around the world,’ CharlesBogosta explained. ‘We immediatelycame up with a business structure.Our aim is to establish at least 25 can-cer centres internationally within thenext 10 years. In these, we’d like toprovide the opportunity of high quali-ty cancer care that we offer in the USand Ireland. UPMC would lead themanagement side and the develop-ment of clinical protocols and path-ways.’

Described their collaboration as a‘win-win’ situation, Jim Torresexplained: a win for UPMC as theclinical operator and a win for thecountries where the new centres willbridge the lack of services. ‘UPMCwill bring best quality clinical knowl-edge and GE the state-of-the-art med-ical diagnostic technologies. Togetherwe can bring solutions for a level ofquality of care that otherwise would-n’t be possible.’

The partnership is a continuation ofa 20-year relationship between GEand UPMC, Charles Bogosta pointedout. ‘In Western Pennsylvania, wherewe planned 14 new cancer centres,GE provided all the technologies theycurrently use. So it was natural totake this relationship oversees, as wedid in Ireland. Now we’ve formalizedthat and are levering GE’s marketintelligence and international exper-tise. This is very complementary.’

90% of oncological care occurs insmaller communities, Charles

US ONCOLOGY EXPERTISE TO SPREAD GLOBALLYThe University of

Pittsburgh MedicalCenter and GE

Healthcare plan toestablish over 25 local

cancer centres invarious countries

within the comingdecade

Bogosta pointed out. ‘Our model is tosettle the centres in these. Going in toseveral countries, we’ve found greatinterest in this specific concept –every country in the world could be acandidate for this. It has to be cus-tomized wherever we go. As yet, wejust don’t know whether we will placeone or more centres in a country; dis-cussions with the countries are verypreliminary right now.’

Speaking of project financing,Charles Bogosta said this will mainlybe handled by their local partners –i.e. hospital companies and govern-

ments. ‘With the current economic sit-uation things are going a bit slowerthan in other times. But so far, discus-sions with our partners are very opti-mistic. Oncology is targeted as a veryhigh priority in every country.’

Asked whether the centres will becentrally linked, he explained that,although they will be local, each will beable to make the most of its interna-tional background and share educationand research. ‘We already have manycentralised processes that will bringefficiency to all these locations.’

Finally, Jim Torres added: ‘This pro-

ject is going along with our strategyfor globalization and becoming localin the global markets. GE Healthcareis already in over a hundred coun-tries, so we have a strong under-standing of local markets, know thekey players, and can provide thatintelligence to UPMC and find theright locations and partners. GE is aglobal player in providing healthcaresolutions; we have a broad spectrumof products, so we provide the globalfootprint – the healthcare solutions –whilst UPMC brings the clinicalexpertise.’

8 EUROPEAN HOSPITAL Vol 17 Issue 6/08

I T & T E L E M E D I C I N E

A study carried out this year by theVHitG e.V. (a German association of ITsolutions providers for healthcare) pro-duced the first complete market analy-sis of systems installed in hospitals,along with an evaluation of the use ofIT through the subjective appraisals ofthe users. The objective of the stan-dardised online questionnaire, in which480 people participated, was to deter-mine the trends, focus and require-ments of users.

Based on a differentiated evaluationof IT used in the hospital from the per-spective of three important groups ofdecision makers (106 commercial, 167medical and 206 IT leaders) the poten-tials, requirements and obstacles in ITuse, from users’ viewpoints, wereexamined. Additionally, the futurerequirements for IT leaders were inves-tigated.

The study results show that usersviewed the IT contribution as essential-ly positive. In fact, it is considered sovaluable that the topic of IT is typicallynot just approached purely from a costperspective. Moreover, there is agree-ment that hospitals cannot survivewithout IT. To the contrary, the IT andmedical decision makers agree that, torealise new and profitable businessmodels for their hospitals, IT is neces-sary. In this context they criticise thelack of networking facilities with theoutside world and the insufficient pro-vision of software training. The biggestpotential for IT use is considered to beimmediate data availability. Furtheropportunities are seen in particular inknowledge-based systems, the trans-parency of the invoicing and account-ing structure and support for manage-ment decisions. As yet there is little evi-dence of IT use to optimise processes inclinical systems and in the implementa-tion of new business processes.

Another, major insight from the studyconcerns the role of the head of IT,which is due to undergo major change.

A new IT system, designed toimprove the efficiency andeffectiveness of the therapydepartment at the RoyalOrthopaedic Hospital (ROH) NHSFoundation Trust in Birmingham, isreported to have shown clearbenefits for therapists, managersand patients.

Wireless technology enables thetherapists to use laptops or tabletPCs during their rounds. NamedTIARA, the new system givesclinicians rapid, easy access to fullpatient histories and allows detailsof assessments and interventions tobe recorded onto the system.

As one of the busiest orthopaediccentres in Europe, the ROH Trustprovides elective surgery to thepopulation of Birmingham andprovides a spinal service to the WestMidlands. About 65,000 out-patientsare seen annually, with 13,000patients treated as in-patients or daycases.

In terms of therapy services thehospital offers in- and out-patientservices, including physio andoccupational therapy, rehabilitationand sports medicine and has a busyhydrotherapy service.

ROH Therapy Manager Nikki

Mason explained that TIARIreplaces three previous systems that

Biometric fingerprints – TheBarmherzige Brüder hospitalgroup, Austria’s biggest privatehospital chain, has dispensed withpasswords, in preference for bio-metric fingerprint access to its sys-tems. In its previous system‘account groups’ of users couldaccess and amend patients’ med-ical records: this was found to beoutdated, insecure and unsafe,with managers unable to directlytell who had accessed any particu-lar records and when.

The group’s first hospital to golive was in Graz; since last April,270 members of staff have used abiometric solution delivered bySiemens IT Solutions and Services.

The group is now introducingthe system across nine hospitalsand three nursing homes.Password log on will go wheneach access point to the hospitalinformation system (HIS) will beequipped with a PC mouse withbiometric sensor to identify a userby his or her fingerprint.

Michael Wiltschnigg, thegroup’s IT chief, said the systemwas successfully tested for threemonths last year and is now beingintroduced to more of its hospi-tals. ‘The staff can now access thesystem within 2-3 seconds, where-as when we had a password sys-tem it took up to 15 seconds. Ourusers log in to our health informa-tion systems up to 50 times a day,

Based on Swedish firm Anoto’sDigital Pen and Paper (DP&P) tech-nology, each pen is fitted with adigital camera and comes withraster paper, which can be printedout either as a care form ordeployment transcript. As the penis used to write on the rasterpaper, letters and words are recog-nised and digitised, and then thedata can be transferred from thepen, via a USB docking station to aPC. There, it can be opened as aPDF file in the DocumentManagement System (DMS) forfurther processing, or be madeinstantly accessible to theHealthcare Fund Medicinal Service

TIARA enhancestherapists’ workflow

By Mark Nicholls

were incompatible. Since the systemwent live last April, implementationhas been phased; initially it was usedfor appointments, registration andcollection of statistics and auditingpatient attendance. ‘We now have fullelectronic patient records forinpatient physiotherapy, inpatientoccupational therapy and outpatientphysiotherapy,’ she said. ‘However,

we do not have the system forhydrotherapy because of problemswith having laptops in a waterenvironment; we are looking atways to resolve that.’

Since its introduction, the new ITsystem for therapists has madesignificant improvements and seenhand-written notes phased out. Ithas also helped managers withstatistical data, assisted in managingpatient flow and seenphysiotherapists spend less time onadministration. ‘We have a betteridea of waiting times and canmanage our waiting lists moreeffectively,’ Nikki Mason added.‘From the physiotherapist’sperspective there are some patientswith more complex needs thatcover several areas. Instead ofhaving separate notes in thosedifferent areas, the notes are on thelaptop and we can see them straightaway.’ The therapist can movebetween patients in wards or

consulting rooms, carrying nodocuments, only the laptop, andclinical records can be viewed bymultiple users with appropriateaccess.

‘The system can detail patientattendance, highlighting for examplewhich patients are poor attendees,so we can address that situation; oridentify those patients that are morededicated to their treatment,’ NikkiMason pointed out. Data collectionand storage is also more formattedand standardised. ‘The system is alot more auditable and helps usmove towards improved evidence-based practice. Ultimately, thepatient is receiving an audited,quality service and it is helping usreduce waiting times.’

Security – The laptop will notwork away from the hospital; datais all encrypted and it is web-basedso there is no data stored directlyon the laptop. Further potential – A next step isto take electronic referrals formGP surgeries and consultantswithin the Trust.

The hospital reception also has atouch-screen computer check-insystem where patients can register,so that members of staff areprepared for their arrival at therelevant department.

Speeding up HIS accessand tightening security

Aiming to streamlineaccess to IT systems and

ensure access securitymany hospitals are usingsmart cards while othersare opting for a biometric

fingerprint sign-onso throughout the day that saves alot of time. It’s also much moresecure than with the former pass-word system.’

Barmherzige Brüder also pointsout that it is now easier to tellwhich user had accessed the sys-tem and which documents theyhad read or changed. However, toaccess the system users need tohave clean fingers and not be wear-ing gloves.

By mid-2009, when implementedacross all the group’s centres invarious locations (e.g. Vienna, Linz,Salzburg), it will be used by about3,500 employees.

One smartcard and PIN –England’s Norfolk and NorwichUniversity Hospital aims to intro-duce a new, single sign-on frame-

work that will enable clinical usersto log on to all software applica-tions using one password. Initially itwill implement Imprivata’s SingleSign-On software across its busyA&E department. If successful, thesystem will be deployed Trust-wide.

The OneSign appliance-basedauthentication and access manage-ment solution – to be installed byEnline – will integrate with existingConnecting for Health (CfH) smart-card technology, allowing users tosign on to all applications using onesmartcard and pin number.Presently, employees must remem-ber multiple usernames and pass-words.

With OneSign the Trust can moni-tor, capture and log password-relat-ed user events in a centralised auditlog and administrators can monitoraccess records for every user, appli-cation or workstation in one centrallocation.

Bill Fisher, the Trust’s Head of IT,said that the system should deliveradditional efficiency savingsthrough a reduction in downtimecaused by users who are locked outof their computers and have to callthe IT helpdesk.Report: Mark Nicholls

Hospitals cannotsurvive without IT

Study examines the benefits andshortcomings of the use of IT in healthcare

DIGITAL PENS QUICKLYCOLLECT CARE DATAWithin a project named ‘Healthcare Documentation& Digital Pen’, Hamburg based IT firm Allpen is tosupply digital pens to 300 employees of thehealthcare association Diakonie Pflegeverbund Berlin

The IT head of the future will sooncontribute to an organisation’s finan-cial results; be involved in the hospi-tal’s strategy and will need to gainknowledge of clinical processes tooptimise comprehensively the hospitalprocesses.

From the association’s point of view,among the essential conclusions in thepublished results is the high IT contri-bution to workflow support, setagainst the background of a low distri-bution of these workflow systems,which was clearly evident. This demon-strates an important potential toincrease the IT contribution signifi-cantly. On the other hand, a lack ofinterfaces is seen as an obstacle. Theassociation sees potential here notonly in education for end users, butalso in the support of integration andstandardisation.

The investigation looked at VHitGmember companies, whose productsare used in 90% of German hospitals,and specifically at the number of ITsolutions installed in 2007 in all 2,093German hospitals.

Based on the differentiation of ITsolutions installed in 45 segments, thestudy shows that most hospitals usesolutions from different suppliers, andthe HIS is not the only system they use.The study also investigates whetherthe software had been developed bythe providers themselves, or whetherthey had merely installed third partyproducts, or whether they were justthe retailer. For quality assurance, theVHitG study was monitored by twoindependent organisations: MunichTechnical University and ConsulticMarketing & Industrieberatung GmbH.

The ‘usability’ obstacle raises sever-al questions because this subjectincludes a broad range of technicaland ergonomic aspects. Thus VHitG isconsidering a follow-up study in 2009,in which the focus on usability willincrease.

(MDK) for review.About 40 people employed in

Niederschönhausen, Berlin, areusing the pens, to be followed by afurther deployment of pens tohealthcare association’s staff atBerlin Mitte and Berlin Weissensee.

Before using the technology, datawas transferred by hand into thepatient management system aftereach case.

Besides archiving and presentingthe forms, the system has a rangeof additional functions that supportuser administration, assignment ofpens to staff and the managementand downstream processing of caredata and rendered care services.

‘

‘I T & T E L E M E D I C I N E

EUROPEAN HOSPITAL Vol 17 Issue 6/08 9

Initiated by private hospital chainssuch as Asklepios and Rhön, andbacked by the German HospitalAssociation (DKG), the eFAproject is widely considered one ofthe most important ITstandardisation projects inGerman healthcare. Under the eFAumbrella, the Berlin-basedFraunhofer ISST has been workingsince 2007 on technicalspecifications for an EPR withdecentralised data storage to bedeployed in regional and supra-regional connected care scenarios.In Germany, because this type ofEPR is not a life-long record butrecords only a specific treatment,it is referred to an ‘electronic caserecord’ (elektronische Fallakte).

Pilot projects of eFA at fourhospital chains and another eightindividual hospitals have beenrunning for more than a year.Following the BerlinConnectathon, eFA is bound toleave the pilot stage: ‘This was animportant step towardscommercial products that areavailable for all hospitals as off theshelf solutions,’ said ISST-projectmanager Dr Jörg Caumanns.

The Connectathon providedthree scenarios to test thesolutions live and in public. Allthree solutions that entered therace – iSoft’s Lorenzo, Siemens’Soarian Integrated Care, andIspro’s Jesaja.net – weresuccessful in the scenarios ‘eFAclient compatibility’ and ‘eFAservices compatibility’. The formermeans that it is possible to accessand edit data in electronic caserecords of competing providers viaan eFA client. ‘eFA servicescompatibility’ means that it is alsopossible to use eFA-relatedservices, for example a searchfunction.

Only the Siemens productreceived a certificate for the thirdscenario ‘eFA peer to peercompatibility’, which means thatthe system can build up regionalnetworks with the electronic caserecords of other providers. This isessential, because otherwise adoctor in private practice whowants to communicateelectronically with differenthospitals would have to usedifferent portal solutions to accessdifferent case records.

All in all, hospitalrepresentatives were quitesatisfied with what they saw inBerlin, and announced that theywill implement the current eFAspecification 1.2 as soon aspossible. ‘At Asklepios we willenter the national rollout at ourhospitals beginning in April 2009,’confirmed Uwe Pöttgen, head ofIT for this hospital chain.

Dirk Herzberger of Helios isalready using Jesaja.net: ‘We willfinish the eFA rollout in our ten

eFA project gains accolades in ConnectathonSAP-based hospitals in 2008, andwill add another twenty hospitalswithout SAP in 2009.’ Rhön isrunning eFA pilots based onSoarian Integrated Care in Leipzig,Frankfurt/Oder and Hildesheim.Aachen University Hospital (UKA),which uses iSoft’s Lorenzo, hasalready implemented two eFAprojects with cooperating hospitalsand, next year, will start a thirdwith cardiologists in the Aachenregion. ‘We are also envisioning

cooperation with Maastrichthospital, based on eFA standards,’said Dr Silke Haferkamp of UKA.However, there is presently notime scale for this.

To make the eFA initiativesustainable, hospitals and hospitalchains are now launching a non-profit organisation – the eFAAssociation (eFA-Verein).Membership fees will be used toupdate the eFA-specification andmake it compatible with the

The first Connectathon of ‘eFA’, a hospital-drivenGerman electronic patient record (EPR) project wasconsidered a success by health IT providers and hospitalrepresentatives. During the Berlin event, Siemens, iSoft,and Ispro received certificates for implementing basiceFA functionalities in their connected care solutions,writes Philipp Grätzel von Grätz

German national health ITinfrastructure, including itssmartcard components. ‘Ourambitious goal is to create anationwide standard in the end,’said Uwe Pöttgen, who alsoproudly reminded the guests thatthe hospitals have invested a sixdigit amount of money so far intothe development of the eFAstandard, and that this standardnonetheless remains freelyaccessible for anyone.

INTRODUCING SuperPACS™ ARCHITECTURE. Now you can synchronize disparate PACSsystems using your existing infrastructure within a multi-site healthcare network, providingyou ONE global worklist no matter where your site or data is located.

SHARE clinical resources and balance radiology workload with ONE rules-based global worklist across all sites.COLLABORATE with peers, clinicians and referring physicians. Diagnose and REPORT quickly with numerous advancedclinical tools and set profiles. Experience common reading and reporting for all sources and formats of data.ONE chair. ONE workstation. ONE solution.

ONE

Supe

rPA

CS™

ARC

HIT

ECT

URE

info

rmat

ion

is p

rovi

ded

for

plan

ning

pur

pose

s.

Com

mer

cial

ava

ilabi

lity

is p

endi

ng s

ubm

issi

on to

and

cle

aran

ce b

y FD

A a

nd o

ther

regu

lato

ry a

genc

ies.

©

Car

estr

eam

Hea

lth, I

nc. 2

00

9.

Want to find out more?it.carestreamhealth.comECR 2009 EXPO B

The multicentre inter-national trial CorE-64trial has demonstrat-ed that CT is increas-ingly important in thenon-invasive diagno-sis of obstructive

coronary artery disease.For the first time, radiologists have

tested the reliability of cardiac CTresults compared to cardiac catheterisa-tion in this multicentre internationaltrial (carried out by the CharitéUniversity Clinic in Berlin and JohnsHopkins University, USA, among others).

10 EUROPEAN HOSPITAL Vol 17 Issue 6/08

R A D I O L O G Y / N U C L E A R M E D I C I N E

Carestream Health plans to demonstrate its newest,low cost, digital imaging and IT solutions at ECR 2009(European Congress of Radiology). The range includes: RIS/PACS

This new platform from Carestream will becomeavailable worldwide in spring 2009.

The Web-based RIS employs a Microsoft .NETarchitecture, which will offer tremendous flexibilityand scalability in a thin-client solution, Carestreamexplains. ‘This architecture will allow users to refinefeatures to automate workflow and speedimplementation. It also will deliver secure remoteaccess for physicians; enable greater collaborationusing IBM Sametime technology; and offer an optionalportal that allows patient scheduling within parametersset by healthcare providers.’

The new PACS will help increase radiologistproductivity with a unified virtual desktop that canfacilitate faster reading of CT, MR and PET/CT examsthrough automatic registration, Carestream adds. ‘Italso will offer an innovative power viewer that builds asingle virtual study with real-time volume matching ofall relevant studies (new and prior) to automaticallyregister and synchronise them in one click.’The first SuperPACS Architecture

Carestream Health will showcase the very firstSuperPACS Architecture. Designed to integrate multi-vendor, multi-site PACS into an efficient enterprisesolution, this can be ordered also in spring 2009.

‘This new architecture will allow healthcareproviders to streamline workflow—using existingPACS resources, since it will enable the sharing ofpatient images and information, while also delivering aglobal work-list that balances examination readingamong on-site and off-site radiologists,’ Carestreamreports. ‘This architecture is designed to reduceexpenses by maintaining use of existing PACS andstorage devices and allowing for consolidation ofresources. As part of its workflow grid, the newarchitecture can synchronise disparate PACS. Imagesand reports are automatically sent back to the originalPACS or RIS for local storage and distribution.’

Hot on the heels ofcardiac catheterisation

Coronary artery evaluation using 64-RowMultidetector Computed Tomography Angiography

using CT with the same precision aswith the cardiac catheter, which meansnon-invasive CT examination that isfree of complications is equally capableof identification as catheterisation,’ DrDewey concluded.

‘64-slice CT is currently the mostpromising procedure for non-invasivecoronary angiography. However, in adirect, multi-centre comparison withconventional coronary angiographylimitations are also evident. The sensi-tivity of 85% and the negative predic-tive value of 83% are lower than inprevious single-centre studies,’ he

Biograph mCTSignalling the beginning of molecular CT

Markus LusserAt Medica 2008, Siemens introduced

its latest generation PET-CT, theBiograph mCT. During a EuropeanHospital interview, Markus Lusser

(ML), worldwide Head ofDistribution and Marketing forMolecular Imaging at Siemens,

outlined the advantages of the newhybrid system, which aims to extendthe spectrum of medical imaging to‘molecular computed tomography’

What makes the mCT differentfrom other PET-CT systems?Markus Lusser: The Biograph mCTcombines our highest-performanceCT platform with our latest PET scan-ner. This means the system combinestwo high quality modalities in onemachine, whereas with conventionalPET-CT systems the CT componenthas limitations for complicated CTexaminations. To increase patientcomfort, we have now integratedboth components in a very small sys-tem, so that the scanner has a tunnellength of only one metre. This meansthat examinations with the BiographmCT can be carried out in just five tosix minutes, whereas conventionalmachines still take about half an hour.Does this mean the system is notreally a PET but a CT withintegrated PET module?Yes, a powerful CT with high perfor-mance PET. With its adaptive doseshield, a scanning area of up to twometres and a maximum time resolu-tion of up to 150 milliseconds – with128 slices per rotation – the CT scan-ner ensures pin-sharp and clearimages. This makes it suitable for rou-tine diagnostics as well as complexexaminations in cardiology andoncology.These are different medicaldisciplines. The mCT constitutesthe interface between radiologyand nuclear medicine. Will thesetwo disciplines be forced intoincreased cooperation due to thistechnical development?

I wouldn’t use the word forced, becausePET-CT is already an established modali-ty. It means that nuclear medicine spe-cialists and radiologists jointly establishthe diagnosis.A specialist in nuclear med-icine typically cannot evaluate and diag-nose the results of a CT examination, anda radiologist cannot evaluate PET results,so we are supporting closer cooperationwith our mCT.But this has a significant biastowards radiology. Some hospitalsin Germany have nuclear medicinedepartments and professorships. Touse the new mCT effectively, radiol-ogy and nuclear medicine will nowhave to work together in onedepartment. As the manufacturer, we don’t think somuch in terms of the structural categoriesbut look at issues from a clinical point ofview. Moving away from the situation inGermany, internationally there is a strong

ECR 2009 The latest Carestream HealthIT for radiology will go on show

trend towards integrated imaging – andwe aren’t interested in promoting onegroup to the detriment of another.Hybrid systems, such as molecular CT,need the expertise of both groups if thepotential of ‘molecular imaging’ is to befully exhausted. For example, this type ofCT can actually be used for organ perfu-sion. However, that requires a radiolo-gist’s expertise in the necessary techno-logical skills. If you then superimposethe result with that of a PET examina-tion – and this is where nuclear medi-cine comes into play – you gain a thirdtype of measurement, at no extraexpense, which can be relevant for fastand precise diagnosis. But the crucialpoint is that about 95% of all PET-CETusers do not use CT for advanced exam-ination protocols, such as contrast-CT.So they are only driving your luxurylimousine in first gear?ML: Only in first gear, and to pop to theshops, so to speak. And this was whySiemens focused on how to motivateusers to make full use of the potentialsof a CT examination. The solution: anenhanced CT that can also be used tocarry out CT angiography. The mCT cangive a surgeon a complete image of thelungs, for example. This clearly showswhere the bronchial tubes and tumoursare. It can even show blood vessels –and all this in an integrated examinationfor which the Biograph Molecular CTonly requires a fraction of the time thatcurrently used machines take to do it.

First Wireless, Cassette-Size DR Detector

The company has announced that it will alsodemonstrate the industry’s first wireless, cassette-sizeDR detector that can be used with existing wall standor table-based Buckys. ‘The Carestream DRX-1 Systemis expected to be available during the first quarter of2009. It incorporates a console and a wireless 35 x 43cm (14 x 17 inch) cassette-size detector that providesa rapid, affordable conversion for users ofradiographic film or computed radiography systems. Itrequires no modifications to existing analogueequipment, resulting in very low installation costs. The

NEW

DRX-1 system delivers high-quality preview images infewer than five seconds, which significantly improvesproductivity, even for users of computed radiography(CR) systems.’

Carestream reports that imaging service providers thathave seen advance previews of the new DR detectorcomplimented its affordability and productivity.Radiologist Dr Peeter Ross MD, at East Tallinn CentralHospital of Estonia, commented: ‘The easy transition andaffordable price offered by the new DRX-1 system shouldlead to increased use of DR, which enables greaterproductivity because it is faster than CR or screen-filmsystems. It also can offer better image quality, with thepossibility of reduced exposures and less radiation doseto patients.’

The result: Non-invasive CT facilitatesthe safe detection of vasoconstriction;however, for a precise assessment ofthe severity of obstructions, thecatheter was still superior to CTenhanced imaging. ‘The result makesus feel confident. The study shows thatCT is hot on the heels of angiography,’said lecturer Dr Marc Dewey (above),of the Institute of Radiology, CharitéMitte Campus, Berlin, who led thestudy in Germany. ‘Catheterisation isnot without its risk. Deposits removedfrom the vascular walls can lead toconstrictions in other parts of theorgan, or the vascular walls can actual-ly tear,’ he pointed out.

Unsurprisingly, about 75% ofpatients stated they would prefer fastand painless CT for future examina-tions. According to the radiologist onlya third of catheterisations are actuallycombined with therapy, i.e. the vesselsare only widened in about a third ofcases. In all other cases, catheterisationis only used for clarification.Seeking a low-impact diagnosticprocedure

For some time, radiologists havebeen looking for a way to assess reli-ably the condition of coronary arterieswhilst avoiding the complicationsimplicated in doing this via angiogra-phy. CT has proved to be the procedurewith the biggest potential to take overfrom catheterisation, as the interna-tional team carrying out the CorE-64study discovered.

Some 400 patients with diagnosedor suspected coronary heart diseaseunderwent a two-fold examination(approved by the Federal Office forRadiation Protection), employingcatheterisation and CT. ‘We were ableto detect stenosis requiring treatment

explained. ‘This means that, with large-scale use of 64-slice CT for coronaryangiography, the realistic results fordiagnostic precision are lower than inprevious examinations (with about a95% sensitivity) which were not multi-centre. Nevertheless, and this is clearlydemonstrated by our first international,multi-centre study, the diagnostic valueof CT is higher than with all other non-invasive procedures to detect coronaryartery stenosis. Moreover, CT was on apar with conventional coronary angiog-raphy in the prediction of the necessityof coronary revascularisation.’

In terms of assessing for which riskscore cardiac catheterisation and CT areappropriate Dr Dewey added: ‘Non-inva-sive cardiac CT could be a sensible “fil-ter” prior to cardiac catheterisation forpatients with low to medium probability(20-60% pre-test probability) of coro-nary artery stenosis. For example, theseare patients with asymptomatic com-plaints or existing, conflicting results ofother examinations. Patients with typi-cal, symptomatic problems should defi-nitely still be examined via cardiaccatheterisation and, if necessary, revas-cularisation. On the other hand, it hasbeen shown that there is no improve-ment in clinical, long-term results inasymptomatic patients, which meansthat CT does not seem to be a sensibleapproach for these patients. As Rita FRedberg writes in her article about ourstudy in the New England Journal ofMedicine, there is a need for more ran-domised – and ideally publicly spon-sored – studies to further analyse thebenefits of low-impact, non-invasive CTprior to the large-scale use of cardiac CT.* The CorE-64 results were first publishedin the New England Journal of Medicine(2008; 359: 2324-36).

CT plays anincreasinglyimportant role incoronary diseasediagnoses

Shenzhen Landwind Industry Co.

Ltd. (Landwind) began operationsas a distributor for Siemens andPhilips ultrasound products inmainland China and later com-menced production of its ownblack and white ultrasound equip-ment on an Original DesignManufacture (ODM) basis forHONDA in 2004.

Today, Landwind manufacturesultrasound diagnostic scanners andother medical imaging systems, aswell as hospital information man-agement systems.

The company’s three ultrasoundimaging systems – C Series, FSeries and Veterinary – are far moreadvanced than the firm’s initialproduct. Elegantly designed andwith foldaway backlit keyboards,their features include a 10in high-resolution monitor or LCD monitor;dynamic focusing and apertureimaging; multi-frequency, high den-sity probes; a full range of mea-surement and calculation softwarepackages; display modes B, B/B,B+B, B/M, M; cine review, storagecapacity, and much else.

This year, the company present-ed its ultrasound equipment atMEDICA in Germany and the RSNAin Chicago. Landwind’s VicePresident, Wang Guozhong, waspresent at both events. When inDusseldorf, he met with Daniela

Zimmermann (European Hos-pital) to talk about the firm’s prod-ucts and aims. ‘Generally speaking,we just provide good products ataffordable prices,’ he explained.‘For ultrasound and X-ray technolo-gy we have our own R&D capabili-ties. The products have the samefeatures as others on the market,because all the products almost dothe same thing; but, compared withcompetitors’ products, our perfor-mance is very good; the image qual-ity and powerful clinical functionsare very good and very powerful.And initially we will take the locali-sation strategy to expand our busi-ness in European countries.

Landwind’s colour Doppler ultra-sound equipment – MIRROR 2 – isdesigned on all-digital architectureand delivers outstanding perfor-mance and smooth workflow tomeet different needs of patientsand clinicians. It integrates the lat-est image processing technology,such as Multi-beam Parallel imag-ing, Superior Aptitude Filter, andMagic Focus, and provides versa-tile clinical applications, fromabdomen, OB/GYN and plays a partin ergonomic design to relieve doc-tors from fatigue.

‘For X-ray, we produce themobile DR, and CR, and the all-dig-ital DR, and a hanging-bracket forthe Dr These are also in the medi-um price range.’ Wang Guozhongsaid.

Did the firm’s presence at MEDICAprove valuable? ‘It’s the best tradeshow for medical equipment in theworld,’ he responded. ‘This is thefourth time our company has beenhere, and we’ve done very, verywell in Hall 10. It’s a very goodopportunity for us, and we want toenlarge our space next year, to bein the middle of the hall with our

EUROPEAN HOSPITAL Vol 17 Issue 6/08 11

R A D I O L O G Y

LANDWIND A Chinese company firmly determinedto expand its global presence

competitors.’Broached with the ticklish ques-

tion of European and Americanreservations that Chinese firms maycopy their products, WangGuozhong counteracted that hiscompany has only a 15-year historyand that, ‘…for the R&D experi-

ence, and particularly for high-tech equipment, we want to do itourselves. We learn from our com-petitors, but we need to have ourown technologies, our own devel-opment. We learn from Philips orSiemens, but we don’t do the me-

too products. We pay much moreattention to our own R&D centre;just over 10% of our gross margingoes into that. In China weemploy almost 700 people and ourannual turnover is almost€100,000,000.’

Landwind, playing a more andmore important role in medicalequipment provider international-ly will be global and definitelyexpanding.

Wang Guozhongwith DanielaZimmermann

Selenia.

HOLOGIC BREAST HEALTH

Not all mammography systems are created equal

Selenia™ digital mammography completely eliminates light scatter,giving you incredibly sharp and high contrast images in a matter of seconds. Our new tungsten x-ray tube with a combination ofrhodium and silver filters provides optimal image quality while minimizing dose over the entire range of breast thicknesses.

Hologic breast biopsy systems from upright and prone solutions tothe latest in stereotactic, ultrasound, and MRI guided breast biopsydevices and markers are the preferred solution in leading hospitalsand imaging centers the world over.

Combine the power of Hologic digital mammography, dedicatedmammography workstations, breast biopsy systems, and R2 computer aided detection, and you’ll have a combination that can’t be beat.

In the fight against breast cancer, early detection means hope formillions of women. Find out more about our solutions for women'shealth. Call +32 2 711 46 80, e-mail womenshealth@hologic.com or visit www.hologic.com

Together we can make a difference.

Hologic NV • Leuvensesteenweg 250 A • Be-1800 VilvoordeCome visit us at ECR, Expo C, Booth # 312

‘

‘

12 EUROPEAN HOSPITAL Vol 17 Issue 6/08

R A D I O L O G Y

Moscow, December – With 20,000visitors, Russia’s most important med-ical trade fair and congress –Zdravookhraneniye – again demon-strated to the 1,000 exhibitors from 49

Zdravookhraneniye 2008

Real-time Tissue Elastography Radiologists are paying increasing attention to ultrasound real time tissue elastography(HI-RTE). Earlier this year, at their annual meeting, the Austrian, Swiss and GermanUltrasound Societies (ÖGUM, SGUM, DEGUM), highlighted the effectivenessof the method in differentiating soft from stiff tissue, i.e. healthy areas fromtumours, a key differentiation in breast cancer diagnosis. Meeting withEllison Bibby, European Product Manager for Radiology Ultrasound withHitachi Medical Systems, Daniela Zimmermann, of European Hospital,asked for an update on the use of sonoelastography in this area The breast is the best-known exam-ple of how patients are taught topalpate for tumours. A tumour isstiff compared to the surroundingtissue, and that’s exactly what real-time tissue elastography images,’Ellison Bibby explained. ‘The stiff-ness relative to the surrounding tis-

sue. It is similar in the prostategland: the digital rectal examina-tion is used to palpate the prostatefor hard lumps and, on the elasto-graphy image, we can see areas thatare stiffer. Normal ultrasound givesus information about the anatomyand reflectivity of the tissues, but

HI-RTE is like a ‘palpation image’,that looks at new additional informa-tion – how the tissues react to stress,which is related to tissue elasticity’.

The tissues are gently compressedby the transducer in a repetitive man-ner to distort the tissue. ‘The echodata from one image frame is com-

pared to the next to build up a pat-tern of tissue displacement. Wherethere are differences in tissue stiff-ness, the amount of displacementvaries – normal soft tissues willshow greater distortion than stiffertissues’.

Asked about the field of work inwhich this technique can be used,Ellison Bibby explained that if,after mammography and an ultra-sound examination, the results arestill uncertain, elastography can beused to provide further differentia-tion. ‘It can build a bridge betweenmammography screening pro-grammes and additional MR- exam-inations or biopsies. Today, this is avery sensitive area and very fewdoctors would be convinced to dis-pense with the biopsy, even whenthe real-time tissue elastographyresults look perfectly benign. But,several published studies, withquite large numbers of patientshave shown comparable results,which, in those patients that are of

low suspicion for cancer, elastogra-phy could be used to decide whichstrategy to follow: biopsy or follow-up imaging after a short interval.But, of course we need more stud-ies before we reach the stage ofreplacing biopsy with sonoelastog-raphy’.

Today, the BI-RADS categories,based on imaging appearances, areused for screening, but there areproblems in terms of reproducibili-ty, especially for BI-RADS 3 (proba-bly benign) and BI-RADS 4a (lowsuspicion of cancer). It has beenreported that approximately 70% ofpatients with benign lesions under-go further investigation – eithershort term follow up, aspiration orbiopsy. Our goal is to show con-vincingly in this group of patients,that when we have a benign resultwith sonoelastography we couldeffectively downgrade the BI-RADSscore by 1, giving sonoelastographya definitive role in breast cancerdiagnosis.’

A bridge between mammography and biopsy

C A R D I O L O G Y

Germany’s 1st InterdisciplinaryCongress on Interventional CardiologyCardiologists and cardiac surgeons aim to treat patients jointly Anja Behringer reports

that stent implants and heart bypasssurgery should preferably be carried outin centres where cardiologists and car-diac surgeons hold daily ‘cardiac con-ferences’ to decide on individually cus-tomised treatment for each patient.Unlike cancer screening programmes,which medical insurers cover, cardiaccoronary disease CT diagnosis is stillconsidered an ‘individual health service’that should be paid for privately. By wayof primary intervention, general practi-tioners (GPs) should recognise the indi-cation and significance of the calciumscore and inform patients about thisguideline-based examination. As coro-nary heart disease is one of the mostcommon causes of death, particularly inindustrialised countries, the event isbeing supported by the most importantGerman-speaking cardiac, cardiovascu-lar and radiological societies, and ispartnered by the American TCTCongress.

Lower risks with drug-elutingstents (DES)

In Germany, 299,000 patients have hada PCI, and 260,000 stents have beenimplanted (German Heart Report). Incertain cases, drug-coated stents (DES)can avoid the need for a renewed inter-vention. Prof Silber explained that 22DES types are now licensed, but only

space, prompting the show’s organiserto plan for additional space for 2009.‘With 100 companies on 4,000 squaremetres, Germany is the biggest inter-national exhibitor at this show,’Dietmar Terviel, Project Manager atMesse Dusseldorf, explained. ‘It’s oneof the most important means of con-tact with the Russian market, whichcontinues to be very promising,’

One key exhibition area, which pre-sented the full range of medical diag-nostics equipment and therapies, alsohighlighted the latest ultrasounddevelopments, attracting keen crowdinterest.

The first German-language congresson the diverse medical disciplinesinvolved in cardiac care has been heldunder the scientific leadership ofProfessor Sigmund Silber (Munich).During the two-day event, live broad-casts of state-of-the-art proceduresand treatments, from 12 German,Austrian and Swiss hospitals, wereviewed by over 500 participants, whoalso interactively discussed the inter-ventions.

The focus was on which specialistshould treat patients suffering fromcoronary heart disease, with whichtherapies; the right choice of imagingprocedure (CT or MRI); new drug treat-ments, and problems with stents.

Cardiologist Prof ThomasMeinertz (Hamburg) and cardiac sur-geon Prof R P Körfer (North Rhine-Westphalia), who works in Europe’sbiggest open-heart surgery centre,agreed that it is not only better forpatients, but also economically, for dif-ferent medical disciplines to choosejointly what treatment should be givenand proceed with that treatmenttogether. Much depends on the individ-

ual patient whether, for example, aheart bypass or stent should be thechoice.

Results from the SYNTAX study,introduced at the ESC in Munichunder the presidency of Prof Meinertzand Prof Axel Haverich (Hanover),President of the German Society forThoracic and Cardiovascular Surgery,

seven approved by the German CardiacSociety. The disadvantage of drug-elut-ing stents is that the necessary con-comitant medication makes their usetoo risky for certain patients, which iswhy the congress participants are par-ticularly interested in the developmentof new medicinal treatments. Because,stent implantations are irreversible andas their use is increasingly common,they may later complicate any poten-tially necessary heart bypass opera-tions, which explains the considerableresearch on bio-absorbable drug-eluting stents.

EH@Zdravookhraneniye was snapped up by exhibitors and visitors

The latest ultrasound technology drewcrowds

2008 was the second year of atten-dance for our European Hospital team,who distributed our special Russian lan-guage edition EH@Zdravookhraneniye,an issue that raised a really welcomereaction as well as confirmed interestamong visitors and exhibitors alike.

10% of exhibiting companies wereGerman

countries the potential of this health-care market, despite the global eco-nomic crisis. The overall mood was pos-itive and optimistic. Applications forstands in the German Pavilion, forexample, again exceeded the available

were also discussed. Percutaneouscoronary intervention (PCI) and heartbypass surgery showed almost thesame mortality results (7.7% and 7.6%respectively) and the occurrence ofheart attacks. However, there were dif-ferences in the subgroups.

The gold standard: Dualplatelet aggregation inhibition

Prof F R Eberli (Zurich) emphasisedthat coagulation management in percu-taneous coronary interventions is deci-sive. ‘In borderline stenosis, the cheap-er angiography makes no great differ-ence compared with results achievedwith CT, but the fractional flow reservemanagement is not used oftenenough.’

Prof Silber spoke on cardiac surgeryadvances and decreasing need for theheart-lung machine. He recommended

Prof F R Eberli

minimizing colourshadows due to a

selected mixtureof speciallyarranged coldand warmwhite LEDs.‘Each of the

many light emit-ting diodes in our

surgical lights isbacked by a specially developedreflector system for the generationof an individual light field. Thisnewly developed arrangement oflight modules results in a homoge-

EUROPEAN HOSPITAL Vol 17 Issue 6/08 13

Israel – A slow frozen pig’s liver hasbeen thawed without damage andsuccessfully transplanted into anotherpig, according to Israeli scientists (ini-tial results published in RejuvenationResearch, followed by the journal NewScientist).

Working at the AgriculturalResearch Organisation in Bet-Dagan,the scientists used a much slowerfreezing system than usual. To reducethe formation of jagged damagingcrystals in water inside the cells, theycooled the organ by just 0.3 degreesCelsius per minute. About an hour anda half later, the pig liver was fullyfrozen. It was then thawed immediate-ly and transplanted into the other ani-mal, next to its own liver. Two hourslater, after the recipient was killed, thetransplanted liver was checked andfound to have regained some signs ofblood flow and was producing a bile-like liquid, indicating that some of itsfunctions were working again.

However, it had been working intandem with the existing liver, andonly working for a couple of hoursbefore the examination as to its func-tion. Thus the research could notascertain whether it could recover allits functions to work independentlyand keep the animal alive.

If further experiments to test thisare successful, the researchers hopethat frozen organs could be banked forfuture transplants

Surgical lights gain LED technology

The popularity of LED lighting unitsis inevitably increasing because LEDlight is infrared-free and cool, creat-ing good work conditions for sur-geons, and minimising the danger oftissue dehydration. In addition, thenearly limitless service life of LEDslowers maintenance costs andensures safe, reliable work, theoperating theatre equipment andsurgical lighting specialist Berchtoldexplains.

This year, the firm introduced theE-Generation Chromophare surgicallights with gas discharge and halo-gen technology, and has added newLED models. Berchtold explainsthat the light ensures optimum dif-ferentiation of tissue types while

Slow frozen liversuccessfullytransplanted

neously illuminated, shadow-freelight field under all working condi-tions. And, our ‘Spectronixx’colour optimization filter puts thefinishing touches to a light thatremains homogeneous at everytype of colour temperature.Moreover, the infrared-free lightensures a cool light field even dur-ing surgical procedures that maylast for several hours. Higher tem-peratures near the surgeon’s headand shoulders are reduced to aminimum – as with all E-Serieslights from Berchtold.’

In addition, if needed, the colour

temperature can be adjusted freelyover a range of 3,600 to 5,000Kelvin. ‘Berchtold’s special ColourSelect feature brings optimum visi-bility to colour contrasts. The flat,self-contained design of the surgi-cal light ensures easy, hygieniccleaning with a minimum of turbu-lence to laminar air flow.’

A specially developed sensorsystem in the handgrips allowsrepositioning of the lighting unitwithout changing the light fieldadjustment. ‘Adjustment of thelight field is carried out purelyelectronically to eliminate mechan-

ical aberrations,’ Berchtold pointsout. ‘Operating theatre personnelhave a choice of ergonomic, intu-itive adjustment directly on thelighting unit itself or via a wall-mounted control panel. Easy-to-understand symbols eliminate com-plications in turning the light onand off, or adjusting parameterssuch as the light field, lightingintensity, and colour temperatures.The accompanying, downward-pointing GuideLite for orientationcan also be managed with either ofthe control panels. The GuideLiteoffers c. 10% residual light andserves to ensure visibility in thesurroundings during endoscopicprocedures.’

Fig 1: Thenew LEDmodelsChromophare E 778 andE 558

Fig. 2 : Ergonomic, intuitive adjustmentdirectly on the lighting unit itself withsymbols for turning the light on and offor adjusting parameters like the lightfield, lighting intensity, and colourtemperatures

S U R G E R Y

regional traumacentres and basictrauma surgeryaim to ensure thatevery seriouslyinjured patient istaken to theshock room of asuitable or evencertified hospitalwithin a 30-minute drive from theaccident site.

The White Paper on trauma carefor severely injured persons(Weissbuch der Schwerverletzten-versorgung) published by the DGUin 2006, demands the following:• Defined criteria for the admis-sion of accident victims from thesite to a trauma centre or facilityoffering basic trauma surgery.• Implementation of harmonisedstaff, infrastructural and organisa-tional preconditions (e.g. shockroom).• Standardised treatment pathsand transfer criteria for the earlyphases of trauma care for severelyinjured patients, according to theevidence-bases DGU guidelines(e.g. DGU guideline S3).• Harmonisation of medical quali-fications by joint training pro-grammes (e.g. ATLS. www.atls.de).• Participation in external andinternal quality assurance pro-grammes and collection of currentcare figures and workflow on thebasis of the DGU trauma register(www.traumaregister.de).• Implementation of telecommu-nication systems that enable par-ticipating hospitals to coordinatethe further care path in or imme-diately after the acute treatmentphase.

Currently, more than 500 hospi-tals, forming 56 regional traumanetworks, are registered in thecertification process (www.dgu-traumanetzwerk.de).

14 EUROPEAN HOSPITAL Vol 17 Issue 6/08

S U R G E R Y

Osteoarthritis of the knee is a degener-ative disease that causes joint pain,stiffness and decreased function. Its fre-quency increases dramatically withageing populations. Treatment is multi-disciplinary; combinations of pharma-cology, physiotherapy and/or surgeryare used for most patients. Before thedisease reaches the stage where a totalreplacement is the only course ofaction, keyhole surgery is often per-formed. Using arthroscopy, lavage ofthe joint removes fragments of carti-lage and calcium deposits. Also surgicalsmoothing (debridement) of the articu-lar surfaces and osteophytes is under-taken, aiming to reduce synovitis andeliminate any mechanical obstructionto joint mobility.

Although widely practiced there is infact little or no scientific evidence forany benefit from this procedure inosteoarthritis of the knee. In fact theresults from a large-scale, randomised,controlled trial published in 2002showed no benefit of surgery (MoseleyJB, O’Malley K, Petersen NJ, et al. A con-trolled trial of arthroscopic surgery forosteoarthritis of the knee. N Engl J Med2002;347:81-8). The trial methodologywas heavily criticised and arthroscopycontinued to be routinely used.

Endoscopic submucosaldissection (ESD) The non-invasive resection

of gastric tumours

High resolution endoscopy triggers new approaches tothe detection and resection of early-stage carcinomas.Zoom, Narrow Band Imaging and HDTV allow significantmagnification of the endoscopic image and increasinglydetailed rendering of the mucous membrane.Consequently, pathologic changes can be detected earlier.Endoscopic submucosal dissection (ESD) providesexperienced endoscopists with a new technique to resectearly gastric cancer without damaging the organ affected.Thus, invasive surgery is no longer required to removeearly-stage tumours of the oesophagus or the stomach.

‘The decision about whether a malignant gastrictumour may be resected by ESD depends on the tumour’ssize and surface area,’ explained Dr Siegbert Faiss,medical director of the gastroenterology department atAsklepios Klinik Barmbek, Germany. ‘ESD is an option ifthe tumour of the oesophagus and the stomach affectsonly the lower mucosal layer or, in the case of a colontumour, the lower submucosal layer.’

First, to mark the submucosa, a liquid is injected intoit. Then insulation-tip diathermic knives – also known asIT-knives, hook-knives of flex-knives – are used to cut themucosa generously around the neoplasm. Finally, thesubmucosal tissue under the neoplasm is dissected.Thus, an organ-sparing en bloc resection is performed.ESD ensures negative margins and local recurrence isreduced.

Though very promising, ESD has certaindisadvantages: the procedure takes some time andbleeding as well as perforation risk are still quite high.This holds true particularly for inexperienced users,explains Barbara Opalka, product manager forendotherapy instruments at Olympus Medical SystemsGermany, which produces ESD knives. ‘There are certainpreconditions for their use: intensive patient information,sufficient training and an experienced operator,’ sheadds.

In ESD workshops organised by Olympus to promoteESD, experienced endoscopists train surgeons to use thenew instruments and ensure they can adequately handlecomplications if or when they occur.

The firm also supports the national ESD register,launched in October under the auspices of, amongothers, Dr Faiss’s department at Asklepios KlinikBarmbek and in partnership with the German Society forGastroenterology (DGVS). The register aims to documentthe application of the ESD procedure to obtaininformation on outcomes. Data is being recorded onindication, complications and the therapy course for eachpatient. Within days of the announcement of the register30 of the 120 German hospitals where ESD is currentlybeing offered, had signed up, the company reports.

The DGU trauma network By Professor Steffen Ruchholtz MD, (below) Chairman ofthe Department of Trauma, Hand and ReconstructiveSurgery at University Hospital Giessen and Marburg GmbHGerman pre-clinical and clinicaltrauma care of severely injuredpeople enjoys an excellent reputa-tion nationally and internationallydue to the country’s intensive workin trauma surgery and relatedmedical disciplines. Nevertheless,it should be pointed out that thecurrent outcome of polytraumacare in Germany is extremely het-erogeneous. Data collected by theFederal Statistics Bureau, releasedin 2002, indicate that the mortalityrate among traffic accident victimsvaries greatly between the FederalStates: e.g. 2.7% in Mecklenburg-Vorpommern, 1.1% in North Rhine-Westphalia and 0.5% in Berlin.Moreover, data in the trauma reg-ister maintained by the GermanSociety for Trauma Surgery(Deutsche Gesellschaft fürUnfallchirurgie – DGU) show signif-icant differences for individualhospitals regarding the mortalityrate following severe trauma.These quality differences can beattributed to two primary causes:• The catchment areas of the indi-vidual hospitals differ markedly inthe Federal States: 4634 km2 inMecklenburg-Vorpommern and541 km2 in North Rhine-Westphalia. Similar differencesapply to the area covered per med-ical helicopter and the size of theregional road grid.• The different care classifications,organisation, staff availability,infrastructure and materialresources of the hospitals partici-pating in polytrauma care vary sig-nificantly.In view of these differences, in2004 the DGU launched theTraumanetzwerk initiative, whichaims to raise the quality of poly-trauma care to a single, high levelthroughout Germany

Local trauma network structuresbetween supraregional and

Arthroscopic surgeryDoes it provide additional

benefit for the osteoarthriticknee? By Jane McDougall

This September new results fromOntario (Canada) were published(Kirkley A, Birmingham T B, Litchfield RB,et al. A randomized trial of arthroscopicsurgery for osteoarthritis of the knee. NEngl J Med 2008;359:1097-1107). Thissingle-centre, randomised, controlledtrial of arthroscopic surgery was carriedout in 188 patients with moderate-to-severe osteoarthritis of the knee.Patients were randomly assigned to sur-gical lavage and arthroscopic debride-ment, together with optimised physio-therapy and medication (which includedanalgesics and non-steroidal anti-inflammatory agents) or to physiothera-py and medication alone. Arthroscopicsurgery was performed under generalanaesthesia within six weeks of ran-domisation of the patient.

At two years follow-up, the primaryoutcome was the total Western Ontarioand McMaster Universities Osteo-arthritis Index (WOMAC) score (range, 0to 2400; higher scores indicate moresevere symptoms). While secondary out-

comes included the Short Form-36 (SF-36) Physical Component Summary score(range, 0 to 100; higher scores indicatebetter quality of life).

The patients were assessed by a nurse,blinded to treatment, 3, 6, 12, 18, and 24months from the start of treatment.Interestingly, it was only at the first three-month visit that the results from surgerywere significantly better than those inthe medical group p>0.01. At the end ofthe study no difference was foundbetween the two treatment groups:WOMAC scores were 874±624 in thearthroscopy group compared with897±583 in the medical group (NSp=0.93). Different sub-group analysesalso failed to find an advantage for surgi-cal over medical treatment. Likewisesurgery failed to show any improvementover medical treatment for quality of lifeand pain assessments (secondary end-points).

However, as in all trials this one haslimitations, perhaps excluding thosepatients who have large meniscal (‘buck-et handle’) tears, in whom arthroscopicsurgery is considered an effective option,biased the results towards medical inter-vention.

Perhaps the answer is for rheumatolo-gists to judge each case on its individualmerits and surgery be proposed aftercareful consideration of the particularindividual rather than as a routine prac-tice for all.

Fig. 1: ESD diagram: Marking the lesion; incision; submucosaldissection of lesion; removal of the en-bloc resected lesion

Fig. 2: ESD (en bloc R0 resection): Early stomach carcinoma;marking of lesion

Fig. 3: Incision of marked lesion: Submucosal dissection(submucosa dyed blue)

Fig. 4:Complete resection. Specimen of curatively resected earlystomach carcinoma (T1m, G1, L0, V0)

Fig 5: Olympus ESD instruments for ESD of early carcinoma in agastrointestinal tract

EUROPEAN HOSPITAL Vol 17 Issue 6/08 15

Easy-to-use hand held immunoassays

The incubator venture at which heworks is one of several ventures setup by Philips to develop new andvery different technologies in fieldsbeyond its existing businesses, sothat it can create new businesses.

The first partnership for HandheldImmunoassays is with the UK all-in-one drug testing firm Concateno.Under development is the first appli-cation of a new saliva-based drugsabuse product. ‘A few years ago,Philips Research started a magneticbiosensor research project, and thisled to our group being set up to focuson developing it for handheldimmunoassay platforms. Think aboutglucose testing at point of care,where you have a finger-prick ofblood and test for glucose; with ourdevice, sensitivity goes up to 600 mil-lion times more than a glucose mea-surement. So, the possibility is that,with this technology, you could mea-sure all kinds of different proteins –in home settings as well as in ambu-lances, at hospital admissions depart-ments and in intensive care. It’s labtesting outside the central lab.

‘This is not specifically Philips’ lineof business, so we launchedMagnotech Technology to takePhilips into the world of point-of-care (POC) diagnostics. We are notthe first to do this, but we are con-vinced we have something differentin POC testing devices, because withthis technology you only need a fin-ger-prick of blood. We are looking fora solution within two minutes, andone offering ease of use, with no mix-ing of reagents or adding reagents, sothat an untrained person could do it.At the moment, a heart attack patientis brought to hospital and monitored,and a blood sample is sent to the cen-tral lab. A very well-organized labora-tory can send results back in 30-60minutes – but the standard is about60 minutes – and the patient is stilllying there. Suppose you have a tech-nology that can give results in twominutes, in an ambulance or admis-sions department. You could decideon the right treatment even beforethe patient is admitted.’

The elderly with chronic diseasescould also benefit from this type oftechnology, he pointed out. Theywould not need to visit a clinic for ablood test and results would be readyimmediately, thus two visits wouldbecome unnecessary. ‘In the future, apatient could use this technology athome; take a finger-prick of blood,send the information over the Web orvia a television (TV). Of course, it alldepends on their age. Philips’research shows that elderly peopledon’t like computers too much; theyprefer friends. So Philips has a lot ofhome solutions, such as TV systemsthrough which data can be trans-ferred to the doctor, who looks at itand sends a recommendation to thepatient, for example: You’re okay, go

on with your medication, or Come

continued on page 16

Marcel van Kasteel MBA, is VP of Philips and CEO of HandheldImmunoassays, a Philips Incubator venture in Eindhoven, theNetherlands, which recently announced that, by the end of nextyear, the first device to test for drug abuse will be marketed thatwill make on the spot testing simple and quickfor use by the police. Daniela Zimmermannasked him about the development and whatmakes it different from testing kits that arealready available

L A B O R A T O R Y & P H A R M A C E U T I C A L S

The Magnotech technology is based on a cartridge,with built –in analyser andsoftware. A drop of blood (or saliva) is put into the cartridge, filtered, and thenpasses through different areas that hold tiny amounts of different reagents. ‘It’sbasically a test strip,’ Marcel van Kasteel explained. ‘Next,the cartridge is to beplaced into the analyser, where the real reaction takes place. I think the keymessage is the potential this technology offers – ease of use, so that non-trainedpeople could run it; speed, so you could get results in a couple of minutes; thisopens the possibility for multi-tests with the same cartridge, also important forcertain viral diseases when you’d like a combination of certain assays.’

Changing the way we live

16 EUROPEAN HOSPITAL Vol 17 Issue 6/08

L A B O R A T O R Y & P H A R M A C E U T I C A L S

to the hospital urgently. That’s thevision for our POC solutions. Ofcourse, many patients want to actual-ly visit their doctors; it’s a socialthing.’

A lot has been progressed abouthome monitoring, particularly in theUSA, he added. There are daily bloodpressure and weight checks, and TVcommunication between doctor andpatient, even on a daily basis. Butwith POC testing there can be a short-er period between communicationand even more of it with a doctor.And, he pointed out, if case resultsare bad ‘then, of course, the doctorcan still contact a patient directly –but overall he is saving time.’Referring to the group research onthe handling of certain chronic dis-eases, he added: ‘With some, if it’s sobad that you have to stay home, yoursocial life is not there any more. But,imagine that you could be testedweekly and this could predict flare-ups of certain diseases and your med-ication could be adjusted, and youcould start having a normal social lifeagain. It’s a big benefit for patients aswell. That’s a big benefit.

Philips is currently manufacturingthe devices -- cartridge, analyser andsoftware. The firm is also in discus-sion with various pharmaceuticalcompanies for the assay develop-ment. In the future, he pointed out;they may be involved with diagnos-tics companies with novel biomark-ers.

Saliva is the first platform. The firstproduct – for use by the police atroadsides, to test for drug abuse, isexpected to be launched by the endof 2009. ‘There’s a big push for imple-mentation in the Netherlands, forexample, but they’re waiting for theright technologies. Already there’ssome technology, but the police haveto put the reagents in, mix it, and it’stoo complicated. With our solution apolice officer will be able to collect alittle saliva with a swab, and do thatthrough the window when the driveris still in the car. After he has put thesample in the analyser, in 60 secondshe will get the result. If it’s positive,he can take the driver to anotherplace to draw blood and do the nextanalysis. So, next to the current alco-hol testing, this could be an ideal sit-uation to start doing roadside testingfor drug abuse. It’s already happeningin the UK and Australia, and a lot ofcountries, including Germany,Holland, Italy and France, would liketo implement this kind of device.

‘We are also developing a bloodsolution to test for different proteinson the same technology, and we’relooking for cooperation with a lot ofpharma and in vitro diagnostics (IVD)companies to see which type of mark-ers they see for this. We’re interestedin three or four major areas: oncolo-gy, cardiology, women’s health andinfectious diseases. Why? Becausethen we can combine it with the otherPhilips solutions, to integrate thetotal solutions. We can integrate allthe information from in vivo and invitro, and have the right solutions.Very briefly, that’s what we’re doing.Again, it’s a new technology, in whichI think we have a great advantage. Wehave our first partner, Concateno, fordrugs of abuse, and are actively look-ing for partners in pharma as well asIVD companies. In my previous job Iwas a Vice-President of Europe,Middle East, and Africa at BeckmanCoulter, so we are focusing a lot onthe IVD companies.’ Reader inquiries:Handheld Immunoassays:High Tech Campus 5,5656 AE Eindhoven,The NetherlandsTel: +31 40 27 49 792Fax: +31 40 27 45 479Email: magnotech@philips.com

The overall quality of laboratoryoperations has traditionally beenevaluated using a combination ofthree variables: analytical quality,timeliness (turnaround time) andoperational efficiency.

One hospital that hassucceeded on all three measuressimultaneously is St. Mary’sHospital Centre (SMHC), a 414acute-care-bed, McGill-affiliatedteaching hospital located inMontreal, Quebec, Canada.

In 1998, SMHC acquired a pre-analytical automation systemfrom Beckman Coulter for itscore laboratory. Over the nextfive years, as the hospital’ssample volume continued to rise,the lab’s pre-analytical systemwas gradually upgraded, finallyto become, by the end of 2003, aTotal Lab Automation (TLA)system, under the direction ofRalph Dadoun, PhD, MBA, Vice-President of Corporate andSupport Services.

The results of this endeavourproved to be profound – andcontinue to deliver prominentbenefits today. Not only did thelaboratory witness improved costefficiency and quality of services,it also achieved a lower risk ofhuman errors. Benefits include:

Higher Quality Patient Care –SMHC’s pre-analytical automationsystem improved the lab’s TAT(from the lab’s receipt of thespecimen to the validation of theresult) by more than 50%, (90percent of results are delivered inunder 30 minutes). Moreimportantly, the automationsystem drastically reduced thevariability of results, whichimproved reliability and physiciansatisfaction.

By reducing the number ofmanipulations by more than 75percent, robotic automationdrastically reduced the number oferrors and enabled the lab tocatch errors that were notpreviously identified.

St Mary’sHospitalCentre‘The Most Productive and CostEfficient Core Laboratory in Quebec’

Increased Productivity and Cost EfficiencySMHC’s overall productivity – the number of reportableresults per hour worked – improved by 106% and wasachieved during a 48% increase in volume and a 27%decrease in worked hours (16 FTEs).

Fewer Manual ManipulationsAutomation in the laboratory, as in any other field,drastically reduces the number of manual steps needed toobtain a test result, and therefore reduces labour. At SMHC,the number of manipulations per sample dropped from 12to two. On a typical day this represents a reduction inthousands of manual steps. Furthermore, fewer manualmanipulations equates to a lower risk of exposure toblood-borne pathogens, thus increasing staff safety.

Better Use of Lab SpaceBy implementing a core lab, coupled with automation, thelab reduced its lab space while doubling its volume ofactivity. Lab space reduction: from 7,720 sq. ft. to 5,775 sq.ft. Volume of reportable results (RR): up from 1,241,000 to2,398,339. This brought the number of RR/sq. ft. from 161to 416.

Increased Revenues and Profits – Automationcoupled with the Laboratory Information System(LIS) enabled the SMHC lab to enjoy a 60 percentgrowth in its outreach testing program and asubstantial increase in profits.

Quick Return on InvestmentSMHC achieved a pay-back period within threeyears. The NPV and IRR were $1.54M and 35%(respectively) over six years, with an estimateduseful life of the automation system of more than10 years.

Due to the stunning improvements evidenced atSMHC, the laboratory has received numerousawards, including one from the Canada’s ProvincialMinistry of Health and Social Services, which namedSMHC the Most Productive and Cost Efficient CoreLaboratory in Quebec. Today, the lab continues to bea positive reference for global laboratories seekingimprovements through automation.Source: Beckman Coulter

continued from page 15

Evolution of volume, labour and productivity before and afterautomation

Implementing a core lab with an automation system enabledSMHC to reduce its space while doubling its volume

Evolution of volume, labour and productivity before andafter automation

EUROPEAN HOSPITAL Vol 17 Issue 6/08 17

Advances inautoimmunediseasediagnosticsEuropean revenues couldreach $722 million in 2015

The 14th Eppendorf Young InvestigatorAward 2008, worth €15,000, was pre-sented at MEDICA in November.

The winner, Dr Simon Boulton ofthe DNA Damage ResponseLaboratory, London Research Institute(UK), received the award for his workdescribing a novel protein that impactshuman genome stability and cancer. Bycombining his knowledge ofCaenorhabditis elegans (a nematode)and yeast DNA repair systems, hedevised a screening strategy that led tothe discovery of a novel helicase in C.elegans, which has many of the prop-erties of the yeast helicase. He thenidentified the human counterpart(RTEL-1) and could demonstrate thatthis protein functions as an anti-recom-

binase. Dr Boulton managed to identifythis anti-recombinase activity, which isimportant for maintaining genome sta-bility in animals. In RTEL-1 deficientmice, activity deregulation of homolo-gous recombination is the probablecause of the loss of genome integrity.Conversely, over-expression of RTEL-1also causes cancer through promiscu-ous disassembly of the recombinationintermediates involved in repair andleading to mutations that cause cancer-ous growth. A prospective therapeuticdrug is already being tested clinically.

During his acceptance speech at agala dinner attended by scientists andthose from related industries, DrBoulton mentioned his PhD supervisorProfessor Stephen Jackson, from the

Wellcome/CRC Institute, Cambridge(UK), who received the first EppendorfYoung Investigator’s Award in 1995.Other speakers were Dr MichaelSchroeder of Eppendorf, Dr NickCampbell of Nature publishing group,Professor Kai Simons, Director of theMax-Planck-Institute of Molecular CellBiology and Genetics in Dresden, andProfessor Hermann Gaub fromMunich.

Launched in 1995 to coincide withEppendorf’s 50th anniversary, the prizehonours outstanding molecular biolo-gy-based, life sciences research work inEurope, sponsoring young Europeanscientists (up to 35 years old). To raisethe award’s profile further, a partner-ship with the publishing group Nature

was forged. The group publicises thewinner’s work via a blog and podcaststo an ever growing internet communityof young research scientists represent-ing the future of biomedical research.

Eppendorf AG has strong links withthis research field and its founderswant the award to reflect their com-mitment to advancing research in

healthcare. An independent scientificcommittee selects the annual winners,each receiving a personal gift of€15,000.Award details:www.eppendorf.com/award2009 award applications:http://www.nature.com/nature/awards/eppendorf

From left: Günter Bechtler, Kai Simons, award winner Simon Boulton, Dieter Häussinger,Reinhard Jahn, Michael Schroeder

The European market for autoimmunedisease diagnostics has demonstratedsustained growth due to advances indetection technology and automation,according to a new analysis from Frost& Sullivan (F&S) (http://www.drugdis-covery.frost.com). ‘Active consolida-tion is occurring in the market, pro-moting technology and product inte-gration. However, the lack of claritywith regard to reimbursement policiesfor autoimmune diagnostic tests per-sists, posing a challenge to marketexpansion,’ F&S reports. ‘The marketearned revenues of $513.5 million in2008 and estimates this to reach$722.0 million in 2015.’

F&S research analyst SurajRamanathan adds: ‘The developmentof novel biomarker panels has acceler-ated the diagnosis of many autoim-mune complications. Exhaustive R&Dby many universities and researchorganisations has yielded promisingresults in the use of multiple biomark-ers for autoimmune disease diagnosis.’

Patient screening with multiple bio-markers associated with severalautoimmune diseases has been seento improve diagnostic accuracy, bring-ing advantages to physicians. Amongthe public, however, there is a generallack of awareness about autoimmunediseases, which presents a challengeto this market’s growth, F&S explains.‘Such low levels of awareness mayderive from the rarity of many autoim-mune complications among thegeneral population,’ says SurajRamanathan. ‘Many patients inEurope, unable to find a proper treat-ment for their condition, are conse-quently switching to traditional meth-ods, such as oriental medicine. In con-junction with medical research organi-sations and hospitals, manufacturersshould establish awareness pro-grammes and interactive workshopsfor the public,’ he advises. ‘These couldhighlight the prevalence of autoim-mune diseases, while encouragingphysicians to interact with the publicon the symptoms, aetiology and pro-gression of autoimmune diseases.’

To receive a virtual brochure on thismarket in Europe, e-mail PatrickCairns, giving your full name and title,company name, phone number,company e-mail address, website, city,state and country(pcairns_pr@frost.com).

The Eppendorf Young Investigator Award 2008 L A B O R A T O R Y & P H A R M A C E U T I C A L S

NOVARTIS

Your Partner in the

Therapy of Hypertension

Information Service: +49 -1802 / 232 300

(Mon - Fri 9 a.m. - 6 p.m.,

infoservice.novartis@novartis.com

Roonstraße 25

90429 Nürnberg

Germany

• Evidence/consensus and benefitevaluation of compression andlymphatic drainage therapy

The programe, including termsand conditions of participation, isat www.wunde-wissen.de

Abstracts based on thesetopics: guidelines and qualitystandards, fascination lymphology,compression and wound healing,must be submitted before or by15 January atwww.wunde-wissen.de

18 EUROPEAN HOSPITAL Vol 17 Issue 6/08

P A T I E N T C A R E

Questions arose at MEDICA 2008 aboutwhich assistive/care devices reachpatients, what is their quality and whopays for them.Legal definitions • Assistive devices are actual medical ser-vices, such as prostheses, bandages, walk-ing frames, suction apparatus, mattressesetc., i.e. all services and items that coun-teract the physical or mental functionaldeficits of patients, ensuring ongoingtreatment success or the prevention of dis-ability. These devices listed in the assistivedevices index and must be prescribed by adoctor. The costs are either fully or partial-ly borne by medical insurers.• Care devices are tangible means or tech-nical aids that ease care, relieve the med-ical conditions of those who need care andhelp to facilitate an independent lifestyle.The costs are borne by nursing care insur-ers up to a certain limit. Care devices arelisted in the care devices index.How products reach patientsa) A patient visits the doctor, who diag-noses the illness and need for an assistiveor care device. He issues a special prescrip-tion.b) The patient contacts his/her medicalinsurer which names its ‘preferred suppli-ers’, which have contracted to supplydevices with favourable costs for the insur-er.c) From this list, a patient chooses the clos-est supplier to where s/he lives (in somecases, up to 50 km distance is acceptable,according to insurers). The patient receivesan estimate which must then be autho-rised by the insurer, and it will then be pre-pared to cover the costs, less the amountthe patient legally must pay.Who covers the costs?Insurers – Statutory insurance based onthe SGB (Social Security Code) V, statutorynursing care insurance (SGB XI), statutoryaccident insurance (SGB VII); private insur-ance

Statutory medical insurance and nursingcare insurance are statutory insurances forall workers and employees with a certain,top level of earnings, as well as pensioners,recipients of social security and the unem-ployed. Employers and employees usuallyshare the contributions 50:50, the self-employed pay for both shares. The cost ofthis insurance for pensioners, social securi-ty recipients and the unemployed is cov-ered by the respective statutory pensioninsurers and authorities.

From a certain level of income upwardsit is possible to take out private insurance.This also applies for the self-employed andcivil servants. With private insurance, theinsured person pays for services up frontand, depending on the contract, is eitherreimbursed the full costs or a partialamount.The patient – Because insurers only covercosts up to a certain limit, the patient mustbear a certain share of costs determined bylaw. If he wants a certain product from aspecific supplier he must also bear anyadditional costs this may involve. This con-tribution requirement also applies to caredevices.

ADVERTORIAL Sponsored by

NUTRITION AND HEALTHXXL Babies: Foetal macrosomiais on the increaswPrecise weight monitoring is essentialIncreasingly in the industrialised nations every tenth newborn suffersfrom foetal macrosomia. In Germany, for example, between 8-10% ofnewborns weigh up to 4,000g. A similar development has beenobserved in other countries. In early 2008, a newborn baby boy inRussia weighed 6.1kg, with a body length of 63cm.The main reasons for these bigger babies are overweight Type II dia-betic mothers or mothers who develop diabetes during pregnancy,especially if they are older. The foetus receives increased amounts ofblood sugar via the mother and reacts to this with an increased pro-duction of insulin, which is a growth hormone. However, as the pla-centa is not permeable for insulin the hormone cannot exit from thefoetus and converts the blood sugar into a fat deposit. This abnormalweight gain can then cause birth problems: a natural birth is often notpossible and Caesarean section the only option.Although many of these neonates are perfectly healthy, foetal macro-somia can still lead to later health problems. Despite its size, the devel-opment of the child’s individual organs can be ‘immature’. Thus anexact determination of birth weight is vital, to ascertain whether or nota newborn belongs to the risk group.The seca range of baby scales delivers precise results. With a capacityof 20kg and a large weighing tray, these scales are not pushed to theirlimits even when it comes to weighing extra large (XXL) babies.Macrosomia babies also should remain under medical supervision afterbirth, because they have a higher risk of developing diabetes Type II.Moreover, they often develop into overweight children and adults.

Wipes meetinternationalregulationsPal International, which has manu-factured a wide range of hygieneproducts and protective clothingfor over three decades and current-ly supplies products to over 70countries, has launched a newrange of healthcare wipes that arecompliant with the MedicalDevices Directive (93/42/EEC),international quality standardISO13485:2003 and carry the CEmark.

The wipes provide disinfectionof external non-porous surfaces ofmedical equipment and devicesprior to sterilisation in healthcareenvironments such as hospitals,dental surgeries and care homes.‘Effective against 99.9% of bacteria,as well as viruses and fungi, micro-organisms such as Clostridium dif-ficile, MRSA, and the H1N1Influenza virus are destroyed, mak-ing Pal disinfectant wipes ideal inpreventing cross-contaminationand limiting hospital acquiredinfections,’ the firm reports. ‘Palalso offer a 70% alcohol andChlorhexidine disinfectant wipesas part of the healthcare wipesrange, all with proven efficacy

Congress: The German Society for WoundHealing and Wound Care (e.V.)Congress main topics• Prevention of vascular disease and

lymphoedema• Importance of differential diagnostics

for compression therapy• Patient education and self-care abilities

for people receiving compression andlymphatic drainage therapy (venous,lymphatic, traumatic)

• Particular aspects of podologicaltreatment for vascular disease and/orlymphoedema

• Particular aspects of physiotherapy forvascular disease and/or lymphoedema

25-27 June 2009Kassel, Germany

MCare Portal and MCare Remote Servicesstreamline service, uptime and education

At MEDICA 2008, Maquet CriticalCare introduced two new MCareServices components, MCare Portaland MCare Remote Services, toenhance the current Maquet MCareworldwide services and provide moreflexibility.

As a customised platform for hos-pitals, MCare Portal provides accessto installed base information, the lat-est news, training material, extensiveproduct information, and an inter-face to e-learning, providing a highstandard of training and develop-ment for medical staff, Maquet point-ed out. ‘It offers access to all docu-mentation needed throughout thelifecycle of the product such as userand service documentation, trainingschedules and recorded symposia aswell as the installed base informa-

Want to open a care facility?Germany – Operators and fundingbodies of care facilities, politiciansand representatives from nursingcare insurance companies and theiradvisory body the Medical Service ofthe Central Organisation for MedicalInsurers (MDS), as well as investors,gathered in November for the two-day Euroforum Conference. With afocus on the future of care facilities,it became clear that current struc-tures are no longer line up withpatients’ demands, and that new con-cepts – particularly structural – areneeded.

Determining trends in demandAnyone wishing to develop or takeover a care facility should initiallycheck the market to avoid bad invest-ment:• What is the demand level of future

residents? What is the local demo-graphic structure?

• Is this market already saturated?• What, depending on the popula-

tion structure, should be offeredfor future residents to accept thefacility?

• Is access to public transport andnearby shops good enough fortheir needs?

• What do future residents demandfrom a care facility, so that theyfind it an acceptable residence?The (often enforced) move to aretirement home/care facility is asignificant step in people’s lives; itoften happens too quickly, even ifanticipated; it entails a reductionin previous living space, as well asloss of autonomy.

What services are required?Categories expected by futureresidents:• Assisted Living, allowing a

seamless, individually customisedtransition to the next categories…

• In-patient geriatric care• Care for mentally and physically

disabled residents• Long-term care • Hospice care if requiredThey must also be able to affordthese.

What does ‘trends in demand’mean?

To avoid over capacities, a futurecare facility must orient itself aroundthe respective birth rates from about70 years ago, i.e. they must considerthe lowered birth rates after the eco-nomic crisis of 1929 and during WorldWar II. Additionally, after WWII, dueto the late return of war prisoners,the birth rate only began to rise againin about 1956.

Moreover, due to improved carestructures in out-patient services,people who need care can remain in

their own homes for longer. Theaverage time spent in care facilitieshas dropped from 280 days to 180days. Hospice spaces are in greaterdemand. The future, calculatedneeds up to 2030 is expected to bearound 200,000 beds, which equateswith 2,000 new facilities if one looksat a usage/life expectancy of build-ings of about 25 years.

What should be done?Care facilities with a future shouldorientate around the concreteneeds of current or future targetgroups. They should offer all ser-vice categories. However, theyshould still be manageable and theirsize should not deter future resi-dents. Rural areas in particular havemany small facilities with about 30-50 beds, which may be pleasant forresidents but not economicallyviable. One possibility may be ‘satel-lite models’, i.e. having a centraloffice hat deals with administrationfor all facilities belonging to theorganisation in a 50km radius. Thefacilities are relatively small (50-100beds) and can – through franchis-ing, for example – be let out to dif-ferent operators. Administration,apart from purely administrativetasks, could also include manage-ment of catering, bed and laundry.Personnel costs would be borne bythe funding body.

The residents have apartmentswith a small kitchen and a washingmachine, to retain their autonomyas far as and long as possible. Whenneeding nursing and out-patientcare, the cooperation of partners ofthe funding body is involved.Nowadays, carers are so welltrained that they make it possiblefor those living alone and needingterminal care to remain in their ownhomes, helped by the social ser-vices, relatives or voluntary carers,although these obviously are notused to replace the professionalcarers.

Coping with temporary over orunder capacity

To meet demand, smaller facilitiescan quickly be converted into, forexample, hospices. They do notneed to be closed. Existing struc-tures could also be utilised for com-pletely new target groups; this issomething that will result from ademand analysis.Summary – Internationally, the caremarket is subject to constantchanges, including socio-economic.If their facilities are to have afuture, operators, funding authori-ties and investors must recognise achange at an early stage, and reactto it adequately.

tion. Furthermore, MCare Portalprovides an interface to e-learning,available 24/7, which ensures com-petence building. It also providesan interface to MCare RemoteServices.’

MCare Remote Services offersquick response time and maximiseduptime through a direct link toMaquet’s technicians, enablingthem to start troubleshootingimmediately. MCare RemoteServices works through the existingnetwork’s security tools. SERVO-iand SERVO-s ventilators are using adirect path to communicate with

Assistive devicesfor illness and careHow do the products reach thepatients? By Heidi Heinhold

against numerous bacteria, virusesand micro-organisms. Available in avariety of packaging, the single usewipes deliver a correct dose of pre-mixed disinfectant solution to thesurface and require no rinsing.’

The firm’s team of techniciansand microbiologists develop stan-dard and bespoke products in its in-house laboratories. Pal’s range isthen independently tested byapproved organisations, such asBlu Scientific (Glasgow CaledonianUniversity), City HospitalBirmingham and Campden &Chorleywood Food ResearchAssociation.Details: www.palinternational.com

MCare Remote Services. No prior ITconfiguration is needed.

Using this solution, the firm’s expertscan analyse logs from the unit andmore quickly solve a problem remotely.‘Maquet Critical Care is excited to beable to offer a solution that is environ-mentally friendly by cutting the needfor travel,’ Dan Rydberg, ManagingDirector of Maquet Critical Care point-ed out. ‘Not only does MCare RemoteServices provide environmental bene-fits but it also increases the uptime forunits in the hospitals, leaving medicalstaff to focus on its patients.’Details: www.maquet.com

NEW

AUSTRIAAnna Köck, Dipl. Rel-Päd (FH), CatholicHospital Pastor at GrazUniversity Hospital,Head of the Centre forGraz Hospital Staff and

Head of the Christians and Muslims inthe Hospital symposium, discusses thelegal position of Islam in Austria andexamines the question of cooperationor conflict between Christians and

EUROPEAN HOSPITAL Vol 17 Issue 6/08 19

THECZECHREPUBLIC

Our correspondent Rostislav Kuklik(above) reports that the physician-to-patient relationship is always very spe-cific when it comes to different culturesor ethnics. ‘Worldwide, local doctorswho care for patients from other than amajor cultural background must beprepared to handle difficult situations,and solve truly unexpected issues.That’s also true for Czech physicians,who may be confronted with patientscoming basically from two differentgroups: visitors from abroad or localminorities, such as gypsies, the latterrepresenting most of the potentialpatients from different cultural back-grounds, because 300,000 of them livein this country. No exact data exists onthis, because there is huge differencebetween the number of people activelyendorsing their gypsy origin and thenumber who claim gypsy as their pri-mary language (mother tongue).Estimates of their real count varybetween 200,000 and half a millionindividuals.

In terms of foreigners, physiciansdon’t usually face many problems dur-ing their care, because they all comehere on purpose – for business,tourism, or as patients seeking medicalprocedures that are cheaper than intheir own countries, or for similar rea-sons – and it is highly likely that theycome from a good social environment,at least middle class. In any case, alldoctors need to solve their healthcareproblems, deal with sometimesdemanding communication, and satisfythese patients, is a good command ofEnglish, empathy, and the usual profes-sional attitude towards a patient.When it comes to local gypsy patients,communication may become verytricky in the blink of an eye. In thisregard, their behaviour patterns arevery similar to other Indo-Europeannations, which include their very strongfamily relations and loud emotionalexpressions and gestures. However,any physician with average psycholog-ical skills and much patience can rela-tively easily handle large families(around 10 members coming to visit isnormal). A real problem emerges whena gypsy patient is hospitalised andmust pay for the treatment. This is avery sensitive issue, because many areeither long-term unemployed (lifetimeunemployment is not an exception inthis ethnic group) or currently without

PATIENT CAREMeeting the needs of religious faiths and different culturesIncreasing migrations of people of various ethnic backgrounds and faiths means theirnumbers among hospital patients is also rising. In the last issue of European Hospital (vol. 17,5/08) we highlighted efforts to accommodate the religious needs of patients in various EUcountries. Clearly, these important and often confusing issues are also affecting hospitals inmany others. We continue with reports from correspondents and contributors on how theircountries approach and tackle this trend to enhance medical care

an income. According to UnitedNations research in 2003, about 70%of gypsies in the CEE region live sole-ly on state unemployment benefitsand child allowances. In truth, gypsypatients praise physicians as peoplewith almost extraordinary powers,but saving money comes first, solengthy talks about how much to payaccompanied by a little shouting isquite usual.

It must therefore be rememberedthat the gypsy patient requires spe-cific professional attitude with regardto the specificity of their thinking andsocial behaviour:• Health and related problems arevery sensitive topics – the entire fam-ily becomes involved, and the patientdraws a lot of family attention ontohimself.• They are very reserved in terms ofgaining their trust – a physician mustpresent considerable strength toprove to them that he is trustworthy.• Reasonable judgment must beused whenever it comes to clinicalsigns of the disease – the gypsypatient hardly ever straightforwardlysays what his or her real problemsare, tending to either under or overestimate their symptoms.• Due a different psychology, physi-cian needs to be careful in terms ofdifferently expressed disease subjec-tive symptoms (pain, etc.).

All in all, simple communicationpatterns, considerable empathy,awareness of various social specifics,and heedful, tactful behaviour aremore than recommended for anyonewho deals with gypsy patients.However, many sensitive questionsremain and one surpasses all others:Is it really sensible that physiciansare forced by so-called sociallyobnoxious circumstances to learnhow to behave in front of similarpatients? Wouldn’t it be far better ifpatients coming from minority popu-lations learn how to change theirbehaviour, especially when seekingmedical help from real professionalswith an academic education?

Muslims in the hospital.A young Islamic woman in a surgical

ward pulls a blanket up to her nose andwatches a nurse approaching to takeher blood pressure. The patient under-stands hardly any German and herenvirons feel alien. Being an in-patient,and surgery, tend to make any one feelhelpless and powerless. For thispatient, the addition of an anti-Islamicremark had unnecessarily poisoned theatmosphere. Although the staff try tobuild her trust, it proves difficult.

She has just given birth. Her largefamily arrives. After the changeover tothe night shift, the staff is puzzled bynoises and smells from the commonroom. The family has spread out foodand begun to cook.

These are just two examples of diffi-culties that can arise.

Austrian law and IslamIslam in Austria has the same rightsand duties as the Christian churches,going back to the Law on Islam, passedin 1912 by Emperor Franz Joseph. Forthese rights to be followed, the exis-tence of a legal person as a counter-part to the state was required. Since1979, this has been the Islamic com-munity, which means that Muslims inthis country have a legal status uniquein Europe. Islam has the freedom ofspeech, gatherings and press. There isno impediment to practicing Islam.There is Islamic religious education instate schools based on a state-devisedcurriculum as well as the respectiveteacher training. Muslim females canwear headscarves at Austrian universi-ties. The complexity of problems sur-rounding Islamic schools in Germany isunheard of in Austria. In return, theLaw on Islam commits Muslims torecognise the Austrian constitution,and the Islamic community abides bythis. A Muslim woman who insistedthat the law on religious freedommeant she could wear a yashmak (veil)in court was forbidden by law to do so.The Islamic religious community statedthat Islam does not call for the wearingof a yashmak and that a headscarf suf-fices for a woman to ensure adherenceto religious duties.

Legal situations can arise that arenot compatible with everyone’s per-ception of Islam. Individual Muslimsmust accept this because, in return,they are granted religious freedom, butvice versa they do not have the right toimpose their views on others.

How Muslims perceiveEuropeans/Christians

Many Muslims are migrants from tradi-tional, Islamic countries where religionis an important part of everyday publiclife. Religion is something visible, notjust an inward matter. In Austria theyjoin a society where religion is more ofa private matter, a personal choice,respected but not playing an essentialpart in everyday public life and not sopublicly displayed.

Europe – and therefore Austria – is

considered by Muslims to be Christianin a way that, to them, makes it anessential part of the Austrian identity tobe Christian. The largely internalisedreligiousness of many Christians isoften hard for Muslims to recognise andthey conclude that religion is not impor-tant to Christians. Social deficienciesand circumstances are interpreted as alack of lived faith, further evidence forMuslims that their religion is not impor-tant to Christians. This sometimes leadsto the questioning of a presence ofChristian symbols in public spaces. Theexperience of hospital nurses showsthat the Christian faith, and its symbols,are well respected and tolerated ifsomeone professes their Christian faithand strongly defends its importance.

How Austrians view MuslimsAn ostentatious religious custom or rit-ual – such as unrolling the prayer rugon the hospital ward or wearing aheadscarf – seems strange to Austriansand is considered inappropriate,because, as pointed out, religion is con-sidered a private matter. Muslimsrealise that, in Austria, Islam is per-ceived as backward, formalistic andmisogynistic. Islam is also increasinglyconnected with an inclination towardsviolence and we tend towards a sub-liminal distrust of Muslims.

I remember, when invited to a cele-bration of the end of Ramadan, talkingto a lady who ran a Turkish grocerystore with her husband in a small town.Suddenly she nervously asked: ‘Tell, me,why are these people so afraid of uswhen all we want to do is live here inpeace?’ I was very affected by this.

These views lead to tensions andmisgivings that are also evident in hos-pitals. This is why the Centre for NursingStaff, an institution run by the parish atthe University Hospital Graz, in cooper-ation with the Styrian Department forHospital Pastoral Care of the DioceseGraz-Seckau and the NursingDirectorate of the University HospitalGraz, held an inter-religious and inter-disciplinary study day on the subjects ofChristians and Muslims in the hospitallast March.

Dr Markus Ladstätter, Vice Director ofthe Catholic University College forEducation Graz and specialist in Islam,gave the following recommendationsand advice for the dialogue betweenChristians and Muslims. He warnedinsistently against over-hasty valua-tions.• Islam is complex. Islam existed intimes of openness and in times ofrestriction. Therefore it must not bereduced to a certain period in time asprogress, modernity and openness can-not be claimed by just any one religion.• We should try to refrain from over-hasty assessments. Someone alreadywith a preconception will perceive any-thing that confirms these views and willnot learn anything new. Learningmeans opening ourselves up to newfacets.

Anna Köck

M A N A G E M E N T

continued on back page

EUROPEAN HOSPITAL

www.european-hospital.com

EUROPEAN HOSPITAL Publisher,Theodor-Althoff-Str. 39, 45133 Essen, GermanyPhone: +49 (0)201 87 126 850Fax: +49 (0)201 87 126 864e-mail: info@european-hospital.com

Editor-in-Chief Brenda MarshArt Director Mary PargeterExecutive Directors Daniela Zimmermann,

Reiner HoffmannInternational Media/Editor Gabriela Eriksen/ Denise HennigManaging Editor Meike LernerEditorial Assistant Karoline LaarmannProduction & Distribution: Janka HoppeRussian Supplement Sergey Bezrukov,

Fibrotex GmbH,Fischerstr. 140477 DüsseldorfTel: +49 211 550 49 70, e-mail: fibrotex@gmx.net

Founded by Heinz-Jürgen Witzke

CorrespondentsAustria: Christian Pruszinsky. Baltic: Andrius Vagoras.Czech Republic: Rostislav Kuklik. France: JaneMcDougall, Keith Halson. Germany: Anja Behringer,Annette Bus, Karl Eberius, Guido Gebhardt, HeidiHeinhold. Great Britain: Brenda Marsh, Ian Mason.Poland: Pjotr Szoblik. Russia: Olga Ostrovskaya. Spain:Eduardo de la Sota. Switzerland: Dr André Weissen.USA: Karen M Dente, Kerry Heacox, i.t. Communications,Ivan Oransky, Craig Webb.UK editorial address55 Wey Meadows,Weybridge, Surrey KT13 8XY

SubscriptionsJanka Hoppe, European Hospital,Theodor-Althoff-Str. 39, 45133 Essen, Germany

Subscription rate6 issues: 42 Euro, single copy: 7 Euro. Send order andcheque to: European Hospital Subscription Dept

Finishing media technique jöhri, Weilerswist, Germany

Printed by VVA GmbH,Düsseldorf, Germany

Publication frequency bi-monthly

European Hospital ISSN 0942-9085

RepresentativesGermany, South Europe, AUS, BRAndreas Conze, Head Office, Tel: +49 201 87 126 950,e-mail: ac@european-hospital.com

China & HongkongGavin Hua, Sun China Media Co., Ltd, Room 802, 15th Building, BinJiang Residential Quarter, Dongyuan Road, Futian District, Shenzhen, Guangdong, China, Code: 518031Tel: +86-0755-81 324 036e-mail: gh@european-hospital.com

GB, Scandinavia, BeNeLux, FranceSimon Kramer, Willem Alexander Plantsoen 25, 2991 NA BarendrechtTel:/Fax +31 180 6200 20e-mail: sk@european-hospital.com

IsraelHannah Wizer, International Media, Dep. of El-Ron Adv. & PR Co., Ltd., 7, Leteris street, Tel-Aviv 64166, IsraelTel: +972-3-6 955 367email: hw@european-hospial.com

JapanTetsuzo Asoshina, Echo Japan Corporation, Grande Maison Room 3032-2 Kudan Kita, 1 Chome Chiyoda-KuTokyo 102, JapanTel: + 81 3 3263 5065e-mail: ta@european-hospital.com

South KoreaCH Park, Far East Marketing Inc, Room 103-1011, Brown Stone, 1330, Baekseok-dong, Ilsan-ku,Goyang-si, Gyunggi-do, Korea 410-360Tel: +82 2 730 1234e-mail: ch@european-hospital.com

TaiwanBen Chen, Jurassic Communications Corp., 10th Floor-4, No 235, Chang Chuen Road,Taipei 10479, Taiwan R.O.C.,Tel: +886 2 2503 8028e-mail: bc@european-hospital.com

USA & CanadaHanna Politis, Media International, 8508 PlumCreek Drive, Gaitherburg, MD 20882, USATel: +1 301 8696 610email: hp@european-hospital.com

GERMANYA universitycourse in MigrantMedicine

Migrant medicine as a course forGerman medical students? This is aunique concept in a country where it iscurrently only being offered at theJustus Liebig University in Giessen.Since 2004 trainee medical doctorshave been able to spend a term learn-ing about dealing with migrants andfacing new types of problems withfuture patients. How does one deal, forinstance, with a patient who doesn’tspeak a word of German?

Almost 10% of Germany’s popula-tion is now of foreign origin, with Turks,Kurds and Arabs making up the largestgroup, followed by migrants from for-mer Yugoslavia. For medical studentsspending time on hospital wards for thefirst time this means every tenth patientthey face is different.

SWITZERLANDFrom Switzerland, DrAndré Weissen (left)reports that there areno consistent hospitalguidelines regardingpatients’ faiths. ‘Thereare neither any direc-tives nor binding rulesas to how a hospital is

to treat Muslim patients, for example.Nevertheless, everybody everywhere istrying their utmost to accommodatetheir specific needs. Nurses are receiv-ing training as to what type of prob-lems may occur and what the possiblesolutions should be. A lot of referenceis being made to a small publicationon this topic. Published in 2003, thiswas not meant to be a handbook orset of guidelines, but was actually theresult of a project by five trainee nurs-es at the nursing school at the St ClaraHospital in Basle. However, it is nowconsidered to be almost a benchmarkon this subject. The publication can befound (German only) at:http://www.pflegeschule-clara.ch/pro-jektarbeiten/PSC_Mu_imSpital.pdf.’

As reported in our previous articleson this subject, Dr Weissen points outsignificant considerations. ‘A Muslimviews illness not as punishment but asa test, created, as everything else, byGod. There is a cure for each illness,but God alone is the healing power. AMuslim is required by his faith to raisethe power and patience to be healedas quickly as possible. Relatives arerequired to support the patient in thistest as best and intensively as possi-ble.

‘Mixing genders? Within the Muslimfaith, dealing with unknown membersof a different sex is usually limited tothe strictly necessary. Muslims have amuch more pronounced sense ofshame than Western Europeans. This isthe issue causing the most conflicts

20 EUROPEAN HOSPITAL Vol 17 Issue 6/08

M A N A G E M E N T

• When comparing religions it isimportant to compare like for like, i.e.theory with theory, practice with prac-tice. Too often, we tend to compare‘good’ theories of our own religionwith a failed practice of another – amistake common in Christianity aswell as Islam.• The Second Vatican Council discuss-es Islam with respect and encouragesdialogue. Catholic Teaching demandsinter-religious dialogue with Islam.• Where Muslims are involved, we aretoo quick to attribute conflicts withothers to religion, though may havehad problems with that personwhether Muslim or not. In reality, anidentity is always multilayered; it con-sists not only of religious but alsosocial and cultural aspects.

Graz University Hospital An Islamic prayer room was openedmany years ago in Graz UniversityHospital. Common rooms weredesigned to ensure patients couldmeet visitors without undue distur-bance to other patients. However, thebiggest problem in daily hospital life islanguage – not to do with Islam butwith migration, further complicatedwhen different cultural and religiousviews converge.

Communication is critical in medicalcare. In the obstetrics department, forexample, women from 83 nations,speaking 37 different languages, aretreated.

Initiatives of the Islamicorganisations

The intercultural Women’s AssociationDschanuub runs the ‘Rahma’ project.Organised by migrants and Muslims,members of Rahma want migrants tofeel self-confident in public and able tolook after their own interests. The ser-vice includes providing someone whospeaks in a patient’s mother tongue, aswell as German, to accompany womenfor medical appointments or hospitalvisits – a service that also eases workfor the staff. They not only translate,but keep in touch during an in-patient’s stay, and mediate with staffwhen communication problems arise.If required, they also can provideQuran recitation, help with terminalcare or the ritual washing of thecorpse.

Another project run by this organi-sation was called ‘Marhama’.Sponsored by the EU, it resulted in thedevelopment of the ‘Female Muslimsin our Hospitals’ booklet (download athttp://www.dschanuub.at/home-page_marhama/links.htm).

During a study day, the hospital staffwas very interested in telephone num-bers, to contact people who can medi-ate in difficult situations with femaleMuslim patients. It takes a long timeand calls for resilience and commit-ment to spread this knowledge acrossall wards in such highly complex insti-tutions. The committed Muslims tendto interpret these difficulties as preju-dice against their religion. This is defi-nitely not the case. Other, externalorganisations, and even departmentswithin the hospital, have problemswith this.

Complex IslamAs in Christianity, there are many dif-ferent views and interpretations ofreligiously motivated actions amongstMuslims. Whilst some Muslim men willshake women’s hands in greeting, oth-ers would never do this. Whilst someaccept they will be treated by medicsof the opposite sex, others cannot con-ceive of it and would rather go withoutnecessary treatment – despite theIslam commands that followers lookafter their health and seek treatment.

Religiously motivated behaviour isoften strongly characterised by cultur-ally dependent interpretations of Islamin different countries of origin. Thisresults in lifestyle differences not spe-cific to Islam.

Visiting hours – progress orregression?

Even after intensive discussion manyquestions remain unanswered. Whatappears to be easy and logical in the-ory is not quite so in practice. SomeAustrian hospitals have reverted to there-introduction and enforcement ofstrict visiting hours. Not so in Graz.Some consider strict visiting hours as aquality criterion; others view this as aregression to the 1950s.

Recognising stepsI am aware of the enormous dedica-tion and readiness of the staff to meetspecific needs not only of Islamic butall patients. At the same time, there isrepeated disappointment becausethese efforts are apparently (or actual-ly, which I’m not in a position to judgefor sure) neither appreciated norrecognised by Muslim patients, andthis leaves people wondering ‘Whatelse do we have to do to please them?They should be meeting us halfway.’The big, unresolved issues of migrants’integration are therefore reflected inthe hospital.

Developing common rulesNot all demands and requests justifiedwith reasons of religion are actuallybased on religion. Rude behaviourshould not be tolerated, independentof the individual and his or her reli-gion. Considerate behaviour is expect-ed of everybody, particularly in hospi-tal.

I can sense a certain amount of hes-itancy regarding boundary setting,because no one wants to be accusedof racism – historically understand-able, but actually nothing to do withthis issue. Of course, this does notanswer the question of where unac-ceptable behaviour starts. I am con-vinced that this requires a discussionwith the objective to develop commonrules, which would be a relief foreveryone.

Muslim needs are the needs ofeveryone

Making provisions for the particularneeds of Muslims should be seen inthe broader context of more focus onthe patient, which applies to allpatients. Non-Muslims also have cer-tain preferences or intolerances whenit comes to food, they have differentinhibitions, some would also preferexamination by a person of the samesex, etc. In this respect, all patientscould ultimately benefit from the factthat hospitals are becoming moreopen to trans-cultural issues.

Ulrike Drexler-Zack, the PublicRelations Officer for the CatholicHospital Pastor at Graz UniversityHospital, reports on practical stepsdeveloped to meet the challenges.

Sprechen Sie Deutsch?’ or ‘Doyou speak…?

The proportion of foreign-languagepatients in the Department forGynaecology and Obstetrics at theUniversity Hospital has increased con-tinuously since 2005. Data for 2007show that almost a fifth of out-patients and nearly 25% of in-patientsdid not speak German. In an extremecase, 22 of a ward’s 26 patients spokea foreign language.

According to Rita Kober, of thenursing directorate, initially inter-preters were supplied with the supportof the hospital management. Some

planning difficulties arose becausesome patients did not attend appoint-ments whilst others had long waitingtimes for unscheduled appointments.Nowadays patients are asked to bringsomeone to help with translation ifnecessary.

KOMA (communication materials),a pilot project set up with the help ofthe departments for organisationaldevelopment and quality manage-ment and helped by Islamic religiouscommunity, developed and publishedthe most urgent communicationmaterials – including house rules – ineight languages. Apart from files andfolders the project developed word-sentence-lists and pictograms (for theilliterate). It transpired that, althoughthese materials are helpful, in mostcases they cannot entirely replace aninterpreter.

Apart from language barriers mostpotential for conflict arises from cul-tural differences (as described in EHissue 4, and below by Dr Weissen).However, there are one or two addi-tional points: prayers are carried outnot only by patients but also their vis-itors, which can cause of problems, ascan rivalries between different groupsin the community. These situations aresometimes perceived by the indige-nous patients with incomprehensionand viewed as a burden.

within the hospital, which is whysome principles should be adhered toas far as possible. The easiest thingwould be for men only to be treatedby men and women to be treated bywomen – meaning doctors as well asnurses. Certainly, exceptions are notviewed as sins, so examinations bydoctors or nurses of the opposite sexare possible. However, it should beavoided whenever possible.

‘If this is unavoidable, it is veryimportant to ensure that the patientto be examined is not alone in a roomwith the doctor or nurse who willexamine them. Particularly in the caseof female patients it makes sense toensure that a third person, of thefemale sex, is present during an exam-ination, because it is a difficult issuefor a female Muslim whose clothesrepresent mental and physical protec-tion. Even with a female chaperonepresent, they find it difficult to removetheir clothes in the presence ofunknown males.

‘Diet? The Muslim faith forbids theconsumption of foods considered tobe unclean. This particularly includesalcohol and pork. A solution would beto offer kosher meat prepared accord-ing to Jewish guidelines. Muslims canconsume dairy produce, eggs, fish,vegetables and fruit. Another option: avegetarian diet, as long as this doesnot contravene a diet prescribed bythe doctor. Another possibility is forrelatives to supply food from outsidethe hospital.

‘Hospital visits: Muslim patientstend to receive many visitors. This isbased on the religious duty ofMuslims to look after someone who isill, but is also simply something that isdone. Relatives and friends visit, oftenwith the children, and often bringfood. Visits are particularly importantif a patient is dying; according toIslamic rules, someone who is dyingshould never be alone. The dying per-son forgives those who may havedone something to him in earliertimes. Therefore, it is important toensure that relatives are able to offerthe patient this spiritual, terminal carein a separate room.

Giessen University Hospital hasbeen tending migrants in their ownlanguages for almost 20 years. Thedepartment responsible for treat-ment of out-patient migrants hasaccess to an interpreter serviceoffering 40 different languages.

‘Because of our migrants’ clinicwe obviously also have many moreforeign patients on the wards thanother hospitals,’ explained DrAhmet Akinci, consultant at theMedical Clinic II at Hanau CityHospital. ‘We realised that out stu-dents have always been interestedin finding out something about thespecific diseases or psychologicalproblems among this group ofpatients and also in better under-standing their culture-specificbehaviours, which is why wethought of offering the courseMigrant Medicine – InterdisciplinaryAspects of Medical Care for Patientswith a Background of Migration. DrAkinci is a member of the MigrantMedicine working party at GiessenUniversity and has no complaintsabout a lack of interest in his sub-ject: ‘So far, the seminars havealways been full. However, we try tolimit the groups to between 20 and25 participants to create a relaxedatmosphere. Every term I take twoor three patients to the lecture; ofthese, at least one doesn’t speak aword of German. When I ask my stu-dents to find out what the problemis with this foreign language speak-ing patient they eventually under-stand this intercultural problem.’

The objective of the course is forthe students to develop a certainintuition in dealing with foreignpatients and to gain an overview ofcertain migrant-specific disease pat-terns. ‘When a trainee doctor does-n’t know that every third Arab overthe age of 50 suffers from diabetesthen, of course, he is surprised thatevery diabetes test from patientsoriginating from this region is posi-tive. These facts are commonlyknown, but are often not taught tostudents by university professors.Again and again, even I encountercases at the migrant treatmentdepartment that I’ve never seenbefore – be it an unknown type ofworm in the intestine of an Indianpatient, which he has harboured foryears, or a Turkish family of nine, allof whom want to be simultaneouslytested for Hepatitis B in my cubicle.Of course I also discuss these typesof cases with my students.

‘At the beginning of term I initial-ly discuss the basic question: Whatdoes migration actually mean?What are the reasons for it? What isthe current situation in Germany, i.e.which are the countries where mostmigrants originate and where domany of them tend to live?’ In thenext stage, the students – who, hepoints out, also come from verymixed ethnic backgrounds – arefamiliarised with ways of thinkingand cultural differences amongpatients with a background ofmigration. ‘Once a term we hold ajoint film evening where we showproductions that relate to migrant-specific problems. In the course,comprised of ten double-periods, wealso have many guest lecturers fromdifferent fields who examine thetopic from different angles. At theend, we ask the students to write areport about their personal encoun-ters with migrants. Many visit areasthat have a particularly high ratio ofmigrants for this purpose. Above allwe want to teach them that culturaldiversity can be an obstacle – butnot one which cannot be overcome.’

Dr Ahmet Akinci