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News . . . . . . . . . . . . . . . . 1-5Intensive care . . . . . . . . 6-9Laboratory . . . . . . . . . . . . 10Futures & research . . . . . 11Urology . . . . . . . . . . . . 12-13Hygiene . . . . . . . . . . . . . . 14IT . . . . . . . . . . . . . . . . . .15-18Global events &medical tourism . . . . . . . 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

V O L 1 6 I S S U E 1 / 0 7 F E B R U A R Y / M A R C H 2 0 0 7

5, 12, 13 UrologyNew study to be presented at

EAU Congress; plusprostate

cancer andcurrentreports

6-9 Intensive careStrong role for anaesthesia in

MRI procedures. Draeger’sventilator

for usewith 3-

Tesla

New Labour Code causesconfusion and angerThe amended version of the newCzech Labour Code stipulatesthat emergency working hoursand overtime in hospitals andsocial care institutes be altered sothat employees are paid no lessthan they receive for regularworking hours. Many stronglyoppose this change - includingtop Czech EU representativessuch as MEP Cabrnoch (CivilDemocratic Party), who said theCode imposes even more regula-tions than the EU requires. A keyissue, he said, is whether or notbeing ‘on standby’ for work is tobe included in hours worked.

Some hospital directors say it istoo early to assess the Code’simpact on local wages. Physiciansmust be reachable by phone,24/7. However, on standby, theycannot stay in hospital, but mustbe home to receive emergencycalls. Staying in hospital is work!That’s too expensive, ICU man-agers say. ‘We are sending dutyphysicians home, and some willalso be working in shifts, because

it’s cheaper for us.’The reason is clear – they want

to save money by paying doctorsat work only a fraction of whatthey deserve according to the EUnorm and Labour Code. Stayingby the phone is not work!

Many think wages will remainthe same as now and, generally,physicians accepted the changesto their working hours withoutmuch discontent. Any salarychanges will be soon be knownfrom the new work contractsbeing prepared in line with thenew Labour Code. If adverse,effects will be mostly felt inICUs, operating theatres,orthopaedic and plastic surgeryunits.

Right wing politicians blamethis situation on those whopushed the bill through parlia-ment - the Social Democrats andCommunists. Some note thatCommissioner Spidla’s draft EUlabour regulation will clarify thematter and define what work isto be included in working hours.

Rostislav Kuklik reports on the effect of EU rules on Czech healthcare

16-18 IT & telemediSoft - Alive and kickin’.Plus: IT in Italy, and EU

e-healthnews and

events

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SIDE

16-page pull-out

The ECR special supplement plus

presentations from the

EH Hospital Manager Symposium

French fundraisersfund geriatric wardsA nationwide fundraising campaignaimed at improving the lives of elderlyhospital patients collected €1,750 mil-lion last year, beating the 2005 totalby more than 17%.

Cash raised by the campaign, called‘Operation + de Vie’, will help to fund363 projects in geriatric wardsthroughout France. These are imple-mented with the help of the medicalteams concerned and include develop-ing activities for patients, helping torelieve their pain and improving recep-tion facilities for visiting families.

Other projects include buying equip-ment to provide a hairdressing andbeauty salon, supplying special anti-bedsore mattresses, and buying a pro-jector and films for long-stay patients.* European Hospital will feature thepotential value of employing aprofessional fund raising manager toaugment investment funds in hospitals.Read about our special managerssymposium, to be held at the ECR thisMarch. ECR supplement (centre pull out).Pages 12–13. Also, go to our website:www.european-hospital.com

Vitamin pills increasemortality Denmark – Vitamins A, E and betacarotene, taken singly or with othersupplements, ‘significantly increasemortality’ according to a review studyreleased by the Cochrane Hepato-Biliary Group* at CopenhagenUniversity Hospital. Their study, pub-lished in the Journal of the AmericanMedical Association (JAMA), did notfind evidence that vitamin C couldincrease longevity, but did find thatselenium tended to reduce the risk ofdeath.

The Copenhagen researchersanalysed 68 previous trials of the fiveantioxidant supplements, involving232,606 participants, and say theirfindings contradict those of observa-tional studies that claim antioxidantsimprove health. ‘Considering that 10-20% of the adult population (80-160million people) in North America andEurope may consume the assessedsupplements, the public health conse-quences may be substantial.’

The team reported that 47 ‘low-biasrisk’ trials, with 180,938 participants,were ‘best quality’. Based on thoselow-bias studies, vitamin supplementswere found to be associated with a 5%increased risk of mortality. Betacarotene was associated with a 7%risk, vitamin A with a 16% risk and vit-amin E with a 4% risk. No increasedmortality risk with vitamin C or seleni-um were seen.* The Cochrane is an internationalnetwork of experts who carry outsystematic reviews of scientific evidenceon health interventions.

ECR 1-16Radiology

Current aggressive IVFtreatments put patients at risk

Dutch researchers showhealth and cost benefitsin ‘milder’ approach

The Netherlands – In-vitro fertili-sation (IVF) is an overly aggres-sive treatment and needlesslyexposes childless women to sub-stantial risks of complications andserious discomfort, according toresearchers at the UniversityMedical Centre, in Utrecht.

During standard IVF treatment,high drug doses are used to stimu-late the ovaries – but these cause

Replacing one embryo, and freezinganother for use in a second attemptif necessary, cut the twin rate to onein 200 births compared with one ineight births when two embryoswere replaced at the same time.

Twin births have risen by 66% inBritain from 6,000 a year in 1975to almost 10,000 a year today, dri-ven by the increase in IVF. One infour IVF pregnancies leads to thebirth of twins compared with onein 80 natural conceptions.

An expert group commissionedby the Human Fertilisation andEmbryology Authority (HFEA) inthe UK recommended last Octoberthat tough controls be introducedto cut the number of patients inwhom two embryos are replaced.The report is to go out to publicconsultation next month and theHFEA is due to announce its newpolicy in the autumn. A spokesmansaid: “We know that multiple birthsare the single biggest risk for moth-ers and children.”(The Lancet. 2/3/07. ‘A mildtreatment strategy for in-vitrofertilisation: A randomised non-inferiority trial’).

menopausal symptoms such assweating, flushing, depression andloss of libido for two to threeweeks. From a study comparingmild and standard IVF treatments,which involved 404 patients, theUtrecht team concluded thatlower drug doses are not only aseffective as higher doses, but alsoless unpleasant.

Reporting in The Lancet Bart CJ M Fauser and colleagues said:‘Our findings should encouragemore widespread use of mildovarian stimulation and singleembryo transfer in clinical prac-tice. However, adoption of ourmild IVF treatment strategy wouldneed to be supported by coun-selling both patients and health-care providers to redefine IVF suc-cess and explain the risks associat-ed with multiple pregnancies.’

The mild version also provedcheaper at €8,333 per pregnancy,compared with €10,745 for stan-dard treatment. The researchersalso point out that replacing oneembryo in the womb at a time,instead of the usual two embryos,

achieved almost the same live birthrate – 44% – over a year, whilst italso dramatically cut the chances ofproducing twins

Also writing in The Lancet, IVFspecialist Professor William Ledger,of the University of Sheffield, com-mented that as success rates in IVFhave risen in recent decades, atten-tion has turned to improving thesafety of the procedure. ‘Somepatients want to complete the pro-cedure as quickly as possible andsee twins as the most desirable out-come,’ he added. ‘While 75% ofIVF treatment in the UK continuesto be paid for by the patients them-selves, many couples will opt fordouble embryo transfer because itis much less costly.’

It was pointed out that the stan-dard treatment could producetwins but using the mild treatmentto produce a single baby wouldmean the patient paying for a fur-ther treatment cycle.

Multiple births carry a higherrisk of complications for motherand babies, including an increasedrisk of being born prematurely.

EH CORRESPONDENT ROSTISLAV KUKLIC’S CZECH UPDATE C Z E C H R E P U B L I C

2 EUROPEAN HOSPITAL Vol 16 Issue 1/07

N E W S

Attractingforeign patientsCzech hospitals maintain a very highstandard of medical care, and theircharges are more than affordable forforeign patients. However, local hospi-tals still lag behind in attracting them;foreign patients are just 0.5% of allclients – a dismal situation.

Czech economists think hospitalcare, based on medical know-how ofreal specialists, is fertile ground forbusiness here. Unfortunately, the waythe healthcare system needs to changefirst. Patients are not allowed, forexample, to pay for above standardhealth insurance on their own which,some insurance agents claim, leads toextremely low motivation to travel herefor treatment. If all treatment costs arefully covered only by State insurance,and there is no prospect of better carecovered by private funding, local med-ical settings simply will not be swarm-ing with foreign clients.

One idea to help secure extra fundsfor the healthcare system is to combinetourism with healthcare services.Patients could travel to sightsee, and intheir spare time have some minor plas-tic surgery that was planned before-hand. ‘As of now,’ said Michal Veber,Secretary of the Travel AgenciesAssociation, ‘our tourist agencies donot offer any of this kind of service,although it is very common abroad.’

Former Minister of health, David Rathadded: ‘There are buses stuffed withpensioners from Germany and Austriadriving regularly to Hungary – becauseof the quality and low-cost of dentalcare provided by Hungarian dentists.’

Only for the chosenSince EU accession in 2004, increasingnumbers of wealthy patients haveindeed travelled to Western Europeancountries for treatment. Unfortunately,only very specific specialists are profit-ing from that phenomenon. Patientspay cash to orthopaedic specialists,plastic surgeons or reproductive medi-cine specialists, because they come toCZ to have joints replaced, eyelids re-shaped, and in-vitro fertilization is alsovery popular. Other medical specialistsmust depend on an income generatedonly by domestic clients.

The main obstacle for even morepatients to come for treatment of dif-ferent ‘illnesses’ is the fact that foreignhealth insurers do not pay for plannedtreatment but only for acute care, andthey are also not paying more thanlocal insurers pay for the same treat-ment for local residents. Such a policyresults in lower interest among Czechhospitals to tend foreign patients whodo not pay cash, but pay through healthinsurers in their country of origin.

Another reason might be the lan-guage barrier, which means a need forspecially trained staff.

Probably most foreign patients go toHospital Na Homolce – where foreign-ers make up almost 5% of all patients.Among these, 1.2% pay cash.

Nonetheless, numbers of foreignerstreated in Czech hospitals are risingvery slowly: 2001, foreign patients4,781 (0.2%); 2005, patients 8,861(0.4%).Medical tourism conference detailsand further thoughts -EH back page (p.20)

Czech Republic authorities force unlawful membership of professional chambersHurrah! The Czech Republic finallyapproved a trustworthy government.After ‘merely’ seven months, we madeit! What’s not so encouraging is thatthe new government also doesn’t knowhow to deal with some perennial prob-lems – those hindrances that haveslowed Czech healthcare’s develop-ment and reforms for years. A deepneed for a circumstantially restructuredhealthcare system has been preventedby problems that began with missingfunding and progressed to insufficientinsurance legislation - or maybe it was

a pure lack of political will to do some-thing.

This time, a new European-size prob-lem emerged – an inability to incorpo-rate EU rules into the Czech MedicalChamber (CMC) and Czech DentalChamber (CDC) legislations.

Czech law requires foreign doctorsand dentists wanting to work in this country to become members ofCzech professional medical chambersalthough, under EU legislation, practi-tioners should need only a certificatefrom their home country. The require-

ment for being a chamber member isreally absurd - it applies also to thosephysicians or dentists simply visitingthe country, not to mention the factthat all CMC/CDC members must paymembership fees. In other words, for-eign doctors staying in the CzechRepublic end up as double-memberswith double-money paid. Which ain’treally too fair. The situation should havebeen corrected by a revision of profes-sional chambers last year.

Unfortunately, Czech President Klausvetoed that law, stating there were too

many appendices to it that made thewhole situation unclear. In the lastweeks of January the European Courtof Justice ruled that the CzechRepublic is breaching EU law by notacknowledging doctors’ diplomas andcertificates issued by other MemberStates. For the moment, CzechRepublic must pay court expenses, andsoon, the European Commission willdecide further steps to be takenagainst the Republic.Follow up: www.lkcr.cz http://www.dent.cz/cs/csk

From innovations to insights,Siemens now gives you the whole picture.

EUROPEAN HOSPITAL Vol 16 Issue 1/07 3

N E W S

THE growing influx of English-speaking people to France has sparked a rise inlanguage classes for French doctors keen to avoid embarrassing linguistic andcultural faux pas.

In 2000, Parisian doctor Marc Bonnel launched his formations a l’anglais, aseries of courses aimed at hospital medics and general practitioners. They aredesigned to promote better use of English, in particular the correct medicalterms needed when dealing with English-speaking patients. Most of these areBritish, but they also include Dutch or Germans, for whom English is their sec-ond language rather than French.

A key part of the courses is teaching French doctors what is consideredacceptable to patients from different national and social cultures. For example,by French standards, the British are considered more prudish. One doctor,whose practice is close to the Dordogne, an area with a high number of Englishpeople, said: ‘If I ask an Englishwoman to undress for an examination, I have

A HEALTHCARE ROUNDUP FROM OUR CORRESPONDENT KEITH HALSONF R A N C E

to do it very carefully and make sure she understands exactly the reasons why itis necessary. Similarly, a male patient has to understand what is happening if it isnecessary to examine his prostate. This is why it is vital to know the language well.The courses not only help us learn the correct medical terms but also the correctprotocols of behaviour. They also help us explain what drugs we prescribe and howthe patients should take them.

‘We practise doctor-patient role-playing, as an English teacher listens and cor-rects us. We also learn about medical and healthcare systems in the UK and otherEuropean countries. Press cuttings in English about medicine are discussed andthere is a strong emphasis on grammar and vocabulary.

‘In our profession we are always taking medical training courses to update ourskills and practices, but this makes a nice change.’

Dr Bonnel offers 11 courses throughout the year from a number of locations inFrance, while others are held in London and Malta.

Learning English for the English patient

Booming babies France is one of the few European coun-tries whose population growth comesfrom births rather than immigration.

According to the country’s statisticsagency INSEE, more babies were bornhere during 2006 than in any year in thepast quarter of a century. Over 830,000babies arrived in that year (the highestnumber since 1981) taking the Frenchpopulation to 63.4 million.

The fertility rate is now two childrenper woman, up from 1.92 in 2005. INSEEreports this has been climbing since1996, but has still not reached 2.1, therate considered adequate to replace apopulation in developed countries.

The government says the figures are avictory for its family-friendly healthcarepolicies, cheap day care, generous post-natal parental leave and a wide range ofother social and financial benefits.

National smokingban beginsFrom 1 February, France has implementedthe first wave of a national smoking ban,with all health and administrative build-ings, educational establishments andpublic transport becoming smoke-freeareas. Smoking is also banned in all otherworkplaces, except in specially designat-ed smoking rooms, which non-smokerswould not have to enter for any reason.

Individuals breaking the law will befined 65 euros. Companies and otherswho flout the ban will be fined 135euros.

However, the French government willpay for nicotine substitutes and ‘willpow-er’ courses to help people who wish toquit the habit.

A hospital spokesman in Périgueux, inthe south-west of the country, said:‘Smoking has been banned for manyyears in all the hospital’s buildings andpeople who want a cigarette have had togo outside. We are now stepping up ourefforts to encourage those members ofour staff who smoke to quit, and explain-ing and emphasising to patients that it isthe single most avoidable cause ofdeath.’

The second part of the ban, which willaffect bars, restaurants, hotels, casinosand cafes, will come into force in 1January 2008.

Bitter pill forpharmacistsMany French pharmacists are falling onhard times after a year of falling rev-enues. Those most affected are in rural orsemi-rural areas, where there is a grow-ing shortage of doctors willing to set uppractice or where resident GPs are leav-ing for the more populous towns.

In one central region of the country,pharmacists reported a drop in sales ofalmost 7% in 2006. Delegates at a recentregional conference complained: ‘What isthe point of having a pharmacy in a vil-lage where there is no doctor? Local peo-ple have to travel to the nearest town toseek medical attention, so naturally theyalso buy their medicines there.’

A change in prescribing practice hasalso hit pharmacists’ profits. They arenow required to supply at least 74% ofmedicines in generic form rather thanthose made by brand-name drugs com-panies.

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Two best-practice examples:Germany: Hire-purchaseThe Medical Centre Dr Neumaierand Colleagues, in Regensburg,Germany, offers its patients diag-nostic options that extend farbeyond traditional methods oftreatment. More than almost anyother medical specialists, radiolo-gists rely on the latest technologi-cal equipment. This is why, as earlyas five years ago, radiologist DrNeumaier decided to finance imag-ing systems through SiemensFinancial Services. He has chosenthis financing method over andover again.

His most recent investment is thelatest generation magnetic reso-nance tomography (MRT). TheMagnetom Trio scanner fromSiemens Medical Solutions offersan extremely high magnetic fieldforce (3-Tesla), which producesunprecedented quality and, as aresult, assures the diagnostic use-

retain title to the equipment anddispose of it at the end of the lease.At the same time the healthcareprovider would enjoy the efficiencybenefits of current technology andhave the option of refreshing olderequipment with modern wheneverattractive to do so.

The call for wider usage of assetfinancing can also meet thedemand for costs to be in line withactual equipment utilisationthrough payment -per-usage struc-tures, where assets are rented orleased on the basis of a fee per unitof utilisation.

Modern financing methodstherefore can enable organisationsto upgrade to superior new tech-nology at their discretion, withoutan increase in rental payments orexpenditure of scarce capital bud-get, and can also pass to thefinancier the risks of disposing ofolder equipment and of the level ofutilisation of the new equipment.

The potential for modern financ-


N E W S

Financing the futureof European healthcareModern financing approaches, such as public-private partnerships (PPP) and asset finance,are necessary to meet the challenge of affordability in healthcare systems today, writesMike Treanor, Managing Director, Siemens Financial Services (SFS) GmbH, Munich

“Siemens Financial Services (SFS)recently published an internationalwhite paper focusing on the financ-ing of European and US healthcaresystems. Our aim was to offer professionals in the field some met-rics and fresh perspectives on theissue at a time when the minds ofmany strategists are occupied withthe viability and sustainability ofnational healthcare systems. One of the key conclusions from ourstudy is that flexible capital isabsolutely critical to the timely pro-vision of modern healthcare equip-ment, technology and IT – but thata substantial proportion of capitalis currently ‘frozen’ in Europeanhealthcare systems because it is noteffectively or efficiently deployed.

major medical devices and IT - areprime candidates to be leased, oracquired through other assetfinancing techniques.

The report suggests that if thisfrozen capital were transferredinto asset-financing plans, thenhealthcare financing could start toprovide more modern technologyand equipment. Such plans wouldmean that the organisation wouldbe charged an equipment lease/rental and maintenance costagainst revenue budgets, whichwould reduce longer-term outlaybecause the asset financier would

ing techniques to accelerate theintroduction of modern technologyto the healthcare industry is justone area highlighted by our in-depth study. We conclude thatalthough some areas of healthcarecosts require structural, long-termsolutions, others may be addressedin a more immediate fashion withavailable finance solutions. Theprivate sector (and not just the pri-vate medical sector) is alreadyaware that it no longer makes senseto buy depreciating assets outright– and public health authoritiesshould follow their example.

We defined ‘frozen’ capital ascapital funding that is radicallyout of step with the purposes towhich it is being applied, and istherefore not delivering value formoney. On this basis, we calculat-ed that the main Europeaneconomies are tying up some €10billion or more of capital (seeFigure 1). The main cause of thisis the old-fashioned practice thatdictates that technology andequipment should be owned, at atime when the pace of technologi-cal change has placed a majorquestion mark over the advan-tages of actually owning capitalequipment. In reality, the twomain areas of capital equipmentthat we study in our report –

The first, pan-European guidelines to bepublished on the treatment of valvularheart disease (VHD), diabetes and car-diovascular diseases (CVD) have made aseries of new recommendations thatexperts hope will contribute to improv-ing the outcome for patients.

Published in February, in theEuropean Society of Cardiology’sEuropean Heart Journal in February, theguidelines for VHD highlight whatshould be happening according to thebest available evidence from clinical tri-als. Professor Alec Vahanian, chair of theESC VHD guidelines task force and headof the cardiology department of theBichât Hospital, in Paris, said a uniquefeature of the guidelines is the integra-tion of the current practice in Europeand emphasis on particular issues thatwere not adequately performed in cur-rent practice.

The guidelines on diabetes, pre-dia-betes and CVD - also published recentlyin the EHJ - underline the fact physiciansshould check for both conditions if theysee a patient with one of them.Professor Eberhard Standl, co-chair ofthe diabetes and CVD guidelines taskforce, chair of the Diabetes ResearchInstitute in Munich and president-elect

of the International Diabetes Federationof Europe, said the great merit of theguidelines is that they recognise thatCVD and diabetes are ‘on the same coin;diabetes on one side, CVD on the other’.

One of the problems for the interna-tional experts collaborating to write theVHD guidelines was the lack of evidenceon best practice. Prof Vahanian said:‘Our guidelines are based on evidencethat exists and the consensus of all theexperts involved in each step of thewriting process.’

The VHD guidelines deal with everyaspect of treatment, from evaluation tosurgery, other therapies and manage-ment during pregnancy. Prof Vahaniansaid one important recommendationconcerned the use of stress testing, andrecommended this should be used moreoften, to ensure patients who are notsymptomatic receive the right treat-ment.

The need to use of echocardiographyas the key technique to confirm a diag-nosis of VHD is also emphasised. (Somecountries provide better access toechocardiography facilities for patients,than other countries).

Although VHD occurs most frequentlyin the elderly, Prof Vahanian pointed

fulness of the MRT images. Patientsthen can receive the best possibletreatment, and the number of patientscan be improved.

‘I think it is very important for asmany people as possible to benefitfrom medical progress,’ said DrNeumaier. ‘It is important to us thatwe receive the technology and financ-ing from a single source. This particu-lar deal was structured as a hire-pur-chase arrangement where ownershiptransfers to us at the end of the financ-ing term. As such, the equipment isimmediately on our balance sheet sothat we can claim all available taxbreaks and allowed depreciation. Thecustomary fast and smooth handlingof our financing requests and theoption of financing the value-addedtax gives my practice much-neededbudgetary freedom. As a doctor, thisallows me to concentrate even moreclosely on my patients.’France: An ‘Operating Lease’ arrange-ment with upgrade flexibilityThe Centre d’Imagerie MédicaleSainte Marie, based in Osny, hasfinanced its major equipment pur-chases through Siemens FinancialServices since 1994, spanning MRIscanners, ultrasound, radiologyequipment, and more. As an indepen-dent imaging centre, obtaining equip-ment out of capital expenditurewould not have been economical.‘Today, in the private medical sector,the use of asset financing, and partic-ularly operating leases, is becomingincreasingly standard,’ said theCentre’s Director, Dr Valentin. ‘Weare a specialist organisation, and soit is imperative for us to offer thehighest quality imaging capabilitiesusing the very latest equipment. Wewere the first organisation in Franceto acquire a multi-slice MRI scanner.But we have no desire now to ownthis equipment, just to have use of itto provide the services we offer.’

François Yon, Financial Director ofthe Centre, added: ‘Operating leasesare the ideal financing vehicle, espe-cially since we wrap up equipment,maintenance, insurance, and so oninto a single 360° arrangement thatensures that we have a reliable fixedmonthly outlay. We also remain freeto upgrade or change our equipmentif – as happens – a technologicalbreakthrough occurs, rather thanbeing burdened with having to get ridof obsolete equipment. This kind offinancing is simple to understand, andflexible in the face of change. Also,when compared with other financialmethods, it remains competitive.”

out, the Euro Heart Survey showed manyof them were not even considered forsurgery, often for unjustified reasons. Theguidelines stress the need for precise riskstratification before decisions are madeabout treatment for elderly patients.

A joint task force of the ESC and theEuropean Association for the Study ofDiabetes (EASD) wrote the diabetes, pre-diabetes and CVD guidelines. They believethere is still much to be done to improvetreatment of these patients. Among theissues that they highlight is screening forundiagnosed diabetes.

Prof Standl said the team had ‘..not rec-ommended mass screening for asympto-matic diabetes until there is evidence thatthe prognosis of such patients willimprove by early detection and treatment.Indirect evidence suggests that screeningmight be beneficial, improving possibili-ties for the prevention of cardiovascularcomplications.’

Since many patients with CAD mayhave asymptomatic diabetes, or pre-dia-betes, the guidelines recommend thatpatients should have an oral glucose tol-erance test if their diabetic status isunknown. Additionally, every diabeticshould be screened for CAD, so they canreceive the right treatment.

The first pan-European VHD, CVD and diabetes guidelines

Figure 1

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Urology is a surgical speciality witha limited number of consultants in Europe (around 134,000). Thefield is very well organised andactive. At a European level, theEAU (European Association ofUrology) and EBU (EuropeanBoard of Urology) are the mainsenior urologists associations. Interms of residents and trainees inUrology, the ESRU is the soleEuropean organisation fully dedi-cated to them.

One of the main ESRU objectivesis to improve training for youngurologists and contribute to theestablishment of standards in train-ing, to ensure that an optimal uro-logical service can be offered to theEuropean population.

One of the first steps to individu-alise the good points of training, isto be able to compare the actualsituation of trainees betweenEuropean countries. Hence, ESRUrecently conducted a survey tocompare urological residencies,helped by 496 trainees living in 30European countries.

Variations in urological residencies

Stéphane Larré, Chairman ofthe European Society ofResidents in Urology (ESRU)outlines resultsfrom astudy to bepresentedat the EAUCongress thisMarch

The first step todiscovering

Europe’s besttraining system

department of about half ofEastern trainees, compared withone third of Western residents.National courses are also organ-ised in many countries in Europe,and more often in Eastern coun-tries. Many European courses arenow offered to residents (mainlywith the help of the EAU), butonly 43% of trainees had goodunderstanding of English, with abetter level in Western countries.

The last aspect of the study wasto compare residents’ interest inresearch. Around 90% of them

were more interested in funda-mental research than Westerntrainees (50% vs. 40%).

Globally, we observed that therewere many differences from onecountry to another in Europe, butthe impact on the training level isstill poorly known. It is nonethe-less likely that increasing the num-ber of departments where resi-dents are trained, and decreasingthe number of residents in eachdepartment, might increase expe-rience and hence the global levelof trainees.

Their ages were 22–33 years(average: 28 years) when theybegan their residencies. Those inWestern countries started later thanin Eastern countries – especiallyDenmark, the United Kingdom andIreland. The number of residents ineach department was also very dif-ferent from country to country,ranging from two to 15 with amean of six, but there were no dif-ferences when comparing Easternand Western Europe.

Residents had also been trainedin a variable number of urologicaldepartments, ranging from 1–5with a mean of 2.7. Many of them(83%) had also completed trainingin other specialities for a mean peri-od of 21 months.

Residents from Western countrieswere more likely to have moved fortraining in another country, and theoverall rate of residents whodeclared moves was 12%.Residents were globally satisfiedwith their working conditions(70%) and social status (78%),especially in Western countries, butthis was associated with less satis-faction in non-professional activi-ties for Western residents (52% vs.64%). Eastern residents were lesslikely to be satisfied with salariesthan Western residents (5% vs.19%); the mean salary was alsolower. The average hours traineeswork in their departments was 67,with many variations (ranging from24 to 160 hours). This is about 20hours more than the EuropeanUnion directives, which establishedthat the maximum must be an aver-age 48 hours weekly in a three-month period, for all doctors,including trainees.

Access to new surgical techniqueswas less often present in Easterncountries, with no laparoscopicprocedures performed in the

The EAU provides support forresidents in urology to travel toanother country to complete theirtraining, which is very appreciat-ed. The centres where residentsare trained are also very impor-tant, and many differences alsoexist from one centre to another,within the same country. Hence,ESRU will continue its evaluationsby focusing on centres more thancountries, to highlight the aspectof the training that are the mostefficient for increasing trainee lev-els in Europe.Details: www.esru.net

More Urology features in EHpages 12 – 13

considered clinical research asessential, with no differencesbetween Eastern and Western res-idents. Although, Eastern trainees


N E W SN E W SI N T E N S I V E C A R E

Among presentations and discussions:Sepsis: New mediators and potentialtargets for effective therapies for sepsispatients. Ongoing controversies over var-ious management strategies, e.g. corti-costeroid use, tight glucose control, acti-vated protein C.Monitoring: Less-invasive methods forhaemodynamic monitoring. Studyresults, using various techniques to mon-itor microcirculation – a possible role inresuscitation and ongoing therapy?Respiratory failure: Insights into thepathogenesis, monitoring and treatmentof patients with ARDS, non-invasive ven-

tilation, and causes and prevention ofventilator-induced lung injury.Disasters: General principles of majordisaster preparation in general, as wellas specific approaches to pandemics,natural disasters, and terrorist threats.ICU management: Important facetsaffecting ICU management, includingadmission and discharge criteria, long-term outcomes, the benefits and limita-tions of medical emergency or outreachteams, and the need (or not) for follow-up clinics.Details of the four-day meeting:www.intensive.org

BLOOD GAS ANALYSERS AND MONITORS IMMEDIATE BEDSIDE RESULTS INCREASE SALESIn 2006 blood gas analysers and monitors earnedmanufacturers revenues of around US$360.5 mil-lion, and revenues could reach US$470 million in2013, according to a new market report from Frost& Sullivan (F&S). ‘Laboratory tests that used to takearound 30 minutes for the result to be obtained arenow a thing of the past; currently manufacturedpoint of care devices yield immediate answers,’ thereport’s author, research analyst C R Hema Varshika,explained. That instant bedside capability, alongwith a rising patient population is, she believes, thecause of a notable sales boost.

The main challenges for manufacturers includeeach country having its own purchasing system,which will only change when countries adopt uni-form laws. The author attributes other problems tothe high levels of brand consciousness among hos-

The role of anaesthesiain MRI procedures

In response to increasing demand for anaesthesia procedures thatcomplement MRI procedures, Dräger Medical is developing a new

ventilator that will be compatible with field strengths of up to 3-Tesla

Currently, to expand andcentralise the MRIDepartment at theUniversity Hospital

Schleswig-Holstein in Luebeck,Germany, a new building is beingplanned. This will include theinstallation of two 1.5-Tesla MRIsystems to cover most routinescans, and one 3-Tesla MRIsystem. The new MRIDepartment also plans to installDraeger Medical’s new MRI-compatible anaesthesiaworkstation, which includes allmodern ventilation modes(volume and pressure controlledventilation, SIMV/PS and PS), aswell as compliance compensation.A new MRI-compatible patientmonitor complements theworkstation.

Professor Karl-Friedrich KlotzMD, Vice Director and headphysician at the hospital’sAnaesthesiology Clinic, andAnaesthesia Nurse Stephan Hinz,

with Sevoflurane during inductionand move on to intravenous orbalanced anaesthesia. For therecovery phase we preferSevoflurane anaesthesia. Neonatesand children should be ventilatedduring anaesthesia by pressure-controlled modes. Neonatesweighing less than three kilogramsrequire special attention andqualified equipment. Theanaesthesia device currentlyinstalled in our MRI suite can

in the MRI suite; this procedureoften includes elongating pumptubes. Easy measures, such assafety blankets, provide shieldingfor these additional devices.’

These intensive-care patients areoften ventilated in quitesophisticated ways that must bemodified during MRI scans, ProfKlotz pointed out. ‘Even pressure-controlled ventilation should bestandardised from a therapystandpoint. We have to chooseeasier modes for device reasons.Intensive care patients are handedover to critical care wardpersonnel directly after the scan, tobe transferred back to the ward.’

MRI patients need treatment atleast once every other day, StephanHinz said, and sometimes scanscan be scheduled three to fourdays in advance. However, thenpatients from critical care wards ortrauma units often arriveunexpectedly, needing high staffinput. ‘We have a special kind of

pitals and ‘intense competition from local participants’.This, Ms Farshika suggests, can be overcome throughinnovative products and effective marketing strategies.‘Proactive marketing of technologically advanced anduser-friendly products will lead to a rise in market share,’she then predicts.

F&S points out that this analysis - ‘The European BloodGas Analysers and Monitors Market’ (M00B – 56) - is partof its Patient Monitoring Subscription, which includesresearch on: Remote Patient Monitoring and theStrategic Analysis of the European NeurologicalMonitoring Market.

For a virtual brochure, e-mail Radhika Menon Theodore- Corporate Communications at [email protected],giving your name, company name, title, phone number, e-address, city, state, and country.(http://www.patientmonitoring.frost.com)

Stephan Hinz (left) and Karl-Friedrich Klotz (right)

only ventilate patients weighingmore than five kilograms anddoes not have compliancecompensation, which is advisable.And hand-bagging this very tinypatient through three metre-longhoses without propercompensation information is likeflying blind. Hence, we do notusually anaesthetise neonates, butprepare them for MRI scans bysedating them.’

A large number of patientsarriving from critical care wardsalso need anaesthesia in the MRIsuite, Stephan Hinz added. ‘Thisgroup of high acuity patients iscomprised of neurology,neurosurgery, and coma patientswho require mandatoryventilation, as well as patientswith blood clots, aneurysms, andepilepsy. These patients oftenarrive already connected to, orwearing, other devices, forexample invasive blood-pressuremeasuring devices, pacers,infusions, Catecholamine therapy,and so on. Additional mandatorydevices, such as syringe pumps,have to be arranged peripherally

‘Over 230 established and emerging international leaders in intensive careand emergency medicine will provide participants with a state-of-the artreview of the most recent advances in diagnosis, monitoring, andmanagement of critically ill patients,’ Jean-Louis Vincent, Head of theDepartment of Intensive Care, Erasme Hospital, Free University of Brussels,Belgium, promises the expected 5,000 participants at this year’sInternational Symposium of Intensive Care and Emergency Medicine (ISICEM)

Brussels27–30March

who is responsible for medicalpractice guidelines, explainedthat, in the induction room, astandard anaesthesia machine willcontinue to be used. ‘The userinterface of the older inductionroom anaesthesia machine cannotbe compared with that of the newdevice,’ Prof Klotz pointed out,‘but at present our personnel isfamiliar with it. In another step, aFabius® Tiro could be added here,in order to simplify and unify theoperating philosophy.’

Who would need anaestheticduring MRI scans?High-acuity patients and, facedwith confinement in a narrowMRI scanner, claustrophobicpatients. Some of the latter,Stephan Hinz pointed out, onlyneed reassurance and mildsedation (Medizolam), whilstothers need more complexanaesthetic procedures, e.g. classicvolume-controlled ventilation.

Sedation is also needed forneonates and older childrentreated by paediatricians, saidProf. Klotz. ‘For these we begin

logistical problem related to MRIscans,’ he said. ‘The MRIanaesthesia device is the only oneof its kind in the universityhospital. Therefore, not only arethere special requirements andaspects of the delicate MRIenvironment that need attention,but also our staff is not routinelyfamiliar with the user interface ofthe anaesthesia device. As said,many cases cannot be planned, sotrained staff cannot beprescheduled. Therefore, we needto implement time-consumingtraining for our nurses andanaesthesiologists – over and overagain – to have trained personnelavailable at all times.’

Prof Klotz estimated that, ifobtaining an MR image takes sixminutes, 30 minutes are needed forthe anaesthetic procedure. Butcurrently the MRI unit is in adistant part of the hospital campus,so the physicians and specialisednurses needed to prepared andsupport any unscheduled MRIprocedure are taken away fromtheir routine hospital work for upto four hours. ‘If you add the time

THE 27th ISICEM

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needed to arrange all supplies andto prepare and check theanaesthesia device, it might easilyconsume ten hours of physician,nurse, and logistics personneltime. However, the hospital isonly allowed to bill for theanaesthesia time, not the actualeffort and time required.’

Presently, near the hospital’sMRI suite, the induction room isstocked with MRI compatibleaccessories, e.g. consumablepatient hoses, soda lime canisters,MRI-specific ECG electrodes etc.Stephan Hinz explained. ‘MRIcompatibility has to be checkedby our anaesthesia nurses inadvance. We use a non-MRI-compatible anaesthesia device andpatient monitoring in theinduction room.’

‘Whereas for adult patients,induction is mostly appliedintravenously,’ said Prof Klotz ,‘we often use Sevoflurane forchildren to avoid venous in-dwelling cannulae, which mightcause traumatic situations whilethe injection is taking place.’

‘The following steps comprisebalanced and/or even intravenousanaesthesia,’ Stephan Hinzcontinued. ‘Leaving the inductionroom, the patient is placeddirectly on the MRI table, thenconnected to the MRI-compatibleanaesthesia device, which hasbeen checked and tested inadvance. In our hospital, the MRIanaesthesia device stays in theMRI suite. Electrocardiograms(ECG) and partial, arterial oxygensaturation (SpO2) patient cablesare specified for use in MRIenvironments.’

So, what would a ventilatorneed to offer to alleviate problemsin the MRI suite – simply morecompatibility with the imagingprocedures?

The usual patient data ismonitored (oxygen, ventilationpressure, tidal volume, carbondioxide, and anaesthetic agentconcentrations). ‘The mostimportant ventilation modes arevolume-controlled ventilation forhealthy (even claustrophobic)patients and pressure-controlledventilation for paediatric andcritical care patients,’ Prof Klotzrecapped. ‘So far, the moreadvanced ventilation modes,synchronised intermittentmandatory ventilation (SIMV)and pressure support (PS) forspontaneously breathing patients,have seldom been required. Wehave standardised our patientmonitoring throughout thehospital. This is a tough task inthe MRI suite because the MRenvironment requires varioussensors, for example for ECG,non-invasive or invasive bloodpressure (NIBP, IBP), and SpO2,and a dedicated user philosophy.To reduce the challenge to staff asmuch as possible, the differencesbetween using a main operatingroom (OR) device and the MRI-compatible unit should be kept toa minimum. Unfortunately, thisdoes not reflect the current statusat our hospital.’

The ventilation and monitoringdevices installed in the MRI suiteare unique and require a highlevel of training and support tokeep them up and runningsmoothly, Stephan Hinz pointedout.

Along with that, theanaesthesiologist is only needed ifspecial patient conditions occurduring the MRI procedure - forexample, overcoming a 10–15second apnoea phase, Prof Klotzexplained. So, he added, mostly,the anaesthetist watches the MRIprocedure through safety


I N T E N S I V E C A R Ewindows. Therefore, a largerdisplay screen would beadvantageous, he said, ‘…sincethe anaesthesiologist needs toget an angle on the vital curvesand patient data provided bythe anaesthesia workplace fromoutside. If the screens are toosmall for external viewing, anadditional screen outside theMRI suite is needed, to displayall important information. Wecurrently use hand-writtenanaesthesia reports in the MRIsuite. As soon as our hospital-wide automated record keepingsystem is installed, we willconsider saving the MRIanaesthesia data directly in anelectronic patient file.’

Multi-taskventilator testers Made by TSI GmbH, the battery-operatedCertifier FA and Certifier FA Plus ventilator testsystems are flow analysers that can be used totest a variety of other medical equipment, e.g.anaesthesia gas delivery machines, insufflatorsand oxygen concentrators.

Of compact design, the testers are not onlyfor use in hospitals and nursing/care homes but,TSI points out, they are also ideal for thelaboratory, biomedical shops, manufacturing,production applications and in field service.Contact: [email protected]: +49 241-52303-0 Fax: +49 241-52303-49


E M E R G E N C Y & I N T E N S I V E C A R E

SpiroStar is the smallest lung func-tion testing system in the world,reports its Finnish manufacturerMedikro Oy. Weighing just 22grams, this also became one of thefirst to satisfy the new andchanged requirements for the cal-culation of lung function testing,meeting the latest ATS/ERS spirom-etry standards.The current, globally accepted,spirometry standards were devel-oped jointly by the AmericanThoracic Society (ATS) andEuropean Respiratory Society(ERS). Among other changes in thelatest version of those standards(released Dec. 2005), the criteriafor the reproducibility of testswere amended, and the allowedrange of variation was reduced.

The easy to operate SpiroStarlung function testing system can beconnected directly to a PC through

The Von Bergh Global Medical Consulting groupMartin von Bergh MD PhD MBA, founder and CEO of GlobalMedical Consulting, is a practicing medical doctor,emergency physician and disaster manager, with an MBA inInternational Hospital Management. His organisationadvises governmental organisations, hospitals, privatepractices, and other healthcare providers and industries onemergency and disaster management, and assists in theimprovement of emergency medical services as well asdisaster preparedness and response.

The services ● Development of innovative and economically efficient concepts for pre-

hospital emergency care ● Evaluation and improvement of current Emergency Medical Services ● Consulting for mass event preparedness ● Redesign of international concepts for disaster scenario management● Strategic planning and implementation of new emergency/disaster relief units

and facilities● Planning and execution of disaster drills with evaluation and improvement

recommendationDetails: www.GlobalMedicalConsulting.netPhone: +49 (0) 6432 50 72 10. Email: [email protected]

ACCIDENTS, EMERGENCIES AND DISASTERSOut-of-hospital digital documentation

By Martin von Bergh Vital patient-related data must be doc-umented by emergency medical ser-vices, disaster relief units and emer-gency physicians, in out-of-hospitalsettings, and currently most of this isdone entered manually on paper. Apartfrom being time consuming, this prac-tice also makes it difficult to reviewcertain protocol details, pass on data tothe admitting hospitals or to extractinformation for research.

Lately, numerous soft and hardwaresolutions have been introduced to digi-tise pre-hospital patient data. Thesesystems range from scanning in proto-cols with handwriting-recognition, to

the biggest problem is that most hospi-tals and healthcare providers use dif-ferent systems, and in most cases evenseveral different ones in the same insti-tution. This makes it difficult toexchange data internally or transfer itto another institution.

To overcome the problem OrionHealth has developed an applicationfor mobile devices that allows digitalentering of data in to emergency pro-tocols and transferring this data intoany existing hospital software. This ispossible due to a software integrationengine that translates incoming datainto the format required by a hospital’scurrent applications. Furthermore, thepatient data can be stored on a centraldatabase to be accessible for certifiedusers, using a web-based integrationapplication named Concerto. Later, allstored data can be analysed, statisticscan be extracted and reviewing data iseasily possible.

To ease data entry as much as possi-ble, the emergency protocol applica-tion on the mobile device follows thelogical structure of the paper forms

GUESS THE BESTBasic cardiopulmonaryresuscitation (CPR), particularlywhen performed immediately bythose witnessing a cardiac orrespiratory arrest, definitivelysaves lives - especially inwitnessed cases of ventricularfibrillation (VF) and childhooddrowning events. Nevertheless,the frequency of bystander CPRstill remains mostly low. In turn,survival chances for potentiallysalvageable patients remain low,even in well-developed, rapidly-responding EMS systems.

Most people believe thatlearning to perform CPR is veryimportant. However, theinevitable hurdle is getting themto the classroom. Communitiesthat have experienced a relativelyhigh frequency of bystander CPRand accompanying high survivalrates for out-of-hospital VF havebeen those in which healthcare isa major industry, or where CPRtraining is provided for allstudents in their school systems.Therefore, widespread CPRtraining often requires a focus oncaptured audiences who arerequired to learn CPR.

Considering this concept,another key strategy to ensurewidespread CPR is to require it(or make it easily available) inthe general (non-healthcare)workplace. Anecdotally, whenqueried, many employers agreethat having all their employees

World’s smallestmeets latest ATS/

trained in CPR and the use of anautomated external defibrillator(AED) is valuable, in that itcreates a ‘safer workplace’ andalso benefits the families of thatworkforce.

However, the problems lie increating adequate time for a busy,productive workforce to betrained, and securing, schedulingand paying an adequate numberof ‘certified’ instructors to do thetraining of, perhaps, up tothousands of workers. Atraditional CPR-AED class takes3-4 hours, and requires a ratio ofone instructor for every five orsix trainees, so logistic, financial,and productivity obstacles canbecome enormous – and otherexpenses need consideration(training equipment, instructorand/or location fees, catering,etc).

Training in under 30 minutesThe concept of teaching CPR andAED use in less than half an hourbecame a reality thanks tolongstanding efforts ofeducational researchers, theAmerican Heart Association(AHA) and the LaerdalCorporation (Stavanger,Norway). Using modern digitalvideo disk (DVD) technology andadult learning principles, the 20-minute CPR course ‘CPRAnytime for Family and Friends’was developed and launched

the facilitator also points outinappropriate hand placement orreinforce that the individualtrainees follow the cadence of theperson who serves as the CPRdemonstrator on the DVD.Nevertheless, they do not need tobe ‘certified’ instructors, nor dothey need to spend several hourswith students. Most importantly,two or three facilitators couldeasily manage a group of 60trainees in 30 minutes, comparedwith the traditional 10 or 12certified instructors needed forthe 3-4 hour course.

Whilst the effectiveness of theAHA 20 minute CPR DVDcourse has been shown to be justas effective as traditional coursesimmediately at the end of course,the all important questionremained: Could those learnedskills be retained long term?Additionally, early pilot studieshad not involved the critical skillsof choking rescue and AED use.Accordingly, a recent study(comparing traditional 3-4 hourtraining for CPR, choking andAEDs to a modified half hoursession for the same skills)examined both immediateperformance of these life-savingskills and comparativeperformance six months later.

In that study, several hundredsubjects, participating fromvarious positions and diverseeducational backgrounds, at the

American Airlines administrationheadquarters in Dallas, werestudied in a randomised,prospective manner. Theirperformances were compared usingblinded evaluations involving bothobjective measurements and videorecordings of performance. Theevaluations were conducted bothimmediately following training andat the critical six-month juncturepreviously shown to be bestcorrelated with long term retentionof skills.

This so-called C-30 course (CPR,choking and defibrillation in 30minutes) proved not only to be justas successful in terms of measuredperformance, but the results werethe same when trainee skills weremeasured at the six-month timemark, thus also demonstratingexcellent retention. In fact, AEDuse was superior using the five-minute training for this in the 30minutes course, compared with themuch longer traditional AEDcourses. Moreover, with no interimtraining to reinforce the initialdemonstration of skills, 93% of thepeople evaluated at six monthswere judged to be operating theAED adequately.

Community-wide CPR training?The success of the 30-minute CPR-Choking-AED courses is trulycompelling. If an employer, church,

about two years ago. Subsequentresearch demonstrated that byusing this technique adults couldlearn CPR successfully within 20minutes and perform basic CPRas well as those taught during a3–4 hour traditional course.

During 20 minute trainingsessions conducted by a‘facilitator’, each participant istold to open a large textbook-sizebox, which contains a small,inflatable manikin and a fewother small components,including a facemask. Thefacilitator then plays a video forthem to follow. After a quick,guided set-up, the trainees(numbering from 5 to even 500,depending on the logistics, videoscreen size and audio set-up)simply follow along as the videonarrator demonstrates thetechniques. First they learn chestcompressions, then mouth-to-mouth ventilation and laterintegrate the two steps at a 30:2compressions-to-breaths ratio.Then they practise for severalmore minutes. In fact,cumulatively, the trainees actuallydo more hands-on practice(almost continuously for about17 minutes) than those takingtraditional courses, becauseusually the latter must wait foranother trainee to finish his orher session with one of thetraditional bulky manikins.

Also in the 30-minute course,

already used in a certain area. Due toits modular configuration it could beeasily adjusted to the needs of a vari-ety of Emergency Medical Serviceproviders. To enhance recognition byhospital personnel, the print out couldalso match the style of the paper ver-sion. To maximise efficiency, most datais entered by checking boxes or is auto-matically received from diagnosticappliances via Bluetooth.

Since this new application runs onmobile hardware solutions, such asTablet-PCs or PDAs, apart from manualdata entry, additional information canbe added to the protocol. Digital cam-eras can capture images and videos ofthe patient, captured by digital cam-eras at the emergency site, can beadded to the electronic version of theprotocol. When under time pressure itcan be beneficial to simply audiorecord medical findings instead of typ-ing them at the site.

After completing the entire emer-gency protocol, a print out could becreated on a mobile printer built in tothe ambulance. Then the digital file canbe sent either via cell phone network(GPRS) or uploaded directly into thehospital system using Wireless-LAN.

The most important reason to imple-ment modern technology in emergencysituations is to improve or ease work-ing procedures. The digitisation ofpatient data in the out-of-hospital set-ting can only be an asset if easy to useand of a familiar pattern. Therefore anyapplication for use by EmergencyMedical Services must be adapted tothe needs of the paramedical and med-ical personnel, which was carefullydone when this new mobile emergencyprotocol application was designed.

Traditional or 30-minute CPR & AED training?

digital pens that analyse the writingprocess and translate viewed move-ments into digital letters, and finally,mobile devices such as PDAs andtablet-PCs.

The success of any solution formobile data digitisation is mainlydetermined by software - to process,transfer, store and display the informa-tion. Numerous programmes for allkinds of medical care needs are avail-able, but given their enormous variety,

Martin von Bergh

Paul E Pepe

SpiroStar: The software for this computer-based system is available in 14 languages,and it runs with all available Windowsoperating system versions


By Paul E Pepe MD MPH, Professorand Chair, Emergency Medicine,University of Texas, Lynn P RoppoloMD, and Ahamed H Idris MD

© M

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lung function testing systemERS spirometry standards

or civic leader wants to host alunch, or lunches, and suppliesthe inflatable manikins(available viawww.cpranytime.org) to everyemployee, church member orconstituent, the participants willnot only return from a half-hourlunch-break knowing how tosave a life, they also could takethe training kits home andbecome facilitators for theirfamilies and friends. Thus, inthe resulting ‘multiplier effect’,the number of trained lifesaverswould grow.

Additionally, due to thesessions’ shortness and becausefew resources are needed forinstructors and materials, morefrequent re-training could takeplace to improve skill retention.So, one can envision suchsessions being held routinely atthe places mentioned as well asother potential mass trainingvenues. A class could be heldanywhere if a big video screenand adequate sound system isavailable.

Long-term results would likelybe that more people in a givencommunity would be trained inthe latest CPR techniques,subsequently translating intomany more lives being saved incoming decades.

Contact:[email protected]

a serial interface or USB, deliveringreproducible and reliable results,Medikro reports. ‘Together with itscorresponding software Spiro2000,SpiroStar can be directly operatedwith all Windows-based operatingsystems, and can also be includedin database and hospital informa-tion systems.

‘By satisfying the latest ATS/ERSstandards, SpiroStar providesphysicians with the assurance thatit is conducting dynamic lung func-tion tests according to the latestinternational scientific require-

GE Healthcare and Germany’s DGAI(the country’s society for anaesthesiol-ogy and intensive care) are offeringtheir first clinical sciences researchprize, worth 60,000 euros. To be fund-ed by GE for the next three years, theaward aims to promote comprehen-sion of clinical practice in anaesthesi-ology, intensive care and emergencymedicine and pain therapy, via inten-sive clinical research.

Applications for the first GE/DGAIresearch prize closed on 15 February.Now it will be up to the panel ofjudges to decide on the first winner.The panel includes internationally

recognised medical professionals suchas Professor Peter M Suter, VicePresident of Research at the Universityof Geneva and Professor D PierreCoriat, of the C.H.U. Pitié-Salpétrière,and Chairman of the Dépt.D’Anesthésie-Réanimation in Paris, andis headed by Professor Sten G.E Lindahlof the Karolinska Institute, who is alsoHead of Research and Education atKarolinska University Hospital,Stockholm.

The award will be presented at thisyear’s anaesthesiology congress inHamburg (5-8 May), held by the DGAI.Founded as a medical/scientific society

ments. At the same time, the lungfunction testing system, composedof SpiroStar and Spiro2000, offersa guarantee of reproducible, reli-able and easily manageable testresults,’ Medikro says, adding:‘Another component of the systemis the hygienic, disposable flowtransducer. For calibration purpos-es, a calibrated, specially adaptedand easy to operate calibrationsyringe is available.’Details: www.medikro.com

One of the award’s initiators: DGAI’s newPresident, Professor Hugo Van Aken, Head ofthe Anaesthesiology and Surgical IntensiveCare Unit at Münster University Hospital

E M E R G E N C Y & I N T E N S I V E C A R ENEW GE/DGAI prize for research

in 1953, today the Society reports ithas over 12,000 members and contin-ues to encourage them to worktogether to scientifically expand andadvance anaesthesiology, intensivecare medicine, emergency medicineand pain therapies.www.dgai.de (‘Infoservice’section)

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Because you careEmergency Care > Perioperative Care > Critical Care > Perinatal Care > Home Care

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L A B O R A T O R Y

The new Olympus E-330 micro-imaging system for microscopyincludes the world’s first digitalSLR camera to show real-timeframe images on the LCD, thecompany reports. ‘The system isbased around a 7.5 Megapixelsensor, which together with anarray of unique features deliversincredibly sharp and vibrantimages directly onto a 2.5 inchhigh-resolution colour LCD.Other features of the micro

imaging system include a 1.2xadapter, RM-1 multifunctionremote control and a multi-cable,which can be linked to either a TVmonitor or PC.’

The system consists of theworld’s first digital Single-LensReflex (SLR) camera to featureLive View, making it possible toframe images on the large, colour,high-resolution liquid crystaldisplay (LCD). Olympus adds thatthe camera is easily adaptable for

use with anymicroscopevia its 1.2xadapter, andthe microscopecan also beoperated while viewing liveimages on a TV or PCmonitor.

‘The E-330 camerafeatures the latest generationMOS (Metal OxideSemiconductor) sensor that

produces full-scale7.5 Megapixelquality imagingduring continuous

viewing of livemicroscopeimages. Idealfor long-termimagingapplications,

“no touch”image capture can

also be achieved byusing the multi-function remotecontrol unit, whichcompletely eliminatescamera shake andvibration,’ Olympus

points out. ‘The newly

developed 7.5 Megapixel LiveMOS image sensor provides high-sensitivity, high-speed processingwhile maintaining superior imagequality through its high-resolution,Full-Frame Transfer (FFT) ChargedCoupled Device (CCD). Theadvanced sensor also capturesmicroscope images with accurateedge-to-edge detail, displayed invivid colour on any screen withexceptional clarity. The 100% fieldof view allows accurate framingand a designated area of the imagecan be enlarged up to 10x whilstviewing images under macroobservation.’

The camera presents continousLive View subject framing via a 2.5inch 215,000-pixel high-resolutionHyperCrystal LCD, which offersmany times the contrast ofconventional LCD’s and simplifiesframing and focusing, the companyadds. ‘This rear-mounted display isdesigned with advanced swivelcapability, providing super clearimages over a 160° viewing angle.The larger LCD also means theicons and text on the camera’smenu display are large enough foreasy viewing.’

When the camera is switched on,the Dust Reduction System shakesat 35,000 vibrations per second toremove dust and debris from itssensor.

An Auto-Connect USB transfersimages and Live images for viewingon a computer monitor. ‘Multipleslots support CompactFlash Type Iand II, MicroDrives or xD-Picturemedia cards providing users withconvenient multiple storagesolutions,’ Olympus adds. ‘The E-330 can also be controlled by theoptional Olympus cell* familyimaging software, which enablesfull camera control in live modeand image acquisition.’

New test to relievechemotherapy toxicityOlympus Life and Material ScienceEuropa, GMBH – Diagnostics(Olympus) and Saladax BiomedicalInc. (SBI) are to co-develop a bloodtest expected to help oncologists tomore effectively adminsiter the

chemotherapy agent 5-fluorouracil(5-FU) and thus reduce toxicity.

SBI will adapt the first of a lineof Personalised ChemotherapyManagement (PCM) assays forquantifying the concentration of 5-FU (Rubex/Efudex/Adrucil) incancer patients to the OlympusAU400 clinical chemistry system,while the parties finalise the termsof the non-exclusive multi-yeardistribution agreement.

Dr Salvatore J Salamone,Chairman and CEO of Saladax,further explained: ‘There is a largebody of published clinical evidencethat managing 5-FU dosing bymeasuring blood concentration hasa significant positive impact onresponse to therapy and reductionof toxic side-effects. However,today doctors have no clinicalrelevant tool by which to get thisinformation. Saladax plans tolaunch a simple 5-FU test withinthe year.’Details: www.olympus-europa.com

For use with microscopesWORLD’S FIRST DIGITAL SLR WITH LIVE VIEW

Gunter Danner MA PhD, studied history, economicsand international relations inGreat Britain, South Africa and the USA.

Today, he is personal advisor on socio-political andeconomic affairs to the CEO of TechnikerKrankenkasse, which is Germany’s third largest not-for-profit health fund.

In addition, Dr Danner is Deputy Director of thepermanent liaison bureau of the joint associations ofGerman statutory social insurance in Brussels. He alsoregularly lectures on socio-economic subjects,specialising in the international comparison of socialsecurity systems in France, Germany, Switzerland andSweden.

Along with major researchon questions arising fromEU-developments andenlargement, Dr Danneralso participates inPHARE/TACIS projects forsocial reform in all EastEuropean countries,including Russia.


F U T U R E S

Since the human genome wasmapped ‘systems biology’ cen-tres have sprung up all overEurope, including Bioquant in

Heidelberg, Germany.Systems biology is defined as the

quantitative analysis of molecular andcellular biosystems, which involvesexperts in life sciences, mathematics,physics and chemistry. Their aim is tofully comprehend the complex anddynamic processes in a cell, or organ,and visualise them. This could take 10–20 years.

‘Systems biology is a hot topic inscience,’ said Professor JürgenWolfrum of the Institute for PhysicalChemistry at Heidelberg University andfounding director of Bioquant, during aninterview with Meike Lerner of EuropeanHospital. When the human genome was

A ‘World HealthInsurance’COULD INTERNATIONAL SOLIDARITYBE ACHIEVED TO ATTAIN SUCH A GOAL?In a recently published article, a team from Médecines SansFrontières have suggested a ‘World Health Insurance’ to helpprovide healthcare for people in poorer nations (see box).Over 50% of the 42 countries carrying that healthcareburden would be European. We asked Gunter Danner MAPhD to examine the broader implications for these countriesif they became legally bound to contribute to such a scheme

From a Euro centrist’s pointof view, true global solidari-ty and a ‘World HealthInsurance’ are rather unusu-

al topics. For innumerable yearscalls for less, rather than more,social protection have been thenorm. Consequently, in WesternEurope most healthcare systemsare permanently battling againstshrinking funds and a noticeabledecrease in political relevance.Recent international research haspresented the idea of ‘health’ as ahuman right, enshrined by inter-national treaties and perhapssome day legislation. However, inpractice such rights might be quitedifficult to ensure. No insurance,no matter whether statutory orprivate, can guarantee ‘health’ toany individual. However, it canensure that people in need willreceive some treatment, irrespec-tive of their own solvency.

Thus the practical value of ahealth insurance for a sick indi-vidual is influenced by, for exam-ple, the generosity and decency ofthe scope of benefits offered, theavailability of medical care andthe ability of the insured to payhis or her dues as contributions ortaxes.

Even throughout the EU thisreality shows vast differences.Many systems are almost papertigers, making illegal co-paymentsinevitable. Lots of the 27 differenthealthcare models are under-fund-ed. Therefore, increasing out-of-pocket payments are quite nor-mal. Productivity does notalways guarantee quick treatmentrather than lengthy waiting lists.Even Central and East European

Countries, with mostly poor pub-lic systems, ask for heavy contri-butions. Backhanders may haveto be added on top.

Such contributions will be hardto get in Third World countries.Universal coverage – if possiblenot just on paper – is thus almostnon-existent. The idea of a uni-versal health fund, subsidised by‘rich’ countries and allottingfunds to those considered ‘poor’,therefore runs the risk of mixingup different levels of action.Nobody, not even Brussels, hasever insured a Member State.Health insurance is logicallyaimed at the individual, not theGovernment. In the eyes of many,paying Governments to do or toleave something has not lived upto expectations as far as the cre-ation of a better quality of life ineconomically challenged countriesis concerned. Consequently, theadditional ‘burden sharing’ of a‘World Health Insurance’(Author’s note: the term ‘insur-ance’ is misleading since noinsurance principle – social orbased on risks assessment – isinvolved) might ask the UK for anadditional US$4.4 billion; Francefor US$2.6 billion, and Germanyfor US$2.9 billion. (It remains anopen question, why Britain, withher problematic NHS, should payroughly the same as the US, orone third more than France orGermany, with their still far moregenerous systems of healthcare).Given the pressures on their ownsystems, local voters might notlike this idea at all.

On the other hand, the widen-ing gulf between well-to-do coun-

tries and those where most peopleare forced to live in appalling con-ditions should not be brushed asidesimply for reasons of local pop-ulism. Questions to be answered arestill perhaps more complicated thanjust another call for more money toalleviate poverty gaps betweenGovernments. Indeed, by concen-trating existing means on healthand other basic services of generalinterest, much might be achieved.Yet, the sometimes tragic politicalconditions in receiving countriesmay render this quite difficult (The history of the arms’ raceamong poor countries does notspeak in favour of many localGovernments). Initially, publicawareness in donating countriesought to be changed from the pre-vailing scepticism to a positivesocio-strategic vision. Thus struc-tural development aid, locally pro-vided, double and triple checkedagainst corruption, is of the essence.After all, millions of weary Westerntaxpayers rather than a few devotedThird World activists must be con-vinced that indeed more cash isneeded and will do some good.

This calls for a well-balancedapproach. More basic help andchange should be made directlyavailable to the suffering on thespot. Any anonymous global insti-tution telling others what they haveto do could add to the problemsrather than bring about a solution.At home, a new approach to socialissues in so-called ‘rich’ countriesunder a growing demographicstrain is important. Even here,injustice and poverty are unfortu-nately rising, albeit less horrifyingthan elsewhere.

Seeking life’schemical processes

Before he became founding director ofBioquant in 2005, physicist and physicalchemist Prof Jürgen Wolfrum headed a group of 50 scientists and students at HeidelbergUniversity. His many awards include the 1987the Philip Morris Research Prize, 1993 MaxPlanck Research Prize; 1999 BMW ScientificAward, and the 2000 Polanyi Medal of theRoyal Society of Chemistry

FUNDING The federal state of Baden-Württemberg funds the research building.

The mathematical models projects at the Centre for Modelling andSimulation in Biosciences are funded by Heidelberg University, KlausTschira Foundation, EMBL, German Cancer Research Centre (DKFZ), MaxPlanck Society and the federal state of Baden-Württemberg.

Within the German National Excellence in Science initiative, Bioquantwon the ‘Cellular Networks’ cluster (From molecular mechanisms toquantitative understanding of complex functions).

The Federal Ministry for Education and Research (BMBF) supports theViroquant project under the systems biology initiative ForSys (SystemsBiology of Virus-Cell Interactions).

The BMBF and DKFZ fund dSBCancer (System Biology of Signalling inCancer).

Optical firms such as Leica, Nikon and Olympus, provide specialisedmicroscopy equipment.

mathematics.‘Bioquant offers ideal conditions to

tackle this problem. Even the buildingwas designed to facilitatecommunication between the disciplines.Systems biology is a vast field. TheHeidelberg working group will focus onvirology and the cellular network. Ourconcept also encompasses a technologyplatform, primarily for high-resolutionmicroscope diagnostics and digitalimage processing. We want to developthe technological foundation to observecomplex cellular processes andcommunication between cells in vivo.We need diagnostic procedures thatdon’t interrupt or disturb thoseinteractions. Light is best suited toachieve this – so, for example, we areworking with laser microscopy on anano scale. Another procedure – the

In their article published in Plos Medicine (vol. 3, issue 12,2006. Pp.2174), Médecines Sans Frontières (MSF) membersGorik Ooms, Katharina Derderian and David Melodyquestioned: ‘Do we need a ‘World Health Insurance’ torealise the right to health?’

Although international recognition that health should beconsidered a human right has grown, the authors point outthat far less attention has been paid to any legal obligationto provide international assistance. They suggest two majorreasons why many countries avoid their obligation toprovide such healthcare assistance:1. The concept of shared responsibility. ‘Poor states can

blame rich states for not honouring their obligation toprovide assistance, thus leaving poor states withinsufficient means to meet their core obligations. Richstates can blame poor states - and each other -for notdoing enough,’ the MSF team points out.

2. The notion of ‘progressive realisation’, i.e. recognitionthat economic, social, and cultural rights cannot be fullyrealised in a short period. ‘This allows states to claim thatthey are doing, or have done, everything they can,’ theauthors suggest.

They then argue that a ‘world health insurance’ could solve boththose problems by defining rights and duties for both rich andpoor states. But how could such an insurance scheme work?

Ooms et al. cite the example of the Global Fund to Fight AIDS,Tuberculosis and Malaria. The creation of this fund, they say,‘…demonstrates the merits of ambitious thinking: the provisionof anti-retroviral therapy to people living with AIDS, previouslydismissed as unsustainable, became widely accepted as soon asthe Global Fund provided a long-term funding perspective.Other health interventions deserve a similar approach’.

The team’s suggested framework for a world health insuranceinvolves rich states paying a fair contribution and poor stateshaving the right to assistance for healthcare needs that theycannot finance themselves. The WHO has estimated that a stateneeds to spend at least $35 per person per year to financeadequate levels of healthcare. Ooms et al suggest that richcountries should be obliged to assist those countries unable toreach this financial outlay alone.

Their original article can be accessed at:http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030530

mapped, scientists had access to allinformation on a molecular level for thefirst time, the professor explained. ‘Withthis knowledge we can now begin tostudy the elementary chemical processesof complex molecules – the buildingblocks of life – this means the entirecomplex system operating in a cell downto the accumulation of cells into tissueand organs. We want to understand andvisualise these quantitative processes –a task that cannot be solved by onediscipline alone; this needs joint effortsof all life sciences, chemistry, physics and

single molecule technique - allows usto apply fluorescent markers toindividual molecules then track them.Finally, there’s cryo-electron microscopy,in which frozen cells can be studied ona nano scale. We hope to apply thesethree methods simultaneously, so wecan set off the weaknesses of eachindividual approach by the strengths ofthe others.’

The work should reveal how a viruscan dock on to a cell, penetrate themembrane and use certain proteinsinside the cell to proliferate. ‘We areparticularly interested in finding outwhich proteins the virus needs andwhich genes activate those proteins.With the European Molecular BiologyLaboratory (EMBL), we are building anultra-fast high-throughput microscopeto screen the genome and find outwhich genes are responsible for theproteins that help the virus. Then, oneday, we might be able to stop theproliferation of the virus and thus theinfection. The results of opticaltechniques are being combined withmathematical models. Both researchapproaches – screening the genomeand building mathematical models –will yield enormous amounts of datathat cannot be handled with normalmemory capacities. So we’re supportedby a high energy physics workinggroup, specialised in processing largeamounts of data – we are talkingabout petabyte, which means onemillion gigabyte.’

European congresses are nowbeing organised to draw the separatesystems biology centres together. ‘Thereis little danger of double work inresearch because the systems biologyfield is very wide,’ Prof Wolfrumreassured, adding that, in this complex,time-consuming research, exchangingresults is important. ‘The more centresthat work in this field, the faster wecan put together the pieces of thispuzzle. No doubt, the next few yearswill be thrilling and we’ll gain essentialnew insights into the functioning of ourbodies’.

The proposition


U R O L O G Y

Test combination predictshigh risk of relapse and deathin bladder cancer patients

A new testing approach haseffectively identified patients atthe highest risk of cancerrelapse after bladder cancersurgery, according to a studypublished in the February issueof The Lancet Oncology(http://oncology.thelancet.com.Vol 8 Feb 2007 91. ‘Bladdercancer and apoptosis: matters oflife and death’). ‘Bladder cancerrecurs in many patients afterradical cystectomy (bladder andsurrounding tissue removal).Conventional prognosticfeatures such as tumour grade,stage, and lymph-node statusare not accurate enough topredict outcomes in patientswith bladder cancer,’ explainedDr Yair Lotan, one of thestudy’s researchers at the TexasSouthwestern Medical Centre,Dallas, Texas.

For the study, the teamanalysed bladder samples, from226 patients, which had beenremoved during bladder cancersurgery. Using a tissue profiling

technique, the authors tested forfour different proteins (P53, Bcl-2, caspase-3, and survivin) whichhave been implicated in causingcancer. When hen expression ofall four proteins was altered, theresearchers found the patientshad a greater risk of developinga recurrence of their bladdercancer - and eventual death fromthe disease - compared withpatients who had no change ofexpression of these proteins. ‘Wefound that evaluation ofcombined apoptosis biomarkers[markers of cell death] status canhelp identify patients at high riskof recurrence and death frombladder cancer after radicalcystectomy, independent ofconventional prognosticfeatures,’ said Dr Jose Karam,another member of the researchteam.

Lead researcher ProfessorShahrokh Shariat, the teams leadresearcher added, ‘…clinicaltrials are needed to targetbladder cancer in patients with a

high number of [alterations], asthese patients have poor survivalrates with current treatmentsand might benefit the most fromexperimental therapy’.

In a Lancet Oncology‘Reflection and Reaction’ link(see website), Dr Francisco Realand Dr Nuria Malatscommented that this is the firststudy in which multipleapoptosis markers have beenused together to assess the valuein improving accuracy ofpredicting outcome for patientswith bladder cancer. However,they add: ‘Although the paperprovides important, novelinformation, the findings do notcall for any change in currentclinical practice.’

They point out: ‘Ideally, thesehypotheses should be tested inmulticentre prospective studiesin the context of eitherstandardised clinical care ortherapeutic trials. Even then, theresults will need to beindependently replicated before

PROSTATE CANCERClinic’s technique preserves continenceand potency in 96% of patientsThe Martini Clinic, a privateclinic located at the Hamburg-Eppendorf University Hospital(UKE), specialises exclusivelyin the diagnosis and therapyof one medical condition:prostate cancer.

Modelled on similar clinicsin the USA, such an approachis unique in Germany, but hasproven a success in just twoyears. During the first year,200 patients underwentsurgery, generating a turnoverof 2.4 million euros. ‘Lastyear, our success continued,’said Dr Michael Moormann,Director of the Martini Clnic.‘We performed 450 surgicalinterventions.’ The clinic metgrowing demand by increasingits beds from nine to 17.

Martini patients are nowinternational. Along withGermany, they hail fromcountries such as Greece,Cyprus, Sweden, Austria,Poland, the Ukraine and,increasingly, from Arabiccountries. For all of them thefacility not only provides highperformance medicine andamenities similar to those of aluxury hotel (meals are à lacarte), but it is alsoconveniently within easy reachof Hamburg airport, andoffers a specialaccommodation package forfamily and friends. Private

NEW

rooms have en suite bathrooms,refrigerators and multimediaterminals with internet access.

More importantly, the nurseshave been trained in the care of

prostate cancer patients, and mostimportant of all, the two renownedheads of surgery enjoy an excellentreputation, throughout Europe, fornerve-preserving radical

Professor HartwigHuland, one of the

inventors of theprocedure

The clinic’s entrance hall echoes thetop class accommodation within

Dr Markus Graefenperfected the

technique with theprofessor

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Tilting MRI

and

Fusion Imaging

Discover

at ECR 2007

News . . . . . . . . . . . .

. . . . 1-5

Intensive care . . . . . . . . 6-9

Laboratory . . . . . . . . . . . .

10

Futures & research . . . . . 11

Urology . . . . . . . . . . . .

12-13

Hygiene . . . . . . . . . . . .

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IT . . . . . . . . . . . .

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Global events &

medical tourism . . . . . . . 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

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

F E B R U A R Y / M A R C H 2 0 0 7

5, 12, 13 Urology

New study to be presented at

EAU Congress; plus

prostate

cancer and

currentreports

6-9 Intensive care

Strong role for anaesthesia in

MRI procedures. Draeger’s

ventilator

for use

with 3-Tesla

New Labour Code causes

confusion and anger

The amended version of the new

Czech Labour Code stipulates

that emergency working hours

and overtime in hospitals and

social care institutes be altered so

that employees are paid no less

than they receive for regular

working hours. Many strongly

oppose this change - including

top Czech EU representatives

such as MEP Cabrnoch (Civil

Democratic Party), who said the

Code imposes even more regula-

tions than the EU requires. A key

issue, he said, is whether or not

being ‘on standby’ for work is to

be included in hours worked.

Some hospital directors say it is

too early to assess the Code’s

impact on local wages. Physicians

must be reachable by phone,

24/7. However, on standby, they

cannot stay in hospital, but must

be home to receive emergency

calls. Staying in hospital is work!

That’s too expensive, ICU man-

agers say. ‘We are sending duty

physicians home, and some will

also be working in shifts, because

it’s cheaper for us.’

The reason is clear – they want

to save money by paying doctors

at work only a fraction of what

they deserve according to the EU

norm and Labour Code. Staying

by the phone is not work!

Many think wages will remain

the same as now and, generally,

physicians accepted the changes

to their working hours without

much discontent. Any salary

changes will be soon be known

from the new work contracts

being prepared in line with the

new Labour Code. If adverse,

effects will be mostly felt in

ICUs, operating theatres,

orthopaedic and plastic surgery

units. Right wing politicians blame

this situation on those who

pushed the bill through parlia-

ment - the Social Democrats and

Communists. Some note that

Commissioner Spidla’s draft EU

labour regulation will clarify the

matter and define what work is

to be included in working hours.

Rostislav Kuklik reports on the effect of EU rules on Czech healthcare

16-18 IT & telemed

iSoft - Alive and kickin’.

Plus: IT in Italy, and EU

e-health news andevents

FREE INSIDE16-page pull-out

The ECR special supplement plus

presentations from the

EH Hospital Manager Symposium

French fundraisers

fund geriatric wards

A nationwide fundraising campaign

aimed at improving the lives of elderly

hospital patients collected €1,750 mil-

lion last year, beating the 2005 total

by more than 17%.

Cash raised by the campaign, called

‘Operation + de Vie’, will help to fund

363 projects in geriatric wards

throughout France. These are imple-

mented with the help of the medical

teams concerned and include develop-

ing activities for patients, helping to

relieve their pain and improving recep-

tion facilities for visiting families.

Other projects include buying equip-

ment to provide a hairdressing and

beauty salon, supplying special anti-

bedsore mattresses, and buying a pro-

jector and films for long-stay patients.

* European Hospital will feature the

potential value of employing a

professional fund raising manager to

augment investment funds in hospitals.

Read about our special managers

symposium, to be held at the ECR this

March. ECR supplement (centre pull out).

Pages 12–13. Also, go to our website:

www.european-hospital.com

Vitamin pills increase

mortality Denmark – Vitamins A, E and beta

carotene, taken singly or with other

supplements, ‘significantly increase

mortality’ according to a review study

released by the Cochrane Hepato-

Biliary Group* at Copenhagen

University Hospital. Their study, pub-

lished in the Journal of the American

Medical Association (JAMA), did not

find evidence that vitamin C could

increase longevity, but did find that

selenium tended to reduce the risk of

death.The Copenhagen researchers

analysed 68 previous trials of the five

antioxidant supplements, involving

232,606 participants, and say their

findings contradict those of observa-

tional studies that claim antioxidants

improve health. ‘Considering that 10-

20% of the adult population (80-160

million people) in North America and

Europe may consume the assessed

supplements, the public health conse-

quences may be substantial.’

The team reported that 47 ‘low-bias

risk’ trials, with 180,938 participants,

were ‘best quality’. Based on those

low-bias studies, vitamin supplements

were found to be associated with a 5%

increased risk of mortality. Beta

carotene was associated with a 7%

risk, vitamin A with a 16% risk and vit-

amin E with a 4% risk. No increased

mortality risk with vitamin C or seleni-

um were seen.

* The Cochrane is an international

network of experts who carry out

systematic reviews of scientific evidence

on health interventions.

ECR 1-16Radiology

Current aggressive IVF

treatments put patients at riskDutch researchers show

health and cost benefits

in ‘milder’ approach

The Netherlands – In-vitro fertili-

sation (IVF) is an overly aggres-

sive treatment and needlessly

exposes childless women to sub-

stantial risks of complications and

serious discomfort, according to

researchers at the University

Medical Centre, in Utrecht.

During standard IVF treatment,

high drug doses are used to stimu-

late the ovaries – but these cause

Replacing one embryo, and freezing

another for use in a second attempt

if necessary, cut the twin rate to one

in 200 births compared with one in

eight births when two embryos

were replaced at the same time.

Twin births have risen by 66% in

Britain from 6,000 a year in 1975

to almost 10,000 a year today, dri-

ven by the increase in IVF. One in

four IVF pregnancies leads to the

birth of twins compared with one

in 80 natural conceptions.

An expert group commissioned

by the Human Fertilisation and

Embryology Authority (HFEA) in

the UK recommended last October

that tough controls be introduced

to cut the number of patients in

whom two embryos are replaced.

The report is to go out to public

consultation next month and the

HFEA is due to announce its new

policy in the autumn. A spokesman

said: “We know that multiple births

are the single biggest risk for moth-

ers and children.”

(The Lancet. 2/3/07. ‘A mild

treatment strategy for in-vitro

fertilisation: A randomised non-

inferiority trial’).

menopausal symptoms such as

sweating, flushing, depression and

loss of libido for two to three

weeks. From a study comparing

mild and standard IVF treatments,

which involved 404 patients, the

Utrecht team concluded that

lower drug doses are not only as

effective as higher doses, but also

less unpleasant.

Reporting in The Lancet Bart C

J M Fauser and colleagues said:

‘Our findings should encourage

more widespread use of mild

ovarian stimulation and single

embryo transfer in clinical prac-

tice. However, adoption of our

mild IVF treatment strategy would

need to be supported by coun-

selling both patients and health-

care providers to redefine IVF suc-

cess and explain the risks associat-

ed with multiple pregnancies.’

The mild version also proved

cheaper at €8,333 per pregnancy,

compared with €10,745 for stan-

dard treatment. The researchers

also point out that replacing one

embryo in the womb at a time,

instead of the usual two embryos,

achieved almost the same live birth

rate – 44% – over a year, whilst it

also dramatically cut the chances of

producing twins

Also writing in The Lancet, IVF

specialist Professor William Ledger,

of the University of Sheffield, com-

mented that as success rates in IVF

have risen in recent decades, atten-

tion has turned to improving the

safety of the procedure. ‘Some

patients want to complete the pro-

cedure as quickly as possible and

see twins as the most desirable out-

come,’ he added. ‘While 75% of

IVF treatment in the UK continues

to be paid for by the patients them-

selves, many couples will opt for

double embryo transfer because it

is much less costly.’

It was pointed out that the stan-

dard treatment could produce

twins but using the mild treatment

to produce a single baby would

mean the patient paying for a fur-

ther treatment cycle.

Multiple births carry a higher

risk of complications for mother

and babies, including an increased

risk of being born prematurely.

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Signature Date


U R O L O G Y

Since 13,000 urologists attended lastyear’s congress in Paris, a similar num-ber is expected in Berlin, making theEAU the second biggest internationalurology event (after the AmericanUrological Society’s congress). ‘Itbegan as a European congress, butover the last few years has increasing-ly developed into a world congress,’explained Professor Dr Udo Jonas(right), Head of Hanover MedicalSchool’s Urology Department and EAUSecretary General and this year’s

The 22nd Annual Congress of theEuropean Association of Urology (EAU)

President. ‘We expect, for example, alarge delegation from Iran. Also, Japanhas always been very well represented.With the accession of the EasternEuropean countries, we gained valu-able new discussion partners. The glob-alisation of medicine has long been afact. Medicine knows no borders.’

During recent years oncology issuesproved particularly popular at the con-gresses, he said. ‘So one of the majorareas this year will be prostate cancerdiagnosis and therapy. The agenda is

cussed during the following days.The organisers point out that, since

the EAU congress was last held inBerlin, it has become a particularlyattractive venue – for it is now a thriv-ing, modern and exciting city, withboth historical and impressive contem-porary buildings standing side by side.‘So,’ the professor added,‘we are looking forwardto being the hosts andare certain that thisyear’s congress will bean enjoyable and enlight-ening experience for all.’Details:www.eauber-lin2007.org

clinical application is justified.These studies will require fiveyears or more of follow-up,depending on sample size, toachieve the number of eventsnecessary to reach statisticalpower. Because many othermarkers are rapidly beingreported (e.g., molecularprofiling), it would be moreefficient to assess them withinthe same studies, to bettercompare their predictiveaccuracy. Meanwhile,confirmation in large, highquality, retrospective studiesmight be warranted; thisstrategy could allow for a pre-screening of the many competingmarkers, to reduce the numberof hypotheses to be tested inprospective studies, and thelikelihood of false-positiveresults.

‘The major challenge thaturologists, oncologists,pathologists, and generalscientists face is to integratetheir scientific interests andwork together in large,collaborative, prospective studiesin order to answer questions ofclinical relevance. It is certainlynot an easy task, but it is amatter of life or death.’

Contact: Dr Jose Karam, UTSouthwestern Medical Centre,Dallas, USA. Phone: 001-214-417-7687

divided into 13 sections, which coverthe entire field of urology: andrologicalurology, female urology, male genitalsurgery and reconstructive urology tooncological urology, transplant urologyand urological research, imaging andpathology – to name a few. The chair-person of each section is responsiblefor the programme, both in terms ofconcept and realisation. It is already atradition that all sections meet duringthe first day, and the results and evalu-ations will then be presented and dis-

prostatectomy. This ‘soft’ surgicalprocedure, combined with highquality care, means the Martinipatients can be discharged withinsix days – particularly appreciatedby businessmen.

Invented and developed by UKEHamburg, the success of thisprocedure depends a lot on thesurgeon’s experience. Entry is viathe abdominal wall, so the nervebundles running along theprostate gland are preserved.Professor Hartwig Huland, whohas been director of the UKEUrology Department since 1992,was one of the inventors of theprocedure. He and Dr MarkusGraefen perfected it and, to date,they have carried out thisoperation more than 5,000 times.

In addition, the professor’scurrent studies impressivelydemonstrate that potency andcontinence can be maintained in96% of patients.

According to these two chiefsurgeons, today the surgicalremoval of the prostate isconsidered the gold standard forpatients with localised prostatecancer. ‘The soft surgical methodthat we have perfected has provedmuch more successful than newtechnologies,’ Professor Hulandpointed out.

The clinic also takes aninnovative approach to drug-based therapy, which aims toimprove potency after surgery. DrGraefen explained: ‘Theprecautionary therapy withpotency-increasing medication inthe particularly vulnerable post-operative phase substantiallyincreases erectile function.’

The clinic obviously also offersall the established therapies thatare adapted to fit the health andpersonal situation of theindividual patient. ‘The range ofservices we offer is unmatched inGermany,’ Dr Graefen confirmed. Details: www.martini-klinik.de

Berlin, Germany21-24 March

This is different inCritical colonisation: In this statebetween colonisation and localinfection there is increasedexposure to bacteria. There are noobvious signs of healing and thefirst signs of infection are present.If granulation tissue is present itappears sensitive. There is anincreased production of woundexudate, healing is delayed andpockets may develop as well asdiscolouration with surfaces thatcause intensive, malodoroussmells. Local pain can develop orexisting pain may intensify as asign of an active infection, which ischaracteristic ofInfection: Here we see the classicand systemic signs of infection:Redness, heat, swelling and pain,along with multiplying bacteria.Oedemas develop around thewound, its surroundings aresensitive to pain, there is increased


H Y G I E N E

NUTRITION AND HEALTH14 million European children are overweightAccording to figures released in 2006 by the International Obesity Task Force(IOTF), around 14 million children, aged 7-11 years, are overweight - and threemillion of these are obese. Each year 400,000 overweight first-graders enterschool. Most of the overweight kids live in southern Europe, but northernEurope is catching up: the steepest increases in the number of obese childrenhave been recorded in England and Poland.

The health consequences for these children are well known. They run a sig-nificantly higher risk of cardiovascular problems, diabetes or joint disease.Psycho-social problems further exacerbate the situation. Last, but not least,come the economic consequences. According to IOTF estimates, 2-8% ofhealthcare costs in western European countries are caused by overweight andobesity. A further increase is expected.

When is a child considered overweight?Internationally, the agreed method to determine of the nutritional status ofchildren is the Body Mass Index [BMI = weight/height2 (kg/m2)]. Modernscales and measuring systems, made, for example, by seca, calculate the BMIautomatically after height and weight have been determined.

In children and teenagers the BMI is age and sex specific due to changes inthe amount of body fat. Consequently, these factors must be taken intoaccount: Sex specific age percentiles were established with the 90th BMI per-centile being the cut-off value. This means the BMI of 90% of all children of acertain age lies below this cut-off value. If the BMI is above this 90th per-centile, that child is considered overweight; if it is above the 97th percentilethe child is considered obese.

Definitions: Obesity or adipositas?In children, weight fluctuates for many reasons, so an increase is not neces-sarily problematic. The word adipositas is used when body fat increases tosuch a degree that it affects a person’s health.

The fact that increasing numbers of children are overweight cannot bereduced to a single factor. According to experts contributors to this escalatingproblem are: food high in fat and energy dense; changing eating habits; over-all lack of physical exercise and their social background. Therefore any treat-ment should apply a multidisciplinary approach and aim at a sustainablelifestyle change. Better records reveal more bugs

Clostridium difficile has killed more patients than MRSAUK - According to new figuresobtained from death certificatesby the Office for NationalStatistics (ONS) deaths involvingClostridium difficile rose by 69%to 3,800 in the 2004-05 period,whilst MRSA increased by 39%to 1,629. (In two hospitals in onecity, C. difficile was linked to thedeaths of 12 patients in just fourweeks and, in another city, in oneeight-month period, at least 49people died after catching C.difficile).

Although the bacteria werementioned on the deathcertificates, the ONS pointed outthat does not mean they were theactual cause of death.

In addition, this apparentincrease in cases might be due togreater public awareness ofClostridium difficile, and so anincrease in recording its presenceon the certificates, the ONSsuggested.

Lord Hunt, the British HealthMinister, agreed with thispossibility, but said it nonethelessremains ‘…a major challenge forthe NHS and a top priority forgovernment’. However, he addedthat tough hygiene targetsshowed that the NHS isbeginning to see significantreductions in MRSA infections.

C. difficile, lives up to its‘difficult’ name. Alcohol handrubbing and other measures thatcombat MRSA appear to havelittle effect on these bacteria,which produce spores thatbecome airborne, and can survivewell on surfaces for some time.

What wounds tell usBy Heidi Heinhold

IMAG

ES C

OURT

ESY

OF C

OLOP

LAST

Every day, patients areadmitted to surgeries,hospitals and outpatientclinics with chronic wounds.

Careful inspection gives a woundtherapist clues to the appropriateprimary care required even beforefurther diagnostic procedures arecarried out. So what do the clinicalsigns and symptoms tell us?

Wound surfaceNot all surfaces indicate woundinfection. There are greasy whitesurfaces that are hard to detachfrom the wound and look like pus.However, this is actually fibrin that

has to be removed when treatingthe wound but which is not a signof bacterial colonisation orinfection. Bacterial colonisation isdifferentiated as follows:Contamination: Bacteria are presentin the wound but they are notmultiplying. The granulation tissueappears rosy, the healing process isnot affected, the typical woundsmell does not develop; thisappearance is also found in Colonisation: Here the wound iscolonised with germs which canmultiply but the patient andwound healing are not yet affected.

Microfiltrex Biofil PES filter cartridges

Despite thorough cleansing, endoscopytools can be re-contaminated becausenon-sterile water is used for the final

rinse. Biofil PES filters, developed byMicrofiltrex ([email protected]) can make that water bacteria-

free during an automatedendoscope reprocessing (AER) cyclebecause, the firm reports, they are

composed of an asymmetricpolyethersulphone membrane that

enhances bacterial retention.‘They are manufactured in class10,000 clean rooms, using FDA

approved materials, andvalidated in accordance with the

HIMA guidelines for sterile waterprovision,’ the firm adds.

The filters are available as point-of-use capsules or water treatment

system cartridge filters suitable foruse with most OEM systems.

development of resistance.Pseudomonas aeruginosa isphenotypically resistant to silver– one should use only dressingstested and certified by themanufacturer concerning theireffectiveness against this species.

Wound rimChronic wounds, particularlythose found on the lowerextremities, point to underlyingdiseases not apparent ordiagnosed for years. Each causesa typical appearance of the rim ofa wound so that the therapist canstart treatment accordingly.

An irregular, non-horny rim,independent of a warm foot anddistended veins, can indicate anulcus cruris venosum (venous legulcer). A regular wound rim withkeratosis, independent of a cool,

pale to bluish discoloured, andnon-oedematous leg, canindicate an ulcus crurisarteriosum (arterial leg ulcer).

A regular, slightly raised andhorny wound rim that almostlooks cut out with warm, rosybut dry skin can be an indicationof undiagnosed or insufficientlytreated diabetes mellitus.

We purposely did not showthe fourth criterion, woundexudate, because there is not anunambiguous correlation withcertain underlying diseases andthe resulting wound careprocedures, which we have onlybeen able to hint at. Theimportant issue is to increase theclinical awareness of the signsthat make wound diagnosispossible even at the first contactwith the patient. This is thenfollowed up with furtherdiagnostics, particularly withregard to microbial colonisation.

However, vigorous disinfectantcleansing of affectedenvironments and the hands ofhospital staff is effective.

From the death certificates itwas seen that most of them, fromboth types of bacteria, were ofolder patients.

Pseudomonas aeruginisa Staphylococcus aureus

Contaminated/colonised woundInfected wound

secretion of (as the case may be)purulent fluids. The patient maydevelop a fever and the bloodcount may show an increasednumber of leucocytes.

Wound smellSmell is one of the first signs ofan infection caused by certaintypes of bacteria. It is necessaryto carry out an antibiogram andresistance determination to treatthe pathogens systematically.Staphylococci and streptococci –particularly the MRSA strains –initially do not cause specificsmells, which makes earlyidentification difficult.Suspected MRSA/VRE infection:These pathogens cause neithersmells nor colourings of thewound cover. As the woundsmay have existed for months oreven years it is advisable to carryout a germ and resistancedetermination to prevent further

Patient safety duringendoscopy

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

How much IT does healthcare really need?The question is increasinglysignificant. Informationtechnology (IT) has thrust itselfinto all corners of life – someargue for better, some forworse, largely because efficientelectronic networking cannothappen overnight. Thusgatherings to share experiencesare valuable, as seen in theBerliner Klinik-IT Forum, atwo-day event in January,supported by the CharitéBerlin. The theme was: ‘IT as aprocess enabler – How muchIT does healthcare need?’

Subjects aired by some 100participants included: sensibleIT integration, networkarchitecture facility control andIT requirements of hospitalsand private practices; what apatient and a partner portalshould look like; what isneeded for inter-departmentalcommunications; whether ahospital’s entire workflowshould be served by one HIS, orwhether it would be better tohave individual solutions, builton dedicated databases, to fitthe needs of specificdepartments. And, finally, howthose choices would affect thetasks and responsibilities ofhospital IT staff.

a centralised IT infrastructurethat connects and controls alldepartments and tasks on oneplatform, down to the paperlesshospital. Implementing such aproject takes several years andrequires a solid design and closeco-operation with everybodyconcerned - as our projectplanning and implementation atSt. Olavs university hospital, inTrondheim, Norway, illustrates.’

When planning began in 2002to renovate and update the 100-year-old St Olavs, the installation

of state-of-the-art information andtelecommunications technologieswere included. Partnered by severalhard- and software groups (e.g.Cisco) Hewlett Packardimplemented an integratedinfrastructure for speech, data andvideo communication, which alsoserves as a platform for all thehospital’s clinical and administrativeapplications. More information onthis and other hospitals with similarsystems can be accessed onwww.hp.com (Enterprise section).See also: www.stolav.no

EH reporter Denise Hennigasked Thorsten Matthies, ofHewlett Packard’s DigitalHospital Business Developmentdepartment, for his thoughts.‘Today hospital IT is still seensomewhat as an appendage,’ heresponded. ‘But information andtelecommunications technologiesshould be regarded as a strategicissue by hospital management.This requires a change ofattitude. However, change canonly be brought about by amanagement that focuses oneconomics and is prepared totake tough decisions and breakup ossified structures. Theadvantage is obvious: the newtechnologies will help tooptimise primary and secondaryprocesses and thus realisesavings.’

Those new technologies arenot free, he pointed out. Basicinvestments are required thatdiffer from hospital to hospital,he added. ‘However, if you lookat the total costs of a hospital,those investments will have paidoff within three to four yearsbecause they optimise processesand workflows.’ Since these newtechnologies need to be operatedand further optimised, future ITbudgets need to be increased. InGermany, hospitals have takenjust a few initial steps on thelong road towards the digitalhospital. Currently, mostlyindividual hospital areas –administration, radiology,laboratory - have IT solutions,i.e. they are interfaced, but stillisolated solutions. ‘We developone-stop-shoppinginfrastructures and look at thehospital as a whole, because ‘Wewant to get away from nichesolutions,’ Thorsten Matthiesexplained. ‘We look at processesin a hospital and, based on thisanalysis, develop a seamless andintegrated solution. We aim for

Management must taketough decisions and break

up ossified structures

www.seca.com

If you were a seca, people would smile at you a dozen times a day. Not only doctors

and nurses who know that the seca is a reliable precision instrument but also dealers

for whom the sale of the high-quality seca technology is always a profitable pleasure.

Because, as the world’s Number 1, seca supplies products which are extremely good

value but at the same time ensure margins which, on the sales side too, always evoke

the seca attitude: real satisfaction.

A seca sees satisfaction.The best quality simply makes sure business is good.

29_01_476_EH_RZ_.indd 1 15.02.2007 10:57:13 Uhr

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


IT introduction is increasinglyconsidered a strategic element,since it is capable of supportingdifferent decision processes atvarious levels (top management,middle management andprofessionals) and guiding themtowards concrete objectives: costcontrol and containment,improved efficiency, evaluationand enhancement of servicequality. Italy has a specific policyto improve IT implementation,particularly in publicadministration. Central topics:● digital management of

administrative workflows● use of digital signature and

management of documentsworkflow (signature,distribution, conservation, etc.)

● the use of only digitaldocumentation (paperless)

● use of electronic smart cards(CIE Electronic Identity Card,CNS National Card forServices)

● development of a nationalnetwork connecting publicadministrations.

All public administrations andhealthcare structures are shiftingtowards those objectives, andsome actually represent a beaconin IT implementation.

In recent years, Treviso LocalHealth Authority ULSS 9, inVeneto, has invested in thedevelopment of technologyprojects, in the implementation ofICT prototypes and in theadoption of telemedicine servicesand applications. This hasresulted in considerableimprovements for users andproviders alike.

Treviso is improving itshealthcare services by setting-uptelemedicine applications and fulldigital management of medicaldocuments. Treviso Hospitalleads two important, closelyconnected projects: HealthOptimum and Escape/TeleMed-Escape. It also manages Near toNeeds, an innovative satellitecommunication project.

Approved and co-funded by theEuropean Community within the

ITALY

By C Dario, General Director of Treviso ULSS 9;S Giovannetti, IT and Project manager of ULSS 9, andE Procaccini, of the Near to Needs project working group

eTEN programme, thetelemedicine project HealthOptimum involves Italy, Spain andDenmark. Its aims are to validateexisting application experiencesand demonstrate the value oforganisational, procedural,technological and medical-legalpractices applied in neurosurgicaltele-counselling and tele-laboratory - services perfectlyextendible to other specialities.This is possible through thesignificant re-engineering ofprocesses obtained fromEscape/TeleMed-Escape projects,which developed a fully digitalsystem of signing, transmitting,

delivering and storing clinicaldocuments, and maintaining theprivacy and security of healthcaredata.

Health Optimum became the‘Best e-TEN project of 2005’ andwill be financed fordissemination, extending theproject experience to otherspecialties and other countries,namely Sweden and Romania.

The satellite platformRomania is already a Trevisopartner in the Near to Needs(telemediciNE via sAtellite tobRidge iTalian and rOmaniaNhEalthcare and EDucationalServices) project. Co-funded bythe European Space Agency(ESA), and important privatesupporters such as GruppoVeneto Banca, (Veneto Banca andone of its subsidiaries, BancaItalo Romena), the Near toNeeds project will develop andvalidate a pre-operational serviceto support diagnosis, treatmentand medical training betweentwo local health authorities in

● A tele-counselling position forreal time consultations betweenTreviso and Timisoara specialists,to evaluate and/or discussdifficult cases (virtual referral andtele-counselling) e.g. suspectedstroke or head trauma; theteleconsultation will be tested forneurosurgical and cardiologycases.● An e-learning service to trainstaff and nurses: for academicpurposes videoconferencesessions between physicians willbe organized and lessons fornurses also managed.

To share clinical informationrelative to a patient record (tests,

radiological images, reports, tele-counselling opinions,…) thecreation of an electronic patientrecord (EPR) is envisaged. Asystem based on the I.H.E.Infrastructure TechnicalFramework XDS (ExtendedData Service) will be used torealise the EPR, while thetelecounselling repository is setup according to the XDS profilearchitecture.

This will allow physicians inthe polyclinic and specialists inthe centre of excellence to accessa patient’s documents, naturallyin accordance with locallegislation for personal dataprotection.

Italy – After five months’ work, thefirst installation phase of Agfa’shospital and clinical informationsystem (HIS/CIS) Orbis for theGruppo Malzoni (Malzoni Group ofhospitals), has been completed atthe Clinica Medica Malzoni, inAvellino, and staff are alreadyworking with the system.

Agfa reports that four Orbismodules (Master Data & Security,Ward Graphic, MedicalDocumentation and Order Entry &Result Reporting) were installed inthe hospital’s obstetric-gynaecolo-gy department, which has 90 bedsin two different sites.

In the second project phase, theAgfa HealthCare HIS will be rolled

ORBIS PROJECT: FIRST PHASE CONCLUDEDout to the other hospital wards,the Laboratory InformationSystem (LIS) of the hospital groupwill be interfaced and AgfaHealthCare’s RIS/PACS (RadiologyInformation System / PictureArchiving and CommunicationSystem) will be implemented.

In the third and final phase,other clinical modules of Orbis areto be implemented.

The Malzoni Hospital Group,one of the largest private health-care groups in southern Italy, anduser of Agfa HealthCare’s CR solu-tions (Computed Radiography),directly or indirectly controls over500 in-patient beds and a series ofout-patient facilities in the

Campania region.Agfa speculates that, apart from

the fact that Orbis is already usedby 400,000 people daily, in 750hospital sites throughout Europe,Malzoni chose the firm as an ITpartner due to the conceptualdesign of the core system of Orbis.‘It is inherently based on processes,with macro- and micro-workflowsand functions that can be tailoredto the specific needs of its hospi-tals. The group now has the possi-bility of creating control nodes forits key processes, resulting in directtrace-ability and accountability ofall decisions and interventions. Anadditional reason for the hospitalgroup to opt for Orbis is that the

core system can be easily connectedto all existing departmental systemscurrently in use in the group.’

Apart from full-documentation ofmedical care, and trace-ability,Antonio Pernice, Managing Directorof the Malzoni Group, said: ‘It alsoenables us to easily analyse theresponse times and draw our atten-tion in case of organisational bottle-necks…. enabling us to perma-nently fine-tune our current process-es.’

Ruggero Lietti, Agfa HealthCareCluster Manager, Italy & Greece, alsopointed out: ‘With Orbis, the MalzoniGroup will be able to introduce theElectronic Patient Record (EPR)throughout the hospital group.’

The Treviso ULSS 9 experience

two different geographical areasof the continent: Treviso andTimisoara (Romania). Begun inJune 2006, this project will endin June this year.

A healthcare structure is to becreated in Timisoara CountyHospital and directly connectedto the Treviso local healthauthority. Using telemedicineservices when necessary, thestructure will provide care forItalian or Romanian employeesof Veneto companies in Romania,as well as to Romanian citizens.

After analysis of the usergroups and needs, the projectcoordination chose a telemedicine

application for experimentation,envisaging the following services:● Laboratory diagnostics throughPoint of Care Testing (POCT), toconduct tests in the polyclinics,then have the analysis and reportcarried out in a laboratory inItaly (tele-laboratory); this servicewill benefit from the HealthOptimum experience and, usingcardiac markers and a portableECG, will allow a quickevaluation of cardiovasculardiseases. ● Multi-functional radiologydiagnostics (chest etc.) with thepossibility of sending the data toItaly if a specialist opinion isneeded (tele radiology).

Connected areas


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

Teleradiology workflowThe polyclinic has an antibioticresistance reader to detect bacteriathat cause nosocomial infections –by far the commonestcomplications affecting hospitalisedpatients. As well as monitoringthose infections, the reader helpswith epidemiological studies. The Near to Needs project enablesus to:● promote synergies betweendifferent healthcare structures andtraining systems, cultures andworking environments betweenItaly (an EU member state) andRomania (new EU member state)● promote the integration andsustainability of ICT in dailyhealthcare provision andmedical/nursing training● analyse the potential of a satelliteplatform in healthcare, with a viewto ESA’s future telemedicineprogramme● provide first aid healthcareservices thanks to the help ofmedical and technical personnel inloco● provide specialist healthcarebecause qualified personnel areconnected remotely● act as a star centre for networkconnections with local RomanianCentres of Excellence● produce a complete electronicpatient record (EPR) that can beconsulted by the patient’s physician,wherever he may be● carry out epidemiological studiesto prevent and safeguard againstinfectious diseases by introducingnew tests and methodologies,following standards recognised at aEuropean and international level. In conclusion: For new EUmembers, such as Romania,delivering even basic health careand education to remote, sparselypopulated regions has long seemedan almost insurmountablechallenge. Today, thanks to theadvent of broadbandcommunication links, and advancesin compression and imageprocessing technology, telemedicineand tele-education applications arebecoming cost-effective solutions.

Satellite communication is anefficient support to broadcast andmulti-point communications formedical education and consultationsessions and, in particular, for theNear to Needs project, where aninter-hospital link has to beprovided.The use of telemedicine servicesshould be considered one of themost appropriate service solutionsto ● give prompt, effective answers forcritical or borderline medicalconditions ● provide safe diagnosis supportedby specialists in centres ofexcellence ● overcome geographic limitscaused by distance, providingqualified healthcare in a uniformmanner and optimising time andpatient transfer reduce costs,particularly those related toinappropriate admissions that couldbe avoided by specialist teleconsul-tations or to the expected reductionof transfers of borderline patients.

In this context satellitecommunications could play acrucial role in providingtelemedicine services. The satelliteconnection is actually moreversatile, reliable, seamless, fast,expandable and flexible than theterrestrial channel, granting a moreefficient workflow in deliveringhealthcare through telemedicine.

As already proved with the Nearto Needs project, and with its pastsuccessful experiences, the Trevisohealthcare unit always stands at thesharp end of technologicalinnovation.

IT EVENTS Med-e-Tel – the InternationalEducational and Networking Forumfor eHealth, Telemedicine and HealthICT - expects to host IT industry spe-cialists, government representatives,healthcare providers, payers/insurers

will include the World HealthOrganisation’s eHealth Co-ordina-tor, the Acting President of theWorld Academy of BiomedicalTechnologies (WABT/UATI-ICET/UNESCO) and the Director ofGlobal Healthcare Strategy atindustry giant Intel.

The ETSI (European Telecom-munications Standards Institute)Specialist Task Force on Telecarewill host a workshop focused on‘User Experience Guidelines forTelecare Services’.

A session titled ‘The Need forUser and Provider Involvement inthe Development of AgeingServices Technologies’ and con-ducted by the InternationalAssociation of Homes and Services

eHealth week Berlin 200716-20 April • Berlin

ITeG 2007 is also central in severalhealthcare IT and telematics eventstaking place within eHealth weekBerlin, which aims to promoteeHealth discussions and exchangeof views to present medium-termsolution options for cross-border,interoperable processes andEurope-wide electronic services.

’We are convinced that thebundling of high quality eHealthevents at the ITeG provides addedvalue for our specialist visitors,said Dr Wolrad Rube, Chair ofVHitG, adding: ‘This year we cancreate a European platform fromour national platform.’

Parallel events to IteG:● Within the EU Presidency of the

Council framework, the EUCommission and Federal Ministryfor Health (BMG) organised theeHealth Conference 2007(www.ehealth2007.de); whichwill present EU member stateseHealth activities, and targetthose responsible for telematicsin governments, health insur-ance, service provision and userorganisation at home andabroad. The eHealth Conferenceis on the level of EuropeanUnder-Secretaries of State.

● Telemed (www.telemed.de) isdirected at scientists in healthtelematics and telemedicine. Maintopics: electronic patient records(EPR), health portals, etc.

● The KIS Conference of the GMDSorganisers will be involved inworkshops.

● The European Connectathon of theIHE (Integrating the HealthcareEnterprise) will run in tandem withthese events. IHE is an internation-al initiative, in which users andindustry work on the interoper-ability of IT in medicine. AtConnectathon almost 140 IT sys-tems from some 300 developerswill be tested for compatibility.

The VHitG The VHitG – the registered associa-tion of healthcare IT solutions manu-facturers – represents manufacturerswhose products are used in over90% of German hospitals andaround 20% of doctors practices andpharmacies. The products includeclinical and administrative IT, com-munications and archive solutions,systems for pharmacists and materi-als management, laboratories, radi-ology and other specialist centres,and solutions for a sector-wide com-munication system.

Luxembourg18–20 April

for the Ageing (IAHSA), will inves-tigate how technology acts as acondition and driver for economicparticipation of senior citizens,with European comparative stud-ies providing lessons.

In addition, the InHam livinglabs (in-house adapted movement)will be highlighted. These havebeen designed to help demon-strate, test and design specificbuilding and living technology, toprovide maximum independencefor the disabled elderly.

Representatives from theAmerican Centre for AgeingServices Technologies (CAST) willdiscuss how emerging technolo-gies can improve life for the aged.

A regional (Be-Lux) seminar, co-ordinated by the Luxembourg CRP-Santé, will look at how new ITtools can improve healthcare per-formance and quality. Leadinghealthcare providers and policymakers from the region, as well asfirms such as Cisco, Hippocad, IBM,IRIS, Noemalife, will provide mar-ket and policy updates and pre-sent successful business cases.

At the event, Med-e-Tel, in asso-

Med-e-Tel 2007and researchers from 50 countries atthis 5th conference and exhibition.

Supported by the InternationalSociety for Telemedicine & eHealthand the European Commission, theorganisers reports that participants

ciation with Rays of HopeFoundation and HealthSpanInternational, will also set upa ‘funding’ roundtable discus-sion, drawing together thosewith specific healthcare needs(especially in developing andemerging regions) and sus-tainable solutions providers(using ICT tools) as well asrepresentatives from financegroups.

The organisers emphasisethat Med-e-Tel offers thechance to see and evaluateactual products, technologiesand services, as well as greatnetworking opportunities.www.medetel.lu

17-19 April • ITeG 2007

Following the success of three previous events theInternational Forum for Healthcare IT (IteG) expects over 250specialist exhibitors at its 2007 event.

Aimed at IT managers, healthcare decision-makers, doctorsand those responsible for IT in nursing, participation in theITeG specialist programme is free of charge.

The Luxembourg venue

Conference


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

The MPOWER projectaims to help older peopleto live independently andwell, in their own homes,for as long as possible.‘This objective influencesboth organisational,

reimbursement and technical issues. Inthis respect the project aims at the eas-iest part – the provision of technologythat enables the other changes,’ theorganisers explain. ‘The project surveysorganisational and reimbursementissues – issues that need to beapproached by every national andregional authority in near future.’ DrElly de Heus (above), of the EuropeanAssociation of Homes and Services forthe Aging (EAHSA) reports:

“In the MPOWER trials all profession-als supporting older people, as well asnon-professionals e.g. relatives, friendsand neighbours, will be included in anintegrated approach in which informa-tion is collected and shared on a need-to-know basis. The Proof-of-Conceptapplications will be tested in the projectin Trondheim, Norway and Krakow,Poland. The project focuses on creating

iSOFT Alive and kickin’

Once upon a time iSOFT was the software‘wunderkind’, with sales hitting the

billion-euro mark. Then disaster struck.Money and reputation vanished. But that

was once upon a time… today iSOFT isback - with fresh strategies aimed at a

happy ending. Daniela Zimmermann, ofEuropean Hospital, met with Peter

Herrmann (above), Managing Director ofiSOFT Deutschland, to discuss old

mistakes and new plans

Peter Herrmann: The English parentcompany caused the turbulence, which,in turn, affected the entire group. Themedia, particularly the English-languagepress, covered our story in detail. Therewere three major issues leading toiSOFT’s troubles: First, we were unableto meet the high expectations the mar-ket had placed in us, which forced us toissue profit warnings on the stockexchange. Next, there were deliverydelays due to a lack of co-ordinationbetween the systems integrators inEngland, which obviously didn’t pleaseour customers. And finally, we were a bitoverly optimistic in posting sales regard-ing licences and got out of sync with theactual time frame of projects implemen-tation. What this means is that we

recorded sales quite early but then –with the delays – had to post losses forquite a long time, so the overall picturelooked skewed. All those factors led tosubstantial changes within the compa-ny - most prominently on managementlevel, with the chairman, John Weston,temporarily also acting as CEO. It washe who brought in a consulting compa-ny to develop a restructuring plan, whichled to the new iSOFT company strategy.

A crucial part of this strategy is theimproved co-operation between indi-vidual countries. In the past, iSOFT wasa conglomerate of basically auto-nomous national companies, which allmore or less had their own agendas.That will change. We will present our-selves as a unity so that each of us can

Will other European countries dothe same as the Britain?Other countries are about to get start-ed, but England is the avant-garde.One reason is that the English health-care system was not as decentralisedas, for example, Germany’s. This meansthe Ministry of Health has more powerto implement things, to drive ideas anddevelopments. But, we have to admitthat healthcare IT in European coun-tries does not yet rate as high as inBritain. However, if the English modelis successfully implemented, I imagineother European countries will follow.Could other languages cause aproblem for Lorenzo?Not really. Lorenzo was designed forthe international healthcare market.

profit from their own successes and thatof the others. Case in point: Germany.Our lab solutions have been very popu-lar for some time; we are the undisput-ed market leader. Compared with iSOFTsolutions offered in other countries, theGerman version is also convincing. Inthe past, our head office did notacknowledge this, but now the Germansolution will be implemented interna-tionally. This means that, in the future,the centre of competence ‘laboratory’will be based in Germany.

To identify best practice, other solu-tions will be evaluated. For example, theGerman radiology solution has verygood chances to prevail within thegroup internationally.

We also moved competencies from

our development centre in India backinto individual countries. It turned out tobe a mistake that management of thecurrent product range had been movedentirely to India - it was more than theIndian organisation could handle partic-ularly because they were also busy withour new development - Lorenzo.

With the company restructuring, theindividual countries can again take overand manage systems that are marketedlocally, whilst colleagues in India contin-ue to focus on Lorenzo.Is Lorenzo iSOFT’s answer to yourcompetitors’ systems?As a matter of fact, Agfa or Siemenstried to counter our LorenzoSolutionCentre with their solutions. Theidea and design for Lorenzo (an inter-sectoral IT system for healthcare econo-my) are already a couple of years old.Nonetheless, it is still so innovative that,so far, our competitors haven’t reallybeen able to come up with an answer.Our solutions for administration, clinical& care, radiology and lab are convinc-ing. They offer an unmatched breadthand depth of functions. The competitionis still lagging behind.Lorenzo should have hit the marketlike a bomb. Why hasn’t it, if theproduct is ahead of its time?That’s not quite correct. Look at thehuge success in England; and also werecorded quite impressive sales shortlyafter its launch in Germany. We countleading healthcare facilities among ourcustomers and partners. But yes, wecould not yet establish Lorenzo as amajor contender. Therefore, whenrestructuring, we scrutinised everything– the philosophy, concept, design

–everything! We couldn’t identify a sin-gle fault. What might have been ourweak point was the lack of consistentimplementation of the entire productstrategy - to bring to market exactlywhat was on paper. We will do that now,but obviously we lost a lot of time andgave our competitors a chance to gainground.But in England you have anotherace in the hole: iSOFT’s Lorenzo ispart of the world’s biggest IT pro-ject - the National Health Service’sNational Programme for IT (NPfIT).Right! Lorenzo’s roots are in Englandand the NHS project was a major driverfor us - not surprisingly, since this pro-ject will radically change the structuresof the healthcare system. Projects such

as Lorenzo benefit from the sheer vol-ume of the NHS programme and enabledevelopment. But there are also twosides to this: Such a groundbreakingconcept cannot always run smoothly. Toavoid dependence on a few companiesthe government created several regionsand contracted different firms for eachregion. As soon as something goeswrong with one company in a region,all other companies in that region arealso blamed. That’s unfortunately whathappened in two regions in whichiSOFT participated with Lorenzo.However, we are still very successful inthe NHS project.

The core product - areas that are identi-cal worldwide - is handled by an inter-national project management teammade up of English German, Dutch andso on. As for adaptation to different sys-tems, in my opinion the major part of theeffort to develop such a system is replic-able. In England, a patient’s record, forexample, is very similar to that inGermany. Obviously there are differ-ences – for example reimbursement sys-tems, or the legal framework for qualityassurance. But Lorenzo is a modular sys-tem, which means we have a fixed corearound which we build the differentmodules. For Germany, for example, wecan provide a DRG-based reimburse-ment model without having to redesignthe entire system.

So, we believe the LorenzoSolutionCentre has enormous potential.Moreover, we want our successful RIS –the market leader in England andGermany – to profit in the long run fromthe state-of-the-art Lorenzo technology.We will continue to resolutely developboth our radiology system (RadCentre)and our lab system (LabCentre). In addi-tion, we want to position iSOFT morestrongly in markets in which, in the past,our distribution partners took care ofour products. In those European coun-tries where iSOFT is already well posi-tioned, we see a lot of potential forgrowth over the next few years – partic-ularly for Lorenzo – as far as follow-upproducts are concerned. All in all, wehave ambitious plans and are optimisticthat we will realise them successfully.

New strategy New self-confidence

MPOWER Aiming for empowermentto age happily at home

Mpower partnersSINTEF ICT, SP Andersenv 15b, Trondheim,N-7465, Norway (projectleader); NorwegianCentre for Dementia Research (NCDR);University of Krakow, Poland; University ofCyprus, Greece; DI, Spain; TBSOL, Spain;Ecomit, Spain; ARC Seibersdorf ResearchGmbH, Austria; Ericsson, Croatia; EAHSA,Brussels; IAHSA, Washington

confidence for the older people as wellas their relatives. Technology is utilisedto support older people and help pro-vide enhanced healthcare services. Itincludes:● an individual (medical) plan forpatients, which contains relevant infor-mation from all stakeholders, includingmedical information that can be sharedbetween the different treatment andcare providers ● communication technology includingvideo-conference, chat and telephone,through TV, mobile phone and apart-ment communication system● smart house technology, which helpsthe target groups to support them-selves in daily life and will make it pos-sible to grow older at home, rather thanmove to a care facility ● biosensors and patient question-

naires that provide the capability to con-tinuously monitor the patient ● interoperable information communica-tion between professional care providersthat will relieve doctors in hospitals fromroutine procedures that could easily bedone without seeing the patient in person.

MPOWER will deliver an open platformsupporting rapid development and deploy-ment of distributed integrated services forthe target groups. For this platform -which features distributed and shared care- usability, security and interoperability isof central importance. Biosensors andsmart house technologies are integrated;and structured mechanisms are providedfor adapting to changes in user context ina distributed, mobile environment sup-porting various user contexts.

The project will promote the interna-tional use of the MPOWER frameworkthrough the European Association ofHomes and Services for the Aging (EAHSA)in Brussels, in association with theInternational Association of Homes andServices for the Aging (IAHSA) inWashington DC, USA.”Details: Dr de Heus.Phone: 00 31 55 576 62 44


Company Speciality/Product PageAgfa IT – imaging 10 & 5 ECR supplement

Advanced Instruments Lab equipment 6

Aunt Minnie Radiology website 9 ECR supplement

Dräger medical Intensive care 9

Esaote Ultrasound – MRI 1

Fiera Milano Medical & hospital exhib. in Italy 19

GE Diagnostic imaging 7 ECR supplement

Hologic Mammography 11 ECR Supplement

ITeG Internat. forum for healthcare IT 18

ISICEM Internat. symposium on ICU & EM 7

Kiosk Expo 2007 14

Kodak Diagnostic imaging 3 ECR supplement

Komet Medical Surgical instruments 4

Medison Ultrasound 5

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Medtron Contrast agent injectors 1 & 2 ECR supplement

Noras MR products 13 ECR supplement

Parker Ultrasound 1 ECR supplement

Philips Speech regcognition 17

Provotec X-Ray accessories 13 ECR supplement

RADbook European radiology guide 10 ECR supplement

Schindler Kiosk Europe EXPO 2007 14

seca Scales 15

Shimadzu Diagnostic imaging flap

Siemens Medical Solutions Diagnostics 2/3

Sony Digital radiology imagers 4U ECR supplement

Toshiba Diagnostic imaging 13

Ulrich medical Contrast agent injectors 13 ECR supplement

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MilanoCheckUp is the new medical and healthcare exhibition that targets companies, professionals and the medical-scientific and healthcare community, organised by Fiera Milano Tech. At a single event of international appeal, visitors willhave the opportunity to get up to date on the most innovative technology and participate in the specialised conferenceswithin The Future of Medical Sciences congress. The congress will involve top authorities on numerous clinical-medicalspecialisations and from the business world. When health and science take the stage, it’s worth being there.

MilanoCheckUp. The new medicaland healthcare exhibition.

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G L O B A L E V E N T S

2 0 0 42007MARCH

9-13 Vienna, AustriaEuropean Congress of Radiology -ECR 2007 Over 16,000 visitors from 92countries makes this Europe’s biggestmedical imaging gathering. www.ecr.org

15-18 Athens, GreeceMEDIC EXPO 2007Medical and Hospital Exhibition.www.medicexpo.com

19-21 New Delhi, IndiaDisaster Management 2007www.dmindiaexpo.com

19-20 Manchester, United Kingdom3rd National Conference on Obesity& Health 2007www.obesityandhealth.co.uk

22-23 Geneva, Switzerland International Health WorkforceMigration ConferenceOrganised by the International HospitalFederation & Health Research & EducationTrust.www.hret.org/hret/publications/ihwm.html

26-28 Paris, FranceThe World Health Care Congress -Europe 2007 www.worldcongress.com

27-30 Cairo, Egypt Egyptian E-medicine InternationalConferencewww.onlinediabetes.net/emedicine

APRIL

11-13 Vienna, Austria15th International Conference onHealth Promoting Hospitals (HPH)www.univie.ac.at/hph/vienna2007

13-14 Lisbon, PortugalAnnual European Forum of MedicalAssociations (EFMA)The Portuguese Medical Association will hostrepresentatives of the leading medicalsocieties.www.euro.who.int/healthcaredelivery/EFMA/efma

13-14 April Bratislava, Slovak Republic.International Medical TourismConference (See feature below)

19-22 Prague, Czech Republic IHOF Technology www.ihofforum.com

22-24 Beijing, ChinaChina Med 0719th International Medical Instruments andEquipment Exhibition. www.chinamed.net.cnE-mail: [email protected]

23-24 London, United KingdomReporting Adverse Eventswww.smi-online.co.uk

25-28 Santo Domingo, Dominican RepublicAnnual Investment & HealthcareConference Organiser: American HospitalManagement Companywww.americanhospitalmanagement.com/

29-2 May, Prague , Czech Republic ICNC 8 International scientific nuclearcardiology meeting, with additional focus onPET and cardiac CT imaging.

MAY

1-3 Sydney, AustraliaCeBIT Australia 2007Organised by Hanover Fairs Australia.www.cebit.com.au

15-18 SingaporeHIMSS AsiaPac07 Conference &Exhibition focusing on healthcare ITchallenges in the Asia Pacific region, andsponsored by Cerner, Microsoft, Siemens andthe Dictaphone-a Division of Nuance Corp.Email for details:[email protected]

21-23 SingaporeWorld Health Care Congress Asiahttps://www.worldcongress.com

JUNE

9-12 Hamburg, GermanyHeart Failure [email protected]

18-19 London, United Kingdom Pharmaceutical Portfolio & ProductLife Cycle Managementsmi-online.co.uk

20-22 London, United KingdomNHS Confederation AnnualConference & Exhibitionwww.nhsconfed.org

24-27 Lisbon, Portugal Europace 2007 The European HeartRhythm Association (EHRA), a registeredbranch of the European Society of Cardiology.Focus: arrhythmias and cardiac pacing inEurope. [email protected]

27-30 Berlin, Germany CARS 2007 Computer Assisted Radiologyand Surgery. www.cars-int.org

27-1 July Glasgow, ScotlandWorld Congress on Design andHealth Organiser: International Academy forDesign and Health.www.designandhealth.com E-mail:[email protected]

JULY

2-5 York, United KingdomSociety of Occupational MedicineAnnual Scientific Meetingwww.som-asm.org.uk

SEPTEMBER

26-29 Paris, FranceSepsis 2007 Venue: The Pasteur Institute.www.sepsisforum.org

OCTOBER

6-11 Philadelphia, USAAHIMA 2007Convention of the American HealthInformation Management Association. E-mail:[email protected]

23-26 Vienna, Austria2007 World of Health IT conference& exhibition sponsored by HIMSSContact: [email protected]

Nations HealthCareerSchool of Management

MBAInternational Hospital andHealthcare Management

Start date: 4 May 2007Deadline for applications: 9 March 2007

www.nations-healthcareer.com

Sanigest Europe s.r.o., an internationalhealthcare and management consultingcompany, has organised a two-dayinternational conference to discuss therapidly growing development of MedicalTourism. ‘By 2010 medical tourism isexpected to be a $40-billion business, withover 780 million patients seeking careoutside of their principal country ofresidence,’ the conference organiser pointsout. ‘The rapid growth of this industry, andthe central role that Eastern Europe isplaying in the development of a medicaltourism market in the European Union,provides a unique opportunity to bringtogether governments from around theEU, leading insurance companies,providers participating in the medicaltourism market, and patient associationsto discuss the current and futureexpansion of the medical tourism industry.Likewise, the tourism industry in generalwill also be heavily impacted, bringingmore business to hotels, travel agencies,and low cost airlines.’

Sanigest continues: In India alone, medicaltourism is expected to generate $2.2billion in revenues for providers by thebeginning of the next decade. Last year,an estimated 150,000 foreigners visitedIndia for medical procedures, and thenumber is increasing at the rate of about15% annually, according to ZakariahAhmed, a healthcare specialist at theConfederation of Indian Industries. CostaRica, Argentina, Cuba, Jamaica, SouthAfrica, Jordan, Malaysia, Hungary, Latvia,and Estonia all have entered into thisprofitable market, and more countries jointhe list every year.’

‘According to Christopher Jones, a facultyresearch associate at Johns HopkinsUniversity School of Public Health inBaltimore, the growing number of self-

Huge cost-savingsfor private insurersBUT FOR SOME ‘HOME IS BEST’By Brenda Marsh, Editor-in-Chief, European Hospital

insured patients who decide to travelabroad for treatment are fuelling thistrend. “With low-cost air travel, manymiddle-class people are accepting thepromise of a vacation combined with theirmedical procedures, together, at a fractionof the cost they might otherwise pay.” Atthe same time, patient mobility in the EUimplies that people are increasingly ableto travel among EU countries for care,with their insurance company in theirhome country covering the costs. Aswaiting lists grow in the UK and otherWestern European countries, patients areincreasingly seeking a solution to theirproblems abroad.

‘But by overall the biggest draw topotential customers are the savings, whichin some cases could be more than€70,000 after travel arrangements.Surgery prices are much cheaper in foreigncountries because of lower costs formanpower, real estate and administrativeconcerns like insurance, said Vishal Bali,CEO of Wockhardt Hospitals, a Mumbai,India-based company with 10 hospitals inthe country. The cost of surgery in India,Thailand, or South Africa can be one-tenthof what it is in the United States orWestern Europe, and sometimes even less.

‘Some sceptics fear that the quality of carein these developing countries is inferior towhat is offered in the United States;however, the hospitals and clinics thatcater to the tourist market often areamong the best in the world, and manyare staffed by physicians trained at majormedical centres in the United States andEurope.’

Conference and sponsorship details:http://www.sanigest.com/MedTourism/index.html

E-contact: [email protected].

According to an as yet undefined rulingof the European Court of Justice, EUpatients whose names have been onlong waiting lists for surgery in theirhomeland now have a right to be treat-ed in another EU country, and this is tobe reimbursed by their national healthinsurers.

Such cross-border patient numbersare not yet significant, in part becausemany people prefer to be treated near-er their homes. However, acute painover a long period does change minds,and those who have had successful hipops, for example, in foreign lands havefound medical tourism more thanworthwhile.

For the private health insurer it holdsanother attraction. Hospitals in the lessfinancially well off EU and other coun-tries can offer surgical procedures in

wide that has accreditation from JointCommission International (JCI), USA,the international arm of the JointCommission on Accreditation ofHealthcare Organizations that evalu-ates quality standards of US hospitals.

The Group also points out that itsfacilities are not only cheaper than inthe USA and other countries, but so areIndian pharmaceuticals. In addition,the private rooms are more luxuriousthan most, providing air conditioning, acomputer, TV, DVD Player, en suitebathroom, sofa-bed for a companion,room and laundry services, etc.

In a survey by United GroupPrograms, an established Florida-basedinsurer, to examine the benefits ofoverseas treatments in India andThailand, the firm found that a heartbypass would cost US$16,000 in

state-of-the-art units for perhaps 50%less than in many Western countries.So, even adding in travel costs forpatients, the savings on major surgerycan be immense.

Currently, for the British healthtourist, Belgium is said to have leaptahead of France and Germany as themost popular choice; with the highestnumber of doctors and hospitals,Belgian costs for private surgical treat-ment range between 20–50% less thanthose in the UK (Gastric bypass - UK£11,800, Belgium £5,000; total knee orhip replacement - UK £10,300 and£9,000, Belgium £6,500 and £5,600respectively). Other, newer EU memberstates, e.g. Malta, Estonia and Latvia,are also offering surgery to foreignpatients, and all are reported to haveexcellent surgical facilities. Yet, theycan cost up to 70% less than in othercountries (e.g. private hip replacement:£4,000).

One day, might such cost savingsalso attract our national health insur-ers? As yet, the concept is still quitenovel to private insurers.

Medical tourism and the healthinsurerSince 2000, US health insurance premi-ums for employers rose 73%, and aver-age employees’ contributions rose143%. In 2004, the average USpatient’s hospital bill (US$6,280) wastwice that of other Western countries.

Thus a few private health insurers inthe USA have already recognised theeconomic value of what’s on offer inEastern countries and are carving aniche in this market. One, IndUShealthin Raleigh, North Carolina, specialisesin sending certain medical cases fortreatment in India, and some toThailand and Indonesia.

In India IndUShealth works with theWockhardt Hospitals Group, owned bya large Indian pharmaceuticals andbiotechnology firm. With modern facili-ties in Bangalore, Mumbai, Hyderabad,Nagpur and Calcutta, this group hascreated a division specifically for inter-national patients, which includeschauffeured airport pickup, or by lifesupport ambulance, with interpretersto hand. These modern hospitals carryout complex surgical procedures andmany of the doctors have eitherreceived their medical training inWestern countries or have worked inthem.

Wockhardt Hospitals states that itsservices compare ‘more thanfavourably with American or EuropeanHospitals’, and indeed its Mumbai hos-pital is one of only 70 hospitals world-

Thailand, and US$80,000 back home. Inaddition, the facilities and care provedequal to, or even better than in the US.The ratio of nurses to patients was high,and many doctors were US-trained orhad practiced there. The insurer nowworks with a Thai hospital.

Other US firms are cautiously examin-ing the feasibility of overseas care forpatients, specifically with hospitals thathave Joint Commission Internationalaccreditation or accreditation from TheInternational Standards Organization inGeneva.

The numbers of patients receivinginsured treatments in the Far East are asyet only in the hundreds, but the marketis revving up at a remarkable rate.

Suggested hazards in medicaltourism:● Surgery followed by lengthy air travel● Limited malpractice laws to protect

patients● Frequently, no prior referrals needed

from patients’ own doctors.So far, most people (around 65%) whoindependently seek surgery beyondtheir own boundaries want dentistry orcosmetic surgery, often due to far lowercosts elsewhere. Referrals are obviouslyvital for cosmetic surgery becausewould-be patients might suffer underly-ing psychological problems for whichtreatment is the better course.

The patients? For some, home isbest In the USA, Mexican workers have beencross-border patients for decades(insured largely via their agriculturalassociations, though nowadays by morecross-border insurance plans).

Although given a choice of plans byinsurers, which include care in the USA,most choose the Mexico-based careplans, and currently around 150,000Mexicans and their families are coveredfor healthcare in Mexico. Premiums forplans sold by Blue Shield of California,Health Net of California and theMexican firm SIMNSA, can be 50%cheaper than traditional US insurancefor workers and their employers.

The insurers are said to check that thephysicians used are licensed in Mexicoand meet any specialty board require-ments. In medical emergencies thoseinsured can be treated either side of theUS-Mexico border.

Since the majority of the Mexicanworkers show they prefer to seeMexican doctors in their native land,the same could be assumed for themajority of other nationals.

The future of medical tourism clearlydepends on many factors.

International Medical Tourism Conference‘Building a road map for medical

tourism development’Bratislava, Slovak Republic. 13–14 April

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