surgical care

High-tech innovation and advanced surgical techniques have transformed the field of ophthalmology, with new treatment options making surgery faster and more accurate. We speak to Professor Rudy Nuijts, a leader in the field of cataract surgery, about the radical changes he has seen and what the future may hold. How has cataract care changed since you began working as an ophthalmic surgeon ? I was trained in extracapsular surgery which involved making incisions of at least 6mm to remove the patient’s lens. In the early 1990s, ophthalmologists in the Netherlands started to embrace phacoemulsification – a new alternative where the lens is broken into tiny fragments using ultrasound energy before being removed. That changed everything. How did these advances help patients? The recovery process was much faster and there was less post-operative astigmatism . Since then, technology has improved further: the machinery we use results in a more stable anterior chamber, with less risk of posterior capsule rupture and there is much more choice and versatility in the range of lenses available for implantation. Are there other technological advances that have improved outcomes for patients? The introduction of multifocal intraocular lenses (IOLs) has meant patients can be spectacle-independent after cataract surgery. Instead of just fixing the cloudy vision caused by their cataract, patients can now have a refractive lens implanted which improves their vision. These include toric IOLs which allow us to correct astigmatism and make patients spectacle independent for distance. Another big leap forward has been multifocal lenses. Most surgeons in Europe have, over the last year or two, moved from bifocal to trifocal lenses. This has big advantages for patients. For example, with multifocal trifocal lenses they can read at intermediate distances – for iPads or reading a computer screen, this is a distinct advantage. Bifocal lenses were...
Surgical Site Infections (SSIs) were high on the agenda at the 4 th International Conference on Prevention & Infection Control (ICPIC) last week in Geneva. And it’s no surprise given the statistics - although no global registry exists to track surgical site infections, health authorities estimate that each year, one in five patients undergoing surgery acquires an infection. It is difficult to calculate the financial burden this places on health systems but NICE has suggested a cost of £700m a year in the UK. Whereas, in the US, the annual cost has been estimated to range from $3.5 billion to$10 billion . What the global cost must be is unknown, but there’s no doubt that it will be high. And this is an epidemic that knows no boundaries – from the most advanced, specialist healthcare centers to the most basic clinics, from the elderly and infirm to the young and healthy; there is unfortunately, a very real possibility of contracting an SSI. What’s also shocking is that approximately 50% of SSIs may be preventable . And with this in mind, the World Health Organization (WHO) has issued global guidelines on the prevention of SSIs. This was a hotly debated topic of conversation during a symposium, held at last week’s conference – where several leading wound closure specialists came together to discuss the latest advancements and recommendations to ease the burden of SSIs. One innovation discussed was the use of antibacterial sutures. There is a growing body of evidence that suggests triclosan-coated sutures are an important tool in the fight against SSIs. The WHO has highlighted the use of triclosan-coated sutures across all types of surgery to reduce the risk of SSI, and further support has followed from the Centers for Disease Control and Prevention , the American College of Surgeons/Surgical...

David Leaper

University of Huddersfield and University of Newcastle upon Tyne, United Kingdom
The European Parliament adopted another report this week focused on safety in healthcare highlighting the huge costs to healthcare systems, not to mention the enormous costs to patients, for preventable injuries, complications and infections. While I admire the Parliament’s attention to these issues, it is still clear that many of the calls for improved monitoring of patient safety and mitigating steps to avoid such events still fall on deaf ears at the national level. This is particularly relevant to the wound care community, given the stubborn incidence of pressure ulcers and surgical site infections which occur in healthcare facilities. Patient safety in wound care Safety is especially important in wound care where appropriate treatment can help prevent the development or prolongation of a wound as well as adverse outcomes such as infection or amputation. Advanced wound care treatments have a significant role to play in the prevention of patient safety events such as pressure ulcers and surgical site infections, particularly in hospital settings. When managed inappropriately these events can result in avoidable morbidity, extended hospital stays and even mortality. While the EU institutions recognize at a macro level that appropriate care and treatment can deliver improved efficiency – essentially improved outcomes at lower cost - at a national level the focus remains on cost containment. Driven by austerity measures and increasing demands, most healthcare decision makers revert to managing budgets on a short-term basis and look for cost savings, particularly in the procurement of medical supplies. This issue is worsened by an absence of accurate, routinely collected data on patient safety events across many EU health systems. Whilst some health systems, such as the English NHS, have implemented data collection on pressure ulcers and surgical site infections, this remains highly variable across member states. The absence of data means that...
Surgical devices
The upcoming MDD revision can learn a lot from a 2007 mistake in woundcare regulation. Burn wounds result in some of the most horrific pictures one can come across as a surgeon. Burn victims not only have to suffer the immediate pain associated with burn wounds, but also have to deal with often permanent scar tissue, a lifelong reminder of that terrible moment.
The prominence of World Kidney Day (11th March) brings into sharp focus the changing epidemiology of our times and the impact of modern life styles of the developed world on the demands placed on healthcare systems. The surge in incidence of diabetes coupled with extending life expectancy are producing a parallel rise in the incidence of kidney disease and all of the costs associated with managing that disease. The medical technology industry has much to offer now and in the future in dealing with this challenge. Dialysis is at the centre of maintaining patients with acute kidney disease and the sophistication and safety of treatments in this area have been the subject of continuous improvement since the first effective process was performed on a patient by Dutch physician Dr Willem Kolff in 1943 at the University of Groningen Hospital. Like many innovations in the medical technology field, Kolff's was viewed as madness by many of his colleagues and it took another two decades before dialysis was taken seriously by the broader medical community. Also like many products of European innovators, Kolff's inventions were taken up in the United States where the majority of the scientific and commercial development took place. So committed to getting his ideas adopted was Kolff that he gave his five prototype 'artificial kidneys' to hospitals as a way of encouraging them to develop the concept. One of these, Mount Sinai Hospital in New York, was where Kolff continued to develop his ideas although these were not popular with the hospital management and eventually the project moved to Boston's Peter Bent Brigham Hospital where the next generation of dialyser was made and lead to the first kidney transplant in 1954. This story is just one of many which illustrates both the tortuous path of medical technology innovation...