SPRING 2010
The newsletter for GPs from The Wellington Hospital
FATTY ISSUES The obesity epidemic
The latest news, views and features from the largest independent hospital in the United Kingdom
WELCOME At the time of writing this introduction The Wellington Hospital (TWH) has just marked up its 36th birthday since its opening way back in April 1974. How time flies. There have clearly been many new additions and developments at the hospital over this period but perhaps we are about to embark on the most exciting phase in our history. In something less than a years time we will see the opening of our new Platinum Medical Centre which is an extensive outpatients and diagnostic facility incorporating day case and outpatient surgical theatres across six floors of accommodation. With one of the largest radiology departments ever built in the UK supporting 50 consulting rooms we are justly proud of this additional state of the art centre. The new Centre will see the reinstatement of cancer care services to the Wellington campus since it was removed in a strategic review some 18 years ago. This will be in the
form of comprehensive Oncology consulting suite, the very latest design of a 10 bed chemotherapy unit with supporting high end cancer diagnostics. Patients requiring ongoing cancer care will now be able to access this service at the Medical Centre rather than be transferred off site as was previously the case. A clear improvement in patient services and access. Perhaps more importantly we want to set up a private GP consulting suite in the heart of the centre and if you feel you would like to enter the field of private GP practice then I would certainly like to hear from you. So as we move into our 37th year we look forward to exciting times ahead by improving our services to our local patients, and to those that visit us from the UK and globally.
Keith Hague CEO
INSIDE THIS ISSUE
SPRING 2010
TWENTY FOUR SEVEN The Medical Admissions Unit (MAU) was set up to provide easy access for GPs wishing to admit patients with acute medical problems. Find out more on page 7
4
8
AT THE HEART OF THE MATTER Trans-catheter aortic valve implantation (TAVI) is a minimally invasive procedure for the treatment of aortic stenosis. We take a look on page 4
10
GP COMMENT & DEBATE
7 11
NURSES CORNER
12
WELLINGTON EVENTS
EDITORIAL TEAM Claire Allen
Editor
Tel 020 7483 5109
Email claire.allen@hcahealthcare.co.uk
Jean Anderson
Managment & Distribution
Tel 020 7483 5336
Email jean.anderson@hcahealthcre.co.uk
Comments, personal views & opinions expressed by contributors are not necessarily those of The Wellington Hospital.
The key thing to recognise is the difference between pathological pain and mechanical pain CARING FOR MARATHON RUNNERS
Design and Produced by Spectrum Print & Creative Services 01932 222100
2
practicematters spring 2010
www.thewellingtonhospital.com
www.thewellingtonhospital.com WELLINGTON IN FOCUS
WELLINGTON IN FOCUS
The obesity epidemic A frank view by a gastroenterologist A global epidemic that has the potential to kill more people than a flu pandemic is being ignored. Everyone has heard of SARS, swine flu, and AIDS. Not many realise that the obesity epidemic we are facing will probably kill more people. 30% of the UK population and 50% of the population in the USA is obese: a condition that can cause diabetes mellitus, hypertension, liver disease, osteoarthritis and lead to strokes and heart disease, resulting in premature death. These are the biggest killers in Western society. However, as social norms change over the years, obesity has become more acceptable; few realise just how dangerous being significantly overweight can be. Yet, for those who do, there is a lot that can be done. Sensible eating and exercise is the mainstay of weight reduction. It’s simple really: if you eat 3000 calories a day, and spend only 2000 calories a day, you will gain weight; if you eat 1500 calories a day and spend 2500 calories a day by exercising more, you will lose weight; guaranteed. However, translating this into practice is more difficult, we lead such sedentary and busy lives, it is often impossible to find the time, or the inclination to get out and get some exercise. In evolutionary terms, our ancestors were on the go constantly, hunting and gathering food, farming to survive: A lot of physical
exercise, with relatively little in the way of nutrition at the end of it. A primitive diet had FIVE times as much fibre in it and a FIFTH of the fat we currently consume. Our modern lifestyle is very different to what the human body was designed to deal with. If various diets and exercise have been tried and the body mass index is still above the normal range (20-25), what next? Drugs are really not the answer. Although, there are two types of drugs available: ones that increase basal metabolic rate and make the patient expend more calories while watching the telly, but give them hypertension or possibly scar their heart valves. The other (Orlistat) stops the body absorbing fats in your diet. The result: slimy smelly stools with oil dribbling out of the bottom when not expected. Additionally, these cannot be used for more than 3 months, before the body becomes deficient in the fat-soluble vitamins A,D,E, and K. What next? This is where opinions begin to differ. There are two basic approaches that are used: 1) Reducing the size of the stomach so the patient can’t eat as much 2) Re-plumbing the intestines so that no matter how much is eaten, it fails to absorb as much and as a result weight is lost. Reducing the size of the stomach is traditionally done via keyhole (laparoscopic) surgery. An inflatable band is placed around the stomach and inflated to varying degrees to limit the opening of the stomach and reduce that ability to eat large meals. This works for those who are moderately overweight and who eat three meals a day or less. It doesn’t work for those who snack constantly throughout the day. Another approach is the relatively non-invasive technique of the intra-gastric balloon. A silicone balloon is introduced into the stomach by an endoscope using sedation and inflated to occupy most of the stomach,
limiting the space available for food. It is noninvasive, because when you remove it, it leaves no trace and you don’t need open surgery under general anaesthesia (not the best thing for people who are seriously overweight). However, non-invasive does not equate with easy, because following the introduction of the balloon, patients often feel nauseated and may vomit for a few hours or days, until the stomach adapts to the presence of the balloon. This process of adaptation means the patient may have to be admitted for intravenous fluids and anti-sickness medication until the body accepts the presence of the balloon within the stomach. Once again, spectacular results for highly motivated patients who avoid snacking during the day. The problem with this technique is that it is not offered widely, and is not covered by the NHS, so the cost can be prohibitive. If gastric reduction techniques don’t work, then bariatric surgery is a last resort. This has taken off in spectacular style in the UK over the last five years and there is no doubt that it is very effective. Patients on hundreds of units of insulin a day are coming off insulin altogether within weeks, losing more than half their body weight and getting their lives back. Yet, do not be fooled, it is risky surgery, complications are not infrequent and can be serious. Overall, patients who sail through surgery are usually very happy with the end result. Ultimately, when a patient makes a decision about the treatment of obesity the question they have to ask is: what are the consequences of doing nothing to my health? Answer: Painful knees, chronic back pain, shortness of breath on minimal exertion, lots of tablets to control diabetes and blood pressure and possibly daily insulin injections, and yes… a shorter life. So whatever the patient decides to do, they need to do it sooner rather than later, get out and start walking, go easy on the chocolates… and make steps towards a healthier future. Dr Ray Shidrawi is a Consultant Gastroenterologist at Wellington Hospital G.I Unit and The Homerton Hospital.
Intra-gastric balloon
Enquiry Helpline: 0207 483 5148
spring 2010 practicematters
3
WELLINGTON IN FOCUS
At the heart Trans-catheter aortic valve implantation at the Wellington Hospital Trans-catheter aortic valve implantation (TAVI), also known as percutaneous aortic valve replacement, is a minimally invasive procedure for the treatment of aortic stenosis in people for whom the risks of conventional open aortic valve replacement surgery would be high.
Aortic stenosis limits cardiac output and can present with exertional dyspnoea and chest pain, progressive heart failure or sudden death. Medically treated symptomatic aortic stenosis carries a poor prognosis with 1- and 5-year survival rates of 60% and 32%, respectively. Aortic valve replacement is the only effective treatment that alleviates symptoms and improves prognosis. There is, however, no doubt that it is a ‘big’ operation involving a sternotomy and cardio-pulmonary bypass. In ‘low risk’ patients, conventional aortic valve replacement surgery has an estimated operative mortality of 4% but this increases substantially with increasing age and in the presence of medical conditions such as renal impairment, COPD, heart failure or previous heart surgery.* In these patients trans-catheter aortic valve implantation is an excellent alternative. This is a relatively new procedure that was first performed in 2002 and has only been widely available for the last 3-4 years. It is currently reserved for elderly patients and for those in whom the risks of conventional surgery are high because at present we do not know the long term (over five years) outcome. This is likely to change as the results of long term randomised studies become available. THE ARTIFICIAL VALVES There are two different makes of valve, the Sapien Transcatheter Heart Valve made by Edwards Lifesciences and the CoreValve made by Medtronic, both of them involve
soft pliable valve leaflets attached to a rigid frame. The leaflets are made from bovine or equine pericardial tissue. The frames are made from either stainless steel or a material called nitinol. The valves are initially compacted down to allow their passage through catheters. THE PROCEDURE There are two main options; the trans-femoral and the trans-apical approach. Both of these are performed without cardio-pulmonary bypass, avoiding the complications associated with this. The trans-femoral approach Using standard cardiac catheterization techniques, a wire is passed into a femoral artery (usually the right) up the aorta and across the stenosed aortic valve into the left ventricle. The compacted replacement artificial valve is then tracked along this wire into position where it is expanded into shape, crushing the old valve to one side leaving the new normally functioning valve in its place. Trans-apical approach In some people, particularly those with peripheral vascular disease, the femoral arteries are not big enough to accommodate the artificial valve even in its compacted form and the trans-apical approach can then be used. This involves a small left thoracotomy incision to expose the apex of the left ventricle where a purse-string suture is placed. A needle is passed through the apex, allowing the
Simon Kennon is a consultant cardiologist and director of structural heart disease at the London Chest Hospital, Barts and the London NHS Trust where he is lead cardiologist for the busy TAVI programme. Wael Awad is a cardiac surgeon at the London Chest Hospital and is lead surgeon for the programme.
Edwards SAPIEN XT™ Transcatheter Heart Valve
4
practicematters spring 2010
* (Lung, B. Heart. 2008; 94:519-524)
www.thewellingtonhospital.com
www.thewellingtonhospital.com
of the matter
passage of a wire into the left ventricle and then across the aortic valve. The compacted replacement valve is then tracked along the wire as per the trans-femoral approach. At the end of the procedure the hole is closed by drawing the purse-string suture. THE ANAESTHETIC Usually the procedure is performed under general anaesthetic but under some circumstances the trans-femoral approach can be performed using a local anaesthetic. AFTER THE PROCEDURE The advantages of trans-catheter aortic valve implantation include early mobilization and less wound related pain. Generally patients remain in ITU for one night and are discharged from hospital within seven days. There is no requirement for formal anticoagulation with warfarin. Patients are generally discharged on aspirin and clopidogrel which they take
Enquiry Helpline: 0207 483 5148
for six months, although patients with a history of peptic ulcer disease are usually limited to clopidogrel in combination with a proton pump inhibitor. Trans-catheter aortic valve implantations involve a team of cardiologists, cardiac surgeons and anaesthetists who all have
substantial experience in performing the procedure. The team is led by Dr Simon Kennon and Mr Wael. For more information call the Wellington Hospital Enquiry Helpline on 020 7483 5148.
FURTHER LINKS For information about the ongoing PARTNER trial: clinicaltrials.gov/ct2/show/NCT00530894 Different types of valve: http://www.edwards.com/products/transcathetervalves/sapienthv.htm http://www.medtronic.com/corevalve/other.html To view an animation of the trans-femoral procedure: http://www.edwards.com/products/transcathetervalves/transfemoralanimation. htm?SapienTHV=1 To view an animation of the trans-apical procedure: http://www.edwards.com/products/transcathetervalves/transapicalanimationclip. htm?TransfemoralDeployment=1
spring 2010 practicematters
5
WELLINGTON IN FOCUS
We hope to provide an exciting and beneficial service to patients of the Wellington Hospital…
Through the keyhole Laparoscopic Colorectal Surgery (LCS) has been performed world wide since 1991. Several trials have demonstrated advantages of LCS over open surgery such as less post-operative pain, shorter inpatient stay, better cosmesis and less long term complications (e.g incisional hernia and adhesions). Laparoscopic Surgery is not a new concept; gallbladder surgery is now almost exclusively performed by laparoscopic or keyhole surgery. Other conditions that can be treated by laparoscopic surgery include hernias, certain gynaecological procedures and more recently prostate and kidney operations. About 70% of patients who are diagnosed with colorectal cancer will have surgery. Traditionally many of these operations for colorectal cancer were undertaken by ‘open’ surgery i.e with long abdominal incisions (picture 1). However, it is now possible to perform a large number of these procedures using laparoscopic (keyhole) surgery. This procedure has demonstrated significant benefit to patients in terms of shorter hospital stay [average stay for laparoscopic colon and rectal cancer surgery is five days, compared to seven to ten days for open operations], less post operative pain (picture 2) and quicker recovery of function. Most laparoscopic patients are mobilising by the first or second
6
practicematters spring 2010
day, and eating by the third day after surgery. In open surgery, this happens after the fifth or sixth day. Most importantly patients get exactly the same operation as they would have done as an open operation with no compromise to clearance of the cancer. A recent comparison of our laparoscopic procedures against open surgery for colorectal cancer in patients aged over 80 has shown a 50% reduction in inpatient stay and a 65% reduction in postoperative complications for the laparoscopic group. To date we have undertaken over 140 laparoscopic colorectal operations; the vast majority have been for colon and rectal cancer, but operations for diverticular disease and colitis have also been successfully done. Patients’ ages have ranged from 26 to 85 years. All operations are undertaken jointly by us, as we believe that this confers a greater benefit to the patients. Laparoscopic Colorectal Surgery is here to stay and is now the future of colorectal surgery. In time the vast majority of colorectal conditions will be treated by laparoscopic surgery. We hope to provide an exciting and beneficial service to patients of the Wellington Hospital. If you would like any further information please call the Wellington Hospital Enquiry Helpline on 0207 483 5148
1. Typical scar after open surgery
2. Typical scar after laparoscopic surgery Mr Pawan Mathur and Mr Colin Elton are two Consultant Colorectal Surgeons from Barnet Hospital who have begun work at the Wellington Hospital. They underwent laparoscopic training throughout their Registrar years and further evaluation in 2005 under the Laparoscopic Preceptorship Programme established by the Association of Laparoscopic Surgeons
www.thewellingtonhospital.com
www.thewellingtonhospital.com Medical Admissions Unit
Our help is right there when you need it The Medical Admissions Unit (MAU) was set up to provide easy access for GPs wishing to admit patients with acute medical problems. The MAU has a rota of nine consultant physicians, who between them are available 24 hours a day, seven days a week. There is also additional support from an on site medical officer, at the level of a medical Registrar, Also available 24/7. It is located in the North building with all rooms offering cardiac monitoring and is situated next to the ITU with immediate availability of facilities should patients suffer acute deterioration. Patients can be easily referred through the reservations team or the Enquiry Helpline during the daytime and through the senior nurse out of hours. The consultants are able to offer care for a variety of medical problems including: •Pneumonia&COPD •HeartFailure •Gastroenteritis&Diarrhoea •Constipation •DeepVeinThrombosis&PE •UrinaryTractInfection&Pyelonephritis •Dehydration
In addition, with a wide variety of specialty groups at the Wellington Hospital, including Cardiology, Gastroenterology, Neurology, Neurosurgery, Orthopaedic and Vascular surgery, the MAU consultants are often happy to accept the care of patients that traditionally would not be first referred to a medical specialist in the NHS. Please be aware that it may take up to three hours for a private ambulance to arrive and collect referred patients as other patients may have pre-booked ambulances. The MAU group would be pleased to explain its services further and to receive feedback. Kindly contact the chairman of the MAU, Dr Michael Fertleman. The Enquiry Helpline can be contacted by calling 0207 483 5148. The Reservations Team can be contacted on 0207 586 4926/ 3948. If you are calling before 8am or after 6pm please call the Wellington Hospital Switchboard on 0207 586 5959 and you will be put in contact with the senior nurse.
Fibroscan
Scanning technology leads the way in fibrosis diagnosis The Wellington Hospital is pleased to announce the arrival of Fibroscan technology for the noninvasive measurement of liver fibrosis.
UK is one of the few developed nations with an upward trend in mortality from liver problems.
Fibroscanning is exciting new technology that allows for the degree of fibrosis (scarring) in the liver to be assessed without the need for biopsy and can be done as an out-patient procedure. Fibroscanning uses ultrasound to measure the degree of elasticity of liver tissue and can give a result in minutes. The average age of death from liver disease is 59 years, compared to 82-84 years for heart and lung disease or stroke. Liver disease is the fifth largest cause of death in the UK and the
Non-invasive measurement of fibrosis using the Fibroscan is a convenient way of identifying patients who have, or are at risk of advanced fibrosis; thus allowing timely intervention before the development of cirrhosis. Fibroscanning is appropriate in the investigation and management of patients with viral hepatitis, fatty liver disease and is also helpful to exclude advanced fibrosis in patients with abnormal liver function tests.
Enquiry Helpline: 0207 483 5148
Fibroscanning is quick, safe, and painless and is available through the Wellington Hospital Liver Unit via an appointment with Dr James O’Beirne or Dr David Patch.
spring 2010 practicematters
7
WELLINGTON IN FOCUS
The London Marathon is one of the worlds leading marathons, in 2009 it attracted 35,000 competitors and 2010 is promising to be even bigger! The London Marathon is one of the highlights of the sporting calendar, and a showcase for the capital. Each spring, The Wellington Foot and Ankle unit is on standby to care for the large number of stress injuries sustained by runners avidly training for and competing in the London Marathon. Consultant surgeons Mr Mark Herron and Mr Nick Cullen talk to us about common problems runners encounter in the lead up to the London marathon… More than with any other sport, once people get into distance running it seems to become truly addictive. Runners are used to “running through” or simply ignoring many aches and pains, so Nick and I appreciate that by the time a runner comes through our doors symptoms are reasonably serious, and often stopping them running at all. There are no specific running injuries but problems are generally due to the effects of repetitive high impact activity on the bones, joints and soft tissues of the lower limbs. The other key thing to recognise is the difference between pathological pain, due to acute or chronic injury, and mechanical pain due to normal human anatomy functioning at the extremes of its tolerance. The latter is common and is why it is of key importance that if you are going to take to distance running seriously, that you do so gradually with a proper conditioning programme, advice on technique and the correct shoes. At the Wellington Foot and Ankle unit we work closely with specialist physiotherapists around London as well as specialist running coaches like Ben Pochee of LGN Wellbeing to make sure runners get the advice and treatment they need. Both Nick and I also tend to speak to a lot of GPs at this time of year with specific queries about the quickest way of getting their patients back on track to cross the start line for the marathon. In runners one of the common areas to misbehave is the Achilles tendon. Most patients know it’s their Achilles because it is such a straightforward area to identify. That said, 8
practicematters spring 2010
most people have little idea of the processes affecting the tendon or that a lot of successful options exist before any operation need be considered. The two main chronic problems it suffers are either a superficial inflammation (called tendonitis) or deeper seated ‘wear and tear’ of the tendon (known as tendonosis). If its wear and tear then the tendon tends to have a very discreet and tender swelling, with normal and pain-free tendon above and below it. In either case the tendon responds in about 75% of people to either a course of physiotherapy or temporary immobilisation in an Aircast boot or lightweight walking boot and running should be avoided. It can take six weeks or so before symptoms start to improve. If it’s important to have as little time away from running as possible, then ultrasound guided injections of steroid or patients own blood cells can be used. Mr Nick Cullen explains that marathon running is an endurance sport that generates huge cumulative stresses within the skeleton, which leave athletes at an increased risk of a wide variety of stress injuries. Stress fractures are amongst the most common stress injuries, they often start innocuously, producing vague aching whilst running which settles shortly after finishing. The majority of stress fractures occur in the foot and ankle (80% occurring in the tibia, fibula, metatarsal and heel).
RU PAIN Runners who present with stress fractures usually do not report any history of trauma or injury. Over time, often when an athlete is increasing their mileage leading up to the marathon, the pain becomes more severe, localized and persistent. The foot or ankle may begin to swell and may be tender to the touch. Eventually pain is severe enough to prevent running, which is the stage where most people present to the Foot and Ankle Unit. In terms of treating a stress fracture, once it has been diagnosed, a period of rest is advised, a pneumatic walking boot is frequently prescribed, which obviously has a big impact on training. Some stress fractures do not respond to immobilization alone and require surgery to stabilize them and promote healing. However, the optimal management of stress fractures is prevention; there are many simple things that can be done to help prevent injury. Remember that your bones respond to exercise and loading by strengthening, but this is a gradual process. For emerging marathon runners, joining a running club or enrolling the help of an experienced runner will help set realistic targets and training schedules. Running distances should be increased gradually and especially early on ‘cross training’ is useful, where running is alternated with other forms of cardiovascular exercise such as cycling and rowing.
www.thewellingtonhospital.com
www.thewellingtonhospital.com
UNNING THROUGH THE N BARRIER
Nick Cullen is Consultant Foot & Ankle surgeon at the Wellington Foot & Ankle Unit and The Royal National Orthopaedic Hospital at Stanmore.
Mark Herron is Consultant Foot & Ankle surgeon at the Wellington Foot & Ankle Unit and to the British Gymnastics team. Ben Pochee runs LGN Wellbeing a running specialist company
Mr Cullen and Mr Herron are happy to be contacted through the Wellington Hospital Enquiry Helpline on 0207 483 5148 Ben Pochee can be contacted on 07900 921 124 5148 or at www.lgnwellbeing.com
Good footwear supports the foot and decreases the forces transmitted through your skeleton, good running shoes are essential kit for a marathon runner. Shoes should be replaced regularly ideally every six months, as worn out shoes can increase the forces transmitted to your joints when running. It may also be useful to enrol the help of a physiotherapist; a good physiotherapist will help to improve your balance, posture and running gait, which will help reduce stress injury. As there over 34 joints in the foot, which absorb the shock and forces produced by every stride; the joints of the foot and ankle are understandably prone to injury. These vary from sprains of the ankle, to damage affecting the surrounding muscles and tendons or damage to the joint surface. With recent advances in surgery these injuries may no longer be career threatening. At the Wellington Foot and Ankle Unit, we utilize the latest advances and techniques, including minimally invasive and arthroscopic (key hole surgery) techniques to effectively treat a wide array of injuries whilst reducing recovery times and allowing early return to training.
Enquiry Helpline: 0207 483 5148
KEEP ON RUNNING: LGN’S TOP TIPS Consistency, control and confidence are key running principles and for the London Marathon, finding and developing gentle consistency without overly worrying about pace or distance is vital. Use initial weeks to find running rhythm and ensure training schedule fits with your unique life. Resist the temptation to be bullied by your schedule, instead fit it in when possible and you’ll soon enough learn to love running and find more time for it.
Turn off your iPod and GPS and listen to your body. Noticing foot stride, heart beat and breathing – it is the best way to understand how to vary pace and set tempo for running success. The desire to build up the mileage and do it early can be overwhelming. For new runners in initial weeks it is vital for connective tissue (ligaments and tendons) to adapt to new stress, push too hard too early and long term problems can arise, keep to short runs and progress gradually.
spring 2010 practicematters
9
GP COMMENT DEBATE The Wellington Hospital is dedicated to supporting GPs…
It’s a question of choice Last year, the Secretary of State for Health, Andy Burnham announced plans to abolish the current GP registering system in England and proposed a new scheme whereby patients may choose their GP surgery, regardless of where they live. This would then open up more choice to those patients that wish to register at a GP surgery close to where they work, perhaps where their children attend school or possibly a surgery they may live near but find themselves currently out of their catchment area. Though this new system does have many positive points, such as patients being able to choose a GP surgery that specialises in their conditions or has female GPs, there are of course drawbacks. Medical professionals have stressed concerns in particular areas, such as how this affects home visits, referring outside of locally-based services and
added pressure on already busy A&E’s. Andy Burnham has for 12 weeks, opened a consultation period where both medical professionals and patients can add their opinions to the debate. On the 28th May 2010 consultation closes; these proposals will be published in September 2010 and implemented in April 2011. Will it complicate things? Is it a step forward? Can it in practice, work? We would be interested to know what your opinions are to print in the next issue of Practice Matters. Any suggestions for topics you would like to read about and comment on in future issues would also be warmly welcomed. To have your say email claire.allen@hcahealthcare.co.uk Further details about GP Choice at www.gpchoice.dh.gov.uk
GP LIAISON NEWS The Wellington Hospital is proud to reintroduce our newly expanded GP Liaison service. Since November 2007 the GP Liaison team has provided a ‘one-stop shop’ service for all patients and GPs who wished to use the services here at The Wellington Hospital. After a successful first two years we are delighted to announce, as of January 2010, we have grown to seven fulltime members of staff, soon to increase to nine. They are dedicated to assisting GPs and self-referring private patients to quickly and efficiently access our medical services and extensive outpatient and diagnostic facilities. Meet the team Working closely with GPs we understand that you and your staff can spend a disproportionate
amount of your time trying to arrange a private referral for your patients. We have two GP Liaison Officers, who are directly available to aid GPs based in Central and North-West London including Middlesex and Hertfordshire. Our specialist service means that with one phone call, a convenient time can be arranged for your patient to see one of our specialists or utilise our comprehensive diagnostic facilities. As well as providing information about the services available at the hospital, we also set up and run internal and external events specifically for GPs and other medical professionals. We can also organise for a consultant specialist to give talks to your staff in your own practice on a range of your preferred topics. Our officers would be happy to visit you at your surgery to discuss any comments or queries you may have about any aspect of our service.
Katy Cross call: 07826 551318 email: katy.cross@hcahealthcare.co.uk Amit Sharma call: 07889 317769 email: amit.sharma@hcahealthcare.co.uk Our remote officers are supported by five onsite GP Liaison Assistants who will handle all calls, providing help with general enquiries and offering a knowledgeable and professional service when dealing with referrals. Our assistants have access to a high number of top London consultants at The Wellington Hospital. If your patients need treatment we may not provide, our helpline will be pleased to search and help refer the enquiry to another of our London hospitals in the HCA network. Our current GP Liaison Assistants are: Daisy Stokeld, Ricky Mckinson, Jennifer Vero, Vadney Waldron and Prinita Naidoo. As a team we pride ourselves on providing a personal service for everyone, and we are determined to make sure that the scale of our operation doesn’t stop us from delivering a first-class service to each of our private patients and to GPs referring people to one of the 400 consultants who work here. We look forward to helping and working with you in the future.
10
practicematters spring 2010
www.thewellingtonhospital.com
NURSES CORNER
London hospitals clean up in latest survey HCA hospitals pioneer revolutionary real time hygiene auditing system
HCA’s six leading independent hospitals in central London have all been awarded the top five star status for cleanliness and safety in the first UK survey by the revolutionary electronic Quality Inspection Tool, e-QIT. The hospitals, The Wellington, The London Bridge Hospital, The Harley Street Clinic, The Portland Hospital for Women and Children, The Lister Hospital and The Princess Grace Hospital, have consistently achieved high standards of cleanliness in recent years. In 2009 for example, there were no cases of hospital acquired MRSA in any of them. The revolutionary new e-QIT system uses special hand held computers loaded with a comprehensive database which includes the complete layout of hospital buildings from the largest wards and theatres to the smallest cupboards. Senior staff can then use the tool to inspect, photograph, log and report on infection control, cleanliness, infrastructure, décor and health and safety issues – in real time. If any of the thousands of measurables stored on the laptop are not up to standard, departmental heads are given an agreed timetable to rectify the situation. These state-of-the-art inspections will be carried out on a regular basis or as a spot check with no prior notice given to staff. e-QIT was developed by Infection Control Services Ltd, a company formed by six consultant microbiologists, in collaboration with HCA International Ltd.
Enquiry Helpline: 0207 483 5148
Project leader for HCA, Sue Smith, who is also Chief Executive Officer of the Princess Grace Hospital, said that before e-QIT was developed, an inspection was only as good as the person who looked at the audit results. “Until now systems of inspection and audit have really only been a paper trail and there was always a danger that things would be overlooked. There was little or no accountability,” she said. “Now we have a mobile, flexible tool with a huge database which includes current legislation and regulations and which demands that non compliant situations be dealt with immediately and under the responsibility specific manager. The system, which automatically uploads findings onto our IT network, simply won’t allow problems to be left or forgotten,” she said. The leader of the e-QIT development team at Infection Control Services, microbiologist Michael Shemko, said one of the goals was to make e-QIT future proof. “Legislation is changing as new methods of improving hygiene and health and safety in healthcare become available. When the goal posts change, e-QIT can be immediately upgraded and this in turn, modifies inspection and compliance criteria,” he said. HCA International President and Chief Executive Officer, Michael Neeb, said he was delighted with the success of the new system. “I congratulate everyone involved in this most important project. This is an industry first and the result of an innovative partnership which will enable all healthcare providers to create and maintain a culture of constant high standards in infection control, cleanliness and health and safety,” he said. The e-QIT system is being rolled out to HCA’s diagnostic and outpatient centres in and around London, over the coming months.
NEW CONSULTANTS Cardiology Dr Azad Ghuran Consultant Cardiologist Dr George Amin-Youssef Consultant Cardiologist Dermatology Dr David Orton Consultant Dermatologist General Surgery Mr Barry Paraskeva Consultant General Surgeon Mr Paul Ziprin Consultant General Surgeon General Physicians Dr Brian O’Connor Respiratory Physician Dr Harsha Kariyanawasam Allergy & Rhinology Physician Gynaecology Mr Ellis Downes Consultant Gynaecologist Ms Eleni Mavrides Consultant Gynaecologist Ms Amina Shafik Consultant Gynaecologist Nephrology Dr Jennifer Cross Consultant Nephrologist Orthopaedics Mr Rahul Patel Consultant Orthopaedic Specialist Mr Mark Rickman Consultant Orthopaedic Specialist Mr Michael Oddy Consultant Orthopaedic Specialist Urology Mr Rizwan Hamid Consultant Urologist
spring 2010 practicematters
11
EVENTS DIARY Live Surgery Event : 14.04 The Wellington Hospital hosted its very first Live Surgery event on Wednesday 14th April at Lord’s Cricket Ground. It was met with huge success, by an audience of local GP’s, practice managers, and consultants. Surgery was performed by Mr Barry Paraskeva, Consultant General and Laparoscopic Surgeon and the event was chaired by Mr Austin Obichere, Consultant General and Laparoscopic Colorectal Surgeon. A live link, streamed from the North Building Theatres to the Thomas Lord suite at Lords Cricket Ground, allowed the delegates to view Mr Paraskeva and his team demonstrating a gallbladder removal via Single Incision Laparoscopic Surgery (SILS), as it took place. Mr Barry Paraskeva has pioneered single incision laparoscopic surgery / single port laparoscopic surgery and was the first surgeon in the UK to remove the appendix and gallbladder using SILS. Mr Paraskeva is a keen educator and respected lecturer in surgery and has authored many texts on surgery.
He talked the audience through the surgery step by step and they were encouraged to interact with him, through Mr Obichere, as the surgery progressed. After the surgery had been successfully completed – Mr Paraskeva joined his audience at Lord’s Cricket Ground for a Q&A session. If you missed this event and are interested in the SILs technique, the footage will shortly be available to view through the medical professionals section on our main website www.thewellingtonhospital.com
THE PROCEDURE The SILS technique can be utilised to safely manage common surgical conditions including: •Removaloftheappendix •Removalofgallbladderorgallstones •Herniarepair •Colonoperations •Otheroperationsonthestomach The majority of single port operations are performed as a daycase and the patient will only have one scar which is concealed in the belly button, the pain will be less and the recovery period is quicker.
Post Graduate Education at The Wellington Continued Professional Development (CPD) and Continuing Medical Education (CME) has always been a feature of medical life and The Wellington Hospital is in the forefront of providing this for a wide range of healthcare professionals. With the enthusiastic support of its CEO, Keith Hague, the hospital is an active supporter of continued professional development and provides a wide range of healthcare staff with the opportunity to attend a varied programme of high quality and engaging medical education initiatives throughout the year. The hospital offers a mix of seminars, masterclasses, symposia and study days, which
are generally held in the evenings or on Saturday mornings and take place at either the hospital itself or at easily accessible external venues nearby. The hospital’s education programme serves to inform actual or potential users of the hospital’s services the depth and quality of care available at The Wellington Hospital. Specific educational lecture programmes for GPs are developed and managed by the hospital’s Postgraduate Dean Dr Martin Sarner. Our dedicated website www.wellingtonevents. co.uk contains details of all our forthcoming educational events plus booking information.
www.thewellingtonhospital.com Enquiry Helpline: 0207 483 5148
Educational events scheduled for the next three months are outlined below. For further information and booking details please see our website: www.wellingtonevents.co.uk 06.05 GP Seminar: Advances in laparoscopic surgery – Board Room, Wellington Hospital 11.05 GP Seminar: An update on cancer – WDOC Golders Green 25.05 Orthopaedic Masterclass: Life as a special forces surgeon – Huxley Lecture Theatre, London Zoo 03.06 GP Seminar: Latest developments in obstetrics and gynaecology – Board Room, Wellington Hospital 09.06 3rd HPB Masterclass: Work up of the jaundiced patient. Surgery for Ca Pancreas – Mappin Suite, London Zoo 17.06 GP Seminar: Evolving management of liver cancer – WDOC Golders Green 19.06 Cardiac Services Seminar – Snow and Paget Rooms, BMA 29.06 Orthopaedic Masterclass: High performance sports medicine – Huxley Lecture Theatre, London Zoo 01.07 GP Seminar: Common respiratory dilemmas in the community – Board Room, Wellington Hospital 03.07 Pain Management – BMA 17.07 Cardiac Services Seminar – Snow and Paget Rooms, BMA 27.07 Orthopaedic Masterclass: Common Hand Problems – Huxley Lecture Theatre, London Zoo 29.07 GP Seminar: Bowel cancer surgery – new treatments – Board Room, Wellington Hospital