Sandwell and West Birmingham hospitals NHS trust: technology innovation award runner-up

Dr Matthew Lewis (far right) takes part in an electronic board round with his team.

Sandwell and West Birmingham hospitals NHS trust's established electronic bed management system (eBMS), which runs across its three acute hospitals, was expanded to help reduce bed-blocking and improve the quality of patient care.

The system can track a patient from admission to an acute medical unit until they are discharged to go home and keeps a log of the care they receive along the way.

Dr Matthew Lewis is the trust's group director for medicine and emergency care and a consultant in gastroenterology. He says: "At an individual patient level it's a single tool which enables us to co-ordinate the care we provide in different teams both inside and outside the hospital."

The eBMS, says Lewis, has become "the centrepiece of an electronic board round", where every day a ward's multi-disciplinary team will refer to the system to discuss a patient's progress and his or her readiness to go home.

The eBMS has other benefits too. "On a different level, it is also used as a way for us to look at the [bed] capacity issue. It means at any one time we can see whether we are on track or not," he says.

The eBMS has real-time operational dashboards, which track variations in patient flow, showing any reduction in length of stay, bed turnover intervals and delayed discharge. "The dashboards allow key staff to monitor at ward level any specific area of patient care during the inpatient stay which will cause a queue," says Lewis.

eBMS also includes 44 manual flags that can be applied to highlight a clinical patient alert and another 37 clinical alert flags are automatically triggered via electronic messaging from the hospital's other IT systems. These alerts are passed on to doctors via text, email, dashboard or bleep.

Lewis adds: "The combined functionality of patient-flow tracking, coupled with the many alerts and flags, enables the clinicians to have up-to-date information in real time to enable them to make informed clinical decisions quickly, that not only saves lives but improves the overall experience of patients during their inpatient stay."

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National blood service, Oxford University hospitals NHS trust: technology innovation award runner-up

Oxford University hospitals NHS trust uses handheld computers at the bedside to scan the identity barcode on a patient's wrist band.

Introducing an identity barcode on a patient's wrist band, using handheld computers at the bedside, electronically controlling the temperature of blood fridges and tracking stock have improved patient safety Oxford University hospitals NHS trust's national blood trust and saved £528,000.

The trust wanted to reorganise its bedside and laboratory transfusion service in order to reduce the number of deaths from "wrong transfusion" – the second most frequent cause of death from transfusion reported to the UK's serious hazards transfusions scheme. In the past 15 years, errors in the UK transfusion service were responsible for 27 deaths and 120 cases of major morbidity.

Oxford hoped that by using technology it would also reduce the amount of time staff spent checking blood, reduce blood wastage and the inappropriate use of supplies, as well as speed up the supply of blood in emergencies.

Consultant haematologist professor Michael Murphy says: "For many members of the public or patients to think a process that is so important is relying on bits of paper and people looking at long numbers, is just unbelievable."

Today transfusion patients are identified by a barcode on their wrist band, which is scanned by a nurse at the bedside using a handheld computer. The nurse also scans his or her own barcode before following the transfusion process written on the computer screen.

There is now a complete electronic audit trail of blood supplies after the blood bank IT system was linked to others in the trust, which has led to significant improvements in blood sample collection, the collection of supplies from fridges and the transfusion-related admin.

Paperwork has been cut by 52 minutes per patient and the bedside transfusion process now requires one nurse instead of two. The initiative is recognised as an exemplar NHS evidence, quality, innovation, prevention and productivity project. The Oxford team wrote a national specification for the electronic transfusion service for the former National Patient Safety Agency.

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Intelesant: winner, technology innovation award

With the End of Life Monitoring and Assessment tool, GPs can be notified of care home residents' end of life wishes.

An app-like tool that has the potential to change the culture around advanced plans for frail and older people in care homes has been developed in Trafford, Greater Manchester.

The End of Life Monitoring and Assessment (Elma) tool allows care homes to electronically send a resident's advanced plan – a statement of their end of life wishes – via a handheld device direct to the individual's GP computer system. The plan, which is Read-coded and compatible with the practice system, can then be accessed around the clock by other NHS staff from ambulance teams to A&E doctors and community nurses.

It means that for the first time care home staff can directly share their knowledge about a resident with the wider NHS. Crucially, Elma also allows GPs and other NHS staff to be kept up-to-date with the advanced plan of an older person living in the residential care system whom they may rarely see and may be little known to them.

With the resident's consent, Elma can also be accessed by their family or friends using a secure two-factor authentication. Uniquely, Elma has also been designed to be used as an experiential training tool by care home staff to teach them how to create and develop an advanced plan with a resident.

Before Elma was introduced, care homes that did promote advanced plans for residents used paper versions, which then had to be faxed to the GP surgery. The time-consuming process was open to error and the information the plans held was often inconsistent, says physiotherapist Louise Rogerson, director of service development at Intelesant – the company behind Elma.

Because of Elma, it is hoped that eventually all people living in Trafford – not just care home residents – will have an advanced plan, which can be securely accessed by healthcare professionals and the individual's family. Rogerson said: "Any of us who have an advanced plan can use this system; it's not just for people in the last years of their life, it's for anybody who wants an advanced plan."

Additional coded data about the resident, which has been added by the care home staff can also be accessed via Elma by healthcare professionals, if necessary. That data includes latest information about a resident's usual level of consciousness; their mobility; their diet and their weight.

Rogerson says: "These are key indicators about how well a patient is, about how frail they are, and was something which the doctors in A&E said would be useful. It's the kind of information which the care home staff would have."

The electronic tool, developed by Intelesant, Trafford clinical commissioning group and the local hospice, has already been used by one local care home and is in the process of being rolled out to another nine.

The data Elma captures also reflects that required by the electronic palliative care co-ordination system, which is part of the national end of life care programme in England.

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Five minutes with ... the founder of a healthcare technology company

'I'd like there to be a much more open and transparent culture in the NHS, in terms of information sharing,' says Frank Hester.

Describe your role in one sentence. My role now is completely varied – from being a spokesperson for our vision of connected healthcare to working hands-on with our teams in the Leeds office, every day brings something different.

Why did you want to work in healthcare? I was inspired by my wife's work as a GP. She worked so hard to care for her patients yet I could see her constant struggle with the lack of connectivity and integration between NHS services.

How do you want to see the sector change in the next five years? I'd really like there to be a much more open and transparent culture in the NHS, in terms of information sharing, procurement and contracts.

My proudest achievement at work was ... being invited to be part of the trade mission to India with David Cameron earlier this year. We've been working alongside Healthcare UK to export SystmOne abroad.

The most difficult thing I've dealt with at work is ... managing to keep our small company values and culture despite growing very quickly.

The biggest challenge facing the NHS is ... achieving the digital strategy. The technology to make it happen is here now, but the NHS will have to make some necessary cultural changes.

The people I work with are ... unbelievably inspiring. We have very passionate, driven staff who are excited to come to work every day.

I do what I do because ... I'm one of those people who believes I can make a difference to the world and I now know our product has made that difference. I regularly meet the doctors and nurses who use SystmOne, and every time they tell me it makes their working lives easier, or has helped patient care, I know I'm still in the right job.

Sometimes people think that I ... am just the chief executive but in reality, I have a very hands-on approach to the company. At heart, I'm still a computer programmer and nothing gives me greater pleasure than sitting down with our software developers and getting to the heart of a technical problem.

Right now I want to ... make sure that we don't take our foot off the gas. We're accelerating at a very quick rate and sometimes that can be a little daunting.

At work I am always learning that ... communication is key. At TPP we have a very open culture and I'm constantly reminded that people working in teams, talking to each other, gets a better, faster result than someone struggling on their own.

The one thing always on my mind at work is ... remembering that everything we do is for the benefit of patients and health professionals.

If I could go back 10 years and meet my former self, I'd tell them ... not to worry about making mistakes. We're always learning and evolving, making mistakes is an inevitable part of developing and growing a product.

If I could meet my future self I'd expect them to be ... exhausted! My team works extremely hard and as a result I do, too, but I have no plans to slow down any time soon.

What is the best part of your job? Hearing stories about how SystmOne has saved someone's life. The amount of information available to clinicians is enormous, and having visibility of that data can drastically change the decisions that are made about how to care for a patient.

What is the worst part of your job? Hitting barriers created by bureaucracy. It's sometimes frustrating for people who are as creative and innovative as we are to wait around for endless processes to be implemented. The NHS is a wonderful thing, but it is bogged down by slow moving management.

What makes you smile? Sitting alongside my staff in the pub on a Friday night. I think the social side of working is extremely important, and, after a hard week at work, having a drink with my staff reminds me how lucky I am.

What keeps you awake at night? I've been a computer programmer for 33 years and I still get excited about how IT can improve the quality of our lives. I'd say the only thing that really keeps me awake at night is me looking forward to getting on with the next day!

If you would like to feature in our 'Five minutes with ...' series, or know someone who would, then you can let us know by emailing healthcare@theguardian.com

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MAPS technology may generate vaccines conferring strong immunity at reduced cost and risk

Main Category: Immune System / Vaccines
Article Date: 30 Jul 2013 - 2:00 PDT Current ratings for:
MAPS technology may generate vaccines conferring strong immunity at reduced cost and risk

A new method of vaccine design, called the Multiple Antigen Presentation System (MAPS), may result in vaccines that bring together the benefits of whole-cell and acellular or defined subunit vaccination. The method, pioneered by researchers at Boston Children's Hospital, permits rapid construction of new vaccines that activate mulitple arms of the immune system simultaneously against one or more pathogens, generating robust immune protection with a lower risk of adverse effects.

As reported by Fan Zhang, PhD, Ying-Jie Lu, PhD, and Richard Malley, MD, from Boston Children's Division of Infectious Disease, in the Proceedings of the National Academy of Sciences on July 29, the method could speed development of new vaccines for a range of globally serious pathogens, or infectious agents.

Broadly speaking, the vaccines available today fall into two categories: whole-cell vaccines, which rely on weakened or killed bacteria or viruses; and acellular or subunit vaccines, which include a limited number of antigens - portions of a pathogen that trigger an immune response. Both approaches have advantages and disadvantages.

"Whole-cell vaccines elicit a broad range of immune responses, often just as an infection would, but can cause side effects and are hard to standardize," said Malley. "Acellular vaccines can provide good early immunity with less risk of side effects, but the immune responses they induce wane with time."

The MAPS method may allow vaccine developers to take a middle ground, where they can link multiple protein and polysaccharide (sugar) antigens from one or more pathogens together in a modular fashion, much as one would connect Lego blocks.

The resulting complex - which resembles a scaffold of polysaccharides studded with proteins - can stimulate both antibody and T-cell responses simultaneously much like whole-cell vaccines, resulting in stronger immunity to the source pathogen(s). However, because the composition of a MAPS vaccine is well defined and based on the use of isolated antigens (as one would find with an acellular vaccine) the risk of side effects should be greatly reduced.

For instance, mice injected with a MAPS vaccine combining proteins from tuberculosis (TB) and polysaccharides from Streptococcus pneumoniae (pneumococcus) mounted vigorous antibody and T-cell responses against TB, whereas those vaccinated with TB protein antigens alone mounted only an antibody response.

Similarly, 90 percent of mice given a MAPS-based vaccine containing multiple pneumococcal polysaccharide and protein antigens were protected from a lethal pneumococcus infection, mounting strong antibody and T-cell responses against the bacteria. By contrast, 30 percent of mice vaccinated with the same antigens in an unbound state survived the same challenge.

"The MAPS technology gives you the advantages of: whole-cell vaccines while being much more deliberate about which antigens you include; doing it in a quantitative and precise way; and including a number of antigens so as to try to replicate the effectiveness of whole-cell vaccination," Malley explained. "The immunogenicity of these constructs is greater than the sum of their parts, somewhat because they are presented to the host as particles."

The system relies on the interactions of two compounds, biotin and rhizavidin, rather than covalent binding as is used in most of the current conjugate vaccines. To build a MAPS vaccine, biotin is bound to the polysaccharide(s) of choice and rhizavidin to the protein(s). The biotin and rhizavidin then bind together through an affinity interaction analogous to Velcro. The construction process is highly efficient, significantly reducing the time and cost of vaccine development and production.

While his team's initial work has focused on bacterial pathogens, Malley believes the technology could impact vaccine development for a broad range of pathogens, in particular those of importance in the developing world. "Technically, one could construct MAPS vaccines for viruses, parasites, even cancer antigens," he said. "And the modularity is such that one could include antigens from multiple pathogens into the same vaccine, allowing the development of combinatorial vaccines much more efficiently."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our immune system / vaccines section for the latest news on this subject.

Fan Zhang, Ying-Jie Lu, and Richard Malley "Multiple antigen-presenting system (MAPS) to induce comprehensive B- and T-cell immunity" Published online before print July 29, 2013, doi: 10.1073/pnas.1307228110

The study was supported by the National Institute for Allergy and Infectious Diseases (grant R01AI067737) and the Translational Research Program at Boston Children's Hospital.

Boston Children's Hospital

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Solar-powered sterilization technology supported by Gates Foundation

Main Category: Public Health
Article Date: 25 Jul 2013 - 0:00 PDT Current ratings for:
Solar-powered sterilization technology supported by Gates Foundation

Rice University nanotechnology researchers have unveiled a solar-powered sterilization system that could be a boon for more than 2.5 billion people who lack adequate sanitation. The "solar steam" sterilization system uses nanomaterials to convert as much as 80 percent of the energy in sunlight into germ-killing heat.

The technology is described online in a paper in the Proceedings of the National Academy of Sciences Early Edition. In the paper, researchers from Rice's Laboratory for Nanophotonics (LANP) show two ways that solar steam can be used for sterilization - one setup to clean medical instruments and another to sanitize human waste.

"Sanitation and sterilization are enormous obstacles without reliable electricity," said Rice photonics pioneer Naomi Halas, the director of LANP and lead researcher on the project, with senior co-author and Rice professor Peter Nordlander. "Solar steam's efficiency at converting sunlight directly into steam opens up new possibilities for off-grid sterilization that simply aren't available today."

In a previous study last year, Halas and colleagues showed that "solar steam" was so effective at direct conversion of solar energy into heat that it could even produce steam from ice water.

"It makes steam directly from sunlight," she said. "That means the steam forms immediately, even before the water boils."

Halas, Rice's Stanley C. Moore Professor in Electrical and Computer Engineering, professor of physics, professor of chemistry and professor of biomedical engineering, is one of the world's most-cited chemists. Her lab specializes in creating and studying light-activated particles. One of her creations, gold nanoshells, is the subject of several clinical trials for cancer treatment.

Solar steam's efficiency comes from light-harvesting nanoparticles that were created at LANP by Rice graduate student Oara Neumann, the lead author on the PNAS study. Neumann created a version of nanoshells that converts a broad spectrum of sunlight - including both visible and invisible bandwidths - directly into heat. When submerged in water and exposed to sunlight, the particles heat up so quickly they instantly vaporize water and create steam. The technology has an overall energy efficiency of 24 percent. Photovoltaic solar panels, by comparison, typically have an overall energy efficiency of around 15 percent.

When used in the autoclaves in the tests, the heat and pressure created by the steam were sufficient to kill not just living microbes but also spores and viruses. The solar steam autoclave was designed by Rice undergraduates at Rice's Oshman Engineering Design Kitchen and refined by Neumann and colleagues at LANP. In the PNAS study, standard tests for sterilization showed the solar steam autoclave could kill even the most heat-resistant microbes.

"The process is very efficient," Neumann said. "For the Bill & Melinda Gates Foundation program that is sponsoring us, we needed to create a system that could handle the waste of a family of four with just two treatments per week, and the autoclave setup we reported in this paper can do that."

Halas said her team hopes to work with waste-treatment pioneer Sanivation to conduct the first field tests of the solar steam waste sterilizer at three sites in Kenya.

"Sanitation technology isn't glamorous, but it's a matter of life and death for 2.5 billion people," Halas said. "For this to really work, you need a technology that can be completely off-grid, that's not that large, that functions relatively quickly, is easy to handle and doesn't have dangerous components. Our Solar Steam system has all of that, and it's the only technology we've seen that can completely sterilize waste. I can't wait to see how it performs in the field."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our public health section for the latest news on this subject.

Paper co-authors include Curtis Feronti, Albert Neumann, Anjie Dong, Kevin Schell, Benjamin Lu, Eric Kim, Mary Quinn, Shea Thompson, Nathaniel Grady, Maria Oden and Nordlander, all of Rice. The research was supported by a Grand Challenges grant from the Bill & Melinda Gates Foundation and by the Welch Foundation.

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