Kate Jackson explains her concept, Ralph Packs, during the lunchtime poster presentations

The shortlisted teams came from across the UK to present their ideas to an audience of investors, students, university faculty, and like minded innovators.  A busy networking lunch allowed all shortlisted candidates to showcase their innovations via poster presentations and idea demonstrations. Finalists from each category pitched to the delegates and judges, and an alarmingly high quality of ideas were showcased – wide ranging innovations with the potential to effect great impact on a diverse range of beneficiaries.

All attendees also got to take part in workshops to hone their networking skills, build business know-how, become effective clinical leaders, and actively engage in healthcare politics. Interdisciplinary networking was encouraged throughout the day, and a lively Start-Up Garage demonstrated the value of this interdisciplinary working, when teams developed business ideas to solve problems in healthcare delivery.

Category winners were announced after much deliberation and include:

[care] Sponsored by Janssen: Harriet Treacy’s  I.C.E. innovation to improve patients’ feelings of power and well-being.

Elspeth Hill, Chair of Fastbleep, awards wardWatch with their prize cheque

[edu] Sponsored by Janssen: wardWatch, a web based innovation to allow medical students to take control of their own hospital learning.

[tech] Sponsored by Janssen: Ward Wizard, a software to enable more effective clinical hand-overs.

 [need] Sponsored by MIMIT:  Ziacath – an improved catheter design to minimise complications within the bladder

Move Eat Treat won Best Poster with their campaign to move towards a proactive healthcare system, with an increase the emphasis afforded to lifestyle advice given by healthcare professionals and included in healthcare education curricula

The People’s Choice Award was won by Inovus Surgical Solutions, with over 4,500 Facebook “Likes” for their innovation – the Pyxus© laparoscopic box trainer

As this year’s innovators take their ideas forward,  Fastbleep have big plans for next year’s competition, and will be opening entries for FastForward 2013 in the near future.

The Team

Umair Khan: Medicine, University of Leicester
Dr. Tahir Khan: Consultant Histopathologist
Ammar Khan: Mathematics, University of Leeds

The Problem 

Hospital acquired infections is a major problem in NHS which has required deep cleaning of the wards with excess expenditure. Whilst the doctors and the hospital staff take necessary care to clean their hands with alcohol gel in between patients, the most commonly used stethoscope of doctors escape attention. Having started my clinical rotations, being on the wards has allowed me to experience this first-hand. I personally have wiped my stethoscope with alcohol wipes a few times whilst I see consultant physicians not paying attention to the issue. There are alcohol wipes available on the wards but due to the practicalities of it, it is not surprising that doctors hardly clean their stethoscope, hence leaving patients exposed to potential source of bacteria.

These are some papers which provide evidence regarding the risk of cross-contamination between patients associated with stethoscopes as they harbour various bacterial growth. For example a study by Tang PH et al concluded that bacterial contamination rates are high in Emergency department on stethoscopes (1). Even more shocking was the study by Merlin MA et al (2) which found that about every 1 in 3 stethoscopes in Emergency department  were contaminated by MRSA.

The paper by Schroeder A et al (3) highlights that rubbing alcohol pads are a good solution to decreasing bacterial colonisation on stethoscope but are infrequently used and “not always available”. Therefore a more simpler and easy solution is needed to the problem.

The Current Solution

Currently the solution available is to wipe the stethoscope with alcohol pads. Although this is effective in killing bacteria and infection control, the practicality of it makes it an unpopular choice. Having to open up alcohol pads every time after seeing a patient is cumbersome for a doctor, especially in the busy ward round. Also they may not be available sometimes.

The Idea

StethoFILM aims to reduce the risk of cross-contamination between patients due to stethoscopes. It is a simple practical device which will be cheap, easy and fast to use for the doctor, especially in a busy ward round.

We propose to produce a device which is a simple thin plastic disposable film that will stick to the stethoscope diaphragm using a film dispenser (see design prototypes below), allowing it to be removed after completing the examination of the patient and discarded. The design of the plastic will ensure that the sounds heard on auscultation are not or minimally impeded. This will be a cheap, fast and easy method for a doctor to use rather than wasting time with alcohol pads.

The following diagram shows how the StethoFILM will look like and some of its features:

The following shows the dispenser design in which the StethoFILM will be packaged. The design aims to allow for quick application of StethoFILM from the dispenser, saving time.

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References

(1) Tang PH et al. Examination of staphylococcal stethoscope contamination in the emergency department (pilot) study (EXSSCITED pilot study). CJEM, Can. j. emerg. med. care. 13(4):239-44, 2011 Jul

(2) Merlin MA et al. Prevalence of methicillin-resistant Staphylococcus aureus on the stethoscopes of emergency medical services providers. Prehosp Emerg Care, 13 (2009), pp. 71–74

(3)  Schroeder A et al. What’s growing on your stethoscope? (And what you can do about it.). J Fam Pract, 58 (2009), pp. 404–409

                                                                                                                                                                                                                     

THE PROBLEM

80% of all patients admitted to hospital have an intravenous cannula inserted as part of their treatment. Despite substantial progress with the inception of care

bundles to reduce infection rates, peripheral cannulation still carries great infection risks, including introducing MRSA into the patient. Organisms causing cannula related noscomial infections can originate from the patients skin flora and a lack of aseptic insertion technique by the administering healthcare professional. The effects of such an infection range from “discomfort to the patient, prolonged or permanent disability and patient death.”¹

More than 50% of all outbreaks of hospital acquired bacterae

mia or candidaemia reported in the world literature between 1965 and 1990 originated from vascular devices2^,3 and between 5% and 25% of intravascular devices are found to be colonised by skin organisms⁴. The ideal catheter, a catheter that combines low-co

st coating technology, wide-spectrum and long-lasting antimicrobial properties, and safe utilization, has yet to be developed. The Department of Health has set targets for the NHS to reduce MRSA infection rates by 29% during 2012-2013.

Nationally, hospital trusts have developed their own local guidance on how to reduce complications associated with inserting an intravenous cannula. Universally, the guidance encourages improvements in technique, preparation, adequate monitoring and documentation. However, there is no focus on improving the device itself being inserted.

THE SOLUTION

Coating intravenous cannulae with non-toxic particles of silver nitrate will reduce infection rates associated with device insertion. The released silver is active against microorganisms commonly found responsible for noscomial infections. It accumulates at the site of insertion thereby enhancing local protection against infection with no risk of systemic toxicity.  The anti-microbial properties of silver have long been known about whereby silver disrupts the energy metabolism and electrolyte transport systems, when it binds to bacterial proteins.

Research in animals has already demonstrated the safety and efficacy of using silver nitrate to tackle the commonly offending micro-organisms. The increased costs of the cannula are outweighed by the savings made due to reduced use of antibiotics, reduced hospital stay due to patient complications and decreased morbidity and mortality experienced by patients⁵.

A- Staphylococcus aureus without silver treatment as found on a catheter

B- Staphylococcus aureus on a silver-containing material with microdispersed silver particles throughout the matrix.

We therefore propose the coating of intravenous cannulas with silver nitrate nanoparticles.

To develop this intravenous cannula, we have decided to use the same cannula currently in use in clinical practice to aid familiarity and reduce manufacturing costs. With regards to the coating, we have sourced the materials necessary to coat the cannula from the current evidence base.  The most effective method of coating catheters appears to be melting silver in a microwave oven and pouring over plastic intravenous catheters placed in screw cap tubes. The tubes are then centrifuged to remove the air trapped inside the catheters and quickly placed in a thermostated oven set at 53°C.  After 16 h, the coating solution is removed and the catheters are rinsed with various aqueous solutions.  After which, the catheters are placed on bench-top paper, dried and sterilized (autoclave at 121°C for 15 min), ready for use.

WHO STANDS TO BENEFIT

Patients throughout all medical and surgical disciplines would benefit from this innovative and simple solution.  Reducing peripheral cannulation infection rates would reduce ensuing local and systemic consequences of cannula associated infection.  Reduced patient morbidity and mortality will parallel reduced healthcare costs. For example, abolish the 3-10days added to a patients length of hospital stay, saving healthcare trusts an additional £4,000-£10,000 that is required to treat a patient with an infection than one without an infection⁶. Fewer infections will spare the use of antibiotics, which is in line with current public health measures trying to tackle antibiotic resistance.  In addition, this innovative work has far reaching applications in addition to intravenous cannulas, reducing potential infection from all indwelling equipment used in medicine, such as central lines, pacemakes, urinary catheters and so on safely guarding all those admitted into hospital and in particular those that are most vulnerable, the immunocompromised patient.

THE NEXT STEPS…

The next steps involve obtaining the necessary materials and preparation of purifying solutions, and the application of silver nitrate onto the intravenous cannula. Parallel to developing the product, we need to work closely with the ethical committee to enrol the product into a prospective clinical trial to confirm safety and efficacy.

OUR TEAM

Our team comprises 2 junior doctors, 2 final year medical students and one design and technology recent graduate.  By involving members who have clinical exposure, we were able to come up with the idea and the solution to this rife problem.  Our technology team member was able to estimate costs of the design and the feasibility of the project.   As our team included members of a medical and design and technology background, we were able to pool our ideas together and challenge each other’s ideas to ensure they worked and that any stumbling blocks had been considered and tackled.

REFERENCES

1. National audit office.

2. Maki DG. Nosocomial bacteremia. Am J Med 1981;70:719-32.

3. Maki DG, Mermel LA. Infections due to infusion therapy. In: Bennett JV, Brachman PS, editors.

Hospital Infections. 4th ed. Philadelphia: Lippincott-Raven Publishers; 1998. p. 689-724.

4. Pratt RJ, Pellowe C, Loveday HP, Robinson N, Smith GW, Barrett S, et al. The epic project:

developing national evidence-based guidelines for preventing healthcare associated infections.

Phase I: Guidelines for preventing hospital-acquired infections. Department of Health (England). J

Hosp Infect 2001;47 Suppl:S3-82.

5. Antimicrobial surface functionalization of plastic catheters by silver nanoparticles. Roe D, Karandikar B, Bonn-Savage N, Gibbins B, Roullet JB. J Antimicrob Chemother. 2008 Apr;61(4):869-76.

6. Department of Health 2008.

The Move. Eat. Treat. Campaign

Move. Eat. Treat. will function as a movement to focus attention on the issue of lifestyle advice and preventative medicine.

The primary focus of the movement is to co-ordinate a petition and campaign to improve the provision of lifestyle advice teaching to all healthcare professionals at both undergraduate and postgraduate levels.

The Innovation

The second focus of the organisation is to act as a social enterprise to deliver training to current healthcare professionals on the delivery of effective lifestyle advice to their patients. This will be particularly appealing to General Practitioners who have a financial as well as medical incentive to keep patients healthy and out of hospital. The profit from these sessions will be invested back into “Move. Eat. Treat.” to fund the campaign, provide further teaching and to commission research and policy papers into the area of public health and obesity prevention.

Our Vision

Move. Eat. Treat. hopes to promote the importance of preventative medicine with the aim of eventually developing a healthcare system, which doesn’t wait until patients become ill before it acts, but works to keep the population healthy – a true health service that is proactive and not reactive

Visit MoveEatTreat.org for more information and don’t forget to click the “Like” button below!

Team name: Preston Psych Soc

Members: Rebecca Adams, Elizabeth Berry, Christina Kaewchaluay, Ergul Kaide, Holly Wolton

Application name: CBT for me

The problem:

1 in 4 people will suffer with a mental health disorder in their lifetime. Anxiety and depression are currently the most prevalent psychiatric conditions with around 1 in 10 people in the UK experiencing depressive episodes or debilitating symptoms of anxiety every year. NICE guidelines continue to recommend Cognitive Behavioural Therapy (CBT) as the gold standard for the management of both anxiety and depression as it is shown to be the most effective long term solution. However, access to CBT is limited with long waiting lists and restrictions on the number of sessions allocated per patient.

Our research has shown that there are applications currently available which offer a mobile alternative to CBT in a health setting; however these are unfortunately unregulated, unofficial and costly with poor patient awareness of their availability.

The solution:

‘CBT for me’ App

We have come up with a patient-centred, easily accessible and user-friendly app to combat the problems we have highlighted; combining the effectiveness of CBT with the independence and confidence that the use of an app can bring.

We would like to encourage health professionals such as GPs, community nurses and psychiatrists; who work with patients with anxiety and depressive disorders on a regular basis; to promote the use of the app. We would also be interested in exploring the possibility of health care professionals obtaining access to patients’ mood diaries and mood scores in advance of upcoming consultations to monitor patient progress.

Examples:

Finally:

We are so excited about this innovation in patient care, which we genuinely believe can help anyone with anxiety and depression – regardless of how severe their symptoms are. The more time we have spent designing this app, the more we have come to realise this is something that cannot be overlooked, particularly within the current economic climate and increasing limitation of resources. We truly think this is an effective and worthwhile app to develop upon, and we hope you do too.

Any questions or suggestions are welcome – please feel free to comment below or contact us personally via email at prestonpsychsoc@hotmail.co.uk.

Its another busy day on the ward and the consultant strides into the first bay followed by a hoard of junior doctors and medical students.  The first patient is a 94 year old gentleman who has been on the ward for a few weeks now and seems to be improving.  The consultant briefly looks at him and asks loudly ’And how are we today sir?’.  The patient, seeing the consultant looking at him, smiles and nods.  ‘Good,good.’ the consultant replies and then turns to his juniors and lists his plan for the patient.  The consultant turns to the medical students and asks them what they observe from the patient.  Amongst the standard answers one says that the patient seems to be grasping his shoulder a lot.  The consultant looks back at the patient to confirm this.  Sure enough he seems to be rubbing his right shoulder. ‘I believe this gentleman has a painful arthritic joint,’ he announces to the students before turning to one of his juniors ‘ perhaps we should up his pain meds.’ Turning to the patient, ‘Is you shoulder giving you jip?’ he says.  ‘Hmm?’ the patient replied, whilst fiddling with his whistling hearing aid.  ‘Your shoulder,’ the consultant booms whilst jabbing at his own shoulder.  ‘What, er, yes, hmm shoulder.’ The patient replies.  The consultant nods satisfied and moves his crowd onto the next patient, tutting as he is already behind on time.

The pain medication given to this patient was unneeded and unwanted because better communication would have given the patient the ability to state it wasn’t a painful shoulder he was rubbing but was, in fact, itching, and all over.  This itching turned out to be a sign of worsening kidney function and the pain medication merely made him constipated.

There is a lack of effective communication between patients with hearing difficulties or are deaf or Deaf, and their healthcare team.  This can lead to frustration from both sides and to sub-optimal care and lack of compliance.

Often there is a lack of time or understanding to make sure that the patient has heard everything that is said, not only on a busy ward round but also in clinics.  Outrageously the patient is sometimes left out completely in the decisions of his/her care as they may simply nod along to what the doctor says without really hearing them.

With an ageing population and personal music players commonplace, hearing loss is likely to be a problem around for some time.  Lack of communication is one of the main reasons for patients or their relatives to make formal complaints.  It stands to reason that if there is already an existing obstacle to communication this problem can only be compounded.

The scale of the problem is vast, and there have been many studies about communication between people with hearing loss or are deaf or Deaf, in a healthcare setting.  It is not a problem unique to the UK and is evident globally.  Whilst all studies universally state that there is a consistent and widespread problem very few make practical suggestions on how to rectify this.  There are hundreds of thousands of people who are registered deaf or hard of hearing and many more people who have significant hearing loss.  This barrier of communication can often deterr people from seeking help at all.

It is a problem that is obvious and frequent to many clinicians throughout many medical settings. 

Although there are BSL interpreters available it is not always easily arranged and computer software designed to tackle the problem is scarce. Interpreters are often not used correctly with the doctor talking only to the interpreter.  Some patients bring a pen and pad for the doctor to write on but unless the doctor or medical staff knew the patient they may not think to ask.

There is very little in the way of existing solutions to this problem.  Even some innovations like hearing aids are poorly understood by many medical staff and patients can regularly be heard whistling away if they have them in at all.

The Solution

My innovation is in 2 parts.  Firstly, to raise awareness that there might be a problem with communicating with the patient.  This could be done by placing a laminated sign over the patient’s bed stating hard of hearing, deaf or Deaf.

Secondly, to try to rectify some of the loss of communication.  This could be achieved by every suitable patient being given a communication pack when they are on the ward.  This would include a pad of paper, a pen, and a set of 20 large pre-printed common sentences and questions that are used by patients in hospitals such as ‘I am in pain’ or ‘what is going to happen now?’.

Staff have to be aware that these packs exist and how to use them.  It is not a difficult concept and could be compared to hospital passports for patients with learning difficulties which are used in many hospitals already.  Since the majority of people affected by hearing loss are likely to be found on a geriatric ward, the packs could be tried in these wards first.

These packs would be cheap to produce and easy to use.  It is not high tec stuff but could be readily accessible to many with very little in the way of staff training.

Who is Ralph?

Ralph is the quiet elderly gentleman who sits in his chair on the ward and doesn’t make a fuss.  He has trouble hearing and doesn’t want to bother people by getting them to repeat things a lot.  He nods and smiles when nurses ask him how he is.  They are busy and he doesn’t want to be a nuisance so he doesn’t tell them he wants a drink or that the dressing is wet.  Sometimes the dietitian or physio will come round and talk to him, but the ward is pretty noisy and he can only seem to hear the background noise and not the voice speaking to him.  Although the ward is full of people he feels very isolated.  Sometimes the nurses don’t stop and chat to him like they do the other patients.  He dosen’t blame them, its difficult to make conversation for him too.  The pills they send him home with are many and although they explained them he didn’t hear much.  He depends on his family a lot to be his ears and doesn’t like to think how things would be without them.  He would tell you he has 11 grandchildren and 14 great-grandchildren.  This story is not uncommon and it’s a bit like many peoples grandfather.  He was my grandfather

Foundation Doctors and Medical Students have to carry many important items needed for daily ward work around their body, including stethoscope, tourniquet, ID, bleep, alcohol gel, pen, pen torch: the list is endless.

The Problem

• Risk of infection is high as items are not contained and are likely to come into contact with patients and other healthcare professionals.  For example, stethoscopes are currently carried around the neck in contact with bare skin and hang loosely interfering with daily interactions.
• Lost or misplaced items are very common issues within the wards.  The highly demanding and busy duties of Foundation Doctors and Medical Students, as well as the lack of personal storage, means the risk of losing personal items is high.
• The current way of carrying items is uncomfortable and unprofessional as Foundation Doctors are forced to walk around with bulging pockets and items hanging off the body.  There is also a lack of choice of attire, as many skirts and dresses do not have pockets.

The Solution

ESSENTIAL ACCESSORY+

• Infection proof
• Securely store items on the body
• Tailored to Foundation Doctors and Medical Students needs
• Functional and well designed

The Essential Accessory+ will be the ultimate solution for Foundation Doctors and Medical Students.  Made from tightly woven, non-porous fabric with anti-bacterial and hygienic properties, the Essential Accessory+ can be safely used to organise and carry all items needed for daily clinical activities.

The Team – DesignAid+

DesignAid+ is a team of one Medic, Wen Ling and two Textile Designers, Lucy and Anna from the University of Dundee who are working together to design and produce a solution, the Essential Accessory+. With support from Foundation Doctors, medical students and Consultants, the necessity for this item is evident.

“Infection control is a key issue in healthcare, bringing increasing restrictions on what junior doctors and other healthcare professionals may wear in our hospitals. Keeping the tools of the trade safe, clean and to hand is vital, so the Essential Accessory+ will help to facilitate safe, efficient healthcare.”

Dr Miles D Witham

Consultant Geriatrician and Senior Lecturer, University of Dundee

By engaging with designers, the request to make the product unobtrusive, well designed and aesthetically pleasing will be achieved.

“Research shows the critical value of design in helping solve problems in health and wellbeing.  Empathising with users, understanding the context of problems and applying creative thinking to their solutions is what design is all about.  This project could prove invaluable in providing new insights and solutions to a well established problem.” 

Professor Mike Press

Associate Dean of Design, University of Dundee

For further information in to our research process and development please visit our blog, follow us on Twitter and like us on Facebook.

The Future

Design and production will lead to trial use within hospitals with the intention of receiving constructive feedback which will be used to improve and further the product.

As smart fabrics become more accessible, there will be the potential to adapt this product.

(Fig1.0 Pyxus© by INOVUS)

Current laparoscopic box trainers are prohibitively expensive for individual users and are currently only available for use at institutions and main hospitals. A lack of technical skill in surgery has been found to correlate with decreased patient safety (Barone and Lincer, 1991). Studies show the use of laparoscopic box trainers increase visuo-spatial skill and improve surgical outcomes (Kobayashi et al, 2010).

Our plan is to provide a more affordable solution to laparoscopic trainers that would make these devices more readily available to both medical students and surgical trainees. Box trainer performance is shown to significantly correlate with actual laparoscopic surgery performance (Newmark et al, 2007) and increasing their availability would improve surgical outcome in the long run.

Our solution is the Pyxus© box trainer. This comprises an abdomen with four portholes located in each of the abdominal quadrants, two sets of forceps and a platform at the base of the abdomen which forms the surgical field. What sets Pyxus© apart from the existing more expensive competition is that it is fully USB-powered and can be viewed on any laptop screen without the need for expensive and complicated software. Further, it can be manufactured for a very reasonable price (at this point we do not wish to disclose our method of mass production). Although more expensive alternatives are available including virtual reality simulators the basic method embodied in the Pyxus© box trainer has been proven to be as effective if not more effective than its six figure sum counterparts (Kimura et al, 2006). As well as this Pyxus© allows users the ability to switch between forward and reverse views. This allows the user to practice switching positions and views of the surgical field which occurs regularly during actual surgery. Practicing switching types of views has been shown to help with mental rotation of obscurely angled laparoscopic camera images (Conrad et al, 2006).

Further to the Pyxus© box trainer we aim to develop surgical training videos to aid its effective use. Current training involving laparoscopic box trainers revolves around a surgeon being present on the day delivering a training session. Our plan is to create an interactive website with pre-recorded tutorials available for access anywhere in the world.

To date a fully working prototype has been assembled (Fig 1.0) and further investment would be used to develop the prototype further as well as recording the online tutorials.

References

Barone, J.E., &Lincer, R.M. (1991).A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern    Surgeons Club [Electronic version]. The New England Journal of Medicine, 324, 1073-1078.

Conrad, J., Shah, A.H., Divino, C.M., Schluender, S., Gurland, B., Shlasko, E., et al, (2006).The role of mental rotation and memory scanning on the performance of laparoscopic skills.Surgical Endoscopy, 20(3), 504-510.

Kimura, T., Kawabe, A., Suzuki, K., & Wada, H. (2006).Usefulness of a virtual reality simulator or training box for endoscopic surgery training.Surgical Endoscopy , 20, 656-659.

Kobayashi, S.A., Jamshidi, R., O’Sullivan, P., Palmer, B., Hirose, S., Stewart, L. et al., (2010).
Bringing the Skills Laboratory Home: An Affordable Webcam-Based Personal Trainer for Developing Laparoscopic Skills. Journal of Surgical Education, 68, 105-109.

Newmark, J., Dandolu, V., Milner, R., Grewal, H., Harbison, S., & Hernandez, E. (2007).Correlating virtual reality and box trainer tasks in the assessment of laparoscopic surgical skills. American Journal of Obstetrics and Gynecology, 197, 1-4.

Robyn Scott: The Story of an African Childhood from Tattered Cover on FORA.tv

He enjoys teaching medical students and currently tutors at Magdalen College, Oxford.

He is also passionate about medical management and leadership, being the national foundation doctor advisor to the UK Foundation Programme Office and a founding member of the council of the Faculty of Medical Leadership and Management.  He is also commencing a Masters in Business Administration at the Said Business School and Magdalen College, Oxford in October 2012.

He has an active interest in politics.  He is the recent past chairman of Conservative Future in Oxfordshire and Buckinghamshire and is currently the chairman of the Oxford East Constituency Conservatives.  He is also standing as a conservative council candidate for the 2012 Oxford City elections.

Ultimately, his interests focus on working with others to bring about positive change both in healthcare institutions and society at large.