http://www.nic.nhs.uk Recent Challenges Copyright 2009 NHS. This SOCN was one of a number of clinical needs which were generated from a SOCN Meeting at York District Hospital on 14th January 2010. The meeting was organised with the help of Marco Baroni (Vascular Surgeon) and this clinical need was identified by the Renal Dialysis Group, which was represented by Dr Worth. Wouldn’t it be great if there was the opportunity for a patient on renal dialysis to be able to take some exercise and thereby gain the health benefits of exercise during the down-time of needing to attend hospital often for several lengthy sessions per week. Such an exercise capability could attach to both a bed and also be built into the dialysis chair for the sitting patient. The exercise regimen could work for both lower body and upper body segments. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=81 Sun, 31 Oct 2010 10:07:41 GMT On the 14th January 2010 a number of clinical needs were generated from a SOCN (Statement of Clinical Needs)Meeting at York District Hospital. The meeting was organised with the help of Marco Baroni (Vascular Surgeon) and this clinical need was identified by the Renal Dialysis Group, which was represented by Dr Worth. It would be great if the needles used to gain access into the vascular system could be avoided altogether. However, if needles are to be used there are several opportunities for potential improvement. A major issue is the damage caused by the needle as it is inserted and withdrawn from the body. Such venous puncture, and the presence of the catheter in the vein, initiates an adverse response in the vascular tissues called intimal hyperplasia in which the cells in the vessel wall start proliferating and producing various tissue components. The effect is to thicken the vessel wall and make it unsuitable as a site for subsequent venous access. Intimal hyperplasia is also a major complication for other types of vascular surgery. Clearly the need to repeatedly search for new vascular access points leads to sites which are less then ideal and finally to the stage where vascular access becomes difficult or impossible – making the dialysis process itself impossible. Needle use that avoids the tissue damage that can lead to this serious complication is required. It would also be great if there was a needle that did not unintentionally become detached from the patient – the ideal case. If this is not practical, an alternative needle fitting could signal when it did become detached accidentally to avoid cases of significant blood loss. Local anaesthesia, such as lidocaine gel, is an expensive part of the procedure. A cheaper and efficient means of anaesthesia to accompany the needle insertion is required. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=79 Sun, 31 Oct 2010 10:06:36 GMT This SOCN was one of a number of clinical needs which were generated from a SOCN Meeting at York District Hospital on 14th January 2010. The meeting was organised with the help of Marco Baroni (Vascular Surgeon) and this clinical need was identified by the Renal Dialysis Group, which was represented by Dr Worth. Wouldn’t it be great if patients could have home-based dialysis, preferably throughout the night. This would be convenient for the patient, but also enable a slow and more physiological dialysis which is less traumatic to the circulatory system. This would require dialysis that is:- • Compact and easy to use – perhaps a machine that one can take on holiday. • Affordable - disposable components for single use make the treatment very expensive. • Patients must be able to access veins without clinical expertise • Overnight dialysis must be safe with no risk of exsanguination • Some form of connection is needed to stop the needle coming out during the night, or at least provide a warning system. It would be even better if the artificial kidney could be truly portable – like the real thing. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=80 Sun, 31 Oct 2010 10:05:25 GMT This SOCN was one of a number of clinical needs which were generated from an Infection Control SOCN (Statement of Clincial Need) Meeting on 24th February 2010, Manchester. The meeting was organised with the help of Dr Roz Kelly, Prof Jackie Oldham and colleagues at MIMIT and this clinical need regarding norovirus was discussed by Andrew Turner and Kirsty Dodgson: Norovirus is extremely disruptive to hospital care, due to its highly infective nature. The virus is airborne, and all patients on any given ward are at risk of being contaminated when spores are released in to the atmosphere (e.g. one infected patient vomits on the ward). Current diagnostics mean that patients on an affected ward must be isolated for up to 48 hours due to the incubation and diagnostic screening lead times before they can be moved, treated or discharged. The ward is then completely closed for deep-cleaning. Wouldn’t it be Great if... there was a quick norovirus diagnostic tool for screening of incoming patients Wouldn’t it be Great if... there was early detection of norovirus infection Wouldn’t it be Great if...there were better isolation facilities on the wards http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=82 Wed, 29 Sep 2010 11:44:52 GMT Wouldn't it be great if there were suitable non invasive technologies (or minimally invasive technologies) to replace the current invasive testing methods and which could be carried out at the bedside and offer multiple testing capability delivered via the same platform. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=74 Tue, 22 Jun 2010 16:28:25 GMT Wouldn't it be great if there were improved diagnostic and investigative testing for children which included a rapid assessment of ER based vital signs; could demonstrate a differentiation of viral versus bacterial infections and could offer a multiple specific and generic tests that could network visualisation for quick decision making….. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=75 Tue, 22 Jun 2010 16:26:37 GMT Wouldn’t It Be Good If ……… we could raise the profile of continence care both at primary and secondary care, by upgrading awareness of the importance of managing incontinence and lessen the associated stigma, for both urinary and faecal incontinence, in people of all age groups. Background – There are ongoing initiatives to improve communication between primary and secondary care teams with the development of pathways organised by the commissioners in the UK. – The NICE report on incontinence in women and the forthcoming NICE report on male lower urinary tract symptoms are going to facilitate a better understanding of the existing literature relating to the management of lower urinary tract symptoms (LUTS) and urinary incontinence. – There remains a need to further increase awareness of the importance of adequate LUTSmanagement and streamline the communication, diagnosis and treatment of continence problems in both primary and secondary care. – To improve continence service capacity, GPs require easier access to information and specialist facilities providing , quick and reliable diagnosis of urinary infection and instruction in bladder training, pelvic floor exercises etc – Whilst diagnosis of urinary infections by dipstick testing has a number of flaws, it nevertheless provides a basis for screening. The dip stick currently is over sensitive, unreliable, non-specific and leads to over-prescribing of antibiotics. The long turnaround of lab-tests limits their usefulness. – It is important to adequately interpret LUTSand the basis for interpretation is a frequency volume chart. Advances in this area would be very helpful at primary care level. – The evidence base for the use of flow rates and post voiding ultrasound residual would suggest that neither of these investigations are useful at primary care level. This needs to be further evaluated.. – The management of other conditions, such as the sensory bladder disorders and urethral syndrome, is at present severely limited by lack of understanding of their aetiology and the absence of adequate treatment modalities. Without this understanding, multiple unsuccessful interventions over a long period of time and at considerable expense are a result. – All of the above combine to make the assessment ofLUTS, and therefore treatment pathways, uncontrolled and unnecessarily delayed. Clinical Need The following clinical needs are therefore required to help manage the incontinent patient on their journey though the patient pathway:- (1a) The Patient and their Pathway – A quick and accurate means to diagnose urinary infection is needed for diagnostic accuracy and to improve patient management. Accuracy, specificity/sensitivity and speed are critical issues – A robust, easy to use and interpret frequency volume assessment techniques. – Systems for recording and feedback onliquid intake would be useful in conservative management of urinary problems after identification of inappropriate fluid outputusing a frequency volume chart. For example, advice on reducing caffeine intake. – – An improved urinal for urine volume measurements which should be easy to transport and dispose of, to aid collection of such information. It would be ideal if it was also biodegradable. Systems of recording and feedback of liquid intake are needed to assist both patients in the home and consultation in primary care. – Scanning for post-voiding urine retention does exist, but it is expensive and is consequently not widely used. – – Pelvic floor training – instead of just an advice leaflet, it would be good to provide a patient with better means to conduct effective pelvic floor training. – Validated patient advice websites relating to continence, and closer collaboration with patient advocacy groups which allow patients to access the existing services in a more seamless fashion (1b) The Devices and the Treatment – Improved external urinary collection devices. to improve the dignity of the situation in the management of continence. – Improvements in catheter design to make them more comfortable and less likely to encrustation. This could include new materials and potentially new designs, for example, being able to dispense with the standard Foley catheter retention system. – A reduction in catheter acquired urinary infections and improvements in encrustation rates. – Improvements in self-catheterisation technology. Can ISC be done without discomfort and infection? Can catheters be made more acceptable and less fiddly? – Improvements in catheter bag design, i.e. size of tubing, length of tubing and devices to register when a bag is full. – Improved flip-flow valves to allow automatic emptying of the bladder – Improved designs of bed pans and urinals to restore dignity. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=77 Tue, 22 Jun 2010 16:24:52 GMT we could improve the diagnosis and biopsy procedure in patients with suspected prostate cancer to avoid unnecessary therapies. Background – PSA tests have led to a large increase in suspected cases of prostate cancer requiring an invasive biopsy of the prostrate – Biopsy of the prostate require samples taken from multiple sites to ensure representative tissue sampling, it is inaccurate and unpleasant for the patient and has significant complications. – In around 70% of cases, the biopsy process does not reveal a clinically significant prostate cancer which requires further surgical intervention. – Already significant resource though has focussed on biomarkers and the only new one is PCO3, which is some way off being accepted as being useful. – Alternatives to biopsy with innovative imaging techniques have also been extensively examined.and have shown promise, but at present there is no easy to use and accurate means of imaging prostate cancer within the gland. Clinical Need What is needed is a better biomarker or means of imaging the prostate to reduce the need for biopsy and provide a mechanism for improved decision making by indicating:- – Which men have a cancer? – Whether that cancer is of a clinical significance? Alternatives to biopsy could arise from:- – Imaging issue to target clinically significant cancer – high res PET scanner (MRI, CT), ultrasound developments – Marker to enhance area of prostate (contrast) agent to pin down higher grade tumours and the extent for staging. – Increase specificity with an aim to reduce over-treatment. – (Standardised texture - contour imaging of prostrate) Then should biopsy prove to be necessary, there is a need for improving this procedure and improving patient experience by:- – Improving accuracy of biopsy. – Using a stabiliser device to target biopsy – More accurate interpretation informs patient choice, this relates back to improved imaging, grade & extent. – Analgesia of prostate – Biopsy gun bang – this has a psychological impact. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=76 Tue, 22 Jun 2010 16:22:48 GMT Laparoscopy is a minimally invasive technique of performing various intra abdominal procedures , however unlike open surgery it is difficult to obtain a good field of view without the use of multiple retractors as used in open procedures. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=78 Tue, 22 Jun 2010 16:18:45 GMT The Smart Glass screen was developed under the Smart Ideas programme. The NHS Smart Ideas programme consisted of workshops held during the autumn of 2007 with around 500 NHS front line staff and other professionals associated with infection prevention and control. The purpose was to gather their ideas about how technology might be used to help combat HCAIs more effectively. From a long list of 157 ideas, 10 were prioritised by the original delegates as showing the most promise in terms of both practical effect and the current availability of the science. These were designed and piloted (in partnership with industry where appropriate) and the evidence submitted to the RRP for approval. Renfrew Group worked with the steering group and the National Innovation Centre (NIC) to innovate within these requirements and to rapidly create tangible proposals in the form of concept designs, sketches, CAD models and physical block models. A series of reviews were then arranged giving stakeholders the chance to interact with the realistic models in various settings and to input their thoughts to the designs. This collaborative process has dramatically reduced the time needed to arrive at product solutions to defined Staff needs. http://competitions.nic.nhs.uk/NewChallengeIdea.aspx?challenge=69 Mon, 25 Jan 2010 17:35:49 GMT