SMTL Blog

The SMTL have been referenced in a recent paper published in the British Journal of Nursing, 2017, Vol 26, No 13, by Melanie J Thomas and Karen Morgan ("The development of Lymphoedema Network Wales to improve care").  This article describes the establishment of Lymphoedema Network Wales (LNW) which was developed to improve lymphoedema patient care with a focus on service delivery centred on evidence-based practice.

Compression garments are the mainstay of lymphoedema treatment as they support and reduce swelling, and the project identified the requirement to establish a National Compression Garments Contract and Formulary to manage garment usage for primary and secondary care.  The SMTL was a key stakeholder in this process, testing tendered products to ensure that only garments that produced specific graduated pressure profiles were purchased by NWSSP Procurement Services for the formulary.  This project has ensured NHS Wales is using compression garments that provide the best clinical outcome for patients, and this work was recognised with LNW, NWSSP Procurement Services and SMTL being awarded a Patient Safety Award in 2016 for this development.

SMTL have been undertaking the testing of compression products for over 30 years, and are active participants in the current standardisation project with BSI which is revising these standards (SMTL hold the posts of Chair and Editor on this project).

Since the untimely death of Wayne Jowett in 2001, who died after a toxic cancer drug was wrongly injected into his spine at Nottingham's Queen's Medical Centre, the NHS, medical device industry and various global standards organisations have been trying to produce a mechanical barrier to prevent further tragedies, after the Toft report in 2001 recommended "A new spinal needle with a connection that cannot fit Luer mount intravenous syringes should be introduced, in conjunction with a new syringe which can only be fitted to that specific spinal needle."  In the intervening years various attempts have been made to produce a design which is accepted internationally and which would mitigate these 'wrong route' risks.  

9 years ago, Welsh Government set up a group (the Welsh Non-Luer Connectors Reference Group - WNCRG) which was responsible for monitoring developments in this area and for coordinating the introduction of such devices when they were available.  An international standard was published 2 years ago specifically for epidural and neuraxial devices (ISO 80369-6) which specified new connectors for syringes and needles which would reduce the risks of further wrong-route incidents. Since the publication of that standard, industry have adopted it and have been working with the NHS to deliver medical devices incorporating the new connector.

A decision was made in mid 2017 that Aneurin Bevan University Health Board would be the first Welsh organisation to roll out the new devices.  Doctors Stephen Edwards (Deputy Medical Director - Secondary Care,  ABUHB) and  Paul Nichols (Consultant Anaesthetist, ABUHB)  have since been working with colleagues in Welsh Procurement, WNCRG and their own health board to ensure a smooth transition, and finally in mid January 2018, NRFit compatible medical devices were deployed in ABUHB.  

At the date of writing (26th Feb 2018) 3 hospitals have made the transition including the Royal Gwent Hospital in Newport.  Other hospitals in Wales will start changing over to the new devices later this year, but completion of the process will not be possible until all of the epidural administration sets are available in NRFit designs. This could mean some hospitals or procedures may have to wait until  Spring 2019 before all the equipment they need is available.

 

Last year we announced that we had been working with Consultant ENT surgeon Mr Dave Owens and one of his ENT junior house officers (Yousef Ibrahim)  to undertake in vitro assessments of the hydrostatic head required to penetrate grommets. 

The paper has now been published in Eur Arch Otorhinolaryngol (2017) 274:3613–3617.  The full citation is:

Ibrahim Y, Fram P, Hughes G, Phillips P, Owens D. Water penetration of
grommets: an in vitro study. Eur Arch Otorhinolaryngol. 2017
Oct;274(10):3613-3617.

Last year, NWSSP commissioned Dr Steve Thomas to write a review of the use of compression wraps in lymphodema.

A paper based on this work has now been published in the Journal of Lymphoedema, 2017, Vol 12, No 1, pages 32–38​.

Dr Thomas concluded:

"Although the evidence is by no means overwhelming, the controlled extended use of compression wraps for the treatment of lymphoedema appears to be supported both on clinical and financial grounds and, therefore, should be given serious consideration."

 

SMTL were invited to the 8th RCSEd All Wales Medical & Dental Student Surgical Research symposium at Margam Orangery in October 2017 to judge poster and oral presentations and to present the SMTL award for best science paper.  The winner was Gargi Pandey for her poster on "A systematic review and meta-analysis on  the effectiveness of Radiofrequency Ablation in patients with low-grade dysplastic Barrett's oesophagus.".  Gargi also won the best overall poster award. The photo shows Pete Phillips, Director of SMTL, handing Gargi her award trophy.

 

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