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EH 1_2015

KUGEL medical GmbH & Co. KG Hermann-Köhl-Straße 2a DE-93049 Regensburg · Germany Phone +49 (0) 9 41/20 86 48-0 Fax +49 (0) 9 41/20 86 48-29 E-Mail MADE IN GERMANY WE CREATE SOLUTIONS FOR HISTO-PATHOLOGY LABS EUROPEAN HOSPITAL  Vol 24 Issue 1/15 4 NEWS & MANAGEMENT Interview: Ralf Mateblowski Electricity is not the only thing that should come out of an elec- trical socket; ideally so should cold atmospheric plasma, accord- ing to Dr Georg Daeschlein, at the Dermatology Department, University of Greifswald, who has investigated its medical properties for years. Put very simply, this plasma only requires ambient air, high electrical voltage and strong, i.e. even visible discharges. Experienced manufactur- ers now offer stable and safe genera- tors in pocket format, such as ‘plas- ma pens’ for instance. Admittedly, there are now even battery-operated models… Asked about the effective com- ponents of plasma, Daeschlein admits that a lot is not fully under- stood: ‘Although not all the molecu- lar angles have been completely explored as yet, we know that the antimicrobial effect plays a central part, being very potent, wide-ranging and easily reproducible.’ The second important aspect to him is the stimulation of cellular repair mechanisms and the genera- tion of mediators relevant for healing that promote tissue regeneration and therefore wound healing. Looking back… The use of plasma in medicine, such as for sterilisation and disinfection procedures and especially for sur- gery, began in the 1930s, although hot (thermal) plasma was used then. Only its ‘domestication’ over the last few years paved the way for use in humans with so-called cold plasma. Its effect on parasites, bacteria, virus- es and fungi is impressive and can be medically utilised and the effect has by no means been exhausted. Therapeutic treatment with cold plasma was first described around 100 years ago, although it was then known as high-frequency or D’Arsonval treatment and recom- mended for a multitude of diverse indications, ranging from migraine to vaginal yeast infections and depres- sion. Now, however, the effects of plasma are being scientifically stud- ied, using up-to-date techniques to facilitate specific and optimised treat- ment. It is an interesting fact that clinical success in the treatment of major skin infections, such as cuta- neous tuberculosis, was described even in the early days of treatment, but at the time no scientific explana- tion could be found. … and the present Current therapeutic approaches range from the treatment of all types of chronic cutaneous wounds to the use as a skin antiseptic against highly-resistant problem pathogens. A working group under derma- tologist Professor Jürgen Lademann, at Charité University Hospital in Berlin, demonstrated antimicrobial effects that reach deeper ‘under the skin’ than conventional treatments, which may have great significance for the fight against postoperative infections. When asked which area of application is currently the most defined, the experienced clinician described this as the ‘promotion of healing processes, in particular those with the involvement of micro-organ- isms and other processes which are difficult to treat’. One major advantage of the pro- cedure is the detection of a ‘physical’ antiseptic effect on problem patho- gens on the skin and in wounds that cannot be treated, or only treated with great difficulty, using conventional methods. The advan- tages, apart from the high potency described, include the lack of need for ‘chemistry’, i.e. no necessity for the costly storage of dangerous, flammable materials. The solution simply comes out of a power socket: Switch on, disinfect, switch off – and the procedure is entirely without side effects. Looking ahead A definite ‘yes’ is Daeschlein’s reply when asked about the prospects of the procedure. ‘The potential use of plasma is huge, although there is still currently a lack of scientifically grounded facts. The use in tumour treatment for instance is at very early stages, with our own group as well as a number of French working groups able to demonstrate the basic effectiveness in animal experiments. This makes the use for primary as well as palliative tumour treatment conceivable and, due to the com- paratively simple technology and handling, also for a home care set- ting, although there is still a long way to go. ‘Technical safety and protection against undesired effects are of cen- tral importance. The prerequisites for use, apart from safety concerns, are a firm medical indication as well as medical supervision and aftercare. In Germany we now have a number of reputable suppliers as well as reputa- ble users and researchers. However, the use of plasma in cases where the indication is not assured or with (improper) enhancements of use, which may possibly lead to unde- sired side effects, could endanger the expansion of the product.’ The mandate Plasma is a mixture of different, proven biophysical methods of action, which have never before been used in combination. So what should happen next? ‘Apart from further research into basic methods of action the most important objective for the next few years will be not only to determine the optimum configura- tion of devices (such as energy dose, wavelength, frequency, pulsing, sig- nal shape) for each respective dis- ease where the basic effectiveness of the treatment has been proven, but also respectively to work out the optimum form of treatment for each indication, i.e. treatment intervals, dose, reactions occurring in the tis- sue and the body. ‘This is a move in the direction of personalised medicine, i.e. an attempt to find out which entities are beneficial for each individual patient and their symptoms.’ Daeschlein also emphasises the definite basis for many medically suggestive treatments and adds: ‘A further highlight is the impressive, sustainable and effective treatment of pain in cases where severe, chron- ic symptoms can otherwise not or scarcely be relieved, such as after viral infections or when the cranial nerves are affected. ‘The results of this treatment have already attracted attention among pain therapists because they promise success without the need for conven- tional medication. This could make many other invasive, risky as well as expensive and longwinded treat- ments redundant. Treatment for pain relief with “plasma at home” and under self-direction in the same way as other types of feedback therapy and auto-suggestion treatment for chronic pain is conceivable, safe and has already proved successful.’ Cold atmospheric plasma Trainee surgeons suffer permanent stress Treatment out of a power socket BothimagesbyCourtesyof HenryScheinServicesGmbH Georg Daeschlein MD, Laboratory head at the Clinic and Polyclinic for Dermatology, University of Greifswald (Director Prof. Michael Jünger MD), graduated from the Christian Albrecht University in Kiel and the Free University Berlin. In 1992 he attained the first of four advanced specialist medical qualifications: Laboratory Medicine; Microbiology and Infection Epidemiology; Infection Prevention and Control and Environmental Medicine and, in 2014, Dermatology and Sexually Transmitted Diseases. Dr Daeschlein’s research is on infection medicine, wound healing, physical procedures and plasma medicine. Plasma ONE is a therapeutic device that uses cold plasma for disinfection and more rapid wound healing. The charged particles of the plasma can burst the outer shell of the germs, because they combine with the cell membranes of bacteria and produce cracks by mutual repulsion. ‘The prevailing economic view of medicine is wrong. It cannot con- tinue in this way’ Report: Chrissanthi Nikolakudi ‘There are still only 24 hours in a day – even for surgeons,’ said Professor Vogt MD during our European Hospital interview. The Director of the clinic for plastic, hand and reconstructive surgery at Hanover Medical School and President of the DGCH (German Society of Surgery) is calling for solutions to the dilem- ma trainee surgeons face: undergo- ing high-quality specialist medical training while completing accept- able daily shifts that should ideally not exceed ten hours. Asked why trainee surgeons have such long and labour-intensive shifts and what might be done to alleviate their stress, Prof. Vogt suggests that either the special- ist training duration needs to be substantially increased, or trainee surgeons must be released from additional work, not only to relieve stress but also to ensure they are sufficiently trained. ‘The advanced training should be completed within a reasonable period of time; interna- tionally, this period varies between six and eight years,’ he explained. ‘If we want to ensure high qual- ity, specialist medical training in Germany we need to change from a system where training is carried out alongside regular work to a truly training-based system. ‘The trainee would then be enti- tled to comprehensive and systemat- ic training and would be exonerated from all the administrative tasks. Too much administration ‘The number of administrative tasks has grown to such an extent that it has become almost unacceptable – there is a lot of documentation to be completed, documents to encode and decode. There are hospitals where doctors have to type their own letters – but there are still only 24 hours in a day, even for surgeons. ‘The second option to help align training and working hours would be to extend the overall training period. Swedish surgeons are setting a good example: The completion of surgical training in Sweden takes ten years.’ ‘Medicine is all about documenta- tion these days. You have to gen- erate qualitative data in the clini- cal accounting system so that the respective DRG reimbursements for services can be processed. The turnaround times for documents have also been cut significantly: when patients are discharged surgi- cal reports and doctor’s letters must be available immediately and the turnover of patients is now much higher than ten years ago.’ High economic pressure demands great hospital efficiency. He sug- gests: ‘Administrative tasks could be passed on as a matter of delegation, not substitution. There is a lot of discussion around this in our spe- cialist society.’ Country comparisons Prof. Vogt pointed out that Germany is very different from Great Britain or the USA. In the latter a reduction to 80 working hours caused an out- Peter M Vogt MD directs the clinic for plastic, hand and reconstructive surgery at Hanover Medical School. He is also President of the DGCH Continued on page 31 Phone +49 (0) 941/208648-0 Fax +49 (0) 941/208648-29

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