Putting physical science and engineering into healthcare in Salisbury

The department of clinical science and engineering at Salisbury District Hospital comprises a team of 30, with professions ranging from clinical scientists to orthotists, physiologists to administrative staff, and technicians to students and trainees.

Its research and skills put physical science and engineering into healthcare in Salisbury.

The department has four main clinical science services: orthotics, medical engineering, neurophysiology and medical physics.

Dr Duncan Wood, head of the department, joined the team in 1995. He said: "At school I enjoyed science and maths and choosing engineering as a degree allowed me to continue with those subjects. However, I still maintained my interest in how the human body worked, so later on I completed further studies and a PhD in biomedical engineering.

"I joined the hospital as a clinical engineering researcher then worked in clinics before qualifying as a consultant clinical scientist in 2004 and becoming head of department last year. It is a great team to work in, with everyone so committed to helping the patients.

"We always try and encourage young people to think of it as a possible career. We go into schools and show how our work fits into the care a hospital provides.

"You need to be good at science and have a passion for it as well as having an enquiring mind and willing to try different things, but entry into this field can be done at any level post-16.

"We link with a number of local universities and are a national training centre for those that have completed a science or engineering degree and now require work-based training before they become qualified.

"Our staff work directly with other departments at the hospital, but we also run our own specialist clinics. It's therefore important for us to be able to build up a rapport with patients, as well as to liaise with doctors and nurses using their own terminology."

* Linked with the department is Odstock Medical, a Salisbury NHS company which is the leading manufacturer of Clinical Functional Electrical Stimulation systems. The company was a result of work carried out within the hospital and involves a technique to assist walking and also a means of practicing functional movements for therapeutic benefit. Some clinical engineers from the hospital are also involved in the company.

ORTHOTICS
ORTHOTISTS work with a variety of patients, ranging from diabetics to people suffering spinal injuries.

Seeing just short of 1,500 new patients and a further 4,000 reviews each year, they are involved with the design, production and use of devices, such as splints, braces and special footwear. 

"We may have a patient referred by a surgeon, GP or physiotherapist, needing a particular type of splint to help them walk," Dr Wood says.

"It could be a patient who has had a stroke and is unable to lift their foot when they want to swing their leg through. We fit them with a simple splint on the lower part of leg which would allow them to walk more safely so they have less trips and falls. 

"Or, it could involve something more complex such as a patient on the spinal unit where we cast and provide a supportive brace to immobilise the patient to make sure the spine stays in a certain position.

"A large group of patients we see are diabetic who have poor blood flow, especially in the hands and feet. Pressure points in shoes can be quite severe for diabetics and we provide specialist footwear and insoles to relieve pressure points.

"We use a variety of materials, including thermoplastics which can be moulded around a person, in producing our devices."
 
Products come from a range of suppliers with orthotists working with companies to modify products or design completely new ones.

"While some hospitals use private orthotic services, we are fortunate in Salisbury to have our own in-house service, often being able to provide a more versatile response."

MEDICAL ENGINEERING 
MUCH of a medical engineer's time is involved with providing a range of seating solutions for wheelchair users, using the assessment techniques and workshop machinery on site.

Dr Wood said: "It could be for a child with cerebral palsy whose mobility is limited and whose posture is poor when they are sitting.

"They may not be able to support their head - their head tilts forward - which means their social interaction is much reduced because they can't look you straight in the eyes.

"By designing and providing a contoured seating system and accessories made to individual requirements, this may mean that a child or young person is then able to participate more fully in school, watching and listening to their teacher, as well communicating with others."

He added: "When each of us sit down, we are constantly moving to redistribute weight and relieve the pressure points. Unfortunately many of the people we see in wheelchairs, such as those with spinal injuries, are unable to do that because they don't have that sensation or mobility.

"We work with nurses to help reduce the risk of pressure sores and improve quality of life for patients."

Medical engineers also work with the estates department to help to solve various issues such as designing and manufacturing solutions to carry oxygen cylinders around the hospital, as well as maintaining its many wheelchairs.
 

NEUROPHYSIOLOGY
PEOPLE with nerve injuries, stroke patients, children who suffer from epilepsy or people experiencing a tingling or numbness in their hands and fingers are at some stage likely to see a physiologist.

Physiologists in Salisbury work to provide a range of assessment and diagnostic techniques for people with a wide range of neurological conditions, completing about 2,000 tests last year.

If a patient is referred suffering from carpal tunnel syndrome - a tingling in the hands and fingers which could be caused by doing repetitive work, such as typing - physiologists would stimulate the nerves and work out where the damage is and what the extent is. 

This is carried out by putting electrodes on the forearm and sending electrical impulses down the nerve to the hands. Physiologists measure the impulse, helping to predict where the nerve compression is taking place. They then make a recommendation to GPs and consultants on whether surgery is an option.

Another common test is with children suffering from epilepsy, where physiologists look at EEGs measuring and recording electrical activity in the brain to provide an overall picture of what's happening and work out why a particular patient is suffering from seizures.

MEDICAL PHYSICS
THE hospital has a range of imaging systems to look inside the human body, such as X-Rays and MRI and CT scanners (a CT scanner is pictured above).

These are generally operated by the radiology department but medical physicists from the clinical science and engineering team get heavily involved in ensuring that the equipment remains safe for both patients and staff and that the images are of the best quality.

The physicists will perform the necessary tests, as well as train staff in its correct use.

"X-rays and radiation are completely safe if used correctly and maintained safely," Dr Wood said. "And this is important for people coming in for simple tests, such as measuring bone density for people at risk of osteoporosis and related conditions."

Dr Wood said: “Since the department has a range of specialist scientific, technical and clinical services the work is quite varied and incredibly interesting.

"Our goal is to provide an ever-increasing quality of care to our patients giving them the best diagnostics and improving their function, through service developments and training.

"To that end, we are always looking at training options and we are beginning to look at providing apprenticeships to help us in recruitment.”