C4TS SUMMER 2014 NEWSLETTER
Issue 3
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C4TS
SUMMER 2014 newsletter
WELCOME
Welcome to the Summer 2014 edition of the Barts Centre for Trauma Sciences (C4TS) newsletter. In this edition, we outline some recent achievements and the current priorities for the Brain and Spinal Cord Injury research theme. A practical and effective means of measuring recovery and quality of life after neurotrauma (or indeed any traumatic injury) is essential for achieving our Centre’s aim of ‘Total translation of trauma research into practice’. Here we highlight the “Evaluation of Rehabilitation Outcome after Severe Trauma (EROS)” study, undertaken by the Outcomes support core that aims to develop a globally-applicable Prof. Adina Michael-Titus: Lead, assessment tool to address this currently unmet need in trauma. Brain & Spinal Cord Injury Theme
Lead, Brain and
Neurotrauma The need to study Brain and Spinal Cord Injury Traumatic brain injury (TBI) and spinal cord injury (SCI) lead to devastating consequences for patients and are associated with significant health care costs. TBI accounts for over half of all trauma fatalities and is a major cause of prolonged disability and significant long-term burden, for both survivors and their carers. It is estimated that 10 million people globally will be affected by TBI every year. There are an estimated 40,000 spinal cord injured people in the UK – with one more person injured every eight hours. The annual cost of caring for people paralysed by SCI is conservatively estimated at more than £500 million in the UK alone. SCI affects predominantly young people (16 to 35 year olds); the most common causes are falls and road traffic collisions, but also include sporting accidents (e.g. horse riding, rugby, diving). Recent trends show that more over 50s are becoming affected by this type of injury. There remains an ever increasing unmet need for the provision of treatments that protect the brain and spinal cord immediately after injury.
By
Adina Michael-Titus (Professor of Neurosurgery)
Research background Despite many advances in imaging and brain monitoring, there are few therapeutic options for neurotrauma and outcomes remain universally poor. New treatment approaches and products have been characterized in the laboratory but we need to identify the key reasons for their repeated translational failure in the clinic. The consequences associated with TBI and SCI are due to the fast propagation of tissue destructive processes, in the minutes and hours following trauma. Most trials of neuroprotective agents have had a period of 8 hours or longer between injury and administration of the drug. Our research focuses on the development and hyperacute delivery (i.e. on scene within minutes of injury) of new interventions and drugs that promote both neuroregeneration and neuroplasticity (connectivity), which ultimately lead to some restoration of function. Research achievements to date We have at present a large preclinical programme of research focused on a polyunsaturated omega-3 fatty acid, Docosahexaenoic acid (DHA).
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Figure 1 - DHA exhibits high neuroprotective potential in experimental models of neurotrauma. DHA administered in the “golden hour” after injury (Figure A) significantly reduces the lesion size in the spinal cord compared to a control model group (Figure B), and yields better neurological outcome. Research priorities Our pre-clinical work with DHA has validated this compound in a number of SCI and TBI models. We are also working on novel preparations which could be used in the chronic phase of neurotrauma, to support the restoration of circuits damaged by injury. The most significant challenge remains the development of clinical trials where DHA could be administered to patients by the prehospital emergency team and the demonstration that it significantly modifies the neurological outcome after injury. Click here to find out more about C4TS research and clinical trials activities.
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Research Project Spotlight “Evaluation of Rehabilitation Outcome after Severe Trauma” (EROS) Background According to the World Health Organization (WHO), trauma is associated with moderate to severe disability for over 45 million people each year worldwide. Many disabled people are unable to fully participate in society due to lack of access to suitable medical care, rehabilitation, employment and education. Rehabilitation outcomes are an important measurement of existing trauma care effectiveness and of new interventions that have the potential to enhance post-injury recovery. However, there does not currently exist a clinically-applicable, validated rehabilitation score or framework available to evaluate health and rehabilitation needs after trauma.
The ICF is a classification system consisting of approx. 1400 categories related to health and environmental factors (see Figure 2). To aid the application and uptake of the ICF in rehabilitation, smaller core sets have been developed for conditions such as stroke, multiple sclerosis and spinal injuries.
Karen Hoffman:
Sr. Research Fellow Outcomes Core
Methodology The projects early complimentary work packages were designed to identify the priorities from both the patients’ and the health care professional perspective:
Figure 2 – Factors considered in the scoring of rehabilitation need by the WHO International Classification of Function, Disability and Health (ICF).
This has significantly improved the comparison of health outcomes between different patient groups, via the standardization of language and thereby understanding.
Previous studies have recommended that the World Health Organisation of International Classification Function, Disability and Health (WHO ICF) should be used as an international classification system to evaluate all aspects of rehabilitation.
By
Overall objective The EROS project was conceived to specifically evaluate to what extent the ICF can be used as a framework to capture and evaluate health and rehabilitation outcome of patients following traumatic injuries.
1. EVIDENCE. Systematic review of the literature has explored how well outcomes terms used frequently in trauma, to capture health aspects, are identified by the ICF. 2. PATIENTS. Via semi structured qualitative patient interviews, we explored their perspective of rehabilitation priorities. Transcribed interviews were then analysed by ‘meaning condensation’ (i.e. the grouping of keywords and phrases) and the patient data coded to the ICF using established methods. 3. PROFESSIONALS. By conducting an international online survey, using the acute and post-acute ICF core set, we finally explored the health care professional (HCP) perspective of priority health and rehabilitation needs after trauma. Result Potential categories for trauma ICF core set have now been developed, based on an informed combination of patient, as well as HCP evidence.
NEXT STEPS
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The proposed Trauma ICF core set shall be presented, optimised and approved at an international consensus conference.
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Once approved, a multi centre validation study will be developed to measure the practicality and effectiveness of the Trauma Core set for health and rehabilitation outcome assessment of severely injured patients.
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NEW RESEARCH STAFF
Trauma Education th
Friday 15 August will be the start of the MSc Trauma Sciences (Military & Austere) Summer School. This is an opportunity for Trauma Trainees to come to London, meet international trauma leaders and engage in activities with other trainees. There are workshops at the Royal College of Surgeons, London’s Helicopter Emergency Medical Services and the Barts Education Academy. Click here for more information about our masters courses, including our new masters in orthopaedic trauma sciences.
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Outreach Activities The Big Bang Fair South East is an interactive science and engineering fair which is part of a nationwide program aimed at celebrating and raising the profile of young people in STEM (Science, Technology, Engineering & Maths) activities. On 1st July 2014, in excess of 4000 9 – 19 year olds and their teachers attended the event.
(Above - starting from the top)
Andreas Frietag Public Health and Policy “With a background in medicine and global and public health, I’ve been working on various projects on health policy and sports-related injuries. I’m particularly focusing on injuries among school children and adolescents.”
Eleanor Bruce Outcomes “Having worked in a clinical healthcare setting,
The C4TS clinical research group promotes STEM subjects and facilitates engagement of young people with science. Towards that end, we hosted an exhibit at the event to demonstrate the effect of injury on the body and how medical advances and surgical techniques are used to save lives. The 'Trauma Surgery: The Science of the bleeding obvious!' exhibit offered visitors the chance to learn about the exciting research being undertaken to improve outcomes for patients of traumatic injury. Young people got to build their own blood clot and learn about what happens when this goes wrong and even had a go at being trauma surgeons themselves. ANNOUNCEMENTS
C4TS’s strategic aims include a program of education for young people and families to help them understand in a tangible way the reality and risk of traumatic injury. Our interactive Trauma Show is happening at the Centre of the th Cell on 28 August, book tickets here. th
We will also be exhibiting at the British Science Festival 8 -10 September in Birmingham. For more information click here.
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I am keen to put my experience to use in the research field. I am currently working with the outcomes department looking at how people recover following serious traumatic injuries. This involves interviewing patients to discuss all aspects of their recovery, both physical and mental, and this helps us better understand the longer term impacts of Trauma.”
Orli Thau Zuchman Brain and spinal injury “I explore immediate and delayed inflammatory responses induced by Traumatic Brain Injury, specifically the impact of therapeutic agents on recovery. I develop TBI models for assessing the efficacy of these agents. My approach draws both from my background as a neuroscientist and my clinical experience as a neuro-rehabilitation physiotherapist.
ENGAGE WITH US Please do connect with us via our website (www.C4TS.qmul.ac.uk) and via Twitter (@BartsC4TS).