Author: ITM_admin

A method for detecting traumatic brain injury at the point of care has been developed by scientists at the University of Birmingham based here at the ITM.

Using chemical biomarkers released by the brain immediately after a head injury occurs, researchers are able to pinpoint when patients need urgent medical attention. This saves time in delivering vital treatment and avoids patients undergoing unnecessary tests where no injury has occurred.

The technique was developed by multi-disciplinary team of researchers in the group of Advanced Nanomaterials, Structures and Applications (ANMSA) led by Dr Pola Goldberg Oppenheimer.

Following a proof-of-concept study, the group has now completed Innovate UK’s commercialisation programme, iCURE, to identify commercialisation routes for the technique, identifying potential partners across eight countries.

The method works using a spectroscopic technique called surface enhanced Raman scattering, in which a beam of light is ‘fired’ at the biomarker.  The biomarker, taken from a pin prick blood sample, is prepared by being inserted into a special optofluidic chip, where the blood plasma is separated and flows over a highly specialised surface. The light causes the biomarker to vibrate or rotate and this movement can be measured, giving an accurate indication of the level of injury that has occurred.

To produce the level of accuracy required, the test needs to be extremely sensitive, rapid and specific and this is where the Biomedical Engineering expertise at the ANMSA group at the University of Birmingham comes to the fore. The key to sensitivity is in the way the biomarkers interact with the surface. The team developed a low-cost platform, made from polymer and covered with a thin film of gold. This structure is then subjected to a strong electric field, which redistributes the film into a distinctive pattern, optimised to resonate in exactly the right way with the light beam.

Dr Goldberg Oppenheimer explains: “This is a relatively straightforward and quick technique that offers a low-cost, but highly accurate way of assessing traumatic brain injury which up until now has not been possible.”

According to the charity Headway, around 1 million people each year will visit A&E following a head injury. Current methods of assessing TBI frequently rely on the Glasgow Coma Scale, in which clinicians make a subjective judgement based on the patient’s ability to open their eyes, their verbal responses and their ability to move in response to an instruction.

“The current tools we use to diagnose TBI are really quite old fashioned, and rely on the subjective judgement of the paramedic or the emergency doctors,” says Dr Oppenheimer. “There’s an urgent need for new technology in this area to enable us to offer the right treatment for the patient, and also to avoid expensive and time-consuming tests for patients where there is no TBI.”

Research demonstrating the technique was published in the journal Nature Biomedical Engineering. In the study, 48 patients were assessed using the engineered device, with 139 samples taken from patients with TBI and 82 from a control group. The study showed that in the TBI group, the levels of the biomarker were around 5 times higher than in samples taken from the control group. The team also found the levels tailed off rapidly around one hour after the injury occurred, further highlighting the need for rapid detection.

Additional funding from the Royal Academy of Engineering, has enabled a market analysis including paramedics, neurosurgeons and sports therapists which has confirmed a strong need for the technology.

The next stage for this research will be to miniaturise the device technology used to analyse the samples, so that it could be easily stored on board an ambulance for use by paramedics, used at sporting events where head injuries can be hard to detect, at local GP services or in hospitals where it could be used over time to monitor patients to see how the head injury is progressing. The team is working towards optimising and trailing a prototype technology on a larger patient cohort.

A UK trial into the effectiveness of giving blood to trauma patients before they come to hospital has recently introduced an innovation that, if proven to be successful, could be adopted across the country.

Previously, only doctors could recruit patients to the RePHILL (Resuscitation with Pre-Hospital Blood Products) trial. The RePHILL team have developed a training course to enable paramedics to recruit and give blood to patients taking part in the trial.

Mark Beasley, The Air Ambulance Service (TAAS) Critical Care Paramedic, said: “I was excited but apprehensive when I learnt that paramedics would be authorised to recruit patients.

“The comprehensive training package and support provided by the RePHILL team meant I was confident in my ability to recruit, and I was left feeling that the patient had received the best possible care.”

The trial is sponsored by the NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), who work closely with a number of regional ambulance services, with TAAS the first to train their paramedics to recruit patients. The SRMRC is based within the ITM.

Patients either receive blood before their arrival to hospital or the current standard care, saline, with the trial assessing whether the early use of blood could help to save lives.
Hazel Smith, Research Paramedic, added: “Giving blood to patients before they arrive in hospital is a fairly recent development in the UK, with the first patient receiving pre-hospital blood in 2012. Transfusion is traditionally decided by doctors. However, non-medical authorisation is increasingly being seen as an important advanced skill not only for nurses but also for the paramedic community.

“We believe we are the first team in the UK to support rolling this out within a clinical trial setting. Having more people who can enrol patients into RePHILL will really help with our recruitment and patient care.”

Dr Heidi Doughty, Consultant Haematologist with NHS Blood and Transplant and a member of the RePHILL team, said: “Non-medical authorisation and research are both really important developments for the emergency community. The experience of these paramedics should help shape future training courses and pre-hospital transfusion trials.”

So far, two TAAS paramedics have recruited patients to RePHILL, which has recruited almost 400 patients overall.

Recruitment to the trial is currently ongoing and is expected to finish by the end of the year.

Professor Subrata Ghosh, Director of the Institute of Translational Medicine, is one of three University of Birmingham Professors to be named among the UK’s most prominent biomedical and health scientists by the Academy of Medical Sciences which has announced its prestigious list of newly elected Fellows.

Professor Ghosh is joined by Christine MacArthur, Professor of Maternal and Child Epidemiology and Charles Craddock CBE, Director of the Blood and Marrow Transplant Unit and Professor of Haemato-oncology,

in a list of 50 new Fellows, representing the UK’s leading medical scientists from academia, healthcare, industry and the public service.

The Academy’s newest Fellows have been chosen for their exceptional contributions to advancing biomedical science via world-leading research discoveries, scientific communication and engagement programmes and translating scientific advances into benefits for patients and the public. They are also the only three academics from Midlands based Universities elected this year. They will be formally admitted to the Academy on 25 June 2020.

Professor Subrata Ghosh said: “I am deeply honoured to be elected as a Fellow of the Academy of Medical Science. I appreciate the research platform that has been very productive at University of Birmingham and the impact it had on the lives of patients suffering from Inflammatory Bowel Disease. I must thank our wonderful research team at the NIHR Biomedical Research Centre and our study nurses who contribute significantly to all I do.”

Speaking of her election, Professor Christine MacArthur said: “I am very pleased to receive this award and particularly delighted for the recognition it gives to research on maternal health and the problems that women can experience after childbirth.  I have no doubt that this award also recognises the collaboration and support of the many colleagues that I have worked with in my time at University of Birmingham.”

Professor Charles Craddock CBE added: “It’s a huge honour and privilege to have been elected to the Academy of Medical Sciences. As a coalface blood cancer clinician and active clinical triallist I am greatly looking forward to contributing to the vital work of the Academy translating medical research into patient benefit. As an adopted Brummie I am also to advocate the strengths- and huge attendant opportunities- of the Regional Life Sciences sector in Birmingham and the Midlands”

Professor David Adams, Head of the College of Medical and Dental Sciences and Director of Birmingham Health Partners said: “I am delighted to be able to announce that three of our most distinguished academics have been elected to the Academy of Medical Sciences this year.  Election to the Academy is highly competitive with only 50 new fellows elected this year from across the UK so to have 3 fellows elected from Birmingham is a tremendous accolade for the University as well as being a great personal achievement.”

Professor Sir Robert Lechler PMedSci, President of the Academy of Medical Sciences said: “I am delighted to welcome these 50 new Fellows into the Academy’s Fellowship. Each one has made their own outstanding contribution to biomedical science and together they are advancing the health of our society in the UK and internationally. Their work affects us all, from the way we keep healthy through our lifestyle, to how we are treated if we become ill, to the way we receive information about health.

“This year our new Fellows announcement happens amidst a global health crisis. Some will face the challenge of how to continue to lead on some of the most pressing health challenges our society faces beyond coronavirus, such as heart disease, diabetes or cancer. Others have joined the global research effort to tackle the coronavirus pandemic, whether that be through working out how to treat those with the virus, joining efforts to develop a vaccine, or looking to limit the impact of the pandemic more broadly on our physical and mental health.

“Never has there been a more important time to recognise and celebrate the people behind ground-breaking biomedical and health research, working harder than ever to further knowledge and protect patients and the public.

“It brings me great pleasure to congratulate the new Fellows, and see our Fellowship grow to even greater heights of evidence-based advice, leadership and expertise.”

Medical device specialists have joined together to support the supply and deployment of vital medical equipment into the healthcare system.

The aim is to support healthcare providers in ordering new devices such as ventilators, infusion pumps, dialysis and critical care equipment that is fit for purpose and appropriate for use in treating COVID-19 patients.

Activities range from sourcing suitable suppliers and devices and checking devices are compliant, through to commissioning, training, ensuring availability of replacement parts and potential ongoing maintenance. The work will include both domestic suppliers and imported equipment, striking a balance between fast access and due process to make sure vital equipment is supplied in a safe and reliable manner.

The team includes researchers from the Healthcare Technologies Institute based within the Institute of Translational Medicine, as well as staff from Hugo Technology, a medical equipment maintenance and management company and MRA Technology, a medical device consultancy.

Experts in the Healthcare Technologies Institute and at MRA Technology are working on sourcing suppliers and carrying out initial due diligence on machines, while assessment and specialist testing could then be carried out in Birmingham and at Hugo Technology.

Dr Richard Williams, from the Healthcare Technologies Institute, explains: “It’s well known that healthcare providers are in urgent need of basic medical equipment that can be supplied rapidly and in large volumes. It is so important, however, that this vital equipment will perform to the expected standard.

“We are keen to work closely with our NHS partners to find out what they need, because not all the equipment available on the market will be suitable for treating COVID-19 patients. Even in times of national emergency we need to uphold patient safety and make sure processes are in place for staff to be able to have the correct equipment to carry out their duties.”

The team has already been at work verifying ventilators and infusion devices from suppliers across the world prior to their being installed in NHS hospitals and in the new NHS Nightingale Hospital set up in London’s ExCel exhibition centre.

Dr Mark Reeves, from MRA Technology said: “Without having physically met the other team members we gravitated quickly, defined how we could best contribute to the crisis and performed tasks required according to our skills and availability at any time.”

Beyond the current pandemic, the plan is to help set in place systems and processes that are sufficiently robust to enable the NHS to respond to future emergencies.

Dr Reeves further commented: “Multidisciplinary expert teams such as ours must be front and centre when reviewing the response to this crisis and planning how to avoid equipment shortages in the inevitable future pandemics. Next time we need the time and resources to procure, hold in readiness and distribute additional complex medical equipment into whatever medical mass-emergency hits us next.”

A disposable plastic ‘pop-up tent’ which creates a protective barrier between patients and healthcare professionals could be the latest line of defence for frontline NHS workers thanks to a new product developed by a collaborative team effort in Birmingham.

Designed by experts at the University of Birmingham, the Disposable Resuscitation, Intubation and Nebulisation Kit Shield – or DRs INK Shield – is a compact device designed to cover the patient’s head, neck and shoulder area while treatments for COVID-19 are administered.

The transparent plastic shield, which features self-closing access points, protects medical staff from airborne droplets that may put them at risk of contracting the virus while allowing them line-of-sight access to the patients’ airways to perform life-saving procedures such as inserting or removing breathing tubes.

Barrier products like these already exist, however current designs are often hard walled boxes which are not only difficult to store in large numbers, but difficult to manoeuvre in emergency situations. The DRs INK Shield is around five times lighter and one third of the cost of currently available solutions.

Its pop-up design means it can be assembled in seconds as well as easy to store prior to use while the disposable material means that it can be disposed of along with other clinical waste.

The project, which has rapidly moved from conception through product development to launch and taking orders in less than a week, has brought together the expertise of staff from the University’s College of Medical and Dental Sciences and College of Engineering and Physical Sciences.

The prototype was tested at the Royal Orthopaedic Hospital in Birmingham with nursing staff, recovery room technicians and anaesthetists. Medical staff using the equipment reported feeling safer and more comfortable, and that it is easy to assemble and use.

Design lead Matthew Campbell-Hill from the Institute of Clinical Sciences said: “We’re told that COVID-19 is primarily spread through respiratory secretions which transmit the virus via the fine spray of droplets released when infected people talk, cough, sneeze or even yawn.

“With much of the treatment for the virus focused around the airways, it is imperative that healthcare workers are protected from potential contamination while still being able to deliver the vital treatments that will save people’s lives.

“Our shield offers an additional form of PPE that can be rapidly assembled during emergency situations adding an extra layer of protection for frontline staff. Staff who have used it report increased confidence in their personal safety, as well as the ease of use and lightness. While this design has the potential to be a vital tool during the current pandemic, we envisage its use in a range of care settings beyond hospitals including ambulances, care homes and public areas.”

Dr Richard Williams, Research Fellow in the Healthcare Technologies Institute within the Institute of Translational Medicine added: “Taking the time to fully understand the clinical problem and then move at speed was essential. Even in this national emergency, some basic considerations of placing a product into service still apply. We drew upon our key contacts and worked remotely to provide an appropriate solution in a timely manner with the ability to scale.”

The equipment is designed to reduce exposure to COVID-19 during procedures such as intubation, resuscitation, ventilation by Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BiPAP), delivering treatments by nebuliser, and any other intervention that requires medical staff to be close to the patient’s face.

Aerosol Shield is being manufactured by Airquee, a company that makes medical, emergency and decontamination tents for the military, health services, and humanitarian organisations.  The product is being sold at near-cost to healthcare providers (with a small margin to allow for any potential changes in raw material or manufacturing costs).

The next stage of the project will see the team deploy the solution as quickly as possible to the front-line of COVID-19 care. More information about the DRs INK Shield can be found on the Aerosol Shield website.

Aerosol Shield was designed by: Matthew Campbell-Hill; Dr Egidio da Silva, Consultant Anaesthetist at the Royal Orthopaedic Hospital; GP Dr Lydia Campbell-Hill; Dr Mark Reeves, Director at MRA Technology Ltd; and Dr Richard Williams.  Commercial support was delivered by David Juggins from Hugo Technology Ltd, and Design Assistant Richard Baker-Stevens.