Author: ITM_admin

The face of trauma and emergency medicine is undeniably changing.

Between 2008 and 2017, there were almost 250,000 major trauma cases in the NHS – and the complexity of cases has increased for a number of reasons:

> Patients are getting older.

In 2008, the median age of trauma patients was 45. By 2017, it was 59. And in addition, the number of patients over the age of 65 had doubled, from 22% to 42%.

> Trauma is trickier to treat.

As a possible result of the above, trauma patients are now more likely to present with co-morbidities – existing health conditions such as diabetes, COPD, asthma or mental health problems – which may make acute trauma and injuries more difficult to treat. In 2008, only 40% of patients fell into this category – by 2017, almost two-thirds of trauma patients had one or more pre-existing health complication.

> More severe incidents are more common.

Although the median severity of injury hasn’t changed significantly, there has been a marked increase in patients with an injury severity score (ISS) of eight or more – up by 260%.

Worldwide, the picture is much the same. With road traffic increasing in developing countries, significant construction projects in countries with less stringent health and safety regulations, and human conflicts becoming more complex, global health practitioners are increasingly interested in trauma research to improve outcomes.

It’s often said that ‘war is good for medicine’ – with weaponry evolving, the types of injuries sustained by servicemen and women may never have been seen before, meaning field medical teams have to quickly develop new interventions and techniques. For example, during military operations in Iraq and Afghanistan (2003-12), survival rates for UK combat casualties improved consistently due to factors including: pre-hospital interventions during rapid transfer; more effective pre-deployment training; and enhanced protocols.

With the right teams and training in place, military medics returning to the UK now bring with them vast experience of critical, multiple injuries which they can use when treating civilian casualties. To maintain these improvements, the NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC) was established in January 2011 at the ITM – with the aims of:

• • Translating lessons learnt from the military to civilian practice
  • Designing clinical trials that can be tested in the NHS and then implemented on the battlefield
  • Developing innovative, holistic academic and clinical training for the leaders of the future
  • Facilitating engagement with industry by developing collaborative research partnerships

In addition, even when people survive trauma, the impacts are felt long after discharge. The life expectancy of trauma survivors is some ten years shorter than the general population, meaning there are potential implications for the study of ageing – and therefore the possibility of benefit for the non-trauma population too.

It’s for these reasons that SRMRC exists.

Located centrally in Birmingham, SRMRC is co-located with the Royal Centre for Defence Medicine at the renowned major trauma centre, the Queen Elizabeth Hospital. The ‘QE’ – and its parent trust University Hospitals Birmingham – is the largest teaching hospital trust in England, treating 2.2m people every year.

But more important than the size of the Trust is its depth of expertise: it is a level 1 trauma centre and receives patients from across the Midlands and further afield for emergency treatment, and its trauma team includes medics from across the armed forces.

And as part of the wider Birmingham Health Partners ecosystem, SRMRC researchers are able to collaborate with colleagues from various specialties including genomics, inflammation and ageing, metabolomics, burns research and healthcare technologies – as well as specialist clinical trials units.

The annual cost of trauma to the UK economy is some £3.8bn – but back in 2010, trauma accounted for only one per cent of research expenditure.

Now, however, with SRMRC covering trials in neurotrauma; trauma and orthopaedics; critical care; burns; hand injuries; peripheral nerve damage; and emergency and pre-hospital medicine, there is every chance that survivorship, reenablement and rehabilitation will continue to improve for both civilian and military casualties, here and overseas.

You might also be interested in:

• • Visit the SRMRC website
  • Meet the SRMRC’s 24/7 research nursing team

The Scar Free Foundation – based at the Institute of Translational Medicine – has won one of The Sun’s prestigious Military Awards for pioneering research carried out in partnership with Birmingham Health Partners founder members UoB and UHB, aiming to advance the rehabilitation and recovery of injured servicemen and women.

Prime Minister Boris Johnson helped hand out the awards – affectionately dubbed the Millies – which honour serving personnel and reservists for acts of sacrifice and gallantry during the past year, and pay tribute to the companies and charities that have supported the Armed Forces community.

The Scar Free Foundation received an award for Innovation, in recognition of its unique partnership with The CASEVAC Club and pioneering research underway at The Scar Free Foundation Centre for Conflict Wound Research.  The centre is based within the Healthcare Technologies Institute and is a partnership with the University of Birmingham, the Centre for Appearance Research at the University of the West of England), and the CASEVAC injured veterans club.  It aims to develop new approaches to reduce, and eventually eliminate scarring altogether.

The award ceremony took place at Banqueting House, Whitehall, and was attended by the Secretary of State for Defence, The Rt Hon Ben Wallace, who hosted a reception at Downing Street beforehand.

The Scar Free Foundation has always enjoyed a close relationship with the Armed Forces and veteran community and hopes its work will improve the outcomes for those injured in conflict, both now and in the future.

Marking the 200^th anniversary of Florence Nightingale’s birth, 2020 has been named the ‘Year of the Nurse and Midwife’ by the World Health Organization (WHO). While many of us will think of a hospital ward-based caregiver when asked to picture a nurse, they actually undertake a much wider variety of roles than you may know. In the first of a series of blogs, we meet the professionals working around the clock to support clinical trials – the SRMRC research nurses.

Every patient should have the chance to take part in a research trial. But what happens when illness or injury strikes suddenly, outside of normal working hours?

The NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC) has sought to ensure that trauma and serious illness would no longer be a barrier to research since its nursing team was established in 2012. However, the first year revealed difficulties in recruiting to trauma trials during evenings and weekends. As a result a 7am-7pm on-call service was established, to ensure that even the most critical patients – no matter what their injuries are or when they are admitted – have the opportunity to join a study. Additionally, two critical care nurses work over the weekend so that recruitment can continue – vitally important when we consider the trauma risks of leisure and social activities that occur on Saturdays and Sundays.

The 24/7 research nurse team is a trailblazer – the first nurse-led team in the UK to operate out of a major trauma centre 24 hours a day, every day of the year – with a reputation for recruiting to the trials no-one else could. In 2012 they were lauded as the fastest-recruiting team to the SyNAPSE study, even though the trial was open at hundreds of centres and in 21 countries worldwide.

Members of the SRMRC research team on the steps of the ITM. Upper row L-R: Karen – research nurse; Chris – research nurse; Morgan – trial administrator; Tracy – research nurse. Lower row: Elaine – research nurse; Kamal – research fellow;  Tony Belli – Professor of Trauma Neurosurgery; Ronald – senior research nurse

Advancing scientific understanding, improving care and shaping the treatments of the future

Covering trials in neurotrauma; trauma and orthopaedics; critical care; burns; hand injuries; peripheral nerve damage; and emergency and pre-hospital medicine, the SRMRC research nurses see patients and families at their most vulnerable. The incredibly complex studies to which they recruit require the highest level of skill to screen and enrol patients, alongside the empathy and compassion needed to support extremely sick people and their families at a time when clinical research is the least of their concerns.

The team are also master multi-taskers – the 10 nurses are currently recruiting to over 30 clinical trials, and with their expertise held in such high regard, new studies are sent to them on an almost daily basis. Thanks to the high rates of recruitment they achieve around the clock, the exemplary quality of the data that they collect and the dedication of each individual team member, SRMRC is regularly named the top recruiter to complex, multi-centre and even international trials.

As well as working with colleagues in research and clinical care across the BHP members, the research nurse team has developed collaborative partnerships with more than 50 international universities, trial centres and pharmaceutical companies – including global brands such as AstraZeneca and GlaxoSmithKline – as well as the MoD. These collaborations are vital for developing treatments for trauma patients and translating scientific discoveries from the bench to the bedside.

The SRMRC nurses have also set-up a dedicated research Patient and Public Involvement (PPI) group to make sure the patient is at the centre of all its work. The group has provided feedback for studies, co-designed research materials and acted as lay representatives on grant applications – all of which helps to keep the centre’s work focused on the needs of patients.

Vital to the ground-breaking research being carried out both here in Birmingham and around the country, the team’s ability to recruit patients 24/7/365 has enabled the capture of data which truly reflects the general population. Its work is underpinned by a belief that a trauma patient coming into the emergency department at 3am should have the same opportunity to take part in research – and to contribute to scientific discoveries – as someone coming in between 9 and 5. The research nurse team has allowed research in trauma and emergency care to become embedded as part of normal clinical care and a fundamental stage in the patient journey.

As a former research patient summed up: “being able to take part in a trial meant that something positive could come from one of the worst days of my life.”

Medtech is of critical importance to the Midlands economy, a new report has found.

The report focuses upon the nature and scale of the medtech sector, its contribution to the regional economy, what Midlands businesses need in order to achieve growth, and the barriers faced.

Key findings from the Midlands MedTech Sector Analysis include the following:

• Medtech contributes an estimated £1.6bn in GVA for the region annually
• It is a driver of high productivity, with GVA per worker standing 40% higher than the Midlands average
• There are close to 1,000 MedTech businesses operating in the Midlands – the largest number of medtech companies in any region in the UK
• Midlands medtech employs 23,600 people – the second highest UK region for employment

The report, commissioned by MI Health and supported by the Midlands Engine, was produced by the independent consultancy Hatch Regeneris Ltd.

It states the case for supporting the continued need for a large-scale, fully-integrated approach to medtech across the Midlands, developing existing critical infrastructure and opening new close-to-market opportunities.

Sir John Peace, Chairman of Midlands Engine who funded the study, said: “Medical technologies were identified as a strength of the region in our Midlands Engine Science and Innovation Audit. This new study gives us important information about our medtech businesses and highlights the importance of the sector to our region, including the impressive rate of growth being seen in this sector. Significantly, the report also shines a light on the need for a pan-Midlands approach to supporting our medtech clusters.”

Professor Mark Lewis, Convener of MI Health, said: “This report represents a ‘golden thread’ through an ambitious series of activities that will enhance the Midlands’ reputation as a global player in medtech. This ambition builds upon world-leading regional strengths, such as our outstanding medtech companies, a unified group of research-intensive universities and a network of engaged health and medicine professionals within our NHS Trusts. Our national assets include the £300m Defence Military Rehabilitation Centre, which has been the catalyst for the UK government’s commitment to establish a National Rehabilitation Centre on the same site. Marshalling these opportunities will enable the Midlands vision to be realised.”

The University of Birmingham has announced two projects with Southeast University in China that could help to fight cancer and aid regeneration of the human body.

Supported by a total of ¥2 million funding from Jiangsu Industrial Technology Research Institute (JITRI), researchers are combining multi-modal magnetic resonance imaging (MRI) technology, pathology and artificial intelligence (AI) to help diagnose brain tumours more quickly.

Meanwhile, biomedical engineering experts are exploring the potential of a new class of bone cement capable of degrading and simultaneously stimulating the body to gradually replace it with natural bone. This could reduce the risk of long-term implant failure and reduce the need for human bone grafts.

The projects were announced today by University of Birmingham Vice-Chancellor Professor Sir David Eastwood and Southeast University President Professor Zhang Guangjun in a special ceremony at Southeast University.

Professor Sir David Eastwood commented: “The University of Birmingham is a world leader in biosciences and our partnership with experts at Southeast University and JITRI is making promising progress in the fight against diseases such as cancer and the regeneration of the human body.

“We are a global university with a civic outlook and I am delighted that we are continuing to build our excellent relationship with Southeast University. Our new venture could help to improve health outcomes for millions of people in China and beyond.”

The announcement follows the universities’ agreement signed in May 2018 to establish a Joint Research Centre (JRC) in Biomedical Engineering – allowing the partners to work on applied research projects that will use the University of Birmingham’s expertise to strengthen innovation in the Jiangsu Province across a range of biomedical technologies.

Professor Sir David Eastwood and Professor Zhang Guangjun today signed a further agreement to develop a joint research centre for data science in biomedical research – building on the strengths of the partnership between the two universities.

Professor Wang Baoping, Executive Vice President of Southeast University commented: “Both SEU and Birmingham are world-renowned universities with solid foundation and growing research strengths in the field of biomedical and life science. The Joint Research Center for Data Science and Biomedical Research signed today, will give full play to the research advantages of two universities and to build an international high-level platform dedicated to research and education on biological big data, aiming to jointly address the global challenges and achieve win-win cooperation.”

Birmingham’s contribution to the partnership is led by the University’s Healthcare Technologies Institute (HTI), working with the Southeast University (SEU) Institute of Biomedical Devices (IBMD).

The partners are using their expertise to develop programmes leading to products that can help improve health outcomes for patients in China with biomedical themes covering:

• • • Ocular drug/cell delivery and protection
    • Osteoinductive materials
    • Switchable biological surfaces and molecular diagnostic technologies
    • Brain image analysis

Professor Yu Sun, from Southeast University and director of UoB-SEU international laboratory for Children’s Medical Imaging Research, commented: “Combining enhanced health data collection, advanced MR imaging, and artificial intelligence means we can greatly reduce the risk of complications due to invasive surgery, cut diagnostic time and increase the accuracy of early diagnosis of brain tumours – improving patient survival.

“We want to enable a range of powerful diagnostic tools to be transferred to routine clinical practice through this system, enabling clinicians to use these technologies quickly and easily, benefiting more patients, hospitals, medical companies and research institutions.”

Professor Liam Grover, from the University of Birmingham and Dr Richard Williams, Co-Deputy Director, University of Birmingham and Southeast University Joint Research Centre for Biomedical Engineering, are both based at the ITM and will lead the project to develop more effective alternatives to ceramic bone cements. These cements remain in the body for a long time, but are generally brittle meaning that implants pose a long-term risk of failure.

“Conventional cements are usually formed from calcium orthophosphates with a similar composition to bone,” commented Professor Grover. “Adding another kind of phosphate triggers deposition of new bone around the implant and resorption of the cement into the body – avoiding the major issues associated with ceramic bone replacements.

“Previously, components were not available in a form pure enough to allow use as a medical device, but we’re working with our Chinese partners to reformulate the material with pure components and demonstrate that the material retains its unique biological properties.”

SEU allocated space within its IBMD facility at Suzhou Hi-tech Park to create a state-of-the-art medical technologies development laboratory to host JRC projects. The partnership also strengthens links between Jiangsu Province and the City of Birmingham in medical research and development.

Both the University of Birmingham and SEU have strong links with their respective national healthcare technology regulatory bodies. This will help to ease co-developing, translating and commercialising novel healthcare products into UK, EU and Chinese markets.

The announcement follows a recent biomedical engineering workshop – jointly hosted in Birmingham – that gave British businesses the opportunity to meet key players in the UK-China biomedical engineering sector. The event focused on developing and commercialising new healthcare products by linking innovators, wider industry and professional service support.