Effective September 4, 2010 there will be 30 accredited trauma centers in Pennsylvania:

Adult Level I Trauma Centers

1. Allentown – Lehigh Valley Hospital

2. Bethlehem – St. Luke’s Hospital

3. Danville – Geisinger Medical Center

4. Hershey – The Milton S. Hershey Medical Center

5. Johnstown – Conemaugh Memorial Medical Center

6. Philadelphia – Albert Einstein Medical Center

7. Philadelphia – Hahnemann University Hospital

8. Philadelphia – Temple University Hospital

9. Philadelphia – Thomas Jefferson University Hospital

10. Philadelphia – The University of Pennsylvania Health System, University of Pennsylvania Medical Center

11. Pittsburgh – Allegheny General Hospital

12. Pittsburgh – The University of Pittsburgh Medical Center – Mercy

13. Pittsburgh – The University of Pittsburgh Medical Center Presbyterian

Adult Level II Trauma Centers

1. Abington – Abington Memorial Hospital

2. Altoona – Altoona Hospital

3. Erie – Hamot Medical Center

4. Lancaster – Lancaster General Hospital

5. Langhorne – St. Mary Medical Center

6. Philadelphia – Frankford Hospital, Torresdale Campus

7. Reading – The Reading Hospital and Medical Center

8. Sayre – Robert Packer Hospital

9. Scranton Community Medical Center

10. Upland Crozer-Chester Medical Center

11. Wilkes Barre Geisinger Wyoming Valley Medical Center

12. York – York Hospital

Pediatric Level I Trauma Centers

1. Hershey – The Milton S. Hershey Medical Center

2. Philadelphia – St. Christopher’s Hospital for Children

3. Philadelphia – The Children’s Hospital of Philadelphia

4. Pittsburgh – The Children’s Hospital of Pittsburgh

Pediatric Level II Trauma Centers

1. Allentown – Lehigh Valley Hospital

2. Danville – Geisinger Medical Center

Level III Trauma Centers

1. East Stroudsburg – Pocono Medical Center

2. Seneca – UPMC Northwest

The Pennsylvania Trauma Systems Foundation (PTSF) is a non-profit corporation recognized by the Emergency Medical Services Act (Act 1985-45). The PTSF is the organization responsible for accrediting trauma centers in the Commonwealth of Pennsylvania. It has been reviewing and surveying applicant hospitals since May of 1986.

Trauma centers are hospitals with resources immediately available to provide efficient surgical intervention to reduce the likelihood of death or permanent disability to injured patients. Accredited trauma centers must be continuously prepared to treat the most serious life threatening and disabling injuries. They are not intended to replace the traditional hospital and its emergency department for minor injuries.

In Pennsylvania there are three levels of trauma centers. Level I trauma centers require trauma research, a surgical residency program, and an annual volume of 650 major patients per year. A level II trauma center meets the same high level of care but does not require the research and residency components, and volume requirements are 350 major trauma patients per year. Level III trauma centers are smaller community hospitals which do not require a minimum volume of trauma patients. Their focus is to stabilize severe trauma in preparation for transport to a higher level trauma center as well as care for patients with moderate trauma. They do not need neurosurgical resources. Level I and II trauma centers can also be categorized as either Adult Trauma Centers or Pediatric Trauma Centers.

Each trauma center regardless of its level is an integral component of the emergency medical services system. The EMS system assures appropriate patient care management from the time of injury to treatment at a local hospital and/or trauma center and through the rehabilitative phase of care.

Source: Pennsylvania Trauma Systems Foundation

People recover faster after surgery for ankle fracture if they are given a cast or splint that can be removed to let them exercise the ankle, than if their foot is placed in an immobilising plaster cast. If the fracture is stable, then encouraging them to walk soon after surgery is also beneficial. However, increased activity does increase the chance of experiencing problems with the surgical wound. These conclusions are published in a systematic review included in the latest update of The Cochrane Library.

Ankle fracture is one of the most common fractures of the lower limb, especially in young men and older women. In about half of the cases, the broken bone requires surgery to realign the bones, and then the lower leg and foot are placed in a cast to immobilise and protect the area.

The problem with immobilisation is that it can lead to pain, stiffness, weakness and swelling in the ankle. A team of Cochrane Researchers therefore looked to see whether there was evidence that using removable casts or splints can improve outcome.

The researchers found only limited evidence, but current research indicated that removable casts or splints which allow the ankle to be exercised soon after surgery reduced pain and increased mobility when compared to using a traditional plaster cast. But early exercise on the ankle also led to increased (albeit mainly minor) adverse events, such as problems with the surgical wound and changes in skin sensation.

“Getting a patient to exercise soon after surgery has significant benefits, but the increased risks to the wound show that you need to make sure that a person can do this safely before supplying them with a removable cast or splint instead of a standard cast,” says Christine Lin, who works at the Musculoskeletal Division of The George Institute for International Health, Australia.

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News from The Cochrane Library

Source: Jennifer Beal

Wiley-Blackwell

Three prominent speakers have been added to the slate of experts – which includes military medical leaders – for the USU-HJF Military Medicine Symposium: Advancing Public-Private Partnerships, on September 23, 2010, at the Omni Shoreham Hotel in Washington, D.C. The event is a premier opportunity for representatives of the public and private sectors to come together to discuss medical partnerships to benefit our nation’s wounded warriors and their families.

Army Colonel David Sutherland, special assistant to the chairman of the Joint Chiefs of Staff for warrior and family support, will provide the symposium’s opening keynote address. With deployments to Iraq, Kuwait and Southwest Asia, Sutherland has commanded at all levels from platoon through brigade, including the 1st Cavalry Division’s 3rd Heavy Brigade Combat Team. He has been recognized for his work on behalf of wounded warriors and Gold Star families.

Sutherland, along with Army Major John Copeland, authored “Sea of Goodwill: Matching the Donor to the Need,” a white paper that seeks to foster better transitional support of veterans and their families as they return to civilian life. The paper highlights the importance of military-civilian collaborations to ensure optimal care for returning servicemen and women. In his keynote, Sutherland will discuss the many emotional and physical challenges facing servicemembers on the battlefield and at home.

Nancy Berglass, director of the Iraq Afghanistan Deployment Impact Fund (IADIF) and principal, Berglass Community Investment Consulting, has 25 years of leadership experience in grassroots and institutional philanthropic and nonprofit organizations. Berglass is the strategic force behind the IADIF, a groundbreaking grants program that has distributed nearly $250 million to nonprofit organizations serving the needs of men, women and families affected by deployment to Iraq and Afghanistan.

She was honored with the 2008 Department of Defense Distinguished Civilian Humanitarian of the Year Award. Berglass will present the afternoon keynote address, which will emphasize the importance of new and promising solutions to issues of warrior care involving collaborations among the Department of Defense and civilian partners.

Army Colonel (Ret.) Charles Hoge, M.D., a neuropsychiatry consultant to the Office of the Army Surgeon General and senior scientist at Walter Reed Army Institute of Research, will deliver the luncheon address. Hoge directed the U.S. military’s premier research program on the mental health and neurological effects of the wars in Afghanistan and Iraq from 2002 to 2009. He deployed to Iraq in 2004 to improve combat stress care.

Hoge’s articles on post-traumatic stress disorder, mild traumatic brain injury and stigma are among the most frequently cited medical publications resulting from the wars in Iraq and Afghanistan. He continues to work as a staff psychiatrist, treating servicemembers, veterans and families.

TriWest Heathcare Alliance will sponsor the symposium luncheon. TriWest partners with the Department of Defense to support the healthcare needs of 2.7 million members of America’s military family in the 21-state TRICARE West Region.

“TriWest is honored to support this vibrant dialogue on critical health care issues facing our servicemembers and their families,” said David J. McIntyre, President and CEO of TriWest Healthcare Alliance. “As a private-sector partner with the Military Health System, we value the opportunity to serve the medical needs of military families every day, and this symposium provides an outstanding platform for optimizing care delivery for those who serve and sacrifice for our nation.”

The 2010 USU-HJF Military Medicine Symposium is designed to foster collaboration and expand public-private partnerships to advance military medical research. The program will include opportunities for discussion and networking among participants. In addition to keynote and other featured speakers, the day will include expert-discussion panels on regenerative medicine, as well as topics in traumatic stress, including resilience and suicide prevention.

The program will culminate in a military medical leaders panel, during which speakers including the Navy and Air Force Surgeons General, Army Deputy Surgeon General and Medical Officer of the Marine Corps will identify areas of need that could be addressed through new or expanded civilian partnerships. All panels will end with question-and-answer periods to ensure that attendees have opportunities to explore featured topics in greater depth. The day will conclude with a networking reception.

The event is hosted by the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF) and its Center for Public-Private Partnerships, in conjunction with the Uniformed Services University of the Health Sciences (USU). For more information, including the full agenda, click here.

Source:
JoAnn C. Sperber
Henry M. Jackson Foundation for the Advancement of Military Medicine

Dr Charles Worringham of Queensland University of Technology’s Institute of Health and Biomedical Innovation said the unique ‘Cardiomobile’ monitoring system, developed by Gold Coast company Alive Technologies, was being further developed and trialled together with QUT under an ARC Linkage Grant.

“The program allows people who have been in hospital for a heart attack or heart surgery to undergo a six-week walking exercise rehabilitation program wherever it’s convenient, while having their heart signal, location and speed monitored in real time,” Dr Worringham said.

“We are trying this approach because 80 per cent of cardiac patients never complete recommended hospital outpatient rehabilitation programs, despite the fact that they cut recurrent heart attacks by 17%, substantially reduce deaths, prevent re-hospitalisation, and improve both function and quality of life.”

“It’s not because they don’t want to take part, it’s usually because they cannot get to the hospital’s program easily, because there simply isn’t one nearby, or because work or family commitments take priority.”

Dr Worringham said country singer and songwriter Alan McPherson was one of the first to trial the system.

“Mr McPherson was able to do his rehabilitation sessions while on tour from Queensland to Victoria knowing he was being properly monitored,” he said.

“Without the system he would have either had to cancel his tour, forego the rehab program, or take a chance and exercise with no monitoring or support.”

The Cardiomobile system works by the patient attaching to their chests a mini ECG (electrocardiogram or heart signal) monitor and wearing a cap with a lightweight GPS receiver, both connected to a mobile phone via Bluetooth.

“Patients phone in at the start of their scheduled session and then their heart signal, location, speed and gradient are monitored in real-time over the web by a qualified exercise scientist, who guides the patient’s program and checks their progress,” Dr Worringham said.

“If there is any problem with the heart signal we can immediately contact the patient, and consult with the cardiologist if needed.

“Although serious problems in cardiac rehab are very rare, if there is an emergency we can direct the paramedics to the exact location without delay. While this approach is different from a hospital-based program, we are talking about a group of patients who either wouldn’t exercise at all or would have to go it alone – something many lack the confidence for after heart attacks and surgery.”

“If this approach works, it could go a long way towards assisting the recovery of heart patients not reached by conventional rehabilitation, and help to cut the number of avoidable re-admissions to hospital,” Dr Worringham said.

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Source: Niki Widdowson
Queensland University of Technology

The human brain is a powerful simulation machine. Sports professionals and amateurs alike are well aware of the advantages of mentally rehearsing a movement prior to its execution and it is not surprising that the phenomenon, known as motor imagery, has already been extensively investigated. However, a new study published in the September 2010 issue of Elsevier’s Cortex suggests that there may be more to motor imagery than previously thought. A group of neuroscientists in Italy have shown that the brain is able to invent creative new solutions in order to perform impossible actions.

Researchers from two Rome universities (Tor Vergata, La Sapienza) and a rehabilitation institution (IRCCS Fondazione Santa Lucia) teamed up to investigate the complexity of motor imagery processes. Close similarities are thought to exist between the brain structures that support imagined and real actions, but findings from neuropsychological research tend to contradict this. “In fact, if brain damage disrupts [real] motor functions, simulated actions may or may not show a similar impairment”, notes Dr. Elena Daprati. “We took these inconsistencies as a hint that motor imagery might be a more complex phenomenon than previously understood, and reasoned that people involved in rehabilitation should be made aware of this issue for approaches based on mental practice to be successfully applied to patients.”

The researchers proposed three tasks commonly assumed to rely on motor imagery to stroke patients with varying degrees of motor impairment. All patients performed correctly, but only those with milder motor impairments appeared to have used mental simulation during the tasks. Patients with severe impairments, especially of dominant limbs, avoided mentally mimicking the actions that they could no longer perform, using instead alternative mental strategies to complete the tasks. “These findings indicate that the notion of motor imagery should be expanded to include processes that are not limited to simulation, but also rely on creative operations,” said the researchers. “These alternative modes would support the brain’s creative potential to invent novel motor patterns, tools and machinery, and evidently, the ability to imagine what may never be achieved in reality.”

Sources: Elsevier, AlphaGalileo Foundation.

Researchers have developed an experimental tongue-based system that may allow individuals with debilitating disabilities to control wheelchairs, computers and other devices with relative ease and no sophistication.

Because the tongue is directly connected to the brain via cranial nerves, it usually remains mobile when other body parts lose function to disease or accidents. That mobility underlies the new system, which may one day provide greater flexibility and simplicity to individuals who would otherwise use sip-and-puff controls or brain implants.

Electrical engineer Maysam Ghovanloo developed the Tongue Drive system in collaboration with graduate student Xueliang Huo and presented the findings June 29 at the 2008 Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Annual Conference in Washington, D.C.
“Tongue Drive is inherently wireless and touch-free because it relies on a tiny magnetic tracer attached to the tongue with no power consumption,” said Ghovanloo. “Tongue movements are also fast, accurate and do not require much thinking, concentration or effort.”

Developed with funding from the National Science Foundation and additional support from the Christopher and Dana Reeve Foundation, the technology is already showing speed and flexibility that rivals or surpasses other technologies.

Click here for further details regarding the Tongue Drive.

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Principal Investigators

Maysam Ghovanloo, Georgia Institute of Technology

The National Science Foundation (NSF) is an independent federal agency that supports fundamental research and education across all fields of science and engineering, with an annual budget of $6.06 billion. NSF funds reach all 50 states through grants to over 1,900 universities and institutions. Each year, NSF receives about 45,000 competitive requests for funding, and makes over 11,500 new funding awards. NSF also awards over $400 million in professional and service contracts yearly.

Source: Joshua A. Chamot

National Science Foundation

A researcher at MIT’s Picower Institute for Learning and Memory has pinpointed stem cells within the spinal cord that, if persuaded to differentiate into more healing cells and fewer scarring cells following an injury, may lead to a new, non-surgical treatment for debilitating spinal-cord injuries.

The work, reported in the July issue of the journal PLoS (Public Library of Science) Biology, is by Konstantinos Meletis, a postdoctoral fellow at the Picower Institute, and colleagues at the Karolinska Institute in Sweden. Their results could lead to drugs that might restore some degree of mobility to the 30,000 people worldwide afflicted each year with spinal-cord injuries.

In a developing embryo, stem cells differentiate into all the specialized tissues of the body. In adults, stem cells act as a repair system, replenishing specialized cells, but also maintaining the normal turnover of regenerative organs such as blood, skin or intestinal tissues.

The tiny number of stem cells in the adult spinal cord proliferate slowly or rarely, and fail to promote regeneration on their own. But recent experiments show that these same cells, grown in the lab and returned to the injury site, can restore some function in paralyzed rodents and primates.

The researchers at MIT and the Karolinska Institute found that neural stem cells in the adult spinal cord are limited to a layer of cube- or column-shaped, cilia-covered cells called ependymal cells. These cells make up the thin membrane lining the inner-brain ventricles and the connecting central column of the spinal cord.

“We have been able to genetically mark this neural stem cell population and then follow their behavior,” Meletis said. “We find that these cells proliferate upon spinal cord injury, migrate toward the injury site and differentiate over several months.”

The study uncovers the molecular mechanism underlying the tantalizing results of the rodent and primate and goes one step further: By identifying for the first time where this subpopulation of cells is found, they pave a path toward manipulating them with drugs to boost their inborn ability to repair damaged nerve cells.

“The ependymal cells’ ability to turn into several different cell types upon injury makes them very interesting from an intervention aspect: Imagine if we could regulate the behavior of this stem cell population to repair damaged nerve cells,” Meletis said.

Upon injury, ependymal cells proliferate and migrate to the injured area, producing a mass of scar-forming cells, plus fewer cells called oligodendrocytes. The oligodendrocytes restore the myelin, or coating, on nerve cells’ long, slender, electrical impulse-carrying projections called axons. Myelin is like the layer of plastic insulation on an electrical wire; without it, nerve cells don’t function properly.

“The limited functional recovery typically associated with central nervous system injuries is in part due to the failure of severed axons to regrow and reconnect with their target cells in the peripheral nervous system that extends to our arms, hands, legs and feet,” Meletis said. “The function of axons that remain intact after injury in humans is often compromised without insulating sheaths of myelin.”

If scientists could genetically manipulate ependymal cells to produce more myelin and less scar tissue after a spinal cord injury, they could potentially avoid or reverse many of the debilitating effects of this type of injury, the researchers said.

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This study was supported by grants from the Swedish Research Council, the Swedish Cancer Society, the Foundation for Strategic Research, the Karolinska Institute, EuroStemCell and the Christopher and Dana Reeve Foundation.

Source: Teresa Herbert

Massachusetts Institute of Technology

Most girls in the Kurdish regions of northern Iraq undergo female genital mutilation, and Kurdish authorities have failed to address the issue because of cultural concerns, according to a report released by the U.S.-based group Human Rights Watch on Wednesday, the AP/Washington Post reports. The report said the Kurdish Regional Government, elected in July 2009, has made progress on domestic violence and so-called “honor killings” but has been reluctant to recognize FGM as a type of violence against women.

Seventy-three percent of Kurdish women and girls older than age 14 reported having undergone FGM, according to a survey by the non-governmental organization Association for Crisis Assistance and Development, or WADI, that is included in the report. WADI surveyed 1,408 girls and women from September 2007 through May 2008.

WADI worked with lawmakers in the former regional government in 2008 to develop an anti-FGM strategy but that support was suddenly pulled without explanation, according to WADI official Fallah Muradkhan.

HRW said Kurdish officials’ long-term strategy for reducing FGM should include an awareness campaign on the health consequences and a law prohibiting FGM for children and non-consenting adults (Al-Shalchi/Barzanji, AP/Washington Post, 6/16).

PRI Interviews HRW Official

On Wednesday, HRW’s Jessie Graham discussed the report on Public Radio International’s “The World” (Werman, “The World,” PRI, 6/16).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families.

© 2010 National Partnership for Women & Families. All rights reserved.

A researcher at MIT’s Picower Institute for Learning and Memory has pinpointed stem cells within the spinal cord that, if persuaded to differentiate into more healing cells and fewer scarring cells following an injury, may lead to a new, non-surgical treatment for debilitating spinal-cord injuries.

The work, reported in the July issue of the journal PLoS (Public Library of Science) Biology, is by Konstantinos Meletis, a postdoctoral fellow at the Picower Institute, and colleagues at the Karolinska Institute in Sweden. Their results could lead to drugs that might restore some degree of mobility to the 30,000 people worldwide afflicted each year with spinal-cord injuries.

In a developing embryo, stem cells differentiate into all the specialized tissues of the body. In adults, stem cells act as a repair system, replenishing specialized cells, but also maintaining the normal turnover of regenerative organs such as blood, skin or intestinal tissues.

The tiny number of stem cells in the adult spinal cord proliferate slowly or rarely, and fail to promote regeneration on their own. But recent experiments show that these same cells, grown in the lab and returned to the injury site, can restore some function in paralyzed rodents and primates.

The researchers at MIT and the Karolinska Institute found that neural stem cells in the adult spinal cord are limited to a layer of cube- or column-shaped, cilia-covered cells called ependymal cells. These cells make up the thin membrane lining the inner-brain ventricles and the connecting central column of the spinal cord.

“We have been able to genetically mark this neural stem cell population and then follow their behavior,” Meletis said. “We find that these cells proliferate upon spinal cord injury, migrate toward the injury site and differentiate over several months.”

The study uncovers the molecular mechanism underlying the tantalizing results of the rodent and primate and goes one step further: By identifying for the first time where this subpopulation of cells is found, they pave a path toward manipulating them with drugs to boost their inborn ability to repair damaged nerve cells.

“The ependymal cells’ ability to turn into several different cell types upon injury makes them very interesting from an intervention aspect: Imagine if we could regulate the behavior of this stem cell population to repair damaged nerve cells,” Meletis said.

Upon injury, ependymal cells proliferate and migrate to the injured area, producing a mass of scar-forming cells, plus fewer cells called oligodendrocytes. The oligodendrocytes restore the myelin, or coating, on nerve cells’ long, slender, electrical impulse-carrying projections called axons. Myelin is like the layer of plastic insulation on an electrical wire; without it, nerve cells don’t function properly.

“The limited functional recovery typically associated with central nervous system injuries is in part due to the failure of severed axons to regrow and reconnect with their target cells in the peripheral nervous system that extends to our arms, hands, legs and feet,” Meletis said. “The function of axons that remain intact after injury in humans is often compromised without insulating sheaths of myelin.”

If scientists could genetically manipulate ependymal cells to produce more myelin and less scar tissue after a spinal cord injury, they could potentially avoid or reverse many of the debilitating effects of this type of injury, the researchers said.

This study was supported by grants from the Swedish Research Council, the Swedish Cancer Society, the Foundation for Strategic Research, the Karolinska Institute, EuroStemCell and the Christopher and Dana Reeve Foundation.

Source:
Deborah Halber
mit.edu

With a season of record-breaking snowfalls and eight weeks of winter to go, Washingtonians have become all too familiar with the icy sidewalks, the sore muscles, and the coughs and colds that come along with winter weather. But for those feeling the effects of a recent fall or tighter joints due to a lack of exercise, therapeutic massage – including simple tips you can do at home – can offer much-needed relief.

“We tend to be less active in the cold weather months, catch more colds and flus, and get depressed more easily. Massage is proven to help with all these winter ailments,” says Winston Moore, massage therapist and the Regional Operations Manager for Massage Envy, which has 19 locations in the Baltimore/Washington, DC area. “Massage increases circulation, boosts the immune system and causes your body to release more stress-fighting hormones. With winter not even half over, we can all use that right about now,” adds Moore.

Massage Envy reports a significant increase in clients with aches and pains, and many are weather-related. Integrating therapeutic massage as a regular health practice can not only help alleviate pain but increase overall wellness during the cold weather months and beyond.

But what happens when you’re snowed in? Moore says fighting the winter woes can be easier than you think, and can be had with simple items from around the house. Here are a few simple tips that he recommends:

- Simple stretches and movements can help your muscles warm up before you do any activity. Similar to a resistance band, hold the ends of a beach towel in each hand. While standing, place under one foot and pull up until taut to stretch the leg muscles. Stretching is key before any strenuous activity to avoid potential injury.

- Stress can play a large role in the quality of your sleep. If you have more trouble falling asleep in the winter, try using a tennis ball to help stretch tense muscles and promote relaxation. While lying face up in bed place a tennis ball in the crook of your neck and apply pressure for about ten minutes.

- The feet contain many nerve endings that refer to different parts of the body. To help alleviate pain in your feet, massage a golf ball into each foot while sitting on the couch or at your desk. Remove your shoes and place a golf ball on the ground. Roll along the bottom of the foot while applying pressure. Repeat for 10-15 minutes to help relieve tension and relax your body.

- If experiencing strain or soreness, ice is great for soothing muscles. Because pain may indicate injury, be advised that ice should always be applied prior to heat. If applying heat causes more pain to the trouble area, this could indicate something more serious and medical attention should be sought. Try using a bag of frozen vegetables to relieve exacerbated muscle and avoid the mess of ice cubes.

Before trying any of these techniques, Moore suggests an initial professional massage to make sure techniques are being applied properly. To learn more about these techniques, and many others that can be incorporated into an at-home wellness strategy, book an appointment at the Massage Envy near you, at MassageEnvy.

Source
Massage Envy