Jim Mashburn felt his legs cook.

Mr. Mashburn, a worker at a paper-recycling plant, fell through a loose grate and into a sump pit in September 2008 as he was preparing to inspect a steam valve. Super hot condensate, at a temperature of at least 140 degrees Fahrenheit, enveloped his legs instantly, searing skin up to his thighs.

A co-worker was able to pull Mr. Mashburn out of the pit within 30 seconds, sparing him a worse fate, but he was left with first-, second- and third-degree burns on both legs.

“Once I got out and pulled my pants and my boots off, I remember just watching the skin peel away like you were taking a ladies stocking off. That’s how fast the skin went away,” he recalled.

Mr. Mashburn, 56, was airlifted to Parkland Memorial Hospital in Dallas, where he received skin grafts on his right leg and both ankles before returning to his Rockwall County home for rehabilitation. His wounds are healing, but the resulting itching requires the application of moisturizing lotion several times a day to relieve the constant sensory irritation.

“Every day on a scale of one to 10, it’s about a 3 or a 4. If the moisturizing lotion wears off, if the skin dries and starts to flake and gets a sunburned look, it gets to 8 or 9 on the itch scale. It’s pretty intense,” Mr. Mashburn said. “If you’ve ever had a really bad case of poison ivy, that’s what it’s like.”

He has also had to forgo blue jeans because his calves rub against the pants legs.

Chronic itching, medically termed as pruritus, is an almost universal problem for people recovering from major burns, and it can become debilitating by interfering with daily activities. UT Southwestern Medical Center rehabilitation specialists, after reviewing studies and treatments, have compiled recommended guidelines that appear in the Journal of Burn Care and Research.

“When you’re not itchy, itching seems minor. But when you’re itchy, you constantly think about it,” said Dr. Vincent Gabriel, assistant professor of physical medicine and rehabilitation at UT Southwestern and clinical director for the North Texas Burn Rehabilitation Model System. “It disturbs the patients’ sleep. At times, they compromise wound healing by scratching. In an extreme case I can recall, one patient would get up at night and rub his back up against door frames and even a tree to get relief.”

Burn scar tissue lacks the usual oil glands found in normal skin. As a result, the scar is chronically dry and prone to itching simply from a lack of hydration or lubrication, Dr. Gabriel said.

He and his colleagues outlined a possible hierarchy of treatment strategies in the study, starting with topical creams and ointments and progressing to oral antihistamines as well as evaluating non-medicinal treatments such as lasers, nerve stimulators and massage.

“Your arm is about 9 percent of your body’s surface area, and your chest is 18 percent. It’s not practical to use one treatment for all of that space, so you have to combine the topical and oral treatment to come up with the best protocol,” he said.

Researchers ranked the effectiveness of typical treatments using a method called the Physiotherapy Evidence Database, or PEDro, score. No treatments garnered an “excellent” rating and none were found effective on all patients. Treatments categorized as “good” include:
cimetidine, a prescription antihistamine pill;

colloidal oatmeal bath as a topical treatment; and

pulsed dye laser therapy, in the non-medicine category.

Massage, nerve stimulation and treatment with an antihistamine called Atarax scored “fair.”

Other findings from the study include:
Persistent, post-burn itching was estimated to affect about 87 percent of all patients.

Itching typically begins in the first two weeks after a burn injury.

Predictors of itching included wounds requiring more than three weeks to heal.

Itching is typically worse around the edges of the burned area.

“For years and years afterward, patients will have problems with itching. It’s not something that comes up during healing and goes away. It’s a chronic problem for them,” Dr. Gabriel said.

Dr. Gabriel said the study arose from his and his colleagues’ struggles to help alleviate the problem for patients. Researchers reviewed the medical literature since 1950 and found only 10 trials and one case report on effective treatments that met standards for establishing burn care practice guidelines.

“We found a dearth of well-done studies on itching,” he said. “Our recommendations combined best evidence available as well as our clinical experience in our very active burn program.”

Funding for the study was through UT Southwestern’s clinical research scholars program and the Department of Physical Medicine and Rehabilitation.

Visit utsouthwestern/rehabilitation to learn more about UT Southwestern’s clinical services in rehabilitation.

Source: Russell Rian

UT Southwestern Medical Center

View drug information on Cimetidine Hydrochloride Oral Solution.

Ossur (ICEX: OSSR) – the Iceland-based developer and supplier of orthopedic devices – has launched more scientifically advanced prosthetic innovations than any other company in the field. That technological superiority, its commitment to R&D, and its significant contributions to enhancing amputees’ lives, merited Frost & Sullivan’s 2006 Medical Devices Technology Innovation Award for Ossur’s Bionic Technology family of products.

In 2005, Ossur took the same award for its first Bionic Technology product, the RHEO KNEE™, a system so smart it automatically adapts to the wearer’s walking style and environment, learning continuously until it reaches optimal efficiency. The 2006 award honors Ossur’s entire and expanded Bionic Technology platform that now includes two additional ground-breaking prostheses that represent a seamless fusion of electronics, mechanics, and human physiology.

One is the POWER KNEE™, the world’s first motor-powered knee that replaces true muscle activity, thus making it possible, for the first time ever, for an amputee to go up stairs and inclines foot-over-foot. The other – and the latest to launch – is the PROPRIO FOOT™, the world’s first motor-powered and intelligent foot that thinks for itself. The PROPRIO FOOT™, like the POWER KNEE™, replaces muscle function that was lost with the amputation. The foot enables amputees to perform activites in a normal and functional pattern by:

* 1 Sensing. Knowing where their foot is in space is a huge safety issue for amputees. Sophisticated sensor technology mimics the body’s own neural receptors that are sensitive to mechanical change, providing artificial proprioception (that sense of where the limb is in space). Hence the name PROPRIO FOOT™.

* 2 Thinking. Patent-pending artificial intelligence (AI) processes information from the sensors and activates the most appropriate response for the next step.

* 3 Acting. The AI transmits a constant stream of signals which instruct high-precision actuator technology to act and deliver optimal function.

“This award recognizes Ossur’s singular talent to successfully develop and introduce new technology, formulate a well-designed product family, and make significant product performance contributions to the industry,” says Shantayan Panda, Research Analyst, Medical Devices for Frost & Sullivan.

The Frost & Sullivan award comes on the heels of Ossur being named a Technology Pioneer by the World Economic Forum for 2006. Its Bionic Technology prostheses have also received accolades in the press, and prosthetists and users alike have been lavish in their praise of them. In fact, the Department of Defense and the VA are both actively using all of Ossur’s Bionic Technology prostheses to benefit servicemen injured in current conflicts, and veterans.

“All this recognition is gratifying,” says Eythor Bender, President of Ossur America. “But what drives our highly motivated team is that bionic technology represents a quantum leap forward when it comes to improving the quality of life for amputees.”

A look at technologies yet to come for lower limb prosthetics reveals osseointegration, the science of implanting man-made, load bearing anchoring mechanisms directly into the living bone; and neurosensing, when a prosthetic device is connected to the human neurological system enabling the user to regain voluntary control over the prosthesis at a thinking level. “We are determined that the changes in our field will continue to be rapid and positive,” says Bender.

The PROPRIO FOOT™ was developed entirely in-house by Ossur’s R&D department, with expertise in real-time motion analysis provided by Canadian company, Dynastream. The RHEO KNEE™ was co-invented with Hugh Herr, Ph.D., associate professor at MIT and director of the Biomechatronics department at MIT’s Media Lab. The POWER KNEE™ was co-developed with Victhom Human Bionics, an Ossur partner.

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OSSUR

Ossur (Icelandic Stock Exchange: OSSR) is as much about helping people to live a life without limitations as it is about its orthopaedic products. A trusted and global leader in the development, manufacturing, distribution, sales and marketing of bracing and support products and prosthetics, Ossur pioneers award-winning designs – including its Bionic Technology platform – and partners with the health practitioners who use them to deliver successful clinical and business outcomes. Headquartered in Reykjavik, Iceland, the company has operations and a distribution network throughout the world. The company allocates an industry record of 6-8 percent of its revenue on research and development to conceive and harness the most advanced technologies for incorporation in its product designs, and provides extensive education programs through the Ossur Academy. Ossur is a 2006 World Economic Forum Technology Pioneer. Website: ossur/

FROST & SULLIVAN

Frost & Sullivan, a global growth consulting company, has been partnering with clients to support the development of innovative strategies for more than 40 years. The company’s industry expertise integrates growth consulting, growth partnership services, and corporate management training to identify and develop opportunities. Frost & Sullivan serves an extensive clientele that includes Global 1000 companies, emerging companies, and the investment community by providing comprehensive industry coverage that reflects a unique global perspective and combines ongoing analysis of markets, technologies, econometrics, and demographics. For more information, visit awards.frost/ .

Contact:

Ossur Global Marketing:
Edda H. Geirsdottir – Director
Reykjavik, Iceland

Ossur Public Relations:
Beverly Millson
Missing Sock Public Relations

Frost & Sullivan:
Stacie Jones
Corporate Communications

Contact: Beverly Millson

Ossur

Researchers at the University of Washington (UW) are working on an implantable electronic chip that may help establish new nerve connections in the part of the brain that controls movement. Their most recent study, to be published in the Nov. 2, 2006, edition of Nature, showed such a device can induce brain changes in monkeys lasting more than a week. Strengthening of weak connections through this mechanism may have potential in the rehabilitation of patients with brain injuries, stroke, or paralysis.

The authors of study, titled “Long-Term Motor Cortex Plasticity Induced by an Electronic Neural Implant,” were Dr. Andrew Jackson, senior research fellow in physiology and biophysics, Dr. Jaideep Mavoori, who recently earned a Ph.D. in electrical engineering from the UW, and Dr. Eberhard Fetz, professor of physiology and biophysics. For many years Fetz and his colleagues have studied how the brains of monkeys control their limb muscles.

When awake, the brain continuously governs the body’s voluntary movements. This is largely done through the activity of nerve cells in the part of the brain called the motor cortex. These nerve cells, or neurons, send signals down to the spinal cord to control the contraction of certain muscles, like those in the arms and legs.

The possibility that these neural signals can be recorded directly and used to operate a computer or to control mechanical devices outside of the body has been driving the rapidly expanding field of brain-computer interfaces, often abbreviated BCI. The recent Nature study suggests that the brain’s nerve signals can be harnessed to create changes within itself.

The researchers tested a miniature, self-contained device with a tiny computer chip. The devices were placed on top of the heads of monkeys who were free to carry out their usual behaviors, including sleep. Called a Neurochip, the brain-computer interface was developed by Mavoori for his doctoral thesis.

“The Neurochip records the activity of motor cortex cells,” Fetz explained, “It can convert this activity into a stimulus that can be sent back to the brain, spinal cord, or muscle, and thereby set up an artificial connection that operates continuously during normal behavior. This recurrent brain-computer interface creates an artificial motor pathway that the brain may learn to use to compensate for impaired pathways.”

Jackson found that, when the brain-computer interface continuously connects neighboring sites in the motor cortex, it produces long-lasting changes. Namely, the movements evoked from the recording site changed to resemble those evoked from the stimulation site.

The researchers said that a likely explanation for these changes is the strengthening of pathways within the cortex from the recording to the stimulation site. This strengthening may have been produced by the continuous synchronization of activity at the two sites, generated by the recurrent brain-computer interface.

Timing is critical for creating these connections, the researchers said. The conditioning effect occurs only if the delay between the recorded activity and the stimulation is brief enough. The changes are produced in a day of continuous conditioning with the recurrent brain-computer interface, but last for many days after the circuit is turned off.

“This unusually long-lasting plasticity may be related to the fact that the conditioning is associated with normal behavior,” Fetz said.

###

The research was supported by grants from the National Institutes of Health, the Office of Naval Research, and the University of Washington Royalty Fund.

Contact: Leila Gray

University of Washington

On March 10, the Amputee Coalition of America will have more than 150 amputees from across the country in Washington, D.C., urging Congress members to support fair insurance coverage for artificial arms and legs.

“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition President and CEO. “We intend to turn this tide, and our Lobby Day is a great example of the grassroots support we have from across the country to do so. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”

Amputees and their families are making the trip to Washington, D.C., to tell lawmakers that they need their own “bailout.” While the U.S. Department of Veterans Affairs, the Department of Defense, Workers’ Compensation insurance, Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and even Congress’ health insurance plan cover prosthetic and orthotic devices, a growing number of group and private insurance companies cap the benefit so low that the average working family can’t afford adequate prosthetic care.

“Although an average adult amputee needs a replacement prosthesis every five years and children even more frequently,” Calhoun said, “some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.”

Such practices pose especially grave challenges for families of children with limb loss. Take Evan Light, for example. At 8, he is already on his fifth pair of prosthetic legs, and the last pair alone cost more than $20,000. Until the legislature in his home state of Indiana took action, his prosthetics benefit under the family’s insurance plan was only $4,000.

“Families like Evan’s are essentially penalized $20,000 or more because their child has grown and their arm or leg no longer fits,” said Calhoun. “Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime. No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”

“The legislation we are seeking support for would ensure that children like Evan have access to arms and legs that keep them active and productive at home and at school,” says Evan’s father, Randy, who plans to attend Lobby Day with his son to support the legislation.

Senators Olympia Snowe (R-ME) and Tom Harkin (D-IA) and Representatives Robert Andrews (D-NJ) and George Miller (D-CA) are key sponsors of the bill, called the Prosthetic and Orthotic Parity Act. This bill would require employer-paid health plans to provide coverage for prosthetic and custom-fabricated orthotic devices on par with the coverage offered for medical and surgical services.

“People pay their monthly health insurance premiums and expect their coverage to take care of catastrophic situations like losing a limb,” said Calhoun. “This is the very reason people purchase health insurance. No American deserves to be forced to continue using a device that no longer fits or is broken.”

Statistics compiled by the Amputee Coalition indicate that passing legislation that ensures fair coverage for prosthetic devices will return people to work and ensure that there is no cost-shifting to government programs for coverage. Data also indicates that the proposed legislation would cost less than 60 cents per member per month in insurance premiums.

Currently, 11 states – Colorado, Maine, New Hampshire, Rhode Island, Massachusetts, California, Oregon, New Jersey, Indiana, Vermont and Louisiana – have passed laws that ensure fair coverage for prosthetics, and more than 30 states have legislation in various stages in their state capitols.

“These state laws have helped many people, but they are not enough,” said Morgan Sheets, the Amputee Coalition’s national advocacy director, who is leading the Lobby Day activities. “Without a federal law, there will always be amputees who fall through the cracks.”

Lorenzo Smith, whose right leg was amputated when he was 12, did just that. His mother, Albertha Jackson-Smith, vividly recalls the tragic day she had to explain to her young son that he couldn’t have an artificial leg because the family’s insurance wouldn’t cover it.

“We are fighting for people like Lorenzo Smith, Evan Light, and even for those people who are not aware of their lack of coverage, but it’s a difficult battle,” said Sheets. “Insurance companies have a powerful voice. The Amputee Coalition and its citizen lobbyists are like David taking on Goliath. However, we trust that our congressional representatives will see the logic in our claims and do what is right. This year, they will have a wonderful opportunity to help us achieve a great victory for American families.”

About the Amputee Coalition of America

The Amputee Coalition, based in Knoxville, Tennessee, is a national nonprofit organization that empowers people who have experienced amputation or are born with limb differences, through education, support and advocacy. For more information about limb loss, please visit the Amputee Coalition Web site at amputee-coalition.

Amputee Coalition of America

Following surgery and radiation treatments for prostate cancer, most men suffer some degree of incontinence. For approximately 14 percent of these men, the problem lingers five years later.

Improving the lives of these men is the goal of a new “Stay Dry” intervention being tested by Amy Zhang, assistant professor of nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University, and colleagues from University Hospitals Case Medical Center, Cleveland Clinic and the Louis Stokes Cleveland Department of Veteran Affairs Medical Center.

Researchers have received a four-year, $2.4 million grant from the National Institutes of Health to determine the effectiveness of teaching pelvic floor muscle exercises combined with biofeedback techniques and subsequent therapy.

The new study will enroll 312 men who have undergone prostate surgery at the three medical centers. Men will be selected at random to be part of one of three groups. The first group will receive exercise instructions with biofeedback and group therapy. The second group will also receive exercise instructions with biofeedback, but will receive six phone sessions instead of group therapy. The third, control group will receive standard care, which includes verbal instructions from their doctors about how to control incontinence .

Men will be assessed over seven months to find the differences between the group that received biofeedback and six group meetings, biofeedback and six phone contacts every other week for three months, and the group that receives usual care.

The study also involves two sub-studies. One research project will examine the overall cost effectiveness of this new intervention technique long term, as compared with standard care. A second project will analyze the physical changes to 51 men with moderate to severe incontinence to determine muscle changes as a result of the interventions.

The consequences of incontinence

Incontinence is suffered by some of the 200,000 men who annually undergo surgery, radiation or a combination of the two after a prostate cancer diagnosis.

Leakage of urine is a common side effect, as the surgical procedure to remove cancerous tumors involves some degree of loss of control of the sphincter muscle, which supports the bladder.

In addition to recovering from surgery and treatment, many men have to deal with the consequences of incontinence, including distress, self-identity issues and increased healthcare costs due to potential loss of work time, nursing care or medical supplies.

Finding an effective intervention is increasingly important, said Zhang. “While most men with prostate cancer are older, sophisticated diagnostic methods are able to find the cancer at a younger age, and the population with prostate cancer is growing,” said Zhang.

“Strengthening the pelvic muscles shows promise in benefiting these men,” said Zhang.

Notes:

Research collaborators:

CASE WESTERN RESERVE UNIVERSITY: Shirley Moore, associate dean of research at FPB and director of the Center of Excellence for Self-Management Advancement Through Research and Translation, and Nahida Gordon, professor of medicine and nursing; and formerly from the university, Laura Siminoff, professor and chair of the department of Social and Behavioral Science, Virginia Commonwealth University.

CLEVELAND CLINIC: Eric Klein, professor of surgery and director of Cleveland Clinic’s Section of Urologic Oncology; Alex Fu, assistant professor and health economist at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.

VETERAN AFFAIRS MEDICAL CENTER: Donald Bodner, professor of urology, Dr. Hui Zhu, assistant professor of urology, Gerald Strauss and Kim Schaub, health psychologists.

UNIVERSITY HOSPITALS CASE MEDICAL CENTER: Lee Ponsky, assistant professor of urology and a surgeon in the urology department; Denise Kresevic, gerontological nurse practitioner, and clinical researchers.

Case Western Reserve University is among the nation’s leading research institutions. Founded in 1826 and shaped by the unique merger of the Case Institute of Technology and Western Reserve University, Case Western Reserve is distinguished by its strengths in education, research, service, and experiential learning. Located in Cleveland, Case Western Reserve offers nationally recognized programs in the Arts and Sciences, Dental Medicine, Engineering, Law, Management, Medicine, Nursing, and Social Work. case.edu/.

Susan Griffith

Case Western Reserve University

Breast cancer survivors might one day avoid the prospect of invasive breast reconstruction surgery, opting instead for an approach that would involve using stem cells derived from their own fat, suggest University of Pittsburgh researchers who are studying the potential these cells may have for regenerating new breast tissue.

In animal models, the researchers hope to prove that an injection of fat-derived stem cells that are seeded onto microscopic scaffold structures will enable the production of a durable, replacement soft tissue. The team, led by J. Peter Rubin, M.D., assistant professor of plastic and reconstructive surgery at the University of Pittsburgh School of Medicine, recently received a three-year grant from the National Cancer Institute to further explore this unique approach.

“The surgical options for breast reconstruction involve either the use of implants or a procedure whereby fat tissue taken from another part of the body is shaped into the form of a breast. Neither is ideal nor without risk. The use of adipose- or fat-derived stem cells may represent a better solution for soft tissue reconstruction in breast cancer patients,” said Dr. Rubin, who also is co-director of the Aesthetic Surgery Center at the University of Pittsburgh Medical Center.

The use of stem cells to treat disease or regenerate tissue is believed to hold promise because of their potential to develop into different specialized cell types. Indeed, when exposed to specific conditions in the laboratory, fat-derived stem cells have been shown to differentiate into cells characteristic of those from tissues such as fat, bone, cartilage, nerve, muscle and blood vessels.

Dr. Rubin and his colleagues are focusing their efforts on an approach that involves combining the fat-derived stem cells with microscopic beads composed of a type of extracellular matrix (ECM) that has regenerative properties. Preliminary results indicate that the stem cells can easily attach themselves to these beads and are able to differentiate into mature fat cells. When injected under the skin in a rat model, the cellular combination eventually formed what they describe as a “mound” of tissue.

The fat-derived stem cells being used in the study are obtained from breast cancer patients.

“We need to demonstrate that fat-derived stem cells taken from a breast cancer patient behave no differently than those from other women. Moreover, our studies will seek to understand what effect, if any, these stem cells may have on cancer cells. A major question is whether they will in some way promote the growth of cancer cells. We certainly hope this proves not to be the case,” Dr. Rubin cautioned.

In 2001, researchers from the University of California Los Angeles and the University of Pittsburgh first reported that adult stem cells could be isolated from adipose tissue, more commonly known as fat. Since then, laboratory studies have suggested adipose-derived stem cells have potential for treating heart attack, stroke or bone injury, although there have been no clinical trials in the U.S. to date. Experts estimate that one pound of whole fat removed in a tummy tuck, for example, can yield up to 200 million stem cells, which in culture can be expanded by 10 times over the course of two weeks. If and when fat-derived stem cells are tried in patients for breast reconstruction, Dr. Rubin predicts surgeons will obtain the cells from the patients’ own stores of abdominal fat.

According to the American Cancer Society, more than 214,000 new cases of invasive breast cancer will be diagnosed by the end of 2006. For women who require mastectomy, the loss of one or both breasts can cause significant discomfort and psychosocial distress. More than 80,000 breast reconstruction operations are performed each year, according to American Society of Plastic Surgeons statistics.

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CONTACT: Clare Collins

Working with Dr. Rubin on the NIH-funded grant are co-investigators Kacey G. Marra, Ph.D., from the department of surgery, division of plastic surgery, School of Medicine, and the department of bioengineering, School of Engineering; Albert D. Donnenberg, Ph.D., from the department of medicine, division of hematology/oncology, School of Medicine, and the University of Pittsburgh Cancer Institute (UPCI); and Vera S. Donnenberg, Ph.D., of the department of surgery, School of Medicine and UPCI. Stephen Badylak, D.V.M., M.D., Ph.D., from the department of surgery, School of Medicine, and the University of Pittsburgh McGowan Institute for Regenerative Medicine; and Howard D. Edington, M.D., of the department of surgery, division of surgical oncology, School of Medicine and the McGowan Institute, are consultants.

Contact: Lisa Rossi

University of Pittsburgh Medical Center

But away from the front line, review highlights concern about variation in standards and poor maintenance of buildings.

The Healthcare Commission today (Monday) praised the British military’s “exemplary” trauma and rehabilitation services for personnel injured in battle.

It published the first ever independent review of the Defence Medical Services (DMS), which is responsible for providing healthcare to defence personnel and their families in the UK and overseas.

The independent watchdog conducted the review at the request of the Surgeon General, Lieutenant General Louis Lillywhite.

It praised the care provided to casualties of war, highlighting systems to reach and treat casualties quickly, innovations in the treatment of major injuries, the training of staff, design of field hospitals, clinical audits to feedback important lessons and rehabilitation for injured personnel.

The Commission also identified a range of areas for improvement, urging the DMS to: ensure that universal standards are in place across all services; address problems relating to maintenance and cleanliness at some medical units away from the frontline; urgently replace ambulances in Cyprus; and improve awareness of procedures for safeguarding children.

The DMS provides healthcare to 258,000 people, including service personnel, their families and other civilians entitled to care. It encompasses care provided in the Royal Navy, British Army, Royal Air Force and supporting units.

The DMS mostly provides primary care, such as general practice, dentistry, occupational medicine and community mental health services within the UK and defence outposts overseas.

It also provides medical care in zones of conflict and is responsible for rehabilitation services in Headley Court Defence Medical Rehabilitation Centre in Surrey and at a number of other centres in the UK and Germany.

The DMS commissions inpatient hospital care from six NHS trusts for personnel and their families needing hospitalisation in England. The review does not cover these services as the Commission assesses their performance already as part of the annual ratings for each trust* (see note to editors below for rating).

Sir Ian Kennedy, Chair of the Healthcare Commission, said: “By asking for this review, the Surgeon General has thrown the spotlight on these services in a way that has never been done before. He has invited us to report publicly on the good and the bad. That is something for which he deserves a huge amount of credit: indentifying where problems exist is the first step to getting them fixed.

“There is absolutely no question that personnel injured in battle have a better chance of survival than ever before. That is entirely due to efficient and innovative care, delivered under exceptionally difficult circumstances. The NHS’ urgent and emergency services could learn a lot from how the defence service plans care, trains staff and constantly seeks to learn and improve trauma services.

Sir Ian added: “By the services’ own assessments, they still have some way to go before they can tell all their patients – in all parts of the armed services – that standards are in place to provide high quality care wherever they get treatment. By commissioning this review, the DMS has taken the first step towards achieving this important goal. The results provide a clear agenda for action.

“Away from the frontline and the spotlight of war, the DMS must give urgent attention to the maintenance and cleanliness of buildings. It must also improve awareness that 16 and 17 year-olds are still legally children – military personnel or not – and healthcare workers have a responsibility to act on any suspicion of bullying or abuse.”

The review involved self-assessments by reference to the 24 core standards set out by the Department of Health for the NHS. The Commission received declarations from 153 DMS units or regions encompassing a number of units. This included military hospitals, rehabilitation centres, dental services, community mental health services and general medical services.

This was followed-up by inspections at 53 units in the UK and overseas. The review also incorporated 500 comments from current and ex-service personnel, family members and organisations that work with the DMS.

The Commission praised the following areas of exemplary practice:

- Trauma care is exceptional and has greatly increased the chance of survival and recovery for injured personnel. Trauma care is delivered to personnel injured in war zones, with an aim to save life, stabilise the patient’s condition and transport them for further treatment. A helicopter can be airborne within minutes of receiving a call, transporting highly trained clinical staff to the casualty on the frontline. Casualties are assessed and treated very quickly, greatly improving their chance of recovery. They are then transported for further medical treatment, in a field hospital or in the UK. Aeromedical evacuation teams provide treatment in-flight and can transport injured personnel from the frontline to the UK within 24 hours. The field hospital inspected in Iraq was well-planned and extremely clean.

- Rehabilitation services are excellent. Services are provided at Headley Court rehabilitation centre and regional units in the UK and Germany. Some personnel described services as “outstanding” and “first-class”.

- Innovative “patients’ diaries” aid recovery for those with memory loss. Patients’ diaries are kept for personnel recovering from injury in military hospitals who may suffer from memory loss. Staff record important milestones in recovery and visitors also add messages. This helps patients to fill in time lost from their memories and aids recovery.

- Clinical audits of services for trauma and rehabilitation mean care is continuously improving and innovating. Clinical experts closely examine all aspects of a patient’s treatment, from when a person suffers a major trauma, through to rehabilitation. They then feedback lessons weekly to the field hospitals.

However, the Commission urges the DMS to:

- Ensure that standards are in place across all services. Medical centres and field hospitals inspected in Iraq declared compliance with all core standards and no declarations were overturned upon inspection. But, there was significant variation in compliance with core standards at those services away from conflict zones and seven standards where more than 20% of DMS declared non-compliance, including those relating to important issues such as infection control, appropriate environments and safeguarding of children. Looking across the DMS, standards relating to obtaining consent (C13b) and ensuring that staff update skills and techniques (C5c) were the standards where most units declared compliance (97%). Ninety-six per cent of units declared compliance with the standard relating to treating patients with dignity and respect (C13a). However, declared compliance with the standard relating to participation in mandatory training was low at 64%. Only 69% of units declared compliance with standards relating to infection control (C04a) and appropriate care environments (C21).

- Address problems relating to maintenance and cleanliness of buildings and replace ambulances in Cyprus. The Commission visited three medical centres in the UK and one in Cyprus where primary care was delivered in unacceptable conditions. This included very poor maintenance, inadequate facilities for clinical staff to work in and poor levels of cleanliness. The Commission immediately raised concerns with the DMS, which then implemented a programme of deep cleaning, renovation and maintenance. Standards relating to infection control and the environment were among the standards where declared compliance was lowest. The Commission changed declarations to “non-compliant” at five out of 13 units inspected on infection control and nine out of 19 inspected on the environment. The Commission also raised concern about the continued use of nine ambulances in Cyprus, which had previously been identified in internal inspections as unsafe and needing urgent replacement. The DMS is currently modifying the vehicles. The Commission considers, however, that the ambulances continue to present a risk to the safety of patients. New vehicles are planned to be delivered in June or July this year.

- Improve awareness of procedures to safeguard children. The DMS does not always recognise that personnel under the age of 18 are still legally children. While no concerns were found relating to the practice of treating and safeguarding children, some DMS staff did not know processes for reporting matters relating to child protection or safeguarding, including staff at units providing services to the families of personnel. The standard relating to safeguarding of children (C02) had the fifth lowest level of declared compliance at 73%.The Commission assessed this standard at eight units and overturned declarations of compliance at five.

- Collect information centrally to allow comparison across all services and to provide a clear overview of quality of services across the whole organisation. Currently, regular audits and reviews are conducted differently by each of the navy, army, air force and dental services. This means that it is not possible to make comparisons between areas. The Defence Medical Information Programme being rolled out will provide electronic records for patients and a central database. This is expected to improve the way the DMS collects and uses information.

Notes

The DMS commissions inpatient hospital care from six NHS trusts. Defence personnel are integrated with civilian patients, and treated by both civilian and military clinicians. The six trusts and their annual health check rating are:

- University Hospital Birmingham NHS Trust – quality of services “good”, use of resources “excellent”

- Portsmouth Hospitals NHS Trust – quality of services “excellent”, use of resources “good”

- South Tees Hospitals NHS Trust – quality of services “good”, use of resources “fair”

- Frimley Park Hospital NHS Foundation Trust – quality of services “excellent”, use of resources “excellent”

- Plymouth Hospitals NHS Trust – quality of services “fair”, use of resources “good”

- Peterborough and Stamford Hospitals NHS Foundation Trust – quality of services “weak”, use of resources “excellent”

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

Healthcare Commission

The funds will support research centers at WPI that are developing systems to improve the odds of surviving battlefield injuries and technology to integrate prosthetic limbs and organs with the nervous system.

Two groundbreaking research programs at Worcester Polytechnic Institute (WPI) will each receive $1 million in federal funding through a U.S. Senate Defense Appropriations Bill, setting the stage for the university to further its leadership in two key areas of biomedical research.

The allocations will go to two centers within the university’s Bioengineering Institute (BEI): the Center for Untethered Healthcare, which is developing an integrated system of medical sensors, portable ultrasound scanners, and wireless technology to provide more effective medical care for soldiers in the field to improve their odds of surviving battlefield injuries; and the newly founded Center for Neuroprosthetics and BioMEMS, which is developing technology that will make it possible for prosthetic limbs and organs to be controlled by signals from the brain.

“These are critically important areas of investigation with far-reaching implications for national security and the quality of human life around the world,” said WPI President Dennis D. Berkey. “With this new federal funding, WPI will have even greater opportunity to contribute leadership and new knowledge to such vital areas of bioengineering and biomedical research.”

WPI’s appropriation was part of a U.S. Senate Defense Appropriations Bill that included $12.3 million in spending to improve national security for the 3rd Congressional District represented by U.S. Senators Edward M. Kennedy and John F. Kerry, and U.S. Congressman James P. McGovern. “We are most grateful that the work of our outstanding scholars and researchers has been recognized in this way,” Berkey said.

BEI Center for Neuroprosthetics and BioMEMS

This new center is engaged in research aimed at developing technology that will place prosthetic limbs and organs under the control of the nervous system, enabling users to control these devices in the same way they control their natural limbs and organs. For military personnel who have lost limbs or organs, neuroprosthetics will offer more rapid recovery and rehabilitation.

The center draws upon WPI faculty expertise in the life sciences and biomedical, electrical, and mechanical engineering, including such areas as electronic control systems, communications, imaging, sensors, biocompatibility, and biomaterials, as well as the university’s growing capabilities in bioMEMS (BioMicroElectroMechancial Systems), miniature devices that are critical components of prosthetics control systems. WPI recently established a state-of-the-art MEMS clean room.

This research is aligned with the needs and interests of the U.S. Army’s Military Amputee Research Program (MARP) at the Telemedicine and Advanced Technology Research Center (TATRC) at Fort Detrick, Md., which has supported the Center for Untethered Healthcare over the past five years. WPI hopes to establish a similar technical relationship with MARP that will lead to the development of advanced neuroprosthetic systems, noted BEI Director W. Grant McGimpsey.

BEI Center for Untethered Healthcare

Working with the U.S. military, this center is building upon more than a decade of work by WPI researchers. The center’s goal is to develop technology that can provide critical information to military medical personnel where and when they need it to increase the odds of survival for wounded soldiers on the battlefield. Center researchers are developing four specific technologies:

* Wireless, intelligent physiological sensors that can monitor vital signs of soldiers and alert medics and field commanders when problems arise.

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Ad-hoc wireless networks that will permit sensor data and ultrasound images to be transmitted, securely and reliably in the unforgiving environment of the urban battleground.

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A handheld microfluidic blood analyzer that can measure and analyze the levels of important blood constituents to help in the diagnosis of trauma, injury, or illness.

* Wearable ultrasound technology that enables a medic or physician to bring the ultrasound scanner to the patient, rather than transporting the patient to a hospital or clinic to be scanned.

“We are actively marketing the ultrasound and blood analysis technology,” McGimpsey said. “This new federal funding will allow us to continue to develop these technologies and the other important research of these two centers closer toward a commercial endpoint.”

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About Worcester Polytechnic Institute

Founded in 1865 in Worcester, Mass., WPI was one of the nation’s first engineering and technology universities. WPI’s 18 academic departments offer more than 50 undergraduate and graduate degree programs in science, engineering, technology, management, the social sciences, and the humanities and arts, leading to the BA, BS, MS, ME, MBA and PhD. WPI’s world-class faculty work with students in a number of cutting-edge research areas, leading to breakthroughs and innovations in such fields as biotechnology, fuel cells, and information security, materials processing, and nanotechnology. Students also have the opportunity to make a difference to communities and organizations around the world through the university’s innovative Global Perspective Program. There are more than 20 WPI project centers throughout North America and Central America, Africa, Australia, Asia, and Europe.

Contact: Michael Dorsey

Worcester Polytechnic Institute

The Bill and Melinda Gates Foundation will devote $1.5 billion over the next five years to maternal and child health, family planning and nutrition programs in developing nations with high maternal and infant death rates, the New York Times reports.

Melinda Gates, who announced the planned spending at an international women’s health conference in Washington, D.C., on Monday, said the money will be used to train health workers, develop improved antibiotics to treat infections in newborns and find better ways to treat hemorrhage in mothers.

Gates noted the example of Malawi, one of Africa’s poorest nations, which has started to lower its child and maternal mortality rates. She said pregnancy and childbirth in developing nations often “end in tragedy,” but many deaths could be prevented at a “stunningly” low cost (Grady, New York Times, 6/8).

Gates also said the problem is not caused by a lack of medical knowledge but because “we haven’t tried hard enough.” She added, “Policymakers in both rich and poor countries have treated women and children, quite frankly, as if they matter less than men. They have squandered opportunities to improve the health of women and babies” (Burns, AP/CBS News, 6/7).

The Gates Foundation, which has assets totaling roughly $35.2 billion, already has spent $10 billion on global health projects, including $1.8 billion for maternal, newborn and child health efforts. The foundation’s primary focus to date has been vaccines and infectious diseases, including HIV/AIDS (New York Times, 6/8).

United Nations Secretary General Ban Ki-moon also spoke at Monday’s conference to promote a joint action plan intended to improve women’s and children’s health. He called on business leaders, lawmakers and health experts to submit ideas and proposals before the action plan is finalized in the next few months (AP/CBS News, 6/7).

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.

New research and new collaboration are the goals for the University of Houston’s department of health and human performance (HHP) as its Laboratory of Integrated Physiology (LIP) expands to the National Center for Human Performance in the Texas Medical Center (TMC).

“This opens the door to other investigators within the Medical Center who are working in similar areas of motor behavior,” said Charles Layne, professor and department chair. “This is the culmination of years of work and marks the beginning of a new era in research for UH and for HHP.”

The National Center for Human Performance was founded in 2004 with the goal of maintaining and enhancing human performance in the arts, sports, space exploration, military and in the public, through the ethical and appropriate applications of research and education in medicine and related sciences.

The department’s LIP is the first occupant at the center. Its advisory board members include astronauts, former athletes, an Olympic coach and representatives from many TMC entities.

“We’re excited about the caliber of research and research partners,” Layne said. “By extension, our students will have opportunities to work alongside seasoned investigators who may one day become colleagues.”

Established four years ago by the HHP department, the LIP is a fully equipped human performance, physiology, biochemistry laboratory capable of performing a wide variety of testing and analyses, ranging from the cellular and molecular levels up to the organ and systems levels. The cross-disciplinary expertise among the LIP researchers allows integrated study of the musculo-skeletal, cardiovascular, nervous and immune systems using biochemical, physiological and engineering approaches.

“We’re hopeful that our presence in the National Center for Human Performance will provide a focal point for multidisciplinary studies related to human neuromotor control,” said Professor William Paloski, leader of the LIP research team in the National Center for Human Performance. “By bringing together scientists, engineers and clinicians in this way, we work to improve the quality of life for those disabled by the effects of injury, disease or aging.”

Paloski’s research investigates normal and abnormal sensory-motor control of balance and locomotion, with applications to aging populations and space flight. Paloski spent 23 years at NASA’s Johnson Space Center as a researcher in its neuroscience laboratory studying postural stability control and sensory motor performance in astronauts during and after space flight.

Assistant professor Adam Thrasher investigates biomechanics and electrical stimulation of paralyzed muscles to restore function. Thrasher works with spinal cord injury patients and those with Parkinson’s disease. His research has used imaging software to measure the pressure exerted in the gluteus muscles when a spinal cord patient sits for prolonged periods. Currently, he and his team are investigating walking function in those with incomplete spinal cord injuries.

Assistant Professor Jian Liu investigates gait analysis and the biomechanics of slips and falls. Lieu conducts occupational studies to calculate the fall-risk assessment in the elderly or those with mobility challenges. Using “fall event detection technology” Liu examines how the elderly and those with walking difficulties can prevent falls and the injuries related to falls.

Notes:

For more information about the UH department of health and human performance or the Laboratory of Integrated Physiology, visit hhp.uh.edu/.

For more information about the National Center for Human Performance, visit tinyurl/bwbrr8

Source: Marisa Ramirez

University of Houston