thank you Namoo hello everyone and a very warm welcome to you all I’d like to just say it’s lovely to be here doing this in the daylight last time I did one of these it was definitely pitch black outside so it’s very nice to have some daylight to do this tonight thank you to all the members for joining and welcome to members of the public or anyone who’s joining one of these lectures for the very first time my name is Adele White and I’ve been a governor here at Cambridge University Hospitals (CUH) for six years I was firstly a patient here and then became a member and then I joined the board of governors in 2017 so Cambridge University Hospitals (CUH) membership our membership program it’s free and it’s open to anyone who’s over sixteen years old patients carers members of the public anyone can become a member who has an interest in what we do here at the Trust and we need members opinions and we need your input to help us to improve our hospitals and in return we offer NHS discounts health related events such as these Medicine for Members lectures we do listening sessions and offer other experiences across the campus and you can also vote in the governor elections and we have some governor elections at the moment and voting will close on the 20th of May at 5pm and we’ve got around eight vacancies I think at the moment so just before we start I’d like to encourage patients public staff members if you’re on this session if you can vote if you haven’t already because it’s important elected candidates are going to represent your views and influence important decisions at board level and champion local community’s needs and all of this is going to help us to improve the future of Addenbrooke’s Hospital and The Rosie Hospital for those of you who are not members yet you can sign up tonight via our website www.cuh.nhs.uk and I think if you do tonight you could possibly still vote in the elections so it’s my great pleasure tonight to introduce the Medicine for Members topic and the speakers and we’re going to have a question and answer (Q&A) session at the end of the presentation so tonight’s Medicine for Members topic is all about traumatic brain injury (TBI) and our Cambridge HealthTech Research Centre and all about the advancements in traumatic brain injury (TBI) management so traumatic brain injury it’s one of the commonest causes of death under the age of forty in high income countries and I think that’s quite a stunning statistic I had no idea that was the case and this lecture tonight is going to discuss some of the causes the investigations and treatments and how we can influence the outcomes of traumatic brain injury (TBI) we’re going to hear tonight about the HealthTech Research Centre and how it’s going to help to improve management of traumatic brain injury (TBI) and the lives of the patients and those other people affected such as parents carers families so we’ve got two speakers for you tonight we’ve got Professor Peter Hutchinson who’s a neurosurgeon here at Cambridge University Hospitals (CUH) and he’s the director of the Cambridge HealthTech Research Centre for brain and spine injury and we’ve got Alexis Joannides who’s a neurosurgeon also here at Cambridge University Hospitals (CUH) and he is co-director of the Cambridge HealthTech Research Centre so Professor Hutch is a consultant neurosurgeon at Addenbrooke’s and his sub-specialist interest is in the management of neuro-trauma and specifically head and traumatic brain injury he also has a research interest in acute brain injury in utilising monitoring technology to increase understanding of the pathophysiology of brain injury and also in the investigation and treatment of concussion which is a really important area so Mr Alexis Joannides who is also an academic consultant neurosurgeon and his sub-specialty interest is in brain tumours and brain fluid disorders Alexis is co-director of the HealthTech Research Centre in brain injury and he was previously deputy director of the brain injury MedTech Co-operative which I think was the precursor to what we currently have now and they’re going to talk to us a little bit about the centre tonight and Alexis supports the development of new devices and technologies for improving quality of life of patients following any kind of brain injury so this evening we’re going to ask you if you could to insert any questions you might have for our speakers into the chat at the top of your screen in the chat box which you’ll see and if you could maybe try and do that through the session as the speakers are presenting then we can start the questions as soon as the presentations have finished and also it means you don’t forget your question if we don’t get through all the questions tonight we’ll get back to you we’ve got your email addresses and if you like you can post the questions directly to the speakers so what I’m going to do now is pass over to Professor Hutch to kick things off and then I’ll come back to you when we start the question and answer (Q&A) session great thank you very much Namoo and Adele for the invitation to speak to members and welcome everybody to the virtual presentation we’re going to do this in two parts as Adele said I’m going to talk about head and traumatic brain injury I’m Peter Hutchinson Professor neurosurgery at the University and consultant here and then my colleague Alexis is going to talk about this really exciting new centre that we’ve just kicked off in Cambridge so neurotrauma traumatic brain injury or head injury is a journey for a patient from the scene of an incident through hospital care so emergency department some patients require surgery intensive care unit but the goal is rehabilitation and getting these patients home and as Adele said traumatic brain injury (TBI) is the commonest cause of death under the age of forty but what is of great concern is the morbidity or disability in many of the survivors from this condition and that’s what we’re trying to address so what are the causes of traumatic brain injury they fall into four categories road traffic collisions falls assaults and then sporting injuries road traffic collisions are often a severe cause of injury as are some falls but then the sporting injuries are slightly different in that these tend to provoke a milder form of brain injury called concussion in terms of the management of this condition in the eastern region Addenbrooke’s holds the East of England Major Neurotrauma Surgical Centre so that’s the major trauma network and all the patients with severe injury are transferred directly to Cambridge if they are within forty-five minutes to an hour beyond that they will be taken to the nearest hospital to be stabilised so our catchment for traumatic brain injury is around 5.4 million people across six counties we cover twenty other hospitals and within the region this is a common condition about 100,000 patients per annum 10,000 admissions the way to diagnose these injuries is through scanning so this is a CT scan and patients with severe injury broadly speaking have two types of scans they may have a blood clot that you can see on this scan here the white is the bone inside is the dark area of the brain and this is a blood clot this requires urgent brain surgery to remove it but some patients don’t have a blood clot but the brain is generally diffusely swollen and the problem is that the brain is swelling within the tight confines of the skull so we know after injury the brain like any other part of the body will swell but because the brain is confined within the skull this ICP this intracranial pressure the pressure within the brain increases and that affects the blood supply to the brain the amount of oxygen to the brain and if it’s not treated energy failure and cells will die which provokes more swelling so this cycle is what we’re trying to treat we measure the pressure in the brain by making a very fine hole in the skull so these patients are unconscious they’re on life support in the intensive care unit we make a very fine twist drill into the skull and then insert these pressure monitor probes and we have some idea of what normal and abnormal brain pressure is normal is around what we call ten millimetres of mercury above 20 is abnormal but what’s happened recently and part of this is being driven through the HealthTech Research Centre and its predecessors is there’s now a whole host of different probes that we can insert into the brain to measure various parameters including the pressure how much oxygen the brain is getting and the brain chemistry and that includes how much glucose the brain is receiving glucose is a really important substance for metabolism of the brain so we developed this device to insert these monitors these are really sophisticated new technologies but what’s interesting is some of the technologies we use is really old so look these are the neurosurgical instruments that we used in the middle ages and these are instruments that we still use today and you can see some of the similarities there so the modern management of these patients is to insert the device that we designed through the skull and then we place these monitoring probes of pressure oxygen and chemistry glucose monitors and measuring these parameters helps us guide the management of the patients and there’s various techniques that we can use to try and control brain pressure and swelling we can nurse the patient’s head up we can sometimes place tubes into the fluid spaces to drain some of the brain fluid cooling is effective in some patients and then there’s a whole armamentarium of drugs that we can use to sedate the patient we can increase the blood pressure to help encourage blood flow into the brain sometimes despite that the brain pressure remains really high and all our medical treatment is failing the brain is very swollen it’s compressed in the skull the pressure is going up so we’ve developed this concept of releasing the pressure by removing a large piece of the skull of the patient a neurosurgical operation and then we put the scalp back over the brain why do we do that because it opens that box and it gives the brain somewhere to swell to under the scalp and then of course further down the line we need to put the skull back together how do we do that sometimes we replace the patient’s own bone that we’ve stored within the freezer or sometimes we place the bone within the patient’s own abdomen the stomach in order to keep it clean and sterile but what we tend to do now is use synthetic materials as a replacement for the bone so this is called plastic polyether ether ketone what we tend to use now is titanium this operation of bone removal to treat brain swelling is called decompressive craniectomy and we performed a large clinical trial of decompressive craniectomy to show whether this operation would improve life and survival and when we did that we showed that if you took a hundred patients and underwent this experimental procedure decompressive craniectomy you saved twenty-one more patients what’s important is about quality of survival and about two-thirds of these patients have what we would regard as a good outcome independent at home or outside the home but some of the patients following the surgery were dependent and we’re doing further investigations to try and work out how we can improve recovery for those patients I think what’s really important is that historically we focused on this condition in the United Kingdom but actually about ninety percent of head injuries occur in low and middle income countries including parts of Asia South America and Sub-Saharan Africa in order to try and address this problem as well as the HealthTech Centre that Alexis is going to talk about we run a global health group addressing the issue in particularly Sub-Saharan Africa and India and this is a slide to remind us of the importance of this condition this is the world upside down or my colleagues in Cape Town say this is actually how we should look at the world but what is really striking is that trauma is a major major cause of death trauma causes 11,000 deaths per day on the planet and about half of those are due to a head and traumatic brain injury and about ninety percent of them are occurring in low middle income countries and this is not about fancy neurosurgery this is about simple measures particularly related to road traffic accidents this gentleman on the motorcycle is Lawrence of Arabia he died in 1934 and that led Hugh Cairns a neurosurgeon in Oxford to develop helmets during the second world war but this is a photograph that I took in Chennai in India a few years ago where the whole family is on the motorbike but only dad is wearing the helmet and we look at that but then we think actually if you come back home you see many people around Cambridge and beyond who are cycling without a cycle helmet so there is this campaign called protect your melon where we’ve undertaken a number of research studies looking at patients who’ve come in to the hospital following cycling accidents with and without cycle helmets and there’s no doubt that these studies show that cycle helmets are protective for all types of head injury even high velocity accident so we very much from neurosurgery advocate the use of cycle helmets and this is an example this is a patient who was in the public press and we launched a campaign after that called better to have a broken helmet than a fractured skull you look at her helmet she made a really good recovery it’s dreadful to think what might have happened if she wasn’t wearing this helmet as part of the global work we’re developing new technologies and Alexis is going to talk about new technologies in more detail but this is a new scanner that’s handheld that can be used to detect blood clots where CT is not available we can use mobile phones to follow patients up use text messaging we can use ultrasound to help look at how the brain is functioning when other scans are not available and then we’re doing quite a lot of work in Africa running neurotrauma courses and trying to improve the management of patients when full intensive care is not available so finally putting this all together once the patients discharged from hospital we see them back in the neurotrauma clinic neurosurgery we have two amazing specialist nurses Nicola Owen and Kirsty Grieve who help us manage these patients rehabilitation consultants Dr Anwar and her colleague Harry Mee neuropsychology but what we’ve recently started is a specific sports concussion clinic so we now have a clinic dedicated to managing patients with sports concussion and we’re working with the UK government the Department for Culture, Media and Sport Department of Health and Social Care on these concussion guidelines for non-elite grassroots sport and then with my colleague Naomi Deakin we have an interest in motorsports so we’re developing the concussion protocols for safe return from all sorts of sports specifically motorsport but also rugby and soccer I’d just like to acknowledge that this work is being undertaken by many people not least the patients who’ve participated in our research in Cambridge and their families collaborating clinicians and research staff for many of the funders including the National Institute for Health and Care Research that Alexis is going to talk about many colleagues in neurosurgery in Cambridge and beyond and finally I’d like to invite you all to this conference this is a scientific medical conference called NeuroTrauma 2024 it is being held in Cambridge from the 31st of August to the 5th of September but this includes as well as the neurosurgical talks a public engagement event and we have a number of people who are interested in sports concussion we have a paralympian cyclist who is injured we have the daughter of Jeff Astle Dawn Astle and Jeff was injured through repetitive heading of the football so you’d all be very welcome to register for this public engagement event and that will be held in the Corn Exchange but we can distribute further details so that’s all I wanted to say and I’m now going to pass on to my colleague Alexis who’s going to talk about this really exciting new centre that we’re developing in Cambridge right thank you Hutch and thank everybody for coming in to listen to some of our work I’m just going to set up my screen right so the second part of this talk is really saying right well we know head injury is a problem and we know that there’s some groundbreaking research that is happening to take that further but there’s still a lot of work to do and how do we really upscale this to involve more people more patients more solution providers to make things happen quickly and of course we learnt some very positive and valuable lessons with the pandemic as well so my talk is really around three parts and just focusing on why do you need a new centre and why do you need to have a special approach for health technology and brain injury so first of all why do you need to treat brain injury differently as opposed to just have it as part of a wider healthcare centre what kind of things and how can we make the adoption of technology work better and what kind of activities would one need to do and then ending really by just looking at some examples of the kinds of technologies that we’ve supported in the past and also working at the moment to deliver into the future so this is really just putting things in context from what you’ve heard earlier and this is really putting some numbers this was from a report which is now six years old and it was called Time to Change it was an all parliamentary group in brain injury they identified a number of areas where brain injury had a significant impact and this infographic just illustrates some of the issue so at the top you can see the sheer number of patients who are living with disability these are UK figures and it’s not just numbers but it does have a wider impact in society not least economic impact in that costs of healthcare problems with returning to work quality of life family relationships and if you look there and I suspect now this figure is probably higher it was estimated that all this problem could work out about ten percent of the total NHS budget so really this is something that does count not just because of patient quality of life but also because it does impact on the wider UK society and the economy so why is brain injury different and I think there’s one aspect that is very different from other conditions and one injury on one patient is very different from one individual to the next and that’s because each part of the brain does a very specific function and if you have a road traffic collision or even other conditions I’ll talk about later the effect can be completely different depending on which part of the brain is affected so it’s much more unique now why is this a problem now if you think of solutions which are there to address a specific patient need it means that you have a lot more individual needs so if you’re a solution provider for a company working on some big technology some of them may not be big money spinners so you have less of an incentive to develop solutions that can help a specific need because the number of patients with that need may not be very big so that’s one challenge the second one is head injury is not often visible and the needs are not often reported and a lot of patients will live with a disability or problems families will live with looking after people with head injuries and not really speak up so that means knowing about what the problems are and evaluating the right solution in the right individual or family is not straightforward so these are two barriers that we need to have a specific approach for head injury which is very different from other conditions and when we talk about brain injury if you look at that top thing that it’s the brain location it’s not just head injury which can cause that so in a way whether you have a brain bleed whether you have a tumour that you’ve had surgery for whether you’ve had an infection or an inflammatory disease where the immune system turns on itself if it affects the same location you can get the same problems irrespective of the disease so actually when we talk about brain injury you’re dealing with an even bigger problem that these figures would suggest so the way we’ve approached brain injury saying actually if the brain suffers an injury from any cause the problems are similar and the approach to deal with those problems ought to be similar as well so then how do support new technology to help patients because you’ve heard you know some of the ground breaking research that’s been done in Cambridge and other places but what about the sort of bigger picture and this is something that a program that was started by the National Institute for Health and Care Research (NIHR) which you’ve heard from Adele and really the NIHR is the research arm of the NHS they fund a lot of research in making a difference to how we practice medicine and making difference to patients lives so it started off with a program about twelve years ago called a health technology cooperative and they funded a number of centres across the country each one looking at a particular problem and we were involved in the brain injury healthtech technology cooperative as you can see those are some pictures from some time ago looking slightly younger in some of our team members and this has evolved so after five years the program was expanded by the National Institute for Health and Care Research (NIHR) to what’s called the MedTech Co-operative and as of this year it’s been expanded even more with a bigger budget and a more ambitious mission to call it a HealthTech Research Centre now you see this complicated figure here and let’s just look at the top how do you take a a promising idea or a solution into being used in everyday clinical practice and all these little boxes are individual organisations that sit along this pathway and by this pathway you’ve got the invention on the left you need to work out if it works and does it do what we claim it’s doing then saying can it be taken up by the health service is it affordable is it workable and then diffusion at the end of saying well would more hospitals community practices patients at home be able to take it up and as you can see there’s quite a lot of boxes there and the health technology cooperatives filled a very small space they said well that’s all very complicated how do you work with all these people well the good news is over the years this picture has been simplified so as I said the HealthTech research ambition is actually more ambitious and you can see here that this is really spanning the whole pathway from an early concept and invention all the way to making something ready to be bought by the NHS providers outside the NHS outside the UK patients carers and just looking at this bigger picture so we’ve actually got quite a lot more to do than when we first started doing this work and that’s again working with some other areas particular around research trials that you can see at the bottom and also the more early stage biomedical research centres have early aspect of molecular technology for example so that’s the sort of approach at the national scene so if we now go back to brain injury and I said we’ve talked about the specific challenges of brain injury how have we done it so far and how do you want to do it over the next five years so this is the MedTech Co-operative and this was our approach there just to recap this was the last five years and we broke the pathway into something very similar to what you heard from Professor Hutchinson you need to think of prevention you need to think of what happens when the patient is in acute care be that in critical care or in a hospital setting you need to think about working out who will do well who will not and how do you best support each group of patients think about recover and rehabilitation and just think of longer term reintegration back to normal life as well as possible and the approach you developed was the three fs find facilitate and foster and find as you can see that these are some figures from the last five years how do we know what’s relevant especially in these underrepresented groups people who don’t express the problems with you know their head injury or patients have a particular struggle so we did a lot of work around working with patients and charities and professionals to work out what are the unmet needs that we don’t know about then knowing that saying well okay which projects have a good promise or which ones do they need a bit of a push to actually be supported by more than just us so we set up what was called a Seedcorn competition up to £10,000 to promising ideas just to give them that first step onto the ladder of developing their solution and this was extremely successful and we were able to support a lot of these innovation into wider scale funding applications by the National Institute for Health and Care Research (NIHR) and other funding organisations and then the fostering was really just trying to develop the broader environment around innovators academics and universities NHS clinicians patients charity groups to take things that had a promise of working with some early evidence and take that forward so this is what was done in the last five years and how do we take that further said more ambitious now this is a busy slide so obviously the key points are to the right but we’ll just talk a bit about these issues and if we think about what we need to know before we drive a solution forward I mentioned unmet needs before and that’s very important what do we need what are the problems that have not been addressed and that’s not always obvious but in addition to that there are two other questions because there are lots of people who might have a solution and so we really need to know what is out there that might work for us and sometimes the solutions might be in a completely different field which is not related to brain injury so a lot of our work is really working with other solution providers companies charities and find out what is out there that might be adapted and then of course is how do we know that this could work rather than just investing a lot up front and so that’s the other bit of who do you ask for advice so as part of the scoping element or the identified part of our work is identifying all the experts not just in Cambridge who can give us the most correct accurate honest opinion on what will work and as I said because head injury has so many specific problems you need a lot of people with the expertise to guide us in that and this is an important first step now the second bit the evaluate is really the biggest part of the HRC programs work so the HealthTech Research Centres work and that asks the broader question of does a solution that we think might work does it actually work in the right patient group and is the effect that it delivers worthwhile now again there are lots of individual bits as you can see this is a complex area and there are lots of individual questions that we need to ask but how do you make this more structured and in a way that can actually work in a more straightforward way well we’re creating this technology valuation program where the HealthTech Research Centre working with all its experts is able to take something that has some good promising evidence and just work through and develop the studies as you’ve heard some of the studies around say for example decompressive craniectomy so what studies do you need to prove that this solution actually makes a difference before we then start saying is it worthwhile taking it up wider within the NHS and beyond and so a lot of our work is looking at developing these studies and I’ll talk about some examples in the last part of the talk and the third bit is right we’ve shown something works but can it really work in how things work at the moment and is it affordable and again this as you hear with the budget constraints and all the other problems with the economy this is an important consideration and a lot of innovations are what we call you know the National Institute for Health and Care Research (NIHR) calls the valley of death in particular we know they work we know they have a role but they don’t make it and then a lot of companies or solutions essentially go bust because of that so it’s really saying we’ve shown this can we work with the wider partners to actually say well can you consider taking it up and making a difference so again this is really finishing off this pathway into the wider world beyond just research so other part has who do you work with I said you need lots of experts and you need lots of experts across different organisations and across different sectors so the HealthTech Research Centre while it’s based in Cambridge is actually a partnership with people across the UK so we work with six other NHS trusts as well as four universities which form the core partnership you can see them there we have a number of key collaborators outside academia and the NHS which include small companies large companies charities and other government supported organisations and as I said The wider infrastructure or the wider you know number of organisations supported by the National Institute for Health and Care Research (NIHR) you can see the research arm of the NHS have specific organisations that can help us with that work and also other organisations which for example evaluate how effective interventions are and whether it’s safe to do that and then you can see here this is across the UK so the last bit of the talk is well this is what we want to do and this is with who we are going to do it so really the last bit is what kind of technology say that’s all well and good can you give me some examples and the work is really divided into five themes now three of them correspond to the bits that you can make a difference in head injury as you can see those three on the left so first all is preventing an injury from happening in the first place reducing the damage that it can cause as we called neuroprotection and you heard some examples around you know pressure monitoring that you’ve heard in the critical care unit and then if it does happen how do you support recovery of a patient and their family to return back to a new balance a normal life as much as possible the other two themes are really dealing with the specific challenges around diagnostic tests and also the specific challenges at the extremes of age for example neonates so young babies and what happens if they have a head injury and also at the other end extreme you know in the elderly so I’ll just give you some examples which I’m sure we can you know discuss as part of the question and answer (Q&A) so you’ve heard some things around concussion and the concussion clinic and the work around that so for example just looking at some projects that we’ve supported the scores project is something that we’ve supported and this is looking at cognitive assessment over time in professional athletes and particularly footballers and that’s really trying to ask the question well you heard of some interesting case studies that oh yes people who have headed the ball may get dementia but this is looking in a more structured way and saying can we measure this over time and just get a very objective way of measuring this and I can see that from the timeline you need to do it over a long time to get robust data and this is some that’s been going on and is now in phase three of this project and at the other end is well what about the solutions you have so for example we’ve supported through one of our Seedcorn competitions that I’ve mentioned we’re working with a company called Rezon they have protective headgear and you know they’re asking a question that we’ve supported if you wear a specific helmet does it change your behavior and then doing that specific assessment in women’s rugby so again there are all these little details that can help us understand how we apply these preventative approaches and altogether they fit into the broader picture if we move on to neuroprotective strategies again this is largely in the accident and emergency department even in the ambulance before in the critical care I’ll give you two particular examples one is a non-invasive device as opposed to putting a wire in if you put a non-invasive device can you detect a blood clot in somebody who had a head injury early on so for example this could be using the ambulance or as soon as the patient arrives into the accident and emergency department (A&E) before they’ve had the chance for a CT scan so this could mean that you prioritise patients that have been flagged as you know more prone to deterioration and prioritise them before you get the sequela of injury on the other side you’ve heard about cooling as a strategy the problem of cooling is that a lot of the approaches we use now cool the whole body and whilst we know that cooling is good for the brain in some conditions like cardiac arrest the studies which have been done in brain injury have shown that overall it’s not a good idea but likely because of all the negative effects on the rest of the body particularly the lungs so we’ve worked with a company called Neuron Guard is to develop a collar that just cools the blood going to the head so we’ve did the first study on ten patients showing that this works it does cool the head and we’re looking now for further studies to show that it could actually make a difference to outcome down the line and then what about the third bit the longer term recovery into rehabilitation and again this shows why the specifics of a brain injury matter this solution we worked with a company called Animorph and which has been working with the University of East Anglia in Norwich is for looking at a specific problem that some patients have with brain injury which is called neglect and that’s where you’re not aware of one side of the body and or one side of sensory so that includes vision touch hearing perception and that can be very debilitating and it can really stop your recovery and a lot of studies have shown that but the problem is how do you get therapists to support that or how long do patients need to be in hospital so the solution that we have supported is an app that can work on a tablet and hence can be delivered at home and what it does is it tries to use a technology that has been shown to work so if you keep having these dots moving on a screen towards the side that you’re not aware of if you keep doing that your brain learns to recognise more effectively to recognise that side so we’ve developed a trialled app you can do two sessions a day for over a period of five weeks could that mean you need less therapy input in hospital or could it even mean that patients could go home and do this at home rather than being in hospital so again the cost impact within rehabilitation and what about at home so we’ve worked with two companies looking at digital rehabilitation and support at home you’ve heard the problem of concussion earlier so this is an initiative that again we supported a lot of the early work to generate the evidence and this is a digital programme to support recovery from concussion in specific ways that can be done in the home or for people with more severe brain problems so this is another app that we’ve worked with and the company to just give support to you know specific problems for both the patient and the family to help with coping with everyday tasks as you can see different ends of the spectrum from mild to more severe head injury and in recovery and two more things to say one is about bringing things together within a broader pathway of care and also the fact that not all brain injury because of head injury this is a project that I’ve worked on this is a project looking at a condition called normal pressure hhydrocephalus which is also known as a form of reversible dementia and the problems we have with that is that you have problems with walking problems with cognition thinking and memory and also problems with your bladder control and whilst we had diagnostic tests that can be used you know high-end science looking at brain pressures this project really looked at putting everything together and really can this diagnostic test work as part of a pathway can we engage with clinicians particular in the community like GPs to refer patients they think might have this condition and then can we deliver this cost effectively so we set up a clinic information leaflet a media campaign so we’re able to increase our referrals by three-fold and also decrease the amount of time it takes to treat as well as the number of bed days it takes to treat so now we have a much more efficient process and this of course has been taken up by the NHS into a new type of care pathway and last but certainly not least is how to engage with patients carers so working beyond professionals so two ways I mean we set up a database called RHITE so any patient carer or professional can say I’m interested in you know learning more about brain injury I’m interested in being involved in these studies I’m interested in only giving feedback on how these studies should be defined or feedback on what are the unmet needs that I have experienced so this RHITE database has been going on for five years it keeps on expanding and really as part of that for example we’ve set up an outreach programme for when you want to get patients and carers to evaluate a solution that comes our way we arrange a session they give feedback which can then be taken on board either when refining the design of a solution or potentially designing the next study so again this is part of all our programmes of work not just the evaluation phase but this is a very important part which has not really been done as well as it could across a lot of research so just to summarise the three bits I said why is a healthtech resarch in brain injury relevant because brain injury has specific needs how do you make this happen we need to know what’s out there and what is needed we need to have good quality evidence that will then support wider adoption and then of course what kind of technology I’m hoping I’ve given you a flavour of some of the very specific problems that we’ve tried to address with some of the work to date and some of the work we’re addressing and of course just to finish off I think it’s worth acknowledging you know the many many people who have supported us in this process and continue to support us we’ve had a number of experts who have worked as our team leads but also core to the program Mita Brahmbhatt who’s been our senior programme manager for the last ten years is also senior programme manager moving forward and also as part of the mix Jackie Green who worked as a project manager and particularly her work with the outreach programme and with that I’d also like to thank you for your attention thank you very much Alexis thank you thank you Professor Hutchinson wow we’ve covered a lot of ground I think in a very short space of time there I’m sure there’s a lot more that you could have put into that but you know thank you for compressing some of that for us all to hear this evening I’d just like to say that you know just looking at those early pictures you put up of the tools that we used to treat brain injury many years ago compared to some of the high tech solutions you’ve outlined what a journey so thank you for that I would like to just open the question and answer (Q&A) session now and invite you to submit any questions you have to our speakers on what you’ve heard this evening through the chat box Namoo I can’t see any at the moment but I’m not sure if I’m sort of getting everything at the moment in the chat box so while we’re just waiting there is one yeah sorry yeah sorry Adele there is one so there’s one from Roy Swain which says do some cardiac arrest sufferers constitute a proportion of the traumatic brain injury (TBI) statistics? Roy that’s a great question thank you for asking it the traumatic brain injury (TBI) statistics in their purest form which is a million patients coming with a head injury to an emergency department here in the UK do not include cardiac arrest sufferers so cardiac arrest I think is different that’s a primary event that affects the heart but having said that severe traumatic brain injury can result in cardiac arrest for some patients and also cardiac arrest without traumatic brain injury for a prolonged period of time can lead to impairment of oxygen to the brain and another form of brain injury acquired brain injury what we call hypoxic brain injury when there’s a lack of oxygen supply so there is a a relationship between cardiac traumatic brain injury (TBI) but it’s not included in the pure TBI statistics thank you so much yes I can see the chat now started to come in through my feed and we’ve got one here from David what advances do you believe will be in place (medical care and preventative) twenty years from now that will change the dynamic of care for these patients and their clinical outcomes I would say that being slightly provocative that this is a very fast moving field and from our experience when we start you know looking at five years ago and where we are now a lot of innovations we weren’t even aware of at the time so I would like to say that we need to be adaptable and we need to think on shorter timelines to make things you know apply change so I would say that it would be very difficult to know in twenty years where we would be because ideally we would have very good neuroprotective strategies and also very good support for whatever head injury you have and how you can get back but I would like to think you know we should be working five year time rather than twenty years yeah there’s another one about accessing RHITE oh I will put a link so two things one is around our patient engagement there is an email address which I’m putting in the chat and also put the address for RHITE in a moment thank you I’ve got a question actually you talked a little bit about new technology in the sporting community particularly on sporting concussion and particularly I know a lot of what you’re doing is you know you need funding for it has the sporting community been forthcoming in terms of because they’ve got lots of money basically has that happened for you is that an area that you’re hopeful more will be able to come from from the sporting community yeah I think in a way working very closely with the sporting community particularly the governing bodies so I sit on the independent concussion panel of the Rugby Football Union and we have a close relationship with the motorsport community and Silverstone so I think the most important thing is that there’s a much greater awareness of the problem and the sporting bodies are very committed to try and reduce the effects of concussion and get safe return and a lot of that is through technologies but there is quite a lot of concerning government at the moment through the Department for Culture, Media and Sport Department of Health and Social Care (DHSE) about how we’re going to tackle that problem and there are some more research opportunities coming through so that’s all going in the right direction then hopefully I mean it’s going in the right direction it could always go quicker and as as I said I think the professional sporting bodies generally have good mechanisms in place but what we’re really concerned about is grassroots sport so schools and particularly universities’ sports and access to good quality care which is our incentive for setting up the specialist sports concussion clinic in Cambridge and we seen of university students and we’re seeing an increasing number of children in that clinic yeah my son had concussion from a rugby injury so you know I know a little bit about that yeah I think there’s a balance between making sport safe but what we don’t want to do is stop people playing sport because it’s really important for the health of the nation and it’s a really important activity for people so we’re just there to try and make it safe yeah so one of the things you talked about I think Alexis was around almost a business case you talked about for supporting innovation so some of the innovations that potentially could help it’s almost as if you have to present or there has to be a business case for it can you tell us a little more about that that was part of the I think the last few slides of your presentation thanks Adele and as I mentioned a lot of things that could work very well don’t make it to being sustainable and this is a big problem and the take home message that we hear from other funding bodies the NHS National Institute for Health and Care Excellence (NICE) is that you need to start that process early and what I mean by that is you need to say how would this work in which point in the pathway what kind of impact do you need to achieve to make it worthwhile compared to what we’re doing now and I think there’s a large area of work around budget impact analysis health economics that needs to happen with in parallel with developing refining the solution because the two can interact so for example it may be that you have something that works but it could work in a slightly different way which is more cost effective and by that I mean well you might have something that works for measuring brain pressure without having a wire now of course that might have been developed for the intensive care unit (ICU) but a lot of the time if it’s more expensive and you end up putting wire for other reasons then it might not have such a strong case however there are other reasons we want to measure brain pressure and people have brain pressure disorders and then that will make a huge difference to be able to do non-invasively because the patient doesn’t need to come to hospital they don’t need to go into theatre to have a wire inserted and they don’t need to stay in hospital for two days to measure their pressure so for example you can see how sometimes asking the economic question means you change the direction of the solution to make it sustainable and the real focus is try and do that early and in parallel to make sure that you ultimately succeed into the real world could I just pick up one of the questions from the chat because it’s a really important question it’s from Kate Kendrick and it’s about raising the profile of therapists so I think what’s often forgotten is that the management of these patients is multidisciplinary so it involves a lot of specialist consultants but also nursing staff already talked about our specialist nurses but you know the role of the occupational therapists the physiotherapists speech and language therapy and neuropsychology is absolutely paramount and I think we do need to do more to raise the profile and a lot of that can be done by getting therapists engaged in research and I know the National Institute for Health and Care Research (NIHR) in terms of career development are really trying to focus on allied medical professionals and therapists so that’s a great question from Kate and something that we need to do more on thank you thank you I think we’ve also got one regarding traumatic brain injury (TBI) in the elderly dementia delirium an infectious cause of fall and head injury who would like to talk about this one that’s relevant to your revert yeah so if we think of injuring it does pose particular challenges the fact that you know as the question says there are multiple comorbidities and you also need multi specialists as well as multidisciplinary input so I can give two examples one in sort of elective care and one in sort of non elective emergency care so as I mentioned normal pressure hydrocephalus is a form of injury that is potentially reversible so again how do you approach that in terms of differentiating from other causes well you need to have good diagnostic tests and they need to work within the pathway and that’s the kind of work we’ve done if you look at a different condition which is more acute is something called chronic subdural hematoma which you could also call it a reversible form of stroke it’s when you have blood between the brain and the skull and you can drain it through a smallish hole so it’s not as invasive as a large portion of the skull coming off and there again we’ve done a lot of work around the pathway of that involving very different professionals both within a neurosurgical centre which can treat it surgically and also centres within the whole region that would look after patients who could have this condition working with other specialities including elderly medicine working with therapists and really just trying to set up a pathway to recognise the problems and act on them and again it’s very multifaceted so for example in this project that’s been driven by particularly two trainees who really engaged everyone together you know you have to do with establishing guidelines and we’ve done work around you know creating a set of guidelines showing the problems of the pathway and then evaluating the outcomes so it’s not one solution fits all but you really need to ask the problem and think of particular challenges in elderly care and then get the right people together to come up with solutions then act on them and yes that’s a very big focus particularly in the broader NHS thank you thanks we have an earlier question here from Deborah what do you think mostly affects those who don’t return to a normal life post traumatic brain injury (TBI) what specific comorbidities do you see I think the comorbidities can be divided into three and the first is physical so physical symptoms headaches visual impairment dizziness fatigue second is psychological or cognitive so memory impairment impairment of high executive function so planning and thought processing which can be a real challenge and thirdly behavioural and personality change so mood disturbance and often frustration and aggression in some patients often particularly the male patients make a really good physical recovery but it’s often quite subtle in terms of their cognition and behaviour that becomes the rate limiting step to return to normality thanks yeah we’ve got another question about rehab and acute care undertaken and about how you evaluate it the short answer right sorry a little technical issue the short answer is it’s challenging because it is delivered in parallel with the acute care and you know you might need to do further medical interventions surgical interventions and also the provision is quite variable so I mean there has been a lot of work in this area so for example in trauma the concept of rapid access acute rehab is now reasonably well established but there is also an issue of access and some of our rehab collaborators have done some work in looking at the impact for example Rapid Access Acute Rehabilitation (RAAR) in its entirety but unfortunately if you look at the scale of the problem and how much is being covered there is still a mismatch and for example as I said on unmet needs there’s a lot of work now on gap analysis to say well these are the requirements for rehab how many people need it how many people get it and needs versus get is actually a very large area of discussion at the moment thank you we’ve got a couple of questions about the hand held scanner Professor Hutchinson perhaps you could just tell a little more about that please yeah so I don’t know if everybody can see the chat but the website is infrascanner.com and that’s being developed because CT scanning we take for granted in the UK but many parts of the world do not have CT or access to CT so that’s a device that uses a special type of near infrared light frequency to penetrate through the scalp and the skull and can detect blood clots within 3 centimetres of the surface of the brain so that’s something we’re pioneering in Colombia and Guatemala at the moment okay thank you for that thanks okay thank you so much I’m just looking at the time here we’ve got pretty much through most of the questions here I think apologies the questions feed on my screen was quite slow coming through so we it was a little bit random responding to you but I think we’ve covered most of the ones here so thank you very much and I think that we need to close the conversation now so I’d just like to say thank you all for joining us this evening and thank you to our two speakers it’s been absolutely fascinating to hear about this topic and to hear about the the extraordinary work that you are doing to everyone who’s joined us this evening we would be really grateful if you could complete our short survey and Namoo has put the survey link in the chat box which should be hopefully at the top of your screen even if it’s not on top of mine the recording this webinar is going to be posted on the Cambridge University Hospitals (CUH) website and also we put it onto YouTube and hopefully that will be by the end of next week so thank you very much all of you it’s been a great evening and look forward to seeing you at more of our Medicine for Members events thank you all bye thank you thank you bye
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