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IGEH/INRO NEWSLETTER SUMMER 2003
To: All Supporters, Friends and Colleagues
The summer here in Vienna is hot and sunny. Temperature keeps around 30 C (86 F), sometimes up to 36 C (96.8 F), however very dry. In spite of this we have some news to share with you to keep you informed of what is going on with us. We intend to circulate this newsletter regularly by email. You are welcome to share it with any of your colleagues who might be interested and archived copies of the newsletter can be found on our web site http://www.igeh.org/. There is a possibility for new readers to be signed in (and un-register) for our newsletter mailing list.
Contents
You can access the IGEH’s Annual Report on our web site http://www.igeh.org/.
a) EU 5th Framework Program – Reducing mortality and long-term disability of TBI victims through research into treatment procedures used in Bosnia-Herzegovina, Macedonia and Croatia, RESEARCH-TREAT-TBI
The project was successfully kicked off at the first workshop meeting, which took place on the 19th 20th of January, 2003 at the hotel ARCOTEL Wimberger in Vienna. Representatives from IGEH, AU Vienna Epidemiology, CZ Brno, SK Nove Zamky, HR Osijek, Zagreb, FYROM Skopje and BH Sarajevo were in attendance. The participants exchanged information on the current situation in the centers, discussed the communication policy of the project and the software for the ITCP database system was demonstrated. All issues raised related to project implementation were addressed accordingly. Presentations given by Walter and Martin introduced the concept of the project. Ivan presented on the ITCP database.
There was a visit of the IGEH team to Zagreb – Rebro Hospital and to Rijeka Hospital in March. A presentation was given by Martin to the Neurosurgical staff of the both Hospitals in order to introduce them to Participant 1 – IGEH and the project. A general overview was given and all questions pertaining to the project were fielded. Each hospital team received a computer with the ITCP database installed. Issues related to the program flow were discussed in details.
Martin visited Hospital in Osijek, Skoplje and Sarajevo. He presented ‘Evidence Based Approaches to Traumatic Brain Injuries’ at the First Regional Meeting of Young Anesthesiologists in Skopje.
The centers have been using the ITCP database and have recorded 415 patients until now. The introduction of the database was carried out easily without major problems. The enhanced help features now provide more information on individual items along with links to Internet sources.
b) Forschungsprojekt „Behandlungsstandards bei schwerem SHT“, Jubiläumsfonds-Projekt Nr. 8987
The activities of the team were oriented towards the following objectives: i) Finalization of the ITCP database as a mean for collecting prospective data; ii) Interim analysis of data collected using the TBI_trac® database; iii) Collection of prospective data on the treatment of TBI patients providing the baseline for the forthcoming analysis of prospective data; and iv) Distribution and implementation of TBI Guidelines.
The overall emphasis was put on the long term outcomes of the treatment. The ITCP database proved its potential in this regard.
a) The ITCP database (International Traumatic Coma Program) was created and the most recent version, version 1.3.3, was updated with several changes. The current product allows for collection of: (1) Characteristics of each trauma facility. This is important for the standardization of outcomes during analysis. (2) Information of a patient’s management during transport to hospitals. (3) Characteristics of leading causes of trauma, important for preventive actions. (4) Daily detailed info on patient’s management in a hospital with several points standardizing the trauma modality. (5) Long-term outcomes of trauma (up to 180 days after trauma).
The database is being used in several Austrian hospitals: (1) AKH, Wien (2) Landes-Nervenklinik Wagner-Jauregg, Linz (3) Landeskrankenhaus-Universitätsklinikum Graz, Graz (4) Landeskrankenhaus, Klagenfurt (5) Universität-Klinik für Neurochirurgie, Innsbruck (6) Landeskliniken Salzburg, St.Johanns-Spital, Salzburg (7) Lorenz Bohler Unfall Krankenhaus in Wien.
Despite initial problems with data collection (all users were trained before the database was installed) we were able to collect 251 patients records. By engaging Miss. Ingrid Wilbacher, the number of entries has increased significantly.
b) Interim statistical analysis. By the end of 2002 we carried out an interim statistical analysis of data collected retrospectively (1999 to 2001) using the TBI_trac© database. Now we have started to prepare an analysis of all data collected.
c) Prospective data collection brought up very interesting views on what is occurring in individual centers. Data collection will be finished in 2003 and conclusions will be derived afterwards.
d) Data maintenance and quality check ups were performed by IGEH. There has been no meeting of the entire group, visits into individual centers were paid for by the coordinator and the IT manager.
The project approaches the final year, with an emphasis on data analysis and conclusions derivation.
A member of the project group Dr. Johannes Leitgeb spent half a year in South Africa and he is now back to AKH now. Dr. Petra Dado has joined the IGEH core team.
The first 6 months of the year 2003 we were busy writing new proposals. Unfortunately, the one where we invested a lot of time and energy – the EU COST program - was rejected. We are persevering and this is the list of recently submitted proposals:
a) Identifying and Addressing Grand Challenges in Global Health: A project proposal SCIENTIFIC EVIDENCE-BASED APPROACH TO THE MANAGEMENT OF TRAUMATIC BRAIN INJURIES: “IMPROVING PATIENT OUTCOMES AND SAVING COSTS” was developed. It replied to the request for suggestions of innovative areas in the field of health for developing world from The Bill & Melinda Gates Foundation, in collaboration with the National Institute of Health and the Foundation for the National Institutes of Health. In close cooperation with Peter Quinn from the Neurotrauma Foundation in New York and Prof. Daniel West from the University of Scranton, USA, we have developed an idea of how to adjust guidelines and implement them in developing countries.
b) Treatment Variation and Health Outcome in Traumatic Brain Injuries (TREATVAR) A project in implementing TBI Guidelines was proposed for Georgia and Armenia. The proposing consortium is made up of Internationale Gesellschaft zur Erforschung von Hirntraumata – Austria, Universita' Degli Studi Di Ancona – Italy, National Health Management Center – Georgia, National Center for Disease Control and Medical Statistics – Georgia, State Medical Academy, Sarajishvili Institute of Neurology and State Medical University – Georgia, Georgian Society of Child Neurologists and Neurosurgeons – Georgia, Healhy Child in the World – Georgia, Yerevan State Medical University – Armenia. The funding was requested through the EU 6th Framework Program in Research INTAS Open Call 2003. The results will be announced early next year.
c) Intensive care units in Austria share a common database with principle data on patients. A project is being developed to use this database to estimate the extent of TBI epidemics in Austria. This proxy will be used later on along with our ITCP database data to assess needs for TBI activities in Austria.
d) A proposal has been submitted to the EU in Brussels to acquire funding for a Slovak doctor to work with us for 3 years. If this fellowship is obtained, she will be fully engaged in our work. The decision will probably be announced in September 2003.
e) The IGEH was incorporated into two proposals for EU Public Health Programme. The decision should be announced in September. i) The first one is entitled Maintenance, Development and Promotion of the ISS Hospital Survey in the current and enlarged EU, submitted to the EU Health and Consumer Protection Directorate-General under the call for Call for Proposals 2003 Programme of Community Action in the field of Public Health (2003-2008) (OJ L 271 of 9 October 2002). Austrian Organization Kuratorium fuer Schutz und Sicherheit Institute “Sicher Leben” is the coordinator for this activity. The general objective of this project is the Maintenance and Quality Assurance of the ISS/EUPHIN Data Collection. Specifically this includes (1) Expansion of ISS hospital survey to Candidate Countries; (2) Extension of ISS survey to all injuries, including intentional injuries; (3) Provision of EHLASS/ISS data and promotion of EHLASS/ISS data collection through the European Network of Injury Registries; (4) Maintenance of the „total“ ISS Quality Management and QM Training of NDAs - for de-central Upload and Quality Assurance; (5) Maintenance and further development of central Data Transformation (incl. MDS-I), Quality Control Programs, Upload and Auto-Reporting Tools; (6) Development of standardised procedures for statistical analysis: population based injury rates; (7) Development of guidelines of Ownership of data, rules of dissemination
ii) The second project under the heading Analysis of Injury Mortality in the European Union (ANAMORT) is led by the Danish Institute of Public Health. The general objective of the project is to assess and improve the quality and the comparability of the results established by the cause-of-death certificates, in the field of injuries.
You may have noticed that new guidelines were made public recently: 1. Head Injury: triage, assessment, investigation and early management of head injury in infants, children and adults. Published by National Collaborating Centre for Acute Care Guideline commissioned by the National Institute for Clinical Excellence in June 2003. You can access the full text through our website http://www.igeh.org/ 2. Carney NA, Chesnut R, Kochanek PM.: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Crit Care Med. 2003 Jun;31(6 Suppl):S407-91. or J Trauma. 2003 Jun;54(6 Suppl):S235-310 or Pediatr Crit Care Med. 2003 Jul;4(3 Suppl):S1.
There are some new features offered on our web site http://www.igeh.org/ that you may not be aware of: 1. Some partners provided more detailed information about themselves and their hospitals (see the EU 5th Project Description); 2. Under ITCP you can find current numbers of patients recorded; 3. Under PEOPLE you can find a recent composition of IGEH management; 4. The members area provides storage for files you may want to access through the internet (useful when traveling). It also provides you with limited access to your patients in the ITCP database with an indication of the compliance level with US TBI Guidelines. This section is not yet finished. Those who would like to have access to the members’ area, please contact Ivan.
As you may have already noticed, since the January 1st, 2003 the IGEH has new location. We are now very close to the city center in the 8th district of Vienna ‘Josefstadt’ (see map below).
IGEH was joined by three volunteers: Dr.Med. Petra Dado, Austrian, who is working on her Ph.D. at the University of Trnava as well as planning to study two semesters at the London School of Epidemiology and Tropical Medicine. She will be involved mostly in the Austrian ICUs project.
Dr. Med. Alexandra Brazinova, Ph.D., MPH, will stay with us based on the fellowship from the Marie Curie EU fellowship schema. She will concentrate on issues of public health and patients with TBI.
Dr.Med. Anna Lisa Rosso graduated from the Roma Medical School last year and is now looking for further medical training. She will undertake the translation of our web site into Italian.
7) PUBLIC RELATIONS and FUND RAISING
Our new brochure was developed under the funding from EBEWE - pharmaceutical company and the Orsini-Rosenberg & Senden Vermogensverwaltung GmbH. The brochure will be used for fundraising and public relations purposes.
US Siemens corporation approached NTF’s Director Peter to continue discussions on TBI based on handheld computers. We continue our close cooperation with Siemens in Vienna further developing the mITCP (mobile ITCP) version.
Three doctors from a hospital in Georgia have visited us accompanied by Prof. Daniel West, a member of our Scientific Medical Board. They were interested in our program and met Prof. Walter Mauritz to discuss opportunities for further collaboration. A letter inviting the Georgian Deputy Minister of Health to visit IGEH and the Lorenz Bohler Trauma Hospital was sent.
We wish you a great rest of the summer and look forward to continuing our work with you in the future.
With regards,
Annelise, Ingrid, Ivan, Martin, Petra, Sasha and Walter |