The Operating Theatre Journal May 2022

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Largest ever study on traumatic brain injury highlightsglobal inequality in causes and treatmentNeurosurgery experts fromCambridge have led the largestever study examining the surgicalmanagement of traumatic braininjuries, highlighting regionalinequalities in both major causesand treatment of such injuries.The Global NeurotraumaOutcomes Study, funded by theNIHR, is published in The LancetNeurology and provides data toassist in decision making andimproving outcome for patientswith traumatic brain injuryglobally.The paper focuses on types ofcases, the way they are managed,and death rates, and wascompiled using data submittedby 159 hospitals in 57 countriesto a central database, which theresearchers then analysed. Theresearchers stratified countriesinto four tiers (very high, high,medium, low) according to theirHuman Development Index (HDI),which takes account of factorslike life expectancy, education,and income.The prospective study determinedthat patients in the low HDI tierwere often young and tendedto suffer skull fractures due toassault but were classified as‘mild’ traumatic brain injury(TBI).In the medium and high HDI tiers,patients were also young, butmost had moderate to severe TBIcaused by a road traffic collisionand extradural haematoma – ableed on the outside of the duramater, the membrane covering ofthe brain.In the very high tier, patientstended to be older and presentedwith a moderate or severe TBIassociated with a fall and acutesubdural haematoma - a bleedon the inner surface of the duramater.Quality of care was generally lessfavourable in lower HDI settings,including delays to surgery and alack of postoperative monitoringequipment and intensive care.The very high HDI tier had thehighest proportion of operationsin which the most senior surgeonpresent in the operating theatrewas a fully qualified neurosurgeon,while the medium HDI tier hadthe lowest proportion. The studyalso found significant variationsbetween hospitals in the outcomeof patients.Angelos Kolias, ConsultantNeurosurgeon at CambridgeUniversity Hospitals NHSFoundation Trust (CUH) and NIHRGlobal Neurotrauma ResearchGroup associate director, said:“The results show that overallmortality is low, reflecting thelife-saving nature of surgery fortraumatic brain injuries. Many ofthese patients would have diedwithout an operation. However,we also need to address deficitsin pre-hospital management andlong-term rehabilitation.”David Clark, a traineeneurosurgeon and University ofCambridge research fellow, said:“A particularly important findingis that outcome is influenced moreby hospital characteristics thancountry of origin, which raisesthe possibility that changing thesystems and processes of care inindividual hospitals might be ableto improve mortality. The papersows the seeds for discussion andchange.”The research was funded by theNIHR using UK government aid tosupport global health research.Alexis Joannides, ConsultantNeurosurgeon at CUH and NIHRGlobal Neurotrauma ResearchGroup informatics lead, added:“The contribution of severalclinicians and researchers fromseveral hospitals across the worldhas been possible due to theinfrastructure and collaborationssupported by the NIHR.“The database and datamanagement process used inthe study have now laid thefoundation for a global registryof traumatic brain injuries thatwe have established to supportongoing quality improvement andresearch in the field of traumaticbrain injury.”Peter Hutchinson, Professor ofNeurosurgery at the Universityof Cambridge and Director ofthe NIHR Global NeurotraumaResearch Group, said: “This is thelargest study in the world lookingat the surgical managementof head injuries and will be ofpractical value to clinicians andothers planning strategies for thefuture.“The collaboration across sucha vast number of hospitals andcountries, together with thesupport of the World Federationof Neurosurgical Societiesand continental neurosurgicalsocieties, has been phenomenal.”ReferenceClark, D et al. Casemix, management,and mortality of patients receivingemergency neurosurgery for traumaticbrain injury in the Global NeurotraumaOutcomes Study: a prospectiveobservational cohort study. TheLancet Neurology; 17 March 2022; DOI:10.1016/S1474-4422(22)00037-0OXYGEN GENERATORS SAVING LIVES IN THE PHILIPPINESRecent figures released by the Philippines health department revealed that over 1,000 people receiving treatment for Covid-19 are severe orcritical cases. As with other hospitalised patients, a continuous flow of life-saving Oxygen is crucial for their recovery but can supply be guaranteedwhen ordering traditional cylinders?To achieve self-sufficiency with this vital gas a growing number of medical facilities in the Philippines are switching to Oxygen Pressure SwingAdsorption (PSA) technology from Oxair, supplied in the country by distributor and hospital systems specialist Brilliant Metal Craft & MachineDesign (BMC).PSA systems are high quality, robust medical devices designed to last and deliver consistent, high purity oxygen on tap to hospitals and healthcarefacilities – even in the remotest locations around the world. BMC has now installed almost 40 Oxair PSA solutions in hospitals across the region,from Isabela to Tagum City, with more in the pipeline.Australia-based Oxair, a global leader in gas processing systems, offers a simpler, safer alternative to dependence on cylinder-stored medicaloxygen. As it extracts its supplies directly from the atmosphere, PSA oxygen provides better patient care with a permanent flow of high-qualityoxygen.This system saves room space, offers output pressure and a flow rate to suit the needs of the hospital and is capable of piping oxygen to everydepartment where it is needed. Many medical centres across Philippine islands now have peace of mind, free from the worries associated withdeliveries of cylinders – thanks to the dedicated work from BMC.Oxair’s system delivers constant oxygen of 94-95 per cent purity through PSA filtration, a unique process that separates oxygen from compressedair. The gas is then conditioned and filtered before being stored in a buffer tank to be used directly by the end user on demand. Oxair has expandedits operations in order to keep up with demand for standalone Oxygen PSA units.BMC’s Kristine Belle, explained: “PSA systems enable self-generated oxygen so supply for the hospital is secured. No more worries and red tapeassociated with deliveries of cylinder-stored oxygen. Handling and storage difficulties are also effectively eliminated.”The cost to a Philippines health facility generating its own oxygen is a fraction of purchased oxygen, meaning fast equipment investment paybackand great savings in the long term.David Cheeseman of Oxair added: “We’ve seen terrible consequences from a lack of life-saving medical oxygen, especially when treating Covid-19patients. Medical facilities in the Philippines can rely on our technology for their oxygen needs as it is tried and tested over many years and theinstallations are carried out by BMC to an extremely high standard.”The covid-19 pandemic is far from over and is continuing to place additional pressure on oxygen supplies. More and more hospitals in the Philippinesare recognising that PSA systems provide almost instant access to vital oxygen supplies under significantly safer conditions.For further information on Oxair’s products and services visit: www.oxair.com.auYou can find out more about BMC at https://www.brilliantmetalcraft.com/hospital-systems/Find them at C. Borces St., Mabolo, Cebu City, Philippines or call (032) 233-5927 or (032) 231-768420 THE OPERATING THEATRE JOURNAL www.otjonline.com
THESEPTEMBER 2020 ISSUE NO. 360 ISSN 0000-000XTHETHESEPTEMBER 2020 ISSUE NO. 360 ISSN 0000-000XThe Operating SEPTEMBER 2020 ISSUE NO. Theatre 360 ISSN 0000-000XJournalThe TheOperating OperatingTheatre WWW.OTJONLINE.COMTheatreJournalGet Your Personal copy fromOTJONLINE.COMThe Leading Independent Print & Digital Journal For ALL Operating Theatre StaffODPs, Theatre, Anaesthetic & Recovery NursesYour Favourite Journal is available ONLINEOTJONLINE.COMOTJONLINE.COMThe Leading Independent Print & Digital Journal For ALL Operating Theatre StaffThe Leading Independent Print & Digital Journal For ALL Operating Theatre StaffJobs, News, Study Days, Books,Clinical Articles £2.00Register Today at:www.otjonline.com£2.00£2.00Jobsite:www.operatingtheatrejobs.comView the journal online @ www.otjonline.comOTJ Back issues are also available to viewRegistration is Free !www.otjonline.comNew chronic pain treatment suite opens at Halton HospitalA new Clinical Treatment Suite based in the Nightingale Building atHalton Hospital has opened which will help to reduce waiting lists forthose suffering with chronic back pain.A capital investment of £145k, has provided a facility which will allowpatients to be seen and treated without requiring admitting to a wardor visiting an operating theatre to have their procedure, helping toreduce waiting lists. This development is part of ongoing plans tofurther improve the chronic pain service and to reduce waiting times.The plan is to treat up to 14 patients a day, Monday to Friday for chronicback pain; minor vascular procedures for symptomatic varicose veinsand minor urology procedures will also be performed in the facility.These will be performed under local anaesthetic with the ability toprovide sedation where required. Patients who do require additionalcare following their procedures can be referred to the surgical ward,located on the main corridor from the treatment room, but the majoritywill go home within hours of their procedure direct from the ClinicalTreatment Room.The design of the facility is a walk in/walk out approach to provideefficiency and allowing more patients to be treated. The focus forthe Clinical Treatment Suite is to treat patients who are experiencingchronic back pain and to improve their quality of life.Louise Hughes from Runcorn was the first patient to receive hertreatment in the new facility and commented, “I was very impressedwith the new Clinical Treatment Suite, the fact it was all within one areaprovided privacy and dignity, as previously you booked into the ward,but then had to be transported to Theatres and back. “I particularlyliked the locker facilities, which allowed me to bring my tablet/phoneto look at pre-procedure and then after. I was delighted to be able togo home within hours of my procedure.“Having this facility will make a huge difference to those like mesuffering from chronic pain, who have had to wait three years fortreatment because of the delays caused by the pandemic and I amfeeling a lot better after having my radio frequency treatment lastweek, it has improved my daily life.”Guy Hanson, service manager for Theatres explained,Pictured: Bev Caine, ward manager with patient Louise Hughes andRosie McCann, Theatres Manager in the Clinical Treatment Suite.“The Clinical Treatment Room will provide us with more flexibilityfor treating more patients and releasing valuable capacity in ouroperating theatres to allow more surgery to take place on the Haltonsite. Previously, patients requiring pain injections would book into abed space on the main ward and be taken to Theatres to have theirinjection, reducing surgery slots.“Now with this new facility it will enhance our patients’ experience, asthey will book in, be shown to the changing room to get changed intoa gown, then seated in our comfortable bays, whilst they await theirturn for their procedure in our treatment suite. Once they have hadtheir procedure, they will be cared for in our 2 bedded recovery area,before returning to the chair bays to be monitored and provided withrefreshments if required, before being discharged.”The facility will also be used in partnership with The Walton Centre forchronic pain procedures and Countess of Chester Hospital for vasculartreatment.Source Halton HospitalFind out more 02921 680068 • e-mail admin@lawrand.com Issue 380 May 2022 21
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The Operating Theatre Journal May 2022

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