Research Strategy for Department of Neurorehabilitation, National Hospital (Rigshospitalet), Denmark

Transcription

1 Research Strategy for Department of Neurorehabilitation, National Hospital (Rigshospitalet), Denmark Introduction Research strategy, October Contact: 1

2 This is the research strategy for the Department of Neurorehabilitation. As a highly specialised clinic, the clinic holds a research obligation. Therefore, the clinic management established RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen) in Participation in research and implementation of research is part of the clinical development work for all employees. The research strategy is based on the overall objectives and ambitions of the Capital Region of Denmark: "The research-strategic ambition of the Capital Region of Denmark: In a strong interplay with clinical work and training, excellent research shall ensure a healthier population and patient care at a high international level thereby forging a coherent and effective national healthcare service. It is a research strategic objective to establish a culture that ensures joint regional objectives and a shared understanding of the role of research in the development of clinical activities and training programmes. The aim of the present research strategy is to describe our research visions, objectives and priorities. The research strategy will also be employed to assess the achieved results in the short and long term. Research in the field of brain injury is encumbered by special research-ethical challenges as many patients are unable to provide their consent for participation in research projects. Therefore, providing information to the relatives and the staff responsible for patient care is a priority. The research strategy was prepared as a joint effort counting the clinic management and the head of research. The clinic and its patients The clinic s task is to provide highly specialised neuro-rehabilitation first and foremost to patients with severe traumatic brain injury (TBI), and secondly to patients with non-traumatic severe brain injury, e.g. following SAH, haemorrhagic stroke, cardiac arrest and meningitis. Patients are admitted as soon as possible after suffering their injury. Typically, they are admitted after neurosurgery when they do not require artificial respiratory support. The clinic has 22 beds, four of which are for children. Furthermore, the clinic counts an outpatient clinic offering follow-up to all patients after their discharge. We phone all patients 2 months after discharge. And at 12 and 18 months after the brain injury, patients and relatives are invited to attend a follow-up session. Additionally, patients with a previously acquired brain injury may be referred to the outpatient clinic for work-up, planning of treatment and, if relevant, rehabilitation requiring a highly specialised level of service, e.g. investigation and treatment of spasticity and difficulty eating/swallowing. The interdisciplinary staff in the clinic counts doctors, nurses, nurse assistents, physiotherapists and occupational therapists, neuropsychologists, speech therapists, a social adviser, and secretaries. Research strategy, October Contact: ingrid.poulsen@regionh.dk 2

3 The clinic reports data to two clinical quality databases. The Danish Head Trauma Database (DHD), a nationwide database we have operated since 2004 in collaboration with the Regional Hospital Hammel Neurocenter. The DHD compiles data on all patients hospitalised with TBI (children and adults). The Database for Highly Specialised Brain Injury Rehabilitation in Eastern Denmark (Danish abbreviation: HSHØ), that holds data on all patients treated, since the clinic was established in year 2000 i.e., data on patients with traumatic as well as non-traumatic brain injury. Data are acollected on both children and adults. Research mission, vision and strategy Mission The mission is to generate novel knowledge furthering the treatment of patients with acquired brain injury at a high professional level. Vision Our vision is to spearhead clinical and translational 1 research in the field of neuro-rehabilitation, focusing on the prognosis, prevention and treatment of severe brain injury and aiming to improve the quality of life of patients and relatives. Strategy To ensure a strong focus in the strategy period, our research projects shall fall within one of the following three areas. 1. Pathophysiological changes in severe acquired brain injury. 2. Boosting the evidence base in rehabilitation methods and approaches, including the use of technology in the early phase following severe acquired brain injury. 3. Research based on systematic data collection including analysis of the patients and relatives starting point, experiences and perceptions about rehabilitation following severe acquired brain injury. Pathophysiological changes in severe acquired brain injury The three research projects: Alterations in the brain s connectome during recovery from severe traumatic brain injury. A critical step towards predicting and understanding recovery of consciousness, The MRI project (PhD Student Sara Andreasen), Early rehabilitation after 1 The research findings must be translated and used to provide prognosis information and be implemented in our clinical work. Research strategy, October Contact: ingrid.poulsen@regionh.dk 3

4 severe traumatic brain injury, Early Mobilisation (PhD Student Christian Riberholt), and Physical activity on heart rate variability in patients with severe acquired brain injury, "The heart variability project" (Graduate Student Jon Damsager) will be completed within the 2- year strategy period (for a detailed description of the projects, please see the 2016 Annual Report). No later than in the beginning of 2019, a decision will be made concerning the continuation of the two latter-mentioned projects. Boosting the evidence base in rehabilitation methods and approaches, including the use of technology in the early phase following severe acquired brain injury In spring 2018, a Post.Doc/ will be employed to implement a research plan aiming to describe, investigate and boost the evidence base of selected elements of the rehabilitation measures. The research project will serve to determine if the content, intensity and duration of the rehabilitation provided is optimal for patients in the early phase following severe acquired brain injury. In the same period, and taking as our starting point a national and international collaboration, a research plan will be described and implemented that aims to outline, investigate and boost the evidence base of elements of fundamental nursing care (Fundamental of Care) in the field of neurorehabilitation. Examples of such elements include prevention of urinary tract infections, prevention of infections of the oral mucosa, stabilisation of the circadian rhythm, pain relief and prevention of weight loss. In this project, efforts are being made to employ a PhD student. As a starting point for the Fundamental Care project, we have used data from the DHD to document the frequency of complications to urinary tract infections, contractures, etc. In the strategy period, both databases will be used in a minimum of two independent research projects. Research based on systematic data collection including analysis of the patients and relatives starting point, experiences and perceptions about rehabilitation following severe acquired brain injury Here, knowledge of the patients and relatives experiences, wishes and diverse resources will be employed to inform healthcare professionals by adding new knowledge to the organisation of patient pathways and thus underpin those affected in their lives following severe brain injury. The PhD project Winners and losers in rehabilitation a qualitative study of patients and relatives kinds of capital and strategies during rehabilitation pathways following stroke and severe traumatic brain injury, Inequality in rehabilitation (PhD Student Rikke Guldager) will conclude by August 2018 (Please see the Annual Report). By mid-2018, a decision will be made with respect to the implementation of the results and possible continuation of the project. Innovation Our innovation work will be extended, e.g. in collaboration with the VihTek (in Danish: Videnscenter for Hjælpemidler og Velfærdsteknologi Region Hovedstaden) and the DTU (Denmark Technical University), to ensure that we produce a minimum of two ideas with the strategy period Research strategy, October Contact: ingrid.poulsen@regionh.dk 4

5 for rehabilitation technology, which will be investigated and tested in our clinic. We will aim to produce research-based technology assessments by collecting adequate and necessary data during testing. Quality assurance of the research strategy To ensure progress, the specific elements in the research strategy will be assessed every 6 months during the strategy period. Furthermore, the number of scientific publications accepted for publication will be assessed. A total of two annual publications are required per project. The assessment will be made in collaboration between the management of the clinic and the head of research. Recruitment 1. In pursuance of the current research strategy, a vacancy in the training field will be filled spring 2018, by a post.doc. 2. No later than at the occupancy of the new neurorehabilitation house (2021), a professor of neurorehabilitation should be appointed in neurorehabilitation in the field of brain injury. 3. One of the consultant positions in the clinic must be a shared clinical and research position. Research strategy, October Contact: ingrid.poulsen@regionh.dk 5