European Pressure Ulcer Advisory Panel

My Background and Future Plans for the EPUAP

In September 2008 I was elected by the board of trustees to be the next president of the EPUAP. It will be a major challenge to be the successor of our current president Carol Dealey and I would like to start by thanking all the trustees and Carol for the confidence they expressed in me.

I will be the first president of EPUAP without a medical related training so you deserve an introduction on my background and on how I got involved with EPUAP.

I am a physicist by training and obtained my masters degree at Eindhoven University of Technology in The Netherlands. Already, during my undergraduate studies, I developed an interest in biomedical problems and I graduated on a project on improvement of artificial heart valves. In the beginning of the eighties I moved to the University of Twente to do a PhD and that is where I first came in touch with the pressure ulcer problem. For me personally the PhD work formed the basis for my specialization in soft tissue biomechanics and a lifelong interest in the pressure ulcer problem. After my PhD in 1985 I was appointed as an assistant professor in the Mechanical Engineering Department of Eindhoven University of Technology with as my research profile: mechanical characterization of biological and technical materials.

In 1990 I became an associate professor. In 1998 I moved to the department of Biomedical Engineering. In 1995 we started in Eindhoven with research on the aetiology of pressure ulcers. The reason for this was a survey that was done in the hospitals in Eindhoven and close environment on high priority problems for which the technical university could be helpful. To my surprise pressure ulcers was on top of the list. It is a problem with certainly technical (read: mechanical) aspects in it and a major issue from a societal point of view. Like most institutes we started modestly with one post-doc on university funding, later one Ph-D student, but we managed (with a lot of luck) to build a research group with on average four externally funded PhD-students and post-docs that worked at the same time on the problem. In the beginning our work was very fundamental and rather academic, but gradually (partly because our contacts with medical practitioners intensified) the goals shifted to early detection of pressure-related deep tissue injury and to the development of a monitoring system for risk assessment of patients that enter a hospital.

I would like to mention two major conditions that had an enormous influence on the success of our group. We started at a time that the Biomedical Engineering Department at TU/e was founded. Because of this a lot of money was raised or re-allocated. That allowed us to have a quick start and built up the critical mass and past performance to attract external funding. Because of this the TU/e was able to attract people from different disciplines (magnetic resonance imaging, cell and tissue engineering, cell biology, biochemistry, biomechanics) that were able to work together in one institute.

A second condition was that we started a strong international cooperation, first with Dan Bader from Queen Mary University of London resulting in a part-time appointment of Dan in Eindhoven. More recently Amit Gefen from Tel Aviv University spent a year in our laboratory, which also forms the basis for a long lasting cooperation.

In our research we have come a long way from very fundamental studies on cells, tissue-engineered muscle and skin, animal studies and some pilots with human volunteers and patients to a point that fundamental research meets medical practice. Personally, I see it as my task for the next 5 to 10 years to bridge that gap and in one way or the other translate the knowledge that comes out of our lab (and other similar laboratories worldwide) to everyday practice in the clinic, with as the ultimate goal to prevent pressure ulcers from occuring. For readers who are interested in our research I would like to refer them to: http://www.mate.tue.nl/~oomens.

The Eindhoven decubitus group in May 2009. From left to right:
Sandra Loerakker, Emmy Manders, Dan Bader, Cees Oomens and Elise Huisman. The picture was taken in the Magnetic Resonance Imaging laboratory of Klaas Nicolay.

This brings me back to EPUAP and my role as the future president. In the last year some of our valued members in the board of trustees have stepped down and several new experienced and un-experienced, usually younger, trustees accepted the nomination. Because of this, the time was right to have a discussion on the past achievements and future plans for EPUAP. This resulted in a strategy meeting in Birmingham at the end of March, where the majority of trustees were present. There we discussed our future activities and possible effects these might have on the organization. It was a very open and stimulating discussion and we will use the results to write a strategy plan that will be presented shortly after our meeting in Amsterdam in September.

At this spot I do not want to get ahead of the decisions of the trustees, but some points are worth mentioning. Everyone in Birmingham agreed that the achievements of EPUAP in the last ten years were impressive in terms of awareness (f.e. prevalence measurements) in Europe and the influence on prevention and treatment. The EPUAP guidelines have been translated in many languages and have formed the basis for many national guidelines all over Europe. Up to the present day requests for guidelines reach the business office every week. Recently EPUAP joined efforts with the North American Pressure Ulcer Advisory Panel (NPUAP) to develop new evidence based prevention and treatment guidelines. The final presentation of these guidelines will be done at the 12th annual meeting in Amsterdam. Activities in the field of education were many in publications, but also in our annual conference, which forms a medium for profiling of EPUAP, for education of health care professionals, for networking, for dissemination of research and for contact with industry. Several working groups have assessed themes like pressure measurements, nutrition, moisture lesions, usually resulting in valuable publications.

How we will progress in the near future will become clear when the trustees have agreed upon the future strategy, but I would like to highlight two points.

It is clear that the development of the new EPUAP/NPUAP prevention and treatment guidelines is not an end point. There is still a huge amount of work to be done, because we have to facilitate implementation of the guidelines in the different countries of Europe, each with their own vagueness within their health care system. We are committed to translate a short version as quickly as possible in the relevant languages in Europe and we will stimulate that all necessary information about the guidelines will be available for everyone who needs it. We will also continue to educate health care professionals, patients and their relatives.

Next to this I have a personal goal. Looking into the scientific literature you will notice that in the last 30 to 40 years several groups started with pressure ulcer research with one or two MSc/PhD-students and then stopped, even though what they did was worthwhile and of high quality. One of the reasons is the difficulty to get structural funding for this type of research. In Europe and many national funding agencies there is a trend to either supply personal grants to a privileged few researchers or distribute the funds via very large programs where millions of Euros are spent, but where the research has to fit within a theme. If your theme is not on the political agenda you do not have a chance of getting that funding. There are a few ways of getting around this problem, i.e. bending your research in such a way that it fits within the framework of some of the relevant themes (difficult) or put effort in putting your theme on the political agenda (even more difficult). I think that an organization like EPUAP should play a role in that, probably in cooperation with other similar societies. Researchers should also be keen on the possible application of modern technologies like nanotechnology, genomics or molecular imaging to pressure ulcers.

Until that time there is another thing we can do and that is to identify groups in Europe and worldwide that perform high quality research on similar themes and to start cooperating and use each others complementarities and expertise. We have started to do this with colleagues in both Europe, Canada and Australia. In the end this will supply critical mass for these groups and possibly the means to get large scale funding. For this our annual meeting is a very important tool. We must attract scientists with a common interest in pressure ulcers, without losing the educational, clinical ‘feel’ of the meeting. In that case scientists can meet each other, but also the bridge with health care professionals and industry can be crossed. All trustees in Birmingham agreed that this mixed character of our meeting makes it a unique event.

So I would like to end, by inviting you all to come to our beautiful city of Amsterdam next September for fun, education and science.

Cees Oomens

May 2009