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MEDICAL SCIENCES (2268 journals)            First | 1 2 3 4 5 6 7 8 | Last

Showing 201 - 400 of 3562 Journals sorted alphabetically
Audiology - Communication Research     Open Access   (Followers: 10)
Auris Nasus Larynx     Full-text available via subscription  
Australasian Journal of Ultrasound in Medicine (AJUM)     Hybrid Journal  
Australian Coeliac     Full-text available via subscription   (Followers: 1)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 2)
Autopsy and Case Reports     Open Access  
Avicenna     Open Access   (Followers: 3)
Avicenna Journal of Clinical Medicine     Open Access  
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 2)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 4)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 4)
Bangladesh Journal of Medical Physics     Open Access   (Followers: 1)
Bangladesh Journal of Medical Science     Open Access  
Bangladesh Journal of Medicine     Open Access   (Followers: 1)
Bangladesh Journal of Physiology and Pharmacology     Open Access  
Bangladesh Journal of Scientific Research     Open Access   (Followers: 1)
Bangladesh Medical Journal     Open Access  
Bangladesh Medical Journal Khulna     Open Access  
Basal Ganglia     Hybrid Journal  
Basic Sciences of Medicine     Open Access   (Followers: 2)
Batı Karadeniz Tıp Dergisi / Medical Journal of Western Black Sea     Open Access  
Baylor University Medical Center Proceedings     Hybrid Journal  
BBA Clinical     Open Access  
BC Medical Journal     Free  
Benha Medical Journal     Open Access  
Beni-Suef University Journal of Basic and Applied Sciences     Open Access   (Followers: 4)
Bijblijven     Hybrid Journal  
Bijzijn     Hybrid Journal   (Followers: 1)
Bijzijn XL     Hybrid Journal  
Bio-Algorithms and Med-Systems     Hybrid Journal   (Followers: 2)
BioDiscovery     Open Access   (Followers: 2)
Bioelectromagnetics     Hybrid Journal   (Followers: 2)
Bioelectronic Medicine     Open Access   (Followers: 1)
Bioengineering & Translational Medicine     Open Access  
Bioethics     Hybrid Journal   (Followers: 17)
Bioethics Research Notes     Full-text available via subscription   (Followers: 14)
Biologics in Therapy     Open Access  
Biology of Sex Differences     Open Access   (Followers: 2)
Biomarker Research     Open Access   (Followers: 3)
Biomarkers in Medicine     Hybrid Journal   (Followers: 2)
BioMed Research International     Open Access   (Followers: 4)
Biomédica     Open Access  
Biomedical & Life Sciences Collection     Full-text available via subscription   (Followers: 3)
Biomedical and Biotechnology Research Journal     Open Access   (Followers: 1)
Biomedical Engineering     Hybrid Journal   (Followers: 17)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Engineering Letters     Hybrid Journal   (Followers: 6)
Biomedical Engineering Research     Open Access   (Followers: 7)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Biomedical Journal     Open Access   (Followers: 3)
Biomedical Materials     Hybrid Journal   (Followers: 7)
Biomedical Microdevices     Hybrid Journal   (Followers: 8)
Biomedical Optics Express     Open Access   (Followers: 6)
Biomedical Photonics     Open Access  
Biomedical Reports     Full-text available via subscription  
Biomedical Research Reports     Full-text available via subscription   (Followers: 2)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
Biomedical Science and Engineering     Open Access   (Followers: 7)
BioMedicine     Open Access  
Biomedicine Hub     Open Access  
Biomedicines     Open Access   (Followers: 1)
Biomedika     Open Access  
Biomolecular and Health Science Journal     Open Access   (Followers: 1)
Biophysics Reports     Open Access  
BioPsychoSocial Medicine     Open Access   (Followers: 8)
Biosalud     Open Access   (Followers: 1)
Biostatistics & Epidemiology     Hybrid Journal   (Followers: 1)
Birat Journal of Health Sciences     Open Access  
BIRDEM Medical Journal     Open Access   (Followers: 1)
Birth Defects Research     Hybrid Journal  
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 3)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal  
BJR|Open     Open Access   (Followers: 1)
BJS Open     Open Access   (Followers: 1)
Black Sea Journal of Health Science     Open Access  
BLDE University Journal of Health Sciences     Open Access  
Blickpunkt Medizin     Hybrid Journal  
BMC Biomedical Engineering     Open Access  
BMC Medical Ethics     Open Access   (Followers: 21)
BMC Medical Research Methodology     Open Access   (Followers: 9)
BMC Medicine     Open Access   (Followers: 13)
BMC Obesity     Open Access   (Followers: 8)
BMC Proceedings     Full-text available via subscription   (Followers: 1)
BMC Research Notes     Open Access   (Followers: 4)
BMC Sports Science, Medicine and Rehabilitation     Open Access   (Followers: 34)
BMH Medical Journal     Open Access   (Followers: 2)
BMI Journal : Bariátrica & Metabólica Iberoamericana     Open Access  
BMJ     Hybrid Journal   (Followers: 1751)
BMJ Case Reports     Hybrid Journal   (Followers: 26)
BMJ Evidence-Based Medicine     Hybrid Journal   (Followers: 3)
BMJ Global Health     Open Access   (Followers: 3)
BMJ Innovations     Hybrid Journal   (Followers: 6)
BMJ Leader     Hybrid Journal  
BMJ Open     Open Access   (Followers: 42)
BMJ Open Quality     Open Access   (Followers: 19)
BMJ Open Science     Open Access   (Followers: 1)
BMJ Sexual & Reproductive Health     Hybrid Journal   (Followers: 2)
BMJ Surgery, Interventions, & Health Technologies     Open Access  
Bodine Journal     Open Access  
Boletín del Consejo Académico de Ética en Medicina     Open Access  
Boletín del ECEMC     Open Access  
Boletin Médico de Postgrado     Open Access  
Boletín Médico del Hospital Infantil de México     Open Access  
Bone     Hybrid Journal   (Followers: 18)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Bone Marrow Research     Open Access   (Followers: 2)
Bone Reports     Open Access  
Bosnian Journal of Basic Medical Sciences     Open Access  
Bozok Tıp Dergisi / Bozok Medical Journal     Open Access  
Brachytherapy     Full-text available via subscription   (Followers: 6)
Brain and Development     Full-text available via subscription   (Followers: 5)
Brain Connectivity     Hybrid Journal   (Followers: 5)
Brain Impairment     Full-text available via subscription   (Followers: 2)
Brazilian Journal of Medical and Biological Research     Open Access  
Brazilian Journal of Medicine and Human Health     Open Access  
Brazilian Journal of Pain (BrJP)     Open Access  
Brazilian Journal of Physical Therapy     Open Access   (Followers: 1)
Breastfeeding Review     Full-text available via subscription   (Followers: 18)
British Journal of Biomedical Science     Full-text available via subscription   (Followers: 7)
British Journal of General Practice     Full-text available via subscription   (Followers: 38)
British Journal of Hospital Medicine     Full-text available via subscription   (Followers: 16)
British Medical Bulletin     Hybrid Journal   (Followers: 6)
Buddhachinaraj Medical Journal     Open Access  
Bulletin Amades     Open Access  
Bulletin de la Société de pathologie exotique     Hybrid Journal   (Followers: 1)
Bulletin of Legal Medicine     Open Access  
Bulletin of Medical Sciences     Open Access  
Bulletin of the History of Medicine     Full-text available via subscription   (Followers: 18)
Bulletin of the Menninger Clinic     Full-text available via subscription  
Bulletin of The Royal College of Surgeons of England     Free  
Bulletin of the Scientific Centre for Expert Evaluation of Medicinal Products     Open Access  
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz     Hybrid Journal   (Followers: 6)
Burapha Journal of Medicine     Open Access  
Burns     Hybrid Journal   (Followers: 10)
Cadernos de Naturologia e Terapias Complementares     Open Access   (Followers: 1)
Calcified Tissue International     Hybrid Journal   (Followers: 2)
Canadian Bulletin of Medical History     Hybrid Journal  
Canadian Family Physician     Partially Free   (Followers: 13)
Canadian Journal of Pain     Open Access   (Followers: 2)
Canadian Journal of Rural Medicine     Full-text available via subscription   (Followers: 1)
Canadian Medical Association Journal     Open Access   (Followers: 17)
Canadian Medical Education Journal     Open Access   (Followers: 10)
Canadian Prosthetics & Orthotics Journal     Open Access  
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 1)
Cardiac Electrophysiology Clinics     Full-text available via subscription   (Followers: 1)
Care Management Journals     Hybrid Journal   (Followers: 5)
Case Reports     Open Access  
Case Reports in Acute Medicine     Open Access  
Case Reports in Clinical Medicine     Open Access   (Followers: 1)
Case Reports in Clinical Nutrition     Open Access   (Followers: 1)
Case Reports in Medicine     Open Access   (Followers: 2)
Case Reports in Transplantation     Open Access  
Case Reports in Vascular Medicine     Open Access  
Case Reports in Women's Health     Open Access   (Followers: 4)
Case Study and Case Report     Open Access   (Followers: 5)
CBU International Conference Proceedings     Open Access   (Followers: 3)
Cell & Bioscience     Open Access   (Followers: 6)
Cell Adhesion & Migration     Open Access   (Followers: 9)
Cell and Molecular Response to Stress     Full-text available via subscription   (Followers: 2)
Cell and Tissue Transplantation and Therapy     Open Access   (Followers: 2)
Cell Cycle     Full-text available via subscription   (Followers: 6)
Cell Death and Differentiation     Hybrid Journal   (Followers: 7)
Cell Death Discovery     Open Access   (Followers: 1)
Cell Health and Cytoskeleton     Open Access   (Followers: 1)
Cell Medicine     Open Access   (Followers: 6)
Cell Research     Hybrid Journal   (Followers: 8)
Cell Transplantation     Open Access   (Followers: 4)
CEN Case Reports     Hybrid Journal  
Central African Journal of Medicine     Full-text available via subscription  
Ceylon Journal of Medical Science     Open Access  
Ceylon Medical Journal     Open Access  
Chattagram Maa-O-Shishu Hospital Medical College Journal     Open Access  
Chiang Mai Medical Journal     Open Access  
ChiangRai Medical Journal     Open Access  
Chimerism     Full-text available via subscription  
Chinese Journal of Integrative Medicine     Hybrid Journal   (Followers: 3)
Chinese Journal of Natural Medicines     Full-text available via subscription   (Followers: 1)
Chinese Medical Journal     Open Access   (Followers: 10)
Chinese Medical Record English Edition     Hybrid Journal  
Chinese Medical Sciences Journal     Full-text available via subscription   (Followers: 2)
Chinese Medicine     Open Access   (Followers: 2)
Chinese Medicine     Open Access   (Followers: 4)
Chisholm Health Ethics Bulletin     Full-text available via subscription   (Followers: 1)
CHRISMED Journal of Health and Research     Open Access   (Followers: 2)
Christian Journal for Global Health     Open Access  
Chronic Diseases and Translational Medicine     Open Access  
Chronic Illness     Hybrid Journal   (Followers: 6)
Chronic Wound Care Management and Research     Open Access   (Followers: 4)
Chronobiology International     Hybrid Journal   (Followers: 3)
ChronoPhysiology and Therapy     Open Access  
Chulalongkorn Medical Bulletin     Open Access  
Chulalongkorn Medical Journal     Open Access  
Ciencia e Innovación en Salud     Open Access  
Ciencia e Investigación Medico Estudiantil Latinoamericana     Open Access  
Ciencias Clínicas     Open Access  

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Similar Journals
Journal Cover
Burns
Journal Prestige (SJR): 1.044
Citation Impact (citeScore): 2
Number of Followers: 10  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0305-4179
Published by Elsevier Homepage  [3147 journals]
  • Cutaneous laser surgery for secondary burn reconstruction: Cost benefit
           analysis
    • Abstract: Publication date: Available online 16 January 2020Source: BurnsAuthor(s): Ernest A. Azzopardi, Robert T. Duncan, Mollie Kearns, Francesco Marangoni, Nader Ibrahim, Ernest A.F. Azzopardi, Dean Boyce, Matteo Tretti, Maxwell S.C. MursionAbstractThermal disease presents a major burden to individual patient morbidity, healthcare cost as well as to over all economy. Burns also also represent a significant per-patient utlilisation of finite healthcare resources. Secondary complications in these patients, such as multiple drug resistant organisms, may have a devastating effect.Laser surgery has recently come of age as an optimal tool in the secondary reconstruction of burn injury, that is able to simultaneously address significant sheet scar tightness, hypertrophic, atrophic, and keloid complications, pruritus, microstomia, ectropion, skin graft honeycombing, and improve range of movement whilst reducing the risk of infection to
       
  • Firework-related injuries in young people: An update and recent
           initiatives
    • Abstract: Publication date: Available online 15 January 2020Source: BurnsAuthor(s): Ashwin Venkatesh, Ankur Khajuria
       
  • Establishing scald prevention measures in UK maternity units from takeaway
           drinks
    • Abstract: Publication date: Available online 3 January 2020Source: BurnsAuthor(s): M. Kostusiak, A. Naik, C.J. Lewis, K.P. AllisonAbstractAimTo identify policies on the consumption of hot drinks by patients and visitors on all perinatal and postnatal wards in the United Kingdom, and to seek the opinions of members of the wider burns MDT as to whether standardised patient education or regulation of hot drinks around newborn babies is required.MethodsAll maternity units with postnatal wards across the United Kingdom were surveyed to establish availability of hot drinks on site and whether these were permitted on postnatal wards around infants. An online questionnaire was distributed to members of the British Burn Association to ascertain opinions on hot drinks policies.ResultsHot takeaway drinks were permitted around newborn infants in 194 of surveyed postnatal wards and were only banned by two units. The online survey received 49 responses from different members of the British Burn Association. Thirty responders (61%) supported a takeaway hot drink ban, while those against the policy would alternatively encourage patient education, dedicated drinking areas and introduction of safety measures.ConclusionsAlmost every postnatal unit in the UK has access to hot drink retailers on site allowing parents and visitors to bring them into close contact with babies. With varying local regulations, this poses potentially serious consequences during feeding or carrying. We propose a standardised antenatal education be made available, together with standardised designated areas on wards for parents and visitors to consume hot drinks away from infants.
       
  • Implications of chlorhexidine use in burn units for wound healing
    • Abstract: Publication date: Available online 3 January 2020Source: BurnsAuthor(s): Philippe Abdel-Sayed, Dorian Tornay, Nathalie Hirt-Burri, Anthony de Buys Roessingh, Wassim Raffoul, Lee Ann ApplegateAbstractChlorhexidine is known to be a potent antiseptic with evidence of a beneficial role in burn care. Nevertheless, several in vitro studies have reported cytotoxicity on cultured cells, while in vivo and clinical data seem to show more controversial results. In the frame of this work, we aimed to evaluate the use of chlorhexidine in burn units worldwide be sending a survey to professionals of the field. We associated survey results to those perspectives reported in the literature to update recommendations for the use of chlorhexidine in specific protocols for burn management. The survey results showed that there is no clear consensus on the use of chlorhexidine regarding the concentrations, the type of excipient and the cleansing after application. Literature searches showed evidence that the skin of premature infants appears to be more sensitive to chlorhexidine that adult skin, with more reported cases of adverse effects. It was also determined that aqueous formulations of chlorhexidine do not appear to be necessarily less efficient than with alcohol as an excipient, and that lower concentrations are as efficient as higher concentrations. In view of this study, we have adjusted our protocols for the use of aqueous formulations at low concentrations and investigated further the role of washing after application in order to standardize the indication of chlorhexidine and minimize the probability of adverse effects.
       
  • Exploring the Burn Model System National Database: Burn injuries,
           substance misuse, and the CAGE questionnaire
    • Abstract: Publication date: Available online 31 December 2019Source: BurnsAuthor(s): Gabrielle G. Grant, Audrey E. Wolfe, Catherine R. Thorpe, Nicole S. Gibran, Gretchen J. Carrougher, Shelley A. Wiechman, Radha Holavanahalli, Frederick J. Stoddard, Robert L. Sheridan, Lewis E. Kazis, Jeffrey C. Schneider, Colleen M. RyanAbstractBurn survivors who misuse alcohol and/other substances have been associated with poorer long-term outcomes and clinical complications following injury. The self-reported CAGE questionnaire (Cut down, Annoyed, Guilty, and Eye-opener) is an outcomes assessment tool used to screen for potential substance misuse. Understanding the persistence and emergence of potential substance misuse through examination of CAGE scores may provide important information about this population. Using data collected from the Burn Model System National Database, demographic and clinical characteristics of individuals who reported positive CAGE scores (total score of ≥2) and those who reported negative CAGE scores (total score of 0 or 1) for either alcohol or other drugs were compared.
       
  • Dimensions of burn survivor distress and its impact on hospital length of
           stay: A national institute on disability, independent living, and
           rehabilitation research burn model system study
    • Abstract: Publication date: Available online 31 December 2019Source: BurnsAuthor(s): Kyle H. O'BrienAbstractObjectiveGuided by the Transactional Model of Stress and Coping, this study seeks to (1) examine the independent relationships between the level of distress among burn survivors, pre-morbid psychiatric history, and burn severity on length of hospital stay, and (2) to examine the relationship between having a premorbid psychiatric history and level of distress following a burn injury.MethodsData collected by the National Institute on Disability, Independent Living, Rehabilitation Research funded Burn Model System (N = 846) was used to theoretically link psychological distress with the length of hospital stay for survivors of burn injuries. Structural Equation Modeling was used to evaluate the aims of this study.ResultsAlthough counterintuitive, and while significant, burn severity was found to have a rather modest association with a burn survivor’s level of distress, indicating that one’s ability to cope may be a better predictor of distress rather than burn severity alone. Premorbid psychiatric history was significantly associated with increased levels of distress. While burn severity was associated with length of stay, level of distress did not act as a partial mediator. Length of stay was, however, significantly related to having a premorbid-psychiatric history. Of notable interest, a significant racial, ethnic, and gender difference exists in level of distress. Women and people of color experience higher levels of distress holding constant burn severity and psychiatric history.ConclusionA need exists to assess for and address premorbid and current mental health challenges of burn survivors, specifically the ability to cope, especially among people of color and women, regardless of the burn size or severity.
       
  • Sleep quality as a target for improving quality of life in burn patients
    • Abstract: Publication date: Available online 31 December 2019Source: BurnsAuthor(s): Leeba Rezaie, Sadiqa Kendi
       
  • Checklists in surgery: Considerations for Implementation
    • Abstract: Publication date: Available online 28 December 2019Source: BurnsAuthor(s): Christian Smolle, Gerald Sendlhofer, Daniel Popp, Lars-Peter Kamolz
       
  • Protection of sildenafil citrate hydrogel against radiation-induced skin
           wounds
    • Abstract: Publication date: Available online 20 December 2019Source: BurnsAuthor(s): Shweta Kulshrestha, Raman Chawla, Sukhvir Singh, Pooja Yadav, Navneet Sharma, Rajeev Goel, Himanshu Ojha, Vinod Kumar, J.S. AdhikariRadiation induced skin wound/dermatitis is one of the common side effects of radiotherapy or interventional radiobiology. In order to combat impaired healing of radiation wounds, alternative therapy to use sildenafil citrate (SC) topical hydrogel as a therapeutic option was proposed that has known to enhance nitric oxide in wounds. Our aim was to develop a radiation induced skin wound model and to investigate the wound healing efficacy of 5% SC hydrogel formulation in Sprague-Dawley rats. In the present study, the radiation wound inducing dose was optimized using a multi-dose localized γ-radiation trail with 10−55 Gy range (15 Gy interval). Optimal irradiation dose for wound induction was selected based on radiation skin damage assessment criteria followed the relative change from 55 Gy showed significant variation and median 45 Gy γ-dose was selected for studying acute effects of radiation on wound healing. Significant (p 
       
  • Endothelial glycocalyx shedding in patients with burns
    • Abstract: Publication date: Available online 20 December 2019Source: BurnsAuthor(s): Harald Welling, Hanne Hee Henriksen, Erika R. Gonzalez-Rodriguez, Jakob Stensballe, Todd F. Huzar, Pär I. Johansson, Charles E. WadeAbstractShedding of syndecan-1 from the endothelial glycocalyx layer (EGL), referred to as endotheliopathy of trauma (EoT), is associated with poorer outcomes. This study aims to determine if EoT is also present in the burn population. We enrolled 458 burn and non-burn trauma patients at a Level 1 trauma center and defined EoT by a syndecan-1 level of ≥40 ng/mL. Sixty-eight of the enrolled patients had burns with a median TBSA of 19%, with 27.9% also suffering inhalational injury (II). Mortality was similar between the burn and non-burn group, also for patients with EoT. The incidence of II was significantly greater in the EoT+ burn group compared to the EoT− group (p = 0.038). Patients with II received significantly larger amounts of i.v. fluids (p = 0.001). The incidence of EoT was significantly different between the II-groups, as was mortality (pEoT = 0.038, pmortality 
       
  • The effect of the acute inflammatory response of burns and its treatment
           on clot characteristics and quality: A prospective case controlled study
    • Abstract: Publication date: Available online 20 December 2019Source: BurnsAuthor(s): N.J. Marsden, M. Lawrence, N. Davies, G. Davies, K. Morris, P.R. Williams, I.S. Whitaker, P.A. EvansAbstractIntroductionBurns are known to have an effect on coagulation in the early period after burn. Current coagulation tests have been criticised in acute burns due to their inherent limitations. This study aims to investigate the potential for a new quantitative functional biomarker of clot quality, fractal dimension, to identify changes in clot microstructure as a result of the burn inflammatory response and its treatment.MethodsA total of fifty-eight burn patients were included in this prospective case-controlled study. The control group (29 patients mean TBSA 1%), and case group (29 patients mean TBSA 30%) were compared at baseline and the case group investigated further over four time points (baseline, 12 h, 24 h and 5–7 days). Fractal analysis was performed, as well as current markers of coagulation, inflammatory markers and point-of-care tests, Thromboelastography and Multiplate analysis.ResultsFractal dimension did not differ between groups at admission (1.73 ± 0.06 and 1.72 ± 0.1), and fell within the healthy index normal range (1.74 ± 0.7), suggesting a normal clot microstructure in the early period after burn. Fractal dimension significantly reduced from baseline over the first 24 h following injury (1.59 ± 0.03 p 
       
  • Universal off-the-shelf skin substitutes for cosmetic and reconstructive
           surgery
    • Abstract: Publication date: Available online 19 December 2019Source: BurnsAuthor(s): Sina Kardeh, Mohsen Mazloomrezaei, Mehdi Dianatpour, Shirin Farjadian
       
  • Comments on“Comparison of efficacy and safety of intralesional
           triamcinolone and combination of triamcinolone with 5-fluorouracil in the
           treatment of keloids and hypertrophic scars: Randomisedcontrol trial”
    • Abstract: Publication date: Available online 19 December 2019Source: BurnsAuthor(s): Feng-Lai Yuan, Jian Wang, Zi-Li Sun, Qian-Yuan Wu, Xia Li, Guo-Zhong Lv
       
  • Impact of allogeneic blood transfusions on clinical outcomes in severely
           burned patients
    • Abstract: Publication date: Available online 19 December 2019Source: BurnsAuthor(s): Alexander Kaserer, Julian Rössler, Ksenija Slankamenac, Michael Arvanitakis, Donat R. Spahn, Pietro Giovanoli, Peter Steiger, Jan A. PlockAbstractBackgroundAllogeneic blood transfusions are common in the treatment of severely burned patients as surgery may lead to major blood loss. However, transfusions are associated with a number of adverse events. Therefore, the purpose of our study was to investigate the impact of allogeneic blood transfusions on clinical outcomes in severely burned patients.MethodsThis retrospective study included all adult patients admitted to the burn center of the University Hospital Zurich between January 2004 and December 2014, with burn injuries greater than 10% of total body surface area and receiving both surgical and intensive care treatment. Primary Endpoints were infectious or thromboembolic complications and mortality and secondary endpoints were length of hospital and ICU stay. Simple and multivariable logistic and linear regression models, adjusted for injury severity and confounders, were applied.Results413 patients met inclusion criteria of which 212 patients (51%) received allogenic blood products. After adjustment for injury severity and confounders, red blood cell transfusion was independently associated with wound infection (OR 13.5, 95% CI 1.7–107, p = 0.014), sepsis (OR 8.3, 4.2–16.3; p 
       
  • Contribution of thermal imaging in determining the depth of pediatric
           acute burns
    • Abstract: Publication date: Available online 19 December 2019Source: BurnsAuthor(s): S. Ganon, A. Guédon, S. Cassier, M. AtlanAbstractBackgroundEarly burn wound assessment is a major problem in pediatrics. It involves regular clinical evaluations, and may be helped by objective tools, such as thermal imagers. Because of the skin temperature difference between partial and full thickness burns, due to injured vascular perfusion of the dermis in the latter, it could precisely identify areas with superficial burns which could heal from controlled wound healing, and those with deep burns which would need skin graft, at an early stage. The objective of this study was to assess the validity of the Flir one thermal imager® for this purpose.MethodsThermal images were obtained by a single observer three times after burn: day 1–3 (T1); day 4–7 (T2); day 8–10 (T3). ΔT (temperature difference between burned area and healthy skin) was calculated on a tablet with Flir One application. Validity was assessed by comparing ΔT obtained at each time between two groups at day 15 depending on the healing time of the burn wounds : before or after day 15. Primary outcome was the AUC (area under curve) of the ROC (Receiver operating characteristic) curve for ΔT at T1, T2 and T3, representing the ability of the Flir One Thermal Imager® to discriminate between a healing time 15 days.Results40 patients were included (13 months to 13 years old). AUC at T1 and T2 are 0.700 (95% CI: 0.649; 0.925) and 0.787 (95% CI: 0.523; 0.877), respectively. AUC at T3 is 0.968 (95% CI: 0.918; 1.00). A ΔT threshold of −1.2 °C at T3 is associated with a specificity of 100% allowing to diagnose as of day 8 all the patients having deep burns which heal after 15 days.ConclusionsThe Flir One Thermal Imager® is an inexpensive, non-invasive, and easy-to-use device. It measures indirectly but with an excellent specificity the dermis perfusion reflecting the burns depth in children. However its low sensitivity calls for additional research to allow skin grafts earlier in common practice and decrease the length of stay.
       
  • TBSA and length of stay impact quality of life following burn injury
    • Abstract: Publication date: Available online 18 December 2019Source: BurnsAuthor(s): Deena Kishawi, Amy W. Wozniak, Michael J. MosierAbstractIntroductionBurn injuries create physiologic, physical, and emotional effects acutely and long-lasting. Recovery is extensive and requires long-term care. Impaired function related to pain, deconditioning, weakness, and contracture formation are common. We sought to determine factors that impact quality of life (QOL) post recovery. Specifically, to assess whether Health Related QOL (HRQOL) decreases with increasing percent total body surface area (TBSA) and length of stay (LOS). We also explored QOL as a function of burn mechanism.MethodsPatients>18 years of age with>9.5% TBSA between 1 and 6 years post-burn injury were contacted by mail and asked if they were willing to participate. Those who agreed responded by returning their completed Burn Specific Health Scale-Brief (BSHS-B). Medical records were accessed to determine demographic and treatment information.ResultsStatistical analysis revealed a strong correlation between total QOL (total score of BSHS-B) and LOS and TBSA. All domains were negatively correlated with increasing LOS and TBSA. LOS was most strongly correlated with decreasing work function and social function. There were no differences in QOL between burn mechanism.ConclusionsQOL is greatly impacted by TBSA and LOS.More attention to body image and returning to work should be given, regardless of the type of burn mechanism.
       
  • Re: Combination therapy for Toxic Epidermal Necrolysis: It is time for
           anti-TNFa biologics comparison
    • Abstract: Publication date: Available online 18 December 2019Source: BurnsAuthor(s): Christopher H. Pham, T. Justin Gillenwater, Warren L. Garner
       
  • The effect of progressive muscle relaxation on anxiety and sleep quality
           in burn patients: A randomized clinical trial
    • Abstract: Publication date: Available online 18 December 2019Source: BurnsAuthor(s): Mehdi Harorani, Fahimeh Davodabady, Behnam Masmouei, Niloofar BaratiAbstractBackground and objectivesBurn patients experience a high level of anxiety and poor sleep quality due to their special physical and psychological conditions. The present study aimed to investigate the effect of progressive muscle relaxation on anxiety and sleep quality in burn patients.Methodology and participantsIn this randomized controlled clinical trial, a total of 80 patients admitted to burn ward were enrolled using convenient sampling and randomly assigned to one of the experimental or control groups. In the experimental group, patients were intervened using Jacobson’s relaxation technique 20−30 min daily for three consecutive days. During this period, the control group received only routine care and treatment. Patients' anxiety and their sleep quality were measured and recorded before and after the intervention using the Spielberger State-Trait Anxiety Inventory (STAI) and St Mary’s Hospital Sleep Quality Questionnaire (SMHSQ) respectively. Eventually, data analysis was conducted using SPSS version 20.0 software (IBM Corp., Armonk, N.Y., USA).ResultsThe findings of the present study showed a statistically significant decrease in anxiety and improvement in sleep quality in the experimental group compared to the control group (P 
       
  • The effect of a new wound dressing on wound healing: Biochemical and
           histopathological evaluation
    • Abstract: Publication date: Available online 18 December 2019Source: BurnsAuthor(s): Serdar Tort, Fatmanur Tuğcu Demiröz, Şule Coşkun Cevher, Sanem Sarıbaş, Candan Özoğul, Füsun AcartürkAbstractElectrospinning process has gained importance in the production of wound dressings in recent years. The wound dressings prepared by electrospinning method provide many advantages over conventional wound dressings. The aim of this study was to assess the histological, biochemical, and immunohistochemical evaluation of collagen/doxycycline loaded nanofiber wound dressing in both acute and chronic wound healing. Full-thickness wound model was created on rats and rats were divided in two main groups: normoglycemic (acute) and hyperglycemic (chronic) groups. Each group was divided into three sub groups: not treated (control) group, treated with nanofiber wound dressing group and treated with commercial product group. Wound closure rates were measured. Oxidative events were investigated by biochemical analyses. In addition to histological studies, matrix metalloproteinase, tissue inhibitor of metalloproteinase, vascular endothelial growth factor, basic-fibroblast growth factor, and von Willebrand factor levels were investigated with immunohistochemical studies. According to the biochemical analyses, it was concluded that the nanofiber wound dressing helps to increase antioxidant capacity and decrease lipid peroxidation. Immunohistochemical studies showed that nanofiber wound dressing enhanced angiogenesis and shortened the inflammatory phase. It was concluded that an effective and safe prototype nanofiber wound dressing, which has similar wound healing effect to the commercial product, has been developed to be used in acute or chronic wound treatment.
       
  • Burn wound infections and Pseudomonas aeruginosa
    • Abstract: Publication date: Available online 16 December 2019Source: BurnsAuthor(s): Alen J. Salerian
       
  • paid MBP advert JBUR_ISBI2020_121019
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s):
       
  • The use of MolecuLight™ for early detection of colonisation in
           dermal templates
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): S. Redmond, C.J. Lewis, S. Rowe, E. Raby, S. Rea
       
  • Psychological needs of the families of patients who attempted suicide by
           self-immolation: An overlooked issue
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Leeba Rezaie, David C. Schwebel
       
  • Response to “Use of digital photography in burn patients: Diagnosis,
           treatment and follow-up”
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): K.S. Koetsier
       
  • Use of digital photography in burn patients: Diagnosis, treatment and
           follow-up
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): David Boccara, Kevin Serror
       
  • Differentiating local and systemic inflammatory responses to burn injuries
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Petra Kotzbeck, Elisabeth Hofmann, Sebastian P. Nischwitz, Lars-Peter Kamolz
       
  • Development of the Pan African burn services directory
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Cameron Gibson, James Gallagher, Jamie HeffernanAbstractBackgroundInternational burn societies in many parts of the world have created electronic registries of burn centers in their region. No such directory exists for the continent of Africa.ObjectiveTo create the first electronic directory of burn care providers in Africa.MethodologyEmails were sent out to attendees of the Pan African Burn Congress and members of the Pan African Burn Society (PABS) asking if they would like to participate in the directory. Basic information about each burn site were obtained from respondents and compiled into the directory. An online interactive map was created and made available to the public.Results40 burn sites were identified across 14 different countries. The majority of burn sites are located in only 5 countries. The most common language spoken is English, followed by French, Amharic, and Afrikaans.ConclusionThis is the first known online directory of burn sites in Africa. Significant challenges exist identifying burn care providers in large portions of the continent.
       
  • Non intentional burns in children: Analyzing prevention and acute
           treatment in a highly developed country
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Theres Moehrlen, Markus A. Landolt, Martin Meuli, Ueli MoehrlenAbstractThe objective of this study was to evaluate where and when pediatric burn injuries occurred. Furthermore the quality of first aid treatment, ratio of skin grafting and length of hospital stay were evaluated.The patient records of 749 children with acute burns admitted to the University Children’s Hospital of Zurich, Switzerland, were retrospectively reviewed over an 11-year period.Burn injuries in children with an immigrant background were overrepresented in our study population, whereby the proportion of immigrants decreased with rising age.Sixty-five percent of all patients received some form of first aid. Of those 4.5% did not comply with the current guidelines. Furthermore initial assessment of total body surface area (TBSA) by the first line physician was overestimated in 76% of cases.Flame injuries occurred mainly in summertime in outdoor settings and needed significant more often skin grafts than scalds, which mainly occurred indoors and in wintertime. As a result, patients with flame injuries had to stay significantly longer in hospital (flames: 21 days (range: 1–259 days; median: 30; interquartile range (IQR): 30) versus scalds: 7 days (range: 1–130 days; median: 7; IQR: 12); p 
       
  • Early hypothermia as risk factor in severely burned patients: A
           retrospective outcome study
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Benjamin Ziegler, Theresa Kenngott, Sebastian Fischer, Gabriel Hundeshagen, Bernd Hartmann, Johannes Horter, Matthias Münzberg, Ulrich Kneser, Christoph HircheAbstractIntroductionBurn trauma-related hypothermia is a frequent observation but risk factors and impact on patient related outcome are ambiguously reported. It is expected that hypothermia is associated with increased mortality and reduced overall outcome in severely burned patients, but available evidence is limited.MethodsThis retrospective single-center-study reviewed preclinical service protocols and medical records of patients sustaining a burn with a total body surface area (TBSA) ≥15% from 2008 to 2012. General patient and burn specific characteristics, outcome parameters as well as body temperature at admission measured via urine catheter or nasal temperature probe were recorded and statistically analyzed comparing normothermic (≥36 °C), mild hypothermic (
       
  • Comparison of efficacy of silver-nanoparticle gel, nano-silver-foam and
           collagen dressings in treatment of partial thickness burn wounds
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Miying Erring, Sunil Gaba, Subair Mohsina, Satyaswarup Tripathy, Ramesh Kumar SharmaAbstractIntroductionThis study was carried out to compare the efficacy of silver nanoparticle gel (SG), nanosilver foam (SF) and collagen (C) dressings in partial thickness burn wounds.MethodsThis was a single-center, prospective cohort study carried out over a period of 1 year on patients with 15–40% partial thickness thermal burns ≤48 h. Each patient received all three dressings (silver-nanoparticle gel, nanosilver foam, collagen) simultaneously at 3 randomly selected areas which were comparable in terms of burn depth and surface area. Efficacy of the dressings was assessed in terms of healing rates, time taken and ease of application, pain at dressing change, cost, wound-swab culture and scar quality (at 3 months).ResultsA total of 20 patients were included. In SF group, number of patients with 60%–80% re-epithelialization on day10 (SG: 10/20; C: 10/20; SF: 16/20; p = 0.042) and complete healing on day14 (SF: 11/20, C: 6/20, SG: 4/20; p = 0.032) was significantly higher. The time for dressing change was similar at admission (p = 0.918) and day 10 (p = 0.163), although majority of the patients in SF group needed less than 10 min. The time taken (
       
  • Irrigation with phosphate-buffered saline causes corneal calcification
           during treatment of ocular burns
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): N.F. Schrage, Sabah S. Abu, L. Hermanns, C. Panfil, R.M. DutescuAbstractCorneal calcification is a vision-threatening manifestation of calcium containing agents in ocular burn. As we previously reported, our interest was sparked by a particular discrepancy of a case: A patient treated for a non-calcium containing agent in eye burn from exposure to an alkaline mixture of NaOH and KOH, who unexpectedly developed corneal calcification. This current study aims to elucidate whether the 2 min lasting irrigation with a phosphate-buffered saline itself, regardless of rinsing regimen, triggers corneal calcification. The Ex Vivo Eye Irritation Test (EVEIT) system was used on rabbit corneas to replicate the very same phosphate-buffered saline solution the patient was treated with. The rabbit corneas were first burned with 1 M NaOH, rinsed with 4.9% phosphate-buffered saline for 2 min, and were then moisturized with an artificial tear solution for 48 h. All corneas were fluorescein-stained for photo documentation, snap-frozen, lyophilizated, and the electrolyte content was analyzed by Energy-Dispersive X-ray spectroscopy (EDX). The EDX analysis revealed pathological phosphorous in corneal stroma after a single rinsing with phosphate-buffered saline. Ongoing application of artificial tears containing physiological 14.581 mmol Ca2+ /l led to macroscopically visible calcification, but only in areas of induced corneal erosion. Regardless of the rinsing protocol neither 2 or 15 min of eye rinsing with phosphate containing rinsing solutions, we have given proof that corneal calcification is a foreseeable effect of the phosphate-buffered saline rinsing of mechanically epithelial damaged and chemically burnt eyes. Thus, it is crucial to legally restrict the formulations of phosphate-buffered salines in the medical treatment of eye burns, corneal erosions or chemical splashes of the eye.
       
  • Protective effect of Myrtle (Myrtus communis) on burn induced
           skin injury
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Ozan Ozcan, Hazal Ipekci, Burcin Alev, Unsal Veli Ustundag, Esin Ak, Ali Sen, Ebru Emekli Alturfan, Goksel Sener, Aysen Yarat, Sule Cetinel, Tugba Tunali AkbayAbstractThermal skin burns cause local injury as well as triggers acute systemic inflammation response where the imbalance between oxidative and antioxidative system occurs.As an alternative treatment, various medicinal herbs are used to treat burn injuries in many countries. In this study, the possible protective role of oral or topical Myrtle (Myrtus communis L.) treatment against burn-induced damage was investigated. The dorsum of the Wistar Albino rats was shaved and exposed to 90 °C water bath in burn group or 25 °C water bath in control group for 10 s under ether anesthesia. Myrtle extract was applied 100 mg/kg/day for 2 days either orally or topically. In skin samples; malondialdehyde and glutathione levels, catalase, superoxide dismutase, nitric oxide and tissue factor activities were determined. Skin tissues were also examined by light microscopy. Severe thermal skin burn injury caused a significant decrease in glutathione level, superoxide dismutase, catalase and tissue factor activities as well as nitric oxide level, which was accompanied with significant increases in skin malondialdehyde level. Myrtle treatment reversed all these biochemical indices except topical Myrtle treated group’s nitric oxide level, as well as histopathological alterations, which were induced by thermal trauma. Both oral and topical Myrtle extract treatment was found to have protective role in the burn induced oxidative injury, which may be attributed to the potential antioxidant effect of Myrtle. As a conclusion, Myrtle significantly diminishes burn-induced damage in skin.
       
  • A Road Less Travelled: using Experience Based Co-Design to map
           children’s and families’ emotional journey following burn injury and
           identify service improvements
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): K. Coy, P. Brock, S. Pomeroy, J. Cadogan, K. BeckettAbstractBackgroundThe emotional impact after a child’s burn injury is poorly understood. Greater insight into the emotional journey can aid services’ ability to meet patients/families’ needs. To bridge the gap, this study employed an abbreviated form of Experience Based Co-Design (EBCD) to explore the emotional/experiential aspects of moderate to severe burn injuries in children.MethodFollowing EBCD, parents and health professionals were invited to share their experiences. Interviews were analysed and a short film was produced and shown at a focus group event for health professionals and families. Both positive and negative aspects of the journey were identified along with potential service improvements.ResultsFamilies’ journeys could be described by the following five distinct phases: life overturned, dawning reality, riding the emotional roller-coaster, aftershocks and, adapting to a new normal. Key areas for improvements were: communication, isolation, dressing changes and managing expectations.DiscussionEBCD facilitated collaborative discussion between researchers, families and health professionals. Families felt empowered to shape the future of burn care and health professionals felt included. Study challenges were mainly in participant engagement and the scheduling of interviews and the focus event. Overall the study outcome was successful in generating ideas for service improvements, and the production of a training video for healthcare professionals.
       
  • Impact of “opening the lung” ventilatory strategy on burn patients
           with acute respiratory distress syndrome
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Nguyen Nhu Lam, Tran Dinh Hung, Dong Khac HungAbstractObjectiveThe objective of this study was to investigate the feasibility and influence of opening the lung strategy ventilation on burned patients complicated with ARDS.MethodsA prospective study was carried out in 66 moderate to severe burned patients also presented with ARDS who were randomly divided into the control group (ventilated as ARDS net) and the study group (ventilated with open lung strategy). All patients were ventilated with volume control mode until weaning.ResultsOpening the lung procedure was safe in all patients with optimal PEEP of 14.8 ± 1.8 cmH2O. After 24 h of lung recruitment and PEEP titration, oxygenation significantly improved (PaO2/FiO2 ratio increased from 119.8 ± 7.4 to 263.4 ± 11.6; p 
       
  • Topical diclofenac sodium — An unexpected summer burn
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Juanita Parnis, Joseph E. Briffa
       
  • Patient perception of long-term burn-specific health and congruence with
           the Burn Specific Health Scale-Brief
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Emelie Gauffin, Caisa ÖsterAbstractIntroductionThis qualitative study aims to explore former burn patients’ perception of burn-specific health and investigate how these experiences correspond to the subscales in the Burn Specific Health Scale-Brief (BSHS-B).MethodRespondents were former burn patients, admitted to the Uppsala Burn Centre between 2000 and 2007. A total of 20 respondents with a Total Body Surface Area (TBSA) of 20% or larger, were approached at 10–17 years after burn and interviewed using a semi-structured guide. Data was analyzed using thematic analysis.ResultsDespite extensive burn injuries, respondents said they led a close-to-normal life. Their descriptions validated the significance of the existing themes of BSHS-B. Additional themes of importance for health after burn were skin related problems, morphine de-escalation, the importance of work, stress and avoidance, mentality and the healthcare system.ConclusionThe BSHS-B alone may not be sufficient in providing a comprehensive picture of former burn patients’ self-perceived health in the long-term perspective. Investigating supplementary areas reflecting former patients’ sociocultural and attitudinal environment, as well as personal factors, may be of great importance.
       
  • Assessment of a quality improvement intervention to improve the
           consistency of total body surface area burn estimates between referring
           facilities and a pediatric burn center
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Leticia Manning Ryan, Philomena Costabile, Susan Ziegfeld, Lisa Puett, Amiee Turner, Valerie Strockbine, Bruce L. KleinAbstractBackgroundBurns are a significant source of pediatric morbidity and frequently result in transfer of care to a pediatric burn center. Data suggest that referring facilities often overestimate the total body surface area (%TBSA) of burns in comparison to the subsequent assessment at the pediatric burn center. Such discrepancies may trigger inappropriately aggressive interventions with potential for patient harm. Our baseline assessment of data from 106 patients transferred to our pediatric burn center over a one-year period showed that 59/106 (56%) patients had a %TBSA recorded at the time of transfer and 18/59 (31%) had clinically significant differences (>5% difference) in estimates between the referring facility and the pediatric burn center.MethodsInformed by this clinical audit and a root cause analysis, we implemented practices to enhance consistency of clinical assessments between referring facilities and our pediatric burn center. These practices included the use of a common clinical assessment instrument (a standardized Lund and Browder form) that was integrated into the interfacility transfer process as well as educational outreach at referring facilities for providers who treat children with burns, prioritizing facilities with the highest number of discrepancies.ResultsFollow up data was reviewed 16–23 months after initiating the intervention. Cumulatively, we found significant improvement in the proportion of patients with %TBSA recorded (94% vs 56%, p 
       
  • Joint flexibility problems and the impact of its operationalisation
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): A.M. Oosterwijk, L.M. Disseldorp, C.P. van der Schans, L.J. Mouton, M.K. NieuwenhuisAbstractBackgroundDissatisfaction is being voiced with the generally used way joint flexibility problems are defined (operationalised), i.e. as a range of motion (ROM) one or more degrees lower than normative ROM of healthy subjects. Other, specifically more function-related operationalisations have been proposed. The current study evaluated the effect of applying different operationalisations of joint flexibility problems on its prevalence.MethodROM data of 95 joints affected by burns of 23 children were used, and data on 18 functional activities (Burn Outcome Questionnaire (BOQ)). Five methods were used to operationalise joint flexibility problems: (1) ROM below normative ROM, (2) ROM below normative ROM minus 1SD, (3) ROM below normative ROM minus 2SD, (4) ROM below functional ROM, and (5) a score of 2 or more on the Likert Scale (BOQ).ResultsPrevalence of joint flexibility problems on a group level ranged from 13 to 100% depending on the operationalisation used. Per joint and movement direction, prevalence ranged from 40% to 100% (Method 1) and 0% to 80% (Methods 2–4). 18% of the children received ‘2’ on the Likert Scale (Method 5).ConclusionThe operationalisation of joint flexibility problems substantially influences prevalence, both on group and joint level. Changing to a function-related operationalisation seems valuable; however, international consensus is required regarding its adoption.Trial registrationThe study is registered in the National Academic Research and Collaborations Information System of the Netherlands (OND1348800).
       
  • Course of prevalence of scar contractures limiting function: A preliminary
           study in children and adolescents after burns
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Anouk M. Oosterwijk, Leonora J. Mouton, Moniek Akkerman, Matthea M. Stoop, Margriet E. van Baar, Sonja M.H. Scholten-Jaegers, Cees P. van der Schans, Marianne K. NieuwenhuisAbstractBackgroundScar contracture is a well-known sequela of burns that is specifically relevant as it may limit function. Reports regarding the course of scar contractures, however, are scarce and, moreover, not focussed on function. This study describes the course of prevalence of scar contractures that limit function in children and adolescents after burns.MethodRange of motion (ROM) of extremity joints of 20 children and adolescents after burns were assessed at discharge (T0) and at six weeks (T1), three months (T2), and six months (T3) after discharge. A scar contracture limiting function was defined as a measured ROM lower than the functional ROM, i.e., ROM used to perform daily activities by unimpaired subjects.ResultsAt discharge (T0), 89.5% of the subjects had one or more scar contractures that limited function. Six months later (T3), this prevalence was 76.5%. At discharge (T0), less function limiting scar contractures were found for the upper extremity (29.7%) than the lower extremity (53.3%). Over time, prevalence of contractures in both extremities fluctuated between 22% and 35%.ConclusionsThe majority of children and adolescents (13/17) still had scar contractures limiting function six months after discharge (T3). Substantial longitudinal studies over a longer period of time are needed to increase our knowledge on the course of these scar contractures in order to support improvements in burn care.Trial registration: The study is approved by the Regional Committee for Patient-Oriented Research Leeuwarden in the Netherlands (NL45917.099.13).
       
  • The longitudinal validity, reproducibility and responsiveness of the
           Brisbane Burn Scar Impact Profile (caregiver report for young children
           version) for measuring health-related quality of life in children with
           burn scars
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): M. Simons, R. Kimble, S. McPhail, Z. TyackAbstractBackgroundThe measurement of health-related quality of life (HRQoL) provides information about the perceived burden of the health condition and treatments from a lived experience. The Brisbane Burn Scar Impact Profile (caregiver report for young children, BBSIP0–8), developed in 2013, is a proxy-report measure of burn scar-specific HRQoL. The aim of this study was to report its psychometric properties in line with an evaluative purpose.MethodsCaregivers of children up to 8 years of age at risk of burn scarring were recruited into a prospective, longitudinal cohort study. Caregivers completed the BBSIP0–8, Pediatric Quality of Life Inventory and Patient Observer Scar Assessment Scale at baseline (approximately ≥85% of the total body surface area re-epithelialised), 1–2 weeks after baseline and 1-month after baseline. Psychometric properties measured included internal consistency, test–retest reliability, validity and responsiveness.ResultsEighty-six caregivers of mostly male children (55%), of a median age (IQR) of 1 year, 10 months (2 years, 1 month) and total body surface area burn of 1.5% (3.0%) were recruited. Over one third of participants were grafted and 15% had contractures or skin tightness at baseline. Internal consistency of ten item groups ranged from 0.73 to 0.96. Hypothesised correlations of changes in the BBSIP0–8 items with changes in criterion measures supported longitudinal validity (ρ ranging from −0.73 to 0.68). The majority of item groups had acceptable reproducibility (ICC = 0.65–0.83). The responsiveness of five item groups was supported (AUC = 0.71–0.90).ConclusionThe psychometric properties tested support the use of the BBSIP0–8 as an evaluative measure of burn scar-related health-related quality of life for children aged below eight years in the early post-acute period of rehabilitation. Further investigation at longer time period after burn injury is indicated.
       
  • The value of a bariatric specific chart to initiate resuscitation of adult
           bariatric burns
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Guang Hua Yim, Ojas Jyoti Singh Pujji, Indervir Singh Bharj, Edmund Farrar, Jeffery Steven LAAbstractIntroductionThe prevalence of obese adults is rising across the world with a tripling of rates since 1975. The resuscitation of large burns in obese patients brings unique challenges leading some to advocate the use of a bariatric specific burn chart.AimsWe sought to determine whether bariatric burn specific charts can better estimate burn percentage to prevent under resuscitation. We also reviewed the impact of obesity upon the length of hospital stay, morbidity and mortality at our institution.MethodsA retrospective case note review, of patients identified from the prospective International Burns Injury Database (iBID), was undertaken of patients’ ≥18 years of age with burns ≥15% of their total body surface area.ResultsThere were 79 overweight and 53 bariatric patients from a total of 232 patients identified. There was no statistical difference in burn percentage or fluid input estimation between the Lund & Browder and Neaman charts. Complications were seen in 51% of the normal weight patients. Obese patients had a similar incidence of death (24%) compared to the normal weight group (26%). The class I obese had the lowest complication rate at 28% and lowest mortality rate at 11%.ConclusionsBariatric specific charts did not demonstrate any benefits in optimising bariatric resuscitation. There appears to be a ‘physiological benefit’ in the class I obese who sustained burns undergoing resuscitation.
       
  • Associations between clinical characteristics and the development of
           multiple organ failure after severe burns in adult patients
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Asako Ogura, Amy Tsurumi, Yok-Ai Que, Marianna Almpani, Hui Zheng, Ronald G. Tompkins, Colleen M. Ryan, Laurence G. RahmeAbstractTo determine the association between potential risk factors and multiple organ failure (MOF) in severe burn adult patients, we performed a secondary analysis of data from the “Inflammation and the Host Response to Injury” database, which included patients from six burn centers in the United States between 2003 and 2009. Three hundred twenty-two adult patients (aged ≥16 years) with severe burns (≥20.0% total body surface area [TBSA]) were included. MOF was defined according to the Denver score. Potential risk factors were analyzed for their association with MOF. Models were built using multivariable logistic regression analysis. Eighty-eight patients (27.3%) developed MOF during the study period. We found that TBSA, age, and inhalation injury were significant risk factors for MOF. This predictive model showed good performance, with the total area under the receiver operating characteristic curve being 0.823. Moreover, among patients who developed MOF, inhalation injury was significantly associated with the development of MOF in the acute phase (within three days of injury) (adjusted odds ratio 3.1; 95% confidence interval 1.1–8.3). TBSA, age, lactate, and Denver score within 24 h were associated with the late phase development of MOF. Thus, we have identified key risk factors for the onset of MOF after severe burn injury. Our findings contribute to the understanding of individualized treatment and will potentially allow for efficient allocation of resources and a lower threshold for admission to an intensive care unit, which can prevent the development of MOF and eventually reduce mortality.
       
  • Effects of adjunct treatments on end-organ damage and histological injury
           severity in acute respiratory distress syndrome and multiorgan failure
           caused by smoke inhalation injury and burns
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Jae Hyek Choi, Corina Necsoiu, Daniel Wendorff, Bryan Jordan, Alexander Dixon, Teryn R. Roberts, Brendan M. Beely, Leopoldo C. Cancio, Andriy I. BatchinskyAbstractBackgroundWe investigated effects of mesenchymal stem cells (MSC) or low-flow extracorporeal life support (ECLS) as adjunctive treatments for acute respiratory distress syndrome (ARDS) due to inhalation injury and burns. We hypothesized that these interventions decrease histological end-organ damage.MethodsAnesthetized female swine underwent smoke inhalation injury and 40% TBSA burns, then critical care for 72 h. The following groups were studied: CTR (no injury, n = 4), ICTR (injured untreated, n = 10), Allo (injured treated with allogenic MSC, n = 10), Auto (injured treated with autologous MSC, n = 10), Hemo (injured and treated with the Hemolung low flow ECLS system, n = 9), and Nova (injured and treated with the NovaLung low flow ECLS system, n = 8). Histology scores from lung, kidneys, liver, and jejunum were calculated. Data are presented as means ± SEM.ResultsSurvival at 72 h was 100% in CTR; 40% in ICTR; 50% in Allo; 90% in Auto; 33% in Hemo; 63% in Nova. ARDS developed in 0/10 CTR; 10/10 ICTR; 8/9 Hemo; 5/8 Nova; 9/10 Allo; 6/10 Auto. Diffuse alveolar damage (DAD) was present in all injured groups. MSC groups had significantly lower DAD scores than ICTR animals (Allo 26.6 ± 3.4 and Auto 18.9 ± 1.5 vs. ICTR 46.8 ± 2.1, p 
       
  • Exploring the collagen nanostructure of dermal tissues after injury
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): Feng Tian, Yiwen Niu, Yuzhi JiangAbstractScar often occurred during wound repair. It was known that there were differences in collagen structure in dermal tissues at millimeter scale and micron scale, however, it was not known whether there were differences in collagen structure in dermal tissues at nanoscale during wound repair. In order to compare the difference at nanoscale, skin samples from patients were selected, the control groups were the normal skin from the same patients. These samples were tested by the small angle X-ray scattering techniques (SAXS) and wide angle X-ray scattering (WAXS) techniques. The transmission electron microscopy (TEM) was used as a comparison. The results showed that there were not only significantly differences between the normal tissue and scar tissue, but also between the center and the margin of the scar tissue at nanoscale by SAXS and WAXS, which was not demonstrated by other studies. These findings demonstrated that the SAXS and WAXS were excellent tools to detect the collagen structure at nanoscale and the orientation of the collagen alignment, which was beneficial for skin tissue engineering and skin regenerative medicine.
       
  • An open-label, prospective, randomized, controlled, multicenter, phase 1b
           study of StrataGraft skin tissue versus autografting in patients with deep
           partial-thickness thermal burns
    • Abstract: Publication date: December 2019Source: Burns, Volume 45, Issue 8Author(s): James H. Holmes, Michael J. Schurr, Booker T. King, Kevin Foster, Lee D. Faucher, Mary A. Lokuta, Allen R. Comer, Peggy J. Rooney, Kelly F. Barbeau, Stuart T. Mohoney, Angela L.F. Gibson, B. Lynn Allen-HoffmannAbstractObjectiveThis open-label, controlled, randomized study assessed the safety, tolerability, and efficacy of StrataGraft tissue compared to autograft in the treatment of deep partial-thickness (DPT) burns.MethodsThirty subjects with DPT thermal burns (3%–43% total body surface area) were treated with StrataGraft tissue as follows: cohort 1, ≤220 cm2 refrigerated tissue; cohort 2, ≤440 cm2 refrigerated tissue; and cohort 3, ≤440 cm2 cryopreserved tissue. On each subject, two comparable areas of DPT burn were randomized to receive StrataGraft tissue or autograft. Coprimary end points were the percent area of the StrataGraft tissue treatment site undergoing salvage autografting by Day 28 and wound closure of treatment sites by 3 months.ResultsBy Day 28, no StrataGraft tissue treatment sites underwent autografting. By 3 months, 93% and 100% of the StrataGraft tissue and autograft treatment sites achieved complete wound closure, respectively. No significant differences in observer total and overall opinion POSAS scores between StrataGraft tissue and autograft treatment sites were observed at any timepoint. The most common adverse event was pruritus (17%).ConclusionsStrataGraft tissue treatment of DPT thermal burns reduced the need for autograft, resulted in wound closure and treatment-site cosmesis comparable to that of autograft, and was well tolerated.
       
  • “Mixed messages” — Ongoing confusion with hydrogel dressings in burn
           1st aid. Commentary on the trial report from Holbert et al. 2018/19
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Nicholas Goodwin
       
  • UK tetanus guidelines for burns — Are they irrelevent'
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Karl Walsh
       
  • “The impact of skin allograft on inpatient outcomes in the treatment of
           major burns 20–50% total body surface area — A propensity score
           
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Sarvnaz Sepehripour, Elizabeth Chipp
       
  • A study of Kurdish women’s tragic self-immolation in Iran: A
           qualitative study
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Javad Yoosefi lebni, Morteza Mansourian, Mohammad Hossain Taghdisi, Bahar Khosravi, Arash Ziapour, Gülcan Demir ÖzdenkAbstractSelf-immolation is one of the most painful methods of suicide which is widespread among women in Kurdish regions of Iran. The present study aimed to explore the causes and sociocultural groundwork of choosing self-immolation methods by women in Kurdish regions of Iran.This present study was conducted using a qualitative approach and conventional content analysis. The research population included women who self-immolated and were rescued in Kurdish regions of Iran. The data collection method was a deep interview as well as observation. The sampling method was based on objective and snowball sampling. The data collection continued to theoretical saturation, the number of participants reached 25 in the end, and Lincoln and Guba criteria were used to strengthen the research. From the analysis of the data obtained in this study, the 8 sub-themes related to cause of suicide attempt from the participants’ viewpoints including unbridled coherence, lack of supportive social and environmental structures, economic pressure, aggravation of violence, humiliated ego, dominance of modern values over the local and indigenous ones, incoherent family, and giving up on changing conditions as well as 6 sub themes based on the cause of choosing the method of self-immolation including protesting, frightening the family, catching more attention, championing and showing courage, inducing more guilty feelings in the family and society, fashion or imitation, and easy access were revealed. Self-immolation is one of the most important problems in the Kurdish regions of Iran, which is rooted in various economic, social, psychological and cultural causes. To reduce this social harm, there is a need for comprehensive programs that cover all dimensions.
       
  • Euphorbia honey and garlic: Biological activity and burn wound recovery
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Leila Ait Abderrahim, Khaled Taïbi, Nawel Ait Abderrahim, Mohamed Boussaid, Cesar Rios-Navarro, Amparo Ruiz-SauríAbstractCurrently, chronic wounds and microbial resistance to antibiotics have led to search new healing agents. Combinations of natural products are widely practiced in traditional medicine and exhibited synergistic activity with increased efficacy in treating several pathologies. This study assays the antioxidant, synergistic antimicrobial and burn wound healing activities of Euphorbia honey and Allium sativum (garlic). The minimal inhibitory concentration (MIC) of each natural product was determined against microorganisms commonly found in wound infections. The synergistic antimicrobial effect was assessed by mixing different concentrations of honey and garlic extract below their relative MICs. Subsequently, the antioxidant activity, total phenolic (TPC) and flavonoid (TFC) contents of both natural products and a selected mixture of them were evaluated. Efficacy of that mixture was also evaluated as topical application on male and female Wistar rats skin burn wound, compared to Euphorbia honey and two conventional treatments. Results showed that the mixture honey–A. sativum has synergistic antimicrobial effect against all tested strains. Besides, A. sativum presented higher antioxidant activity along with higher TPC and TFC compared to honey and their mixture. However, the mixture showed higher wound healing activity reflected by shorter epithelialization and wound contraction time, as well as, better histological recovery of the treated tissues. Our results also showed that burn wound healing is not affected by gender. Our findings support the idea of combining natural products as an effective therapy.
       
  • Denatured acellular dermal matrix seeded with bone marrow mesenchymal stem
           cells for wound healing in mice
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Yongjun Qi, Zhengxue Dong, Hongzhen Chu, Qi Zhao, Xiao Wang, Ya Jiao, Hongmin Gong, Yi Pan, Duyin JiangAbstractIt is the basic task of burn therapy to cover the wound with self-healthy skin timely and effectively. However, for patients with extensive burns, autologous skin is usually insufficient, and allogenic or heterogeneous skin leads to strong immune response. It is vital to choose an appropriate treatment for deep extensive burns. Nowadays, the dermal substitute combined with bone marrow mesenchymal stem cells (BM-MSCs) is a prospective strategy for burn wound healing. Denatured acellular dermal matrix (DADM), as one of dermal substitutes, which prepared by burn skin discarded in escharotomy, not only maintains a certain degree of 3D structure of collagen, but also has good biocompatibility. In this study, the preparation method of DADM was improved and DADM was seeded with BM-MSCs. Then BM-MSCs-seeded DADM (DADM/MSCs) was implanted into mice cutaneous wound, and the effect of DADM/MSCs dermal substitute was assessed on skin regeneration. As a result, BM-MSCs survived well and DADM/MSCs scaffolds significantly promoted wound healing in terms of angiogenesis, re-epithelialization and skin appendage regeneration. DADM/MSCs scaffold may represent an alternative promising therapy for wound healing in deep extensive burns.
       
  • Analgesia protocols for burns dressings: Challenges with implementation
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): S.L. Wall, D.L. Clarke, N.L. AllortoAbstractBackgroundThe aim of this study is to compare doctors’ knowledge regarding analgesia in paediatric burns patients in a setting where analgesia protocols are provided but not reinforced to a setting where the same protocols are used but with constant re-enforcement from burns surgeons.MethodsWe reviewed questionnaires completed anonymously by doctors managing burns children in the Pietermaritzburg (PMB) Hospital Complex and the referral hospitals.ResultsThe questionnaire was completed by 43 doctors with 53% of the participants working in the referral hospitals. Procedural sedation was given by 98% of doctors. All PMB doctors giving procedural sedation used ketamine compared to 39% in the referral hospitals, which was statistically significant (×2 = 18.237; p 
       
  • Plasma protein C levels are directly associated with better outcomes in
           patients with severe burns
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Thomas Charles Lang, Ruilong Zhao, Albert Kim, Aruna Wijewardena, John Vandervord, Rachel McGrath, Siobhan Fitzpatrick, Gregory Fulcher, Christopher John JacksonAbstractProtein C circulates in human plasma to regulate inflammation and coagulation. It has shown a crucial role in wound healing in animals, and low plasma levels predict the presence of a wound in diabetic patients. However, no detailed study has measured protein C levels in patients with severe burns over the course of a hospital admission. A severe burn is associated with dysfunction of inflammation and coagulation as well as a significant risk of morbidity and mortality. The current methods of burn assessment have shortcomings in reliability and have limited prognostic value. The discovery of a biomarker that estimates burn severity and predicts clinical events with greater accuracy than current methods may improve management, resource allocation and patient counseling. This is the first study to assess the potential role of protein C as a biomarker of burn severity.We measured the plasma protein C levels of 86 patients immediately following a severe burn, then every three days over the first three weeks of a hospital admission. We also analysed the relationships between burn characteristics, blood test results including plasma protein C levels and clinical events. We used a primary composite outcome of increased support utilisation defined as: a mean intravenous fluid administration volume of five litres or more per day over the first 72 h of admission, a length of stay in the intensive care unit of more than four days, or greater than four surgical procedures during admission. The hypothesis was that low protein C levels would be negatively associated with increased support utilisation.At presentation to hospital after a severe burn, the mean plasma protein C level was 76 ± 20% with a range of 34–130% compared to the normal range of 70–180%. The initial low can be plausibly explained by impaired synthesis, increased degradation and excessive consumption of protein C following a burn. Levels increased gradually over six days then remained at a steady-state until the end of the inpatient study period, day 21. A multivariable regression model (Nagelkerke’s R2 = 0.83) showed that the plasma protein C level on admission contributed the most to the ability of the model to predict increased support utilisation (OR = 0.825 (95% CI = 0.698-0.977), P = 0.025), followed by burn size (OR = 1.252 (95% CI = 1.025–1.530), P = 0.027), burn depth (partial thickness was used as the reference, full thickness OR = 80.499 (1.569–4129.248), P = 0.029), and neutrophil count on admission (OR = 1.532 (95% CI = 0.950–2.473), P = 0.08). Together, these four variables predicted increased support utilisation with 93.2% accuracy, 83.3% sensitivity and 97.6% specificity. However if protein C values were disregarded, only 49.5% of the variance was explained, with 82% accuracy, 63% sensitivity and 91.5% specificity. Thus, protein C may be a useful biomarker of burn severity and study replication will enable validation of these novel findings.
       
  • The adaptation of the Burn Specific Health Scale-Revised (BSHS-R) into the
           Portuguese context
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): A. Silva, J. Marzo, J.A. García del CastilloAbstractThe objective of this study was the adaptation of the Burn Specific Health Scale-Revised (BSHS-R) into the Portuguese context. The authors of the original version of BSHS-R with 31 items are Blalock, Bunker and DeVellis and it was developed to evaluate the health status of burns victims.The Brazilian version of the BSHS-R was translated from Portuguese (Brazil) to Portuguese (Portugal), through a semantic adaptation process, by independent Portuguese-Brazilian specialists, followed by a verbal comprehension assessment of all items, with a heterogeneous group of people, in terms of age, education and occupation.After the survey adaptation to Portuguese (Portugal), a psychometric study of the BSHS-R has been realized with a sample of 92 patients, which had been hospitalized in the Burn, Plastic and Reconstructive Surgery units of the Prelada Hospital, Porto, Portugal. For the process of instrument validation, a factorial exploratory analysis has been conducted and the internal consistency indicators were analysed using Cronbach’s alpha (reliability).The results analysis allowed to assess and identify the validity of the construct through the factorial exploratory analysis, which confirmed the same previous factorial structure identified in the original language and in the Brazilian version. The BSHS-R also presented good internal consistency indicators (global α = .921; affect and body image α = .874; heat sensitivity α = .830; simple functional abilities α = .893; treatment regimens α = .772; work α = .876; interpersonal relationships α = .804).The Portuguese (Portugal) adapted version has revealed useful, valid and reliable for the quality of life assessment related to the health of people that suffered burn injuries.
       
  • Skin wound repair: Results of a pre-clinical study to evaluate electropsun
           collagen–elastin–PCL scaffolds as dermal substitutes.
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Cassandra Chong, Yiwei Wang, Ali Fathi, Roxanne Parungao, Peter K. Maitz, Zhe LiAbstractThe gold standard treatment for severe burn injuries is autologous skin grafting and the use of commercial dermal substitutes. However, resulting skin tissue following treatment usually displays abnormal morphology and functionality including scarring, skin contracture due to the poor elasticity and strength of existing dermal substitutes. In this study, we have developed a triple-polymer scaffold made of collagen–elastin–polycaprolactone (CEP) composite, aiming to enhance the mechanical properties of the scaffold while retaining its biological properties in promoting cell attachment, proliferation and tissue regeneration. The inclusion of elastin was revealed to decrease the stiffness of the scaffold, while also decreasing hysteresis and increasing elasticity. In mice, electrospun collagen–elastin–PCL scaffolds promoted keratinocyte and fibroblast proliferation, tissue integration and accelerated early-stage angiogenesis. Only a mild inflammatory response was observed in the first 2 weeks post-subcutaneous implantation. Our data indicates that the electrospun collagen–elastin–PCL scaffolds could potentially serve as a skin substitute to promote skin cell growth and tissue regeneration after severe burn injury.
       
  • Temperature dissociation of liquids in reusable thermoplastic
           containers—An eco-friendly scald risk'
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): A. Naik, C.J. Lewis, K.P. AllisonAbstractRecent global concern regarding the impact of plastic waste on the environment has resulted in efforts to utilise reusable drink containers. Research is lacking regarding temperature dissociation of drinks in reusable thermoplastic cups. This study aimed to compare the cooling time of two common hot drinks sold at a UK retailer, in the three vessels they are sold; ceramic, disposable paper (with and without lid) and reusable thermoplastic cups (with and without lid). All temperatures were collated from 250 ml volumes of black Americano coffee or café latte in the three different containers. The cooling time was measured every sixty seconds using a standardised digital thermocouple thermometer until a threshold liquid temperature of 43 °C was reached. All experiments were performed in triplicate and temperatures converted to a dimensionless logarithmic scale prior to statistical analysis.Cooling time was significantly slower for lidded cups irrespective of material. Unlidded thermoplastic cups significantly slowed cooling times for both black Americano coffee and café latte compared to ceramic and unlidded disposable paper cups.The growing trend in reusable cups does not in itself pose an increased risk of scald injury. However, we consider that the potentially increased ambulatory behaviour associated with using a lidded rather than unlidded cup may increase scald risk. We propose that further consumer guidance should be disseminated regarding the use of any lidded takeaway container to prevent scalds in both adults and children.
       
  • Incorporation of 3D stereophotogrammetry as a reliable method for
           assessing scar volume in standard clinical practice
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Mitchell Peake, Kristen Pan, R. Maxwell Rotatori, Heather Powell, Laura Fowler, Laura James, Elizabeth DaleAbstractSignificant disfigurement and dysfunction is caused by hypertrophic scarring, a prevalent complication of burn wounds. A lack of objective tools in the assessment of scar parameters makes evaluation of scar treatment modalities difficult. 3D stereophotogrammetry, obtaining measurements from 3D photographs, represents a method to quantitate scar volume, and a 3D camera may have use in clinical practice. To validate this method, scar models were created and photographed with a 3D camera. Measurements from 3D image analysis of these scar models were compared to physical measurements of scar model volume. Reliability of 3D image analysis was assessed with both scar models and burn patient scars. Measurements of scar models by two independent observers were compared to determine inter-rater reliability, and measurements from 3D images of burn patient hypertrophic scars were compared to determine the consistency of the method between observers. The time taken for patient photography was recorded. No significant differences were found between the two methods of volume calculation (p = 0.89), and a plot of the differences showed agreement between the methods. The correlation coefficient between the two observers’ measurements of scar model volume was 0.92, and the intra-class correlation coefficient for patient scar volume was 0.998, showing good reliability. The time required to capture 3D photographs ranged from 2 to 6 min per patient, showing the potential for this tool to be efficiently incorporated into clinical practice. 3D stereophotogrammetry is a valid method to reliably measure scar volume and may be used to objectively measure efficacy of scar treatment modalities to track scar development and resolution.
       
  • Prospective observational study comparing burn surgeons’ estimations of
           wound healing after skin grafting to photo-assisted methods
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): K.S. Koetsier, J.N. Wong, L.A. Muffley, G.J. Carrougher, T.N. Pham, N.S. GibranAbstractIntroductionAppropriate graft healing after split-thickness skin graft and early recognition of complications (graft loss) are critical to burn patient management. Larger mesh ratio expansions and Meek micrografting may pose a greater challenge in estimating the percentage of wound healing. This study looks at the reliability of photograph assessments and the concordance of bedside evaluation to photograph assessments of wound healing after skin grafting.MethodsThree assessment methods for percentage of wound healing after skin Grafting were assessed: (1) clinicians’ bedside rating, (2) clinician assessment of high-definition photographs, and (3) digital image analysis through color subtraction using Adobe Photoshop. We compared each method using a mixed-effects model on absolute agreement using intra-class correlation (ICC) and Bland Altman (BA) plots.ResultsFourteen burn patients were enrolled with 38 grafted wounds (100 sites). Bedside assessments had a mean ICC of 0.64 (compared to digital image analysis) and 0.69 (compared to photo assessment), with a wide range on BA-plots. Inter-rater reliability of photo assessment was excellent (0.96) among six clinicians. Repeated photo-assisted assessments had good intra-rater reliability (ICC: photo assessment: 0.88; digital analysis: 0.97).ConclusionsBedside wound healing assessments show variability; photograph documentation of sequential wound progression could supplement active clinical management or studies for more reliable assessments.
       
  • MRSA colonization and acquisition in the burn unit: A systematic review
           and meta-analysis
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Markos Kalligeros, Fadi Shehadeh, Spyridon A. Karageorgos, Ioannis M. Zacharioudakis, Eleftherios MylonakisAbstractBackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is one of the most commonly encountered bacteria in the burn unit. In order to investigate the magnitude of this challenge, we assessed the prevalence of MRSA colonization on admission and the incidence of MRSA acquisition within burn units.MethodsWe searched PubMed and EMBASE for studies reporting MRSA colonization among patients admitted in burn units.ResultsWe identified 16 articles that fulfilled our inclusion criteria and found an overall pooled prevalence of MRSA colonization upon the first 72 h of admission (colonization on admission) to the burn unit of 4.1% (95% CI: 2.7%–5.7%). MRSA acquisition in studies without a decolonization protocol was 21.2% (95% CI: 13.2%–30.5%) with a statistically significant downward trend over the years. Studies that implemented a decolonization protocol yielded a MRSA acquisition incidence rate of 4.5% (95% CI: 0.9%–10.6%). MRSA acquisition was higher among patients that have had inhalation injury (OR 3.96, 95% CI: 2.51–6.23), flame burns (OR 1.85, 95% CI: 1.25–2.73), or ICU admission (OR 3.12, 95% CI: 2.18–4.47).ConclusionOur study yielded that among burn victims, MRSA colonization prevalence on admission is not negligible and the risk of becoming MRSA colonized during hospitalization is higher when no decolonization protocols are implemented. Flame burns, admission to ICU, and inhalation injury were found to be associated with MRSA acquisition.
       
  • Infant burns: A single institution retrospective review
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): C. Brink, Q. Isaacs, M.F. Scriba, M.E.H. Nathire, H. Rode, R. MartinezAbstractThermal injuries amongst infants are common and a cause of significant mortality and morbidity in South Africa. This has been attributed to the lack of an enabling environment (poverty-related lack of safe living conditions) and the cognitive and physical developmental immaturity of infants, who depend on their surroundings and adults to keep them safe. This is a retrospective observational study of 548 infant admissions over 48 months. Infant was defined as children below 13 months of age. The 548 infants constituted 23% of all paediatric burn admissions of ages 0–12 years. Three hundred and fourteen were males (57%) and 234 (42.7%) females. The infants were divided in a pre-ambulatory group of 143 (26%) infants of 0–6 months and an ambulatory group of 7 months to 12 months consisting of 457 (83.3%). The total body surface area (TBSA) ranged from 2–65%. Seventy-six percent (417 infants) occurred in the home environment. Scalds accounted for 86% (471 infants) and 6% (33 infants) were as a result of flame burns. Non-accidental injuries accounted for 1.2%. The anatomical distributions varied between the pre-ambulatory and ambulatory groups. Conservative management was done in 397 (72.4%) and 101(18.4%) infants underwent surgery. Infection was suspected in 76 (13.5%) infants with positive blood cultures in 15(20%) of the 76. ICU care was received in 46 (8.3%) infants and 15 (32.6%) of these had inhalation injuries. Of the inhalation injuries 11(23.9%) infants underwent mechanical ventilation of an average of 4.4 days. Ventilator associated pneumonia was diagnosed in 8(17%) of the ventilated children. The mortality rate was 0.36%. The surgically treated patients acquired more complications than the conservatively treated group. Special treatment considerations should be considered in this paediatric sub-group.
       
  • Dakin’s Solution: “One of the most important and far-reaching
           contributions to the armamentarium of the surgeons”
    • Abstract: Publication date: November 2019Source: Burns, Volume 45, Issue 7Author(s): Jeremias Georgiadis, Vanessa B. Nascimento, Catherine Donat, Ikenna Okereke, Mohammadali M. ShojaAbstractHenry Drysdale Dakin is a notable person in the history of surgery, wound care, military medicine and infectious disease control. Dakin is an exemplar scientist who in the midst of war forged an international collaboration with scientists in multiple fields to create and universalize an antiseptic utopia, which saved thousands lives during World War I, remarkably diminished functional disabilities from wounds and continues to be a “far-reaching armamentarium” of the surgeons and wound care specialists around the globe. Dakin investigated over 200 different antiseptic substances to finally conclude that a 0.5% buffered sodium hypochlorite solution satisfies his criteria for an ideal antiseptic. The only potential limitation was that the germicidal property of the solution was short lived, which meant the solution had to be used continuously or repeatedly delivered into wounds. Dakin’s solution, still in use by modern wound care specialists around the globe, has laid the foundation for wound care management as we know it today. Nevertheless, Dakin contributed more to science than just his solution. In this article, Dakin’s life story, his unique scientific career and his contributions to surgical literature are explored. The article also illustrates how a wartime necessity resulted in a medical discovery that is still in use to date.
       
  • Efficacy of new cephalosporins in treatment of multidrug-resistant strains
           of gram-negative bacteria in burn patients
    • Abstract: Publication date: Available online 26 August 2019Source: BurnsAuthor(s): Břetislav Lipový, Markéta Hanslianová
       
  • Psychiatric needs for self-inflicted burn patients in developing
           countries: A call for action
    • Abstract: Publication date: Available online 25 August 2019Source: BurnsAuthor(s): Leeba Rezaie, David C. Schwebel
       
  • The use of 3D stereophotographic systems as an objective tool in scar
           assessment
    • Abstract: Publication date: Available online 22 August 2019Source: BurnsAuthor(s): Isabelle Sawetz, David B. Lumenta, Lars-Peter Kamolz
       
  • Efficacy of newer β lactams/ β lactamase inhibitors for treatment of
           multidrug resistant gram negative infections in burn patients
    • Abstract: Publication date: Available online 22 August 2019Source: BurnsAuthor(s): Kavita Gupta, Saroj Dash
       
  • Development and pilot of a burns-specific patient-reported experience
           measure
    • Abstract: Publication date: Available online 17 August 2019Source: BurnsAuthor(s): E.L. Hodgkinson, P. Boullin, S. Heary, B. GrantAbstractPatient –reported experience measures (PREMs) are a valuable tool in assessing patient’s subjective experiences within healthcare settings. They assist the evaluation and development of clinical services, and could be considered most useful when they assess elements of care pertinent to the specific health condition or clinical service. Currently there is no existing PREM to assess this in an NHS burns service. In the current project, a burns-specific PREM was created by identifying pre-existing condition specific PREMs in the literature and selecting key items pertinent to burn care for use in a brief questionnaire tool adapted in multiple versions to patient age and care setting. The measure was reviewed by the burns multidisciplinary team and piloted with patients attending the service. Twenty-seven participants completed the measure alongside an evaluation tool briefly assessing clarity, relevance and acceptability. While small, this pilot suggested that patients found the measure acceptable to complete and relevant to their care. It also yielded information not currently assessed by the service in any other format, appearing to promise utility for service development activities. Further work is needed to validate the tool and determine how its use could be implemented at a local and national level.
       
  • A global task force is needed for preventing self-immolation
    • Abstract: Publication date: Available online 17 August 2019Source: BurnsAuthor(s): Mohsen Rezaeian
       
  • How reliable is the charred body scale' An interobserver reliability
           study on scoring burned remains
    • Abstract: Publication date: Available online 14 August 2019Source: BurnsAuthor(s): C.A. KeyesAbstractThe error rates of forensic techniques need to be evaluated. The charred body scale is a method for quantifying the level of decomposition in burned remains. 51 files containing photographs of burned pigs at different stages of decomposition were scored by nine participants. Each pig in the photographs was uniformly burned to a different level (Crow Glassman Scale levels 1 to 3). The Crow Glassman Scale describes five levels of burns that include singing of hair and epidermal blistering (CGS level 1) up to complete cremation of the body reducing it to ash (CGS level 5). The three CGS levels were selected to isolate potential scoring errors that may be caused by different burn levels (not accounted for in the development of the charred body scale). Each of the 51 photograph files was scored by participants using the charred body scale as if it were a unique forensic case at an unknown initial burn level and decomposition stage. Interobserver error, hence reliability, of the scores was tested using individual and average absolute agreement interclass correlations. The charred body scale is reliable for remains burned to a Crow Glassman Scale level 1 but not in higher burn levels. It is suggested that a universal scoring method be developed that accounts for multiple burn levels in a single case.
       
  • It is the time to consider an important IV solutions incompatibility in
           the fluid resuscitation of burn patients
    • Abstract: Publication date: Available online 10 August 2019Source: BurnsAuthor(s): Naemeh Nikvarz
       
  • The Brisbane Burn Scar Impact Profile (child and young person version) for
           measuring health-related quality of life in children with burn scars: A
           longitudinal cohort study of reliability, validity and responsiveness
    • Abstract: Publication date: Available online 3 August 2019Source: BurnsAuthor(s): M. Simons, R. Kimble, S. McPhail, Z. TyackAbstractBackgroundClinical practice benefits from the measurement of health-related quality of life (HRQoL) to reflect the impact of the disease and treatments from the patient’s lived experience. The Brisbane Burn Scar Impact Profile (child and young person version, BBSIP8−18), developed in 2013, is a self-report measure of burn scar-specific HRQoL. The purpose of the study was to test reliability, validity and responsiveness of this measure for an evaluative purpose.MethodsYoung people aged 8–18 years with burn scarring or at probable risk of burn scarring (defined as 14 days or longer to re-epithelialize) were included in a prospective, longitudinal cohort study. Data was collected at a paediatric burn centre at baseline (when ≥85% of the total body surface area re- epithelialized), then 1–2 weeks and 1-month post-baseline. Participants completed measures of HRQoL (BBSIP8−18, Pediatric Quality of Life Inventory) and scar characteristics (Patient Observer Scar Assessment Scale) at each time-point.ResultsSixty-five participants completed the baseline testing. Forty-nine participants completed testing at 1–2 weeks post-baseline and thirty-two at 1-month post-baseline. Internal consistency of item groups ranged from Cronbach’s α 0.60 (frequency of sensory symptoms) to 0.90 (emotional reactions). All item groups expected to be stable had acceptable test-retest reliability (ICC = 0.71–0.83), except ‘mobility’ and ‘friendships and social interaction’ (ICC = 0.52 and 0.45). Construct validity was supported with 10 of 13 (77%) hypothesised correlations of change in the BBSIP8−18 items corresponding with changes in external criterion measures. The responsiveness of 8 out of 10 item groups tested against an external criterion was supported (AUC = 0.71–0.92).ConclusionThe BBSIP8−18 has acceptable reliability, validity and responsiveness supporting its use as an evaluative self-report measure of burn scar-specific HRQoL in the early post-acute phase after burn injury.
       
  • Do we care enough about quality of life in burn patients'
    • Abstract: Publication date: Available online 2 August 2019Source: BurnsAuthor(s): P. Queruel, V. Chauvineau, M.-N. Bartholomei, I. Cochard, M.T. Galledou, B. Renaut
       
 
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