Management Of Burns Research Articles

Old Wine in new Bottles: Silver Sulfadiazine Nanotherapeutics for Burn Wound Management.

According to the World Health Organization (WHO), ∼180,000 casualties are recorded every year due to burns, majorly from low- and middle-income countries that require medical attention. For the last 5 decades, silver sulfadiazine (SSD) 1% cream has been the most widely used topical antimicrobial agent for managing burn wound infections. Although SSD is considered the gold standard therapy in burn wound management, however in the last 10 years, several studies have reported the negative impact of SSD on the wound healing process. The therapeutic potential of SSD is restricted by its poor solubility, and antimicrobial action appears only after the dissociation of SSD into silver ions (Ag+) and sulfadiazine (SD). Pharmaceutical researchers and industries are looking for alternative strategies to overcome the challenges and limitations of the available SSD formulation due to rising costs, extensive time commitment, and the high risk of failure associated with the de novo development of new antimicrobial drugs. Recent advances in drug delivery systems nanotechnology-based strategies have had a colossal impact on them, particularly in burn wound management. Nanoparticulate systems and nanotools could be considered as potential drug delivery approaches for burn management. This contemporary review provides an abridgment of the literature on advanced SSD nanotherapeutics and their importance in managing burns.

High-dose intravenous versus low-dose oral vitamin C in burn care: potential protective effects in the severely burned: a retrospective cohort study.

The hospital burn database was used to obtain data on all patients with second-degree or deeper burns of 20% total-body-surface-area or greater. Fourteen patients were selected at random to receive a scheduled dose of 1250mg intravenous ascorbic acid every 6h for 72h. This was considered the high-dose group. During same period, 40 patients received scheduled 500mg oral ascorbic acid every 6h for 72h and this was considered the low-dose group. We gathered sociodemographic and clinical variables associated with ascorbic acid dosing. In our study, statistically significant variables were fluid requirements (p<0.001), hospital stay (p=0.011), length of time intubated on ventilator (p<0.001), colloids used (p=0.002), and total procedures required (p=0.014). Despite higher modified Baux predicted mortality in the high-dose group (10 patients vs. 24 patients, p=0.026) there was no noted significant association in days until the first infection and mortality rate (p=0.451 and 0.326, respectively). The calculated modified Baux predicted a higher mortality rate with the higher dosing group, yet this study did not find a mortality difference between the groups. We speculate that high-dose intravenous ascorbic acid may have protective effects in burn resuscitation. This finding may support some previous studies that found that high-dose ascorbic acid may improve clinical outcomes.

Management of burns in a major trauma centre

A key factor in attracting plastic surgeons to burn care is to commit to the development of a comprehensive service, writes Heather Cleland.

A Pilot Randomised Controlled Trial Evaluating a Regenerative Epithelial Suspension for Medium-Size Partial-Thickness Burns in Children: The BRACS Trial

Background: There is little evidence regarding the efficacy of Regenerative Epidermal Suspension (RES™) management for paediatric partial-thickness burns. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) Trial evaluated three dressings for the re-epithelialisation of partial-thickness burns in children. Methods: Eligible children (age ≤ 16 years; ≥5% TBSA; ≤48 h of injury) were randomised to silver dressings, RES™/Biobrane® or Biobrane®. The measured outcomes were the time to re-epithelialisation (primary outcome), pain, itch, intervention fidelity, treatment satisfaction, health-related quality of life, health resource utilisation and adverse effects. Results: The median time to re-epithelialisation in days was no different for RES™/Biobrane® at 12 (IQR: 5.6–18.4; n = 7) and slower by two days for Biobrane® at 14 (IQR: 6.3–21.7; n = 7) when compared to silver dressings 12 (IQR: 3.7–20.3; n = 8). Reduced pain, fewer infections, no sepsis, no skin graft, and the lowest impact on health-related quality of life were reported in the RES™/Biobrane® group compared to other groups. Due to the COVID-19 pandemic, recruitment suspension resulted in a smaller cohort than expected and an underpowered study. Conclusions: The pilot trial findings should be interpreted cautiously; however, they indicate that a fully powered randomised controlled trial is warranted to substantiate the role of RES™ for medium to large paediatric partial-thickness burn management.

Emergency burn education: Evaluating a surgical simulation-based intervention

Medical simulation has provided favorable outcomes in the improvement of clinical competence at both the undergraduate and postgraduate levels. The recall of information demonstrably increases when it has been taught in environments similar to the workplace. This study aimed to evaluate the role of a one-day burn simulation session in improving students' knowledge of burn management and interest in plastic surgery as a specialty. A one-day course was designed to deliver multiple lectures covering surgical topics such as the classification and management of burns, followed by a series of practical workshops. Participants were instructed to undergo a pre-course knowledge assessment and a survey focusing on interest in plastic surgery. Students were subsequently instructed to complete a post-course assessment and a survey of knowledge and confidence in managing burns as well as interest in plastic surgery both immediately and 6 weeks post-course. The students' knowledge demonstrated a 54.2% increase in the post-course assessment (p<0.01). 27% of participants (n=14) participated in a 6-week post-course quiz. The knowledge assessment of these participants at 6 weeks post-course also demonstrated a sustained increase of 61.0% (p<0.01). Interest in plastic surgery was increased by 31.4% post-course (p<0.01). At 6 weeks post-course, a sustained increase of 14.7% was demonstrated in comparison to pre-course data (p=0.03). Simulation teaching provides good outcomes in both information retention and interest in plastic surgery as a specialty. Therefore, medical school curriculums may benefit from including burn simulations.

Research advances on the application of music therapy in pain management of children with burns

Pain after burns is a very common problem in children. Severe pain will not only hinder treatment, but also damage children's mental health if not handled in time. Therefore, pain management is very important in treating children with burns. As a safe, effective, and convenient non-drug therapy, music therapy has great advantages in relieving pain and is widely used in a variety of clinical fields. This paper focused on music therapy and its mechanism of pain relief, the current status of research on pain management of pediatric burns, the application and prospect of music therapy in pain management of pediatric burns, etc., to provide reference for clinical application.

Knowledge and Practice of Burn Management Among Physicians Using Burn Manikin in Ha'il, Kingdom of Saudi Arabia.

Background Burn is a skin injury that results in the death of the impacted cells. Burn injuries are frequently unintentional and very avoidable. With proper management, the outcome is improved, and the need for surgical intervention is reduced. This article discusses healthcare providers' knowledge and practice of burn first aid and management to highlight the need for the enhanced practice of burn management and first-aid skills. Objective This study aims to assess the knowledge and practice of burn injuries management among healthcare workers in different specialties in Hail city. Methods A cross-sectional study was conducted via an interviewer-administrated face-to-face questionnaire and video recording of a simulated case of burn injury collected from our skill lab at Hail University and evaluated by a board-certified plastic surgeon. Result The study analyzed 119 physicians (mean age = 36.3 years, SD = 6.7) managing burn cases. Of these, 59.7% were male, and 40.3% were female. The mean evaluation score was 7.71 (SD = 2.84). None of the factors studied, including gender (p = 0.353), age (p = 0.970), education level (p = 0.127), specialty (p = 0.871), professional experience (p = 0.118), working sector (p = 0.178), nationality (p = 0.742), or participation in burn management course (p = 0.131), had a significant effect on burn management skills of physicians. However, some groups had higher mean evaluation scores than others. Further research is needed to explore potential reasons for the observed differences in mean evaluation scores among different groups of physicians. Conclusion We discovered that most physicians were found to have poor practical knowledge of proper burn management, and most of them had not engaged in a burn first aid training, therefore more courses targeting physicians who may meet burn patients are required.

Role of Cyclic Negative Pressure Wound Therapy (NPWT) in Pediatric Scald Burn

Burns and related injuries are common causes of death and disability. The highest incidences of burn cases occur in children and adults. In children less than 2 years of age, contact with hot surfaces and scald burns are the most common presentation to the hospital. The practice of cooking at ground level or sleeping with a burning lamp are some of the causes. Early management of this type of burn results in better outcomes. In this case we describe the role of negative pressure wound therapy (NPWT) as an adjuvant in the management of paediatric thermal burns.

Valuing the benefits of forest restoration on enhancing hydropower and water supply in California's Sierra Nevada

Forest restoration through mechanical thinning, prescribed burning, and other management actions is vital to improving forest resilience to fire and drought across the Western United States, and yields benefits that can be monetized, including improvements in water supply and hydropower. Using California's Sierra Nevada as a study area, we assess the water and energy benefits of forest-restoration projects. By using a scalable top-down approach to track annual evapotranspiration following forest disturbance, coupled with hydropower simulations that include energy-price information, and marginal prices for water sales, we project the potential economic benefits of hydropower and water sales accruing to water-rights holders. The results found that water-related benefits from strategically planned fuels-reduction treatments now being carried out can be sufficient to offset costs of management actions aimed at forest restoration, especially in the face of climate change. Our findings justified investments in restoring forests and reinforce the central role of water and hydropower providers in partnerships for management of source-water watersheds. Results also highlighted the importance of accurate, scalable data and tools from the hydrology and water-resources community.

A comparative study of outcomes of burns across multiple levels of care

BackgroundBurn injuries are a significant contributor to the burden of diseases. The management of burns at specialised burn centres has been shown to improve survival. However, in low- and middle-income countries (LMICs) major burns are managed at non-specialised burn centres due to resource constraints. There is insufficient data on survival from treatment at non-specialised burn centres in LMICs. This study aimed to compare the outcomes of burns treatment between a specialised burn centre and five non-specialised centres. MethodsA prospective cohort study was conducted on patients aged 18 years or above from January 1, 2021 to September 30, 2021. Participants were selected from the admission register at the emergency department. All burns irrespective of the mechanism of injury or %TBSA were included. Data were entered into REDCap. Statistical analysis of outcomes such as positive blood culture, length of hospital stay (LOHS) and 90-day mortality between specialised burn versus non-specialised centres was performed. Furthermore, an analysis of risk factors for mortality was performed and survival data computed. ResultsOf the 488 study participants, 36% were admitted to a specialised burn centre compared to 64% admitted to non-specialised centres. The demographic characteristics were similar between centres. Patients at the specialised burn centre compared to non-specialised centres had a significantly higher inhalation injury of 30.9% vs 7.7% (p < 0.001), > 10%TBSA at 83.4% vs 45.7% (p < 0.001), > 20%TBSA at 46.9% vs 16.6% (p < 0.001), and a median (IQR) ABSI score of 6 (5−7) vs 5 (4−6) (p < 0.0001). Furthermore, patients from specialised burn vs non-specialised centres had a longer median (IQR) time from injury to first burn excision at 7 (4−11) vs 5 (2−10) days, higher rate of burn sepsis 69% vs 35%, increased LOHS 17 (11−27) vs 12 (6−22) days, and 90-day mortality rates at 19.4% vs 6.4%. After adjusting for cofounding variables, survival data showed no difference between specialised burn and non-specialised centres (HR 1.8 95% CI 1.0–3.2, p = 0.05). ConclusionAlthough it appears that the survival of burn patients managed at non-specialised centres in a middle-income country is comparable to those managed at specialised burn centres, there is uncounted bias in our survival data. Hence, a change in practice is not advocated. However, due to resource constraint specialised burn centres in addition to managing major burns should provide training and support to the non-specialised centres.

Slash and burn management and permanent or rotation agroforestry systems: A comparative study for C sequestration by century model simulation

Understanding the effects of agroforestry systems (AFs) on soil organic carbon (SOC) requires long-term experiments, but scenarios simulations can anticipate the potential of these systems to sequester or lose carbon (C). This study aimed to simulate the SOC dynamics in slash and burn management (BURN) and AFs using the Century model. Data from a long-term experiment implemented in the Brazilian semiarid region were used to simulate SOC dynamics under BURN and AFs situations, and the natural vegetation (NV) “Caatinga” as a reference. BURN scenarios considered different fallow periods (0, 7, 15, 30, 50 and 100 years) among cultivation of the same area. The two types of AFs (agrosilvopastoral-AGP and silvopastoral-SILV) were simulated in two contrasting conditions: (i) each one of the AFs and also NV area were permanently conducted with no rotation among these areas; and (ii) the two AFs and NV rotated among them every 7 years. The correlation coefficients (r), coefficients of determination (CD) and coefficients of residual mass (CRM) showed adequate performance, meaning that the Century model is able to reproduce the SOC stocks in the slash and burn management and AFs situations. The equilibrium points of NV SOC stocks stabilized around 30.3 Mg ha−1, as similar to the measured average of 28.4 Mg ha−1 at field conditions. The adoption of BURN without a fallow period (0 years) resulted in a reduction of 50% of SOC, approximately 20 Mg ha−1, after the first 10 years. Permanent (p) and rotating (r) AFs management systems recovered (in 10 years) fast to the original SOC stocks, resulting in higher SOC stocks than NV SOC at equilibrium. The fallow period of 50 years is necessary to recovery SOC stocks in the Caatinga biome. The simulation shows that the AFs systems increase more SOC stocks than observed in natural vegetation in long-term.

Experimentally Induced Burns in Rats Treated with Innovative Polymeric Films Type Therapies.

Considering that microbial resistance to antibiotics is becoming an increasingly widespread problem, burn management, which usually includes the use of topical antimicrobial dressings, is still facing difficulties regarding their efficiency to ensure rapid healing. In this context, the main objective of this research is to include new oxytetracycline derivatives in polymeric-film-type dressings for the treatment of wounds caused by experimentally induced burns in rats. The structural and physico-chemical properties of synthesized oxytetracycline derivatives and the corresponding membranes were analyzed by FT-IR and MS spectroscopy, swelling ability and biodegradation capacity. In vitro antimicrobial activity using Gram-positive and Gram-negative bacterial strains and pathogenic yeasts, along with an in vivo study of a burn wound model induced in Wistar rats, was also analyzed. The newly obtained polymeric films, namely chitosan-oxytetracycline derivative membranes, showed good antimicrobial activity noticed in the tested strains, a membrane swelling ratio (MSR) of up to 1578% in acidic conditions and a biodegradation rate of up to 15.7% on day 7 of testing, which are important required characteristics for the tissue regeneration process, after the production of a burn. The in vivo study proved that chitosan-derived oxytetracycline membranes showed also improved healing effects which contributes to supporting the idea of using them for the treatment of wounds caused by burns.

Association of age with perioperative morbidity among patients undergoing surgical management of minor burns.

Burn injuries are associated with significant morbidity, often necessitating surgical management. Older patients are more prone to burns and more vulnerable to complications following major burns. While the relationship between senescence and major burns has already been thoroughly investigated, the role of age in minor burns remains unclear. To better understand differences between elderly and younger patients with predominantly minor burns, we analyzed a multi-institutional database. We reviewed the 2008-2020 ACS-NSQIP database to identify patients who had suffered burns according to ICD coding and underwent initial burn surgery. We found 460 patients, of which 283 (62%) were male and 177 (38%) were female. The mean age of the study cohort was 46 ± 17 years, with nearly one-fourth (n = 108; 23%) of all patients being aged ≥60 years. While the majority (n= 293; 64%) suffered from third-degree burns, 22% (n = 99) and 15% (n = 68) were diagnosed with second-degree burns and unspecified burns, respectively. An average operation time of 46 min, a low mortality rate of 0.2% (n = 1), a short mean length of hospital stay (1 day), and an equal distribution of in- and outpatient care (51%, n = 234 and 49%, n = 226, respectively) indicated that the vast majority of patients suffered from minor burns. Patients aged ≥60 years showed a significantly prolonged length of hospital stay (p<0.0001) and were significantly more prone to non-home discharge (p<0.0001). In univariate analysis, advanced age was found to be a predictor of surgical complications (p= 0.001) and medical complications (p = 0.0007). Elevated levels of blood urea nitrogen (p>0.0001), creatinine (p>0.0001), white blood cell count (p=0.02), partial thromboplastin time (p = 0.004), and lower levels of albumin (p= 0.0009) and hematocrit (p>0.0001) were identified as risk factors for the occurrence of any complication. Further, complications were more frequent among patients with lower body burns. In conclusion, patients ≥60 years undergoing surgery for predominantly minor burns experienced significantly more complications. Minor lower body burns correlated with worse outcomes and a higher incidence of adverse events. Decreased levels of serum albumin and hematocrit and elevated values of blood urea nitrogen, creatinine, white blood count, and partial thromboplastin time were identified as predictive risk factors for complications.

Multidisciplinary staff perceived barriers and enablers to early mobilization of patients with burns in the ICU

BackgroundComplex challenges face clinicians managing critically ill patients with burns, particularly in the context of enhancing outcomes after a stay in ICU. Compounding this, a dearth of research explores the specific and modifiable factors that impact early mobilization in the ICU environment. AimTo explore the barriers and enablers of early functional mobilization for patients with burns in the ICU from a multidisciplinary perspective. DesignA qualitative phenomenological study. MethodsSemi-structured interviews supplemented by online questionnaires conducted with 12 multidisciplinary clinicians (four doctors, three nurses and five physical therapists) who previously managed burn patients at a quaternary level ICU. Data were thematically analysed. ResultsFour main themes: patient, ICU clinicians, the workplace and the physical therapist were identified as impacting on early mobilization. Subthemes identified barriers or enablers to mobilization but all were strongly influenced by overarching theme of the clinician’s “emotional filter.” Barriers included high levels of pain, heavy sedation and low levels of clinician exposure to treating patients with burns. Enablers included higher levels of clinician’s experience and knowledge about burn management and benefits of early mobilization; increased coordinated staff resources when undertaking mobilization; and, open communication and positive culture towards early mobilization across the multidisciplinary team. ConclusionPatient, clinician and workplace barriers and enablers were identified to influencing the likelihood of achieving early mobilization of patients with burns in the ICU. Emotional support for staff through multidisciplinary collaboration and development of structured burns training program were key recommendations to address barriers and strengthen enablers to early mobilization of patients with burns in the ICU.

Introducing the "SIMline"-A Simulation Course in the Management of Severe Burns as a Tool in Undergraduate Medical Education.

Background: Management of burn injuries presents a complex and challenging situation for medical staff, especially for inexperienced young doctors. However, training on how to treat burn victims in the clinical setting is rarely taught in undergraduate medical classes. We have created the "SIMline", a simulation training program explicitly designed for coaching medical students in burn management. Methods: A total of 43 students participated in the "SIMline" course, which took place at the training facility at the Medical University of Graz, between 2018 and 2019. The course provided theoretical classes, practical exercises, and a full-scale care process simulation training. The learning progress of the students was monitored via a formative integrated test. Results: Students showed great progress throughout the course of the "SIMline" program, as their test scores improved by an average of 88%. The passing rate was 0% at the first exam (prior to course) as compared to 87% at the final exam, taken after the training. Conclusions: Comprehensive practical training programs in burn care are underrepresented in medical education. The "SIMline" course presents a novel and effective approach in training medical students in burn management. However, follow-up evaluation is necessary to confirm long-term educational benefits.

Current clinical practice of orofacial contracture management in head and neck burn patients among physical therapists of Hyderabad.

To evaluate the current clinical practices of orofacial contracture management among physical therapists dealing with head and neck burn patients. The cross-sectional observational study was conducted at the Isra Institute of Rehabilitation Sciences, Hyderabad, Pakistan, from May 14 to December 31, 2021, and comprised physical therapists working in different hospitals and clinics and having clinical experience >1 year. Data was collected using a questionnaire based on literature which included questions related to demographics, service provision, clinical training, orofacial burn wound assessment, orofacial contracture intervention and outcome measurement in multiple choice, dichotomous or open response formats. Data was analysed using SPSS 22. Of the 100 subjects, 38(38%) were males and 62(62%) were females, while 71(71%) were aged 20-30 years, 22(22%) were aged 31-40 years, and 7(7%) were aged 41-50 years. Besides, 57(57%) physical therapists used stretching/exercise in the management of superficial-partial thickness burn, while 49(49%) used it in deep-partial thickness burn, and 44(44%) in full-thickness burn. Also, 43(43%) therapists used presence or maturation of the scar tissue as the indicator to escalate/reduce the intensity of the treatment. Regarding splinting, 49(49%) therapists used it on the 5th day of grafting and 35(35%) used it after complete healing. There was minimal knowledge regarding the use of specific interventions and specific regimes at particular stages.

Treatment of Pediatric Upper Extremity Burns

Pediatric upper extremity burns are common. There is significant literature outlining the treatment of surgical hand burns; however, the appropriate treatment of nonoperative burns is less well described. Options for treatment are plentiful, and choosing an ideal strategy requires consideration of numerous factors. At our center, pediatric upper extremity burns are managed using a multidisciplinary approach. This topical review outlines the management of pediatric upper extremity burns. We focus on the management of nonoperative burns, but additional information is provided outlining the indications for and techniques of operative management for more severe burns.

ANALISIS FAKTOR YANG MEMPENGARUHI KEMAMPUAN PERTOLONGAN PERTAMA LUKA BAKAR SETELAH PEMBERIAN EDUKASI

Burns are one type of wound caused by extreme temperatures or heat that occurs in human activities. Good or bad first aid for burns is greatly influenced by each person. is to analyze the factors that most influence the community's ability to perform first aid for burns in Campur Village, Gondang District, Nganjuk Regency. The research design in this study was logistic regression. The sample size of 40 respondents was selected by purposive sampling, the data were analyzed using logistic regression tests. The results of the logistic regression test showed that the educational factor resulted in a p-value of 0.000 with an OR of 0.192 and a 95% CI of 0.14 – 2.622, which means that education is the factor that most influences the ability of first aid in the management of burns. A person's level of education can affect the process of learning. A person who has a high level of education has more knowledge. The level of education can affect a person's ability to perform first aid for burns. Through education, a person will get more knowledge. A person's educational level relates to the person's ability to understand the information received.

Burn injury characteristics, referral pattern, treatment (costs), and outcome in burn patients admitted to a hospital with or without a specialized Burn Centre (BURN-Pro)

PurposeData on the epidemiology, treatment, and outcome of burn patients treated at non-burn centre hospitals are not available. The primary aim was to compare the burn characteristics of patients admitted to a hospital with or without a specialized burn centre.MethodsThis multicentre, prospective, cohort study enrolled patients with burns admitted to a hospital without a burn centre and patients with < 10% total body surface area (TBSA) burned admitted to the burn centre. Primary outcome measure was the burn-related injury characteristics. Secondary outcome measures were adherence to the Emergency Management of Severe Burns (EMSB) referral criteria, treatment (costs), quality of life, and scar quality.ResultsDuring the 2-year study period, 48 patients were admitted to a non-burn centre and 148 patients to the burn centre. In the non-burn centre group, age [44 (P25–P75 26–61) versus 30 (P25–P75 8–52) years; P = 0.007] and Injury Severity Score [2 (P25–P75 1–4) versus 1 (P25–P75 1–1); P < 0.001] were higher. In the burn centre group, the TBSA burned was significantly higher [4% (P25–P75 2–6) versus 2% (P25–P75 1–4); P = 0.001], and more surgical procedures were performed (in 54 versus 7 patients; P = 0.004). At 12 months, > 85% of the non-burn centre group and > 75% of the burn centre group reported no problems in quality of life. Scar quality score was < 1.5 in both groups, with significantly poorer scores in the burn centre group (P ≤ 0.007).ConclusionBoth groups differed in patient, burn, and treatment characteristics. At 12 months, quality of life and scar quality were good in both groups. Significantly poorer scar quality scores were found in the burn centre group. This might be related to their larger burns and more frequent surgery. The organization of burn care in the Netherlands seems to work adequately. Patients are treated locally when possible and are transferred when necessary.

Epidemiological features and management of eye burn patients in Wuxi, China

BackgroundThe current study aimed to analyse epidemiological data on eye burns in Wuxi, China, for the years 2015–2021, and to provide insight into the development of appropriate prevention strategies.MethodsA retrospective...