Patient Safety in Burn Care: Application of Evidence-based Medicine to Improve Outcomes

Dry Needling and Acupuncture for Scars-A Systematic Review

Objectives: This research aims to synthesize existing data on the evidence gap in scar treatment and evaluate the effectiveness of acupuncture and dry needling in treating scars and related symptoms. Methods: The article adhered to the PRISMA 2020 statement for recommended reporting elements in systematic reviews. The inclusion criteria followed the PICO methodology. The literature search was conducted using databases including PubMed, Cochrane Library, Semantic Scholar, Europe PubMed Central, and Google Scholar. Studies on acupuncture and dry needling for scar treatment were included. Because of the diversity of the studies' results and methodologies, a systematic review was conducted to organize and describe the findings without attempting a numerical synthesis. Results: Nineteen studies relevant to the article's theme were identified, with eleven selected for detailed review. The studies included two case reports on dry needling, one case series on dry needling, five case reports on acupuncture, two randomized controlled trials on acupuncture, and one case report on Fu's subcutaneous needling. A quality assessment was conducted using the JBI CAT and PEDro scales. Four case reports scored 7 points, one case scored 8 points, three cases were rated 6 points or lower, the case series was rated 6 points, and the randomized controlled trials scored 8 and 5 points. Most studies demonstrated a desired therapeutic effect in scar treatment with acupuncture and dry needling, but the level of evidence varied across studies. The analysis does not conclusively support the use of acupuncture and dry needling to improve scar conditions. Conclusions: Although dry-needling and acupuncture techniques are popular in physiotherapy, adequate scientific evidence is currently not available to support their effectiveness in scar treatment. There are gaps in the research methodology, a lack of randomized trials, and significant heterogeneity in the assessment of effects.

A Systematic Review of Quality Improvement Interventions in Burn Care

Quality improvement interventions (QIIs) are intended to improve the care of patients. Unlike most traditional clinical research, these endeavors emphasize the sustainable implementation of scientific evidence rather than the establishment of evidence. Our purpose was to conduct a systematic review of QII publications in the field of burn care. A systematic review was conducted utilizing electronic databases (MEDLINE, Embase, and Cochrane Library) of all studies relating to "quality improvement" in burn care published until March 31, 2020. Studies were excluded if no baseline data were reported, or if no intervention was applied and tested. Studies were scored using a novel 10-point evaluation system for QII. We evaluated 414 studies involving "quality improvement" in burn care. Only 82 studies contained a QII while 332 studies were categorized as traditional research. Several traditional research studies made claims to be QIIs, but few met the criteria. Of the 82 QII references, only 20 (24%) were accessible as full-text manuscripts, the remainder were published as abstracts only. The mean score was 7.95 for full-text studies (range 6-10) and 7.4 for abstract-only studies (range 5.5-9.5). Despite the importance of quality improvement (QI) in burn care, very few studies have been published that employ true QI methodology, and many QII studies never advance beyond publication as abstracts in conference proceedings. Based on this systematic review, we propose guidelines to improve the quality of QII submissions.

Mesenchymal Stromal Cell Preconditioning: The Next Step Toward a Customized Treatment For Severe Burn

Over the last century, the clinical management of severe skin burns significantly progressed with the development of burn care units, topical antimicrobials, resuscitation methods, early eschar excision surgeries, and skin grafts. Despite these considerable advances, the present treatment of severe burns remains burdensome, and patients are highly susceptible to skin engraftment failure, infections, organ dysfunction, and hypertrophic scarring. Recent researches have focused on mesenchymal stromal cell (MSC) therapy and hold great promises for tissue repair, as reported in several animal studies and clinical cases. In the present review, we will provide an up-to-date outlook of the pathophysiology of severe skin burns, clinical treatment modalities and current limitations. We will then focus on MSCs and their potential in the burn wound healing both in in vitro and in vivo studies. A specific attention will be paid to the cell preconditioning approach, as a means of improving the MSC efficacy in the treatment of major skin burns. In particular, we will debate how several preconditioning cues would modulate the MSC properties to better match up with the burn pathophysiology in the course of the cell therapy. Finally, we will discuss the clinical interest and feasibility of a MSC-based therapy in comparison to their paracrine derivatives, including microvesicles and conditioned media for the treatment of major skin burn injuries.