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Stanton E, Pedreira R, Rizk N, Swaminathan A, Sheckter C. Burn Care Funding in the Era of Price Transparency-Does Verification Signal Bargaining Power? J Burn Care Res 2024:irae078. [PMID: 38733210 DOI: 10.1093/jbcr/irae078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Indexed: 05/13/2024]
Abstract
The Price Transparency Rule of 2021 forced payors and hospitals to publicly disclose negotiated prices to foster competition and reduce cost. Burn care is costly and concentrated at less than 130 centers in the US. We aimed to analyze geographic price variations for inpatient burn care and measure the effects of American Burn Association (ABA) verification status and market concentration on prices. All available commercial rates for 2021-2022 for burn-related Diagnosis Related Groups (DRG) 927, 928, 929, 933, 934, and 935 were merged with hospital-level variables, ABA verification status, and Herfindahl-Hirschman Index (HHI) data. For the DRG 927 (most intensive burn admission) a linear mixed effects model was fit with cost as the outcome and the following variables as covariates: HHI, plan type, safety net status, profit status, verification status, rural status, teaching hospital status. Random intercepts allowed for individual burn centers. There were 170,738 rates published from 1541 unique hospitals. Commercial reimbursement rates for the same DRG varied by a factor of approximately three within hospitals for all DRGs. Similarly, rates across different hospitals varied by a factor of three for all DRGs, with DRG 927 having the most variation. Burn center status was independently associated with higher reimbursement rates adjusting for facility-level factors for all DRGs except for 935. Notably, HHI was the largest predictor of commercial rates (p<0.001). Negotiated prices for inpatient burn care vary widely. ABA-verified centers garner higher rates along with burn centers in more concentrated/monopolistic markets.
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Affiliation(s)
- Eloise Stanton
- University of Southern California Keck School of Medicine, Los Angeles, CA USA
| | - Rachel Pedreira
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Nada Rizk
- Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, MA, US
| | | | - Clifford Sheckter
- Division of Plastic & Reconstructive Surgery, Stanford University, Stanford, CA USA
- Regional Burn Center, Santa Clara Valley Medical Center, San Jose, CA USA
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Lagziel T, Quiroga LH, Ross E, Khoo KH, Shamoun F, Asif M, Caffrey JA, Hultman CS. The impact of different co-morbidities on clinical outcomes and resource utilization in critically ill burn and surgical patients: A population-based analysis of social determinants of health. Burns 2024; 50:823-828. [PMID: 38492980 DOI: 10.1016/j.burns.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/25/2024] [Accepted: 03/02/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND This study aims to establish the significance of social determinants of health and prevalent co-morbidities on multiple indicators for quality of care in patients admitted to the Burn and Surgical Intensive Care Unit (ICU). METHODS We performed a retrospective analysis of population group data for patients admitted at the Burn and Surgical ICU from January 1, 2016, to November 18, 2019. The primary outcomes were length of hospital stay (LOS), mortality, 30-day readmission, and hospital charges. Pearson's chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. RESULTS We analyzed a total of 487 burn and 510 surgical patients. When comparing ICU patients, we observed significantly higher mean hospital charges and length of stay (LOS) in BICU v. SICU patients with a history of mental health ($93,259.40 v. $50,503.36, p = 0.013 and 16.28 v. 9.16 days, p = 0.0085), end-stage-renal-disease (ESRD) ($653,871.05 v. $75,746.35, p = 0.0047 and 96.15 v. 17.53 days, p = 0.0104), sepsis ($267,979.60 v. $99,154.41, p = <0.001 and 39.1 v. 18.42 days, p = 0.0043), and venous thromboembolism (VTE) ($757,740.50 v. $117,816.40, p = <0.001 and 93.11 v. 20.21 days, p = 0.002). Also, higher mortality was observed in burn patients with ESRD, ST-Elevation Myocardial Infarction (STEMI), sepsis, VTE, and diabetes mellitus. 30-day-readmissions were greater among burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus. CONCLUSIONS Our study provides new insights into the variability of outcomes between burn patients treated in different critical care settings, underlining the influence of comorbidities on these outcomes. By comparing burn patients in the BICU with those in the SICU, we aim to highlight how differences in patient backgrounds, including the quality of care received, contribute to these outcomes. This comparison underscores the need for tailored healthcare strategies that consider the unique challenges faced by each patient group, aiming to mitigate disparities in health outcomes and healthcare spending. Further research to develop relevant and timely interventions that can improve these outcomes.
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Affiliation(s)
- Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Luis H Quiroga
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Plastic and Reconstructive Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Emily Ross
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kimberly H Khoo
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Feras Shamoun
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Mohammed Asif
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie A Caffrey
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jančič U, Trček J, Verestiuc L, Vukomanović M, Gorgieva S. Bacterial nanocellulose loaded with bromelain and nisin as a promising bioactive material for wound debridement. Int J Biol Macromol 2024; 266:131329. [PMID: 38574906 DOI: 10.1016/j.ijbiomac.2024.131329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
The bacterial nanocellulose (BnC) membranes were produced extracellularly by a novel aerobic acetic acid bacterium Komagataeibacter melomenusus. The BnC was modified in situ by adding carboxymethyl cellulose (CMC) into the culture media, obtaining a BnC-CMC product with denser fibril arrangement, improved rehydration ratio and elasticity in comparison to BnC. The proteolytic enzyme bromelain (Br) and antimicrobial peptide nisin (N) were immobilized to BnC matrix by ex situ covalent binding and/or adsorption. The optimal Br immobilization conditions towards the maximized specific proteolytic activity were investigated by response surface methodology as factor variables. At optimal conditions, i.e., 8.8 mg/mL CMC and 10 mg/mL Br, hyperactivation of the enzyme was achieved, leading to the specific proteolytic activity of 2.3 U/mg and immobilization efficiency of 39.1 %. The antimicrobial activity was observed against Gram-positive bacteria (S. epidermidis, S. aureus and E. faecalis) for membranes with immobilized N and was superior when in situ modified BnC membranes were used. N immobilized on the BnC or BnC-CMC membranes was cytocompatible and did not cause changes in normal human dermal fibroblast cell morphology. BnC membranes perform as an efficient carrier for Br or N immobilization, holding promise in wound debridement and providing antimicrobial action against Gram-positive bacteria, respectively.
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Affiliation(s)
- Urška Jančič
- University of Maribor, Faculty of Mechanical Engineering, Smetanova ulica 17, 2000 Maribor, Slovenia.
| | - Janja Trček
- University of Maribor, Faculty of Natural Sciences and Mathematics, Department of Biology, Koroška cesta 160, 2000 Maribor, Slovenia; University of Maribor, Faculty of Chemistry and Chemical Engineering, Smetanova ulica 17, 2000 Maribor, Slovenia.
| | - Liliana Verestiuc
- Grigore T. Popa University of Medicine and Pharmacy, Faculty of Medical Bioengineering, Department of Biomedical Sciences, 9-13 Kogalniceanu Street, 700454, Iasi, Romania.
| | - Marija Vukomanović
- Jozef Stefan Institute, Advanced Materials Department, Jamova cesta 39, 1000 Ljubljana, Slovenia.
| | - Selestina Gorgieva
- University of Maribor, Faculty of Mechanical Engineering, Smetanova ulica 17, 2000 Maribor, Slovenia.
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Hanson-Viana E, Rojas-Ortiz JA, Rendón-Medina MA, Luna-Zepeda BL. Bacterial fluorescence imaging as a predictor of skin graft integration in burn wounds. Burns 2024:S0305-4179(24)00122-0. [PMID: 38735804 DOI: 10.1016/j.burns.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/26/2024] [Accepted: 04/06/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Split-thickness skin graft (STSG)1 integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to improve the likelihood of graft-take. Incorporating technological aids such as fluorescence (FL)2 imaging (MolecuLight®), which accurately locates areas of bacterial loads above 104 CFU/gr, for graft site assessment and preparation could yield better outcomes. METHODS This single-center, prospective observational study included adult burn patients with previously infected wounds that had been deemed clinically and microbiologically clean and were therefore candidates for grafting. Prior to grafting, a FL imaging assessment (blinded to the surgical team) localized areas positive for moderate-high bacterial loads (>104 CFU/gr). Intra-operatively, a standard swab sample from the recipient site was collected by the surgical team. Postoperatively, areas positive/negative for FL and areas of graft take and failure were overlapped and measured (cm2) over a 2D schematic. The performance and accuracy of FL imaging and swab sampling in relation to graft outcomes were assessed. RESULTS 38 patients were enrolled in the study. The mean total body surface area (TBSA)3 involvement was 14.5 ± 12.4 % [range 0.8 - 40.2 %]. 25/38 of the subjects enrolled had complete graft take while 13 had partial graft losses. There were no total losses. FL-imaging was positive in 100 % of losses versus 31 % (4/13) of the swab microbiology. FL-imaging was found to have a sensitivity of 86 %, specificity of 98 %, PPV of 72 %, NPV of 99 %, and an accuracy of 94 % for predicting any type or range of graft loss in the entire cohort. Meanwhile, the sensitivity of microbiology from swab samples was 30 %, with a specificity of 76 %. CONCLUSIONS FL imaging is an accurate method for assessing recipient sites and predicting the outcome of a skin graft among burn patients. These findings suggest that FL imaging can inform better decision-making surrounding grafts that may lead to better outcomes. LEVEL OF EVIDENCE Level IIA, Therapeutic study.
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Affiliation(s)
- Erik Hanson-Viana
- Plastic and Reconstructive Surgery Department, Mexico City General Hospital Dr. Rúben Leñero, Mexico.
| | - Jorge Arturo Rojas-Ortiz
- Plastic and Reconstructive Surgery Department, Mexico City General Hospital Dr. Rúben Leñero, Mexico
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Langley D, Zimmermann K, Krenske E, Stefanutti G, Kimble RM, Holland AJA, Fear MW, Wood FM, Kenna T, Cuttle L. Unremitting pro-inflammatory T-cell phenotypes, and macrophage activity, following paediatric burn injury. Clin Transl Immunology 2024; 13:e1496. [PMID: 38463658 PMCID: PMC10921233 DOI: 10.1002/cti2.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024] Open
Abstract
Objectives The aim of this study was to characterise the dynamic immune profile of paediatric burn patients for up to 18 months post-burn. Methods Flow cytometry was used to measure 25 cell markers, chemokines and cytokines which reflected both pro-inflammatory and anti-inflammatory immune profiles. Peripheral blood mononuclear cells from 6 paediatric burn patients who had returned for repeated burn and scar treatments for > 4 timepoints within 12 months post-burn were compared to four age-matched healthy controls. Results While overall proportions of T cells, NK cells and macrophages remained relatively constant, over time percentages of these immune cells differentiated into effector and proinflammatory cell phenotypes including Th17 and activated γδ T cells. Circulating proportions of γδ T cells increased their expression of pro-inflammatory mediators throughout the burn recovery, with a 3-6 fold increase of IL-17 at 1-3 weeks, and NFκβ 9-18 months post-burn. T-regulatory cell plasticity was also observed, and Treg phenotype proportions changed from systemically reduced skin-homing T-regs (CCR4+) and increased inflammatory (CCR6+) at 1-month post-burn, to double-positive cell types (CCR4+CCR6+) elevated in circulation for 18 months post-burn. Furthermore, Tregs were observed to proportionally express less IL-10 but increased TNF-α over 18 months. Conclusion Overall, these results indicate the circulating percentages of immune cells do not increase or decrease over time post-burn, instead they become highly specialised, inflammatory and skin-homing. In this patient population, these changes persisted for at least 18 months post-burn, this 'immune distraction' may limit the ability of immune cells to prioritise other threats post-burn, such as respiratory infections.
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Affiliation(s)
- Donna Langley
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Immunology and Infection Control (CIIC)QIMR Berghofer Medical Research Institute, Queensland University of Technology (QUT)BrisbaneQLDAustralia
- Centre for Biomedical Technology (CBT)Queensland University of Technology (QUT)Kelvin GroveQLDAustralia
| | - Kate Zimmermann
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Immunology and Infection Control (CIIC)QIMR Berghofer Medical Research Institute, Queensland University of Technology (QUT)BrisbaneQLDAustralia
| | - Emma Krenske
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Immunology and Infection Control (CIIC)QIMR Berghofer Medical Research Institute, Queensland University of Technology (QUT)BrisbaneQLDAustralia
| | - Giorgio Stefanutti
- Department of Paediatric Surgery, Urology, Burns and TraumaChildren's Health Queensland, Queensland Children's HospitalSouth BrisbaneQLDAustralia
| | - Roy M Kimble
- Department of Paediatric Surgery, Urology, Burns and TraumaChildren's Health Queensland, Queensland Children's HospitalSouth BrisbaneQLDAustralia
| | - Andrew JA Holland
- The Children's Hospital at Westmead Burns Unit, Department of Paediatrics and Child Health, Kids Research InstituteSydney Medical School, The University of SydneySydneyNSWAustralia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical SciencesThe University of Western AustraliaPerthWAAustralia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical SciencesThe University of Western AustraliaPerthWAAustralia
- Burns Service of Western AustraliaPerth Children's Hospital and Fiona Stanley HospitalPerthWAAustralia
| | - Tony Kenna
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Immunology and Infection Control (CIIC)QIMR Berghofer Medical Research Institute, Queensland University of Technology (QUT)BrisbaneQLDAustralia
| | - Leila Cuttle
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Biomedical Technology (CBT)Queensland University of Technology (QUT)Kelvin GroveQLDAustralia
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Spronk I, Wood FM, Fear MW, Lansdorp CA, Edgar DW. The Short- and Long-Term Outcome Priorities of a Western Australian Adult Burn Population. J Burn Care Res 2024; 45:451-458. [PMID: 37936534 PMCID: PMC10911694 DOI: 10.1093/jbcr/irad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Indexed: 11/09/2023]
Abstract
To optimize patient recovery, understanding which outcomes are most important to burn patients is key. However, research to determine what outcomes are patient priorities is limited. Therefore, we assessed what outcomes are most important to Western Australian burn patients, separately in the short-term (<6 months) and long-term (6-24 months) after injury. Adult patients who had a burn injury 3-36 months ago completed a survey, rating the importance of 36 short- and long-term outcomes. The survey items were ranked according to the number of patients reporting the outcome as "very important." Results were compared between subgroups based on age, gender, burn size, and number of surgeries. Ninety-three patients were included. In the short-term, "not having a wound infection" (87.1%), "good wound healing" (83.9%), and "walking or moving around" (74.7%) were the most important outcomes. "Lifting or moving something" (67.6%), "walking or moving around" (66.2%), and "being independent" (66.2%) were reported as most important in the long-term. Scar-related outcomes were more important to females and to patients with multiple surgeries; mental health outcomes were priorities for females and patients with major burns; walking and moving around to males and older patients; and social and financial outcomes were rated highly by patients with major burns and multiple surgeries. In conclusion, the most important outcomes were consistent across time periods, indicating the importance of core outcomes in longitudinal follow-up. The wide range of priority outcomes and differences between subgroups underlines the need for multidisciplinary care and a patient-centered approach to support patients.
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Affiliation(s)
- Inge Spronk
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, 3000CA, The Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, 3007AC, The Netherlands
- Dutch Burns Foundation, Beverwijk, 1941AJ, The Netherlands
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
| | - Corine A Lansdorp
- Department Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, 1007MB, The Netherlands
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
- Institute for Health Research, Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, WA 6959, Australia
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, WA 6992, Australia
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Hauc SC, Stögner VA, Ihnat JM, Hosseini H, Huelsboemer L, Kauke-Navarro M, Rivera JC, Williams M, Glahn JZ, Savetamal A, Pomahac B. Understanding the Drivers of Cost and Length of Stay in a Cohort of 21,875 Patients with Severe Burn. J Burn Care Res 2024; 45:425-431. [PMID: 37882472 DOI: 10.1093/jbcr/irad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Indexed: 10/27/2023]
Abstract
Burn management has significantly advanced in the past 75 years, resulting in improved mortality rates. However, there are still over one million burn victims in the United States each year, with over 3,000 burn-related deaths annually. The impacts of individual patient, hospital, and regional demographics on length of stay (LOS) and total cost have yet to be fully explored in a large nationally representative cohort. Thus, this study aimed to examine various hospital and patient characteristics using a sample of over 20,000 patients. Inpatient data from the National Inpatient Sample from 2008 to 2015 were analyzed, and only patients with an ICD-9 code for second- or third-degree burns were included. In addition, a major operating room procedure must have been indicated on the discharge summary for patients to be included in the final dataset, ensuring that only severe burns requiring complex care were analyzed. Analysis of covariance models was used to evaluate the impact of various patient, hospital, and regional variables on both LOS and cost. The study found that skin grafts and fasciotomy significantly increased the cost of hospitalization. Having burns on the face, neck, and trunk significantly increased costs for patients with second-degree burns, while burns on the trunk resulted in the longest LOS for patients with third-degree burns. Infections in the hospital and additional procedures, such as flaps and skin grafts, also led to longer stays. The study also found that the prevalence of postoperative complications, such as electrolyte imbalance, was high among patients with burn surgery.
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Affiliation(s)
- Sacha C Hauc
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Viola Antonia Stögner
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Jacqueline M Ihnat
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Helia Hosseini
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Lioba Huelsboemer
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Jean C Rivera
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Mica Williams
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Joshua Z Glahn
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Alisa Savetamal
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Bohdan Pomahac
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
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Gerstl JVE, Ehsan AN, Lassarén P, Yearley A, Raykar NP, Anderson GA, Smith TR, Sabapathy SR, Ranganathan K. The Global Macroeconomic Burden of Burn Injuries. Plast Reconstr Surg 2024; 153:743-752. [PMID: 37093034 DOI: 10.1097/prs.0000000000010595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Standardized estimates of global economic losses from burn injuries are lacking. The primary objective of this study was to determine the global macroeconomic consequences of burn injuries and their geographic distribution. METHODS Using the Institute of Health Metrics and Evaluation database (2009 and 2019), mean and 95% uncertainty interval (UI) data on incidence, mortality, and disability-adjusted life-years (DALYs) from injuries caused by fire, heat, and hot substances were collected. Gross domestic product (GDP) data were analyzed together with DALYs to estimate macroeconomic losses globally using a value of lost welfare approach. RESULTS There were 9 million global burn cases (95% UI, 6.8 to 11.2 million) and 111,000 deaths from burns (95% UI, 88,000 to 132,000 deaths) in 2019, representing a total of 7.5 million DALYs (95% UI, 5.8 to 9.5 million DALYs). This represented welfare losses of $112 billion (95% UI, $78 to $161 billion), or 0.09% of GDP (95% UI, 0.06% to 0.13%). Welfare losses as a share of GDP were highest in low- and middle-income countries (LMICs) of Oceania (0.24%; 95% UI, 0.09% to 0.42%) and Eastern Europe (0.24%; 95% UI, 0.19% to 0.30%) compared with high-income country regions such as Western Europe (0.06%; 95% UI, 0.04% to 0.09%). Mortality-incidence ratios were highest in LMIC regions, highlighting a lack of treatment access, with southern sub-Saharan Africa reporting a mortality-incidence ratio of 40.1 per 1000 people compared with 1.9 for Australasia. CONCLUSIONS Burden of disease and resulting economic losses because of burn injuries are substantial worldwide and are disproportionately higher in LMICs. Possible effective solutions include targeted education, advocacy, and legislation to decrease incidence and investing in existing burn centers to improve treatment access.
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Affiliation(s)
- Jakob V E Gerstl
- From the Departments of Neurosurgery
- University College London Medical School
| | - Anam N Ehsan
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | - Nakul P Raykar
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | - Geoffrey A Anderson
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | | | - S Raja Sabapathy
- Department of Plastic Surgery, Hand, Reconstructive, and Burn Surgery, Ganga Hospital
| | - Kavitha Ranganathan
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
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9
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Duan D, Deng H, Chen Y, Wang Y, Xu W, Hu S, Liu D, Mao Y, Zhang Z, Xu Q, Han C, Zhang H. Associated predictors of prolonged length of stay in patients surviving extensive burns: A large multicenter retrospective study. Burns 2024; 50:413-423. [PMID: 37865601 DOI: 10.1016/j.burns.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Patients with extensive burns are critically ill and have long treatment periods. Length of stay (LOS) is a good measure for assessing treatment. This study sought to identify predictors of prolonged LOS in patients with extensive burns (≥50% TBSA). METHODS This retrospective multicenter cohort study included adults aged ≥ 18 years who survived extensive burns in three burn centers in Eastern China between January 2016 and June 2022. Epidemiological, demographic and clinical outcomes data were extracted from electronic medical records and compared between patients with/without prolonged LOS, which was defined as LOS greater than the median. Logistic regression analysis was used to identify predictors of prolonged LOS. RESULTS The study sample included 321 patients, of whom 156 (48.6%) had an LOS of 58 days (IQR 41.0-77.0). Univariate regression analysis showed that increased total burn area and increased full-thickness burn area; electrical, chemical and other burns; increased erythrocytes, leukocytes, platelets or serum creatinine within 24 h of admission; concomitant inhalation injury, pulmonary edema, sepsis, bloodstream infection, wound infection, pulmonary infection, urinary tract infection, or HB < 70 g/L during hospitalization were associated with prolonged LOS in patients with extensive burns. Increased number of surgical operations, mechanical ventilation and renal replacement therapy were also associated with prolonged LOS (P < 0.05 or P < 0.001). Multivariate regression analysis revealed that increased total burn area (ratio 1.032, 95%CI 1.01-1.055; P = 0.004), electrical and chemical or other burns (3.282, 1.335-8.073; P = 0.01), development of wound infection (2.653 1.285-5.481; P = 0.008) and increased number of operative procedures (1.714, 1.388-2.116, P < 0.001) were significant predictors. CONCLUSIONS Increased area of full-thickness burn,occurrence of electrical and chemical or other burns,occurrence of wound infection and increased number of surgeries are the best predictors of prolonged LOS in patients with extensive burns. Clarifying relevant predictors of burn patients' LOS provides a reliable reference for clinical treatment.
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Affiliation(s)
- Deqing Duan
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongao Deng
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Chen
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiran Wang
- Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Wanting Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - ShiQiang Hu
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dewu Liu
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuangui Mao
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhongwei Zhang
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qinglian Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Chunmao Han
- Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Hongyan Zhang
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China.
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van de Warenburg MS, Munk EFL, Davies A, McBride CA, Edgar DW, Vehmeijer-Heeman MLAW, Young AE. Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care. J Burn Care Res 2024; 45:112-119. [PMID: 37310702 PMCID: PMC10768758 DOI: 10.1093/jbcr/irad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.
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Affiliation(s)
- Milly S van de Warenburg
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Elleke F L Munk
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anna Davies
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Craig A McBride
- Centre for Children’s Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia
- Burn Injury Research Node, The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Mariëlle L A W Vehmeijer-Heeman
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Amber E Young
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
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11
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Jovic TH, Watson R, Gorse SH, Drew PJ, Cubitt JJ. Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre. J Plast Reconstr Aesthet Surg 2024; 88:352-359. [PMID: 38064914 DOI: 10.1016/j.bjps.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 01/02/2024]
Abstract
INTRODUCTION This study aimed to identify the spectrum of desquamating skin diseases referred for tertiary burns care and quantify the care requirements and expenses associated with caring for these patients within the burns service. METHODS Patient records were identified with nonburn-induced skin loss between 2016 and 2022. Data was extracted from inpatient records, operative notes, and dressing clinic records. A cost analysis was conducted using figures from the National Schedule of National Health Service Costs and our own unit-specific costs. RESULTS Twenty patients were identified, with a median age of 46.5 and a median total body surface area of 30%. The mean length of stay was 21.2 days, with 8/20 patients requiring intensive care. Overall mortality was 30%, rising to 50% if patients required intensive treatment unit (ITU) admission. Patients had a mean of 1.5 procedures under general anaesthesia and a mean operative time of 169 min per patient. Postoperatively, a mean of 8.3 dressing changes was required per patient (range 1-21). Of 75% of patients referred as suspected toxic epidermal necrolysis syndrome (TENS), only 32% of patients histologically had TENS (32%), with linear IgA disease, pemphigus vulgaris and bullous lupus comprising the other diagnoses. Cost analysis predicted a total cost to the unit of £1,422,106. CONCLUSION Desquamating dermatological diseases are life-threatening conditions with exhaustive care requirements. Our experiences highlight the importance of awareness of the range of desquamating skin conditions beyond TENS to enable optimum management and the need to ensure adequate financial provisions to accommodate the care requirements mandated by these patients.
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Affiliation(s)
- Thomas H Jovic
- Reconstructive Surgery & Regenerative Medicine Research Centre, Swansea University, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
| | - Rebecca Watson
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Peter J Drew
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Jonathan J Cubitt
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Shahriarirad R, Shekouhi R, Nabavizadeh SS, Zardosht M, Tadayon SMK, Ahmadi M, Keshavarzi A. Cohort analysis of 50% lethal area (LA50) and associating factors in burn patients based on quality improvements and health policies. Sci Rep 2023; 13:19034. [PMID: 37923785 PMCID: PMC10624683 DOI: 10.1038/s41598-023-45884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
Burn injuries are among the common traumatic injuries, which can be accompanied with lifelong morbidity and mortality. The Lethal Area Fifty Percent (LA50) index is another reliable outcome measurement tool that assesses the standard of medical care at burn centers. It is widely used as a benchmark for assessing the quality of burn care and is considered the percentage at which 50% of burn patients are expected to die because of burn-related injuries. We aimed to determine and compare the LA50 in burn patients admitted to Shiraz Burn Referral Centers in 2018-2021 and 2011-2018 with regard to improving the quality of special care and infection control in the new hospital. We conducted a retrospective cohort analysis on patients admitted to Amir al-Momenin Burn Injury Hospital in Shiraz, Fars, Southern Iran. Data were retrospectively gathered from March 2011 to January 2022, and subsequently analyzed with standard statistical analysis, and also multivariate and probability analysis. A total of 7382 patients with acute burns injuries were identified. Among them, 4852 (65.7%) patients were men, and the median age was 27 years [Q1-Q3 7-40; range 1-98]. Most of the patients were in the pediatric and early adulthood age range, with 76.2% being younger than 40 years old. The median TBSA was 24% [IQR 14, 43], and the median duration of hospitalization was 11 [IQR 11] days. Most injuries were secondary to flame and fire (33.5%; n = 2472). The mortality rate in our study was 19.0% (n = 1403). We evaluated our patients based on two main time intervals: March 2011 till February 2018 (n = 3409; 46.2%), and March 2018 to January 2022 (n = 3973; 53.8%). Based on multivariate analysis, the second interval of our study was significantly correlated with a more female patients, higher age, lower TBSA, less burn injuries due to scald, contact, but more frequent fire and flame injuries, and also lower mortality rate. Factors correlated with higher mortality included male gender, older age, shorter hospitalization duration, higher TBSA, etiology of fire and flame, and accidental burn injuries. A Baux score of 76.5 had a sensitivity of 81.1%, specificity of 87.3%, accuracy of 86.1% in predicting mortality among our patients. The mortality probability for the study intervals were 20.67% (SD 33.0%) for 2011-2018, and 17.02% (SD 29.9%) for 2018-2022 (P < 0.001). The LA50 was 52.15 ± 2 for all patients. This ammount was 50 ± 2% in 2011-2018, and 54 ± 2 in 2018-2022 (P < 0.001). The mean LA50 values showed significant improvements following significant modifications in our critical care for burn victims, including augmented intensive care unit capacity, prompt relocation of inhalation burn cases to the intensive care unit, establishing a well-trained multidisciplinary team, and improved infection control. To improve outcomes for burn patients in developing countries, major changes should be made in the management of burn patients and LA50 is a reliable assessment tool for evaluating the how these changes affect patient's outcomes.
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Affiliation(s)
- Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, 71348-14336, Iran
| | - Ramin Shekouhi
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mitra Zardosht
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, 71348-14336, Iran
| | | | - Meysam Ahmadi
- School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Abdolkhalegh Keshavarzi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, 71348-14336, Iran.
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Keshri VR, Abimbola S, Parveen S, Mishra B, Roy MP, Jain T, Peden M, Jagnoor J. Navigating health systems for burn care: Patient journeys and delays in Uttar Pradesh, India. Burns 2023; 49:1745-1755. [PMID: 37032275 DOI: 10.1016/j.burns.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/17/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India. METHODS We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework. RESULTS Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restrictions influenced all three delays. CONCLUSIONS Burn care pathways are adversely affected by barriers to timely access. We propose using the modified 3-delays framework to analyse delays in burns care. There is a need to strengthen referral linkage systems, ensure financial risk protection, and integrate burn care at all levels of health care delivery systems.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, India; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The George Institute for Global Health, Sydney, Australia
| | - Samina Parveen
- The George Institute for Global Health, India; Ipas Development Foundation, New Delhi, India
| | - Brijesh Mishra
- Department of Plastic Surgery, King George's Medical University, Lucknow, India
| | - Manas Pratim Roy
- Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
| | - Tanu Jain
- Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
| | - Margie Peden
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, London, United Kingdom; School of Public Health, Imperial College London, United Kingdom
| | - Jagnoor Jagnoor
- The George Institute for Global Health, India; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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Keshri VR, Peden M, Singh P, Norton R, Abimbola S, Jagnoor J. Health systems research in burn care: an evidence gap map. Inj Prev 2023; 29:446-453. [PMID: 37532304 DOI: 10.1136/ip-2023-044963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Burn injury is associated with significant mortality and disability. Resilient and responsive health systems are needed for optimal response and care for people who sustain burn injuries. However, the extent of health systems research (HSR) in burn care is unknown. This review aimed to systematically map the global HSR related to burn care. METHODS An evidence gap map (EGM) was developed based on the World Health Organization health systems framework. All major medical, health and injury databases were searched. A standard method was used to develop the EGM. RESULTS A total of 6586 articles were screened, and the full text of 206 articles was reviewed, of which 106 met the inclusion criteria. Most included studies were cross-sectional (61%) and were conducted in hospitals (71%) with patients (48%) or healthcare providers (29%) as participants. Most studies were conducted in high-income countries, while only 13% were conducted in low-and middle-income countries, accounting for 60% of burns mortality burden globally. The most common health systems areas of focus were service delivery (53%), health workforce (33%) and technology (19%). Studies on health policy, governance and leadership were absent, and there were only 14 qualitative studies. CONCLUSIONS Major evidence gaps exist for an integrated health systems response to burns care. There is an inequity between the burden of burn injuries and HSR. Strengthening research capacity will facilitate evidence-informed health systems and policy reforms to sustainably improve access to affordable, equitable and optimal burn care and outcomes.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Margaret Peden
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Pratishtha Singh
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
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Sulastri E, Lesmana R, Zubair MS, Abdelwahab Mohammed AF, Elamin KM, Wathoni N. Ulvan/Silver nanoparticle hydrogel films for burn wound dressing. Heliyon 2023; 9:e18044. [PMID: 37483826 PMCID: PMC10362238 DOI: 10.1016/j.heliyon.2023.e18044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023] Open
Abstract
Ulvan is a polysaccharide from green algae that shows good hydrogel film dressing characteristics. Silver nanoparticles (AgNP) can be incorporated into the hydrogel film to improve antibacterial properties and provide a potential burn treatment. In this study, we developed a novel hydrogel film wound dressing composed of ulvan and silver nanoparticles. Two concentrations (0.5 mM and 1 mM) of silver nitrate were used to produce ulvan-silver nanoparticles hydrogel film (UHF-AgNP0.5 and UHF-AgNP1), respectively. The physicochemical characteristics of the hydrogel films were evaluated, including particle size, zeta potential, Fourier transform infrared (FTIR), X-ray diffractometry (XRD), scanning electron microscope and energy-dispersive X-ray (SEM-EDX). Furthermore, the in vitro antimicrobial activity, and second-degree burn wound healing test were evaluated. The UHF-AgNP0.5 showed the highest antimicrobial activity compared to UHF-AgNP1 and UHF film. Meanwhile, an in vivo study using Wistar rats induced second-degree burns showed that UHF-AgNP0.5 significantly accelerated the healing process by regulating the inflammatory process, increasing re-epithelialization, and improving the vascularization process. Ulvan-silver nanoparticle hydrogel films have the ability to accelerate the healing of second-degree burns and are potential candidates for wound dressings.
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Affiliation(s)
- Evi Sulastri
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, 45363, Indonesia
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Tadulako, Palu, 94119, Indonesia
| | - Ronny Lesmana
- Department of Anatomy, Physiology and Biology Cell, Faculty of Medicine, Universitas Padjadjaran, Sumedang, 45363, Indonesia
| | - Muhammad Sulaiman Zubair
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Tadulako, Palu, 94119, Indonesia
| | | | - Khaled M. Elamin
- Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Nasrul Wathoni
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, 45363, Indonesia
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Wang K, Shen K, Han F, Bai X, Fang Z, Jia Y, Zhang J, Li Y, Cai W, Wang X, Luo L, Guo K, Wang H, Yang X, Wang H, Hu D. Activation of Sestrin2 accelerates deep second-degree burn wound healing through PI3K/AKT pathway. Arch Biochem Biophys 2023; 743:109645. [PMID: 37225009 DOI: 10.1016/j.abb.2023.109645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 05/26/2023]
Abstract
Deep second-degree burns heal slowly, and promoting the healing process is a focus of clinical research. Sestrin2 is a stress-inducible protein with antioxidant and metabolic regulatory effects. However, its role during acute dermal and epidermal re-epithelialization in deep second-degree burns is unknown. In this study, we aimed to explore the role and molecular mechanism of sestrin2 in deep second-degree burns as a potential treatment target for burn wounds. To explore the effects of sestrin2 on burn wound healing, we established a deep second-degree burn mouse model. Then we detected the expression of sestrin2 by western blot and immunohistochemistry after obtaining the wound margin of full-thickness burned skin. The effects of sestrin2 on burn wound healing were explored in vivo and in vitro through interfering sestrin2 expression using siRNAs or the small molecule agonist of sestrin2, eupatilin. We also investigated the molecular mechanism of sestrin2 in promoting burn wound healing by western blot and CCK-8 assay. Our in vivo and in vitro deep second-degree burn wound healing model demonstrated that sestrin2 was promptly induced at murine skin wound edges. The small molecule agonist of sestrin2 accelerated the proliferation and migration of keratinocytes, as well as burn wound healing. Conversely, the healing of burn wounds was delayed in sestrin2-deficient mice and was accompanied by the secretion of inflammatory cytokines as well as the suppression of keratinocyte proliferation and migration. Mechanistically, sestrin2 promoted the phosphorylation of the PI3K/AKT pathway, and inhibition of PI3K/AKT pathway abrogated the promoting role of sestrin2 in keratinocyte proliferation and migration. Therefore, sestrin2 plays a critical role in activation of the PI3K/AKT pathway to promote keratinocyte proliferation and migration, as well as re-epithelialization in the process of deep second-degree burn wound repair.
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Affiliation(s)
- Kejia Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Kuo Shen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Fu Han
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Xiaozhi Bai
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Zhuoqun Fang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Yanhui Jia
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Jian Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Yan Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Weixia Cai
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Xujie Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Liang Luo
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Kai Guo
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Hongtao Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Xuekang Yang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Huina Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China.
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710038, China.
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Zeng Z, Li N, Yang L, Feng X, Zuo F, Luo G, Peng Y, Yuan Z. Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study. Front Public Health 2023; 10:1052293. [PMID: 36699890 PMCID: PMC9868295 DOI: 10.3389/fpubh.2022.1052293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Background Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China. Methods Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records. Results A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome. Conclusion We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.
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Quentin W, Stephani V, Berenson RA, Bilde L, Grasic K, Sikkut R, Touré M, Geissler A. How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems. Int J Health Policy Manag 2022; 11:2940-2950. [PMID: 35569000 PMCID: PMC10105175 DOI: 10.34172/ijhpm.2022.6536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Diagnosis-related group (DRG)-based hospital payment can potentially be inadequately low (or high) for highly variable, highly specialized, and/or low volume care. DRG-based payment can be combined with other payment mechanisms to avoid unintended consequences of inadequate payment. The aim of this study was to analyze these other payment mechanisms for acute inpatient care across six countries (Germany, Denmark, England, Estonia, France, the United States [Medicare]). METHODS Information was collected about elements excluded from DRG-based payment, the rationale for exclusions, and payment mechanisms complementing DRG-based payment. A conceptual framework was developed to systematically describe, visualise and compare payment mechanisms across countries. RESULTS Results show that the complexity of exclusion mechanisms and associated additional payment components differ across countries. England and Germany use many different additional mechanisms, while there are only few exceptions from DRG-based payment in the Medicare program in the United States. Certain areas of care are almost always excluded (eg, certain areas of cancer care or specialized pediatrics). Denmark and England use exclusion mechanisms to steer service provision for highly complex patients to specialized providers. CONCLUSION Implications for researchers and policy-makers include: (1) certain areas of care might be better excluded from DRG-based payment; (2) exclusions may be used to incentivize the concentration of highly specialized care at specialized institutions (as in Denmark or England); (3) researchers may apply our analytical framework to better understand the specific design features of DRG-based payment systems.
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Affiliation(s)
- Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | | | | | - Lone Bilde
- Danish Institute for Applied Social Sciences Research, Copenhagen, Denmark
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Katja Grasic
- Centre for Health Economics, University of York, York, UK
| | | | - Mariama Touré
- Poverty, Health and Nutrition Division (PHND), International Food Policy Research Institute (IFPRI), Washington, DC, USA
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Second-Degree Burns and Aloe Vera: A Meta-analysis and Systematic Review. Adv Skin Wound Care 2022; 35:1-9. [DOI: 10.1097/01.asw.0000875056.29059.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stynes G, Haertsch P, O'Hara J, Knight R, Issler-Fisher AC, Maitz PKM. Alginate dressings continuously for fourteen days on uncontaminated, superficial, partial thickness burns. J Burn Care Res 2022:6743261. [PMID: 36181757 DOI: 10.1093/jbcr/irac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 01/27/2023]
Abstract
Calcium alginate dressings are commonly used on split-thickness skin donor sites, where they are typically removed after 14 days. Alginates have been used previously on superficial, partial thickness burns, but changed every 3-4 days. In this study, alginates were applied to superficial, partial thickness burns on adults within 36 hours of injury, then left intact for up to 14 days. Wound healing (≥95% wound epithelialisation) and pain were measured. Twenty-one burns were reviewed on ten patients. Per the initial protocol, six patients were reviewed every 3-5 days, with removal of only secondary dressings, until day 13-14, when the alginate dressings were removed. One patient was reviewed every 3-5 days until day 10, when a clinic nurse removed the alginate dressing. Restrictions on movement during the COVID pandemic necessitated a protocol change, with only one review at approximately day 14 for removal of alginate and secondary dressings; three patients were reviewed in this manner. Burns on all patients were 100% epithelialised at the time of final review and there were no complications, such as scarring, infection, or need for grafting. Following initial debridement and dressings, patients reported minimal pain. Dressing costs appeared to be significantly decreased. This protocol may be particularly useful for patients managed in rural and remote locations, with telemedicine support if required.
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Affiliation(s)
- Gil Stynes
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia.,Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Peter Haertsch
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Justine O'Hara
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW
| | - Robert Knight
- Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Andrea C Issler-Fisher
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia
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21
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Richards H, Staruch R, King A, Pugh C, Kinsella S, Savović J, Young A. Protocol for a Global Burns Research Priority Setting Partnership to agree the most important unanswered questions in international burns care. BMJ Open 2022; 12:e065120. [PMID: 36104134 PMCID: PMC9476147 DOI: 10.1136/bmjopen-2022-065120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Burns affect 11 million people globally and can result in long-term disability with substantial associated healthcare costs. There is limited research funding to support trials to provide evidence for clinical decision-making. Research prioritisation ensures that research focuses on the topics most important to stakeholders, addressing issues of research waste and evidence gaps. The aim of this project is to agree the global top 10 research priorities important to international patients, carers and clinicians from all income status countries. METHODS AND ANALYSIS The Global Burns Research Priority Setting Partnership will use James Lind Alliance methods to establish the top 10 research priorities in global burns care. An initial international online multilingual survey will collect candidate research priorities from stakeholders. To increase equity in participation, the survey will also be available via the social media app WhatsApp. Additionally, interviews will be conducted. Data will be analysed to identify and collate research questions and to verify that the priorities are true clinical uncertainties. This list will then be ranked by stakeholders in order of importance via a second online survey. Finally, a consensus meeting will identify the top 10 research priorities. ETHICS AND DISSEMINATION The University of Bristol Medical School Faculty Ethical Committee has approved this project. Research into burn care should be prioritised to ensure that funding is focused where most needed. This should be undertaken internationally, to ensure inclusion of the views of professionals and patients from lower income countries, where the incidence of thermal burns is highest. The involvement of the James Lind Alliance will ensure that the methodology is robust and that the patient voice is heard. The final top 10 priorities will be disseminated to funders, governments and researchers internationally to inform future global burns research.
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Affiliation(s)
- Hollie Richards
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University Hospitals Bristol and Weston NHS Foundation and the University of Bristol, Bristol, UK
| | - Robert Staruch
- Botnar Research Centre, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Anni King
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University Hospitals Bristol and Weston NHS Foundation and the University of Bristol, Bristol, UK
| | - Catrin Pugh
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzannah Kinsella
- James Lind Alliance, National Institute for Health Research, School of Healthcare Enterprise and Innovation, University of Southampton, Alpha House, Enterprise Road, Southampton, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Amber Young
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Children's Burns Research Centre Bristol, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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22
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Regenerative Medicine to Improve Outcomes of Ventral Hernia Reconstruction (REPAIR Study) Phase 1: Find the Best Decellularization Protocol for the Human Dermis. J Pers Med 2022; 12:jpm12091411. [PMID: 36143199 PMCID: PMC9505465 DOI: 10.3390/jpm12091411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Tissue regeneration is a complex process that allows wounds to heal. Many options are currently available to help human skin repair and to reduce the recurrence of hernias. The aim of this study is to analyze the best decellularization protocol for allogenic human dermal tissues. Methods: Dermal flaps from donors were used and compared with a control group. Each flap was subjected to seven different decellularization protocols and washed with a sequence of five solutions. The samples were then subjected to four control tests (such as Nile Red), and long-term contacts were analyzed to assess whether the decellularized dermis samples could support the growth of human fibroblasts. Results: All the samples had an average residual viability of 60%. Except for one sample, the decellularization treatments were able to reduce cell viability significantly. The Nile Red test showed a significant reduction in phospholipid content (mean 90%, p-value < 0.05) in all treatments. The cell growth increased in a linear manner. As described in the literature, sodium-dodecyl-sulfate (SDS) caused an interference between the test and the detergent. Conclusions: This paper shows the first step to finding the best decellularization protocol for allografting human dermal tissues. Further biocompatibility tests and DNA quantification are necessary.
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23
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Young AE, Staruch RMT, Dziewulski P. Why is priority setting important for global burn care research? Burns 2022; 48:1035-1039. [PMID: 35525771 DOI: 10.1016/j.burns.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022]
Abstract
The use of robust evidence is a key component of providing high quality care to patients. Synthesised evidence to support clinical decision-making is lacking for many aspects of clinical burn care. Identifying the most important areas of care that lack high quality evidence and requires research is necessary, as funding for primary research is limited. Priority setting research studies are a joint endeavour between patients, carers and clinicians to identify and rank topics for research in a healthcare area in order to reduce research waste. Such an exercise has yet to be undertaken in burns. The aim of this paper is to outline the importance of research prioritisation in burn care, to discuss how it facilitates the maximum benefit from limited research funding and to explain the methodologies used.
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Affiliation(s)
- A E Young
- Population Health Sciences, Bristol Medical School, University of Bristol, UK.
| | - R M T Staruch
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - P Dziewulski
- St Andrews Centre for Burns & Plastic Surgery, Chelmsford, UK
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24
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Rogers AD, Amaral A, Cartotto R, El Khatib A, Fowler R, Logsetty S, Malic C, Mason S, Nickerson D, Papp A, Rasmussen J, Wallace D. Choosing wisely in burn care. Burns 2022; 48:1097-1103. [PMID: 34563420 DOI: 10.1016/j.burns.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/15/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Choosing Wisely Campaign was launched in 2012 and has been applied to a broad spectrum of disciplines in almost thirty countries, with the objective of reducing unnecessary or potentially harmful investigations and procedures, thus limiting costs and improving outcomes. In Canada, patients with burn injuries are usually initially assessed by primary care and emergency providers, while plastic or general surgeons provide ongoing management. We sought to develop a series of Choosing Wisely statements for burn care to guide these practitioners and inform suitable, cost-effective investigations and treatment choices. METHODS The Choosing Wisely Canada list for Burns was developed by members of the Canadian Special Interest Group of the American Burn Association. Eleven recommendations were generated from an initial list of 29 statements using a modified Delphi process and SurveyMonkey™. RESULTS Recommendations included statements on avoidance of prophylactic antibiotics, restriction of blood products, use of adjunctive analgesic medications, monitoring and titration of opioid analgesics, and minimizing 'routine' bloodwork, microbiology or radiological investigations. CONCLUSIONS The Choosing Wisely recommendations aim to encourage greater discussion between those involved in burn care, other health care professionals, and their patients, with a view to reduce the cost and adverse effects associated with unnecessary therapeutic and diagnostic procedures, while still maintaining high standards of evidence-based burn care.
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Affiliation(s)
- A D Rogers
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - A Amaral
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - R Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - A El Khatib
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - R Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - S Logsetty
- Manitoba Firefighters Burn Unit, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C Malic
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - S Mason
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - D Nickerson
- Calgary Firefighters' Burn Treatment Centre, Foothills Medical Centre, Department of Surgery, University of Calgary, Alberta, Canada
| | - A Papp
- BC Professional Firefighters' Burn Unit, Vancouver General Hospital, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Rasmussen
- Queen Elizabeth II Health Sciences Centre Burn Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - D Wallace
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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25
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Venturi M, Bruzziches F, Orlandi C, Altini M, Rubegni P, Melandri D. Economic Burden of Denatured Alcohol-Induced Burns: A 20-Year Retrospective Study. Front Med (Lausanne) 2022; 9:914976. [PMID: 35783652 PMCID: PMC9241105 DOI: 10.3389/fmed.2022.914976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Burn care has rapidly improved over the past decades, but health innovations are expensive. We present the first study focusing on the economic burden of exclusive denatured alcohol-induced burns. The goal of this study was to determine costs for the public health system due to inpatients’ burn care because of these specific burns. Moreover, we aimed to observe the incidence of methylated spirit-related burns in the past 20 years. We performed an observational retrospective study in our burn unit including all patients with a denatured alcohol-related burn injury from 1 January 2001 to 31 December 2020. A total of 503 patients with a mean burn size of 24% were hospitalized; the mean annual total costs per patient was €43,879, varying from €31,518 to €63,274.00€; the total costs for denatured alcohol-related burns during the period 2001–2020 was €21,145,076. We noted an increasing incidence of denatured alcohol-related burns and related costs over the years, especially in the last decade. Our results highlight that burns by methylated spirits are still a real and expanding problem. Therefore, authorities should focus on sales rules, characteristics of the containers, and education of people who misuse denatured alcohol, based on historical habits of use. To reduce the socioeconomic costs of burns, future intervention strategies and studies from the dermatology community and burn specialists should focus on prevention programs and prompt wound healing to shorten the length of hospital stay, enable quick return to work, and improve the outcomes of patients with burns.
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Affiliation(s)
- Michela Venturi
- Dermatology Unit and Burn Center, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
| | - Francesco Bruzziches
- Dermatology Unit and Burn Center, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
- Dermatology Unit, Department of Medical, Surgical and Neurological Science, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Catuscia Orlandi
- Dermatology Unit and Burn Center, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
| | - Mattia Altini
- Medical Direction, Azienda Unità Sanitaria Locale (AUSL) Romagna, Ravenna, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Science, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Davide Melandri
- Dermatology Unit and Burn Center, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
- *Correspondence: Davide Melandri,
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26
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Chao T, Parry I, Palackic A, Sen S, Spratt H, Mlcak RP, Lee JO, Herndon DN, Wolf SE, Branski LK, Suman OE. The effects of short bouts of ergometric exercise for severely burned children in intensive care: A randomized controlled trial. Clin Rehabil 2022; 36:1052-1061. [PMID: 35473409 PMCID: PMC9420547 DOI: 10.1177/02692155221095643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the effects of short bouts of ergometric exercises on the number of days in the burn intensive care unit (ICU), body mass, and functional ambulation. DESIGN Multi-center, randomized controlled trial. SETTING Burn intensive care unit. PARTICIPANTS Children ages 7-17 with severe burns covering over 30% total body surface area (TBSA). INTERVENTION All patients received standard of care (Control) with the experimental group receiving additional exercise with a cycle ergometer (Exercise). MAIN MEASURES The number of days in the ICU, total weight, lean body mass (LBM), and functional ambulation were taken shortly after randomization and again within one week of the scheduled hospital discharge. Results of outcomes are expressed as median ± interquartile range (IQR), unless otherwise noted (e.g. demographics). RESULTS Fifty-four severely burned children (n = 18 Control, n = 36 Exercise) were included. The average ± standard deviation for age was 12 ± 3 years and TBSA was 48 ± 16%. The median ± IQR ICU days for Control was 46 ± 51 days vs 31 ± 29 days for Exercise. The median total weight loss for Control was 2.2 ± 1.2 kg vs 1.8 ± 1.4 kg in Exercise. Control lost 0.75 ± 0.8 kg of LBM vs 0.46 ± 0.43 kg in Exercise. Both groups showed significant improvement in functional ambulation (p < 0.01). However, exercise did not add additional benefits. CONCLUSION Short bouts of ergometric exercises are feasible for severely burned patients while receiving care in the ICU but did not add additional benefits.
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Affiliation(s)
- Tony Chao
- Department of Physical Therapy, School of Health Professions, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Ingrid Parry
- 8789University of California-Davis, Shriners Children's Northern California Hospital, Sacramento, CA, USA
| | - Alen Palackic
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, 31475Medical University of Graz, Graz, Austria
| | - Soman Sen
- 8789University of California-Davis, Shriners Children's Northern California Hospital, Sacramento, CA, USA
| | - Heidi Spratt
- Office of Biostatistics, 351229Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Ronald P Mlcak
- 24174Shriners Children's Texas Hospital, Galveston, TX, USA
| | - Jong O Lee
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - David N Herndon
- 276672Joseph Still Burn Research Foundation, Journal of Burn Care and Research, Augusta, USA
| | - Steven E Wolf
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Ludwik K Branski
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Oscar E Suman
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA
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27
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Wen JJ, Mobli K, Rontoyanni VG, Cummins CB, Radhakrishnan GL, Murton A, Radhakrishnan RS. Nuclear Factor Erythroid 2-Related Factor 2 Activation and Burn-Induced Cardiac Dysfunction. J Am Coll Surg 2022; 234:660-671. [PMID: 35290286 PMCID: PMC9634710 DOI: 10.1097/xcs.0000000000000119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our previous studies have found that burn injury induces cardiac dysfunction through interruption of the antioxidant-response element (ARE) pathway in cardiac mitochondria. Nuclear factor erythroid 2-related factor 2 (Nrf2) is a key regulator that activates many antioxidant enzymes. Oltipraz (Olti) is a Nrf2 activator and a well-known inducer of NQO1 along with other enzymes that comprise the Nrf2-associated antioxidants. We propose that Nrf2 activation will induce the ARE pathway, leading to abrogation of burn-induced cardiac dysfunction. STUDY DESIGN In this study, we investigated the effect of Nrf2-deficiency in mice on burn-induced cardiac dysfunction. Wild-type (WT) and Nrf2-deficient mice received 30% total body surface area burn injury and were treated with or without Olti and then harvested at 3 hours and 24 hours post burn (3 hpb and 24 hpb). RESULTS As expected, Nrf2-deficient mice exhibited exacerbated cardiac dysfunction after burn injury, as measured by Vevo 2100 echocardiography. Electron microscopy showed that Nrf2 depletion worsened burn injury-induced cardiac mitochondrial damage. In addition, Nrf2 depletion increased cardiac mitochondrial dysfunction and myocardial fibrosis after burn injury. Treatment with Olti ameliorated the heart dysfunction in burned Nrf2-/+ mice, improved cardiac mitochondrial structure and oxidative phosphorylation, as well as decreased cardiac fibrosis. These results suggest that Nrf2 and its downstream targets modulate cardiac function after burn injury. CONCLUSIONS In summary, Nrf2 depletion worsens cardiac dysfunction after burn injury. Nrf2 activation, with a drug such as Olti, offers a promising therapeutic strategy for abrogating burn-induced cardiac dysfunction.
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Affiliation(s)
- Jake J Wen
- From the Departments of Surgery (Wen, Mobli, Rontoyanni, Cummins, Murton, RS Radhakrishnan), University of Texas Medical Branch at Galveston, Galveston, TX
| | - Keyan Mobli
- From the Departments of Surgery (Wen, Mobli, Rontoyanni, Cummins, Murton, RS Radhakrishnan), University of Texas Medical Branch at Galveston, Galveston, TX
| | - Victoria G Rontoyanni
- From the Departments of Surgery (Wen, Mobli, Rontoyanni, Cummins, Murton, RS Radhakrishnan), University of Texas Medical Branch at Galveston, Galveston, TX
| | - Claire B Cummins
- From the Departments of Surgery (Wen, Mobli, Rontoyanni, Cummins, Murton, RS Radhakrishnan), University of Texas Medical Branch at Galveston, Galveston, TX
| | - Geetha L Radhakrishnan
- Pediatrics (GL Radhakrishnan, RS Radhakrishnan), University of Texas Medical Branch at Galveston, Galveston, TX
| | - Andrew Murton
- From the Departments of Surgery (Wen, Mobli, Rontoyanni, Cummins, Murton, RS Radhakrishnan), University of Texas Medical Branch at Galveston, Galveston, TX
| | - Ravi S Radhakrishnan
- From the Departments of Surgery (Wen, Mobli, Rontoyanni, Cummins, Murton, RS Radhakrishnan), University of Texas Medical Branch at Galveston, Galveston, TX
- Pediatrics (GL Radhakrishnan, RS Radhakrishnan), University of Texas Medical Branch at Galveston, Galveston, TX
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28
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Sheckter CC, Carrougher GJ, Wolf SE, Schneider JC, Gibran N, Stewart BT. The Impact of Burn Survivor Preinjury Income and Payer Status on Health-Related Quality of Life. J Burn Care Res 2022; 43:293-299. [PMID: 34519793 PMCID: PMC10026600 DOI: 10.1093/jbcr/irab170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The costs required to provide acute care for patients with serious burn injuries are significant. In the United States, these costs are often shared by patients. However, the impacts of preinjury finances on health-related quality of life (HRQL) have been poorly characterized. We hypothesized that lower income and public payers would be associated with poorer HRQL. Burn survivors with complete data for preinjury personal income and payer status were extracted from the longitudinal Burn Model System National Database. HRQL outcomes were measured with VR-12 scores at 6, 12, and 24 months postinjury. VR-12 scores were evaluated using generalized linear models, adjusting for potential confounders (eg, age, sex, self-identified race, burn injury severity). About 453 participants had complete data for income and payer status. More than one third of BMS participants earned less than $25,000/year (36%), 24% earned $25,000 to 49,000/year, 23% earned $50,000 to 99,000/year, 11% earned $100,000 to 149,000/year, 3% earned $150,000 to 199,000/year, and 4% earned more than $200,000/year. VR-12 mental component summary (MCS) and physical component summary (PCS) scores were highest for those who earned $150,000 to 199,000/year (55.8 and 55.8) and lowest for those who earned less than $25,000/year (49.0 and 46.4). After adjusting for demographics, payer, and burn severity, 12-month MCS and PCS and 24-month PCS scores were negatively associated with Medicare payer (P < .05). Low income was not significantly associated with lower VR-12 scores. There was a peaking relationship between HRQL and middle-class income, but this trend was not significant after adjusting for covariates. Public payers, particularly Medicare, were independently associated with poorer HRQL. The findings might be used to identify those at risk of financial toxicity for targeting assistance during rehabilitation.
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Affiliation(s)
- Clifford C Sheckter
- Department of Surgery, Stanford University, California, USA
- Regional Burn Center at Santa Clara Valley Medical Center, San Jose, California, USA
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Steven E Wolf
- Shriners Burns Hospital, University of Texas Medical Branch, Galveston, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
- Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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29
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Weiss F, Agua K, Weinzierl A, Schuldt A, Egana JT, Schlitter AM, Steiger K, Machens HG, Harder Y, Schmauss D. A modified burn comb model with a new dorsal frame that allows for local treatment in partial-thickness burns in rats. J Burn Care Res 2022; 43:1329-1336. [PMID: 35259276 DOI: 10.1093/jbcr/irac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn wound progression (BWP) leads to vertical and horizontal injury extension. The "burn comb model" is commonly used, in which a full-thickness burn with intercalated unburned interspaces is induced. We aimed to establish an injury progressing to the intermediate dermis, allowing repeated wound evaluation. Furthermore, we present a new dorsal frame that enables topical drug application. 8 burn field and 6 interspaces were induced on each of 17 rats' dorsa with a 10-second burn comb application. A developed 8-panel aluminum frame was sutured onto 12 animals and combined with an Elizabethan collar. Over 14 days, macroscopic & histologic wound assessment and Laser-Speckle-Contrast-Imaging (LSCI) were performed besides evaluation of frame durability. The 10-second group was compared to 9 animals injured with a full-thickness 60-second model. Frame durability was sufficient up to day 4 with 8 of 12 frames (67%) still mounted. The 60-second burn led to an increased extent of interspace necrosis (p=0.002). The extent of necrosis increased between days 1 and 2 (p=0.001), following the 10-second burn (24%±SEM 8% to 40%±SEM 6%) and the 60-second burn (57%±SEM 6% to 76%±SEM 4%). Interspace LSCI perfusion was higher than burn field perfusion. It earlier reached baseline levels in the 10-second group (on day 1: 142%±SEM 9% vs. 60%±SEM 5%; p<0.001). Within day 1, the 10-second burn showed histological progression to the intermediate dermis, both in interspaces and burn fields. This burn comb model with its newly developed fixed dorsal frame allows investigation of topical agents to treat BWP in partial-thickness burns.
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Affiliation(s)
- Fabian Weiss
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Kariem Agua
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Andrea Weinzierl
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Anna Schuldt
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Jose Tomas Egana
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anna Melissa Schlitter
- Institute of Pathology, School of Medicine, Technische Universität München, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, School of Medicine, Technische Universität München, Munich, Germany
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Yves Harder
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Daniel Schmauss
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Hoghoughi MA, Marzban MR, Shahrbaf MA, Shahriarirad R, Kamran H, Meimandi FZ, Salimi M, Hosseinpour H. Burn Injuries in People Who Used Drug, 2009-2017: A Case-Control Study in Shiraz, Southern Iran. J Burn Care Res 2022; 43:1170-1174. [PMID: 35029683 DOI: 10.1093/jbcr/irac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Burn injury is a critical health issue, which is associated with several morbidities and mortalities. Substance abuse, which is an important public health problem in Iran, can affect burn injury outcomes and etiologies in victims. This study was aimed to evaluate different aspects of burn injuries in people who used drug (PWUD) in two referral centers in the south of Iran. METHODS This Case-Control Study was conducted on burn victims referred to Amir-al Momenin Hospital and Ghotb-al-din Hospital from 2009 to 2017. Patients with a history of drug consumption were selected from the database and compared to randomly selected burn victims with no history of drug use. Demographics, burn etiology, underlying disease, total body surface area, hospitalization duration, and also the outcomes were collected and recorded in both groups. Data analysis was done by SPSS software. RESULTS A total of 5,912 inpatients were included in this study, which 2,397 of them (40.54%) were female. The mean age of the patients was 26.12 ± 19.18. Drug history was positive in 659 patients (11.15%). Familial issues and mental disorders were significantly higher in the PWUD group compared to the control group (P<0.001). Explosion etiology was significantly higher in the PWUD group (P<0.001). Psychiatric disorders (P<0.001), total body surface area (P=0.023), and hospital stay (P<0.001) were significantly higher in PWUD; however, the mortality rate had no statistically significant differences between the groups (P=0.583). CONCLUSION Substance abuse is a risk factor in burn victims, which can affect burn etiology and burn-related morbidities.
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Affiliation(s)
- Mohammad Ali Hoghoughi
- Department of Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohammad Reza Marzban
- Department of Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran
| | | | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Zahmatkesh Meimandi
- Department of Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran
| | - Maryam Salimi
- Department of Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran
| | - Hamidreza Hosseinpour
- Department of Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran
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31
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Morarasu S, Morarasu BC, Ghețu N, Dimofte MG, Iliescu R, Pieptu D. Experimental models for controlled burn injuries in rats: a systematic analysis of original methods and burn devices. J Burn Care Res 2021; 43:1055-1065. [PMID: 34888684 DOI: 10.1093/jbcr/irab234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Despite a wide variety of models found in literature, choosing the right one can be difficult as many of them are lacking precise methodology. This study aims to analyze and compare original burn models in terms of burn device and technique, parameters, and wound depth assessment. METHODS A systematic search was performed according to PRISMA guidelines on studies describing original experimental burn models in rats. The adapted PICO formula and ARRIVE checklist were followed for inclusion and assessment of quality of studies. Characteristics of animals, burn technique, burn parameters and method of histological confirmation of burn depth were recorded. RESULTS Twenty-seven studies were included in the final analysis. Most studies used direct contact with skin for burn infliction (n=20). The rat's dorsum was the most common site (n=18). Ten studies used manually controlled burn devices, while ten designed automatic burn devices with control over temperature (n=10), exposure time (n=5), and pressure (n=5). Most studies (n=7) used a single biopsy taken from the center of the wound to confirm burn depth immediately after burn infliction. CONCLUSION From the wide variety of burn models in current literature, our study provides an overview of the most relevant experimental burn models in rats aiding researchers to understand what needs to be addressed when designing their burn protocol. Models cannot be compared as burn parameters variate significantly. Assessment of burn depth should be done in a standardized, sequential fashion in future burn studies to increase reproducibility.
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Affiliation(s)
- Stefan Morarasu
- Center of Simulation and Training in Surgery (CSTC), Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania.,2nd Department of Surgical Oncology, Regional Oncology Institute, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Bianca-Codrina Morarasu
- Center of Simulation and Training in Surgery (CSTC), Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Nicolae Ghețu
- Center of Simulation and Training in Surgery (CSTC), Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Plastic and Reconstructive Surgery, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mihail-Gabriel Dimofte
- 2nd Department of Surgical Oncology, Regional Oncology Institute, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Radu Iliescu
- Department of Pharmacology, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Dragos Pieptu
- Center of Simulation and Training in Surgery (CSTC), Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Plastic and Reconstructive Surgery, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
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Lee A, Wang Y, Nadarajah CC, Lipner SR. Cross-sectional analysis of national electronic injury surveillance system for burn injuries presenting to United States emergency departments 2000-2018. Burns 2021; 48:1347-1354. [PMID: 34924228 DOI: 10.1016/j.burns.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Patients with burns commonly present to Emergency Departments (EDs), in addition to burn centers. Patients at burn centers typically have more severe burns than those at EDs, and previous studies have analyzed burn center databases. To update the overall burn epidemiology in the United States (US), we analyzed burn injury trends and sources across all age groups using the National Electronic Injury Surveillance System (NEISS), which collects all injuries reported to US EDs. A total of 97,986 burn injuries were recorded in NEISS, 2000-2018. We found a downward trend in the pediatric burn rate and an upward trend in the adult burn rate. Almost half of burns were in children (48.41%), especially in those under 5 (29.79%), and slightly more common in men (53.93%). Most were treatable in the ED (87.83%) and hot water was the most common source overall (20.88%), followed by hair curlers for children less than 2 years old, ranges/ovens for 2 to <5 years, microwaves for 5 to <10 years, and cookware for 10 to <18 years and adults ≥18 years. The most common injured region was the hand for all age groups (34.44%). Although most burn injuries were potentially preventable, the overall burn rate did not decrease 2000-2018. Therefore, we offer guidance on prevention strategies for high-risk sources and age groups.
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Affiliation(s)
- April Lee
- The State University of New York Downstate College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Yu Wang
- Wake Forest University, Department of Dermatology, 475 Vine Street, Winston-Salem, NC 27101, USA
| | | | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, NY 10021, USA.
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33
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Natural rubber dressing loaded with silver sulfadiazine for the treatment of burn wounds infected with Candida spp. Int J Biol Macromol 2021; 189:597-606. [PMID: 34418421 DOI: 10.1016/j.ijbiomac.2021.08.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 01/02/2023]
Abstract
Millions of people are burned worldwide every year and 265,000 of the cases are fatal. The development of burn treatment cannot consist only of the administration of a single drug. Due to the infection risk, antibiotics are used in conjunction with gels and damp bandages. In this work, an inexpensive curative based on silver sulfadiazine (SS) and natural rubber latex (NRL) was developed to treat burn wounds. It was produced by the casting method. The infrared spectrum presented no interaction between drug and biopolymer. At the same time, electronic micrographs showed that the SS crystals are inserted on the polymeric dressing surface. Mechanical properties after the drug incorporation were considered suitable for dermal application. About 32.4% of loaded SS was released in 192 h by the dressings that also inhibited the growth of Candida albicans and Candida parapsilosis at 75.0 and 37.5 μg·mL-1, respectively. The curative proved to be biocompatible when applied to fibroblast cells, in addition to enhancing cellular proliferation and, in the hemocompatibility test, no hemolytic effects were observed. The good results in mechanical, antifungal and biological assays, combined with the average bandage cost of $0.10, represent an exciting alternative for treating burn wounds.
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34
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Aggarwala S, Harish V, Roberts S, Brady M, Lajevardi S, Doherty J, D'Souza M, Haertsch PA, Maitz PKM, Issler-Fisher AC. Treatment of Partial Thickness Burns: A Prospective, Randomized Controlled Trial Comparing Four Routinely Used Burns Dressings in an Ambulatory Care Setting. J Burn Care Res 2021; 42:934-943. [PMID: 32930784 DOI: 10.1093/jbcr/iraa158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This prospective, randomized controlled trial study compared the effects of four dressings for adult partial thickness burns, focusing on re-epithelialization time and cost effectiveness. Adults with partial thickness burns meeting inclusion criteria were randomized to either Biobrane™, Acticoat™, Mepilex® Ag, or Aquacel® Ag. Primary endpoint for analysis was >95% re-epithelialization. Incremental cost-effectiveness ratios were calculated based on dressing costs. Dominance probabilities between treatment arms were calculated from bootstrap resampling trial data. One hunderd thirty-one partial thickness burn wounds in 119 patients were randomized. Adjusting for sex, age, smoking status, burn mechanism, TBSA, and first aid adequacy, Mepilex® Ag had a reduced time to re-epithelialization compared to Biobrane™ (IRR: 1.26; 95% CI: 1.07-1.48, P < .01). Economic analysis showed that there was a 99%, 71%, and 53% probability that Mepilex® Ag dominated (cheaper and more effective) Biobrane™, Acticoat™, and Aquacel® Ag, respectively. Mepilex® Ag achieved faster re-epithelialization and better cost effectiveness. Patient satisfaction and comfort seems better with Biobrane™ although not reflected within the end outcome of the healed wound. It is the patients' (after extensive education) and clinicians' choice, level of experience, and availability of products in praxis that will guide the decision as to which the product is used individually on which patient.
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Affiliation(s)
- Shivani Aggarwala
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia
| | - Varun Harish
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Roberts
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Megan Brady
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sepehr Lajevardi
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia
| | - James Doherty
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Mario D'Souza
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Peter A Haertsch
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia
| | - Andrea C Issler-Fisher
- Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia
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35
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Dearman BL, Boyce ST, Greenwood JE. Advances in Skin Tissue Bioengineering and the Challenges of Clinical Translation. Front Surg 2021; 8:640879. [PMID: 34504864 PMCID: PMC8421760 DOI: 10.3389/fsurg.2021.640879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 07/31/2021] [Indexed: 01/17/2023] Open
Abstract
Skin tissue bioengineering is an emerging field that brings together interdisciplinary teams to promote successful translation to clinical care. Extensive deep tissue injuries, such as large burns and other major skin loss conditions, are medical indications where bioengineered skin substitutes (that restore both dermal and epidermal tissues) are being studied as alternatives. These may not only reduce mortality but also lessen morbidity to improve quality of life and functional outcome compared with the current standards of care. A common objective of dermal-epidermal therapies is to reduce the time required to accomplish stable closure of wounds with minimal scar in patients with insufficient donor sites for autologous split-thickness skin grafts. However, no commercially-available product has yet fully satisfied this objective. Tissue engineered skin may include cells, biopolymer scaffolds and drugs, and requires regulatory review to demonstrate safety and efficacy. They must be scalable for manufacturing and distribution. The advancement of technology and the introduction of bioreactors and bio-printing for skin tissue engineering may facilitate clinical products' availability. This mini-review elucidates the reasons for the few available commercial skin substitutes. In addition, it provides insights into the challenges faced by surgeons and scientists to develop new therapies and deliver the results of translational research to improve patient care.
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Affiliation(s)
- Bronwyn L. Dearman
- Skin Engineering Laboratory, Adult Burns Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adult Burns Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
- Faculty of Health and Medical Science, The University of Adelaide, Adelaide, SA, Australia
| | - Steven T. Boyce
- Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - John E. Greenwood
- Skin Engineering Laboratory, Adult Burns Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adult Burns Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
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Cost-effectiveness of adjunctive negative pressure wound therapy in paediatric burn care: evidence from the SONATA in C randomised controlled trial. Sci Rep 2021; 11:16650. [PMID: 34404842 PMCID: PMC8371025 DOI: 10.1038/s41598-021-95893-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Negative pressure wound therapy (NPWT) has been shown to improve clinical outcomes for children with burns by accelerating wound re-epithelialisation. Its effects on healthcare costs, however, remain poorly understood. The aim of this study was to evaluate the cost-effectiveness of NPWT from a healthcare provider perspective using evidence from the SONATA in C randomised controlled trial, in which 101 children with small-area burns were allocated to either standard care (silver-impregnated dressings) or standard care in combination with adjunctive NPWT. The primary outcome, time to re-epithelialisation, was assessed through a blinded photographic review. Resource usage and costs were prospectively recorded for each participant for up to 6 months. Incremental cost-effectiveness ratios and dominance probabilities were estimated and uncertainty quantified using bootstrap resampling. Mean costs per participant—including dressings, labour, medication, scar management, and theatre operations—were lower in the NPWT group (AUD $903.69) relative to the control group (AUD $1669.01). There was an 89% probability that NPWT was dominant, yielding both faster re-epithelialisation and lower overall costs. Findings remained robust to sensitivity analyses employing alternative theatre costs and time-to-re-epithelialisation estimates for grafted patients. In conclusion, adjunctive NPWT is likely to be a cost-effective and dominant treatment for small-area paediatric burns (ANZCTR.org.au:ACTRN12618000256279).
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Saavedra PAE, De Oliveira Leal JV, Areda CA, Galato D. The Costs of Burn Victim Hospital Care around the World: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:866-878. [PMID: 34183945 PMCID: PMC8223566 DOI: 10.18502/ijph.v50i5.6104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/22/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Burn injuries are very common and fire-related burns account for over 300,000 deaths per year globally. The costs of the treatment of these patients change around the world. The aim of the present study was to conduct a systematic literature review to identify the costs related to hospital stays of burn victims in countries with different Human Development Index (HDIs). METHODS PubMed, CINAHL and BVIS databases were searched using the following terms: "burn," treatment" and "costs". The review included articles that presented cost studies or economic assessments of burn victims in which the costs were reported, and published between 2012 and 2019. The quality of the evidence was assessed using the Consensus on Health Economic Criteria. This review presents register in Prospero (CRD42019137580). RESULTS The review included 19 economic studies conducted in 13 countries, most with a very high HDIs. Most studies estimated direct acute burn care costs through bottom-up costing and institutional data. Total hospital care costs ranged from US$ 10.58 to US$ 125,597.86 per patient, the cost of 1% of total body surface area burned ranged from US$ 2.65 to US$ 11,245.04, and the cost of hospital care per day, from US$ 24.23 to US$ 4,125.50. CONCLUSION The costs are high and show wide discrepancies among countries. Medical costs and other losses caused by fatal and non-fatal burn injuries differ considerably among demographic groups, care protocols, and country HDIs.
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Affiliation(s)
- Pamela Alejandra Escalante Saavedra
- Health Sciences and Technology Post-Graduate Program, University of Brasilia, Brasília, Distrito Federal, Brazil
- Research Group on Access to and Responsible Use of Medications, University of Brasilia, Brasília, Distrito Federal, Brazil
| | | | - Camila Alves Areda
- Research Group on Access to and Responsible Use of Medications, University of Brasilia, Brasília, Distrito Federal, Brazil
- Pharmacy Graduate, University of Brasilia, Brasília, Distrito Federal, Brazil
| | - Dayani Galato
- Health Sciences and Technology Post-Graduate Program, University of Brasilia, Brasília, Distrito Federal, Brazil
- Research Group on Access to and Responsible Use of Medications, University of Brasilia, Brasília, Distrito Federal, Brazil
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38
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The cost of inpatient burn management in Nepal. Burns 2021; 47:1675-1682. [PMID: 33947601 DOI: 10.1016/j.burns.2021.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/18/2020] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The management of burns is costly and complex with inpatient burns accounting for a high proportion of the costs associated with burn care. We conducted a study to estimate the cost of inpatient burn management in Nepal. Our objectives were to identify the resource and cost components of the inpatient burn care pathways and to estimate direct and overhead costs in two specialist burn units in tertiary hospitals in Nepal. METHODS We conducted fieldwork at two tertiary hospitals to identify the cost of burns management in a specialist setting. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with burn experts; unit cost data was collected from hospital finance departments, laboratories and pharmacies. The study focused on acute inpatient burn cases admitted to specialist burn centres within a hospital-setting. RESULTS Experts divided inpatient burn care pathways into three categories: superficial partial-thickness burns (SPT), mixed depth partial-thickness burns (MDPT) and full thickness burns (FT). These pathways were confirmed in the FGDs. A 'typical' burns patient was identified for each pathway. Total resource use and total direct costs along with overhead costs were estimated for acute inpatient burn patients. The average per patient pathway costs were estimated at NRs 102,194 (US$ 896.4), NRs 196,666 (US$ 1725), NRs 481,951 (US$ 4,227.6) for SPT, MDPT and FT patients respectively. The largest cost contributors were surgery, dressings and bed charges respectively. CONCLUSION This study is a first step towards a comprehensive estimate of the costs of severe burns in Nepal.
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Bayuo J, Bristowe K, Harding R, Agbeko AE, Wong FKY, Agyei FB, Allotey G, Baffour PK, Agbenorku P, Hoyte-Williams PE, Agambire R. "Hanging in a balance": A qualitative study exploring clinicians' experiences of providing care at the end of life in the burn unit. Palliat Med 2021; 35:417-425. [PMID: 33198576 DOI: 10.1177/0269216320972289] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although the culture in burns/critical care units is gradually evolving to support the delivery of palliative/end of life care, how clinicians experience the end of life phase in the burn unit remains minimally explored with a general lack of guidelines to support them. AIM To explore the end of life care experiences of burn care staff and ascertain how their experiences can facilitate the development of clinical guidelines. DESIGN Interpretive-descriptive qualitative approach with a sequential two phased multiple data collection strategies was employed (face to face semi-structured in-depth interviews and follow-up consultative meeting). Thematic analysis was used to analyze the data. SETTING/PARTICIPANTS The study was undertaken in a large teaching hospital in Ghana. Twenty burn care staff who had a minimum of 6 months working experience completed the interviews and 22 practitioners participated in the consultative meeting. RESULTS Experiences of burn care staff are complex with four themes emerging: (1) evaluating injury severity and prognostication, (2) nature of existing system of care, (3) perceived patient needs, and (4) considerations for palliative care in burns. Guidelines in this regard should focus on facilitating communication between the patient and family and staff, holistic symptom management at the end of life, and post-bereavement support for family members and burn care practitioners. CONCLUSIONS The end of life period in the burn unit is poorly defined coupled with prognostic uncertainty. Collaborative model of practice and further training are required to support the integration of palliative care in the burn unit.
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Affiliation(s)
- Jonathan Bayuo
- Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College, Abetifi, Eastern, Ghana.,School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, Kings College, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, Kings College, London, UK
| | | | | | - Frank Bediako Agyei
- Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College, Abetifi, Eastern, Ghana
| | - Gabriel Allotey
- Burns Intensive Care Unit, Plastics and Reconstructive Surgical Unit, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ashanti, Ghana
| | - Prince Kyei Baffour
- Burns Intensive Care Unit, Plastics and Reconstructive Surgical Unit, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ashanti, Ghana
| | - Pius Agbenorku
- Plastics, Burns and Reconstructive Surgical Division, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ashanti, Ghana.,School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Paa Ekow Hoyte-Williams
- Plastics, Burns and Reconstructive Surgical Division, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ashanti, Ghana
| | - Ramatu Agambire
- Department of Nursing, Garden City University College, Kumasi, Ghana
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Song Y, Cui Y, Hao L, Zhu J, Yi J, Kang Q, Huang J, Lu J. Wound-healing activity of glycoproteins from white jade snail (Achatina fulica) on experimentally burned mice. Int J Biol Macromol 2021; 175:313-321. [PMID: 33539960 DOI: 10.1016/j.ijbiomac.2021.01.193] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
Burns are a global public health problem and the treatment of burn wounds is a major medical and economic issue. White jade snails (Achatina fulica) are now widely distributed in Asia, and they have been used to treat burns in folk medicine of China. In this study, the glycoproteins from white jade snails were investigated and their effect on burn healing was evaluated by a mouse burn model. The results showed that the snail mucus was mainly composed of proteins and polysaccharides, and it had good adhesion. The main component of snail mucus was glycoprotein from the results of DEAE Sepharose FF ion exchange chromatography. The 2,2-Diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging effect of 1 mg/mL snail mucus reached 13.77%. The wound healing rate of the snail mucus group was higher than that of the control group (p < 0.0001). Histopathological results showed that mice in the snail mucus group had a faster healing than that of the control group. The biochemical analysis was in agreement with the histopathological findings. These results suggested that glycoproteins from snail mucus showed effective wound healing activities in the skin of experimentally burned mice.
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Affiliation(s)
- Yiming Song
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Yinxin Cui
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Limin Hao
- The Quartermaster Research Institute of Engineering and Technology, Academy of Military Sciences PLA China, Beijing 100010, China.
| | - Jiaqing Zhu
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Juanjuan Yi
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Qiaozhen Kang
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Jinyong Huang
- School of Agricultural Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Jike Lu
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China.
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Katsu A, Tyack Z, Mackey M, Elliott JM, Mackenzie L. Return to employment for working-aged adults after burn injury: a scoping review protocol. BMJ Open 2021; 11:e044145. [PMID: 33408216 PMCID: PMC7789466 DOI: 10.1136/bmjopen-2020-044145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cutaneous burns can have a catastrophic effect on people's lives and may restrict opportunities for employment due to physical impairment and psychosocial deficits. Failure or delay in return to work can result in loss of income and support for the family unit. It can also negatively affect life role and identity and present difficulties with future opportunities. Current literature indicates multiple discrete influences on return to work as a result of burn injury but an understanding of how working-aged adults resume employment after burn injury is lacking. This scoping review will provide a comprehensive overview of the current literature by mapping and consolidating knowledge in this area of burn recovery and thus provide an informative basis for developing return-to-work programmes for survivors of burn injury. METHODS AND ANALYSIS This scoping review protocol will follow the Arksey and O'Malley's (2005) methodological framework. A comprehensive search strategy has been developed with subject expert librarians. These databases were used: OvidSP: Medline, Embase, PsycINFO, PubMed and Cochrane Central Register of Controlled Trials and EBSCOhost: CINAHL and Scopus. Reference lists of selected full text will be hand searched for additional literature. To enhance consistency and rigour, all reviewers will undertake a calibration exercise before paired reviewers independently screen all records using Rayyan. Full-text articles meeting the study inclusion criteria will be retrieved and examined. Extracted data will be analysed using the International Classification of Functioning, Disability and Health. ETHICS AND DISSEMINATION Ethics approval is generally not required for scoping reviews. Findings of this scoping review will be reported in a peer-reviewed journal and presented at conferences.
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Affiliation(s)
- Akane Katsu
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Occupational Therapy, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, University of Queensland, South Brisbane, Queensland, Australia
| | - Martin Mackey
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - James M Elliott
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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PECULIARITIES OF METABOLIC PARAMETERS IN THE HEALING OF WOUNDS COMPLICATED BY EXPERIMENTAL CHRONIC KIDNEY DISEASE. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-4-78-233-237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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43
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Gacto-Sánchez P, Molina-Morales J, Rodríguez-Vela F, Moreno-Conde J, Sendin-Martin M, Parra-Calderon C, Gomez-Cía T, Pereyra-Rodriguez JJ. Diagnostic accuracy of a telemedicine tool for acute burns diagnosis. Burns 2020; 46:1799-1804. [DOI: 10.1016/j.burns.2020.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
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Sumsuzzman DM, Choi J, Khan ZA, Hong Y. Protective Effects of Melatonin against Severe Burn-Induced Distant Organ Injury: A Systematic Review and Meta-Analysis of Experimental Studies. Antioxidants (Basel) 2020; 9:antiox9121196. [PMID: 33261180 PMCID: PMC7760393 DOI: 10.3390/antiox9121196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
Extensive burns result in a local wound response and distant-organ injury (DOI) caused by oxidative-stress and inflammation. Melatonin (MT) shows promise in alleviating oxidative-stress and inflammation, but its role in thermal injury is largely unexplored. The present systematic review and meta-analysis were designed to assess the effects of MT on oxidative-stress and inflammatory markers against severe burn-induced DOI. Mean difference (MD)/standard mean difference (SMD) with 95% confidence interval (CI) were estimated using fixed-effect/random-effects models. Eighteen experimental studies met the inclusion criteria. Compared with the control group, MT significantly decreased the levels of malondialdehyde (SMD, −1.03; 95% CI, −1.30, −0.76, p < 0.00001) and 4-hydroxynonenal (MD, −1.06; 95% CI, −1.57, −0.56, p < 0.0001). Additionally, MT increased the levels of glutathione (SMD, 1.94; 95% CI, 1.27, 2.61, p < 0.00001) and superoxide-dismutase (SMD, 0.76; 95% CI, 0.08, 1.45, p = 0.03). Finally, MT significantly decreased the levels of tumor necrosis factor-α (SMD, −1.34; 95% CI, −1.92 to −0.77; p < 0.00001) and C-reactive protein (MD, −12.67; 95% CI, −16.72 to −8.62; p < 0.00001). Meta-analysis indicates that severe burn followed by immediate MT (10 mg/kg) intervention shows significant beneficial effects after 24-h against DOI by regulating oxidative-stress and the inflammatory response.
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Affiliation(s)
- Dewan Md. Sumsuzzman
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Jeonghyun Choi
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Zeeshan Ahmad Khan
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Yonggeun Hong
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
- Department of Medicine, Division of Hematology/Oncology, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Correspondence: ; Tel.: +82-55-320-3681; Fax: +82-55-329-1678
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Nurczyk K, Chrisco LP, Di Corpo M, Nizamani R, Sljivic S, Calvert CT, Jones SW, Cairns BA, Williams FN. Work-Related Burn Injuries in a Tertiary Care Burn Center, 2013 to 2018. J Burn Care Res 2020; 41:1009-1014. [PMID: 32598473 DOI: 10.1093/jbcr/iraa105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The features of work-related burn (WRB) injuries are not well defined in the literature and they vary depending on geographical location. We wanted to describe these characteristics among patients treated in the UNC Burn Center to evaluate the potential impact of commonly accepted prevention efforts. Adults of working age, admitted between January 1, 2013, and December 31, 2018, were identified using our Burn Center Registry. Demographic data, characteristics of injury, course of treatment, and patients' outcomes were described. Differences between work-related and non-work-related injuries were evaluated using the Chi-square test and Student t-test where appropriate. Three thousand five hundred and forty-five patients were included. WRB cases constituted 18% of the study population, and this proportion remained relatively stable during the study timeframe. Young white males were the majority of this group. When compared with non-WRB patients, they were characterized by fewer co-morbidities, decreased TBSA burns, decreased risk of inhalation injury, shorter time of intensive care treatment, shorter lengths of hospital stay, and lower treatment cost. In contrast to non-WRB, among which flame injuries were the main reason for admission, work-related patients most often suffered scald burns. They also had a dramatically increased proportion of chemical and electrical burns, making the latter the most common cause of death in that group. WRB are characterized by a characteristic patient profile, burn etiologies, and outcomes. Learning specific patterns at this group may contribute to optimize work safety regulations and medical interventions.
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Affiliation(s)
- Kamil Nurczyk
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.,2nd Department of General and Gastrointestinal Surgery, and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Poland
| | - Lori P Chrisco
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.,North Carolina Jaycee Burn Center, Chapel Hill, USA
| | - Marco Di Corpo
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.,Department of General Surgery, Nuevo Hospital San Roque, Cordoba, Argentina
| | - Rabia Nizamani
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.,North Carolina Jaycee Burn Center, Chapel Hill, USA
| | - Sanja Sljivic
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.,North Carolina Jaycee Burn Center, Chapel Hill, USA
| | - Catherine T Calvert
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.,North Carolina Jaycee Burn Center, Chapel Hill, USA
| | - Samuel W Jones
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.,North Carolina Jaycee Burn Center, Chapel Hill, USA
| | - Bruce A Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.,North Carolina Jaycee Burn Center, Chapel Hill, USA
| | - Felicia N Williams
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
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Lowin JL, Poudel AN, Price PE, Potokar TS. A Structured Review to Assess the Current Status of Cost-Based Burns Research in Nepal. J Burn Care Res 2020; 42:93-97. [PMID: 32780811 PMCID: PMC7856442 DOI: 10.1093/jbcr/iraa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The management of burns is costly and complex. The problem is compounded in low and middle income countries (LMICs) where the incidence of burn injuries is high but infrastructure and funding for management and prevention is limited. Cost of illness studies allows for quantification of the costs associated with public health problems. Without cost quantification, focus and allocation of funding is challenging. The authors explored the availability of cost-focused burns research data in a target LMIC. The focus of their research was Nepal. A structured literature review including published papers, Ministry of Health (MOH) and World Health Organization (WHO) statistics was conducted to identify cost of illness studies or evidence relating to burn-related resource and costs. Gaps in the evidence base were highlighted. Research methodologies from other LMICs were reviewed. We found 32 papers related to burn injury in Nepal, one key MOH document and one relevant WHO data source. Most research focused on the epidemiology and etiology of burns in Nepal. Of the papers, only 14 reported any type of burn-related resource use and only 1 paper directly reported (limited) cost data. No studies attempted an overall quantification of the cost of burns. MOH statistics provided no additional insight into costs. Our study found an almost complete lack of cost-focused burns research in Nepal. Primary research is needed to quantify the cost of burns in Nepal. Initial focus could usefully be on the cost of care in tertiary hospitals. A full cost of burns for Nepal remains some way off.
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Affiliation(s)
- Julia L Lowin
- Swansea Centre for Health Economics (SCHE), Swansea University
| | | | - Patricia E Price
- Interburns, Welsh Centre for Burns and Plastic Surgery.,Centre for Global Burn injury Policy and Research, Swansea University, Swansea, UK
| | - Tom S Potokar
- Interburns, Welsh Centre for Burns and Plastic Surgery.,Centre for Global Burn injury Policy and Research, Swansea University, Swansea, UK
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47
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Yu TC, Zhang X, Smiell J, Zhou H, Tan R, Böing E, Tan H. Healthcare resource utilization, treatment patterns, and cost of care among patients with thermal burns and inpatient autografting in two large privately insured populations in the United States. Burns 2020; 46:825-835. [DOI: 10.1016/j.burns.2019.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/24/2019] [Accepted: 10/26/2019] [Indexed: 01/15/2023]
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Bayuo J, Wong FKY, Agyei FB. "On the Recovery Journey:" An Integrative Review of the Needs of Burn Patients From Immediate Pre-Discharge to Post-Discharge Period Using the Omaha System. J Nurs Scholarsh 2020; 52:360-368. [PMID: 32445507 DOI: 10.1111/jnu.12563] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND To establish a conceptual understanding of the needs of burn patients, the specific research question asked is: "What are the needs of burn patients from 1-week pre-discharge to the post-discharge period?" METHODS Whittemore and Knafl's integrative review approach was used to answer the review question. The databases searched were the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, and Scopus. Thirty-two primary studies were retained at the end of the screening process. Directed content analysis was undertaken, with the Omaha system as an organizing framework. RESULTS Recovery after burns is not a linear process, but an intricate one filled with varied needs in the physiological (pain, skin, neuro-musculo-skeletal, and infection), psychosocial (social contact, role changes, spirituality, grief, mental health, and sexuality), health-related behavior (nutrition, sleep and rest patterns, and physical activity), and environmental (income) domains of the Omaha system. The nature and intensity of these needs change over time, suggesting that recovery for the burn patient is an ongoing process. CONCLUSIONS Several needs exist from 1 week before discharge to the post-discharge period. The mutual relationship and evolving nature of these needs create an avenue for a flexible, regular, holistic transitional program, similar to the support offered to persons living with chronic conditions. CLINICAL RELEVANCE Hospital discharge does not imply an end to the recovery of burn patients, and burn survivors still require holistic care even after discharge. The review shows the applicability of the Omaha system in exploring and classifying the needs of burn survivors and situates nursing at the core of such a program. It is possible that a nurse-led program of care needs to be considered.
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Affiliation(s)
- Jonathan Bayuo
- PhD Candidate, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | | | - Frank Bediako Agyei
- Lecturer, Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College, Agogo, Ghana
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Rashaan ZM, Krijnen P, Kwa KAA, van Baar ME, Breederveld RS, van den Akker‐van Marle ME. Long-term quality of life and cost-effectiveness of treatment of partial thickness burns: A randomized controlled trial comparing enzyme alginogel vs silver sulfadiazine (FLAM study). Wound Repair Regen 2020; 28:375-384. [PMID: 32022363 PMCID: PMC7217050 DOI: 10.1111/wrr.12799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
The clinical effectiveness and scar quality of the randomized controlled trial comparing enzyme alginogel with silver sulfadiazine (SSD) for treatment of partial thickness burns were previously reported. Enzyme alginogel did not lead to faster wound healing (primary outcome) or less scar formation. In the current study, the health-related quality of life (HRQoL), costs, and cost-effectiveness of enzyme alginogel compared with SSD in the treatment of partial thickness burns were studied. HRQoL was evaluated using the Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L questionnaire 1 week before discharge and at 3, 6, and 12 months postburn. Costs were studied from a societal perspective (health care and nonhealth-care costs) for a follow-up period of 1 year. A cost-effectiveness analysis was performed using cost-effectiveness acceptability curves and comparing differences in societal costs and Quality Adjusted Life Years (QALYs) at 1 year postburn. Forty-one patients were analyzed in the enzyme alginogel group and 48 patients in the SSD group. None of the domains of BSHS-B showed a statistically significant difference between the treatment groups. Also, no statistically significant difference in QALYs was found between enzyme alginogel and SSD (difference -0.03; 95% confidence interval [CI], -0.09 to 0.03; P = .30). From both the health care and the societal perspective, the difference in costs between enzyme alginogel and SSD was not statistically significant: the difference in health-care costs was €3210 (95% CI, €-1247 to €7667; P = .47) and in societal costs was €3377 (95% CI €-6229 to €12 982; P = .49). The nonsignificant differences in costs and quality-adjusted life-years in favor of SSD resulted in a low probability (<25%) that enzyme alginogel is cost-effective compared to SSD. In conclusion, there were no significant differences in quality of life between both treatment groups. Enzyme alginogel is unlikely to be cost-effective compared with SSD in the treatment of partial thickness burns.
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Affiliation(s)
- Zjir M. Rashaan
- Department of SurgeryLeiden University Medical CentreLeidenNetherlands
- Department of SurgeryRed Cross HospitalBeverwijkNetherlands
- Burn Centre, Red Cross HospitalBeverwijkNetherlands
| | - Pieta Krijnen
- Department of SurgeryLeiden University Medical CentreLeidenNetherlands
| | - Kelly AA Kwa
- Department of SurgeryLeiden University Medical CentreLeidenNetherlands
- Burn Centre, Red Cross HospitalBeverwijkNetherlands
| | - Margriet E. van Baar
- Association of Dutch Burn Centres, Maasstad HospitalRotterdamNetherlands
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamNetherlands
| | - Roelf S. Breederveld
- Department of SurgeryLeiden University Medical CentreLeidenNetherlands
- Burn Centre, Red Cross HospitalBeverwijkNetherlands
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50
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Tsai SY, Lio CF, Yao WC, Liu CP, Shih SC, Wang TYT, Leong KH, Sun FJ, Kuo CF. Cost-drivers of medical expenses in burn care management. Burns 2020; 46:817-824. [PMID: 32291114 DOI: 10.1016/j.burns.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Profound differences exist in the cost of burn care globally, thus we aim to investigate the affected factors and to delineate a strategy to improve the cost-effectiveness of burn management. METHODS A retrospective analysis of 66 patients suffering from acute burns was conducted from 2013 to 2015. The average age was 26.7 years old and TBSA was 42.1% (±25.9%). We compared the relationship between cost and clinical characteristics. RESULTS The estimated cost of acute burn care with the following formula (10,000 TWD) = -19.80 + (2.67 × percentage of TBSA) + (124.29 × status of inhalation injury) + (147.63 × status of bacteremia) + (130.32 × status of respiratory tract infection). CONCLUSION The majority of the cost were associated with the use of antibiotics and burns care. Consequently, it is crucial to prevent nosocomial infection in order to promote healthcare quality and reduce in-hospital costs.
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Affiliation(s)
- Shin-Yi Tsai
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei City, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Graduate Institute of Long-Term Care, Mackay Medical College, New Taipei City, Taiwan; Graduate Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States.
| | - Chon-Fu Lio
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Wei-Cheng Yao
- Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Tao-Yuan, Taiwan
| | - Chang-Pan Liu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shou-Chuan Shih
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tina Yu-Ting Wang
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Kam-Hang Leong
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei City, Taiwan
| | - Chien-Feng Kuo
- Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
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