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van Zoonen EE, van Eck IC, van Baar ME, Meij-de Vries A, van Schie CHM, van der Vlies CH. Aetiology of bioethanol related burn accidents: A qualitative study. Burns 2024; 50:733-741. [PMID: 38242767 DOI: 10.1016/j.burns.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Since insight into the motivation of behaviour in bioethanol related burn accidents is lacking, this study aimed to qualitatively examine influencing factors in bioethanol related burn accidents. In order to identify target points for effective burn prevention. METHODS Patients previously admitted with bioethanol related acute non-intentional burn injury to the three Dutch burn centres were eligible. One interviewer conducted fourteen semi-structured interviews. Interviews were transcribed and coded by two independent researchers. Conclusions were drawn based on generalised statements on the concerned topics. RESULTS Four overall themes in influencing factors were found, namely 1) motivation; including non-designated use and impaired judgement, 2) knowledge and education; including unknown product and properties and information overload, 3) risk perception; including poor recognisability of risks and preferred trial and error and 4) thresholds; including easy availability and unclear liability. CONCLUSION Trust in consumers may be over-estimated, as proper use cannot be expected. To prevent future bioethanol related burn incidents, thresholds for obtaining and using bioethanol should be increased, safe alternatives to ignite open fires and wood stoves should be provided and knowledge and warnings should be improved.
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Affiliation(s)
| | | | - Margriet E van Baar
- Association of Dutch Burn Centres (ADBC), Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Annebeth Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Association of Dutch Burn Centres (ADBC), Beverwijk, the Netherlands; Pediatric Surgical Center, Emma Children's Hospital, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Erasmus MC, Trauma Research Unit, Department of Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Salemans RFC, van Uden D, van Baar ME, Haanstra TM, van Schie CHM, van Zuijlen PPM, Lucas Y, Scholten-Jaegers SMHJ, Meij-de Vries A, Wood FM, Edgar DW, Spronk I, van der Vlies CH. Timing of surgery in acute deep partial-thickness burns: A study protocol. PLoS One 2024; 19:e0299809. [PMID: 38466683 PMCID: PMC10927102 DOI: 10.1371/journal.pone.0299809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
For deep partial-thickness burns no consensus on the optimal treatment has been reached due to conflicting study outcomes with low quality evidence. Treatment options in high- and middle-income countries include conservative treatment with delayed excision and grafting if needed; and early excision and grafting. The majority of timing of surgery studies focus on survival rather than on quality of life. This study protocol describes a study that aims to compare long-term scar quality, clinical outcomes, and patient-reported outcomes between the treatment options. A multicentre prospective study will be conducted in the three Dutch burn centres (Rotterdam, Beverwijk, and Groningen). All adult patients with acute deep-partial thickness burns, based on healing potential with Laser Doppler Imaging, are eligible for inclusion. During a nine-month baseline period, standard practice will be monitored. This includes conservative treatment with dressings and topical agents, and excision and grafting of residual defects if needed 14-21 days post-burn. The subsequent nine months, early surgery is advocated, involving excision and grafting in the first week to ten days post-burn. The primary outcome compared between the two groups is long-term scar quality assessed by the Patient and Observer Scar Assessment Scale 3.0 twelve months after discharge. Secondary outcomes include clinical outcomes and patient-reported outcomes like quality of life and return to work. The aim of the study is to assess long-term scar quality in deep partial-thickness burns after conservative treatment with delayed excision and grafting if needed, compared to early excision and grafting. Adding to the ongoing debate on the optimal treatment of these burns. The broad range of studied outcomes will be used for the development of a decision aid for deep partial-thickness burns, to fully inform patients at the point of consent to surgery and support optimal person-centred care.
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Affiliation(s)
- Roos F. C. Salemans
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Margriet E. van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Tjitske M. Haanstra
- Department of Dermal Therapy, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands
- Dutch Burns Foundation, Beverwijk, the Netherlands
- Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | | | - Paul P. M. van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
- Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, the Netherlands
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
- Paediatric Surgical Centre, Emma’s Children’s Hospital, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Ymke Lucas
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Annebeth Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
- Paediatric Surgical Centre, Emma’s Children’s Hospital, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - Fiona M. Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia
| | - Dale W. Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Institute for Health Research, Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Burn Injury Research Unit, Faculty of Medicine and Dentistry, University of Western Australia, Crawley, Western Australia, Australia
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia
| | - Inge Spronk
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Dermal Therapy, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands
- Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Cornelis H. van der Vlies
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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van Zoonen EE, van Baar ME, van Schie CHM, Koppes LLJ, Verheij RA. Burn injuries in primary care in the Netherlands: Risk factors and trends. Burns 2022; 48:440-447. [PMID: 34167851 DOI: 10.1016/j.burns.2021.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Research to date has mainly focused on burn injuries treated in secondary care. This study aims to provide knowledge on the epidemiology of burn injuries in primary care, to give directions for burn prevention. METHODS Data were derived from routine electronic health records of general practices and their out-of-hours service organisations in the Netherlands that participated in the Nivel Primary Care Database 2010-2015. We studied risk factors and trends. RESULTS The average burn injury prevalence rate was 4.40 (95% CI 4.27-4.53) per 1000 person-years in daytime general practice care and 1.47 (95% CI 1.46-1.49) per 1000 inhabitants in out-of-hours care. Children of 0-4 years old, especially boys, and young adult women had a higher risk. Burn injury risk was higher during the summer months and around New Year's Eve. Living in low socioeconomic and strongly urbanised neighbourhoods was associated with a higher risk of burn injury than living in other neighbourhoods. CONCLUSION Dutch general practitioners have a large share in burn care and therefore can play a significant role in burn prevention. Prevention may be most effective in the summer and around New Year's Eve, and specific attention seems to be warranted for low socioeconomic groups and strongly urbanised neighbourhoods.
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Affiliation(s)
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Lando L J Koppes
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Faculty of Health, Nutrition & Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
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van Schie CHM, van der Linden ML, Boulton AJM. Foot pressures, peripheral neuropathy, and joint mobility in asian and europid patients with diabetes . Wounds 2011; 23:216-227. [PMID: 25879175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Objective. A cross sectional study was developed to investigate ethnic differences in foot pressure and joint mobility in non-diabetic and diabetic subjects with and without neuropathy in a hospital-based diabetes clinic. METHODS The subject groups consisted of a volunteer sample of 10 Asians (AC), 11 Europid non-diabetic controls (C), a consecutive sample of 12 Asians (ADC) and 11 Europid (DC) non-neuropathic patients, and 12 Asian (ADN) and 13 Europid (DN) neuropathic diabetic patients. All subjects were matched with respect to age and gender. The main outcome measures were foot pressures and joint mobility. RESULTS Peak foot pressure was increased in DN (1150 ± 412 kPa, mean ± SD) compared to AC, ADC, ADN, C, and DC (510 ± 164 kPa, 673 ± 331 kPa, 623 ± 222 kPa, 707 ± 240 kPa, 793 ± 196 kPa, respectively; P < 0.05). Passive range of motion of the subtalar joint, ankle (AC only), first metatarsophalangeal and fifth metacarpophalangeal joints (MCJP) were reduced in DN compared to the Asian controls and diabetic patients (P < 0.05). Dynamic ankle and rearfoot (subtalar) joint angles were not different among groups. Only the fifth MCJP extension had an effect on peak plantar pressure while controlling for ethnicity (P < 0.05). CONCLUSION Peak foot pressure was higher and joint mobility was lower in Europid compared to Asian diabetic neuropathic patients; however, no relationship was observed between reduced foot joint mobility and increased foot pressures. The association between fifth MCJP extension and peak pressure suggest that fifth MCJP extension may be used as a screening method for increased pressure. The low foot pressures exhibited by the Asian subjects are most likely caused by factors other than those investigated in this study.
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Affiliation(s)
- Carine H M van Schie
- University Department of Medicine, Manchester Royal Infirmary, Manchester, United Kingdom;
| | | | - Andrew J M Boulton
- University Department of Medicine, Manchester Royal Infirmary, Manchester, United Kingdom
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Abstract
OBJECTIVE High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes. RESEARCH DESIGN AND METHODS Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study. Fifteen (78%) of the patients were male, 40-80 years of age, and ulcer-free at the time of recruitment. In-shoe plantar pressure measurements were recorded using the F-Scan and compared PFC socks with ordinary supermarket socks. The analysis measured differences in maximum foot contact area and plantar pressure for the whole foot, forefoot, and peak plantar pressure areas. RESULTS The results showed a significant increase in maximum foot contact area of 11 cm2 (95% CI 7-11) when subjects wore the PFC socks (P < 0.01). This was accompanied by 5.4 kPa (3.5-7.3) or 9% reduction in total foot pressure (P < 0.01). Similar results were observed at the forefoot, which showed a 14.2% increase in contact area and a 10.2% reduction in peak forefoot pressure. CONCLUSIONS These results suggest that the wearing of PFC socks increases the underfoot contact area and hence decreases plantar foot pressures. Further studies are required to determine whether the pressure and friction reductions achieved by this simple intervention would be effective in reducing the incidence of foot ulcers in high-risk patients.
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Affiliation(s)
- Adam P Garrow
- Diabetes Foot Clinic, Disablement Services Centre, Withington Hospital, Cavendish Road, Manchester M20 1LB, UK.
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van Schie CHM, Vermigli C, Carrington AL, Boulton A. Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in caucasian diabetic men. Diabetes Care 2004; 27:1668-73. [PMID: 15220244 DOI: 10.2337/diacare.27.7.1668] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the relationships among muscle weakness, foot deformities, and peroneal and tibial nerve conduction velocity in diabetic and nondiabetic men. RESEARCH DESIGN AND METHODS A neuropathic and foot evaluation was undertaken in 10 nondiabetic control subjects (group C) and in 36 consecutive diabetic patients attending Diabetes Centre clinics, including 10 diabetic control subjects (group D), 15 diabetic neuropathic patients (group DN), and 11 diabetic patients with a history of ulceration (group DU). Neuropathy was defined as a peroneal motor nerve conduction <40 m/s. Muscle weakness was assessed in seven intrinsic and seven extrinsic muscles of the foot using a semiquantitative score (max score per muscle = 3). Foot deformities were assessed using a foot deformity score (max score = 3). A higher score indicated increased muscle weakness or more severe foot deformities. Muscle weakness and foot deformities were assessed without prior knowledge of patient and neuropathy status. RESULTS Peroneal and tibial nerve conduction velocity were associated with weakness in muscles innervated by, respectively, the peroneal and tibial nerve (r = -0.70 and r = -0.51, P < 0.01) and foot deformities (r = -0.60 and r = -0.59, P < 0.001). The DN and DU groups had more weakness in intrinsic and extrinsic muscles compared with the C and D groups. Muscles innervated by the tibial nerve had a greater proportional muscle weakness than those innervated by the peroneal nerve in the DN and DU groups. The DN and DU patients had more foot deformities (median food deformity score [interquartile range]) (3 [2-3] and 2 [2-3]) compared with D and C patients (0 [0-0.75] and 0 [0-0]). CONCLUSIONS Important relationships have been shown between motor nerve conduction deficit and muscle weakness; however, it is still not clear whether abnormal nerve function, leading to a decrease in muscle strength, could be responsible for the development of foot deformities.
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Abstract
The aim of this study was to evaluate whether high plantar foot pressures can be predicted from measurements of plantar soft-tissue thickness in the forefoot of diabetic patients with neuropathy. A total of 157 diabetic patients with neuropathy and at least one palpable foot pulse but without a history of foot ulceration were invited to participate in the study. Plantar tissue thickness was measured bilaterally at each metatarsal head, with patients standing on the same standardized platform. Plantar pressures were measured during barefoot walking using the optical pedobarograph. Receiver operating characteristic analysis was used to determine the plantar tissue thickness predictive of elevated peak plantar pressure. Tissue thickness cutoff values of 11.05, 7.85, 6.65, 6.55, and 5.05 mm for metatarsal heads 1 through 5, respectively, predict plantar pressure at each respective site greater than 700 kPa, with sensitivity between 73% and 97% and specificity between 52% and 84%. When tissue thickness was used to predict pressure greater than 1,000 kPa, similar results were observed, indicating that high pressure at different levels could be predicted from similar tissue thickness cutoff values. The results of the study indicate that high plantar pressure can be predicted from plantar tissue thickness with high sensitivity and specificity.
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Affiliation(s)
- Frag Abouaesha
- Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, England
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