European burn journal最新文献

Background: Full-thickness burn injuries (FTBI) not only lead to a significant burden in multiple ways, including social life and self-esteem, but have also a tremendous impact on environmental interaction by reducing sensibility in manifold ways. On these grounds, possible ways and solutions to recover sensibility in burn wounds are essentials and should not be overlooked.

Methods: A review of experimental, clinical studies and the related literature was performed with the aim to highlight post-burn nerve regeneration and discover ways for sensory re-integration to complement the therapeutic concept.

Results: In human burn injuries, it has been hypothesized that grafted cells, partly multipotent stem cells, could be additionally responsible for nerve regeneration in burn wound areas. In addition, burn eschar excision, performed within a short post-burn time frame, can reduce or even avoid long-term nerve damage by reducing post-burn toxic mediator release. Various animal studies could demonstrate sensory reinnervation of different qualities in burn wounds. Post-burn scar tissue prevents, or at least decelerates, nerve reinnervation, but could be reduced by targeted mediators.

Conclusion: Sensory loss is present in skin grafted areas following full-thickness burn-wound excision, thereby leading to a reduction in quality of life. In addition, various mediators might reduce or avoid nerve damage and should be considered at an early stage as part of a holistic burn-patient therapeutic approach. In addition, supportive multifaceted physical therapy strategies are essential.

Tap water scalds from domestic outlets can afflict large body surface areas. Such injuries are preventable and carry significant associated morbidity, mortality, and economic burden. Previously identified risk factors include age (<5 or >65 years old) and the presence of physical or mental disabilities. Education campaigns and advances in legislation mandating the restriction of tap water temperature at user outlets have been employed in an attempt to prevent such injuries. Nonetheless, the incidence of these injuries persists, and further mitigating measures must be implemented to minimize their occurrence. The purpose of this study was to determine the groups at risk for such injuries and whether this has recently changed. A retrospective observational study was carried out to include patients admitted with tap water scalds to a regional burn's unit from October 2016 to September 2020. Twenty-three patients were included, and their incidence was 5.75 cases per year, equating to 5.1% of all scalds requiring inpatient treatment. The very young (<5 years old) and elderly (>65 years old) accounted for the majority of admissions (65.2%), 26.1% had a mental disability, and 30.4% had a physical disability. Tap water scalds continue to cause preventable injuries affecting all ages, and in particular, the elderly and patients with pre-existing disabilities.

National and international research budgets are insufficient to approve all requests for funding, even if a methodology is of high quality and the outputs are likely to have an impact on improving patient outcomes [...].

Despite intensive research and increased knowledge over the past decades, the handling of severe burn injuries remains complex and is mainly based on clinical experience. High demands in terms of the diagnosis and choice of therapy often confront clinicians with challenging circumstances. Thus, the treatment of burn injuries has predominantly remained under the responsibility of specialised centres. As a new approach in addition to conventional surgery, enzymatically controlled debridement has come into focus for the treatment of burn injuries over the past years. The efficacy and safety of enzymatic debridement has already been implemented by numerous reputable studies. Promising results from the literature are enhanced by feedback from various conference contributions, intradisciplinary exchanges, and international collaborations. The implementation of enzymatic debridement in initial care management was found to be capable of reforming Standards of Care in numerous burn centres by facilitating treatment determinations and reducing the number of classical surgical interventions. Nevertheless, its use is also subject to certain restrictions as usage has shown limitations concerning efficacy when applied to scalds or pre-treated wounds. Enzymatic debridement shows high efficacy in terms of tissue debridement by combining this feature with the minimisation of collateral damage and a broad field of application in burn injuries. Due to their impressive performance in the treatment of burn injuries, enzyme-based techniques have also attracted attention for the treatment of other pathologies such as chronic wounds and are objects of ongoing research in this field. In this article, we illustrate the significance of enzyme-based treatment in initial burn care and shed some light on the potential value of enzymatic approaches in future burn surgery.

Burn injuries have a tremendous impact on not only the physical health of the burn survivor, but also mental health and social outcomes of the individual and their support systems. While much effect occurs at the point of injury, post-injury pain, infection, scarring, inflammatory response and metabolic changes all impact the long-term health of the burn survivor. The goal of the following article is to explore how to examine long term outcomes associated with burn injury, including mental disorders, suicide, loss of work and quality of life in the context of risk factors for burn injury, including social determinants of health. We then discuss ways to examine post-burn outcomes, including the important role of administrative data, the advantages of mixed methodology research studies including qualitative research, and the importance of considering sex, gender and vulnerable populations, not only in study design, but in prevention and intervention programs.

Burn survivors may benefit from screening for a broad area of problems to improve communication and inform referral needs. Therefore, the aim of this study was to investigate clinical utility aspects such as appropriateness and acceptability to clinicians and completers of an existing, frequently used screening instrument in oncological populations, the Distress Thermometer and Problem List (DT and PL).

Methods: Paediatric and adult patients visiting the outpatient clinic after admission to the burn centre were invited to complete the instrument. The DT and (problem domains of) the PL were related and compared to the need to discuss the reported problems.

Results: A total of 160 patients were invited to complete the DT and PL, of which 139 agreed. The study shows evidence for appropriateness and high acceptability to clinicians and completers, although the effectiveness of the PL may be lower compared to the DT and needs adaptation to better meet the burn survivors' situation.

Discussion: The use of a screening instrument in the outpatient clinic environment has shown to be appropriate and acceptable and informs clinical practice to identify supportive needs in patients with burns. However, the PL needs to be adapted to the situation of the burn survivors.

The unique challenges burn patients face along the trajectory of recovery necessitate an interdisciplinary team approach to care. As much as providers rely on care-team members for delivery of optimal treatment, the patient must be an active collaborator in their care. Optimal burn recovery outcomes hinge on treatment adherence. In addition to general challenges faced in ubiquity by burn patients, there are specific patient populations for whom treatment adherence is particularly challenging. Although psychological interventions have been used successfully with burn patients, very few are appropriate for both inpatient and outpatient care environments and most do not focus on treatment adherence. This paper reviews unique facets of Motivational Interviewing (MI) that may be applicable in interdisciplinary burn treatment teams across inpatient and outpatient settings to optimize treatment adherence.

In burn scar rehabilitation, electronic patient-reported outcome measures (ePROMs) are increasingly being used in research and clinical settings as part of patient- and family-centred care. These measures can identify patients' needs and monitor the therapeutic progress of both adults and children. The feedback of information from ePROMs to clinicians treating patients with scarring and psychosocial issues may have therapeutic benefits. However, testing the effectiveness of ePROMs used in the routine clinical care of patients with burn scarring is in its infancy, and one of the greatest challenges remains the implementation of ePROMs in real-world clinical settings. The aim of this paper is to provide a guide for clinicians and researchers involved in burn scar rehabilitation to assist in implementing ePROMs in clinical settings. The guide outlines strategies, processes, and considerations for ePROM implementation and the accompanying resources. Two real-world case studies of ePROM implementation are presented in burn scar clinics in Belgium and Australia. Additionally, ten recommendations for the implementation of ePROMs are provided based on research evidence and the lessons learned by the authors. The information provided should pave the way forward for using and testing these ePROMs in research and practice.

Burn injuries with cutaneous loss result in a severe systemic response when profound injuries exceed 20% of the total body surface area. The management of severely burned patients is a complex and dynamic process. Timely and safe operative interventions are critical components of multidisciplinary care. Effective management of severely burned patients, their cutaneous injuries, and the associated systemic disease requires a comprehensive understanding of the pathophysiologic response to trauma, objective indicators of patient status, and an appreciation for the dynamic nature of these parameters. Progress in both clinical and basic science research has advanced our understanding of these concepts and our approach to the management of burn patients. Incorporating concepts such as early total care, damage control surgery (DCS), and safe definitive surgery (SDS) in the polytraumatized patient may further aid in optimizing outcomes and quality of care for burn patients. This article connects current knowledge of the lethal triad, inflammation, immunosuppression, and eschar-derived toxins, with surgical burn care, especially burn wound debridement. The concepts of DCS and SDS for the care and management of burn patients are strongly advocated. Experimental and clinical studies are encouraged to validate these concepts in an effort to optimize patient outcomes.

The EQ-5D is increasingly used to assess the health-related quality of life (HRQL) of adult patients with intermediate burns. However, this generic instrument may lack sensitivity, as important problems for burn patients, such as itching and cognition problems are not included in this instrument. This retrospective observational study investigates the value of adding an itching and cognition item to the EQ-5D-3L. Patients completed the EQ-5D-3L, and the Patient and Observer Scar Assessment Scale (POSAS), including an itching item and an extra cognition item three months postburn. The potential added value of an itching and cognition item was studied by distribution, informativity, convergent validity, dimension dependency, and explanatory analyses. In total, 120 patients were included of whom 65% reported itching and 23% reported cognition problems. Adding an itching item to the EQ-5D improved the discriminatory power and informativity of the EQ-5D-3L, but barely increased the explanatory power (0.4%) and decreased the convergent validity (r = -0.529 vs. r = -0.612). In contrast, adding a cognition item slightly improved the informativity and discriminatory power. Moreover, convergent validity (r = -0.617 vs. r = -0.612) and explanatory power increased (4.0%). In conclusion, adding an itching item to the EQ-5D-3L provides some additional information, however, the added value is small, whereas adding a cognition item improved the measurement properties of the EQ-5D-3L in our sample and should be considered when assessing HRQL in adult patients with intermediate burns.