Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,spec...Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,specifically,has not been described.This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists(RCs)with non-recidivists(NRCs).Methods:A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record.Continuous variables were reported using medians and interquartile ranges(IQR).Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic,burn,and hospitalization characteristics between NRCs and RCs.Results:A total of 7134 burn patients were admitted,among which 51(0.7%)were RCs and accounted for 129(1.8%)admissions.Of the 51 RCs,37 had two burn injuries each,totaling 74 admissions as a group,while the remaining 14 RCs had between three and eight burn injuries each,totaling 55 admissions as a group.Compared to NRCs,RCs were younger(median age 36 years vs.42 years,p=0.02)and more likely to be white(75%vs.60%,p=0.03),uninsured(45%vs.30%,p=0.02),have chemical burns(16%vs.5%,p<0.0001),and have burns that were≤10%total body surface area(89%vs.76%,p=0.001).The mortality rate for RCs vs.NRCs did not differ(0%vs.1.2%,p=0.41).Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs(75%vs.15%,p<0.001).Median total hospital charges per patient were nearly three times higher for RCs vs.NRCs($85,736 vs.$32,023,p<0.0001).Conclusions:Distinct from trauma recidivism,burn recidivism is not associated with more severe injury or increased mortality.Similar to trauma recidivists,but to a greater extent,burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs.Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.展开更多
We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doub...We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doubt whether applying this strategy to every patient during a mass burn event could be realistic.Of note,while there is an undisputed consensus that early burn wound excision is the gold standard of burn care,what‘early’actually means is still debated.Depending on the authors,the corresponding time limit typically varies from 24 h to a few days[2,3].展开更多
Post burn dorsal foot contractures of the toes of the IV degree cause functional limitations of all lower extremities, which creates a serious cosmetic defect, and therefore, needs surgical reconstruction. The series ...Post burn dorsal foot contractures of the toes of the IV degree cause functional limitations of all lower extremities, which creates a serious cosmetic defect, and therefore, needs surgical reconstruction. The series of 11 patients (7 men and 4 women) with extended contracture of the 4th degree of toes after burn were operated upon by using the new method with the flap including subcutaneous tissue (bridge-like stem), and the operations were performed at Samarkand Burn Center, Samarkand, Uzbekistan. We observed a good result with no complications. The flap was viable, and its sensibility was preserved. No marginal necrosis was noticed. As a result, the use of this method allowed achieving normal aesthetic outlines. The flap acquired the properties of the healthy skin without contracture. For the whole operated feet, it is important to wear pressure socks as soon as the wounds are fully healed and to continue this pressing therapy until the edema and recurrence of contracture are no longer being the problems. This usually means a period of 6 to 9 months.展开更多
<strong>Background:</strong> Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequen...<strong>Background:</strong> Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequency of alcohol and poly-drug combinations in patients triaged by Trauma Team Activation (TTA) codes. <strong>Methods:</strong> A retrospective study of a Level I hospital trauma registry was initiated with 14,972 patients of whom 7028 (47%) were Substance Users (SU). There were 10,369 TTA patients: 5396 (52%) were SU, and 4603 (31%) non-TTA patients, of whom 1632 (35.5%) were SU. Inclusion criteria were: age ≥14 years old, blood alcohol level and Urine Drug Screen (UDS) documentation, Injury Severity Score (ISS), TTA code, hospital charges and Length of Hospitalization (LOS). Statistical analyses were performed with one-way ANOVA, Maximum Likelihood chi squared, and Mann-Whitney U tests. <strong>Results:</strong> The median ISS was 5 for both groups. TTA patients were younger than non-TTA patients (median 33 years versus 41 years). Mortality was significantly higher for TTA (4.7%) than for non-TTA (0.7%) patients. From 2010-2013 to 2014-2018, all substance users had a significant decrease in alcohol only use (58.0% to 42.0%) with an increase in single drug (42.0% to 58.0%) and poly-drug use (36.9% to 63.1%), <em>p</em> < 0.0001. For all SU patients (TTA and non-TTA), the major single drugs used were opiates (19.9%), cannabinoids (THC) (15.2%), benzodiazepines (7.7%), amphetamines (6.6%), and cocaine (2.5%). The major poly-drugs were: opiates/THC (4.7%), opiates/benzodiazepines (4.6%), THC/amphetamines (3.1%), THC/benzodiazepines (2.2%). <strong>Conclusions:</strong> By trauma activation code designation, the TTA group had most of the positive alcohol and drug screens in this study. Since the change in mandated opioid prescription practices in 2014, this study showed increased poly-drug use (two to six-drug combinations) in urban trauma patients between 2014-2018. Opioids and cannabinoids continued to be the most frequently used drugs singly and in combinations.展开更多
Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-...Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-conductive dressing to our standard burn dressing at removing edema fluid from partial-thickness burns and present the proposed mechanisms of action of the hydroconductive dressing. Methods: An internally controlled comparison of two wound dressings was performed on 10 patients with non-contiguous partial-thickness burns. Each patient served as his/her own control. One burn was treated with our standard burn dressing and the other with hydroconductive dressing. Dressings were weighed prior to application, removed at 24 and 48 hours, weighed, and new pre-weighed dressings applied. Weight gain of each dressing at 24 and 48 hours was determined. Statistics were applied using the Student’s paired T-test. The VAS pain scale was measured prior to, during, and after each dressing change. Results: At 24 hours, the hydroconductive dressing had increased 85.6% ± 29.3% in weight compared with 61.3% ± 32.7% for the control (P = 0.053). For the second 24 hour period, the respective numbers were statistically significantly different at 59.7% ± 23.4% vs. 34.2% ± 19.1% (P = 0.038). Averaging the weight gain over the two dressing periods demonstrated that the differences were highly statistically significant as the hydroconductive dressing increased in weight by 71.0% ± 20.3% compared with 44.5% ± 17.4% for the gauze dressing (P = 0.005). VAS scores revealed no statistical differences. Mechanisms of action included capillary, hydroconductive, and electrostatic actions. Conclusions: A hydroconductive dressing designed to draw off excessive wound fluid removes more wound edema fluid than standard burn gauze dressings.展开更多
目的探讨构建移动护理终端(personal digital assistant,PDA)翻身管理模块并评价其临床应用效果。方法回顾相关文献,并在临床使用的纸质翻身卡基础上,构建基于PDA的翻身管理模块。选取温州医科大学附属第一医院烧伤伤口中心2020年7月至1...目的探讨构建移动护理终端(personal digital assistant,PDA)翻身管理模块并评价其临床应用效果。方法回顾相关文献,并在临床使用的纸质翻身卡基础上,构建基于PDA的翻身管理模块。选取温州医科大学附属第一医院烧伤伤口中心2020年7月至12月收治的需要建立翻身卡的患者60例为对照组,2021年1月至7月收治的需要建立翻身卡的患者60例为试验组。对照组使用传统的纸质翻身卡,试验组使用基于PDA的翻身管理模块。比较两组翻身措施落实率、减压工具使用率、翻身记录所需时间以及护理人员的满意度。结果试验组翻身措施落实率为90%,明显高于对照组的80%,两组比较差异有统计学意义(P<0.05);试验组减压工具使用率(气垫床100%、翻身枕91.6%、泡沫敷料53.33%),均高于对照组(气垫床90%、翻身枕75%、泡沫敷料33.3%),两组比较差异有统计学意义(P<0.05);试验组翻身记录所需时间(10.96±1.21)s,少于对照组的(15.03±1.28)s,两组比较差异有统计学意义(P<0.05);试验组护理人员满意度90%,高于对照组的72.5%,两组比较差异有统计学意义(P<0.05)。结论基于PDA的翻身管理模块可提高需建立翻身卡患者的翻身措施落实率、减压工具使用率,缩短翻身记录所需时间,提高护理人员使用满意度。展开更多
Marine algae are valuable sources of health-promoting molecules that have been consumed by Asians for decades.Among aquatic flora,marine algae stand out in terms of high content of marine algae polysaccharides(MAP)suc...Marine algae are valuable sources of health-promoting molecules that have been consumed by Asians for decades.Among aquatic flora,marine algae stand out in terms of high content of marine algae polysaccharides(MAP)such as carrageenan,alginate,fucoidan,laminaran,agarose,rhamnan,and ulvan.When hydrolyzed,MAP generate marine algae oligosaccharides(MAO),which have attracted interest in recent years due to their superior solubility compared with MAP.Besides,MAO have been demonstrated numerous biological activities including antioxidant,antidiabetic,anti-inflammatory,antimicrobial,and prebiotic activities.Thus,this review summarizes the main chemical classes of MAO,their sources,and the main processes used for their production(i.e.,physical,chemical,and biological methods),coupled with a discussion of the advantages and disadvantages of these methods.Highlights of the biological activities of MAO and their potential applications in food,nutraceutical,and pharmaceuticals would also be discussed and summarized.展开更多
Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing...Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.展开更多
基金supported by the University of North Carolina at Chapel Hill Junior Faculty Development Award.
文摘Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,specifically,has not been described.This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists(RCs)with non-recidivists(NRCs).Methods:A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record.Continuous variables were reported using medians and interquartile ranges(IQR).Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic,burn,and hospitalization characteristics between NRCs and RCs.Results:A total of 7134 burn patients were admitted,among which 51(0.7%)were RCs and accounted for 129(1.8%)admissions.Of the 51 RCs,37 had two burn injuries each,totaling 74 admissions as a group,while the remaining 14 RCs had between three and eight burn injuries each,totaling 55 admissions as a group.Compared to NRCs,RCs were younger(median age 36 years vs.42 years,p=0.02)and more likely to be white(75%vs.60%,p=0.03),uninsured(45%vs.30%,p=0.02),have chemical burns(16%vs.5%,p<0.0001),and have burns that were≤10%total body surface area(89%vs.76%,p=0.001).The mortality rate for RCs vs.NRCs did not differ(0%vs.1.2%,p=0.41).Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs(75%vs.15%,p<0.001).Median total hospital charges per patient were nearly three times higher for RCs vs.NRCs($85,736 vs.$32,023,p<0.0001).Conclusions:Distinct from trauma recidivism,burn recidivism is not associated with more severe injury or increased mortality.Similar to trauma recidivists,but to a greater extent,burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs.Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.
文摘We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doubt whether applying this strategy to every patient during a mass burn event could be realistic.Of note,while there is an undisputed consensus that early burn wound excision is the gold standard of burn care,what‘early’actually means is still debated.Depending on the authors,the corresponding time limit typically varies from 24 h to a few days[2,3].
文摘Post burn dorsal foot contractures of the toes of the IV degree cause functional limitations of all lower extremities, which creates a serious cosmetic defect, and therefore, needs surgical reconstruction. The series of 11 patients (7 men and 4 women) with extended contracture of the 4th degree of toes after burn were operated upon by using the new method with the flap including subcutaneous tissue (bridge-like stem), and the operations were performed at Samarkand Burn Center, Samarkand, Uzbekistan. We observed a good result with no complications. The flap was viable, and its sensibility was preserved. No marginal necrosis was noticed. As a result, the use of this method allowed achieving normal aesthetic outlines. The flap acquired the properties of the healthy skin without contracture. For the whole operated feet, it is important to wear pressure socks as soon as the wounds are fully healed and to continue this pressing therapy until the edema and recurrence of contracture are no longer being the problems. This usually means a period of 6 to 9 months.
文摘<strong>Background:</strong> Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequency of alcohol and poly-drug combinations in patients triaged by Trauma Team Activation (TTA) codes. <strong>Methods:</strong> A retrospective study of a Level I hospital trauma registry was initiated with 14,972 patients of whom 7028 (47%) were Substance Users (SU). There were 10,369 TTA patients: 5396 (52%) were SU, and 4603 (31%) non-TTA patients, of whom 1632 (35.5%) were SU. Inclusion criteria were: age ≥14 years old, blood alcohol level and Urine Drug Screen (UDS) documentation, Injury Severity Score (ISS), TTA code, hospital charges and Length of Hospitalization (LOS). Statistical analyses were performed with one-way ANOVA, Maximum Likelihood chi squared, and Mann-Whitney U tests. <strong>Results:</strong> The median ISS was 5 for both groups. TTA patients were younger than non-TTA patients (median 33 years versus 41 years). Mortality was significantly higher for TTA (4.7%) than for non-TTA (0.7%) patients. From 2010-2013 to 2014-2018, all substance users had a significant decrease in alcohol only use (58.0% to 42.0%) with an increase in single drug (42.0% to 58.0%) and poly-drug use (36.9% to 63.1%), <em>p</em> < 0.0001. For all SU patients (TTA and non-TTA), the major single drugs used were opiates (19.9%), cannabinoids (THC) (15.2%), benzodiazepines (7.7%), amphetamines (6.6%), and cocaine (2.5%). The major poly-drugs were: opiates/THC (4.7%), opiates/benzodiazepines (4.6%), THC/amphetamines (3.1%), THC/benzodiazepines (2.2%). <strong>Conclusions:</strong> By trauma activation code designation, the TTA group had most of the positive alcohol and drug screens in this study. Since the change in mandated opioid prescription practices in 2014, this study showed increased poly-drug use (two to six-drug combinations) in urban trauma patients between 2014-2018. Opioids and cannabinoids continued to be the most frequently used drugs singly and in combinations.
文摘Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-conductive dressing to our standard burn dressing at removing edema fluid from partial-thickness burns and present the proposed mechanisms of action of the hydroconductive dressing. Methods: An internally controlled comparison of two wound dressings was performed on 10 patients with non-contiguous partial-thickness burns. Each patient served as his/her own control. One burn was treated with our standard burn dressing and the other with hydroconductive dressing. Dressings were weighed prior to application, removed at 24 and 48 hours, weighed, and new pre-weighed dressings applied. Weight gain of each dressing at 24 and 48 hours was determined. Statistics were applied using the Student’s paired T-test. The VAS pain scale was measured prior to, during, and after each dressing change. Results: At 24 hours, the hydroconductive dressing had increased 85.6% ± 29.3% in weight compared with 61.3% ± 32.7% for the control (P = 0.053). For the second 24 hour period, the respective numbers were statistically significantly different at 59.7% ± 23.4% vs. 34.2% ± 19.1% (P = 0.038). Averaging the weight gain over the two dressing periods demonstrated that the differences were highly statistically significant as the hydroconductive dressing increased in weight by 71.0% ± 20.3% compared with 44.5% ± 17.4% for the gauze dressing (P = 0.005). VAS scores revealed no statistical differences. Mechanisms of action included capillary, hydroconductive, and electrostatic actions. Conclusions: A hydroconductive dressing designed to draw off excessive wound fluid removes more wound edema fluid than standard burn gauze dressings.
文摘目的探讨构建移动护理终端(personal digital assistant,PDA)翻身管理模块并评价其临床应用效果。方法回顾相关文献,并在临床使用的纸质翻身卡基础上,构建基于PDA的翻身管理模块。选取温州医科大学附属第一医院烧伤伤口中心2020年7月至12月收治的需要建立翻身卡的患者60例为对照组,2021年1月至7月收治的需要建立翻身卡的患者60例为试验组。对照组使用传统的纸质翻身卡,试验组使用基于PDA的翻身管理模块。比较两组翻身措施落实率、减压工具使用率、翻身记录所需时间以及护理人员的满意度。结果试验组翻身措施落实率为90%,明显高于对照组的80%,两组比较差异有统计学意义(P<0.05);试验组减压工具使用率(气垫床100%、翻身枕91.6%、泡沫敷料53.33%),均高于对照组(气垫床90%、翻身枕75%、泡沫敷料33.3%),两组比较差异有统计学意义(P<0.05);试验组翻身记录所需时间(10.96±1.21)s,少于对照组的(15.03±1.28)s,两组比较差异有统计学意义(P<0.05);试验组护理人员满意度90%,高于对照组的72.5%,两组比较差异有统计学意义(P<0.05)。结论基于PDA的翻身管理模块可提高需建立翻身卡患者的翻身措施落实率、减压工具使用率,缩短翻身记录所需时间,提高护理人员使用满意度。
基金financially supported by grants from the National Natural Science Foundation of China(31901692)2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant(2020LKSFG02E)Natural Science Foundation of Guangdong Province,China(2021A1515011495)。
文摘Marine algae are valuable sources of health-promoting molecules that have been consumed by Asians for decades.Among aquatic flora,marine algae stand out in terms of high content of marine algae polysaccharides(MAP)such as carrageenan,alginate,fucoidan,laminaran,agarose,rhamnan,and ulvan.When hydrolyzed,MAP generate marine algae oligosaccharides(MAO),which have attracted interest in recent years due to their superior solubility compared with MAP.Besides,MAO have been demonstrated numerous biological activities including antioxidant,antidiabetic,anti-inflammatory,antimicrobial,and prebiotic activities.Thus,this review summarizes the main chemical classes of MAO,their sources,and the main processes used for their production(i.e.,physical,chemical,and biological methods),coupled with a discussion of the advantages and disadvantages of these methods.Highlights of the biological activities of MAO and their potential applications in food,nutraceutical,and pharmaceuticals would also be discussed and summarized.
文摘Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.
