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BACKGROUND: Burn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies regarding diagnosis and management of BII. A modified DELPHI study using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method (RAM) systematically analysed the opinions of an expert panel. Expert opinion was combined with available evidence to determine what constitutes appropriate and inappropriate judgement in the diagnosis and management of BII. METHODS: A 15-person multidisciplinary panel comprised anaesthetists, intensivists and plastic surgeons involved in the clinical management of major burn patients adopted a modified Delphi approach using the RAM method. They rated the appropriateness of statements describing diagnostic and management options for BII on a Likert scale. A modified final survey comprising 140 statements was completed, subdivided into history and physical examination (20), investigations (39), airway management (5), systemic toxicity (23), invasive mechanical ventilation (29) and pharmacotherapy (24). Median appropriateness ratings and the disagreement index (DI) were calculated to classify statements as appropriate, uncertain, or inappropriate. RESULTS: Of 140 statements, 74 were rated as appropriate, 40 as uncertain and 26 as inappropriate. Initial intubation with ≥ 8.0 mm endotracheal tubes, lung protective ventilatory strategies, initial bronchoscopic lavage, serial bronchoscopic lavage for severe BII, nebulised heparin and salbutamol administration for moderate-severe BII and N-acetylcysteine for moderate BII were rated appropriate. Non-protective ventilatory strategies, high-frequency oscillatory ventilation, high-frequency percussive ventilation, prophylactic systemic antibiotics and corticosteroids were rated inappropriate. Experts disagreed (DI ≥ 1) on six statements, classified uncertain: the use of flexible fiberoptic bronchoscopy to guide fluid requirements (DI = 1.52), intubation with endotracheal tubes of internal diameter

Offers a rationale for using cooperative learning in higher education, identifying six elements essential to its success: positive interdependence; face-to-face verbal interaction; individual accountability; social skills; group processing; appropriate grouping. Describes and compares three distinct approaches in medicine, dentistry, and mathematics in relation to these six elements. Shares lessons learned from research and practice. (Author/MSE)

Michael Bradfield Economics Department Dalhousie University B3H 3J5 NS Ken Dunn Mathematics Department Dalhousie University B3H 3J5 NS While most regional scientists feel the neoclassical approach is too limited, it [...]

An editorial is presented on the brief introduction to national secondary care data sets and their use in capturing and reporting pressure ulcer occurrence. The article discusses that Pressure ulcers (PU) are a long-standing challenge to health care, impacting on quality of life (QoL) and allocation of time and resources; and the COVID-19 pandemic has posed additional challenges, and an increase in PU occurrence was identified during the first wave of the pandemic.

Objectives To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. Design Proof of concept before and after study with feasibility of delivering the intervention. Setting Three burns services within two UK hospital trusts. Participants Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention. Intervention Introduction of LF sheets and pillowcases during a 15-month period. Outcome measures For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding. Results 131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the primary outcome of the proportion needing regrafting was halved in the LF cohort, the confidence interval (CI) crossed 1 (OR (95% CI): 0.56 (0.16 to 1.88)). Partial graft loss (any loss) was significantly reduced in the LF cohort (OR (95% CI): 0.27 (0.14, 0.51)). Inpatient LoS was no different between the two cohorts (difference in median days (95% CI): 0 (-2 to 1)), and the estimated difference in LoS cost was £-1139 (-4829 to 2551). Practical issues were easily resolved, and no safety incidents occurred while patients were nursed on LF bedding. Conclusions LF bedding is safe to use in burned patients with skin grafts and we have shown proof of concept for the intervention. Further economic modelling is required to see if an appropriately powered randomised control trial would be worthwhile or if roll out across the National Health Service is justified. Trial registration number ISRCTN82599687. [ABSTRACT FROM AUTHOR]

Objective: To describe, for the first time, distribution (by geography, age, sex) and time trends in burn injury in England and Wales over the period that the international Burn Injury Database (iBID) has been in place. Setting: Data from the iBID for the years 2003-2011 were used for a retrospective descriptive observational study of specialised services workload and admissions in England and Wales. Participants: All patients who have been visited or admitted to the burn injury specialised health service of England and Wales during the time period 2003-2011. Data cleaning was performed omitting patients with incomplete records (missingness never exceeded 5%). Outcome measures: Workload, admissions, mortality, length of stay (LOS), geographical distribution, sex differences, age differences, total burn surface area, mechanism of Injury. Results: During 2003-2011, 81 181 patients attended the specialised burn service for assessment and admission in England and Wales. Of these, 57 801 were admitted to the services. Males accounted for 63% of the total workload in specialised burn injury services, and females for 37%. The median (IQR) burn surface area was 1.5% (3.5%). The most frequent reason for burn injury was scald (38%). The median (IQR) age for all the referred workload for both genders was 21 (40). The overall mortality of the admitted patients was 1.51% and the median (IQR) LOS was 1 (5) days. Conclusions: Mortality from burn injuries in England and Wales is decreasing in line with western world trends. There is an observed increase in admissions to burn services but that could be explained in various ways. These results are vital for service development and planning, as well as the development and monitoring of prevention strategies and for healthcare commissioning. [ABSTRACT FROM AUTHOR]

The article discusses the study on nurses wound knowledge. The study aimed at identifying the educational needs of nurses in dealing with acute and chronic wounds. Practice nurses have the lowest level of involvement in wound care. Education in the management of wounds is necessary. Initiatives such as telemedicine and the development of web based directed learning packages are important for access to local and national knowledge bases.

The pancreatic islet is a complex system containing numerous cell types, including endocrine, immune, and endothelial. The pathologies of T1D and T2D originate in this organized, multicellular environment in vivo, and thus can only be fully understood in this context. We have developed several adaptable tools to generate a versatile platform combining intravital microscopy (IVM), virally-packaged biosensors, and abdominal imaging windows (AIW) allowing us to gather β cell specific measurements in vivo longitudinally. Here, we present characterization of in vivo physiology of mouse β-cells using two virally-packaged biosensors roGFP2 and GcAMP6s. To achieve in vivo expression of the biosensors, we used IP injected AAV8 to transduce in situ β cells. Using redox-sensitive roGPF2, we measured the response in biosensor signal after IV administration of the cytotoxic glucose analog alloxan from islets in situ (∼5-fold change vs. saline). To test the portability of the platform, we utilized Alox15 knockout mice (Alox15-/-), which show protection against oxidative stress. We observed a rapid 4.6-fold increase in biosensor signal ratio in WT mice, compared to a 3.3-fold increase in Alox15-/- mice after IV alloxan treatment. Using AAV8-GcAMP6s, we measured calcium activity of β-cells in situ after a glucose bolus and detected a small sub-population of β cells that oscillate at a 2x frequency compared to the entire islet. To overcome the endpoint nature of standard IVM, we next implanted AIWs over the pancreas of biosensor-labeled mice, which allows for stable, longitudinal imaging of islets in situ over for several weeks. Using IVM through AIW's in AAV8-roGFP2 transduced mice, we monitored individual islets, before, during, and after streptozotocin-induced β cell ablation. We measured a ∼75% reduction in islet area by 10 days post ablation. Altogether, this versatile platform can lead to novel experiments examining β-cell physiology and signaling in vivo longitudinally in a variety of unique scenarios. Disclosure: C.A. Reissaus: None. S.A. Tersey: None. K.W. Dunn: None. A.K. Linnemann: None. R. Mirmira: None. [ABSTRACT FROM AUTHOR]