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This study investigated the effects of halibut oil cream, containing omega-3 fatty acids, vitamins A and D, and hydroxyproline, on burn wound healing in rats. Acute dermal toxicity tests confirmed its nontoxicity. Wistar rats were divided into five groups: a control, a positive control treated with silver sulfadiazine 1% (SSD), and three groups treated with 3%, 9%, and 27% halibut oil cream Formulation (HBOF). The SSD and HBOF groups showed significant healing improvements compared to the control. Histopathological analysis indicated increased collagen production in the HBOF groups, suggesting halibut oil cream's potential as a topical treatment for burn wounds. [ABSTRACT FROM AUTHOR]

Background Aeromonas virulence may not be entirely dependent on the host's immune status. Pathophysiologic determinants of disease progression and severity remain unclear. Methods One hundred five patients with Aeromonas infections and 112 isolates were identified, their clinical presentations and outcomes were analyzed, and their antimicrobial resistance (AMR) patterns were assessed. Two isolates (A and B) from fatal cases of Aeromonas dhakensis bacteremia were characterized using whole-genome sequencing. Virulence factor- and AMR-encoding genes from these isolates were compared with a well-characterized diarrheal isolate A. dhakensis SSU and environmental isolate Aeromonas hydrophila American Type Culture Collection_7966T. Results Skin and soft tissue infections, traumatic wound infections, sepsis, burns, and intraabdominal infections were common. Diabetes, malignancy, and cirrhosis were frequent comorbidities. Male sex, age ≥ 65 years, hospitalization, burns, and intensive care admission were associated with complicated disease. High rates of AMR to carbapenems and piperacillin-tazobactam were found. Treatment failure was observed in 25.7% of cases. Septic shock and hospital-acquired infections were predictors of treatment failure. All 4 isolates harbored assorted broad-spectrum AMR genes including blaOXA , ampC , cphA , and efflux pumps. Only clinical isolates possessed both polar and lateral flagellar genes, genes for various surface adhesion proteins, type 3 and 6 secretion systems and their effectors, and toxin genes, including exotoxin A. Both isolates A and B were resistant to colistin and harbored the mobile colistin resistance-3 (mcr-3) gene. Conclusions Empirical therapy tailored to local antibiograms may facilitate favorable outcomes, while advanced diagnostic methods may aid in identifying correct Aeromonas spp. of significant clinical importance. [ABSTRACT FROM AUTHOR]

Background: Sexual well-being is a key part of being human yet often remains shrouded in secrecy and poorly addressed in the clinical setting. The impact of burns and its long-term sequelae often lead to concerns regarding body image disturbance, self-esteem issues, and interpersonal challenges which can impact on an individual's sexual well-being. However, existing post-burn rehabilitation programmes usually lack components addressing concerns regarding sexual well-being. As a part of a larger project, we developed a nurse-led aftercare programme, and this study sought to examine the effects of the programme in addressing the post-burn sexual well-being of adult burn survivors. Methods: A randomised controlled trial approach was used. Sixty burn survivors aged ≥ 18 years with burn size ≥ 10% total burn surface area were assigned to intervention and control groups. Participants in the intervention group underwent the nurse-led aftercare programme which involved pre-discharge support and proactive follow-up support over 8 weeks. The sexuality subscale of the Burn Specific Health Scale-Brief was used to evaluate the outcome of interest. Data were collected at three timepoints: baseline (T0), post-intervention (T1), and follow-up (T2). Results: Using a corrected p value of 0.017, the study observed only statistically significant time effect at both T1 and T2. Both group and interaction effects were statistically insignificant for this outcome. Conclusion: Issues regarding sexual well-being are often considered sacred and may be challenging to discuss. Thus, a longer duration of the intervention may be considered with ongoing training of practitioners to identify and resolve emerging challenges. Despite the non-significant interaction and group effects, including sexual well-being support in post-burns rehabilitation programmes will facilitate access to and utilisation of the service among burn survivors who may need it. Trial registration: Prospectively registered on 14th August 2020. ClinicalTrials.govNCT04517721. [ABSTRACT FROM AUTHOR]

Bioengineered allogeneic cellularised constructs (BACC) exert pro‐healing effects in burn wounds and skew macrophage phenotype towards a predominately reparative phenotype. However, whether BACC can modulate the phenotype of dysregulated macrophages, like those present in burn wounds, is not known. To better understand the macrophage modulatory characteristics of the BACC, primary human macrophages were polarised to the M2b phenotype, an immunosuppressive phenotype relevant to burn wounds, by simultaneously exposing macrophages to polystyrene plate‐coated immunoglobulin G and the endotoxin lipopolysaccharide (LPS). The resulting macrophage phenotype upregulated both inflammatory and reparative genes, and increased secretion of the M2b marker CCL1 compared to five different in vitro macrophage phenotypes. M2b macrophages were cultured with the BACC in the presence or absence of LPS to mimic infection, which is a common occurrence in burn wounds. The BACC caused up‐regulation of reparative gene sets and down‐regulation of pro‐inflammatory gene sets, even when LPS was present in the cell culture media. Co‐cultures were maintained for 1, 3, or 5 days in the presence of LPS, and by day 1 both non‐activated macrophages and M2b macrophages exhibited signs of endotoxin tolerance, as demonstrated by a reduced secretion of tumour necrosis factor α (TNFα) in response to fresh LPS stimulus. The BACC was not able to prevent endotoxin tolerance, but reparative genes were upregulated in macrophages chronically exposed to LPS. These results suggest that the BACC can promote a reparative phenotype in dysregulated macrophages relevant to the pathophysiology of burns. [ABSTRACT FROM AUTHOR]

Dermal substitutes have been introduced in burn care to improve wound healing outcomes; however, their use remains limited in standard treatments. This systematic review and meta‐analysis aimed to evaluate the outcomes of dermal substitutes in patients with burns and patients requiring burn scar reconstruction and subsequently contribute to optimising the integration of dermal substitutes into clinical practice and reducing the knowledge gap. A comprehensive search across various databases included human studies from peer‐reviewed journals on dermal substitutes for deep dermal and full‐thickness burns, and scar reconstruction across all ages. Data from comparative trials were extracted, focusing on patient and wound characteristics, treatment specifics, and outcomes related to wound healing and scar quality. Meta‐analysis was performed on trials reporting similar post‐burn measures, with statistical heterogeneity assessed. Outcomes were presented using mean differences or odds ratios with 95% confidence intervals. A total of 31 comparative trials were included. The overall quality of the studies was considered moderate. The meta‐analysis indicated delayed re‐epithelialization 4–7 days after treatment with a collagen‐elastin matrix compared to split‐thickness skin graft in acute burns (−7.30%, p = 0.02). Significant improvement in subjective scar quality was observed with acellular dermal matrix compared to split‐thickness skin graft in acute burn wounds 6 months post‐operative (−1.95, p <0.01). While acknowledging the initially delayed wound healing, incorporating dermal substitutes into the surgical treatment of burn patients holds promise for enhancing scar quality. However, future research must prioritise outcome measure uniformity, address variations in dermal substitute application, and standardise indications for consistent and effective practices. [ABSTRACT FROM AUTHOR]

Burn depth determination is critical for patient care but is currently lacking accuracy. Recent animal studies showed that Short Wave Infrared (SWIR) imaging can distinguish between superficial and deep burns. This is a first human study correlating reflectance of multiple SWIR bands using a SWIR assessment tool (SWAT) with burn depth classifications by surgeons and histology. Burns and adjacent normal skin in 11 patients with thermal injuries were imaged with visual and narrow bands centred at 1200, 1650, 1940 and 2250 nm and biopsies were taken from select areas. Reflectance intensities for each band in 273 regions of interest (ROI) were divided by the normal skin reflectance and combined into three Reflectance Indices (RIs). In addition, burns in ROIs and biopsies were classified by five surgeons and three pathologists, respectively, as superficial partial, deep partial, or full thickness. Results show that for burn depth increase classified by the surgeons, reflectance increased at 1200 and 2250, decreased at 1940, and didn't change at 1650 nm. In contrast, all three RIs increase with burn depth and predict the deep and full depths ROIs representing operable regions (Area Under Curve >0.6507, p < 0.0001). Pathologists' classification matched surgeons' classification of burn category only in eight of 21 biopsies (38.1%), but reflectance at all bands and one RI for all deep partial and full thickness biopsies were larger than in non‐biopsy normal and superficial partial thickness ROIs (p < 0.0118). In conclusion, multi‐spectral imaging with a new SWAT is a promising approach for evaluation of burn wound depth. [ABSTRACT FROM AUTHOR]

This prospective interventional study investigated the impact of individualized nutritional interventions on immune function and infection rates in burn patients. This study enrolled 120 burn patients between December 2022 and January 2024. The nutritional interventions focused on protein supplementation, micronutrient replenishment, and inclusion of anti-inflammatory nutrients, specifically omega-3 fatty acids and vitamin C. The nutrients were administered through oral, enteral, and parenteral routes based on dietary preferences and the medical condition of individuals. Protein was prioritized because of its role in leukocyte production; zinc and vitamin C were supplemented to optimize immune function; and omega-3 fatty acids were included to mitigate inflammation and enhance wound healing. The study assessed outcomes through changes in leukocyte and lymphocyte counts, cytokine levels, infection rates, wound healing rates, and the length of hospital stays. Results indicated significant improvements in immune markers and reduced infection rates post-intervention (P < 0.05). Leukocyte count increased significantly, cytokine levels decreased, and the infection rate reduced from 30% to 14.2% (P < 0.05). These outcomes highlighted the efficacy of targeted nutritional interventions in supporting immune health and reducing infections in burn patients. The findings advocated for integrating comprehensive nutritional strategies in managing burn injuries to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: This scoping review aimed to identify the barriers, facilitators and benefits of returning to work following burn injury, outcome measures used, management strategies, and models of care. OBJECTIVE: To provide a comprehensive overview about working-aged adults returning to their preinjury employment after burn injury METHODS: We followed a pre-determined scoping review protocol to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT and CDSR databases between 2000 to December 2023. Papers reporting primary data from previously employed adults with cutaneous burn injuries were included. RESULTS: In all, 90 articles met the review criteria. Return-to-work was both an outcome goal and process of recovery from burn injury. Physical and psychological impairments were identified barriers. Job accommodations and modifications were important for supporting the transition from hospital to workplace. Employment status and quality of life sub-scales were used to measure return-to-work. CONCLUSIONS: Consistent definitions of work and measurements of return-to-employment after burn injury are priorities for future research. Longitudinal studies are more likely to capture the complexity of the return-to-employment process, its impact on work participation and changes in employment over time. The social context of work may assist or hinder return-to-work more than physical environmental constraints. Equitable vocational support systems would help address disparities in vocational rehabilitation services available after burn injury. [ABSTRACT FROM AUTHOR]

Burn injuries remain a public health issue with risk of mortality and multiple post-burn morbidities. This article aims to systematically review and meta-analyse data about burns in the Middle-East and North-Africa (MENA) region. Methods Pubmed, Web of Science, Scopus, Global Index Medicus, Cochrane Library and Google scholar data were searched from their dates of inception till April 2024. Results One hundred and one studies were included in this review, representing data from twelve countries in the region. Data was sub-grouped into two groups: pediatric group and emergency room (ER) group. The pooled random-effect estimates were male gender 58.6% [95% CI 56.9–60.2%], accidental injury 91.1% [95% CI 85.9–94.5%], scald burn 50% [95% CI 46.7–53.4%], at home injury 79.9% [95% CI 76.7–82.8%], upper limbs involvement 51.7% [95% CI 46.8–56.6%], mean body surface area burned (BSAB) 17.2% [95% CI 14.69–19.84%], second-degree burns 56.5% [95% CI 49–63.8%], length of stay 11.18 days [95% CI 9.68–12.68%] and mortality rate 9.1% [95% CI 7.5–11%]. All included studies were of good quality. Conclusion This review shows scarcity of studies from many countries in the MENA region. These data will inform policy makers and burn specialists about the extent of this public issue in the region. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of the transitional tele-rehabilitation programme on quality of life of adult burn survivors. Design: A prospective, single centre, randomised controlled trial and reported according to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Participants: Adult burn survivors aged ≥18 years with burn size ≥10% total body surface area irrespective of the depth was considered eligible to participate. Intervention: The intervention was in two phases: pre-discharge and active follow-up phase (which occurred via WeChat). In both phases, comprehensive assessment and intervention guided by the Omaha System and evidenced-based protocols guided the care delivery over an 8-week period. Main measures: The outcome of interest was quality of life. Two outcome measures were used to assess the outcome of interest: Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L tools. The outcome was assessed at three time points: T0 (baseline), T1 (immediate post-intervention) and T2 (4 weeks from T1). Results: In total, 60 adult burn survivors were randomly allocated to undergo the new programme. The transitional tele-rehabilitation programme elicited statistically significant improvement in simple abilities, affect, interpersonal relationship (T2) and overall quality life (T1 and T2) measured on the BSHS-B. Conclusion: Ongoing rehabilitative care is essential to support the recovery process of burn survivors considering that some quality-of-life subscales may improve faster than others. The study findings highlight the potential of employing a social media platform to improve post-burn quality of life outcomes. Trial registration: ClinicalTrials.govNCT04517721. Registered on 20 August 2020 [ABSTRACT FROM AUTHOR]

Background: Skin injuries, such as burns, can result in an open wound that can lead to the deterioration of the skin, which acts as a protective barrier against external agents, and can cause serious health problems. Pectin, a plant-derived polysaccharide, is a suitable candidate for wound care due to its gel-forming ability and bio- compatibility. Pectin absorbs wound exudates to form a soft gel and is known for its strong anti-inflammatory effects. Pectin-based hydrogel systems promote wound healing by promoting fibroblast proliferation and keratinocyte migration. Methods: In the study, 60 male Wistar albino rats were used, and 6 different treatment groups were formed: Healthy control, burn control, silver sulfadiazine, pectin-based hydrogel system, pectin-based hydrogel system + iodine, pectin-based hydrogel system + plant extract. Rats with burn wounds were treated for 21 days, and the wound healing process was evaluated by macroscopic, biochemical, and histopathological analysis. Results: The results showed that the pectin-based hydrogel system, iodine, and plant extracts promoted healing in burn wounds. Especially in the groups treated with silver sulfadiazine and plant extracts, the development of granulation tissue and regeneration of collagen fibers showed significant improvement. Furthermore, the pectin-based hydrogel system is thought to contribute to wound healing by maintaining skin moisturization. Vascular endothelial growth factor (VEGF) and transforming growth factor-β (TGF-β) levels decreased in the treatment groups compared to the burn group, and it was determined that these factors play an important role in wound healing. Conclusion: This study shows that pectin-based hydrogel systems can be an effective alternative in burn treatment, and their healing effects can be enhanced by the addition of iodine and plant extracts. [ABSTRACT FROM AUTHOR]

Introduction: The Canadian Occupational Performance Measure (COPM) was implemented at a state‐wide burns service to ensure compliance with current best evidence as outlined by the Australian and New Zealand Burns Association 'burn trauma rehabilitation: allied health practice guidelines'‐ Chapter 7 Measuring Post‐Burn Recovery, as a standard outcome measure for individuals with an admission time greater than 24 h. The primary aim of this study is to determine if individuals have a minimal important change in performance and satisfaction with activities that were identified as problematic on the COPM prior to their acute discharge. Previous research confirmed the feasibility of using the COPM in the acute burn ward and recommended the most appropriate timepoint for re‐measurement be confirmed, which is the secondary objective of this study. The benefits of confirming this timepoint include ensuring efficient use of clinicians' time without compromising the accuracy of the assessment and ensuring effective translation of the guidelines' recommendation. Methods: A prospective longitudinal study was undertaken, where all individuals who previously completed a COPM prior to acute discharge were sought to complete a re‐assessment while accessing outpatient services. Time frames for re‐assessment were open. Only individuals who were actively receiving occupational therapy outpatient services were included. COPM assessments were completed in person where possible, particularly for participants who required an interpreter, with phone and video calls also used when needed. Results: A total of 37 participants were included, with the timeframe between initial and post‐COPM assessment ranging from 2 to 643 days. Outcomes plateaued at approximately 12 months (365 days) post‐initial measurement (prior to discharge from acute ward). The most common occupational performance goals that participants identified were returning to work, sport, and driving. 86.5% of participants increased their satisfaction with these activities. The results of this study demonstrate improvements across the domains of performance and satisfaction occur for individuals with burns at approximately 3 months and 12 months post‐injury. Conclusion: Based on this study, it is suggested that when using the COPM assessment in a tertiary burn setting, re‐measurement be completed no earlier than 3 months and later than 12 months from burn injury, or upon discharge from the service. The findings from this study will be translated into clinical practice at this facility. PLAIN LANGUAGE SUMMARY: This study used the Canadian Occupational Performance Measure (COPM) to measure change in individuals' reports of performance and satisfaction of activities, which were identified as problematic post‐burn injury. Rehabilitation post‐burn injury is lengthy and can take months or years depending on the individual. A change in two or more scores on the COPM is determined as an important change. Thirty‐seven individuals participated in this study at different time points post‐discharge from the acute ward. The results demonstrate that the COPM should be used 3 months and 12 months post‐discharge from the acute ward for individuals who sustained a burn injury. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is a frequent complication of acute hospital care, and this extends to inpatient rehabilitation. The timely use of appropriate thromboprophylaxis in patients who are at risk is a strong, evidence-based patient safety priority that has reduced clinically important venous thromboembolism, associated mortality and costs of care. While there has been extensive research on optimal approaches to venous thromboembolism prophylaxis in acute care, there is a paucity of high-quality evidence specific to patients in the rehabilitation setting, and there are no clinical practice guidelines that make recommendations for (or against) thromboprophylaxis across the broad spectrum of rehabilitation patients. Herein, we provide an evidence-informed review of the topic with practice suggestions. We conducted a series of literature searches to assess the risks of venous thromboembolism and its prevention related to inpatient rehabilitation as well as in major rehabilitation subgroups. Mobilization alone does not eliminate the risk of venous thromboembolism after another thrombotic insult. Low molecular weight heparins and direct oral anticoagulants are the principal current modalities of thromboprophylaxis. Based on the literature, we make suggestions for venous thromboembolism prevention and include an approach for consideration by rehabilitation units that can be aligned with local practice. [ABSTRACT FROM AUTHOR]

A few studies have examined post‐traumatic growth (PTG) after burns, a relatively new area of research. To understand how to promote PTG in burn survivors, we need to know how PTG and coping are presented, how they change over time, and the components that influence development. Based on the criteria of the PRISMA statement, we conducted our initial search on 1 February 2023. This study systematically reviewed relevant studies in five PubMed, Web of Science, Google Scholar, Scopus and Science Direct search databases. The search used the following keywords: Post‐traumatic Growth, Psychological Growth, Post‐traumatic Growth, Psychological, PTG, Burns and Burn. The two researchers evaluated the quality of the included studies using a 20‐item tool called the appraisal tool for cross‐sectional studies (AXIS tool). A total of 1396 burn patients participated in 12 studies. Among the studies included in this systematic review, seven were cross‐sectional, and five were cohort. The average age of the patients in this study was 35.77 (SD = 10.19). Among the participants, 52.4% were men. The total body surface area (TBSA) percentage in these patients was 32.77 (SD = 16.42). The mean of PTG inventory (PTGI) was 54.08 (SD = 20.46) out of 105, which is a moderate level. Factors such as coping strategies, perceived social support, TBSA, religion/spirituality and severity of burn are positive factors for PTG in burn survivors. Also, factors such as depression, post‐traumatic stress disorder and physical and mental recovery are negative factors for PTG in burn survivors. These factors can be improved through targeted intervention strategies, including overall function, quality of life, social support, optimism, hope and new opportunities. There is a need for further research in several areas related to growth, intervention and measurement. [ABSTRACT FROM AUTHOR]

Background In burn patients, skin barrier disruption and immune dysfunctions increase susceptibility to invasive fungal diseases (IFDs) like invasive candidiasis (IC) and invasive mold infections (IMI). We provide an in-depth analysis of IFD-related factors and outcomes in a 10-year cohort of severe burn patients. Methods This retrospective cohort study includes adult patients admitted to the burn intensive care unit (BICU) between April 2014 and May 2023 with total burn surface area (TBSA) ≥15%. Patients were classified as proven IFD according to EORTC/MSGERC criteria applicable for IC. Putative IMIs were defined with: ≥2 positive cultures from a skin biopsy/bronchoalveolar lavage or ≥2 positive blood specific-quantitative polymerase chain reactions (qPCRs) or a combination of both. Results Among 1381 patients admitted, 276 consecutive patients with TBSA ≥15% were included. Eighty-seven (31.5%; IC n = 30; IMI n = 43; both n = 14) patients fulfilled the criteria for probable/putative IFD. At Day 30 after the burn injury, the estimated cumulative incidence proven/putative (pr/pu) IFD was 26.4% (95% confidence interval [CI], 21.4%–31.8%). Factors independently associated with IFDs were TBSA, severity scores and indoor burn injury (ie, from confined space fire). Overall mortality was 15.3% and 36.8% in the no IFD, pr/pu IFD groups respectively (P <.0001). IFD was independently associated with a risk of death (hazard ratio [HR]: 1.94 for pr/pu IFD; 95% CI, 1.12–3.36; P =.019). Conclusions This study describes twenty-first-century characteristics of IFDs in severe burn patients confirming known risk factors with thresholds and identifying the indoor injury as an independent factor associated to IFDs. This suggests a link to contamination caused by fire damage, which is highly susceptible to aerosolizing spores. [ABSTRACT FROM AUTHOR]

Introduction: Classic heat stroke is a severe trauma which can lead to multi-organ dysfunctions and is associated with a high mortality. Case presentation: In this case report we present a 73-year-old patient with a classic heat stroke. His initial core body temperature was over 42 °C and he had a GCS of 3. Due to severe burn injuries the patient was transferred to a specialized burn center. The patient developed different organ failures and showed a prolonged course on the intensive care unit. Although the patient demonstrated different impaired organ systems, he recovered completely after receiving painstaking supportive therapy. Conclusions: This is a rare case of a patient who fully recovered after a heat stroke with a temperature over 42 °C and severe sequelae. [ABSTRACT FROM AUTHOR]

Porcine models are frequently used for burn healing studies; however, factors including anatomic location and lack of standardised wound methods can impact the interpretation of wound data. The objectives of this study are to examine the influence of anatomical locations on the uniformity of burn creation and healing in porcine burn models. To optimise burn parameters on dorsal and ventral surfaces, ex vivo and in situ euthanized animals were first used to examine the location‐dependence of the burn depth and contact time relationship. The location‐dependent healing in vivo was then examined using burn and excisional wounds at dorsal, ventral, caudal and cranial locations. Lactate dehydrogenase (LDH) and H&E were used to assess burn depth and wound re‐epithelialization. We found that burn depth on the ventral skin was significantly deeper than that of the dorsal skin at identical thermal conditions. Compared with burns created ex vivo, burns created in situ immediately post‐mortem were significantly deeper in the ventral location. In live animals, 2 out of 12 burn wounds were fully re‐epithelialized after 14 days in contrast to complete re‐epithelialization of all excisional wounds. Among the burn wounds, those at the cranial‐dorsal site exhibited faster healing than at the caudal‐dorsal site. This study showed that anatomical location is an important consideration for the consistency of burn depth creation and healing. These data support symmetric localization of treatment and control for comparative assessment of burn healing in porcine models to prevent misinterpretation of results and increase the translatability of findings to humans. [ABSTRACT FROM AUTHOR]

Individuals with severe burn injuries may develop depression, yet knowledge about psychological risk factors for depression following trauma is limited. This study investigated the prospective impact and interplay of prior depression and trauma-related cognitive processes (posttraumatic negative appraisals and trauma-related rumination) to depressive symptoms between 6 and 24 months after burn injury. Taiwanese adult survivors of burn (N = 118) participated in surveys immediately post-burn and at 6-, 12-, and 24-months follow-up. Participants were 7 5% men, with an average age of 41.8 years and an average of TBSA of 18.3%. A total of 8.5%, 5.9%, and 4.2% met criteria for probable major depression at 6, 12, and 24 months post-burn, respectively. The prevalence increased to 23.7%, 11.0%, and 5.9% using the cutoff on the PHQ-9. Prior depression and trauma-related cognitive processes immediately post-burn explained 13.5%, 20.5%, and 18.6% of the variance in depressive symptoms at 6, 12, and 24 months post-burn, respectively. Posttraumatic negative appraisals strongly predicted depressive symptoms post-burn across follow-ups. Moreover, posttraumatic negative appraisals significantly mediated the effect of prior depression on subsequent depressive symptoms across follow-ups. Prior depression significantly moderated the effect of trauma-related rumination on depressive symptoms at 6 months post-burn. Our results are the first to demonstrate the role and interplay of prior depression and trauma-related cognitive processes in post-burn depression. Findings highlight that pre-and post-trauma psychological factors jointly affect depression following trauma, broadening the applicability of cognitive theories of PTSD. • This study examined the contribution effect of early psychological risk factors to post-burn depressive symptoms. • Depression is relatively common at 6 months post-burn and then gradually decreased. • Posttraumatic negative appraisals strongly predicted depressive symptoms between 6 and 24 months post-burn. • Posttraumatic negative appraisals mediated the effect of prior depression on long-term depressive symptoms after burn. [ABSTRACT FROM AUTHOR]

Objective: This study attempts to examine long-term pain medication usage after burn injury and its association with functional and psychosocial outcomes. Design: This is a multicenter retrospective cohort study utilizing the Burn Model System National Longitudinal Database. Participants injured from 2015 to 2021 were divided into two groups, those taking and not taking prescription pain medication at 12 mos after injury. Regression analyses examined associations between pain medication use and outcomes at 12 mos, adjusting for demographics, burn size, length of hospital stay, and preinjury pain medication use and employment status. Outcomes included VR-12 Physical and Mental Component Summary scores Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores, Satisfaction with Life Scale, and employment status. Results: Of 358 participants analyzed, prescription pain medication use was associated with worse outcomes at 12 mos: Physical Component Summary (β = -7.11, P < 0.001), Mental Component Summary (β = -6.01, P < 0.001), and Patient-Reported Outcomes Measurement Information System Depression (β =4.88, P < 0.001) and Anxiety (β = 6.16, P < 0.001). Satisfaction with Life Scale was not significantly associated with pain medication use (P = 0.069) and those taking pain medication were 52% less likely to be employed at 12 mos (P = 0.035). Conclusions: There is a significant association between prescription pain medication use and worse physical, mental, and employment outcomes at 12 mos after burn injury. [ABSTRACT FROM AUTHOR]

Background: Burns are a common and severe medical emergency requiring immediate specialized care to minimize damage and prevent complications. Burn severity depends on depth, extent, and location, with more complex care needed for burns on critical areas or extensive burns. Nursing is essential in burn management, providing immediate care, adapting treatments, managing pain, preventing infections, and offering emotional support for recovery. The study aims to analyse the epidemiological and clinical characteristics of burns treated at the Hospital Emergency Department of the Hospital Complex of Cáceres (Spain) from January 2018 to December 2022. It looks at factors like gender, age, hospital stay duration, emergency type (paediatric or adult), main diagnosis, skin thickness, burn degree, affected body areas, percentage of body surface area burned, and treatment types. It also investigates how treatment varies by gender, age, skin thickness, and burn severity. The relevance of this research lies in the fact that periodic epidemiological studies are essential to monitor changes in diseases, evaluate the effectiveness of interventions, detect outbreaks quickly, update knowledge on risk factors, and guide health policy decisions. This ensures an adapted and effective response to the needs of the population. Methods: Retrospective, observational study that analysed burn cases treated at the Hospital Complex of Cáceres (Spain) 2018–2022. Inclusion criteria were based on ICD-10 codes for burns, excluding severe cases not treated in this service. Data were analysed using descriptive statistics, Student's t-tests, Chi-square tests, and ANOVA. Results: 220 patients surveyed, with a mean age of 47 years and 60.9% male. Most burns (95.5%) affected the external body surface, with a mean hospital stay of 7.86 days. Medical treatment was provided to 75.5% of patients, and 24.5% required surgical intervention. Significant differences in treatment procedures were observed according to age, skin thickness, and burn degree. Older patients had more procedures and longer hospital stays. Excision and transfer procedures were more common in full-thickness and severe burns. Conclusions: The findings align with previous research on burn demographics and treatment approaches. Treatment differences by age and burn severity highlight the need for tailored interventions. The study underscores the importance of comprehensive burn management, including psychological support for improved long-term outcomes. Further research could explore the impact of socio-economic factors on burn incidence and treatment. This study was not registered. [ABSTRACT FROM AUTHOR]

Purpose: Nowadays, it is largely accepted that albumin should not be used in hypoalbuminemia or for nutritional purpose. The most discussed indication of albumin at present is the resuscitation in shock states, especially distributive shocks such as septic shock. The main evidence-based indication is also liver disease. In this review, we provided updated evidence-based instruction for definite and potential indications of albumin administration in clinical practice, with appropriate dosing and duration. Methods: Data collection was carried out until November 2023 by search of electronic databases including PubMed, Google Scholar, Scopus, and Web of Science. GRADE system has been used to determine the quality of evidence and strength of recommendations for each albumin indication. Results: A total of 165 relevant studies were included in this review. Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin. Moreover, albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use. Also, in modest volume paracentesis, severe hyponatremia in cirrhosis has a low to moderate quality of evidence and a weak recommendation. Conclusion: Albumin administration is most indicated in management of cirrhosis complications. Fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments, is another rational use for albumin. Implementation of evidence-based guidelines in hospitals can be an effective measure to reduce inappropriate uses of albumin. [ABSTRACT FROM AUTHOR]

Background: Inflammation is the hallmark of critical illness and triggers the neuro-endocrine stress response and an oxidative stress. Acute inflammation is initially essential for patient's survival. However, ongoing or exaggerated inflammation, due to persistent organ dysfunction, immune dysfunction or poor inflammation resolution, is associated to subsequent hypermetabolism and hypercatabolism that severely impact short and long-term functional status, autonomy, as well as health-related costs. Modulation of inflammation is thus tempting, with the goal to improve the short- and long-term outcomes of critically ill patients. Findings: Inflammation can be modulated by nutritional strategies (including the timing of enteral nutrition initiation, the provision of some specific macronutrients or micronutrients, the use of probiotics) and metabolic treatments. The most interesting strategies seem to be n-3 polyunsaturated fatty acids, vitamin D, antioxidant micronutrients and propranolol, given their safety, their accessibility for clinical use, and their benefits in clinical studies in the specific context of critical care. However, the optimal doses, timing and route of administration are still unknown for most of them. Furthermore, their use in the recovery phase is not well studied and defined. Conclusion: The rationale to use strategies of inflammation modulation is obvious, based on critical illness pathophysiology and based on the increasingly described effects of some nutritional and pharmacological strategies. Regretfully, there isn't always substantial proof from clinical research regarding the positive impacts directly brought about by inflammation modulation. Some arguments come from studies performed in severe burn patients, but such results should be transposed to non-burn patients with caution. Further studies are needed to explore how the modulation of inflammation can improve the long-term outcomes after a critical illness. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This study aimed to assess the methods used for ripening fruits by sellers and to examine the knowledge regarding the health risks associated with the use of calcium carbide (CaC2) among both fruit sellers and consumers in Ado-Ekiti. Methods: The study employed a cross-sectional design, utilizing a semi-structured questionnaire administered in major markets within Ado-Ekiti. Knowledge levels were categorized into good (> 70% score), fair (50–69% score), and poor (< 50% score). One way Analysis of variance (ANOVA) and Independent sample t-test was used to indicate knowledge score difference with respect to socio demographic characteristics. Results: The study involved 357 consumers and 20 fruit sellers, with a majority being females (54.9% of consumers; 80.0% of sellers) and aged predominantly between 18–27 years and 28–39 years. The findings revealed that the use of CaC2 (50%) and natural ripening methods (100%) were common among fruit sellers. Sellers cited cancer (60%), bacterial infections (35%), and chest tightness (15%) as associated risks with CaC2 usage. Similarly, consumers expressed concerns about consuming CaC2-ripened fruits, attributing risks such as abdominal burns (70%), cancer (70.6%), and diarrhoea (67.3%). A significant proportion of sellers (90%) exhibited poor knowledge regarding the risks associated with CaC2, while 24.6% of consumers demonstrated fair knowledge on the subject. Conclusion: The study identified common fruit ripening practices among sellers. Fruit sellers showed poor knowledge, while consumers displayed fair to poor understanding of health risks linked to calcium carbide use in artificial fruit ripening. [ABSTRACT FROM AUTHOR]

INTRODUCTION: With advancements in laser technology, urologists have been able to treat urinary calculi more efficiently by increasing the energy delivered to the stone. With increases in power used, there is an increase in temperatures generated during laser lithotripsy. The aim of this study was to evaluate the thermal dose and temperatures generated with four laser settings at a standardized power in a high-fidelity, anatomic model. METHODS: Using high-fidelity, 3D-printed hydrogel models of a pelvicalyceal collecting system with a synthetic BegoStone implanted in the renal pelvis, surgical simulation of ureteroscopic laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H2O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations: at the stone and ureteropelvic junction. RESULTS: Greater cumulative thermal doses and maximal temperatures were achieved with greater ODCs and longer laser activation periods. There were statistically significant differences between the thermal doses and temperature profiles of the laser settings evaluated. Temperatures were greater closer to the tip of the laser fiber. CONCLUSIONS: Laser energy and frequency play an important role in the thermal loads delivered during laser lithotripsy. Urologists must perform laser lithotripsy cautiously when aggressively treating large renal pelvis stones, as dangerous temperatures can be reached. To reduce the risk of causing thermal tissue injury, urologists should consider reducing their ODC and laser-on time. [ABSTRACT FROM AUTHOR]

Background: There is no standardized practice in pediatric pain assessment with burn injuries in the outpatient clinic setting. Objective: This review aims to identify reliable, validated tools to measure pain in the pediatric burn clinic population. Methods: The literature search for this integrative review was conducted using the databases of PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, and Embase from 2011 to 2023. Quality and relevance were appraised using the Johns Hopkins Nursing Evidence-Based Practice Model. Reporting was done according to a Preferred Reporting Items for Systemic Reviews and Meta-Analysis checklist. Results: Fourteen articles and two clinical practice guidelines met inclusion criteria and were included in this review. Conclusion: The Pain Observation Scale for Young Children and the COMFORT Behavior Scale tools have shown good reliability and construct validity and can be safely used to measure background and procedural pain in daily burn practice. Further research on reliable, validated pain assessment techniques in the pediatric burn population is needed. [ABSTRACT FROM AUTHOR]

The objective of this work was to assess the potential effect of bone marrow mast cells (BMMCs) on burn wound healing in rats. We included 45 male rats into three groups of 15 animals each: CNTRL group: We treated the burn wounds with normal saline (0.1 ml). TRTMENT group: In this group, the burn wounds were treated with bone marrow mast cells (1× 106/ml). SSD (Positive control) group: In this group, the wounds were treated with silver sulfadiazine 1% ointment. Wound area reduction measurements, histopathological studies, and biochemical assessments levels showed significant differences between rats in TRTMENT group in comparison with other groups (p < 0.05). Accelerated repair of the wounds in TRTMENT group showed that local application of BMMCs could be taken into consideration in burn wound healing. [ABSTRACT FROM AUTHOR]

Introduction: Fire is one of the greatest discoveries in the history of mankind. It fully transforms the way of living of humans. But just like a double edged sword it also affects the human life in a negative way. Fire is easy and dangerous weapon in kitchen to be used for suicide for females in developing country like India. Due to this, thermal burn is a big problem and have significant share in medico-legal autopsies. Aim and objective: The aim of present study is to provide a brief analysis of thermal burn mortality across all age group brought in the mortuary of GRMC, Gwalior and to study the various medico-legal aspects of fatal thermal burn cases. Material & Method: This is a retrospective analysis of 82 cases of thermal burns which were brought for medicolegal autopsy at Forensic Medicine & Toxicology department in Gajra Raja Medical College, Gwalior (Madhya Pradesh) during the whole year. The data was complied, tabulated and analysed statistically. Results: 3.6% of total medico-legal autopsies are of thermal burn. Most of the thermal burn cases fall in the age group of 21-30years. 57.3% victims are female.81.1% of the victims are married. Most of the victims (64.6%) showed total body surface area involvement between 71-100%. Most of the cases (39%) survived for 7 days or more. Most common cause of death (74.4%) in this study is Septicaemia. About 69.5% of thermal burn cases were accidental manner. Conclusion: In most of the cases thermal burn is totally preventable and manageable. Education at school level plays a key role. Most of the accidental thermal burns can be avoided if, people know the proper safety measures for using fuels for cooking. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cultured epidermal autograft, JACE®, was introduced into the Japanese national health insurance system in 2009 and has been used in more than 1000 cases of extensive burns. The aim of this study was to investigate whether the use of JACE® contributes to survival rate in extensive burns. In this study, 119 cases were selected from 3990 cases in Tokyo Burn Unit Association registry data from 2009 to 2023, excluding cases with less than 40% total body surface area, cases of deaths within 4 weeks and cases with unknown length of hospital stay. In total, 25 patients treated with JACE® were selected and matched with another 25 patients who did not receive JACE® using propensity score matching. The results showed that patients treated with JACE® had a significantly higher survival rate than did those who were not treated with JACE® at all time points between 6 and 9 weeks post‐injury. In addition, there was no significant difference in length of hospital stay between the groups. These results suggest that the use of JACE® in patients with extensive burns contributes to patient survival and does not prolong hospital stay. [ABSTRACT FROM AUTHOR]

Background: Unintentional injuries disproportionately impact American Indian and Alaska Native (AI/AN) populations. Developing effective and culturally tailored data collection and intervention programs requires an understanding of past prevention efforts in AI/AN communities, but limited peer-reviewed literature on the topic is available. This scoping review aims to summarize efforts that have been published in the Primary Care Provider newsletter, a source of gray literature available through the Indian Health Service. Methods: The research team obtained all injury related articles in the Provider newsletter and excluded those that did not describe an unintentional injury prevention effort. Included articles were organized chronologically and by topic, and outcomes were described in a data abstraction form. Results: A total of 247 articles from the Provider newsletter were screened, and 68 were included in this review. The most number of articles were published in 2007 (n = 15). Many focused not specifically on one tribal community but on the AI/AN community as a whole (n = 27), while others reported that certain tribes were the focus of study but did not identify tribes by name (n = 24). The following is a list of 14 tribal communities explicitly mentioned: Omaha, Cherokee, Ute, Yakama, Chippewa, Apache, Ho-Chunk, The Crow Tribe, Tohono O'odham Nation, Fort Mojave Tribe, Chemehuevi Tribe, The Rosebud Tribe, Navajo, and The Pueblo of Jemez. Published unintentional injury prevention efforts have covered the following 7 topics in AI/AN communities: falls, motor vehicle crashes, poisonings, improving data, burns, children, and other. Conclusion: This scoping review makes available and searchable information on injury prevention work conducted in and for AI/AN communities that is not currently found in the peer-reviewed literature. [ABSTRACT FROM AUTHOR]

Objective(s). Given the increasing rate of methicillin‐resistant Staphylococcus aureus (MRSA) resistance to antibiotics, the use of plant‐based antimicrobials to treat the infection has been considered. This study is aimed at evaluating the effect of Myrtus communis leaf extract ointment and silver nanoparticles on the healing of burn wounds caused by MRSA in rats. Materials and Methods. In a research experiment, 48 male Wistar rats were anesthetized and second‐degree burns were induced on their backs. The rats' wounds were then uniformly inoculated with MRSA. Various treatments were applied to the burn wounds daily, including Myrtus ointment, silver nanoparticles, silver nanoparticles‐Myrtus ointment, silver sulfadiazine‐Myrtus ointment, silver sulfadiazine 1%, mupirocin ointment, and a positive control. The study measured the antimicrobial effects, wound area, percentage of wound healing, antioxidant capacities, malondialdehyde, and nitric oxide concentrations in the serum of the rats. Data analysis was performed using GraphPad software, with one‐way ANOVA and Tukey's tests used to determine the statistical significance of the results. Results. Rats treated with Myrtus ointment, silver nanoparticles‐Myrtus ointment, and mupirocin had reduced bacterial growth compared to the positive control group, nanoparticle ointment, and silver sulfadiazine (P < 0.05). The wound area of the Myrtus ointment group decreased significantly on the seventh and fourteenth days, as well as the level of MDA and nitric oxide, compared to the other groups. In Myrtus and silver sulfadiazine‐Myrtus ointment increased the thickness of the epidermis and dermis compared to the other groups. Conclusion. Based on the anti‐inflammatory, antimicrobial, and wound healing properties of Myrtus, with further studies, an ointment of this plant may be used as a main or complementary treatment for burn wound infections caused by MRSA. [ABSTRACT FROM AUTHOR]

The article discusses research which examined trends and factors associated with opioid use for pediatric pain management in emergency departments (ED) in the U.S. from 2011 to 2020 using the National Hospital Ambulatory Medical Care Survey data. The study analyzed primary outcome of treatment with opioid during ED visit by race, ethnicity, age group, sex, ambulance arrival, payor, geographic region, triage category, pain level, type of painful condition and five-year time lapse intervals.

Self-harm behaviors (performed with either lethal and non-lethal intentions) are common, especially among individuals suffering from mood disorders, and the reasons individuals self-harm vary both by person and by the type of behavior. Understanding these variations may help clinicians determine levels of risk more accurately. To understand whether culture and gender are associated with the likelihood of engaging in specific self-harm behaviors and whether the intention (lethal, ambivalent, non-lethal) of these behaviors vary with culture and gender. 2826 individuals took part in an international multilingual online depression/suicidality screening study and reported at least one instance of self-harm in the past year. Participants were grouped into six broad cultural categories (Latin America, South Asia, Russian, Western English, Chinese, Arab). 3-way (culture x gender x intent) interactions were observed for several self-harm behaviors (overdosing, self-burning, asphyxiating, poisoning, and jumping from heights), suggesting that individuals engage in each of these behaviors with different intentions depending on gender and culture. Cultures and genders likewise differed in the likelihood of engaging in several self-harm behaviors. Clinicians should consider culture and gender when assessing for suicide risk, as similar self-harming behaviors may reflect different intentions depending on an individual's culture and gender. [ABSTRACT FROM AUTHOR]

The purposes for performing negative pressure wound therapy (NPWT) in severe burns are diverse, but few reports comprehensively discussing its indications and methods have been published. We included patients with a ≥30% total burn area. There were 4 patients, and a total of 9 NPWT were performed. The therapy sites were the upper extremity (n = 2), the elbow (n = 1), the dorsum of the hand (n = 5), and the knee (n = 1). The purposes of the therapy were bridge-to-skin grafting (n = 5), dressing the artificial dermis (n = 1), therapy for bolstering the autograft (n = 1), bridge-to-flap surgery (n = 1), and covering the flap (n = 1). The devices used were bedside wall suction (n = 5) and dedicated device (n = 3). Therapy was converted to wall aspiration after use of the dedicated device in 1 case. NPWT is an effective option in severe burn treatment. For each purpose, it is necessary to consider the device used, negative pressure setting, starting date, frequency of dressing changes, and period of therapy. NPWT in severe burns also has the advantage of prioritizing life-prolonging treatment. If strict control of negative pressure is required, a dedicated device should be used rather than wall suction. [ABSTRACT FROM AUTHOR]

Background: There is a high incidence of burns in China and the sequelae of post-burn scar growth, disfigurement, and other body image disorders can cause serious psychological distress to burns patients, and negatively affecting the patient's dignity. However, there is limited knowledge relating to the dignity of burns patients. Aim: To investigate the factors that affect dignity in burns patients. Design: Cross-sectional study. Participants and research context: We recruited 323 burn patients from the burn unit of a tertiary care hospital. The Patient Dignity Scale, Burn Specific Health Scale-Brief, Hospital Anxiety and Depression Scale were used to assess burn patients' dignity, quality of life, anxiety, and depression, respectively. 18 sociodemographic variables were included in the questionnaire. Ethical considerations: Before the data were collected, the study protocol was reviewed and approved by the Ethics Committee of the Guangzhou Red Cross Hospital of Jinan University (Reference: 2022-149-02) and all patients provided and signed informed consent forms. Findings: This study included 323 burns patients; of these, 26 (8%) had a mild loss of dignity, 94 (29.1%) had a moderate loss of dignity, 125 (38.7%) had a severe loss of dignity, and 78 (24.1%) had a very severe loss of dignity. The main factors that influence the loss of dignity in burns patients, including the department in which the patient was treated after their burns, gender, the clinical stage of the burn, quality-of-life, depression, resident medical insurance, the cause of the burn, and the burn site. Conclusions: In most cases, the loss of dignity after burn injury is serious. Clinical health care professionals can provide personalized whole-life dignity care for patients by considering the factors that affect the dignity of burns patients, developing targeted dignity management programs, and implementing individualized interventions to maintain dignity, thus helping burns injury patients return to social life and work. [ABSTRACT FROM AUTHOR]

Scalp and forehead region reconstruction is a complex clinical area, typically necessitated by conditions like skin cancers, intracranial lesions, trauma and burns. Various reconstructive techniques exist, from primary closure upscaling to free tissue transfer. Reconstructive options are largely determined by the size and location of the defects, as well as other factors such as age and comorbidities. Preserving natural hair patterns and utilising native scalp tissue, whenever possible, are essential for achieving aesthetic success. This article provides a concise overview of scalp wound reconstruction, emphasising the advantages and limitations of each option. [ABSTRACT FROM AUTHOR]

Background: Despite the relative importance, the prevalence of workplace safety and health issues in hospital food service workers is not well studied. This study describes the epidemiology of work-related injuries and occupational diseases among hospital food service workers (FSWs) in a tertiary hospital in Singapore. Methods: Using a total population sampling approach, a cross-sectional self-administered questionnaire was distributed to all FSWs employed at a major tertiary hospital in Singapore. Results: The response rate was 98.4% (n = 125). The overall prevalence of workplace injuries and musculoskeletal symptoms was 35% (n = 43) and 53% (n = 65) respectively. The most common workplace injuries were cuts/lacerations (35.8%), muscle strain (25.4%) and burns (19.4%). The prevalence of workplace injuries among staff performing food preparation duties was higher at 56.3% as compared to 21.6% among staff with no food preparation duties (p < 0.01). The prevalence of workplace injuries among staff performing cooking duties was also higher at 47.5%, compared to 29.3% among staff with no cooking duties (p = 0.05). Staff performing food preparation duties had a higher prevalence of musculoskeletal symptoms at 66.7% as compared to 44.6% among staff with no food preparation duties (p = 0.02). Obese staff had a higher prevalence of musculoskeletal symptoms at 78.9%, compared to overweight staff at 53.8% and staff with normal weight at 43.1% (p = 0.03). Conclusion: FSWs with jobs involving cooking and preparation of food, and those with obesity, are at higher risk of sustaining workplace injuries or musculoskeletal symptoms. Targeted interventions should be implemented for injury prevention and to mitigate these risks. [ABSTRACT FROM AUTHOR]

Background: The efficacy and safety of cefiderocol in ICU patients with difficult-to-treat resistance (DTR) non-fermenting Gram-negative bacteria (Nf-GNB) are not as well-established. Consequently, we conducted a cohort study to compare Cefiderocol with the Best Available Therapy (BAT) in ICU patients. Methods: We included adult patients from 9 different ICUs, including a burn ICU unit, from 2019 to 2023 treated with Cefiderocol for DTR Nf-GNB isolated from the blood or lungs. We matched each patient at a 1:2 ratio based on the same DTR Nf-GBN isolated pathogen, and when possible, within the same type of ICU (burn unit or not). The primary endpoint of the study was the clinical cure at 15 days, with secondary endpoints including clinical cure at 30 days, relapse, and in-ICU mortality. For each outcome, adjusted odds ratios were estimated using bidirectional stepwise regression in a final model, which included 13 preselected confounders. Results: We included 27 patients with cefiderocol, matched with 54 patients receiving the BAT. Four patients were not exactly matched on the type of ICU unit. Characteristics were comparable between groups, mostly male with a Charlson Comorbidity Index of 3 [1–5], and 28% had immunosuppression. Cefiderocol patients were most likely to have higher number of antibiotic lines. The main DTR Nf-GNB identified was Pseudomonas aeruginosa (81.5%), followed by Acinetobater baumanii (14.8%) and Stenotrophomonas maltophilia (3.7%). Pneumonia was the identified infection in 21 (78.8%) patients in the Cefiderocol group and in 51 (94.4%) patients in the BAT group (p = 0.054). Clinical cure at 15 and 30-day and the in-ICU mortality was comparable between groups, however relapse was higher in the cefiderocol group (8-29.6% vs. 4-7.4%;aOR 10.06[1.96;51.53]) Conclusion: Cefiderocol did not show an improvement in clinical cure or mortality rates compared to BAT in the treatment of DTR Nf-GNB, but it was associated with a higher relapse rate. Key points: What was known: •The use of cefiderocol remains debated and under-evaluated in patients admitted to the ICU. What this article tells us: •In a cohort of 27 patient with cefiderocol treatment, compared with 54 patients treated with best available therapy, no difference was observed compared regarding the 15 and 30-day clinical cure, and in ICU mortality. •However, a higher risk of relapse was observed in the cefiderocol group: 29% vs. 7%. [ABSTRACT FROM AUTHOR]

Wounds pose significant challenges to public health, primarily due to the loss of the mechanical integrity and barrier function of the skin and impaired angiogenesis, causing physical morbidities and psychological trauma to affect patients. Reconstructing the vasculature of the wound bed is crucial for promoting wound healing, reducing scar formation and enhancing the quality of life for patients. The development of pro‐angiogenic skin substitutes has emerged as a promising strategy to facilitate vascularization and expedite the healing process of burn wounds. This review provides an overview of the various types of skin substitutes employed in wound healing, explicitly emphasising those designed to enhance angiogenesis. Synthetic scaffolds, biological matrices and tissue‐engineered constructs incorporating stem cells and primary cells, cell‐derived extracellular vesicles (EVs), pro‐angiogenic growth factors and peptides, as well as gene therapy‐based skin substitutes are thoroughly examined. The review summarises the existing challenges, future directions and potential innovations in pro‐angiogenic dressing for skin substitutes. It highlights the need for continued research to develop new technologies and combine multiple strategies and factors, and to overcome obstacles and advance the field, ultimately leading to improved outcomes for wound patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although ambient temperature has been linked with injury incidence, there have been few nationwide studies to quantify the temperature-related risk and burden of cause-specific injury hospitalizations. Additionally, the impact of human-induced climate change to injury burden remains unknown. OBJECTIVES: Our objectives are to examine the associations between ambient temperature and injury hospitalizations from various causes and to quantify the contribution of human-induced warming to the heat-related burden. METHODS: We collected injury hospitalization data from a nationwide hospital-based registry in China during 2000–2019. Using a time-stratified case-crossover design, we investigated the associations between daily mean temperature (°C) and cause-specific injury hospitalizations. We also quantified the burden of heat-related injuries under the scenarios with and without anthropogenic forcing, using the Detection and Attribution Model Intercomparison Project to assess the contribution of human-induced warming. RESULTS: Our study included a total of 988,087 patients with hospitalization records for injuries. Overall, compared to the temperature at minimum risk of hospitalization (-12:1°C), the relative risk of hospitalization at extreme hot temperature (30.8°C, 97.5th percentile) was 1.18 [95% confidence interval (CI): 1.14, 1.22], with an approximately linear association between temperature and hospitalization. Vulnerability to heat-related injuries was more pronounced among males, young (<18 years of age) or middle-aged (45–64 years of age) individuals, and those living in the North. The heatrelated attributable fraction increased from 23.2% in the 2000s to 23.6% in the 2010s, with a corresponding increase in the contribution of humaninduced change over time. In the 2010s, the heat-related attributable fractions for specific causes of injury ranged from 12.4% to 54.4%, with humaninduced change accounting for 6.7% to 10.6% of the burden. DISCUSSION: This nationwide study presents new evidence of significant associations between temperature and cause-specific injury hospitalizations in China and highlights the increasing contribution of human-induced warming to the injury burden. [ABSTRACT FROM AUTHOR]

Background: The percentage of total body surface area (%TBSA) burned and burn depth provide valuable information on burn injury severity. Objective: This study investigated the concordance between The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and expert burn clinicians in assessing burn injury severity. Method: We conducted a retrospective population-based review of all patients who sustained a burn injury between July 1, 2009, and June 30, 2019, requiring admission into a specialist burn service across Australia and New Zealand. The %TBSA burned (including the percentage of full thickness burns) recorded by expert burn clinicians within the Burns Registry of Australia and New Zealand (BRANZ) were compared to ICD-10-AM coding. Results: 20,642 cases (71.5%) with ICD-10-AM code data were recorded. Overall, kappa scores (95% confidence interval [CI]) for burn size ranged from 0.64 (95% CI 0.63–0.66) to 0.86 (95% CI 0.78–0.94) indicating substantial to almost perfect agreement across all %TBSA groups. When stratified by depth, the lowest agreement was observed for < 10% TBSA and < 10% full thickness (kappa 0.03; 95% CI 0.02–0.04) and the highest agreement was observed for burns of ≥ 90% TBSA and ≥ 90% full thickness (kappa 0.72; 95% CI 0.58–0.85). Conclusion: Overall, there was substantial agreement between the BRANZ and ICD-10-AM coded data for %TBSA classification. When %TBSA classification was stratified by burn depth, greater agreement was observed for larger and deeper burns compared with smaller and superficial burns. Implications: Greater consistency in the classification of burns is needed. [ABSTRACT FROM AUTHOR]

Objective: We aim to report on the Laser-Sclerosing Foam Hybrid Treatment (LSFHT) and its outcomes when used on patients with great saphenous vein (GSV) insufficiency. Methods: This was a single center retrospective cohort study on patients with GSV insufficiency that were treated with the LSFHT technique, a surgical procedure that comprises the use of both sclerosing foam and endovenous ablation and avoids the use of tumescent anesthesia. Occlusion rates and complications were reported. Results: 139 legs from 106 patients were operated, achieving a 100% occlusion rate, while only a small burn and 2 popliteal vein thrombosis cases occurred. Conclusion: The study suggests that the LSFHT is a feasible fast procedure that proved both effective and safe for the treatment of GSV insufficiency. [ABSTRACT FROM AUTHOR]

Objective: Burn injuries pose a heightened risk of infection, which is primarily responsible for increased morbidity and mortality. Factors such as extensive skin damage and compromised immunity exacerbate this vulnerability. Pseudomonas aeruginosa and Staphylococcus aureus are frequently identified in burns, with Gram-negative Pseudomonas aeruginosa often resistant to antibacterial agents. While Flaminal, an alginate-based wound dressing (Flen Health, Belgium), aids wound healing, its antibacterial effects are limited compared with 1% silver sulfadiazine (1% SSD). In contrast, Prontosan Wound Gel X, a betaine and polyhexanide-based hydrogel (B. Braun Medical AG, Switzerland), has been shown to effectively combat various microbes and promotes wound healing. Method: In this study, two research cohorts were retrospectively established (control group: patients receiving standard of care with the alginate-based wound dressing; intervention group: patients receiving the polyhexanide hydrogel wound dressing), comprising patients admitted to a burn centre between 2019 and 2022. Patients were eligible when continuous wound treatment with either of the two wound dressings was performed. Laser Doppler imaging (LDI) scans were conducted. Regions of interest (ROIs) were selected based on LDI scans and divided into healing time categories. Wound swabs were collected and the presence of Pseudomonas aeruginosa and Staphylococcus aureus was documented. Bacterial load was evaluated using a semiquantitative scale. Wound healing was recorded. Results: The control group consisted of 31 patients with 93 ROIs, while the intervention group had 67 ROIs involving 29 patients. Both groups exhibited similar proportions of healing time categories (p>0.05). The polyhexanide hydrogel dressing outperformed the alginate-based dressing in antiseptic efficacy by significantly reducing the incidence of Pseudomonas aeruginosa- and Staphylococcus aureus-positive cultures in patients' wounds. Wound healing time for conservative treatment was comparable between groups. Conclusion: In this study, the polyhexanide hydrogel dressing minimised Pseudomonas aeruginosa and Staphylococcus aureus colonisation in burn wounds, demonstrating strong antibacterial properties, emphasising its potential to minimise infections in burn injuries. [ABSTRACT FROM AUTHOR]

The joint definition of pressure ulcers by the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Ulcer Advisory Panel (NPUAP) states, "Localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure alone or in combination with shear." Treating pressure ulcers proves challenging and contributes to increased costs due to prolonged hospitalization stays. In this case study, we address the care of a patient, 18 years of age, hospitalized due to burns, tracheostomized, with a percutaneous endoscopic gastrostomy tube, unconscious, and developed a pressure ulcer. The objective is to provide care for the patient with a stage 3 pressure ulcer on the sacrum by current guidelines. When planning care, a multidimensional assessment was scheduled alongside wound care. Skin assessment and care, appropriate wound dressing selection, nutrition, weight monitoring, hydration, repositioning, and the utilization of support surfaces were carried out as per guidelines. The overall roadmap followed includes: recognizing and staging pressure ulcers, treatment modalities for staged ulcers, monitoring, and basic care principles for pressure ulcers (nutrition, pain management). Following the implemented interventions, the patient's pressure ulcer showed signs of healing. [ABSTRACT FROM AUTHOR]

Preservation and restoration of hand function after burn injuries are challenging yet imperative. This study aimed to assess the curative effect of a composite skin graft over an acellular dermal matrix (ADM) and a thick split‐thickness skin graft (STSG) for treating deep burns on the hand. Patients who met the inclusion criteria at the First Affiliated Hospital of Wenzhou Medical University between September 2011 and January 2020 were retrospectively identified from the operative register. We investigated patient characteristics, time from operation to the start of active motion exercise, take rates of skin graft 7 days post‐surgery, donor site recovery, complications and days to complete healing. Patients were followed up for 12 months to evaluate scar quality using the Vancouver Scar Scale (VSS) and hand function through total active motion (TAM) and the Jebsen–Taylor Hand Function Test (JTHFT). A total of 38 patients (52 hands) who received thin STSG on top of the ADM or thick STSG were included. The location of the donor sites was significantly different between Group A (thick STSG) and Group B (thin STSG + ADM) (p = 0.03). There were no statistical differences in age, gender, underlying disease, cause of burn, burn area, dominant hand, patients with two hands operated on and time from burn to surgery between the two groups (p > 0.05). The time from operation to the start of active motion exercise, take rates of skin graft 7 days post‐surgery and days to complete healing were not significantly different between Group A and Group B (p > 0.05). The rate of donor sites requiring skin grafting was lower in Group B than in Group A (22.2% vs. 100%, p < 0.001). There were no statistically significant differences in complications between the groups (p = 0.12). Moreover, 12 months postoperatively, the pliability subscore in the VSS was significantly lower in Group A than in Group B (p = 0.01). However, there were no statistically significant differences in vascularity (p = 0.42), pigmentation (p = 0.31) and height subscores (p = 0.13). The TAM and JTHFT results revealed no statistically significant differences between the two groups (p = 0.22 and 0.06, respectively). The ADM combined with thin STSG is a valuable approach for treating deep and extensive hand burns with low donor site morbidity. It has a good appearance and function in patients with hand burns, especially in patients with limited donor sites. [ABSTRACT FROM AUTHOR]

Introduction: Luminal esophageal temperature (LET) monitoring during atrial fibrillation (AF) ablation is widely used to reduce the incidence of endoscopically detected esophageal lesion (EDEL). We sought to assess whether specific patterns of LET variation are associated with EDEL. Methods: A high‐fidelity multisensor probe was used to record LET in AF patients undergoing radiofrequency ablation (RFA) or cryoballoon ablation (CBA). Explainable machine learning and SHapley Additive exPlanations (SHAP) analysis were used to predict EDEL and assess feature importance. Results: A total of 94 patients (38.3% persistent AF, 71.3% male, 72 RFA, and 22 CBA) were included. EDEL was detected in 11 patients (10 RFA and one CBA). In the RFA group, the highest LET recorded was similar between patients with and without EDEL (40.6 [40.1–41]°C vs. 40.2 [39.1–40.9]°C; p =.313), however, the rate of LET rise for the highest recorded peak was higher (0.08 [0.03–0.12]°C/s vs. 0.02 [0.01–0.05]°C/s; p =.033), and the area under the curve (AUC) for the highest peak was smaller (412.5 [206.8–634.1] vs. 588.6 [380.4–861.1]; p =.047) in patients who had EDEL. In case of CBA, the patient with EDEL had a faster LET decline (0.12 vs. 0.07 [0.02–0.14]°C/s), and a smaller AUC for the lowest trough (2491.3 vs. 2629.3 [1712.6–5283.2]). SHAP analysis revealed that a rate of LET change higher than 0.05°C/s and an AUC less than 600 were more predictive of EDEL in RFA. Conclusion: The rate of LET change and AUC for the recorded temperature predicted EDEL, whereas absolute peak temperatures did not. [ABSTRACT FROM AUTHOR]

RSDL® (Reactive Skin Decontamination Lotion) Kit is approved for decontaminating chemical warfare agents and T-2 fungal toxins. This work aimed to investigate the efficacy of RSDL or water irrigation for sulfuric acid dermal decontamination against untreated control in rabbit models. Rabbits were randomly assigned to Groups 1 (no decontamination), 2 (water) or 3 (RSDL) and exposed to sulfuric acid (0.1 mL/3-4 cm²) for 30 seconds Decontaminants remained on-site for 2 minutes. Decontamination efficacy with RSDL and water were similar. Wound pH was higher and erythema persisted longer after decontamination versus control. Oedema developed by Day 3 and resolved by Day 15 in all groups. Necrosis started by Day 3, and all wounds had necrosis by Day 21. Wound areas following decontamination were significantly smaller than controls. Microscopically, all wounds in all groups had full-thickness epidermal and dermal necrosis. In summary, RSDL and water were similarly effective in reducing wound size and increasing wound pH by Day 3 compared to controls. Histopathology data demonstrated similar tissue injury across all groups and showed no signs of wound healing after exposure RSDL was a reliable decontamination method in the absence of immediate access to water. [ABSTRACT FROM AUTHOR]