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Apeldoorn, Netherlands

Rashaan Z.M.,Leiden University | Krijnen P.,Leiden University | Klamer R.R.M.,Leiden University | Schipper I.B.,Leiden University | And 4 more authors.
Wound Repair and Regeneration | Year: 2014

The evidence for application of silver-containing dressings and topicals in the treatment of partial-thickness burns in pediatric patients is largely based on clinical trials involving adult patients despite the important differences between the skin of children and adults. A systematic review and meta-analysis was performed of all randomized controlled trials comparing nonsilver treatment with silver-containing dressings and silver topical agents in children with partial-thickness burns in the acute stage. Endpoints were wound healing, grafting, infection, pain, number of dressing changes, length of hospital stay, and scarring. Seven randomized controlled trials were included involving 473 participants. All trials used silver sulfadiazine as control in comparison with five different nonsilver treatments. Most trials were of moderate quality with high risk of bias. Use of nonsilver treatment led to shorter wound healing time (weighted mean difference: -3.43 days, 95% confidence interval: -4.78, -2.07), less dressing changes (weighted mean difference: -19.89 dressing changes, 95% confidence interval: -38.12, -1.66), and shorter length of hospital stay (weighted mean difference: -2.07 days, 95% confidence interval: -2.63, -1.50) compared with silver sulfadiazine treatment, but no difference in the incidence of wound infection or grafting was found. In conclusion, nonsilver treatment may be preferred over silver sulfadiazine, but high-quality randomized controlled trials are needed to validly confirm the effectiveness of silver containing preparations, in particular silver-containing dressings, above nonsilver treatments. © 2014 by the Wound Healing Society.

Landgraf J.M.,HealthActCHQ | Vogel I.,Erasmus Medical Center | Oostenbrink R.,Erasmus MC Sophia | Van Baar M.E.,Association of Dutch Burn Centers | Raat H.,Erasmus Medical Center
Quality of Life Research | Year: 2013

Purpose: To derive and evaluate a shorter infant/toddler quality of life questionnaire (ITQOL) for use in clinical care. Methods: Stepwise regression, factor analysis, and item-scaling principles were used to derive and guide item selection using data from a large general sample in the Netherlands (n = 5,211) and a "wheezing illness" sample (n = 138). Item internal consistency, discriminant validity, and floor and ceiling effects were evaluated using a general Dutch sample (Salland Region n = 410) and two clinical samples: Functional abdominal pain (FAP, n = 81) and Burn (n = 194). Reliabilities were estimated using Cronbach's alpha. Relative precision (RP), the ability to distinguish between clinical subgroups, was computed by comparing the proportion of variance explained by the short-form scales versus respective full-length scales. Results: The ITQOL was reduced from 97 to 47 items. Median alpha coefficients were 0.77 Salland sample, 0.76 (FAP), and 0.84 (Burn). Ninety-one to 100 % scaling successes for item discriminant validity were observed for 21 of 24 tests (8 scales, 3 samples). Floor effects were not observed; some ceiling effects were detected. RP estimates in the Salland sample ranged from 2.40 (physical abilities) to 0.58 (temperament and moods). RP estimates in the FAP sample were 0.85 (bodily pain), 1.36 (temperament and moods) and 1.62 (parental-impact emotional) and for Burn, 1.51 (temperament and moods) and 0.59 (general health perceptions). Conclusion: The ITQOL-SF47 is reliable and valid and exceeds item-level scaling criteria. © 2012 Springer Science+Business Media B.V.

Middelkoop E.,Association of Dutch Burn Centers
Plastic and Reconstructive Surgery | Year: 2010

Background: Application of dermal substitutes has been reported to improve the outcome of burns. However, the long-term effectiveness of dermal substitutes has not been investigated objectively. The aim of this study was to evaluate long-term effectiveness of a collagen-elastin dermal substitute in acute and reconstructive burn surgery. Methods: From 1996 to 1998, an intraindividual comparison was carried out between a dermal substitute with a split-skin graft and a split-skin graft alone in patients with acute and reconstructive wounds. In this follow-up, scar elasticity, vascularization, pigmentation, and surface roughness were determined objectively. In addition, a subjective scar assessment was performed. Results: In 46 patients, 69 pairs of substituted and conventionally treated sites were measured, consisting of acute and reconstructive burn scars. In reconstructive scars, one surface roughness parameter was significantly better in substituted scars. Subjective assessment in acute and reconstructive burn scars showed several statistically significant differences in favor of substituted scars, such as pliability, relief, and the general observer score. Elasticity measurements showed higher scores for substituted scars, although the difference was not statistically significant. For the subcategory of scars treated with a largely expanded meshed skin graft, a significantly higher elasticity was found for the substituted area. Conclusion: In this first long-term and objective follow-up of dermal substitution, the authors found improved scar parameters in both acute and reconstructive wounds treated with the substitute, indicating a long-lasting effect on scar quality. Copyright © 2010 by the American Society of Plastic Surgeons.

Jelsma L.D.,University of Groningen | Jelsma L.D.,Catholic University of Leuven | Geuze R.H.,University of Groningen | Klerks M.H.,Practice for PT | And 2 more authors.
BMC Pediatrics | Year: 2013

Background: The purpose of this study was to determine whether joint mobility is associated with motor performance in children referred for Developmental Coordination Disorder (DCD-group) in contrast to a randomly selected group of children between 3-16 years of age (Random-Group).Methods: 36 children with DCD and 352 typically developing children (Random-Group) participated. Hypermobility was classified based on the Beighton score (cut-off ≥5 for 3-9 years and ≥4 for 10-16 years) using goniometry. Motor performance was assessed with the Movement Assessment Battery for Children (MABC).Results: The mean Beighton score in the DCD-group was 5.0 versus 2.6 in the Random group. Prevalence of hypermobility was higher in the DCD-group than in the Random Group (64% and 33% respectively; χ 2 = 16.09, p < .001). There was a significant [negative] correlation (rp = -.38, p = .02) between Beighton score and total MABC scores within the DCD group, but not in the Random Group (rp = -0.07, p = .20). More specifically, in the DCD group we found a significant negative correlation between the MABC total score and the degree of hyperextension of the knees.Conclusion: The extremely high prevalence of hypermobility when applying the recommended cut-off scores stresses the need for an international agreement on firm cut-off points and the use of standardized measurement of Beighton mobility manoeuvres. The results of this study show that a cut-off of 7 is more appropriate, resulting in a prevalence of 6% in children aged 3-16 years. Although in the general population motor performance and joint mobility are not related, this is the case in children referred for DCD. We argue that more mobility of the joints may be a disadvantage when motor coordination is poorly developed. © 2013 Jelsma et al.; licensee BioMed Central Ltd.

Hop M.J.,Association of Dutch Burn Centers | Hop M.J.,Burn Center | Polinder S.,Erasmus Medical Center | Van Der Vlies C.H.,VU University Amsterdam | And 3 more authors.
Wound Repair and Regeneration | Year: 2014

Burn care is traditionally considered expensive care. However, detailed information about the costs of burn care is scarce despite the increased need for this information and the enhanced focus on healthcare cost control. In this study, economic literature on burn care was systematically reviewed to examine the problem of burn-related costs. Cost or economic evaluation studies on burn care that had been published in international peer-reviewed journals from 1950 to 2012 were identified. The methodology of these articles was critically appraised by two reviewers, and cost results were extracted. A total of 156 studies met the inclusion criteria. Nearly all of the studies were cost studies (n=153) with a healthcare perspective (n=139) from high-income countries (n=127). Hospital charges were often used as a proxy for costs (n=44). Three studies were cost-effectiveness analyses. The mean total healthcare cost per burn patient in high-income countries was $88,218 (range $704-$717,306; median $44,024). A wide variety of methodological approaches and cost prices was found. We recommend that cost studies and economic evaluations employ a standard approach to improve the quality and harmonization of economic evaluation studies, optimize comparability, and improve insight into burn care costs and efficiency. © 2014 by the Wound Healing Society.

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