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Leuven, Belgium

Hoeksema H.,Ghent University | Baker R.D.,University of Salford | Holland A.J.A.,University of Sydney | Perry T.,Regional Burn Center | And 3 more authors.
Burns | Year: 2014

Introduction: Laser Doppler imaging (LDI) provides early accurate determination of wound healing potential. LDI can scan large areas of up to 2500 cm2 within 2 min. This duration may require additional sedation in a mobile, uncooperative child. In five burn centres a faster Laser Doppler Line Scanner (LDLS) was assessed. This new imager scans 300 cm2 in 4 s with potential benefit for patients and operators. The aim of this study was to assess the accuracy and convenience of the LDLS and to compare this with an established LDI imager.Methods: Outpatients and admitted patients were included. LDI and LDLS images were obtained between 2 and 5 days post burn (PB). Photographs and records of wound and healing were obtained on day of scan and at 14 and 21 days PB. This provided data on three categories of burn wounds: healing within 14 days, 1421 days and not healed within 21 days.Results: The analysis included 596 burn areas from 204 burns patients. An accuracy of 94.2% was found with use of the LDLS compared with 94.4% for the original LDI imager.Conclusions: The high accuracy of the new line-scan imager was comparable to that of the traditional LDI. Its size and mobility enabled easier ward and outpatient use. The higher scan speed was particularly beneficial for scans in paediatric patients. © 2014 Elsevier Ltd and ISBI. All rights reserved.

Fries C.A.,Selly Oak Hospital | Fries C.A.,Royal Center for Defence Medicine | Jeffery S.L.A.,Selly Oak Hospital | Jeffery S.L.A.,Royal Center for Defence Medicine | And 2 more authors.
Injury | Year: 2011

Background: Topical negative pressure (TNP) has been used as a method of wound management for some years. Use of TNP is accepted best practice at Role 4. There are advocates of using TNP after initial wound surgery at Role 3 or 2E. The evidence to support forward use of TNP is not comprehensive, especially when considering this narrow cohort of patients and injury pattern. It is the aim of this review to evaluate the current evidence for the use of TNP in all wounds, and to find what evidence there is that may be applicable to military wounds. Methods: A literature search of Cinahl, Embase, Medline, ProQuest and the Cochrane Library was conducted; references were cross-referenced. All Randomised Controlled Trials (RCTs) were included in all languages over a comprehensive time period. An interim review was conducted by the Wound Management Working Group of the Academic Department of Military Surgery and Trauma. A further literature review was conducted to find all papers relating to the use of TNP on military wounds. Results: 17 reports were reviewed relating to 14 studies including 662 patients. Of these 131 were reported to have had traumatic injuries. Significant results were reported with respect to time to wound healing, patient comfort and reduction in wound volumes. Bacterial load was not affected, in the 3 trials which commented on this, but in 1 there was a significant reduction in wound infections in the TNP group. Several of the trials were small, methodology was not consistent therefore no meta-analysis was possible. 2 papers were found describing case series of military patients being treated with TNP. Conclusions: There is very little published evidence in the form of RCTs to support the use of TNP in the acute traumatic military setting. This review supports the requirement for further investigation to evaluate whether this method of wound management has a place forward of Role 4. © 2010 Elsevier Ltd. All rights reserved.

Ramon-Lopez A.,University of Strathclyde | Ramon-Lopez A.,University Miguel Hernandez | Allen J.M.,Queen Victoria Hospital | Thomson A.H.,University of Strathclyde | And 5 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2015

Objectives: To develop a population model to describe the pharmacokinetics (PK) of intravenous meropenem in adult patients with severe burns and investigate potential relationships between dosage regimens and antimicrobial efficacy. Patients and methods: A dose of 1 g every 8 h was administered to adult patients with total body surface area burns of ≥15%. Doses for subsequent courses were determined using results from the initial course and the patient's clinical condition. Five plasma meropenem concentrations were typically measured over the dosage interval on one to four occasions. An open, two-compartment PK model was fitted to the meropenem concentrations using NONMEM and the effect of covariates on meropenem PKwas investigated. Monte Carlo simulations investigated dosage regimens to achieve a target T>MIC for ≥40%, ≥60% or ≥80% of the dose interval. Results: Data comprised 113 meropenem concentration measurements from 20 dosage intervals in 12 patients. The parameterswere CL (L/h)=0.196 L/h/kg×[1-0.023×(age-46)]×[1-0.049×(albumin-15)], V1=0.273 L/kg× [1=0.049×(albumin-15)], Q=0.199 L/h/kg and V2=0.309 L/kg×[1-0.049×(albumin-15)]. For a target of ≥80% T>MIC, the breakpoint was 8 mg/L for doses of 1 g every 4 h and 2 g every 8 h given over 3 h, but only 4 mg/L if given over 5 min. Conclusions: Although 1 g 8 hourly should be effective against Escherichia coli and CoNS, higher doses, ideally with a longer infusion time, would be more appropriate for empirical therapy, mixed infections and bacteria with MIC values ≥4 mg/L. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Farroha A.,Burns Center | McGregor J.,University of Swansea | Paget T.,University of Swansea | John A.,University of Swansea | Lloyd K.,University of Swansea
Journal of Burn Care and Research | Year: 2013

Burn injuries are associated with depression. Patients show variable incidence of postburn depression. The purpose of this study was to use anonymized, routinely collected healthrelated data in Wales (United Kingdom) to estimate the incidence of depression postburns. The incidence of postburn depression was estimated using routinely collected health data of complete years (1999-2007) from all general practitioner surgeries in Swansea and all National Health Service hospitals in Wales. This had been collected, double encrypted, and stored at the Secure Anonymised Information Linkage databank of the Health Information Research Unit for Wales at College of Medicine, Swansea University. The incidence of depression within 5 years after the burn injury was 5.9% in patients registered with general practitioner surgeries in Swansea. The incidence was 7.4% in female patients and 4.3% in male patients. The incidence of depression within 5 years after the burn was 3.2% in patients admitted to National Health Service hospitals in Wales. The incidence was 4.5% in female patients and 2.6% in male patients. The advantages of using the anonymized, routinely collected data were avoiding bias, protecting patients' confidentiality, including all patients thus minimizing attrition and greatly reduced costs. It is concluded that anonymized, routinely collected, health-related data may have value in monitoring postburn depression in Wales. Copyright © 2013 by the American Burn Association.

Patel M.,Birmingham Childrens Hospital NHS Foundation Trust | Thomas H.C.,Burns Center | Room J.,Birmingham Childrens Hospital NHS Foundation Trust | Wilson Y.,Burns Center | And 2 more authors.
Journal of Hospital Infection | Year: 2013

An outbreak of the PVL-positive USA300 clone of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) occurred in a UK paediatric burns centre from January to February 2010. Four patients, two staff members and one family member of a patient were affected. The outbreak strain had similar antibiotic susceptibilities to other MRSA seen in the hospital, and was only identified when a patient and a staff member presented simultaneously with skin infections. Infection control measures included screening and decolonization of staff and patients, environmental sampling and enhanced cleaning. Isolation of the outbreak strain from an asymptomatic staff member and the environment demonstrates the potential for CA-MRSA to survive and become endemic in UK hospitals. © 2013 The Healthcare Infection Society.

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