Burns : journal of the International Society for Burn Injuries
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A liposomal hydrogel with 3% povidone-iodine (PVP-ILH, Repithel) has shown clinical benefit in settings where inflammation and/or reactive oxygen species are thought to impede wound healing (e.g., burns, chronic wounds and in smokers). This in vitro study investigated whether PVP-ILH is able to reduce inflammatory events responsible for the impairment of the wound healing process in such patients. Therefore, the following assays were conducted with PVP-ILH (and derived control hydrogels to identify the component responsible for the effect): inhibition of reactive oxygen species production by human polymorphonuclear neutrophils (PMNs) and in a cell-free system, oxygen consumption assay of PMNs (prior to oxidative burst), inhibition of human complement (limiting the generation of complement factors), mast cell degranulation, nitric oxide production by murine macrophages and TNF-alpha production by human monocytes/macrophages. ⋯ Furthermore, povidone-iodine inhibited PMN production of reactive oxygen species (inhibition of oxygen consumption) and a mast cell inhibitory (stabilising) activity was observed. Based on these results, the clinically observed, beneficial wound healing effects of PVP-ILH may also be attributed to an impediment of inflammatory activity, mainly by iodine's free radical scavenging. Controlling oxidative stress in the wound may be of great importance, especially since further reactions as, e.g., the formation of peroxynitrite from NO and ROS are prevented.
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Randomized Controlled Trial
The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: a randomised controlled trial.
In children, the pain and anxiety associated with acute burn dressing changes can be severe, with drug treatment alone frequently proving to be inadequate. Virtual reality (VR) systems have been successfully trialled in limited numbers of adult and paediatric burn patients. Augmented reality (AR) differs from VR in that it overlays virtual images onto the physical world, instead of creating a complete virtual world. ⋯ Respiratory and pulse rates showed significant changes over time within groups, however, these were not significantly different between the two study groups. Oxygen saturation did not differ significantly over time or between the two study groups. This trial shows that augmented reality is a useful adjunct to pharmacological analgesia.
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Severe pruritus after burn continues to be a clinical challenge that is inadequately addressed by traditional therapies. The success of naltrexone, an opioid antagonist, in treating pruritus in other patient populations, supported the concept that it may also be effective in burn survivors. Thus, burn patients who were dissatisfied with itch relief obtained after a course of traditional therapy were offered naltrexone. ⋯ There was a statistically significant reduction in their visual analogue scale intensity ratings of itch "at its worst". Thus, naltrexone positively impacted the itch experienced by burn patients in association with a high percentage of patient-satisfaction. Further controlled trials are recommended.
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Diagnosis of sepsis is difficult, particularly in cases of burn where signs of sepsis may be present in the absence of a real infection. This study compared serum levels of procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) among 60 burned people with and without infection, in order to assess the value of the information for diagnosis of sepsis. ⋯ Non-survivors had a mean PCT level significantly higher than that of survivors. Thus the serum PCT level was a highly efficient laboratory parameter for the diagnosis of severe infectious complications after burn, but WBC, neutrophil, ESR and CRP levels were of little value.
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Patient satisfaction is an important outcome in health care but has not been studied in relation to burn care. The aim was to explore factors related to satisfaction with care 1-6 years after a burn. Participants were 86 adult burn patients, injured on average 3.6 years previously. ⋯ Total amount of explained variance ranged between 18% and 25% for the PS-RESKVA subscales. In summary, satisfaction with burn care was only moderately explained by health and personality characteristics. Further, former patients rated satisfaction with nursing staff higher than other aspects of care, especially information routines.