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Critical burns

Sophie Duignan, Aedin Ryan, Brian Burns, Damien Kenny, Colin J McMahon
Optimal outcomes are as much influenced by critical decision making pathways as by the technical skill of the operator. The complexity and potential cognitive traps underlying critical decision making has long been recognized in the aviation and business communities, however, remains a largely subconscious, unexamined discipline amongst congenital cardiac interventionalists. Challenges to making good decisions in the catheterization laboratory include heuristics, biases, and cognitive traps. In this paper we discuss some of the more common decision making challenges encountered and we address potential solutions to such decision making with particular focus towards standardization...
August 13, 2018: Pediatric Cardiology
Jonathan Bayuo, Frank Agyei Bediako, Gabriel Allotey, Prince Kyei Baffour
AIM: To build a comparative understanding of nurses' experiences with caring for burned patients with the goal of eliciting possible support strategies. BACKGROUND: Considering the stressful nature of burns nursing, there is a need to develop support strategies for burn care nurses. DESIGN: This meta-ethnographic study used Noblit and Hare's approach and followed PRISMA guidelines. DATA SOURCES: The search databases included PsycINFO, EbscoHost, Google Scholar, ScienceDirect, and PubMed from 1990 to 2017...
August 12, 2018: International Journal of Nursing Practice
E Estrecho, T Gao, N Bobrovska, M D Fraser, M Steger, L Pfeiffer, K West, T C H Liew, M Matuszewski, D W Snoke, A G Truscott, E A Ostrovskaya
A bosonic condensate of exciton polaritons in a semiconductor microcavity is a macroscopic quantum state subject to pumping and decay. The fundamental nature of this driven-dissipative condensate is still under debate. Here, we gain an insight into spontaneous condensation by imaging long-lifetime exciton polaritons in a high-quality inorganic microcavity in a single-shot optical excitation regime, without averaging over multiple condensate realisations. We demonstrate that condensation is strongly influenced by an incoherent reservoir and that the reservoir depletion, the so-called spatial hole burning, is critical for the transition to the ground state...
August 9, 2018: Nature Communications
Angela Melder, Prue Burns, Ian Mcloughlin, Helena Teede
INTRODUCTION: Healthcare service redesign and improvement has become an important activity that health system leaders and clinicians realise must be nurtured and mastered, if the capacity issues that constrain healthcare delivery are to be solved. However, little is known about the critical success factors that are essential for sustaining and scaling up improvement initiatives. This situation limits the impact of these initiatives and undermines the general standing of redesign and improvement activity within healthcare systems...
August 5, 2018: BMJ Open
Lawton R Burns, Allison D Briggs
BACKGROUND: Most hospitals outsource supply procurement to purchasing alliances, or group purchasing organizations (GPOs). Despite their early 20th century origin, we lack both national and trend data on alliance utilization, services, and performance. The topic is important as alliances help hospitals control costs, enjoy tailwinds from affiliated regional/local alliances, and face headwinds from hospital self-contracting and criticism of certain business practices. PURPOSE: We compare the utilization, services, and performance of alliances in 2004 and 2014...
August 3, 2018: Health Care Management Review
Shuohao Sun, Travis Babola, Gabriela Pregernig, Kathy S So, Matthew Nguyen, Shin-San M Su, Adam T Palermo, Dwight E Bergles, Joseph C Burns, Ulrich Müller
Type I spiral ganglion neurons (SGNs) transmit sound information from cochlear hair cells to the CNS. Using transcriptome analysis of thousands of single neurons, we demonstrate that murine type I SGNs consist of subclasses that are defined by the expression of subsets of transcription factors, cell adhesion molecules, ion channels, and neurotransmitter receptors. Subtype specification is initiated prior to the onset of hearing during the time period when auditory circuits mature. Gene mutations linked to deafness that disrupt hair cell mechanotransduction or glutamatergic signaling perturb the firing behavior of SGNs prior to hearing onset and disrupt SGN subtype specification...
July 30, 2018: Cell
Areg Grigorian, Jeffry Nahmias, Sebastian Schubl, Viktor Gabriel, Nicole Bernal, Victor Joe
Combined trauma in the burn patient has been previously shown to have higher mortality. With improved critical care and multidisciplinary approach, we hypothesized the risk of mortality in combined burn and trauma has decreased. A retrospective analysis of trauma, burn and combined burn-trauma patients in the National Trauma Data Bank was performed comparing years 2007-2015 to years 1994-2002. The impact of burn injuries on mortality in patients with minor trauma has decreased (OR 2.45, CI 2.26-2.66, p<0...
July 31, 2018: Burns: Journal of the International Society for Burn Injuries
Jason F Naylor, Michael D April, Guyon J Hill, Kelley M Kempski, Allyson A Arana, Steven G Schauer
OBJECTIVES: Pediatric casualties made up a significant proportion of patients during the recent military conflicts in Iraq and Afghanistan. Damage control resuscitation strategies used by military physicians included rapid reversal of metabolic acidosis to mitigate its pathophysiologic consequences, primarily through hemorrhage control and volume restoration. Alkalizing agents, including tris(hydroxymethyl)aminomethane (THAM), are potential therapeutic adjuncts to treat significant acidosis...
August 2018: Southern Medical Journal
P I Heidekrueger, S Wecker, H-G Machens, L Prantl, D Ehrl, R Giunta, A Daigeler, M Lehnhardt, M Ninkovic, P N Broer
BACKGROUND AND OBJECTIVES: Plastic surgery includes a broad range of activities; however, there are no studies available in Germany which evaluated the specific role plastic surgeons play in providing patient care. The aim of the project was thus to analyze the public and professional perception of plastic surgery in Germany and to what degree the range of activities is appropriately represented. MATERIAL AND METHODS: An anonymous survey inquiring about demographic data and specific knowledge regarding plastic surgery procedures was conducted in various regions in German...
August 3, 2018: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Sharon R Lewis, Michael W Pritchard, David Jw Evans, Andrew R Butler, Phil Alderson, Andrew F Smith, Ian Roberts
BACKGROUND: Critically ill people may lose fluid because of serious conditions, infections (e.g. sepsis), trauma, or burns, and need additional fluids urgently to prevent dehydration or kidney failure. Colloid or crystalloid solutions may be used for this purpose. Crystalloids have small molecules, are cheap, easy to use, and provide immediate fluid resuscitation, but may increase oedema. Colloids have larger molecules, cost more, and may provide swifter volume expansion in the intravascular space, but may induce allergic reactions, blood clotting disorders, and kidney failure...
August 3, 2018: Cochrane Database of Systematic Reviews
Maria Punchak, Kaitlin Hall, Amir Seni, W Chris Buck, Daniel A DeUgarte, Emily Hartford, Robert B Kelly, Valéria I Muando
OBJECTIVES: Delivery of pediatric critical care in low-income countries is limited by a lack of infrastructure, resources, and providers. Few studies have analyzed the epidemiology of disease associated with a PICU in a low-income country. The aim of this study was to document the primary diagnoses and the associated mortality rates of patients presenting to a tertiary PICU in Mozambique in order to formulate quality improvement projects through an international academic partnership. We hypothesized that the PICU mortality rate would be high and that sepsis would be a common cause of death...
July 30, 2018: Pediatric Critical Care Medicine
Miriam Anne Coyle, Hui Chen Chang, Pippa Burns, Victoria Traynor
The current integrative literature review explored the impact of interactive delirium care education in facilitating knowledge transfer to health care practitioners and improving health outcomes for older adults. Academic databases, including MEDLINE, CINAHL, and Web of Science, were searched using the terms delirium and simulation or interactive education. Selected articles were analyzed using Critical Appraisals Skills Programme tools. Twenty studies were reviewed and three themes generated to explain the current understanding of the impact of interactive delirium care education on outcomes for: (a) individuals with delirium; (b) organizational health care; and (c) health care practitioners...
August 1, 2018: Journal of Gerontological Nursing
David Wyler, Michael Esterlis, Brittany Burns Dennis, Andrew Ng, Abhijit Lele
BACKGROUND: A recent paradigm shift within the intensive care discipline has led to implementation of protocols to drive early recovery from the intensive care unit (ICU). These protocols belong to a large knowledge, translation and quality improvement initiative lead by the Society of Critical Care Medicine, aiming to "liberate" patients from the ICU. They "bundle" evidence-based elements shown to lower ICU stay and mortality and optimize pain management. The bundled elements focus on Assessing, preventing and managing pain; Both spontaneous awakening trials and spontaneous breathing trials; Choice of analgesia and sedation; assessment, prevention, and management of Delirium; Early mobility and exercise; and Family engagement and empowerment (ABCDEF)...
July 24, 2018: Systematic Reviews
Nathan Markiewitz, Carrie Cox, Kelly Krout, Michael McColl, Julie A Caffrey
Burnout, defined by feelings of inefficacy, cynicism, and emotional exhaustion, affects the performance and wellbeing of health care providers. Burn care exposes providers to factors known to cause or worsen burnout, but no research has presented prevalence rates of burnout in this population. We estimate the rates of anxiety, depression, and burnout among non-physician providers in a regional burn center and compare those rates to a reference population of critical care nurses. In our sample of 22 providers, 64% screened positive for anxiety; 32% for depression; 82% for emotional exhaustion; 18% for personal achievement burnout; and 54% for depersonalization...
July 19, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Laura Suhlrie, Jamie Bartram, Jacob Burns, Lauren Joca, John Tomaro, Eva Rehfuess
BACKGROUND: Modern energy enables health service delivery. Access to electricity is, however, unreliable in many health facilities in developing countries. Little research has explored the relationships between energy and service delivery. METHODS: Based on extensive literature searches and iterative discussions within the research team, we first develop a conceptual framework of the role of energy in health facilities. We then use this framework to explore how characteristics of electricity supply affect distinct energy uses in health facilities (e...
2018: PloS One
Kyle H O'Brien, Victor Lushin
Recovery of burn patients may be impeded by mental health problems. By gaining a better understanding of the impact that psychological factors may have on hospital length of stay, providers may be better informed to address the complex needs of burn survivors through effective and efficient practices. This systematic review summarizes existing data on the adverse psychological factors for the length of burn patients' hospitalization, and assesses the methodological quality of the extant literature on mental health conditions of burn survivors...
July 18, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Martha A Q Curley, R Scott Watson, Amy M Cassidy, Cheryl Burns, Rachel L Delinger, Derek C Angus, Lisa A Asaro, David Wypij, Sue R Beers
There is increasing concern that sedatives commonly used during critical illness may be neurotoxic during the period of early brain development. The Sedation strategy and cognitive outcome after critical illness in early childhood (RESTORE-cognition) study is a prospective cohort study designed to examine the relationships between sedative exposure during pediatric critical illness and long-term neurocognitive outcomes. We assess multiple domains of neurocognitive function 2.5-5 years post-hospital discharge, at a single time point and depending on participant and clinician availability, in up to 500 subjects who had normal baseline cognitive function, were aged 2 weeks to 8 years at pediatric intensive care unit admission, and were enrolled in a cluster randomized controlled trial of a sedation protocol (the RESTORE trial; U01 HL086622 and HL086649)...
July 11, 2018: Contemporary Clinical Trials
Emily A Ohrtman, Gabriel D Shapiro, Laura C Simko, Emily Dore, Mary D Slavin, Cayla Saret, Flor Amaya, J Lomelin-Gascon, Ni Pengsheng, Amy Acton, Molly Marino, Lewis E Kazis, Colleen M Ryan, Jeffrey C Schneider
Social interactions and activities are key components of social recovery following burn injuries. The objective of this study is to determine the predictors of these areas of social recovery.This study provides a secondary analysis of a cross-sectional survey of adult burn survivors. The Life Impact Burn Recovery Evaluation-192 was administered to 601 burn survivors for the field-testing of the Life Impact Burn Recovery Evaluation Profile. Survivors aged 18 years and older with injuries ≥5% total body surface area or burns to critical areas (hands, feet, face, or genitals) were eligible to participate...
July 16, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Hui Chen, Yonghao Li, Jianjun Gu, Lin Yin, Fang Bian, Lishi Su, Yanhua Hong, Yang Deng, Wei Chi
Alkali burn (AB) is one of the most serious ocular traumas in the world, characterized by extreme ocular surface disorders, critical secondary dry eye and irreversible vision loss. The exact mechanisms involved are unknown. Innate immunity, including the involvement of Toll-like receptors (TLRs) and NOD-like receptors (NLRs), is believed to participate in the pathogenesis of the epithelia, but the exact mechanisms by which TLRs transduce signals to NLRs and downstream molecules to initiate innate immunity remain poorly defined...
July 2, 2018: Experimental Eye Research
Roxana-Maria Amărandi, Diana F Becheru, George M Vlăsceanu, Mariana Ioniță, Jorge S Burns
Regenerative medicine is challenged by the need to conform to rigorous guidelines for establishing safe and effective development and translation of stem cell-based therapies. Counteracting widespread concerns regarding unproven cell therapies, stringent cell-based assays seek not only to avoid harm but also to enhance quality and efficacy. Potency indicates that the cells are functionally fit for purpose before they are administered to the patient. It is a paramount quantitative critical quality attribute serving as a decisive release criterion...
2018: BioMed Research International
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