11 research outputs found
Diphoterine for Chemical Burns of the Skin: A Systematic Review
No full textThe incidence of chemical burns appears to be increasing. Diphoterine is an amphoteric, chelating, polyvalent solution used for the decontamination of chemical splashes. In this systematic review, we aimed to assess the effect of diphoterine on chemical burns compared with water or no treatment. The primary endpoint was the depth of burn, and secondary outcomes included pain, duration of hospitalization, time to return to work, need for surgery, pH, and complications. PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar were systematically searched using the terms “Diphoterine”, “Previn”, and ““Amphoteric solution” AND “burn””. A total of nine studies were included. One study evaluated the depth of chemical burns and found no difference between the diphoterine group and the control group. Four studies reported on pain, three of which found a more pronounced decrease in pain when using diphoterine compared to the control groups. Two studies found a significant neutralization of pH when using diphoterine. No differences were found for the remaining endpoints. Based on the very low certainty of evidence, this systematic review reports no observed difference between diphoterine and water or no treatment on the depth of a chemical burn. Diphoterine appeared to be associated with less pain and to have a neutralizing effect
Reply to Hall et al. Comment on “Dinesen et al. Diphoterine for Chemical Burns of the Skin: A Systematic Review. <i>Eur. Burn J.</i> 2023, <i>4</i>, 55–68”
No full textWe thank Hall et al. [...
Anaesthesia in patients undergoing esophago-gastro-duodenoscopy for suspected bleeding
No full textINTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a common emergency. Currently, there are no agreed guidelines on the level of anaesthetic support required in patients undergoing acute esophago-gastro-duodendoscopy (EGD).METHODS: An online questionnaire comprising 19 questions was distributed to all members of the Danish Association of Anaesthesiology and Intensive Care (n = 1,418) and the Danish Society of Anaesthesiologists in Training (n = 566). The questions concerned clinical practice for anaesthesia care to patients undergoing EGD for suspected UGIB and availability of local guidelines.RESULTS: A total of 521 anaesthetists who had, on average, concluded medical school 14 years earlier (range: 9-27 years) answered the questionnaire. Of the responders, 65.5% (167/255; 95% confidence interval (CI): 59.7-71.3) had provided anaesthesia to five or more patients with suspected UGIB during the previous six months. 32.9% (110/333; 95% CI: 27.9-38.0) had a local guideline for this procedure. Rapid sequence induction was part of the guideline for 71.8% (79/110; 95% CI: 63.4-80.2) in case of general anaesthesia (GA). The preferred choice of anaesthesia was GA with endotracheal intubation (56.2%; 187/333; 95% CI: 50.9-61.5).CONCLUSIONS: We found considerable variation in daily clinical practice of anaesthesia for patients undergoing EGD for suspected UGIB. The fact that anaesthesia for UGIB is a complex emergency procedure may underline the need for development of an international or at least a national guideline.FUNDING: The study received financial support from Karner's Foundation, Denmark.TRIAL REGISTRATION: not relevant.</p
Keraunoparalysis after lightning injury with transient ischaemia and paralysis of an extremity
No full textKeraunoparalysis is a transient paralysis of the extremities, which results from close contact with lightning. In this case report, a 58-year-old man came in close contact with a bolt of lightning. His left foot was pulseless, pale, cold and with absence of capillary refill. His symptoms were initially interpreted as arterial occlusion, and therefore bypass surgery and even amputation were considered. However, his symptoms resolved within hours. Therefore, clinicians must consider keranoparalysis as a differential diagnosis in patients struck by lightning.</p
New Nordic guidelines on management of burn injuries
No full textDenmark has recently entered a collaboration with other Nordic countries to ensure a common strategy in the management of burn mass casualties. The collaboration is based upon the guideline Emergency Management of Severe Burns originating from the Australian and New Zealand Burn Association. The desire to establish a common Nordic strategy has led to a number of changes in the national guidelines for the treatment of burn injuries. The new guidelines recently implemented at the national university hospital of Denmark, Rigshospitalet, are presented in this review.</p
Use of selective decontamination of the digestive tract in burn patients:A European survey
No full textBACKGROUND: Infectious complications are a major cause of morbidity and mortality in burn patients. Selective decontamination of the digestive tract (SDD) is a prophylactic antimicrobial strategy aimed at suppressing potential pathogenic microorganisms in the gut microbiome. This study aimed to assess the values and preferences for the use of SDD in burn centres across Europe and to evaluate clinicians' interest in further research on its efficacy.METHODS: We circulated a survey on the values and preferences for the use of SDD between March and October 2024, targeting surgeons, anaesthesiologists, and intensivists at European burn centres. The survey comprised 13 questions focusing on SDD usage criteria, regimens, and willingness to participate in a multicentre randomised clinical trial. Data were analysed and presented descriptively.RESULTS: We invited 45 burn centres to participate; 22 responded (49 % response rate). Among these, 27 % (6/22) reported routine use of SDD, primarily for patients with extensive burns or those requiring intensive care. Most centres using SDD (5/6) administered a combination of enteral and intravenous antibiotics and/or antifungals, while one centre (1/6) relied on enteral antimicrobials alone. The most common regimen included intravenous cefotaxime combined with enteral polymyxin E, tobramycin, and amphotericin B or nystatin. Notably, 82 % (18/22) of respondents expressed interest in participating in a multicentre randomised clinical trial on SDD in burn patients.CONCLUSION: A minority of European burn centres routinely used SDD, while the majority did not. Among those that used SDD, treatment regimens were largely aligned with practices commonly used in ICU patients. Notably, there was significant interest among European burn centres in participating in future clinical trials comparing SDD versus no SDD in burn patients.</p
Management of bleeding in major burn surgery
No full textMajor burn surgery is often associated with excessive bleeding and massive transfusion, and the development of a coagulopathy during major burn surgery is associated with increased morbidity and mortality. The aim of this study was to review the literature on intraoperative haemostatic resuscitation of burn patients during necrectomy to reveal strategies applied for haemostatic monitoring and resuscitation. We searched PubMed, EMBASE, and CENTRAL for studies published in the period 2006–2017 concerning bleeding issues related to burn surgery i.e. coagulopathy, transfusion requirements and clinical outcomes. In a broad search, a total of 1375 papers were identified. 124 of these fulfilled the inclusion criteria, and six of these were included for review. The literature confirmed that transfusion requirements increases with burn injury severity and that haemostatic monitoring by TEG® (thrombelastography) or ROTEM® (rotational thromboelastometry) significantly decreased intraoperative transfusions and was useful in predicting and goal-directing haemostatic therapy during excision surgery. Resuscitation of bleeding during major burn surgery in many instances was neither standardized nor haemostatic. We suggest that resuscitation should aim for normal haemostasis during the bleeding phase through close haemostatic monitoring and resuscitation. Randomised controlled trials are highly warranted to confirm the benefit of this concept.</p
Selective decontamination of the digestive tract in burn patients:Protocol for a systematic review
No full textBackgroundNosocomial infections contribute significantly to mortality and morbidity in burn patients. Selective decontamination of the digestive tract is an infection prevention measure that has been shown to improve survival in mechanically ventilated intensive care unit (ICU) patients. It has been hypothesized that burn patients may benefit from selective decontamination of the digestive tract.Methods/DesignWe will conduct a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials (RCTs) assessing the patient-important effects of selective decontamination of the digestive tract in burn patients, as compared with placebo or no intervention/standard of care. The primary outcome will be 30-day mortality. Secondary outcomes include serious adverse events, anti-microbial resistance, pneumonia, blood stream infections, ICU- and hospital-free days and 90-day mortality. We will search the following databases: CENTRAL, MEDLINE, EMBASE, BIOSIS, Web of Science and CINAHL and follow the recommendations provided by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The certainty of evidence will be assessed according to the GRADE approach: Grading of Recommendations Assessment, Development and Evaluation.DiscussionThere is clinical equipoise about the use of selective decontamination of the digestive tract in burn patients. In the outlined systematic review and meta-analysis, we will assess the desirable and undesirable effects of selective decontamination of the digestive tract in burn patients.Background: Nosocomial infections contribute significantly to mortality and morbidity in burn patients. Selective decontamination of the digestive tract is an infection prevention measure that has been shown to improve survival in mechanically ventilated intensive care unit (ICU) patients. It has been hypothesized that burn patients may benefit from selective decontamination of the digestive tract. Methods/Design: We will conduct a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials (RCTs) assessing the patient-important effects of selective decontamination of the digestive tract in burn patients, as compared with placebo or no intervention/standard of care. The primary outcome will be 30-day mortality. Secondary outcomes include serious adverse events, anti-microbial resistance, pneumonia, blood stream infections, ICU- and hospital-free days and 90-day mortality. We will search the following databases: CENTRAL, MEDLINE, EMBASE, BIOSIS, Web of Science and CINAHL and follow the recommendations provided by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The certainty of evidence will be assessed according to the GRADE approach: Grading of Recommendations Assessment, Development and Evaluation. Discussion: There is clinical equipoise about the use of selective decontamination of the digestive tract in burn patients. In the outlined systematic review and meta-analysis, we will assess the desirable and undesirable effects of selective decontamination of the digestive tract in burn patients.</p
Selective decontamination of the digestive tract in burn patients:A systematic review with meta-analysis
No full textBackgroundIn mechanically ventilated adult patients in the intensive care unit (ICU), selective decontamination of the digestive tract (SDD) has been shown to reduce the risk of infections and improve survival. While the benefits of SDD have been documented in this population, it remains unclear whether burn patients, who are at increased risk of infection and have distinct clinical characteristics, may experience similar benefits. In this systematic review we aimed to assess the desirable and undesirable patient-important effects of administering SDD to burn patients.Methods/designWe conducted a systematic review with meta-analysis of randomized clinical trials (RCTs) assessing the effects of SDD versus placebo or no SDD in burn patients. The primary outcome was 30-day mortality. Secondary outcomes included serious adverse events, antimicrobial resistance, pneumonia, blood stream infections, ICU- and hospital-free days, and 90-day mortality. We searched all major databases and followed the recommendations provided by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The certainty of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation approach.ResultsWe identified four RCTs with a total of 457 burn patients. All trials were assessed as having either ‘some concerns’ or ‘high risk’ of bias. The evidence was found to be very uncertain across all outcomes assessed. For mortality, the relative risk (RR) was 0.62 (95 % confidence interval (CI) 0.22–1.78, I2 = 75 %, random-effects model (REM), very low certainty evidence). For pneumonia, the RR was 0.75 (95 % CI 0.48–1.19, I2 = 0 %, fixed-effect model, very low certainty evidence). For bloodstream infections, the RR was 1.10 (95 % CI 0.71–1.69, I2 = 0 %, REM, very low certainty evidence). For hospital length of stay, the mean difference was −2.03 days (95 % CI −9.64–5.59, I2 = 51 %, REM, very low certainty evidence). We did not perform meta-analyses for the remaining secondary outcomes due to limited or no data. Trial sequential analysis could not be performed due to insufficient number of total participants and events in the included trials.ConclusionWe found that the certainty of evidence is very low about the effects of SDD on patient-important outcomes in burn patients. Extrapolating from the evidence on mechanically ventilated adult ICU patients may be reasonable until more data from RCTs in burn patients emerge.Background: In mechanically ventilated adult patients in the intensive care unit (ICU), selective decontamination of the digestive tract (SDD) has been shown to reduce the risk of infections and improve survival. While the benefits of SDD have been documented in this population, it remains unclear whether burn patients, who are at increased risk of infection and have distinct clinical characteristics, may experience similar benefits. In this systematic review we aimed to assess the desirable and undesirable patient-important effects of administering SDD to burn patients. Methods/design: We conducted a systematic review with meta-analysis of randomized clinical trials (RCTs) assessing the effects of SDD versus placebo or no SDD in burn patients. The primary outcome was 30-day mortality. Secondary outcomes included serious adverse events, antimicrobial resistance, pneumonia, blood stream infections, ICU- and hospital-free days, and 90-day mortality. We searched all major databases and followed the recommendations provided by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The certainty of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: We identified four RCTs with a total of 457 burn patients. All trials were assessed as having either ‘some concerns’ or ‘high risk’ of bias. The evidence was found to be very uncertain across all outcomes assessed. For mortality, the relative risk (RR) was 0.62 (95 % confidence interval (CI) 0.22–1.78, I2 = 75 %, random-effects model (REM), very low certainty evidence). For pneumonia, the RR was 0.75 (95 % CI 0.48–1.19, I2 = 0 %, fixed-effect model, very low certainty evidence). For bloodstream infections, the RR was 1.10 (95 % CI 0.71–1.69, I2 = 0 %, REM, very low certainty evidence). For hospital length of stay, the mean difference was −2.03 days (95 % CI −9.64–5.59, I2 = 51 %, REM, very low certainty evidence). We did not perform meta-analyses for the remaining secondary outcomes due to limited or no data. Trial sequential analysis could not be performed due to insufficient number of total participants and events in the included trials. Conclusion: We found that the certainty of evidence is very low about the effects of SDD on patient-important outcomes in burn patients. Extrapolating from the evidence on mechanically ventilated adult ICU patients may be reasonable until more data from RCTs in burn patients emerge.</p
The information design of ecological cycle network diagrams in science textbooks
No full textNetwork diagrams of ecological cycles, eg, carbon and nitrogen cycles, are a common feature in science textbooks for 14-18 years age groups. From an information design perspective these diagrams raise a particularly interesting challenge; that of categorising up to six types of biological information using two graphic syntactic roles – nodes and connecting arrows – whilst ensuring an efective and unambiguous message. This practice-led thesis reviews the precision of information categorisation in 209 network diagrams collected from UK and Danish science textbooks (1935-2009).
Visual content analysis and graphic syntax theory (Engelhardt, 2002) is applied to review the existing information categorisation in relation to four types of graphic inefectiveness: 1) implicit nodes, 2) imprecise relative spatial positioning of graphic objects, 3) polysemy, and 4) inconsistent visual attributes or verbal syntax. This review finds 29 types of ineffective graphic tactics, which may result in ambiguous messages due to illogical linking sequences, implicit circulating elements, and confusion about chemical transfer and transformations. Based on these analysis indings, the design process in educational publishing is investigated. This identifies the rationale informing the transformation of information into network diagrams, based on semi- structured interviews with 19 editors, authors, designers, and illustrators in six publishing houses (3 in UK , 3 in Denmark).
The rationale is mapped using phenomenographic analysis method and existing theories on the design process, namely brief development and translation stages (Crilly, 2005), choice points and the problem setting process (Schön, 2006), problem- solution co-evolution (Dorst and Cross, 2001), and design constraints (Lawson, 2006). The curriculum purpose of the ecological cycle network diagram is found to tightly constrain the identiied rationale and the graphic decision-making based mainly on tacit knowledge. In a final discussion the research indings are integrated by identifying models of design activities (Dumas and Mintzberg, 1993) present in investigated professional practice. This reveals how design decisions may inluence the occurrence of inefective graphic tactics. Recommendations for alternative information transformation strategies are then presented, centred on integrating graphic syntax knowledge into the current processes. These recommendations are anchored in suggestions by the interviewed participants
