ORCID Profile
0000-0002-2449-7707
Current Organisations
The Institute of Cancer Research
,
The University of Edinburgh
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Publisher: Wiley
Date: 14-06-2011
DOI: 10.1111/J.1469-7610.2011.02431.X
Abstract: Infants, toddlers and preschoolers are the highest risk group for burn injury. However, to date this population has been largely neglected. This study examined the prevalence, onset, comorbidity and recovery patterns of posttrauma reactions in young children with burns. Parents of 130 unintentionally burned children (1-6 years) participated in the study. The Diagnostic Infant Preschool Assessment was conducted with parents at 1 and 6 months postinjury. The majority of children were resilient. However, 35% were diagnosed with at least one psychological disorder, there was a high rate of comorbidity with posttraumatic stress disorder, and 8% of children did not experience recovery in distress levels over the course of 6 months. These outcomes are likely to have serious repercussions for a young child's medical and psychosocial recovery as well as their normal developmental trajectories. It is recommended that screening, prevention and early intervention resources are incorporated into paediatric health care settings to optimise children's psychological adjustment following burn injury.
Publisher: Public Library of Science (PLoS)
Date: 25-02-2015
Publisher: Oxford University Press (OUP)
Date: 05-2011
Publisher: Springer Science and Business Media LLC
Date: 2002
Abstract: Slow anastomotic function is a common problem in the management of congenital duodenal obstruction. We describe a simple technique of excision duodenoplasty (ED) that results in a fixed open anastomosis, which facilitates early commencement of feeds and discharge from hospital. A retrospective case-note review (1981-2000) was undertaken to compare the results of ED with side-to-side duodenoplasty (SSD) and diamond-shaped anastomosis (DD). The outcome measures were days to commencement of feeds, duration of total parenteral nutrition (TPN), and length of hospital stay. In ED a 1.0 to 1.5-cm elliptical segment of dilated duodenum is excised. A longitudinal incision is made in the smaller distal duodenum. A side-to-side one-layer anastomosis is performed. The wall of the proximal duodenal stump is thick, and excision of the ellipse keeps the anastomosis open by preventing apposition of the opposing walls. This facilitates good drainage across the anastomosis. The time to onset of feeding was longer after SSD (median 7 days) compared to ED (5 days) and DD (5 days). The total duration of TPN was also longer for SSD (9 days) in comparison to ED (7 days) and DD (7 days). Although the duration of hospital stay was more for SSD (18 days) than ED (13 days) and DD (16 days), this difference was not statistically significant. The ED technique thus gives an equally good result as DD and a better result than SSD. It is simple to perform and to teach.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.BURNS.2008.03.012
Abstract: Many alternative therapies are used as first aid treatment for burns, despite limited evidence supporting their use. In this study, Aloe vera, saliva and a tea tree oil impregnated dressing (Burnaid) were applied as first aid to a porcine deep dermal contact burn, compared to a control of nothing. After burn creation, the treatments were applied for 20 min and the wounds observed at weekly dressing changes for 6 weeks. Results showed that the alternative treatments did significantly decrease subdermal temperature within the skin during the treatment period. However, they did not decrease the microflora or improve re-epithelialisation, scar strength, scar depth or cosmetic appearance of the scar and cannot be recommended for the first aid treatment of partial thickness burns.
Publisher: Wiley
Date: 02-12-2014
Abstract: Severe burn injury results in substantial skin loss and cannot be treated by autografts. The Integra Dermal Regeneration Template (IDRT) is the leading synthetic skin substitute because it allows for wound bed regeneration and wound healing. However, all substitutes suffer from slow blood vessel ingrowth and would benefit considerably from enhanced vascularization to nurture tissue repair. It is shown here that by incorporating the human elastic protein tropoelastin into a dermal regeneration template (TDRT) we can promote angiogenesis in wound healing. In small and large animal models comprising mice and pigs, the hybrid TDRT biomaterial and IDRT show similar contraction to autografts and decrease wound contraction compared to open wounds. In mice, TDRT accelerates early stage angiogenesis by 2 weeks, as evidenced by increased angiogenesis fluorescent radiant efficiency in live animal imaging and the expression of endothelial cell adhesion marker CD146. In the pig, a full thickness wound repair model confirms increased numbers of blood vessels in the regenerating areas of the dermis closest to the hypodermis and immediately below the epidermis at 2 weeks post-surgery. It is concluded that including tropoelastin in a dermal regeneration template has the potential to promote wound repair through enhanced vascularization.
Publisher: Oxford University Press (OUP)
Date: 03-2009
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.BURNS.2008.10.005
Abstract: This study describes the evaluation of a clinical scar scale for our porcine burn scars, which includes scar cosmetic outcome, colour, height and hair, supplemented with reference porcine scar photographs representing each scar outcome and scar colour scores. A total of 72 porcine burn scars at week 6 after burn were rated in vivo and/or on photographs. Good agreements were achieved for both intra-rater reliability (correlation is 0.86-0.98) and inter-rater reliability (ICC=80-85%). The results showed statistically significant correlations for each pair in this clinical scar scale (p<0.01), with the best correlation found between scar cosmetic outcome and scar colour. A multivariate principle components analysis revealed that this clinical scar assessment was highly correlated with scar histology, wound size, and re-epithelialisation data (p<0.001). More severe scars are clinically characterised by darker purple colouration, more elevation, no presence of hair, histologically by thicker scar tissue, thinner remaining normal dermis, are more likely to have worse contraction, and slower re-epithelialisation. This study demonstrates that our clinical scar scale is a reliable, independent and valuable tool for assessing porcine burn outcome and truthfully reflects scar appearance and function. To our knowledge, this is the first study demonstrating a high correlation between clinical scar assessment and scar histology, wound contraction and re-epithelialisation data on porcine burn scars. We believe that the successful use of porcine scar scales is invaluable for assessing potential human burn treatments.
Publisher: Elsevier BV
Date: 06-2002
DOI: 10.1016/S0305-4179(02)00019-0
Abstract: To document and describe the effects of c fire burns on children. To identify the sources of danger contributing to such injuries, so that a prevention strategy can be devised. Departmental database and case note review of all children with c fire burns seen at the Burns Unit of a tertiary referral children's hospital between January 1999 and June 2001. Number and ages of children burned risk factors contributing to the accidents injuries sustained treatment required and long-term sequelae. Thirty-three children, median age 2.5 years, sustained burns, usually to the hands and feet, with eight requiring surgery and the majority requiring some form of scar therapy. Seventy-four percent of the children were burned by hot ashes and coals, usually from the previous night's fire, rather than by open flames. C fires cause serious injuries to children. In particular, hot ashes and coals from inadequately extinguished c fires pose the greatest danger. Increasing the awareness of this easily preventable problem amongst c ers is intended through a public education c aign.
Publisher: Wiley
Date: 27-10-2008
Publisher: JMIR Publications Inc.
Date: 10-03-2018
Abstract: ew technologies, widespread availability of the internet, the rise of social media and increased ownership of smartphones provide new opportunities for health researchers to communicate and engage with target audiences. his new technology was used to recruit mothers of young children to a smartphone application (app) to increase their knowledge about childhood burns (specifically hot beverage scalds) and correct burn first-aid. This six-month intervention deployed on the Cool Runnings app, used gamification techniques to reinforce intervention messages and engage participants. two-group, parallel, single blinded, randomized controlled trial (RCT) to evaluate the efficacy of a smartphone app-based burn prevention intervention. Participants were women aged 18+, living in Queensland, Australia, with at least one child aged 5-12 months at the time of enrolment. The primary outcome measure was change in knowledge around burn risk and correct burn first-aid assessed via two methods: overall score and categorised as adequate (score =4) vs inadequate (score less than 4). The secondary outcome measure was the efficacy of gamification techniques (measured by: app opens, photo uploads, pop quiz completions and content views). n total, 498 participants were recruited via social media and enrolled. At 6-month follow-up, 244 participants completed the post-test questionnaire. Attrition rates in both groups were similar. Participants who remained in the study did not differ from those who were lost to follow up on any characteristics except for education level. Although similar at baseline, intervention group participants achieved significantly greater improvement in overall knowledge post-test than control group participants on both primary outcome measures (overall knowledge intervention: mean=2.68± 1.00 vs control mean:2.13±1.03 intervention: 20.47% adequate vs control: 7.3%). Consequently, the NNT was 7.46. Logistic regression showed participants exposed to the highest level of disadvantage were 7.3 times more likely to improve overall knowledge scores than participants in other levels of disadvantage. There were also significant correlations between each of the four gamification techniques and knowledge change (p .001). In addition, participants with low/moderate ‘app activity’ were 8.59 times more likely to have improved knowledge between baseline and 6-month follow-up than those who had no app activity (95%CI=2.9-25.02) participants with high app activity were 18.26 times more likely to have improved knowledge (95%CI=7.1-46.8). espite substantial loss to follow-up, this RCT demonstrates the Cool Runnings app was an effective intervention for improving knowledge about hot beverage scald risks and burn first-aid in mothers of young children. The benefits of combining gamification elements in the intervention were also highlighted. Given the low cost and large reach of smartphone apps to deliver content to, and engage with targeted populations, results from this RCT provides important information on how smartphone applications can be used for widespread injury prevention c aigns, and public health c aigns generally. his trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000019404)
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2002
Publisher: BMJ
Date: 09-2010
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.BURNS.2008.10.011
Abstract: Throughout history there have been many different and sometimes bizarre treatments prescribed for burns. Unfortunately many of these treatments still persist today, although they often do not have sufficient evidence to support their use. This paper reviews common first aid and pre-hospital treatments for burns (water--cold or warm, ice, oils, powders and natural plant therapies), possible mechanisms whereby they might work and the literature which supports their use. From the published work to date, the current recommendations for the first aid treatment of burn injuries should be to use cold running tap water (between 2 and 15 degrees C) on the burn, not ice or alternative plant therapies.
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.BURNS.2013.11.024
Abstract: The relationships between pain, stress and anxiety, and their effect on burn wound re-epithelialization have not been well explored to-date. The aim of this study was to investigate the effect of the Ditto™ (a hand-held electronic medical device providing procedural preparation and distraction) intervention on re-epithelialization rates in acute pediatric burns. From August 2011 to August 2012, children (4-12 years) with an acute burn presenting to the Royal Children's Hospital, Brisbane, Australia fulfilled the study requirements and were randomized to [1] Ditto™ intervention or [2] standard practice. Burn re-epithelialization, pain intensity, anxiety and stress measures were obtained at every dressing change until complete wound re-epithelialization. One hundred and seventeen children were randomized and 75 children were analyzed (n=40 standard group n=35 Ditto™ group). Inability to predict wound management resulted in 42 participants no longer meeting the eligibility criteria. Wounds in the Ditto™ intervention group re-epithelialized faster than the standard practice group (-2.14 days (CI: -4.38 to 0.10), p-value=0.061), and significantly faster when analyses were adjusted for mean burn depth (-2.26 days (CI: -4.48 to -0.04), p-value=0.046). Following procedural preparation at the first change of dressing, the Ditto™ group reported lower pain intensity scores (-0.64 (CI: -1.28, 0.01) p=0.052) and lower anxiety ratings (-1.79 (CI: -3.59, 0.01) p=0.051). At the second and third dressing removals average pain (FPS-R and FLACC) and anxiety scores (VAS-A) were at least one point lower when Ditto™ intervention was received. The Ditto™ procedural preparation and distraction device is a useful tool alongside pharmacological intervention to improve the rate of burn re-epithelialization and manage pain and anxiety during burn wound care procedures.
Publisher: Elsevier BV
Date: 09-2008
DOI: 10.1016/J.BURNS.2007.10.010
Abstract: 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. This prospective randomised controlled trial investigated the use of AR as an adjunct to analgesia and sedation in children with acute burns. Forty-two children (30 male and 12 female), with an age range of 3-14 years (median age 9 years) and a total burn surface area ranging from 1 to 16% were randomised into a treatment (AR) arm and a control (basic cognitive therapy) arm after administration of analgesia and/or sedation. Pain scores, pulse rates (PR), respiratory rates (RR) and oxygen saturations (SaO2) were recorded pre-procedurally, at 10 min intervals and post-procedurally. Parents were also asked to grade their child's overall pain score for the dressing change. Mean pain scores were significantly lower (p=0.0060) in the AR group compared to the control group, as were parental pain assessment scores (p=0.015). 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.
Publisher: Elsevier BV
Date: 02-2010
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.DET.2009.10.012
Abstract: Kindler syndrome is caused by genetic defects in the focal contact-associated protein, fermitin family homologue 1 (FFH1), encoded by the gene FERMT1 (known as KIND1). Defects in FFH1 lead to abnormal integrin activation and loss of keratinocyte epidermal adhesion to the underlying basal lamina, disruption in normal cell cytoskeleton within keratinocytes, and altered signaling pathways, leading to increased extracellular matrix production. Null mutations in FERMT1 result in skin blistering from birth and early childhood progressive poikiloderma, mucosal fragility, and increased risk of cancer. The complete range of FFH1 functions in skin and other epithelia has yet to be determined.
Publisher: Wiley
Date: 20-11-2007
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.BURNS.2013.12.001
Abstract: Burns and their associated wound care procedures evoke significant stress and anxiety, particularly for children. Little is known about the body's physiological stress reactions throughout the stages of re-epithelialization following an acute burn injury. Previously, serum and urinary cortisol have been used to measure stress in burn patients, however these measures are not suitable for a pediatric burn outpatient setting. To assess the sensitivity of salivary cortisol and sAA in detecting stress during acute burn wound care procedures and to investigate the body's physiological stress reactions throughout burn re-epithelialization. Seventy-seven participants aged four to thirteen years who presented with an acute burn injury to the burn center at the Royal Children's Hospital, Brisbane, Australia, were recruited between August 2011 and August 2012. Both biomarkers were responsive to the stress of burn wound care procedures. sAA levels were on average 50.2 U/ml higher (p<0.001) at 10 min post-dressing removal compared to baseline levels. Salivary cortisol levels showed a blunted effect with average levels at ten minutes post dressing removal decreasing by 0.54 nmol/L (p<0.001) compared to baseline levels. sAA levels were associated with pain (p=0.021), no medication (p=0.047) and Child Trauma Screening Questionnaire scores at three months post re-epithelialization (p=0.008). Similarly, salivary cortisol was associated with no medication (p<0.001), pain scores (p=0.045) and total body surface area of the burn (p=0.010). Factors which support the use of sAA over salivary cortisol to assess stress during morning acute burn wound care procedures include sensitivity, morning clinic times relative to cortisol's diurnal peaks, and relative cost.
Publisher: AMPCo
Date: 12-2011
DOI: 10.5694/MJA11.11319
Abstract: Teaching children how to behave around dogs can reduce the incidence.
Publisher: BMJ
Date: 27-01-2011
Publisher: Public Library of Science (PLoS)
Date: 16-06-2016
Publisher: Oxford University Press (OUP)
Date: 03-2009
Publisher: Elsevier BV
Date: 05-2009
Publisher: Springer Science and Business Media LLC
Date: 12-04-2007
DOI: 10.1007/S00383-007-1918-6
Abstract: LB was a male infant born via spontaneous vaginal delivery at term in a peripheral centre. A provisional diagnosis of oesophageal atresia (OA) with tracheoesophageal fistula (TOF) was made and the child was transferred to a tertiary centre for further evaluation. On day two of life he underwent repair of his oesophageal atresia and ision of his distal tracheoesophageal fistula. The upper and lower oesophageal segments were brought together with average tension. An extrapleural drain was inserted with the tip sutured close to the anastomosis. His post-operative course was complicated by two failed extubations secondary to respiratory distress and the development of a salivary leak. Despite repositioning of the extrapleural drain on two separate occasions, the salivary leak continued. Day 25 post-operatively he underwent direct laryngoscopy, bronchoscopy and oesophagoscopy. The extrapleural drain was found to be causing tracheal compression and the tip of the drain was located within the lumen of the oesophagus. Saliva leak is not an uncommon complication of this oesophageal atresia repair. This is the first report of an extrapleural drain being found in the oesophagus causing salivary leak and tracheal compression. These complications may have been prevented by ensuring the drain did not impinge on the anastomosis site, by pulling the drain back at an earlier time or by not having used an extrapleural drain at all.
Publisher: Wiley
Date: 08-2004
Publisher: BMJ
Date: 04-09-2015
DOI: 10.1136/INJURYPREV-2014-041216
Abstract: Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents. A systematic search was undertaken on literature published between 1980 and 2010 relating to interventions around fatal and non-fatal drowning prevention in children and adolescents 0-19 years of age. Search methods and protocols developed and used by the WHO Global Burden of Disease Injury Expert Group were applied. Seven studies fulfilled the inclusion criteria. Interventions were categorised into three themes of Education, Swimming Lessons and Water Safety, and Pool Fencing. All are possible effective strategies to prevent children from drowning, particularly young children aged 2-4 years, but very little evidence exists for interventions to reduce drowning in older children and adolescents. There were methodological limitations associated with all studies, so results need to be interpreted in the context of these. Relatively few studies employ rigorous methods and high levels of evidence to assess the impact of interventions designed to reduce drowning. Studies are also limited by lack of consistency in measured outcomes and drowning terminology. Further work is required to establish efficacy of interventions for older children and adolescents. There is a need for rigorous, well-designed studies that use consistent terminology to demonstrate effective prevention solutions.
Publisher: American Society for Clinical Investigation
Date: 02-06-2016
Publisher: Wiley
Date: 03-2005
DOI: 10.1111/J.1067-1927.2005.130210.X
Abstract: Early to mid-term fetuses heal cutaneous incisional wounds without scars however, fetal response to burn injury has not been ascertained. We present a fetal model of thermal injury and subsequent analysis of fetal and lamb response to burn injury. A reproducible deep dermal burn injury was created in the fetus by application of water at 66 degrees C for 7 seconds, and at 82 degrees C for 10 seconds to the lamb. Macroscopically, the area of fetal scald was undetectable from day 7 post injury, while all lamb scalds were readily identified and eventually healed with scarring. Using a five-point histopathology scoring system for alteration in tissue morphology, differences were detected between control and scalded skin at all stages in lamb postburn, but no difference was detected in the fetal model after day 7. There were also large differences in content of alpha-smooth muscle actin and transforming growth factor-beta1 between control and scalded lamb and these differences were statistically significant at day 14 (P < 0.01). This novel model of fetal and lamb response to deep dermal injury indicates that the fetus heals a deep burn injury in a scarless fashion. Further elucidation of this specific fetal process of burn injury repair may lead to improved outcome for patients with burn injury.
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.JPEDSURG.2012.01.010
Abstract: A sutureless ward reduction (SWR) protocol was implemented in the neonatal intensive care unit of a tertiary level hospital in 1999. Although the short-term outcomes associated with SWR have been documented, the long-term outcomes are unknown. Retrospective data were collected from the medical records of all neonates with gastroschisis from September 1999 to December 2010. Data on their growth and development and the prevalence of any health problems were collected. Eighty-eight patients with gastroschisis were managed over an 11 year period. Forty-four of these patients received SWR, with 2 deaths in the neonatal period. In the 42 survivors, 35 patients were reviewed at a median age of 7 years and 10 months (range, 6-134 months interquartile range, 37-124 months). One patient experienced failure to thrive and developmental delay, and later died of a medical complication. Thirty-two patients (91.4%) developed an umbilical hernia, only 2 of whom required umbilical herniotomy. Four patients (11.4%) developed small bowel obstruction, all within the first year. Most patients with SWR exhibited normal growth with minimal bowel complications. Despite the high incidence of umbilical hernia, the majority resolved spontaneously and did not require subsequent herniotomy.
Publisher: JMIR Publications Inc.
Date: 24-10-2017
DOI: 10.2196/RESPROT.8189
Publisher: JMIR Publications Inc.
Date: 10-10-2018
DOI: 10.2196/10361
Publisher: Springer Science and Business Media LLC
Date: 13-01-2018
DOI: 10.1007/S10567-017-0252-3
Abstract: Understanding how parents influence their child's medical procedures can inform future work to reduce pediatric procedural distress and improve recovery outcomes. Following a pediatric injury or illness diagnosis, the associated medical procedures can be potentially traumatic events that are often painful and distressing and can lead to the child experiencing long-term physical and psychological problems. Children under 6 years old are particularly at risk of illness or injury, yet their pain-related distress during medical procedures is often difficult to manage because of their young developmental level. Parents can also experience ongoing psychological distress following a child's injury or illness diagnosis. The parent and parenting behavior is one of many risk factors for increased pediatric procedural distress. The impact of parents on pediatric procedural distress is an important yet not well-understood phenomenon. There is some evidence to indicate parents influence their child through their own psychological distress and through parenting behavior. This paper has three purposes: (1) review current empirical research on parent-related risk factors for distressing pediatric medical procedures, and longer-term recovery outcomes (2) consider and develop existing theories to present a new model for understanding the parent-child distress relationship during medical procedures and (3) review and make recommendations regarding current assessment tools and developing parenting behavior interventions for reducing pediatric procedural distress.
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.BURNS.2007.02.012
Abstract: We wished to determine whether changing our centre's practice of using Acticoat instead of Silvazine as our first-line burns dressing provided a better standard of care in terms of efficacy, cost and ease of use. A retrospective cohort study was performed examining 328 Silvazine treated patients from January 2000 to June 2001 and 241 Acticoat treated patients from July 2002 to July 2003. During those periods the respective dressings were used exclusively. There was no significant difference in age, %BSA and mechanism of burn between the groups. In the Silvazine group, 25.6% of children required grafting compared to 15.4% in the Acticoat group (p=0.001). When patients requiring grafting were excluded, the time taken for re-epithelialisation in the Acticoat group (14.9 days) was significantly less than that for the Silvazine group (18.3 days), p=0.047. There were more wounds requiring long term scar management in the Silvazine group (32.6%) compared to the Acticoat group (29.5%), however this was not significant. There was only one positive blood culture in each group, indicating that both Silvazine and Acticoat are potent antimicrobial agents. The use of Acticoat as our primary burns dressing has dramatically changed our clinical practice. Inpatients are now only 18% of the total admissions, with the vast majority of patients treated on an outpatient basis. In terms of cost, Acticoat was demonstrated to be less expensive over the treatment period than Silvazine . We have concluded that Acticoat is a safe, cost-effective, efficacious dressing that reduces the time for re-epithelialisation and the requirement for grafting and long term scar management, compared to Silvazine.
Publisher: Wiley
Date: 19-07-2004
Publisher: Wiley
Date: 22-07-0012
DOI: 10.1111/WVN.12014
Publisher: Oxford University Press (OUP)
Date: 07-2008
Publisher: Springer Science and Business Media LLC
Date: 11-03-2014
Publisher: Elsevier BV
Date: 06-2003
DOI: 10.1016/S0305-4179(03)00008-1
Abstract: To document and describe the effects of flammable liquid burns in children. To identify the "at risk" population in order to tailor a burns prevention programme. Retrospective study with information obtained from the departmental database of children treated at the burns centre at The Royal Children's Hospital, Brisbane between August 1997 and October 2002. Number and ages of children burned, risk factors contributing to the accident, injuries sustained, treatment required and long-term sequelae. Fifty-nine children sustained flammable liquid burns (median age 10.5 years), with a clear preponderance of males (95%). The median total body surface area burned was 8% (range 0.5-70%). Twenty-seven (46%) of the patients required debridement and grafting. Hypertrophic scars occurred in 56% of the children and contractures in 14%, of which all of the latter required surgical release. Petrol was the causative liquid in the majority (83%) of cases. The study identified the population most at risk of sustaining flammable liquid burns were young adolescent males. In the majority of cases these injuries were deemed preventable.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.BURNS.2008.11.016
Abstract: Laser Doppler imaging (LDI) was compared to wound outcomes in children's burns, to determine if the technology could be used to predict these outcomes. Forty-eight patients with a total of 85 burns were included in the study. Patient median age was 4 years 10 months and scans were taken 0-186 h post-burn using the fast, low-resolution setting on the Moor LDI2 laser Doppler imager. Wounds were managed by standard practice, without taking into account the scan results. Time until complete re-epithelialisation and whether or not grafting and scar management were required were recorded for each wound. If wounds were treated with Silvazine or Acticoat prior to the scan, this was also recorded. The predominant colour of the scan was found to be significantly related to the re-epithelialisation, grafting and scar management outcomes and could be used to predict those outcomes. The prior use of Acticoat did not affect the scan relationship to outcomes, however, the use of Silvazine did complicate the relationship for light blue and green scanned partial thickness wounds. Scans taken within the 24-h window after-burn also appeared to be accurate predictors of wound outcome. Laser Doppler imaging is accurate and effective in a paediatric population with a low-resolution fast-scan.
Publisher: Wiley
Date: 28-04-2009
DOI: 10.1111/J.1440-1754.2008.01329.X
Abstract: The aim of this study was to report on the severity and incidence of children injured by treadmills and to promote the implementation of safety standards. This retrospective review of children with treadmill friction injuries was conducted in a single tertiary-level burns centre in Australia between January 1997 and June 2007. The study revealed 37 children who sustained paediatric treadmill friction injuries. This was a presentation of 1% of all burns. Thirty-three (90%) of the injuries occurred in the last 3.5 years (January 2004 to June 2007). The modal age was 3.2 years. Thirty-three (90%) injuries were either full thickness or deep partial friction burns. Eleven (30%) required split thickness skin grafts. Of those who became entrapped, 100% required skin grafting. This study found that paediatric treadmill friction injuries are severe and increasing in incidence. Australian standards should be developed, implemented and mandated to reduce this preventable and severe injury.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.BURNS.2011.04.012
Abstract: In 1957, Hynes first described the shaving and grafting procedure for the treatment of mature hypertrophic scars (HTSs). This procedure involved excision of mature HTS using a scalpel blade followed by split-skin grafting (SSG). We have modified this technique through the novel application of Versajet™ (Smith & Nephew, Hull, UK) for the sub-total excision of mature HTS with SSG. To date, this modified technique has shown excellent cosmetic results. A review of cases and an ex le of the technique is provided.
Publisher: Springer Science and Business Media LLC
Date: 19-02-2011
DOI: 10.1007/S00383-011-2868-6
Abstract: Negative pressure wound therapy (NPWT) is an accepted form of treatment in managing complex wounds in adults and children. It is not as widely used in the neonatal population due to limited clinical experience. We describe the application of the RENASYS™ system (Smith and Nephew, UK) in delivering NPWT to four neonates with complex gastroschisis, all of whom achieved successful outcomes.
Publisher: Elsevier BV
Date: 09-2002
DOI: 10.1016/S0305-4179(02)00077-3
Abstract: Burns for contact with irons are an important preventable cause of burns in children. The objective of this study, was to document and describe these burns. The report describes 50 children with iron burns who were treated at our Burns Unit between 1997 and 2001. Prospective data collection demographics, nature of contact with iron, site, body surface area (BSA), medical and surgical interventions and complications and hand preference were examined. The median of age patients was 17 months. The majority of burns were caused by touching the iron (44%) or by pulling the cord (38%). Most of the children were supervised (74%) and the iron was switched off in 34% of the injuries. Seventy-six percent of children sustained hand burns. Although, burn areas were relatively small, 36% required grafting. Residual scarring occurred in 42% and contractures in 10%. Surgical release of contractures was required in 4%. There is clearly a wide scope for prevention of hot iron burns. A public education c aign is now planned including: leaflets distributed at the point of purchase of the iron, public education via media outlets and lobbying of iron manufacturers to improve safety features.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.BURNS.2014.02.009
Abstract: A novel burn wound hydrogel dressing has been previously developed which is composed of 2-acrylamido-2-methylpropane sulfonic acid sodium salt with silver nanoparticles (silver AMPS). This study compared the cytotoxicity of this dressing to the commercially available silver products Acticoat™, PolyMem Silver(®) and Flamazine™ cream. Human keratinocytes (HaCaT and primary HEK) and normal human fibroblasts (NHF) were exposed to dressings incubated on Nunc™ polycarbonate inserts for 24, 48 and 72h. Four different cytotoxicity assays were performed including Trypan Blue cell count, MTT, Celltiter-Blue™ and Toluidine Blue surface area assays. The results were expressed as relative cell viability compared to an untreated control. The cytotoxic effects of Acticoat™ and Flamazine™ cream were dependent on exposure time and cell type. After 24h exposure, Acticoat™ and Flamazine™ cream were toxic to all tested cell lines. Surprisingly, HaCaTs treated with Acticoat™ and Flamazine™ had an improved ability to survive at 48 and 72h while HEKs and NHFs had no improvement in survival with any treatment. The novel silver hydrogel and PolyMem Silver(®) showed low cytotoxicity to all tested cell lines at every time interval and these results support the possibility of using the novel silver hydrogel as a burn wound dressing. Researchers who rely on HaCaT cells as an accurate keratinocyte model should be aware that they can respond differently to primary skin cells.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.BURNS.2014.12.017
Abstract: The early and accurate assessment of burns is essential to inform patient treatment regimens however, this first critical step in clinical practice remains a challenge for specialist burns clinicians worldwide. In this regard, protein biomarkers are a potential adjunct diagnostic tool to assist experienced clinical judgement. Free circulating haemoglobin has previously shown some promise as an indicator of burn depth in a murine animal model. Using blister fluid collected from paediatric burn patients, haemoglobin abundance was measured using semi-quantitative Western blot and immunoassays. Although a trend was observed in which haemoglobin abundance increased with burn wound severity, several patient s les deviated significantly from this trend. Further, it was found that haemoglobin concentration decreased significantly when whole cells, cell debris and fibrinous matrix was removed from the blister fluid by centrifugation although the relationship to depth was still present. Statistical analyses showed that haemoglobin abundance in the fluid was more strongly related to the time between injury and s le collection and the time taken for spontaneous re-epithelialisation. We hypothesise that prolonged exposure to the blister fluid microenvironment may result in an increased haemoglobin abundance due to erythrocyte lysis, and delayed wound healing.
Publisher: Wiley
Date: 27-10-2014
Abstract: The present study evaluates the prehospital care of paediatric burn patients in Queensland (QLD). As first aid (FA) treatment has been shown to affect burn progression and outcome, the FA treatment and the risk of associated hypothermia in paediatric patients were specifically examined in the context of paramedic management of burn patients. Data were retrospectively collected from electronic ambulance response forms (eARFs) for paediatric burn patients (0-5 years) who were attended by Queensland Ambulance Service (QAS) from 2008 to 2010. Data were collected from 117 eARFs of incidents occurring within the Brisbane, Townsville and Cairns regions. Initial FA measures were recorded in 77.8% of cases, with cool running water FA administered in 56.4% of cases. The duration of FA was recorded in 29.9% of reports. The duration of FA was significantly shorter for patients in Northern QLD (median = 10 min, n = 10) compared with Brisbane (median = 15 min, n = 18), P = 0.005. Patient temperatures were recorded significantly more often in Brisbane than in other regions (P = 0.041) however, in total, only 24.8% of all patients had documented temperature readings. Of these, six (5%) were recorded as having temperatures ≤ 36.0°C. Burnaid(TM) was the most commonly used dressing and was applied to 55.6% of all patients however, it was applied with a variety of different outer dressings. Brisbane paramedics applied Burnaid significantly less often (44.3%) compared with paramedics from Northern QLD (72.7%) and Far Northern QLD (60.9%), P = 0.025. Despite FA and patient temperatures being important prognostic factors for burn patients, paramedic documentation of these was often incomplete, and there was no consistent use of burns dressings.
Publisher: Mary Ann Liebert Inc
Date: 02-2014
Abstract: Early childhood is a high-risk time for exposure to potentially traumatic medical events. We have previously reported that 10% of young children continue to have posttraumatic stress disorder (PTSD) 6 months after burn injury. This study aimed to 1) document the prevalence and prospective change in parental psychological distress over 6 months following their child's burn injury and 2) identify risk factors for posttraumatic stress symptoms (PTSS) in young children and their parents. Participants were 120 parents of 1-6-year-old children with unintentional burn injuries. Data were collected within 2 weeks, 1 month, and 6 months of burn injury using developmentally sensitive diagnostic interviews and questionnaires. Within the first month, ∼ 25% of parents had a probable PTSD diagnosis, and moderate to extremely severe levels of depression, anxiety, and stress. Distress levels decreased significantly over time however, 5% of parents still had probable PTSD at 6 months. Hierarchical multiple regression and path analyses indicated that parent posttraumatic stress reactions contributed significantly to the development and maintenance of child PTSS. Other risk factors for child PTSS included premorbid emotional and behavioral difficulties and larger burn size. Risk factors identified for parent PTSS included prior trauma history, acute distress, greater number of child invasive procedures, guilt, and child PTSS. The findings from this study suggest that parents' responses to a traumatic event may play a particularly important role in a young child's psychological recovery. However, further research is needed to confirm the direction of the relationship between child and parent distress. This study identified variables that could be incorporated into screening tools or targeted by early intervention protocols to prevent the development of persistent child and parent PTSS following medical trauma.
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.BURNS.2005.04.030
Abstract: To evaluate the safety and efficacy of Acticoat use in primary burn injuries and other skin injuries in premature neonates. An audit of eight premature neonates who sustained burn injuries and other cutaneous injuries from various agents were treated with Acticoat. Serum silver levels were measured in three neonates. Wounds were assessed for infection and blood cultures were taken where sepsis was suspected. Neonates ranged from 23 to 28 weeks gestation (weight: 578-1078 g). Causative injury mechanisms included: alcoholic chlorhexidine, alcoholic wipes, electrode jelly, extravasated intravenous fluids, artery illuminator, temperature probe and adhesive tape removal. Total burned body surface area ranged from 1 to 30%. All neonates were treated with Acticoat dressing changed every 3-7 days. All wounds re-epithelialised by day 28 and scar management was not required. There were four mortalities secondary to problems associated with extreme prematurity. Serum silver levels ranged from 0 to 1 micromol/L. There were no wound infections or positive blood cultures during the treatment period. Acticoat is a suitable dressing for premature neonates who have sustained burn injury, with the advantage of minimal handling as the dressing need only be changed every 3-7 days.
Publisher: Elsevier BV
Date: 04-2022
Publisher: BMJ
Date: 28-09-2012
Publisher: Springer Science and Business Media LLC
Date: 25-07-2014
DOI: 10.1007/S00383-014-3545-3
Abstract: The degree of viscero-abdominal disproportion often makes single-stage reduction difficult in large abdominal wall defects, without risking respiratory or hemodynamic compromise. As a consequence, clinicians have adopted a number of different methods to control these defects. Repair may be in the neonatal period, or later in life. Delayed repairs require epithelialization of the gastroschisis or omphalocele. Definitive repair may be in single or multiple stages. This paper describes four children in whom negative pressure wound therapy (NPWT) was used to facilitate closure of these complex defects.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.BURNS.2011.03.005
Abstract: Prior to 2004, Australia and New Zealand lacked a systematic method to measure burn incidence, aetiology and quality of care or outcomes for burn patients. The Australian and New Zealand Burn Association (ANZBA) commenced the Bi-National Burns Registry (Bi-NBR) at that time. As a result of the limitations identified with the registry, ANZBA collaborated with Monash University to develop the registry as a clinical quality registry [1]. A Steering Committee was formed to oversee the conduct and development of the registry. A Reference Committee revised the minimum dataset and working parties developed clinical quality indicators, and an outcome pilot project. Institutional ethics approval has been obtained for 16 out of 17 sites and a formalised governance process developed. The minimum dataset was improved and includes clinical quality indicators. The Bi-NBR clinical quality registry was launched on July 1st 2009. A long-term outcome pilot project has been developed with five burn units participating (recruitment commenced October 2009). Through a rigorous development process, a clinical quality registry for burns has been established which allows benchmarking of processes and outcomes between units. The intention is that all burns units across Australia and New Zealand will contribute to the registry.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Publisher: Wiley
Date: 06-2009
DOI: 10.1111/J.1600-0560.2008.01141.X
Abstract: Silver dressings have been widely and successfully used to prevent cutaneous wounds, including burns, chronic ulcers, dermatitis and other cutaneous conditions, from infection. However, in a few cases, skin discolouration or argyria-like appearances have been reported. This study investigated the level of silver in scar tissue post-burn injury following application of Acticoat, a silver dressing. A porcine deep dermal partial thickness burn model was used. Burn wounds were treated with this silver dressing until completion of re-epithelialization, and silver levels were measured in a total of 160 scars and normal tissues. The mean level of silver in scar tissue covered with silver dressings was 136 microg/g, while the silver level in normal skin was less than 0.747 microg/g. A number of wounds had a slate-grey appearance, and dissection of the scars revealed brown-black pigment mostly in the middle and deep dermis within the scar. The level of silver and the severity of the slate-grey discolouration were correlated with the length of time of the silver dressing application. These results show that silver deposition in cutaneous scar tissue is a common phenomenon, and higher levels of silver deposits and severe skin discolouration are correlated with an increase in the duration of this silver dressing application.
Publisher: Elsevier BV
Date: 06-2008
Abstract: Topical administration of growth factors has displayed some potential in wound healing, but variable efficacy, high doses, and costs have h ered their implementation. Moreover, this approach ignores the fact that wound repair is driven by interactions between multiple growth factors and extracellular matrix (ECM) proteins. We report herein that complexes comprising IGF and IGF-binding proteins bound to the ECM protein vitronectin (VN) significantly enhance cellular functions relevant to wound repair in human skin keratinocytes in two- and three-dimensional in vitro cell models and are active, even in the presence of wound fluid. Moreover, these responses require activation of both the IGF receptor and the VN-binding alpha(v) integrins. Further, we assessed the complexes as a topical agent in the treatment of deep dermal partial thickness burns in a porcine model. This pilot study revealed that the complexes may hold promise as a wound healing therapy. Critically, the significant responses observed in vitro and the encouraging preliminary data in vivo were obtained with nanogram doses of growth factors. This suggests that coupling delivery of growth factors to ECM proteins such as VN may ultimately prove to be a more effective strategy for developing a wound healing therapy.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.BURNS.2014.11.005
Abstract: This study compared the effects of three silver dressing combinations on small to medium size acute partial thickness burns in children, focusing on re-epithelialization time, pain and distress during dressing changes. Children (0-15 years) with clean, ≤ 10% total body surface area (TBSA) partial thickness burns who met the inclusion criteria were included in the study. Children received either (1) Acticoat™ (2) Acticoat™ with Mepitel™ or (3) Mepilex Ag™ dressings. Measures of burn re-epithelialization, pain, and distress were recorded at dressing changes every 3-5 days until full re-epithelialization occurred. One hundred and three children were recruited with 96 children included for analysis. No infections were detected for the course of the study. When adjusted for burn depth, Acticoat™ significantly increased the expected days to full re-epithelialization by 40% (IRR = 1.40 95% CI: 1.14-1.73, p < 0.01) and Acticoat™ with Mepitel™ significantly increased the expected days to full re-epithelialization by 33% (IRR = 1.33 95% CI: 1.08-1.63, p ≤ 0.01) when compared to Mepilex Ag™. Expected FLACC scores in the Mepilex Ag™ group were 32% lower at dressing removal (p = 0.01) and 37% lower at new dressing application (p = 0.04) and scores in the Acticoat™ with Mepitel™ group were 23% lower at dressing removal (p = 0.04) and 40% lower at new dressing application (p < 0.01), in comparison to the Acticoat™ group. Expected Visual Analog Scale-Pain (VAS-P) scores were 25% lower in the Mepilex Ag™ group at dressing removal (p = 0.04) and 34% lower in the Acticoat™ with Mepitel™ group (p = 0.02) at new dressing application in comparison to the Acticoat™ group. There was no significant difference between the Mepilex Ag™ and the Acticoat™ with Mepitel™ groups at all timepoints and with any pain measure. Mepilex Ag™ is an effective silver dressing, in terms of accelerated wound re-epithelialization time (compared to Acticoat™ and Acticoat™ with Mepitel™) and decreased pain during dressing changes (compared to Acticoat™), for clean, < 10% TBSA partial thickness burns in children.
Publisher: Elsevier BV
Date: 10-2004
DOI: 10.1093/BJA/AEH236
Publisher: Oxford University Press (OUP)
Date: 08-08-2010
Abstract: Commercially available generic Superglue (cyanoacrylate glue) can be used as an alternative mounting medium for stained resin-embedded semithin sections. It is colourless and contains a volatile, quick-setting solvent that produces permanent mounts of semithin sections for immediate inspection under the light microscope. Here, we compare the use of cyanoacrylate glue for mounting semithin sections with classical dibutyl phthalate xylene (DPX) in terms of practical usefulness, effectiveness and the quality of the final microscopic image.
Publisher: Wiley
Date: 03-2004
DOI: 10.1046/J.1445-2197.2004.02916.X
Abstract: Burn sepsis is a leading cause of mortality and morbidity in patients with major burns. The use of topical antimicrobial agents has helped improve the survival of these patients. Silvazine (Sigma Pharmaceuticals, Melbourne, Australia) (1% silver sulphadiazine and 0.2% chlorhexidine digluconate) is used exclusively in Australasia, and there is no published study on its cytotoxicity. This study compared the relative cytotoxicity of Silvazine with 1% silver sulphadiazine (Flamazine (Smith & Nephew Healthcare, Hull, UK)) and a silver-based dressing (Acticoat (Smith & Nephew Healthcare, Hull, UK)). Dressings were applied to the centre of culture plates that were then seeded with keratinocytes at an estimated 25% confluence. The plates were incubated for 72 h and culture medium and dressings then removed. Toluidine blue was added to stain the remaining keratinocytes. Following removal of the dye, the plates were photographed under standard conditions and these digital images were analysed using image analysis software. Data was analysed using Student's t-test. In the present study, Silvazine is the most cytotoxic agent. Seventy-two hour exposure to Silvazine in the present study results in almost no keratinocyte survival at all and a highly statistically significant reduction in cell survival relative to control, Acticoat and Flamazine (P<0.001, P<0.01, P<0.01, respectively). Flamazine is associated with a statistically significant reduction in cell numbers relative to control (P<0.05), but is much less cytotoxic than Silvazine (P<0.005). In this in-vitro study comparing Acticoat, Silvazine and Flamazine, Silvazine shows an increased cytotoxic effect, relative to control, Flamazine and Acticoat. An in-vivo study is required to determine whether this effect is carried into the clinical setting.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.BURNS.2013.05.011
Abstract: A novel burn wound hydrogel dressing has been previously developed which is composed of 2-acrylamido-2-methylpropane sulfonic acid sodium salt with silver nanoparticles. This study compared the antimicrobial efficacy of this novel dressing to two commercially available silver dressings Acticoat™ and PolyMem Silver(®). Three different antimicrobial tests were used: disc diffusion, broth culture, and the Live/Dead(®) Baclight™ bacterial viability assay. Burn wound pathogens (P. aeruginosa, MSSA, A. baumannii and C. albicans) and antibiotic resistant strains (MRSA and VRE) were tested. All three antimicrobial tests indicated that Acticoat™ was the most effective antimicrobial agent, with inhibition zone lengths of 13.9-18.4mm. It reduced the microbial inocula below the limit of detection (10(2)CFU/ml) and reduced viability by 99% within 4h. PolyMem Silver(®) had no zone of inhibition for most tested micro-organisms, and it also showed poor antimicrobial activity in the broth culture and Live/Dead(®) Baclight™ assays. Alarmingly, it appeared to promote the growth of VRE. The silver hydrogel reduced most of the tested microbial inocula below the detection limit and decreased bacterial viability by 94-99% after 24h exposure. These results support the possibility of using this novel silver hydrogel as a burn wound dressing in the future.
Publisher: Wiley
Date: 09-2008
Publisher: Elsevier BV
Date: 11-2006
DOI: 10.1016/J.BURNS.2006.02.023
Abstract: We developed a reproducible model of deep dermal partial thickness burn injury in juvenile Large White pigs. The contact burn is created using water at 92 degrees C for 15s in a bottle with the bottom replaced with plastic wrap. The depth of injury was determined by a histopathologist who examined tissue sections 2 and 6 days after injury in a blinded manner. Upon creation, the circular wound area developed white eschar and a hyperaemic zone around the wound border. Animals were kept for 6 weeks or 99 days to examine the wound healing process. The wounds took between 3 and 5 weeks for complete re-epithelialisation. Most wounds developed contracted, purple, hypertrophic scars. On measurement, the thickness of the burned skin was approximately 1.8 times that of the control skin at week 6 and approximately 2.2 times thicker than control skin at 99 days after injury. We have developed various methods to assess healing wounds, including digital photographic analysis, depth of organising granulation tissue, immunohistochemistry, electron microscopy and tensiometry. Immunohistochemistry and electron microscopy showed that our porcine hypertrophic scar appears similar to human hypertrophic scarring. The development of this model allows us to test and compare different treatments on burn wounds.
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.BURNS.2008.05.030
Abstract: This retrospective review examines healing in different sites on a porcine burn model 24 pairs of burns on 18 pigs from other animal trials were selected for analysis. Each pair of burns was located on the either the cranial or the caudal part of the thoracic ribs region, on the same side of the animal. The burns were 40-50 cm(2) in size and of uniform deep-dermal partial thickness. Caudal burns healed significantly better than cranial burns, demonstrated by earlier closure of wounds, less scar formation and better cosmesis. To our knowledge, this is the first detailed study reporting that burn healing is affected by location on a porcine burn model. We recommend that similar symmetrical burns should be used for future comparative assessments of burn healing.
Publisher: Springer Science and Business Media LLC
Date: 2013
Publisher: Oxford University Press (OUP)
Date: 10-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
DOI: 10.1002/HEP.26937
Abstract: Although nonalcoholic fatty liver disease (NAFLD) is conventionally assessed histologically for lobular features of inflammation, development of portal fibrosis appears to be associated with disease progression. We investigated the composition of the portal inflammatory infiltrate and its relationship to the ductular reaction (DR), a second portal phenomenon implicated in fibrogenesis. The portal inflammatory infiltrate may contribute directly to fibrogenesis as well as influence the fate of the DR hepatic progenitor cells (HPCs), regulating the balance between liver repair and fibrosis. The presence of portal inflammation in NAFLD was strongly correlated with disease severity (fibrosis stage) and the DR. The portal infiltrate was characterized by immunostaining NAFLD liver biopsy sections (n = 33) for broad leukocyte subset markers (CD68, CD3, CD8, CD4, CD20, and neutrophil elastase) and selected inflammatory markers (matrix metalloproteinase 9 and interleukin [IL]-17). Cells expressing all markers examined were identified throughout the liver lobules and in portal tracts, although portal tracts were more densely populated (P < 0.01), and dominated by CD68(+) macrophages and CD8(+) lymphocytes, at all stages of disease. An increase in portal macrophages in NAFLD patients with steatosis alone (P < 0.01) was the earliest change detected, even before elevated expression of the proinflammatory cytokines, IL1B and TNF, in patients with early NASH (P < 0.05). Portal and periductal accumulation of all other cell types examined occurred in progressed NASH (all P < 0.05). Knowledge of the complex cellular composition of the portal inflammatory infiltrate and HPC/DR niche in NAFLD will shape future functional studies to elucidate the contribution of portal inflammation to HPC differentiation and NAFLD pathogenesis.
Publisher: Elsevier BV
Date: 09-2009
Publisher: Wiley
Date: 25-04-2013
DOI: 10.1111/JPC.12204
Abstract: To describe paediatric (0-15 years) motorcycle incidents in Queensland, inform safety policy and identify opportunities to improve data in this area. Population-based study of motorcycle-related child (0-15 years) trauma, resulting in fatality or hospital admission beyond 24 h to any Queensland public hospital (2007-2009). Data compiled by Statewide Trauma Network and Commission for Children and Young People and Child Guardian. Ten child fatalities were recorded (child death rate = 0.36/100,000 population 0-15 years). All were male and primary riders of their motorcycle. Nine fatalities were related to head injury of these, five wore inadequate head protection. The coroner identified rider factors as contributory (speed, age or substance abuse) in seven cases. Motorcycle-related incidents were the second most common mechanism recorded after bicycles, comprising 6.8% of 9141 paediatric trauma cases (619 motorcycle-related incidents 1225 injuries admission rate = 22.2/100,000 population 0-15 years). Compared with the all-trauma population, patients were older (median age = 13 vs. 10 years) and more frequently male (85% vs. 67%). Average admission was 4.4 days (head injuries = 7.0 days burns = 5.8 days). Most children incurred >1 injury (mean = 2.01 injuries) with fractures (45%) and open wounds (17%) most common. As a proportion of all diagnoses, most injuries were to lower limb (44%), upper limb (26%) or head and neck (16%). These data emphasise the need for children to use full protective equipment, especially helmets. Children are not currently protected by legislation mandating safety standards. Regulating rider age and safety standards (protective equipment, training and vehicle maintenance) may reduce the rate and severity of injury.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.BURNS.2013.09.027
Abstract: An important treatment goal for burn wounds is to promote early wound closure. This study identifies factors associated with delayed re-epithelialization following pediatric burn. Data were collected from August 2011 to August 2012, at a pediatric tertiary burn center. A total of 106 burn wounds were analyzed from 77 participants aged 4-12 years. Percentage of wound re-epithelialization at each dressing change was calculated using Visitrak™. Mixed effect regression analysis was performed to identify the demographic factors, wound and clinical characteristics associated with delayed re-epithelialization. Burn depth determined by laser Doppler imaging, ethnicity, pain scores, total body surface area (TBSA), mechanism of injury and days taken to present to the burn center were significant predictors of delayed re-epithelialization, accounting for 69% of variance. Flame burns delayed re-epithelialization by 39% compared to all other mechanisms (p = 0.003). When initial presentation to the burn center was on day 5, burns took an average of 42% longer to re-epithelialize, compared to those who presented on day 2 post burn (p < 0.000). Re-epithelialization was delayed by 14% when pain scores were reported as 10 (on the FPS-R), compared to 4 on the first dressing change (p = 0.015) for children who did not receive specialized preparation/distraction intervention. A larger TBSA was also a predictor of delayed re-epithelialization (p = 0.030). Darker skin complexion re-epithelialized 25% faster than lighter skin complexion (p = 0.001). Burn depth, mechanism of injury and TBSA are always considered when developing the treatment and surgical management plan for patients with burns. This study identifies other factors influencing re-epithelialization, which can be controlled by the treating team, such as effective pain management and rapid referral to a specialized burn center, to achieve optimal outcomes.
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.BURNS.2009.08.002
Abstract: Using our porcine model of deep dermal partial thickness burn injury, various durations (10min, 20min, 30min or 1h) and delays (immediate, 10min, 1h, 3h) of 15 degrees C running water first aid were applied to burns and compared to untreated controls. The subdermal temperatures were monitored during the treatment and wounds observed weekly for 6 weeks, for re-epithelialisation, wound surface area and cosmetic appearance. At 6 weeks after the burn, tissue biopsies were taken of the scar for histological analysis. Results showed that immediate application of cold running water for 20min duration is associated with an improvement in re-epithelialisation over the first 2 weeks post-burn and decreased scar tissue at 6 weeks. First aid application of cold water for as little as 10min duration or up to 1h delay still provides benefit.
Publisher: Elsevier BV
Date: 08-2002
DOI: 10.1016/S0305-4179(02)00046-3
Abstract: To document and describe the effects of woodstove burns in children. To identify how these accidents occur so that a prevention strategy can be devised. Retrospective departmental database and case note review of all children with woodstove burns seen at the Burns Unit of a Tertiary Referral Children's Hospital between January 1997 and September 2001. Number and ages of children burned circumstances of the accidents injuries sustained treatment required and long-term sequelae. Eleven children, median age 1.0 year, sustained burns, usually to the hands, of varying thickness. Two children required skin grafting and five required scar therapy. Seven children intentionally placed their hands onto the outside of the stove. In all children, burns occurred despite adult supervision. Woodstoves are a cause of burns in children. These injuries are associated with significant morbidity and financial costs. Through public education, woodstove burns can easily be prevented utilising simple safety measures.
Publisher: Wiley
Date: 08-08-2020
DOI: 10.1111/JPC.15117
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.JPEDSURG.2004.11.030
Abstract: In gastroschisis it is proposed that gut reduction may be achieved without intubation or general anesthesia (GA) through ward reduction. The authors aimed to determine if ward reduction decreased morbidity and duration of treatment. Infants born from January 1, 1995, to December 31, 2001, with gastroschisis were managed with either reduction under GA in the operating theatre (OT group)--up to September 1999, or ward reduction (when eligible) in the neonatal unit without GA/ventilation (ward reduction [WR] group)--from September 1999. Of the 37 infants, 31 were eligible for ward reduction-15 from the OT group, 16 from the WR group. All infants in the OT group had at least 1 episode of ventilation and 1 GA: 62% of infants in the WR group avoided ventilation (P = .0002) and 81% avoided GA (P < .0001). Infants who had ward reduction had significantly shorter durations of ventilation and oxygen therapy. Septicemia occurred in 31% of the WR group and 7% of the OT group (P = .17). Infants who had ward reduction left intensive care 16 days earlier (P = .02) and tended to reach full enteral feeds 8 days sooner (P = .06) and be discharged from hospital 15 days earlier (P = .05). Infants who had ward reduction do better in terms of avoiding GA/ventilation, establishing feeds, and going home earlier. A randomized, controlled trial comparing the 2 approaches is feasible, safe, and worthwhile.
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.BURNS.2007.08.004
Abstract: Microskin is a sprayed on, computer color-matched, skin camouflage which can last for up to 5 days after application. It binds to the epidermis and the patient can sweat and swim with it on. The purpose of the current study was to determine whether Microskin produces psychosocial benefit in pediatric burns patients. Twenty children with mature burn scars took part in the study and used Microskin for 5 weeks. Initially, 10 children were randomized to a treatment group while the remaining 10 became a wait-list group for 7 weeks. The wait-list group subsequently received Microskin for 5 weeks. Before and after using Microskin, children completed three psychosocial measures the Strengths and Difficulties Questionnaire (SDQ), the Family Assessment Device-General Functioning scale (FAD-GF), and the Microskin Questionnaire (MQ-a questionnaire about their experience using Microskin developed specifically for this study). All children were followed up with the same measures 6 months after their completed use of Microskin. After the 5-week Microskin trial there was improvement on all scales of the SDQ for the 10 children in the first treatment group but not for the wait-list group. After the wait-list group used Microskinfor 5 weeks they too improved on all scales. Combining the results for all 20 children from before to after using Microskin there was a statistically significant improvement in the SDQ Emotional Symptoms and Total Difficulties. There was also improved perception of family functioning after using Microskin. Six-month follow-up data showed continued psychosocial improvement. Overall, children felt more confident, happier, and enjoyed social outings more when they had Microskin on, with 95% intending to continue to use Microskin. Microskin improves psychosocial functioning in pediatric burn patients and is well-tolerated and acceptable. The small s le size precludes sophisticated statistical analyses and generalization of results. There is a need for a full scale randomized controlled study of Microskin with a larger s le size.
Publisher: Springer Science and Business Media LLC
Date: 08-02-2015
Publisher: Springer Science and Business Media LLC
Date: 03-04-2003
DOI: 10.1007/S00383-002-0886-0
Abstract: This retrospective study elicits information regarding the dependence of neonatal outcome in gastroschisis upon: (1) the mode of delivery, (2) place of birth, (3) time for birth to surgery, (4) method of closure, (5) time from operation to commencement of first enteral feeds. The neonatal intensive care database from five major tertiary centres was used to identify 181 neonates with gastroschisis from 1990 to 2000. There were 8 deaths. There were no significant differences in outcome for infants delivered vaginally (102) versus Caesarean section (79), those born near the tertiary centre (133) as compared to infants born away (48), ones operated within 7 hours (125) compared with those operated after 7 hours (56), with delayed closure (30) versus primary closure (151). Neonates fed within 10 days of operation (85) had significantly lower incidence of sepsis, duration of TPN and hospital stay when compared to those fed after 10 days (96). Early commencement of feeds decreases the incidence of sepsis, duration of total parenteral nutrition (TPN) and hospital stay. Place of delivery, mode of delivery, time to surgery and type of closure do not influence neonatal outcome.
Publisher: Elsevier BV
Date: 02-2004
DOI: 10.1016/J.BURNS.2003.09.008
Abstract: Burn sepsis is a leading cause of mortality and morbidity in patients with major burns. The use of topical anti-microbial agents has helped improve the survival in these patients. There are a number of anti-microbials available, one of which, Silvazine (1% silver sulphadiazine (SSD) and 0.2% chlorhexidine digluconate), is used only in Australasia. No study, in vitro or clinical, had compared Silvazine with the new dressing Acticoat. This study compared the anti-microbial activity of Silvazine, Acticoat and 1% silver sulphadiazine (Flamazine) against eight common burn wound pathogens. Each organism was prepared as a suspension. A 10 microl inoculum of the chosen bacterial isolate (representing approximately between 10(4) and 10(5) total bacteria) was added to each of four vials, followed by s les of each dressing and a control. The broths were then incubated and 10 microl loops removed at specified intervals and transferred onto Horse Blood Agar. These plates were then incubated for 18 hours and a colony count was performed. The data demonstrates that the combination of 1% SSD and 0.2% chlorhexidine digluconate (Silvazine) results in the most effective killing of all bacteria. SSD and Acticoat had similar efficacies against a number of isolates, but Acticoat seemed only bacteriostatic against E. faecalis and methicillin-resistant Staphylococcus aureus. Viable quantities of Enterobacter cloacae and Proteus mirabilis remained at 24h. The combination of 1% SSD and 0.2% chlorhexidine digluconate (Silvazine) is a more effective anti-microbial against a number of burn wound pathogens in this in vitro study. A clinical study of its in vivo anti-microbial efficacy is required.
Publisher: SAGE Publications
Date: 03-2008
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.BURNS.2009.05.019
Abstract: Medical student attendance in the Outpatient Department is not only essential for the teaching of paediatric burns, but is also important in the recruitment of promising in iduals for the growth of our speciality. In 2008, 110 consecutive parents were asked to complete written surveys before the start of their clinic appointment. Only one parent per family could choose to complete the survey. The response rate was 100%. Parents from a erse range of cultural, educational and socioeconomic were represented in this study. Eighteen parents (16.4%), 48 parents (46.3%) and 44 parents (40.0%) considered their child's burn to be severe, moderate and mild, respectively. One hundred and nine parents (99.1%) accepted the attendance of medical students. Forty-two parents (38.5%) preferred fewer than 3 students, 35 parents (32.1%) would be comfortable with 3-5 medical students and 32 parents (29.4%) could accept more than 6 medical students. One hundred and two parents (92.7%) would allow students to physically interact with their children and 108 parents (99.2%) would allow medical students to freely ask questions in burns clinic. Using logistic regression analysis, we found that high income earners would be comfortable with fewer medical students attending clinic than low income earners (p=0.007). Also, younger parents (p=0.002) and parents from families who made less than A$25,000 a year (p=0.009), believed that they could perceive 'a lot of benefit' from observing medical students being taught, whereas older parents and parents from higher income families responded more often with a perception of only 'some benefit'. This first study in a paediatric outpatient setting shows that parents are overwhelmingly prepared to have medical students involved in the care of their child.
Publisher: BMJ
Date: 21-01-2014
Publisher: Elsevier BV
Date: 06-2008
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.BURNS.2011.03.017
Abstract: We have developed a method to test the cytotoxicity of wound dressings, ointments, creams and gels used in our Burn Centre, by placing them on a permeable Nunc™ Polycarbonate cell culture insert, incubated with a monolayer of cells (HaCaTs and primary human keratinocytes). We performed two different methods to determine the relative toxicity to cells. (1) Photo visualisation: The dressings or compounds were positioned on the insert's membrane which was placed onto the monolayer tissue culture plate. After 24 h the surviving adherent cells were stained with Toluidine Blue and photos of the plates were taken. The acellular area of non-adherent dead cells which had been washed off with buffer was measured as a percentage of the total area of the plate. (2) Cell count of surviving cells: After 24 h incubation with the test material, the remaining cells were detached with trypsin, spun down and counted in a Haemocytometer with Trypan Blue, which differentiates between live and dead cells. Seventeen products were tested. The least cytotoxic products were Melolite™, White soft Paraffin™ and Chlorsig1% Ointment. Some cytotoxicity was shown with Jelonet™, Mepitel(®), PolyMem(®), DuoDerm(®) and Xeroform™. The most cytotoxic products included those which contained silver or Chlorhexidine and Paraffin Cream™ a moisturizer which contains the preservative Chlorocresol. This in vitro cell culture insert method allows testing of agents without direct cell contact. It is easy and quick to perform, and should help the clinician to determine the relative cytotoxicity of various dressings and the optimal dressing for each in idual wound.
Publisher: Oxford University Press (OUP)
Date: 05-2004
DOI: 10.1097/01.BCR.0000124821.22553.24
Abstract: Our objective was to compile data on the mechanism and severity of injuries associated with hot beverage burns in children. We identified 152 children over a 3-year period who attended a tertiary level burns center, representing 18% of all children treated. Their median age was 17.5 months and median body surface area burned was 4% (range, 0.25% to 32%). Significantly, 52% of children required admission, 18% received a split skin graft, and 26% required long-term scar management. In 70% of all cases, the mechanism of injury was the child pulling the hot beverage over himself or herself. In 80% of incidents, a primary care giver witnessed the injury. These findings indicate that scalding from hot beverages carries significant morbidity and is an important pediatric public health issue. It is clear that further research towards effective education programs for primary caregivers is warranted.
Publisher: Wiley
Date: 2005
DOI: 10.1111/J.1440-1754.2005.00531.X
Abstract: Objectives: To identify and demonstrate necrotizing dermatitis in infancy an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation and in particular on the speculative role of the Australian White‐tailed spider, L ona cylindrata . Methods: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. Result: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine crème. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White‐tailed spider, L ona cylindrata , does not occur in Queensland, but L ona murina does neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. Conclusion: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.BURNS.2011.03.013
Abstract: High-resolution, high-contrast, three-dimensional images of live cell and tissue architecture can be obtained using second harmonic generation (SHG), which comprises non-absorptive frequency changes in an excitation laser line. SHG does not require any exogenous antibody or fluorophore labeling, and can generate images from unstained sections of several key endogenous biomolecules, in a wide variety of species and from different types of processed tissue. Here, we examined normal control human skin sections and human burn scar tissues using SHG on a multi-photon microscope (MPM). Examination and comparison of normal human skin and burn scar tissue demonstrated a clear arrangement of fibers in the dermis, similar to dermal collagen fiber signals. Fluorescence-staining confirmed the MPM-SHG collagen colocalization with antibody staining for dermal collagen type-I but not fibronectin or elastin. Furthermore, we were able to detect collagen MPM-SHG signal in human frozen sections as well as in unstained paraffin embedded tissue sections that were then compared with hematoxylin and eosin staining in the identical sections. This same approach was also successful in localizing collagen in porcine and ovine skin s les, and may be particularly important when species-specific antibodies may not be available. Collectively, our results demonstrate that MPM SHG-detection is a useful tool for high resolution examination of collagen architecture in both normal and wounded human, porcine and ovine dermal tissue.
Publisher: Wiley
Date: 09-09-2012
DOI: 10.1111/J.1445-2197.2012.06212.X
Abstract: About two-thirds of medical students are distributed among the major metropolitan tertiary teaching hospitals in Queensland, while the remainder are sent to regional hospitals up to 500 km away. The aim of this study was to investigate the feasibility and effectiveness of conducting surgical tutorials via videoconferencing (VC) for medical students undertaking at remote hospitals. Surgical tutorials were offered to final-year medical students at the Royal Children's Hospital (RCH) in Brisbane and shared by VC to students undertaking clinical placement at nine remotely located hospitals in Queensland. We have conducted a retrospective review of service activity, student satisfaction and subject scores from 2008 to 2010. The main outcome measures were VC activity, medical students' satisfaction and student exam results pre- and post-introduction of the surgical tutorial programme. Between March 2009 and November 2010, a total of 57 VC tutorials were conducted during nine rotations for a total of 669 students. Approximately, 35% of students (236) attended tutorials face-to-face at the RCH while the remainder (including those at the Mater Children's Hospital in Brisbane and eight regional sites) participated via VC. A snapshot survey to measure satisfaction of both groups of students showed that overall satisfaction was very high. A total of 299 students completed the paediatrics and child health multiple-station assessment task exam in 2008, 326 in 2009 and 382 in 2010. The pre-intervention (tutorials not delivered by VC) median scores (interquartile range) of surgical and non-surgical questions were 5 (4-6) and 23 (21-25). Post-intervention, surgical scores increased significantly to 6 (5-7) (P < 0.001), while non-surgical scores remained similar at 23 (21-25) (P = 0.64). Our study demonstrates that VC is a feasible and effective method of engaging medical students regardless of their location. VC provides equitable access to medical teaching for medical students undertaking remote clinical placements.
Publisher: Wiley
Date: 03-2005
DOI: 10.1111/J.1067-1927.2005.130211.X
Abstract: Our group has developed an ovine model of deep dermal, partial-thickness burn where the fetus heals scarlessly and the lamb heals with scar. The comparison of collagen structure between these two different mechanisms of healing may elucidate the process of scarless wound healing. Picrosirius staining followed by polarized light microscopy was used to visualize collagen fibers, with digital capture and analysis. Collagen deposition increased with fetal age and the fibers became thicker, changing from green (type III collagen) to yellow/red (type I collagen). The ratio of type III collagen to type I was high in the fetus (166), whereas the lamb had a much lower ratio (0.2). After burn, the ratios of type III to type I collagen did not differ from those in control skin for either fetus or lamb. The fetal tissue maintained normal tissue architecture after burn while the lamb tissue showed irregular collagen organization. In conclusion, the type or amount of collagen does not alter significantly after injury. Tissue architecture differed between fetal and lamb tissue, suggesting that scar development is related to collagen cross-linking or arrangement. This study indicates that healing in the scarless fetal wound is representative of the normal fetal growth pattern, rather than a "response" to burn injury.
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.BURNS.2007.07.016
Abstract: To determine the numbers of paediatric scald injuries associated with the practice of inhaling warmed vapour or warm-humidification of rooms for treatment of upper respiratory tract infection (URTI). Cases comprised a 6-year consecutive series of scalds in children 0-14 years attending the Royal Children's Hospital (RCH) in Brisbane, Australia. All scalds were sustained either directly from a container of hot water, or by room humidification. During 2001-2006, 27 children were treated for scald injury associated with breathing humidified air. Aged from 7 months to 14 years, 44% were under 3 years old and the modal age was 1 year. Injuries included steam burns to the hands from commercial vapour-producing devices in children younger than three, and spills from containers of hot water which resulted in larger scalds to multiple body sites in children aged 5-14. No child received an airway scald from hot vapour. Two children required grafts and four had a prolonged hospital stay. Total body surface area (TBSA) scalded, ranged from 1% to 15% and the majority of burns were deep dermal partial thickness. The common practice of warm-humidification of inspired air as home treatment of URTI's carries an under-recognised risk of serious scalding. An alternative means of providing humidified air is to sit with your child in a closed bathroom whilst running the shower for a short time. If warm humidification is to be used, increased awareness of the risk by both parents and health professionals may reduce the incidence of this serious burn.
Publisher: Elsevier BV
Date: 08-2008
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Roy Kimble.