Scar outcomes for conservatively managed children post burn injury: A retrospective study.

Hypertrophic scarring is a significant complication post burn injury, especially for delayed healing after 3 weeks. Burn injuries healing prior to 3 weeks also have the potential to develop hypertrophic scarring, even when prescribed prophylactic conservative scar interventions. A retrospective chart audit reviewed 326 burn patients treated at a paediatric tertiary hospital from 2014 to 2019 who sustained a partial thickness burn, healed >14 days and did not receive skin grafting. A scar was deemed hypertrophic if >1 mm in height. Early hypertrophic scar prevalence was defined as 3-6 months post burn, while persistent hypertrophic scarring was defined as 12-18 months post burn. Median days to wound closure was 18. The prevalence of early and persistent hypertrophic scarring was 56.1% and 16.3%, respectively. Seventeen (5.2%) children underwent medical interventions for scar modulation. Early signs of hypertrophic scarring were seen in just over half the patients presenting to burn therapy and despite scar intervention, persistent hypertrophic scarring was seen in 16.3%. At both time points, just over half of the children presenting healed between 14 and 21 days. Therefore, children healing prior to 21 days have potential to develop hypertrophic scarring.

Dupilumab induced ocular surface disease: A prospective case series.

PURPOSE: To identify the incidence, risk factors, demographics, and clinical profile of dupilumab-induced ocular surface disease (DIOSD) in patients with atopic dermatitis (AD), propose a standardised treatment protocol (STP) and evaluate the response. METHODS: Prospective case series of AD patients treated in the Dermatology Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK developing ocular symptoms after commencing Dupilumab between September 2018 and February 2020. A standard history and examination protocol were used including subjective symptom severity grading and Ocular Surface Disease Index (OSDI) questionnaire on each visit. Standard treatment was prescribed, and response evaluated. RESULTS: 32 of 113 included patients (28.31%) developed DIOSD, of which 20 (62.5%) were referred to the Cornea Service. Median age was 38.0 years (IQR 26.8; range 19-74). Male to female ratio was 1:1. Average time to onset of ocular symptoms from starting dupilumab was 9.2 weeks (IQR 8.8; range 0.1-40). 90% patients had bilateral conjunctival inflammation and blepharitis at presentation. Significant improvement in the subjective severity scale and the median OSDI score (from 34.0 to 10.2) was noted in response to topical eye treatment. Dupilumab was discontinued in none. CONCLUSIONS: DIOSD is not uncommon although, with timely referral and appropriate topical treatment better clinical outcome and patient satisfaction can be achieved without the need to discontinue Dupilumab. Prior allergic conjunctivitis did not affect the incidence or severity of DIOSD. Further prospective studies with longer follow-up and more focus on possible disease mechanism such as goblet cell related changes and immune response are needed.

Further examination of knowledge and interactions in ageism among college students: Value for promoting university activities.

Ageism is recognized as a reason that few students pursue careers in aging. While widely studied, the findings regarding factors that contribute to ageism are mixed. The findings from previous studies are also tempered by methodological issues. To better understand the factors that contribute to ageism among students and guide the development of programming and activities to reduce ageism, a survey study was conducted. The study explores associations between frequency of interactions with older adults, quality of the interactions, and ageism. Students' knowledge of aging is also examined. Using refined measures to assess knowledge of aging and interactions with older adults, the study includes data from 1,040 college students, most of whom are traditional age students (i.e., under the age of 25). Findings from multiple regression analyses document the interplay between frequency and quality of interactions and the role of knowledge on multiple dimensions of ageism. Frequency of interactions with older adults is significantly associated with lower levels of ageism only when the interactions are perceived as favorable. Knowledge of aging is significantly associated with lower levels of ageism. The findings provide valuable information for developing activities to reduce ageism. A new ageism reduction program, which was guided by the study findings and age-friendly university framework, is described. Implications for gerontological education are also discussed.

Managing patients with hidradenitis suppurativa.

Hidradenitis suppurativa affects the apocrine-bearing areas of the skin. The onset is variable but usually occurs in the second and third decades of life, coinciding with development of the apocrine glands. The condition is characterised by painful, inflammatory papules and nodules which frequently progress to form abscesses, sinus tracts and hypertrophic scars. Bacteria are not felt to have a primary role in lesion formation, and abscesses are often sterile. The diagnosis of hidradenitis suppurativa is clinically based, without a specific diagnostic test. The most important non-genetic factors implicated in hidradenitis suppurativa are obesity and smoking. Locally recurring lesions can be treated surgically and more widespread disease may be better managed with a combination of medical treatment and surgery.

Prototype electronic stethoscope vs. conventional stethoscope for auscultation of heart sounds.

In an effort to decrease the spread of hospital-acquired infections, many hospitals currently use disposable plastic stethoscopes in patient rooms. As an alternative, this study examines a prototype electronic stethoscope that does not break the isolation barrier between clinician and patient and may also improve the diagnostic accuracy of the stethoscope exam. This study aimed to investigate whether the new prototype electronic stethoscope improved auscultation of heart sounds compared to the standard conventional isolation stethoscope. In a controlled, non-blinded, cross-over study, clinicians were randomized to identify heart sounds with both the prototype electronic stethoscope and a conventional stethoscope. The primary outcome was the score on a 10-question heart sound identification test. In total, 41 clinicians completed the study. Subjects performed significantly better in the identification of heart sounds when using the prototype electronic stethoscope (median = 9 [7-10] vs. 8 [6-9] points, p value <0.0001). Subjects also significantly preferred the prototype electronic stethoscope. Clinicians using a new prototype electronic stethoscope achieved greater accuracy in identification of heart sounds and also universally favoured the new device, compared to the conventional stethoscope.

Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients.

INTRODUCTION: Immobilisation in the intensive care unit (ICU) leads to muscle weakness and is associated with increased costs and long-term functional disability. Previous studies showed early mobilisation of medical ICU patients improves clinical outcomes. The Surgical ICU Optimal Mobilisation Score (SOMS) trial aims to test whether a budget-neutral intervention to facilitate goal-directed early mobilisation in the surgical ICU improves participant mobilisation and associated clinical outcomes. METHODS AND ANALYSIS: The SOMS trial is an international, multicentre, randomised clinical study being conducted in the USA and Europe. We are targeting 200 patients. The primary outcome is average daily SOMS level and key secondary outcomes are ICU length of stay until discharge readiness and 'mini' modified Functional Independence Measure (mmFIM) at hospital discharge. Additional secondary outcomes include quality of life assessed at 3 months after hospital discharge and global muscle strength at ICU discharge. Exploratory outcomes will include: ventilator-free days, ICU and hospital length of stay and 3-month mortality. We will explore genetic influences on the effectiveness of early mobilisation and centre-specific effects of early mobilisation on outcomes. ETHICS AND DISSEMINATION: Following Institutional Review Board (IRB) approval in three institutions, we started study recruitment and plan to expand to additional centres in Germany and Italy. Safety monitoring will be the domain of the Data and Safety Monitoring Board (DSMB). The SOMS trial will also explore the feasibility of a transcontinental study on early mobilisation in the surgical ICU. RESULTS: The results of this study, along with those of ancillary studies, will be made available in the form of manuscripts and presentations at national and international meetings. REGISTRATION: This study has been registered at clinicaltrials.gov (NCT01363102).

Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions.

PURPOSE: Persistent low-level hypotension represents a barrier to discharging patients from the intensive care unit (ICU). Midodrine may be an effective adjunct to wean intravenous (IV) vasopressors and permit ICU discharge. We tested the hypothesis that midodrine, given to patients on IV vasopressors who otherwise met ICU discharge criteria, increased the magnitude of change in IV vasopressor rate. MATERIALS AND METHODS: This was a prospective, observational study in 20 adult surgical ICU patients who met ICU discharge criteria except for an IV vasopressor requirement. We compared the change in phenylephrine equivalent rates during the day before midodrine to the change in phenylephrine equivalent rates after midodrine initiation and analyzed changes in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count during this period. RESULTS: Patients received 41.0±33.4 µg/min of phenylephrine equivalents and the change in IV vasopressor rate (slope) decreased significantly from -0.62 µg/min per hour of phenylephrine equivalents before midodrine to -2.20 µg/min per hour following the initiation of midodrine treatment (P=.012). Change in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count did not correlate with change in IV vasopressor rate. CONCLUSION: Midodrine treatment was associated with an increase in the magnitude of decline of the IV vasopressor rate. Oral midodrine may facilitate liberation of surgical ICU patients from an IV vasopressor infusion, and this may affect discharge readiness of patients from the ICU.

The impact of deployment on the psychological health status, level of alcohol consumption, and use of psychological health resources of postdeployed U.S. Army Reserve soldiers.

This study was conducted to investigate the impact of deployment on the psychological health status, level of alcohol consumption, and use of psychological health resources of postdeployed Army Reserve (AR) soldiers. Data were collected from 51,078 postdeployed AR soldiers via DD Form 2900 to detect existing psychological and medical issues. As predicted, findings indicate that AR soldiers screened 7 or more months post redeployment are significantly more likely than those screened 3 to 6 months post redeployment to screen positive for moderate (chi2 (1, N = 44,319) = 15.75, p < 0.001) and severe (chi2 (1, N = 44,319) = 7.82, p < 0.05) functional impairment and PTSD (chi2 (1, N = 51,017) = 14.43, p < 0.001). Present findings are consistent with previous research, suggesting that adverse psychological health issues can be detected during their mild stages and resolved to prevent further degradation when screenings are performed according to military policy.

Comparative analgesic and cardiopulmonary effects of bupivacaine and ropivacaine in the epidural space of the conscious dog.

OBJECTIVE: To compare the cardiopulmonary effects and sensory blockade of epidural bupivacaine and ropivacaine. STUDY DESIGN: Prospective randomized study. ANIMALS: Six young adult medium-sized crossbred dogs weighing 25.7 ± 7.1 kg. METHOD: Dogs were chronically implanted with a lumbosacral epidural catheter. Acepromazine sedated dogs received all treatments: 0.5% bupivacaine at 0.14 mL kg-1 (LB5) or 0.22 mL kg-1 (HB5); 0.5% ropivacaine at 0.14 mL kg-1 (LR5) or 0.22 mL kg-1 (HR5); 0.75% bupivacaine at 0.22 mL kg-1 (HB7.5) or 0.75% ropivacaine at 0.22 mL kg-1 (HR7.5). Loss of sensation was tested at the level of the perineum, hind toe webs, flank, and caudodorsal rib areas before injection, and post-injection (PI) up to 150 minutes PI. Systemic arterial blood pressure and heart rate were recorded before injection, and every 10 minutes PI until 150 minutes PI. Arterial blood gas analyses were performed prior to injection, and at 30, 60 and 150 minutes PI. RESULTS: No statistical differences existed between groups for the cardiopulmonary data or time to onset of block. Group HR7.5 had lower systolic (10-70 minutes PI) and diastolic (10-70 minutes PI) blood pressures and group HR5 had lower mean (10-90 minutes PI) and diastolic (10-90 minutes PI) blood pressures compared to baseline. Heart rate was lower compared to baseline in groups LR5 and HB7.5. A significant, but mild metabolic acidosis developed in groups LR5 and HB7.5 (150 minutes PI). No differences were present for the duration of block between groups, but duration of block in the dorsocaudal rib area was shorter in group HR5 compared to HR7.5. CONCLUSION: Epidural ropivacaine and bupivacaine at the doses used have mild effects on the cardiopulmonary system, and extent of block are similar. CLINICAL RELEVANCE: The 0.75% concentration of bupivacaine and ropivacaine at 0.22 mL kg-1 appeared to contribute to greater success of block (>80%) at dermatomes L5-L7.