Properties of an ideal burn dressing: A survey of burn survivors and front-line burn healthcare providers.

OBJECTIVES: The objective of this study is to identify what burn survivors and front-line staff indicate would improve satisfaction with burn dressings, and the ranking of importance of different burn dressing characteristics. These findings will guide the development of future dressings to meet these needs. METHODS: Burn survivors (including the person injured and their family) and front-line burn healthcare providers completed a questionnaire on the importance given to different burn dressing characteristics (non-stick, absorbent, able to wear for a long time, flexible, easy to put on, easy to take off, antimicrobial, and non-bulky), and about the adequacy of pain management during dressing changes. RESULTS: A total of 99 individuals filled out the questionnaire (31 caregivers/survivors and 68 front-line burn healthcare providers). The most important dressing characteristics by both groups were "non-stick" and "fights infection". There was a significant difference between burn survivors and front-line burn healthcare providers pertaining to adequacy of pain management during dressing change. Adequate pain management was reported by 59% of burn survivors, which was significantly higher than that reported by the 25% front-line burn healthcare providers (p=0.002). CONCLUSIONS: Our study suggests that burn survivors and front-line burn providers have similar views on what constitutes an ideal dressing. A significantly proportion of caregiver/survivors felt that pain associated with dressing changes is being adequately managed despite healthcare providers' perception.

Evaluation of a multidisciplinary burn care journal club: Lessons learned.

BACKGROUND: Journal clubs allow discussion of the quality and findings of recent publications. However, journal clubs have not historically been multidisciplinary. Burn care is recognized as a true collaborative care model, including regular multidisciplinary rounds. Since 2011 we have offered a multidisciplinary burn journal club at our institution. We present an evaluation of the factors that have made the sessions successful to facilitate others to commence their own club. METHODS: At the end of each journal club session participants anonymously completed a structured evaluation. Five-point scales were used to evaluate understanding, meeting objectives, presentation and appropriateness of information. Qualitative questions were asked to identify beneficial factors, suggestions for improvements, ideas for future sessions and feedback for the facilitator. RESULTS: Attendance grew from six to a maximum of 19. Members included physicians, nurses, dieticians, physiotherapists, occupational therapists, social workers, basic scientists and students. Presentations were undertaken by all of these disciplines. Ratings improved steadily over time. Understanding increased from a score of 4.5 to 4.8; meeting objectives from 4 to 4.9; satisfaction with method of presentation from 4.3 to 4.9 and with level of information from 3 to 4.9. CONCLUSIONS: Over time, the journal club has evolved to better meet the needs of our team. Successful multidisciplinary journal club implementation requires identification of champions and ongoing evaluation. APPLICABILITY OF RESEARCH TO PRACTICE: The success of the journal club has been possible through the engagement of the entire burn team. Champions within each discipline, facilitated discussion and evaluation tools have helped nurture a nonthreatening team based learning environment.

Wildlife and paratuberculosis: a review.

Paratuberculosis (PTB) is an infectious granulomatous enteritis caused by Mycobacterium avium paratuberculosis (MAP) causing significant economic losses in livestock. However, PTB in free-living and captive wildlife has not been as extensively studied as in livestock. We reviewed the existing literature references on MAP to (i) determine the potential impact of MAP infection in wildlife species; (ii) analyze whether wildlife reservoirs are relevant regarding MAP control in domestic ruminants; (iii) assess the importance of MAP as the cause of potential interferences with tuberculosis diagnosis in wildlife. The mean MAP prevalence reported in wildlife was 2.41% (95% confidence interval 1.76-3.06). Although MAP should be considered an important disease in farmed cervids, its impact on free-ranging species is questionable. MAP reservoirs may exist locally but their significance for PTB control in livestock is quite limited. The most critical aspect derived of MAP infection in wildlife is the interference with tuberculosis diagnosis.

Unexpected high responses to tuberculin skin-test in farmed red deer: implications for tuberculosis control.

Tuberculosis (TB) in deer is a serious zoonotic disease of worldwide distribution. Detection of infected animals is usually performed using single or comparative skin-testing (SST/CST), although false responses due to sensitization to other mycobacteria may occur, hampering diagnostic specificity. We describe the evolution of the responses to the SST, CST and to an in-house serological assay in a red deer farm subjected to regular TB testing in southern Spain in an attempt to understand the dynamics of possible non-specific reactions occurring under field conditions. We performed 2288 skin-tests and ELISAs in nine sampling periods between May 2009 and January 2011. In May 2010, a strong increase in skin fold thickness in response to avian purified protein derivative (PPD) (mean=4.0mm, 95% CI=3.5-4.5) and bovine PPD (mean=1.8mm, 95% CI=1.6-2.0) was observed in yearling deer hinds (n=150), compared to values recorded for the same individuals in November 2009 (avian PPD: mean=0.7 mm, 95% CI=0.6-0.8 and bovine PPD: mean=0.7 mm, 95% CI=0.6-0.7) and in January 2011 (avian PPD: mean=2.2mm, 95% CI=1.9-2.4 and bovine PPD: mean=1.1mm, 95% CI=1.0-1.2). Using SST, 54 animals (36%) of the yearlings tested in May 2010 would have been classified as positive reactors, while none of them was positive in the CST. The five animals with highest skin fold increases to mycobacterial antigens were culled and subjected to post-mortem analysis, which confirmed the absence of Mycobacterium tuberculosis complex (MTBC) infection but demonstrated the presence of environmental mycobacteria and closely related bacteria in four out of the five analyzed animals. Our results demonstrated how non-specific responses to mycobacterial antigens can adversely affect the specificity of TB diagnosis based on the SST. Thus, once TB infection has been ruled out using confirmatory techniques, application of comparative diagnostic tests is highly advisable to maximize test specificity and avoid the slaughter of false positive reactors.

No evidence that wild red deer (Cervus elaphus) on the Iberian Peninsula are a reservoir of Mycobacterium avium subspecies paratuberculosis infection.

The potential role of red deer (Cervus elaphus) as a reservoir of Mycobacterium avium subspecies paratuberculosis (MAP) infection is largely unknown. A total of 332 wild red deer were investigated using post-mortem examination, bacteriology and serology. Only three animals (1.12%) were found to have lesions on histopathological examination and no MAP bacteria were recovered on culture. The results suggest it is unlikely that wild red deer make a significant contribution to the maintenance of MAP infection in the region. The cross-reactivity of the ELISAs used indicates this diagnostic modality is ineffective in the detection of MAP infection in this species. The implications of these results for the control of this important pathogen in both livestock and wildlife are discussed.

The testing season affects red deer skinfold increase in response to phytohaemagglutinin.

Red deer (Cervus elaphus) have a pronounced seasonality in their physiology. The aim of this study was to assess the effect of the season on red deer responsiveness to skin testing with the phytohaemagglutinin (PHA) mitogen. Study subjects included 270 farmed adult red deer (19 stags and 251 hinds). The skin testing was carried out between January 2009 and August 2010. The animals were injected intradermally with a 0.1 ml volume containing 250 µg of PHA diluted in phosphate buffered saline. The skinfold thickness was measured immediately prior to injection and 72 h after administration, always by the same person and with three repeats per measurement. Single effects of sex and time on skin test responsiveness were significant (p < 0.001) as well as their interaction (p < 0.001). In winter (January), and considering the average of two years, the skinfold increase in response to the intradermal injection of 250 µg PHA was 2.1 times larger in stags and 1.4 times in hinds than in summer (August). While stags had 1.3 times larger responses than hinds in winter, the inverse occurred in summer, with 1.1 times larger responses in hinds. We also evidenced a limited inter-annual variation of skinfold increase in response to PHA in red deer. These findings have important consequences regarding the interpretation of skin test results in the ante-mortem diagnosis of tuberculosis and paratuberculosis, at least in deer.