GPR179 is required for high sensitivity of the mGluR6 signaling cascade in depolarizing bipolar cells.

Parallel visual pathways are initiated at the first retinal synapse by signaling between the rod and cone photoreceptors and two general classes of bipolar cells. For normal function, ON or depolarizing bipolar cells (DBCs) require the G-protein-coupled receptor, mGluR6, an intact G-protein-coupled cascade and the transient receptor potential melastatin 1 (TRPM1) cation channel. In addition, another seven transmembrane protein, GPR179, is required for DBC function and recruits the regulators of G-protein signaling (RGS) proteins, RGS7 and RGS11, to the dendritic tips of the DBCs. Here we use the Gpr179(nob5) mouse, which lacks GPR179 and has a no b-wave electroretinogram (ERG) phenotype, to demonstrate that despite the absence of both GPR179 and RGS7/RGS11, a small dark-adapted ERG b-wave remains and can be enhanced with long duration flashes. Consistent with the ERG, the mGluR6-mediated gating of TRPM1 can be evoked pharmacologically in Gpr179(nob5) and RGS7(-/-)/RGS11(-/-) rod BCs if strong stimulation conditions are used. In contrast, direct gating of TRPM1 by capsaicin in RGS7(-/-)/RGS11(-/-) and WT rod BCs is similar, but severely compromised in Gpr179(nob5) rod BCs. Noise and standing current analyses indicate that the remaining channels in Gpr179(nob5) and RGS7(-/-)/RGS11(-/-) rod BCs have a very low open probability. We propose that GPR179 along with RGS7 and RGS11 controls the ability of the mGluR6 cascade to gate TRPM1. In addition to its role in localizing RGS7 and RGS11 to the dendritic tips, GPR179 via a direct interaction with the TRPM1 channel alters its ability to be gated directly by capsaicin.

Adherence With Early Allied Health Assessments in Specialist Burn Services.

Appropriate multidisciplinary allied health assessment during the early stages of admission following burn injury positively influences recovery and quality of life. Variation in allied health care may affect patient outcomes. We aimed to explore adherence in providing early allied health assessments in accordance with local parameters. Associations between the number of assessments and hospital length of stay (LOS) were also explored. The Burns Registry of Australia and New Zealand was queried for adult (≥ 16 years) burn injured patients admitted to a specialist burn service for > 48 hours between July 2016 and June 2020. Quality indicator data relating to allied health assessment processes were examined; patients were grouped according to the number of assessments they received within 48 hours of admission. Of the 5789 patients included in the study, 5598 (97%) received at least one allied health assessment within 48 hours of admission and 3976 (69%) received all three assessments. A greater proportion of patients who received no assessments were admitted on a Saturday. Patients receiving three assessments had more severe injuries compared to their counterparts who received fewer assessments. Hospital LOS was not associated with the number of allied health assessments during an acute admission following burn injury after accounting for confounding factors, particularly TBSA. Multidisciplinary allied health teams provide routine burn care to Australian and New Zealand burns patients at a consistent level. Further, this study provides evidence that allied health input is prioritized towards patients with increasing severity of burn injury, playing an integral role in early rehabilitation.

Examining the patient profile and variance of management and in-hospital outcomes for Australian adult burns patients.

BACKGROUND: Burn injuries are a common subtype of trauma. Variation in models of care impacts clinical measures of interest, but a nation-wide examination of these measures has not been undertaken. Using data from the Burns Registry of Australia and New Zealand (BRANZ), we explored variation between Australian adult burn services with respect to treatment and clinical measures of interest. METHODS: Data for admissions July 2016 to June 2020 were extracted. Clinical measures of interest included intensive care admission, skin grafting, in-hospital death, unplanned readmissions, and length of stay (LOS). Estimated probabilities, means, and corresponding 95% confidence intervals (CI) were calculated for each service. RESULTS: The BRANZ recorded 8365 admissions during the study period. Variation between specialist burn services in admissions, demographics, management, and clinical measures of interest were observed. This variation remained after accounting for covariates. Specifically, the adjusted proportion (95% CI) of in-hospital mortality ranged from 0.15% (0.10-0.21%) to 1.22% (0.9-1.5%). The adjusted mean LOS ranged from 3.8 (3.3-4.3) to 8.2 (6.7-9.7) days. CONCLUSIONS: A decade after its launch, BRANZ data displays variation between Australian specialist burn services. We suspect differences in models of care between services contributes to this variation. Ongoing research has begun to explore reasons underlying how this variation influences clinical measures of interest. Further engagement with services about models of care will enhance understanding of this variation and develop evidence-based guidelines for burn care in Australia.

Early physiotherapy experience with a biodegradable polyurethane dermal substitute: Therapy guidelines for use.

OBJECTIVE: The purpose of this study was to investigate and develop range of motion (ROM) and mobilisation guidelines in adult patients where a newly developed synthetic dermal substitute was applied in our adult burn centre. METHOD: A retrospective case note audit was conducted on the first 20 acute burn injured patients who had a synthetic dermal substitute applied. Data collected included days to commencement of ROM, days to clearance for mobilisation, and joint ROM achieved after dermal substitute application (prior to delamination) and after split skin grafting (SSG) for the elbow, knee and shoulder joints. Scar assessments were completed at 12 months after injury using two scar assessment scales. RESULTS: Clearance to mobilise occurred at mean 10.4 and 4.9 days after dermal substitute and after skin graft application to lower limbs respectively. ROM commenced at a mean of 9.9 (upper limbs) and 12.7 (lower limbs) days after dermal substitute application. Following skin grafting, ROM commenced at a mean of 6.6 and 6.5 days for upper limbs and lower limbs respectively. Prior to dermal substitute delamination mean flexion at the knee (86.3°), elbow (114.0°) and shoulder (143.4°) was achieved. Mean ROM continued to improve after grafting with knee (133.2°), elbow (126.1°) and shoulder (151.0°) flexion approaching normal ROM in most cases. Mean extension of the elbow (-4.6°) was maintained close to normal levels after skin grafting. There were no recorded instances of knee extension contracture. Patient and Observer Scar Assessment Scale and Matching Assessment of Photographs of Scars scores indicated good cosmetic outcomes with relatively low levels of itch and minimal pain reported at 12 months after injury. CONCLUSION: A steep learning curve was encountered in providing therapy treatment for patients managed with this relatively new synthetic dermal substitute. Trends indicated that as experience with this new dermal substitute grew, patients progressed toward active therapy earlier. A guideline for therapy treatment has been developed but will continue to be evaluated and adjusted when required.

Moisturisers in scar management following burn: A survey report.

Scar management is a recognised key component of rehabilitation following burn. Moisturising often combined with massage is commenced once healing tissue has gained sufficient strength to tolerate surface friction, with the aim being to hydrate the dry scar. The studies on various moisturisers and creams provide some guidance on moisturiser selection, but many are inconclusive. OBJECTIVE: This survey aimed to determine the current expert opinion regarding moisturiser recommendations, including the basis for these recommendations, across the burns community. METHODS: A brief web-based survey was distributed to burn therapists via mailing lists of the Australian and New Zealand Burn Association (ANZBA), and American Burn Association (ABA) 'Occupational and Physical Therapist Burn Special Interest Group'. RESULTS: The fifty three respondents indicated that there were 29 different moisturisers commonly recommended in practice. Three main themes were indicated as influencing recommendations for moisturiser: the perceived effects on the scar/skin (48%); the general properties of the moisturiser (38%); the ingredients (14%). Therapists reported that the principle stimuli determining their recommendations were patient feedback and the choice of the previous burn therapist in their service. Many were also guided by medical staff, pharmacists and sales representatives. Only three respondents were able to provide citations for published evidence supporting their recommendations. CONCLUSIONS: There is a paucity of evidence currently to support optimal moisturiser choice. This survey demonstrates that conflicting opinions are held on the ideal moisturiser brand, properties and ingredients. The recommendations made are based on low level evidence. Further research is required to inform clinicians which moisturiser to recommend to their clients. An ideal moisturiser should be one that is conducive to scar maturation, non- or minimally irritant, prevent skin drying, minimise transepidermal water loss and have no negative effect on barrier function.

The effectiveness of moisturizers in the management of burn scars following burn injury: a systematic review.

BACKGROUND: The common mantra with which patients often leave a burns unit is "moisturize and massage". Various products have been reported for use in practice including aqueous cream BP, bees wax and herbal oil creams, silicone based creams, paraffin/petroleum/mineral oil based products and aloe vera gels. Often combined with other scar management techniques such as pressure therapy, massage and contact media, moisturizers convey active properties of their own.  To date no published review on the optimal moisturizer for burn scar management has been identified via searches of recognized databases. OBJECTIVES: The objective of this review was to identify and synthesize the best available evidence on the effectiveness of moisturizer use in the management of active burn scars following burn injury.  More specifically, this review focused on the following questions:  Does moisturizer use have an effect on scar outcomes following burn injury, including scar formation, skin breakdown, patient acceptance and water loss?  What is the optimal base composition of moisturizers used in scar management for patients who have sustained a burn injury? INCLUSION CRITERIA: Types of participants:  Patients of any age who have sustained a burn injury of any size, and have been admitted to a hospital or regional burn unit or burn centre for the management of their injury.  Types of intervention(s)/phenomena of interest:  Studies evaluating moisturizer applied to healed skin following burn injury were considered for inclusion. Moisturizer may have been compared to usual care as defined by the individual study, other interventions, or a different type of moisturizer. Studies comparing moisturizer and massage compared to moisturizer alone were excluded.  Types of studies:  This review primarily considered experimental study designs, including randomized and pseudo-randomized controlled trials.  Types of outcomes:  Primary outcomes for examination in this review included scar formation and skin breakdown, measured by objective tools or subjective scales.  Secondary outcomes included product acceptance, patient compliance and transepidermal water loss. SEARCH STRATEGY: A search was conducted to identify published and unpublished studies via electronic databases. Reference lists of all papers selected for full text retrieval were then hand searched for potential additional citations. METHODOLOGICAL QUALITY: Articles meeting pre-determined eligibility criteria for the review were assessed by two independent reviewers using standardized checklists from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Corresponding authors were contacted where additional information was required; however this strategy did not yield additional information that altered study eligibility status. DATA COLLECTION: Data was extracted from the included paper using the standardized data extraction tool from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS: Narrative synthesis of the included study was undertaken. RESULTS: One study, following a randomized controlled design, was eligible for inclusion in this review. This study investigated the effect of vitamin E cream versus a base moisturizing cream on outcomes including range of motion, scar thickness, cosmetic appearance and graft size. No significant differences between groups for all reported outcomes were observed. CONCLUSIONS: Despite the common practice involving moisturizers TRUNCATED AT 500 WORDS.

A Prospective Multi-Center Audit of Nutrition Support Parameters Following Burn Injury.

The importance of nutrition support delivery to the severe burn-injured patient is well recognized, however, nutrition provision to the patient may be sub optimal in practice. The aim of this study was to conduct a prospective multi-center audit across Australia and New Zealand using the Joanna Briggs Institute Burns Node Nutrition audit criteria. Thirty-four patients with severe burn injury (≥20% TBSA in adults and ≥10% TBSA in children) were identified on admission or on referral to the Dietitian at the eight participating Burn Units between February 1, 2012 and April 30, 2012 for inclusion in the study. De-identified patient data was analyzed using the Joanna Briggs Institute, Practical Application of Clinical Evidence System. Compliance with individual audit criterion ranged from 33 to 100%. Provision of prescribed enteral feed volumes and weekly weighing of patients were highlighted as key areas for clinical improvement. Clinical audit is a valuable tool for evaluating current practice against best evidence to ensure that quality patient care is delivered. The use of the Joanna Briggs Institute Burns Node audit criteria has allowed for a standardized multi-center audit to be conducted. Improving nutrition support delivery in burn patients was identified as a key area requiring ongoing clinical improvement across Australia and New Zealand. Clinician feedback on use of the audit criteria will allow for future refinement of individual criterion, and presentation of results of this audit has resulted in a review of the Bi-National Burns Registry nutrition quality indicators.

The Effects of Sex and Chronic Restraint on Instrumental Learning in Rats.

Chronic stress has been shown to impact learning, but studies have been sparse or nonexistent examining sex or task differences. We examined the effects of sex and chronic stress on instrumental learning in adult rats. Rats were tested in an aversive paradigm with or without prior appetitive experience, and daily body weight data was collected as an index of stress. Relative to control animals, reduced body weight was maintained across the stress period for males (-7%, P ≤ .05) and females (-5%, P ≤ .05). For males, there were within-subject day-by-day differences after asymptotic transition, and all restrained males were delayed in reaching asymptotic performance. In contrast, stressed females were facilitated in appetitive and aversive-only instrumental learning but impaired during acquisition of the aversive transfer task. Males were faster than females in reaching the appetitive shaping criterion, but females were more efficient in reaching the appetitive tone-signaled criterion. Finally, an effect of task showed that while females reached aversive shaping criterion at a faster rate when they had prior appetitive learning, they were impaired in tone-signaled avoidance learning only when they had prior appetitive learning. These tasks reveal important nuances on the effect of stress and sex differences on goal-directed behavior.

Outcome measurement tools currently used to assess pediatric burn patients: an occupational therapy and physiotherapy perspective.

Given the high incidence of burn injuries in children, it is important that all clinicians involved in the care of these patients, including occupational therapists and physiotherapists, are able to assess patients with valid, sensitive, and reliable measurement tools to optimize outcomes and clinical management. The aims of this study were to identify therapist- relevant outcome measurement tools that have been previously used with pediatric burn patients and to ascertain the outcome measurement tools currently used by occupational therapists and physiotherapists working in pediatric burns units. A literature review was undertaken to identify therapist-relevant outcome measurement tools that have been used in the pediatric burn population. A survey involving therapists working in Australian pediatric burns units was then conducted to identify outcome measurement tools in common usage. Few outcome measurement tools were identified that had been specifically validated for use, or were in common usage in Australia, with pediatric patients with burn injury. The lack of validated and widely used measurement tools adversely impacts on the ability of therapists to accurately assess outcomes of treatment and undertake clinical research involving pediatric patients with burn injury.