ABSTRACT
This prospective, randomized study compared protocols of care using either AQUACEL Ag Hydrofiber (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL Ag dressing protocol tended to have lower total treatment costs (Dollars 1040 vs. Dollars 1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of Dollars 1,409.06 for AQUACEL Ag dressing and Dollars 1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL(R) Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.
Subject(s)
Anti-Infective Agents, Local/therapeutic use , Burns/drug therapy , Carboxymethylcellulose Sodium/therapeutic use , Occlusive Dressings/economics , Silver Sulfadiazine/therapeutic use , Silver/therapeutic use , Adult , Aged, 80 and over , Anti-Infective Agents, Local/adverse effects , Anti-Infective Agents, Local/economics , Carboxymethylcellulose Sodium/adverse effects , Carboxymethylcellulose Sodium/economics , Child, Preschool , Cicatrix/prevention & control , Cost-Benefit Analysis , Epithelium/growth & development , Health Care Costs/statistics & numerical data , Humans , Infant , Male , Occlusive Dressings/adverse effects , Outcome Assessment, Health Care , Pain Measurement , Pediatrics , Prospective Studies , Silver/adverse effects , Silver/economics , Silver Sulfadiazine/adverse effects , Silver Sulfadiazine/economicsABSTRACT
This report reviews the response of a regional burn center to the disaster that occurred in New York City at the World Trade Center on September 11, 2001. In addition, it assesses that response in the context of other medical institutions in the region. There were facilities in the region that had 120 burn care beds; only two-thirds of the burn-injured patients who required hospital admission were admitted to designated burn centers, and only 28% of burn-injured victims initially were triaged to regional burn centers. The care rendered at this center was made possible by a "disaster-ready" facility and supplementation of personnel from the resources provided by The National Disaster Medical System. The patient outcomes at this center exceeded that as predicted by logistic regression analysis.
Subject(s)
Burn Units/organization & administration , Disaster Planning/organization & administration , Emergency Medical Services/organization & administration , September 11 Terrorist Attacks , Adult , Bed Occupancy , Burn Units/statistics & numerical data , Female , Humans , Male , Middle Aged , New York City/epidemiology , Organizational Case Studies , Patient Care Team , Trauma Centers/organization & administration , Trauma Centers/statistics & numerical data , TriageABSTRACT
Our metropolitan area employs approximately 11,000 firefighters who respond to more than 435,000 fire-related incidents per year. It is inevitable that some of these firefighters will suffer burn injuries. This 10-year retrospective review describes the epidemiology of firefighters with burn injuries who were treated at our burn center. From 1992 to 2002, 987 firefighters were treated at our burn center. The total number of firefighters treated for burn injuries and the number of firefighters who were treated for burn injuries to the lower extremities occurred in a bimodal distribution. Injury prevention efforts will continue to further reduce the incidence of burn injuries in the firefighters of our community.
Subject(s)
Burn Units/statistics & numerical data , Burns/epidemiology , Burns/therapy , Fires/statistics & numerical data , Occupational Diseases/epidemiology , Occupational Diseases/therapy , Adult , Ambulatory Care/statistics & numerical data , Female , Fires/prevention & control , Hospitalization/statistics & numerical data , Humans , Incidence , Leg Injuries/epidemiology , Leg Injuries/therapy , Longitudinal Studies , Male , New York City/epidemiology , Skin Transplantation/statistics & numerical dataABSTRACT
Monocyte adherence induces the formation of focal adhesions, the interaction sites of intracellular signaling molecules and cytoskeletal proteins such as actin. We previously demonstrated that adherence potentiates human monocyte LPS-induced TNFalpha production. Hence, we hypothesized that the actin cytoskeleton is integral to adherence-induced priming for enhanced LPS-induced TNFalpha production. In contrast to nonadherent cells, LPS induced significant transcription of TNFalpha mRNA and production of TNFalpha in adherent monocytes. Disrupting the actin cytoskeleton with cytochalasin D (CD) in adherent monocytes inhibited LPS-induced TNFalpha production by 55%, thereby abrogating adherence-induced priming. Moreover, CD pretreatment abrogated adherence-induced activation of Pyk2, a major focal adhesion kinase, and ERK 1/2, a component of the mitogen-activated protein kinase (MAPK) signaling pathway, and it completely inhibited LPS-induced ERK 1/2 activation. However, CD treatment of nonadherent monocytes failed to inhibit cytokine production. In conclusion, the actin cytoskeleton is integral in the reprogramming of the monocyte for enhanced cytokine production and in maintaining this "primed" state.