Myofibroblast Activity in an Animal Model for Human Hypertrophic Scar

2002 ◽  
Author(s):  
Derek A. Affonce ◽  
Erik S. Sojka ◽  
Livingston Van De Water ◽  
Robert Sheridan ◽  
Alex J. Fowler
Keyword(s):  
Animal Model ◽  
Hypertrophic Scar ◽  
Hospital Admissions ◽  
Burn Injury ◽  
The United States ◽  
Burn Patients ◽  
Hypertrophic Scarring ◽  
Burn Survivors ◽  
Long Term Consequences

Approximately 100,000 burn patients require hospital admissions each year in the United States. About 90% of those patients survive to face the long term consequences of burn injury [1]. The primary cause of long term disability in burn survivors is hypertrophic scarring. These thick, deforming scars physically impair movement and cause major psychological morbidity. Hypertrophic scarring is particularly severe in young children [2].

Socioeconomic and comorbid factors associated with frostbite injury in the United States

2021 ◽  
Author(s):  
Frederick W Endorf ◽  
Rachel M Nygaard
Keyword(s):  
United States ◽  
Burn Injury ◽  
Multivariable Analysis ◽  
The United States ◽  
Mental Health Disorder ◽  
Burn Patients ◽  
Peripheral Vascular ◽  
Black Race ◽  
Factors Associated

Abstract Frostbite largely impacts the extremities and often results in long term disability due to amputation. More regions are experiencing extremes in temperature which increases risk of frostbite injury. The aim of this study is to detail social and comorbid factors associated with frostbite injury compared to isolated hand or foot burns. We used the National Inpatient Sample from years 2016 to 2018 to identify admissions included in this study. Weighted incidence and multivariable analysis assessed characteristics and outcomes of frostbite and isolated hand or foot burn injury. In the United States, the estimated incidence of frostbite injury in those aged 15 and over was 0.95 per 100,000 persons and 4.44 per 100,000 persons with isolated hand and foot burns. Homelessness, mental health disorder, drug or alcohol abuse, and peripheral vascular disease were all associated with risk of frostbite injury when compared to burn injury. We found that other insurance was associated with amputation following burn injury, while Black race and homelessness were associated with amputation during a non-elective primary admission following frostbite injury. The differing risk factors associated with early amputation in frostbite and burn patients warrant a multicenter study including burn centers in North America.

Justifying Interventions—The Case of ECOWAS in Liberia

2021 ◽  
pp. 339-354
Author(s):  
Nina Wilén
Keyword(s):  
The United States ◽  
Regional Level ◽  
Military Interventions ◽  
Discursive Analysis ◽  
System P ◽  
Long Term Consequences ◽  
Constitutive Norm ◽  
Normative Order ◽  
The Relationship

In contrast to the other chapters in Part V, Nina Wilén’s focus is on multilateral military interventions at the regional level: She explores the relationship between sovereignty, intervention, and the international normative order, by examining how ECOWAS, an African regional organization, justified its intervention in Liberia’s civil war referring to international norms. Based on a critical discursive analysis of the speeches related to ECOWAS’ decision to intervene in Liberia in 1990, as well as the responses the justifications provoked from the UN and the United States, it is argued that ECOWAS’ intervention and the justifications which accompanied it were clearly influenced by an international normative order where sovereignty is the key constitutive norm and non-intervention the main regulative norm. Yet the fact that ECOWAS also violated the very same norms through its intervention, created a precedent for future regional interventions and implied long-term consequences for the international normative system.

A Scoping Review on the Long-Term Outcomes in Persons with Adult-Acquired Burn Injuries

2019 ◽  
Vol 41 (3) ◽  
pp. 472-502
Author(s):  
Stephanie R Cimino ◽  
Jorge N Rios ◽  
Matthew Godleski ◽  
Sander L Hitzig
Keyword(s):  
Community Participation ◽  
Scoping Review ◽  
The United States ◽  
Community Dwelling ◽  
Burn Injuries ◽  
Computer Assisted ◽  
Long Term Outcomes ◽  
Burn Survivors ◽  
The Impact

Abstract Adult-acquired burn injuries are a life-altering event that can lead to debilitating functional or psychological impairments. With advancements in health care resulting in decreased mortality rates, survivors of burn injuries can expect to live longer. This warrants a shift in focus to better understand what happens to adults once they are discharged from the hospital into the community. Therefore, the purpose of this scoping review was to map the literature regarding the long-term outcomes of community-dwelling adult-acquired burn survivors. A computer-assisted literature search was conducted on literature from January 1, 2000 to August 31, 2018 utilizing four large databases (MEDLINE, EMBASE, CINHAL, and PsycINFO). Articles were included if they had a minimum of five individuals with a burn injury as a result of an accidental injury who were at least 18 years of age at the time of injury. Fifty-four articles were found suitable for inclusion in this review. The majority of studies were conducted in the United States and were longitudinal in design. Four themes were apparent from the articles: postburn complications, psychosocial outcomes, quality of life, and community participation. Data are lacking with respect to outcomes more than 5 years postburn as well as qualitative research. Furthermore, more literature is needed to understand the impact of postburn complications, coping strategies, and posttraumatic growth as well as barriers to community participation. Overall, there is an emerging body of literature that describes the long-term outcomes of adult-acquired burn survivors up to 5 years postburn.

scholarly journals Neuronal Plasticity Associated with Burn Injury and Its Relevance for Perception and Management of Pain in Burn Patients

2000 ◽  
Vol 5 (3) ◽  
pp. 205-213
Author(s):  
Terence J Coderre ◽  
Manon Choinière
Keyword(s):  
Neuronal Plasticity ◽  
Pain Perception ◽  
Burn Injury ◽  
Clinical Care ◽  
Strong Support ◽  
Burn Injuries ◽  
Burn Patients ◽  
Pain Mechanisms ◽  
Gate Control Theory

Through the introduction of the gate control theory and various subsequent works, Ronald Melzack has inspired many investigators worldwide to realize two important facts about pain. First, incoming pain messages are subject to both negative and positive modulation, which significantly affect its perception. Second, the progression of knowledge about the basic mechanisms underlying persistent and chronic pain is critically dependent on the increased understanding of the complexity of the symptoms experienced by pain patients. The present paper examines these two very important issues in an effort to understand better the mechanisms that underlie the pain suffered by burn patients. The physiological responses to burn injury involve many different mediators and mechanisms, all of which contribute to pain perception and development of neuronal plasticity underlying short and long term changes in pain sensitivity. While experimental burn injuries in humans and animals are typically well controlled and mild, in burn victims, the severity is much more variable, and clinical care involves repeated traumas and manipulations of the injured sites. Recurrent inputs from damaged and redamaged tissue impinge on a nervous system that becomes an active participant in the initiation of changes in sensory perception and maintenance of long term sensory disturbances. Recently acquired experimental evidence on postburn hyperalgesia, central hyperexcitability and changes in opioid sensitivity provides strong support that burn patients need an analgesic approach aimed at preventing or reducing the 'neural' memory of pain, including the use of more than one treatment modality. Burn injuries offer a unique opportunity to combine experimental and clinical research to understand pain mechanisms better. Over the years, Ronald Melzack has insisted that one of the most laudable enterprises in research is to span the gap between these two often separate worlds.

scholarly journals A Review of Adjunctive Therapies for Burn Injury Pain During the Opioid Crisis

2019 ◽  
Vol 40 (6) ◽  
pp. 983-995 ◽  
Author(s):  
Daniel E Kim ◽  
Kaitlin A Pruskowski ◽  
Craig R Ainsworth ◽  
Hans R Linsenbardt ◽  
Julie A Rizzo ◽  
...  
Keyword(s):  
Pain Management ◽  
Randomized Controlled Trials ◽  
Systematic Reviews ◽  
Burn Injury ◽  
The United States ◽  
Pain Severity ◽  
Controlled Trials ◽  
Burn Patients ◽  
Opioid Use ◽  
Randomized Controlled

Abstract Opioids are the mainstay of pain management after burn injury. The United States currently faces an epidemic of opioid overuse and abuse, while simultaneously experiencing a nationwide shortage of intravenous narcotics. Adjunctive pain management therapies must be sought and utilized to reduce the use of opioids in burn care to prevent the long-term negative effects of these medications and to minimize the dependence on opioids for analgesia. The purpose of this review was to identify literature on adjunctive pain management therapies that have been demonstrated to reduce pain severity or opioid consumption in adult burn patients. Three databases were searched for prospective studies, randomized controlled trials, and systematic reviews that evaluated adjunctive pain management strategies published between 2008 and 2019 in adult burn patients. Forty-six studies were analyzed, including 24 randomized controlled trials, six crossover trials, and 10 systematic reviews. Various adjunctive pain management therapies showed statistically significant reduction in pain severity. Only one randomized controlled trial on music therapy for acute background pain showed a reduction in opioid use. One cohort study on hypnosis demonstrated reduced opioid use compared with historical controls. We recommend the development of individualized analgesic regimens with the incorporation of adjunctive therapies in order to improve burn pain management in the midst of an abuse crisis and concomitant national opioid shortage.

Campylobacter jejuni Infection during Pregnancy: Long-Term Consequences of Associated Bacteremia, Guillain-Barré Syndrome, and Reactive Arthritis†

2002 ◽  
Vol 65 (4) ◽  
pp. 696-708 ◽  
Author(s):  
JAMES L. SMITH
Keyword(s):  
Pregnant Women ◽  
Campylobacter Jejuni ◽  
Reactive Arthritis ◽  
The United States ◽  
Guillain Barre Syndrome ◽  
Normal Infant ◽  
Guillain Barré Syndrome ◽  
Long Term Consequences ◽  
Guillain Barré

Campylobacter jejuni infections are the main cause of foodborne gastroenteritis in the United States and other developed countries. Generally, C. jejuni infections are self-limiting and treatment is not necessary; however, infections caused by this organism can lead to potentially dangerous long-term consequences for some individuals. Bacteremia, Guillain-Barré syndrome (GBS; an acute flaccid paralytic disease), and reactive arthritis (ReA) are the most serious of the long-term consequences of C. jejuni infections. During pregnancy, foodborne infections may be hazardous to both the woman and the fetus. C. jejuni–induced bacteremia during pregnancy may lead to intrauterine infection of the fetus, abortion, stillbirth, or early neonatal death. Infection of a newborn by the mother during the birth process or shortly after birth may lead to neonatal enteritis, bacteremia, and/or meningitis. C. jejuni enteritis is the inducing antecedent infection in approximately 30% of cases of GBS. Thus, pregnant women infected with C. jejuni may contract GBS. GBS during pregnancy does not affect fetal or infant development and does not increase spontaneous abortion or fetal death; however, it may induce spontaneous delivery during the third trimester in severe cases. Reactive arthritis occurs in approximately 2% of C. jejuni enteritis cases and leads to the impaired movement of various joints. Pregnant women with C. jejuni–induced reactive arthritis can be expected to deliver a normal infant. A pregnant patient with GBS or ReA may be unable to care for a newborn infant because of the physical impairment induced by these diseases. Since C. jejuni infections put both fetuses and pregnant women at risk, pregnant women must take special care in food handling and preparation to prevent such infections.

Deal

2020 ◽  
pp. 25-50
Author(s):  
Dan P. McAdams
Keyword(s):  
United States ◽  
Real Estate ◽  
The United States ◽  
Maximum Pressure ◽  
Present Moment ◽  
Chapter Deal ◽  
Unique Manner ◽  
Long Term Consequences ◽  
Deal Making

The second chapter, “Deal,” examines Donald Trump’s unique manner of making deals, focusing ultimately on his efforts to broker a nuclear deal with North Korea’s Kim Jong-un in the summer of 2018. For Trump, deal-making is always about wielding power in the ever-present moment, operating as the quintessential episodic man who pays no heed to long-term consequences. The chapter delineates five principles of Trumpian deal-making: (i) fill a need, (ii) bend the rules, (iii) put on a show, (iv) exert maximum pressure, and (v) always win. The chapter traces the origins of the first three principles back to the deal-making displayed by Trump’s grandfather, Friedrich Trump, when he immigrated to the United States, and by his father, Fred Trump, as a builder and real estate mogul in Queens during the middle years of the 20th century. The latter two principles derive from Trump’s book, The Art of the Deal, as well as his life.

77 Functional Outcomes in Patients with Hand Burns Receiving Long Term Hand Therapy

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S50-S50
Author(s):  
Katherine J Choi ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
John Carney ◽  
Dawn Kurakazu ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Burn Injury ◽  
Functional Independence ◽  
Hypertrophic Scarring ◽  
Hand Therapy ◽  
Outpatient Therapy ◽  
Time To Surgery ◽  
Hand Burns

Abstract Introduction Sparse data exists on functional outcomes of patients receiving outpatient therapy after admission with hand burns. The purpose of our study is to evaluate the effectiveness of long-term outpatient occupational therapy (OT) on hand joint range of motion (ROM), activities of daily living (ADL) status, and pain after burn injury. Methods All patients with hand burns admitted to a single ABA verified burn center from January 2015 to May 2016 with properly documented outpatient OT follow up were included. Demographics (TBSA, hand dominance, mechanism), interventions (time-to-surgery, procedures), and long-term outcomes (further procedures, pain, ROM, contractures, scars, ADL) were evaluated. The effect of patient demographics and interventions on outcomes were evaluated with descriptive statistics and multivariate logistic regression. Results Of 61 patients with hand burns, 43 were referred for outpatient therapy, but only 31% (n=19) consistently presented for follow up. Mean age was 37±14 years, 74% (n=14) were male, and mean TBSA was 12%±17. Surgical management was required in 63% (n=12), and the mean time-to-surgery was 16±37 days from injury. Contractures occurred in 16% (n=3), 11% (n=2) had hypertrophic scarring, and 21% (n=4) developed both contractures and hypertrophic scarring. Of these patients, 21% (n=4) required further surgical intervention, including 3 contracture releases and 1 triamcinolone injection. Mean OT follow up was 16±14 weeks. As of the last OT note, 84% (n=16) had independent ADL function, 16% (n=3) required assistance, and none were poorly functioning. Likewise, 47% (n=9) had normal ROM, 53% (n=10) were within functional limits, and none had poor ROM. 79% (n=15) demonstrated improvement of ADL function, and 84% (n=16) had improvement of ROM. At OT intake, 68% (n=13) reported pain as a major limitation, but by end of therapy, only 21% (n=4) were limited by pain. Those with contractures or hypertrophic scars were 9.9 times less likely to have improvement in ADL status (p=.03, RR 9.9, CI 1.3–67). Conclusions Most patients referred for hand therapy after burn injury return to functional independence and have functional ROM. Applicability of Research to Practice Referral to and compliance with dedicated long-term hand therapy leads to improvements to ADL and ROM in patients admitted with hand burn injuries.

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