| 1. |
- Berner, Juan Enrique, et al.
(författare)
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International Lower Limb Collaborative (INTELLECT) study : a multicentre, international retrospective audit of lower extremity open fractures
- 2022
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Ingår i: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 109:9, s. 792-795
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-two centres in 16 countries contributed with 2,694 open fractures cases to an international, multi-centric, retrospective cohort study involving different healthcare settings. The INTELLECT study results show that there are significant disparities on the management of open lower limb fractures internationally. A timely, multidisciplinary, guideline-directed care is a protective factor for developing infective complications, non-union and requiring an amputation.
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| 2. |
- Holm, Sebastian, 1993-, et al.
(författare)
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Alkoholbaserade tvättlösningar kan ge brännskador vid diatermi : [Diathermy can cause deep burns after alcohol preparation or through direct contact]
- 2022
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Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 119:19-20
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Tidskriftsartikel (refereegranskat)abstract
- Flera fall av vårdorsakade brännskador har rapporterats till Ivo och Socialstyrelsen de senaste decennierna.Alkoholbaserade lösningar för perioperativ steriltvätt i kombination med diatermi kan orsaka brand och brännskador om lösningen inte torkat ordentligt.Tvättlösningar kan ansamlas i draperingsveck eller i tyger. Det är viktigt att säkerställa att alkoholbaserade tvättlösningar har torkat ordentligt före användning av diatermi.Majoriteten av incidenter relaterade till intraoperativa brännskador orsakade av diatermi beror på felaktig användning.
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| 3. |
- Holm, Sebastian, 1993-, et al.
(författare)
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Does the estimation of burn extent at admission differ from the assessment at discharge?
- 2021
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Ingår i: Scars, Burns & Healing. - : Sage Publications. - 2059-5131. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Estimation of total body surface area (TBSA) burnt and burn depth are among the most central parts of acute burn assessment/treatment as they determine the level and type of care needed. Traditional methods for determining burn extent on admission often lead to inaccurate estimations, especially in paediatric or overweight patients.Aim: To compare %TBSA at admission with validated %TBSA at discharge in different patient populations to investigate if significant over- or underestimation occurs.Method: This retrospective observational study is based on a patient registry of all the patients (n = 863) treated at the Uppsala University Hospital's Burn Centre between 2010 and 2018. The patients were divided into subgroups based on age, gender, body mass index (BMI) and validated burn extent. The %TBSA estimated at admission was compared to the validated %TBSA in all groups separately.Results: As has been published before, we also found that the %TBSA in paediatric patients was more often overestimated as were the smaller injuries, whereas larger injuries were often underestimated. BMI did not clearly affect the estimations and there was no clear difference between the genders in estimated %TBSA.Conclusion: Inaccurate estimations of %TBSA are common, particularly for paediatric patients and small or large injuries. We recommend a careful accurate approach when calculating %TBSA in the paediatric population to avoid over- and under-resuscitation. Increased education and training are recommended to improve accurate estimation in the future.Lay summary: The correct estimation of both extent and depth of burn is very important. This assessment guides the lever of care needed, the necessary amount of fluid resuscitation, the predicted outcome and more. It has been proven notably difficult to correct assess, especially the extent of a burn. Despite different tools as the "Rule of Nine" (body area divided into multiples of 9% body surfaces), the "Rule of Palm" (Patient's palm, fingers included, approximates 1% of body surfaces), the Lund & Browder chart (detailed, age-specific body areas) and different more technical solutions. Often inaccurate estimations are done which thus affect the treatment. This depth and extent estimation is usually performed when the patient is admitted. However, it is known that burns change appearance during the first few days of care. In our Burn Center we have also performed this estimation when the patient is discharged. At this point it is known the true extent and depth of the initial burn. In this retrospective observational study, we compared the burn extent estimated on admission with the one on discharge to investigate whether the initial assessment is accurate. This study highlights the issue of frequent inaccurate burn extent estimations, especially in subgroups as overweight patient or pediatric patients.
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| 4. |
- Holm, Sebastian, 1993-, et al.
(författare)
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Is the pre-operative wound culture necessary before skin grafting minor burns? A pilot study in a low resource setting burn service
- 2024
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Ingår i: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488.
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Tidskriftsartikel (refereegranskat)abstract
- The most common cited cause of split-thickness skin graft failure is infection and due to the association between bacterial findings in wound beds an attempt to decrease the bacterial burden before skin-grafting evolved. Thus, pre-operative microbiology swabs of the wound bed became routine at some institutions prior to grafting. This is not standard practice in the Pietermaritzburg burn service. Emphasis is instead placed on a strict protocol of intra-operative wound bed preparation to promote adequate graft take. This pilot study aims to evaluate whether pre-operative wound swabs are appropriate. We performed a prospective observational study to determine if positive wound cultures were associated with graft failure. All patients with a burn surface area of less than 10 %, where delayed grafting (later than 28 days from time of burn injury) was performed, from March to December 2021 were analyzed. Patient demographics, days from burn to graft, %TBSA burn, %TBSA grafted, whether sharp debridement prior to grafting in the same procedure was performed or not, use of topical gentamicin intra-operatively, graft outcome (% graft loss), need for regraft, and organism grown were recorded into an excel spread sheet for analysis. The sample included 52 patients. Of these, 17 (31.5%) were female. The median %TBSA grafted was 8% (IQR 4-13%) and similar in both groups. The median days from burn to grafting was 35 days. Thirty-nine patients (75%) had graft Take and 13 (25%) had graft Failure. In the failed group, median % graft failure was 50% (30 - 70%). Of the group with successful graft take, 90% were noted to have had a positive wound culture prior to grafting. A positive wound culture was not found to be a risk factor for graft failure (p=0.993). Despite the positive wound cultures graft take was more than 90 % in 75% of grafts performed and only 2/52 patients required supplementary grafting. We believe that this demonstrates that our local protocol is reasonable in this setting and that waiting for negative wound swabs prior to grafting should not be a reason to delay grafting.
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| 5. |
- Holm, Sebastian, 1993-, et al.
(författare)
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Låg inkomst och asylstatus var kopplad till brännskador hos barn
- 2022
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Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; :25-26
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Tidskriftsartikel (refereegranskat)abstract
- I Sverige skadas 40 000 människor av brännskador per år, och 1 300 patienter vårdas på sjukhus. Tidigare studier har beskrivit ett samband mellan socioekonomisk status och skaderisk hos barn, där brännskador inkluderas. I de flesta höginkomstländer har incidensen av brännskador minskat. I Sverige minskade antalet brännskador med 45 procent mellan 1987 och 2010 [1]. Förebyggande strategier med bland annat branddetektorer, elsäkerhet, vattentemperaturreglering och säkrare byggnader samt utbildning har bidragit till denna positiva utveckling.I Sverige finns två brännskadecentrum – ett i Linköping och ett i Uppsala. Man hade noterat ett ökat inflöde av barn med brännskador, och detta behövde undersökas närmare.En retrospektiv studie [2] med uppgifter från dessa två centrum kombinerade med uppgifter från Statistiska centralbyrån och Migrationsverket genomfördes därför för perioden 2010–2020. Alla barn (0–17 år) som hade vårdats inom öppenvård eller slutenvård ingick i studien. Studien omfattade 2 455 patienter. De flesta av barnen var under 5 år (76 procent) och var pojkar (60 procent). Studiedeltagarnas postnummer registrerades, och 83 procent (n = 1 974) bodde i områden med en inkomstnivå under den nationella medianen (Figur 1).Barn med asylstatus hade närmare 10 gånger ökad risk (medelvärde 9,6) att drabbas av brännskador jämfört med andra barn. Det är känt sedan tidigare studier runt om i världen att risken för att få en brännskada är kopplad till låg socioekonomisk status. Detta stämmer, enligt studien, även i Sverige.Brännskador hos barn kan undvikas genom prevention. Givet den ökade risken för brännskador hos barn bland asylsökande och dem som bor i områden med låg inkomst bör preventiva åtgärder designas för och implementeras med dessa grupper i åtanke.Den ökade risken kan vara kopplad till hur barnen och deras familjer bor, då trångboddhet är en riskfaktor för brännskador hos barn.
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| 6. |
- Holm, Sebastian, 1993-, et al.
(författare)
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Sociodemographic Patterns of Pediatric Patients in Specialized Burn Care in Sweden
- 2022
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Ingår i: Plastic and Reconstructive Surgery - Global Open. - : Lippincott Williams & Wilkins. - 2169-7574. ; 10:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Trauma is a leading cause of mortality in children. Burns affect children disproportionally. Although burn incidence and mortality are decreasing, differences in the risk depend on socioeconomic status. The present study aimed to investigate the sociodemographic patterns of pediatric patients (0-17 years) managed at the two burn centers in Sweden, Uppsala, and Linköping, between 2010 and 2020.Method: This retrospective register-based study used hospital records from the two burn centers combined with information from Statistics Sweden plus data regarding number of asylum seekers from the Swedish Migrations Agency. Choropleth maps representing the patients' geographical distribution were created. Information about income levels per geographic area was added. A Wilcoxon signed-rank test was performed to investigate differences in median income levels between the areas where the patients lived, related to Sweden's median income.Results: The study included 2455 patients. Most of the children aged below 5 years (76%) and were boys (60%). The mean percentage of total skin area was 4.2%. There was no significant increment or decrease in the incidence of pediatric burns during the study. Most patients with recorded zip codes lived in areas with an income level below the national median (n = 1974, 83%). Children with asylum status were over-represented compared with residents and/or Swedish citizens.Conclusions: In Sweden, most pediatric burns occur in families that live in areas with low-income levels. Pediatric burns affect children with asylum status disproportionally compared with those who are residents in and/or citizens of Sweden. Prevention strategies should be designed and implemented to alleviate this health inequity.
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| 7. |
- Mohammad Ismail, Ahmad, 1993-, et al.
(författare)
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β-adrenergic blockade is associated with a reduced risk of 90-day mortality after surgery for hip fractures
- 2020
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Ingår i: Trauma surgery & acute care open. - : BMJ Publishing Group Ltd. - 2397-5776. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a significant postoperative mortality risk in patients subjected to surgery for hip fractures. Adrenergic hyperactivity induced by trauma and subsequent surgery is thought to be an important contributor. By downregulating the effect of circulating catecholamines the increased risk of postoperative mortality may be reduced. The aim of the current study is to assess the association between regular β-blocker therapy and postoperative mortality.Methods: This cohort study used the prospectively collected Swedish National Quality Registry for hip fractures to identify all patients over 40 years of age subjected to surgery for hip fractures between 2013 and 2017 in Örebro County, Sweden. Patients with ongoing β-blocker therapy at the time of surgery were allocated to the β-blocker-positive cohort. The primary outcome of interest was 90-day postoperative mortality. Risk factors for 90-day mortality were evaluated using Poisson regression analysis.Results: A total of 2443 patients were included in this cohort of whom 900 (36.8%) had ongoing β-blocker therapy before surgery. The β-blocker positive group was significantly older, less fit for surgery based on their American Society of Anesthesiologists classification and had a higher prevalence of comorbidities. A significant risk reduction in 90-day mortality was detected in patients receiving β-blockers (adjusted incidence rate ratio=0.82, 95% CI 0.68 to 0.98, p=0.03).Conclusions: β-blocker therapy is associated with a significant reduction in 90-day postoperative mortality after hip fracture surgery. Further investigation into this finding is warranted.Level of evidence: Therapeutic study, level III; prognostic study, level II.
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| 8. |
- Petráková, A., et al.
(författare)
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Strengthening core competences of medical and public health students for public health emergencies
- 2020
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 30:Supplement 5, s. V15-V15
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Tidskriftsartikel (refereegranskat)abstract
- Background: The importance of public health capacity development with a focus on public health emergencies and humanitarian assistance is continuously increasing at the global scale. In the time of Public Health Emergencies of International Concern is crucial to provide basic training in core public health competences to all health professionals, including students. Faculty of Medicine & Dentistry, Palacký University Olomouc, Czech Republic (full ASPHER member), implemented in medical as well as public health curricula new topics focused on core competences of health professionals in the area of public health emergencies and humanitarian assistance.Objectives: To strengthen competences and skills of medical as well as public health students to prepare them better for public health emergencies and humanitarian assistance in the time of increasing risk of global public health emergencies. New modules were proposed and tested in all education programmes at our Faculty of Medicine & Dentistry, Palacký University Olomouc (CZ): General Medicine (Czech and English programmes), Dentistry (Czech and English programmes) and Public Health (Czech programme).Results: New modules on Public Health Emergencies, including preparedness, responses, risk management and risk communication were successfully tested in all education programmes during the academic year 2018/19 and fully implemented for the academic year 2019/20. New module has blended learning structure based on combination of face-to-face seminars and exercises with e-learning parts, including self-assessment. New module is presented in details.Conclusions: This new education module fully supports international recommendations to strengthen public health competences and skills of medical as well as public health students to be ready for any unexpected public health emergencies at all levels, in particular at the local community level. COVID-19 pandemic confirmed.
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| 9. |
- Pircher, Achmed, et al.
(författare)
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Left orbital compartment syndrome and right anterior ischemic optic neuropathy in a patient with severe burns despite non-aggressive fluid resuscitation
- 2021
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Ingår i: Scars, Burns & Healing. - : Sage Publications. - 2059-5131. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Ophthalmological complications such as orbital compartment syndrome (OCS) and ischemic optic neuropathy are rare complications in patients with burns and have been described in patients where aggressive fluid resuscitation was performed. While OCS requires urgent surgical intervention, no current treatment is established to treat, or prevent, ischemic optic neuropathy in patients with burns.Methods: The authors report a case of a 38-year-old woman with flame burns including the periorbital regions who developed OCS on the left side and anterior ischemic optic neuropathy (AION) on the right side despite non-aggressive fluid resuscitation. Immediate lateral canthotomy combined with inferior cantholysis was performed on the left side.Discussion and conclusion: OCS and AION need to be considered as potential complications even in critically ill patients with facial burns who do not receive aggressive fluid resuscitation. Whether an early surgical intervention will lower the risk of AION development is, however, speculative.Lay summary: Ophthalmological complications such as orbital compartment syndrome and ischemic optic neuropathy are rare complications in patients with burns and have been described in patients where aggressive fluid resuscitation was performed. We present a case of a critically ill patient with severe facial burns who developed orbital compartment syndrome on the left side and anterior ischemic optic neuropathy on the right side even though our patient did not receive aggressive fluid resuscitation.Our case is particular because both of these rare complications are seen in a single patient and neither received aggressive fluid resuscitation. The fact that the patient did not develop ischemic optic neuropathy on the side where the lateral canthotomy was performed (only on the side where the patient had orbital compartment syndrome), this case might raise the discussion of whether an early surgical intervention might lower the risk of ischemic optic neuropathy development in patients with facial burns.
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| 10. |
- Stašek, Martin, et al.
(författare)
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Perioperative oesophagogastroduodenoscopy in the prevention and therapy of anastomotic complications - A review : [Prioperační ezofagogastroduodenoskopie v prevenci a terapii anastomotických komplikací - přehledový článek]
- 2020
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Ingår i: Gastroenterologie a Hepatologie. - : Ambit Media, a.s.. - 1804-7874 .- 1804-803X. ; 74:3, s. 217-227
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Forskningsöversikt (refereegranskat)abstract
- The current development of endoscopic and minimally invasive methods show new techniques to treat early anastomotic complicationsin the upper gastrointestinal tract. The aim of this paper is to summarise current knowledge about endoscopic methods and their relation tosurgical treatment in terms of their timing of use, alternative procedures and previous study results. The main methods discussed are endoscopicvacuum therapy (EVAC) and the use of stents and clips, particularly the over-the-scope variant (OTSC). Intraoperative endoscopy is an importantoption, due to the navigation of surgery and combined surgical and endoscopic therapy. Included in this paper is an evaluation of the benefitsof individual methods employed in the complications of oesophagogastric and oesophagojejunal anastomoses as well as in bariatric surgery(sleeve gastrectomy, gastric bypass). An evaluation of the benefits of individual methods employed in the complications of oesophagogastric andoesophagojejunal anastomoses as well as in bariatric surgery (sleeve gastrectomy, gastric bypass) is included in a comprehensive review.
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