A state-wide analysis of pediatric scald burns by tap water, 2016–2018

IntroductionUnsafe tap water temperatures (>120 °F) are a risk factor for pediatric burns, which may disproportionally impact low-income, urban communities. We sought to estimate the incidence and demographic characteristics of tap water burns and their association with housing characteristics.MethodsWe performed a secondary data analysis to summarize emergency department discharge records from 2016 to 2018 involving children <18 years with an ICD-10-CM code for tap water burn (X11), and town-level housing data from the American Community Survey. Unpaired student’s t-test and spearman’s correlation analysis were performed for comparative analyses.ResultsA total of 146 tap water burn visits were identified, representing an incidence of 2 per 10,000 ED visits. The majority of cases were male, non-Hispanic White, of public insurance type, and from an urban CT town. The median age was 3 years, with 58% of cases <5 years. Towns with at least one tap water burn had a significantly higher average percentage of multi-family unit and renter housing as compared to towns with no tap water burns (p < 0.0001).ConclusionsOur results identified a significant number of tap water burns in children. Primary prevention efforts targeting education or regulation of water temperatures may work to reduce burns in underserved areas.     

Is the red-yellow-black scheme suitable to classify donor site wounds? An inter-observer analysis

Background

The red-yellow-black-scheme (RYB) is a well-known and validated scheme to classify chronic and acute wounds, based on wound color and moistness. We investigated whether this RYB-scheme is also useful to classify donor site wounds uniformly (DSW).

Methods

Twenty-three digital photographs of DSWs in various stages of wound healing were presented to internationally renowned wound scientists (n = 11), surgical doctors (n = 31), specialized wound nurses (n = 55), and surgical nurses (n = 28). These observers classified the color and moistness of the wound according to the RYB-scheme, yielding seven wound categories. Inter-observer agreement (IOA) was expressed as a kappa (κ) value.

Results

IOA's among specialized wound nurses were moderate when based on wound color and moistness (κ = 0.41; 95% CI 0.33-0.49), wound color only (κ = 0.41; 95% CI 0.29-0.53), or moistness only (κ = 0.54; 95% CI 0.45-0.64). However, these IOA's tended to be better than those among the scientists, doctors and nurses. Scientists showed the lowest agreement (k-values between 0.17 and 0.25). Doctors scored slightly better than nurses.

Conclusion

Clinicians and scientists have difficulty with classifying DSWs by means of the RYB-scheme. Therefore, this scheme does not appear useful to classify donor site wounds in a uniform manner.     

Do stakeholders in wound care prefer evidence‐based wound care products? A survey in the Netherlands

For several wound products compelling evidence is available on their effectiveness, for example, from systematic reviews. The process of buying, prescribing and applying wound materials involve many stakeholders, who may not be aware of this evidence, although this is essential for uniform and optimum treatment choice. In this survey, we determined the general awareness and use of evidence, based on (Cochrane) systematic reviews, for wound products in open wounds and burns among wound care stakeholders, including doctors, nurses, buyers, pharmacologists and manufacturers. We included 262 stakeholders. Doctors preferred conventional antiseptics (e.g. iodine), while specialised nurses and manufacturers favoured popular products (e.g. silver). Most stakeholders considered silver‐containing products as evidence‐based effective antiseptics. These were mostly used by specialised nurses (47/57; 82%), although only few of them (9/55; 16%) thought using silver is evidence‐based. For burns, silver sulfadiazine and hydrofibre were most popular. The majority of professionals considered using silver sulfadiazine to be evidence‐based, which contradicts scientific results. Awareness and use of the Cochrane Library was lower among nurses than among doctors (P < 0·001). Two thirds of the manufacturers were unaware of, or never used, the Cochrane Library. Available compelling evidence in wound care is not equally internalised by stakeholders, which is required to ensure evidence‐based decision making.     

Non‐muscle‐invasive bladder cancer surveillance for which cystoscopy is partly replaced by microsatellite analysis of urine: a cost‐effective alternative?

OBJECTIVE

To determine how good microsatellite analysis (MA) markers in voided urine samples should be to make a surveillance procedure cost‐effective in which cystoscopy is partly replaced by MA for patients with non‐muscle‐invasive urothelial carcinoma (NMI‐UC).

PATIENTS AND METHODS

We constructed a semi‐Markov model with a time horizon of 2 years, and a man aged 65 years as reference case. Data were used from a randomized trial (including 448 patients with NMI‐UC from 10 hospitals), and from other data sources. The costs and effects (probability of being in a specific health state) were compared for two surveillance strategies: (i) cystoscopy of the urinary bladder every 3 months (conventional arm), and (ii) semi‐automated MA of voided urine samples to identify loss of heterozygosity every 3 months, with a control cystoscopy at 3, 12 and 24 months (test arm). Various sensitivity analyses were used to determine the sensitivity, specificity, and costs of MA of urine for which the test arm was as cost‐effective as the conventional arm.

RESULTS

The probability of being without recurrence after 2 years of surveillance was similar (86.6% conventional arm vs 86.3% test arm) with currently available MA markers (sensitivity of 58% and specificity of 73%). However, the test arm led to higher costs (€4104 vs €3433 per head). The test arm would be as effective and cost the same as the conventional arm if the sensitivity of the currently available MA markers was increased at ≥61%, had a specificity of 73%, and decreased the costs of the MA test per follow‐up sample from €158 to <€70.

CONCLUSIONS

Over 2 years, surveillance in which cystoscopy is partly replaced by currently available urinary MA to reduce patient burden can only provide a cost‐effective alternative to the conventional surveillance if the MA urine test had a slightly higher sensitivity and its costs could be reduced.     

What is behind phylogenetic analysis of hospital‐, community‐ and livestock‐associated methicillin‐resistant Staphylococcus aureus?

Methicillin‐resistant Staphylococcus aureus (MRSA) has been shown to be the predominant life‐threatening pathogen in Egypt. MRSA is a major cause of severe healthcare‐associated (HA) infections. During the last decades, the incidence of community‐associated (CA) MRSA infections has a complex epidemiology arising from the circulation of different strains in the general population. Moreover, livestock‐associated (LA) MRSA emerged recently becomes an emerging threat to public health. Therefore, it is important to illuminate the differences between CA‐, HA‐ and LA‐MRSA to shed light on their genetic diversity and evolution. This study presents the first data on analysing the correlation between CA‐, LA‐ and HA‐MRSA using antibiogram typing, molecular characteristics and antimicrobial resistance and virulence genes’ profiles. Overall, HA‐MRSA strains tended to be multidrug resistant and less virulent than both LA‐ and CA‐MRSA strains. Importantly, CA‐MRSA strains had a high homology with each of HA‐ and LA‐MRSA. However, no similarity was observed between HA‐ and LA‐MRSA. Our findings suggest that the epidemiological changes in genetic behaviour between HA‐ and LA‐MRSA are due to the presence of CA‐MRSA confirming that CA‐MRSA has created a public health crisis worldwide.     

On what are our end‐of‐life decisions based?

BACKGROUND: The incidence of withholding and withdrawing life support from the critically ill has increased in recent years. The aim of this study was to assess the degree of consistency between the weight assigned by intensivists to different determinants and their relation to end-of-life decisions, and to evaluate the current concepts in withholding or withdrawing intensive care in Nordic countries. METHODS: Forty-one intensivists from Nordic countries completed a questionnaire sent by e-mail: consistency between contributing factors and the decisions regarding 10 actual cases was evaluated by logistic regression analysis and by the classification (leave-one-out) method. Concepts in management after the withdrawal decision were also analyzed. RESULTS: The median (range) number of withdrawals per physician was four (range 0-10) out of 10 cases. No single factor was an independent covariant of all decisions made. The classification method revealed that approximately 70% only of decisions could be predicted correctly. Different actions taken after a decision to withdraw intensive care varied from 9.8% (discontinuing ventilator therapy) to 97.6% (informing relatives). CONCLUSIONS: No generally accepted grounds for end-of-life decisions could be detected among Nordic intensivists. In addition, the current concept of management after decision to withdraw therapy varies markedly. This study has implications in further assessment of the individual decision-making process and the uniformity of actions after withdrawal decisions.     

Is Ambulatory Status a Prognostic Factor of Survival in Patients with Spinal Metastases? An Exploratory Meta‐analysis

This study was conducted to identify the influence of ambulatory status prior to treatment on survival of patients with spinal metastases. Two investigators independently retrieved relevant electronic literature in PubMed, Embase, and Cochrane Library databases, to identify eligible studies. Effect estimates for hazard risk (HR) were extracted and synthesized through fixed‐effects or random‐effects models as appropriate. A total of 17 eligible studies were identified, with an accumulated number of 3962 participants. HR from 14 studies regarding comparison between ambulatory versus non‐ambulatory groups were pooled using a random‐effects model, and statistical significance was presented for the pooled HR (HR = 1.96; 95% confidence interval [CI], 1.65–2.34). In subgroups of mixed primary tumor and lung cancer, ambulatory status was considered to be a significant prognostic factor (P < 0.05), while in the subgroup of prostate cancer it was not (HR = 1.72; 95% CI, 0.79–3.74). HR from 4 studies related to comparison between Frankel E versus Frankel C–D were pooled using a fixed‐effects model, which revealed statistical significance (HR = 1.73; 95% CI, 1.27–2.36). Ambulatory status is a significant prognostic factor in patients with spinal metastases. However, in patients with primary prostate cancer, the prognostic effect of ambulatory status has not yet been confirmed to be significant.