A Simple Technique for Protecting Exposed K Wire Ends

Several techniques have been described for protecting the sharp ends of Kirschner wires intraoperatively. We describe a simple, inexpensive technique, which can be used to protect the ends of the wires both intraoperatively and postoperatively.     

Management of iatrogenic full thickness electrical burn in a preterm neonate using W-plasty technique combined with a median sternotomy incision

Burns in the neonatal period are rare and most commonly due to iatrogenic causes. We report a case of a preterm neonate who sustained a full thickness electrical burn following the use of a temporary pacing pad. The case was complicated by significant co-morbidities and the need for cardiac surgery. We describe the surgical management of the case, using excision and closure in the form of a W-plasty. We discuss the reasons for this surgical decision and the importance of managing complex cases such as this on an individual basis.     

A 1 year study of burn injuries in a British Emergency Department

OBJECTIVES: To determine the number of patients attending an Emergency Department with burns and to establish the epidemiology, management and outcome of these cases. METHOD: A retrospective study of all patients attending an Emergency Department with a diagnosis of "burn" during 2004. RESULTS: Seven hundred and eighty-five patients presented with a diagnosis of burns, accounting for 1% of all attendances. Fifty-three percent of patients were male and most were young adults of working age. Scalds and flame injuries were the most common causes of injury. Only 30% of patients performed adequate first aid. The majority of burns were small and did not require admission to hospital. Assessment and documentation by the Emergency Department staff was found to be generally poor and this may reflect a lack of experience in managing burns. CONCLUSION: Burns remain a relatively uncommon presenting complaint in the Emergency Department, even in a hospital accepting tertiary referrals. Most injuries are minor and are managed within the department. This study suggests that there is a role for better education of less experienced staff in the management of burns. There remains a need for public education in the prevention and first aid of burns.     

The safety of nanocrystalline silver dressings on burns: a study of systemic silver absorption

INTRODUCTION: Wound dressings containing silver have been in widespread use for many years. However, there are few quantitative data on the systemic absorption of silver or whether there is associated clinical risk. OBJECTIVES: To assess systemic silver levels when Acticoat dressings containing nanocrystalline silver were used, and to determine whether increases in such levels were associated with haematological or biochemical indicators of toxicity. METHOD: A prospective, single-centre, open-label study of 30 patients with relatively small burns that required skin grafting. Serum silver levels were measured before, during and at discontinuation of the use of the Acticoat dressings, and again at 3 and 6 months following completion of treatment. RESULTS: The median total postoperative wound size was 12% of the total body surface area. The median time to maximum silver levels was 9 days. The median maximum serum silver level was 56.8 microg/l. The median serum level at 6 months was 0.8 microg/l. There were no haematological or biochemical indicators of toxicity associated with the silver absorption observed in this study. CONCLUSION: This study has confirmed our view that Acticoat products are safe for use on burns and they remain a standard part of treatment at our centre.     

Clinical placements for medical students: factors affecting patients' involvement in medical education

Many medical students now have contact with patients from the very beginning of their course and the increasing numbers of medical students means that more and more patients will be exposed to students during their medical treatment. This paper presents the attitudes of 281 patients towards medical students encountered in a primary or secondary care setting. Particular attention is paid to consent, types of procedures undertaken and the title given to the medical student. The study showed that the likelihood of patients agreeing to be involved in medical education depended on the patient, the student and the procedure being undertaken. Recommendations have been made to the university on the basis of the results with the aim of maximizing patient involvement and satisfaction in order to further medical student education.     

Health Risk Factors in an Adolescent Psychiatric Residential Treatment Facility

To date, there is limited information regarding prevalence of health-related risks profiles of youths in psychiatric residential treatment, including weight and physical activity. To address this gap in the literature, weight and associated health risk behaviors in a sample of adolescents in a psychiatric residential treatment center were assessed. Adolescents in this sample have nearly twice the rate of being overweight or obese (46.6%) when compared to national (28.8%) norms and only 47.8% met national physical activity recommendations. Adolescent psychiatric residential treatment facilities are poised to intervene with adolescents who are at high risk for unhealthy weight.     

Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses

Purpose

The COVID-19 pandemic has many potential impacts on people with mental health conditions and on mental health care, including direct consequences of infection, effects of infection control measures and subsequent societal changes. We aimed to map early impacts of the pandemic on people with pre-existing mental health conditions and services they use, and to identify individual and service-level strategies adopted to manage these.

Methods

We searched for relevant material in the public domain published before 30 April 2020, including papers in scientific and professional journals, published first person accounts, media articles, and publications by governments, charities and professional associations. Search languages were English, French, German, Italian, Spanish, and Mandarin Chinese. Relevant content was retrieved and summarised via a rapid qualitative framework synthesis approach.

Results

We found 872 eligible sources from 28 countries. Most documented observations and experiences rather than reporting research data. We found many reports of deteriorations in symptoms, and of impacts of loneliness and social isolation and of lack of access to services and resources, but sometimes also of resilience, effective self-management and peer support. Immediate service challenges related to controlling infection, especially in inpatient and residential settings, and establishing remote working, especially in the community. We summarise reports of swiftly implemented adaptations and innovations, but also of pressing ethical challenges and concerns for the future.

Conclusion

Our analysis captures the range of stakeholder perspectives and experiences publicly reported in the early stages of the COVID-19 pandemic in several countries. We identify potential foci for service planning and research.