Basic investigation into the present burn care system in China: Burn units, doctors, nurses, beds and special treatment equipment

Dipicolylamine-Zn Induced Targeting and Photo-Eliminating of Pseudomonas aeruginosa and Drug-Resistance Gram-Positive Bacteria

The emergence of drug-resistant bacteria, particularly resistant strains of Gram-negative bacteria, such as Pseudomonas aeruginosa, poses a significant threat to public health. Although antibacterial photodynamic therapy (APDT) is a promising strategy for combating drug-resistant bacteria, actively targeted photosensitizers (PSs) remain unknown. In this study, a PS based on dipicolylamine (DPA), known as WZK-DPA-Zn, is designed for the selective identification of P. aeruginosa and drug-resistant Gram-positive bacteria. WZK-DPA-Zn exploits the synergistic effects of DPA-Zn2+ coordination and cellular uptake, which could effectively anchor P. aeruginosa within a brief period (10 min) without interference from other Gram-negative bacteria. Simultaneously, the cationic nature of WZK-DPA-Zn enhances its interaction with Gram-positive bacteria via electrostatic forces. Compared to traditional clinical antibiotics, WZK-DPA-Zn shows exceptional antibacterial activity without inducing drug resistance. This effectiveness is achieved using the APDT strategy when irradiated with white light or sunlight. The combination of WZK-DPA-Zn with Pluronic-based thermosensitive hydrogel dressings (WZK-DPA-Zn@Gel) effectively eliminates mixed bacterial infections and accelerates wound healing, thereby achieving a synergistic effect where "1+1>2." In summary, this study proposes a precise strategy employing DPA-Zn as the targeting moiety of a PS, facilitating the rapid elimination of P. aeruginosa and drug-resistant Gram-positive bacteria using APDT.

Resource generation challenges for burn care in Iran

BACKGROUND

Given the importance of investment in human and physical resources and knowledge in burn injuries for improving health service performance, this study endeavoured to identify resource production challenges in the burn care of Iran.

METHODS

In this descriptive qualitative study, semi-structured interviews were conducted with 21 key informants. The purposive sampling method was applied to select interviewees, and data collection through interviews was continued to achieve data saturation. Using the framework of Adams et al. for health resource production, the directed content analysis approach was undertaken to analyse the qualitative data.

RESULTS

Three main themes and seven sub-themes were identified, and the main themes (sub-themes) were human (the lack of motivation, job stressors and the lack of clinical staff), physical (capital resources and consumables) and intellectual (burn care education and staff training) resources.

CONCLUSION

In general, investment in different areas would help provide better burn services, including educating and empowering employees, motivating through identifying and defining their needs, and considering points for job stressors as work hardship, burnout and workplace harassment. Other areas of investment are increasing the recruitment of burn section personnel, providing burn specialized equipment and updating them, providing standard physical space, and supplying consumables such as medicines and dressings.

A Smartphone Application for Burn Self-care

Burn treatment and management is largely patient-dependent and self-care education helps reducing tangible and intangible costs as well as improving quality of care. Thus, this study aimed to develop a smartphone application for burn self-care. This research, conducted in 2018, consisted of two phases. Initially, the educational content required for the application was determined based on the literature review and clinicians' and patients' perspectives. The setting of the study was the largest burn and plastic surgery hospital in the country. Based on the results derived from the first phase of the study, the application prototype was designed in the Persian language to be used on smartphones. The usability of the application was evaluated by using a standard questionnaire and the data were analyzed by using descriptive statistics. The educational content of the application included eight different areas of self-care; namely, wound care, scar management, care and control of hypertrophic burn scars, nutrition, in-home pain management, mental health, follow-up, and rehabilitation. A specialist was consulted and related texts and images were selected to be included in the application. The application was used by burn patients for a week and users evaluated its usability at a good level. It seems that the application designed in the present study can help to increase patients' knowledge about burn conditions and improve their self-care skills. Further studies are needed to present the efficiency and effectiveness of the application in practice.

The epidemiology and prognosis of patients with massive burns: A multicenter study of 2483 cases

OBJECTIVE

Epidemiological features of massively burned patients in China remains unclear. This study was designed to investigate the epidemiological characteristics and evaluate the burn index (BI) and other risk factors associated with the prognosis of massively burned patients.

METHODS

Data of patients with ≥30% total body surface area burned admitted in 2014 were retrieved from 106 burn centers in the mainland of China. Information of epidemiological features and the outcome were collected for retrospective analysis.

RESULTS

A total of 2483 massively burned patients were included in this study, with a male-to-female ratio of 2.29:1, the mean age of 49.23±16.67 years, mean TBSA of 55.53±21.39% and the mean BI of 39.75±21.59. Scald accounted for 81.07% of the injuries in children, while flame accounted for 66.89% and 74.31% of the injuries in adults and seniors. Approximately 17.76% of the patients were admitted to the local burn center after 6h of injury, and the wound areas of 1154 (46.48%) patients were covered with folk remedies. The mortality was 9.79%, and the area under the receiver operating characteristic (ROC) curve for BI was 0.941 (95% CI, 0.929-0.954). When the value of BI was above a threshold of 29 in the 0-14 years age group, 43.5 in the 15-59 years age group and 35.5 in the 60 years or older age group, the mortality increased significantly. Multivariate logistic regression analyses showed that the odds ratio (OR) of death increased 6% with an increase in the BI of 1.0. Patients older than 60 years, the admission time longer than 6h after-injury (adjusted OR, 1.797; 95% CI, 1.179-2.740; adjusted p<0.001), and patients with a combined inhalation injury (adjusted OR, 6.649; 95% CI, 4.517-9.789; adjusted p<0.000), were at higher risk of death.

CONCLUSIONS

There are etiological characteristics of the different age groups that should be considered for prevention. BI can be a reliable index of prognosis in severely burned patients. The results of the study showed that a large BI, elderly age, delayed admission after injury and combined inhalation injury are the main risk factors for extensively burned patients.