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Lee KC, Bamford A, Gardiner F, Agovino A, Ter Horst B, Bishop J, Sitch A, Grover L, Logan A, Moiemen NS. Investigating the intra- and inter-rater reliability of a panel of subjective and objective burn scar measurement tools. Burns 2019; 45:1311-1324. [PMID: 31327551 PMCID: PMC6731390 DOI: 10.1016/j.burns.2019.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/13/2019] [Accepted: 02/07/2019] [Indexed: 01/03/2023]
Abstract
Subjective scar measures have poor reliability unless repeated by more than one assessor. Objective scar measures have been demonstrated to have good to excellent reliability. Physical symptoms of scars such as pain and itch were found to be more important to patients compared to surface, area and colour although this finding was not sustained when corrected for multiple comparisons.
Background Research into the treatment of hypertrophic burn scar is hampered by the variability and subjectivity of existing outcome measures. This study aims to measure the inter- and intra-rater reliability of a panel of subjective and objective burn scar measurement tools. Methods Three independent assessors evaluated 55 scar and normal skin sites using subjective (modified Vancouver Scar Scale [mVSS] & Patient and Observer Scar Assessment Scale [POSAS]) and objective tools. The intra-class correlation coefficient was utilised to measure reliability (acceptable when >0.70). Patient satisfaction with the different tools and scar parameter importance were assessed via questionnaires. Results The inter-rater reliabilities of the mVSS and POSAS were below the acceptable limit. For erythema and pigmentation, all of the Scanoskin and DSM II measures (except the b* value) had acceptable to excellent intra and inter-rater reliability. The Dermascan ultrasound (dermal thickness, intensity) had excellent intra- and inter-rater reliability (>0.90). The Cutometer R0 (firmness) had acceptable reliability but not R2 (gross elasticity). All objective measurement tools had good overall satisfaction scores. Patients rated scar related pain and itch as more important compared to appearance although this finding was not sustained when corrected for multiple comparisons. Conclusion The objective scar measures demonstrated acceptable to excellent intra- and inter-rater reliability and performed better than the subjective scar scales.
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Affiliation(s)
- K C Lee
- Scar Free Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - A Bamford
- University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - F Gardiner
- University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - A Agovino
- Scar Free Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - B Ter Horst
- Scar Free Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - J Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - A Sitch
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - L Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - A Logan
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - N S Moiemen
- Scar Free Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
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Ter Horst B, Moakes RJA, Chouhan G, Williams RL, Moiemen NS, Grover LM. A gellan-based fluid gel carrier to enhance topical spray delivery. Acta Biomater 2019; 89:166-179. [PMID: 30904549 DOI: 10.1016/j.actbio.2019.03.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 03/10/2019] [Accepted: 03/19/2019] [Indexed: 12/27/2022]
Abstract
Autologous cell transplantation was introduced to clinical practice nearly four decades ago to enhance burn wound re-epithelialisation. Autologous cultured or uncultured cells are often delivered to the surface in saline-like suspensions. This delivery method is limited because droplets of the sprayed suspension form upon deposition and run across the wound bed, leading to uneven coverage and cell loss. One way to circumvent this problem would be to use a gel-based material to enhance surface retention. Fibrin systems have been explored as co-delivery system with keratinocytes or as adjunct to 'seal' the cells following spray delivery, but the high costs and need for autologous blood has impeded its widespread use. Aside from fibrin gel, which can exhibit variable properties, it has not been possible to develop a gel-based carrier that solidifies on the skin surface. This is because it is challenging to develop a material that is sprayable but gels on contact with the skin surface. The manuscript reports the use of an engineered carrier device to deliver cells via spraying, to enhance retention upon a wound. The device involves shear-structuring of a gelling biopolymer, gellan, during the gelation process; forming a yield-stress fluid with shear-sensitive behaviours, known as a fluid gel. In this study, a formulation of gellan gum fluid gels are reported, formed with from 0.75 or 0.9% (w/v) polymer and varying the salt concentrations. The rheological properties and the propensity of the material to wet a surface were determined for polymer modified and non-polymer modified cell suspensions. The gellan fluid gels had a significantly higher viscosity and contact angle when compared to the non-polymer carrier. Viability of cells was not impeded by encapsulation in the gellan fluid gel or spraying. The shear thinning property of the material enabled it to be applied using an airbrush and spray angle, distance and air pressure were optimised for coverage and viability. STATEMENT OF SIGNIFICANCE: Spray delivery of skin cells has successfully translated to clinical practice. However, it has not yet been widely accepted due to limited retention and disputable cell viability in the wound. Here, we report a method for delivering cells onto wound surfaces using a gellan-based shear-thinning gel system. The viscoelastic properties allow the material to liquefy upon spraying and restructure rapidly on the surface. Our results demonstrate reduced run-off from the surface compared to currently used low-viscosity cell carriers. Moreover, encapsulated cells remain viable throughout the process. Although this paper studies the encapsulation of one cell type, a similar approach could potentially be adopted for other cell types. Our data supports further studies to confirm these results in in vivo models.
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Affiliation(s)
- B Ter Horst
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom; University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom; The Scar Free Foundation Birmingham Burn Research Centre, United Kingdom.
| | - R J A Moakes
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom
| | - G Chouhan
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom
| | - R L Williams
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom
| | - N S Moiemen
- University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - L M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom
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Kemperman GJ, Ter Horst B, Van de Goor D, Roeters T, Bergwerff J, Van der Eem R, Basten J. The Synthesis of Substituted Benzo[c]chromen-6-ones by a Suzuki Coupling and Lactonization Sequence Using Ionic Liquids – from Laboratory Scale to Multi-Kilogram Synthesis. European J Org Chem 2006. [DOI: 10.1002/ejoc.200600188] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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