The properties of an “ideal” burn wound dressing – What do we need in daily clinical practice? Results of a worldwide online survey among burn care specialists

Burns ◽  
2012 ◽  
Vol 38 (7) ◽  
pp. 960-966 ◽  
Author(s):  
Harald F. Selig ◽  
David B. Lumenta ◽  
Michael Giretzlehner ◽  
Marc G. Jeschke ◽  
Dominic Upton ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Wound Dressing ◽  
Online Survey ◽  
Daily Clinical Practice ◽  
Burn Wound ◽  
Burn Care

Multiple Sclerosis Progression Discussion Tool: Usability and Usefulness in Clinical Practice (Preprint)

2021 ◽  
Author(s):  
Tjalf Ziemssen ◽  
Gavin Giovannoni ◽  
Enrique Alvarez ◽  
Virender Bhan ◽  
Carrie Hersh ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Practice ◽  
Cognitive Function ◽  
Disease Progression ◽  
Online Survey ◽  
Likert Scale ◽  
Daily Clinical Practice ◽  
Daily Activities ◽  
Final Questionnaire ◽  
The Impact

BACKGROUND A digital tool (Multiple Sclerosis Progression Discussion tool, MSProDiscuss) was developed to facilitate a discussion between a healthcare professional (HCP) and patient in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. OBJECTIVE To report findings on the usability and usefulness testing of the MSProDiscuss tool in the real-world clinical setting. METHODS In this cross sectional, online survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability and usefulness, and integration and adoption into clinical practice to capture their overall experience on using the tool). Responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. RESULTS In total, 301 HCPs tested the tool in 6974 MS patients, of which 77% were relapsing remitting MS patients including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was 1-4 minutes in 97% (initial) to 98% (final) of the cases. In 94% (initial) to 97% (final) cases, HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions from the tool. HCPs were willing to use the tool again in the same patient 91% (initial) of the cases. MSProDiscuss was useful in discussing MS symptoms and their impact on daily activities (88% initial and 92% final) and cognitive function (79% for both initial and final) and in discussing progression in general (88% initial and 90% final). While completing the final questionnaire, 95% of HCPs agreed that the questions were similar to those asked in regular consultation and the tool helped to better understand the impact of MS symptoms on daily activities (91%) and cognitive function (80%). Overall, 92% of the HCPs would recommend MSProDiscuss to a colleague, and 86% are willing to integrate it into their clinical practice. CONCLUSIONS MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on disease progression in daily clinical practice. Most HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice.

Pediatric neurosurgery in Asia and Australasia: training and clinical practice

2021 ◽  
Vol 27 (1) ◽  
pp. 93-101
Author(s):  
Ronnie E. Baticulon ◽  
Michael C. Dewan ◽  
Nunthasiri Wittayanakorn ◽  
Philipp R. Aldana ◽  
Wirginia J. Maixner
Keyword(s):  
Clinical Practice ◽  
Online Survey ◽  
Vascular Malformations ◽  
Economic Status ◽  
Pediatric Neurosurgery ◽  
Income Group ◽  
Fellowship Training ◽  
Pediatric Epilepsy ◽  
Skill Sets ◽  
Survey Responses

OBJECTIVEThere are limited data on the pediatric neurosurgical workforce in Asia and Australasia. The training and clinical practice of pediatric neurosurgeons need to be characterized in order to identify gaps in knowledge and skills, thereby establishing a framework from which to elevate pediatric neurosurgical care in the region.METHODSAn online survey for pediatric neurosurgeons was created in REDCap (Research Electronic Database Capture), collecting demographic information and data on pediatric neurosurgical training and clinical practice. The link to answer the survey was sent to the mailing lists of the Asian Australasian Society for Pediatric Neurosurgery and the Japanese Society for Pediatric Neurosurgery, disseminated during the 2019 Asian Australasian Pediatric Neurosurgery Congress, and spread through social media. The survey was open to neurosurgeons who operated on patients ≤ 18 years old in Asian Australasian countries, whether or not they had completed fellowship training in pediatric neurosurgery. Descriptive statistics were computed and tabulated. Data were stratified and compared based on surgeon training and World Bank income group.RESULTSA total of 155 valid survey responses were analyzed, representing neurosurgeons from 21 countries. A total of 107 (69%) considered themselves pediatric neurosurgeons, of whom 66 (43%) had completed pediatric neurosurgery training. Neurosurgeons in East Asia commonly undergo a fellowship in their home countries, whereas the rest train mostly in North America, Europe, and Australia. A majority (89%) had operating privileges, and subspecialty pediatric training usually lasted from 6 months to 2 years. On average, trained pediatric neurosurgeons perform a higher number of pediatric neurosurgical operations per year compared with nonpediatric-trained respondents (131 ± 129 vs 56 ± 64 [mean ± SD], p = 0.0001). The mean number of total neurosurgical operations per year is similar for both groups (184 ± 129 vs 178 ± 142 [mean ± SD], p = 0.80). Respondents expressed the desire to train further in pediatric epilepsy, spasticity, vascular malformations, craniofacial disorders, and brain tumors.CONCLUSIONSBoth pediatric and general neurosurgeons provide neurosurgical care to children in Asia and Australasia. There is a need to increase pediatric neurosurgery fellowship programs in the region. Skill sets and training needs in pediatric neurosurgery vary depending on the country’s economic status and between pediatric-trained and nonpediatric-trained surgeons.

The CSF p-tau181/Aβ42 Ratio Offers a Good Accuracy “In Vivo” in the Differential Diagnosis of Alzheimer’s Dementia

2019 ◽  
Vol 16 (7) ◽  
pp. 587-595 ◽  
Author(s):  
Roberto Santangelo ◽  
Alessandro Dell'Edera ◽  
Arianna Sala ◽  
Giordano Cecchetti ◽  
Federico Masserini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Diagnosis ◽  
Fdg Pet ◽  
Amyloid Β ◽  
Cost Effective ◽  
Daily Clinical Practice ◽  
Different Types ◽  
Experimental Trials ◽  
Csf Findings

Background: The incoming disease-modifying therapies against Alzheimer’s disease (AD) require reliable diagnostic markers to correctly enroll patients all over the world. CSF AD biomarkers, namely amyloid-β 42 (Aβ42), total tau (t-tau), and tau phosphorylated at threonine 181 (p-tau181), showed good diagnostic accuracy in detecting AD pathology, but their real usefulness in daily clinical practice is still a matter of debate. Therefore, further validation in complex clinical settings, that is patients with different types of dementia, is needed to uphold their future worldwide adoption. Methods: We measured CSF AD biomarkers’ concentrations in a sample of 526 patients with a clinical diagnosis of dementia (277 with AD and 249 with Other Type of Dementia, OTD). Brain FDG-PET was also considered in a subsample of 54 patients with a mismatch between the clinical diagnosis and the CSF findings. Results: A p-tau181/Aβ42 ratio higher than 0.13 showed the best diagnostic performance in differentiating AD from OTD (86% accuracy index, 74% sensitivity, 81% specificity). In cases with a mismatch between clinical diagnosis and CSF findings, brain FDG-PET partially agreed with the p-tau181/Aβ42 ratio, thus determining an increase in CSF accuracy. Conclusions: The p-tau181/Aβ42 ratio alone might reliably detect AD pathology in heterogeneous samples of patients suffering from different types of dementia. It might constitute a simple, cost-effective and reproducible in vivo proxy of AD suitable to be adopted worldwide not only in daily clinical practice but also in future experimental trials, to avoid the enrolment of misdiagnosed AD patients.

scholarly journals A Narrative Review of the History of Skin Grafting in Burn Care

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 380
Author(s):  
Deepak K. Ozhathil ◽  
Michael W. Tay ◽  
Steven E. Wolf ◽  
Ludwik K. Branski
Keyword(s):  
Donor Site ◽  
Subsequent Development ◽  
Skin Grafting ◽  
Human Condition ◽  
Surgical Instruments ◽  
Wound Management ◽  
Burn Wound ◽  
Medical Progress ◽  
Burn Care ◽  
History Of

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go.

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