Goed om te zien dat je geïnteresseerd bent in onze content. Onafhankelijke informatie is alleen niet gratis. Je mag onze artikelen uitsluitend kopiëren voor persoonlijk gebruik. Zo zal je geen inbreuk maken op onze Algemene Voorwaarden. Vragen? Stuur een e-mail naar: marketing@ntvg.nl.Voor het instellen van de optimale therapie van brandwonden – conservatief of operatief – is een vroege, accurate bepaling van de brandwonddiepte belangrijk. ‘Laser Doppler imaging’ (LDI) is een techniek waarmee een nauwkeurige inschatting van de brandwonddiepte kan worden gemaakt door het meten van de dermale perfusie. Hoewel is aangetoond dat de keuze voor het wel of niet verrichten van een operatie met LDI eerder kan worden gemaakt, heeft dit niet geleid tot een kortere tijd tot wondgenezing of kostenbesparing in de Nederlandse brandwondenzorg. LDI wordt in alle Nederlandse brandwondencentra gebruikt. Bij twijfel over de brandwonddiepte in de eerste of tweede lijn is doorverwijzing naar een brandwondencentrum raadzaam.
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Goed om te zien dat je geïnteresseerd bent in onze content. Onafhankelijke informatie is alleen niet gratis. Je mag onze artikelen uitsluitend kopiëren voor persoonlijk gebruik. Zo zal je geen inbreuk maken op onze Algemene Voorwaarden. Vragen? Stuur een e-mail naar: marketing@ntvg.nl.Voor het instellen van de optimale therapie van brandwonden is een vroege, accurate bepaling van brandwondendiepte belangrijk. De meest gebruikte techniek om brandwondendiepte te bepalen is de klinische inschatting. Dit is een goedkope techniek, maar niet de meest accurate. ‘Laser-doppler-imaging’ is een techniek waarmee, door van het meten van de dermale perfusie, een accuratere (> 95%) inschatting van brandwondendiepte kan worden gemaakt. De hypothese is dat de introductie van laser-doppler-imaging zal leiden tot een snellere keuze voor het wel of niet verrichten van een operatie, met mogelijk een kortere ligduur en lagere kosten tot het gevolg. Om deze hypothese te testen, loopt er momenteel een gerandomiseerd gecontroleerd onderzoek in de Nederlandse brandwondencentra.
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AIMS: To evaluate the effect of video interaction guidance on improving the nurse-child relationship during the wound care procedures. Additionally, determine whether the interactional behavior of nurses is related to pain and distress experienced by children.METHODS: The interactional skills of seven nurses receiving video interaction guidance were compared with those of ten other nurses. The nurse-child interactions were video-taped during wound care procedures. Of the nurses receiving video interaction guidance, three wound dressing changes were videotaped before they received video interaction guidance and three after. The interaction between nurse and child was scored with the Nurse-child interaction taxonomy by two experienced raters. The COMFORT-B behavior scale was used to assess pain, and distress. All raters were blinded regarding video interaction guidance allocation and the sequence of tapes RESULTS: Five nurses in the intervention group (71 %) showed clinically relevant progress on the taxonomy while only four nurses (40 %) showed similar progress in the control group [p = .10]. A weak association was found between the nurses' interactions and the children's pain and distress [r = -.30, p = .002].CONCLUSIONS: This is the first study to show that video interaction guidance can be used as a tool to train nurses to become more effective during patient encounters. Furthermore, nurses' interactional skills are positively associated with a child's pain and distress level.
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Patients with extensive and complex wounds due to Necrotizing Soft-Tissue Infections (NSTI) may be referred to a burn center. This study describes the characteristics, outcomes, as well as diagnostic challenges of these patients. Patients admitted to three hospitals with a burn center for the treatment of NSTI in a 5-year period were included. Eighty patients (median age 54 years, 60% male) were identified, of whom 30 (38%) were referred by other centers, usually after survival of the initial septic phase. Those referred from other centers, compared to those primarily admitted to the study hospitals, were more likely to have group A streptococcal involvement (62% vs 35%, p = .02), larger wounds (median 7% vs 2% total body surface area, p < .001), and a longer length of stay (median 49 vs 22 days, p < .001). Despite a high incidence of septic shock (50%), the mortality rate was low (12%) for those primarily admitted. Approximately half (53%) of the patients were initially misdiagnosed upon presentation, which was associated with delay to first surgery (16 hours vs 4 hours, p < .001). Those initially misdiagnosed had more (severe) comorbidities, and less frequently reported pain or blue livid discoloration of the skin. This study underlines the burn centers' function as referral centers for extensively affected patients with NSTI. Besides the unique wound and reconstructive expertise, the low mortality rate indicates these centers provide adequate acute care as well. A major remaining challenge remains recognition of the disease upon presentation. Future studies in which factors associated with misdiagnosis are explored are needed.
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Het pakket bestaat uit twee delen: Deel A: Het achtergronddocument: hierin worden u allerlei theoretische en procedurele gegevens aangereikt die van belang zijn om goed met het interventiepakket te kunnen werken. Deel B: Het werkboek: dit werkboek biedt u praktische ondersteuning om in samenwerking met de patiënt effectief met het zelfverwondende gedrag om te gaan. Het werkboek kan als WORD-document digitaal worden opgeslagen. Denkt u hierbij vanzelfsprekend aan de privacybescherming van de patiënt. Bij het werkboek behoren een aantal bijlagen.
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Deze publieksrapportage geeft een samenvatting van de resultaten die staan weergegeven in de onderzoeksrapportages van de zes deelnemende regio’s. De ETHOS-telling is een initiatief van Hogeschool Utrecht en Kansfonds.
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Ingezonden artikel in MEMO RAD: dit artikel is een samenvatting van afstudeeronderzoek dat de eerste auteur heeft uitgevoerd ter afronding van de bachelor opleiding Medisch Beeldvorming en Radiotherapeutische Technieken aan de hogeschool Inholland.
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BACKGROUND: Value-based healthcare (VBHC) is increasingly implemented in healthcare worldwide. Transparent measurement of the outcomes most important and relevant to patients is essential in VBHC, which is supported by a core set of most important quality indicators and outcomes. Therefore, the aim of this study was to develop a VBHC-burns core set for adult burn patients.METHODS: A three-round modified national Delphi study, including 44 outcomes and 24 quality indicators, was conducted to reach consensus among Dutch patients, burn care professionals and researchers. Items were rated on a nine-point Likert scale and selected if ≥ 70% in each group considered an item 'important'. Subsequently, instruments quantifying selected outcomes were identified based on a literature review and were chosen in a consensus meeting using recommendations from the Dutch consensus-based standard set and the Dutch Centre of Expertise on Health Disparities. Time assessment points were chosen to reflect the burn care and patient recovery process. Finally, the initial core set was evaluated in practice, leading to the adapted VBHC-burns core set.RESULTS: Twenty-seven patients, 63 burn care professionals and 23 researchers participated. Ten outcomes and four quality indicators were selected in the Delphi study, including the outcomes pain, wound healing, physical activity, self-care, independence, return to work, depression, itching, scar flexibility and return to school. Quality indicators included shared decision-making (SDM), the number of patients receiving aftercare, determination of burn depth, and assessment of active range of motion. After evaluation of its use in clinical practice, the core set included all items except SDM, which are assessed by 9 patient-reported outcome instruments or measured in clinical care. Assessment time points included are at discharge, 2 weeks, 3 months, 12 months after discharge and annually afterwards.CONCLUSION: A VBHC-burns core set was developed, consisting of outcomes and quality indicators that are important to burn patients and burn care professionals. The VBHC-burns core set is now systemically monitored and analysed in Dutch burn care to improve care and patient relevant outcomes. As improving burn care and patient relevant outcomes is important worldwide, the developed VBHC-burns core set could be inspiring for other countries.
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INTRODUCTION: It is difficult to adjust fluid balance adequately in patients with severe burns due to various physical changes. B-type natriuretic peptide (BNP) is emerging as a potential marker of hydration state. Proteinuria is used as a predictor of outcome in severe illness and might correlate to systemic capillary leakage. This study investigates whether combining BNP and proteinuria can be used as a guide for individualized resuscitation and as a predictor of outcome in patients with severe burns.METHODS: From 2006 to 2009, 38 consecutive patients (age 47 ± 15 years, 74% male) with severe burns were included and followed for 20 days. All had normal kidney function at admission. BNP and proteinuria were routinely measured. Ordered and actually administered fluid resuscitation volumes were recorded. The Sequential Organ Failure Assessment (SOFA) score was used as the measure of outcome.RESULTS: BNP increased during follow-up, reaching a plateau level at Day 3. Based on median BNP levels at Day 3, patients were divided into those with low BNP and those with high BNP levels. Both groups had comparable initial SOFA scores. Patients with high BNP received less fluid from Days 3 to 10. Furthermore, patients with a high BNP at Day 3 had less morbidity, reflected by lower SOFA scores on the following days. To minimize effects of biological variability, proteinuria on Days 1 and 2 was averaged. By dividing the patients based on median BNP at Day 3 and median proteinuria, patients with high BNP and low proteinuria had significantly lower SOFA scores during the entire follow-up period compared to those patients with low BNP and high proteinuria.CONCLUSIONS: Patients with higher BNP levels received less fluid. This might be explained by a lower capillary leakage in these patients, resulting in more intravascular fluid and consequently an increase in BNP. In combination with low proteinuria, possibly reflecting minimal systemic capillary leakage, a high BNP level was associated with a better outcome. BNP and proteinuria have prognostic potential in severely burned patients and may be used to adjust individual resuscitation.
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