OBJECTIVE: To evaluate the effect of doxepin hydrochloride 5% cream on reducing pruritus in burn scar patients compared to a placebo cream.METHOD: We conducted a multicenter triple-blind randomized clinical placebo-controlled crossover trial in which burn patients ≥18 years with an itch intensity ≥3 on a Visual Analogue Scale (VAS) were randomized between a doxepin-placebo or placebo-doxepin treatment protocol. Patients used each cream during two weeks with a wash-out period of one week in between. Primary outcome was change in itch intensity in two weeks' time using the VAS. Secondary outcome included the impact of itch (Burn Itch Questionnaire). Other parameters were the use of hydrating cream, silicon treatment, pressure garments, and other antipruritic medication.RESULTS: Twenty-seven patients were included. The change in itch intensity (VAS) was not different during the doxepin and placebo period (p=0.994); neither the doxepin cream nor placebo cream reduced itch intensity. However, based on the Burn Itch Questionnaire, we observed a statistically significant decrease in itch intensity and improvement in impact scores in both treatment groups, but no difference in the degree of reduction between the groups.CONCLUSION: Doxepin cream was not effective in reducing pruritus in our burn patient study population.
A growing interest in person-centered care from a biopsychosocial perspective has led to increased attention to structural screening. The aim of this study was to develop an easy-to-comprehend screening instrument using single items to identify a broad range of health-related problems in adult burn survivors. This study builds on earlier work regarding content generation. Focus groups and expert meetings with healthcare providers informed content refinement, resulting in the Aftercare Problem List (APL). The instrument consists of 43 items divided into nine health domains: scars, daily life functioning, scars treatment, body perceptions, stigmatization, intimacy, mental health, relationships, financial concerns, and a positive coping domain. The APL also includes a Distress Thermometer and a question inquiring about preference to discuss the results with a healthcare provider. Subsequently, the APL was completed by 102 outpatients. To test face validity, a linear regression analysis showed that problems in three health domains, i.e., scars, mental health, and body perceptions, were significantly related to higher distress. Qualitative results revealed that a minority found the items difficult which led to further adjustment of the wording and the addition of illustrations. In summation, this study subscribes to the validity of using single items to screen for burn-related problems.
Background: Only a few papers are published on the safety and effectiveness of acute burn care in low-income countries. A cohort study was therefore carried out to determine such outcomes.Methods: The study was conducted in a rural Tanzanian hospital in 2017-2018. All patients admitted with burns were eligible. Complications were scored during admission as an indication for safety. Survivors of severe burn injuries were evaluated for time of reepithelialization, graft take, disability (WHODAS2.0) and quality of life (EQ5D-3L) up to 3 months post-injury, as an indication of effectiveness.Results: Patients presented on average at 5 days after injury (SD 11, median 1, IQR 0-4). Three patients died at admission. The remaining 79 were included in the cohort. Their median age was 3 years (IQR 2-9, range 0.5-49), mean TBSA burned 12% (SD10%) and mortality rate 11.4%. No surgery-related mortality or life-threatening complications were observed. Skin grafting was performed on 29 patients at a delayed stage (median 23 days, IQR 15-47). Complications of skin grafts included partial (25% of procedures) and complete graft necrosis (8% of procedures). The mean time to reepithelialization was 52 (SD 42) days after admission. Disability and quality of life improved from admission to 3 months after injury (p<0.001, p<0.001, respectively).Conclusion: In this resource-limited setting patients presented after a delay and with multiple complications. The mortality during the first two weeks after admission was high. Surgery was found to be safe and effective. A significant improvement in disability and quality of life was observed.
Motivatie Het versterken van de samenwerking tussen relevante lectoraten door het ontwikkelen van een multidisciplinaire onderzoeksagenda op het terrein van Arbeid in de brede zin van het woord. Hierdoor kan de thematiek rondom toegang tot en behoud van arbeid vanuit meerdere kanten worden aangevlogen én kan focus en massa worden gecreëerd voor onderzoeksprogrammering en –funding. Daardoor kunnen we als lectoraten een belangrijke rol te spelen bij vraagstukken die betrekking hebben op het duurzaam (weer) aan het werk gaan én duurzaam aan het werk blijven. Achtergrond Om als individu zelfstandig en volwaardig te kunnen deelnemen aan onze participatiemaatschappij, is het hebben van werk cruciaal. Werk is echter voor mensen met minder of onvoldoende arbeids-, persoonlijk-, sociaal-, en cultureel kapitaal en/of toegang tot hulpbronnen steeds minder vanzelfsprekend. Naast traditioneel kwetsbare groepen – zoals laagopgeleiden, mensen met een chronische aandoening en migranten - zijn er nieuwe categorieën, waaronder veel middelbaar en hoog opgeleiden, voor wie het lastig is/wordt structureel betaald werk te vinden. De oorzaak ligt voornamelijk bij de toenemende digitalisering en robotisering in combinatie met de flexibilisering van de arbeidsmarkt. Ook werk op academisch niveau, dat gebaseerd is op regels, bijvoorbeeld accountancy en rechtspraak, zal steeds vaker (deels) geautomatiseerd kunnen worden (Est et al. 2015, Went et al. 2015). Anderzijds zijn er sectoren, zoals techniek en ICT, die een steeds grotere behoefte hebben aan hoogopgeleid personeel en waar het lastig is om voldoende gekwalificeerde mensen te krijgen. Tot slot zien we in alle sectoren een toename van stress- en burn-out klachten, die deels gerelateerd zijn aan traditionele, functioneel ingerichte organisaties. Het bovenstaande biedt geen rooskleurig beeld voor grote groepen in de samenleving en vanuit een breed Platform Arbeid willen we de thema’s op het terrein van arbeid vanuit meerdere perspectieven benaderen en in samenhang beschouwen.
The Cashing Cashew project focuses on isolation and purification of Cashew Nut Shell Liquid (CNSL) from Cashew Nut Shells (CNS) in order to fully utilize this valuable by-product of the cashew nut production. Global cashew nut production is about 4 million mt/ tons/yr. Of the cashew nut, about 70 % is shell that is removed in processing and currently typically burned as a dirty and inefficient fuel or discarded as waste. This is not only creating an environmental issue but also wasting valuable by-products. The shell contains circa 20-30 % brown viscous liquid, Cashew Nut Shell Liquid (CNSL). This natural resin contains valuable chemical components, for example, cardanol, cardol, and anacardic acid. CNSL and its derivatives have several industrial uses as for example biobased additives, polymeric building blocks, and biodiesel. Part of the CNSL can be extracted during the roasting process prior to separating the shell and nut kernel. The shell waste still has a high CNSL concentration that can be isolated by solvents or pressing (expeller). Expeller process is simple and not capital-intensive; therefore it is commonly used. The main disadvantages of the method are the high energy consumption and that 3-5 % oil remains in the press-cake producing harmful gases in burning. Also, the resulting cake is too dense to be further processed to charcoal or other useful application. The objective of this project is to study the purification of the CNSL obtained from pyrolytic isolation to find the most efficient way of making use of the CNSL oil and the total Cashew Nut Shell biomass. An initial evaluation of potential applications is also performed.
