Biomedical subjects

Kevin N Foster

Publications and source records attributed to Kevin N Foster.

7 recordsLinked to original sources

PubMed2006

Effect of blood transfusion on outcome after major burn injury: a multicenter study.

OBJECTIVE: To delineate blood transfusion practices and outcomes in patients with major burn injury. CONTEXT: Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study. DESIGN: Multicenter retrospective cohort analysis. SETTING: Regional burn centers throughout the United States and Canada. PATIENT POPULATION: Patients admitted to a participating burn center from January 1 through December 31, 2002, with acute burn injuries of >or=20% total body surface area. OUTCOMES MEASURED: Outcome measurements included mortality, number of infections, length of stay, units of blood transfused in and out of the operating room, number of operations, and anticoagulant use. RESULTS: A total of 21 burn centers contributed data on 666 patients; 79% of patients survived and received a mean of 14 units of packed red blood cells during their hospitalization. Mortality was related to patient age, total body surface area burn, inhalation injury, number of units of blood transfused outside the operating room, and total number of transfusions. The number of infections per patient increased with each unit of blood transfused (odds ratio, 1.13; p<.001). Patients on anticoagulation during hospitalization received more blood than patients not on anticoagulation (16.3+/-1.5 vs. 12.3+/-1.5, p<.001). CONCLUSIONS: The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.

Adult↗

PubMed2006

Accidental foot burns in children from contact with naturally heated surfaces during summer months: experience from a regional burn center.

BACKGROUND: Foot burns in children often result from contact with heated surfaces due to high ambient temperatures during summer in the southwestern United States. The objective of this study was to describe the unique cause and clinical characteristics of this type of injury. METHODS: A retrospective review of medical records of pediatric patients presenting with contact burns of the foot in Arizona Burn Center, which is the third largest burn center in the United States. Participants included children 5 years and under who were treated for pedal burns during a 5-year period between January 2000 and August 2005. RESULTS: Seventy-four children with contact burns of the foot were treated of which 34 (46%) were from naturally heated surfaces. When compared with those who sustained pedal burns as a result of contact with other hot objects, children with burns from naturally heated surface more commonly had bilateral (82.4%), second degree (82.4%) burns involving primarily the plantar surface (94.1%) of the foot and the injury usually occurred in the peak of the summer. Also, physical abuse was more commonly suspected in this group. CONCLUSION: Contact with a hot surface during summer months is a dominant cause of foot burns in small children in the southwestern United States with characteristic clinical presentation and calls for preventive educational interventions.

Burn Units↗

PubMed2005

Quantification of cytokines involved in wound healing using surface plasmon resonance.

Sensing of three cytokines related to chronic wound healing, interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha), with detection limits at or below 1 ng/mL in buffered saline solution and spiked cell culture medium (CCM) has been achieved. Fiber-optic surface plasmon resonance (SPR) sensors are coated with an antibody binding layer and antibodies specific to the cytokine of interest are covalently attached to this layer. To achieve such detection limits in a complex medium such as CCM, total protein content of 4 mg/mL, the use of a novel N-hydroxysuccinimide ester of 16-mercaptohexadecanoic acid (NHS-MHA) is necessary. A comparison of the detection limits for IL-6 using currently widely used CM-dextran and NHS-MHA shows an improvement by a factor of 3 using NHS-MHA. The detection limits for the monitoring of cytokines in spiked saline solutions and CCM were similar for TNF-alpha and slightly higher for IL-1 and IL-6. The detection of each cytokine in the presence of interfering agents resulted in concentration prediction well within the error of calibration. The SPR sensors are stable in CCM after 20 min of pretreatment in CCM, minimizing the reliance on a reference sensor to quantify the cytokines in complex media. This technique enables a major advancement in the field of real-time monitoring of biologically relevant molecules in complex biological fluids.

Biomarkers↗

PubMed2002

Development of a continuous renal replacement program in critically ill patients.

BACKGROUND: Critically ill patients encounter many obstacles, such as acute renal failure, that increases length of stay as well as hospital cost. Dialysis in these patients is often ineffective thereby prolonging the inevitable and significantly increasing the cost of care. A dialysis program that could improve patient care, potentially improve outcome and be "revenue neutral" would be ideal. METHODS: A continuous renal replacement therapy (CRRT) program was developed to significantly impact the care of critically ill patients Using the latest CRRT equipment along with an innovative hands-on CRRT training program, a specialized CRRT team was created. Working in conjunction with the hospital business office, new revenue charge codes were created and existing codes were updated. Patients who underwent CRRT had their financial records reviewed for: hospital cost to perform CRRT, total hospital billing to the payer, CRRT revenue 881 (billing units) charged to the payer, total charges and reimbursement for the account, percentage of reimbursement, collected revenue, and payer. RESULTS: From April 2000 to February 2002, 39 critically ill patients underwent CRRT. Initial set-up cost was US$79,622.80 and the cost of CRRT was US$222,323.98. The hospital billed for US$656,090.63 and assuming 100% reimbursement, the potential profit was US$427,678.50. However, loss of revenue, mainly from noncompliance with charge capture resulted in the hospital billing only US$386,794.32 with a total reimbursement of US$165,779.86. The 21 burn patients who underwent CRRT yielded a net profit of US$10,294.12, with the highest reimbursement from workman's compensation and private payers. The overall mortality rate was 59% and 65% for the burn patients; significantly lower than published national averages. CONCLUSIONS: An in-house CRRT program improved patient care by providing dialysis in patients who normally would not tolerate the procedure. Although there was a loss of revenue, CRRT in the burn patients appeared "revenue neutral." Although not specifically studied in this review, based on published data, mortality rates in this population were lower than expected especially in critically ill burn patients.

Continuity of Patient Care↗

PubMedDate not supplied

Hydrofluoric acid burn resulting from ignition of gas from a compressed air duster.

A young female suffered burns to her hand after the ignition of gas from a compressed air duster. After debridement and dressing, the patient continued to have pain out of proportion to injury that was refractory to intravenous morphine. The material safety data sheet revealed that the chemical used was 1,1-difluoroethane. High temperatures can cause decompensation to form hydrofluoric acid. Calcium gluconate gel was applied topically to the patient's burns, which caused prompt and complete relief of her pain. A review of different compressed air duster products revealed that the main ingredient in each was a halogenated hydrocarbon. Although not considered flammable, all products have warnings regarding the possibility of ignition under various circumstances. Ignition of the gas in compressed air cleaners not only can cause flame burns, it can also cause chemical damage from exposure to hydrogen and fluoride ions. Prompt recognition and treatment is necessary to prevent severe injury.

Adult↗

PubMedDate not supplied

Aquacel Ag in the management of partial-thickness burns: results of a clinical trial.

Aquacel Hydrofiber is a moisture retentive topical dressing that has been demonstrated to be safe and efficacious for the management of partial-thickness burns, showing parity for most dressing related aspects to cadaver skin for this indication. Recently, 1.2% w/w silver has been added to the Aquacel Hydrofiber, to create Aquacel Ag. This new material releases silver within the dressing for up to two weeks, and it is this duration that differentiates it from other sustained release silver delivery products indicated for burn management. The dressing was tested in a phase II noncomparative trial in superficial, mid dermal, and mixed partial-thickness burns. Percentage and speed of reepithelialization were satisfactory and appear to be similar at least to results noted with silver sulfadiazine, although, no direct comparisons were performed in this study. Pain reduction between baseline and postburn day number three and five was statistically significant. Conformability, general ease of use and other functional dressing properties were rated very positively. Overall, Aquacel Ag combines several properties known to be beneficial for the management of partial-thickness burns and is a very good choice for superficial and mid-thickness burn injuries.

Adult↗

PubMedDate not supplied

Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns.

This prospective, randomized study compared protocols of care using either AQUACEL Ag Hydrofiber (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL Ag dressing protocol tended to have lower total treatment costs (Dollars 1040 vs. Dollars 1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of Dollars 1,409.06 for AQUACEL Ag dressing and Dollars 1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL(R) Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.

Adult↗