ABSTRACT
INTRODUCTION: More than half a million patients suffer from minor burns in Germany per year. In 2018, almost 2000 patients needed intensive care for their burn injuries. Despite high standards of burn care, mortality remains high. Burn injuries may lead to long-term sequelae. In order to provide up-to-date burn care, guidelines are available online with public access. METHODS AND RESULTS: This overview presents a summary of the German AWMF guideline for the treatment of thermal injuries in adults (https://www.awmf.org/leitlinien/detail/ll/044-001.html). Experts of eleven different medical organisations and specialties have contributed to this S2k guideline with their expertise. The focus of the article is on acute burn wound assessment, the indication for specialised care in burn centres, the management of the burn wound at the trauma scene and in hospitals as well as scar management and rehabilitation. CONCLUSION: This overview reports on the consensus-based treatment of acute burn wounds in adults in Germany. The article is intended to guide doctors and professional caretakers to perform state-of-the-art burn care. The current guideline aims to improve burn outcome.
Subject(s)
Burns , Adult , Burn Units , Burns/therapy , Germany , HumansABSTRACT
Ergotherapy is part of the multidisciplinary treatment concept in the field of orthopedics and trauma surgery. The occupational therapist treats patients together with doctors, nurses, physiotherapists, psychologists, social workers/pedagogues, speech therapists and other professional groups · with congenital malformations,. · with chronic diseases,. · with degenerative diseases,. · after accidental injuries or surgical interventions.. Therapy takes place in terms of client centricity and sees the patient as a full member of the team. Together, therapy goals are determined and the therapy is designed. Occupational therapy has a wide range of treatment options that are individually tailored to the patient's situation and needs.The start of treatment is early in acute care hospitals - some already in the intensive care unit, z. For example, with bar treatments for physiological storage, ADL training, aid care, functional treatment with increasing load increase, sensitivity training, etc., with the aim of helping the patient to carry out activities in his important areas of life and to largely independently create his own life.In rehabilitation clinics or in outpatient settings, occupational therapists pass on these treatment measures, adapting the therapy contents to the status and possibly changed needs of the patient and his goals in the rehabilitation process. Accompanying up to professional reintegration is possible.One domain of occupational therapy is the inclusion of contextual factors of the patient in therapy (biopsychosocial model).Occupational therapy is not deficit-oriented but knows how to integrate the patient's resources into the treatment and to support him in becoming an expert in his illness. This in turn has a positive effect on the adherence in occupational therapy treatment.
Subject(s)
Occupational Therapists , Occupational Therapy , Orthopedics , Return to Work , Surgical Procedures, Operative , Germany , Humans , Orthopedic Procedures , Rehabilitation , Trauma CentersABSTRACT
Dendritic cells (DC) are increasingly used for the immunotherapy of cancer. Both the induction of tumor-specific T cells and some clinical regressions have been observed in early phase I/II trials by using either DC isolated from blood, DC generated from CD34+ precursors ex vivo, and most frequently, by employing monocyte-derived DC. As DC vaccination is now awaiting phase II/III trials with larger patient collectives, it becomes increasingly important to overcome prior limitations such as the repetitive, labor-intensive generation of DC in a large number of open culture vessels. We describe here as a result of several years of optimization, in detail, a procedure that uses the so-called Nunc cell factories to process a whole apheresis product, labor- and cost-effectively in a quasi-closed system to reproducibly generate (by using GM-CSF+IL-4 followed by a maturation cocktail composed of IL-1beta+IL-6+TNF-alpha +PGE(2)) large numbers (8.32+/-3.8% of input peripheral blood mononuclear cells (PBMC)) of mature (>85% CD83+), monocyte-derived DC that can be successfully cryopreserved. Our report is based on the processing of >100 aphereses including 52 unselected aphereses in advanced melanoma patients. This allows us also to suggest meaningful quality and validation criteria. The DC generation method appears particularly promising as respective DC vaccination proved to be immunogenic in cancer patients and cell factories can readily be converted to a fully closed system by using appropriate valves, tubings, and bags.
