German, European or American burn guidelines - Is one superior to another?

Adequate medical care of severe burn injuries requires special organizational infrastructure and high educational standards, with an appropriate number of health care professionals. Guidelines were written by the German Society for Burn Treatment (DGV), the European Burns Association (EBA) and the American Burn Association (ABA) to assist with the delivery of such care. Current DGV (2010), EBA (2013) and ABA (2001/2006/2008) guidelines are compared, focusing on similarities, differences, conciseness and completeness. This publication presents advantages and disadvantages of each of them. DGV guidelines outline understandable treatment recommendations for first aid measures, clinical procedures and wound care. Extensive rehabilitation guidelines with clearly defined indications and precise infrastructure requirements for a Burn Centre are stated. Negative aspects are the presence of multiple documents containing redundant and confusing information. EBA guidelines offer the most comprehensive treatment recommendations with multidisciplinary approaches. Overall, infrastructural requirements are weighted much higher than staff qualification demands - in contrast to ABA guidelines. However, lack of conciseness and complicated criteria regarding transfer of patients to a Burn Center - including imprecise indications for rehabilitation treatment - have to be mentioned as disadvantages. ABA guidelines have a clear focus on staff qualifications and easy-to-understand transfer criteria. Another focus is on detailed clinical procedures. However, these guidelines lack burn definition and precise treatment recommendations for rehabilitation. The reviewed guidelines provide standardized treatment recommendations for burn patients. Despite their usefulness, they all have weaknesses and discrepancies. Findings should be used to improve each of them.

La prise en charge correcte des brûlés graves nécessite une organisation spécifique, une expertise adaptée et un nombre adéquat de personnels entraînés. Des recommandations spécifiques ont été édictées par la « German Society for Burn Treatment ¼ (DGV), l'European Burns Association (EBA) et l'American Burn Association (ABA) afin d'aider à cette prise en charge. Nous les avons comparées, en nous focalisant sur les similarités, les différences, la concision et l'exhaustivité, chacune d'entre eux ayant ses points positifs et négatifs, que nous présentons ici. Les recommandations allemandes insistent sur la prise en charge initiale et le traitement local. La rééducation et les infrastructures nécessaires sont explicitées. Les documents sont cependant multiples et fréquemment redondants, obérant leur facilité d'utilisation. Les recommandations européennes sont plus exhaustives et s'attachent à l'approche multidisciplinaire. Les obligations infrastructurelles y ont un poids supérieur à l'expertise soignante, ce qui diffère des recommandations américaines. Cependant, une concision argumentable et des critères d'hospitalisation en CTB compliqués (ainsi que des critères de rééducation spécialisée flous) doivent être marqués défavorablement. Les recommandations américaines ont l'avantage de la clarté en ce qui concerne le niveau d'expertise des intervenants, les critères d'hospitalisation en CTB et le détail de la prise en charge. Elles pêchent cependant par le flou concernant la définition d'une brûlure et l'absence de préconisation concernant la rééducation. Globalement, ces recommandations ne présentent que des approches incomplètes de la prise en charge des brûlés et devraient toutes être optimisées.

[The medical dissertation in Germany : A quantitative analysis of promotion regulations in medical faculties]. / Die medizinische Doktorarbeit in Deutschland : Eine quantitative Analyse der Promotionsordnungen medizinischer Fakultäten.

BACKGROUND: The medical dissertation represents an independently processed scientific project. In the field of medicine this has for many years displayed the basis for controversial discussions. The aim of the study presented here was to evaluate the prerequisites of all current promotion regulations in German medical faculties in order to develop a comparability on the basis of a scoring system. METHOD: An independent analysis of all promotion regulations from German medical faculties for the year 2014 was carried out according to 12 primary outcome measures and a scoring system. RESULTS: The average total score of promotion regulations at 37 German medical faculties was 57.2 points (SD ±9.5) out of a possible 100 scoring points. The highest scores with 72-85 points were achieved by 3 faculties and 5 achieved scores of only 42-45 points. The range of the different criteria tested was broad. While the written thesis, the review process, the examination requirements as well as the grading of the thesis were defined in all regulations, the introduction into good clinical practice, knowledge of methodology as well as a check for plagiarism only seem to play minor roles. CONCLUSION: The promotion regulations at German medical faculties show a great variation using the scoring system presented here for the first time. Standardized federal promotion regulations might help to establish a structured transparency as well as a national equality of opportunity.

Assessing burn depth in tattooed burn lesions with LASCA Imaging.

Tattoos are on the rise, and so are patients with tattooed burn lesions. A proper assessment with regard to burn depth is often impeded by the tattoo dye. Laser speckle contrast analysis (LASCA) is a technique that evaluates burn lesions via relative perfusion analysis. We assessed the effect of tattoo skin pigmentation on LASCA perfusion imaging in a multicolour tattooed patient. Depth of burn lesions in multi-coloured tattooed and untattooed skin was assessed using LASCA. Relative perfusion was measured in perfusion units (PU) and compared to various pigment colours, then correlated with the clinical evaluation of the lesion. Superficial partial thickness burn (SPTB) lesions showed significantly elevated perfusion units (PU) compared to normal skin; deep partial thickness burns showed decreased PU levels. PU of various tattoo pigments to normal skin showed either significantly lower values (blue, red, pink) or significantly increased values (black) whereas orange and yellow pigment showed values comparable to normal skin. In SPTB, black and blue pigment showed reduced perfusion; yellow pigment was similar to normal SPTB burn. Deep partial thickness burn (DPTB) lesions in tattoos did not show significant differences to normal DPTB lesions for black, green and red. Tattoo pigments alter the results of perfusion patterns assessed with LASCA both in normal and burned skin. Yellow pigments do not seem to interfere with LASCA assessment. However proper determination of burn depth both in SPTB and DPTB by LASCA is limited by the heterogenic alterations of the various pigment colours.

Les tatouages sont de plus en plus fréquents, et donc l'incidence des brûlures sur peau tatouée augmente. L'évaluation clinique correcte de la profondeur de la brûlure se heurte à la pigmentation du tatouage. Nous avons utilisé dans ce but l'imagerie laser, chez un patient porteur d'un tatouage multicolore, dans des zones le portant et ne le portant pas. La perfusion relative était mesurée en Unités de Perfusion (UP), comparée à des pigments colorés connus, et à l'aspect clinique. Les brûlures superficielles étaient plus perfusées que la peau normale, quand les brûlures profondes l'étaient moins. Les pigments bleus, rouges et rose entraînent une diminution des UP de la peau saine, les noirs une augmentation, l'effet artéfactuel des oranges et des jaunes étant non significatif. En cas de brûlure superficielle, les zones bleues et noires ont une perfusion diminuée, alors que le jaune ne change pas le résultat comparativement à une telle brûlure en zone non tatouée. L'aspect laser des brûlures profondes sur des tatouages noirs, rouges ou verts est semblable à celui observé avec les mêmes brûlures sur peau non tatouée. Les tatouages changent les résultats de l'évaluation laser de la perfusion cutanée, que la peau soit normale ou brûlée, sauf avec les pigments jaunes. En cas de tatouage multicolore, l'évaluation de la profondeur d'une brûlure par laser est prise en défaut.