Massey Beveridge

Minimizing blood loss in burn surgery

BACKGROUND Significant blood loss continues to plague early tangential excision of the burn wound. Although various techniques to reduce intraoperative blood loss have been described, there is an absence of uniformity and consistency in their application. Furthermore, it is unclear whether these techniques compromise intraoperative tissue assessment and wound outcome. The purpose of this study was to evaluate the effects of a comprehensive intraoperative blood conservation strategy on blood loss, transfusion requirements, and wound outcome in burn surgery. METHODS An intraoperative blood conservation strategy (CONSV) that included donor site and burn wound adrenaline tumescence, donor site and excised wound topical adrenaline, and limb tourniquets was prospectively evaluated and compared with a historical control group (HIST) where only topical adrenaline and thrombin were applied to donor sites and excised wounds. RESULTS Estimated blood loss was reduced from 211 +/- 166 mL per percentage body surface area excised and grafted in the HIST group to 123 +/- 106 mL in the CONSV group (p = 0.02). Similarly, the intraoperative transfusion requirement in the HIST group was reduced from 3.3 +/- 3.1 units per case to 0.1 +/- 0.3 units per case in the CONSV group (p < 0.001). There was no compromise in wound outcome in the CONSV group, which had a mean skin graft take rate of 96 +/- 4.2%. CONCLUSION The application of a strict and comprehensive intraoperative blood conservation strategy during burn excision and grafting resulted in a profound reduction in blood loss and transfusion requirements, without compromising wound outcome.

Relevance of Electronic Health Information to Doctors in the Developing World: Results of the Ptolemy Project’s Internet-based Health Information Study (IBHIS)

The aim of this study was to determine the current usage, relevance, and preferences for electronic health information (EHI) in the participant surgeons’ clinical, research, and teaching activities. The Internet-Based Health Information Survey (IBHIS) was conducted from August to December 2003. Thirty-seven doctors (primarily practicing in East Africa) participated, all of whom had been using the Ptolemy resources for at least 6 months. Survey questions concerned time spent reading medical literature, preferred information sources, preferred type of publication, relevance, preference for western versus local medical literature, and academic productivity. Among the 75 eligible participants, 37 (48%) responded. From these responses it was found that African surgeons with access to EHI read more than articles than they did before they had such access, and they find that the information obtained is highly relevant to their clinical, teaching, and research activities. They prefer electronic journals to textbooks and are more inclined to change their practice based on information found in western journals than local journals. Ptolemy resources helped the respondents who reported academic work write a total of 33 papers for presentation or publication. Overall, access to EHI enables doctors in Africa to read more, is relevant, and contributes directly to academic productivity; thus Western medical literature is useful in the developing world, and EHI delivery should continue to expand.