In the first part of this thesis, we investigated treatments of early (burn) wound management. Our systematic review showed that convincing evidence in favor of any debridement technique in burns... Show moreIn the first part of this thesis, we investigated treatments of early (burn) wound management. Our systematic review showed that convincing evidence in favor of any debridement technique in burns is lacking. We performed a prospective cohort study in patients with deep hand burns treated with enzymatic debridement that showed that hand function returns to near normal at 12 months post-burn. Our ex-vivo experiment showed that enzymatic debridement is not useful in burn wounds sustained by low temperature. We investigated the use of fibrin sealant in the fixation of skin grafts in children and concluded that it is equally effective in graft take as staples. Our study of negative pressure wound therapy (NPWT) showed that, when comparing post-, to pre-NWPT, the incidence of infection was lower, the bacterial load was higher, and that the presence of Staphylococcus aureus was higher.In the second part we investigated pruritus in burn patients. We assessed the effect of acute stress symptoms on chronic itch and confirmed that age, skin grafting, and traumatic stress symptoms are significant predictors of itch following burns. Finally, we performed two trials investigating the effect of doxepin cream in the treatment of pruritus in burn patients, leading to the conclusion that the use of doxepin cream as a standard treatment is not recommended. Show less
This dissertation investigated placebo and nocebo effects in itch. Placebo and nocebo effects are positive and negative treatment outcomes respectively, that cannot be attributed to active... Show moreThis dissertation investigated placebo and nocebo effects in itch. Placebo and nocebo effects are positive and negative treatment outcomes respectively, that cannot be attributed to active treatment ingredients. Consistent with previous research, the dissertation shows that these effects play an important role in itch. The studies moreover illustrate that placebo effects can still occur when people are informed about them.The results described in this dissertation show that expectations about itch can be formed in various ways. People's expectations of treatment outcomes have been found underlie placebo and nocebo effects. For instance, the information that is given about how much itch an experimental test elicits (i.e., verbal suggestions) can influence expectations and lead to placebo or nocebo effects. The results also show that placebo effects can be automatically induced for itch by associative learning (through pharmacological conditioning). In addition, these effects may also occur when people know they are placebo effects. These results illustrate the importance of expectations and the psychosocial context in the treatment of somatic symptoms complaints such as itch. The results of this thesis may help improve existing treatments for itch. For example, medicine use can potentially be reduced by applying pharmacological conditioning, existing treatment can be improved by providing optimal treatment information, and the importance of expectations for treatment outcomes can be discussed with patients. Show less
Itch is a commonly experienced symptom of acute and chronic dermatological and systemic conditions. Placebo and nocebo effects, positive and negative effects experienced after both real and sham... Show moreItch is a commonly experienced symptom of acute and chronic dermatological and systemic conditions. Placebo and nocebo effects, positive and negative effects experienced after both real and sham interventions, putatively due to positive or negative outcome expectancies, can have a significant impact on the experience of itch and its treatment. Experimental methods to induce and study placebo and nocebo effects on itch have been developed, utilizing various combinations of expectancy-induction methods (eg, conditioning, verbal suggestions) and short-acting itch-evoking stimuli (eg, histamine, electrical, or mechanical stimulation). The aim of this review is to describe the current research methods used to induce placebo and nocebo effects on itch, and the results of these studies. The benefits and drawbacks of different expectancy-induction methods and itch-evoking stimuli are described, and future directions for research and clinical application are discussed. Show less
Bolier, R.; Vries, E.S. de; Pares, A.; Helder, J.; Kemper, E.M.; Zwinderman, K.; ... ; Netherlands Assoc Study Live 2017
