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Blome-Eberwein SA, Schwartz A, Ferdock M, Starner S, Gogal C. Minimally invasive burn reconstruction with subcutaneous scar contracture release. Burns 2024; 50:1597-1604. [PMID: 38609745 DOI: 10.1016/j.burns.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Scar contracture bands after burns are frequent problems that cause discomfort and physical limitation. This study investigates the efficacy of a minimally invasive contracture band release technique (MICBR) inspired by closed platysmotomy. METHODS Patients with burn scars treated with MICBR in our center were included retrospectively. Our routine scar and contracture treatments (non-invasive and invasive) were utilized prior to undergoing MICBR. Range of motion (ROM) and Vancouver Scar Scale was measured before and after the procedure when feasible. RESULTS Forty-five patients were included, with 97 total contracture sites treated all over the body. An average of 1.6 sites were treated per patient, with a maximum of six. Patients age was 6-68 years; total burn surface area ranged from 0.5% to 85%. 24% were performed under local anesthesia. 84% were in originally skin grafted areas. We found significant improvements in ROM and VSS. 84% of patients surveyed were "satisfied" or "very satisfied". 95% reported improved mobility. No significant adverse events occurred. CONCLUSION This MICBR technique is a versatile, safe, and well-tolerated adjunct procedure that can help patients regain mobility after a burn injury.
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Affiliation(s)
- Sigrid A Blome-Eberwein
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Adam Schwartz
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | | | - Sophia Starner
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Christina Gogal
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, PA, USA
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Higginbotham S, Workman VL, Giblin AV, Green NH, Lambert DW, Hearnden V. Inhibition and reversal of a TGF-β1 induced myofibroblast phenotype by adipose tissue-derived paracrine factors. Stem Cell Res Ther 2024; 15:166. [PMID: 38867276 PMCID: PMC11170827 DOI: 10.1186/s13287-024-03776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Hypertrophic scarring results from myofibroblast differentiation and persistence during wound healing. Currently no effective treatment for hypertrophic scarring exists however, autologous fat grafting has been shown to improve scar elasticity, appearance, and function. The aim of this study was to understand how paracrine factors from adipose tissues and adipose-derived stromal cells (ADSC) affect fibroblast to myofibroblast differentiation. METHODS The transforming growth factor-β1 (TGF-β1) induced model of myofibroblast differentiation was used to test the effect of conditioned media from adipose tissue, ADSC or lipid on the proportion of fibroblasts and myofibroblasts. RESULTS Adipose tissue conditioned media inhibited the differentiation of fibroblasts to myofibroblasts but this inhibition was not observed following treatment with ADSC or lipid conditioned media. Hepatocyte growth factor (HGF) was readily detected in the conditioned medium from adipose tissue but not ADSC. Cells treated with HGF, or fortinib to block HGF, demonstrated that HGF was not responsible for the inhibition of myofibroblast differentiation. Conditioned media from adipose tissue was shown to reduce the proportion of myofibroblasts when added to fibroblasts previously treated with TGF-β1, however, conditioned media treatment was unable to significantly reduce the proportion of myofibroblasts in cell populations isolated from scar tissue. CONCLUSIONS Cultured ADSC or adipocytes have been the focus of most studies, however, this work highlights the importance of considering whole adipose tissue to further our understanding of fat grafting. This study supports the use of autologous fat grafts for scar treatment and highlights the need for further investigation to determine the mechanism.
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Affiliation(s)
- S Higginbotham
- Department of Materials Science and Engineering, University of Sheffield, Sheffield, UK.
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | - V L Workman
- Department of Materials Science and Engineering, University of Sheffield, Sheffield, UK
| | - A-V Giblin
- Department of Plastic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N H Green
- Department of Materials Science and Engineering, University of Sheffield, Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - D W Lambert
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - V Hearnden
- Department of Materials Science and Engineering, University of Sheffield, Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
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3
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Katsu A, Mackenzie L, Elliott JM, Mackey M, Tyack Z. Return-to-employment for working-aged adults after burn injury: A mixed methods scoping review. Work 2024:WOR230148. [PMID: 38578910 DOI: 10.3233/wor-230148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND This scoping review aimed to identify the barriers, facilitators and benefits of returning to work following burn injury, outcome measures used, management strategies, and models of care. OBJECTIVE To provide a comprehensive overview about working-aged adults returning to their preinjury employment after burn injury. METHODS We followed a pre-determined scoping review protocol to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT and CDSR databases between 2000 to December 2023. Papers reporting primary data from previously employed adults with cutaneous burn injuries were included. RESULTS In all, 90 articles met the review criteria. Return-to-work was both an outcome goal and process of recovery from burn injury. Physical and psychological impairments were identified barriers. Job accommodations and modifications were important for supporting the transition from hospital to workplace. Employment status and quality of life sub-scales were used to measure return-to-work. CONCLUSIONS Consistent definitions of work and measurements of return-to-employment after burn injury are priorities for future research. Longitudinal studies are more likely to capture the complexity of the return-to-employment process, its impact on work participation and changes in employment over time. The social context of work may assist or hinder return-to-work more than physical environmental constraints. Equitable vocational support systems would help address disparities in vocational rehabilitation services available after burn injury.
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Affiliation(s)
- Akane Katsu
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - James M Elliott
- The Kolling Institute, Northern Sydney Local Health District, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martin Mackey
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Zephanie Tyack
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation and School of Public Health and Social Work, Queensland University of Technology, Australia
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Spronk I, van Uden D, van Dammen L, van Baar ME, Nieuwenhuis M, Pijpe A, Visser I, van Schie C, van Zuijlen P, Haanstra T, Lansdorp CA. Outcomes that matter most to burn patients: A national multicentre survey study in the Netherlands. Burns 2024; 50:31-40. [PMID: 37985268 DOI: 10.1016/j.burns.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/09/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The use of patient-reported outcomes to improve burn care increases. Little is known on burn patients' views on what outcomes are most important, and about preferences regarding online Patient Reported Outcome Measures (PROMs). Therefore, this study assessed what outcomes matter most to patients, and gained insights into patient preferences towards the use of online PROMs. METHODS Adult patients (≥18 years old), 3-36 months after injury completed a survey measuring importance of outcomes, separately for three time periods: during admission, short-term (<6 months) and long-term (6-24 months) after burn injury. Both open and closed-ended questions were used. Furthermore, preferences regarding the use of patient-reported outcome measures in burn care were queried. RESULTS A total of 140 patients were included (response rate: 27%). 'Not having pain' and 'good wound healing' were identified as very important outcomes. Also, 'physical functioning at pre-injury level', 'being independent' and 'taking care of yourself' were considered very important outcomes. The top-ten of most important outcomes largely overlapped in all three time periods. Most patients (84%) had no problems with online questionnaires, and many (67%) indicated that it should take up to 15 minutes. Patients' opinions differed widely on the preferred frequency of follow-up. CONCLUSIONS Not having pain and good wound healing were considered very important during the whole recovery of burns; in addition, physical functioning at pre-injury level, being independent, and taking care of yourself were deemed very important in the short and long-term. These outcomes are recommended to be used in burn care and research, although careful selection of outcomes remains crucial as patients prefer online questionnaires up to 15 minutes.
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Affiliation(s)
- I Spronk
- Erasmus MC University Medical Centre Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands; Dutch Burns Foundation, Beverwijk, the Netherlands.
| | - D van Uden
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - L van Dammen
- Dutch Burns Foundation, Beverwijk, the Netherlands
| | - M E van Baar
- Erasmus MC University Medical Centre Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - M Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; Hanze University of Applied Sciences, Groningen Research Group Healthy Ageing Allied Health Care and Nursing, Groningen, the Netherlands
| | - A Pijpe
- Burn Centre Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute Amsterdam UMC, Amsterdam, the Netherlands
| | - I Visser
- Dutch Association of Burn Survivors, Beverwijk, the Netherlands
| | - C van Schie
- Dutch Burns Foundation, Beverwijk, the Netherlands
| | - P van Zuijlen
- Burn Centre Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences (AMS) Institute Amsterdam UMC, Amsterdam, the Netherlands; Department of Plastic Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location University of Amsterdam, Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam, the Netherlands
| | - T Haanstra
- Dutch Burns Foundation, Beverwijk, the Netherlands; Department of Dermal Therapy, Faculty of Health Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - C A Lansdorp
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands
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5
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Moser WJ, Bilka KR, Vrouwe SQ, Glick JC, Ramaiah V. Running water while bathing is a risk factor for pediatric scald burns. Burns 2023; 49:1714-1718. [PMID: 37193613 DOI: 10.1016/j.burns.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023]
Abstract
INTRODUCTION Scalds are the most common mechanism of burn injury in pediatric populations and scald burns sustained during bathing present a unique opportunity for injury prevention. Evidence-based infant bathing educational resources recommend checking water temperature and having a caregiver present for the duration of the bath, but do not explicitly recommend avoiding running water or explain the associated risks. This study seeks to determine the incidence and role of running water in bathing scald burns at our institution. METHODS This is a retrospective review of pediatric patients (<3 years) admitted to the University of Chicago Burn Center with scald injury from bathing between 2010 and 2020. Cases were reviewed to assess the following risk factors: whether there was running water, whether water temperature was checked before placing the child in water, and whether a caregiver was present for the entire bath. Injuries in which the manner of injury was abuse or indeterminate were excluded. RESULTS The study cohort included 101 cases of scalds due to bathing, with a mean age of 13 months and mean burn size of 7% TBSA. Of these 101 cases, 96 (95%) involved running water. Thirty-seven cases (37%) had only one of the three risk factors and 95% of those 37 cases involved running water. Twenty-nine cases (29%) involved all three risk factors while only two cases (2%) involved none of the three risk factors. Sixty-one cases (60%), thirty-nine cases (39%), and one case (1%) occurred in a sink, bathtub, or infant tub, respectively. CONCLUSION We found that the vast majority of bathing scald burns involved running water, identifying a specific bathing recommendation that should be added to existing guidelines to reduce the incidence of bathing scald burns.
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Affiliation(s)
- William J Moser
- Division of Child Abuse Pediatrics, Northwestern University, Chicago, IL, USA.
| | - Kristen R Bilka
- Section of Academic Pediatrics, University of Chicago, Chicago, IL, USA
| | - Sebastian Q Vrouwe
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA
| | - Jill C Glick
- Section of Academic Pediatrics, University of Chicago, Chicago, IL, USA
| | - Veena Ramaiah
- Section of Academic Pediatrics, University of Chicago, Chicago, IL, USA
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Düken ME, Yayan EH, Zengin M, Sevgi T. The effects of the posttraumatic stress and general health status on paediatric burns and their sleep habits. Burns 2023; 49:1321-1327. [PMID: 36566094 DOI: 10.1016/j.burns.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/18/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Burns are serious injuries that can require hospitalization and have physical and emotional sequelae. Sleep disturbance can occur after trauma as evidenced by posttraumatic stress symptoms such as re-experiencing of a trauma with repetitive dreams, memories and flashbacks. This area has been minimally examined with pediatric burn survivors; therefore, the aim of this study was to investigate the effects of posttraumatic stress and general health on sleep habits of pediatric burn survivors from. METHOD This is a correlational descriptive study. Its sample included 7-18-year-old inpatients at the burn clinic of a university hospital from January to November 2019. This study used the Posttraumatic Stress Disorder Reaction Index, the General Health Questionnaire (12) and the Children's Sleep Habits Questionnaire for data collection. RESULTS Of the participants, 58.6% were male, 46.5% were primary school students, and 62.6% had no diseases other than their burns. 20.2% of the children had epilepsy, 14.2% had diabetes and 3% had pneumonia. Of the child burn victims, 45.5% were brought to the hospital because of contact with fire. All of them had first-degree burns, 59.6% had second-degree burns, and 80.8% had third-degree burns. After their burns, infections developed in 20.2% during trauma and in 43.4% during burn treatment. A structural equation model indicated that the child burn victims' general health perceptions did not significantly affect their sleep habits (p > 0.05). A significant correlation was found between the children's posttraumatic stress disorder and their sleep habits (p < 0.05). Posttraumatic stress disorder explained 7.2% of their sleep habits. A positive and significant correlation was found between the children's general health perceptions and posttraumatic stress disorder (r = 0.74, p < 0.05). CONCLUSION Burns of any kind can cause posttraumatic stress, sleep disorders and impairment of health status in children.
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Affiliation(s)
- Mehmet Emin Düken
- Health Sciences of Facult, Department of Child Health and Diseases Nursing, Harran University, Şanlıurfa 63000, Turkey.
| | - Emriye Hilal Yayan
- Faculty of Nursing, Department of Child Health and Diseases Nursing, Inönü University, Malatya 44280, Turkey.
| | - Mürşide Zengin
- School of Health, Department of Child Health Nursing, Adıyaman University, Adıyaman 02000, Turkey.
| | - Tekcan Sevgi
- Department of Child Health ve Disease of Nursing, Adana Yuregir State Hospital-Child Health and Diseases Service, Adana, Turkey.
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Hoffmann C, Davies P, Elliott D, Young A. Exploring what is important during burn recovery: a qualitative study investigating priorities of patients and healthcare professionals over time. BMJ Open 2023; 13:e059528. [PMID: 36764717 PMCID: PMC9923305 DOI: 10.1136/bmjopen-2021-059528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVES This qualitative study aimed to investigate: (1) priorities of patients and healthcare professionals during recovery from a burn injury, (2) how priorities change over time and (3) how priorities map to outcomes currently reported in burns research. DESIGN Semi-structured interviews were conducted. Interviews were audio recorded, transcribed and analysed thematically. SETTING, PARTICIPANTS A total of 53 patients and healthcare professionals were recruited from four National Health Service (NHS) burn services across England and Wales across England and Wales. Patient participants (n=32) included adults, adolescents and parents of paediatric patients, with a variety of burn injuries in terms of severity and cause of burn injury. Healthcare professionals (n=21) were NHS staff members involved in burn care and included professionals with a range of clinical experience and roles (eg, nurses, surgeons, occupational therapists, physiotherapist, administration). RESULTS Ten themes relating to priorities (outcomes) during recovery from a burn injury were identified for patients and professionals. Of those, six were identified for patients and professionals ('pain and discomfort', 'psychological well-being', 'healing', 'scarring', 'function', 'infection'), three were unique to professionals ('patient knowledge, understanding and support', 'sense of control', 'survival') and one was unique to patients ('uncertainty'). Results highlighted that importance of these priorities changes over time (eg, 'survival' was only a concern in the short term). Likewise, priorities differed between patients and professionals (eg, 'pain' was important to patients throughout their recovery, but not for professionals). Seven out of 10 themes overlapped with outcomes commonly assessed in burn research. CONCLUSION Professionals' and patients' priorities (important outcomes) change over time after burn injury and differ between those groups. Burn care research should consider measuring outcomes at different time points during the recovery from a burn injury to accurately reflect complexity of burn recovery.
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Affiliation(s)
- Christin Hoffmann
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Philippa Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy Elliott
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amber Young
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Children's Burns Research Centre Bristol, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Won P, Celie KB, Rutter C, Gillenwater TJ, Yenikomshian HA. Burn Patient Perspectives on Disability Weights and the Philosophy of Disability: A Gap in the Literature. EUROPEAN BURN JOURNAL 2023; 4:363-372. [PMID: 38528989 PMCID: PMC10961916 DOI: 10.3390/ebj4040037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background Disability-adjusted life years (DALY) have a ubiquitous presence in academic global health, including attempts to understand the global burden of burn injuries. Objective The present scoping review aimed to examine whether disability weights (DWs) were informed by burn patient perspectives and secondarily to determine whether literature indicates which of the three most common philosophical models of disability best aligns with burn patient experiences. Methods A review of six databases was conducted and The Critical Appraisal Skills Program (CASP) checklist was utilized. Results Out of a total of 764 articles, zero studies solicited patient perspectives of DWs. Four articles contained data that could be extrapolated to patient perspectives on disability. All articles utilized semi-structured interviews of burn survivors and reported thematic elements including return to work, self-image, and social integration. Patients reported similar themes that burn injuries were disabling injuries and instrumentally detrimental, with modulation based on the patient's social circumstances. Conclusions This scoping review highlights a significant gap in literature. First, no studies were found directly investigating burn patient perspectives on burn DWs. Current DWs have been derived from expert opinions with limited input from patients. Second, the limited primary patient data gleaned from this review suggest patients consider their injuries as instrumentally detrimental, which aligns most closely with the welfarist view of disability. More explicit investigations into the philosophical model of disability best aligning with burn patient experiences are needed to ground the health economics of burns in sound theory.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Karel-Bart Celie
- Uehiro Center for Practical Ethics, University of Oxford, Oxford OX1 1PT, UK
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA 90033, USA
| | - Cindy Rutter
- Independent Researcher, Los Angeles, CA 90033, USA
| | - T. Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA 90033, USA
| | - Haig A. Yenikomshian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA 90033, USA
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Challita R, Bazzi N, Fazaa E, Maassarani D, Habib T, Bazzi M, Ghanime G, Sleiman Z. Management of Burn Scars: A Five-Year Retrospective Study. Cureus 2022; 14:e31448. [DOI: 10.7759/cureus.31448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/14/2022] Open
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10
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Are burns a chronic condition? Examining patient reported outcomes up to 20 years after burn injury-A Burn Model System National Database investigation. J Trauma Acute Care Surg 2022; 92:1066-1074. [PMID: 35081598 PMCID: PMC9133040 DOI: 10.1097/ta.0000000000003547] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND People living with burn injury often face long-term physical and psychological sequelae associated with their injuries. Few studies have examined the impacts of burn injuries on long-term health and function, life satisfaction, and community integration beyond 5 years postinjury. The purpose of this study was to examine these outcomes up to 20 years after burn injury. METHODS Data from the Burn Model System National Longitudinal Database (1993-2020) were analyzed. Patient-reported outcome measures were collected at discharge (preinjury status recall) and 5 years, 10 years, 15 years, and 20 years after injury. Outcomes examined were the SF-12/VR-12 Physical Component Summary and Mental Component Summary, Satisfaction with Life Scale, and Community Integration Questionnaire. Trajectories were developed using linear mixed models with repeated measures of outcome scores over time, controlling for demographic and clinical variables. RESULTS The study population included 421 adult burn survivors with a mean age of 42.4 years. Lower Physical Component Summary scores (worse health) were associated with longer length of hospital stay, older age at injury and greater time since injury. Similarly, lower Mental Component Summary scores were associated with longer length of hospital stay, female sex, and greater time since injury. Satisfaction with Life Scale scores decrease negatively over time. Lower Community Integration Questionnaire scores were associated with burn size and Hispanic/Latino ethnicity. CONCLUSION Burn survivors' physical and mental health and satisfaction with life worsened over time up to 20 years after injury. Results strongly suggest that future studies should focus on long-term follow-up where clinical interventions may be necessary. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III.
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Rontoyanni VG, Kudlicki A, Palackic A, Gibran N, Stewart B, Schneider JC, Ryan CM, Murton AJ, Wolf SE, Kowalske K, Suman OE. Strength of association between body mass index and physical function scores in paediatric burn patients: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System study. Burns 2022; 48:824-832. [PMID: 35410694 PMCID: PMC9232948 DOI: 10.1016/j.burns.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Increased body weight has been associated with reduced muscle wasting in the early catabolic phase after a severe burn. Yet, overweight and obese non-burn children often exhibit impaired musculoskeletal function, which may lead to poor physical function (PF). We aimed to determine the association between body mass index (BMI) at discharge and self-reported PF and caregiver proxy-reported PF during recovery of burned children. MATERIALS AND METHODS This is a retrospective multisite longitudinal study in paediatric burn patients ((8-17 y old at time of burn). PF outcome measures were self-reported mobility, proxy-reported mobility, and upper extremity PF evaluated using PROMIS measures at 6-, 12-, and 24-months after injury. Primary exposure variable was BMI-for-age at discharge. RESULTS A total of 118 paediatric patients, aged 11.7 ± 3.3 y, with burns covering 37.6 ± 18.8% of their total body surface area (TBSA) and BMI-for-age of 23.1 ± 5.4 kg/m2 at discharge were analyzed. BMI at discharge was not significantly associated with self-reported mobility scores 6 months after burn (beta coefficient =-0.23, p = 0.31), had a positive effect on mobility at 12 months (beta = 0.46, p = 0.05), and no effect at 24 months after injury (beta=-0.10, p = 0.60), when adjusted for burn size. BMI did not have a significant effect on proxy-reported mobility or upper extremity PF. CONCLUSION A greater BMI at discharge was associated with improved self-reported PF at 12 months after burn but not at 6 months or 24 months, which suggests a faster recovery of PF in paediatric patients of larger body weight. Our data suggests that a larger body weight does not compromise the recovery of PF after burn.
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Affiliation(s)
| | - Andrew Kudlicki
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, Seattle, WA
| | - Barclay Stewart
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, Seattle, WA,Harborview Injury Prevention & Research Center, Seattle, WA, USA
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Hospital for Children-Boston, Boston, MA, USA
| | - Andrew J. Murton
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oscar E. Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA,Corresponding author: Oscar E. Suman, PhD, Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0737; Office: 409.772.3889; Fax: 409.747.0966;
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12
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Cleland H, Fernando DT, Gabbe BJ. Trends in Victorian burn injuries 2008-2017. Burns 2022; 48:703-712. [PMID: 34304930 DOI: 10.1016/j.burns.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/01/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe incidence and characteristics of hospital presentations and deaths due to burn injury in the Australian state of Victoria from 2008 to 2017 and identify trends in incidence and patterns. METHODS Three population-based datasets were used to ascertain burn-related hospital admissions, emergency department presentations, and deaths. These were the Victorian Admitted Episodes Dataset (VAED), Victorian Emergency Minimum Dataset (VEMD), and the Cause of Death-Unit Record File (COD-URF), respectively. Descriptive statistics on demographics (age and gender), burn injury characteristics (intent, cause, burn size and body region) and hospital burden (length of stay (LOS) and costs) were used to present the profile of patients. Incidence rates by age, gender and intent were calculated. Trend analysis on incidence was carried out using forced Poisson Regression models with the natural logarithm of the annual populations as an offset. Incident rate ratios were used to interpret the models. Risk ratios were used to compare the risk differences between population sub-groups. A negative binomial model was used to test the association between LOS and age and the total body surface area (TBSA) of the burn. RESULTS Overall males had higher rates of death, admission and ED presentation. For adults, the elderly had the highest rates of deaths and admissions while for children, the very young had highest rates for admissions and presentations. Exposure to smoke, fire and flames was the most common cause of deaths, and contact with heat and hot substances was most common among ED presentations. The elderly and those with Total Body Surface Area (TBSA) burn ≥20% had a higher risk of longer hospital stay. Rates of severe burns and deaths from burns remained stable during the study period in the setting of an annual 2% increase in population. Paediatric hospital admission rates decreased over time. CONCLUSION The risk of sustaining burn injury, the types of burn and outcomes, varied by age and gender. We found evidence of a limited decrease in burn injury rates in some sub-groups: appropriate and effective targeted prevention strategies for burns are needed to avoid the significant short and long-term suffering experienced.
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Affiliation(s)
- Heather Cleland
- Victorian Adult Burns Unit, Alfred Hosptal, Commercial Rd, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Commercial Rd, Melbourne, Australia.
| | - Dasamal Tharanga Fernando
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, Clayton, Victoria, Australia.
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, SA2 8QA, United Kingdom.
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Graded aerobic exercise (GAEx): An effective exercise regimen to improve cardio-respiratory fitness and physical and psychosocial functioning in children with burn sequelae of the chest. Burns 2022; 48:337-344. [PMID: 34016485 DOI: 10.1016/j.burns.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The cardio-respiratory function is compromised in children recovering from burns, particularly, those who sustain a burn injury across the chest, which leads to further prejudicial effects on physical and psychosocial health. This study endeavored to explore the efficacy of 12 weeks of graded aerobic exercise (GAEx) on the cardiorespiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest. METHODS Thirty-six burn-injured children aged 10-18 years (%TBSA: 24.2 ± 4.9, and 38.8 ± 12.9 months since injury) were randomly assigned to GAEx group (n = 18; undergone a 12-week intensity- and time-graded aerobic exercise program plus standard rehabilitation) or control group (n = 18; received the standard rehabilitation only). The cardio-respiratory fitness [marked by the peak oxygen uptake (VO2peak), minute ventilation (VE), ventilatory equivalent of inhaled oxygen (VEq/VO2), oxygen pulse (O2P), respiratory exchange ratio (RER), maximum heart rate (HRmax), and the heart rate recovery at one minute (HRR1)] and physical and psychosocial functioning were assessed pre- and post-intervention. RESULTS Children in the GAEx group showed significant increases in VO2peak (P = 0.013), VE (P = 0.026), O2P (P = 0.034), HRmax (P = 0.035), and HRR1 (P = 0.04) and declines in VEq/VO2 (P = 0.009) and RER (P = 0.011) as compared to the control group. Additionally, the GAEx group reported higher physical (P = 0.029) and psychosocial (P = 0.012) functioning. CONCLUSION Twelve weeks of GAEx has salutary effects on cardio-respiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest. These findings suggest that adding GAEx as a complementary therapy to the long-term rehabilitation protocol for this patient population is worthwhile.
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Schouten HJ, Nieuwenhuis MK, van Baar ME, van der Schans CP, Niemeijer AS, van Zuijlen PPM. The degree of joint range of motion limitations after burn injuries during recovery. Burns 2022; 48:309-318. [PMID: 34955294 DOI: 10.1016/j.burns.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to determine the degree of ROM limitations of extremities, joints and planes of motion after burns and its prevalence over time. METHOD The database of a longitudinal multicenter cohort study in the Netherlands (2011-2012) was used. From patients with acute burns involving the neck, shoulder, elbow, wrist, hip, knee and ankle joints that had surgery, ROM of 17 planes of motion was assessed by goniometry at 3, 6 weeks, 3-6-9 and 12 months after burns and at discharge. RESULTS At 12 months after injury, 12 out of 17 planes of motion demonstrated persistent joint limitations. The five unlimited planes of motion were all of the lower extremity. The most severely limited joints at 12 months were the neck, ankle, wrist and shoulder. The lower extremity was more severely limited in the early phase of recovery whereas at 12 months the upper extremity was more severely limited. CONCLUSION The degree of ROM limitations and prevalence varied over time between extremities, joints and planes of motion. This study showed which joints and planes of motion should be watched specifically concerning the development of scar contracture.
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Affiliation(s)
- H J Schouten
- Association of Dutch Burn Centers, Burn Centre, Red Cross Hospital Beverwijk, The Netherlands; Burn Centre and Dept of Plastic & Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Physiotherapy, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Science's Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands.
| | - M K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, The Netherlands; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands
| | - M E van Baar
- Association of Dutch Burn Centers, Burn Centre, Maasstad Hospital Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - C P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, The Netherlands; Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, The Netherlands; Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - A S Niemeijer
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, The Netherlands; Research Institute, Martini Hospital Groningen, The Netherlands
| | - P P M van Zuijlen
- Burn Centre and Dept of Plastic & Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Science's Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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O'Neil AM, Rush C, Griffard L, Roggy D, Boyd A, Hartman B. 5 -Year Retrospective Analysis of a Vented Mobility Algorithm in the Burn ICU. J Burn Care Res 2022; 43:1129-1134. [PMID: 34978322 DOI: 10.1093/jbcr/irab248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early mobilization with mechanically ventilated patients has received significant attention within recent literature, however limited research has focused specifically on the burn population. The purpose of this single center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average total body surface area of 22.8%. No adverse events occurred. Stage 1 (Range of motion) was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges including airway stability, sedation, and line limitations.
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Affiliation(s)
| | | | | | - David Roggy
- Richard M Fairbanks Burn Center, Indianapolis, IN
| | - Allison Boyd
- Richard M Fairbanks Burn Center, Indianapolis, IN
| | - Brett Hartman
- Indiana University School of Medicine, Indianapolis, IN
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Crandall CG, Cramer MN, Kowalske KJ. Edward F. Adolph Distinguished Lecture. It's more than skin deep: thermoregulatory and cardiovascular consequences of severe burn injuries in humans. J Appl Physiol (1985) 2021; 131:1852-1866. [PMID: 34734782 PMCID: PMC8714984 DOI: 10.1152/japplphysiol.00620.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Abstract
Each year, within the United States, tens of thousands of individuals are hospitalized for burn-related injuries. The treatment of deep burns often involves skin grafts to accelerate healing and reduce the risk of infection. The grafting procedure results in a physical disruption between the injured and subsequently debrided host site and the skin graft placed on top of that site. Both neural and vascular connections must occur between the host site and the graft for neural modulation of skin blood flow to take place. Furthermore, evaporative cooling from such burn injured areas is effectively absent, leading to greatly impaired thermoregulatory responses in individuals with large portions of their body surface area burned. Hospitalization following a burn injury can last weeks to months, with cardiovascular and metabolic consequences of such injuries having the potential to adversely affect the burn survivor for years postdischarge. With that background, the objectives of this article are to discuss 1) our current understanding of the physiology and associated consequences of skin grafting, 2) the effects of skin grafts on efferent thermoregulatory responses and the associated consequences pertaining to whole body thermoregulation, 3) approaches that may reduce the risk of excessive hyperthermia in burn survivors, 4) the long-term cardiovascular consequences of burn injuries, and 5) the extent to which burn survivors can "normalize" otherwise compromised cardiovascular responses. Our primary objective is to guide the reader toward an understanding that severe burn injuries result in significant physiological consequences that can persist for years after the injury.
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Affiliation(s)
- Craig G Crandall
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Matthew N Cramer
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Karen J Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
INTRODUCTION Burn-related injuries are a leading cause of morbidity across the globe. Accurate assessment and treatment have been demonstrated to reduce the morbidity and mortality. This essay explores the forms of artificial intelligence to be implemented the field of burns management to optimise the care we deliver in the National Health Service (NHS) in the UK. METHODS Machine Learning methods which predict or classify are explored. This includes linear and logistic regression, artificial neural networks, deep learning, and decision tree analysis. DISCUSSION Utilizing Machine Learning in burns care holds potential from prevention, burns assessment, predicting mortality and critical care monitoring to healing time. Establishing a regional or national Machine Learning group would be the first step towards the development of these essential technologies. CONCLUSION The implementation of machine learning technologies will require buy-in from the NHS health boards, with significant implications with cost of investment, implementation, employment of machine learning teams and provision of training to medical professionals.
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Affiliation(s)
- Lydia Robb
- Core Surgical Trainee, East of Scotland Deanery, Plastic Surgery Department, NHS Lothian, St John's Hospital at Howden, Livingston
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18
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Basha MA, Abdel-Aal NM, Kamel FAH. Effects of Wii Fit Rehabilitation on Lower Extremity Functional Status in Adults With Severe Burns: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 103:289-296. [PMID: 34571011 DOI: 10.1016/j.apmr.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the effects of the Wii Fit rehabilitation program in addition to a standard physical therapy program (SPTP) on lower extremity functional status and functional mobility in adults with severe burns after hospital discharge. DESIGN A single-blinded, parallel groups, randomized controlled trial. SETTINGS Outpatient rehabilitation center. PARTICIPANTS Thirty-four patients (N=34), aged 31.3±7.3 years old, with lower extremity deep partial-thickness and full-thickness burn and total body surface area of more than 40% were allocated randomly into 2 equal groups. INTERVENTIONS The Wii Fit group received the Wii Fit program for 30 minutes in addition to SPTP for 60 minutes, whereas the SPTP group received SPTP only. The intervention was 3 sessions a week for 12 weeks. MAIN OUTCOME MEASURES The primary outcome measurements were the functional status and functional mobility, which were assessed by the high mobility assessment tool, Lower Limb Functional Index, and timed Up and Go test. The secondary outcomes included exercise capacity, muscle strength, and balance measured by the 6-minute walk test, isokinetic muscle strength assessment, and stability index. All the outcome measures were collected at the baseline and after 12 weeks of intervention. RESULTS After 12 weeks of intervention, there were statistically significant differences between groups in all outcome measures in favor of the Wii Fit group (P<.001). Also, statistically significant differences were found in all the measured outcomes after 12 weeks of intervention in each group (P<.05). CONCLUSIONS Patients with lower extremity burns who received the Wii Fit program in addition to the SPTP had better improvements in lower limb functional status, functional mobility, exercise capacity, muscle strength, and balance than patients who received SPTP alone. The Wii Fit program was a useful adjunctive therapy in rehabilitating adults with lower extremity burn injury.
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Affiliation(s)
- Maged A Basha
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Qassim, Saudi Arabia; Department of Physical Therapy, El-Sahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt.
| | - Nabil M Abdel-Aal
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Fatma Alzahraa H Kamel
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Qassim, Saudi Arabia; Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Kamel NM, Toson RA, Elsayeh SM. Response of Aerobic Capacity to Low-Level Laser Therapy in Burned Patients. J Burn Care Res 2021; 43:685-690. [PMID: 34520536 DOI: 10.1093/jbcr/irab173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Severe burns lead to decreased pulmonary function and impaired aerobic capacity for long periods post-injury. Low-level laser therapy is a modality utilized to improve aerobic capacity, enhance exercise performance and increase time until fatigue when utilized before aerobic exercises. PURPOSE This work aims to determine the impacts of pre-exercise low-level laser therapy on aerobic capacity in burn cases. PARTICIPANTS AND METHODS Sixty adults burned cases of both sexes, aged from 25 to 40 years, with second-degree healed thermal burns, and the total burned body surface area ranged from 20 to 40% participated in this study after complete wound healing. They were randomly categorized into two groups of equal numbers. The study group received low-level laser therapy before aerobic exercises, three sessions/week for 12 weeks, while the control group performed aerobic exercises three times weekly for 12 weeks. All cases received the routine physical treatment program. Aerobic capacity was assessed for both groups by measuring maximum oxygen consumption and time to exhaustion at baseline and twelve weeks following interventions. FINDINGS There was a statistically significant rise in the mean values of maximum oxygen usage and time to fatigue after 12 weeks of treatment in both groups. However, after comparison, the improvements in the study group were statistically significant than those in the control group with (p < 0.01), (p < 0.05) respectively. CONCLUSION Low-level laser therapy has a beneficial therapeutic impact on promoting aerobic capacity, improving maximum oxygen consumption, and increasing treadmill time in burned cases when preceding aerobic exercises.
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Affiliation(s)
- Noha Mohamed Kamel
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Rokaia Ali Toson
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Shaimaa Mohamed Elsayeh
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Barış Cartı E, Deniz Uçar A, Yıldırım M. Is carpal tunnel release safe in electrical burn decompressive therapy: Six-years experience. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.4379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Upper extremity electrical burn can create severe sequela and debilitation if not treated properly. Immediate decompression with fasci- otomy and carpal tunnel release seem to be the most promising choice of treatment. Neurologic functional loss can be avoided if median nerve is liberated.
Material and Methods: During 6-year time interval, 50 out of 1158 burn patients underwent upper extremity decompressive fasciotomy with carpal tunnel release. Their hand motor function based on nerve innervation and daily usage questionnaire were followed in 12-month intervals.
Results: Average score rose markedly after 18th month and reached nearly normal at the end of 66th month. Median, ulnar and radial nerve function tests were all positive, and no irreversible nerve function loss observed.
Conclusion: All compartments of the forearm should be explored and carpal tunnel release should be added into upper extremity decompressive fasciotomy after electrical burns.
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Barrera JA, Trotsyuk AA, Maan ZN, Bonham CA, Larson MR, Mittermiller PA, Henn D, Chen K, Mays CJ, Mittal S, Mermin-Bunnell AM, Sivaraj D, Jing S, Rodrigues M, Kwon SH, Noishiki C, Padmanabhan J, Jiang Y, Niu S, Inayathullah M, Rajadas J, Januszyk M, Gurtner GC. Adipose-Derived Stromal Cells Seeded in Pullulan-Collagen Hydrogels Improve Healing in Murine Burns. Tissue Eng Part A 2021; 27:844-856. [PMID: 33789446 DOI: 10.1089/ten.tea.2020.0320] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Burn scars and scar contractures cause significant morbidity for patients. Recently, cell-based therapies have been proposed as an option for improving healing and reducing scarring after burn injury, through their known proangiogenic and immunomodulatory paracrine effects. Our laboratory has developed a pullulan-collagen hydrogel that, when seeded with mesenchymal stem cells (MSCs), improves cell viability and augments their proangiogenic capacity in vivo. Concurrently, recent research suggests that prospective isolation of cell subpopulations with desirable transcriptional profiles can be used to further improve cell-based therapies. In this study, we examined whether adipose-derived stem cell (ASC)-seeded hydrogels could improve wound healing following thermal injury using a murine contact burn model. Partial thickness contact burns were created on the dorsum of mice. On days 5 and 10 following injury, burns were debrided and received either ASC hydrogel, ASC injection alone, hydrogel alone, or no treatment. On days 10 and 25, burns were harvested for histologic and molecular analysis. This experiment was repeated using CD26+/CD55+ FACS-enriched ASCs to further evaluate the regenerative potential of ASCs in wound healing. ASC hydrogel-treated burns demonstrated accelerated time to reepithelialization, greater vascularity, and increased expression of the proangiogenic genes MCP-1, VEGF, and SDF-1 at both the mRNA and protein level. Expression of the profibrotic gene Timp1 and proinflammatory gene Tnfa was downregulated in ASC hydrogel-treated burns. ASC hydrogel-treated burns exhibited reduced scar area compared to hydrogel-treated and control wounds, with equivalent scar density. CD26+/CD55+ ASC hydrogel treatment resulted in accelerated healing, increased dermal appendage count, and improved scar quality with a more reticular collagen pattern. Here we find that ASC hydrogel therapy is effective for treating burns, with demonstrated proangiogenic, fibromodulatory, and immunomodulatory effects. Enrichment for CD26+/CD55+ ASCs has additive benefits for tissue architecture and collagen remodeling postburn injury. Research is ongoing to further facilitate clinical translation of this promising therapeutic approach. Impact statement Burns remain a significant public health burden. Stem cell therapy has gained attention as a promising approach for treating burns. We have developed a pullulan-collagen biomimetic hydrogel scaffold that can be seeded with adipose-derived stem cells (ASCs). We assessed the delivery and activity of our scaffold in a murine contact burn model. Our results suggest that localized delivery of ASC hydrogel treatment is a promising approach for the treatment of burn wounds, with the potential for rapid clinical translation. We believe our work will have broad implications for both hydrogel therapeutics and regenerative medicine and will be of interest to the general scientific community.
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Affiliation(s)
- Janos A Barrera
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Artem A Trotsyuk
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Clark A Bonham
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Madelyn R Larson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Paul A Mittermiller
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Dominic Henn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kellen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chyna J Mays
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Smiti Mittal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alana M Mermin-Bunnell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Dharshan Sivaraj
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Serena Jing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Melanie Rodrigues
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sun Hyung Kwon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chikage Noishiki
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jagannath Padmanabhan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yuanwen Jiang
- Department of Chemical Engineering, Stanford University, Stanford, California, USA
| | - Simiao Niu
- Department of Chemical Engineering, Stanford University, Stanford, California, USA
| | - Mohammed Inayathullah
- Biomaterials and Advanced Drug Delivery Center, Stanford University, Stanford, California, USA
| | - Jayakumar Rajadas
- Biomaterials and Advanced Drug Delivery Center, Stanford University, Stanford, California, USA
| | - Michael Januszyk
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey C Gurtner
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
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Nehme Passos MC, Gragnani A, Sarto Piccolo M, Daher RP, Santana Cordeiro E, Masako Ferreira L. Burn Specific Health Scale - Brief - Brazil and International Classification of Functioning, Disability and Health in burn patients. J Burn Care Res 2021; 43:30-36. [PMID: 33891007 DOI: 10.1093/jbcr/irab055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
With better burn trauma survival rates, quality of life and functionality have become important outcomes in the evaluation of burn patients.The objective of this study was to evaluate the quality of life of burn survivors using the Burn Specific Health Scale-Brief-Br and their function and health using the International Classification of Functioning Disability and Health (ICF) in order to assess whether there is a correlation in the results obtained between the two instruments. A cross-sectional study with 80 burn patients who underwent outpatient follow-up was completed. Quality of life was assessed using the BSHS-B-Br, an instrument translated and validated in Brazilian Portuguese. Based on ICF category concepts, a data collection tool was used with "yes" and "no" answers. A "yes" answer represented the "8" qualifier, indicating a problem without a specific order of magnitude. Both instruments were self-applied in standardized conditions without complications during the process. Results were analyzed through Spearman's rank correlation coefficients. The BSHS-B-Br had an average score of 127.12 (SD ± 23.03). The correlation was moderate between the total BSHS-B-Br score and the answers of ICF for body functions (r= -0.53; p <0.001) and environmental factors (r= -0.50; p <0.001). It was weak for body structures (r= -0.47; p <0.001) and for activities and participation (r= -0.43; p <0.001). This study found a moderate correlation between the results of the Burn Specific Health Scale - Brief - Brazil and the International Classification of Functioning, Disability and Health for burn patients showing that both instruments provide complementary information about burned patients.
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Affiliation(s)
- Maria Claudia Nehme Passos
- Graduate master's degree Program on Translational Surgery at Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), Brazil
| | - Alfredo Gragnani
- Discipline of Plastic Surgery, Surgery Department, (UNIFESP/EPM), Brazil
| | - Mônica Sarto Piccolo
- Orthopedics Department, Traumatology, Plastic Surgery and Physiotherapy, Medicine College of the Universidade Federal de Goiás (UFG), Brazil
| | - Ricardo Piccolo Daher
- Graduate PhD degree Program on Translational Surgery at Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), Brazil
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Itakussu EY, Morita AA, Kakitsuka EE, Pitta F, Cavalheri V, Hernandes NA. Instruments to assess function or functionality in adults after a burn injury: A systematic review. Burns 2021; 47:999-1011. [PMID: 33896659 DOI: 10.1016/j.burns.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Assessment of functionality or function, through valid and reliable instruments, is essential during rehabilitation of adults after a burn injury. Currently, there is no consensus in the literature regarding the most appropriate tool that should be used to assess function or functionality; there is also no synthesis of the current studies published in this area. OBJECTIVES To investigate and report the instruments used to assess function or functionality in adults after a burn injury; to identify the characteristics and evidence on their measurement properties; and to evaluate their clinical utility. METHODS We systematically searched the literature via six electronic databases and via screening reference lists of relevant studies. The review was registered in PROSPERO (CRD42016048065) and reported according to the PRISMA statement. Studies in which function or functionality of upper and/or lower limbs of adults after a burn injury was assessed were included. Exclusion criteria comprised studies in pediatric populations and conference abstracts. RESULTS Thirty-four studies were included. Twelve questionnaires and seven objective tests for function or functionality were identified. Three specific tools were found; four generic instruments have been validated in burns. Nine studies evaluated the instruments' measurement properties, presenting at least one property classified as 'fair' quality. Finally, 18 instruments demonstrated clinical utility. CONCLUSION This systematic review demonstrated that most instruments used to assess function or functionality in adults with a burn injury have not been specifically developed for this population and had their measurement properties poorly studied. Conversely, almost all instruments had clinical utility.
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Affiliation(s)
- Edna Yukimi Itakussu
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil; Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Brazil.
| | - Andrea Akemi Morita
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Emely Emi Kakitsuka
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Fabio Pitta
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Australia; Allied Health, South Metropolitan Health Service, Perth, Australia.
| | - Nidia Aparecida Hernandes
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
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Miroshnychenko A, Kim K, Rochwerg B, Voineskos S. Comparison of early surgical intervention to delayed surgical intervention for treatment of thermal burns in adults: A systematic review and meta-analysis. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cruz MA, Araujo TA, Avanzi IR, Parisi JR, de Andrade ALM, Rennó ACM. Collagen from Marine Sources and Skin Wound Healing in Animal Experimental Studies: a Systematic Review. MARINE BIOTECHNOLOGY (NEW YORK, N.Y.) 2021; 23:1-11. [PMID: 33404918 DOI: 10.1007/s10126-020-10011-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/29/2020] [Indexed: 06/12/2023]
Abstract
Collagen (Col) from marine organisms has been emerging as an important alternative for commercial Col and it has been considered highly attractive by the industry. Despite the positive effects of Col from marine origin, there is still limited understanding of the effects of this natural biomaterial in the process of wound healing in animal studies. In this context, the purpose of this study was to perform a systematic review of the literature to examine the effects of Col from different marine species in the process of skin tissue healing using experimental models of skin wound. The search was carried out according to the orientations of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the descriptors of the Medical Subject Headings (MeSH) were defined: "marine collagen," "spongin," "spongin," "skin," and "wound." A total of 42 articles were retrieved from the databases PubMed and Scopus. After the eligibility analyses, this review covers the different marine sources of Col reported in 10 different papers from the beginning of 2011 through the middle of 2019. The results were based mainly on histological analysis and it demonstrated that Col-based treatment resulted in a higher deposition of granulation tissue, stimulation of re-epitalization and neoangiogenesis and increased amount of Col of the wound, culminating in a more mature morphological aspect. In conclusion, this review demonstrates that marine Col from different species presented positive effects on the process of wound skin healing in experimental models used, demonstrating the huge potential of this biomaterial for tissue engineering proposals.
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Affiliation(s)
- Matheus Almeida Cruz
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil
| | - Tiago Akira Araujo
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil
| | - Ingrid Regina Avanzi
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil
- São Paulo State Faculty of Technology (FATEC), 350 Senador Feijó Avenue, Santos, SP, 11015502, Brazil
| | - Julia Risso Parisi
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), km 235 Washington Luís Road, São Carlos, SP, 13565905, Brazil
| | - Ana Laura Martins de Andrade
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), km 235 Washington Luís Road, São Carlos, SP, 13565905, Brazil
| | - Ana Claudia Muniz Rennó
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil.
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), km 235 Washington Luís Road, São Carlos, SP, 13565905, Brazil.
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Ibrahim ZM, Ali OI, Moawd SA, Eid MM, Taha MM. Low Vibrational Training as an Additional Intervention for Postural Balance, Balance Confidence and Functional Mobility in Type 2 Diabetic Patients with Lower Limb Burn Injury: A Randomized Clinical Trial. Diabetes Metab Syndr Obes 2021; 14:3617-3626. [PMID: 34408458 PMCID: PMC8364844 DOI: 10.2147/dmso.s307414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/25/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Burn injury with pre-existing diabetes has poorer outcomes and complications. Balance and functional mobility are disturbed in diabetic patients with burn injury which increase the risk of total morbidity. The aim of the current study was to evaluate the impact of vibrational training as an additional intervention on postural balance, balance confidence and functional mobility in type 2 diabetic patients with lower limb burn injury. PATIENTS AND METHODS Thirty-eight type 2 diabetic patients of both sexes with healed lower limb burn were randomly assigned into two equal groups: the vibration group and the control group. The vibration group received whole body vibration (WBV), 3 sessions a week for 8 weeks, in addition to the selected exercise program (balance exercises and resisted exercises), while the control group only received the selected exercise program. Biodex Balance System was used to assess the dynamic balance score, the Activities-specific Balance Scale to assess balance confidence and the timed up and go test to assess the functional mobility. All measurements were obtained before and at the end of the study after 8 weeks of treatment. RESULTS Marked improvement in all dynamic balance indices; overall stability index, antero-posterior stability index and medio-lateral stability index, balance confidence and the functional mobility were obtained in both the vibration and the control groups (P< 0.05), whereas post-treatment comparison between groups revealed a statistically significant difference in favor of the vibration group in all measured variables. CONCLUSION Based on the results of the current study, it is possible to conclude that adding WBV training for an 8-week duration to a selected exercise program (balancing and resisted exercises) seems to be effective; in improving postural balance, balance confidence, as well as improving the functional mobility in type 2 diabetic patients with lower limb burn injury.
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Affiliation(s)
- Zizi M Ibrahim
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Correspondence: Zizi M Ibrahim Email
| | - Olfat Ibrahim Ali
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Samah A Moawd
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabi
- Department of Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Marwa M Eid
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Department of Physical Therapy, Faculty of Applied Medical Science, Taif University, Taif, Saudi Arabia
| | - Mona Mohamed Taha
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Quantifying Burn Injury-Related Disability and Quality of Life in the Developing World: A Primer for Patient-Centered Resource Allocation. Ann Plast Surg 2020; 82:S433-S436. [PMID: 30557188 DOI: 10.1097/sap.0000000000001678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Untreated or undertreated burns are commonly encountered by plastic surgeons on medical trips in India and represent a major cause of disability. We sought to utilize validated patient-reported outcomes instruments to identify the patient population with the greatest burn-related disability in order to appropriately allocate plastic surgery resources to those in greatest need. METHODS The Quick Disability of the Arm, Shoulder, and Hand, RAND 36-Item Short Form Health Survey, and Burn-Specific Health Scale-Revised, Brief, and Adapted questionnaires were administered via an interpreter during a plastic surgery trip to Jharkhand, India, in January 2018. Demographics, comorbidities, and burn-specific history were recorded. RESULTS Twenty-eight postburn patients were surveyed (mean age, 17.0 ± 9.2 years; male:female ratio, 1:2.5). Mean time from injury was 4.74 years. No patient had received formal, primary burn care. Mechanism of injury: flame (39%), oil (32%), scalding water (14%), and other (14%). Fifty-four percent were extremity burns; 25%, facial; and 18%, neck burns. The Burn-Specific Health Scale-Revised, Brief, and Adapted demonstrated that the most significantly impacted domains for all patients were body image and skin sensitivity, with more than 80% of patients complaining of issues with skin sensitivity. In addition, children (aged <18 years) had diminished body image domain scores. RAND SF-36 scores were lowest in the energy (73.1 ± 25.0) and general health (76.5 ± 13.8) domains, and females with extremity burns demonstrated statistically significant decreases in their physical limitation domain scores (85.9 ± 17.3, P < 0.05). Females with extremity burns also had statistically significant lower scores in the energy domain (64.09 ± 25.75) as compared with their male counterparts with extremity burns (100 ± 0, P = 0.045). In general, females scored lower than did males in multiple domains, and those results reached statistical significance in the energy (65.9 ± 24.6 vs 93.6 ± 10.9), emotional (77.2 ± 21.5 vs 95.4 ± 11.2), and general health domains (71.1 ± 11.9 vs 90.0 ± 7.5) with P < 0.05. Children demonstrated significantly diminished scores in the emotional (75.5 ± 24.6) and general health (79.1 ± 11.8) domains. CONCLUSION These data demonstrate the significant impact on quality of life that untreated burns have in this population. Male and female children with extremity burns and adult women with extremity burns were most significantly affected in multiple domains. Consequently, children and adult women with extremity burns appear to be the patient cohort with the greatest opportunity to impact their quality of life. These data may be utilized to improve patient triage and resource allocation for future surgical trips but could also be of significant benefit to internal health agencies and ministries for the same purpose.
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Wang Y, Ke Z, He Z, Chen X, Zhang Y, Xie P, Li T, Zhou J, Li F, Yang C, Zhang P, Huang C, Kai L. Real-time burn depth assessment using artificial networks: a large-scale, multicentre study. Burns 2020; 46:1829-1838. [PMID: 32826097 DOI: 10.1016/j.burns.2020.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Early judgment of the depth of burns is very important for the accurate formulation of treatment plans. In medical imaging the application of Artificial Intelligence has the potential for serving as a very experienced assistant to improve early clinical diagnosis. Due to lack of large volume of a particular feature, there has been almost no progress in burn field. METHODS 484 early wound images are collected on patients who discharged home after a burn injury in 48 h, from five different levels of hospitals in Hunan Province China. According to actual healing time, all images are manually annotated by five professional burn surgeons and divided into three sets which are shallow(0-10 days), moderate(11-20 days) and deep(more than 21 days or skin graft healing). These ROIs were further divided into 5637 patches sizes 224 × 224 pixels, of which 1733 shallow, 1804 moderate, and 2100 deep. We used transfer learning suing a Pre-trained ResNet50 model and the ratio of all images is 7:1.5:1.5 for training:validation:test. RESULTS A novel artificial burn depth recognition model based on convolutional neural network was established and the diagnostic accuracy of the three types of burns is about 80%. DISCUSSION The actual healing time can be used to deduce the depth of burn involvement. The artificial burn depth recognition model can accurately infer healing time and burn depth of the patient, which is expected to be used for auxiliary diagnosis improvement.
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Affiliation(s)
- Yuan Wang
- College of Computer Science and Technology, National Defense University of Science and Technology, Changsha, Hunan, China
| | - Zuo Ke
- College of Computer Science and Technology, National Defense University of Science and Technology, Changsha, Hunan, China
| | - Zhiyou He
- Department of Burns and Reconstructive Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Xiang Chen
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Human Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China; Department of Dermatology Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Yu Zhang
- Department of Dermatology Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peizhen Xie
- College of Computer Science and Technology, National Defense University of Science and Technology, Changsha, Hunan, China
| | - Tao Li
- College of Computer Science and Technology, National Defense University of Science and Technology, Changsha, Hunan, China
| | - Jiao Zhou
- College of Computer Science and Technology, National Defense University of Science and Technology, Changsha, Hunan, China
| | - Fangfang Li
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Human Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China; Department of Dermatology Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Canqun Yang
- College of Computer Science and Technology, National Defense University of Science and Technology, Changsha, Hunan, China
| | - Pihong Zhang
- Department of Burns and Reconstructive Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chun Huang
- College of Computer Science and Technology, National Defense University of Science and Technology, Changsha, Hunan, China
| | - Lu Kai
- College of Computer Science and Technology, National Defense University of Science and Technology, Changsha, Hunan, China
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Abdelbasset WK, Abdelhalim NM. Assessing the effects of 6 weeks of intermittent aerobic exercise on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study. Burns 2020; 46:1193-1200. [DOI: 10.1016/j.burns.2019.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/27/2019] [Accepted: 12/22/2019] [Indexed: 12/30/2022]
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Hoogewerf CJ, Hop MJ, Nieuwenhuis MK, Oen IM, Middelkoop E, Van Baar ME. Topical treatment for facial burns. Cochrane Database Syst Rev 2020; 7:CD008058. [PMID: 32725896 PMCID: PMC7390507 DOI: 10.1002/14651858.cd008058.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Burn injuries are an important health problem. They occur frequently in the head and neck region. The face is the area central to a person's identity that provides our most expressive means of communication. Topical interventions are currently the cornerstone of treatment of burns to the face. OBJECTIVES To assess the effects of topical interventions on wound healing in people with facial burns of any depth. SEARCH METHODS In December 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, risk of bias assessment and GRADE assessment of the certainty of the evidence. MAIN RESULTS In this first update, we included 12 RCTs, comprising 507 participants. Most trials included adults admitted to specialised burn centres after recent burn injuries. Topical agents included antimicrobial agents (silver sulphadiazine (SSD), Aquacel-Ag, cerium-sulphadiazine, gentamicin cream, mafenide acetate cream, bacitracin), non-antimicrobial agents (Moist Exposed Burn Ointment (MEBO), saline-soaked dressings, skin substitutes (including bioengineered skin substitute (TransCyte), allograft, and xenograft (porcine Xenoderm), and miscellaneous treatments (growth hormone therapy, recombinant human granulocyte-macrophage colony-stimulating factor hydrogel (rhGMCS)), enzymatic debridement, and cream with Helix Aspersa extract). Almost all the evidence included in this review was assessed as low or very low-certainty, often because of high risk of bias due to unclear randomisation procedures (i.e. sequence generation and allocation concealment); lack of blinding of participants, providers and sometimes outcome assessors; and imprecision resulting from few participants, low event rates or both, often in single studies. Topical antimicrobial agents versus topical non-antimicrobial agents There is moderate-certainty evidence that there is probably little or no difference between antimicrobial agents and non-antimicrobial agents (SSD and MEBO) in time to complete wound healing (hazard ratio (HR) 0.84 (95% confidence interval (CI) 0.78 to 1.85, 1 study, 39 participants). Topical antimicrobial agents may make little or no difference to the proportion of wounds completely healed compared with topical non-antimicrobial agents (comparison SSD and MEBO, risk ratio (RR) 0.94, 95% CI 0.68 to 1.29; 1 study, 39 participants; low-certainty evidence). We are uncertain whether there is a difference in wound infection (comparison topical antimicrobial agent (Aquacel-Ag) and MEBO; RR 0.38, 95% CI 0.12 to 1.21; 1 study, 40 participants; very low-certainty evidence). No trials reported change in wound surface area over time or partial wound healing. There is low-certainty evidence for the secondary outcomes scar quality and patient satisfaction. Two studies assessed pain but it was incompletely reported. Topical antimicrobial agents versus other topical antimicrobial agents It is uncertain whether topical antimicrobial agents make any difference in effects as the evidence is low to very low-certainty. For primary outcomes, there is low-certainty evidence for time to partial (i.e. greater than 90%) wound healing (comparison SSD versus cerium SSD: mean difference (MD) -7.10 days, 95% CI -16.43 to 2.23; 1 study, 142 participants). There is very low-certainty evidence regarding whether topical antimicrobial agents make a difference to wound infection (RR 0.73, 95% CI 0.46 to 1.17; 1 study, 15 participants). There is low to very low-certainty evidence for the proportion of facial burns requiring surgery, pain, scar quality, adverse effects and length of hospital stay. Skin substitutes versus topical antimicrobial agents There is low-certainty evidence that a skin substitute may slightly reduce time to partial (i.e. greater than 90%) wound healing, compared with a non-specified antibacterial agent (MD -6.00 days, 95% CI -8.69 to -3.31; 1 study, 34 participants). We are uncertain whether skin substitutes in general make any other difference in effects as the evidence is very low certainty. Outcomes included wound infection, pain, scar quality, adverse effects of treatment and length of hospital stay. Single studies showed contrasting low-certainty evidence. A bioengineered skin substitute may slightly reduce procedural pain (MD -4.00, 95% CI -5.05 to -2.95; 34 participants) and background pain (MD -2.00, 95% CI -3.05 to -0.95; 34 participants) compared with an unspecified antimicrobial agent. In contrast, a biological dressing (porcine Xenoderm) might slightly increase pain in superficial burns (MD 1.20, 95% CI 0.65 to 1.75; 15 participants (30 wounds)) as well as deep partial thickness burns (MD 3.00, 95% CI 2.34 to 3.66; 10 participants (20 wounds)), compared with antimicrobial agents (Physiotulle Ag (Coloplast)). Miscellaneous treatments versus miscellaneous treatments Single studies show low to very low-certainty effects of interventions. Low-certainty evidence shows that MEBO may slightly reduce time to complete wound healing compared with saline soaked dressing (MD -1.7 days, 95% CI -3.32 to -0.08; 40 participants). In addition, a cream containing Helix Aspersa may slightly increase the proportion of wounds completely healed at 14 days compared with MEBO (RR 4.77, 95% CI 1.87 to 12.15; 43 participants). We are uncertain whether any miscellaneous treatment in the included studies makes a difference in effects for the outcomes wound infection, scar quality, pain and patient satisfaction as the evidence is low to very low-certainty. AUTHORS' CONCLUSIONS There is mainly low to very low-certainty evidence on the effects of any topical intervention on wound healing in people with facial burns. The number of RCTs in burn care is growing, but the body of evidence is still hampered due to an insufficient number of studies that follow appropriate evidence-based standards of conducting and reporting RCTs.
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Affiliation(s)
| | - M Jenda Hop
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
| | - Marianne K Nieuwenhuis
- Burn Centre, Martini Hospital, Association of Dutch Burn Centres, Groningen, Netherlands
| | - Irma Mmh Oen
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
| | - Esther Middelkoop
- Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences and Association of Dutch Burn Centers, Red Cross Hospital, Amsterdam, Netherlands
| | - Margriet E Van Baar
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
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Maitz J, Wang Y, Fathi A, Ximena Escobar F, Parungao R, van Zuijlen P, Maitz P, Li Z. The effects of cross-linking a collagen-elastin dermal template on scaffold bio-stability and degradation. J Tissue Eng Regen Med 2020; 14:1189-1200. [PMID: 32721107 DOI: 10.1002/term.3082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022]
Abstract
MatriDerm is a collagen-elastin dermal template that promotes regeneration in full-thickness wound repair. Due to its noncross-linked status, MatriDerm biodegrades quickly in a wound. Facilitating vascularization and dermal repair, it is desirable for MatriDerm to remain present until the wound healing process is complete, optimizing tissue regeneration and reducing wound contraction. The aim of this study was to investigate the effect of cross-linking MatriDerm on its mechanical and biological properties and to enhance its regenerative functionality. MatriDerm was chemically cross-linked and characterized in comparison with noncross-linked MatriDerm. Scaffold properties including surface morphology, protein release and mechanical strength were assessed. Cell-scaffold interaction, cell proliferation and migration were examined using human dermal fibroblasts. Scaffold biodegradation and its impact on wound healing and contraction were studied in a mouse model. Results showed that cross-linked MatriDerm displayed a small reduction in pore size, significantly less protein loss and a threefold increase in tensile strength. A significant increase in fibroblast proliferation and migration was observed in cross-linked MatriDerm with reduced scaffold contraction in vitro. In the mouse model, noncross-linked MatriDerm was almost completely biodegraded after 14 days whereas cross-linked MatriDerm remained intact. No significant difference in wound contraction was found between scaffolds. In conclusion, cross-linked MatriDerm showed a significant increase in stability and strength, enhancing its durability and cell-scaffold interaction. in vivo analysis showed cross-linked MatriDerm had a reduced biodegradation rate with a similar host response. The extended structural integrity of cross-linked MatriDerm could potentially facilitate improved skin tissue regeneration, promoting the formation of a more pliable scar.
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Affiliation(s)
- Joanneke Maitz
- Burn Injury and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, New South Wales, Australia
| | - Yiwei Wang
- Burn Injury and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, New South Wales, Australia.,Disciplines of Surgery, University of Sydney Concord Clinical School, Concord, New South Wales, Australia
| | - Ali Fathi
- Faculty of Engineering and Information Technologies, University of Sydney, Camperdown, New South Wales, Australia
| | - Francia Ximena Escobar
- Burn Injury and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, New South Wales, Australia
| | - Roxanne Parungao
- Burn Injury and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, New South Wales, Australia
| | - Paul van Zuijlen
- Burn Centre and Dept. of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, the Netherlands.,Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, NH, the Netherlands
| | - Peter Maitz
- Burn Injury and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, New South Wales, Australia.,Burns Unit, Concord Hospital, Concord, New South Wales, Australia.,Disciplines of Surgery, University of Sydney Concord Clinical School, Concord, New South Wales, Australia
| | - Zhe Li
- Burn Injury and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, New South Wales, Australia.,Burns Unit, Concord Hospital, Concord, New South Wales, Australia.,Disciplines of Surgery, University of Sydney Concord Clinical School, Concord, New South Wales, Australia
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The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2907. [PMID: 32802643 PMCID: PMC7413812 DOI: 10.1097/gox.0000000000002907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Worldwide, many scar contracture release surgeries are performed to improve range of motion (ROM) after a burn injury. There is a particular need in low- and middle-income countries (LMICs) for such procedures. However, well-designed longitudinal studies on this topic are lacking globally. The present study therefore aimed to evaluate the long-term effectiveness of contracture release surgery performed in an LMIC.
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Jyoti K, Malik G, Chaudhary M, Sharma M, Goswami M, Katare OP, Singh SB, Madan J. Chitosan and phospholipid assisted topical fusidic acid drug delivery in burn wound: Strategies to conquer pharmaceutical and clinical challenges, opportunities and future panorama. Int J Biol Macromol 2020; 161:325-335. [PMID: 32485249 DOI: 10.1016/j.ijbiomac.2020.05.230] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 02/08/2023]
Abstract
Burn is the immense public health issue globally. Low and middle income countries face extensive deaths owing to burn injuries. Availability of conventional therapies for burns has always been painful for patients as well as expensive for our health system. Pharmaceutical experts are still searching reliable, cheap, safe and effective treatment options for burn injuries. Fusidic acid is an antibiotic of choice for the management of burns. However, fusidic acid is encountering several pharmaceutical and clinical challenges like poor skin permeability and growing drug resistance against burn wound microbes like Methicillin resistant Staphylococcus aureus (MRSA). Therefore, an effort has been made to present a concise review about molecular pathway followed by fusidic acid in the treatment of burn wound infection in addition to associated pros and cons. Furthermore, we have also summarized chitosan and phospholipid based topical dermal delivery systems customized by our team for the delivery of fusidic acid in burn wound infections on case-to-case basis. However, every coin has two sides. We recommend the integration of in-silico docking techniques with natural biomacromolecules while designing stable, patient friendly and cost effective topical drug delivery systems of fusidic acid for the management of burn wound infection as future opportunities.
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Affiliation(s)
- Kiran Jyoti
- Department of Pharmaceutics, Chandigarh College of Pharmacy, Mohali, Punjab, India; IKG Punjab Technical University, Jalandhar, Punjab, India
| | - Garima Malik
- Department of Pharmaceutics, Chandigarh College of Pharmacy, Mohali, Punjab, India
| | | | - Monika Sharma
- University Institute of Pharmaceutical Sciences, Chandigarh University, Mohali, Punjab, India
| | - Manish Goswami
- University Institute of Pharmaceutical Sciences, Chandigarh University, Mohali, Punjab, India
| | - Om Prakash Katare
- University Institute of Pharmaceutical Sciences, Punjab University, Chandigarh, India
| | - Shashi Bala Singh
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Jitender Madan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India.
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Comparison of botulinum toxin type A and aprotinin monotherapy with combination therapy in healing of burn wounds in an animal model. Mol Biol Rep 2020; 47:2693-2702. [PMID: 32146683 DOI: 10.1007/s11033-020-05367-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/29/2020] [Indexed: 12/19/2022]
Abstract
Burns are one of the most common injuries that are complicated by many challenges including infection, severe inflammatory response, excessive expression of proteases, and scar formation. The aim of this study was to investigate the effect of botulinum toxin type A (BO) and aprotinin (AP) separately or in combination (BO-AP) in healing process. Four burn wounds were created in each rat and randomly filled with silver sulfadiazine (SSD), BO, AP and BO-AP. The rats were euthanized after 7, 14, and 28 days, and their harvested wound samples were evaluated by gross pathology, histopathology, gene expression, biochemical testing, and scanning electron microscopy. Both BO and AP significantly reduced expression of interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) at the 7th post wounding day. Moreover, they inhibited scar formation by reducing the TGF-β1 level and increasing basic fibroblast growth factor (bFGF) at the 28th day. AP by decreasing protease production showed more effective role than BO in wound regeneration. AP increased tissue organization and maturation and improved cosmetic appearance of wounds, at 28 days. The best results gained when combination of BO and AP were used in healing of burn wounds. Treatment by BO-AP significantly subsided inflammation compared to the BO, AP, and SSD treated wounds. Treatment with BO-AP also reduced collagen density and led to minimal scar formation. Combination of botulinum toxin type A and aprotinin considerably increased structural and functional properties of the healing wounds by reducing scar formation and decreasing production of proteases.
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Pelekhaty SL, Pajoumand M, Omanwa KS, Galvagno SM, Lantry JH, Deatrick KB, Cornachione CR, Menaker J. Oxandrolone in Patients on Venovenous Extracorporeal Membrane Oxygenation: A Case Series. Nutr Clin Pract 2020; 35:514-521. [PMID: 32083363 DOI: 10.1002/ncp.10468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Venovenous extracorporeal membrane oxygenation (VV ECMO) induces a systemic inflammatory response, which may progress to persistent inflammation, immunosuppression, and catabolism syndrome (PICS). The anabolic steroid oxandrolone may improve the metabolic aberrations of PICS. We report our experience with 3 patients on VV ECMO who received oxandrolone after demonstrating refractory catabolism on serial nitrogen balance (NB) studies or persistent weakness. Patients in cases 1 and 3 were started on oxandrolone on VV ECMO days 45 and 29, respectively, for negative NB despite nutrition optimization. The case 2 patient started oxandrolone for persistent weakness 68 days after cannulation. All patients demonstrated improvements in NB results. One patient developed mild transaminitis while on oxandrolone, which did not alter his medication course and resolved after the medication was discontinued. The impact of oxandrolone on functional capacity varied between patients. Oxandrolone may be beneficial in persistently catabolic VV ECMO patients to improve NB results. In some patients, this may support functional recovery. Additional research is needed to identify optimal patients for therapy and to investigate the impact of oxandrolone in this population.
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Affiliation(s)
- Stacy L Pelekhaty
- University of Maryland Medical Center, Baltimore, Maryland, USA.,R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | | | | | - Samuel M Galvagno
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.,University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James H Lantry
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.,University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Jay Menaker
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.,University of Maryland School of Medicine, Baltimore, Maryland, USA
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Evaluation of measurement properties of health-related quality of life instruments for burns: A systematic review. J Trauma Acute Care Surg 2020; 88:555-571. [DOI: 10.1097/ta.0000000000002584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Elnaggar RK, Samhan AF, Elshafey MA. Differential Effects of Extracorporeal Shockwave Therapy and Botulinum Toxin-A Injection on Postburn Contractures and Gait Kinematics in Burn Children. J Burn Care Res 2019; 41:612-618. [DOI: 10.1093/jbcr/irz212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Postburn contracture is a complex and multifactorial problem that requires intensive inputs from the burn care staff. This study endeavored to evaluate the effectiveness of extracorporeal shockwave therapy and botulinum toxin-A for treating the postburn plantar flexion contracture and optimizing ankle kinematics in burn children. Thirty-eight children with burns and plantar flexion contracture were randomized to receive the standard physical rehabilitation program (control group; n = 13), unfocused extracorporeal shockwave therapy (0.2 mJ/mm2) once a week over four consecutive weeks in addition to the standard physical rehabilitation (n = 12), or botulinum toxin-A injection (0.5–2 U/kg/muscle group with maximum dose of 12 U/kg/body weight) once at entry besides the standard physical rehabilitation (n = 13). Dorsiflexion active range of motion and ankle kinematics were measured before and immediately after treatment. The posttreatment dorsiflexion active range of motion increased significantly in the extracorporeal shockwave therapy group (P = .025) and botulinum toxin-A group (P = .04) when compared to the control group. Likewise, the initial stance–dorsiflexion, stance-maximum dorsiflexion, and swing-peak dorsiflexion angle improved significantly in the extracorporeal shockwave therapy group (P ˂ .001, P = .005, and P = .002, respectively) and botulinum toxin-A group (P = .004, P = .012, and P ˂ .001, respectively) compared to the control group. No significant differences were observed between the extracorporeal shockwave therapy and botulinum toxin-A groups with respect to any of the measured variables. To conclude, extracorporeal shockwave therapy and botulinum toxin-A injection could be effectively used to treat postburn plantar flexion contracture and to optimize the ankle kinematics during walking in children, without preference for either of them.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed F Samhan
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Egypt
| | - Mohammed A Elshafey
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Juengst SB, Osborne CL, Holavanahalli R, Silva V, Kew CL, Nabasny A, Bell KR. Feasibility Study of Problem-Solving Training for Care Partners of Adults With Traumatic Brain Injury, Spinal Cord Injury, Burn Injury, or Stroke During the Inpatient Hospital Stay. Arch Rehabil Res Clin Transl 2019; 1:100009. [PMID: 33543049 PMCID: PMC7853336 DOI: 10.1016/j.arrct.2019.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the feasibility of delivering an evidence-based self-management intervention, problem-solving training (PST), to care partners of individuals with traumatic brain injury (TBI), spinal cord injury (SCI), burn injury, or stroke during the inpatient hospital stay. DESIGN In this single group pre-post intervention pilot feasibility study. SETTING Inpatient rehabilitation or acute care and community. PARTICIPANTS Care partners (spouse or partner, family member, friend who is in any way responsible for the health or well-being of the care recipient) of individuals with TBI, SCI, burn injury, or stroke (N=39). INTERVENTION PST is a metacognitive self-management intervention that teaches individuals a global strategy for addressing self-selected problems. Participants received up to 6 sessions of PST in person or via telephone during their care recipient's inpatient stay. MAIN OUTCOME MEASURES We measured feasibility of recruitment, intervention delivery, and postintervention use of a smartphone app (Care Partner Problem Solving [CaPPS]) and participant satisfaction (Client Satisfaction Questionnaire [CSQ]) and engagement (Pittsburgh Rehabilitation Participation Scale [PRPS]) with the intervention. RESULTS Of 39 care partners approached, n=10 (25.6%) were ineligible. Of n=29 (74.4%) who were eligible, n=17 (58.6%) refused, and n=12 (41.4%) consented, of whom n=8 (66.7%) completed ≥3 PST sessions. Not perceiving any benefit was the most common reason for refusal, followed by no interest in research. Participants were very satisfied with PST (CSQ mean=3.35, SD=0.60), reported strong working alliance (Working Alliance Inventory mean=6.8, SD=3.1), and demonstrated very good engagement (PRPS mean=4.75, SD=1.41). CaPPS was downloaded and used by only n=3 participants. CONCLUSIONS Delivering a self-management intervention to care partners during the care recipient's acute hospital stay is feasible for a subset of potential participants. Short lengths of stay, language fluency, and perceiving no potential benefit were noted barriers. Boosters via smartphone app have potential, but several barriers must first be overcome.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Candice L. Osborne
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Valeria Silva
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chung Lin Kew
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew Nabasny
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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Spronk I, Polinder S, van Loey NE, van der Vlies CH, Pijpe A, Haagsma JA, van Baar ME. Health related quality of life 5–7 years after minor and severe burn injuries: a multicentre cross-sectional study. Burns 2019; 45:1291-1299. [DOI: 10.1016/j.burns.2019.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
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Coghlan N, Copley J, Aplin T, Strong J. The experience of wearing compression garments after burn injury: “On the inside it is still me”. Burns 2019; 45:1438-1446. [DOI: 10.1016/j.burns.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 10/26/2022]
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Lee SZ, Halim AS. Superior long term functional and scar outcome of Meek micrografting compared to conventional split thickness skin grafting in the management of burns. Burns 2019; 45:1386-1400. [DOI: 10.1016/j.burns.2019.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/06/2019] [Accepted: 04/08/2019] [Indexed: 02/03/2023]
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Sánchez-Sánchez M, Martínez JR, Civantos B, Millán P. Perioperative in Intensive Medicine of reconstructive surgery and burned patients. Med Intensiva 2019; 44:113-121. [PMID: 31387770 DOI: 10.1016/j.medin.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/03/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
Burned patients may need prolonged admissions in the Intensive Care Service, both for initial care and for the pre and postoperative treatment of the multiple surgeries they require. The initial resuscitation of critically burned patients requires adequate monitoring to calculate the fluid therapy necessary to replenish the losses and ensure tissue perfusion, but without excesses that increase interstitial edema. In addition, monitoring can evaluate the systemic inflammatory response that can lead to shock and organic dysfunctions. After this initial phase we will find a critical patient who requires multiple reinterventions in non-optimal situations, so he will need special care over a long period of time. In addition, the Intensive Care Service offers specific postoperative care for reconstructive surgery and the transplantation of composite tissues (upper limb and face) in which its success depends on a rigorous control through adequate monitoring and treatment.
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Affiliation(s)
- M Sánchez-Sánchez
- Servicio de Medicina Intensiva, Unidad de Quemados Críticos, Hospital Universitario La Paz-Carlos III-Cantoblanco/IdiPaz, Madrid, España.
| | - J R Martínez
- Servicio de Cirugía Plástica, Estética y Reparadora, Unidad de Quemados Críticos, Hospital Universitario La Paz-Cantoblanco-Carlos III/IdiPaz, Madrid, España
| | - B Civantos
- Servicio de Medicina Intensiva, Unidad de Quemados Críticos, Hospital Universitario La Paz-Carlos III-Cantoblanco/IdiPaz, Madrid, España
| | - P Millán
- Servicio de Medicina Intensiva, Unidad de Quemados Críticos, Hospital Universitario La Paz-Carlos III-Cantoblanco/IdiPaz, Madrid, España
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43
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Rashaan ZM, Kwa KAA, van der Wal MBA, Tuinebreijer WE, van Zuijlen PPM, Breederveld RS. Patterns and predictors of burn scar outcome in the first 12 months after burn: The patient's perspective. Burns 2019; 45:1283-1290. [PMID: 31176509 DOI: 10.1016/j.burns.2019.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/22/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to provide insight into the patterns and factors that predict burn scar outcomes at 3, 6 and 12 months after burn. METHODS The Patient and Observer Scar Assessment Scale (POSAS) was used to assess the scar formation of each patient. Structural equation modelling was used. The predictor variables used in this study were sex, three age categories, TBSA, depth of the wound and cause of the burn. RESULTS The POSAS patient total and individual item scores demonstrated a statistically significant decrease in the first 12 months after burn, except for the relief item. Male patients had a lower total and items scores (better scar quality) for pain and pruritus compared with female patients. Full thickness burns had a higher scores for pruritus, pliability, thickness and relief compared to the partial-thickness burns. Ages younger than 5 years, higher TBSA values and flame burns were predictors of various POSAS items at 3 and 6 months after burn. CONCLUSION The POSAS patient total and individual item scores demonstrated a statistically significant improvement in the scar quality in the first 12 months after burn, except for the relief. Sex, age, depth of the wound, the percentage of TBSA and flame burns were predictors of various POSAS patient items at 3, 6 and 12 months after burn.
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Affiliation(s)
- Z M Rashaan
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - K A A Kwa
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - M B A van der Wal
- Association of Dutch Burn Centres, Zeestraat 27-29, 1941 AJ, Beverwijk, The Netherlands.
| | - W E Tuinebreijer
- Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - P P M van Zuijlen
- Burn Centre and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic and Reconstructive Surgery and MOVE Research Institute, VU University of Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - R S Breederveld
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
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Chong C, Wang Y, Fathi A, Parungao R, Maitz PK, Li Z. Skin wound repair: Results of a pre-clinical study to evaluate electropsun collagen-elastin-PCL scaffolds as dermal substitutes. Burns 2019; 45:1639-1648. [PMID: 31076208 DOI: 10.1016/j.burns.2019.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 01/18/2023]
Abstract
The gold standard treatment for severe burn injuries is autologous skin grafting and the use of commercial dermal substitutes. However, resulting skin tissue following treatment usually displays abnormal morphology and functionality including scarring, skin contracture due to the poor elasticity and strength of existing dermal substitutes. In this study, we have developed a triple-polymer scaffold made of collagen-elastin-polycaprolactone (CEP) composite, aiming to enhance the mechanical properties of the scaffold while retaining its biological properties in promoting cell attachment, proliferation and tissue regeneration. The inclusion of elastin was revealed to decrease the stiffness of the scaffold, while also decreasing hysteresis and increasing elasticity. In mice, electrospun collagen-elastin-PCL scaffolds promoted keratinocyte and fibroblast proliferation, tissue integration and accelerated early-stage angiogenesis. Only a mild inflammatory response was observed in the first 2 weeks post-subcutaneous implantation. Our data indicates that the electrospun collagen-elastin-PCL scaffolds could potentially serve as a skin substitute to promote skin cell growth and tissue regeneration after severe burn injury.
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Affiliation(s)
- Cassandra Chong
- Burns Research Group, ANZAC Research Institute, Concord Hospital, University of Sydney, Concord West, NSW 2139, Australia
| | - Yiwei Wang
- Burns Research Group, ANZAC Research Institute, Concord Hospital, University of Sydney, Concord West, NSW 2139, Australia; Disciplines of Surgery, School of Medicine, University of Sydney, NSW 2006, Australia
| | - Ali Fathi
- School of Chemical and Biomolecular Engineering, University of Sydney, NSW 2006, Australia
| | - Roxanne Parungao
- Burns Research Group, ANZAC Research Institute, Concord Hospital, University of Sydney, Concord West, NSW 2139, Australia
| | - Peter K Maitz
- Burns Research Group, ANZAC Research Institute, Concord Hospital, University of Sydney, Concord West, NSW 2139, Australia; Disciplines of Surgery, School of Medicine, University of Sydney, NSW 2006, Australia; Burns and Reconstructive Surgery Unit, Concord Hospital, Concord, NSW 2139, Australia
| | - Zhe Li
- Burns Research Group, ANZAC Research Institute, Concord Hospital, University of Sydney, Concord West, NSW 2139, Australia; Disciplines of Surgery, School of Medicine, University of Sydney, NSW 2006, Australia; Burns and Reconstructive Surgery Unit, Concord Hospital, Concord, NSW 2139, Australia.
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45
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Santacreu E, Grossi L, Launois P, López S, Torrent-Bertran ML, Barret JP. The influence of age on quality of life after upper body burn. Burns 2019; 45:554-559. [PMID: 31018911 DOI: 10.1016/j.burns.2018.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/03/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Spain, the number of aged persons is increasing. By the year 2066, it is expected that 34.6% of the Spanish population will be over 65 years of age. Elderly people present a higher burning risk owing in part to impaired balance and decreased physical strength, lower cognitive abilities, or socioeconomic context. OBJECTIVE Burns to the upper body body are common and affect both emotional state and physical function, thus leading to reduced quality of life (QoL). Our objective was to determine the influence of age on the QoL of patients who experienced burns to the upper body, with burns with 2 years. METHODS This is an observational study with a sample of 58 patients with burns only on the upper body. Patients were divided into two groups: 29 patients of age over 65 years and 29 patients under 65 years; all of them attended the Vall d'Hebron Burn Center, Barcelona, between 2011 and 2014. From the original sample, 45 patients had survived by the time the information was gathered. The QoL of these individuals was evaluated with the Spanish version of the Burn Specific Health Scale. Demographic data (sex, age, total burn surface area [TBSA], burn mechanism, pathological history, length of hospital stay, and rehabilitation duration) were collected. Statistical analysis included parametric and nonparametric tests as appropriate with R3.3.3. RESULTS There were no differences between groups regarding the mechanism of burn, TBSA, length of hospital stay, and the domains of QoL test. High blood pressure, diabetes, and other comorbidities were significantly more common in the elderly group than in the younger group. Eleven patients died in the elderly group and two in the younger group (p=0.012). CONCLUSION As opposed to what could be expected, in this study, there were no significant differences between surviving patients in both age groups in terms of perceived QoL. Nevertheless, mortality after a burn in the upper side of the body was significantly higher in elderly people than in younger people. The present study results do not support the use of different rehabilitation approaches in elderly patients.
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Affiliation(s)
- Eva Santacreu
- Burn Unit, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Laura Grossi
- Burn Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Silvia López
- Burn Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Juan P Barret
- Burn Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Parry I, Richard R, Aden JK, Yelvington M, Ware L, Dewey W, Jacobson K, Caffrey J, Sen S. Goniometric Measurement of Burn Scar Contracture: A Paradigm Shift Challenging the Standard. J Burn Care Res 2019; 40:377-385. [DOI: 10.1093/jbcr/irz038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT
Standard goniometry is the most commonly used method of assessing the range of motion (ROM) in patients with burn scar contracture. However, standard goniometry was founded on arthrokinematic principles and doesn’t consider the cutaneous biomechanical influence between adjacent joint positions and skin pliability to accommodate motion. Therefore, the use of standard goniometry to measure burn scar contracture is called into question. This prospective, multicenter, comparative study investigated the difference between standard goniometry, based on arthrokinematics and a revised goniometry protocol, based on principles of cutaneokinematics and functional positions to measure ROM outcome in burn survivors. Data were collected for 174 joints from 66 subjects at seven burn centers totaling 1044 measurements for comparison. ROM findings using the revised protocol demonstrated significantly more limitation in motion 38.8 ± 15.2% than the standard protocol 32.1 ± 13.4% (p < .0001). Individual analyses of the motions likewise showed significantly more limitation with revised goniometry compared with standard goniometry for 9/11 joint motions. Pearson’s correlation showed a significant positive correlation between the percentage of cutaneous functional units scarred and ROM outcome for the revised protocol (R2 = .05, p = .0008) and the Δ between the revised and standard protocols (R2 = .04, p = .0025) but no correlation was found with the standard goniometric protocol (R2 = .015, p = .065). The results of this study support the hypothesis that standard goniometry underestimates the ROM impairment for individuals whose motion is limited by burn scars. Having measurement methods that consider the unique characteristics of skin impairment and the impact on functional positions is an important priority for both clinical reporting and future research in burn rehabilitation.
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Affiliation(s)
- Ingrid Parry
- Department of Surgery, University of California, Davis, Sacramento
| | - Reg Richard
- US Army Institute of Surgical Research, San Antonio Texas (Retired)
| | - James K Aden
- Department of Graduate Medical Education, Brooks Army Medical Center, San Antonio, Texas
| | | | - Linda Ware
- Rehabilitation Services Department, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - William Dewey
- Department of the Army, U.S. Army Institute of Surgical Research, San Antonio, Texas
| | - Keith Jacobson
- Rehabilitation Therapy Services Department, North Carolina Jaycee Burn Center at UNC Healthcare,Chapel Hill
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Soman Sen
- Department of Surgery, University of California, Davis, Sacramento
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47
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Regional disparities in access to verified burn center care in the United States. J Trauma Acute Care Surg 2019; 87:111-116. [DOI: 10.1097/ta.0000000000002259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Head and neck burns are associated with long-term patient-reported dissatisfaction with appearance: A Burn Model System National Database study. Burns 2019; 45:293-302. [DOI: 10.1016/j.burns.2018.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/12/2018] [Accepted: 12/22/2018] [Indexed: 01/07/2023]
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Dai A, Moore M, Polyakovsky A, Gooding T, Lerew T, Carrougher GJ, Gibran NS, Pham TN. Burn Patients' Perceptions of Their Care: What Can We Learn From Postdischarge Satisfaction Surveys? J Burn Care Res 2019; 40:202-210. [PMID: 30239737 DOI: 10.1093/jbcr/iry018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Little is understood about the inpatient experience from the burn patients' perspectives. Rather, hospitals emphasize quantitative feedback as part of the ongoing process improvement. Comments returned with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) administrative survey may provide important patient perspectives. They analyzed quantitative and qualitative HCAHPS data to identify areas for care improvement. They reviewed our burn center HCAHPS results over 2 years. They analyzed "top-box" result in each defined HCAHPS category, which is the most frequently reported best result in each composite, including survey scores ≥9 (out of 10). They performed qualitative content analysis of open-text responses via a HIPAA-compliant analysis software. They developed a hierarchy of major expressed themes and organized them using HCAHPS-validated satisfaction domains. A total of 610 inpatient HCAHPS surveys (21% response rate) were returned. Seventy-five percent of respondents ranked their burn center as ≥9 (out of 10) in care scores. Content analysis identified three main components of the inpatient experience: 1) provider/nurse communication, 2) hospital environment, and 3) the discharge experience. Caring, respect, handoff coordination, explanations, listening, and confidence in provider constituted the six key communication themes. Patients generally reported that burn providers listened to their concerns, but others requested clearer explanations of their condition and care. Responses about hospital environment highlighted excessive noise and disrupted sleep, and variable responses related to cleanliness. Challenges in the discharge experience included difficulties procuring wound care supplies and discharge medications. Qualitative data from HCAHPS helped identify major target areas for burn center performance improvement. Analysis of HCAHPS direct patient feedback is useful in process improvement, whereas numerical data alone do not provide sufficient actionable information.
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Affiliation(s)
- Andrea Dai
- Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington
| | - Megan Moore
- Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington
| | - Anna Polyakovsky
- Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington
| | - Tracy Gooding
- Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington
| | - Tara Lerew
- Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington
| | - Gretchen J Carrougher
- Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington
| | - Nicole S Gibran
- Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington
| | - Tam N Pham
- Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington
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Young AE, Davies A, Bland S, Brookes S, Blazeby JM. Systematic review of clinical outcome reporting in randomised controlled trials of burn care. BMJ Open 2019; 9:e025135. [PMID: 30772859 PMCID: PMC6398699 DOI: 10.1136/bmjopen-2018-025135] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Systematic reviews collate trial data to provide evidence to support clinical decision-making. For effective synthesis, there must be consistency in outcome reporting. There is no agreed set of outcomes for reporting the effect of burn care interventions. Issues with outcome reporting have been identified, although not systematically investigated. This study gathers empirical evidence on any variation in outcome reporting and assesses the need for a core outcome set for burn care research. METHODS Electronic searches of four search engines were undertaken from January 2012 to December 2016 for randomised controlled trials (RCTs), using medical subject headings and free text terms including 'burn', 'scald' 'thermal injury' and 'RCT'. Two authors independently screened papers, extracted outcomes verbatim and recorded the timing of outcome measurement. Duplicate outcomes (exact wording ± different spelling), similar outcomes (albumin in blood, serum albumin) and identical outcomes measured at different times were removed. Variation in outcome reporting was determined by assessing the number of unique outcomes reported across all included trials. Outcomes were classified into domains. Bias was reduced using five researchers and a patient working independently and together. RESULTS 147 trials were included, of which 127 (86.4%) were RCTs, 13 (8.8%) pilot studies and 7 (4.8%) RCT protocols. 1494 verbatim clinical outcomes were reported; 955 were unique. 76.8% of outcomes were measured within 6 months of injury. Commonly reported outcomes were defined differently. Numbers of unique outcomes per trial varied from one to 37 (median 9; IQR 5,13). No single outcome was reported across all studies demonstrating inconsistency of reporting. Outcomes were classified into 54 domains. Numbers of outcomes per domain ranged from 1 to 166 (median 11; IQR 3,24). CONCLUSIONS This review has demonstrated heterogeneity in outcome reporting in burn care research which will hinder amalgamation of study data. We recommend the development of a Core Outcome Set. PROSPERO REGISTRATION NUMBER CRD42017060908.
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Affiliation(s)
- Amber E Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Sara Brookes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jane M Blazeby
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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