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Isaraj S, Isaraj A, Belba G. SEVERE BURNS IN CHILDREN IN ALBANIA: HOW HAS THE EPIDEMIOLOGY OF BURNS IN CHILDREN CHANGED IN THE PAST 25 YEARS? ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:180-187. [PMID: 39350894 PMCID: PMC11372276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 10/04/2024]
Abstract
This study is aimed at describing the patterns and trends of burns among children in the past 25 years in Albania, a transitional post-communist country in the Western Balkans. It included all burned children admitted to the Intensive Care Unit of the University Hospital Center "Mother Teresa" of Tirana in the past 5 years (i.e., 2018-2022). Overall, 275 children treated at the Service of Burns and Plastic Surgery were included in this analysis. Incidence of burns in children has importantly declined during the last 25 years. Of 275 children included in this study, 50.2% were boys and 49.8% were girls. The age range was from 2 months to 16 years. The number of children with burns declined progressively, but the lowest number was seen in 2020, which is explained by the Covid-19 pandemic. On the whole, the most affected age group is that of 1-3 year-olds. Regardless of age, hot liquids (51%) and pure hot water (39%) were the main causative agents of burns among children. There was an important decrease in the number of burns due to flame (from 18.5% to 7%) and chemical burns (from 5.9% to 1%). No electrical burns were found in the records. Most of the burned cases were burns of more than one site on the body, representing 35% of all the cases. Burns among children continue to constitute a significant burden of morbidity among Albanian children, which is a cause of concern. However, compared with 25 years ago, the total number of severely burned children has dropped in Albania.
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Affiliation(s)
- S Isaraj
- University Hospital Center "Mother Theresa", Tirana, Albania
| | | | - G Belba
- University Hospital Center "Mother Theresa", Tirana, Albania
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Bayuo J, Wong FKY, Yi W, Chung LYF. Adult Burn Survivors and Burn Care Staff Perceptions Regarding Transitioning From the Burn Unit: A Cross-Country Qualitative Study in Ghana and China. QUALITATIVE HEALTH RESEARCH 2024; 34:607-620. [PMID: 38205790 DOI: 10.1177/10497323231224378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Wang Yi
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
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Fanstone R, Price P, Bodger O, Potokar T, Khan MRK. Risk factors for burn contractures: A cross-sectional study in a lower income country. Burns 2024; 50:454-465. [PMID: 37980272 DOI: 10.1016/j.burns.2023.09.003] [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: 05/02/2023] [Revised: 07/31/2023] [Accepted: 09/09/2023] [Indexed: 11/20/2023]
Abstract
Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n = 104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant's included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. Recommendations for planning and reporting on future contracture risk factor studies are made.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
| | - Owen Bodger
- Faculty of Medicine, Health and Life Sciences, Swansea University, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Keshri VR, Parveen S, Abimbola S, Mishra B, Khurram MF, Peden M, Norton R, Jagnoor J. The health workforce conundrum for burn care in Uttar Pradesh, India: a qualitative exploration. Glob Public Health 2024; 19:2345370. [PMID: 38686925 DOI: 10.1080/17441692.2024.2345370] [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: 09/21/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
Delivering specialised care for major burns requires a multidisciplinary health workforce. While health systems 'hardware' issues, such as shortages of the healthcare workforce and training gaps in burn care are widely acknowledged, there is limited evidence around the systems 'software' aspects, such as interest, power dynamics, and relationships that impact the healthcare workforce performance. This study explored challenges faced by the health workforce in burn care to identify issues affecting their performance. Qualitative in-depth interviews were conducted with a purposively selected sample (n = 31, 18 women and 13 men) of various cadres of the burn care health workforce in Uttar Pradesh, India. Inductive coding and thematic analysis identified three major themes. First, the dynamics within the multidisciplinary team where complex relations, power and normative hierarchy hampered performance. Second, the dynamics between health workers and patients due to the clinical and emotional challenges of dealing with burn injuries and multitasking. Third, dynamics between specialised burn units and broader health systems are narrated in challenges due to inadequate first response and delayed referral from primary care facilities. These findings indicate that burn care health workers in India face multiple challenges that need systemic intervention with a multipronged human resource for health framework.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, New Delhi, India
| | - Samina Parveen
- The George Institute for Global Health, New Delhi, India
- Ipas Development Foundation, New Delhi, India
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Brijesh Mishra
- Department of Plastic Surgery, King George's Medical University, Lucknow, India
| | - Mohammed Fahad Khurram
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Margie Peden
- The George Institute for Global Health, New Delhi, India
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Robyn Norton
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, New Delhi, India
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Keshri VR, Abimbola S, Parveen S, Mishra B, Roy MP, Jain T, Peden M, Jagnoor J. Navigating health systems for burn care: Patient journeys and delays in Uttar Pradesh, India. Burns 2023; 49:1745-1755. [PMID: 37032275 DOI: 10.1016/j.burns.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/17/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India. METHODS We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework. RESULTS Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restrictions influenced all three delays. CONCLUSIONS Burn care pathways are adversely affected by barriers to timely access. We propose using the modified 3-delays framework to analyse delays in burns care. There is a need to strengthen referral linkage systems, ensure financial risk protection, and integrate burn care at all levels of health care delivery systems.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, India; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The George Institute for Global Health, Sydney, Australia
| | - Samina Parveen
- The George Institute for Global Health, India; Ipas Development Foundation, New Delhi, India
| | - Brijesh Mishra
- Department of Plastic Surgery, King George's Medical University, Lucknow, India
| | - Manas Pratim Roy
- Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
| | - Tanu Jain
- Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
| | - Margie Peden
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, London, United Kingdom; School of Public Health, Imperial College London, United Kingdom
| | - Jagnoor Jagnoor
- The George Institute for Global Health, India; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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Nassar JY, Al Qurashi AA, Albalawi IA, Nukaly HY, Halawani IR, Abumelha AF, Osama Al Dwehji AM, Alhartani MM, Asaad A, Alnajashi A, Khojah IM. Pediatric Burns: A Systematic Review and Meta-Analysis on Epidemiology, Gender Distribution, Risk Factors, Management, and Outcomes in Emergency Departments. Cureus 2023; 15:e49012. [PMID: 38111412 PMCID: PMC10726077 DOI: 10.7759/cureus.49012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
Pediatric burns pose a significant public health concern, ranking as the fifth most common nonfatal injury globally. This review consolidates data on the epidemiology, outcomes, and management of pediatric burns presenting to emergency departments. A systematic review was conducted across multiple databases, yielding 22 articles from 1992 to 2020. Utilizing the methodological index for non-randomized studies (MINORS) instrument, non-comparative studies scored from 2 to 11 with an average of 6.87, while comparative studies ranged from 12 to 16, averaging 13.67. The review included a total of 828,538 pediatric patients who were evaluated in the systematic review. Predominantly male victims ranged from 53% to 83%. The youngest victims were aged between 0 to 4 years. Burn etiology was largely attributed to scalds. A majority suffered from second-degree burns, with some studies reporting up to 89%. Limited data on total body surface area (TBSA) were documented, with only 2.5% requiring hospitalization. Common interventions included immediate resuscitation and skin grafting. Essential areas for future research are identified, including household risks, pre-treatment decisions, and the significant role of family dynamics in burn injury recovery. Pediatric burns remain a considerable concern, particularly among males and in household environments. The data underline the imperative for prevention strategies and optimized emergency care to positively influence outcomes for burn victims. Future research areas range from evaluating pre-treatment decisions to assessing community awareness regarding burn first aid.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alanoud Asaad
- Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | - Arwa Alnajashi
- Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | - Imad M Khojah
- Emergency Medicine, King Abdulaziz University, Jeddah, SAU
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Parry I, Mandell SP, Hoarle KA, Bailey JK, Dissanaike S, Harrington DT, Holmes JH, Cartotto R. American Burn Association Strategic Quality Summit 2022: Setting the Direction for the Future. J Burn Care Res 2023; 44:1051-1061. [PMID: 37423718 DOI: 10.1093/jbcr/irad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The American Burn Association (ABA) hosted a Burn Care Strategic Quality Summit (SQS) in an ongoing effort to advance the quality of burn care. The goals of the SQS were to discuss and describe characteristics of quality burn care, identify goals for advancing burn care, and develop a roadmap to guide future endeavors while integrating current ABA quality programs. Forty multidisciplinary members attended the two-day event. Prior to the event, they participated in a pre-meeting webinar, reviewed relevant literature, and contemplated statements regarding their vision for improving burn care. At the in-person, professionally facilitated Summit in Chicago, Illinois, in June 2022, participants discussed various elements of quality burn care and shared ideas on future initiatives to advance burn care through small and large group interactive activities. Key outcomes of the SQS included burn-related definitions of quality care, avenues for integration of current ABA quality programs, goals for advancing quality efforts in burn care, and work streams with tasks for a roadmap to guide future burn care quality-related endeavors. Work streams included roadmap development, data strategy, quality program integration, and partners and stakeholders. This paper summarizes the goals and outcomes of the SQS and describes the status of established ABA quality programs as a launching point for futurework.
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Affiliation(s)
- Ingrid Parry
- Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd. Sacramento, CA 95817, USA
| | - Samuel P Mandell
- UT Southwestern Medical Center, Section Chief, Burn Surgery, Medical Director, Parkland Burn Center, Medical Director, Surgical Quality, Parkland, USA
| | | | | | | | - David Tobin Harrington
- Department of Surgery, Chief Quality Officer for Surgery, Lifespan, Warren Albert School of Medicine at Brown University, USA
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Dash S, Pompermaier L, Lavrentieva A, Rogers AD, Depetris N. Quality indicators in burn care: An international burn care professionals survey to define them. Burns 2023; 49:1260-1266. [PMID: 36764840 DOI: 10.1016/j.burns.2022.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/06/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Quality indicators (QIs) are tools for improving and maintaining the standard of care. Although burn injuries are a major global health threat, requiring standardized management, there is a lack of worldwide accepted quality indicators for burn care. This study aims to identify the best burn care-specific QIs as perceived by worldwide burn practitioners. METHODS The ISBI Burn Care Committee developed a survey to analyze which burn care- specific QIs were relevant to international burn care professionals. The questionnaire was based on the three dimensions of the Donabedian model (i.e., Structure, Process, and Outcome) to evaluate the quality of care. The study was conducted from April to September 2021 and analyzed and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS According to the 124 worldwide respondents, the most relevant QIs were: access to intensive care, burn surgeons, and dedicated burn care nurses (Structure category), 24-hours access to burn services, local protocols based on documented guidelines (Process category), and in-hospital mortality and incidence of severe infections (Outcome category). CONCLUSIONS Specific QIs related to structures, clinical processes, and outcomes are needed to monitor the treatment of burn patients globally, assess the efficiency of the provided treatment, and harmonize the worldwide standard of burn care.
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Affiliation(s)
- Suvashis Dash
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Laura Pompermaier
- Department of Plastic Surgery, Linköping University Hospital, Sweden
| | | | - Alan David Rogers
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nadia Depetris
- Department of Anaesthesia and Intensive Care, City of Health and Science, CTO Hospital, Turin, Italy.
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Lindert J, Bbaale D, Mohr C, Chamania S, Bandyopadhyay S, Boettcher J, Katabogama JB, Alliance BW, Elrod J. State of burns management in Africa: Challenges and solutions. Burns 2023; 49:1028-1038. [PMID: 36759220 DOI: 10.1016/j.burns.2022.12.016] [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: 07/04/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Understand the availability of human resources, infrastructure and medical equipment and perceived improvement helps to address interventions to improve burn care. METHODS Online survey covering human resources, infrastructure, and medical equipment of burn centers as well as perceived challenges and points for improvement. The survey was distributed in English and French via snowball method. Descriptive statistics and AI-based technique random forest analysis was applied to identify determinants for a reduction of the reported mortality rate. RESULTS 271 questionnaires from 237 cities in 40 African countries were analyzed. 222 (81.9 %) from countries with a very low Human Development Index (HDI) (4th quartile). The majority (154, 56.8 %) of all responses were from tertiary health care facilities. In only 18.8 % (n = 51) therapy was free of charge for the patients. The majority (n = 131, 48.3 %) had between 1 and 3 specialist doctors (n = 131, 48.3 %), 1 to 3 general doctors (n = 138, 50.9 %) and more than 4 nurses (n = 175, 64.6 %). A separate burn ward was available in 94 (34.7 %) centers. Regular skin grafting was performed in 165 (39.1 %) centers. Random forest-based analysis revealed a significant association between HDI (feature importance: 0.38) and mortality. The most important reason for poor outcome was perceived late presentation (212 institutions, 78.2 %). The greatest perceived potential for improvement was introduction of intensive care units (229 institutions, 84.5 %), and prevention or education (227 institutions, 83.7 %). INTERPRETATION A variety of factors, including a low HDI, delayed hospital presentation e.g. due to prior care by non-physicians and lack of equipment seem to worsen the outcome. Introduction of an intensive care unit and communal education are perceived to be important steps in improving health care in burns.
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Affiliation(s)
- Judith Lindert
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str 8, 18057 Rostock, Germany; German Society of Global and Tropical Surgery e.V., Germany
| | - Dorothy Bbaale
- Department of Surgery, International Hospital Kampala, Plot 4686 Barnabas Rd, Kampala, Uganda; CURE International, 70 Ionia Ave SW, Suite 200, Grand Rapids, MI 49503, United States
| | - Christoph Mohr
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Shobha Chamania
- Choithram Hospital and Research Centre, 14, Manik Bagh Rd, Indore, India
| | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | | | - Bisimwa Wani Alliance
- Provincial General Reference Hospital of Bukavu, 02, avenue Michombero/Commune de Kadutu, Bukavu, Democratic Republic of the Congo
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Stewart BT, Nsaful K, Allorto N, Man Rai S. Burn Care in Low-Resource and Austere Settings. Surg Clin North Am 2023; 103:551-563. [PMID: 37149390 DOI: 10.1016/j.suc.2023.01.014] [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: 05/08/2023]
Abstract
More than 95% of the 11 million burns that occur annually happen in low-resource settings, and 70% of those occur among children. Although some low- and middle-income countries have well-organized emergency care systems, many have not prioritized care for the injured and experience unsatisfactory outcomes after burn injury. This chapter outlines key considerations for burn care in low-resource settings.
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Affiliation(s)
- Barclay T Stewart
- University of Washington, UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA, USA.
| | - Kwesi Nsaful
- Department of Plastic, Reconstructive Surgery and Burns Unit, Ghana Navy, 37 Military Hospital, Accra, Ghana
| | - Nikki Allorto
- Head Pietermaritzburg Metropolitan Burn Service, Pietermaritzburg, KwaZulu Natal, South Africa
| | - Shankar Man Rai
- National Academy of Medical Sciences, Nepal Cleft and Burn Center at Kirtipur Hospital, Kathmandu, Nepal
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Chaudhary S, Chatterjee S, Jain N, Basu S. Scleral contact lenses for optimal visual recovery in a case of severe acid burn with total lagophthalmos. BMJ Case Rep 2022; 15:e248384. [PMID: 35790322 PMCID: PMC9258505 DOI: 10.1136/bcr-2021-248384] [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] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
Abstract
Chemical injuries can severely damage the ocular surface. We present the case of a man in his 40s with severe periocular chemical injury with total lid loss and severe exposure keratopathy. He sustained burns to 45% of his body surface area and needed tracheostomy and multiple full-thickness skin grafts. Both eyes required surgery, Boston type 1 keratoprosthesis and penetrating keratoplasty for the right and left eye, respectively. There was melting in the right eye and a persistent epithelial defect in the left eye. Eventually, we suggested 18 mm diameter scleral contact lenses for both eyes to aid in ocular surface stabilisation. His best corrected visual acuity improved significantly with the scleral lenses to 20/100 and 20/320 in the right and left eyes, respectively. This case demonstrates that scleral lenses can treat the complications of exposure keratopathy and can improve vision. Therefore, they may be considered for rehabilitation of the ocular surface in eyes with severe chemical periocular injuries.
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Affiliation(s)
- Simmy Chaudhary
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Bausch and Lomb Contact Lens Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Subhajit Chatterjee
- Bausch and Lomb Contact Lens Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Neha Jain
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Borg MTM, Krishna A, Ghanem A. Surgical Training for Burns Care in Low-income Countries: A Literature Review and Critical Appraisal. Burns 2022; 48:1773-1782. [DOI: 10.1016/j.burns.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/15/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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Gyedu A, Mehta K, Baidoo H, Addo D, Abdullah M, Mesic A, Samosorn A, Cancio LC, Nakarmi K, Stewart BT. Preferences for Oral Rehydration Drinks among Healthy Individuals in Ghana: A Single-Blind, Cross-Sectional Survey to Inform Implementation of an Enterally Based Resuscitation Protocol for Burn Injury. Burns 2022; 49:820-829. [PMID: 35715342 DOI: 10.1016/j.burns.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Enterally based resuscitation for major burn injuries has been suggested as a simple, operationally superior, and effective resuscitation strategy for use in austere contexts. However, key information to support its implementation is lacking, including palatability and acceptability of widely available rehydration drinks. METHODS We performed a single-blinded, cross-sectional survey of 60 healthy children (5-14 years), adults (15-54 years) and older adults (≥55 years) to determine palatability and overall acceptability of five oral rehydration solutions (ORS) and a positive control drink (Sprite Zero®) in Ghana. Quantitative data were described and differences between our control drink and the others across age groups were visually examined with Likert plots. Qualitative responses were analyzed using a content analysis framework. RESULTS Twenty participants in each age group completed the study. Participants were as young as 5 years and as old as 84 years. Nearly two thirds of the sample identified as male (n = 38, 63% of all participants). The positive control was reported to taste 'good or 'very good' by the majority of participants (89%) followed by lemon-flavored ORS (78%) and orange-flavored ORS (78%). Conversely, homemade and low-osmolarity ORS were reported to taste 'good' or 'very good' by only 20% and 15% of participants, respectively. There were no major taste differences across the age groups. However, children more frequently reported positively (i.e., tastes 'good' or 'very good') about flavored and sweet drinks than did adults and older adults. When faced with the hypothetical situation of being critically injured and needing resuscitation, participants tended to be more agreeable to consuming all the drinks, even low-osmolarity and homemade ORS. CONCLUSIONS These findings can be used to support the development of protocols that may be more acceptable among patients undergoing enterally based resuscitation, thus improving the effectiveness of the treatment. Specifically, enterally based resuscitation should likely include citrus-flavored ORS when available, given superior palatability and the fact that different flavor additives for patients of different ages do not seem necessary.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, WA, USA.
| | - Hilary Baidoo
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Dorcas Addo
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Mohammed Abdullah
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Aldina Mesic
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Angela Samosorn
- US Army Institute of Surgical Research, Fort Sam Houston, TX, USA; US Army Nurse Corps, San Antonio, TX, USA.
| | | | | | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; Harborview Injury Prevention & Research Center, Seattle, WA, USA; UW Medicine Regional Burn Center, Seattle, WA, USA.
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14
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Jordan KC, Di Gennaro JL, von Saint André-von Arnim A, Stewart BT. Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front Pediatr 2022; 10:954995. [PMID: 35928690 PMCID: PMC9343701 DOI: 10.3389/fped.2022.954995] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Burn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment. METHODS We performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021. RESULTS There were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0-18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1-5 years comprised 62% (n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years (n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as "limited" for 23% of pediatric patients. CONCLUSIONS Children represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.
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Affiliation(s)
- Kelly C Jordan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Jane L Di Gennaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Amélie von Saint André-von Arnim
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Barclay T Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
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15
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Laura P, José A, Nikki A, Khaled A, Barret JP, Jeffery C, Shobha C, Jack CS, Scott C, Nadia D, Moustafa E, Liao J, Josef H, Briana H, Sunil K, Tetsuro K, Jorge LV, Gaoxing L, Hajime M, Ariel MA, Naiem M, Kiran N, Nawar A, Faustin N, Anthony O, Tom P, Liang Q, Man RS, Ingrid S, Ahmed T, Molina VLP, Shelley W, Mark F. Impact of COVID-19 on global burn care. Burns 2021; 48:1301-1310. [PMID: 34903416 PMCID: PMC8664090 DOI: 10.1016/j.burns.2021.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022]
Abstract
Background Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pandemic, and whether country´s income, geographical location, COVID-19-transmission pattern, and levels of specialization of the burn units affected reallocation of resources and access to burn care. Methods The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, χ2 or Fisher’s exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic. Results The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedicated nursing staff was reduced (<0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration between burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors. Conclusions During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care.
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Affiliation(s)
- Pompermaier Laura
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Global Health and Social Medicine Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | - Adorno José
- Burn Unit at Regional Hospital of North Wing, Brasília, Brazil
| | - Allorto Nikki
- Pietermaritzburg Burn Service; Nelson Mandela School of Medicine, University of KwaZulu Natal, South Africa
| | - Altarrah Khaled
- Albabtain Center for Burns and Plastic Surgery, Alshuwaikh Specialist Health District, Alsabah Health Region, Kuwait
| | - Juan P Barret
- Department of Plastic Surgery and Burns, University Hospital Vall d´Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carter Jeffery
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Chamania Shobha
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | | | - Corlew Scott
- Department of Global Health and Social Medicine Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Depetris Nadia
- Turin Burn Centre, Department of Anesthesia and Critical Care 3, Cittá della Salute e della Scienza di Torino, Torino, Italy
| | - Elmasry Moustafa
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Junlin Liao
- Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Haik Josef
- Tel-Aviv University, Derech Sheba 2, Ramat Gan, Tel-Aviv, Israel; National Burn Center, Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel-Aviv, Israel
| | - Horwath Briana
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Keswani Sunil
- National Burns Centre Airoli, Sector 13 Samarth Ramdas Swami Marg, Airoli, Navi Mumbai, Maharashtra, India
| | - Kiyozumi Tetsuro
- Department of Defense Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama Prefecture, Japan
| | - Leon-Villapalos Jorge
- Department of Plastic Surgery and Burns, Chelsea and Westminster Hospital, London, UK
| | - Luo Gaoxing
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongoing, China
| | - Matsumura Hajime
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Moiemen Naiem
- Burns Centre, Birmingham Women's and Children's Hospital, Steelhouse Ln, Birmingham, UK; Queen Elizabeth Hospital Birmingham, University of Birmingham, Birmingham, UK
| | - Nakarmi Kiran
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Kathmandu, Nepal
| | - Ahmed Nawar
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Ntirenganya Faustin
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Olekwu Anthony
- Department of surgery, Federal Medical Centre Owo, Adekunle Ajasin Way, Owo, Ondo state, Nigeria
| | - Potokar Tom
- Centre for Global Burn Injury Policy & Research, Swansea University, Sketty, Wales, UK; Interburns, Swansea University, Swansea, Wales, UK
| | - Qiao Liang
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Rai Shankar Man
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Kathmandu, Nepal; National Academy of Medical Sciences, Kathmandu, Nepal
| | - Steinvall Ingrid
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tanveer Ahmed
- Burn and Plastic Surgery, Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Vana Luiz Philipe Molina
- Divisao de Cirurgia Plastica e Queimaduras, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wall Shelley
- Pietermaritzburg Burn Service; Nelson Mandela School of Medicine, University of KwaZulu Natal, South Africa; DRILL Fellow: Developing Research, Innovation, Localization and Leadership, University of KwaZulu-Natal, South Africa
| | - Fisher Mark
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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16
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Impact of COVID-19 and containment measures on burn care: A qualitative exploratory study. Burns 2021; 48:1497-1508. [PMID: 34903406 PMCID: PMC8595323 DOI: 10.1016/j.burns.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/18/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Burn care in India is limited by multiple constraints. The COVID-19 pandemic and the containment measures restricted access to non-COVID emergency conditions, including burns. The aim of this study was to explore the impact of the pandemic on burn care in India. METHODS Using the qualitative exploratory methods, we conducted in-depth interviews (IDI) with plastic and general surgeons representing burn units from across India. Participants were selected purposively to ensure representation and diversity and the sample size was guided by thematic saturation. Thematic analysis was undertaken adopting an inductive coding using NVivo 12 Pro. RESULTS 19 participants from diverse geographic locations and provider types were interviewed. Three major emerging themes were, change in patient and burn injury characteristics; health system barriers, adaptation, and challenges; and lessons and emerging recommendations for policy and practice. There was change in patient load, risk factors, and distribution of burns. The emergency services were intermittently disrupted, the routine and surgical services were rationally curtailed, follow-up and rehabilitation services were most affected. Measures like telemedicine and decentralising burn services emerged as the most important lesson. CONCLUSIONS The ongoing pandemic has compounded the challenges for burns care in India. Urgent action is required to prioritise targeted prevention, emergency transport, decentralise service delivery, and harnessing technology for ensuring resilience in burns services.
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Potokar T, Bendell R, Phuyal K, Dhital A, Karim E, Falder S, Kynge L, Price PE. The development of the Delivery Assessment Tool (DAT) to facilitate quality improvement in burns services in low-middle income countries. Burns 2021; 48:1488-1496. [PMID: 34903404 DOI: 10.1016/j.burns.2021.10.010] [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: 06/28/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Implementation science is a useful tool to consider ways in which we can introduce improvements to burn services in low-and-middle income countries (LMICs), where the majority of the burden of burn injury is now experienced. This paper outlines the development of the Delivery Assessment Tool (DAT), a method for facilitating quality improvement in burn services in LMICs. We used a participatory approach that ensured that local clinicians and experts were fully involved in piloting the tool. The DAT is based on internationally agreed operational standards for burn care service delivery and has undergone an iterative process of improvement and refinement through an initial three-year project in Nepal and Bangladesh. The DAT, a 50-item tool organised into 10 subsections, is used to assess a service through a participatory focus group discussion with a mixed, multidisciplinary team of staff working at the burn service, typically 6-10 participants. This usually lasts 2-3 h. The staff in the unit then select priority areas for quality improvement programmes that are within their control to achieve, which starts a cycle of audit and review. The final version of the tool was used in a further three-year project to evaluate 11 hospitals in Nepal and Bangladesh. Education and training are key components of this work; both were provided by Interburns as part of on-going support for the clinical teams. At the end of the project a>19% improvement in scores was demonstrated using the final version of the DAT in both Nepal and Bangladesh; this achievement is remarkable given the continued difficulties in service provision where patient numbers far outstrip the resources available to care for them. As a result of this work, we have made a digital version of the tool available free of charge.
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Affiliation(s)
- T Potokar
- Interburns, Cardiff, Wales, UK; Centre for Global Burn injury Policy and Research, Swansea University, UK.
| | | | - K Phuyal
- Interburns, Cardiff, Wales, UK; SAGUN: A Search for Harmony, Kupandol, Lalitpur, Nepal
| | - A Dhital
- Interburns, Cardiff, Wales, UK; SAGUN: A Search for Harmony, Kupandol, Lalitpur, Nepal
| | - E Karim
- Acid Survivors Trust, Bangladesh
| | - S Falder
- Interburns, Cardiff, Wales, UK; Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - L Kynge
- Interburns, Cardiff, Wales, UK
| | - P E Price
- Interburns, Cardiff, Wales, UK; Centre for Global Burn injury Policy and Research, Swansea University, UK
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18
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Shaarbafchizadeh N, Amini-Rarani M, Mohammadi F. Resource generation challenges for burn care in Iran. Int J Health Plann Manage 2021; 36:1600-1612. [PMID: 34013550 DOI: 10.1002/hpm.3241] [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: 04/02/2020] [Revised: 04/06/2021] [Accepted: 05/09/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Given the importance of investment in human and physical resources and knowledge in burn injuries for improving health service performance, this study endeavoured to identify resource production challenges in the burn care of Iran. METHODS In this descriptive qualitative study, semi-structured interviews were conducted with 21 key informants. The purposive sampling method was applied to select interviewees, and data collection through interviews was continued to achieve data saturation. Using the framework of Adams et al. for health resource production, the directed content analysis approach was undertaken to analyse the qualitative data. RESULTS Three main themes and seven sub-themes were identified, and the main themes (sub-themes) were human (the lack of motivation, job stressors and the lack of clinical staff), physical (capital resources and consumables) and intellectual (burn care education and staff training) resources. CONCLUSION In general, investment in different areas would help provide better burn services, including educating and empowering employees, motivating through identifying and defining their needs, and considering points for job stressors as work hardship, burnout and workplace harassment. Other areas of investment are increasing the recruitment of burn section personnel, providing burn specialized equipment and updating them, providing standard physical space, and supplying consumables such as medicines and dressings.
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Affiliation(s)
- Nasrin Shaarbafchizadeh
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Amini-Rarani
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Mohammadi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Li K, Mehta K, Wright A, Lee J, Yadav M, Pham TN, Rai SM, Nakarmi K, Stewart B. Identifying Hospitals in Nepal for Acute Burn Care and Stabilization Capacity Development: Location-Allocation Modeling for Strategic Service Delivery. J Burn Care Res 2021; 42:621-626. [PMID: 33891676 DOI: 10.1093/jbcr/irab064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In Nepal, preventable death and disability from burn injuries are common due to poor population-level spatial access to organized burn care. Most severe burns are referred to a single facility nationwide, often after suboptimal burn stabilization and/or significant care delay. Therefore, we aimed to identify existing first-level hospitals within Nepal that would optimize population-level access as "burn stabilization points" if their acute burn care capabilities are strengthened. A location-allocation model was created using designated first-level candidate hospitals, a population density grid for Nepal, and road network/travel speed data. Six models (A-F) were developed using cost-distance and network analyses in ArcGIS to identify the three vs five candidate hospitals at ≤2, 6, and 12 travel-hour thresholds that would optimize population-level spatial access. The baseline model demonstrated that currently 20.3% of the national population has access to organized burn care within 2 hours of travel, 37.2% within 6 travel-hours, and 72.6% within 12 travel-hours. If acute burn stabilization capabilities were strengthened, models A to C of three chosen hospitals would increase population-level burn care access to 45.2, 89.4, and 99.8% of the national population at ≤2, 6, and 12 travel-hours, respectively. In models D to F, five chosen hospitals would bring access to 53.4, 95.0, and 99.9% of the national population at ≤2, 6, and 12 travel-hours, respectively. These models demonstrate developing capabilities in three to five hospitals can provide population-level spatial access to acute burn care for most of Nepal's population. Organized efforts to increase burn stabilization points are feasible and imperative to reduce the rates of preventable burn-related death and disability country-wide.
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Affiliation(s)
- Kevin Li
- Department of Bioinformatics and Medical Education, University of Washington, Seattle, USA
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, USA
| | - Ada Wright
- Carleton College, Northfield, Minnesota, USA
| | - Joohee Lee
- Public Health Concern Trust Nepal, Kathmandu, Nepal
| | - Manish Yadav
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington and UW Medicine Regional Burn Center, Seattle, USA
| | - Shankar M Rai
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Kiran Nakarmi
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Barclay Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington and UW Medicine Regional Burn Center, Seattle, USA.,Harborview Injury Prevention & Research Center, Seattle, Washington, USA
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20
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Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses. Burns 2021; 48:201-214. [PMID: 33895009 PMCID: PMC8763043 DOI: 10.1016/j.burns.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 11/22/2022]
Abstract
We can empower practitioners to lead quality improvement projects in LMICs. Nurses can play a significant role in the improvement of burns services. Interactive blended-learning courses can support nurses to lead on quality improvement. The training and development must be designed to be context specific.
Background There is an urgent need to empower practitioners to undertake quality improvement (QI) projects in burn services in low-middle income countries (LMICs). We piloted a course aimed to equip nurses working in these environments with the knowledge and skills to undertake such projects. Methods Eight nurses from five burns services across Malawi and Ethiopia took part in this pilot course, which was evaluated using a range of methods, including interviews and focus group discussions. Results Course evaluations reported that interactive activities were successful in supporting participants to devise QI projects. Appropriate online platforms were integral to creating a community of practice and maintaining engagement. Facilitators to a successful QI project were active individuals, supportive leadership, collaboration, effective knowledge sharing and demonstrable advantages of any proposed change. Barriers included: staff attitudes, poor leadership, negative culture towards training, resource limitations, staff rotation and poor access to information to guide practice. Conclusions The course demonstrated that by bringing nurses together, through interactive teaching and online forums, a supportive community of practice can be created. Future work will include investigating ways to scale up access to the course so staff can be supported to initiate and lead quality improvement in LMIC burn services.
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