Machine learning for burned wound management

Chemical burn wounds as a risk factor for gastric cancer: in-silico analyses-experimental research

Introduction

The present study employs bioinformatics tools to identify shared upregulated genes between chemical burns and gastric cancer.

Methods

Gene Expression Omnibus (GEO) retrieved gene sets for this investigation. GSEs with P value less than 0.05 and LOG fold change (FC) greater than 1 were valid and upregulated. Gastric cancer and chemical burn common elevated genes were found using Venn diagram online tools. In the second stage, the "string" visualized gastric cancer elevated genes network, and non-coding RNAs were deleted, and "interaction" greater than 1 was examined to choose important gene nodes. Next, they explored the String gene-interaction network for common genes. To determine the most interacting genes, Gephi (V 0.9.7) used "betweenness centrality" greater than "0" to evaluate the twenty-gene network. TISIDB and drug banks provide gene-related medications.

Results

In the present study, two genes, including ALOX5AP and SERPINB2, were obtained, with the highest centrality among chemical burns and gastric cancer shared genes. Additionally, the current study presented five drugs, including Urokinase, Tenecteplase, DG031, AM103, and Fiboflapon, which can have predicted effects on gastric cancer following chemical burns.

Conclusion

According to current in-silicon analyses, ALOX5AP and SERPINB2 are linked genetic keys between gastric chemical burn and cancer. Considering that burn is an environmental factor that leads to the upregulation of the two genes thus, the chemical burn can be related to the incidence of gastric cancer.

Prediction of immune molecules activity during burn wound healing among elderly patients: in-silico analyses: experimental research

Introduction

Burn injuries lead to dysregulation of immune molecules, impacting cellular and humoral immune pathways. This study aims to determine the prediction of immune molecule activity during burn wound healing among elderly patients.

Methods

The current study utilized the Gene Expression Omnibus (GEO) database to extract the proper gene set. Also, the literature review was conducted in the present study to find immune signatures. The study used the "enrich r" website to identify the biological functions of extracted genes. The critical gene modules related to mortality were identified using the weighted gene co-expression network analysis (WGCNA) R package.

Results

The appreciated GSE was extracted. According to the data, the most upregulated signatures were related to natural killer (NK) cells, and the most downregulated signatures were associated with M1 macrophages. Also, the results of WGCNA have shown that the most related gene modules (P<107 and score 0.17) to mortality were investigated, and the modules 100 first genes were extracted. Additionally, the enrich r analysis has demonstrated related pathways, including the immune process, including regulation of histamine secreted from mast cell (P<0.05), T helper 17 cell differentiation (P<0.05), and autophagy (P<0.05) were obtained. Finally, by network analysis, the critical gene "B3GNT5" were obtained (degree>ten and "betweenness and centrality">30 were considered).

Conclusion

The study identified significant changes in macrophage and NK cell expression patterns post-burn injury, linking them to potential improvements in clinical outcomes and wound healing. The gene B3GNT5, associated with mortality, was highlighted as a key marker for prognostic evaluation.

A systematic review of the exercise effects on burn wound healing

The emerging evidence has indicated the role of microRNAs (miRNA) in various physiological or pathological processes. Also, documents have suggested that exercise, by affecting miRNA regulation, may enhance burn wound healing. The current study aims to systematically review the role of exercise in regulating miRNAs related to burn wound healing to provide potential therapeutic targets. A comprehensive, systematic search was performed in different international electronic databases, such as Embase, PubMed and Google Scholar search engine, Science Direct, ProQuest and Ovid using keywords extracted from Medical Subject Headings from 2010 to September 2023. The keywords, including 'exercise' AND 'burn wound' AND 'microRNA' and finally, six cases were achieved. Evidence has indicated that exercise may promote the healing of burn wounds by regulating certain miRNAs. Studies have found that exercise regulates the expression of miRNAs such as mir-155, miR-21, let-7a, miR-146a, miR-122 and mir-210 in burn wound tissue, which regulate inflammation and angiogenesis. These findings suggest that miRNAs may play a role in the positive effect of exercise on burn wound healing. However, further research is needed to understand the mechanisms involved fully.

Prevalence of anxiety and its risk factors in burn patients: A systematic review and meta-analysis

The primary objective of this systematic review and meta-analysis was to ascertain the prevalence of anxiety and identify associated risk factors among individuals who have suffered burn injuries. We conducted a thorough and systematic search across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the scientific information database (SID). Our search encompassed the period from the earliest available records up to 8 August 2023. We employed keywords derived from Medical Subject Headings (MeSH) such as "Prevalence", "Anxiety" and "Burns". In total, 2586 burn patients participated in 13 cross-sectional studies. The mean age of the participants was 32.88 (SD = 2.51). In a compilation of 13 studies, the documented overall occurrence rate of anxiety among burn patients stood at 16.1% (95% CI: 10.0% to 24.7%; I2  = 93.138%; p < 0.001). The outcomes of a meta-regression analysis, which examined the association between anxiety in burn patients and the year of publication, did not uncover any significant correlation (p = 0.442). Furthermore, there was a notable association between anxiety in burn patients and factors such as gender, TBSA affected, educational level and the types of burn injuries. Therefore, healthcare providers need to recognize the substantial prevalence of anxiety in burn patients as a fundamental consideration. This recognition should prompt a proactive approach toward early detection and timely intervention. Developing personalized intervention strategies tailored to each patient's unique risk factors and needs is paramount. These strategies may encompass a range of therapeutic options such as counselling, psychotherapy or consultations with mental health specialists.

Relationship between body mass index and mortality of burns patients: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the relationship between body mass index (BMI) and mortality of burn patients. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Body mass index", "Burns" and "Mortality" from the earliest to the April 1, 2023. The quality of the studies included in this systematic review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). Finally, six articles were included in this systematic review and meta-analysis. A total of 16 154 burn patients participated in six studies. Their mean age was 46.32 (SD = 1.99). Of the participants, 71.7% were males. The mean length of hospitalization was 18.80 (SD = 8.08) days, and the average TBSA in burn patients was 38.32 (SD = 2.79) %. Also, the average BMI in burn patients was 27.10 (SD = 1.75). Results found mortality in patients with abnormal BMI (overweight to morbidity BMI) was 0.19 more than normal BMI (ES: 1.19, 95%CI: 0.76-1.87, Z = 0.75, I2 : 71.8%, p = 0.45). Results of linear dose-response showed each 5 kg/m2 increase in BMI was associated with a 5% increase in mortality that was marginally significant (ES: 1.05, 95%CI: 1.00-1.11, Z = 1.99, I2 : 22.2%, p = 0.047). There was a non-linear relationship between levels of BMI and mortality (Prob > χ2  = 0.02). There was an increase in mortality from percentile 10 to 50, although it was not significant (Correlational coefficient: 0.01, p = 0.85). Also, there was an increase in mortality rate from percentile 50 to 90 that was statistically significant (correlational coefficient: 0.06, p = 0.047). Finally, the results of the study indicated BMI can increase the chance of mortality by 0.19, although it was not significant. As a result, more studies are needed to better judge the relationship between BMI and mortality in burn victims.

Antibiofilm and antimicrobial activity of Lactobacillus cell free supernatant against Pseudomonas aeruginosa isolated from burn wounds

The present study investigated the antimicrobial and anti-biofilm effects of indigenous Lactobacillus probiotic strains on Pseudomonas aeruginosa isolated from burn wound infection in laboratory conditions. The effect of 7 probiotic strains isolated from infant faeces on the pathogenicity factors of P. aeruginosa, including protease, elastase, antibiofilm and antipyocyanin was measured. Also, diffusion methods in the well and micro broth dilution were used to evaluate the antimicrobial activity of probiotics. All tests were performed in triplicate. A negative control and a positive control were used for each test. SPSS version 22 software was used for statistical analysis, and a p < 0.05 was considered statistically significant. A total of 30 clinical isolates of P. aeruginosa were isolated. The elastolytic activity of P. aeruginosa isolates decreased after adding Cell free supernatant (CFS) of each Lactobacillus. L1, L4, L5, and L6 strains had a 100% inhibitory effect on pathogen isolates. L3 and L7 strains had the lowest inhibitory effect. The inhibitory effect of CFS extracted from lactobacilli on protease production by P. aeruginosa. L1, L4, L5, and L6 strains had an inhibitory effect on all tested isolates. L2, L3, and L7 strains had a less inhibitory effect. L4 strain had the highest inhibitory effect on pyocyanin production by P. aeruginosa (50%), followed by L5 (43.3%), L1 (40%), and L6 (23.3%) strains. L3 and L7 strains had no inhibitory effect on the pyocyanin production of P. aeruginosa isolates. It was found that the CFS of 4 isolates (L1, L4, L5, and L6) was the most active extract and had a 100% inhibitory effect against biofilm formation of all P. aeruginosa strains. The L3 strain had the least inhibitory effect against the biofilm formation of pathogens. Overall, this study showed that probiotics could be promising alternatives to combat the pathogenicity of P. aeruginosa in burn wounds.

Prevalence of non-accidental burns and related factors in children: A systematic review and meta-analysis

Non-accidental burns (NABs) in children had some adverse effects, such as severe burns, requiring skin grafting, and mortality. Previous studies reported NABs in the form of neglect, suspected abuse, and child abuse. Also, different statistics were estimated for the prevalence of NABs in children. Therefore, the current study aimed to comprehensively review and summarise the literature on the prevalence of NABs in children. Also, factors related to NABs as a secondary aim were considered in this review. Keywords combined using Boolean operators and searches were performed in international electronic databases, such as Scopus, PubMed, and Web of Science. Only studies in English were considered from the earliest to 1 March 2023. The analysis was performed using STATA software version 14. Finally, 29 articles were retrieved for the quantitative analysis. Results found that the prevalence of child abuse, suspected abuse, neglect, 'child abuse or suspect abused', and 'abuse, suspect abused, or neglect' was 6% (ES: 0.06, 95% confidence interval [CI]: 0.05-0.07), 12% (ES: 0.12, 95% CI: 0.09-0.15), 21% (ES: 0.21, 95% CI: 0.07-0.35), 8% (ES: 0.08, 95% CI: 0.07-0.09), and 15% (ES: 0.15, 95% CI: 0.13-0.16) among burns victims, respectively. Also, factors related to NABs are categorised into age and gender, agent and area of burns, and family features. Considering the results of the current study, planning for rapid diagnosis and designing a process to manage NABs in children is necessary.

A systematic review of social support and related factors among burns patients

Burn injuries, as a major public health problem, can lead to high morbidity and mortality. Burns is considered as one of the most devastating injuries globally and the fourth most common injury after traffic accidents, falls and interpersonal violence. Burn injuries can affect human life, such as physical and mental health, functional skills, and performance. Changes in appearance, social isolation, stress, anxiety, depression, low self-esteem, unemployment, financial burden and family problems can occur in these patients. These burn complications can be exacerbated without adequate social support. This systematic review evaluated burn patients' social support and related factors. A systematic search was performed on the international electronic databases such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Burns', 'Social support', 'Perceived social support' and 'Social care' from the earliest to 30 April 2022. The quality of the included studies in this review was assessed using the appraisal tool for cross-sectional studies (AXIS tool). A total of 1677 burn patients were included in this review from 12 studies. Mean score of social support in burn patients based on multidimensional scale of perceived social support, Phillips's social support questionnaire, social support questionnaire, social support scale and Norbeck social support questionnaire were 5.04 (SD = 1.59) of 7, 22.06 (SD = 3.05), 78.20 (SD = 15.00) of 95, 82.24 (SD = 13.70) and 4.14 (SD = 0.99), respectively. Factors such as income, educational attainment, burn surface area, reconstructive surgery, quality of life, self-esteem, socialisation, posttraumatic growth, spirituality, and ego resilience had a significant positive relationship with social support of burns patients. Social support in patients with burn had a significant negative relationship with factors such as psychological distress, having children, life satisfaction, neuroticism and post-traumatic stress disorder. Overall, patients with burns had moderate levels of social support. Therefore, it is recommended that health policymakers and managers make it easier for burn patients to adapt to burns by providing psychological intervention programs and the social support needed by burn patients.

A systematic review of health care workers' knowledge and related factors towards burn first aid

The present systematic review was conducted to investigate the knowledge of health care workers (HCWs) regarding first aid in burns. A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Knowledge', 'First aid', 'Health personnel' and 'Burns' from the earliest to 1 February 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 3213 HCWs participated in seven cross-sectional studies. Of the HCWs, 44.50% were physicians. The studies included in this systematic review were conducted in Saudi Arabia, Australia, Turkey, the UK, Ukraine, and Vietnam. The knowledge rate of HCWs related to first aid for burns was 64.78 out of 100, which indicates their relatively desirable knowledge. The factors of first aid training experience, age, and experienced burn traumas had a significant positive effect on the knowledge of HCWs related to first aid for burns. Also, factors such as gender, nationality, marital status, and job position had a significant relationship with the knowledge of HCWs about first aid for burns. Therefore, it is suggested that health care managers and policymakers implement training programs and practical workshops related to first aid, especially first aid for burns.

Perceived stigmatisation and reliability of questionnaire in the survivors with burns wound: A systematic review and meta-analysis

Perceived stigmatisation (PS) can cause different effects on burns survivors such as depression, low self-esteem, body image disturbance, and social anxiety. Current systematic review and meta-analysis aimed to determine the average PS among the burns survivor population and the average reliability of the PS questionnaire (PSQ). A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Stigmatisation", "Burns", "Reliability", and "Questionnaire" from the earliest to February 1, 2023. The COSMIN and the Joanna Briggs Institute (JBI) checklists were applied to evaluate the risk of bias. Data analysis was performed in STATA V.14 and JAMOVI v 2.3.24 software. The analysis consisted of two sections. Firstly, the overall weighted average of PS was calculated based on mean and standard deviation. Then, the reliability average of PSQ was calculated with the reliability generalisation method based on the alpha coefficient, questionnaire items, and sample size of each study. Finally, eight articles were included in the quantitative analysis. The results showed the weighted average of PS was 2.14 (ES: 2.14, 95%CI: 1.77-2.51, Z = 11.40, I2 :97.8%, P < 0.001). The average of PS in the factors of confused/staring behaviour, absence of friendly behaviour, and hostile behaviour was 2.36 (ES: 2.36, 95%CI: 2.05-2.67, Z = 14.86, I2 :92.7%, P < 0.001), 2.13 (ES: 2.13, 95%CI: 1.87-2.39, Z = 16.22, I2 :93.8%, P < 0.001) and 2.07 (ES: 2.07, 95%CI: 1.67-2.47, Z = 10.05, I2 :96.5%, P < 0.001), respectively. The analysis showed that the overall coefficient alpha of the PSQ was 0.88 (ES: 0.88, 95%CI: 0.851-0.910, Z = 58.7, I2 : 95.04%, P < 0.001). Also, the alpha coefficient of factors including confused/staring behaviour, absence of friendly behaviour, and hostile behaviour were 0.847 (ES: 0.847, 95%CI: 0.770-0.924, Z = 21.6, I2 :99.13%, P < 0.001), 0.860 (ES: 0.860, 95%CI: 0.808-0.912, Z = 32.4, I2 :98.02%, P < 0.001) and 0.899 (ES: 0.899, 95%CI: 0.829-0.968, Z = 21.33, I2 : 0.0%, P < 0.001), respectively. In sum, the current study showed that the average PS was 2.14 out of 5 points. Most survivors and parents reported confused/starring behaviour as a common perceived behaviour from different individuals. Also, the average reliability of PSQ was 0.88, and it had acceptable reliability. More studies are required to better judge the level of PS among different age groups. Also, the psychometric properties of PSQ in different cultures are an essential issue.

A systematic review of medical science students' knowledge and related factors towards burns first aids

This systematic review aims to examine the knowledge of medical science students about burn first aid. A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Knowledge", "First aid", "Medical science student" and "Burn" from the earliest to February 1, 2023. The quality of the studies included in this systematic review was evaluated by using the appraisal tool for cross-sectional studies (AXIS tool). Thirteen studies had a total of 5046 students studying medical sciences. Among them, 62.24% were female and 77.67% were medical students. The studies included in this systematic review were conducted in Saudi Arabia, Pakistan, Syria, Egypt, and Malaysia. Medical science students' average knowledge of first aid for burns is 56.92 out of 100, which is considered to be a moderate level of knowledge. Factors such as the experience of first aid training, academic year, clinical experience, and economic status had a significant positive relationship with the knowledge of medical science students about first aid for burns. Also, factors such as age, academic specialisation, academic year, information sources, and fathers' occupation had a significant relationship with the knowledge of medical students about first aid for burns. Therefore, it is suggested that healthcare managers and policymakers make the necessary plans to ensure that first aid training courses are implemented during medical science students' studies as a part of their curriculum.

Caregivers' knowledge with burned children and related factors towards burn first aid: A systematic review

This systematic review aimed to examine the caregivers' knowledge with burned children and related factors towards burn first aid. A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Knowledge", "First aid", "Caregiver", "Burn", and "Child" from the earliest to the December 1, 2022. The quality of the studies included in this systematic review was evaluated by using the appraisal tool for cross-sectional studies (AXIS tool). A total of 11 763 caregivers of children with burns were enrolled in 14 studies. Of the participants, 78.81% were female and 41.15% had a university education. The mean score of caregivers' knowledge with burned children towards burn first aid was 51.44 out of 100. The knowledge of caregivers of burned children towards burn first aid had a significant positive relationship with the level of education, first aid training, age of caregivers, history of burn, number of children, monthly income, social status, and attitude. In addition, caregivers' knowledge had a significant negative relationship with the number of children. Furthermore, there was a significant relationship between caregivers' knowledge and level of education, monthly income, smoking, and previous knowledge of first aid. The level of caregivers' knowledge with burned children towards burn first aid was moderate. Therefore, health managers and policymakers can improve the knowledge of caregivers of burned children towards burn first aid by creating suitable platforms for face-to-face training as well as online training using websites.

A systematic review of life satisfaction and related factors among burns patients

This systematic review aimed to examine the life satisfaction and related factors among burns patients. A comprehensive systematic search was conducted at the international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Burns', 'Life satisfaction', 'Personal satisfaction', and 'Patient satisfaction' from the earliest to the 1 October 2022. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). A total of 3352 burn patients in the nine cross-sectional studies were included in this systematic review. 70.52% of burn patients were male. The mean age of burn patients was 37.47 (SD = 14.73). The mean score of life satisfaction in burn patients based on SWLS was 23.02 (SD = 7.86) out of 35, based on LSI-A was 12.67 (SD = 4.99) out of 20, and based on the life satisfaction questionnaire was 4.81 (SD = 1.67) out of 7. Factors including time since burn, religion, and constant had a positive and significant relationship with life satisfaction in burn patients. Whereas, factors such as single marital status, age at injury, length of hospital stay, presence of pain, larger total body surface area burn, head and neck burn, functional impairment, family satisfaction, satisfaction with appearance, and previous psychiatric treatment had a negative and significant relationship with life satisfaction in burn patients. In sum, this systematic review showed that burn patients were slightly satisfied with their life. Therefore, health managers and policymakers can improve the quality of life of burn victims by planning psychological counselling and behavioural therapy, and consequently increase their life satisfaction.

Effects of non-pharmacological interventions on pain intensity of children with burns: A systematic review and meta-analysis

Pain is one of the complications associated with burns, which can lead to anxiety and sleeplessness in children. Various studies evaluated the effects of non-pharmacological interventions on burn wound care. The present study was conducted to determine the effects of non-pharmacological interventions on pain intensity of children with burns. A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Non-pharmacological', 'Virtual reality', 'Pain', 'Burn', 'Wound' and 'Child' from the earliest to December 1, 2022. The risk of bias in the final articles was also assessed with the Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Finally, a total of 1005 burn patients were included in 19 studies. The age range of the patients was from 0.5 to 19 years. Of the participants, 50.05% were in the intervention group. All studies had a randomised clinical trial design. The results found that non-pharmacological interventions significantly reduced pain intensity in children (ES: -0.73, 95% CI: -1.08 to -0.38, Z = 4.09, I2 :79.8, P < .001). Virtual reality (VR) (ES: -0.54, 95% CI: -1.19 to -0.18, Z = 2.90, I2 :72.9%, P = .004) and non-VR (ES: -0.86, 95% CI: -1.45 to -0.27, Z = 2.86, I2 :91.4%, P = .04) interventions decreased pain intensity significantly in children based sub-group analysis. Non-pharmacological interventions significantly reduced the pain intensity of dressing removal (ES: -0.77, 95% CI: -1.34 to -0.20, Z = 66.3, I2 :91.8%, P = .008), dressing application (ES: -0.53, 95% CI: -0.97 to -0.09, Z = 2.37, I2 :60.8%, P = .02), and physical therapy (ES: -1.18, 95% CI: -2.10 to -0.26, Z = 2.51, I2 :88.0%, P = .01). Also, interventions reduced the pain of burn wound care (ES: -0.29, 95% CI: -1.01 to 0.44, Z = 0.78, I2 :72.6%, P = .43), but it was statistically insignificant. In sum, the result of the present study indicated that using non-pharmacological interventions significantly reduced pain intensity in children. The reduction of pain intensity was greater in non-VR than in VR interventions. Future studies should focus on comparing VR interventions with non-VR and single versus multi-modal distraction to clarify the effectiveness of each.

Effects of massage therapy on pain and anxiety intensity in patients with burns: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to examine the effects of massage therapy on pain and anxiety intensity in patients with burns. A comprehensive, systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Massage therapy', 'Musculoskeletal manipulations', 'Acute pains', 'Burning pain', and 'Burn' from the earliest to October 17, 2022. Cochran's tool is used to check the risk of bias for randomised clinical trial (RCT) articles. The methodological index for non-randomised studies was used to assess the risk of bias in quasi-experimental studies. STATA version 14 software was used to perform the meta-analysis. A 95% confidence interval (CI) was used to determine statistical significance. Heterogeneity was investigated with I² . A P-value less than .1 was considered statistically significant for publication bias value. A total of 733 patients with burns were included in seven studies. Five studies had an RCT design and two studies had a quasi-experimental design. The duration of the study was reported in five studies, with a mean of 42.40 weeks. The duration of the intervention was reported in seven studies with a mean of 22.86 minutes. The results of the meta-analysis showed using various types of massage therapy interventions significantly reduced pain intensity in the intervention group compared with the control group (weighted mean difference: -2.08, 95% CI: -2.55 to -1.62, Z = 8.77, I² : 67.1%, P < .001). Massage therapy intervention significantly reduced the intensity of anxiety in burn patients (standard mean difference: -7.07, 95% CI: -10.13 to -4.01, Z = 4.53, I² : 98.2, P < .001). Overall, the present systematic review and meta-analysis showed that massage therapy can reduce the intensity of pain and anxiety in burn patients. Therefore, it is recommended that health managers and policymakers pay special attention to massage therapy as a simple, low-cost, and efficient non-pharmacological treatment to relieve pain and anxiety in burn patients.

Effects of aromatherapy with Rosa damascene and lavender on pain and anxiety of burn patients: A systematic review and meta-analysis

Pain and anxiety were considered the most common complications of treatment procedures in burn patients. Non-pharmacological drugs, including aromatherapy, can decrease these issues. This systematic review and meta-analysis aim to summarise the effects of aromatherapy with Rosa damascene (RD) and lavender on the pain and anxiety of burn patients. A systematic search was performed on international electronic databases such as Scopus, PubMed, and Web of Science, as well as on Iranian electronic databases such as Iranmedex and Scientific Information Database (SID) with keywords extracted from Medical Subject Headings such as "Burns", "Pain", "Pain management", "Anxiety", and "Aromatherapy" were performed from the earliest to November 1, 2022. The Joanna Briggs Institute (JBI) critical appraisal checklist assessed the quality of randomised control trials (RCTs) and quasi-experimental studies. STATA v.14 software was used to estimate pooled effect size. Heterogeneity was assessed with I² value. Random effect model and inverse-variance method using sample size, mean, and standard deviation changes were applied to determine standard mean differences (SMD). The confidence interval of 95% was considered to determine the confidence level. A total of 586 burn patients participated in six studies, including three RCT studies and three quasi-experimental studies. The results based on RCT studies showed RD significantly decreased the dressing pain average when compared to the control group (SMD: -1.61, 95%CI: -2.32 to -0.99, Z = 5.09, I² : 66.2%, P < 0.001). Aromatherapy with lavender decreased the average pain in the interventional group more than in the control group (SMD: -1.78, 95%CI: -3.62 to 0.07, Z = 1.89, I² : 97.2%, P = 0.06). Using aromatherapy with RD and lavender significantly decreased pain average in the interventional group than the control group (SMD: -1.68, 95%CI: -2.64 to -0.72, Z = 3.42, I² : 94.2%, P = 0.001). The results showed RD significantly decreased the anxiety average in the interventional group than the control group (SMD: -2.49, 95%CI: -2.98 to -2.0, Z = 9.94, I² : 51.6%, P < 0.001). Overall, this study showed that aromatherapy with RD decreased pain and anxiety of dressing procedures in burn patients. Although aromatherapy with lavender decreased pain in the patients, it was not statistically significant. More RCTs studies are required to be able to better judge the effects of aromatherapy with RD and lavender on the pain and anxiety of burn patients.