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Huo T, Zou R, Liu Y, Li Q, Tang W, Ruan J, Xi M, Jiang M, Wang S, Xu C, Xie W, Xu X, Liu S. The association of stress perception on anxiety, depression and sleep quality in parents of children with burns: The moderating effect of social support. Burns 2024; 50:1652-1661. [PMID: 38641500 DOI: 10.1016/j.burns.2024.02.032] [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: 08/19/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Few studies have explored the mental health status of parents of children with burns and the moderating effect of social support on them. METHODS A survey was performed with parents of 112 burn-injured children at a burn center in China. Their perceived stress, anxiety, depression, sleep quality, and social support were measured by the Chinese Perceived Stress Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale. RESULTS ➀ The prevalence of anxiety (46.43%), depression (52.67%) and poor sleep quality (43.75%) of parents indicated that they experienced emotional and sleep disorders;➁ The perceived stress was positively correlated with sleep quality, anxiety and depression(P<0.01), and negatively correlated with perceived social support (p<0.05); ➂ Social support had a significant moderating effect on their perceived stress and anxiety, depression, but not on their sleep quality. With high social support, parental perceived stress had a significant positive association on anxiety and depression, while with low perceived social support, parental perceived stress had no significant association on anxiety and depression. CONCLUSION Parents of burned children had increased stress, obvious symptoms of anxiety and depression, and poor sleep quality. Social support had a significant buffering effect on them under low pressure, and high pressure will hinder the buffering effect of social support on stress. Therefore, the ideal services to improve mental health should be provided for them to face different levels of stress.
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Affiliation(s)
- Ting Huo
- Department of Burns, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan 430060 China
| | - Rong Zou
- College of Sports Medicine, Wuhan Sports University, Wuhan 430079 China; Hubei Key Laboratory of Sport Training and Monitoring, Wuhan Sports University, Wuhan 430079 China
| | - Yangzhuoxin Liu
- College of Sports Medicine, Wuhan Sports University, Wuhan 430079 China
| | - Qingping Li
- College of Sports Medicine, Wuhan Sports University, Wuhan 430079 China
| | - Wenqian Tang
- College of Sports Medicine, Wuhan Sports University, Wuhan 430079 China
| | - Jingjing Ruan
- Department of Burns, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan 430060 China
| | - Maomao Xi
- Department of Burns, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan 430060 China
| | - Meijun Jiang
- Department of Burns, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan 430060 China
| | - Song Wang
- College of Sports Medicine, Wuhan Sports University, Wuhan 430079 China
| | - Chengqi Xu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan 430070, China
| | - Weiguo Xie
- Department of Burns, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan 430060 China
| | - Xiangyang Xu
- Liyuan Hospital of Tongji medical college of Huazhong University of Science and Technology, Wuhan 430077, China.
| | - Shuhua Liu
- Department of Burns, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan 430060 China.
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Griffin BR, Harvey L, Dimanopoulos TA, Curtis KA, Gillen T, Kimble RM. Examining the impact of a paediatric trauma family support service on the quality of life of injured children: A longitudinal cohort study. J Pediatr Nurs 2024; 77:e356-e365. [PMID: 38735803 DOI: 10.1016/j.pedn.2024.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/21/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE We describe and evaluate the introduction of a trauma family support service (TFSS) in an Australian tertiary paediatric hospital. DESIGN AND METHODS A longitudinal mixed-methods cohort study evaluated the effectiveness of the TFSS on quality of life. PedsQL4.0 and EuroQol 5D-Y scores were collected at 6 and 12 months at intervention and non-intervention sites and outcomes were compared using a two-sample t-test. Qualitative data from field notes collected during the administration of the quality-of-life measures were analysed using inductive content analysis. Data were integrated during the interpretation of results to expand and strengthen findings. RESULTS Data from 192 children were collected (intervention site: 104, control site: 88). Significant increases were seen in the PedsQL and EQ-5D-Y scores at the intervention site compared to the control site at both timepoints, indicating an increase in overall health related quality of life. Two main categories were generated from the qualitative analysis: "Psychosocial impact of trauma" and "Access to psychosocial services." CONCLUSIONS The introduction of a dedicated family support service after paediatric injury improved well-being up to 12 months post injury. PRACTICE IMPLICATIONS Healthcare providers should emphasise dedicated family support services for paediatric trauma patients, focusing on their psychosocial needs and ensuring access to suitable resources. Paediatric nurses are a major part of this service and should contribute to future research, co-designing and implementing these improved family support services to better serve families affected by paediatric trauma.
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Affiliation(s)
- Bronwyn R Griffin
- School of Nursing and Midwifery, Griffith University, Level 7, 62 Graham Street, South Brisbane 4101, Queensland, Australia; Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
| | - Lauren Harvey
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
| | - Tanesha A Dimanopoulos
- School of Nursing and Midwifery, Griffith University, Level 7, 62 Graham Street, South Brisbane 4101, Queensland, Australia; Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
| | - Kate A Curtis
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong 2500, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown 2006, New South Wales, Australia.
| | - Tona Gillen
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
| | - Roy M Kimble
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
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Chami S, Babaee T, Jalali M, Saeedi H, Kamali M. Lived experience of children and adolescents with lower-limb loss who used a prosthesis: A qualitative study. Prosthet Orthot Int 2024; 48:320-328. [PMID: 38018993 DOI: 10.1097/pxr.0000000000000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/28/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Children's and adolescents' level of activity, the type of activity, and other features are special to them and can result in unique experiences with lower-limb prosthesis. The specific objective of this study was to explore the lived experience of children and adolescents with lower-limb loss (LLL) who used a prosthesis. METHODS We used a descriptive qualitative study design and in-depth, semistructured, face-to-face interviews. Accordingly, 35 participants, including children and adolescents with LLL who used a prosthesis, their parents, and prosthetists, were interviewed. The collected data were analyzed thematically. RESULTS One hundred sixty-eight codes about the experiences of children, parent(s), and prosthetists were extracted from the transcripts and categorized into 32 subthemes. Finally, 7 broad themes including suitability, provoke reactions, intrinsic nature, infrastructures, the school, availability, and parenting role were extracted. CONCLUSION The experiences of children and adolescents with lower-limb prosthesis are specific as each may face unique challenges and deal with different difficulties. In this study that has been conducted in a developing country, the main challenges faced by children using lower-limb prosthesis and their parents are the prosthetic components, social reactions, long distance, and costs of services. Moreover, designing a more natural prosthesis and gait training for children with LLL were the most important issues faced by prosthetists. However, close relationships with friends and family members, and children's amazing ability to adapt can aid in facilitating prosthetic management.
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Affiliation(s)
- Sara Chami
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Auckland Bioengineering Institute, The University of Auckland, Auckland, Auckland, New Zealand
| | - Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Saeedi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kamali
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Williford DN, Jackson CB, Durkin K, Langholz A, Aballay A, Duncan CL. Utility of a Pediatric Psychosocial Screener in an Outpatient Burn Clinic. J Burn Care Res 2024; 45:630-637. [PMID: 38050330 PMCID: PMC11073576 DOI: 10.1093/jbcr/irad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Indexed: 12/06/2023]
Abstract
Psychosocial concerns are common among youth who sustained a burn injury. Detecting psychosocial distress early is essential to ensure appropriate treatment and referrals. Thus far, research has focused largely on the long-term outcomes of pediatric burn survivors. The current quality improvement initiative details the implementation and outcomes of brief, pragmatic screening to assess psychosocial concerns among pediatric burn survivors in an outpatient setting. A primary caregiver completed an age-appropriate psychosocial screener for youth aged 4-10 years (n = 69), while patients aged 11-17 years (n = 72) completed a self-report screener. Total scores were used to categorize patients as acute risk (i.e., emotional concerns requiring immediate attention), moderate risk (i.e., elevated symptoms, but no immediate safety concerns), or low risk (i.e., endorsing few to no symptoms). Patients with acute risk were evaluated by medical staff to determine the need for immediate psychiatric intervention or social services referrals. Patients with moderate risk met with the on-site psychology team during their clinic visit or were contacted by telephone within 1 week. Patients in the low-risk category warranted no additional follow-up post-screening. Most patients scored in the low-risk category (n = 120; 85%), while 11% (n = 16) and 4% (n = 5) endorsed symptoms consistent with moderate and acute risk, respectively. Results demonstrate the utility of implementing pediatric psychosocial screening in an outpatient burn clinic, the importance of detecting psychosocial concerns in this context, and usage of referrals to address concerns. Findings also shed light on key caveats of psychosocial screening, barriers to accessing psychosocial support, and the potential benefits of embedded psychological support during medical visits.
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Affiliation(s)
- Desireé N Williford
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Carrie B Jackson
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Kristine Durkin
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Ariana Langholz
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Ariel Aballay
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
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Grauberger JN, Joshi N, Joo A, Phelan AL, Lalikos JF. Xeroform Stick-Down Dressing: A Novel Treatment for Pediatric Partial-Thickness Burns. Ann Plast Surg 2024; 92:S123-S128. [PMID: 38319984 DOI: 10.1097/sap.0000000000003795] [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: 02/08/2024]
Abstract
BACKGROUND Burns traditionally require frequent, painful dressing changes to minimize infection risk and promote wound healing. To improve care for our pediatric population, our institution adapted a skin graft donor site dressing into a "stick-down" burn dressing consisting of a one-time application of bacitracin and 3% bismuth tribromophenate/vaseline impregnated gauze (Xeroform) that adheres to the burn and peels off as new epithelialized skin forms. The goal of which is to minimize dressing change frequency and patient discomfort in a cost-effective, widely available manner. This study aimed to compare clinical outcomes of the stick-down versus traditional topical dressings. METHODS A retrospective cohort study of pediatric patients (age <18 year) with partial-thickness burns treated at a level I pediatric trauma center for 4 years was conducted. One hundred eleven patients were included: 74 patients treated with daily silver sulfadiazene (Silvadene) dressings matched to 37 patients treated with the Xeroform stick-down dressing using 2:1 propensity score matching. Univariate analyses used Wilcoxon rank sum and Fisher exact tests. RESULTS The cohorts had similar demographics and burn characteristics. Both groups had similar hospitalization rates (31.1% Silvadene, 32.4% Xeroform), most commonly for pain control (54.5% Silvadene, 58.3% Xeroform), with similar average daily narcotic usage (7.7 ± 12.1 morphine milliequivalents Silvadene, 5.1 ± 9.5 Xeroform; P = 0.91). The Xeroform cohort had a shorter but statistically similar hospital stay (median, 1 vs 2 days). In addition, the Xeroform cohort required significantly less dressing changes with a median of 0.5 changes compared with 12 for the Silvadene cohort ( P < 0.0001). There was no difference in time to burn reepithelialization (median, 13.0 days for Silvadene and 12.0 days for Xeroform; P = 0.20) or wound healing complications (12.5% Silvadene, 2.7% Xeroform; P = 0.15). CONCLUSIONS The Xeroform stick-down dressing has equivalent clinical outcomes to that of standard Silvadene dressings for the treatment of pediatric partial-thickness burns with the major advantages of decreasing dressing change frequency, minimizing patient distress and pain, and streamlining clinical care.
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Affiliation(s)
- Jennifer N Grauberger
- From the Division of Plastic and Reconstructive Surgery, University of Massachusetts Chan Medical School, Worcester, MA
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Wickens N, McGivern L, de Gouveia Belinelo P, Milroy H, Martin L, Wood F, Bullman I, Janse van Rensburg E, Woolard A. A wellbeing program to promote mental health in paediatric burn patients: Study protocol. PLoS One 2024; 19:e0294237. [PMID: 38359022 PMCID: PMC10868872 DOI: 10.1371/journal.pone.0294237] [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: 03/23/2023] [Accepted: 10/27/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND One of the most traumatic injuries a child can experience is a severe burn. Despite improvements in medical treatments which have led to better physical outcomes and reduced mortality rates for paediatric burns patients, the psychological impact associated with experiencing such a traumatic injury has mostly been overlooked. This is concerning given the high incidence of psychopathology amongst paediatric burn survivors. OBJECTIVES This project will aim to pilot test and evaluate a co-designed trauma-focused intervention to support resilience and promote positive mental health in children and adolescents who have sustained an acute burn injury. Our first objective is to collect pilot data to evaluate the efficacy of the intervention and to inform the design of future trauma-focussed interventions. Our second objective is to collect pilot data to determine the appropriateness of the developed intervention by investigating the changes in mental health indicators pre- and post-intervention. This will inform the design of future interventions. METHODS This pilot intervention study will recruit 40 children aged between 6-17 years who have sustained an acute burn injury and their respective caregivers. These participants will have attended the Stan Perron Centre of Excellence for Childhood Burns at Perth Children's Hospital. Participants will attend a 45-minute weekly or fortnightly session for six weeks that involves building skills around information gathering, managing reactions (behaviours and thoughts), identifying, and bolstering coping skills, problem solving and preventing setbacks. The potential effects and feasibility of our intervention will be assessed through a range of age-appropriate screening measures which will assess social behaviours, personal qualities, mental health and/or resilience. Assessments will be administered at baseline, immediately post-intervention, at 6- and 12-months post-intervention. CONCLUSION The results of this study will lay the foundation for an evidence-based, trauma-informed approach to clinical care for paediatric burn survivors and their families in Western Australia. This will have important implications for the design of future support offered to children with and beyond burn injuries, and other medical trauma populations.
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Affiliation(s)
- Nicole Wickens
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Lisa McGivern
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Helen Milroy
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Lisa Martin
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia
- Burn Service of Western Australia, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Fiona Wood
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia
- Burn Service of Western Australia, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Indijah Bullman
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Alix Woolard
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
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Wickens N, van Rensburg EJ, de Gouveia Belinelo P, Milroy H, Martin L, Wood F, Woolard A. "It's a big trauma for the family": A qualitative insight into the psychological trauma of paediatric burns from the perspective of mothers. Burns 2024; 50:262-274. [PMID: 37821283 DOI: 10.1016/j.burns.2023.06.014] [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: 11/17/2022] [Revised: 05/11/2023] [Accepted: 06/15/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Despite the medical and surgical improvements of paediatric burn injuries, burn injuries can be a painful and traumatic experience for the child and their family. It is therefore important to explore the experiences of caregivers who support their child throughout the burn journey. Thus, the purpose of this study was to explore the traumatic nature of paediatric burns on the family from a caregiver's perspective. METHODS This study used a descriptive qualitative approach to conduct online semi-structured interviews with caregivers (18 years and older) of children (aged four to 17 years) that had previously been admitted with an unintentional acute burn injury to a paediatric burns unit in Western Australia. Interviews explored the child's and caregiver's experiences throughout the burn journey from the perspective of the caregiver and were digitally recorded and transcribed verbatim. Transcripts were analysed using Braun and Clarke's six stages of reflexive thematic analysis. RESULTS Eleven mothers participated in the interviews and identified a range of poor psychological and psychosocial outcomes that themselves and their child experienced. Three overarching themes were elaborated from the interviews: Child and caregiver mental health difficulties during and after the burn (including medical trauma, mental health outcomes and caregiver guilt); Lifestyle and physical changes following the burn (including disruptions to routine, appearance concerns and puberty); and factors supporting or inhibiting the recovery journey (including personality factors, coping strategies, family dynamics and support). FINAL CONSIDERATIONS This study has presented the difficulties that children, young people, and their family face throughout a paediatric burn injury, which makes the implementation of timely and effective family centred interventions imperative. Meeting the needs and supporting these families with their mental health throughout this traumatic recovery journey, can ensure positive psychosocial outcomes and adaptive coping strategies are adopted early on.
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Affiliation(s)
- Nicole Wickens
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia.
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia; The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | | | - Helen Milroy
- The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Lisa Martin
- The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Fiona Wood Foundation, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - Fiona Wood
- The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Burn Service of Western Australia, Perth Children's Hospital, Ward 1B, 15 Hospital Avenue, Nedlands, Australia; Fiona Wood Foundation, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - Alix Woolard
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia; The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
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Karahan S, Ay Kaatsiz MA, Erbas A, Kaya Y. A Qualitative Analysis on the Experiences of Mothers of Children in Burn Intensive Care Unit: "She burned on the outside, me inside...". J Burn Care Res 2024; 45:120-129. [PMID: 37625120 DOI: 10.1093/jbcr/irad129] [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: 05/05/2023] [Indexed: 08/27/2023]
Abstract
Mothers closely follow the complex process due to the burning of their children. Caring for and supporting the child can pose various challenges for mothers. With the phenomenological method, this study was conducted to investigate mothers' experiences staying with their children in the pediatric burn intensive care unit. Twelve mothers participated in the study. The semistructured face-to-face interviews obtained data. After each interview, the research team transcribed the interviews verbatim. Interpretive Phenomenological Analysis was used to analyze the data. The experiences of the mothers were classified in four contexts as a result of the interpretative phenomenological analysis; "first reactions to burn trauma" related to the awareness that the child has been burned, "being a mother in the burn intensive care unit" related to caring for the child as a companion in the burn intensive care unit, "coping" related to how they cope with the problems throughout the whole process, and "requirements" regarding the subjects it needs in the process. It was determined that mothers went through a physically and emotionally challenging process from the beginning of the burn trauma and throughout the intensive care unit. During this challenging process, it was observed that mothers could not use effective coping methods and did not receive the necessary professional support. In line with these results, it is recommended that psychological support programs be applied to the mothers and that care focused on the needs of the mothers should be provided.
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Affiliation(s)
- Sabri Karahan
- Surgical Nursing Department, Harran University Faculty of Health Science, 63100 Sanliurfa, Turkey
| | - Melike Ayça Ay Kaatsiz
- Psychiatric Nursing Department, Hacettepe University Faculty of Nursing, 06100 Ankara, Turkey
| | - Atiye Erbas
- Surgical Nursing Department, Duzce University Faculty of Health Science, 81000 Duzce, Turkey
| | - Yunus Kaya
- Department of Child Development, Faculty of Health Science, Aksaray University, 68000 Aksaray, Turkey
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Hocking P, Broadhurst M, Nixon RDV, Gannoni A. Validation of the Psychosocial Assessment Tool 2.0 for paediatric burn patients. Burns 2023; 49:1632-1642. [PMID: 37211476 DOI: 10.1016/j.burns.2023.05.002] [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: 08/10/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The Psychosocial Assessment Tool 2.0 (PAT-B) is an adaptation of an existing screening tool with the aim of the present study to examine its effectiveness and suitability to identify children and families at risk of emotional, behavioral, and social maladjustment following paediatric burns. METHODS Sixty-eight children aged between 6 months - 16 years (M = 4.40) admitted into hospital following paediatric burns, and their primary caregivers, were recruited. The PAT-B comprises several dimensions including family structure and resources, social support, as well as caregiver and child psychological difficulties. Caregivers completed the PAT-B and several standardized measures for validation purposes (e.g., caregiver reports of family functioning, child emotional and behavioural problems, caregiver distress). Children old enough to complete measures reported on their psychological functioning (e.g., posttraumatic stress and depression). Measures were completed within 3 weeks of child admission and then again at 3 months after burn. RESULTS The PAT-B demonstrated good construct validity, evidenced by moderate to strong correlations between the PAT-B Total and subscale scores and several criteria measures (family functioning, child behaviour and caregiver distress, child depressive symptoms, rs ranging from 0.33 -0.74). Preliminary support for criterion validity of the measure was observed when examined against the three tiers of the Paediatric Psychosocial Preventative Health Model. The proportion of families falling within these tiers of risk (Universal [low risk], 58.2%; Targeted, 31.3%; or Clinical range, 10.4%) was consistent with prior research. Sensitivity of the PAT-B to identify children and caregivers at high risk of psychological distress was 71% and 83%, respectively. CONCLUSION The PAT-B appears to be a reliable and valid instrument for indexing psychosocial risk across families who have sustained a paediatric burn. However, further testing and replication using a larger sample size is recommended before the tool is integrated into routine clinical care.
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Affiliation(s)
- Phoebe Hocking
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia
| | - Miriam Broadhurst
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia
| | - Reginald D V Nixon
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia; Flinders University Institute for Mental Health and Wellbeing, Flinders University; Adelaide, South Australia, Australia.
| | - Anne Gannoni
- Department of Psychological Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Jiang L, Zhuang J, Su X, Zheng Q, Hu J. Sufficient mesh polyhedral intralesional injection for treatment of keloids. J Cosmet Dermatol 2023; 22:2769-2773. [PMID: 37157932 DOI: 10.1111/jocd.15790] [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: 01/28/2023] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The recurrence of keloids after intralesional injections is significant, and a review of the literature shows an inconsistent range of success rates. In this study, the modified medical proportion and intralesional injection method were intended to enhance the treatment effect. METHODS Twenty patients completed the study. Regional block anesthesia (lidocaine, ropivacaine) was performed. Triamcinolone acetonide (40 mg/mL), 5-fluorouracil (25 mg/mL), and ropivacaine (7.5 mg/mL) were configured in a ratio of 2:1:4 and applied on the lesion by reticular injection (horizontal fan-shaped stratified and vertical shaking pressurized injection). The minimum volume of injection per square centimeter was approximately 3.5 mL. The outcome indicators were the Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS), treatment frequency. RESULTS The patients had an 82% ± 7% average reduction in VSS scores and 89% ± 13% and 93% ± 10% reductions in VAS scores of pain and pruritus, respectively, after an average of 2.5 ± 0.7 injections administered within 1 year. CONCLUSION The sufficient mesh polyhedral intralesional injection can achieve excellent results for the treatment of keloid scars.
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Affiliation(s)
- Liya Jiang
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhuang
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiaoyuan Zheng
- College of Clinical Medicine, Fudan University, Shanghai, China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kaur D, Sharma N, Samuel AJ. Web-based E-survey in identifying current physiotherapy practices in paediatric burns. Burns 2023; 49:1474-1481. [PMID: 36792471 DOI: 10.1016/j.burns.2023.01.009] [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: 08/19/2022] [Revised: 12/20/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Physiotherapy practices in pediatric burns involves relaxation techniques and exercise training for attaining physical fitness, improving quality of life and, thereby to prevent primary and secondary complications. Physical activity and exercise act as a meaningful and purposeful tool for attaining physical fitness after burn injury. AIM The aim of this e-survey is to identify the current practices of physiotherapy interventions in pediatric burn rehabilitation among physiotherapy students and professionals. METHODS The e-survey was created with validated questionnaire using a Google Forms to gather the information related to current physiotherapy practices in pediatric burns. After the sample size estimation, survey link were sent to identified 144 physiotherapy students and professionals using social networking sites which includes, WhatsApp, Facebook and Instagram for this cross-sectional e-survey. The frequency and percentage of survey responses were analyzed. RESULTS Among 144 identified participants, 62 participants completed the survey, resulting in the response rate of (43.0%). The findings of this study revealed that> 50% of physiotherapy students, and professionals, are performing pain and scar assessment, along with their regular physiotherapy management in children with burns. In addition to these, they also practice physiotherapy for burn conditions in pediatric intensive care units (PICU), pediatric wards, and clinical outpatient department (OPD) settings. CONCLUSION Physiotherapy students and professionals have sufficient knowledge regarding pediatric burns complications, and also, they are well aware regarding recent physiotherapy practices in pediatric burn care management.
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Affiliation(s)
- Daljit Kaur
- Department of Paediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana 133207, Ambala, Haryana, India; Department of Physiotherapy, Narain Hospital & CT Scan Center, Ambala, Haryana
| | - Neha Sharma
- Department of Paediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana 133207, Ambala, Haryana, India
| | - Asir John Samuel
- Department of Paediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana 133207, Ambala, Haryana, India; Yenepoya Physiotherapy College, Yenepoya (Deemed to be University), Naringana, Deralakatte, Mangalore 575018, Karnataka, India.
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12
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Düken ME, Yayan EH, Zengin M, Sevgi T. The effects of the posttraumatic stress and general health status on paediatric burns and their sleep habits. Burns 2023; 49:1321-1327. [PMID: 36566094 DOI: 10.1016/j.burns.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/18/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Burns are serious injuries that can require hospitalization and have physical and emotional sequelae. Sleep disturbance can occur after trauma as evidenced by posttraumatic stress symptoms such as re-experiencing of a trauma with repetitive dreams, memories and flashbacks. This area has been minimally examined with pediatric burn survivors; therefore, the aim of this study was to investigate the effects of posttraumatic stress and general health on sleep habits of pediatric burn survivors from. METHOD This is a correlational descriptive study. Its sample included 7-18-year-old inpatients at the burn clinic of a university hospital from January to November 2019. This study used the Posttraumatic Stress Disorder Reaction Index, the General Health Questionnaire (12) and the Children's Sleep Habits Questionnaire for data collection. RESULTS Of the participants, 58.6% were male, 46.5% were primary school students, and 62.6% had no diseases other than their burns. 20.2% of the children had epilepsy, 14.2% had diabetes and 3% had pneumonia. Of the child burn victims, 45.5% were brought to the hospital because of contact with fire. All of them had first-degree burns, 59.6% had second-degree burns, and 80.8% had third-degree burns. After their burns, infections developed in 20.2% during trauma and in 43.4% during burn treatment. A structural equation model indicated that the child burn victims' general health perceptions did not significantly affect their sleep habits (p > 0.05). A significant correlation was found between the children's posttraumatic stress disorder and their sleep habits (p < 0.05). Posttraumatic stress disorder explained 7.2% of their sleep habits. A positive and significant correlation was found between the children's general health perceptions and posttraumatic stress disorder (r = 0.74, p < 0.05). CONCLUSION Burns of any kind can cause posttraumatic stress, sleep disorders and impairment of health status in children.
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Affiliation(s)
- Mehmet Emin Düken
- Health Sciences of Facult, Department of Child Health and Diseases Nursing, Harran University, Şanlıurfa 63000, Turkey.
| | - Emriye Hilal Yayan
- Faculty of Nursing, Department of Child Health and Diseases Nursing, Inönü University, Malatya 44280, Turkey.
| | - Mürşide Zengin
- School of Health, Department of Child Health Nursing, Adıyaman University, Adıyaman 02000, Turkey.
| | - Tekcan Sevgi
- Department of Child Health ve Disease of Nursing, Adana Yuregir State Hospital-Child Health and Diseases Service, Adana, Turkey.
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13
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Al Zomia AS, Alqarni MM, Alaskari AA, Al Qaed A, Alqarni AM, Muqbil AM, Alshehri DM, Lahiq LA, Alhifthi MA, Alshahrani Y. Child Anxiety, Depression, and Post-traumatic Stress Disorder Following Orthopedic Trauma. Cureus 2023; 15:e42140. [PMID: 37602069 PMCID: PMC10438159 DOI: 10.7759/cureus.42140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Many children and adolescents are exposed to different types of trauma, e.g., abuse or various disasters. Trauma can cause severe and long-term impairment and consequences, the most studied of which are post-traumatic stress disorder (PTSD) and PTSD symptoms (PTSS). PTSD is highly prevalent in clinical practice (with a frequency of about 7%) and is a debilitating consequence of trauma. AIM The current study aimed to assess childhood injuries and their associated anxiety, depression, and post-traumatic stress disorder following orthopedic trauma. METHODS A descriptive cross-sectional study was conducted, including all pediatric patients with trauma at Abha Maternity and Children Hospital in the Seer region of Saudi Arabia, as well as pediatric patients with trauma at Abha Maternity and Children Hospital during the period from January 1, 2021 to December 31, 2022. Data were collected from the children's caregivers using a direct interview questionnaire to assess the children's personal data, depression, anxiety, and post-traumatic stress disorder. Children's trauma-related data were extracted from their medical records using a pre-structured data extraction sheet. RESULTS A total of 100 children with trauma were included. Children ranged in age from eight to 12 years, with a mean age of 7.3 ± 3.4 years. In all, 67 (67.0%) children were males, and only 6 (6.0%) had chronic health problems. The vast majority of the children with trauma had a low-severity experience of depression and anxiety following trauma (97.1% for each), and only one child had a high-severity experience of depression and anxiety. In all, 5 (4.9%) children with trauma experienced clinically significant PTSD, and the vast majority of them showed a low likelihood of the disorder. Multiple fractures and undergoing surgery were significant predictors of developing PTSD (P < 0.05). CONCLUSION In conclusion, the current study revealed that bone trauma was frequent among children, mainly due to playing accidents. Also, a low prevalence of post-traumatic stress disorders and their mental consequences was estimated.
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Affiliation(s)
- Ahmed S Al Zomia
- Department of Medicine and Surgery, King Khalid University, Abha, SAU
| | | | | | - Abdullah Al Qaed
- Department of Medicine and Surgery, King Khalid University, Abha, SAU
| | | | | | - Daher M Alshehri
- Department of Medicine and Surgery, King Khalid University, Abha, SAU
| | - Lama A Lahiq
- Department of Medicine and Surgery, King Khalid University, Abha, SAU
| | | | - Yazeed Alshahrani
- Department of Medicine and Surgery, King Khalid University, Abha, SAU
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14
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Woolard A, Wickens N, McGivern L, de Gouveia Belinelo P, Martin L, Wood F, Janse van Rensburg E, Milroy H. "I just get scared it's going to happen again": a qualitative study of the psychosocial impact of pediatric burns from the child's perspective. BMC Pediatr 2023; 23:280. [PMID: 37277713 DOI: 10.1186/s12887-023-04105-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Advances in medicine have improved the chances of survival following burn injuries, however, psychosocial outcomes have not seen the same improvement, and burn injuries can be distressing for both the child or young person, negatively affecting their wellbeing. Pediatric burn patients are at a higher risk of developing psychopathology compared to the general population. In order to promote resilience and prevent psychopathology post-burn injury for pediatric burn patients, it is crucial to understand the experience of children and young people after a burn. This study aimed to understand the psychosocial impact that a pediatric burn has as perceived by the pediatric burn patient. METHODS Seven pediatric burn patients were interviewed from the Perth Metropolitan area on average 3.1 years after their injury. All participants had been admitted to hospital for their acute injury and stayed for a median length of 2 days in hospital. Interviews with pediatric patients took place online, and the patients were asked about their mental health, coping strategies, changes to lifestyle and supports following their burn injury. The interviews were transcribed and then thematically analysed using an inductive approach. RESULTS Three overarching themes were developed from the interviews: burn-specific impact on the child or young person (including appearance concerns, family factors, and lifestyle factors), the psychological impact (including positive and negative impact on mental health), and factors supporting the recovery journey (including coping strategies and support services). The participants in our study highlighted issues they faced during recovery, the positive and negative impacts of the injury and recovery process and provided suggestions for future opportunities to bolster resilience and promote growth for pediatric burn patients who may face similar challenges in the future. CONCLUSION Factors that improve the mental health and wellbeing of pediatric burn patients should be promoted, such as mental health and social supports, the promotion of adaptive coping mechanisms, and meeting the needs of the family unit as a whole. Ultimately, the implementation of trauma-focused, family centred interventions is crucial for the psychosocial recovery of pediatric burn survivors.
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Affiliation(s)
- Alix Woolard
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia.
- The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Nicole Wickens
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
| | - Lisa McGivern
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
- The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | | | - Lisa Martin
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, WA, 6150, Australia
| | - Fiona Wood
- The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, WA, 6150, Australia
- Fiona Wood Foundation, 11 Robin Warren Drive, Murdoch, WA, 6150, Australia
| | | | - Helen Milroy
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
- The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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15
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Won P, Ding L, McMullen K, Yenikomshian HA. Post-Burn Psychosocial Outcomes in Pediatric Minority Patients in the United States: An Observational Cohort Burn Model System Study. EUROPEAN BURN JOURNAL 2023; 4:173-183. [PMID: 37359277 PMCID: PMC10290777 DOI: 10.3390/ebj4020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to date has investigated disparities in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This observational cohort study addresses this gap and examines seven psychosocial outcomes (levels of anger, sadness, depression, anxiety, fatigue, peer relationships, and pain) in pediatric burn patients. The BMS database is a national collection of burn patient outcomes from four centers in the United States. BMS outcomes collected were analyzed using multi-level, linear mixed effects regression modeling to examine associations between race/ethnicity and outcomes at discharge after index hospitalization, and 6- and 12-months post-injury. A total of 275 pediatric patients were included, of which 199 (72.3%) were Hispanic. After burn injury, of which the total body surface area was significantly associated with racial/ethnicity category (p < 0.01), minority patients more often reported higher levels of sadness, fatigue, and pain interference and lower levels of peer relationships compared to Non-Hispanic, White patients, although no significant differences existed. Black patients reported significantly increased sadness at six months (β = 9.31, p = 0.02) compared to discharge. Following burn injury, adult minority patients report significantly worse psychosocial outcomes than non-minority patients. However, these differences are less profound in pediatric populations. Further investigation is needed to understand why this change happens as individuals become adults.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Li Ding
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195-2100, USA
| | - Haig A. Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA 90033, USA
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16
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Leung KL, Yang JJ, Chen FR, Kim E, Gosman AA. Psychosocial Burden of Pediatric and Adult Patients With Congenital Versus Traumatic Facial Differences: Assessment of Psychiatric Distress and Healthcare Utilization in the United States From 2004 to 2012. Ann Plast Surg 2023; 90:S305-S311. [PMID: 36921336 DOI: 10.1097/sap.0000000000003401] [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: 03/17/2023]
Abstract
BACKGROUND Psychiatric distress and its effects on healthcare utilization in pediatric patients with congenital and traumatic facial differences remain poorly understood. This study analyzes the psychosocial burden along with mental health and reconstructive surgery services utilization of this patient population in comparison with adult patients with such facial differences. METHODS The 2004-2012 Medical Expenditures Panel Survey was queried for all patients with facial differences. Socioeconomic variables, Patient Health Questionnaire 2 and Kessler 6 scores, responses from validated screening surveys, and utilization of mental health and reconstructive surgery (ie, plastic surgery and otolaryngology) services were compared between pediatric and adult patients with congenital and traumatic facial differences. RESULTS Children ages 5 to 12 years were more likely to be affected by facial trauma, whereas adolescents aged 13 to 17 years were more affected by congenital facial conditions. Pediatric patients with congenital facial conditions had higher rates of medical care, education, and special therapy utilization ( P < 0.0001), although their facial trauma counterparts used mental health services more often ( P < 0.0001). In adults, more facial trauma patients reported poorer perceived mental health status ( P = 0.01). Among patients with any facial difference, distressed adult patients were less likely to see a reconstructive surgeon even when controlling for socioeconomic variables (0.55 [0.31-0.97], P = 0.04). CONCLUSIONS In the pediatric population, psychosocial considerations should include both age and etiology of facial differences to best optimize care. Among adults with facial trauma, poor mental health may contribute to lower rates of surgical follow-up, highlighting a potential benefit for provision of mental health services earlier for these patient populations.
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Affiliation(s)
- Karen L Leung
- From the Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA
| | - Jason J Yang
- From the Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA
| | - Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Erinn Kim
- From the Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA
| | - Amanda A Gosman
- From the Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA
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17
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Townsend AN, Batra N, Lilenfeld L, Maurin E, Inverso H, Burd RS, Tully CB. Parent Traumatic Stress After Minor Pediatric Burn Injury. J Burn Care Res 2023; 44:329-334. [PMID: 35452502 DOI: 10.1093/jbcr/irac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/15/2022]
Abstract
Parents are at increased risk for psychological sequelae following their child's burn injury which has demonstrated negative impacts on the child. The current study sought to address gaps in the literature on risk factors for parental distress by examining the relationships among demographic variables, burn characteristics, and child functioning after burn injury, with parent post-traumatic stress symptoms (PTSS). Participants included parents of 660 pediatric burn patients from a regional burn clinic. Parents completed measures during their initial visit to the burn clinic. Additional demographic and burn data were retrospectively collected by medical chart review. Fifteen percent of parents reported at-risk levels of parent PTSS. Parent PTSS was independently associated with child burn characteristics of total body surface area (TBSA) affected by the burn, required hospitalization, number of nights hospitalized, and number of ambulatory burn appointments attended. Minority race was associated with higher parent PTSS than non-minority race status, with Asian parents endorsing the highest scores. Furthermore, when considered simultaneously, impaired child quality of life (QOL), a higher number of ambulatory burn appointments attended, and racial minority status were associated with higher parent PTSS. These findings highlight the need for routine parent trauma screening in pediatric burn clinics, while additionally identifying a feasible screening measure.
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Affiliation(s)
- Allie N Townsend
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA.,The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Nikita Batra
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
| | - Lisa Lilenfeld
- The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Elana Maurin
- The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Hailey Inverso
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
| | - Randall S Burd
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA.,Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC 20020, USA
| | - Carrie B Tully
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
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18
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Wang Y, Wong FKY, Bayuo J, Chung LYF, Zhang L, Wang T. Challenges of nurses and family members of burn patients: Integrative review. Nurs Open 2023; 10:3547-3560. [PMID: 36840702 PMCID: PMC10170885 DOI: 10.1002/nop2.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 11/28/2022] [Accepted: 02/05/2023] [Indexed: 02/26/2023] Open
Abstract
AIMS To identify the challenges facing burn care nurses and burn patients' family members and to explore the relationship between the above challenges. DESIGN Whittemore and Knafl's integrative review. METHODS Databases used for this review included Cochrane Library, Web of Science, PubMed and Embase. The original research published from January 2010 to November 2021 was selected. Studies reporting the challenges of family members or nurses of burn patients identified through extensive database search were considered for inclusion. The Mixed-Method Appraisal-Tool was applied for the evaluation of the quality of the literature. The analysis approach used was content analysis. RESULTS Of the 2746 identified studies, 17 studies were included. Key findings related to the challenges facing nurses and family members of burn patients were extracted. The themes relating to burn care nurses included ethical and religious issues, clinical issues, work-life imbalance and limited support. The themes relating to family members included family's different views on prognosis and treatment, work-life imbalance, psychological issues and lack of multifaceted support. The challenges for the formal and informal caregivers are similar and there is existence of some shared concerns. If the above challenges are not resolved, support for the burn patients may be adversely affected. Corresponding measures should be taken to overcome such challenges.
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Affiliation(s)
- Yi Wang
- School of Nursing, Lanzhou University, Lanzhou, China
| | | | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Li Zhang
- Department of Burns, Gansu Provincial People's Hospital, Lanzhou, China
| | - Taotao Wang
- Department of Burns, Gansu Provincial People's Hospital, Lanzhou, China
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19
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Chen J, Zhang D, Zhang J, Wang Y. Pathological changes in the brain after peripheral burns. BURNS & TRAUMA 2023; 11:tkac061. [PMID: 36865685 PMCID: PMC9972189 DOI: 10.1093/burnst/tkac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/22/2022] [Indexed: 02/09/2023]
Abstract
Brain injuries are common complications in patients with thermal burns and are associated with unpleasant outcomes. In clinical settings, it was once believed that brain injuries were not major pathological processes after burn, at least in part due to the unavailability of specific clinical manifestations. Burn-related brain injuries have been studied for more than a century, but the underlying pathophysiology has not been completely clarified. This article reviews the pathological changes in the brain following peripheral burns at the anatomical, histological, cytological, molecular and cognitive levels. Therapeutic indications based on brain injury as well as future directions for research have been summarized and proposed.
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Affiliation(s)
- Jigang Chen
- Department of Burn and Plastic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Danfeng Zhang
- Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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20
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Kim SW. Response to Letter: Comments on Management of Keloid Scars: Noninvasive and Invasive Treatments. Arch Plast Surg 2023; 50:118. [PMID: 36755663 PMCID: PMC9902105 DOI: 10.1055/s-0042-1758642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea,Address for correspondence Sang Wha Kim Department of Plastic and Reconstructive SurgerySeoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080Korea
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21
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Tawfik AA, Ali RA. Evaluation of botulinum toxin type A for treating post burn hypertrophic scars and keloid in children: An intra-patient randomized controlled study. J Cosmet Dermatol 2023; 22:1256-1260. [PMID: 36718819 DOI: 10.1111/jocd.15634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Consequently, the management of post burn hypertrophic scars and keloid in children are a great challenge for the physicians, parents, and children themselves. PURPOSE OF THE STUDY To assess the efficacy and safety of treating hypertrophic and keloid scars with botulinum toxins injections. PATIENTS AND METHODS This is a randomized intra-patient comparative study was conducted on 15 children with post burn hypertrophic and keloid scars. Children were randomized to receive Intralesional injection of botulinum toxins on one part of the hypertrophic scar/keloid where the other part was left as a control. The assessment of clinical improvement was measured by the Vancouver scar scale (VSS) and by skin analysis camera system. Sessions were performed every month for 6 months. RESULTS Clinical and statistical dramatic improvement in the vascularity, pliability, and height of the lesions which have been injected with neuronox. Evaluation of the lesions by the Antera camera has proven marked changes in the vascularity and height. There was no correlations between Vancouver score improvement and variables such as the age, sex, skin type, and duration and lesion type. CONCLUSIONS The botulinum toxins proved its efficacy and safety in treatment of hypertrophic scars and keloid in children. It improved the associated itching and pain. Moreover it improves the pliability, erythema, and thickness of the scars.
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Affiliation(s)
- Abeer Attia Tawfik
- Nationonal Institute of Laser Enhanced Sciences Cairo University, Cairo University, Giza, Egypt
| | - Rama Ahmad Ali
- Kasar El Eni Faculty of Medicine, Cairo University, Giza, Egypt
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22
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Stewart S, Juang D, Aguayo P. Pediatric burn review. Semin Pediatr Surg 2022; 31:151217. [PMID: 36370620 DOI: 10.1016/j.sempedsurg.2022.151217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA.
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23
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Afzal N, Lyttle MD, Alisic E, Trickey D, Hiller RM, Halligan SL. Barriers to emergency department clinicians' confidence in providing paediatric trauma-informed care. JCPP ADVANCES 2022; 2:e12091. [PMID: 37431384 PMCID: PMC10242876 DOI: 10.1002/jcv2.12091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/22/2022] [Indexed: 11/09/2022] Open
Abstract
Background It has been estimated that around 31% of children will experience a traumatic event during childhood, most commonly serious accidents that lead to hospitalisation. Around 15% of children who experience such events go onto develop post-traumatic stress disorder. Emergency department (ED) clinicians have a unique opportunity to intervene during the early peri-trauma period, which can involve incorporating a trauma-informed approach within their care. The available evidence indicates that clinicians internationally need further education and training to enhance their knowledge and confidence in providing trauma-informed psychosocial care. However, UK/Ireland specific knowledge is limited. Methods The current study analysed the UK and Irish subset of data (N = 434) that was collected as part of an international survey of ED clinicians. Questionnaires indexed clinician confidence in providing psychosocial care, and a range of potential barriers to providing that care. Hierarchical linear regression was used to identify predictors of clinician confidence. Results Clinicians reported moderate levels of confidence in providing psychosocial care to injured children and families (M = 3.19, SD = 0.46). Regression analyses identified negative predictors of clinical confidence, including a lack of training, worrying about further upsetting children and parents, and low levels of perceived departmental performance in providing psychosocial care (R 2 = 0.389). Conclusions The findings highlight the need for further training in psychosocial care for ED clinicians. Future research must identify nationally relevant pathways to implement training programmes for clinicians, in order to improve their skills in relation to paediatric traumatic stress and to reduce the perception of barriers identified in the present study.
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Affiliation(s)
- Nimrah Afzal
- Department of PsychologyUniversity of BathBathUK
| | - Mark D. Lyttle
- Emergency DepartmentBristol Royal Hospital for ChildrenBristolUK
- Research in Emergency Care Avon Collaborative Hub (REACH)University of the West of EnglandBristolUK
| | - Eva Alisic
- Child and Community Wellbeing UnitMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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24
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Stanzel A, Sierau S. Pediatric Medical Traumatic Stress (PMTS) following Surgery in Childhood and Adolescence: a Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:795-809. [PMID: 35958723 PMCID: PMC9360277 DOI: 10.1007/s40653-021-00391-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 05/22/2023]
Abstract
UNLABELLED The purpose of the present review was to systematically review, synthesize and quantify prevalence rates of subclinical and clinical psychological symptoms in children and adolescents who have undergone surgery. Systematic literature searches were conducted twofold in April 8, 2020 and March 7, 2021 in PsycInfo and PubMed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Manuscripts were screened against eligibility criteria and were included if they investigated psychological symptoms in children or adolescents (age between 1 to 21 years at the time of study) who were hospitalized for pediatric surgery. Means and standard deviations weighted by sample size were calculated. Eleven articles met inclusion criteria. The review revealed that a small but substantial number of children and adolescents are at an elevated risk for postoperative psychological symptoms and disorders. Up to 13% had symptoms consistent with a diagnosis of a posttraumatic stress disorder, 6% to 8% exhibited elevated symptoms of depression or anxiety, and about 25% showed internalizing and externalizing symptoms. This review provides preliminary evidence that children and adolescents experience significant psychological distress and posttraumatic stress symptoms after pediatric surgery. Apart from better training of clinicians, prevention, early psychological screening and psychosocial care in surgical wards of hospitals are recommended. Well-designed studies of high methodological quality are necessary to replicate existing findings and provide a broader base of evidence. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00391-9.
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Affiliation(s)
- Anna Stanzel
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Leipzig, Germany
| | - Susan Sierau
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Leipzig, Germany
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
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The role of burn camp in the recovery of young people from burn injury: A qualitative study using long-term follow-up interviews with parents and participants. Burns 2022; 48:1139-1148. [PMID: 34607728 DOI: 10.1016/j.burns.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Children and adolescents recovering from burn injury are at heightened risk of psychosocial problems. An integrative form of psychosocial intervention is burn camp. However, evidence about burn camp effectiveness is equivocal. OBJECTIVES This study examined the role of therapeutic camp experiences in the recovery journeys of children and adolescents who had experienced burn injury and been treated in a tertiary pediatric hospital in Brisbane, Australia. METHODS Retrospective semi-structured interviews were conducted with youths and parents. Inductive reflexive thematic analysis was used with pooled interview data. RESULTS The participants were eight youths who attended at least one burns camp (between 2009 and 2019) and 15 parents of youth campers. An overwhelming majority (96%) reported a positive experience of camp, that they would return, and that they recommended the camp to other youth with burns. The four strengths of the camp experience were fun, adventurous activities; social relatedness (friendships, socializing); camp setting and experience; and acceptance. The four impacts of the camp on youth campers were normalizing ("I'm not the only one", shared experience); social support (making new friendships, social confidence, mentoring others); psychological recovery (happier, mentally stronger, more resilient, independence building); and confidence (increased self-confidence, increased social confidence, leadership development). CONCLUSIONS Although this is the first known research about burn camp in Australia, the findings are similar to a handful of other qualitative studies about burn camp experiences and impacts. Recommendations include future research on aspects of camp experiences that contribute to targeted outcomes, the role of staff and previous camp participants as mentors, and comparisons with other psychosocial interventions for youth burn survivors.
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Karahan S, Demir S, Tuncbilek Z, Cetintas N, Senel E. The cultural adaptation and validation of Turkish version of the satisfaction with appearance scale (SWAP-TR). Burns 2022; 49:914-923. [PMID: 35843805 DOI: 10.1016/j.burns.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022]
Abstract
AIM The aim of this study was to translate, culturally adapt and validate the Satisfaction with Appearance Scale (SWAP) into Turkish to be used in the context of pediatric burn care. METHOD This methodological study was conducted in two stages as Language Adaptation and Psychometric study. In the first stage, the Turkish scale was obtained after expert translations. A pilot study was conducted. After back-translation, and the scale was finalized. In the second stage, the scale was administered to 145 children with burns. Body Appreciation Scale for Children (BASC) was applied to the same group for correlation analysis with the scale. RESULTS A structure explaining 65.98 % of the total variance was obtained. Cronbach's alpha values in the range of 0.995-1000 were quite reliable. A statistically significant correlation was determined between the test and retest applications for all the items (0.99-1.00) in the positive direction (p < 0.001). There is a linear negative moderate correlation between BASC scores and the scores of the SWAP-TR scale (r = -0.621 p<0.001). The dissatisfaction scores of children with face, hand and leg burns are significantly higher than the other groups. CONCLUSIONS SWAP-TR is a reliable and valid instrument for use in a Turkish speaking children with burns. It is recommended to study the validity of this scale in other age groups with burns in Turkey.
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Affiliation(s)
- Sabri Karahan
- Surgical Nursing Department, Hacettepe University Faculty of Nursing, 06100 Ankara, Turkey; Surgical Nursing Department, Harran University Faculty of Health Science, 63100, Sanliurfa, Turkey.
| | - Sabri Demir
- Department of Pediatric Surgery, and Pediatric Burn Center Children Hospital, Ankara City Hospital, Bilkent, 06800 Ankara, Turkey.
| | - Zahide Tuncbilek
- Surgical Nursing Department, Hacettepe University Faculty of Nursing, 06100 Ankara, Turkey.
| | - Nuray Cetintas
- Department of Pediatric Burn Center Children Hospital, Ankara City Hospital, Bilkent, 06800 Ankara, Turkey.
| | - Emrah Senel
- Department of Pediatric Surgery, Medical Faculty, Ankara Yildirim Beyazit University, 06800 Ankara, Turkey.
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van Dalen M, Pasmans SGMA, Aendekerk EWC, Mathijssen IMJ, Koudstaal MJ, Williamson H, Hillegers MHJ, Utens EMWJ, Okkerse JME. Acceptability and feasibility of an online psychosocial intervention for Dutch adolescents with a visible difference: A mixed-methods study. Body Image 2022; 41:298-307. [PMID: 35378339 DOI: 10.1016/j.bodyim.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Adolescents with a visible difference can experience difficult social situations, (e.g., people staring or making unwanted comments) and are at risk for mental health problems. Unfortunately, interventions for adolescents with a visible difference experiencing appearance-related distress are scarce and lack an evidence-base. This study tests the acceptability and feasibility of YP Face IT, an innovative online psychological intervention using social skills training and cognitive behavioural therapy, to Dutch adolescents. Adolescents aged 12-17 with a visible difference and access to an internet-enabled computer or tablet participated. They completed YP Face IT (eight sessions) and questionnaires were administered pre- and post-intervention. After completing YP Face IT, participants were interviewed to assess the acceptability and feasibility of YP Face IT and study procedures. Overall, 15 adolescents consented to participation, one person dropped out after one session. Most adolescents appreciated the intervention and all would recommend it to other adolescents experiencing appearance-related distress. Everyone reported learning experiences after following the sessions. Some struggled with motivation, but reminders by the website and research team were helpful. The Dutch YP Face IT intervention may be acceptable and the current study design is feasible to use. An RCT should be conducted to assess the effectiveness of the intervention.
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Affiliation(s)
- M van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - E W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - H Williamson
- Department of Social Sciences, University of the West of England, United Kingdom
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, The Netherlands; Academic Center for Child Psychiatry Levvel/Department of Child and Adolescent Psychiatry, Academic University Medical Center, The Netherlands
| | - J M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands.
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Cuttle L, Fear M, Wood FM, Kimble RM, Holland AJA. Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:269-278. [PMID: 35051408 DOI: 10.1016/s2352-4642(21)00350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.
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Affiliation(s)
- Leila Cuttle
- Centre for Children's Health Research, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mark Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, South Brisbane, QLD, Australia; Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Andrew J A Holland
- The Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, The University of Sydney, NSW, Westmead, Australia
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Abstract
ABSTRACT In this article, we provide an overview of the literature on contributions of art making and medical art therapy for patients with burn injuries. The potential value of art therapy in addressing the complex physical and psychosocial needs of burn patients is discussed through examination of 7 peer-reviewed articles. Two case examples of burn survivors, 1 pediatric and 1 adult, are included to demonstrate the use of art therapy in an inpatient and outpatient setting, respectively. Art therapy and other intervention strategies for overall psychosocial adjustment of burn patients are often underutilized. Further research in art therapy is needed to examine the psychosocial aspects of burns patients and the potential role that medical art therapy may have in a burn care center.
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Affiliation(s)
- Bani Malhotra
- From the Creative Arts Therapies Department, Drexel University, Philadelphia, PA
| | - Susan A Anand
- University of Mississippi Medical Center, Jackson, MS
| | - Girija Kaimal
- From the Creative Arts Therapies Department, Drexel University, Philadelphia, PA
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Patel KF, Rodríguez-Mercedes SL, Grant GG, Rencken CA, Kinney EM, Austen A, Hou C, Brady KJS, Schneider JC, Kazis LE, Ryan CM. Physical, Psychological, and Social Outcomes in Pediatric Burn Survivors Ages 5 to 18 Years: A Systematic Review. J Burn Care Res 2022; 43:343-352. [PMID: 34922361 PMCID: PMC9272085 DOI: 10.1093/jbcr/irab225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Acute pediatric burn injuries often result in chronic sequelae that affect physical, psychological, and social outcomes. To date, no review has comprehensively reported on the impact of burn injuries across all three domains in school-aged children. The aim of this systematic review was to identify published literature that focuses on the impact of burn injuries on physical, psychological, or social functioning, and report upon the nature of study characteristics and their outcomes. We included literature published after 1980, focusing on burn outcomes in children aged 5 to 18 years. Each eligible study was systematically reviewed and primary outcomes were classified into outcome domains based on existing frameworks. Fifty-eight studies met inclusion criteria, and reported on physical (n = 24), psychological (n = 47), and social (n = 29) domains. The majority of the studies had sample sizes of <100 participants, burn size of <40%, and findings reported by parents and/or burn survivors. Only eight of 107 different measures were used in three or more studies. Parents and burn survivors generally reported better physical and social outcomes and worse psychological functioning compared to non-burn populations. Physical disabilities were associated with psychological and social functioning in several studies. Follow-up data reported improvements across domains. This review demonstrates the importance of physical, psychological, and social status as long-term outcomes in burn survivors. Mixed findings across three outcome domains warrant long-term research. Findings of this review will guide the foundation of comprehensive burn and age-specific instruments to assess burn recovery.
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Affiliation(s)
- Khushbu F. Patel
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | | | | | - Camerin A. Rencken
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Erin M. Kinney
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Amelia Austen
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Carina Hou
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Keri J. S. Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen M. Ryan
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Shriners Hospitals for Children – Boston®, Massachusetts, USA
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Thompson DM, Thomas C, Hyde L, Wilson Y, Moiemen N, Mathers J. At home parent-administered dressing changes in paediatric burns aftercare: Interviews on parents' experiences of treatment. Burns 2022; 48:355-364. [PMID: 34844814 DOI: 10.1016/j.burns.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Paediatric burn injuries present physical and psychosocial effects for children and their parents, including disruption to family life. Some burns services in the UK enable parents to administer dressing changes at home to reduce the number of hospital visits. To date, there is no research on parents' experiences of administering dressing changes. The aim of this study was to describe parents' experiences of administering dressing changes in paediatric burns aftercare. METHODS Semi-structured research interviews were conducted with a purposive sample of parents recruited from a paediatric burns centre in the UK. The interview addressed the initial offer of at-home dressing changes by clinicians; parental decision-making in relation to dressing changes; training and support received; and the experience of administering dressing changes, including practical and emotional considerations. Thematic analysis of the data was informed by the framework approach, including associative analysis using demographic and clinical characteristics. RESULTS Seventeen participants were interviewed. Three themes of parents' experiences of administering dressing changes were identified including (1) Parental Identity concerning the newly undertaken responsibility and the impact on the parental role; (2) Challenges, physical or emotional, confronted or lessened by administering dressing changes; and (3) Reassurance provided by healthcare professionals and others to support parents to adopt and maintain parent-administered dressing changes. CONCLUSION The qualitative data reported here indicates that parents want to be involved in their child's care by administering dressing changes at home, provided they receive sufficient reassurance that they are able to manage the severity of their child's burn. Parents' concerns about the effectiveness of their dressing changes lacks empirical basis, and this study provides preliminary data to support the development and evaluation of best practice guidance for parent-administered dressing changes in paediatric burns aftercare.
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Affiliation(s)
- Dean M Thompson
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Clare Thomas
- Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Lisa Hyde
- Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Yvonne Wilson
- Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Naiem Moiemen
- Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital, University Hospitals Birmingham Foundation Trust, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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Thompson DM, Thomas C, Hyde L, Wilson Y, Moiemen N, Mathers J. At home parent-administered dressing changes in paediatric burns aftercare: A survey of burns centres?" practice. Burns 2022; 48:365-371. [PMID: 34716046 DOI: 10.1016/j.burns.2021.03.012] [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: 09/01/2020] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Following paediatric burn injury, dressings are initially changed in outpatient clinics, necessitating regular visits with substantial burden for parents, children and services. This can potentially be lessened if some parents go on to administer dressing changes for their child at home. However, a lack of data regarding support for parent-administered dressing changes is present. The aim of this study was to describe current practice and views regarding at-home parent-administered dressing changes (PAD) in the UK. METHODS An online survey was distributed to 20 paediatric burns services in England and Wales. The survey used fixed and free-text responses to collect data on whether PAD is offered and the reasons for this; patient and parent eligibility criteria; training and support; and respondents?" views on the advantages and disadvantages of PAD. Analysis comprised simple descriptive statistics and simple content analysis of free-text responses. RESULTS Thirteen responses were received (response rate = 65%). Eleven respondents indicated their service offers PAD. Two respondents reported their service does not offer PAD due to alternative nurse outreach appointments (n = 1), and service resource limitations (n = 1), though another respondent indicated service cost savings. Twelve respondents regard PAD positively (n = 8) or very positively (n = 4). Most respondents reported that 10% or fewer parents refuse PAD when offered (n = 7). Perceived advantages of PAD included reduced travel burden (n = 9), patient better able to cope with dressing changes (n = 8), better school and work attendance for child and parent respectively (n = 6), and reduced financial impact on families (n = 4). No formal eligibility criteria for PAD are extant, though 5 respondents described informal criteria in place in their service, predominantly involving dressing frequency (n = 5), and size or complexity of wound (n = 4). CONCLUSION The survey indicates that most paediatric burns services support PAD. However, the absence of formal eligibility criteria, and informal criteria open to interpretation, risks inequity of support received by children and their families. Further research should evaluate whether this inequity extends to variable clinical outcomes to determine what works for who and under what circumstances when supporting parents in paediatric burns aftercare.
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Affiliation(s)
- Dean M Thompson
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Clare Thomas
- Birmingham Children?"s Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Lisa Hyde
- Birmingham Children?"s Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Yvonne Wilson
- Birmingham Children?"s Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Naiem Moiemen
- Birmingham Children?"s Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital, University Hospitals Birmingham Foundation Trust, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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Kheradmand M, Shoghi M, Zand Aghtaii M. The effect of the active and passive distraction techniques on the burn children's pain intensity and anxiety during dressing changes. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2022. [DOI: 10.4103/jnms.jnms_139_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Snider MDH, Young S, Enlow PT, Ahrabi-Nejad C, Aballay AM, Duncan CL. Coping in Pediatric Burn Survivors and Its Relation to Social Functioning and Self-Concept. Front Psychol 2021; 12:695369. [PMID: 34955941 PMCID: PMC8695557 DOI: 10.3389/fpsyg.2021.695369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
Pediatric burn survivors experience increased risk for bullying, stigmatization, body image concerns, and problematic social functioning. Although coping behaviors are associated with engagement in social supports and positive self-concept in multiple pediatric illness populations, their relation has not been examined in pediatric burns. This study examined coping in relation to social functioning and self-concept in 51 pediatric burn survivors aged 7–17years (M=12.54; SD=2.65). Survivors and their caregivers completed the Child Coping Strategies Checklist (CCSC; youth report); the Burn Injury Social Questionnaire (BISQ; parent and youth report); and the Piers-Harris Children’s Self-Concept Scale-2 (PH-2; youth report). Associations between coping, social functioning, self-concept, demographic features, and burn injury characteristics were examined via bivariate correlations. Hierarchical linear regressions examined whether coping strategies predicted social functioning and youth self-concept beyond burn injury and demographic variables. Social functioning concerns were positively correlated with total body surface area (TBSA; r=0.63 and 0.40, respectively). TBSA was the only significant predictor of parent-reported social concerns (β=0.65, p<0.001). Greater distraction coping predicted fewer youth-reported social concerns (β=−0.39, p=0.01). Greater active coping (B=0.67, p=0.002) and lower avoidance coping (B=−0.36, p=0.03) predicted better youth-reported self-concept. This study advances our understanding of coping as potentially protective for psychosocial adjustment. Clinicians working with child burn survivors should incorporate active coping interventions into treatment. Further research including larger and more diverse samples is needed to understand the role of coping approaches on psychological adjustment during burn healing.
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Affiliation(s)
- Mira D H Snider
- Department of Psychology, West Virginia University, Morgantown, WV, United States.,Department of Surgery, Burn Trauma Center, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, United States
| | - Sarah Young
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Paul T Enlow
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, United States.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Corrine Ahrabi-Nejad
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Ariel M Aballay
- Department of Surgery, Burn Trauma Center, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, United States
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV, United States.,Department of Surgery, Burn Trauma Center, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, United States
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Woolard A, Hill NTM, McQueen M, Martin L, Milroy H, Wood FM, Bullman I, Lin A. The psychological impact of paediatric burn injuries: a systematic review. BMC Public Health 2021; 21:2281. [PMID: 34906121 PMCID: PMC8670283 DOI: 10.1186/s12889-021-12296-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury. DESIGN Systematic review of quantitative and qualitative studies. DATA SOURCES Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020. DATA EXTRACTION AND SYNTHESIS Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies. RESULTS Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality. CONCLUSIONS Our findings highlight paediatric burn patients as a particularly vulnerable population following a burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed. Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.
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Affiliation(s)
- Alix Woolard
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia.
- The University of Western Australia, Perth, Australia.
| | - Nicole T M Hill
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
| | - Matthew McQueen
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
| | - Lisa Martin
- Fiona Wood Foundation, Perth, Australia; Child and Adolescent Health Service, Perth Children's Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Helen Milroy
- The University of Western Australia, Perth, Australia
| | | | - Indijah Bullman
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
- The University of Western Australia, Perth, Australia
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Lernevall LST, Moi AL, Gjengedal E, Dreyer P. Parents' lived experiences of parental needs for support at a burn centre. Int J Qual Stud Health Well-being 2021; 16:1855749. [PMID: 33427115 PMCID: PMC7808374 DOI: 10.1080/17482631.2020.1855749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: A burn injury to a child is a traumatic event and the parent's emotional reactions and coping strategies affect the child's adaptive outcome. It is therefore important that parents get the right support. The aim was to explore parents' lived experiences of their need for support when having a child admitted to a burn centre. Methods: Semi-structured face-to-face interviews were conducted with 22 parents of children age <12 years hospitalised with an accidental burn injury, 9 to 27 days after the burn accident, from April 2017 to July 2018. A Ricoeur-inspired textual analysis method was used. Results: Four themes emerged from the analysis and describe the parents' needs for support. The parents wanted to be taken care of as a whole family and feel safe in the hands of professionals. This, in turn, depended on being informed about the child's condition and treatment, but also on getting help in dealing with feelings of guilt. Not least, parents wanted opportunities to take care of their own fundamental needs in terms of hygiene, food, adequate rest and activities. Conclusion: As an overall understanding the healthcare providers should focus on the family as a whole in care and treatment.
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Affiliation(s)
- Lina S. T Lernevall
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - A. L. Moi
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - E. Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - P. Dreyer
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Public Health, Section of Nursing, Aarhus University, Aarhus C, Denmark
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Malhotra B, Kaimal G. Art therapy in pediatric burn care: A conceptual framework for clinical practice. Burns 2021; 48:1753-1761. [PMID: 34952737 DOI: 10.1016/j.burns.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 01/04/2023]
Abstract
Burn injuries are an unexpected traumatic event and can be physically and emotionally devastating for a child and their families. This article presents a conceptual framework for art therapy practice with pediatric burns, founded on the three stages of burn treatment- critical, acute, and rehabilitation. The framework is based on narrative synthesis of research on the psychosocial needs of children with burn injuries, art therapy literature on pediatric burn patients, as well as in medical settings. Based on the stages of burn recovery, and the role of other relevant stakeholders, the framework provides recommendations for clinical practice of art therapy with children sustaining burn injuries, their caregivers and siblings, and healthcare providers. Robust studies including art therapy as interventions are recommended to determine their effectiveness in addressing the specific psychosocial needs in different stages of pediatric burn care.
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Affiliation(s)
- Bani Malhotra
- Creative Arts Therapies Department, Drexel University, Philadelphia, PA, USA.
| | - Girija Kaimal
- Creative Arts Therapies Department, Drexel University, Philadelphia, PA, USA
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Frestadius A, Grehn F, Kildal M, Huss F, Fredén F. Intranasal dexmedetomidine and rectal ketamine for young children undergoing burn wound procedures. Burns 2021; 48:1445-1451. [PMID: 34895793 DOI: 10.1016/j.burns.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Safe and effective methods for sedation and analgesia in pediatric burn patients are strongly warranted. This retrospective study of electronic health care records aims to evaluate the safety and efficacy of intranasal dexmedetomidine combined with rectal ketamine as procedural sedation for young children undergoing dressing changes and debridement of burn wounds. METHODS Documentation was analyzed from 90 procedures in 58 pediatric patients aged <5 years. Safety and efficacy of the method were assessed based on documentation for complications, adverse effects, pain level, level of sedation and preoperative and recovery time. RESULTS All 90 sedations were completed without significant adverse events with acute airway management or medical intervention. The combination of dexmedetomidine-ketamine produced acceptable analgesia during the procedure and effectively relieved postoperative pain. However, the approach was insufficient for 7/58 patients (7.8%); these patients were converted from the dexmedetomidine-ketamine combination to intravenous anesthesia. In 23% of the cases an extra dose of either ketamine of dexmedetomidine was administered. Moreover, there were two cases of delayed awakening with recovery time >120 min. CONCLUSION The drug combination intranasal dexmedetomidine and rectal ketamine is a safe and reliable approach for procedural sedation and analgesia in pediatric patients undergoing burn wound procedures, producing a clinically stable sedative condition requiring only basic monitoring.
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Affiliation(s)
- Andrea Frestadius
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden.
| | - Filip Grehn
- Vrinnevi County Hospital, 601 82 Norrköping, Sweden.
| | - Morten Kildal
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences, Plastic Surgery, Uppsala University, 752 36 Uppsala, Sweden.
| | - Fredrik Huss
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences, Plastic Surgery, Uppsala University, 752 36 Uppsala, Sweden.
| | - Filip Fredén
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, 752 36 Uppsala, Sweden.
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Tan T, Ko W, Chan P, Tse DA, Chiu T. Epidemiology of paediatric burns in a tertiary centre in Hong Kong: A 10‐year review. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Teresa Tan
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Prince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong
| | - Wai‐shan Ko
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Prince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong
| | - Po‐ling Chan
- Department of Otorhinolaryngology, Head & Neck Surgery Prince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong
| | - Darryl Andrew Tse
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Prince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong
| | - Tor‐wo Chiu
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Prince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong
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Batra N, Colson CD, Alberto EC, Burd RS. Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study. JMIR Form Res 2021; 5:e23242. [PMID: 34264194 PMCID: PMC8323015 DOI: 10.2196/23242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/12/2020] [Accepted: 05/17/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain. OBJECTIVE This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention. METHODS Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays. RESULTS We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P<.001). CONCLUSIONS Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message.
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Affiliation(s)
- Nikita Batra
- Children's National Hospital, Washington, DC, United States
| | - Cindy D Colson
- Children's National Hospital, Washington, DC, United States
| | | | - Randall S Burd
- Children's National Hospital, Washington, DC, United States
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Bhatti DS, Khan MAAK, Rodriguez DU, Cadogan J, Burge T. Paediatric Burns From Deployment of a Concealed Aviation Seatbelt Airbag. Cureus 2021; 13:e15824. [PMID: 34306888 PMCID: PMC8296360 DOI: 10.7759/cureus.15824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 11/12/2022] Open
Abstract
The advantages of airbags in reducing the rate of severe injuries and fatalities in motor vehicle crashes are well known but the physical act of airbag deployment can lead to injury to the passenger and the spectrum of airbag trauma resulting from deployment of vehicle airbags has been extensively reported. We present the first reported case of a pediatric burn injury resulting from the accidental deployment of an airbag in an aircraft. A four-year-old female child sustained injuries to the left side of her face and body while she was aboard a stationary airplane and the airbag concealed within the seat belt of her airplane seat unexpectedly and inexplicably deployed just before departure. We are presenting the case to increase awareness of the possibility of this injury in aircraft and to enable minimization of such accidents as well as help establish protocols for dealing with such mishaps if there were to happen.
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Affiliation(s)
| | | | | | - Julia Cadogan
- Paediatric Burns Service, Frenchay Hospital (North Bristol NHS Trust), Bristol, GBR
| | - Timothy Burge
- Plastic and Burns Surgery, Frenchay Hospital (North Bristol NHS Trust), Bristol, GBR
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Abstract
Severely burned patients suffer from a hypermetabolic syndrome that can last for years after the injury has resolved. The underlying cause of these metabolic alterations most likely involves the persistent elevated catecholamine levels that follow the surge induced by thermal injury. At the cellular level, endoplasmic reticulum (ER) stress in metabolic tissues is a hallmark observed in patients following burn injury and is associated with several detrimental effects. Therefore, ER stress could be the underlying cellular mechanism of persistent hypermetabolism in burned patients. Here, we show that catecholamines induce ER stress and that adreno-receptor blockers reduce stress responses in the HepG2 hepatocyte cell line. Our results also indicate that norepinephrine (NE) significantly induces ER stress in HepG2 cells and 3T3L1 mouse adipocytes. Furthermore, we demonstrate that the alpha-1 blocker, prazosin, and beta blocker, propranolol, block ER stress induced by NE. We also show that the effects of catecholamines in inducing ER stress are cell type-specific, as NE treatment failed to evoke ER stress in human fibroblasts. Thus, these findings reveal the mechanisms used by catecholamines to alter metabolism and suggest inhibition of the receptors utilized by these agents should be further explored as a potential target for the treatment of ER stress-mediated disease.
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43
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Management of keloid scars: noninvasive and invasive treatments. Arch Plast Surg 2021; 48:149-157. [PMID: 33765731 PMCID: PMC8007468 DOI: 10.5999/aps.2020.01914] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/11/2021] [Indexed: 12/11/2022] Open
Abstract
Scars vary from mature linear scars to abnormal excessive scars such as hypertrophic scars and keloid scars. Keloid scars are fibro-proliferative disease entities that reflect an abnormal process of wound healing. They can cause pain, itching, stiffness, and psychological distress, all of which can affect quality of life. Various treatment options have been advocated as ways to prevent and treat keloid scars. These include noninvasive treatments such as use of silicone gel sheeting and compression therapy, and invasive treatments such as intralesional corticosteroid injections, surgery, and radiotherapy. Novel treatments include chemotherapy, immunotherapy, and anti-inflammatory therapies. Unfortunately, keloids continue to pose a significant challenge due to the lack of efficacious treatments. Therefore, clinicians should be familiar with various therapeutic options and apply the most suitable treatment plan for patients. In this review, we introduce the current therapeutic options for the management of keloid scars.
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van Dalen M, Pasmans SGMA, Aendekerk ML, Mathijssen I, Koudstaal M, Timman R, Williamson H, Hillegers M, Utens EMWJ, Okkerse J. Investigating online psychological treatment for adolescents with a visible difference in the Dutch YP Face IT study: protocol of a randomised controlled trial. BMJ Open 2021; 11:e041449. [PMID: 33483443 PMCID: PMC7831738 DOI: 10.1136/bmjopen-2020-041449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This paper outlines the study protocol for the Dutch Young People (YP) Face IT Study. Adolescents with a visible difference (ie, disfigurement) often experience challenging social situations such as being stared at, receiving unwanted questions or being teased. As a consequence, some of these adolescents experience adverse psychosocial outcomes and appearance-related distress. To address this appearance-related distress, an online psychotherapeutic intervention, YP Face IT, has been developed. YP Face IT uses social interaction skills training and cognitive-behavioural therapy. The Dutch YP Face IT Study tests whether this intervention is effective in reducing social anxiety and improving body esteem. METHODS AND ANALYSIS Participants are adolescents aged 12-18 with a visible difference and experiencing appearance-related distress. In this two-armed randomised controlled trial, 224 adolescents will be randomised to care as usual or YP Face IT. Adolescents will complete questionnaires at baseline, at 13 weeks and at 25 weeks. Primary outcomes are differences in social anxiety and body esteem between YP Face IT and care as usual. Secondary outcomes are differences in aspects of self-worth, perceived stigmatisation, health-related quality of life, life engagement, appearance-related distress and depressive symptoms between the two groups. ETHICS AND DISSEMINATION Research ethics approval was obtained from the medical ethics review committee in Rotterdam (reference number MEC-2018-052/NL63955.078.18). Findings will be disseminated through academic peer-reviewed publications, conferences and newsletters to patient associations and participants of the study. TRIAL REGISTRATION NUMBER The Netherlands Trial Register (NL7626).
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Affiliation(s)
- Marije van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Centre of Pediatric Dermatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Marie-Louise Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Irene Mathijssen
- Department of Plastic and Reconstructive and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia-Children's Hospital, Rotterdam, Netherlands
| | - Maarten Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Reinier Timman
- Department of Psychiatry, unit of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
| | - Heidi Williamson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Child Psychiatry Levvel/Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jolanda Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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Seivert NP, Sommerhalder M, Stewart D, Ziegfeld S, Ostrander R, Reynolds EK, Parrish C. Routine Psychological Screening for Parent Depressive Symptoms in an Outpatient Pediatric Specialty Burn Clinic. J Burn Care Res 2020; 40:947-952. [PMID: 31304969 DOI: 10.1093/jbcr/irz130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pediatric burn injuries are stressful for parents, yet few burn clinics report screening caregivers. We evaluated psychometric properties of a two-item depression screener administered to parents of children with burns during outpatient clinic visits. We also examined associations between parent depression symptoms and child characteristics. We used a retrospective review of pediatric patients with burn injuries (n = 496, age range: 0-21 years; M = 5.0 years, SD = 4.4 years) from an outpatient specialty burn clinic. Sample was 54.8% male; ethnicity was 42.4% Black/African American and 42.2% White. Most children (94.7%) had a burn TBSA of 10% or less and partial thickness burns (87%). Depression measure was administered at two time points as part of routine care: T1 (n = 496) and T2 (n = 121). Score range was 0 to 8. The means were 1.17 (SD = 1.74) at T1 and 0.81 (SD = 1.40) at T2. The majority scored ≤3 (89.9% caregivers) at T1. The measure demonstrated satisfactory internal consistency at T1 (Cronbach α = .74) and T2 (α = .82). Scores at T1 and T2 for a subsample (n = 121) were related (r = .61, p < .001). Parents of non-White children tended to report higher depression scores at T1. At T2, being female and greater burn degree were associated with higher depression scores. This brief two-item scale used with caregivers of pediatric burn patients is a reasonable method for screening parental depression in this setting. Given the association between parental depression and child characteristics, further studies are needed, including examination of predictive validity of parental depression with pediatric outcomes.
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Affiliation(s)
- Nicholas P Seivert
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mackenzie Sommerhalder
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dylan Stewart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Ziegfeld
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rick Ostrander
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth K Reynolds
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carisa Parrish
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Brown EA, Egberts M, Wardhani R, De Young A, Kimble R, Griffin B, Storey K, Kenardy J. Parent and Clinician Communication During Paediatric Burn Wound Care: A Qualitative Study. J Pediatr Nurs 2020; 55:147-154. [PMID: 32950822 DOI: 10.1016/j.pedn.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To thematically describe parent-clinician communication during a child's first burn dressing change following emergency department presentation. DESIGN AND METHODS An observational study of parent-clinician communication during the first burn dressing change at a tertiary children's hospital. Verbal communication between those present at the dressing change for 87 families, was audio recorded. The recordings were transcribed verbatim and transcripts were analysed within NVivo11 qualitative data analysis software using qualitative content analysis. FINDINGS Three themes, underpinned by parent-clinician rapport-building, were identified. Firstly, knowledge sharing was demonstrated: Clinicians frequently informed the parent about the state of the child's wound, what the procedure will involve, and need for future treatment. Comparatively, parents informed the clinician about their child's temperament and coping since the accident. Secondly, child procedural distress management was discussed: Clinicians and parents had expectations about the likelihood of procedural distress, which was also related to communication about how to prevent and interpret procedural distress (i.e., pain/fear). Finally, parents communicated to clinicians about their own distress, worry and uncertainty, from the accident and wound care. Parents also communicated guilt and blame in relation to injury responsibility. CONCLUSIONS This study provides a description of parent-clinician communication during paediatric burn wound care. PRACTICAL IMPLICATIONS The results can assist healthcare professionals to be prepared for a range of conversations with parents during potentially distressing paediatric medical procedures.
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Affiliation(s)
- Erin A Brown
- Centre for Children's Burns and Trauma Research, The University of Queensland, QLD, Australia; School of Psychology, University of Queensland, The University of Queensland, QLD, Australia.
| | - Marthe Egberts
- Association of Dutch Burn Centres, Beverwijk, the Netherlands; Department of Clinical Psychology, Utrecht University, the Netherlands.
| | - Rachmania Wardhani
- School of Psychology, University of Queensland, The University of Queensland, QLD, Australia.
| | - Alexandra De Young
- Centre for Children's Burns and Trauma Research, The University of Queensland, QLD, Australia; School of Psychology, University of Queensland, The University of Queensland, QLD, Australia.
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, QLD, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Queensland Health, QLD, Australia.
| | | | - Kristen Storey
- Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Queensland Health, QLD, Australia.
| | - Justin Kenardy
- School of Psychology, University of Queensland, The University of Queensland, QLD, Australia.
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Palmor Haspel S, Benyamini Y, Ginzburg K. Transactional Model of Parental Adjustment and Caregiving Burden Following a Children's Acquired Disability. J Pediatr Psychol 2020; 45:1177-1187. [PMID: 33094315 DOI: 10.1093/jpepsy/jsaa075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pediatric-acquired disability is often a crossroads in the lives of children and their parents, as they set out to adjust to a new physical impairment. This longitudinal study examined associations between the severity of children's-acquired disability, their parents' caregiver burden and adjustment, and parents' perception of the children's adjustment over time. METHODS Participants were parents and medical staff of 140 children with acquired disability, aged 1-18, hospitalized in pediatric or rehabilitation departments. Data were collected about 1 month after diagnosis (T1) and about 4 months later (T2). Parents completed background information, caregiver burden, child, and parental adjustment questionnaires. Medical staff contributed the disability severity indices. RESULTS The severity of the child's disability was negatively associated with parents' adjustment and perception of the child's adjustment. Caregiver burden was positively associated with the severity of the disability, and negatively with parents' adjustment and perception of their child's adjustment, at both time points. Over time, the severity of the disability and caregiver burden decreased, and parents' adjustment and perception of the child's adjustment improved. At T2, parents' and children's adjustment were strongly associated. CONCLUSIONS The findings revealed the relationship between objective severity indices and caregiver burden. They suggest that parents' adjustment may affect their perception of the child's adjustment to disability, and emphasize the role of parental perceptions over time. Therefore, parents who are less likely to adjust effectively should be identified early on to facilitate professional intervention.
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Affiliation(s)
- Shoshi Palmor Haspel
- Shaare Zedek University Medical Center, Jerusalem.,Department of Special Education in the Herzog Academic College, Jerusalem.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
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48
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Tsiampouris I, Charcharidou M, Dousis E, Oikonomidi N, Makrygianni P, Vasilopoulos G, Castana O, Koutelekos I. Investigating the Six-Month Incidence Rate of Burn Disease in Children in Greece. Cureus 2020; 12:e11192. [PMID: 33269123 PMCID: PMC7703708 DOI: 10.7759/cureus.11192] [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] [Indexed: 11/30/2022] Open
Abstract
Introduction Burns in children are painful, can be fatal, and involve a significant risk of complications, along with physical and psychological consequences. This study aimed to investigate the incidence of burns in children, for six months, and the most common causative factors, along with the existing correlations between demographic data and the characteristics of burn injuries. Methods The study was descriptive and prospective, and the sample consisted of minors up to 14 years old with burns in any areas of the body. The research was carried out in the Attica pediatric hospitals’ selected departments for six months (from July to December 2018). Sources for completing the created database were the patients, their guardians, and their medical-nursing documentation and records. Results The cumulative six-month incidence rate of childhood burn disease was 4.9%. The most affected age group appeared to be younger than two years (60%), while liquid heat appeared to be the primary form of the burn factor (76%). The average duration of hospitalization for children with a deep partial-thickness to a total-thickness burn degree was 16.5 days. The correlations that emerged related to the extent of the burn were directly related to the accident’s site, and patients with an increased likelihood of future additional surgeries had an increased mean total body surface area that was burned. Conclusion Continuous surveillance and removal of hazardous materials from the home environment is of utmost need. Early education/understanding of correct behaviors and proper attention to outdoor activities or excursions can significantly reduce burns. Training courses on burn prevention for parents are needed, as the best form of treatment is prevention.
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Affiliation(s)
| | | | | | | | | | | | - Ourania Castana
- Plastic and Reconstructive Surgery, Evangelismos General Hospital, Athens, GRC
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Cowley LE, Bennett CV, Brown I, Emond A, Kemp AM. Mixed-methods process evaluation of SafeTea: a multimedia campaign to prevent hot drink scalds in young children and promote burn first aid. Inj Prev 2020; 27:419-427. [PMID: 33093127 PMCID: PMC8461408 DOI: 10.1136/injuryprev-2020-043909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 11/07/2022]
Abstract
Objectives SafeTea is a multifaceted intervention delivered by community practitioners to prevent hot drink scalds to young children and improve parents’ knowledge of appropriate burn first aid. We adapted SafeTea for a national multimedia campaign, and present a mixed-methods process evaluation of the campaign. Methods We used social media, a website hosting downloadable materials and media publicity to disseminate key messages to parents/caregivers of young children and professionals working with these families across the UK. The SafeTea campaign was launched on National Burns Awareness Day (NBAD), October 2019, and ran for 3 months. Process evaluation measurements included social media metrics, Google Analytics, and quantitative and qualitative results from a survey of professionals who requested hard copies of the materials via the website. Results Findings were summarised under four themes: ‘reach’, ‘engagement’, ‘acceptability’ and ‘impact/behavioural change’. The launch on NBAD generated widespread publicity. The campaign reached a greater number of the target audience than anticipated, with over 400 000 views of the SafeTea educational videos. Parents and professionals engaged with SafeTea and expressed positive opinions of the campaign and materials. SafeTea encouraged parents to consider how to change their behaviours to minimise the risks associated with hot drinks. Reach and engagement steadily declined after the first month due to reduced publicity and social media promotion. Conclusion The SafeTea campaign was successful in terms of reach and engagement. The launch on NBAD was essential for generating media interest. Future campaigns could be shorter, with more funding for additional social media content and promotion.
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Affiliation(s)
| | - C Verity Bennett
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Alan Emond
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Alison Mary Kemp
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Al-Shaqsi S, Al-Busaidi S, Al-Kashmiri A, Hashish AM, Mheisin A, Al-Barashdi J. Beyond skin deep: understanding the physical and psychological sufferings of burn survivors in the Sultanate of Oman. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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