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Mondor E, Barnabe J, Laguan EMR, Malic C. Virtual burn care - Friend or foe? A systematic review. Burns 2024; 50:1372-1388. [PMID: 38490837 DOI: 10.1016/j.burns.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/16/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Evidence on the impact of virtual care for patients with burn injuries is variable. This review aims to evaluate its use in remote assessment, rounding, and follow-up through outcomes of efficacy, usability, costs, satisfaction, clinical outcomes, impacts on triage and other benefits/drawbacks. METHODS A PRISMA-compliant qualitative systematic review (PROSPERO CRD42021267787) was conducted in four databases and the grey literature for primary research published between 01/01/2010 and 12/31/2020. Study quality was appraised using three established tools. Evidence was graded by the Oxford classification. RESULTS The search provided 481 studies, of which 37 were included. Most studies (n = 30, 81%) were Oxford Level 4 (low-level descriptive/observational) designs and had low appraised risk-of-bias (n = 20, 54%). Most applications were for the acute phase (n = 26, 70%). High patient compliance, enhanced specialist access, and new educational/networking opportunities were beneficial. Concerns pertained to IT/connection, virtual communication barriers, privacy/data-security and logistical/language considerations. Low-to-moderate-level (Oxford Grade C) evidence supported virtual burn care's cost-effectiveness, ability to improve patient assessment and triage, and efficiency/effectiveness for remote routine follow-up. CONCLUSION We find growing evidence that virtual burn care has a place in acute-phase specialist assistance and routine outpatient follow-up. Low-to-moderate-level evidence supports its effectiveness, cost-effectiveness, usability, satisfactoriness, and capacity to improve triage.
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Affiliation(s)
- Eli Mondor
- Carleton University, Department of Health Sciences, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada.
| | - Jaymie Barnabe
- Carleton University, Department of Health Sciences, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada
| | | | - Claudia Malic
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada.
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Rehan M, Tariq R, Iqbal T, Sarwar M, tul Ain Q, Waheed U. IMPACT OF BURNS ON ANXIETY, DEPRESSION AND SELFESTEEM AMONG PATIENTS WITH BURN INJURIES: A CROSS-SECTIONAL STUDY. ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:134-139. [PMID: 38974791 PMCID: PMC11225278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/18/2023] [Indexed: 07/09/2024]
Abstract
Burns are a major public health issue. Psychiatric issues require special attention. According to research, lowering stigma and anxiety and raising self-esteem are efficient ways to encourage the social reintegration of burn patients. The current study was aimed at investigating the association between burn patients' anxiety, depression, low self-esteem levels and the total body surface area (TBSA) affected by burn injuries. This single-center, cross-sectional study was conducted from January to June 2022. A sample size of 200 burn patients was calculated. Any patient with a prior psychiatric diagnosis was disqualified from the trial except for nicotine dependency. The patients were evaluated for anxiety, depression and self-esteem using specific scales. The data were tabulated and statistically analyzed using SPSS 25.0. There was male predominance as 55% (n=110) of participants were males. The age range was 18-70 years, and the average age of participants was 36.4±8.6 years. About 68.50% of participants were married, 29.50% were unmarried and 2% were divorced/widowed. Men tended to experience anxiety symptoms more frequently. More than half (58.0%) suffered from burns involving 20-39% of total body surface area (TBSA). No significant relationship was found between TBSA and anxiety, depression or self-esteem. Psychiatric issues are highly prevalent in burn victims. More research is necessary to determine the extent and determinants of psychological issues in burn patients.
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Affiliation(s)
- M. Rehan
- Department of Burn and Reconstructive Surgery, National Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
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Parry I, Bell J. Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry. Burns 2024; 50:813-822. [PMID: 38503574 DOI: 10.1016/j.burns.2024.03.002] [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: 07/25/2023] [Revised: 02/15/2024] [Accepted: 03/02/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Throughout the world, burn injury is a major cause of death and disability. In resource-limited countries, burn injury is one of the leading causes of permanent disability among children who survive traumatic injuries, and burn injury is the fourth leading cause of disability worldwide. This study applied Andersen's model of health care access to evaluate if patient characteristics (predisposing factors), burn care service availability (enabling factors) and injury characteristics (need) are associated with physical impairment at hospital discharge for patients surviving burn injuries globally. Specifically, access to rehabilitation, nutrition, operating theatre, specialized burn unit services, and critical care were investigated as enabling factors. The secondary aim was to determine whether associations between burn care service availability and impairment differed by country income level. METHODS This is a cross-sectional secondary analysis of prospectively collected data from the World Health Organization, Global Burn Registry. The outcome of interest was physical impairment at discharge. Simple and multivariable logistic regressions were used to test the unadjusted and adjusted associations between the availability of burn care services and impairment at hospital discharge, controlling for patient and injury characteristics. Effect modification was analyzed with service by country income level interaction terms added to the models and, if significant, the models were stratified by income. RESULTS The sample included 6622 patients from 20 countries, with 11.2% classified with physical impairment at discharge. In the fully adjusted model, patients had 89% lower odds impairment at discharge if the treatment facility provided reliable rehabilitation services compared to providing limited or no rehabilitation services (OR.11, 95%CI.08,.16, p < .01). However, this effect was modified by county income with the strong and significant association only present in high/upper middle-income countries. Sophisticated nutritional services were also significantly associated with less impairment in high/upper middle-income countries (OR=.04, 95% CI 0.203, 0.05, p < .01), but significantly more impairment in lower middle/low-income countries (OR=2.01, 95% CI 1.50, 2.69, p < .01). Patients had 444% greater odds of impairment if treated at a center with specialty burn unit services (OR 5.44, 95%CI 3.71, 7.99, p < .01), possibly due to a selection effect. DISCUSSION Access to reliable rehabilitation services and sophisticated nutritional services were strongly associated with less physical impairment at discharge, but only in resource-rich countries. Although these findings support the importance of rehabilitation and nutrition after burn injury, they also highlight potential disparities in the quantity or quality of services available to burn survivors in poorer countries.
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Affiliation(s)
- Ingrid Parry
- University of California, Davis, School of Nursing and Health Care Leadership, California, USA.
| | - Janice Bell
- University of California, Davis, School of Nursing and Health Care Leadership, California, USA
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Hur DG, Yao J, Yue TM, Sheckter CC, Choi J. Access to Burn Care in the US. JAMA Surg 2024; 159:463-465. [PMID: 38353985 DOI: 10.1001/jamasurg.2023.7763] [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: 04/11/2024]
Abstract
This cross-sectional study examines burn incidence rates and accessibility of American Burn Association–verified or self-designated burn centers from 2013 to 2019.
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Affiliation(s)
- Dong Gi Hur
- Stanford School of Medicine, Stanford, California
| | | | | | | | - Jeff Choi
- Department of Surgery, Stanford University, Stanford, California
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Bickerton S, Nizamoglu M, Emamdee R, Frew Q, Borrows E, Bangalore H, Hussey J, Khan W, Martin N, Barnes D, El-Muttardi N, Shelley OP, Dziewulski P. An eighteen-year review of intensive care requirements for paediatric burns in a regional burns service. J Plast Reconstr Aesthet Surg 2024; 91:258-267. [PMID: 38428234 DOI: 10.1016/j.bjps.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/22/2023] [Accepted: 02/04/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Advances in burns management have reduced mortality. Consequently, efficient resource management plays an increasingly important role in improving paediatric burns care. This study aims to assess the support requirements and outcomes of paediatric burns patients admitted to a burns centre intensive care unit in comparison to established benchmarks in burns care. METHOD A retrospective review of burns patients under the age of 16 years old, admitted to a regional burns service intensive care unit between March 1998 and March 2016 was conducted. RESULTS Our analysis included 234 patients, with the percentage of TBSA affected by burn injury ranging from 1.5% to 95.0%. The median (IQR) %TBSA was 20.0% (11.0-30.0), and the observed mortality rate was 2.6% (6/234). The median (IQR) length of stay was 0.7 days/%TBSA burn (0.4-1.2), 17.9% (41/229) required circulatory support and 2.6% (6/234) required renal replacement. Mortality correlated with smoke inhalation injury (P < 0.001), %TBSA burn (P = 0.049) and complications (P = 0.004) including infections (P = 0.013). CONCLUSIONS Among children with burn injuries who require intensive care, the presence of inhalational injury and the diagnosis of infection are positively correlated with mortality. Understanding the requirements for organ support can facilitate a more effective allocation of resources within a burns service.
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Affiliation(s)
- Shixin Bickerton
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK.
| | - Metin Nizamoglu
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Russel Emamdee
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Quentin Frew
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Emma Borrows
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Harish Bangalore
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Joseph Hussey
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Waseemullah Khan
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Niall Martin
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
| | - David Barnes
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Naguib El-Muttardi
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Odhran P Shelley
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Department of Surgery, Trinity College Dublin, Ireland
| | - Peter Dziewulski
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; St Andrews Anglia Ruskin Research Group, Anglia Ruskin University, Chelmsford, UK
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Savell SC, Howard JT, VanFosson CA, Medellín KL, Staudt AM, Rizzo JA, Maddry JK, Cancio LC. A Retrospective Cohort Study of Burn Casualties Transported by the US Army Burn Flight Team and US Air Force Critical Care Air Transport Teams. Mil Med 2024; 189:813-819. [PMID: 36165680 DOI: 10.1093/milmed/usac273] [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: 04/21/2022] [Revised: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The US Army Burn Center, the only burn center in the Department of Defense provides comprehensive burn care. The Burn Flight Team (BFT) provides specialized burn care during transcontinental evacuation. During Operations Iraqi and Enduring Freedom, burn injuries accounted for approximately 5% of all injuries in military personnel. To augment BFT capacity, US Air Force Critical Care Air Transport Teams (CCATTs) mobilized to transport burn patients. The purpose of this study was to describe critically ill, burn injured patients transported to the US Army Burn Center by BFT or CCATT, to compare and contrast characteristics, evacuation procedures, in-flight treatments, patient injuries/illnesses, and outcomes between the two groups. MATERIALS AND METHODS We conducted a retrospective cohort study of CCATT and BFT patients, admitted to the burn ICU between January 1, 2001 and September 30, 2018. Patients with total body surface area burned (TBSA) >30% were evacuated by BFT, while CCATT evacuated patients with ≤ 30% TBSA. RESULTS Ninety-seven patients met inclusion criteria for this study. Of these, 40 (41%) were transported by the BFT and 57 (59%) were transported by CCATTs. Compared with patients transported by CCATTs, patients transferred by the BFT had higher median TBSA and full-thickness burn size, higher prevalence of chest, back and groin burns, and higher prevalence of inhalation injury. BFT patients had increased hospital days (62 vs. 37; P = .08), ICU days (29 vs. 12; P = .003) and ventilator days (14 vs. 6; P < .001). TBSA was the only variable significantly associated with ARDS (aOR = 1.04; 95% CI: 1.01, 1.08; P = 0.04), renal failure (aOR = 1.07; 95% CI: 1.03, 1.11; P = .002), and mortality (aOR = 1.08; 95% CI: 1.03, 1.13; P = .001). CONCLUSIONS Evacuation by the BFT was associated with increased ICU and ventilator days, increased mortality, and a greater risk for developing renal failure. The severity of injury/TBSA likely accounted for most of these differences.
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Affiliation(s)
- Shelia C Savell
- United States Air Force En route Care Research Center/59th MDW/ST, Fort Sam Houston, TX 78234, USA
| | - Jeff T Howard
- United States Air Force En route Care Research Center/59th MDW/ST, Fort Sam Houston, TX 78234, USA
- Oak Ridge Institute of Science and Education, Oakridge, TN 37830, USA
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Christopher A VanFosson
- Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
| | - Kimberly L Medellín
- United States Air Force En route Care Research Center/59th MDW/ST, Fort Sam Houston, TX 78234, USA
| | | | - Julie A Rizzo
- Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
- Uniformed Services University, Bethesda, MD 20814, USA
| | - Joseph K Maddry
- Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
- Uniformed Services University, Bethesda, MD 20814, USA
- US Army Institute of Surgical Research, Fort Sam Houston, TX, 78234, USA
| | - Leopoldo C Cancio
- Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
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Lindert J, Bbaale D, Mohr C, Chamania S, Bandyopadhyay S, Boettcher J, Katabogama JB, Alliance BW, Elrod J. State of burns management in Africa: Challenges and solutions. Burns 2023; 49:1028-1038. [PMID: 36759220 DOI: 10.1016/j.burns.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Understand the availability of human resources, infrastructure and medical equipment and perceived improvement helps to address interventions to improve burn care. METHODS Online survey covering human resources, infrastructure, and medical equipment of burn centers as well as perceived challenges and points for improvement. The survey was distributed in English and French via snowball method. Descriptive statistics and AI-based technique random forest analysis was applied to identify determinants for a reduction of the reported mortality rate. RESULTS 271 questionnaires from 237 cities in 40 African countries were analyzed. 222 (81.9 %) from countries with a very low Human Development Index (HDI) (4th quartile). The majority (154, 56.8 %) of all responses were from tertiary health care facilities. In only 18.8 % (n = 51) therapy was free of charge for the patients. The majority (n = 131, 48.3 %) had between 1 and 3 specialist doctors (n = 131, 48.3 %), 1 to 3 general doctors (n = 138, 50.9 %) and more than 4 nurses (n = 175, 64.6 %). A separate burn ward was available in 94 (34.7 %) centers. Regular skin grafting was performed in 165 (39.1 %) centers. Random forest-based analysis revealed a significant association between HDI (feature importance: 0.38) and mortality. The most important reason for poor outcome was perceived late presentation (212 institutions, 78.2 %). The greatest perceived potential for improvement was introduction of intensive care units (229 institutions, 84.5 %), and prevention or education (227 institutions, 83.7 %). INTERPRETATION A variety of factors, including a low HDI, delayed hospital presentation e.g. due to prior care by non-physicians and lack of equipment seem to worsen the outcome. Introduction of an intensive care unit and communal education are perceived to be important steps in improving health care in burns.
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Affiliation(s)
- Judith Lindert
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str 8, 18057 Rostock, Germany; German Society of Global and Tropical Surgery e.V., Germany
| | - Dorothy Bbaale
- Department of Surgery, International Hospital Kampala, Plot 4686 Barnabas Rd, Kampala, Uganda; CURE International, 70 Ionia Ave SW, Suite 200, Grand Rapids, MI 49503, United States
| | - Christoph Mohr
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Shobha Chamania
- Choithram Hospital and Research Centre, 14, Manik Bagh Rd, Indore, India
| | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | | | - Bisimwa Wani Alliance
- Provincial General Reference Hospital of Bukavu, 02, avenue Michombero/Commune de Kadutu, Bukavu, Democratic Republic of the Congo
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Britton GW, Wiggins AR, Halgas BJ, Cancio LC, Chung KK. Critical Care of the Burn Patient. Surg Clin North Am 2023; 103:415-426. [PMID: 37149378 DOI: 10.1016/j.suc.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Care of the critically ill burned patient must integrate a multidisciplinary care team composed of burn care specialists. As resuscitative mortality decreases more patients are surviving to experience multisystem organ failure relating to complications of their injuries. Clinicians must be aware of physiologic changes following burn injury and the implicated impacts on management strategy. Promoting wound closure and rehabilitation should be the backdrop for which management decisions are made.
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Affiliation(s)
- Garrett W Britton
- US Army Institute of Surgical Research, 3698 Chambers Pass Road, San Antonio, TX 78234, USA; Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA.
| | - Amanda R Wiggins
- US Army Institute of Surgical Research, 3698 Chambers Pass Road, San Antonio, TX 78234, USA
| | - Barret J Halgas
- US Army Institute of Surgical Research, 3698 Chambers Pass Road, San Antonio, TX 78234, USA
| | - Leopoldo C Cancio
- US Army Institute of Surgical Research, 3698 Chambers Pass Road, San Antonio, TX 78234, USA; Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA
| | - Kevin K Chung
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA
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DeJesus J, Shah NR, Franco-Mesa C, Walters ET, Palackic A, Wolf SE. Risk factors for opioid use disorder after severe burns in adults. Am J Surg 2023; 225:400-407. [PMID: 36184330 DOI: 10.1016/j.amjsurg.2022.09.023] [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: 07/27/2022] [Revised: 09/09/2022] [Accepted: 09/18/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Risk factors for opioid dependence amongst burn patients have not been well-explored compared to other surgical fields. METHODS The TrinetX database was queried for patients diagnosed with opioid use disorder (OUD) after thermal or chemical burn. Propensity score matching was performed. Opioid and non-opioid analgesia use, ICU care, surgery, and comparative risks among common opiates were examined using descriptive and univariate regression models, including odds ratios. Subgroup analysis evaluated the impact of multimodal analgesia. RESULTS Odds of receiving IV opioids for acute analgesia (p = <0.0001, OR = 1.80, CI = 1.45-2.25), undergoing surgery (p = <0.0001, OR = 1.58, CI = 1.26-1.98), and ICU care (p = <0.0001, OR = 3.60, CI = 2.00-3.83) after burn injury were higher in patients who developed OUD. Patients receiving multimodal therapy within 24 hours of admission had lower odds of developing OUD (OR = 0.74, CI = 2.76-4.68, p = 0.0001) and chronic pain (OR = 0.89, CI = 0.78-1.00, p = 0.05) regardless of TBSA. CONCLUSION Patients who developed opioid use disorder following burn injury had higher odds of receiving opioid exclusive pain management, more frequent surgery, ICU care.
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Affiliation(s)
- Jana DeJesus
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Camila Franco-Mesa
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Elliot T Walters
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, 8036, Austria.
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
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Leon-Villapalos J, Barret JP. Surgical Repair of the Acute Burn Wound: Who, When, What Techniques? What Is the Future? J Burn Care Res 2023; 44:S5-S12. [PMID: 36567475 DOI: 10.1093/jbcr/irac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Modern burns surgery is multidisciplinary, multimodal and includes a dermal preservation approach. The management of the surgical wound starts in the pre-hospital environment with stabilization and assessment of the burn injured patient according to protocols of trauma resuscitation with special emphasis in the assessment of the burn depth and surface area. A large burn requires fluid resuscitation and physiological support, including counterbalancing hyper metabolism, fighting infection and starting a long burns intensive care journey. A deep burn may impose the need for surgical debridement and cover through a staged approach of excision of devitalized tissue depending on its extension and patient circumstances. These methodologies warrant patients survivability and require professionals integrated in a multidisciplinary team sharing decisions and directing management. Burns Multimodality involves multiple techniques used according to patient's needs, wound environment, operators experience and available resources. Traditional practices used together with new techniques may reduce morbidity and operative time but also challenge stablished practice. The concept of using the best teams with the best techniques combines with the need for selective and judicious surgery that preserves tissue architecture and spares as much as possible dermal component, therefore reducing the possibility of functional impairment and cosmetic embarrassment caused by pathological scars. Who is best placed to perform these tasks, the appropriate or best timing of surgery and the different practices used to achieve best results will be discussed, together with a reflection on what the future holds for these fundamental steps in the management of the burn injured patient turning into a functional burn survivor.
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Affiliation(s)
- Jorge Leon-Villapalos
- Consultant Plastic, Reconstructive, Laser and Burns Surgeon, Plastic Surgery and Burns Department, Chelsea and Westminster Hospital, London, UK.,BAPRAS Burns Special Interest and Advisory Group, London, UK.,Senior Honorary Clinical Lecturer, Imperial College School of Medicine, London, UK
| | - Juan P Barret
- Department of Plastic Surgery and Burns, Vall d'Hebron Barcelona Hospital Campus, Universidad Autònoma de Barcelona, Barcelona, Spain
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Vaghardoost R, Najafi A, Sobouti B, Ghavami Y. Evaluation of Patient's Knowledge of Prevention and Treatment of Burn Injuries. World J Plast Surg 2023; 12:71-76. [PMID: 38130385 PMCID: PMC10732296 DOI: 10.52547/wjps.12.2.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/01/2023] [Indexed: 12/23/2023] Open
Abstract
Background Burn injuries are amongst the most devastating causes of trauma worldwide. Preventive measures can be of great value in decreasing burn incidents. Increasing the knowledge and education of patients is a crucial step in this process. Methods In this prospective cross-sectional study, we evaluated 82 patients with burn injuries who were divided into two groups randomly during the 2018 to 2019 at Shahid Motahari Hospital, Tehran, Iran. The first group received an e-Book, and the second group a paperback booklet to read before visiting their primary care. Besides, both groups received a questionnaire on their knowledge of burn injuries and prevention before and after the visit. The e-Book and paperback booklet included basic information about burn injuries and preventive measures. We compared the questionnaire results in both groups before and after reading the e-book and booklet using a paired t-test analysis. Results There was a significant improvement in self-reported knowledge of burn prevention (P < 0.05; CI: 95%). Subjects receiving the eBook performed significantly had better post-survey (P < .01, 95% CI), despite equivalent pre-survey scores compared to those receiving the booklet. Conclusion Increased use of interactive educational modalities, such as an e-book, can benefit patients with knowledge of their disease and improve the quality of care. These modalities may increase compliance with the physician's recommendations regarding their disease states and treatments.
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Affiliation(s)
- Reza Vaghardoost
- Department of Plastic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aminollah Najafi
- Department of Plastic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Sobouti
- Department of Plastic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Ghavami
- Department of Plastic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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12
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Tracy LM, Kurmis R, Heath K, Edgar DW. Adherence with early allied health assessments in specialist burn services. J Burn Care Res 2022:6762642. [PMID: 36255045 DOI: 10.1093/jbcr/irac153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Indexed: 11/12/2022]
Abstract
Appropriate multidisciplinary allied health assessment during the early stages of admission following burn injury positively influences recovery and quality of life. Variation in allied health care may affect patient outcomes. We aimed to explore adherence in providing early allied health assessments in accordance with local parameters. Associations between the number of assessments and hospital length of stay (LOS) were also explored. The Burns Registry of Australia and New Zealand was queried for adult (≥ 16 years) burn injured patients admitted to a specialist burn service for > 48 hours between July 2016 and June 2020. Quality indicator data relating to allied health assessment processes were examined; patients were grouped according to the number of assessments they received within 48 hours of admission. Of the 5789 patients included in the study, 5598 (97%) received at least one allied health assessment within 48 hours of admission and 3976 (69%) received all three assessments. A greater proportion of patients who received no assessments were admitted on a Saturday. Patients receiving three assessments had more severe injuries compared to their counterparts who received fewer assessments. Hospital LOS was not associated with the number of allied health assessments during an acute admission following burn injury after accounting for confounding factors, particularly TBSA. Multidisciplinary allied health teams provide routine burn care to Australian and New Zealand burns patients at a consistent level. Further, this study provides evidence that allied health input is prioritised towards patients with increasing severity of burn injury, playing an integral role in early rehabilitation.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rochelle Kurmis
- Adult Burns Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kathryn Heath
- Adult Burns Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dale W Edgar
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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13
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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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14
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Phillips GS, Wormald JC, Yoshimura R, Gardiner MD, Rodrigues JN, Collins DP. RSTNCOVID Burns: A multi-centre service evaluation and stakeholder survey of the impact of COVID-19 on burns care in England, Wales and Northern Ireland. J Plast Reconstr Aesthet Surg 2022; 75:1602-1609. [PMID: 34955398 PMCID: PMC8631049 DOI: 10.1016/j.bjps.2021.11.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/14/2021] [Indexed: 01/13/2023]
Abstract
As the UK entered the first wave of the COVID-19 pandemic, the National Health Service published consensus guidance to the UK burns services advising changes to the acute management of burns to allow the continuation of safe care while protecting limited hospital resources. We aimed to describe the demographics of burns service users, changes to clinical pathways and experiences of the burns team during the first wave of the COVID-19 pandemic. All burns services in the UK were invited to participate in a national collaborative, trainee-led study supported by the Reconstructive Surgery Trials Network. The study consisted of (1) a service evaluation of patients receiving burns treatment during the COVID-19 pandemic; (2) a multidisciplinary team survey. Analyses were descriptive and narrative depending on data types. Collaborators from 18 sites contributed data from burns MDT surveys and 512 patients. Patient demographics were consistent with typical burns patterns in the UK. The delayed presentation occurred in 20% of cases, with 24 patients developing complications. MDT surveys indicated substantial adaptations and challenges as a result of the pandemic. Access to theatres and critical care were limited, yet a comprehensive acute burns service was maintained. Telemedicine was utilised heavily to reduce patient footfall. Adaptations in the provision of burns care, including greater outpatient care and telemedicine, have emerged out of necessity with reported success. The impact of reduced scar therapy and psychological interventions for burns patients during the pandemic requires longer-term follow-up. Lessons from the UK experience can be used to strategise for future pandemics.
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Affiliation(s)
- Georgina S.A. Phillips
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Justin C.R. Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, United Kingdom,Corresponding author
| | - Ryo Yoshimura
- Hull York Medical School, John Hughlings Jackson Building, University Road, Heslington, York, United Kingdom
| | - Matthew D. Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, United Kingdom,Department of Plastic & Reconstructive Surgery, Wexham Park Hospital, Slough, United Kingdom
| | - Jeremy N. Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, United Kingdom,Department of Plastic & Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, United Kingdom
| | - Declan P. Collins
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom,Department of Surgery and Cancer, Imperial College, South Kensington Campus, London, United Kingdom
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15
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van Zuijlen PPM, Korkmaz HI, Sheraton VM, Haanstra TM, Pijpe A, de Vries A, van der Vlies CH, Bosma E, de Jong E, Middelkoop E, Vermolen FJ, Sloot PMA. The future of burn care from a complexity science perspective. J Burn Care Res 2022; 43:1312-1321. [PMID: 35267022 DOI: 10.1093/jbcr/irac029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Healthcare is undergoing a profound technological and digital transformation and has become increasingly complex. It is important for burns professionals and researchers to adapt to these developments which may require new ways of thinking and subsequent new strategies. As Einstein has put it: 'We must learn to see the world anew'. The relatively new scientific discipline "Complexity science" can give more direction to this and is the metaphorical open door that should not go unnoticed in view of the burn care of the future. Complexity sciences studies 'why the whole is more than the sum of the parts'. It studies how multiple separate components interact with each other and their environment and how these interactions lead to 'behavior of the system'. Biological systems are always part of smaller and larger systems and exhibit the behavior of adaptivity, hence the name complex adaptive systems. From the perspective of complexity science, a severe burn injury is an extreme disruption of the 'human body system'. But this disruption also applies to the systems at the organ and cellular level. All these systems follow principles of complex systems. Awareness of the scaling process at multilevel helps to understand and manage the complex situation when dealing with severe burn cases. The aim of this paper is to create awareness of the concept of complexity and to demonstrate the value and possibilities of complexity science methods and tools for the future of burn care through examples from preclinical, clinical, and organizational perspective in burn care.
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Affiliation(s)
- Paul P M van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - H Ibrahim Korkmaz
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Association of Dutch Burn Centres (ADBC), Beverwijk, The Netherlands
| | - Vivek M Sheraton
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Annebeth de Vries
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.,Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Ziekenhuis, Rotterdam, The Netherlands.,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eelke Bosma
- Burn Centre and Department of Surgery, Martini Ziekenhuis, Groningen, The Netherlands
| | - Evelien de Jong
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.,Intensive Care Unit, Red Cross Hospital, Beverwijk, The Netherlands
| | - Esther Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Association of Dutch Burn Centres (ADBC), Beverwijk, The Netherlands
| | - Fred J Vermolen
- Delft Institute of Applied Mathematics, Delft University of Technology, Delft, The Netherlands.,Computational Mathematics, Hasselt University, Diepenbeek, Belgium
| | - Peter M A Sloot
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands.,Complexity Institute, Nanyang Technological University, Singapore.,ITMO University, Saint Petersburg, Russian Federation
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16
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Perspectives on record-keeping practices in MDT meetings and meeting record utility. Int J Med Inform 2022; 161:104711. [DOI: 10.1016/j.ijmedinf.2022.104711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/24/2022]
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17
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Lu LY, Boggs KM, Espinola JA, Sullivan AF, Cash RE, Camargo CA. Development of a Unified National Database of Burn Centers with Co-located Emergency Departments, 2020. J Burn Care Res 2021; 43:1066-1073. [PMID: 34893840 DOI: 10.1093/jbcr/irab238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The care of severely burned patients comes with unique requirements for specialized burn centers. The American Burn Association sets guidelines for burn centers and provides a voluntary program to verify their quality of care. However, not all burn centers are verified, and it is unclear which nonverified centers have met requirements set by their state health departments. To compile a complete database of all United States emergency departments in facilities with confirmed burn centers, we investigated state requirements to supplement data from the American Burn Association verification process. In 2020, only 13 states set requirements for burn centers; 3 states explicitly required American Burn Association verification, 4 used modified American Burn Association criteria, and 6 used alternate criteria. Only 2 states had separate requirements for pediatric burn centers. Based on adherence to state and American Burn Association criteria, we identified 90 confirmed burn centers in 2020, 85 of which had emergency departments. Of these 85, 45 (53%) were only verified, 17 (20%) were only state-confirmed, and 23 (27%) were both. Emergency departments in a confirmed burn center were more likely-than those without-to have higher adult and pediatric visit volumes, be academic, be a stroke or trauma (adult or pediatric) center, have a dedicated pediatric area, and have a pediatric emergency care coordinator. We compiled the first unified burn center database that incorporates state and American Burn Association lists. This database can be utilized in future health services research and is available to the public through a smartphone application.
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Affiliation(s)
- Lily Y Lu
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Krislyn M Boggs
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Janice A Espinola
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashley F Sullivan
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rebecca E Cash
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Carlos A Camargo
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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18
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Laura P, José A, Nikki A, Khaled A, Barret JP, Jeffery C, Shobha C, Jack CS, Scott C, Nadia D, Moustafa E, Liao J, Josef H, Briana H, Sunil K, Tetsuro K, Jorge LV, Gaoxing L, Hajime M, Ariel MA, Naiem M, Kiran N, Nawar A, Faustin N, Anthony O, Tom P, Liang Q, Man RS, Ingrid S, Ahmed T, Molina VLP, Shelley W, Mark F. Impact of COVID-19 on global burn care. Burns 2021; 48:1301-1310. [PMID: 34903416 PMCID: PMC8664090 DOI: 10.1016/j.burns.2021.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022]
Abstract
Background Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pandemic, and whether country´s income, geographical location, COVID-19-transmission pattern, and levels of specialization of the burn units affected reallocation of resources and access to burn care. Methods The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, χ2 or Fisher’s exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic. Results The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedicated nursing staff was reduced (<0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration between burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors. Conclusions During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care.
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Affiliation(s)
- Pompermaier Laura
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Global Health and Social Medicine Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | - Adorno José
- Burn Unit at Regional Hospital of North Wing, Brasília, Brazil
| | - Allorto Nikki
- Pietermaritzburg Burn Service; Nelson Mandela School of Medicine, University of KwaZulu Natal, South Africa
| | - Altarrah Khaled
- Albabtain Center for Burns and Plastic Surgery, Alshuwaikh Specialist Health District, Alsabah Health Region, Kuwait
| | - Juan P Barret
- Department of Plastic Surgery and Burns, University Hospital Vall d´Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carter Jeffery
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Chamania Shobha
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | | | - Corlew Scott
- Department of Global Health and Social Medicine Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Depetris Nadia
- Turin Burn Centre, Department of Anesthesia and Critical Care 3, Cittá della Salute e della Scienza di Torino, Torino, Italy
| | - Elmasry Moustafa
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Junlin Liao
- Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Haik Josef
- Tel-Aviv University, Derech Sheba 2, Ramat Gan, Tel-Aviv, Israel; National Burn Center, Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel-Aviv, Israel
| | - Horwath Briana
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Keswani Sunil
- National Burns Centre Airoli, Sector 13 Samarth Ramdas Swami Marg, Airoli, Navi Mumbai, Maharashtra, India
| | - Kiyozumi Tetsuro
- Department of Defense Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama Prefecture, Japan
| | - Leon-Villapalos Jorge
- Department of Plastic Surgery and Burns, Chelsea and Westminster Hospital, London, UK
| | - Luo Gaoxing
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongoing, China
| | - Matsumura Hajime
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Moiemen Naiem
- Burns Centre, Birmingham Women's and Children's Hospital, Steelhouse Ln, Birmingham, UK; Queen Elizabeth Hospital Birmingham, University of Birmingham, Birmingham, UK
| | - Nakarmi Kiran
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Kathmandu, Nepal
| | - Ahmed Nawar
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Ntirenganya Faustin
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Olekwu Anthony
- Department of surgery, Federal Medical Centre Owo, Adekunle Ajasin Way, Owo, Ondo state, Nigeria
| | - Potokar Tom
- Centre for Global Burn Injury Policy & Research, Swansea University, Sketty, Wales, UK; Interburns, Swansea University, Swansea, Wales, UK
| | - Qiao Liang
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Rai Shankar Man
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Kathmandu, Nepal; National Academy of Medical Sciences, Kathmandu, Nepal
| | - Steinvall Ingrid
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tanveer Ahmed
- Burn and Plastic Surgery, Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Vana Luiz Philipe Molina
- Divisao de Cirurgia Plastica e Queimaduras, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wall Shelley
- Pietermaritzburg Burn Service; Nelson Mandela School of Medicine, University of KwaZulu Natal, South Africa; DRILL Fellow: Developing Research, Innovation, Localization and Leadership, University of KwaZulu-Natal, South Africa
| | - Fisher Mark
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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19
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Chemali M, Laurent A, Scaletta C, Waselle L, Simon JP, Michetti M, Brunet JF, Flahaut M, Hirt-Burri N, Raffoul W, Applegate LA, de Buys Roessingh AS, Abdel-Sayed P. Burn Center Organization and Cellular Therapy Integration: Managing Risks and Costs. J Burn Care Res 2021; 42:911-924. [PMID: 33970273 PMCID: PMC8483250 DOI: 10.1093/jbcr/irab080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The complex management of severe burn victims requires an integrative collaboration of multidisciplinary specialists in order to ensure quality and excellence in healthcare. This multidisciplinary care has quickly led to the integration of cell therapies in clinical care of burn patients. Specific advances in cellular therapy together with medical care have allowed for rapid treatment, shorter residence in hospitals and intensive care units, shorter durations of mechanical ventilation, lower complications and surgery interventions, and decreasing mortality rates. However, naturally fluctuating patient admission rates increase pressure toward optimized resource utilization. Besides, European translational developments of cellular therapies currently face potentially jeopardizing challenges on the policy front. The aim of the present work is to provide key considerations in burn care with focus on architectural and organizational aspects of burn centers, management of cellular therapy products, and guidelines in evolving restrictive regulations relative to standardized cell therapies. Thus, based on our experience, we present herein integrated management of risks and costs for preserving and optimizing clinical care and cellular therapies for patients in dire need.
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Affiliation(s)
- Michèle Chemali
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
- Department of Interdisciplinary Centers, Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Alexis Laurent
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Corinne Scaletta
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Laurent Waselle
- Department of Interdisciplinary Centers, Cell Production Center, Service of Pharmacy, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Jeanne-Pascale Simon
- DIrectorate Department, Unit of Legal Affairs, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Murielle Michetti
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Jean-François Brunet
- Department of Interdisciplinary Centers, Cell Production Center, Service of Pharmacy, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Marjorie Flahaut
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Nathalie Hirt-Burri
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Wassim Raffoul
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
- Department of Interdisciplinary Centers, Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Lee Ann Applegate
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
- Department of Interdisciplinary Centers, Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, Switzerland
- Oxford Suzhou Center for Advanced Research, Science and Technology Co. Ltd., Oxford University, Suzhou, PR China
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Switzerland
| | - Anthony S de Buys Roessingh
- Department of Interdisciplinary Centers, Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, Switzerland
- Women-Mother-Child Department, Children and Adolescent Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Philippe Abdel-Sayed
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
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20
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Bayuo J, Wong FKY. Intervention Content and Outcomes of Postdischarge Rehabilitation Programs for Adults Surviving Major Burns: A Systematic Scoping Review. J Burn Care Res 2021; 42:651-710. [PMID: 32608488 DOI: 10.1093/jbcr/iraa110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Improvement in burn care has led to more patients surviving the injury but has also led to more burn survivors requiring rehabilitation for a protracted period after discharge. Thus, this review sought to map the intervention content and outcomes associated with existing postdischarge rehabilitation programs for adults surviving major burns. A systematic scoping review approach was utilized. The Template for Intervention Description and Replication (TIDieR) and core outcome set for adult burn survivors were used to guide data extraction following which a narrative synthesis was undertaken. In all, 23 papers were retained in the review. Following discharge and up to 1 year postburn, the components of the rehabilitation programs comprised of physical, psychological, and social components. Beyond 1 year postburn, the rehabilitation programs demonstrated a preponderance of physical therapies. Support for family members was not highlighted in the included studies. Outcomes of rehabilitation programs up to 1 year postburn covered the seven core outcome domains. Outcomes associated with rehabilitation programs beyond 1 year postburn were, however, limited to the perceived quality of life, neuromuscular, and physical role functioning domains. Although most studies reported statistically significant findings, the outcome measures varied across studies which makes it difficult to draw overarching conclusions. The findings suggest that long-term rehabilitation programs for adult burn survivors are lacking. More robust studies are also needed to examine community participation outcomes associated with burns rehabilitation programs. The nature of burns and its far-reaching consequences suggest a patient- and family-centered approach to rehabilitation.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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21
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Ho HY, Chuang S, Dai NT, Cheng CH, Kao WF. Ranking hospitals' burn care capacity using cluster analysis on open government data. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106166. [PMID: 34077867 DOI: 10.1016/j.cmpb.2021.106166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE To deal with burn mass casualty incidents (BMCIs), various countries have established national or regional BMCI emergency response plans (ERPs). A burn care capacity ranking model for hospitals can play an integral role in ERPs by providing essential information to emergency medical services for distributing and handling mass burn patients. Ranking models vary across countries and contexts. However, Taiwan has had no such model. The study aims to develop a ranking model for classifying hospitals' burn care capacity in preparation for the development of a national BMCI ERP. METHODS Multiple methods were adopted. An expert panel provided consultations on data selection and clustering validation. Data on 116 variables from 535 hospitals were collected via open data platforms under the Ministry of Health and Welfare. Data selection and streamlining was conducted to determine 42 variables for cluster analysis. SAS 9.4 was used to analyze the data set -via a hierarchical cluster analysis using Ward's method, followed by a tree-based model analysis to identify the criteria for each cluster. Both internal and external cluster validation were performed. RESULTS Four clusters of burn care capacity were determined to be a suitable number of clusters. All hospitals were arranged into capacity levels accordingly. Results of the Kruskal-Wallis test showed that the difference between clusters were significant. Tree-based model analysis revealed four determining variables, among which the refined level of emergency care responsibility hospital was found to be most influential on the clustering process. Responses from the questionnaire were used as an external validation tool to corroborate with the cluster analysis results. CONCLUSION The use of open government data and cluster analysis was suitable for developing a ranking model to determine hospitals' burn care capacity levels in Taiwan. The proposed ranking model can be used to develop a BMCI emergency response plan and can also serve as a reference for using cluster analysis with open government data to rank care capacity or quality in other domains.
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Affiliation(s)
- Hui Yan Ho
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Sheuwen Chuang
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan; Health Policy and Care Research Center, Taipei Medical University, Taipei, Taiwan.
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Hsin Cheng
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Wei-Fong Kao
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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22
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Demonstration of the Burns Algorithm in Simulation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3650. [PMID: 34150430 PMCID: PMC8208393 DOI: 10.1097/gox.0000000000003650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
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23
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Alhomaidan HT, Rasheed Z, Alsudais MM, AlMutairi AM, Alzaben KA, AlMutairi SM, Alissa LI, Widyan AM, Alkhamiss AS, Alduraibi SK, Al Abdulmonem W. Physicians based emergency medical services for the management of burn injuries in trauma centers of the center region of Saudi Arabia: evaluation of physicians' knowledge and experience. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2021; 11:184-190. [PMID: 34336383 PMCID: PMC8310865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical services at trauma centers regularly encounter severe burn patients but prehospital care of these patients in Saudi Arabia is comparatively unexplored. This study evaluates the knowledge and experience of physicians working in trauma centers of Qassim province of Saudi Arabia for the management of patients with burn injuries. METHODS This is a cross sectional study performed on 204 physicians working in the trauma centers of Qassim province. Physicians' knowledge and experience were assessed via administration of validated questionnaires and the data were analyzed using SPSS software. RESULTS Among total studied physicians, only 35.3% and 24.0% gave the right answer to the question on the diagnosis of burn skin in depth/extent for adults and pediatric patients, respectively. Importantly, 93.6% physicians responded correctly for first aid treatment. For the parkland concept, 62.2% responded correctly, however, only 22.5% understand the colloid fluid concept. The 74% physicians knew the methods of fluid revival for mass burn injuries and about half of studied physicians showed right knowledge for intubation for breathing for mass burn injuries. Only 47.5% physicians understand the concept of electrolyte disorder. CONCLUSIONS This is the first study from the central region of Saudi Arabia that analyzed the knowledge and experience of physicians working in trauma centers for the management of patients with burn injuries. Overall data showed that ~60% physicians working in trauma centers have knowledge for handling the patients with burn injuries but the rest needed counseling, therefore proper training sessions for them are needed for management of burn patients.
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Affiliation(s)
- Homaidan T Alhomaidan
- Department of Family and Community Medicine, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Manal M Alsudais
- Medical Intern, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Asma M AlMutairi
- Department of Internal Medicine, Prince Sultan Military Medical CityRiyadh, Saudi Arabia
| | - Khawlah A Alzaben
- Department of Ophthalmology, King Khaled Eye Specialist HospitalRiyadh, Saudi Arabia
| | - Sara M AlMutairi
- Department of Obstetrician and Gynecology, King Fahad Medical CityRiyadh, Saudi Arabia
| | - Lamees I Alissa
- Department of Obstetrician and Gynecology, Security Forces HospitalRiyadh, Saudi Arabia
| | - Adel M Widyan
- Department of Mathematics, College of Science, Qassim UniversityBuraidah, Saudi Arabia
| | - Abdullah S Alkhamiss
- Department of Pathology, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Sharifa K Alduraibi
- Department of Radiology, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
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Fraser S, Grant J, Mackean T, Hunter K, Keeler N, Clapham K, Edgar DW, Towers K, Teague WJ, Ivers R. Considering difference: clinician insights into providing equal and equitable burns care for Aboriginal and Torres Strait Islander children. Aust N Z J Public Health 2021; 45:220-226. [PMID: 34028905 DOI: 10.1111/1753-6405.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To better understand issues driving quality in burn care related to equity of outcomes and equality of provision for Aboriginal and Torres Strait Islander children. METHODS Seventy-six interviews with team members who provide care for Aboriginal and Torres Strait Islander children in six paediatric burn units across five Australian jurisdictions were completed. Interface research methodology within a qualitative design guided data collection and analysis. RESULTS Three themes were identified: i) Burn team members who identify the requirement to meet the specific needs of Aboriginal and Torres Strait Islander children and deliver differential care; ii) Burn team members who believe in equal care, but deliver differential care based on the specific needs of Aboriginal and Torres Strait Islander children; and iii) Burn team members who see little need for provision of differential care for Aboriginal and Torres Strait Islander children and rather, value the provision of equal care for all. CONCLUSION Burn team members conflate equitable and equal care, which has implications for the delivery of care for Aboriginal and Torres Strait Islander children. Equitable care is needed to address disparities in post-burn outcomes, and this requires clinicians, healthcare services and relevant system structures to work coherently and intentionally to reflect these needs. Implications for public health: Changes in health policy, the embedding of Aboriginal and Torres Strait Islander liaison officers in burn care teams and systems that prioritise critical reflexive practice are fundamental to improving care.
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Affiliation(s)
- Sarah Fraser
- Faculty of Medicine and Health, The University of New South Wales
| | - Julian Grant
- School of Nursing, Midwifery and Indigenous Health, Faculty of Science, Charles Sturt University, New South Wales
| | - Tamara Mackean
- College of Medicine and Public Health, Flinders University, South Australia
| | - Kate Hunter
- The George Institute for Global Health; Faculty of Medicine, The University of New South Wales, New South Wales
| | | | - Kathleen Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, University of Wollongong
| | - Dale W Edgar
- Burn Service of Western Australia, Fiona Stanley Hospital; The Institute for Health Research, The University of Notre Dame Australia
| | - Kurt Towers
- Northern Adelaide Local Health Network, South Australia
| | - Warwick J Teague
- Burns Service, The Royal Children's Hospital, Melbourne, Victoria; Department of Paediatrics, University of Melbourne, Melbourne, Victoria
| | - Rebecca Ivers
- Faculty of Medicine and Health, The University of New South Wales
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Kettering CE, Erpenbeck SP, Stofman GM, Ziembicki JA, Egro FM. Interdisciplinary Representation of Burn Surgery Journal and Society Leadership. J Burn Care Res 2021; 42:459-464. [PMID: 33091111 DOI: 10.1093/jbcr/iraa185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Burn care is a complex craft that requires an interdisciplinary approach. It includes a diverse array of specialty providers to provide holistic, specialized care to burn victims. This study aims to evaluate the diverse array of subspecialties involved in burn surgery journal and society leadership. A cross-sectional study was conducted in July 2019 by examining the characteristics of society and journal leaders. Current governance and committee members of the American Burn Association (ABA) and International Society of Burn Injuries (ISBI) were determined, as well as the editors of five major burn journals. Information gathered included occupation, advanced degrees obtained, and type of residency training. Of 384 editorial board members identified, 76% were physicians (n = 291), with specialties including burn surgery (n = 208, 54%) and anesthesiology (n = 22, 6%). Among nonphysicians (n = 78, 20%), 76% were medical researchers (n = 59), 8% physical therapists (n = 6), and 5% nurses (n = 4). Looking at ABA and ISBI governance (n = 29), 82% were physicians (n = 24). Nonphysician ABA and ISBI leaders were nurses (n = 2, 7%) and occupational therapists (n = 2, 7%). Of 467 identified ABA and ISBI committee members, half were physicians (n = 244, 52%). There was a wide array of nonphysician occupations among committee members, from nurses (n = 99, 21%), to occupational therapists (n = 25, 5%), and even firefighters (n = 6, 1%). Burn surgery journal and society leadership reflect the interdisciplinary nature of burn care by including an array of subspecialties. Yet, physicians tend to dominate academic burn leadership in comparison to other disciplines, highlighting the need for more nonphysician representation in leadership positions.
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Affiliation(s)
- Caroline E Kettering
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Sarah P Erpenbeck
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Guy M Stofman
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Jenny A Ziembicki
- University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pennsylvania.,University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
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Huang Z, Forst L, Friedman LS. Burn Center Referral Practice Evaluation and Treatment Outcomes Comparison Among Verified, Nonverified Burn Centers, and Nonburn Centers: A Statewide Perspective. J Burn Care Res 2021; 42:439-447. [PMID: 33022054 DOI: 10.1093/jbcr/iraa167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The American Burn Association (ABA) has developed comprehensive referral criteria to determine which burn-injured patient should be transferred to burn centers. This was a retrospective analysis of burn injuries using Illinois inpatient and outpatient hospital data from 2010 to 2015. Multivariable logistic and linear regression models were developed to evaluate ABA burn center referral criteria adherence and to compare treatment outcomes among those treated in verified burn center (VB), nonverified burn center (NVB), and other facilities (OF). In this study, 66% of those treated in facilities without specialized burn teams met the ABA referral criteria. Patients who were older than the age of 40 years, lived farther from burn units, and were originally treated in level I trauma center without burn units were less likely to be transferred to burn centers. Those transported and treated in burn centers had overall better treatment outcomes including fewer infection complications (VB vs OF: adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.4-0.6; NVB vs OF: aOR: 0.5, 95% CI: 0.4-0.6), fewer patients requiring additional care in skilled nursing/rehabilitation facilities (VB vs OF: aOR: 0.5, 95% CI: 0.4-0.6; NVB vs OF: aOR: 0.7, 95% CI: 0.6-0.9), shorter length of hospitalization (VB vs OF: β: -0.4, P < .001; NVB vs OF: β: -0.8, P < .001), and comparable in-hospital mortality (VB vs OF: aOR: 1.3, 95% CI: 0.97-1.7; NVB vs OF: aOR: 1.01, 95% CI: 0.7-1.5). While verified and unverified burn centers demonstrated better treatment outcomes, the data demonstrated a need to understand the barriers of adhering to ABA criteria and an improved regional burn center referral guidelines education.
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Affiliation(s)
- Zhenna Huang
- School of Public Health, University of Illinois at Chicago
| | - Linda Forst
- School of Public Health, University of Illinois at Chicago
| | - Lee S Friedman
- School of Public Health, University of Illinois at Chicago
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Gong J, Singer Y, Cleland H, Wood F, Cameron P, Tracy LM, Gabbe BJ. Driving improved burns care and patient outcomes through clinical registry data: A review of quality indicators in the Burns Registry of Australia and New Zealand. Burns 2021; 47:14-24. [PMID: 32811694 DOI: 10.1016/j.burns.2020.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/19/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2009, the Burns Registry of Australia and New Zealand (BRANZ) published a set of clinical quality indicators (QIs) to monitor performance, improve quality of care, and inform and change policy. With several years of data collected since the initial development of the indicators for burns, the BRANZ QI Working Party reviewed the clinical QIs for relevance and meaning, and considered new QIs that had not been collected previously. METHOD Using published literature and expert opinion, the QI Working Party, consisting of multidisciplinary burn clinicians, reviewed the QIs for burn care to be included as routine data items in the BRANZ. RESULTS In July 2016, the list of clinical QIs in the BRANZ was updated to 23 QIs/data items, covering structure, process, and outcome measures. Four QIs were removed as they were not found to be useful, nine QIs/data items were revised, and eight new QIs/data items were added as they were considered to be clinically useful. CONCLUSION This review outlines the changes made to the QIs collected by the BRANZ four years since their development and implementation. Ongoing refinement of the BRANZ QIs will ensure that high quality data is collected to drive improvements in clinical and patient outcomes.
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Affiliation(s)
- Jennifer Gong
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Yvonne Singer
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Fiona Wood
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, Western Australia, 6150, Australia; Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia; Emergency and Trauma Centre, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales, United Kingdom.
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Physiotherapeutic and dietetic parameters in burns patients modelling a multidisciplinary approach to burns practice: A bi-disciplinary illustration of interrelated factors. Burns 2020; 47:1094-1101. [PMID: 33308941 DOI: 10.1016/j.burns.2020.11.002] [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: 08/22/2019] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Early mobilisation and early enteral feeding after burn injury are two of the most important treatment therapies for optimal recovery. These factors form a part of a team approach, but research has historically focused on one discipline at a time and its effects in isolation; integrated inter-disciplinary influences are not typically studied. This observational study combines strategies and outcomes from the disciplines of nutrition and physiotherapy in an attempt to part-way exemplify the team approach. METHODS Patients were recruited through the Burns Unit records and divided into two groups: Group 1 constituted burn patients who were mobilised before surgery and Group 2 constituted burn patients who were mobilised after surgery. RESULTS Patients mobilised after surgery had significantly greater burn surface area, significantly fewer days to wait for surgery (3.4 vs 6.9 days, p < 0.01), significantly more days to mobilise after burn injury (13 vs 2.3 days, p < 0.05), and significantly more time to achieve independent mobilization (42 vs 19.5 days, p < 0.05); they had a significantly longer stay in intensive care (10.8 vs 4.1 days, p < 0.05), and a longer hospital stay (p < 0.05). These patients also had significantly greater episodes of diarrhoea (11.6 vs 4.1 episodes, p < 0.05), significantly lower albumin levels and more days on antibiotics compared with the group of patients who were mobilised before surgery (p < 0.05). Patients mobilised after surgery waited longer to be enterally fed (89 days vs 62.5 days), and although this was not statistically significant, it may be clinically significant. There were significant correlations between independent mobilisation and diarrhoea, independent mobilisation and albumin, length of stay and diarrhoea (p < 0.05). Regression analysis showed hours taken to commence enteral feeding and days in ICU predicted diarrhoea (p < 0.05). CONCLUSIONS This study illustrates the combined approach of two disciplines and their interrelated factors. Mobilisation appears to interrelate with nutrition factors, and this includes diarrhoea (which is likely a manifestation of gut effects due to the nature and timing of substrate delivery). A few factors were revealed in this interrelation that have not been documented previously in burns, namely the associations between mobilisation, diarrhoea, and serum albumin. Team members need to ensure inclusion of key recommendations from other disciplines when a particular, crucial factor from one discipline cannot be applied. Results in this study need to be interpreted with caution due to the small sample size, the use of statistical applications with sample size, and the retrospective nature of the study. A larger, more rigorous prospective research study is required to confirm these results.
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Egro FM, Johnson ED, Kenny EM, Foglio AM, Smith BT, Corcos AC, Ziembicki JA. A Qualitative Survey Study of United States Burn Units: Pathways to a Career in Burn Surgery. J Burn Care Res 2020; 40:595-600. [PMID: 31032517 DOI: 10.1093/jbcr/irz071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
With current changes in training requirements, it is important to understand the venues in the United States for a general surgery (GS) and plastic surgery (PS) resident interested in pursuing a burn surgery career. The study aims to evaluate the pathways to a career in burn surgery and the current state of leadership. A cross-sectional study was conducted between August and September 2017. A 12-question survey was sent to all burn unit directors in the United States, asking about their background, who manages various aspects of burn care and the hiring requirements. Responses were received from 55 burn unit directors (47% response rate). Burn units are lead most commonly by physicians who received GS training (69%), but the majority either did not undergo fellowship training (31%) or completed a burn surgery fellowship (29%). While surgical care (GS = 51%, PS = 42%) and wound care (GS = 51%, PS = 42%) were predominantly managed by GS- or PS-trained burn teams, management of other aspects of burn care varied depending on the institution, demonstrating that a shift in burn care management. The desired hiring characteristics, including GS (67%) or PS residency (44%) and a burn surgery (55%), trauma surgery (15%), or critical care (44%) fellowship. Directors' training significantly influenced their preferences for hiring requirements. While leadership in burn surgery is dominated by GS-trained physicians, the surgical and wound care responsibilities are shared among PS and GS. Although one third of current directors did not undergo fellowship training, aspiring surgeons are advised to obtain a burn surgery and/or critical care fellowship.
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Affiliation(s)
- Francesco M Egro
- University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
| | - Erica D Johnson
- University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
| | - Elizabeth M Kenny
- University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
| | - Aaron M Foglio
- University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
| | - Brandon T Smith
- University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
| | - Alain C Corcos
- University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
| | - Jenny A Ziembicki
- University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania
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30
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Silander NC, Chesire DJ, Scott KS. Psychological Prophylaxis: An Integrated Psychological Services Program in Trauma Care. J Clin Psychol Med Settings 2020; 26:291-301. [PMID: 30341469 DOI: 10.1007/s10880-018-9586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The primary medical goals of acute care are restoration of physical health and return to physical function. However, in response to traumatic events and injuries, psychological factors are critical to one's overall recovery. Both pre-morbid psychiatric comorbidities and post-injury psychological compromise affect physical and psychological recovery in inpatient trauma populations. The Psychological Services Program (PSP), a model trauma/acute care program, addresses these critical factors in a Level 1 Trauma Center. The program routinely treats over one-quarter of the trauma patients at any given time. The incorporation of the PSP into treatment team care ensures that patients in need of mental health support can be identified and treated during their recovery. This unique model is recommended as a potential injury prevention and recovery intervention strategy for the myriad mental health comorbidities that may function as risk factors for poor post-injury adaptation and also as risk factors for possible future traumatic injury.
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Affiliation(s)
- Nina C Silander
- Brooks Rehabilitation Hospital, 3599 University Blvd S., Jacksonville, FL, USA.
| | - David J Chesire
- Division of Acute Care Surgery, Department of Surgery, College of Medicine/Jacksonville, University of Florida, Jacksonville, FL, USA
| | - Kamela S Scott
- Division of Acute Care Surgery, Department of Surgery, College of Medicine/Jacksonville, University of Florida, Jacksonville, FL, USA
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Hahn B, Alex Roh S, Price C, Fu W, DiBello J, Barbara P, Greenstein J, Chacko J. Demographics and clinical patterns of burns requiring emergency hospitalization at a regional north-eastern us burn center. Hosp Pract (1995) 2020; 48:137-145. [PMID: 32326780 DOI: 10.1080/21548331.2020.1760555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND There are known demographic and clinical patterns related to burn injuries and care associated with national and global geography. Still, limited data sources exist to facilitate the study of trends in the regionalization of burn care. OBJECTIVES The current study aims to investigate the demographics and clinical characteristics of patients that presented to the Emergency Department (ED) and were subsequently admitted for treatment to the inpatient unit of a regional burn center. METHODS This retrospective, single-center study was conducted between 1 February 2018 and 31 July 2019, of ED patients who presented with a burn injury and were subsequently admitted to the hospital. RESULTS We identified 329 patients with burn injuries requiring hospitalization. The median age was 22 years [IQR 2-53], and 195 (59%) subjects were males. Monthly and seasonal variations in admissions were identified. The majority of burns occurred at home (84%) and secondary to a scalding injury (59%). The lower extremity was the most common site of injury (29%). Most subjects received antibiotics (59%) and narcotic analgesia (56%) in the ED. The median hospital length of stay was four days [IQR 2-11]. Many subjects did not require surgical intervention (64%) and did not experience complications (79%). CONCLUSIONS In this study, we describe the demographics and clinical characteristics of patients that presented to the ED and were subsequently admitted to a regional burn center. Analyzing the epidemiological information and clinical management of burns may better prepare healthcare providers to offer care to patients with burn injuries.
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Affiliation(s)
- Barry Hahn
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Seungwhan Alex Roh
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Christopher Price
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Wayne Fu
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Jaclyn DiBello
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Paul Barbara
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Josh Greenstein
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Jerel Chacko
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
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Guest JF, Fuller GW, Edwards J. Cohort study evaluating management of burns in the community in clinical practice in the UK: costs and outcomes. BMJ Open 2020; 10:e035345. [PMID: 32273318 PMCID: PMC7245389 DOI: 10.1136/bmjopen-2019-035345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate health outcomes, resource use and corresponding costs attributable to managing burns in clinical practice, from initial presentation, among a cohort of adults in the UK. DESIGN Retrospective cohort analysis of the records of a randomly selected cohort of 260 patients from The Health Improvement Network (THIN) database who had 294 evaluable burns. SETTING Primary and secondary care sectors in the UK. PRIMARY AND SECONDARY OUTCOME MEASURES Patients' characteristics, wound-related health outcomes, healthcare resource use and total National Health Service (NHS) cost of patient management. RESULTS Diagnosis was incomplete in 63% of patients' records as the location, depth and size of the burns were missing. Overall, 70% of all the burns healed within 24 months and the time to healing was a mean of 7.8 months per burn. Sixty-six per cent of burns were initially managed in the community and the other 34% were managed at accident and emergency departments. Patients' wounds were subsequently managed predominantly by practice nurses and hospital outpatient clinics. Forty-five per cent of burns had no documented dressings in the patients' records. The mean NHS cost of wound care in clinical practice over 24 months from initial presentation was an estimated £16 924 per burn, ranging from £12 002 to £40 577 for a healed and unhealed wound, respectively. CONCLUSIONS Due to incomplete documentation in the patients' records, it is difficult to say whether the time to healing was excessive or what other confounding factors may have contributed to the delayed healing. This study indicates the need for education of general practice clinicians on the management and care of burn wounds. Furthermore, it is beholden on the burns community to determine how the poor healing rates can be improved. Strategies are required to improve documentation in patients' records, integration of care between different providers, wound healing rates and reducing infection.
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Affiliation(s)
- Julian F Guest
- Catalyst Consultants, Rickmansworth, UK
- King's College London, London, UK
| | | | - Jacky Edwards
- Burns Nurse Consultant, Burn Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Cook AC, Langston JA, Jaramillo JD, Edwards KE, Wong HN, Aslakson RA. Opportunities for Palliative Care in Patients With Burn Injury-A Systematic Review. J Pain Symptom Manage 2020; 59:916-931.e1. [PMID: 31775021 DOI: 10.1016/j.jpainsymman.2019.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
Abstract
CONTEXT Patients with significant burn injuries likely have palliative care needs. OBJECTIVES We performed a systematic review of existing evidence concerning the palliative care needs of burn patients. METHODS Through November 26, 2018, we systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using terms representing burn injuries and the eight domains of quality palliative care as outlined by the National Consensus Project for Quality Palliative Care. Eligible articles involved burn-injured patients treated with an intervention targeting at least one of the eight domains. RESULTS Our searches yielded 7532 unique records, which led to 238 articles for full review and 88 studies that met inclusion criteria. Seventy-five studies addressed the domain physical aspects of care and merit a separate systematic review; 13 studies were included in our final review. Four of the seven domains-processes of care, psychologic symptoms, social aspects, and end of life-were addressed by studies but three domains-spiritual, cultural, or ethics-were unaddressed. Included studies highlight potential benefits from peridischarge self-care education programs, peer support, and group therapy in improving quality of life. In patients with severe injuries, end-of-life decision-making protocols were associated with increased utilization of comfort-focused treatments. CONCLUSION Most existing palliative care-related research in burn patients addresses interventions for physical symptoms with minimal literature concerning other domains. Opportunities exist for further research of palliative care in burn populations with emphasis on addressing interventions for all domains and better standardizing the language and outcomes for the palliative care interventions.
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Affiliation(s)
- Allyson C Cook
- Department of Medicine, University of California San Francisco, San Francisco, California, USA.
| | - Jessica A Langston
- Department of Medicine, VA NorCal Health Care System, Sacramento, California, USA
| | | | - Kristin E Edwards
- Department of Medicine-Palliative Care, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca A Aslakson
- Departments of Medicine & Anesthesiology, Stanford University, Stanford, California, USA
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Markiewitz N, Cox C, Krout K, McColl M, Caffrey JA. Examining the Rates of Anxiety, Depression, and Burnout Among Providers at a Regional Burn Center. J Burn Care Res 2020; 40:39-43. [PMID: 30032292 DOI: 10.1093/jbcr/iry042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Burnout, defined by feelings of inefficacy, cynicism, and emotional exhaustion, affects the performance and well-being of health care providers. Burn care exposes providers to factors known to cause or worsen burnout, but no research has presented prevalence rates of burnout in this population. We estimate the rates of anxiety, depression, and burnout among nonphysician providers in a regional burn center and compare those rates to a reference population of critical care nurses. In our sample of 22 providers, 64% screened positive for anxiety; 32% for depression; 82% for emotional exhaustion; 18% for personal achievement burnout; and 54% for depersonalization. When compared with a national sample of critical care nurses, burn center providers demonstrated a significantly higher rate of anxiety (risk difference [RD]: 0.453, 95% confidence interval [CI] [0.244, 0.622]), a significantly higher rate of emotional exhaustion (RD: 0.207, 95% CI [0.001, 0.323]), and a significantly lower rate of personal achievement burnout (RD: -0.325, 95% CI [-0.442, -0.119]). These findings constitute the first evidence that many burn care providers meet criteria for burnout and that burnout in burn care providers may qualitatively differ from burnout in other critical care providers. Future research should identify burn care-specific predictors of burnout and determine the feasibility and efficacy of interventions to prevent and reduce burnout in burn care providers.
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Affiliation(s)
| | - Carrie Cox
- Johns Hopkins Adult Burn Center, Baltimore, Maryland
| | - Kelly Krout
- Johns Hopkins Adult Burn Center, Baltimore, Maryland
| | | | - Julie A Caffrey
- Johns Hopkins Adult Burn Center, Baltimore, Maryland.,Department of Plastic and Reconstructive Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland
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Efficacy and Safety of Pirfenidone in Patients with Second-Degree Burns: A Proof-of-Concept Randomized Controlled Trial. Adv Skin Wound Care 2020; 33:1-7. [PMID: 32195729 DOI: 10.1097/01.asw.0000655484.95155.f7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Several studies suggest that pirfenidone may have a potential off-label use for wound healing. However, the effectiveness of this medication in patients with burns remains uncertain. Accordingly, investigators sought to assess wound re-epithelialization in patients with second-degree burns after adding pirfenidone to usual care. DESIGN AND SETTING Single-center pilot, proof-of-concept, single-blind randomized controlled trial. PATIENTS AND INTERVENTION Eight patients with second-degree burns were treated with occlusive hydrocolloid dressings and were randomly allocated to receive either no additional treatment or pirfenidone. OUTCOME MEASURES The primary outcome of the study was to evaluate wound healing between groups based on the thickness of the re-epithelialized epidermis at day 7. Secondary outcomes were to qualitatively assess the development of fibrotic tissue in the dermis, anomalies in the basal membrane, and the development of collagen fibers by histologic analysis. Liver and renal functions were measured daily to assess the overall safety of oral pirfenidone. MAIN RESULTS Patients treated with pirfenidone showed a remarkable improvement in wound re-epithelialization at day 7 (148.98 ± 13.64 vs 119.27 ± 15.55 μm; P = .029; 95% confidence interval, 4.14-55.29). Histologic evaluations showed less wound fibrosis in the pirfenidone group. CONCLUSIONS A decrease in wound healing time by enhancing wound re-epithelialization was observed with pirfenidone. Larger clinical trials are needed to reach more reliable conclusions.
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Legrand M, Barraud D, Constant I, Devauchelle P, Donat N, Fontaine M, Goffinet L, Hoffmann C, Jeanne M, Jonqueres J, Leclerc T, Lefort H, Louvet N, Losser MR, Lucas C, Pantet O, Roquilly A, Rousseau AF, Soussi S, Wiramus S, Gayat E, Blet A. Management of severe thermal burns in the acute phase in adults and children. Anaesth Crit Care Pain Med 2020; 39:253-267. [PMID: 32147581 DOI: 10.1016/j.accpm.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To provide recommendations to facilitate the management of severe thermal burns during the acute phase in adults and children. DESIGN A committee of 20 experts was asked to produce recommendations in six fields of burn management, namely, (1) assessment, admission to specialised burns centres, and telemedicine; (2) haemodynamic management; (3) airway management and smoke inhalation; (4) anaesthesia and analgesia; (5) burn wound treatments; and (6) other treatments. At the start of the recommendation-formulation process, a formal conflict-of-interest policy was developed and enforced throughout the process. The entire process was conducted independently of any industry funding. The experts drew up a list of questions that were formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes). Two bibliography experts per field analysed the literature published from January 2000 onwards using predefined keywords according to PRISMA recommendations. The quality of data from the selected literature was assessed using GRADE® methodology. Due to the current paucity of sufficiently powered studies regarding hard outcomes (i.e. mortality), the recommendations are based on expert opinion. RESULTS The SFAR guidelines panel generated 24 statements regarding the management of acute burn injuries in adults and children. After two scoring rounds and one amendment, strong agreement was reached for all recommendations. CONCLUSION Substantial agreement was reached among a large cohort of experts regarding numerous strong recommendations to optimise the management of acute burn injuries in adults and children.
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Affiliation(s)
- Matthieu Legrand
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, United States.
| | - Damien Barraud
- Hôpital de Mercy, Intensive Care Medicine and Burn Centre, CHR Metz-Thionville, Ars-Laquenexy, France
| | - Isabelle Constant
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | | | - Nicolas Donat
- Burn Centre, Percy Military Teaching Hospital, Clamart, France
| | - Mathieu Fontaine
- Burn Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Laetitia Goffinet
- Paediatric Burn Centre, University Hospital of Nancy, 54511 Vandœuvre-Lès-Nancy, France
| | | | - Mathieu Jeanne
- CHU Lille, Anaesthesia and Critical Care, Burn Centre, 59000 Lille, France; University of Lille, Inserm, CHU Lille, CIC 1403, 59000 Lille, France; University of Lille, EA 7365 - GRITA, 59000 Lille, France
| | - Jeanne Jonqueres
- Burn Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France
| | - Hugues Lefort
- Department of emergency medicine, Legouest Military Teaching Hospital, Metz, France
| | - Nicolas Louvet
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Marie-Reine Losser
- Hôpital de Mercy, Intensive Care Medicine and Burn Centre, CHR Metz-Thionville, Ars-Laquenexy, France; Paediatric Burn Centre, University Hospital of Nancy, 54511 Vandœuvre-Lès-Nancy, France; Inserm UMR 1116, Team 2, 54000 Nancy, France; University of Lorraine, 54000 Nancy, France
| | - Célia Lucas
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France
| | - Olivier Pantet
- Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), BH 08-651, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Antoine Roquilly
- Department of Anaesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, Nantes, France; Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections", University of Nantes, Nantes, France
| | | | - Sabri Soussi
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Interdepartmental Division of Critical Care, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sandrine Wiramus
- Department of Anaesthesia and Intensive Care Medicine and Burn Centre, University Hospital of Marseille, La Timone Hospital, Marseille, France
| | - Etienne Gayat
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Alice Blet
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France; Department of Research, University of Ottawa Heart Institute, Ottawa, ON, Canada
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What informs care? Descriptions by multidisciplinary teams about burns care for Aboriginal and Torres Strait Islander children. Burns 2020; 46:430-440. [DOI: 10.1016/j.burns.2019.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 06/29/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022]
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Abrams TE. Exploring the role of social work in U.S. burn centers. SOCIAL WORK IN HEALTH CARE 2020; 59:61-73. [PMID: 31878843 DOI: 10.1080/00981389.2019.1695704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/25/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
Because burn injuries most often occur within marginalized populations, there is a greater risk for poor psychosocial outcomes and social workers are trained to identify those psychosocial risk and resilience factors. Very little has been written about the role of social workers working in burn critical care teams, therefore leaving a gap in knowledge regarding this specialized area of social work practice. Social workers participating in multidisciplinary burn care teams were invited to participate in this preliminary descriptive study (n = 29). Frequency statistics were calculated for the brief online survey to learn more about professional preparation and continuing education, job responsibilities, and perspectives on job skills. Respondents were primarily white and female, with a mean age of 43.74 years. Most respondents reported holding an MSSW and a state-issued professional license. Responsibilities were described as discharge planning, case management, patient counseling, family counseling, support group facilitation, community education, school reentry/back to work programs, burn prevention, and "other duties", respectively. More than half of the respondents reported responsibilities in other units. With increased understanding of interventions used by social workers inpatient, there can be a greater understanding of patients' continuing needs once discharged.
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Affiliation(s)
- Thereasa E Abrams
- College of Social Work, University of Tennessee, Nashville, United States
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Gueler JR, McMullen K, Kowalske K, Holavanahalli R, Fauerbach JA, Ryan CM, Stoddard FJ, Wiechman SA, Roaten K. Exploratory analysis of long-term physical and mental health morbidity and mortality: A comparison of individuals with self-inflicted versus non-self-inflicted burn injuries. Burns 2019; 46:531-538. [PMID: 31640886 DOI: 10.1016/j.burns.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 09/12/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Self-inflicted burn (SIB) injuries are relatively rare, but patients may experience complex biopsychosocial challenges. This study aimed to compare long-term physical and psychological outcomes for individuals with SIB and non-SIB injuries. METHODS Records of adult SIB (n = 125) and non-SIB (n = 3604) injuries were collected from U.S. burn centers within the Burn Model System between 1993 and 2018. Assessments were administered at discharge, 6 months, 24 months, 5 years, and 10 years. RESULTS SIB patients were more often younger, unmarried, unemployed, male, struggling with pre-morbid psychiatric issues, and injured by fire/flame (all p < 0.001). SIB injury predicted prolonged mechanical ventilation, hospitalization, and rehabilitation (all p < 0.001). After injury, SIB patients had increased anxiety at 24 months (p = 0.0294), increased suicidal ideation at 5 years (p = 0.004), and clinically worse depression at 10 years (p = 0.0695). SIB patients had increased mortality across 24 months compared to non-SIB patients (OR = 4.706, p = 0.010). CONCLUSION SIB injuries are associated with worse physical and psychological outcomes compared to non-SIB injuries including complicated hospitalizations and chronic problems with anxiety, depression, suicidality, and mortality, even when controlling for common indicators of severity such as burn size. This underscores the importance of multidisciplinary treatment, including mental healthcare, and long-term follow-up for SIB patients. Identified pre-morbid risk factors indicate the need for targeted injury prevention.
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Affiliation(s)
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Karen Kowalske
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Radha Holavanahalli
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - James A Fauerbach
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Hospital for Children, Boston, MA, USA
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Shriners, USA
| | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Kimberly Roaten
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
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Endo A, Shiraishi A, Otomo Y, Fushimi K, Murata K. Volume-outcome relationship on survival and cost benefits in severe burn injury: a retrospective analysis of a Japanese nationwide administrative database. J Intensive Care 2019; 7:7. [PMID: 30733868 PMCID: PMC6354429 DOI: 10.1186/s40560-019-0363-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although it has been reported that high hospital patient volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. Methods We conducted a retrospective observational study on severe burn patients, defined by a burn index ≥ 10, using 2010–2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between patient volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days). Generalized linear mixed-effect regression models (GLMMs) in which patient volume was incorporated as a continuous or categorical variable (≤ 5 or > 5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating patients who were directly transported, those with PBI ≤ 120 and those excluding patients who died within 2 days of admission, were also performed. Results We analyzed 5250 eligible severe burn patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in patient volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher volume hospitals. The GLMM model showed that patient volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)] = 1.14 [1.09–1.19]), high healthcare costs (adjusted difference [95% CI] = $4876 [4436–5316]), and few hospital-free days (adjusted difference [95% CI] = − 3.1 days [− 3.4 to − 2.8]). Similar trends were observed in the analyses in which patient volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results. Conclusions Analysis of Japanese nationwide administrative database demonstrated that high burn patient volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results. Electronic supplementary material The online version of this article (10.1186/s40560-019-0363-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akira Endo
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Atsushi Shiraishi
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.,2Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba Japan
| | - Yasuhiro Otomo
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Kiyohide Fushimi
- 3Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Murata
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.,The Shock Trauma and Emergency Medical Center, Matsudo City General Hospital, 933-1 Sendabori,, Matsudo, Chiba Japan
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Litchfield I, Jones LL, Moiemen N, Andrews N, Greenfield S, Mathers J. The role of self-management in burns aftercare: a qualitative research study. Burns 2018; 45:825-834. [PMID: 30545694 DOI: 10.1016/j.burns.2018.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION For severe burns patient care presents a considerable challenge, necessitating an integrated multi-disciplinary approach that utilises a range of treatments. The period of care post-discharge can be lengthy and complex, and include scar management, occupational and physiotherapies, psychological support, and further surgery. How successfully the patient negotiates this complex care regimen is critical to their long-term recovery and in doing so they would appear to employ approaches recognised as "self-management" in other chronic conditions. However their exact nature and how they are used has yet to be explicitly explored amongst chronic burn patients. METHODS Semi-structured interviews were conducted with 24 patients to discuss their experiences of long-term burn treatment as part of a broader mixed- methods feasibility study of the use of pressure garment therapy in preventing hypertrophic scarring after burn injury. The topic guide included questions on the patient experience of their care post discharge, including pressure garment therapy and other scar management techniques; and their expectations and experiences of treatment and recovery. The data were analysed using an established framework of self-management processes. RESULTS Burns patients employ many of the same processes of self-management as those experiencing more widely recognised chronic diseases or illnesses. This is despite the prospect of gradual improvement amongst burns patients absent in those with incurable chronic conditions. The key processes of self-management they share are the ability to focus on their illness needs, activate the appropriate resources and coming to terms with the consequences of living with either the physical or psychological consequences of their condition. CONCLUSION Modern burn care is technologically advanced and delivered by a highly trained, multi-disciplinary team, yet the level of its success relies on the ability of the patient to independently fulfil a number of health-related tasks and activities once leaving hospital. Considering the potential cost-savings to health services and the prospect of improved outcomes for patients capable of self-management our work is an important first step in more precisely understanding the use of self-management amongst burns patients, and the level of implicit or explicit support currently offered by their care providers.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Laura L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Naiem Moiemen
- The Scar Free Foundation Centre for Burns Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Nicole Andrews
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Cleary M, Visentin DC, West S, Andrews S, McLean L, Kornhaber R. Bringing research to the bedside: Knowledge translation in the mental health care of burns patients. Int J Ment Health Nurs 2018; 27:1869-1876. [PMID: 29799653 DOI: 10.1111/inm.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 11/26/2022]
Abstract
Advances in surgical techniques and wound management have improved outcomes for burn patients; however, the psychological impacts on burn survivors have had less attention. There is a higher rate of mental health disorders amongst burns victims, with those with pre-existing mental health conditions likely to have worse outcomes. To implement effective burns care and rehabilitation, knowledge and understanding of mental health issues is required. This position paper discusses the extent to which clinicians currently translate knowledge around mental health and burns into practice to identify enables and inhibitors. Successful knowledge translation requires dissemination and accessibility of information with the capacity and readiness for change. Clinicians and researchers need to identify how translating research to practice can meet the needs of burn survivors. There is a gap in the utilization of evidence concerning mental health and the needs of burns survivors, and we need to understand what we know as compared to what we do. Clinicians are well placed to determine how and why knowledge does not necessarily translate to practice and how they can better accommodate the needs of burn survivors.
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Affiliation(s)
- Michelle Cleary
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| | - Denis C Visentin
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| | - Sancia West
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| | - Sharon Andrews
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Sydney West and Greater Southern Psychiatry Training Network, Cumberland Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia.,Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rachel Kornhaber
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
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Baier C, Ipaktchi R, Ebadi E, Rennekampff HO, Just HM, Vogt P, Bange FC, Suchodolski K. Infection control in german-speaking burn centres: results of an online survey. ANNALS OF BURNS AND FIRE DISASTERS 2018; 31:189-193. [PMID: 30863251 PMCID: PMC6367864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/12/2018] [Indexed: 06/09/2023]
Abstract
To systematically evaluate which infection control measures are in place in burn units, we conducted an online survey among 43 German-speaking burn units. The 29 units that responded and agreed to publication represented more than 125 patient beds. All units were located in advanced care hospitals. A total of 14 units provided single rooms only, and 22 units had a nurse-to-patient ratio of at least 1:2. Infection control practices included pre-emptive barrier precautions (29 units), the use of sterile filters for tap water supply (29 units), and an antibiotic stewardship program (24 units). Microbial screening of the patients on admission (23 units), regular prevalence screening (26 units) and surveillance of nosocomial infections (21 units) were also widely used. The high reply rate to the survey indicates the special relevance of infection control for burn units. Our survey shows that great efforts and several measures are being undertaken to address infection control challenges in burn patient care, but it also underlines the need for increased interdisciplinary infection control and antibiotic stewardship activities.
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Affiliation(s)
- C. Baier
- Claas Baier
Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical SchoolCarl-Neuberg-Straße 1, 30625 HannoverGermany+49 511 532 5833, +49 176 1532 8675+49 511 532 8174
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Abstract
Objectives Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma. Methods This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs). Results There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns. Intra-abdominal and intra-thoracic injuries accounted for 3 and 2% of injuries. The mechanisms and injuries sustained differed significantly between HICs and LMICs. Median length of stay was 1 day and 19% required an operative intervention; this did not differ significantly between HICs and LMICs. No mortality and morbidity was reported from HICs. In LMICs, in-hospital morbidity was 4.0% and mortality was 0.8%. Conclusion The spectrum of paediatric trauma varies significantly, with different injury mechanisms and patterns in LMICs. Healthcare structure, access to paediatric surgery and trauma prevention strategies may account for these differences. Trauma registries are needed in LMICs for future research and to inform local policy.
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Attribution bias underlying burns-induced anxiety symptoms. Burns 2018; 44:1502-1508. [DOI: 10.1016/j.burns.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022]
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Current Challenges of Plastic Surgical Care in Sub-Saharan Africa (Maputo, Mozambique). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1893. [PMID: 30324071 PMCID: PMC6181493 DOI: 10.1097/gox.0000000000001893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/13/2018] [Indexed: 11/26/2022]
Abstract
Background: Limited data exist on plastic surgery practices in Sub-Saharan Africa. The aim of this study was to characterize the spectrum of disease and operative procedures at a teaching hospital in Maputo, Mozambique to help understand the challenges of providing care for the local providers and to provide contextual relevance for training through partnerships. Methods: A mixed-methods approach was utilized to perform an ongoing needs assessment. A retrospective review was performed of plastic surgery operative records, ward admissions records, and death records in a tertiary-care hospital in Maputo, Mozambique for the period January 2015 to December 2015. Results: Limited resources (equipment, block-time, personnel, and perioperative services) were observed. The most common diagnoses for the 455 patients evaluated were burns (44%) and neoplasms (17%). Congenital abnormalities accounted for only 1% of the patient diagnoses. Of the 408 procedures performed, the majority were skin grafts (43%) and skin excisions (31%). Sepsis from burns accounted for 70% of documented deaths (14/20). The mean number of days to skin grafting for inpatients was 53 days. Conclusion: We observed a large burden of burns and skin graft procedures at a public referral teaching hospital in Mozambique. Our findings provide contextual relevance to help focus public health efforts and improve plastic surgery training and practices.
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Grigorian A, Nahmias J, Schubl S, Gabriel V, Bernal N, Joe V. Rising mortality in patients with combined burn and trauma. Burns 2018; 44:1989-1996. [PMID: 30075972 DOI: 10.1016/j.burns.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/07/2018] [Accepted: 07/13/2018] [Indexed: 01/29/2023]
Abstract
Combined trauma in the burn patient has been previously shown to have higher mortality. With improved critical care and multidisciplinary approach, we hypothesized the risk of mortality in combined burn and trauma has decreased. A retrospective analysis of trauma, burn and combined burn-trauma patients in the National Trauma Data Bank was performed comparing years 2007-2015 to years 1994-2002. The impact of burn injuries on mortality in patients with minor trauma has decreased (OR 2.45, CI 2.26-2.66, p<0.001 compared to OR 4.04, CI 4.51-4.66, p<0.001) in years 2007-2015 while the impact of burn injuries on mortality in patients with severe trauma has increased (OR 1.37, CI 1.29-1.47, p<0.001 compared to OR 1.26, CI 1.05-1.51, p<0.001). When controlling for known risk factors of mortality in burn and trauma, the contribution of the severity of trauma on mortality in combined burn-trauma patients with total body surface area ≥20% is negligible. In contrast, an increase in percentage of total body surface area burned is associated with a step-wise increase in mortality for all combined burn-trauma patients. However, the largest impact is seen in patients with minor trauma. This population represents a unique overlap of patients where future collaborative research can help identify best practices and improve outcomes.
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Affiliation(s)
- Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Sebastian Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Viktor Gabriel
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Nicole Bernal
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Victor Joe
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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Burn injury models of care: A review of quality and cultural safety for care of Indigenous children. Burns 2018; 44:665-677. [DOI: 10.1016/j.burns.2017.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/31/2017] [Accepted: 10/14/2017] [Indexed: 11/23/2022]
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Ofir H, Shefler H, Kornhaber R, Cleary M, Harats M, Haik J. Purpose-built national burns center: The Israeli experience. Nurs Health Sci 2018; 20:255-263. [DOI: 10.1111/nhs.12405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Hagit Ofir
- Department of Plastic and Reconstructive Surgery; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Hadas Shefler
- Department of Plastic and Reconstructive Surgery; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Rachel Kornhaber
- Department of Plastic and Reconstructive Surgery; Sheba Medical Center; Tel Hashomer Israel
- School of Health Sciences, College of Health and Medicine; University of Tasmania; Sydney New South Wales Australia
| | - Michelle Cleary
- School of Health Sciences, College of Health and Medicine; University of Tasmania; Sydney New South Wales Australia
| | - Moti Harats
- Department of Plastic and Reconstructive Surgery; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- University of Notre Dame Australia; Fremantle Western Australia Australia
| | - Josef Haik
- Department of Plastic and Reconstructive Surgery; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- University of Notre Dame Australia; Fremantle Western Australia Australia
- Talpiot Leadership Program; Sheba Medical Center; Tel Hashomer Israel
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Thananopavarn P, Hill JJ. Rehabilitation of the Complex Burn Patient with Multiple Injuries or Comorbidities. Clin Plast Surg 2017; 44:695-701. [PMID: 28888295 DOI: 10.1016/j.cps.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with complex burn injuries require interdisciplinary rehabilitation to maximize their functional recovery. Successful rehabilitation from burn injuries starts with addressing the loss of the protective, mechanical, and cosmetic function of the skin and underlying structures. However, other injuries, particularly to the nervous and musculoskeletal systems, need to be identified and managed as part of the rehabilitation plan. Burn injuries can cause losses of functional mobility, self-care skills, psychological well-being, and community participation, which require comprehensive rehabilitation interventions throughout the recovery process.
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Affiliation(s)
- Paul Thananopavarn
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - James J Hill
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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