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Tapking C, Popp D, Herndon DN, Armenta AM, Branski LK, Murton AJ, Suman OE. Cardiovascular Effect of Varying Interval Training Frequency in Rehabilitation of Severely Burned Children. J Burn Care Res 2020; 40:34-38. [PMID: 30247564 DOI: 10.1093/jbcr/iry051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Structured exercise programs initiated after acute hospitalization can improve muscle strength and mass, cardiorespiratory capacity, and quality of life in severely burned children. In this retrospective study, we compared the cardiovascular effects of an exercise program incorporating a large number of interval training sessions with a traditional exercise program incorporating a small number of interval training sessions. Severely burned children who completed a large number of sessions (at least three sessions per week, N = 40) were matched to those completing a small number of sessions (a maximum of two sessions per week, N = 40). Maximal oxygen consumption (VO2 max) was measured via the modified Bruce treadmill protocol at discharge, on completion of the exercise program, and at follow-up visits at 6, 12, and 24 months postburn. Both groups were comparable in age (large 13.5 ± 3.0 years vs small 13.1 ± 3.3 years) and percent total BSA burned (large 50.8 ± 14.8% vs small 49.2 ± 13.3%). For both groups, VO2 max increased from discharge (large 22.6 ± 3.8 ml/kg/min; small 22.6 ± 5.0 ml/kg/min) to postexercise (large 29.5 ± 6.0 ml/kg/min; small 28.0 ± 5.8 ml/kg/min), 6 months (large 33.2 ± 5.9 ml/kg/min; small 29.6 ± 7.0 ml/kg/min), 12 months (large 35.0 ± 7.5 ml/kg/min; small 31.7 ± 7.1 ml/kg/min), and 24 months (large 37.0 ± 7.2 ml/kg/min; small 32.4 ± 9.2 ml/kg/min, P < .001). VO2 increased to a greater extent with a large number of interval sessions than with a small number at 6 and 24 months (both P = .021). These findings suggest that a large number of interval training sessions impart a greater benefit on cardiorespiratory fitness than a small number of sessions.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Daniel Popp
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch.,Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - David N Herndon
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch
| | - Andrew M Armenta
- School of Medicine, University of Texas Medical Branch, Galveston
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch.,Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Andrew J Murton
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch
| | - Oscar E Suman
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch
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Riobueno-Naylor A, Romo S, Kazis L, Wang S, Lydon M, Nelson J, Fowler L, Drexler A, Kogosov A, Haile H, Ryan CM, Chang P, Warner P, Palmieri TL, Lee AF, Stoddard F, Murphy JM, Sheridan RL. Usefulness of a Novel System for Feedback of Patient-Reported Outcome Measures in Children Recovering From Burns. J Burn Care Res 2019; 40:776-784. [PMID: 31102446 DOI: 10.1093/jbcr/irz082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Burn Outcomes Questionnaire for children ages 5-18 years (BOQ5-18) is a widely used, reliable, and valid parent-reported outcome measure designed to assess children's recovery from burn injuries in 12 physical and psychosocial domains. This study evaluated the feasibility, acceptability, and usefulness of a feedback system that delivered BOQ and Pediatric Symptom Checklist (PSC-17; a widely used measure of psychosocial functioning) results to burn care clinicians prior to an outpatient appointment or a postoperative surgical encounter. The BOQ and the PSC-17 were administered to the parents of 147 children receiving outpatient or surgical care in two pediatric burn hospitals. Clinician and parent perceptions of the feedback system were evaluated using debriefing questionnaires. Over half of all patients were at-risk on at least one BOQ subscale, and risk on three or more BOQ domains was significantly associated with a higher likelihood of poor psychological scores on the PSC-17 (P < .001). Significant differences in BOQ scores were found between the two hospital sites on four BOQ subscales, three related to physical ability and one to psychosocial well-being. Parent ratings of the feedback system were positive, with 90% of parents in both settings agreeing that the BOQ tablet experience was easy and helpful. Clinician attitudes differed across the two settings with more positive clinician ratings of the system in the outpatient setting (P < .001). Clinician interviews revealed that the data was especially useful in bringing to light psychosocial aspects of functioning relevant to long-term recovery from burn injuries.
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Affiliation(s)
- Alexa Riobueno-Naylor
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie Romo
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Lewis Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Shirley Wang
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Martha Lydon
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Judith Nelson
- Department of Clinical Research, Shriners Hospitals for Children - Cincinnati, Ohio
| | - Laura Fowler
- Department of Clinical Research, Shriners Hospitals for Children - Cincinnati, Ohio
| | - Alana Drexler
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Ann Kogosov
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Haregnesh Haile
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen M Ryan
- Department of Surgery, Shriners Hospitals for Children - Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Philip Chang
- Department of Surgery, Shriners Hospitals for Children - Cincinnati, Ohio
| | - Petra Warner
- Department of Surgery, Shriners Hospitals for Children - Cincinnati, Ohio
| | - Tina L Palmieri
- Department of Surgery, Shriners Hospitals for Children - Northern California, Sacramento, California.,Department of Surgery, University of California Davis, Sacramento, California
| | - Austin F Lee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Frederick Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Shriners Hospitals for Children - Boston, Massachusetts
| | - J Michael Murphy
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Robert L Sheridan
- Department of Surgery, Shriners Hospitals for Children - Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Hyland EJ, Lawrence T, Harvey JG, Holland AJA. Management and outcomes of children with severe burns in New South Wales: 1995-2013. ANZ J Surg 2015; 86:499-503. [PMID: 26678373 DOI: 10.1111/ans.13398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND As a result of improvements in injury prevention, severe burns appear increasingly uncommon in Australian children. Such injuries continue to have devastating impacts, with major consequences for the patient, their family, treating clinicians and the caring institution. METHODS A retrospective review was undertaken of Australian children who presented to our institution between 1995 and 2013 with burn injuries ≥30% total body surface area (TBSA). RESULTS Ninety children were identified. Their median age was 3.9 years and 57% (n = 52) were male. Most injuries occurred at home (n = 63) due to fires (n = 49). The majority received inadequate first aid (n = 56) and 40 became hypothermic during initial resuscitation. A total of 79% were transferred from other institutions. The median TBSA burnt was 40% and the majority of burns were full thickness (n = 51). All but nine were managed in the Paediatric Intensive Care Unit with a mean initial hospital admission of 43.5 days. Two thirds of children were intubated, over half of those prior to transfer, with 26 having an inhalational injury and 33 escharotomies. Compared with estimated fluid requirements, most children were over-resuscitated by a median of 26.9 mL/kg. There were seven mortalities. Wound infections were common (n = 65) and 36 suffered sepsis. The median number of dressing changes was 13 (range 0-100), operations were six and packed cells transfused was 95.7 mL/kg. Overall, 54 developed hypertrophic scarring and 45 scar contractures that have required subsequent reconstructive surgery. CONCLUSION Severe burn injuries in children have significant morbidity and mortality. They would appear expensive to manage and impact substantially on health care resources.
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Affiliation(s)
- Ela J Hyland
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Torey Lawrence
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - John G Harvey
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Abstract
In developed countries, in the twenty-first century, severe, large total body surface area (TBSA) burn injuries in children are rare. Prevention campaigns, education and public health interventions have significantly decreased the number of children sustaining burn injuries as well as the severity of such injuries. Many technological medical and surgical advances have been developed in burn care over the past several decades, increasing survival. Despite these interventions, long-term survival post burn injury may still be significantly reduced.
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Affiliation(s)
- Ela J Hyland
- 1 Children's Hospital's Burns Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 2 Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J A Holland
- 1 Children's Hospital's Burns Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 2 Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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